We can work on Summit River Nursing Home

Summit River Nursing Home (SRNB#) is a 60-bed nursing home that serves a suburban community inthe
Midwest. The facility provides a broad range of services to its residents, including recreational activities, a
clinical laboratory, dental services, dietary and housekeeping services, mental health and nursing services,
occupational and physical therapies, pharmacy services, social services, and diagnostic X-ray services.
The facility has a good reputation in the community and is well staffed. Each nursing home resident
receives at least two hours of direct nursing care every day. Licensed practical nurses administer
medications and perform certain treatment procedures. Certified nursing assistants perform most of the
direct patient care. A dietary service supervisor and a registered dietitian manage the daily operations of
the food service department. Activity coordinators provide nonmedical care designed to improve cognitive
and physical capabilities. Two social workers work with residents, families, and other organizations; an
important part of their role is to ease the adjustment of residents and their families to the long-term care
environment. They also help identify residents’ specific medical and emotional needs and provide support
and referral services. Environmental service workers maintain the facility with a goal of providing a clean
and safe facility for the residents. Housekeeping staff also have considerable contact with residents on a
day-to-day basis. SRNH has contractual relationships with a dentai practice, physical therapists, a
pharmacist, a psychologist, and a multispecialty physician practice. The management team at SRNH
consists of an administrator, a finance director, a human resources director, a director of nursing, and
administrative support personnel.
Recently, concerns about quality have emerged at the nursing home. Several instances of communication
breakdown among staff have occurred, as have several instances of medication error. A resident
satisfaction survey also revealed problems of which management had been unaware. Some of the
problems concern contract staff members who have not been included in the organization’s performance
management process.
After discussions between management and employees, it was determined that a team atmosphere among
staff was lacking. Each member of the management team was asked to develop a strategy to improve the
level of teamwork in the facility. The human resources director agreed to take action in the following three

1.Ensure that all job descriptions address teamwork and that these changes are discussed with

2.Develop and implement a team-building training program for all employees, including contract staff.
3.Revise the performance management approach so that it focuses on teamwork in addition to individual
skills and accomplishments.

The first two strategies were relatively easy to complete. Job descriptions were revised, and supervisors
met with employees to discuss the changes. With the assistance of an outside consultant, a training
program was implemented to teach employees communication and conflict management skills. Several,
but not all, contract employees attended the training program.

The third strategy, revision of the performance management approach, posed some difficulties. The current
performance management system is traditional, using a 12-item graphic rating scale (some with behavioral
descriptions) that measures aspects of work such as attitude, quality of performance, productivity, attention
to detail, job knowledge, reliability, and availability. The form also provides room for comments by
supervisors and employees. This rating approach was found to be incapable of addressing the team
components of the jobs. An additional problem is that several staff members are on contract and are not
fully integrated into the organization. These staff members currently are not included in the organization’s
performance management process.

The human resources director wants to modify the performance management process to achieve two
goals. First, the system should include methods for assessing and improving team performance. Second,
the system should include contract employees, many of whom work for a limited period and may only work
on a part-time or as-needed basis.

You afe a consultant to the human resources director. Your job is to address these two goals. Consider the
following questions:

« How would you proceed with the task of modifying the performance management process?

« What specific strategies do you think should be considered?

« Whom would you involve in developing the process?

« What obstacles do you see in implementing your approach? How would you overcome these obstacles?

Sample Solution

The main indication of nerve conduction studies are for evaluation of paraesthesias (insensibility, creeping, fiery) or instability of the arms and legs. The type of study depends on symptoms presented. (Gutmann et al., 2003) NCS studies evaluate the dormancy, magnitude, as well as the pattern of the feedback following stimulation of the peripheral nerve through the skin and tissues by an electrical stimuli. The principle of nerve conduction studies (Mallik, Weir., 2005) In NCS we apply depolarizing electrical pulse square wave to the skin over a peripheral nerve generating a proliferate nerve action potential (NAP) recorded at a distant point over the same nerve. A compound muscle action potential (CMAP) originating from the awaking of muscle grains in a destination muscle supplied by the nerve. These propagate nerve action potential and compound muscle action potential may be cited with surface or needle electrodes. Minor electrodes are restricted to allow around the full muscle stimulated, giving data for the time taken for the rapid axons to conduct an impulse to the muscle and the size of the feedback. Needle electrodes for NCS give authentic conduction time information, but because they evident from a small area of muscle or nerve it gives poor information and making numerical analysis difficult. Also it is difficult to obtain patient cooperation in an invasive technique. Nerves to be tested can either be stimulated through the skin with surface catalyst or it can be tested via a needle fixed close to the nerve or nerve roots. Choice of the stimulant depends on the desire to “bracket” above and below the point of a prospective focal contusion and the anatomical opportunity to the applicable structure. (Mallik& Weir et al., 2005). Motor nerve conduction performing motor nerve conduction study the surface electrodes overlying a muscle supplied by nerve to be tested is electrically stimulated and compound muscle action potential (CMAP) is recorded . The recording electrodes are fixed using sticky conducive pads placed in to the overlying target muscle. The effective electrode is placed over the muscle belly and the reference electrode is situated over an electrically inactive site near by muscle tendon. A grounding electrode is placed between the electrodes maintaining a zero voltage reference point. The CMAP is a calculated voltage response from an individual muscle fiber action potentials. The shortened inac>

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