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Wednesday, 22 December 2021 06:54

Nursing theory

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Nursing theory

Nursing theory is a procedure followed as the basis of action or is an organized framework of concepts and purposes designed to guide the practice of nursing (Powers 2011).

How do nurses utilize theories in their practice?

  • Assessment

Nurses use a systematic and dynamic way of data collection and analyzation about a client rather than static as their first step to deliver nursing care. Assessment does not require physiological data only, of course, psychological, spiritual, sociocultural, and life-style as well.

  • The nursing process

Nursing process requires one to be assertive, good approach in solving problem, identification, and treatment of patient problems. This is the common virtue that unites all different type of nurses who work at different areas. This provides an organized frame work for excise of nursing, and actions that nurses bring to patients.

  • Diagnosis

This is the nurse’s clinical knowledge about the patient’s condition to actual health problems. The diagnosis reflects when a patient is in pain as well as other problems including, poor nutrition, anxiety among others.

  • Planning

Based on diagnosis and assessment, nurses usually set achievable and measurable goals for the patient that might include number of times a patient is supposed to be changed from bed to chair a day. However, nurse considers the nutrition by eating a balance diet in small quantity or more frequent.

  • Implementation

Continuous nurse care for clients in hospital and in preparation for release ensures implementation of nurse care.

  • Evaluation

Evaluation is required for both patients and effectiveness of nursing care.

Did you recognize a nursing theory? If so which one and where did you first learn about nursing theorists?

Yes, Grand nursing theory and in specific self-care deficit nursing theory coined by Dorothea Orem.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference

Powers, B. A., & Knapp, T. R. (2011).Dictionary of nursing theory and research.New York, NY: Springer       Pub.Co.

 

Sunday, 05 December 2021 08:27

Nursing Leadership and Change Agent

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Nursing Leadership and Change Agent

Introduction

Just like other professions, the nursing field has gone through numerous changes that the nurses should follow to provide exemplary work to their clients. Although the primary aim of nurse to provide adequate medical care for the patients to improve their conditions within the shortest time possible has not changed, procedures and strategies in the medical institutions are changing to accommodate all nurses in the facility. Nursing leaders are charged with the responsibility to ensure that all nurses are motivated and committed to serving the patients diligently. Actually, leaders who do not engage other nurses in decision-making fail in the quest to meet the facility's objectives. At the same time, the failure of nurse leaders to motivate other staff members leads to reduced patient satisfaction. In the end, this affects the organizational performance since the nurses are not committed to their tasks. An ideal nursing leader should have the skills to enact changes with the changing work environment to improve service delivery and motivate employees at all time (Honkavuo & Lindstro, 2014). In essence, this paper analyzes the essential leadership qualities that would lead to improved working conditions for all nurse and other staff members.

Characteristics of a Nurse Leader

            One of the primary leadership skills of a nurse is communication strategies that encourage other members of staff to improve the interpersonal relationship. A good leader should always ensure that their messages reach the intended audience and provide clarifications when misunderstandings arise. On the same note, leaders should not disclose personal information about other workers because it adversely affects the morale of the employees. Quality nurse leaders should understand that the profession poses challenges that affect the workers’ mental health (Honkavuo & Lindstro, 2014).

According to Honkavuo & Lindstro (2014), nurses experience difficult situations, which lead to suffering. As a result, nurse leaders need the qualities to alleviate suffering from their workers in order to ensure that the service delivery is excellent. A good leader should ensure that the organization has a positive culture because this increases the level of concentration in the workers. At the same time, nurses should learn how to make independent decisions that best suit the prevailing circumstances. For instance, emergency cases cannot wait for the nurse leader to provide the best procedure to apply. Consequently, it is upon the leader to let nurses make ethical decisions without any repercussions.

            Anonson et al (2014) note that, “Nursing leadership is a critical factor in the effective functioning of nursing units, high-quality patient care, retention of nurses and organizational effectiveness" (p. 128). Notably, teamwork is crucial to service delivery in the nursing profession. However, ineffective leaders cannot create the necessary environment for nurses to work in groups to improve the decisions making competencies. The leader should encourage the staff to seek clarifications from their peers to choose the best procedures that uplift the lives of the patients within real time. Such conditions reduce employee turnover, which affects service delivery since the job market does not provide enough replacements for nurses who quit their jobs. The responsibility of the leaders is to ensure that employees are competitively rewarded to dissuade them from joining the competition. Fundamentally, for-profit health care institutions, nurse leaders should not allow their workers to engage in monotonous duties that lead to boredom because it increases the chances of stress in the workplace (Anonson et al, 2014). The field of nursing has one of the highest levels of work-related stress; as such, leaders should not create a situation whereby the junior nurses dislike their work because the situation affects both their physical and mental health.

            Efficient leaders should encourage the virtue of openness. It refers to the ability of the leaders to accept new ideas and incorporate them into their tasks. Leaders who have the trait are curious and more innovative as they search for better ways to perform their duties. In addition, it is the degree of imagination or independence where employees prefer different activities to a strict routine. In addition, conscientiousness, which refers to the leaders’ dependability and higher levels of the organization, is a good trait in nursing leaders. Employees with the trait exhibit self-discipline and act dutifully. In addition, they always aim to achieve their targets while favor planned activities rather than spontaneous actions (Anonson et al, 2014).

On the other hand, extraversion refers to the need to work with others in a bid to meet the organizational objectives. Such leaders seek clarifications from their colleagues while they show positive emotions, sociability, assertiveness, energy, and surgency (Anonson et al, 2014). Moreover, the agreeableness or the propensity to be cooperative and compassionate as opposed to being antagonistic and suspicious towards colleagues provides essential qualities that make leaders better people to work with. Such people show higher levels of trustworthiness and the desire to help others. Lastly, neuroticism or the ability to absorb negative emotions such as vulnerability, depression, anxiety, and anger quickly encourages nurses to seek assistance from the leader. In addition, it is the measure of impulse control and emotional stability. 

Identification of a Current Nurse Leader

            Identification of a good leader is ascertaining that the person has the above-mentioned traits because they are essential to service delivery. Although it is impossible to have a leader with all the basic traits, it is important to look for persons who are ready to learn the modern methods of managing people. Communication plays an integral role in a successful leader; thus, the individual should display excellent communication skills that would create a positive culture I the health facility. Nevertheless, the leader should have self-drive. He or she should not be a person who puts the blame on the staff when things go wrong. In principle, the tendency to blame others affects employees’ motivation because in most cases they fail to act for fear of reprisals. The leader should be ready to work in conjunction with other staff members irrespective of their positions in the institution. In practice, leaders should be ready to defend their staff as long as they act in ethical manner. The outcome of spontaneous decisions should not form the benchmark to evaluate an individual’s performance (Honkavuo & Lindstro, 2014). All nurses should receive equal treatment from the leader to make them feel appreciated by the leadership.

How Your Particular Nurse Leader has Lead or Could Lead Changes in Healthcare

            My leader has excellent communication skills, which he uses to pass any necessary information to the team. In essence, the leader ensures that all the nurses are aware of any looming changes way before they are implemented. The leader has brought numerous changes in the institution because traditionally we were not working in teams because nobody knew the benefits. Nevertheless, the leader encourages every person to work as a group because it helps to make important decisions within a short time. At the same time, interpersonal interactions at the facility have improved and thus conflicts remain in the minimum. I have realized that interpersonal relationships affected my performance since I could spend days in bitterness after a colleague accused me of something that I did not do. The leader organizes breaks where I spend time from the stresses of the wards to freshen up and go back to work as a fresh person. Furthermore, other nurses seem to enjoy the breaks as they engage in chats unrelated to their work.

Conclusion

            In conclusion, it is evident that the nursing profession has undergone tremendous changes where nurse leaders have to perform decisions that were traditionally made by the top leadership in any medical facility. In most nursing facilities, employees work as partners without any clear boundaries between seniors and juniors. Such situations require leaders with exemplary skills who can organize all workers to form a team that improves service delivery. Such leaders should have excellent communication skills that ensure that all the workers are aware of what happens in the offices. Additionally, the nurse should encourage employees to work as teams because this improves satisfaction and motivation. The leaders should appreciate the individual participation of all members of staff to develop decision-making skills in the nurses. In brief, nurse leaders have a crucial role to play to increase patient satisfaction in patients. Such occurrences increase patient loyalty because they trust the nurses to perform a good job and improve the quality of their lives.

 

 

References

Anonson, J., Walker, M.E., Arries, E., Maposa, S., Telford, P. & Berry, L. (2014). “Qualities of exemplary nurse leaders: perspectives of frontline nurses.” Journal of Nursing Management, 22: 127–136. 

Honkavuo, L. & Lindstro, M U. A. (2014). “Nurse leaders’ responsibilities in supporting nurses experiencing difficult situations in clinical nursing.” Journal of Nursing Management 22: 117–126.

 

 

 

Sunday, 05 December 2021 08:25

Nursing Reflection Paper

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 Reflection of Master of Science in Nursing

 

 

 

 

 

 

 


Reflection Paper

Florence Nightingale articulated her views about how nurses should be educated, trained, and how care should be provided in late 1800’s. Today, the model still remains with different category of nursing organizations to ensure professional development of nurses around the globe. After working on a two year plan to obtain my Master of Science in Nursing, it comes the time to evaluate and reassess the program attended to identify if the goals and objectives are met. As a review of this long plan, I remember vividly the first day I attended my orientation spring 2013 track at Florida Southern College. I was not sure what to expect since I have done most of my academic studies in French back in Haiti and a small part little bit in the United States. I was in a new world of working adults with experience ranging from of 5 to 30 plus years of nursing experiences. I always thought that a Master’s program would be difficult due to the extensive writing required and major projects that would have to be done. Throughout this paper I will be summarizing the different courses taken at Florida Southern College during my Master of Science in Nursing Studies.

NUR 515 Advanced Pharmacology: In this class, the objective was to learn how to safely manage and prescribe therapeutic agents use in primary adult care settings. I have also built more knowledge on prior pharmacologic study of actions and effects of medications on the human system across the adult life span. Three major exams were given in this class that covered all the areas of pharmacology. In addition, presentations of different topics were presented by students with emphasis of the latest studies, which were very beneficial to the students because the actual power point presentations were shared on the portal where students could review the content of the subject presented. At the end of the semester, each student had to write an issue paper that based on a topic that was chosen about topic they chose at the beginning of the semester.

My topic was about Coumadin and its effect, which  has helped me achieve the objective of this course; learning how to safely manage and prescribe therapeutic agents use in primary adult care settings. This was achieved after researching on how and when to administer as well as the side effects for different people as I wrote my paper on Coumadin. Overall, Advanced Pharmacology class highlighted on synthesis of pharmacokinetics and pharmacodynamics principles for the prevention and treatment of acute of chronic illnesses, and practice evidence-based outcomes, consensus guidelines and risk-management issues which is supposed to be the backbone of any nurse practitioner in any practice setting. After this unit, I can now safely administer therapeutic agents on patients without any adverse side effects. I understand when and how to monitor intolerable side effects and ensure that I change the prescription before it worsens the life of the patient. With knowledge in pharmacokinetics and pharmacodynamics, I understand how to prevent and treat chronic illnesses effectively managing any risks.   

 

NUR 520 Advanced Pathophysiology: The objectives of this course were for students to be able to describe the physiologic, etiologic, and pathogenesis aspects of the common health alterations seen in everyday practices. In this class, a series of quizzes and exams were given throughout the semester to assess the students’ knowledge of what was learned in class. This class was taught in a manner that helped students understand the disease process that affects each body system. As clinicians, understanding the disease process is vital to make accurate presumptive diagnosis without laboratory /diagnostic results. At the beginning of the semester, the class was divided in groups of three or four for a group project. I have had a great time researching the topic that was assigned to my group, an exercise that increased my knowledge in pathophysiology of diseases. Unfortunately, my project partner had decided after reviewing the power-point to add tons of information without my consent, something I realized while we were presenting. Nevertheless, this incident did not affect my learning on how to treat common health conditions as adult nurse practitioner. Even with the made alterations by my friend, I can now boldly say that I can easily describe the physiology, etiology, and pathogenesis aspects of the common physiological alterations in the lifespan of a person, describe the manifestations of certain altered health states, appreciate the surgical and medical treatment strategies for common illnesses, and appreciate how research findings are applied in certain pathophysiological disorders. From this, I have also garnered information applicable for nursing strategies, pharmacological regimen, and patient education, which are essential in delivering quality patient care.    

 NUR 512 Advance Practice Nurse Roles (APNR): Here, the objectives were for students to be familiar with the APN scope of practice, current laws and rules nationwide predominantly in the state of Florida. In this class, the Nurse-Physician laws were covered in detail so that students understand the strategies that will facilitate effective nurse-physician collaboration. I imagine that this process can be a very complex process that requires intentional knowledge sharing and joint responsibility for patients. To incorporate what was learned from the class, every student had the opportunity of presenting a subject based on a topic chosen during the first day in class. The discussions were vibrant and interesting throughout the term. During my time in APNR, I had the opportunity to conduct a thorough research on the Doctor Nursing Practice (DNP), which I presented in class with a conclusion that between 11,575 and 14, 688 students have enrolled in a DNP program throughout the nations from 2012-2013 with 1,858 to 2,443 graduated the same year. What I understood while attending this class was that collaboration is multidimensional. It does not imply supervision, nor does it imply a one-way or two-way information exchange. An effective professional collaboration relationship requires mutual respect. Negotiate from the start tasks that can be done individually and which must be worked on together, and what the expectations are for joint interactions. I also learned from the normal class learning as well as from the presentations of my friends the different laws and rules governing the APN scope of practice. It is easy to land in legal problems if a nurse is not aware of the laws governing her practice. With this course, I also understand role boundaries with the problems of role ambiguity resolved. I know the extent I can go in practice as an advanced practice registered nurses to avoid legal problems. I also understand in a better way the conceptualizations, leadership, role development, safety, quality, and other competencies required by an advanced practice registered nurse.    

NUR 535 Health Policies and Politics: The objective of this class was for students to be able to analyze the financing methods, access, availability strengths and weakness of the United States healthcare system. During my time in the class, the Affordable Care Act was about six months or less to be effective; the discussion were very heated and interested to know in a small group as my class how opinioned we can be when it comes to health. This class really taught me that clinician health care policies and issues can affect how I will serve my patients at different levels and many in different ways. Prior to attending this class, my focus was on patient safety goals. My time in this class helped me make it a point to stay on top of current healthcare concerns and legislative issues so that I can understand the issues and thus be a better advocate for my patients. From this course, I have learned the healthcare policy, organization of the healthcare delivery services, and healthcare finance. I understand my role as an advanced practice nurse in policy making process on issues that impact the health policy and ensure improved health care services. I also understand the organization of the finance system in healthcare organizations and how this affects the health of patients as well as the health care options patients have. It is clear that the healthcare costs should not be so high that the options of patients are limited.     

MAT 5010 Applied Statistical Analysis: At first, I was very reluctant about the statistics class. While attending the class, I realized the importance of statistics. It helped me understand and apply statistical terminology in research, use descriptive statistics to summarize data especially in my capstone which I had to read more than 15 articles before I wrote the first sentence. The knowledge of applied statistical analysis has helped me a great deal while I was doing an article critique for my research class. This knowledge has helped me achieve my objective of how to conduct research in the nursing field. At first, it was a struggle but I learned enough and will be able to identify inferential statistics to test for differences in measures, for significance of correlations, and for independence variables. I will not have similar difficulties when carrying out any research in the nursing field. This course is very important since nursing is a continuous learning process. A nurse should come up with effective treatment interventions that help solve the increasingly health conditions that are complicated and unable to be treated with the existing treatment methods. This course would thus help me be able to conduct research and analyze the data successfully thus impacting the nursing practice positively.  

NUR 522 Advanced Health Assessment: This course is one of the prerequisite courses that the Adult Geriatric Nursing students are required to take prior to starting any clinical course. The objective of this class was for students to utilize in depth theoretical and practical knowledge of the nursing process in conducting physical examinations and health assessments. Another objective was to be able to demonstrate the understanding of various methods of data collection that include age-appropriate history, physical examination and to allow students to experiment  hands on before stepping out to the real world rotation with nurse practitioners and physicians. For me, this class represented the cornerstone on how I look at the patients. During my health assessment class, I was able to apply the knowledge learned from the class room to a mannequin, which I found to be a great experience moment in my learning process. This course has been of great help to me as an advanced practice nurse. I understand how to generally relate with patients and ensure correct health assessments and physical examinations. The course is important in helping nurses know how to handle patients immediately they get into the nursing facility. I also know how to collect the required data when assessing patients. I understand the most important data to collect including one’s age, history of the presented illness, medications one is using, allergies, past medical history, family history, and one’s history. I also understand the body organs to assess depended on the suspected diagnosis in order to be sure of the diagnosis.        

NUR 525 Nursing Theory & Research: Formatted PICO question was one the first things I learned in this class. Even though it was a review from Bachelor of Science in Nursing, it was very difficult to come up with a well-constructed PICO question.  As a senior student, now I can testify that this course has prepared me for my capstone paper since I can quickly identify researchable problems within the clinical setting, critique theoretical models, and analyze practice outcomes. This class also integrates ethical and legal issues of nursing research. Information acquired in this class will assist me throughout my professional career, to explore philosophical perspectives and different aspects of nursing. Formulating a well-constructed PICO question is very important in aiding any research I decide to carry out in the nursing field. I have clearly defined population to include in the study identifying the problem to be resolved, the best intervention plan to take in the study, the comparison I would make with other treatment interventions to pick on the best, and expected outcome. This makes my research clearly guided and thus I would stay on focus therefore being easy to achieve the intended results of the research.  

NUR 603 Geriatric: Prerequisites for this class were as follows: NUR 515, NUR 520, and NUR 522. It was designed to examine selected clinical issues, health problems and health promotion strategies in older adults. Further, it was to explore older adults care systems, and comprehensive geriatric assessment, diagnoses of common geriatric syndromes and application of evidence-based practice to promote wellness, maximize function, and enhance self-care, mental health concerns, culturally appropriate approaches, and ethical issues. As a foreigner, I can be very sensitive to my culture, the understanding of one cultural element make a big difference especially in assessment of different treatment methods allowed by different cultures and how I can influence a patient from a certain culture to agree to a specific treatment process without disrespecting his culture.

The assessment stage assists me to understand the patient instead of judging his spiritual or cultural beliefs, but to include them in the patient’s care plan. This class also helps me to have a different view of the reality and to use my judgment and use the resource available to the patients in a best way possible. Although I have driven through some areas unnoticed, the community assessments and the windshield surveys showed to me how much information I have been missing. It also makes me realize that there are helpful programs available right in our backyard that provides assistance to others and works for a change. Assisting with maintenance and restoration while respecting the person wishes on how much assistance and effort they are willing to apply for the safety of themselves or their families is of great importance. For example, the homeless will be able to get information on shelter or appropriate programs to assist with stepping back to the work place. This class also emphasized on recognizing current concerns related to older adults medication use, with specific pharmacologic responses and recommended approaches. Given the variation context of ageing as a backdrop, this class focused  on some of the  most critical aspects of aging such as  healthy ageing and health care, ageing and the workforce to name a few. During my time in this class, I quickly realized the ageing of the world’s population is no longer a phenomenon restricted to developed nations but it is evident worldwide. Even though we are the second group that has to take this class, it is evident that this really tackled the growth of older population and how to manage their care outside the office/hospital settings.

NUR 6110 Advanced Practice Nurse I Acute Illness: In this practical experience, the student functioned in the role of advanced practice nurse in settings focused on care of the acutely ill client. Management of the healthcare needs of selected population is addressed incorporating the principles of prioritization, community collaboration and outcomes measurement. In class, case studies were solved and discussed together with development of the case and management. During my clinical hours, I was able to use the different learning experience that I received from the clinical settings and applied them as a floor nurse at the hospital to better serve my patients. The objectives of this course was for students to be able to design plan of care for diverse patients, incorporating evidence-based protocols to address the health needs of acutely ill clients, in a cost-effective manner, including appropriate evaluation strategies.

During my time in APN I, I completed my clinical hours in a clinic that cares primarily for creole speaking patients and it was very rewarding for me to be able to help those individuals whom I am  related to culturally. Even though I was able to communicate with the patients, teaching was very difficult due to lack of knowledge or lack of belief in the prescribed medicine. Even though patients were Limited English Proficiency; the clinician was able to fully practice following guidelines and Evidence-based Practice. This experience is very rewarding, I will encourage students to choose an outpatient clinic for their first clinical rotation because most preceptors will allow you more time with patients while seeing other patients. This course enabled me work in a practical experience, which is very important in preparing a nurse to fit in the practical field after graduation. It enabled me understand the challenges I should expect in the nursing field and how to deal with them.  

NUR 616 Advance Practice Nurse II Chronic Illnesses: The objective of this class was for students to engage in collaborative practice with a diverse workforce and be able to care for patients by developing plans that address the needs of the individual, population, organization utilizing research, current health policy and ethical perspectives. In this class, I completed part of my clinical hours in a clinic where I did my first clinical practice because the majority of the patients do not speak English or Limited English Proficiency. I feel like I was a great asset to the clinic during my time in translating, assessing, and gaining knowledge about my culture that I did not even know. In addition to the clinic, I worked with an alumnus of Florida Southern College in a Long Term Care facility where I had a chance to take care of the population of patients of my interest, which is geriatric. The component of this class was very tense, where student were given a series of hard exams and case studies which are very beneficial for national exam or patient care. This course has prepared me to work in a multicultural society in which I work with different colleagues and patients from different cultural, ethnic, and racial backgrounds. Incorporating the differences patients have in the treatment process helps in achieving positive results. This course helps me develop care plans that incorporate the needs of the patients. 

NUR 621 Advance Practice Nurse III Specialty Role: In this 6 credit hour class, I had to integrate the knowledge acquired during the program in different specialty settings. I had the privilege to work with a Nurse practitioner with 10 years of experience in pulmonary care. I was so impressed and challenged by different cases encountered during my clinical hours; I decided to spent more weeks with her than originally scheduled.  I was also fortunate to have some clinical hours with a physician who used to be a professor at University of Florida School of Medicine Infectious Disease Department, who took the time after each clinical experience to explain further the disease and the infectious process of each case, as well as antibiotic stewardship. The infectious diseases rotation was more fulfilling to me because I had the opportunity to see diverse cases such as HIV, osteomyelitis, pneumonia, and cellulitis and all other infectious diseases related to patients. The class component of APNIII was very interesting with all the mystery diagnosis presentation. The presentation could have been online discussion where all students can participate so the professor can emphasize more teaching on the topic presented.

My experience at Florida Southern College has been outstanding. The Master of Science in Nursing Program is a journey of learning, which embellishes my knowledge and makes me proud of my achievement. The curriculum is very well rounded and relevant to every day practice and focus on evidence-based practice. The faculties at Florida Southern are very knowledgeable in their respective field and available via different avenues.

 

 

 

 

Reducing the Prevalence of Pressure Ulcers in the Elderly

 

 

 

Abstract

 

Heel pressure ulcers have become common, perhaps due to the fact that limited research has been carried out on the manner in which they can be prevented or treated. Although they are caused by external pressure on the heel, the treatment varies depending with the stage of infliction. Patients who are at risk include the aged, those suffering from diabetes mellitus, and those with mobility problems, among others. The purpose of this paper is to explore methods of prevention and treatment, including the waffle boot; however, most have not been found to be effective. Repositioning the client remains among the most important factors that need to be considered in reducing and treating pressure ulcers.

Keywords include heel pressure ulcers, mobility, blood, and tissue.

 

 

Reducing the Prevalence of Pressure Ulcers in the Elderly

Background

            Pressure ulcers occur when external tissues are exerted with excess pressure, which is not adequately relieved. The tissues that are exerted with pressure are mostly due to bony prominence. It is a common occurrence that pressure ulcers mostly inflicts the heel and the sacrum. The outcome of the pressure ulcers at the heel has some immense consequences, because it is expensive to treat and it is very painful, and mobility of the victim is severely limited. It is imperative to acknowledge that heel ulcers are among the most serious and common lower extremity ulcers and in many instances can result in below the knee amputation among patients suffering from diabetes mellitus (Veves, Giurini & LoGerfo, 2012).

            According to the National Pressure Ulcer Advisory (2007), approximately 19% of patients diagnosed with heel pressure ulcers are not diagnosed with diabetes mellitus, whereas approximately 32% are diagnosed with diabetes mellitus, and the number of people suffering from pressure ulcers continues to rise. The heel pressure ulcers mostly begin in the acute care setting, but the prevalence is higher in the long –term care. As one lives longer, the chances of being infected with heel pressure ulcers. The purpose of this literature review is to answer the question, does use of waffle boot and/or preventative dressings, compared to repositioning, affect the prevalence of pressure ulcers among the elderly adults.

Literature Review

The purpose of this paper is to identify current strategies utilized in the prevention and management of heel pressure ulcers in the elderly.  To that aim, a review of the literature was performed using both Ovid and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).  The following terms were used in the literature search: elderly patients, heel pressure ulcers, prevention, management, treatment, and mobility.  The search was limited to the years 2000 to 2015, and only full-text-articles, or articles available in portable document format (pdf) were included.  The articles were then reviewed for appropriateness to the topic, and for specificity to the emergency department setting.  Eleven articles were identified and are included for discussion in this paper.  The articles have been arbitrarily sorted into categories for discussion in this paper and include factors related to development of pressure ulcers on the heel, prevention and treatment research, implications for nursing, and recommendations.

Factor Related to Development of Pressure Ulcers on the Heels

Anatomy and Physiology

            The calcaneus foot, which is the largest bone in human foot is relatively wide and thus the skin has a large surface area despite the fact it is pointed shape due to the bone prominence, and has little subcutaneous fat cautioning it.  As a result, the pressure from the prominence makes the heel very vulnerable. Graff, Bryant and Beinlich (2000), noted that blood is transported to the heel through the peroneal and the posterior arteries. The heel becomes susceptiblebecause it has a delicate subcutaneous tissue pad with a thickness of 18 mm, while the epidermis and the dermis have a thickness of 0.64 mm, hence making the heel to be at risk of ischemia.

            These mechanical forces result in the occlusion of the blood vessels and tissue ischemia, and that results in death of tissues due to hypoxia. Occlusion is mainly attributed to shear force and the tissue interface pressure.  In addition, there are chances that occlusion can occur when there is shear force and in the absence of interface pressure. The heel vasculature has varying blood pressure depending with the load. When weight is completely loaded on the heel, a higher blood pressure is required to get oxygenated blood to the heel, compared to when there is low pressure on the heel, when it is off loaded using padding and/or pillows. However, Mayrovitz et al. (2002) examined the effect of direct surface load and reduction of flow on incidence of pressure ulcers during the ankle-cuff compression. Despite the fact that flow reduction and baseline flows did not show any difference, hyperemia was more evident when the reduction in flow was as a result of direct heel loading. Therefore, the recovery process after offloading actually contributed to the tissue breakdown.  More so, another study carried out on animals and humans revealed an inverse relationship between the intensity and duration of pressure. Hence a conclusion is reached that when the pressure is high, less duration is need for damage and tissue ischemia to occur (Koziak, 2004).

            It is significant to acknowledge that the sole of the foot lacks skin lubrication; therefore, the skin is vulnerable to damage resulting from friction because it is left dry. As one gets older, the skin gets thinner, and the ability to absorb shock declines with age, and that makes the skin to be left with less potential to resist from destructive forces of load. As one ages, arteriosclerosis and age factors can result in impairment of circulation, and that can also occur to young people who suffer from hypertension or diabetes, or those who smoke. As blood pressure in the capillaries reduces, they, the capillaries, become vulnerable due to external pressure (Kannell & Shurtleff, 2000).

Perfusion Problems

Among those suffering from peripheral arterial occlusive ailment, they have higher chances of being diagnosed with heel pressure ulcers. This is because the blood supply to the area is at the end of arterial plexus from the peroneal and posterior tibia arteries. As the heel area carries the body weight, it is left vulnerable because of the decrease of supply of the arterial blood. Heel pressure ulcers occur frequently on the lateral or the medial surfaces, more so, it has chance of occurring on the posterior and plantar aspects. For those diagnosed with diabetes, it can result from involvement with the peroneal and tibial,rather than the dorsalis pedis, arteries (Creager,  Beckman & Loscalzo, 2013). 

Friction

According to the National Pressure Ulcer Advisory (2007), friction is “the resistance to motion in a parallel direction relative to the common boundary of 2 surfaces”.  Friction occurs as part of the skin shifts, while the other remains stationary, and when  that occurs, there is reduced blood supply to the skin, hence a tissue damage occurs. In the presence of friction, the external pressure required to cause tissue damage reduces. In patients, when they become restless, especially those suffering from dementia cannot move in bed due to friction.

Shear

According to the National Pressure Ulcer Advisory (p. 2), shear pressure refers to “force per unit exerted parallel to the plane of interest”. Shear strain refers to the deformation or distortion of tissues arising due to shear stress. Shear is mainly affected by three critical factors, that include the quantity of pressure exerted, coefficient of friction occurring because of making contact withsolid surfaces, and degree of the body contact with the support surface. Shear occurs mainly among those who elevate their heads while in bed, and those who sit while sliding down in the chair.

Immobility

Those who are immobile have a higher chance of being diagnosed with heel pressure ulcers due to their immobility. Thus, 87% of those diagnosed with heel pressure ulcers are those who are not mobile (Beckrich & Aronovitch, 2000). Most of the immobile people, like the inpatients who suffer from fractures, spinal cord injuries, or stroke, have increased chances of suffering from injuries of the skin around the heel. For example, if one suffers a hip fracture, the innervation to the extremity can be impaired, and since one is advised not to move the injured/ fractured leg, the result is increased risk of tissue breakdown on the heel.

Comorbid Risk Factors

            Older adults have increased chances of being diagnosed with heel pressure ulcers. Others who are likely to suffer from the disease include those who are paralyzed, incontinent, debilitated, and those who are suffering from metastatic cancer. Others include patients who are in the intensive care unit (ICU), those on ventilator, and those with diabetes mellitus. All these have similar level of peripheral vascular compromise, which adversely affect blood circulation, which can contribute to neuropathy and deformities on the foot. A study by Krueger (2006) reported that 25% of those suffering from heel pressure ulcers are also diagnosed with peripheral arterial occlusive disease and diabetic neuropathy. Among the major symptoms for people who suffer from heel pressure ulcers and diabetes include ischemic and neuropathic etiologies associated with lower resting perfusion pressures along with higher pressure when loaded. A person with diabetes mellitus is four times like to suffer from heel pressure ulcers than one who does not suffer from diabetes mellitus.

            Neuropathy is defined as the pathological transformations in the peripheral nervous system that are not easily understood; however, it is prevalent among the old adults who suffer from diabetes mellitus. It is common in individuals who have been diagnosed with diabetes mellitus for a period of five to ten years. It impairs sensation and increases the vulnerability to development of pressure ulcers because one is not able to sense and react to pressure changes. He damage occurs in a series of three stages that include loss of sensation, losing the ankle jerk and intrinsic muscles reflex, and the resultant inability to produce oil and absence of sweating. This combination of factors results in the skin losing elasticity and becoming dry (Sussman & Bates-Jensen, 2007).

            Edema limits the ability of blood to flow to the heels. Limited blood flow compromises the transportation of nutrients, oxygen, and the removal of wastes from the body, resulting in excess fluids being retained in the body, thus increasing weight which can cause tissue pressure, and adversely affect the ability of the tissue to tolerate loading weight. This, in turn, can produce heel pressure ulcers that affect the skin integrity full thickness (Cuschieri, 2013).

            A person who has suffered cerebrovascular injury is likely to suffer from heel pressure ulcers due to inability to move legs or due to shear or friction. Those individuals who have been diagnosed with spinal cord injury (SCI) have chances of suffering from neuropathy due to the impairment of the sensory, motor, and autonomic systems. Skin injuries that are neurological can cause metabolic changes that can take up to five hears to stabilize. The changes may include increase in the level of collagen metabolism, abnormal synthesis of collagen, defective reactions by the skin, and declined skin elasticity. Paralysis may result to reducing of the muscle bulk and that may include that over the bony prominences, hence exposing the skin, and that may cause to be susceptible to injuries. Some patients propel themselves in the wheelchairs using their heels, and that increases their risks to heel pressure ulcers (Dennis, Bowen & Cho,2012).

            A study by Black et al. (2007) revealed that among the people who have the highest risk of suffering from heel pressure ulcers are those who have previously suffered from heel pressure ulcers, diabetes mellitus, low serum albumin, poor nutrition, and low Braden scale level. People whose blood circulation has been impaired, those who wear anti-embolus stockings, those with low fluid intake, inadequate sense of temperature or pain and those who smoke, also have high risk factors. More so, patients who undergo surgical procedures lasting for more than one hour are also at risk. Others who have increased chances of being diagnosed with heel pressure ulcers are the patients go through epidural anesthesia/analgesia. This is because this procedure  limits the mobility of the lower extremities, resulting in extended pressure on the heels, and hence losing their protective senses that are responsible for moving the leg as the legs react to increased pressure.

Deep Tissue Injury

            In some instances, heel pressure ulcers may end up developing into deep tissue injury (DTI). According to National Pressure Ulcer Advisory Panel (2007), DTI is a maroon or purple portion of the dermis that is mostly discolored or it may be blister filled containing blood, and it occurs when the delicate tissue, which is under the skin, is damaged as a result of pressure or shear.    Before the occurrence of the deep tissue injury, the injured part may become firm compared with other parts of the skin surrounding it and may be painful and boggy. For the people who are have a dark complexion, it may be complicated to identify the areas that are developing the deep tissue injury. Evolution of the DTI may occur to result to a thin blister covering a wound, them a thin eschar, and sometimes may result to additional layers being exposed. It is a common occurrence for DTI to develop into a stage IV ulcers.

            DTI can appear as a purple or deep red area, have some bruises, or a blister filled with blood. The fluid in the blister is an indication of stage II pressure ulcers, whereas when a blister is filled with blood is a reflection of stage III to IV pressure ulcers. The color of the blister is normally related to the tissue necrosis along with the consequent blood coagulation. Even if the skin undergoes extensive pressure, it cannot lose its viability and can continue to be intact for 14 days even though it is non-viable (Black, 2003).

Heel Pressure Ulcer Prevention and Treatment Research

Many scholars have researched the problem of heel pressure ulcerss in efforts to find a lasting solution. Bots and Apotheker (2004) have studies the manner in which heel pressure ulcers can be prevented. This was using self-adhesivehydro polymer foam for the purpose of dressing. This study revealed that this procedure was only effective in reducing the heel pressure ulcers by only 76.7%. That means the strategy was not quite effective. Another study was carried out on old patients on the impact of shear forces on their heel (Nakagami, et, al, 2006).

In the research, part of the sample was treated by hydrocolloid dressing for prevention of pressure ulcers, while the other was managed using a thin film dressing. The results of the study revealed not differences between the healing of two groups after statistical analysis were carried out; however, statistical differences were noted in regards to the shear forces between the two groups (Ayello & Sibbad, 2012). Further, the results revealed that even though the dressing reduced the shear force, it could not prevent tissue interface pressures, and thus, it was recommended that the dressing could not be employed to elevate the heel for patients who were immobile. The study concluded that the heels needed to be offloaded.

Problem Analysis

            It is imperative to evaluate the products that can employ on patients with morbidity problems arising due to heel pressure ulcers. A device that can reduce heel pressure will end up separating and protecting the ankles, while maintaining heel suspension, and thus prevent the foot drop. Redistributing the pressure will be critical in reducing the interface pressure to be lower than 32 mm Hg. It important to note that, besides the specialty beds and typical dressing, it is important to guarantee that the heel is protected.  A commercial design for elevating the heel is four times more effective than pillows. A 2005 research by Gilcreast, et al, evaluated three devices that were meant to reduce pressure on patients who were vulnerable to heel pressure ulcers. These devices included foot waffle, egg crate and bunny foot. Among those patients who were at risk of getting heel pressure ulcers, 12 of them developed the ailment. However the effectiveness of these devices to prevent heel pressure ulcers among the vulnerable individuals was not significant because the foot waffle, egg crate and bunny boot prevented the ulcers by only 6.6%, 4.6%, and 3.9% respectively.  More so, out of the 41 patients who took part in the research revealed that the heel protector boots and the duoderm are less effective than eggshell foam and foam splints. Among the patients who considered to form the control group, it was found that 22 patients, some whom were under diabetes mellitus medication were not diagnosed with heel pressure ulcers. This is because, as these patients continued with their medication for their respective diseases, they were receiving high level nursing care (Rich, et, al, 2009).

Based on the above research on heel pressure ulcers, it is apparent that the disease continues to haunt the victims because there is not effective medication that has been developed. Despite the disease being discovered long time ago, it appears that the medical researchers have done an insignificant work because it appears that most of the speculated medications and preventative measures are not effective.

Discussion

            Most of the medications used for treatment of heel pressure ulcers are similar to the ones used for prevention of the ailment. Before the health care providers begin to carry out treatment, it is important for them to carry out some risk assessment on the person. Among those who require risk assessments include those with mobility problems or their mobility is impaired, have impaired sensation, are diagnosed with diabetes mellitus, have foot deformities, or their lower extremities have circulation problems. Thus, an extensive research should be done in order to ensure that the assessments are scaled up. It is unfortunate that most of the assessment scales lack the required parameters required for evaluation of the non-movement in the lower extremity as a result, there could be some instances where one can suffer a leg fracture, but lack to be assessed appropriately. More so, the classification of those at risk is not standardized. Nonetheless, most scholars agree that the old adults who have suffered leg or  hip fractures are among those who are at risk. Therefore, appropriate preventive measures should be put in place to guarantee full recovery until they have made full recovery.

It is important that full assessment is done on patients to evaluate their level of risk when they are being admitted. The patients are a higher risk should be monitored closely and frequently. It is required that those in the acute care should be assessed every 48 hours in order to evaluate any significant change in their condition.  For those in the long care, they should be assessed every week, but that can be changed depending on the conditions of the patient. While carrying put the assessment, nurses employ the heel pressure ulcers assessment tool, which has a score. The nurses use the score to tell the patient risk level. Upon carrying out the assessments, patients whose have damaged skins or red skin should be handled with care, and heel protector should be used to prevent further damage of the heel

            The focus for the treatment and prevention of the heel pressure ulcers is the connection between the heel vasculature and the external pressure. In order to prevent cases of heel ulcers arising, comprehensive strategies should be employed, especially among the vulnerable populations. These may include identifying the comorbidities that comprise of skin assessment, the dietary intake, early use of pressure distribution devices, and use of evidence based interventions, among other interventions. According to Black, et, al (2003), among those suffering from diabetes mellitus, it is important that their heel is assessed at least twice in a day. In addition, those who are mentally incapacitated and those in acute care need their heels assessed at least twice or thrice on daily basis.

Implications of the Practice

Among the treatment procedures being carried out on patients suffering from heel pressure ulcers, or the vulnerable aged adults, repositioning or turning the patient frequently is a recommended procedure aimed at preventing the occurrence of the ailment. Defloor, et al (2005) proved that a turning schemes on either viscoelastic foam mattresses or standard mattress proved to be effective after following a preset schedule.

In regards to the heel pressure, it is imperative that this is controlled by use of pressure relief device. Among the people who are at risk of heel pressure ulcers, it is important that such individuals use pressure-redistribution device. This device plays a critical role in ensuring that the heel tissue does not breakdown, and remains protected from the adverse effects of the pressure, shear forces and friction (Black, 2003). Patients with boot type devices are mostly those who have been diagnosed with diabetes mellitus, or those with neuropathy; those with limited or poor mobility, and those who are immobile while recovering. There are varieties of boot type devices for all the diverse clients intending to distribute their pressure, and thus play it safe for their heels. According to Black (2004), the best devices to reduce pressure on are the ones that protect and separate the ankles, whilst at the same time maintaining the heel suspension and preventing the foot drop. In the health care facilities, some specially designed mattresses are built in such a way that they can reduce the pressure on the heels.  Patients normally demand a static device that has the potential to distribute the pressure over a large area, which offers the patients some comfort. Some devices or foam mattresses can be deflated or inflated in order to reduce pressure. In the market, there are some beds constructed in such a way that they have heel area pressure distribution properties. Irrespective of the availability of these devices, there is no device that can replace repositioning. Repositioning of the bed is very important.

            Based on what researchers have found, it is obvious that all the devices are not 100% effective in reducing the tissue interface pressure to the minimum level. The devices normally some limited protection on the heel against bony prominences, shear, and friction. This is mostly when the patient is lying on the side. To some degree, the foam boats are effective because the exterior surface aides in reducing friction. If the foam boot is more rigid, there is a high potential of developing pressure areas in the heel plantar surface or the lateral ankles. The booty type devices can reduce internal and external rotation, but have limited potential but can only manage to reduce the rotation only if they are more rigid. The air boot have less weight and aid in lessening the internal and external rotation, but cannot prevent it. Feet sweat in air bags, thus these bags are required to have air holes to enhance circulation. Boots have surfaces that make them to slip around on the bed surface; however, these allow more positioning checks. Straps ensure the bots stay on, but the straps should not be very tight. Tight straps can cause unnecessary pressure on the dorsum of the feet or the lower leg. Therefore, the boots should be removed at some time, and allow time for the feet to be assessed. Nurses should also check the pressure redistributing device to evaluate whether it is worn correctly.

Recommendations

The integrity of the skin should always be maintained it is important to make certain that the skin is protected from bony prominences and the heel pressure ulcers.  This is achieved by using lubricants removing pressure, and using moisturizers. More so, it is important to maintain protective dressing code. It is important to acknowledge that the dressing does not relief the pressure. At stage I of heel pressure ulcers, the tissues only need to be relieved off the pressure for them to recover. In case of the presence of blisters, one should not break them but should elevate the heel along with the leg. In case the heel pressure ulcers is at the II to IV stage, characterized by eroding of the skin, it is appropriate to dress the heel after cleaning it. In case of any infections, one should not use occlusive dressing because that can hold bacteria and facilitate their spread.  It is critical to monitor the heel closely to evaluate the positive or negative changes. Negative changes indicate deterioration, and they may include fever, odor, pain, exposed bone, and erythema.

            In reference to the literature review, it is apparent that research for stage III and IV of heel pressure ulcers is not inclusively done, and remains controversial. The issue of removal of stable eschar is still being debated. Considering that heel vascularity below the eschar is absent, and there is only fat tissue or subcutaneous tissue, it is susceptible to being infected and had limited potential to fight the infection. It is recommended that in the presence of eschar, the heel should be wrapped with gauze and be relieved off the pressure. Close monitoring of the patient is important. The adults need special care because their immune system may be weak and some bodies’ processes may be hindered by age. While assessing the heel pressure ulcers patient, it is important to take notes about the clinical observations from the score cards and other parameters.  More so, the management of heel pressure ulcers requires nursing nutritional assessment. This nurse should address both the hydration status and the nutrition status. In case the patient is at a nutrition risk, the nurse should give the best recommendation suiting the situation.

The heel pressure ulceris the second most pronounced part of the body infected with pressure ulcers. The current trend in regards to prevalence is a bit alarming, thus posing a real danger to society. Thus, it is important that nursing scholars research on effective mechanisms to prevent and to treat the condition. Identifying the condition at its initial stages is among the most effective ways to ensure that it is effectively managed. Those at high risk need their heels to be assessed frequently. All the health care institutions should have a protocol on the management of the heel pressure ulcers, that must employ evidence based nursing practices.

 

 

 

 

 

 

 

 

References

Ayello, E. A. & Sibbad, G. (2012). NURSING STANDARD OF PRACTICE PROTOCOL: PRESSURE ULCER PREVENTION & SKIN TEAR PREVENTION. Retrieved from http://consultgerirn.org/topics/pressure_ulcers_and_skin_tears/want_to_know_more/

Beckrich, K.,& Aronovitch, S.A. (2000). Hospital-acquired pressure ulcers: a comparison of costs in medical vs. surgical patients. Nursing Economic$, 17, 263-271.

Black, J. (2003). Deep tissue injury. Wounds, 15, 380.

Black, J. (2004). Preventing heel pressure ulcers. Nursing, 34, 17.

Black, J., Baharestani, M.M., Cuddigan, J., Dorner, B., Edsberg, L., Langemo, D.,
Posthauer, M.E., Ratliff, C. & Taler, G. (2007). National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Advanced Skin & Wound Care, 20(5), 269-274.

Bots, T.C.,& Apotheker, B. F. (2004). The prevention of heel pressure ulcers using a hydropolymer dressing in surgical patients. Journal of Wound Care, 13, 375-378.

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel. Journal of Wound Ostomy &Continence Nursing, 33, 267-272.

Creager, M. A., Beckman, J. A., & Loscalzo, J. (2013). Vascular medicine: A companion to Braunwald's heart disease. Philadelphia, PA: Elsevier/Saunders.

Cuschieri, A. (2013). Clinical surgery. Malden, Mass: Blackwell Science.

Defloor, T.,De Bacquer, D., &Grypdonck, M.H.(2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies, 42, 37-46.

Dennis, M., Bowen, W. T., & Cho, L. (2012). Mechanisms of clinical signs. Chatswood, NSW: Churchill Livingstone.

Gilcreast, D.M.,Warren, J. B., Yoder, L. H., Clark, J. J., Wilson, J. A., & Mays, M. Z.(2005). Research comparing three heel ulcer-prevention devices. Journal of Wound Ostomy Continence,32, 112-120.

Graff, M.K., Bryant, K.,& Beinlich, N. (2000). Preventing heel breakdown. Orthopedic Nurse, 19, 63-69.

Kannell, W.B.,& Shurtleff, D. (2000). The Framingham Study. Cigarettes and the development of intermittent claudication. Geriatrics, 28, 61-68.

Koziak, M. (2007). Etiology of decubitus ulcers. Arch Phys Med Rehabil., 42, 19-29.

Krueger, R.A. (2006). Pressure relieving support surfaces: A randomized evaluation.Berlin, Germany: European Pressure Ulcer Advisory Panel Conference.

Mayrovitz,  H. N. (2002). Effects of different cyclic pressurization-relief patterns on heel skin blood perfusion. Adv Skin Wound Care, 15, 158-164.

Nakagami, G.,Sanada, H., Konya, C.,Kitagawa, A., Tadaka, E., &Tabata, K. (2006).

National Pressure Ulcer Advisory Panel (NPUAP). (2007). Terms and definitions related to support surfaces. Washington, DC: NPUAP.  Retrieved from http://www.npuap.org/NPUAP_S3I_TD.pdf.

Rich, S.E, et al. (2009). Pressure Ulcer Preventive Device Use Among Elderly Patients Early in the Hospital Stay. Nurs Res, 58(2): 95–104. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832670/.

Sussman, C.,& Bates-Jensen, B. (2007). Wound Care: A Collaborative Practice Manual for Health Professionals. Philadelphia, PA: Lippincott Williams & Wilkins.

Veves, A., Giurini, J. M., & LoGerfo, F. W. (2012). The diabetic foot: Medical and surgical management. New York, N.Y: Humana Press.

 

Sunday, 05 December 2021 08:15

Nursing-LPN to BS Transition

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Nursing-LPN to BS Transition

 

Nursing LPN to BS Transition

Introduction

            Education is critical for professional growth and it enables one to climb the corporate ladder. Upon securing employment, one is faced with challenges in regard to enrolling for other courses due to commitment to work and family. The tight work schedule along with conflict of interest affect the decision making process; however, technological changes have made is possible for the professionals willing to enroll for part time courses to do so with ease. This is because technological advancement has made it possible for young professionals to enroll for online courses that are flexible. In so doing, they increase their competency and are in a position to climb the professional ladder.  Nursing is among the most critical professionals in regards to promotion of human health and prevention of diseases . Thus, many Licensed Practical Nurses (LPN) or licensed vocational nurses (LVN) are enrolling for Bachelor of Nursing (BN), which is a requirement before enrolling taking the registered nurses examination in some economies. The transition from LPN to RN is not a simple task, but entails a process of professional socialization that makes up eligible for more tasking role in the nursing profession. The chance to bridge between the LPN and RN was traditionally a complex issue that was only available in few universities; however, presently, the transition is offered by numerous universities. This research paper evaluates the LPN to RN transitions, and the differences between the LPN and RN.

Three major role differences between an LPN and RN

            Professional socializing entails learning the norms, values and skills that are required by people of certain social position. Professional socializing is not a simple task. This is because it comes with responsibilities.  In nursing, professional socializing is an important ingredient in their professional competency. The differences between the LPN and RN are caused by the training and education under which the respective nurse goes through. The registered nurses go through extensive training and education more than the licensed practical nurses. The registered nurses have higher chances of earning a higher pay than the LPN due to their differences in training and education.  Having considered that the LPN and RN go through different training and education, it is imperative to consider the role differences between the RN and the LPN.

            According to Duncan and DePew (2011), in regards to the role of the RN and the LPN, the former plays a senior role than the latter. The RN major duties revolve around ensuring that the patient needs are addressed in a favorable environment. Since the registered nurse is the head of the nurses, he/ she takeswritten and verbal instructions from the physicians. The RN must do the initial assessment of the patient, and develop the care management plan on the respective patient. On the other hand, the LPN gets instructions from the RN and performs the follow up for the patient along with daily check up, and must report to the registered nurse. That means the RN has the responsibility of supervising the LPN.  

The licensed practical nurse gives the basic nursing and medical to the patients. This entails routine check-up, which may include checking the blood pressure and inserting catchers among others.  They may also play a critical role in ensuring that patients are comfortable by helping them to bathe, and discuss the patient health status with the patient, and report to the doctor or the registered nurse.  On the other hand, the registered nurse administers treatment and medication to the patient.  They have to carry out the diagnostic tests, analyze them and report to doctors. They advise the patient the required processes of management of the illness after treatment. They also supervise the other nursing aides such as the home care aides and the LPN.

Generally, the RN has more responsibilities than the LPN/ LVN, thus their performance is expected to be higher because they have more medical responsibilities. Even though they can delegate duties to the LPN, the duties should be within the scope of the license of the LVN/ LPN. Therefore, before the LPN performs any medical practice on a patient, it must be approved by the RN.

Strategies and suggestions to the LPN to RN Transition

            Taking into consideration that RN have a more comprehensive medical roles than the LPN/ LVN, the transition require education. The transition can take place in two ways; first, by enrolling for a degree in Bachelor of Science Nursing, and secondly through enrolling for an Associate Degree in Nursing.  There degree courses takes between 1 and 2 years. Upon completing either of them, the LPN/ LVN must take the National Council Licensure Examination (NCLEX-RN) to become registered nurses (Claywel, 2013).  This increases the employment alternatives and guarantees pay increase. Among the courses that one undertakes includes nursing science and nursing theory among many other courses.  Some institutions offer bridging courses that make the LPN to transit to RN. These programs entail using the already acquired skills, knowledge and expertise to enable the LPV acquire the RN license.

Conclusion

Both the registered nurses and the licensed practical nurses are valuable members in health care because they play a critical role in preventing and management of  illness; however, there are some differences in respect to hierarchy. The differences dictate that the RN is superior to LPN, thus the latter is supervised and should report to the former. The differences in respect to their education and training demands that the RN can perform some tasks that LPN cannot perform. Irrespective of the differences, the LPN can go through some education and training and transit to become a RN.

 

 

References

Duncan, G., & DePew, R. (2011). Transitioning from LPN/VN to RN: Moving ahead in your career. Australia: Delmar Cengage Learning.

Claywell, L. (2013). LPN to RN transitions. NY: Elsevier Health Sciences.

Sunday, 05 December 2021 08:03

Family Nurse Practitioner

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Family Nurse Practitioner

 

A family nurse practitioner is a registered advanced practice nurse with the skills and knowledge to manage and assess health issues in people of all ages, from birth to old age. They are responsible for implementing and facilitating health maintenance, disease prevention, restorative care intervention, and health promotion. In order to be qualified to offer the assigned roles as a family nurse practitioner, there are current issues and trends that one should be aware of. To start with, certification depends on one education as well as recognition of abilities, knowledge, competence, or skills developed throughout one’s specialization in family nurse practitioner practicing field (Mezey, McGivern& Sullivan-Marx, 2010).This means that a nurse will only be certified for what he has specialized in and what he proves to be competent in. For this, the NP should be aware of the health issues affecting families and how to address them.

Another major trend in credentialing is the Open Door 2000 Program by the American Nursing Credential Center that requires that nurses qualify for the two levels of credentialing namely Board Certified and Certified. This means that a family practitioner has to be first certified for completing the studies and qualifying with the required skills and competency in the field. This is followed with Board certification in which the family NP should prove to the board that he is qualified and fit to practice as a family NP. Certification is authorized by the Committee for Modular Certification and the Certification for Diploma and Associate Degree Nursing Practice committee. On the other hand, the board certification is by the Board Certification for Advanced Certification and the Baccalaureate Nursing Practice (Cowen &Moorhead, 2014).

The last issue of consideration is the fact that there are new credentials in the field. For instance a family NP who is a registered nurse with diploma or associates in his area of specialization is eligible for RN,C credential. This is different for a family NP with a higher RN,C or Bachelors since he qualifies for RN,BC (Catalano, 2015).  One should thus know the credential he is after in order to determine the education level to pursue. 

 

 

References

Catalano, J. T. (2015). Nursing now: Today’s issues, tomorrow’s trends. Philadelphia: F.A. Davis Company.

Cowen, P. S., & Moorhead, S. (2014). Current issues in nursing. London: Elsevier Health Sciences.

Mezey, M. D., McGivern, D. O. N., & Sullivan-Marx, E. (2010).Nurse practitioners: Evolution of advanced practice. New York, NY: Springer Pub.

 

Core Competencies: care provider advanced role and non-direct care provider

 

 

As noted by Troseth(2012), both direct care provider advanced role and non-direct care provider advanced role are common in core competencies in that they should employ evidence based practice, utilize informatics, and apply quality improvement measures. Further, the two need to have doctorate of master’s degrees in nursing even though each should specialize in his/her field of practice.

Nevertheless, the two are different in a number of ways. According to Task Force Members (2013), direct-care workers are the healthcare workers who provide long-term personal assistance and care to people with disabilities or with chronic illnesses or elderly. The main role of these healthcare workers is to help the clients perform their daily tasks such as bathing and dressing among others. They are very important in the lives of the people they serve as well as to families of those people. These nurses are required to evidence some core competencies that make them successful in their practice. These core competencies include scientific foundation competencies, leadership competencies, quality competencies, practice inquiry competencies, technology and information literacy competencies, policy competencies, and health delivery system competencies. Other groups of competencies are ethics competencies, independent practice competencies. The major titles for direct care provider in advanced role are clinical nurse specialist, nurse practitioner, nurse-midwife, and nurse anesthetist. The nurse is this category should have high level skills in assessment, treatment, and diagnosis of potential health issues, prevention of diseases and injury, provision of comfort, and maintenance of wellness. One should hold a doctoral or master’s education level with clinical ad supervision experiences.

On the other hand, while nurses preparing for non-direct roles require masters and doctorate level of education just as is the case for those in direct roles, they further need to receive focused clinical experiences and education in the areas of specialization. They not only need opportunities to practice in the specialty areas but also have ample time to conduct adequate research in the respective fields (Troseth, 2012).

 

 

References

Task Force Members.(2013). Population-focused nurse practitioner competencies.Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf.

Troseth, M. (2012).Nursing informatics: Roles, competencies, skills, organizations and legislative aspects.Retrieved from http://www.aacn.nche.edu/qsen-informatics/2012-workshop/presentations/troseth/Roles,_Competencies,_Skills.pdf.

Sunday, 05 December 2021 07:44

Value Marketing Analysis: Daylesford Organic farm

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Create the Value Marketing Analysis: Daylesford Organic farm

 

Brief Description of the Daylesford Organic Farm Concept

The organic farm concept at Daylesford presents all the products provided in the retail shop to be organic and enticing. Everyone visiting the retail shop has something to order.  The retail shop is committed to simple passion for actual food. This is meant to ensure that customers visiting the retail center are not only having a variety of products that they should choose from but also confuse them on the best to choose. This way, a customer cannot get out of the retail shop without everything required for everyone. Products offered in the retail center are arranged in such a manner that they are attracting and encourage customers to be loyal to the shop. It is also notable that the center offers products that are better for animals, for humans, and for the environment. Even though customers have to queue before they are served as a result of the enormous numbers of customers visiting the retail shop, they are not bored. They have so much to admire on the waiting lines ranging from kitchen utensils, bath products, and enticing foods (Daylesford, 2014).

The new retail shop to be opened should follow the example set by Daylesford in order to succeed. Customers should be attracted to the new store as a result of originality of the products as well as the manner in which they are arranged in the retail center. Customers should thus find it easy to locate the products of choice and even be attracted to buy other products in the store that they find attractive. Operating a place where people can eat from or purchase food products requires that the customers are encouraged to eat healthily. This implies that we should provide organic food products in the new retail shop to ensure that no health issues are reported as a result of our products. 

 

 

Potential Market Segment

            The new retail store will target all types of customers in theNew England region of United States. This will include the six states in the region namely Maine, Connecticut, Massachusetts, Rhode Island, New Hampshire, and Vermont. Further, the target market will include low, medium, and high income people in the locality. This will be ensured through provision of different types of products so that there is something for everyone who visits the store. Even though there will be low-priced products to be afforded by the low income earners in the locality, this does not mean that quality will be compromised. It is better to have small packages for the low income earners rather than having low quality products. This region comprises of an area of 71,991.8 sq mi (United States, 2014).

            With then region being densely populated, it incorporates both urban and rural areas. The rural areas, which are the majority are known for improving the economy of the country. This is through supplying natural resources to the industrial companies in the urban areas. They also export food products such as fish, cranberries, maple syrup, and Maine potatoes. This is an indication that raw materials (supply of food products) to the new retail shop are not a problem. The climate in the region is varied with Maine, western Massachusetts, Vermont, and New Hampshire having a humid continental climate. This indicates that here there are long winters and heavy snow. In eastern and central Massachusetts, Connecticut, and Rhode Island, the warm/hot summers, short winters, and less snowfall. In the coastal and southern Connecticut, there is a frost free region and sunnier winters(United States, 2014).

            Additionally, the targeted region had an estimated population of 14,618,806 in 2013 with Massachusetts being the most populous and Vermont the least populous. In a survey done between 2006 and 2008, it was estimated that 48.7% of the people in the region were male and the rest, 51.3% were females. Further, around 22.4% were below 18 years old and 13.5% were beyond 65 years. Majority of the families have a size of 5 including the children the parents. It is also notable that most of the aged people are married. The major ancestries in the region are British Isles at 40%, Irish at 21.1%, French at 15.3%, Italian at 14.4%, English at 13.7%, German at 8.2%, Polish at 5.6%, Portuguese at 3.5%, Scottish at 3.1%, Scotch-Irish at 2.1%, and Russian at 1.9%. As a result of the industrial development incorporated with agriculture in the region, most families have high income of between $20,000 and $30,000 per annum(United States, 2014). 

Employment rate in the region is fairly high since very few people are unemployed. By 2014 April, New England had an unemployment rate of 6.1%, Connecticut 6.9%, Maine 5.9%, Massachusetts 6.0%, New Hampshire 4.4%, Rhode Island 8.3% and Vermont at 3.3%.  There are several education institutions in the region ensuring that everyone goes to school. Most people are employed in the agricultural and energy industries, in the media, sports, and their own farms. Catholic was the major religion in 1990 at 50%. Since unemployment rate is low in the region, most people are working class and thus with high level of income. The social activities are sports, music, and traditional knitting among others(United States, 2014). Most people in the region are ambitious as they get to employment to improve their lives. They are heavy users of the introduced products in the new retail shop, are informed and interested in it thus intending to buy, and are enthusiastic that it will improve their health lives. 

Value Proposition

            Most of the products offered in the new retail shop are fresh and organic products from the agricultural firms in the region. These are products that people are used to and only require a little reorganization and rearrangement in the store that they become attractive to the eyes of the customers. Customers will get great value for their money since they will get the quality they desire in their purchases or even a quality much higher. The offered products will be of high quality, priced reasonably, in all sizes of packages, and offered to the customers by well-trained sale personnel. The emotional benefits of the products include the assurance that customers will have improved health, can sit and share with friends/ family members, and are being provided with agricultural products from their own agricultural farms. Apart of high quality products, the self-expressive benefits in the products are the well-arranged shelves from which the customers can make purchase choices, delicious meals served with healthy accompaniments, and provision of products they can associate with (Osterwalder,Pigneur,Bernarda&Smith, 2014).

Conclusion

The new retail shop is expected to improve sales for the mother company because it will offer products that customers are used to, ensure customers of improved health, offer high quality products, and reasonably price the products. In order to ensure that all customers in the region are targeted, the store will package its products in different sizes. In addition, the store will operate in a large sitting and waiting area so that customers are not limited from eating from the store as a result of limited space. The waiting area for service will be organized in such a manner that customers can do a bit of window shopping, which will be beneficial to the store since some will end up buying the products of interest before leaving the center.

 

 

References

Daylesford.(2014). Daylesford organic farm Gloucestershire.Retrieved from http://daylesford.com/.

Osterwalder, A., Pigneur, Y.,Bernarda, G., & Smith.A. (2014).Value proposition design: How to make stuff people want.New York: John Wiley.

United States. (2014). The world factbook 2013-14. Washington, D.C: Central Intelligence Agency.

 

 

Integrated Marketing Communications (IMC) for Starbucks

Executive Summary

Starbucks Corporation is the leader in the coffee business after Costa Coffee of the United Kingdom. The firm was founded in 1971 in Seattle, Washington but it has grown to invest in sixty-eight countries across the world. In addition, the firm promises clients the best coffee that they can ever find in the market. In essence, the firm embraces integrated marketing communication to reach as many customers as possible. Using both traditional and modern marketing methods, the firm has been able to beat the competition because the target customers have access to any information related to the firm’s products. Notably, technological advances across the world have allowed many people to have access to internet. Consequently, Starbucks uses the social media to market its products and answer clients’ queries in real time thus increasing customer loyalty.

 

 

Integrated Marketing Communications (IMC) for Starbucks

Introduction

Integrated Marketing Communications (IMC) refers to applying unchanging brand messaging to the target customers via both traditional and modern marketing channels while using diverse promotional techniques to give each other strength. The world of business is increasingly becoming competitive which means that managers have no choice other than ensuring that they develop marketing strategies that would put them ahead of the competition. Notably, Starbucks Corporation otherwise known as Starbucks Coffee is a market leader in the world ahead of Costa Coffee, which is based in the United Kingdom. Starbucks was founded in Seattle, the United States on 30 March 1971 but it has since grown to open thousands of branches across the world. Innately, the organization has in excess of 21,160 stores spread in more than sixty-three countries around the globe. Starbucks has seven hundred and ninety three stores in the United Kingdom, 1,170 in Japan, 1,451 in Canada, 1,570 in China and 12,067 in the US. Essentially, Starbucks targets customers from all lifestyles irrespective of their religion, race, ethnicity or color of skin.

In essence, by the end of November 2014, Starbucks had its presence in sixty-eight countries, which are listed below according to their geographical locations

Africa

North America

Oceania

South America

Asia

Europe

Egypt

Aruba

New Zealand

Peru

Vietnam

Monaco - La Condamine

South Africa

Bahamas

Australia

Colombia

UAE

UK

Morocco

Canada

 

Chile

Thailand

Switzerland

 

Curaçao

 

Brazil

Taiwan

Sweden

 

Costa Rica

 

Bolivia

Sri Lanka

Spain

 

El Salvador

 

Argentina

South Korea

Russia

 

Guatemala

 

 

Singapore

Romania

 

Mexico

 

 

Saudi Arabia

Portugal

 

Puerto Rico

 

 

Qatar

Poland

 

US

 

 

Philippines

Turkey

 

 

 

 

Oman

Norway

 

 

 

 

Malaysia

The Netherlands

 

 

 

 

Macau

Isle of Wight

 

 

 

 

Lebanon

Ireland

 

 

 

 

Kuwait

Hungary

 

 

 

 

Jordan

Guernsey

 

 

 

 

Japan

Greece

 

 

 

 

Indonesia

Germany

 

 

 

 

India

France

 

 

 

 

Hong Kong

Finland

 

 

 

 

China

Denmark

 

 

 

 

Brunei

Czech Republic

 

 

 

 

Bahrain

Cyprus

 

 

 

 

 

Bulgaria

 

 

 

 

 

Belgium

 

 

 

 

 

Austria

 

Intrinsically, Starbucks has not changed its brand name over all the years since its inception. Consequently, majority of the firm’s loyal customers are always happy to be associated with the brand because it guarantees top quality coffee sourced from the best across the world. In essence, any organization cannot lie low after realizing that it is the market leader in any business, which means that Starbucks’ management has been on the forefront to ensure that their clients understand the firm’s products. Diversification of products is a critical antidote that it uses to ensure that clients have a wide range of products to choose. Ideally, its products include snacks, pastries, full-leaf-teas, micro-ground instant coffee and whole-bean coffee. In addition, majority of its stores offer pre-packaged foods, cold and hot sandwiches as well tumblers and mugs. Moreover, stores offering Starbucks Evenings serve appetizers, beers and wines. Furthermore, the organization runs a subsidiary by the name of Hear Music, which markets film, music and books. At the same time, most of the products are seasonal while others are specifically meant for chosen stores according to their locations. Customers form the backbone of any organization’s success and sustainability, which means that they need to understand what, is happening in the firm of their choice. However, without IMC, it would be impossible to make organization’s products to the target market. Every organization requires a workable IMC strategy that would allow clients to know the latest products and services from the company.

IMC Objectives

The organization embraces IMC to ensure that its products reach the target market in real time. For example from the year 1987 to 2007, the organization was opening an average of two new stores every day. Although the organization was making enormous profits in the 1980s, its expansion to British Columbia and Midwest resulted in significant losses. The management realized that investing in new areas without having proven communication strategies was the main problem. Consequently, the firm invested in California in 1991 after ensuring that its brand had become trendy. IMC allows any organization to realize the need to bring its products closer to the people. As a result, Starbucks opened its first outlet outside US or Canada in 1991 in Tokyo, Japan. Going forward, the firm has about a third of its stores based outside US. Despite the fact that the organization planned to open more than nine hundred stores outside US, the venture led to the closure of three hundred stores in its native country.

These are Starbucks’ IMC Objectives

  • Bring the products closer to the target market
  • Stick to the old brand name “Starbucks”
  • Embrace both traditional and internet marketing to reach the target customer
  • Invest in as many countries as possible to fight competition
  • Prove that the organization offers the best and high quality coffee one could get
  • Higher the best personnel for promoting their products
  • Adhere to cultural differences wherever the organization invests
  • Market analysis

Communications Strategy Plans

For any organization to remain competitive in any business, the management must embrace communication strategy plans that best suit the target customers’ needs. Technological advances and globalization have changed traditional marketing methods as multinationals aspire to reach the highest number of customers within the shortest time possible. However, old global firms have not done away with the traditional marketing methods because some clients do not have access to newest communication methods such as internet. Since Starbucks Corporation has stores in various countries across the world it must adhere to the politics of the country it ventures. Some of the countries such as Mexico and China have different political climates when compared to that of the United States.

Ideally, the organization collaborated with Conservation International to help save the environment for health coffee production in Mexico in order to increase the organization’s acceptance in the society. Ideally, Starbuck did not want to go against Mexican political issues by dealing directly with coffee farmers for the Mexican government could have felt as if it were isolated (Renard, 2010). Although, the organization is non-political, it has faced several protests in countries such as Beirut, Dubai and Cairo (Roark, 2014). In addition, Gaza activists urge people to boycott the organization because they feel that it supports Israeli militarists. Innately, the organization focuses on abiding to laws and regulations for any community that they serve. Notably, guns are allowed in the United States but in countries where they are illegal, Starbucks does not allow them in its stores. By adhering to political stances in any country, Starbucks has been able to grow its business in countries that differ with US in majority of their instances. Essentially, Starbucks does not support any political activists in any country; thus, reducing chances of conflicts between the firm and the government. Intrinsically, Starbucks respects political stability, tariffs, trade restrictions, environmental laws, labor laws and tax policy. The organization employs only authorized people in all countries. Moreover, it pays taxes according to the regulations (Jaffee, 2007). Ideally, its operations are environmentally safe which increases customer loyalty; thus, increasing its revenues.

            Starbucks understands that inflation rates, exchange rates, interest rates and economic growth are vital to its success. At the same time, IMC enables the firm to communicate effectively with both staffers and suppliers thus increasing client loyalty; hence increasing the company’s turnover. Essentially, interest rates affect an organization’s cost of capital because they dictate the amount of resources that an organization has. Since it has invested in several countries, it studies the country’s interest rates before opening a store in the nation. On the other hand, Starbucks outsources only the best coffee from any part of the world. Consequently, exchanges rates determine the cost of any imported or exported service or goods. At the same time, the cost of its products are determined by the amount spend on acquiring raw materials. Furthermore, clients are happy when they know that the products are offered at the best price in the market. Starbucks does not overcharge its customers based on the distance from the source of raw materials (Roark, 2014). 

            Communication would be in vain especially when the management does not value cultural beliefs for they are different in any given community. The firm offers healthy beverages to the communities because it wants to improve their health. Starbucks works on meeting client needs, which are determined by social trends. In young populations, the management employs young people in order to increase the number of customers because they feel more attached to the workers. For example, in China majority of the managers in the organization’s stores are young because most of the clients are youthful. On the contrary, majority of US clients are older hence, the management employs older people in its stores (Roark, 2014).

            Primarily, over the years people have been embracing technology in most of their activities. The management uses automated coffee dispensers in some its stores where a customer does not need an employee to serve him or her. Ultimately, this goes a long way in reducing costs for the organization’s service delivery. In addition, the cost of the firm’s products goes down hence increasing sales and revenue for the organization. The machines can serve two hundred and eighty drink combinations, which offers diversity to the consumers. In addition, they have touch screens and consumers could play a game as they await their order, which provides customers with recreational facility; therefore, increasing customer satisfaction. Intrinsically, the firm gives customers free internet access through their Wi-Fi connections in several stores in Austria, Switzerland and Germany (Melissa, 2008).

            The organization embraces environmentally safe practices because it understands that the environment must be protected at all times. Starbucks serves its clients the best quality coffee across all its stores in the world. In addition, the firm ventures in saving natural lands for coffee growing. It has invested heavily in Mexican coffee growing areas to maintain high quality coffee beans (Melissa, 2008).

            According to IMC regulations for most multinational organizations, they must adhere to the laws of the countries. Laws dealing with areas such as safety, health, employment, anti-trust, consumer and discrimination are all important for Starbucks’ success. The firm respects court decisions in addition to using legal means to protect infringing on its properties such as the logo. It has been involved in several court cases in countries such as China where it sued Xingbake in Shanghai for logo infringement. Moreover, the management does not discuss any matters, which are before the courts (Tice, 2014).

            In addition to providing high quality coffee to its customers, Starbucks has been able to increase its client reach through human connections. Ideally, “Embracing the position as product quality leader and industry segment leader, Starbucks does not aggressively market the company through traditional means but instead focuses almost entirely on high-level marketing and branding of word-of-mouth and key alliances and partnerships” (Lingley, 2009, p. 4). These alliances have helped Starbucks in investing in several countries in the world. The firm entered into an alliance with NAACP, to increase customer share in the coffee business. Starbucks gave donations to NAACP to promote events for marketing its products (Anonymous, 2006). In addition, it is in partnership with several other organizations such as Barnes and Noble bookstores, PepsiCo, United Airlines, Kraft foods among others. The partnerships are ideal for increasing customer awareness on the firm’s products through distribution of mugs bearing the Starbucks’ logo. In addition, the partners increase accessibility for the organization’s products and services across the globe.

            In essence, as a market leader in the coffee business, Starbucks has invested in several states across the world since its inception in 1971. Analysis on the firms activities reveal that the firm adheres to genuine practices as it tries to increase customer share. Starbucks respects laws and politics for countries which it has interests. In addition, the organization respects the environment by saving natural lands for growing coffee. Moreover, the firm has collaborated with several organizations as it tries to reach as many clients as possible. These partnerships take the organization’s products closer to the people thus ensuring client loyalty and increased sales. Consequently, the organization does not use traditional marketing methods because they have failed in many other firms.

  • Traditional Media

Starbucks understands the need to stick to traditional marketing techniques, which involve radio, television and billboards. Consequently, the management ensures that it has huge and colorful billboards in any major entry point in a country that the organization has interests. Moreover, the organization places the same billboards in major highways of these states. Notably, most of the billboards are eye-catching which means that any passerby would be interested in understanding what the firm has in offer. Most of the adverts portray customers enjoying the wide variety of products offered by the firm.

On the other hand, radio offers an easy access to many clients especially those who do not have access to Internet. The commercials are easy to understand because the narrators ensure that they have a connection with the target market by revealing the excellent taste that the products offer. At the same time, Starbucks uses television to promote its products across a wide range of clients irrespective of their locations. The adverts on TV are different video clips collected from several stores showing clients enjoying their favorite products from the company. Furthermore, the ads reveal that the products are healthy and as a result, anyone could use them at all times. Healthy eating is a major medical problem affecting very many people across the globe especially in Europe and the United States. Consequently, Starbucks has taken advantage of this revelation to market its products by showing physically fit clients yet enjoying the firm’s products regularly.

  • Internet

Since its incorporation in 1971, Starbucks Corporation has been providing healthy drinks to its clients. With innovation of social media, the organization has invested enough resources to create accounts on both twitter and Facebook with real people answering to clients’ questions. In addition, the organization posts enough tweets on its twitter account to update clients on any new products and services in the market. The posts are interesting especially because some of them are created like jokes thus drawing readers’ attention. On the other hand, according to Pozin (2014), the management of Starbucks Corporation understands the importance of real time communication with its clients. Since most people across the world have access to the internet, social media, especially Facebook and twitter provides an ideal platform for gathering information.

Facebook and twitter are ideal for the organization because they have millions of subscribers across the world. Consequently, the organization has been growing its client base through use of the social media sites (PR Newswire, 2014). In essence, Starbucks Corporation has a team that responds to clients’ questions promptly on anything about their services. Consequently, client satisfaction has been on the rise while the organization is more efficient. The organization subscription to twitter and Facebook is ideal for its operations because of the high number of subscribers on the two across the world.

However, Starbucks Corporation needs to increase more client responses and comments on the sites because it cannot rely on what the staff tells the clients. Ideally, majority of clients trust more what other customers have to say as opposed to responses from the staff. In addition, it should increase the number of real people on the sites to reduce communication time between staff and passengers. Moreover, the number of highlights on changes in flights should be increased because clients have to know what is happening in the market at all times. At the same time, Nestle should increase the number of photos of its products detailing their nutritious value. Ideally, clients would be happy to understand why Starbucks Corporation foods are ideal for the whole family. At the same time, the organization needs to invest in other social media networks such as LinkedIn and Instagram because they have followers across the world.

  • Direct Marketing

Intrinsically, the management of Starbucks Corporation has realized the importance of direct marketing for it ensures that the firm reaches clients on the streets. Ideally, such customers act as the firm’s advocates by referring their friends and relatives to the company’s stores. Accordingly, the firm realizes increased sales albeit spending lesser resources in its quest to introduce new products and services that the corporation has to offer. Word of mouth has proved to be an essential marketing tool for Starbucks because their friends bring majority of new clients to their stores for the first time. Innately, this reduces marketing expenses, which are associated with other firms in the same business. Starbucks enters into partnerships with other established outlets in the destination country. For example, in 2013, “The first Starbucks inside Danish Supermarket opened in August 2013 in the department stores Salling in Aalborg and Aarhus” (Lingley, 2009, p. 4). Outstandingly, the firm saved marketing resources for it placed its products in an outlet that the target market trusts. 

  • Sales Promotion

Although Starbucks is a well renowned organization in the coffee business, the management ensures that it embraces sales promotion tactics in its IMC strategies. For example, “In 2003, after struggling with fierce local competition, Starbucks closed all six of its locations in Israel, citing "on-going operational challenges" and a "difficult business environment” (Anonymous, 2006). The management realized that the political situation in Israel could not allow promotional gigs to happen in the society. The organization has entered into partnerships with other firms where it promotes its products at a lower cost. Essentially, the firm has branded coffee mugs in major airline companies in the United States. Importantly, the mugs draw clients’ attention to the firm’s products; whereas the firm has promoters based at major streets to beat the competition. They offer free samples to clients in order to encourage them to be taking their beverages. Some of the competitors create advertise that show that the company’s products are unhealthy but Starbucks counters this negativity by offering proving that its products are the best through sales promotion whereby clients interact with employees on one-to-one basis. Most importantly, clients are always happy when they have a chance to talk directly to employees for they have all their questions answered thus reducing any doubts that the clients could have had on the products.   It is worth noting that Starbucks adheres to all legalities before holding any sales promotions according to the country’s laws; therefore reducing chances of legal suits that could tarnish the brands name among the people.

  • Public Relations (PR)

Intrinsically, Starbucks is a multinational organization, which means that it has employees and clients from different cultural backgrounds. Consequently, the management ensures that its PR is in a position to meet the needs of all the people that its serves. Although each store acts as an autonomous entity, it ensures that the clients’ needs are met always by employing workers who rhyme with their needs. For example, in China, the organization employs young managers because most of the customers are middle-aged persons. On the other hand, in the United States majority of the employees are older because the target market is comprised of older people. As a result, the organization manages to serve client’s interests despite their cultural beliefs and ideals. Moreover, all employees are treated equally by promoting the best performers in addition to offering other incentives that ensure that the firm remains competitive. The management does not sit back to enjoy its dominance in the market because it understands that their competitors are watching closely for any chances to overtake the firm. The CEO, Howard Schultz, “has talked about making sure growth does not dilute the company's culture and the common goal of the company's leadership to act like a small company” (Lingley, 2009, p. 5). In essence, the organization does not shy away from replacing any employee who does not perform as per the expectations. For instance, in 2008, Jim Donald was replaced as the CEO after sales went down. His successor Schultz promised to work towards restoring the “distinctive Starbucks experience” because he does not want customers to feel that they can get the same services from the competition. Innately, the prices of raw materials have been changing over the years but the management ensures that it sources its coffee beans from reputable suppliers who do not overcharge them; thus offering customers the best coffee at a reasonable price. Restructuring is an ideal process for any organization that aspires to remain competitive in business and as a result, Starbucks changes employees in any region that sales are going down. In addition, the organization obeys the rule of law by reporting any cases of infringement to their property rights by their competitors.

Conclusion

As a market leader in the coffee business, Starbucks uses IMC to ensure sustainability. Communication is very important for the success of any organization and as a result, Starbucks has embraced all marketing methods to ensure that its products are well known by the target market. Notably, producing a new product and failing to advertise it is equivalent to blinking in the darkness because no one would notice it. Consequently, Starbucks invests resources in creating product awareness to the target market because this increases sales and guarantees sustainability. Although the firm faces stiff competition from firms such as Xingbake and Costa Coffee, it has been able to withstand the challenges by providing the best high quality coffee sourced from natural coffee growing areas. In addition, the firm does not overcharge for its products despite the fact that they are unique. Innately, most people across the globe have access to internet, which shows why the firm uses the social media in marketing its products. Notably, the social media is cheap and reaches a very large number of people within the shortest time possible. On the other hand, Starbucks uses traditional marketing techniques such as radio, word of mouth, television and sales promotions to increase its market share across the world. Consequently, the firm has been growing rapidly and expanding its services since its incorporation in 1971. The CEO is determined to ensure that the competition cannot match the services that Starbucks offers.

 

 

 

References

Anonymous. (2006). Starbucks commits $2.5 million over five years to NAACP; strategic alliance affirms Starbucks commitment to diverse organizations: Business Wire. Retrieved 24 Oct. 2014 http://findarticles.com/p/articles/mi_m0EIN/is_2006_May_26/ai_n26878115/

Jaffee, D. (2007). Brewing Justice: Fair Trade Coffee, Sustainability and Survival. California: University of California Press.

Lingley, R. (2009). "Marketing Strategy and Alliances Analysis of Starbucks Corporation." Faculty Publications and Presentations: Paper 10:1-10.

Melissa, A. (2008). "Starbucks co-founder talks about early days, launching Redhook and Seattle Weekly, too.” Business and Technology.

Pozin, I. (2014). "Forbes Magazine." 20 Companies You Should Be Following On Social Media. Retrieved 13 Nov. from http://www.forbes.com/sites/ilyapozin/2014/03/06/20-companies-you-should-be-following-on-social-media/

PR Newswire. (2014). Nestlé’s Effectiveness of Digital and Social Media Marketing Strategies and Innovations. Retrieved 13 Nov. 2014 from http://www.prnewswire.com/news-releases/nestles-effectiveness-of-digital-and-social-media-marketing-strategies-and-innovations-273846691.html

Renard, M. (2010). "In the Name of Conservation: CAFE Practices and Fair Trade in Mexico". Journal of Business Ethics, 92: 287–299.

Roark, M. (2014). "Payment Systems, Consumer Tragedy and Ineffective Remedies". St. Johns Law Review, 86: 21-26.

Tice, C. (2014). "Starbucks still seeking a rhythm for Circadia". Puget Sound Business Journal, 2(4): 23-34.