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How to lie with statistics

12. The steps in producing a “gee-whiz” graph involve truncating to the bottom and expanding the scale on the y-axis. (Pg. 62-63).

13. Making one picture twice as tall as another on a picture graph leaves an impression that one quantity is eight times as big because when one doubles the height of the picture to make it appear proportional; it becomes double the length as well. It makes the area four times as large but the mind perceives the picture as a representative of a three-dimensional object which then has eight times the volume. (pg. 69-70).

14. If I did not notice the scale, I would assign the Nissan a percentage of 95.3. Using a scale from 0 to 100, the version of the graph would be as shown below.

Model	Percentage (%)
Chevy	98.3
Ford	97.5
Toyota	96.5
Nissan	95.3

Graph showing the percentages of Chevy, Ford, Toyota, and Nissan

15. A semi-attached figure is a figure, fact, or argument that seems at first look as related to the point being made through after close inspection on it, it is not.        

16. In the excerpt from a guest commentary column in the Santa Maria Times by Ron Fink, there are several semi-attached figures that I can spot. The columnist’s thesis states that the lower air quality in Southern Santa Barbara County may be caused by the natural methane seepage. There is nothing in the article to prove the statement and almost the entire article has little evidence associated with it. The major semi-attached figures that I spot in the excerpt are:

A. how does 71 tons of methane generated on a daily basis compare to those released in the areas that meet the air quality standards. In consideration of the issue, how can the reader know that it is 71 tons? The quantity given appears and even sounds official by being precise though it is not clear whether there is a precise amount even for ten tons of methane.

B. There is also an issue with pollen which is not certain how to handle it. How does the detection equipment differentiate between pollen and methane?

C. Does the author suggest that the air quality in Santa Barbara is worse than that of the northern end of the county due to the volcanoes in the Philippines? How can ash that travels 100 miles from Mt. St. Helens in Oregon affect Santa Barbara on the central coast of California?

D. Another issue is to consider whether the ozone layer thinning over the Antarctic affect the air quality in Santa Barbara. The percentages given were not compared to any other existing figures such as the year before eruption, immediately before the eruption, the average thickness, volume, or the screening ability.

E. The author has not given any evidence at all that nature has more contribution to air pollution than the things listed in the conclusion. Even though it does, it is not certain whether it makes the things responsible for the difference between the two ends of the country.

17. Post hoc is a logical fallacy of believing that temporal or time succession implies a causal relationship. Post Hoc is a fallacy that takes the form of: A occurring before B, therefore A is the cause of B. The fallacy is committed when conducted that one event causes another simply because the proposed cause occurred before the proposed effect. The fallacy entails concluding that ‘A’ causes or caused ‘B’ since ‘A’ occurs before ‘B’ but there is inadequate evidence to warrant the claim. 

18. The various kinds of correlation that might lead to post hoc reasoning include:

Chance: One sample may have no correlation at all as such as that of Cancer versus milk (pg. 95-96)

Real relationship: It is uncertain to distinguish the cause and the effect such as the case of Spinsterhood versus college education (pg. 94)

Common cause: An example is that of smoking versus college grades (pg. 87), minister’s salary versus price of rum (pg. 90)

19. The chapter warns against the dangers of extrapolation. An example used in the discussion is Rainfall versus corn height and the years of education versus income (pg.91) whose extrapolation do not result to a true representation of the variables.

20. I think that the people that are most likely to statisticulate and the purpose include: the media to sensationalize, politicians to win the electorate votes, advertisers to sell their products, and anyone attempting to convince another of an issue especially where they have an opportunity to benefit from convincing the other person.    

21. From the maps on page 103, there is none of them drawn fairly without statisculation. It appears that there was a deliberate attempt to statisculate the maps for a defined purpose.

22. Percentages are often the source of statisculation because they mask the very small and largely meaningless results thereby hiding their counts. Percentages can also create different impressions depending on what is selected as the base which in most instances is not stated. Percentages are also not fully understood by first glance by both the writer and the reader’s ends of communication. It is apparent that percentages are not as easy to use when compared to actual figures since many people are not conversant with them.

23.A look at who is offering a statistic for consumption should be associated with bias, conscious or unconscious (pg. 123). The three aspects are critical aspects that influence the manner in which readers perceive and understand various issues.

24. If a respectable organization is cited as a source of a statistic, there are certain aspects to consider about the authority. The major to consider is whether the reputable organization stands behind the information and can substantiate it and not merely being the source. The organization ought to have credible evidence as to all the data that circulates in the media to avoid legal liability.

25. Summary of the five questions we can ask to defend ourselves as a consumer of statistics and explanation of each.

A. Who says so? Is there likelihood of bias to either the one analyzing the data or the one reporting the statistic? Is the cited authority standing behind the statistic?

B. How does he know? Is there a likelihood of bias in the sample? Is it representative?

C. What is missing? Do we have all the things required to be known to fully understand the significance of the statistic being offered?

D. Did someone change the subject? Are the definitions of all the terms fully understood, and consistent for the comparisons? Does the data has a likelihood of being accurate, or was there an opportunity and reason for the subjects to lie? Is correlation being represented as causation?

E. Does it make sense? Is it believable? Or are we being blinded by the seemingly complex analysis processes and the scientific-sounding statistic? Is it reasonable to extrapolate this far?

Reference

Huff D. (2010) How to Lie with Statistics: W.W. Norton, 2010. ISBN 0393070875,           9780393070873

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in write my essay online if you need a similar paper you can place your order from write my essay for me services.

Pepsi pricing tactics

The pricing strategy the Pepsi should use over the next years is geographic pricing. The geographic pricing is when the product is priced differently based on the different locations.  In this case, the pricing of Pepsi can be based on charging a higher price to those customers who are in a distant location so that it can be able to cover the higher costs of transportation. Thus, the company should set the prices for Pepsi in different countries and location. For instance, if the central warehouse of the firm is in a city, the company can consider pricing Pepsi being distributed around the city at a cheaper rate than the cost that customers in regions outside the city will have to pay.

Another strategy that the firm can use to price Pepsi is through the discriminatory pricing strategy. The pricing strategy tends to accommodate the differences in products, location, and customers. When using the price discrimination strategy, the sellers of the Pepsi product may consider charging different prices depending on the volume that a buyer buys. The price for the people who purchase less than three Pepsis will be different from those who purchase more than three. Those buyers who buy a large volume will be charged less than the small buyers. The prices that can be used in the next year when using the discriminatory pricing is through putting different prices depending on the seasons. For instance, the prices can increase during the summer season and then decrease during the winter season.  With such a strategy, it will enable the company to get as much revenue as possible.  

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in write my essay online if you need a similar paper you can place your order from write my essay for me services.

The Multi-Media Website

 Facebook and my political thoughts 2016

Mark Zuckerberg has had more impact than anyone I know for helping me connect with people from as far away as China. I think that without social media, I would not be as knowledgeable about the candidates in the 2016 election. Social media gave every person an opportunity to weigh in, question, debate, provide information, and encourage others to vote. Even though I am not from this country, I learned so much about not only the candidates but the controversy surrounding the candidates. It provided much more information than newspapers or TV, and I was able to see how people from Indiana or abroad thought about the candidates. I don’t think Mark Zuckerberg ever considered what an impact Facebook would have on politics. It started off as a way to connect people socially. However, the political posts I read over the last year helped me to formulate an opinion because I feel that Facebook offered me a more insightful perspective of what people thought about President Trump and Hillary Clinton.

Last year, Facebook had its political action committee as the way of strengthening its ties with Washington D.C that announced new politically themed apps. I was one of those who downloaded the My Vote app which Facebook created through its partnership with the Washington State and Microsoft. The app gave an opportunity to Facebook users like me to register and vote online and also to review important voter information. Facebook also had the “I’m Voting” app that was collaboration with CNN that allowed users to a public commitment to voting, share their political views and identify their most preferred candidates. With the advent of Facebook, the general public is now more highly connected to politics more than the past. Facebook during the last year’s campaign became my fastest way of getting any political news by looking up at the fan page of a politician who has posted the latest information. It is unlike the past whereby to find the latest news one had first to browse the Internet's search engines and online Newspapers. I was also able to interact one on one with the elected officials and candidates concerning the vital issues affecting our society by sending them posts on their wall or a private message. I believe that having this one on one connection or interaction with politicians is one way which citizens can immediately access any political information and further gave us more power as citizens to hold the lawmakers accountable for their actions and words.

 Also, my political thoughts were greatly changed in 2016 through the Facebook platform. I specifically preferred clicking on content posted on Facebook that was in line with my ideological viewed. Such content also included ads that renovate with my views as a voter. Social media specifically Facebook gave me an opportunity to actively engage in politics by airing my opinions and communicating directly with leaders of my community as well as their staff members. I also used Facebook to check up the profiles of political candidates as well as their political agendas. Through these pages of the political candidates, I found that they influenced my opinions towards the candidate for instance how the candidate interacted with other citizens and responded to their questions. I strongly feel that those candidates who used Facebook and other social media sites were my most preferred candidates because I felt that they were opening up to our levels of communication as the Millennial voters. Also, the comments generated by other Facebook users also influenced the political candidate's reputation in that is another person says positive things about a candidate then I too get to like the candidate more compared to the candidate who has been negatively commented on social media. The use of Facebook was also a way of determining who my most preferred political candidates would be.

 Facebook is one of the social media environments whereby I was bombarded with both extremely offensive and highly contentious statements on political candidates, even with the least effort on seeking that kind of information. I believe that such political arguments did encroach into my life whereby I got exposed to various political views and was forced into an environment which constantly reinforced these political opinions. Navigating all through these interactions was particularly difficult especially with the complex mix of ideas from my family members close friends, public figures, my professional connection and other distant quittances who many users and friends in online networks.

 I also found that the political discussions and debates on Facebook to be a regular component in any digital life for me as a social media users. I started to become an active political user and greatly enjoyed the heated discussions between candidates. These debates also gave me an opportunity to engage in such debates through the politics facilities and the social media. I was able of sharing my annoyance towards bad scandals against the political candidates as well as expressing a wide range of opinions through the political interactions taking place on social media platforms. I could also express my aggravation and annoyance in political interactions taking place on the Facebook platform.

Also, I got frustrated and annoyed with the overload of political contents especially on a matter that I did not agree. The Facebook platform gave me a new view on political matters of the United States. I saw many Millennials like me deciding to vote, and I felt for included and motivated to show up to the polling stations. I also became political activists in support of those candidates whom I believed were best subsisted to run for political offices in this nation. I could post slogans to support their ideologies and urge by friends on Facebook to vote them into offices. I was excited to be part of the political processes in urging friends to do the right thing of voting for the right candidates whom we could trust and those political leaders who could speak our language as the Millennials. The social media both Facebook and Twitter gave me access to political education and resources which helped me be an informed voter. I believe that as young people we can make a difference together and expect our leaders to perform their tasks by listening to what we have to say. 

Work Cited

Johncdavi. "Mark Zuckerberg at Startup School 2011." q=Ted+Tallk++Mark+Zuckerberg&view=detail&mid=BA8CA9280BB8D756DC51BA8CA9280BB8D756DC51&FORM=VIRE YouTube. YouTube, 30 Oct. 2011. Web. 20 Apr. 2017.

Wong, Queenie. "Facebook combats fake news with a new warning label." Chicagotribune.com.  Web.

Report about Benchmark Test in Power System

Introduction

In past few years, there has been a tremendous increase in the emphasis on power consumption and cooling of computer systems from both the management and design aspect. Managing electric power has significant consequences for system performance and also draws the attention of the computer architecture and system research communities. Benchmarks in power system are used to develop models of system behavior and experimentally assess new ideas. A ‘benchmark system’ consists of a model of the electric power system together with a set of conventional Power System Stabilizers (PSSs) whose parameters get soundly tuned according to one of the several techniques that are broadly applied in practice. Therefore, the benchmark systems offer a basis for evaluating the damping performance of novel damping controls and tuning approaches to the research community. Installing PSSs so as to increase the damping element of the electrical torque of a synchronous generator through the modulation of its excitation voltage, has been a common practice in the industry for several decades now, and aims at improving the small-signal stability of interconnected power systems. There have been proposals of many variants of the phase compensation designs of the 1970s so as to reduce possible adverse dynamic effects of this controller at non-electromechanical frequencies. The developments in robust control theory in the past few years have also resulted in some of the alternative PSSs, all acting through the automatic voltage regulator (AVR) as well as the exciter of the synchronous machines. Controllers with structures apart from the lead-lag phase compensation and applied to FACTS gadgets have been referred to as Power Oscillation Dampers (PODs) (Hanson, et. al., 2007).

The performance of the new controller get verified by digital simulations and compared to that of a conventional PSS using a test system built primarily to pinpoint the benefits of the new controller. In such kind of cases, there is a tendency to over-emphasize the advantages of the new controller as compared to well applied conventional solutions. Hence, a set of benchmark systems is necessary with soundly tuned conventional PSSs so as to give a common basis for fairly assessing the performance of novel damping controllers and PSS tuning techniques in comparison with conventional methodologies.

One of the areas where there has been increased attention in the electric power system includes the focus on power and controlling of computer systems both from design and management. Similarly, there is also an increasing interest in the understanding of performance effects of power management actions. A majority of the power management actions include dynamic voltage and frequency scaling have performance implications and understating the trade-offs between performance and power is significant all the system design levels. Power systems do not always get run at complete capacity, and designers and users require having knowledge of the power consumption and the performance that they can deliver across the whole range of load intensity, from zero to peak capacity. Simultaneously, the benchmarking tests for power and performance give a more complex measurement problem that has been there for performance benchmarking only. There must be a correlation between the power and performance data with each other through time. Simple end-to-end numbers, t transactions consuming j Joules over s seconds do not give adequate information concerning dynamic runtime behavior. 

The Benchmark systems and their selection criteria

Single Machine Infinite Bus (SMIB) test systems have been employed widely in the study of electromechanical oscillations. The SMIB model considers many of the practical components linked to the field commissioning and testing of stabilizers, in which it is not possible to excite interarea modes (Choo, 2015). The simplifications inherent to the SMIB model, however, limit its applicability to the research of system-wide (inter-area) oscillations in massively interconnected power systems. The other critical elements that need a detailed multi-machine power system representation are 1) the coordination of multiple controllers to simultaneously damp different modes, and 2) robust damping of these electromechanical modes for a range of operating conditions.

The requirements considered in the selection of a power system model as a benchmark system are;

1) The power system should have multiple machines and demonstrate a combination of local and inter-area modes. There can also be other kinds of modes including intra-plant modes so as to reflect practical system conditions in a better way.

2) The power system must be provided with at least one soundly executed conventional damping control method whose action leads into a satisfactory damping performance.

3) The system must have got validated through comparison of its eigenvalues and non-linear time-domain responses from at least two different simulation software packages.

Real-time simulation

Since the mid-twentieth century, there has been a widespread usage of simulation tools for the design and improvement of electrical systems. A simulation refers to a representation of the operation or features of a power system through the utilization or operation of another (Mahanta, et. al., 2015). Simulation tools are significant in the successful development of a vast number of applications that include in the layout of transmission lines in large scale power systems and also in the optimization of motor drives in transportation. The rapid evolution of simulation tools in the past few years is attributed to the rapid evolution of computing technologies. As the developments in the computer technologies have led to decreasing in cost and increase in performance, there has been an improvement in the capability of simulation tools in addressing complex challenges in less time. Various digital simulations can be performed in power systems. In discrete time simulation, the time moves forward in steps of equal duration commonly referred to as fixed time-step simulation. In solving mathematical functions and equations at a provided time-step, all the variables or system states are solved successively as a function of variables and states at the end of the previous time-step. The amount of real time needed during a discrete-time simulation in the computation of all equations and functions representing a power system during a given time-step may be shorter or longer as compared to the duration of the simulation time-step. Another kind of simulation is the real-time simulation, in which the accuracy of computations is dependent upon the precise dynamic representation of the system as well as also on the length of time used to generate results. The real-time simulator used for a real –time simulation to be considered valid must accurately produce the internal variables and outputs of the simulation within an equal length of time that its physical counterpart would take. The time required for computation of a solution at given time-step must be shorter when compared to the wall-clock duration of the time-step. It allows for the real-time simulator to carry out all functions necessary to make a real-time simulation relevant, including driving inputs and outputs (I/O) to and from externally connected gadgets.

Description of Benchmark System solved using Mat-lab to do solution

The benchmark system comprises of 39 buses and 10 generators and the damping control issue is the coordination of multiple stabilizers so as to damp electromechanical modes within a control area.

All the electromechanical modes in the system presented above have local or regional nature, except for one that is observed as the oscillation of generators 2 to 10 against generator 1. The last mode has the lowest frequency. The system does not present much of a problem from the small-signal stability stabilization perspective and gets included herein mostly for historical reasons and the sake of verification of the compatibility of outcomes from different software.

The applied solution of this scenario was based on a classical tuning method, which entailed the calculation of the GEP(s) function of all the system generators and the determination of the PSS gains and phase compensation parameters.

In the modeling and validation, the dynamic elements of the benchmark system were done according to the guidelines from IEEE standards. The system model was done on MATLAB and PacDyn. The eigenvalue analyses obtained from the approaches was used for validation. The figure below displays the nine electromechanical modes of the benchmark system.

The 39-bus system was validated as a reliable matching and is obtained for the other eigenvalues of the system as well.

Conclusion

The modern power systems have evolved significantly hence necessitating to a continuous assessment of new constraints. Simulation tools are essential in designing and planning of electrical power systems. The use of MATLAB has been found to be a necessary simulation tool for benchmark systems as it assists in analyzing and designing the systems.

References

Choo, Y. C. (2015). Small signal stability analysis for a turbine-generator unit connected to an HVDC system.

Hanson, H., Rajamani, K., Rubio, J., Ghiasi, S., & Rawson, F. (2007). Benchmarking for power and performance. In 2007 SPEC Workshop.

Mahanta, P. K., Debnath, K., & Rahman, M. H. (2015). Modeling and Simulation of a PV Module Based Power System Using MATLAB/Simulink. Dhaka University Journal of Science, 62(2), 127-132.

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in write my essay online if you need a similar paper you can place your order from write my essay for me services.

Fatigue and Burnout in the ICU

Chapter One: Introduction

The heavy workload for nurses is a major problem for the American health care system since nurses experience higher workloads than before. The reasons for the burnout are increased demand for nurses, inadequate supply of nurses, reduced staffing, and increased over time; and reduced patient length of stay. The demand for the high population of nurses is due to the aging population. Between the year 2000 and 2020, the estimated population in the United States is expected to grow by 18% and that of people aged 65 and above is expected to grow by 54 % (Ortman, Velkoff & Hogan, 2014). The number of nurses is inadequate to meet the current demand, and the shortage continues to increase since nursing schools are not able to keep up with the increasing educational demand. When the shortage occurs, the workload increases for the people on the job. In response to increased health care costs, many hospitals reduced their nursing staff and implemented the mandatory overtime policies to meet the expected high demands that led to an increase in the nursing workloads. Increased cost of operation force the healthcare organizations to lower the patient length of stay and thus, the hospital nurses take care of patients who are sicker than the past which makes their work intensive. The projected nursing shortage is expected to be more extreme than the earlier days. Aging populations need more and more nursing care, and the nursing leaders also recognize that a large proportion of the nursing workforce is getting older thereby contributing to the nursing shortage. The recent worldwide economic challenges continue to affect the cost of health care both in the U.S and across the globe and present a new challenge to retention of nurses, reducing fatigue, preventing burnout and improving on job satisfaction among the nursing workforce. The nurse managers must realize the challenges and opportunities to attract educate and retain the highly competent and satisfied nurses who ultimately influence patient outcomes. For this research project, fatigue and burnout in the Neurointensive Care Unit (ICU) is discussed and its effect on nursing retention.   

                    

Problem Statement

The significant challenges at the Neuro Intensive Care Unit (ICU) include high turnover and long training period for new Neuro-nursing staff. One of the major factors leading to the high turnover is fatigue and burnout especially for the critical care nurses (McHugh, Kutney-Lee, Cimiotti, Sloane & Aiken, 2011). High nurse turnover is associated with high costs of hiring and training new staff, loss of experienced personnel, information and technological knowledge, and impact on the continuity of care. The newly employed Neuro nurses do not have much experience to undertake their roles (Laschinger, Wong & Grau, 2012). The nursing shortage in Neuro –ICU, as well as other departments, is attributed to the high nurse turnover. The experienced nurses have to attend to intensively sick patients despite poor distribution due to inadequate staff. Nursing shortage makes the health care organizations increase the workloads for the existing nurses or hire temporary nurses who are inexperienced for the work. The nurses are forced to work overtime to fill the existing gap that increases their risk of fatigue and burnout and poor patient outcomes (Carayon & Gurses, 2008). Reduced quality of patient outcomes due to the loss of experienced nurses and inadequate personnel is the most significant cost of the high nursing turnover. The effect on patient outcome due to nursing shortage results to a decline in the institution’s operational revenues. Increased turnover for the nursing workforce is associated with reduced motivation and fatigue and burnout.                   

Problem Background

High turnover for the registered nurses is a major issue faced by the health care sector and more specifically the ICU. An appropriate organizational turnover should range between 5 percent and 10 percent since such a rate enhances a better work environment in the healthcare institution and also eliminates any inefficiencies and boredom in the workplace. The highest turnover of nursing staff occurs within one year of employment (Roussel, Harris & Thomas, 2015).  The cost of turnover of medical institutions is enormous, and the average cost of a replacement nurse is 75 000 dollars that cover for recruitment, replacement, temporary employees, overtime, and orientation.

Fatigue is identified as a symptom for the patients cared for by nurses. A close examination of the unique features of the daily routine of nurses, especially in the emergency department, reveals that mental and physical fatigue is a consequence of nursing. The advent of extended work hours as a solution to nursing shortage is a culture that puts patients and nurses at increased risk of fatigue, burnout, and compassion fatigue. Burnout is an emotional condition and is characterized by fatigue, apathy, and frustration thereby interfering with job performance (McHugh, Kutney-Lee, Cimiotti, Sloane & Aiken, 2011). There have been several studies that focused on the factors that affect the nurse’s workday, but few have looked at the emergency and intensive care unit nursing. The clinicians working in the intensive care unit (ICU) are faced with the fast-paced, high-tech, challenging work environment. The struggles of life and death are exhilarating and also emotionally and physically draining. The stressful and draining environment can result in common syndrome among the ICU clinicians called burnout. The acceptable characteristics of burnout include high emotional exhaustion, detachment, low levels of personal effectiveness and accomplishment (Raftopoulos, Charalambous & Talias, 2012). ICU nurses are studied more extensively on the incidence of burnout. The shortage of intensive care unit providers and the demands of the ICU department have led to increased awareness and recognition of burnout among physicians as well. Some previously studied cross-sectional surveys have reported that 50% of ICU physicians and 33% of the critical care nurses suffer from severe burnout syndrome (Ibid, 2012). Both nurses and physicians experience burnout, but the development of the syndrome arises from various sources in the two groups of professionals. A high number of the working time is a major contributor to burnout. The organizational culture and moral distress surrounding the end-of-life issues are identified as the major contributors to burnout syndrome. 

The major contributor to emotional fatigue in ICU nurses is the stress acquired from the high patient acuity. Another key contributor to ICU nurse burnout is the morally distressing situations encountered on a daily basis in the workplace. Distress arises from undermining one’s integrity and authenticity in their workplace. The feelings of ineffectiveness and lack of personal accomplishment can also be a significant contributor to burnout in ICU nurses. Many of the nursing staff working in the ICU have high standards of care and expectations that they cannot meet. The lack of persona accomplishment can also arise when the nurses think that other physicians have no value to their viewpoint and expertise and also are not involved in the decision-making process of patient care (Thomas, 2011).           

Description of the Practice Change, Quality Improvement, or Innovation

The challenge of high Neuro-nurse turnover significantly affects patient care outcome and quality assurance in the healthcare organization hence crucial to integrate evidence-based practices and change of quality and improvement as well as innovation, so as to enhance performance and increase staff retention. Managing the expenses and quality of patient outcomes is the driving force in the medical sector. The problem can adequately be addressed through proper guidelines, policies, regulations, procedures as well as better terms for the working staff. The effective implementation of evidence-based practice into quality improvement will ultimately result in improved performance. Quality improvement process uncovers inconsistencies or undesirable patient outcomes (Hughes, 2008). Encouraging evidence-based practice and enhancing effectiveness in healthcare requires a robust medical research enterprise, careful evaluation of the effectiveness of care technologies and practices, and strategies to promote dissemination of effective care (Houser & Oman, 2010). The medical institutions that ascribe to evidence-based practice to guide its operations, advance practice and attain outcomes are critical for the macro- to microsystem levels. Sustainability in healthcare organizations plays critical roles when planning and executing healthcare innovations since the lack of sustainability, makes the organization suffer from the same problems repeatedly.

It is necessary that the health care administrators use the available evidence-based research data to address the challenges faced by the nurses working in the ICU department. It is necessary to understand the nurse-patient ratios in the hospitals and compare it with the appropriate nurse-patient ratios for the ICU department.  Practice change will involve enacting mechanisms in place to reduce fatigue and burnout in the ICU since it affects the nurse retention ability. The mechanisms to implement include increasing the nursing staff in the ICU department, and reducing the frequency of working overtime. ICU nurses ought to have adequate time for relaxation for them to be effective in their work. Practice change will also be accomplished through enacting policies that guide on the appropriate patient-nurse ratio to avoid overworking and stressing the ICU nurses who are expected to offer quality services (Andolhe, Barbosa, Oliveira, Costa & Padilha, 2015).

Quality improvement and innovation will be achieved through proper utilization of the available resources in training staff on quality improvement strategies (Shojania, McDonald, Wachter & Owens, 2004). The hospital administration ought to invest more on staff training and providing them with a conducive working environment to ensure that they are comfortable in the workplace and avoid work-related stress types. The stakeholders involved in running the affairs of the hospital should be involved in the provision of solutions to the problem of high turnover due to fatigue and burnout of the nursing staff in the ICU. The timeline for the implementation of the proposed methods of practice change and quality improvement should not be extended beyond the scope of the project, hence necessary to use short timelines.   

Rationale for the Practice Change, Quality Improvement, or Innovation

The necessity for practice change, quality improvement, and innovation leads to better health care services. Over the last few decades, there has been increasing awareness of the need to improve the quality of health care in the general practice. It has been driven by the need to reduce the existing inequalities in health care and also an effective translation of evidence into practice. The initiatives that arise from the evidence-based methods of quality improvement and practice change tend to be effective in impacting patient care. The rationale for quality improvement is the belief that good performance reflects on the good quality practice.

According to Goldsmith (2010), there are various factors associated with the problem of high turnover in health care organization where in some facilities reach an excess of 50%. As such, there is need to address the problem of nurse fatigue and burnout in the ICU department since it leads to increased nurse-patient loads, job dissatisfaction, job stress, overtime work, and poor relations with physicians (Jennings, 2008). High turnover rate makes the patient workload for the experienced Neuro-ICU nurses’ result to fatigue and burnout. The two aspects are associated with work pressure due to the heavy patient assignment, reduced number of personnel, exhaustion, and high patient acuity ((Foglia, 2008). It is necessary to implement practice change initiatives, and quality improvement strategies since burnout and fatigue have an association with decreased quality of care and high turnover due to work inefficiencies. The individual strategies that can prevent burnout include proper time management, stress inoculation training, rational, emotional therapy, relaxation, training in interpersonal and social skills, team building and meditation, and assertiveness training (Le Gall, Azoulay, Embriaco, Poncet & Pochard, 2011). Such methods can be used as practice change initiatives to enhance nursing retention for the ICU nurses.  

Increased fatigue and stress among healthcare professionals is related to heavy workloads and extended work time thus negatively impacting quality and quantity of documentation in the medical record. The most significant risk to fatigue involves working for 12.5 hours or longer. Other contributing factors of fatigue among nurses include pain, psychological harm from doctors and hearing to what seems like a 1, 000 alarms per day of which 90 percent are not urgent results in emotional injury to a nurse. A nursing workforce that is suffering from fatigue is highly likely to make medical errors and mistakes compared to their colleagues.  Among the safety and medication errors reported relating to procedure treatment, or test, up to 88.5 percent of the cases get associated with fatigue among the nursing professionals (Boynton, 2015).  Some of the conditions exhibited by fatigued workers include reduced motivation, compromised problem-solving, lapses in attention and inability to stay focused, irritability, confusion, memory lapses, reduced reaction time, indifference and loss of empathy, impaired communication, etc. The primary approach to executing regulations and guidelines to resolve healthcare worker fatigue is ensuring targeted limiting work hours get adhered. Raising awareness of the risks associated with fatigue is vital.      

Chapter Two: Literature Review

This section focuses on a discussion of the credible sources in use, identification of best practices, an evidence summary, and the recommended practice change, quality improvement, and innovation. The project seeks to design and develop an evidence-based practice, change, quality improvement, and innovation that address the problem of fatigue and burnout among the Neuro-ICU nurses.   

Credible Sources

The search for relevant literature involved a review of credible sources that had to be published within the last five years. The review includes the aspects of the relevance of the sources, the evidence grade assigned, an appraisal of the findings, and establishing whether the source will be included or excluded in the list of those approved for the Capstone project.  

The sources used in the project are obtained from various databases that have full text and peer-reviewed research articles. The databases used include Medline with full text, ProQuest Central, EBSCOhost publishing, and CINAHAL. They are all credible databases with a rich pool of sources that are relevant to the research topic and updated. Some of the articles identified were not peer-reviewed, hence not used extensively in the research project. All the articles included in the research are applicable for the project but have varying strengths.        

Best Practices Identification

The best practices identified from the research articles used include the need to derive information from the evidence-based studies on fatigue and burnout which is essential for practice change and quality improvement. Also proposed is the need for collaborative efforts among nursing leaders in practice and education, government and care executives to ensure that there is an adequate supply of nurses. Effective communication between nurses and patients as well as nurses and other colleagues is postulated as a beneficial strategy in reducing stress among the ICU nurses (Boyle, 2011). The nurses have reduced turnover rates since they are more comfortable in their workplace when they share with others on the day-to-day work experiences. Another best practice is having counseling sessions for nurses to enhance their well-being and reduce fatigue and burnout symptoms. Large populations of ICU nurses suffer from fatigue and burnout effects but lack appropriate mechanisms to address their concerns. Other recommended best practices for the nurses working in the ICU include the need to establish boundaries in their work, taking the time to recharge, learning to relax, and talking to a supervisor on any issues of concern that affect their productivity in the workplace. It is apparent that several best practices can be implemented in the Neuro-ICU department to reduce fatigue and burnout for nurses which affects the nursing retention. It would be necessary to have effective strategies designed to have positive outcomes in reducing the high nurse turnover rates in the ICU department.       

Evidence Summary

The need to address the nursing shortage by increasing the supply of competent registered nurses is a contributing factor to improved performance and increased motivation among nursing staff.

Cowen and Moorhead (2014) published a book published that presents the challenges that nurse’s face in today’s healthcare arena and provided a forum for knowledgeable debate on the important issues that nurse face today such as fatigue and burnout resulting in a nursing shortage. It sums up the issues by suggesting, therefore, the need for a collaborative effort should be adopted among nursing leaders in practice and education, government and care executives so as to ensure the adequate supply of nurses (Cowen & Moorhead, 2014).  Nursing schools can also form strategic partnerships and seek private support to assist in increasing the capacity of nurses.

A study published in 2014 has shown that effective communication and collaborative efforts are paramount in minimizing emotional distress as well as exhaustion that may be contributing to high nurse turnover (Vertino, 2014). Formal staff training in communication and conflict resolution skills can pay a crucial role in assisting ICU nurses in coping with issues in their work. The integration of team workshops and staff education assists ICU providers to cope with moral distress and fatigue.

An article published in 2014 provides a review of an evidence-based research and comprehensive survey of the organization and function of intensive care units. It discusses ethical issues related to providing critical care in regions with scarce resources. This article is crucial for researchers seeking to understand the process and personnel important to the intensive care unit. The use of a daily goals worksheet to enhance communication concerning patient care has also been shown to enhance ICU clinician satisfaction (Scale & Rubenfeld, 2014)

An article published in 2016 emphasizes on proper training and continuous training sessions as crucial in assisting the nursing workforce deal with emerging issues affecting their profession as well as teaching proper time management (Aiken, Marshall & Chaboyer, 2016). The integration of counseling sessions that assist nurses as well as encourage them to undertake individual assessments is critical in enhancing their well-being and reducing fatigue and burnout symptoms.

An article published in 2012 explains that, when work stress becomes chronic, it can be overwhelming and harmful to both physical and emotional health (APA, 2012). Unfortunately, such long-term stress is all too common. The outlined steps were identified in the study as effective strategies. They include: tracking stressors, developing healthy responses, establishing boundaries, taking the time to recharge, learning to relax, talking to a supervisor, and getting some psychological support. The article concluded that individuals can always avoid the tensions that occur on the job and can take steps to manage the work-related stress.

An article by Saunders, Krugman and Schloffman (2013) challenges the nursing executives to take leadership roles in creating a healthy work environment for nurses and all disciplines. It states that engaging in partnerships and empowering clinical nurses to construct the solutions to the existing challenges in meeting the goal of a satisfied and healthy workforce are important strategies toward success (Saunders, Krugman & Schloffman, 2013). This publication reviewed how this strategy works in evaluating projects that a 3-time Magnet-designated academic hospital has implemented, working with shared leadership councils, to meet the standards for a healthy work environment. It concluded that a highly engaged, well-educated, and committed nursing workforce, nurtured by a strong leadership team, has created a positive work environment characterized by low turnover and high retention. 

The study by Boynton (2015) focuses on the successful nurse communication safe care for a healthy workplace and rewarding careers. The authors explain on the need to develop the skills and techniques required in communicating effectively with patients, families, and colleagues in the examination of the critical role played by communication in assuring the safe and ethical practice of nursing. The ability to communicate successfully has a positive impact on the nurse-client, nurse-family, and colleague-colleague relationships and makes the work environment less stressful and manageable for the personal challenges.

In another study, the issues, trends, and management of the contemporary nursing aspects were analyzed and focused on the relevant issues that affect the day to day nursing practices (Cherry & Jacob, 2015). The authors focused on the evolution of nursing, the role of the nurse today, the safe and effective decision-making, collaboration and communication, as well as leadership and the issues that affect healthcare and nursing practice. The study offers relevant information on the factors that affect job satisfaction and among them is fatigue and burnout as experienced by the ICU nurses.   

A qualitative study by Foglia, Grassley, and Zeigler (2010) was conducted to identify the factors that influence pediatric intensive care unit nurses to leave their jobs. The researchers sought to discover the reasons for ten nurses to voluntarily leave the pediatric intensive care unit (PICU) at a big hospital in the Southwest. From the study findings, it was found out that there exists an inescapable and unavoidable tension between human factors and the PICU work environment. The nurses reported unrelieved job stress as the major reason for leaving work. Other factors that contributed to leaving work include the interactive environmental characteristics of the nature of the job, inadequate resources, and negative perceptions of team leaders. The authors recommended the need to focus on the interventions in the areas of nursing practice, education, and research as required in reducing the possibility of losing more PICU nurses.

 A study by Le Gall, Azoulay, Embriaco, Poncet and Pochard (2011) focused on the burnout syndrome among the critical care workers and identifies burnout syndrome (BOS) as a condition that results from extended exposure to job stressors. The authors identify that intensive care units are characterized by a high level of work-related stress. Several of the studies reviewed revealed that burnout syndrome is found in half of all the critical care physicians and one-third of nurses in those settings. The determinants of burnout syndrome vary between groups of caregivers. The intensity of burnout syndrome tends to be high for those with many working hours for the night shift. The severe burnout syndrome for the ICU nurses has a relationship to the facility organization and the end-of-life care policy. The preventive measures discussed include working in groups, enhanced communication during the end-of-life care as well as prevention and management of ICU conflicts.

The article by Houser and Oman (2010) provided an evidence-based practice guideline for the implementation of guidelines in health care organizations. The authors identify that effective clinical practice has a basis in the best possible rigorous evidence. The past decade has seen various advances in information technology that makes research and other types of evidence available to health care practitioners. The triad of evidence-based practice entails the best scientific evidence, the clinical experiences, and the patient preferences. All the health care practitioners ought to use evidence-based research data in their practice to ensure that they solve the existing clinical problems and make decisions on the appropriate interventions. As such, the problem of fatigue and burnout in the ICU should be addressed by using evidence-based research studies that have been conducted on the topic and implemented.            

Recommended Practice Change, Quality Improvement, or Innovation

The nurse administrators and managers in the medical institutions ought to identify solutions in the recruitment of nurses of their medical organizations and also be knowledgeable on how to support and retain nurses after employment. The daily schedule of nurses involves dealing with tragedy, suffering and human distress as they assist patients in overcoming health challenges. Appropriate policies must be developed to balance the demand-and-supply equation of the nursing workforce. The two primary policies that can be developed include increasing the supply of nurses in the department and decreasing nursing turnover rates. There is need to hire many nurses, both young and experienced, to ensure that there are adequate nurses to serve the patients and increase the supply of nurses. This policy is appropriate in achieving both long-term and short-term organizational goals in an institution. The measure will solve the issue of the nursing shortage, thus reduced workloads and consequently reduced burnout and fatigue. Decreasing nursing turnover rates can be achieved by enhancing the working conditions and professional’s requirements of the nurses (Chlan, 2013). Effective communication approaches should also be adopted so as to prevent fatigue and job dissatisfaction among the nursing workforce (Aitken, Marshall & Chaboyer, 2016). Leaves for Neuro nurses should also be included in the program especially for nurses who have served in the hospital for over a year. Nurses who may experience burnout symptoms may require job enrichment so that their employment can be exciting as before. All non-nursing duties should be eliminated for Neuro ICU nurses so as to reduce work pressure.

Successful treatments of Neuro-ICU nurses can also assist in curbing the problem of increased turnover. Successful treatment process commences with the integration of a strategic plan. Innovation may need substantial personnel education and implementation support so as to ensure that all the stakeholders especially the Neuro ICU nurses understand what gets required to attain success. Training and learning in nursing today, are no longer a benefit but an expectation. The nursing workforce expects more than just technical competence. The nurses have to get educated through continuous training that assists in their professional development. There is a need for promotion of awareness, teamwork, effective communication and collaboration along with adopting strategies along with adopting techniques to enhance a healthy work environment. It assists in supporting Neuro-ICU nurses and values their commitment to offering patient and family-centered compassionate care. 

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