The video i need in 250 . ch3 read i just need the question answer

  Watch Diversity.
Review Section 1 and 3.
Discuss the following question:

1.How can schools encourage and embrace diversity?
How can schools encourage and embrace diversity?

Consider the following question:

3. In what ways might a school elicit feedback from its stakeholders?
Diversity section 1 
Diversity section 3 

Read Ch3 its 4 Questions at then end that needs to answer ….
Then the Diversity video by Diversity recommendations in Breaking Ranks
Chapter 8: Diversity
Topic A: Expert Diversity 
Juan R. Baughn, Ed.D. Lecturer, Lehigh University, Bethlehem, PA ? Former Teacher, Principal and Superintendent
Section Navigation
Chapter 3 Understanding the Community 
After completing this chapter you should be able to … 

? Identify key community segments important to school–community relations planning and programming. 
? Distinguish methods for community–audience assessment and identifying influential communicators. 
? Recognize the characteristics of community power structures. 
? Distinguish opinion research techniques commonly deployed in school–community relations programs. 

Before attempting any communication, school administrators must study the intended audience for the message. When trying to communicate with a diverse community, it’s imperative that school officials know the various components of the community.Collecting information about the makeup of the community is a major first step toward a communications program. This enables administrators to plan intelligently and reduce guesswork. When gathering information about the community, the following topics should be considered:

• The nature of the power structure and the way decisions are made in the community 
• The identification of the media and long-term challenges that need attention 
• The expectations of citizens regarding education 
• Situations to be avoided based on the history of conflict in the community 
• Identification of individuals and groups who are friendly or unfriendly toward education 
• Opportunities and ways to effect better cooperative relations with various publics 
• The identification of gaps that need to be filled to produce more public understanding of educational policies and programs 
• The channels through which public opinion is built in the community 
• Changes that are occurring in patterns of community life 
• The identification of leaders and those who influence leaders in the community 
• A listing of the types of organizations and social agencies in the community 

To comprehend all of these factors, the study of the community should be directed at its sociological characteristics, the nature and influence of its power structure, and the way in which people think and feel about education and the programs provided by the district. Since the community is constantly changing, continuing studies are necessary to keep knowledge current.
SOCIOLOGICAL INVENTORY 
To plan an effective program, the district needs to know about the people who make up the community. The more that is known about them, the better the chances are of designing a program that will achieve its objectives. Therefore, it’s recommended that school districts undertake a sociological inventory of their communities. But—and this is a major but—those inventories should not be so complex, time expensive, and costly that by the time they’re done people don’t want to take the time to implement the findings. Too often some educators get wrapped up in the process and place that completed study on a shelf to do little more than wait for its successor. To conduct such a study and not interpret the findings and use the results would be a waste of time and money.Choosing which items to include in such a study can help ensure the study’s success. Some possible topics to include are the following: customs and traditions, historical background, material and human resources, age and gender distribution, educational achievement, organizations and groups, political structure, leadership, power alignments, religious affiliations, housing, racial and ethnic composition, economic life, transportation, communication, standards of living, health, and recreation. It would be extremely time consuming and expensive to include all of the topics. To ensure the effectiveness of the study, school officials should choose the most important categories, focus on them, gather the information in a relatively short time, and then implement the study.Among the topics that should get serious consideration are customs and traditions, population characteristics, existing communication channels, community groups, leadership, economic conditions, political structure, social tensions, and previous community efforts in the area.
Customs and Traditions 
Customs and traditions are the common ideas, attitudes, and habits of people. They may be referred to as folkways, mores, or lifestyles. Significant in regulating conduct and in predicting behavior, they likewise exert an influence in the shaping of social action and in the determination of services rendered by community agencies.Lifestyle differences found among community groups arise from the impact of race, religion, nationality background, economics, politics, and social class structure. Thus, individuals who live in an urban community may share similar ethnic characteristics and may differ in their way of life, their values, their beliefs, and their habits from individuals who reside in a semirural community. Similar differences in lifestyle also may be found among groups who reside in various geographic sections that make up a metropolitan area. One area may consist of a group having a predominant ethnic or cultural background whereas another area may be a microcosm of the overall population.The problem in this part of the sociological inventory is identifying and defining the customs of groups in the community. This information is important to the school in guiding its relations with students, parents, and others. Nothing evokes a quicker reaction from parents and citizens than the adoption of policies and practices that run counter to their established attitudes, beliefs, and habits. This has been evident on many occasions when new blocks of subject matter introduced into the curriculum caused students to think or act contrary to the convictions held by parents and relatives. Equally strong reactions are likely if students are retained after school on days that have been set aside for religious instruction.From another point of view, it is valuable to know how change takes place in group patterns of thought and action. What are the circumstances and forces that produce orderly change? Studies indicate that safe and rapid change occurs during periods of emergency when the need to make adjustments is immediate. Alterations in the physical features of a community, such as the construction of new highways, the improvement of housing, or the rezoning of land use, open the way for modifying social habits and customs. Significant changes are also possible when members of different groups are given opportunities to discuss and share in finding solutions to problems that have an effect on their ways of living.A note of caution is in order here about stereotyping people and groups.

Stereotyping is the process of assigning fixed labels or categories to things and people you encounter or, in the reverse of this process, placing things and people you encounter into fixed categories you have already established.1 

It can be easy to do this with community groups such as senior citizens and young professionals, for example. Not all senior citizens are against spending for education or rigid in their thinking when it comes to educational issues. Nor do all young professionals aspire to send their children to private schools. When studying the characteristics of any population, it’s important to remember that not all members of a particular ethnic group, race, or religion hold the same attitudes, opinions, or voting patterns.
Population Characteristics 
Population characteristics concerning educational attainment, age, sex, gainful occupation, race, creed, and nationality are important in developing an understanding of the community. Publications and services from the U.S. Census Bureau can provide useful information on population characteristics.In looking at the educational attainments of the population, attention is directed to the years of formal schooling completed by adults. The amount of schooling may be classified as elementary, secondary, and college, unless the exact number of years is wanted. This information is useful in the preparation of printed materials. Vocabulary, style, and layout are fitted to the educational backgrounds of the audiences for whom they are intended. This information is also useful in estimating the best manner of transmitting ideas and factual information to the community so that attention and interest are generated. Another use of educational attainment information is constructing stratified samples of the population for purposes of opinion polling.Age data should be broken down into convenient classifications and the implications carefully studied. For example, one community may expect an increase in school enrollments over the next five years, whereas another may just hold its own or suffer a loss. Age distribution may also suggest ideas concerning the future patterns of growth of the community. A fairly young adult population would almost certainly be more demanding of educational services and quality than a population of mostly middle-aged and older people. Similarly, the younger group would most likely support better financing of the school program, whereas the older groups might be more likely to resist an increase in educational expenditures. Thus, it is possible from age distribution to form working estimates of community reaction to various kinds of proposals.In addition to educational achievement, age distribution and sex distribution are used as control factors in constructing stratified random samples of the population for purposes of opinion polling. Occupational information on gainfully employed adults may be organized according to the classification scheme2 used in U.S. census reports. These data are useful in checking population stability, changing occupational opportunities, distribution of occupational classes, and employment outside the community. Findings influence the selection of program activities. The participation of citizens is also considered.The study of population characteristics should be rounded out with data about race, religion, and nationality. These cultural factors may be important to gain an understanding of the community and some of the underlying causes of social tension and conflict. However, the meaning of the data may not always be clear unless the data are correlated with other information. It is well to treat the data statistically and to prepare summaries of the findings. These summaries should be used in the planning process, and copies of them should be distributed to key personnel within the system. At the same time, as much of the information as possible should be depicted on social base maps, with separate sections being blown up for use in individual attendance areas. Statistical summaries and social base maps often provide leads to the solution of everyday problems that are associated with school and community relations.
Communication Channels 
Since the development of public opinion takes place through the exchange of ideas and information, it is necessary to know what communication channels are available in the community, how extensively they are used, and which ones are most effective for reaching different segments of the public. These questions are sometimes difficult to answer, but they can be worked out by persistent inquiry. It may be found that the public at large relies on the Internet, radio, television, and daily newspapers for most of its news and information, making the news media influential in shaping public opinion on some social issues. However, the investigation may reveal that members of special groups in the community receive information from a variety of other sources. These may include publications of clubs and organizations, religious organizations, labor unions, volunteer fire companies, neighborhood publications and newspapers, and foreign-language newspapers. On this last source of information, it is reasonable to assume that parents who speak and read a foreign language in the home may experience some difficulty in understanding student progress reports, school notices, and school news reported in traditional news sources. Where these conditions prevail, it would be advantageous for the school district to employ a number of bilingual home and school visitors, offer school materials in more than one language, and prepare news releases for foreign-language periodicals and newspapers.The Internet, social media, and smartphone apps have added many new channels for information and notably increased the speed of communications. Web sites and e-mail, and the proliferation of cell phones and text messaging, also allow immediate, two-way communication.An unexpected benefit of this new technology is the reduced need for paper and physical files. E-mail and text messages can deliver information to many people with the press of a button. This saves time and the need to make copies to send by regular mail. Messages also can be retained for quick, on-demand access on school Web sites.
Community Groups 
The American community is a composite of groups of people who are organized around special interests. Some of the groups have little or no influence on community affairs, but others have a great deal. Many are highly cooperative with those who hold similar interests, but a number are uncooperative. The variety is tremendous, and the numbers vary considerably from community to community. Informal groups that come into existence because of some common belief or cause may assume many different forms and often blend into a formal type of organization. No sociological inventory is complete without knowing the purposes and programs of these groups and the influence they exert on public opinion.Although cooperation with community groups having an educative function to perform should be encouraged fully, care must be taken to prevent their possible exploitation of students. To some, cooperation means the right to insist that the school approve their requests and modify its program to achieve the ends for which they are working. To others, cooperation is nothing more than a guise for the privilege of disseminating self-serving information in the classroom, promoting product sales and services, and conducting contests for the sake of publicity.On the other hand, some community organizations dominate school politics but are not concerned primarily with educational matters. Composed of small business groups, property and homeowners’ associations, and civic improvement leagues for the most part, they take practically no interest in such matters as dropout rates, standardized test scores, or the qualifications and selection of professional school personnel. Instead they are concerned about the impact of school policies on the community, and they take a strong interest in school costs, especially tax increases and bond proposals.Other community organizations are those known as special interest groups. Many of these are vehemently opposed to each other; even so, they all converge on schools and pressure them to accept their philosophical positions and to alter educational programs. Often they move to change the school curriculum and to censor textbooks and library books. In any inventory of the community, school officials should attempt to identify special interest groups, become familiar with their philosophies, and perhaps anticipate and prepare for their contacts with the schools.The extent to which individuals and families participate in the activities of organized groups, particularly those having to do with civic welfare, should be addressed in the course of the survey. The amount of participation is usually a rather reliable index of community spirit. Research in sociology shows that individuals and families who are active in organized group programs likewise take a strong interest in what happens to their community and that those who are inactive or take part occasionally show only slight interest in needed community improvements.
Leadership 
The next aspect of the inventory concerns the status of leadership in the community. Leadership is a relational concept implying two things: the influencing agent and the persons who are influenced. In other words, when persons are influenced to express organizational behavior on a matter of group concern, then leadership has occurred. Even though this concept may seem too simple and may represent a variance from others that could be cited, it nevertheless provides a feasible base for the examination of leadership and the leadership process.At this point, it might be well to review a few findings from leadership studies without getting involved in too many details. Leadership is not related necessarily to social status or position in the community. An individual usually holds a position of leadership because his or her characteristics approximate the norms or goals of the group. It is equally true that leaders have traits that set them apart from their followers, but these traits may vary from one situation to another. However, all leaders usually have certain characteristics in common, such as special competence in dealing with a particular matter, wide acquaintanceship, easy accessibility, and contact with information sources outside of their immediate circle. Also, they are sometimes members of several community organizations and have more exposure than nonleaders to mass media. These characteristics are acknowledged as important, but they will not necessarily produce leadership. One school of thought sees leadership more as a consequence of an individual’s occupying a certain kind of position in the social system, whereas another view holds that leadership is a situational matter requiring a particular issue and the exercise of influence on others.In any event, the inventory task is that of identifying individuals who are recognized leaders of community groups and organizations and who have an influence on the attitudes and opinions of the members. Information should be obtained about their personal backgrounds, family connections, group affiliations, business interests, fraternal memberships, social and political convictions, special competencies, methods of operation, attitudes toward public education, and power in the community. Knowing their backgrounds is requisite to approaching group leaders on educational community problems and to determining their value in rendering particular services.In working with leaders, it must be remembered that they are not always free to express their own ideas or to take independent action. Their behavior is dependent on the nature of their groups and the beliefs and opinions of the members. They may be especially sensitive to questions concerning patriotism, private property, economics, religion, politics, and respected conventions. They realize that any radical departure from the feelings and convictions of their followers on matters like these could quickly undermine their own security. Leadership, however, is a reciprocal arrangement in that group members depend on leaders to initiate ideas and execute plans of action. The leaders sense what members think and want, and so they can direct thought along lines that meet with acceptance. In doing this they play a powerful role in the determination of the attitudes and opinions held by their followers.The study of leadership should extend to neighborhoods within elementary- and secondary-school attendance areas. Every neighborhood contains a number of men and women who are consulted by neighbors and friends whenever questions come up about the school and its relations with students and parents. Their opinions and judgments are important determinants of grassroots public opinion. It is vital to locate these individuals and to involve them in school activities. They become channels through which the school may be interpreted better on a neighborhood basis, and they can do much to win loyalty and support for institutional policies and practices.
Economic Conditions 
An analysis of economic conditions will provide essential data for obtaining a better understanding of the community. Though a great deal of information about the economics of the community is available in governmental and business reports, an overview is needed. The overview should be limited to generalized findings on agricultural, commercial, industrial, and transportation activities and to employment, employment stability, and wage conditions. Related information on land use, property values, and tax rates should be considered. Such information is usually available in the school system’s business office, which plays an important part in the planning of the annual school district budget. If further data are wanted, attention should be directed to such items as production output, retail stores, levels of income, amount of savings, and standard of living. These details are relevant, as economic conditions determine in some measure the financial support available for public education. Moreover, these conditions affect public feelings toward the school and the means used for trying to bring about closer relations between the school and the community.
Political Structure 
For generations, the public school has tried to uphold the idea of keeping politics out of education and education out of politics. It has done this on the assumption that the school as a nonpartisan, classless, and social institution should remain apart from the political life of the community. As meritorious as this may seem on the surface, the truth is that the school cannot and should not separate itself from the political scene.More money is spent for education at state and local levels than for any other single function of government. This fact alone makes education a thoroughly political enterprise. The support received is the product of political struggles for the tax dollar. These struggles involve the interaction of special-interest groups, political leaders, members of legislative bodies, boards and departments of education, opinion leaders, professional educators, and others. Such items as formulas for the distribution of state aid to local districts, the assessment of property tax rates, and the location, size, and cost of school buildings are frequently matters of political conflict and resolution.If educational leaders are to cope successfully with the problem of getting adequate public support, they need to acquire a sophisticated understanding of political realities. They should seek this understanding through a somewhat detailed study of the political structure and the political process within the local area. It is important that they know who makes political decisions, how these decisions are carried out, and what political instruments are available. In some matters, a similar type of study should be extended to state and even national levels.
Social Tensions 
Social tensions and conflicts exist wherever people work and live together. Some are normal expressions of human behavior; others are indications of weakness in the social structure. These tensions are evident in the refusal of neighbors to speak to one another, sectional conflicts over the location of new school buildings, claims that the board of education is favoring the better residential part of the district, interracial confrontations, the formation of cliques within parent–teacher associations, and discrimination against minority groups.The causes of social tensions may be nothing more than personality clashes, misunderstandings, spite, or petty annoyances, but they may also be associated with economic rivalry, cultural differences, social class competition, racial discrimination, religious conflict, and other major aspects of society. These tensions, no matter what the causes, are disruptive to life in the community and detrimental to the kind of consensus often needed for school success.In the planning of a school–community relations program, the school must be fully aware of the causes of tension and the number of issues involved. If school leaders are not knowledgeable about these conditions, the program is likely to move in directions that will increase the tensions and deepen the cleavages that exist. Its real job is engagement that leads to consensus building—that is, trying to harmonize differences between individuals and groups in the community when the tensions militate against the operation of the school and the attainment of its objectives.
Previous Community Efforts 
A review of previous community efforts—say, over the last 10 to 15 years—supplies useful leads for designing the school–community relations program. In this respect, it is important to know what kinds of projects were undertaken, who sponsored them, the degree to which they succeeded or failed, and the probable reasons for the outcome. With this information at hand, it is possible to determine specifics such as groups that offer the promise of working well together, types of projects that have a fairly good chance of succeeding, errors made in the past that should be avoided, the pattern values held by the community regarding self-improvement, and the steps that must be taken in setting the stage for future school and community undertakings.
Sources of Information 
If the superintendent of schools and members of the administrative team will start the survey by listing questions for which data are wanted, they will be pleasantly surprised to discover how much they know about the community. The answers they provide can then be supplemented from other sources of information. A valuable and readily accessible source is school records. The entry forms that children fill out when they first enroll in school contain information on family backgrounds. If used in accordance with the Family Educational Right to Privacy Act (also know as the Buckley Amendment), these records can provide important demographics of a specific segment of the community. When an annual or biennial census is taken in the district, the returns may supply similar information and other items not contained in the previous records. If supplemental data are wanted, they can easily be obtained by means of questionnaires administered to students. These sources furnish a good picture of home and family conditions in the community.Numerous sources of printed materials, covering practically all aspects of the needed survey, also are available. City directories and telephone books contain the names of organized groups in the community. U.S. Census statistics include detailed information on population. If the community is too small for inclusion in the printed tracts, the information can be secured by writing the U.S. Census Bureau or logging onto its Web site: census.gov. Most social agencies maintain records that are useful on a number of points. Excellent data are available from the local chamber of commerce. City, county, and state historical societies and planning commissions have documentary materials that throw light on the growth of the community. A review of newspaper files tells an interesting story of happenings, traditional observances, community efforts, group tensions and conflicts, and outstanding leaders. Publications by the U.S. Department of Commerce are helpful in understanding the economic life of the community, and the publications of governmental planning boards often prove to be highly valuable sources of broad information. Online and published research resources may be used for biographical information, religious customs, traditional observances, and related items. The minutes of boards of education meetings are sometimes a rich source of data on leaders, group programs, tensions, sectional conflicts, and relations with the community.Additional information may be gathered through personal interviews with prominent residents of the community. These individuals know many of the intimate details of social life that are seldom publicized. Although the reliability of their statements may be open to question, they can be cross-checked when a sufficient amount of information has been collected by this method. The success of these interviews will depend on how well they are planned and conducted.An inventory should be made of what the instructional and noninstructional staff members know. Those who have lived for some years in the community may prove to be valuable sources of information, as these individuals may be asked to fill out questionnaires designed especially for the survey. Comparison of tabulated replies may be used to test the accuracy and completeness of their information.
POWER STRUCTURES 
After completing the sociological inventory, attention should be turned to the power structure or structures and decision making in the community. The concern here is understanding the essential characteristics of the power structures, the areas in which they operate, and the effects of power decisions on educational policy and the school program.In every community certain people exercise considerable control over decisions relating to social, economic, and political matters. They obtain this power for a variety of reasons, such as family background, financial status, political leadership, social influence, property ownership, or labor connections. Mostly, they are members of informal groups that sustain themselves through mutual interests. Because these relationships can be described as a structured way of influencing community decisions, they are identified as power structures.A power structure is an interrelationship among individuals with vested interests who have the ability or authority to control other people, to obtain their conformity, or to command their services. They are accorded this power because of their involvement in the decision-making process and the influence they have on decisional outcomes.
General Characteristics 
If the school is to deal intelligently with the power structure or structures in the community, it should have some knowledge of the characteristics peculiar to this form of organization. Power structures are controlled by people of influence who try to shape community decisions in ways that either protect or advance their own interests or do both. Those who constitute the power structure may have few if any scruples about getting what they want. They are usually individuals with high intelligence and real leadership ability; otherwise it is doubtful that they would be able to command the status they enjoy.Members of power structures are drawn from a wide cross-section of community life. They may be professional people, business executives, bankers, labor leaders, land speculators, newspaper publishers, or industrialists. Many of them make it a point to be associated with influential clubs and organizations, where they have numerous contacts with others of their kind and where they can use the membership to spread their propaganda and to mobilize popular support for policies and projects they favor. They do this very quietly and without thrusting themselves into the limelight. Typically, they use a secondary corps of influential individuals to handle matters for them and to report on the nature of public sentiment toward their proposals and the effectiveness of the strategies being employed.Interestingly enough, power structure members are sincerely concerned with the well-being of the community, especially from an economic point of view. They know that they stand to gain as well if the community moves ahead and enjoys prosperity. It is not unusual for them to assist in bringing new industries into the community, to put pressure on politicians for modifications in the local tax structure, or to secure public funds for such items as urban redevelopment, a new highway, or a recreational area. However, when the public welfare on an issue does not coincide with their interests, they may take steps to swing the decision in their own favor.Members of power structures find it advantageous to align themselves with political parties and holders of public

Health behavior | Nursing homework help

 can you help me to finish this assignment with good quality and be on time please?
Discuss why are ecological models are important in understanding and modifying health behaviors (in at least 200 words)?
NOTE: Provide at least one APA 6th Edition In-Text Citation and Reference.
APA Resource: http://nu.libguides.com/ld.php?content_id=8766101

Lasa 1: case studies presentation

By Wednesday, January 22, 2014, create a Microsoft PowerPoint presentation to educate a group of medical students participating in their grand rounds. There should be at least ten slides in your Microsoft PowerPoint as well as a title slide and a slide listing all your sources for creating this slideshow. You should also create speaker notes for each slide of your presentation, which include the main talking points for the topic addressed on the slide. Save the presentation as AU_PSY350_M3_A2_LastName_FirstInitial.ppt. Submit your assignment to the M3 Assignment 2 LASA 1 Dropbox.
In order to create your slideshow, review the two case studies and then answer the questions following each case study:
Case Study 1: Isaac is a fifty-nine-year-old man. Several months ago, he noticed a slight tremor in his hands. He assumed this to be a normal consequence of aging. The tremor, however, gradually worsened, along with some muscular stiffness and slowness in initiating movement. The tremor was more pronounced when he was not voluntarily moving. Isaac was referred to a neurologist, who diagnosed him with Parkinsons disease. After visiting the neurologist, Isaac and his family ask you to further explain this disorder. Isaac also asks about L-dopa as a treatment—the neurologist had mentioned L-dopa as an effective medication but had instead prescribed selegiline:
•What are the symptoms of Parkinsons disease?
•What are the possible causes? Be sure to discuss both hereditary and environmental factors thought to contribute to this disease.
•What parts of the brain does this disease affect?
•Why do you think the neurologist prescribed selegiline instead of L-dopa?
Case Study 2: Sabrina is a twenty-seven-year-old woman who recently underwent a corpus callosotomy. Initially after surgery, when given a verbal command, Sabrina demonstrated marked apraxia of the left hand. However, the extent of this issue diminished over time. Answer the following questions about this client:
•What disorder was most likely being treated by this operation, and how is the surgery performed?
•In what way is the surgery expected to help Sabrina?
•What are the risks and benefits of the surgery? Compare these to the risks and benefits of an alternative treatment. If the decision were yours, which would you recommend? Explain your decision.
•What was the cause of the apraxia?
•What does the reduction in apraxia symptoms tell us about hemispheric specialization?
 
Assignment 2 Grading CriteriaMaximum Points
Described the symptoms of Parkinsons disease. Discussed what parts of the brain this disease affects.24
Discussed hereditary and environmental factors thought to contribute to Parkinsons disease.24
Analyzed the reasons why selegiline was prescribed instead of L-dopa.28
Discussed the disorder being treated by the corpus callosotomy and how the surgery is performed. Explained how the surgery will help Sabrina.20
Analyzed the risks and benefits of the surgery and an alternative treatment and explained your recommendation.24
Explained the cause of the apraxia.16
Analyzed what the reduction in apraxia symptoms reveals about hemispheric specialization.20
Used standard presentation components.44
Total:200

Statistical analysis chapter 4 and 5

I need someone who is good at APA tables and statistical analysis. The information is already in the attachment. The tables and charts must be in APA format   
Chapter 4: Data Analysis and Results
This chapter will review the collected data, evaluate methods used to analyze the data, and appraise the findings of the study. The purpose of this quantitative project was to determine the degree of relationship between the independent variale of nurse’s participation in an evidence-based CLABSI prevention using CHG bathing and the dependent variables of lowering CLABSI rates in patients with CVCs in a healthcare facility in Texas. The quantitative research methodology was selected as a means to review the collected data, evaluate and analyze the data and to appraise the findings of the quality improvement project. The purpose of the project is to explore the problem of CLABSIs and examine available measures to prevent, control, reduce incidences, and to implement a quality improvement project set forth by this investigator to decrease CLABSIs. More importantly, the project seeks to contribute to the field of evidence-based practices in nursing by showing the role of the nurse in helping to reduce HAIs, such as CLABSIs, in the adult critical care setting. In particular, the present project proposes nurse training on the CUSP toolkit and additional CLABSI maintenance, including CHG bathing as an intervention to prevent CLABSI. Central line Venous Catheters (CVCs) are commonly used for inpatients hospitalized in acute care Intensive Care Units (ICU) to administer blood products, intravenous fluids, parenteral nutrition, and other types of medications, such as antibiotics. The use of catheters is, however, linked to the risk of developing a hospital-acquired infection (HAI), known as Central-line Associated Bloodstream Infection (CLABSI) mainly caused by microorganisms found on the external surface of the patient’s skin, improper hand hygiene, or in the fluid pathway post-catheter insertion. Notably, CVCs have been cited as the most frequent and costliest causes of bloodstream infections (Haddadin Regunath., 2019). CLABSI prevention is one of seven requirements by the Joint Commission for hospitals to accredited nursing care centers and listed as a National Patient Safety Goal (NPSG) NPSG.07.04.01 (Yokoe et al., 2018).
Evidence-based practices, including CHG bathing, adequate hand hygiene, and clear de-escalation protocols for central lines that are no longer medically necessary, were utilized. The Comprehensive Unit-based Safety Program (CUSP) is a program designed to teach and enhance patient safety awareness as well as the quality of nursing care (Basinger, 2015). The project will implement CUSP, which is comprised of five basic steps. The CUSP process starts with providing education on the CUSP Central-line maintenance bundle that includes chlorohexidine gluconate (CHG) bathing, followed by the identification of weaknesses and risks in patient safety, then the partnering of a senior executive of the critical care unit, learning from the flaws, and the execution of communication and teamwork tools (Basinger, 2015). The core CUSP toolkit (appendix B) gives clinical teams the training resources and tools to apply the CUSP CHG bathing intervention for this project to prevent CLABSIs.
The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which proper maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, Niesley, 2015). A CUSP CLABSI maintenance audit tool (Appendix B) was used on the nurses providing care on those patients with CVCs were used within the adult ICU at Texas hospital, to help in determining the CLASBI maintenance bundle compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. The Texas hospital’s nursing data portal was used to gather statistical data that will determine if CHG use has helped reach the benchmark goal of SIR = 75th percentile and the Goal Process Measures or KPIs = 90% compliance compared to other hospitals in the division. Currently, in the last quarter of 2019, the benchmark of the 75th percentile has been achieving post quality improvements that include the addition of CHG bathing. CUSP CLABSI maintenance audit tool (Appendix B) (Heale Twycross, 2015). Statistical significance was calculated at a p-value of .05 and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, Edwards, 2015). 
The Infection rate is calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, the number will be provided by dividing the number of new cases by the total resident days and multiply by 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Standardized Infection Ratio (SRI) is expressed as a ratio and is the comparison of the actual number of HAIs to the predicted number of HAIs in a healthcare organization. This value is based upon data reported to National Healthcare Safety Network (NHSN) during a specified time period. The Hospital Corporation of America’s (HCA) goal is 75th percentile. A SIR can only be calculated if there is at least one predicted infection
Goal: SIR = 75th percentile

To assist in determining if patient outcomes could be improved using simulation 
activities, a rural healthcare facility in Southeast Texas, was chosen to conduct the project. The methodology used for this project was quantitative. A quantitative methodology was chosen to provide absolute value to the rate of incidence or occurrence of adverse events to support measurement of the difference between pre- and post-simulation intervention. A quasi-experimental design was used as participants were not randomly selected. This approach suited the request of the institution to include nurses working in the ED. 
Using comparative analysis, the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows 90 percent compliance, the data met the key performance indicators (KPIs) for a decrease in CLABSI and it’s compliance with evidence based standars has brought down CLABSI infection rates. The Goal Process Measures or KPIs (key performance indicators) = 90% compliance. The bullet graph (Table 1) at the top right corner of Nursing Data Portal trending screens, outlines how to read and interpret progress on performance milestones. The purpose of this chapter is to summarize the collected data, how it was analyzed, and then to present the results. 

Table 1
Table 1 shows the Hospital KPI performance graph on CHG bathing from the organization’s Nursing Data Portal. The table shows the prior month and current month percentage labeled 0% to 100%. Moving from left to right, the graph shows the organizations divisional average at 50% and next the HCA corporate average of 70%. Aspiration goals for CHG bathing are set for the 75th percentile with higher aspirational goals set at 100% or in the 90th percentile. 

Table 2[A1] 
In the present project, a CVC maintenance bundle checklist (Appendix D) was used to observe nurses in the adult ICUs of an acute Texas hospital. The observation will involve the Central Line Audit Form (Appendix B) comparing nurses compliance regarding CVC maintenance and any significant definite statistical decrease in the reported standardize infection rates and was done for one month (Table 3). In 2019 in the first two quarters, the facility has already reported 20 HAIs, according to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) (Painter, 2018). From May to September (five-month trend) the Texas hospital was at 96% overall performance, and the division in which it belongs, the Gulf Coast Division, was at 97% with the goal of overall performance being 98% of all HCA hospitals (Table 2). [A2] The next five-month trend from August to November, the Texas hospital was at 95% overall performance, and the division in which it belongs, the Gulf Coast Division, was at 89% with the goal of overall performance being 98% of all HCA hospitals (Table 2). CLABSI infection and prevention are a factor in the overall performance both at the local, division and national levels. Other size hospitals in Texas have an average of 15 CLABSI per year (Liu et al., 2016). The present project will apply the quantitative approach, which was used in data collection and analysis. The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, Niesley, 2015). A CUSP CLABSI Central Line Maintenance Audit Form (appendix B) on the nurses providing care on those patients with CVCs was used within the adult ICU at Texas hospital, to help in determining CLASBI maintenance CHG bathing compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. CUSP CLABSI maintenance audit tool (Appendix B) (Heale Twycross, 2015). Statistical significance was calculated at a p-value of .05 at 5.59 or 5% and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety [A3] Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, Edwards, 2015). The Infection rate calculation calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, divide the number of new cases by total resident days and multiply by [A4] 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Using comparative analysis, if the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows 90 percent compliance, the data met the KPIs for a decrease in CLABSI. In the present project, a CVC maintenance bundle checklist (Appendix E) was used to observe nurses in the adult ICUs of an acute Texas hospital. The observation involved the Central Line Audit Form (Appendix B) comparing nurses compliance regarding [A5] CVC maintenance and any significant definite statistical decrease in the reported standardize infection rates and was done for one month.
The following clinical question will guide this quantitative project: 
Q: In adult patients with central line catheters, how does staff training on the CUSP CLABSIs maintenance CHG bathing to reduce the incidence of CLABSIs (Central Line-Associated Blood-stream Infections) compared to standard care over one month?
Standard care here is defined as procedural pause, aseptic techniques, hand hygiene, and optimal site selection, to protect the insertion site and to take maximal sterile precautions (Advani, Lee, Long, Schmitz, Camins, 2018).
    
Criterion
Learner Score (0, 1, 2, or 3)
Chairperson Score    (0, 1, 2, or 3)
Comments or Feedback
 
INTRODUCTION (TOTHE CHAPTER)
This section of Chapter 4 briefly restates   the problem statement, the methodology, the clinical question(s) or   phenomena, and offers a statement about what will be covered in this chapter.   
1
 
Re-introduces the purpose of the practice   project.
1
 
Briefly describes the project methodology   and/or clinical question(s) tested.
1
Develop project methodology.
 
Provides an orienting statement about what   will be covered in the chapter.
2
 
Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 
2
 
NOTE:   Once the document has been approved by your chairperson and your committee   and is ready to submit for review, please remove all of these assessment   tables from this document.
Score 0   (not present); 1(unacceptable; needs substantial edits); 2 (present, but   needs some editing); 3 (publication ready).
Descriptive Data
A CHG bath/treatment must be given each day (based off midnight census) for a patient in the adult ICU with a central line, hemodialysis catheter, PICC, midline, or accessed port, and the CHG bath must be documented as per the Texas hospital’s policy. The Texas hospital utilizes Meditech 5.6.x Source System to documents daily CHG bathing (Appendix F). CHG bathing is tracked through the hospitals Nursing Data Portal, a division-wide analytics program. CHG bathing is tracked through the Texas hospitals Nursing Data Portal, a division-wide analytics program. This portal can track CHG compliance, date and time of bath, CVC placement, type of lumens, date and time of access, and any reason CHG bathing was not performed (Appendix E) on the CVC patient, both intervention and nonintervention groups were determined via the CUSP CLABSI Maintenance Audit form. 
The CUSP CLABSI Maintenon Audit form asks the following questions: Was the need for a central line for this patient discussed on patient rounds? Was good hand hygiene used by all personnel involved in line care for this patient (i.e., handwashing with soap and water or with alcohol-based hand sanitizes. If the line was percutaneously placed, was this line placed in a recommended site? Was the dressing changed during this shift? Was Chloraprep or 2% chlorhexidine in 70% Isopropyl alcohol used for skin antisepsis? Were central line tubing and all additions (secondary tubing, etc.) changed during this shift? Was there blood return from each lumen? Was chlorhexidine impregnated BioPatch used? Was a chlorhexidine impregnated occlusive dressing used? Was an antibiotic coated catheter used at insertion? What will you change to improve line maintenance practices? (Appendix B and E). 
A CHG bath/treatment must be given each day for a patient in the ICU with a central line, hemodialysis catheter, PICC, midline, or accessed port, and the CHG bath must be documented in Meditech 5.6x. per the Texas hospital’s policy. From the nursing data portal, this project  the project investigator was able to gather statistical data that determined that CHG use has helped reach the goal of SIR = 75th percentile and the Goal Process Measures or KPIs of 90% compliance. Tallied scores (Table 4) were entered into SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group. This KPI was determined by a decrease in CLABSI rates. Occurrences of events constitute discrete data and are recorded in whole numbers and into various categories (Ali Bhaskar, 2016). Entered in the SPSS program was the independent variable, which is all the nurses in the present project. This group was further divided into two variables an intervention group and a non-intervention group. The intervention group being nurses implementing CUSP CLABSI maintenance bundle CHG bathing and non-interventional group nurses who are attending patients without CHG bathing. All 60 comprised of 30 nurses in each group were coded in Camel case and number, for example, Nurs1 to maintain confidentiality. Dependent variables or numberof infections entered into the SPPS program the quantitative CUSP CLABSI maintenance CHG bathing intervention performed in the adult ICU at Texas hospital. Data entered will allow the investigator to create statistical graphs such as histogram, bar charts, Tukey box plots, line graphs, and scatterplots to give a visual representation of the collected data. The investigator expects that the CUSP intervention groups will have a level of statistical significance of lower CLABSI. CUSP Central line maintenance bundle compliance was measured with the CUSP CLABSI Central line Maintenance Audit Form (appendix B) with the reported standard infection ratio (SIR). The present project shows that the SIR will decrease with the addition of the CHG bathing, and using inferential statistics.
Calculation of the p-value and paired t-test was completed to compare the means of the sample groups (intervention and nonintervention) (Table 3). Statistical significance was calculated at a p-value of .05 and a 95% confidence interval. Tallied compliance scores from the CUSP CVC audit form were entered SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group.
The information filled in the audit (Appendix B) were collected and coded to help in carrying out an unbiased de-identified analysis (See Table 4). The coded data were analyzed using the SPSS software to assist in getting the quantitative aspects of the data (Mihas, 2019). Calculation of standard deviation, p-value, and paired t-test was completed to compare the means of the sample groups. Statistical significance was calculated at a p-value of .05 and a 95% confidence interval. Statistical tests are used to see if the difference between the number of actual infections, and the number of predicted infections are due to just chance alone. If it is doubtful that the difference is due to chance, then the difference is called “statistically significant.” If the SIR is less than 1, and the finding is statistically significant, then the facility’s performance is labeled “Better than Expected.” If the SIR is greater than 1, and the finding is statistically significant, then the facility’s performance is labeled “Worse than Expected.” If the SIR is not statistically significant, then the facilitys SIR is “In the expected range” (Saman Kavanagh, 2013). When the predicted number of infections is less than 1, then the numbers are too small to compare.” Equally, the investigator used descriptive aspects of the data to assist in making meaning out of any complex scientific elements of the data. The analysis of the data is critical clinically in achieving the objective of the project and answering the clinical questions regarding CLABSI prevention and CHG maintenance (Saman Kavanagh, 2013). 
Table 3
   
CHG Audit Dates
30-days pre- intervention
CHG Intervention 
No CHG Intervention
No of Infection
with CHG Intervention
No of Infection
without CHG Intervention
SIR 
Standard Infection Ratio
 
10/15-10/21
0
0
1
1
1
 
10/22-10/28
0
0
1
0
1
 
10/29-11/4
0
0
0
1
0
 
11/5-11/14
0
0
0
1
0
 
Mean
0
0
0.5
0.75
0.5
 
Standard Deviation
0
0
0
0.4
0
 
 
CHG Audit Dates
30-days poet-intervention
CHG Intervention 
No CHG Intervention
No of Infection
with Intervention
No of Infection
without Intervention
SIR
Standard Infection Ratio
 
11/15 -11/21
42
18
0
1
1
 
11/22 – 11/28
47
13
0
1
1
 
11/29-12/06
51
9
0
0
1
 
12/07 – 12/15
58
2
0
0
1
 
Mean
51.6
10.5
0
0.5
–
 
Standard Deviation
6.7
5.9
0
0.5
–
                
CVC/ PICC Line Days –     Current Census for Clear Lake (Campus: Clear Lake)
Date_______________
 
      
Nurse
De-identified
(Nurs1-Nurs60)
Location
ICU/NTICU/CCU
/CVICU
Patient
De-identified
(P1-P30)
Admit Date
Insertion Site
Location
Right/Left
Type
of Catheter
Start Date
CUSP
Audit
CHG Bath
(Y/N[A6] )
 
Nurs1
G.ICU
P1
–
ARM
RIGHT
CVC multi lumen double
–
Y
 
Nurs2
G.ICU
P2
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs3
G.ICU
P3
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs4
G.ICU
P4
–
ARM
RIGHT
Dialysis catheter triple
–
N
 
Nurs5
G.ICU
P5
–
ARM
LEFT
CVC multi lumen triple
–
N
 
Nurs6
G.ICU
P6
–
ARM
LEFT
CVC multi lumen triple
–
Y
 
Nurs7
G.ICU
P7
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs8
G.ICU
P8
–
ARM
LEFT
CVC multi lumen triple
–
N
 
Nurs9
G.ICU
P9
–
ARM
LEFT
Dialysis catheter triple
–
N
 
Nurs10
G.ICU
P10
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs11
G.ICU
P11
–
ARM
LEFT
Dialysis catheter triple
–
N
 
Nurs12
G.ICU
P12
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs13
G.ICU
P13
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs14
G.ICU
P14
–
ARM
RIGHT
CVC multi lumen double
–
Y
 
Nurs15
G.ICU
P15
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs16
G.ICU
P16
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs17
G.ICU
P17
–
ARM
RIGHT
Midline
–
Y
 
Nurs18
G.ICU
P18
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs19
G.ICU
P19
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs20
G.ICU
P20
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs21
G.ICU
P21
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs22
G.ICU
P22
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs23
G.ICU
P23
–
ARM
LEFT
CVC multi lumen double
–
Y
 
Nurs24
G.ICU
P24
–
ARM
RIGHT
Dialysis catheter triple
–
N
 
Nurs25
G.ICU
P25
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs26
G.ICU
P26
–
ARM
RIGHT
Midline
–
Y
 
Nurs27
G.ICU
P27
–
ARM
RIGHT
CVC multi lumen triple
–
N
 
Nurs28
G.ICU
P28
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs29
G.ICU
P29
–
ARM
LEFT
Dialysis catheter triple
–
N
 
Nurs30
G.ICU
P30
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs31
G.ICU
P31
–
ARM
LEFT
Dialysis catheter triple
–
N
 
Nurs32
G.ICU
P32
–
ARM
LEFT
CVC multi lumen triple
–
N
 
Nurs33
G.ICU
P33
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs34
G.ICU
P34
–
ARM
LEFT
CVC multi lumen double
–
Y
 
Nurs35
G.ICU
P35
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs36
G.ICU
P36
–
ARM
LEFT
CVC multi lumen triple
–
Y
 
Nurs37
G.ICU
P37
–
ARM
RIGHT
Midline
–
N
 
Nurs38
G.ICU
P38
–
ARM
CVC multi-lumen triple
–
N
 
Nurs39
G.ICU
P39
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs40
G.ICU
P40
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs41
G.ICU
P41
–
ARM
RIGHT
CVC multi lumen triple
–
N
 
Nurs42
G.ICU
P42
–
ARM
RIGHT
Dialysis catheter triple
–
N
 
Nurs43
G.ICU
P42
–
ARM
LEFT
CVC multi lumen double
–
N
 
Nurs44
G.ICU
P43
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs45
G.ICU
P44
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs46
G.ICU
P45
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs47
G.ICU
P46
–
ARM
LEFT
Dialysis catheter triple
–
N
 
Nurs48
G.ICU
P47
–
ARM
LEFT
CVC multi lumen triple
–
N
 
Nurs49
G.ICU
P48
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs50
G.ICU
P50
–
ARM
RIGHT
CVC multi lumen double
–
N
 
Nurs51
G.ICU
P51
–
ARM
LEFT
Dialysis catheter triple
–
Y
 
Nurs52
G.ICU
P52
–
ARM
RIGHT
CVC multi lumen triple
–
N
 
Nurs53
G.ICU
P53
–
ARM
LEFT
Midline
–
Y
 
Nurs54
G.ICU
P54
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs55
G.ICU
P55
–
ARM
RIGHT
Dialysis catheter triple
–
N
 
Nurs56
G.ICU
P56
–
ARM
RIGHT
Dialysis catheter triple
–
Y
 
Nurs57
G.ICU
P57
–
ARM
RIGHT
CVC multi lumen triple
–
Y
 
Nurs58
G.ICU
P58
–
ARM
RIGHT
Dialysis catheter triple
–
N
 
Nurs59
G.ICU
P59
–
ARM
RIGHT
CVC multi lumen double
–
Y
 
Nurs60
G.ICU
P60
–
ARM
LEFT
Dialysis catheter triple
–
N
Table 4
    
Criterion
Learner Score    (0, 1, 2, or 3)
Chairperson Score    (0, 1, 2, or 3)
Comments or Feedback
 
DESCRIPTIVE DATA
This section of Chapter 4 provides a narrative summary of the population or sample   characteristics and demographics of the   participants in the project. It establishes the number of subjects, gender,   age, level (if appropriate), organization, or setting (if appropriate). The   use of graphic organizers, such as tables, charts and graphs to provide   further clarification and promote readability, is encouraged. 
1
 
Provides a narrative summary of the   population or sample characteristics and demographics.
1
 
Graphic organizers are used as appropriate   to organize and present coded data, as well as descriptive data such as   tables, histograms, graphs, and/or charts.
1
 
Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 
1
 
NOTE: Once the document has been approved by your chairperson and   your committee and is ready to submit for review, please remove all of these assessment   tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2   (present, but needs some editing); 3 (publication ready).
Data Analysis Procedures
A quantitative approach has been successfully used by McKim (2016) to identify barriers to compliance with evidence-based guidelines for central line management. The main objective of using this approach is to strengthen and/or expand conclusions, thereby contributing to existing knowledge. The approach helps to heighten knowledge and increase the validity of the results (Guetterman, Fetters Creswell, 2015).
Reliability was addressed by ensuring that the instrument is consistent. The CUSP CLABSI Maintenance Central line audit was collected and coded to help in carrying out an unbiased analysis. The coded data were analyzed using the SPSS software to assist in obtaining the quality improvement aspects of the data (Mihas, 2019). Data were entered into the SPSS program were the independent variable, which is all the nurses in the present project. This group was further divided into two variables an intervention group and a non-intervention group. The intervention group being nurses implementing CUSP CLABSI maintenance bundle CHG bathing and non-interventional group nurses who are attending patients without CHG bathing. All 60 nurses 30 in each group were coded in Camel case and number, for example, Nurs1 to maintain confidentiality. Dependent variables or numberof infections entered into the SPPS program the quantitative CUSP CLABSI maintenance CHG bathing intervention performed in the adult ICU at Texas hospital. 
The data entered will allow the investigator to create statistical graphs such as histogram, bar charts, Tukey box plots, line graphs, and scatterplots to give a visual representation of the collected data[A7] . The investigator expects that the CUSP intervention groups will have a level of statistical significance of lower CLABSI. CUSP Central line maintenance bundle compliance was measured with the Central line Maintenance Audit Form (appendix B) with the reported standard infection ratio (SIR). The present project shows that the SIR will decrease with the addition of the CHG bathing using inferential statistics.
A Calculation of P-value and paired t-test was completed to compare the means of the sample groups (intervention and nonintervention). Statistical [A8] significance was calculated at a p-value of .05 at 5.59 or 5% and a 95% confidence interval. Tallied (Table 4) compliance scores from the audit form were entered via SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group (Heale Twycross, 2015). SPSS has in-depth statistical capabilities, and the investigator can test Reliability Method Alpha using SPSS, meaning that the same data can be entered several times repeated and whatever the outcome will remain the same or consistent (Ozgur, Kleckner, Li, 2015). 
The quantitative design will involve CUSP central line audit form (Appendix B) for nurse compliance in the adult ICU hospitals for the application of the CUSP CVC maintenance CHG bathing. The quantitative approach has been successfully used by Ider et al. (2012) to identify compliance with evidence-based guidelines for central line management. 
    
Criterion
Learner Score    (0, 1, 2, or 3)
Chairperson Score    (0, 1, 2, or 3)
Comments or Feedback
 
DATA ANALYSIS PROCEDURES
This section presents a description of the   process that was used to analyze the data. If clinical question(s) guided the   project, data analysis procedures can be framed relative to each clinical   question. Data can also be organized by chronology of phenomena, by themes   and patterns, or by other approaches as deemed appropriate according for a   qualitative project. 
1
 
Describes in detail the data analysis   procedures.
1
 
Explains and justifies any differences in   why the data analysis section does not match what was approved in Chapter 3   (if appropriate).
1
 
Provides validity and reliability of the   data in statistical terms for quantitative methodology. Describes approaches   used to ensure validity and reliability for qualitative projects. 
1
 
Identifies sources of error and potential   impact on the data. 
1
 
For a quantitative project, justifies how   the analysis aligns with the clinical question(s) and is appropriate for the   DPI project design. For a qualitative   project justifies how data and findings were organized by chronology of   phenomena, by themes and patterns, or by other approaches as deemed   appropriate.
1
 
Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 
2
 
NOTE: Once the document has been approved by your chairperson and   your committee and is ready to submit for review, please remove all of these   assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs   substantial edits); 2 (present, but needs some editing); 3 (publication   ready).
Results
The focus was placed upon the adverse event of CLABSI infections and the CHG intervention. Table 5 demonstrates the frequency of CLABSI infection events for a year pre CHG intervention and was five occurrences up to this CLABSI [A9] prevention improvement project. The standard deviation (SD) of the sample for the occurrence of CLABSI after CHG intervention was calculated as the SD of 21.68, with a sample variance of 470. The SD of the sample of occurrences of CLABSI without the CHG intervention was calculated at 0.49 with a sample variance of 0.24. The frequency of CLABSI for the 12 months before the CHG intervention and the month post-intervention is displayed in Table 5. The most frequently occurring CLABSI events occurred pre CHG intervention in October 2018 with one reported, January 2019 with one reported, May 2019, with one reported, August 2019, with one reported, and October with one reported[A10] . The median frequency of occurrence for total reported adverse events was 1:6 or 0[A11] .16 events per month. 
There was no identified trend for identifying a specific month marking an excessive frequency of CLABSI events. There is a higher frequency of CLABSI events noted on months when the CHG bathing intervention was not applied[A12] . This quality improvement project was implemented for one month from November to December 2019 with the CHG intervention and no reported CLABSI events occurred. The median frequency of occurrence was 1:2 or 0.5 per [A13] month.
Frequency of CLABSI Adverse Events [A14] 
by Month from December 2018 to December 2019

Table 5
A paired comparison [A15] was performed of the four weeks immediately before intervention and the four weeks post-intervention. Table 3 demonstrates these values. [A16] The mean frequency of occurrence of adverse events pre-intervention was 0.25 with [A17] an SD of 0.5 in errors related to assessment while the mean frequency of events related to intervention was 0.5, and the SD was 0.58 for errors related to intervention. Post-performance of the simulation activity, there were no reported or recorded errors related to assessment or intervention resulting in a mean and SD of zero (o) for both categories[A18] . 
The project may come with [A19] several limitations that would see the objectives of the project, not [A20] conclusively met. There is no way in which the project can control the responses from the nurses. T[A21] he analysis of the responses is based on the assumption that the patients are honest and adhere to the highest ethical standard

Dq62 response | Nursing homework help

Central line associated blood stream infection (CLABSI) is a major contributor to in-hospital morbidity and mortality and is linked with increased expenditure and length of intensive care unit (ICU) stay. The incidence of CLABSI is more in the ICUs due to emergency catheter placement, longer duration and repeated manipulation for sampling, administration of drugs and fluids, the additional confounding factors being chronic illness, old age, sepsis and immunosuppression (Atilla et al., 2016). My proposed solution of addressing this problem is nursing and patient education. Among the health care workers, nurses have the most direct and continuous role in handling CVCs, being involved with both insertion assistance and maintenance of central lines. Thus, they have a unique opportunity to contribute towards preventing these infections.Bedside nurses have the responsibility to implement the right interventions to prevent them. Appropriate training and education in central line management can go a long way in preventing this problem. Nurses are in a unique position to prevent CLABSIs across the health care spectrum. It would not be an overstretch to say that CLABSI prevention is completely a nursing responsibility. Let us consider the current health care scenario: the nursing scope of practice has increased vastly over the past decade and our profession continues to gain significance (Atilla et al., 2016).Educating the patients and families on the best practices of central line care and infection prevention is the responsibility of nursing staff. Making patients and caregivers partners in therapy by creating educational materials in simple language will help motivate adult learners to assimilate the knowledge (Patel et al., 2019). An interactive nurse-led demonstration accompanied by an illustrated guide to best practices of central line management ensure compliance to strict infection prevention practices. Again, this responsibility of educating patients falls on nurses, and patient education is a powerful tool to prevent CLABSIs (Patel et al., 2019). My current perspective was attributed by the fact that education empowers the patient and gives them ownership of their own care and condition.ReferencesAtilla, A., Do?anay, Z., Çelik, H. K., Tomak, L., Günal, Ö., K?l?ç, S. S. (2016). Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean journal of anesthesiology, 69(6), 599.Patel, P. K., Olmsted, R. N., Hung, L., Popovich, K. J., Meddings, J., Jones, K., Chopra, V. (2019). A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection. Annals of Internal Medicine, 171(7_Supplement), 

Project charter elements | Nursing homework help

 
Project Charter Elements
 
When considering the elements of a project charter, project managers focus on the three vitally important elements of scope, cost, and time. Project managers call these elements the “triple constraint” and group them together, as modifying one will typically affect the remaining two. Although the “triple constraint” may serve as the backbone of a project charter, other elements can also prove to be important.
 
In this Discussion, you analyze how the “triple constraint” impacts the development of a project charter and describe two additional project charter elements that you believe to be influential.
 
To prepare:
 

Review this week’s Learning Resources on the elements of a project charter.
Think about the impact of SCOPE on the development of a project charter.
By Day 1 of this week, your Instructor will assign you one element of the “triple constraint.”(SCOPE) Reflect on how SCOPE impacts the development of a project charter.
Consider which project charter elements aside from the “triple constraint” are highly influential.

 
 
 
Post in 24 hours a minimum of 550 words in APA format with a minimum of 3 references which include:
 
1) An analysis of how the element of the “triple constraint” (SCOPE) that you were assigned impacts the development of a project charter.
 
2) Describe two additional elements of a project charter that you believe to be highly influential. Provide a rationale for your selections.
 
 
 
Required Readings
 
 
 
Biafore, B. (2010). Microsoft Project 2010: The missing manual. Sebastopol, CA: O’Reilly.
 

Chapter 1, “Projects: In the Beginning”

“Publicizing a Project and Its Manager” (pp. 35–37)

 
 
 
In this section of Chapter 1, the author describes the typical elements of a project charter. The author also provides guidelines for generating stakeholder support using a project charter.
 
 
 
Coplan, S., Masuda, D. (2011). Project management for healthcare information technology. New York, NY: McGraw-Hill.
 

Chapter 3, “Project Management”

“Prepare Project Charter” (pp. 42–43)

 
 This section of Chapter 3 explains the basic principles of preparing a project charter. The authors summarize a project charter’s key elements.
 
 
 
Project Management Institute. (2013). A guide to the project management body of knowledge (PMBOK guide) (5th ed.). Newtown Square, PA: Author.
 

Chapter 3, “Project Management Processes” (pp. 47–61)

 
 Review this chapter, which supplies information on managing a single project that uses networked processes. The chapter describes project management processes related to each phase of a project. Chapter 4, “Project Integration Management”
 

4.1, “Develop Project Charter” (pp. 66–72)

 
 This section of Chapter 4 details the process of developing a project charter. The text focuses on the inputs, outputs, and tools and techniques of project chartering.
 
 
 
Patel, V. N. (2008). Project management [Ebrary version]. Jaipur, India: Oxford.
 
Retrieved from the Walden Library databases.
 

Chapter 2, “Project Origination/Initiation” (pp. 22–74)

 
 This chapter explores the initiation phase of a project in great detail. The chapter focuses on the key tasks and performers of this phase.
 
 
 
Cortelyou-Ward, K., Noblin, A., Martin, J. (2011). Electronic health record project initiation and early planning in a community health center. Health Care Manager, 30(2), 118–124. 
 
Retrieved from the Walden Library databases.
 
 
 
This article explores the application of project initiation and early planning in a community health center. The authors delve into the issues of quality improvement, planning, and finance.
 
 
 
Kloppenborg, T. (2012). Project selection and initiation questions leading to good risk management [Special section]. PM World Today, 14(1), 1–5.
 
Retrieved from the Walden Library databases.
 
 This article presents questions that project managers may ask to promote effective risk management. The author details questions applicable to the creation of a project charter and the selection of a project.
 
 
 
Eurorec.org. (n.d.). Project charter. Retrieved March 12, 2013, from http://www.eurorec.org/files/filesPublic/ehrworkshop/2007/Project%20Charter%20-%20CRFQ%20Pilot.ppt
 
 This is one of the three files for this week that are examples of project charters for health care organizations.
 
 
 
Hart, S. (2012, July 28). PM-foundations – the project charter [Blog post]. Retrieved from http://pm-foundations.com/2012/07/28/pm-foundations-the-project-charter/
 
 The author of this article reviews the basic elements and considerations of a project charter. In particular, the article explains project charter content, the assignment of charter responsibilities, and six attributes of a good project charter.
 
 
 
 
 
Karim, S. (2012, May 24). A project with no project charter? [Blog post]. Retrieved from http://blogs.pmi.org/blog/voices_on_project_management/2012/05/a-project-with-no-project-char.html
 
 This article focuses on cases in which projects have no corresponding project charter. The author specifies reasons for neglecting a charter and analyzes the potential negative repercussions.
 
 
 
 
 
Microsoft Corporation. (2012c). Project management goal: Initiate a project. Retrieved from http://office.microsoft.com/en-us/project-help/project-management-goal-initiate-a-project-HA102598143.aspx?CTT=5origin=HA101978264
 
 This article describes the process of initiating a project. The article provides a large-scale overview of planning a project.
 
 
 
 
 
Microsoft Corporation. (2012e). The project triangle. Retrieved from http://office.microsoft.com/en-us/project-help/the-project-triangle-HA010351692.aspx?CTT=5origin=HA010359477
 
 This article examines the impact of time, money, and scope on any project. The article suggests various strategies for balancing these three constraints.
 
 
 
 
 
Purdue University. (2006). Electronic health record project charter. Retrieved from http://www.docstoc.com/docs/136685338/EHR-Project-Charter
 
 
 
This is one of the three files for this week that are examples of project charters for health care organizations.
 
 
 
 
 
University of Wisconsin-Madison. (2006). Course guides on the web: Project charter (Version 2.2). Retrieved from http://psst.doit.wisc.edu/Uploads/258_Course%20Guide%20Charter%20V2.2%5B1%5D.doc
 
 This is one of the three files for this week that are examples of project charters for health care organizations.
 
 
 
 
 
Document: Team Project Scenario (PDF)
 
 This document contains the scenario you will use for your Team Project.
 
 
 
Document: Team Project Overview (PDF)
 
 This document provides an overview of the Team Project you will work on throughout this course.
 
 
 
Required Media
 
Laureate Education (Producer). (2013f). Project initiation [Video file]. Retrieved from https://class.waldenu.edu
 
 
 
Note: The approximate length of this media piece is 13 minutes.
 
 
 
In this video, roundtable participants Dr. Mimi Hassett, Dr. Judy Murphy, and Dr. Susan Newbold discuss how a project gets off the ground, who and what should be included in initial planning, the consideration of project risks, and the crucial role communication plays throughout the process.
 
 
 
 
 
 
 

Theater assignment 8-10 pages | Social Science homework help

The course presentation is a more formal research project on a specific theatre topic studied or prominent in the field.  The presentation should be on one of the theatrical topics listed below…or elect to pick a topic of your own (with approval by the instructor).

Early Theatre: The Greek City Dionysia Festival
Japanese Kabuki Theatre
Christopher Marlowe: The Other Elizabethan Playwright
Lord Chamberlains Men
London’s Historic Drury Lane Theatre
Tennessee Williams and Societys Outcasts
American Musicals by Stephen Sondheim
Theatre in Prisons
The Tony Awards
Stage Musicals on Film

Areas that could be covered by this presentation include (but are not limited by) the following.

a general history of the period, event, playwright, etc.
staging and production conventions, if applicable
plays and/or other related productions produced
audience responses to or involvement in theatre

Unlike other assignments in this course, the presentation is not necessarily a normal written essay (though an enhanced written research project would be acceptable).  Think originality and creativity…that is, graphics, charts, images/videos, Powerpoint/Prezi programs, audio or visual presentations, etc. are all accepted and encouraged.  If created in Word, 8-10 page limit is recommended; if created in Powerpoint/Prezi, 14-16 panels is suggested.  Your presentation can be turned in at any time during the semester, but is due no later than the last week of classes (Sun May 1).  Early submissions are encouraged and will always be accepted.  This presentation is graded according to the Research Project/Presentation Rubric (attached).

The domain name system (dns) sht1

QUESTION: The Domain Name System provides services critical to the operation of the network. And yet there have historically been problems with the DNS. What are these problems, and how can they be addressed?
 
 
Guidelines for Submission:use double spacing, 12-point Times New Roman font, and one-inch margins. Sources should be cited according to APA citation method. Page-length requirements: 3–5 pages. 

The systems development life cycle

Write a 1,050- to 1,400-word paper discussing how the systems development life cycle (SDLC) is used in a HCIT project.
Include the following in your paper:

Explain the processes of project management.
Explain the systems development life cycle and how it is used in HCIT.
Examine the role of a health care manager in a typical IT project.
Compare the project management life cycle with the systems development life cycle.

Cite at least 3 peer-reviewed, scholarly, or similar references.
Format your paper according to APA guidelines.

Modifying lesson plan | Education homework help

 
An essential part of being a special educator is writing and implementing IEPs and lesson plans associated with goals on IEPs. Due to legal requirements, special educators should understand the steps that go into planning effective lessons and appropriate accommodations for students with disabilities. Being able to translate IEP goals into learning objectives and accompanying lessons requires practice.
Review Marcus Partial IEP and Lesson to inform the assignment.
Upon reviewing the Present Level of Performance and the second grade literacy-based standards, create one academic goal specific to Marcus needs. Include this academic goal within the “Lesson Summary and Focus” section of the “COE Lesson Plan Template.”
Design a standards-based lesson plan, using the “COE Lesson Plan Template,” that modifies and extends skills taught in Marcus’ sample lesson plan and is aligned to his identified academic goal.
Write a 250-500 word rationale explaining your instructional choices, how your lesson extends the skills taught in the “Sample Lesson Plan” for Marcus, and how the lesson is appropriate for meeting Marcus’ academic goal. Discuss how elements of UDL will be incorporated to enhance Marcus’ learning.