Literature Review Breast Cancer Screening Health And Social Care Essay

Literature Review Breast Cancer Screening Health And Social Care Essay Journals and articles were searched from search engines like pubmed, scientific journals, Google, Google books, Google scholar, British libraries, Health educator recommendations, and science direct periodic journals from university library. The key words used in searching the documents were barriers of screening, ethnic minority women, breast cancer, promoting uptake of screening, promoting quality of breast cancer through health education, government policies. Demographic statistics, Census reports and population statistics are also included. A total of 39 papers were found through the search engines and the number of articles used in the project is narrowed down to 15 based upon relevance and importance. The methods used in the research articles include questionnaires, qualitative analysis, extensive literature search, cross sectional studies, observational studies, census reports, mortality reports, statistics, demographic reports and review papers. RESEARCH FINDINGS: All the fifteen articles were researched thoroughly to analyse the primary objectives, methods employed, results obtained and comments over the conclusions pertaining to subject of interest. All these are summarised in the table below: Author, Year, Location Title Method/Study Results Comments 1. AK Jain and J Serevitch 2004. The Nightingale Centre and Genesis Prevention Centre, UHSM NHS Foundation Trust, Manchester. Breast Cancer Screening- How do we communicate with women of South Asian origin? Questionnaires and structured letters listing the objectives of study were sent to office managers and directors of 99 breast screening units in UK requesting them the communication practice with south Asian women of Indian, Bangladeshi, srilankan and Pakistani origin. Communication was also requested with units of larger South Asian women population. 67 of 69 questionnaires were returned to the office with particulars of initial Breast screening invitation procedures across the south Asian women, Mammographic, recall and breast assessment information and means of communication with the south Asian women in local languages like Bengali, Hindi, Telugu, Tamil and Malayalam. The study reveals that many south Asian women dont get proper information on breast screening procedures and initiatives due to language and management barriers. Pictorial information and motivation in local languages is not given. Distribution of translated scriptures is poorly taken up. Conclusions of the research highlight the communication and financial barriers of the BSU. The recommendations of research include increased initiatives in local languages to the women who dont understand English and increase funding which enables them to improve patient facilities and screening uptake. 2. Scottish Intercollegiate Guidelines Network 2005 , NHS Scotland. Management of breast cancer in women-A national clinical guideline Statistics and Doctor recommendations were collected to design a framework on managing breast cancer in women. SIGN was prescribed as a collection of guidelines for managing breast cancer patients and it includes surgery, therapy and care. Treatment procedures like radiotherapy, systemic therapy and physiological care were prescribed as techniques of improving care. Recommendations of care and surgery were include for information. Additional initiatives were mentioned to improve screening uptake among minority women. 3. Jo Freeman Douglas Eadie 2007. ISM Institute for Social Marketing. Breakthrough Breast Cancer Awareness Campaign: ISM Literature Review Six data bases, grey literature and small archives of data were researched on existing data on awareness programmes, current knowledge and perception of ethnic minority women. The research revealed that limited or inaccurate knowledge and awareness on screening programmes to be the main cause of poor screening uptake. Gender, cultural differences were influential in predicting attendance at screening centers. Perceiving importance of screening was major approach to be addresses. Research shed light on the problem areas and risk factors associated with breast cancer screening. Study focuses on multi-strategy interventions like educational packages, Inter-personal support, use of alternative community channels like community groups and ethnic media, Local publicity events like road shows to increase awareness of self examination and screening. 4. A Szczepura 2005. Ethnic review, Postgrad Med Journal. Access to health care for ethnic minority populations Extensive literature search is performed to identify the care process and quality in ethic minority people. Challenges for clinicians, managers and policy makers in ensuring quality care are discussed. Literature search revealed the primary factors influencing quality to be population diversity, linguistic competence, cultural disparities and lack of orientation and training programs suitable for special needs. The research focuses on the case study of breast cancer screening through NHS and identifies four reasons fro failure which are lack of knowledge on self examination and screening among ethnic communities, language and cultural barriers, inaccurate register of screening, lack of references and recommendations by health care professionals. The study concludes with highlighting improvement by interventions to increase awareness, improving risk perception and improve breast cancer screening for minority women. 5. P.T. Straughan and A. Seow 2000. Social Science Medicine. Attitudes as barriers in breast screening: a prospective study among Singapore women A multistage project was conducted to promote better understanding of Mammographic techniques in Singapore women. The methods included phase-I qualitative analysis, phase-II cross-sectional survey and phase-III prospective study. Items on FATALISM index, BARRIER index and early cancer DETECT index were studied as a result of the methods. Apart from the index results, the other important factors influencing screening uptake include social and cultural factors with perception. 6. Abdullahi et al 2009. Public Health. Cervical screening: Perceptions and barriers to uptake among Somali women in Camden Qualitative study was performed on seven focus groups and eight in depth interviews. The study revealed that there was lack of understanding of risk factors and fatalistic attitudes. Culturally specific barriers like embarrassing situation and past experiences accounted for poor screening uptake. Language barriers and cultural factors account for first stage poor screening. Improvement of language and communication in local language along with continuous support would improve screening uptake .Oral information with explanation about risk factors and advantages of treatment would improve health condition. 7. Ala Szczepura 2003. Centre for Health Services Studies, University of Warwick, Coventry. Ethnicity: UK Colorectal Cancer Screening Pilot Final Report Colorectal cancer screening pilot tests are performed using records of Faecal Occult blood testing. The results focus on the disparities of treatment of cancer patients among the ethnic minority people. The screening uptake studies show the variation in high class areas and the ethnic minority even after equal awareness due to lack of initiation and courage among the ethnic minority. 8. Teresa et al 2007. Journal Of the national medical association. Breast Self Examination: Knowledge Attitudes and Performance Among Black Women A questionnaire was distributed to 180 black women, 18 years Of age and older in metropolitan areas through the church council developed by the authors. Another group comprises participants above 41 years. The survey explained that the frequency of breast self examination is associated with knowledge of self examination. Most of the respondents indicated to have practiced BSE from couple of years. 50% indicated to practice regularly and less than half sample had no knowledge on the practice of BSE. The research revealed that knowledge and practice of BSE is more in the educated class and older people with high income when compared to uneducated lower class women. The study also focussed on attitudinal and demographic variables pertaining to BSE. It also gave a note on confidence and social approval for BSE. 9. Chee et al 2003. BMC Womens Health. Factors related to the practice of breast self examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories A cross sectional survey was conducted among women production workers from ten electronics factories. Self administered questionnaire was collected from 1, 720 women workers. Later statistical analysis was performed by bivariate and multivariate tests like chi square test, odds ratio and binomial regression. BSE rates were recorded as 24.4% a month and 18.4% for pap smear testing in period of three years. Women over 30 years and older, women with upper secondary education and above, answered the questionnaire on BSE correctly. Proportion of pap smear tests were recorded to be high in older married people bearing kids or couples on contraceptive pills and answered the questionnaires on pap smear tests. In comparison with national rates, screening practices were recorded as low in the Malaysian women. Health care factors, socio-demographic factors and education were related as barriers for screening. Educational and promotional strategies were directed for better screening rates among Malaysian women. 10. Cannas et al 2005. Survey methodology for public health researchers, Health education Research. Factors associated with Mammographic decisions of Chinese-Australian women Study involved research over sample of population suffering with breast cancer. 20 Chinese-Australian women were recruited for studies from different Chinese organizations like churches, community centres and clubs. Some of the participants discontinued due to discomfort in talking about the disease. Demographic data and open ended questions were used as a part of research An average of 8 informants among 20 participants has undergone Mammographic testing. Among the eight informants, 3 had it more than twice and the remaining four decided not to have any more. Among other informants who did not have Mammographic testing, 8 informants rejected Mammographic testing while the other four never heard about the term despite publicity. The study reveals that there are numerous factors responsible for poor screening uptake which includes organizational factors and influence of significant family members. The barriers were accounted to be fear of stigmatisation, fear of mammography and modesty. 11. Robb et al 2010. . J Med Screen, Pub med central. Ethnic disparities in knowledge of cancer screening programmes in the UK Cross sectional study and questionnaires were conducted using data from National health interview in 1998. The study resulted in enumerating foreign birth place and lack of adjustment to new culture as primary factors for poor screening among ethnic minority. The study revealed that foreign birth place and socioeconomic factors responsible for poor screening uptake. The study also revealed that foreign blacks are better in screening uptake than the Asians and Chinese. 12. Mark R D Johnson, May 2001. Mary Seacole Research Centre, De Montfort University Palliative Care, Cancer and Minority Ethnic Communities Census reports, hospital episode statistics data (HES), Health of Londoners project analysis, Patient records in hospitals and care centres. Palliative care defers from region to region and factors influencing difference were accounted as language barriers and lack of access and knowledge of palliative centres across the communities. The paper defines palliative care in terms of all types of cancer and highlights the maximum usage of this by the local people rather than the ethnic minority people due to lack of access. The paper calls for equality in treatment and increased awareness in relation to this. 13. Jamesetta Newland, Editors memo, The Nurse Practitioner. Breast Cancer Awareness More Than a Monthly Reminder The study is based on the data available in relation to Susan G. Komen Race for the Cure in developed countries to increase breast cancer awareness. The letter highlights the improvement of health care through awareness and availability of genetic testing protocol for breast cancer in ethnic minority populations. The study focuses on the attitude of breast cancer patients and the fear to reveal the disorder. Patient education and support of health care professionals is of concern in the modern day to eliminate barrier of fear. 14. Wild et al 2006, British Journal of Cancer. Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001-2003 The study is based on mortality data of cancer patients from 2001-2003 throughout the country with England and Wales as reference groups. The population data was collected from 2001 census to study rate of mortality. The number of deaths of women due to breast cancer were recorded as 33, 291. Mortality was recorded high in England and Wales and then women born in North and west Africa. Lower mortality rates were recorded in Eastern Europe and Asian countries. The data revealed the mortality rate of women due to breast cancer in England and Wales calling emergency actions and research to decrease the number of deaths due to breast cancer. 15. NCIN, 2010. National Cancer Intelligence Network, NHS, National Cancer action team. Evidence to March 2010 on cancer inequalities in England The Cancer registries are researched extensively for the data on all individuals Diagnosed with cancer. The information includes age, gender, postcode of residence and hospital of treatment. Survey of population samples are also studied simultaneously. Cancer treatment inequalities are analysed to be based on these factors: Incidence and mortality, prevalence and survival of the patients, Awareness of the patient on treatment procedure and stage of diagnosis of the patient, Screening and patient experience during end of life care. The study focuses on inequalities of treating cancer on the basis of religion, culture and race. Numerous case studies are analysed to draw series of conclusions. Activities against the inequalities of treatment could improve the health condition of patients.

Symbolism in Piggys Specs :: essays research papers

The Symbolism of Piggy's glasses Symbolism pervades throughout the entire narrative of Lord of the Flies and is used to illustrate the fears and tensions that exist within the boys trapped on the island. One of the novel's strength is that it weaves these vivid symbols together to assist its themes and ideas rather than labour them. Piggy's glasses become an important symbol representing the social order of the boys as they try to determine how to lead themselves. Although not a leader Piggy is the voice of reason as he mends the early splits between the boys by way of compromising. Of all the boys on the island it is Piggy who can seen as the most symbolic. His organisation helps the boys make the early decisions and he can be seen as the natural law of order, the reason thinking of humanity. Although despite being described as short and fat in the terms you might describe an animal as Piggy is the most willing to strive for survival in a civialised way. It is Piggy who says the most important words describing how the boys should act "What are we? Humans? Or animals? Or savages. What are grownups going to think?" It is this desire for docorum that underlines Piggy's belief that they will all be saved from the island - the only person to believe this will happen. Therefore Piggy himself becomes symbolic of the boys' hope to be saved from the island. The hope literally comes from his glasses. Piggy's spectacles are taken from him and used to start smoke signals. Without glasses Piggy's sight, like the boys' vision of what is in their best interests, becomes blurred. Piggy, now weakened, is no longer able to aid Ralph in his struggle to lead the group. Without the voice of adulthood that is Piggy, Ralph loses his moral guidance and begins to make bad judgments. The greater Piggy's will to escape and claim salvation so Ralph is drawn into the confusion and misguided pleasures of The Beast". As each pig is killed so a small part of what Piggy represents is corroded away. When Piggy's glasses are broken all apparent hope of escaping with them is destroyed as well. By making the glasses useless the boys are rejecting what the spectacles stand for. Now no longer able to function at all the 'short and fat' Piggy becomes an animal like the rest of the boys, where only the fittest survive.

Organizational Change

Organizational Change Plan-Part One The use of mobile technology for health care professionals, including personal digital assistants (PDAs) has increased exponentially in both clinical practice and nursing education (Farrell & Rose, 2008). Some evidence exists that the use of a PDA in health care settings may improve decision-making, reduce the numbers of medical errors, and enhance learning for both students and professionals (Nilsson, 2008); for these reasons, the Learning Technology Committee (LTC) at Sinclair Community College (SCC) explored the benefits of nursing students using the PDA at the bedside in the clinical setting.The committee proposed a change, Project PDA, to implement the use of PDA among novice nursing students and faculty. The following paragraphs will focus on the assessment and plan of the Project PDA; and examine the rationale for the change, barriers to change, influences on change, application of a theoretical model and resources available to support t he change initiative. Rationale for Change Healthcare is a dynamic and evolving field of knowledge. Nursing students are trying to learn and implement this large amount of information at a rapid pace.Nursing students are generally unsure of their skills, feel insecure about their knowledge level, and lack self-confidence (Fisher & Koren, 2007). Many advantages have been seen with the use of the PDA, such as time savings, reduction of errors, and ease of use (Miller, Shaw-Kokot, Arnold, Boggin, Crowell, Allegri, Blue, & Berrier, 2005). Through the use of the PDA, it is thought, the nursing student will have reduced stress, fear, and improved self-confidence (Martin, 2007). Students will benefit from gaining immediate access to resources at the point of care, become more efficient, and spend more time focusing on patient care.PDAs will provide a bridge for students to apply theoretical learning to practice and foster the development of critical reasoning skills and professiona l autonomy. Nurse educators will need to develop creatively new, innovative models of teaching to keep up with changing society and technological advances in nursing practice (Jeffries, 2005). Adopting this new technological process will ensure SCC is keeping up with the trends of technology in nursing education. Organizational and Individual Barriers to Change Organizational change is a complicated process and is likely to be met with resistance.According to Borkowski (2005), resistance may originate from two sources: organizational barriers and individual barriers. These barriers threaten to impede change success. In an effort to avoid change failure, management must identify and understand potential barriers to change. Organizational barriers are typically beyond the control of management and may be perceived as insurmountable, which in the early stages of change can prove to be futile (Borkowski, 2005). Two potential organizational barriers to implementing Project PDA are cultur al complacency; and the lack of financial and technology resources.The first barrier was cultural complacency. Spector (2010) suggests that organizational culture may enable and create barriers to change. The nursing department has functioned like a well oiled machine as result of shared values and beliefs among faculty and students; subsequently creating a complacent atmosphere. Management must change the culture of the nursing department to engage faculty and students; and promote behaviors in line with the proposed change. The second barrier was the lack of financial and technology resources.The college was in the midst of a new levy campaign and there were no current funds allocated in the nursing department budget for technology improvements including the purchase of equipment. The college does not own PDAs for the students or faculty to use. No process was in place for technical support if students were to experience challenges with the device. The individual barriers identifi ed included lack of motivation, staff support, and computer competency. Faculty and students may lack motivation if they perceive the change will disrupt the status quo, or the preference for the current situation (Borkowski, 2005).The lack of support and acceptance of the new technology by other clinical staff and faculty is one of the key challenges of implementing new technology into educational programs (Farrell & Rose, 2008). Some students and faculty are computer literate, but many are less familiar and lack experience with computer systems. As a result, it will take time for students, faculty, and clinical staff to become comfortable with using the PDA. Factors of Influence The college’s readiness to change could lead to success or failure.The change itself is not the reason, but the organization’s culture of environment and the employees respect, trust, and attitude toward the management implementing the change (Krause, 2008). The attitudes of faculty and s tudents may directly affect how responsive and committed they will be to the change process. The factors of influence within any organization may originate or draw in part on the quality of leadership (Krause, 2008). The leaders must implement strategies to communicate the value of the change, establish a coalition, and empower all participants to become change agents.Theoretical Model Kurt Lewin’s change theory was the theoretical framework selected for analyzing the change process involved in adopting the use of PDAs in the clinical setting as planned in Project PDA. Lewin’s change theory identified three stages in the change process-unfreeze, move, and refreeze. To unfreeze leaders must create a sense of disequilibrium to motivate change. A pre-pilot survey completed by the LTC revealed students and faculty believed time management was the priority challenge for students in the clinical setting.PDA use is expected to improve time management skills. In stage two, cha nge is implemented. Students and faculty will be required to use the PDA during clinical for access required textbooks and other resources. The final stage, refreeze, the change is cemented into the organization’s culture (Spector, 2010). The LTC will evaluate the change process, communicate progress, maintain support structures, reinforce required behaviors and encourage continued commitment to sustain the change. Internal and External ResourcesBorkowski (2005) noted managers must be certain adequate resources are available to implement change and ensure organizational goals are met. The nursing department at SCC is fortunate to have access to internal and external resources needed to support efforts to implement Project PDA. A strong organizational structure facilitates collaboration within the department. Webinars will be used for faculty and student development. The nursing department secured grant funding to purchase 16 i-Touch devices for faculty. Students will use fina ncial aid to purchase the PDA and software undle. E-book resources will be made available through contracted publishing vendors. Learning and troubleshooting tutorials will be included with the software as well as the Sinclair Help Desk will be available for technical support. Information technology has integrated in the health care delivery systems to include the use of personal digital assistants (PDA) and other computer devices (Fisher & Koren, 2007). Teaching institutions are being challenged to keep up with the trends in technology and meet demands for use of hand held devices.In response to this challenge, SCC proposed to implement Project PDA. Students and faculty will begin using PDAs in the clinical setting. The use of these devices will provide real-time access to important resources enabling medical personnel and students to manage point of care activities more efficiently (Lee, 2006). As a result, students will be less stressed, more confident, and more competent hea lth care providers. Change may be complicated by organizational or individual barriers.The specific barriers were identified as cultural complacency, lack of financial and technology resources, employee motivation, staff support, and computer competency. Organizational change in the nursing department at SCC could be influenced by the nursing department’s readiness for change; and the attitudes of faculty, students, and clinical staff toward the change. The Kurt Lewin change theory was applied to Project PDA examining the three stages of the change process. Leaders at SCC have access to internal and external resources necessary to implement the proposed change.The presence of a solid organizational structure, access to grant funding, technology resource vendors, and on-site technical support will facilitate the success and sustainability of Project PDA. Organizational Change Organizational Change Plan-Part One The use of mobile technology for health care professionals, including personal digital assistants (PDAs) has increased exponentially in both clinical practice and nursing education (Farrell & Rose, 2008). Some evidence exists that the use of a PDA in health care settings may improve decision-making, reduce the numbers of medical errors, and enhance learning for both students and professionals (Nilsson, 2008); for these reasons, the Learning Technology Committee (LTC) at Sinclair Community College (SCC) explored the benefits of nursing students using the PDA at the bedside in the clinical setting.The committee proposed a change, Project PDA, to implement the use of PDA among novice nursing students and faculty. The following paragraphs will focus on the assessment and plan of the Project PDA; and examine the rationale for the change, barriers to change, influences on change, application of a theoretical model and resources available to support t he change initiative. Rationale for Change Healthcare is a dynamic and evolving field of knowledge. Nursing students are trying to learn and implement this large amount of information at a rapid pace.Nursing students are generally unsure of their skills, feel insecure about their knowledge level, and lack self-confidence (Fisher & Koren, 2007). Many advantages have been seen with the use of the PDA, such as time savings, reduction of errors, and ease of use (Miller, Shaw-Kokot, Arnold, Boggin, Crowell, Allegri, Blue, & Berrier, 2005). Through the use of the PDA, it is thought, the nursing student will have reduced stress, fear, and improved self-confidence (Martin, 2007). Students will benefit from gaining immediate access to resources at the point of care, become more efficient, and spend more time focusing on patient care.PDAs will provide a bridge for students to apply theoretical learning to practice and foster the development of critical reasoning skills and professiona l autonomy. Nurse educators will need to develop creatively new, innovative models of teaching to keep up with changing society and technological advances in nursing practice (Jeffries, 2005). Adopting this new technological process will ensure SCC is keeping up with the trends of technology in nursing education. Organizational and Individual Barriers to Change Organizational change is a complicated process and is likely to be met with resistance.According to Borkowski (2005), resistance may originate from two sources: organizational barriers and individual barriers. These barriers threaten to impede change success. In an effort to avoid change failure, management must identify and understand potential barriers to change. Organizational barriers are typically beyond the control of management and may be perceived as insurmountable, which in the early stages of change can prove to be futile (Borkowski, 2005). Two potential organizational barriers to implementing Project PDA are cultur al complacency; and the lack of financial and technology resources.The first barrier was cultural complacency. Spector (2010) suggests that organizational culture may enable and create barriers to change. The nursing department has functioned like a well oiled machine as result of shared values and beliefs among faculty and students; subsequently creating a complacent atmosphere. Management must change the culture of the nursing department to engage faculty and students; and promote behaviors in line with the proposed change. The second barrier was the lack of financial and technology resources.The college was in the midst of a new levy campaign and there were no current funds allocated in the nursing department budget for technology improvements including the purchase of equipment. The college does not own PDAs for the students or faculty to use. No process was in place for technical support if students were to experience challenges with the device. The individual barriers identifi ed included lack of motivation, staff support, and computer competency. Faculty and students may lack motivation if they perceive the change will disrupt the status quo, or the preference for the current situation (Borkowski, 2005).The lack of support and acceptance of the new technology by other clinical staff and faculty is one of the key challenges of implementing new technology into educational programs (Farrell & Rose, 2008). Some students and faculty are computer literate, but many are less familiar and lack experience with computer systems. As a result, it will take time for students, faculty, and clinical staff to become comfortable with using the PDA. Factors of Influence The college’s readiness to change could lead to success or failure.The change itself is not the reason, but the organization’s culture of environment and the employees respect, trust, and attitude toward the management implementing the change (Krause, 2008). The attitudes of faculty and s tudents may directly affect how responsive and committed they will be to the change process. The factors of influence within any organization may originate or draw in part on the quality of leadership (Krause, 2008). The leaders must implement strategies to communicate the value of the change, establish a coalition, and empower all participants to become change agents.Theoretical Model Kurt Lewin’s change theory was the theoretical framework selected for analyzing the change process involved in adopting the use of PDAs in the clinical setting as planned in Project PDA. Lewin’s change theory identified three stages in the change process-unfreeze, move, and refreeze. To unfreeze leaders must create a sense of disequilibrium to motivate change. A pre-pilot survey completed by the LTC revealed students and faculty believed time management was the priority challenge for students in the clinical setting.PDA use is expected to improve time management skills. In stage two, cha nge is implemented. Students and faculty will be required to use the PDA during clinical for access required textbooks and other resources. The final stage, refreeze, the change is cemented into the organization’s culture (Spector, 2010). The LTC will evaluate the change process, communicate progress, maintain support structures, reinforce required behaviors and encourage continued commitment to sustain the change. Internal and External ResourcesBorkowski (2005) noted managers must be certain adequate resources are available to implement change and ensure organizational goals are met. The nursing department at SCC is fortunate to have access to internal and external resources needed to support efforts to implement Project PDA. A strong organizational structure facilitates collaboration within the department. Webinars will be used for faculty and student development. The nursing department secured grant funding to purchase 16 i-Touch devices for faculty. Students will use fina ncial aid to purchase the PDA and software undle. E-book resources will be made available through contracted publishing vendors. Learning and troubleshooting tutorials will be included with the software as well as the Sinclair Help Desk will be available for technical support. Information technology has integrated in the health care delivery systems to include the use of personal digital assistants (PDA) and other computer devices (Fisher & Koren, 2007). Teaching institutions are being challenged to keep up with the trends in technology and meet demands for use of hand held devices.In response to this challenge, SCC proposed to implement Project PDA. Students and faculty will begin using PDAs in the clinical setting. The use of these devices will provide real-time access to important resources enabling medical personnel and students to manage point of care activities more efficiently (Lee, 2006). As a result, students will be less stressed, more confident, and more competent hea lth care providers. Change may be complicated by organizational or individual barriers.The specific barriers were identified as cultural complacency, lack of financial and technology resources, employee motivation, staff support, and computer competency. Organizational change in the nursing department at SCC could be influenced by the nursing department’s readiness for change; and the attitudes of faculty, students, and clinical staff toward the change. The Kurt Lewin change theory was applied to Project PDA examining the three stages of the change process. Leaders at SCC have access to internal and external resources necessary to implement the proposed change.The presence of a solid organizational structure, access to grant funding, technology resource vendors, and on-site technical support will facilitate the success and sustainability of Project PDA. Organizational Change Organizational Change Plan-Part One The use of mobile technology for health care professionals, including personal digital assistants (PDAs) has increased exponentially in both clinical practice and nursing education (Farrell & Rose, 2008). Some evidence exists that the use of a PDA in health care settings may improve decision-making, reduce the numbers of medical errors, and enhance learning for both students and professionals (Nilsson, 2008); for these reasons, the Learning Technology Committee (LTC) at Sinclair Community College (SCC) explored the benefits of nursing students using the PDA at the bedside in the clinical setting.The committee proposed a change, Project PDA, to implement the use of PDA among novice nursing students and faculty. The following paragraphs will focus on the assessment and plan of the Project PDA; and examine the rationale for the change, barriers to change, influences on change, application of a theoretical model and resources available to support t he change initiative. Rationale for Change Healthcare is a dynamic and evolving field of knowledge. Nursing students are trying to learn and implement this large amount of information at a rapid pace.Nursing students are generally unsure of their skills, feel insecure about their knowledge level, and lack self-confidence (Fisher & Koren, 2007). Many advantages have been seen with the use of the PDA, such as time savings, reduction of errors, and ease of use (Miller, Shaw-Kokot, Arnold, Boggin, Crowell, Allegri, Blue, & Berrier, 2005). Through the use of the PDA, it is thought, the nursing student will have reduced stress, fear, and improved self-confidence (Martin, 2007). Students will benefit from gaining immediate access to resources at the point of care, become more efficient, and spend more time focusing on patient care.PDAs will provide a bridge for students to apply theoretical learning to practice and foster the development of critical reasoning skills and professiona l autonomy. Nurse educators will need to develop creatively new, innovative models of teaching to keep up with changing society and technological advances in nursing practice (Jeffries, 2005). Adopting this new technological process will ensure SCC is keeping up with the trends of technology in nursing education. Organizational and Individual Barriers to Change Organizational change is a complicated process and is likely to be met with resistance.According to Borkowski (2005), resistance may originate from two sources: organizational barriers and individual barriers. These barriers threaten to impede change success. In an effort to avoid change failure, management must identify and understand potential barriers to change. Organizational barriers are typically beyond the control of management and may be perceived as insurmountable, which in the early stages of change can prove to be futile (Borkowski, 2005). Two potential organizational barriers to implementing Project PDA are cultur al complacency; and the lack of financial and technology resources.The first barrier was cultural complacency. Spector (2010) suggests that organizational culture may enable and create barriers to change. The nursing department has functioned like a well oiled machine as result of shared values and beliefs among faculty and students; subsequently creating a complacent atmosphere. Management must change the culture of the nursing department to engage faculty and students; and promote behaviors in line with the proposed change. The second barrier was the lack of financial and technology resources.The college was in the midst of a new levy campaign and there were no current funds allocated in the nursing department budget for technology improvements including the purchase of equipment. The college does not own PDAs for the students or faculty to use. No process was in place for technical support if students were to experience challenges with the device. The individual barriers identifi ed included lack of motivation, staff support, and computer competency. Faculty and students may lack motivation if they perceive the change will disrupt the status quo, or the preference for the current situation (Borkowski, 2005).The lack of support and acceptance of the new technology by other clinical staff and faculty is one of the key challenges of implementing new technology into educational programs (Farrell & Rose, 2008). Some students and faculty are computer literate, but many are less familiar and lack experience with computer systems. As a result, it will take time for students, faculty, and clinical staff to become comfortable with using the PDA. Factors of Influence The college’s readiness to change could lead to success or failure.The change itself is not the reason, but the organization’s culture of environment and the employees respect, trust, and attitude toward the management implementing the change (Krause, 2008). The attitudes of faculty and s tudents may directly affect how responsive and committed they will be to the change process. The factors of influence within any organization may originate or draw in part on the quality of leadership (Krause, 2008). The leaders must implement strategies to communicate the value of the change, establish a coalition, and empower all participants to become change agents.Theoretical Model Kurt Lewin’s change theory was the theoretical framework selected for analyzing the change process involved in adopting the use of PDAs in the clinical setting as planned in Project PDA. Lewin’s change theory identified three stages in the change process-unfreeze, move, and refreeze. To unfreeze leaders must create a sense of disequilibrium to motivate change. A pre-pilot survey completed by the LTC revealed students and faculty believed time management was the priority challenge for students in the clinical setting.PDA use is expected to improve time management skills. In stage two, cha nge is implemented. Students and faculty will be required to use the PDA during clinical for access required textbooks and other resources. The final stage, refreeze, the change is cemented into the organization’s culture (Spector, 2010). The LTC will evaluate the change process, communicate progress, maintain support structures, reinforce required behaviors and encourage continued commitment to sustain the change. Internal and External ResourcesBorkowski (2005) noted managers must be certain adequate resources are available to implement change and ensure organizational goals are met. The nursing department at SCC is fortunate to have access to internal and external resources needed to support efforts to implement Project PDA. A strong organizational structure facilitates collaboration within the department. Webinars will be used for faculty and student development. The nursing department secured grant funding to purchase 16 i-Touch devices for faculty. Students will use fina ncial aid to purchase the PDA and software undle. E-book resources will be made available through contracted publishing vendors. Learning and troubleshooting tutorials will be included with the software as well as the Sinclair Help Desk will be available for technical support. Information technology has integrated in the health care delivery systems to include the use of personal digital assistants (PDA) and other computer devices (Fisher & Koren, 2007). Teaching institutions are being challenged to keep up with the trends in technology and meet demands for use of hand held devices.In response to this challenge, SCC proposed to implement Project PDA. Students and faculty will begin using PDAs in the clinical setting. The use of these devices will provide real-time access to important resources enabling medical personnel and students to manage point of care activities more efficiently (Lee, 2006). As a result, students will be less stressed, more confident, and more competent hea lth care providers. Change may be complicated by organizational or individual barriers.The specific barriers were identified as cultural complacency, lack of financial and technology resources, employee motivation, staff support, and computer competency. Organizational change in the nursing department at SCC could be influenced by the nursing department’s readiness for change; and the attitudes of faculty, students, and clinical staff toward the change. The Kurt Lewin change theory was applied to Project PDA examining the three stages of the change process. Leaders at SCC have access to internal and external resources necessary to implement the proposed change.The presence of a solid organizational structure, access to grant funding, technology resource vendors, and on-site technical support will facilitate the success and sustainability of Project PDA.

How to Find Enumeration District Maps

An enumeration district (ED) is a geographic area assigned to an individual census taker, or enumerator, usually representing a specific portion of a city or county. The coverage area of a single enumeration district, as defined by the U.S. Census Bureau, is the area for which an enumerator could complete a count of the population within the allotted time for that particular census year. The size of an ED can range from a single city block (occasionally even a portion of a block if it is located within a large city packed with high-rise apartment buildings) to an entire county in sparsely populated rural areas. Each enumeration district designated for a particular census was assigned a number. For more recently released censuses, such as 1930 and 1940, each county within a state was assigned a number and then a smaller ED area within the county was assigned a second number, with the two numbers joined with a hyphen. In 1940, John Robert Marsh and his wife, Margaret Mitchell, famous author of Gone With the Wind, were living in a condo at 1 South Prado (1268 Piedmont Ave) in Atlanta, Georgia. Their 1940 Enumeration District (ED) is 160–196, with 160 representing the City of Atlanta, and 196 designating the individual ED within the city designated by the cross streets of S. Prado and Piedmont Ave. What Is an Enumerator? An enumerator, commonly called a census taker, is an individual temporarily employed by the U.S. Census Bureau to collect census information by going house to house in their assigned enumeration district. Enumerators are paid for their work and provided with detailed instructions on how and when to gather the information about each individual living within their assigned enumeration district(s) for a particular census. For the 1940 Census enumeration, each enumerator had either 2 weeks or 30 days to obtain information from each individual within their enumeration district. Using Enumeration Districts for Genealogy Now that US census records are indexed and available online, Enumeration Districts arent as important to genealogists as they once were. They can still be helpful, however, in certain situations. When you cant locate an individual in the index, then browse page-by-page through the records of the ED where you expect your relatives to be living. Enumeration District maps are also helpful for determining the order that an enumerator may have worked his way through his particular district, helping you to visualize the neighborhood and identify neighbors. How to Locate an Enumeration District To identify an individuals enumeration district, we need to know where they were living at the time the census was taken, including the state, city and street name. The street number is also very helpful in larger cities. With this information, the following tools can help to locate the Enumeration District for each census: Stephen P. Morse’s One-Step Tools website includes ED Finder tools for the 1880, 1900, 1910, 1920, 1930, and 1940 U.S. federal censuses.Morse’s One-Step site also offers an ED conversion tool for converting between 1920 and 1930, and 1930 and 1940 Censuses.The National Archives has online ED maps and geographic descriptions for the 1940 census. Descriptions of Census Enumeration Districts 1830–1890 and 1910–1950 can be found on the 156 rolls of NARA microfilm publication T1224. Enumeration District maps for 1900–1940 are available on the 73 rolls of NARA microfilm publication A3378. The Family History Library also has Enumeration District maps and descriptions on FHL microfilm.