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Term 2 2017 Overview Allsports is a multisport club which has several thousand members who take part in a diverse range of sporting activities such as football cricket athletics and even darts and table tennis. The club publishes a newsletter The Sports Report under the supervision of the club president every week. The newsletter incorporates 10 articles written by club members featuring the highlights of the week in their particular field of sport and 5 small paid advertisements from outside businesses. The income helps to meet the cost of publication. For each newsletter the president selects a club member to act as editor of the newsletter on hourly payment basis and it is the editors responsibility to obtain the articles from other members for inclusion and to obtain the advertisements from advertisers. For all administrative work 5 casual staff members are employed on hourly payment basis. Newsletters are published on the Wednesday of each week and cover activities for the previous Monday to Sunday. The majority of members have email addresses and have agreed to receive the newsletter in an electronic format. Those members who for some reason cannot receive the electronic form may have a paper copy posted to their mailing address. Since there is no online system so all these processes consumes money in terms of manpower and material cost. Currently the president uses word processor and spreadsheet programs but is experiencing some difficulty in keeping track of details such as which members have submitted articles what advertisements have been published and who to schedule as editor for upcoming editions. The president has asked you a business systems analyst with HighVoltage Information Services to carry out analysis and develop the specifications for a new automated information system Allsports Sports Club Information System (ASCIS). More information on their operations is provided below. Proposed system Information that needs to be stored includes: For members: their full names addresses contact phone numbers email address and the sport(s) they play. For newsletters: published weekly so the date of intended publication is shown this could also act as an identifier (perhaps something like 2016NOV09 which would indicate a newsletter to be published on 9th November 2016) titles of articles accepted for inclusion titles (file names) of articles are given by the member submitting and could be something like TennisReport5thNov.docx or ResultsCricketChampionship.docx. details of advertisements such as the identifier as supplied by the advertiser and the subject of the advertisement.which member has been selected to act as editor For advertisers: name address person to contact and their contact details. Some of these requirements may be simple attributes others will need to be modelled as relationships between entities. Problems associated with the current system With the present number of members and limited software options recently some newsletters have been published late. This is causing a degree of dissatisfaction in the members. In addition the president is having difficulty accessing information efficiently. For example the president would like to generate reports of members who have not yet edited a newsletter. While this can be done with a spread sheet it involves filtering content which is complicated and time-consuming. Desired enhancements for the new systems The system is required to generate a number of reports. The following reports are essential: a list of all members and sports played a list of articles to be published in upcoming newsletters a list of advertisements to be published in upcoming newsletters a list of all members and the newsletters they have edited a list of all members with email addresses a list of all members without email addresses Desired New System Toni Carlow owner ofAllsports Sports Club has identified that her major priority is to create a system that ties together all the key elements ofsporting activities transactions. She has hired your company HighVoltage Information Services as consultants to carry out analysis and develop the specifications for anAllsports Sports Club Information System (ASCIS). Toni has earmarked a budget of $60 000 for this project with a discount rate of 6%. She estimates that the new system will help her reduce her staffing cost by $2 000 per month and increase income by atleast another $1 000 per month thus increasing her overall profitability by ($2000+$1000) $3 000 per month. Maintenance cost could be estimated at around $1200 per month. Any other figures could be assumed by giving justifications.

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Have you ever had a drink first thing in the morning to steady your nerves to get rid of a hangover?

Order Description
Combine all elements completed in previous weeks (Topics 1-4) into one cohesive evidence-based proposal and share the proposal with a leader in your organization. (Appropriate individuals include unit managers, department directors, clinical supervisors, charge nurses, and clinical educators.)
Obtain feedback from the leader you have selected and request verification using the Capstone Review Form. Submit the signed Capstone Review Form to

RNBSNclientcare@gcu.edu.
For information on how to complete the assignment, refer to “Writing Guidelines” and the “Exemplar of Evidence-Based Practice Capstone Paper.”
Include a title page, abstract, problem statement, conclusion, reference section, and appendices (if tables, graphs, surveys, diagrams, etc. are created from tools required in Topic 4).
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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NRS-441V: Capstone Project
Writing Guidelines

Use the headings listed below and ensure that your papers contain the needed information for each section.
1) Abstract
a) Length is between 250-450 words.
b) Presents a complete, concise overview of all phases of the proposed project
c) Addresses a problem or issue related to patient care quality
d) References appropriate evidence-based literature; identifies at least one evidence-based solution that may resolve the problem or issue.
2) Problem Description
3) Solution Description
4) Implementation Plan
5) Evaluation Plan
6) Dissemination Plan
7) Review of Literature
8) Appendices
9) APA Style/Mechanics
10) APA format is used consistently in the proposal for the cover page, page header, margins, in-text citations, double-spacing, font size, and reference page.
a) Style is consistent with that expected of a formal project proposal.
b) The highest levels of evidence are used. (Note: Information from Web sites is not considered a professional reference source.)
c) At least 15 professional references (e.g., books, journal articles) are used to develop the proposal.
d) At least eight references are peer-reviewed and from quantitative or qualitative research study reports.
e) Text is free of grammatical, punctuation, typographical, and word-usage errors.
f) Project proposal is within word length requirements.

NRS-441V: Capstone Project
Exemplar of Evidence-Based Practice

Running head: SIGNIFICANCE OF EARLY ASSESSMENT AND INTERVENTION

Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal
(Student Name)(Grand Canyon University
(NRS 441V: Professional Capstone)
Instructor: (Name)
(Date)

Abstract
Based on documented studies, the prevalence of alcohol dependence in medical settings indicates that as many as 1 in 5 patients may require treatment for alcohol withdrawal (AW) while hospitalized for a concurrent illness. Research has indicated a definitive problem in recognizing and treating those patients at risk for AW. Symptom-triggered treatment, based on the use of appropriate assessment tools and treatment protocols, has been shown to be safe, and it is associated with a decrease in the quantity of medication required and the duration of treatment. Implementing standardized screening tools and initiating treatment based on established protocols, can prevent disease progression and an increased complication rate. These interventions can potentially decrease length of stay and health care costs.

Key words: alcohol withdrawal, assessment, CAGE, CIWA-Ar, symptom-triggered, protocol.

(Problem Statement- Module 1)
Significance of Early Assessment and Intervention on the Severity of Alcohol Withdrawal
Patients admitted to the acute care setting with a secondary diagnosis of alcohol abuse carry a significant risk of alcohol withdrawal (AW) when there is a failure to recognize and treat their alcoholism. Early recognition of AW is essential to early intervention, which, in turn, has the potential to prevent or decrease serious complications associated with AW.
(Support from Literature Review- Module 2)
Alcohol withdrawal has been described as a syndrome that affects those people accustomed to regular alcohol intake, who suddenly stop drinking and subsequently develop those clinical manifestations associated with AW (Saitz, 1998). An estimated 15-20% of hospitalized patients are dependent on alcohol, putting them at risk for prolonged or complicated hospital stays (Lussier-Cushing, Repper-DeLisi, Mitchell, Lakatas, Mahmoud, & Lipkis-Orlando, 2007).
Dependence on alcohol usually remains undetected in the hospitalized patient until withdrawal signs appear, secondary to cessation of their alcohol intake. Nursing staff must recognize the warning signs and symptoms of AW. Without an established assessment process, it is difficult to predict withdrawal symptoms or assess risk factors associated with an increased severity of withdrawal symptoms and subsequent impact on the patient?s treatment plan. An established assessment process/protocol has the potential to reduce patient morbidity and mortality as well as health care costs.
One fifth of the total national expenditure for hospital care is related to alcohol dependence, as evidenced by prolonged hospital stays (particularly in the Intensive Care setting) and characterized by major complications for patients progressing through AW, with an increase in utilization of health care resources/services (Phillips, Haycock, & Boyle, 2006). In addition to the increase in required health care resources, patient and staff safety must be considered; consideration for the physical safety of the patient during a withdrawal episode and for the safety of the health care worker exposed to patient behaviors during a withdrawal episode is paramount. Further significant issues related to AW are found/indicated in the progression of symptoms during the course of AW including the increased use of restraints and the increased use of sitters during the progression period (Chaney & Gerard, 2003).
The determination of need for a program directed at identifying and addressing AW within a population should begin with retrospective chart audits of identified patients, and data collection related to cost and length of stay (LOS). Development of an audit tool for an initial risk assessment and the development of an ongoing assessment process should follow. Development of treatment protocols/interventions would be the final step in addressing the identification and treatment of the patient with AW.
Once the process has been developed and approved for implementation, initial and ongoing education for the administrative team, physicians, and nursing staff would be a priority. Updated summaries of program progress during a pilot period should be made available to administration, physicians, and staff alike.
One or more outcome measures should be initiated to determine success of the process. Quality monitoring and data collection through retrospective audits should be completed to determine compliance with the program, as well as the success of the patient assessment and intervention processes as determined by LOS and subsequent health care costs. Further quality monitoring could be obtained through subjective data collection related to patient and staff satisfaction.
Implementation (From Module 3 Plan)
Theories of health behavior and promotion play a decisive role in helping to improve health by directing plans and processes that assist in the identification of risk issues, the management of disease processes, the development of implementation processes, and the measurement of process outcomes. When addressing alcohol withdrawal (AW), referred to as Alcohol Withdrawal Syndrome in some literature, theory helps to understand why AW is problematic and/or a significant health care issue; to identify what information is required in addressing the identified problem and how to use that information; to define and/or develop the necessary changes and processes; and to define what and how to monitor and evaluate the change for outcomes.
(Incorporated Theory from Module 2)
There are two types of theory significant to the planning of health care, and to change in health care planning. Explanatory theory helps to identify why a problem exists and assists in the search for modifiable factors, while change theory guides the development of health promotion interventions (National Cancer Institute, 1998). Consideration of theory allows for review of research, in this case, related to AW and recognized interventions. Explanatory theory allows for focus on the problem of AW, its variables (i.e., co-morbidities, variations in clinical presentation, appropriate treatment); why it is a problem (i.e., increased severity of illness, increased health care costs); and what can be changed. Change theory is directed at improvement processes and helps to identify the strategies for process change (i.e., early identification and assessment of patients at risk for AW, appropriate interventions based on assessments) and makes assumptions related to the success of those interventions. These theories incorporate concepts that can be translated or developed into strategies, plans, and evaluations. The use of theory allows for a complete review and appraisal of available information related to AW, with appropriate emphasis on solutions and interventions. Theory also provides the basis for judging the appropriateness of those solutions and intervention through an evaluation process.
Alcohol withdrawal is most often defined as a group of symptoms that occur with the cessation, usually abrupt, of alcohol intake. It affects people who are accustomed to regular alcohol intake, and is the most common withdrawal syndrome next to nicotine withdrawal. Alcohol addicted patients admitted to an inpatient setting may not be recognized as at risk for AW, which can produce negative outcomes and increase health care costs (Patch, Phelps, & Cowan, 1997). Ten million Americans consume alcohol excessively on a regular basis. Fifteen to forty percent of hospitalized patients are addicted to alcohol, putting them at risk for prolonged and/or complicated hospital stays; 25% of them may experience seizures within the first 24 hours of hospitalization. Alcohol withdrawal has a 1-10% mortality rate with the majority of those deaths occurring from cardiovascular or metabolic complications as a result of severe withdrawal, particularly delirium tremens (DT). Delirium tremens occurs in approximately 5% of patients undergoing withdrawal, appearing 2-4 days after the patient stops drinking (Myrick & Anton, 1998). Twenty percent of the total national expenditure for hospital care is related to alcohol dependence (Phillips et al., 2006). In the year 2008, a total of 90 patients were hospitalized at Casa Grande Regional Medical Center (CGRMC) with a diagnosis of AW: 10 of them with an admission diagnosis of AW, 27 with a principal diagnosis of AW, and 53 with a secondary diagnosis of AW. Despite a significant patient population with documented or verbalized histories of AW, CGRMC currently has no program in place for assessment and intervention related to AW. If changes are not implemented within the Casa Grande Regional Medical Center organization, the impact will remain significant as it relates to patient care, patient safety, and health care costs. Thus, the development of an assessment process and interventional protocol, the initiation of education for the physicians and staff on the new process and protocol, and evaluation of the effectiveness of the process and protocol should be given high priority. If process changes are not considered, developed, and implemented, a health care system already compromised, will continue to be impacted by issues such as AW.
Manifestations of mild AW may begin as soon as 5-12 hours after the patient?s last drink, while major withdrawal syndromes tend to occur 48-72 hours after the last drink, manifesting themselves as hallucinations, seizures and/or delirium tremens (Hartsell, Drost, Wilkens, & Budavari, 2007). Though there are many tools and processes for evaluating the patient with a history of alcohol abuse and/or at risk for AW, a screening process using the CAGE questionnaire (Ewing, 1984)(Appendix A) readily determines whether the patient may be at risk. The CAGE, designed to be a screening tool, was developed by Dr. John Ewing and introduced for international use in Australia in 1970; its simplistic question format has made it the instrument of choice in most clinical settings (O?Brien, 2008). This questionnaire would serve as an initial screening tool for patients having been identified with a past or current alcohol dependency. The CAGE questionnaire can be administered in as little as five minutes; a positive CAGE (a score of 2 or greater) would prompt further assessments of the patient, based on developed protocol, using the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) (Sullivan, Sykora, Schneiderman, Naranjo, & Sellers, 1989) (Appendix B) which has a documented utility for measuring withdrawal symptoms. Pharmacological therapy using the symptom-triggered approach would be initiated according to an approved and established physician order set/protocol, based on the patient?s CIWA-Ar scores.
Nurses can help to improve patient outcomes by developing a plan of care that includes assessment for AW, providing interventions accordingly, and evaluating the outcomes of those interventions. Implementation of a process change, related to a plan of care for those patients identified as at risk for AW, would begin with a patient history and assessment. Early physical indicators of AW can be identified during routine assessments; these indicators occurring as early as 5-12 hours after the patient?s last drink and manifested as mild tremors, diaphoresis, agitation, insomnia, and increased heart rate and blood pressure (Phillips et al., 2006). When implementing the CAGE questionnaire, those patients receiving a score of 2 or greater would then be assessed initially, and at established intervals, using the CIWA-Ar to determine the existence and severity of withdrawal symptoms. A score of less than 10 would prompt supportive care to include maintaining a quiet and safe patient environment and providing psychosocial support. A score equal to or greater than 10 would prompt the initiation of an approved physician treatment order set/protocol (Appendix C) for pharmacological therapies, including symptom triggered dosing of Lorazepam. Thiamine and electrolyte replacement and ongoing assessment guidelines would be also addressed. Patients should be reassessed using the CIWA-Ar every 4 hours while their score remains under 10; when their score equals or exceeds 10, assessment should be completed every hour following the initiation of pharmacotherapy times three doses of medication (Crumpler & Ross, 2005). If a score of less than 10 is not achieved at that time the physician should be notified and further direction obtained. Studies demonstrate that symptom triggered pharmacotherapy/treatment achieves symptom control and has demonstrated a decreased amount of drugs used, decreased duration of treatment, a decrease in the occurrence of oversedation or undersedation, a decrease in the number of adverse events, and a decrease in the use of restraints and sitters (Stanley et al., 2003). All documentation would initially be in paper form using an approved assessment and treatment flow sheet (Appendix D). Pertinent information required by the flow sheet includes hourly assessments, medication administration, any additional nursing interventions applied. Following a 6 month trial period, the suitability of converting the documentation of all process components to an electronic format would be discussed and determined. It is anticipated that electronic documentation would promote consistency, expediency, and efficiency. In addition, there would be an opportunity to write a report within the documentation software to expedite data collection and analysis. Policy and procedure would be developed to support the process change (Appendix E).
The process plan in its entirety would initially be presented to the Senior Administration members at a specifically scheduled meeting, using a PowerPoint presentation and handouts. In addition to the planned process change itself, the group would be given information on the impact of AW on patient morbidity and mortality as well as health care costs. Following presentation to, and approval by this group, a presentation in the same manner would be given to the members of the Medical Executive Board. A third presentation of the same information and in the same format would be given to the Nursing Directors. Following approval by the Medical staff and review by the Nursing Directors, the plan for the process change would be rolled out to the staff. An abbreviated PowerPoint presentation and handouts, with specific focus on process and intervention would be given to the nursing unit Patient Care Coordinators at their monthly meeting. Written information and education would be presented to general nursing staff by means of the hospital?s ?Topic of the Week? education process; additional information by means of oral presentation and handouts would be provided at individual nursing department meetings as needed. Ongoing education would be provided using the Care Learning computerized process during annual competency reviews. Education of the nursing staff would include a pre- and post-test (Appendix F); information/direction on conducting a risk assessment, including patient observation, recognition of early signs and symptoms, and use of the CAGE questionnaire; information on withdrawal management, including use of the CIWA-Ar tool and review of the protocol and/or order set; and discharge planning to include social service referrals and patient education on AW (McKay, Koranda, & Axen, 2004). Education would include orientation focused on the appropriate use of the CAGE questionnaire and the CIWA-Ar assessment tool, using the actual forms as a reference point. In addition, an assessment and treatment algorithm (Appendix G) would be provided to nursing staff to assist in decision making. A review of that form would be included in their process focused education. As well, the treatment protocol/order set would be reviewed/discussed at length during the education process.
Evaluation (From Module 4 Plan)
Outcomes of nursing care must be shown to relate to the specific care aspects of the process change (Frisch & Kelley, 2002). The general purpose of an evaluation is to measure the impact of the process change and to determine if compliance with all aspects of the process has been met. A 6-month pilot will be completed to test the efficacy and feasibility of a process change related to the early recognition and effective management of AW. The AW Protocol Quality Management/Performance Improvement Data Collection Tool (Appendix H) will be used when doing a retrospective audit of charts for all patients admitted with a principal, primary, or secondary diagnosis of AW during the 6-month trial period. Questions to be answered during that audit will include:
? Were the assessment tools (CAGE and CIWA-Ar) appropriately and successfully completed?
? Was the treatment protocol appropriately initiated?
? Was documentation adequately and appropriately completed based on the protocol and policy?
? Was additional supportive care in the form of restraints and/or sitters required?
Data collection for this evaluation process will be limited to a retrospective chart audit that may be labor intensive. However, the actual number of patients diagnosed with AW at Casa Grande Regional Medical Center (90 patients in 2008) may impact the time/work necessitated by this audit. Patient identification for the intent of the audit will be based on information obtained from Health Information Management (HIM), related to and restricted by admission diagnosis type as defined earlier.
Data for this pilot time frame will be collected by the author and prepared for oral presentation to identified groups. Handouts recalling the general outline of the process change/protocol and the results of the chart audit, in graph format, will be made available to all groups. The initial presentation will be made to the senior administrative group and will allow them to review and determine how the data may impact patient care and safety, as well as possible financial impact. The Medical Executive Board will receive the information to review for the appropriate use of the CAGE and CIWA-Ar tools in successfully and accurately identifying patients at risk and in need of treatment. As well, this group will examine the appropriateness of the protocol orders, specifically pharmacotherapy. They would further review data for the accuracy and efficacy of the documentation flowsheet as it relates to assessment and intervention. The nursing department directors will review the data and address the efficiency and efficacy of the assessment tools (CAGE and CIWA-Ar) and the treatment protocol as it relates to nursing assessment and documentation and for any impact on nursing care delivery as it relates the use of restraints and/or sitters. The Patient Care Coordinators and nursing staff groups will review the data and discuss any impact related to the assessment tools, the treatment protocol, and the documentation flowsheet, and they will discuss the use of restraints and/or sitters as it impacts their care delivery. All recommendations will be forwarded to a committee, yet to be formed, at the completion of the pilot.
Following the initial data review by the indicated groups, a quality management/performance improvement team composed of four to six nursing department staff and a medical advisor will be formed. Data will be collected monthly using the same process previously outlined; data will be collated and reported quarterly to all groups. Team meetings will be held monthly to address any newly identified limitations to the protocol and/or the evaluation process, discussing any necessary process changes related to the protocol, and to discuss continued validity of the data collection tool. These activities will help to establish and validate an evidence-based and standardized process for the early identification of AW and any required interventions. In addition, collected data may provide the basis for additional changes including expansion of electronic documentation for AW, development of nursing care plans specific to AW, and development of AW clinical pathways.
Dissemination (From Module 4)
The ultimate impact of a process change rests in the effectiveness of the dissemination strategy and presentation (RUSH, 2001). To promote and expedite the proposed protocol/process change, the intent is to complete the dissemination plan in a 2-month time frame. This would allow for sufficient time to schedule presentations with all groups comprising the audience. The intended audience for the introduction of the protocol/process change at CGRMC is the senior administration team, the medical staff, the nursing department directors, the PCCs, and the professional nursing staff. The variation in audience needs, which is based on position within the CGRMC organization, can be met on all levels by the information provided. The goal of the dissemination plan is for all members of the audience, as previously noted, to have access to information related to the significance and impact of AW, and to the design and implementation of the AW protocol/process change. By way of an objective, that same group will acknowledge an understanding of the significance of the development and implementation of the AW protocol/process change. Content of the presentation will include research data related to the significance and impact of AW on the patient and the health care delivery system, and an outline of the proposed protocol/process change. Secondary to time constraints, all groups will be addressed through oral presentations. Handouts which include data related to the significance/impact of AW and copies of the policy, the assessment tools, the treatment protocol, the documentation flowsheet, and the process evaluation tool will be made available to all members of the audience. A review of all handout information will be included in the presentation.
Ultimately the intent of the presentation is for the audience to improve practice. All members of the identified audience have the skills and awareness levels to effectively promote and implement the protocol/process change. Continued monitoring following implementation will help to keep the group engaged as they become aware of the successes and failures, and what needs to be done to achieve success with the new protocol/process change.
Evaluation of the proposed process change would be based on retrospective chart audits using a specifically developed paper data collection tool. Elements to be examined would include compliance in the use of the Cage and CIWA-Ar screening/assessment tools, compliance in initiating and following the physician order set/protocol, review of the need/use of restraints and/or sitters, and review of the level of care required by the patient. Results of those audits would be reviewed, collated, and made available to Senior Administration, the Medical Executive Board, the Nursing Directors, and the staff on a quarterly basis. Recommendations related to the process and any suggested or needed change would be considered at the end of the 6-month trial period.
Conclusion (Should pull major themes of paper together in concise manner)
Studies and data have demonstrated the significance of AW on patient safety, patient care, and health care in general. Alcohol withdrawal affects as many as 1 in 4 hospitalized patients. Twenty percent of the national expenditure for hospital care is related to alcohol dependence. Early recognition of those patients at risk for AW and early intervention for those affected by AW, is essential to the prevention of the serious complications, or even mortality, which may accompany AW.
The need for a program/process change, directed at identifying and addressing AW within a population, has been determined. This process change has several facets, beginning with using recognized tools for the risk recognition and assessment processes; CAGE and the CIWA-Ar are seen as the tools of choice for this process. Positive risk (= 2) and assessment scores (= 10) would trigger pharmacological interventions based on a written order set/protocol. All ongoing assessments and interventions would be documented on a specifically designed flowsheet. Dissemination of information related to the process change would target an identified audience, using an established presentation mode/method. Education of all identified personnel would ensue, based on a formalized educational process including initial and annual education. Organized data collection would assist in determining the success of the change and provide the basis for any future change or edition to the process.
The risk of AW can be effectively addressed and controlled with early assessment and intervention. Early assessment and intervention can prevent or decrease the severity of AW complications, potentiating safe and effective care.

Review of Literature (from module 2)

Bayard, M., Hill, K. R., Keith, R., & Mcintyre, J. (2004).Alcohol withdrawal syndrome.

American Family Physician, 69(6), 1443-1450.

After briefly addressing the pathophysiology of alcohol withdrawal (AW), and

discussing the diagnosis and evaluation of the patient in AW, this article focuses

extensively on pharmacological interventions. Also includes attachments related to

diagnostic criteria, symptomatology, and treatment regimes. Provides general

information related to assessment, evaluation, and general care of the patient with AW.

Of greater significance and value is the more extensive information related to

pharmacological interventions.

Chaney, M., & Gerard, J. C. (2003). Improving care of patients with alcohol withdrawal in a

community hospital. Joint Commission Journal on Quality and Safety, 29(2), 94-97.

Focuses on a quality improvement process/opportunity as the basis for the development of a process to identify and treat patients with alcohol withdrawal. The process includes the development of an assessment flowsheet. It is significant in that it provides a guideline for this author?s assessment flowsheet design. Also provides insight into criteria selected for the process evaluation.

Crumpler, J., & Ross, A. (2005). Development of an alcohol withdrawal tool: a quality care

initiative. Journal of Nursing Quality Care, 20(4), 297-301.

Discusses the introduction of a formal symptom-triggered protocol at Wake Forest University Baptist Medical Center. Protocol includes use of CIWA-Ar for assessment, an alcohol withdrawal algorithm, and a physician order set. Also discusses the implementation and education processes simply and concisely. It is extremely helpful in the formulating and validating this author?s process change plan and very helpful in directing the implementation and education processes.
Daeppen, J. B., Gache, P., Landry, U., Sekera, E., Schweizer, V., Gloor, S. et al. (2002).

Symptom-triggered vs. fixed-scheduled doses of benzodiazepine for alcohol withdrawal: A randomized treatment trial. Archives of Internal Medicine, 162(10), 1117-1121.

Addresses symptom-triggered versus fixed-scheduled doses of medication for the treatment of alcohol withdrawal syndrome (AWS).The method used is defined as a prospective, randomized, double blind, controlled trial of 117 participants. The study is directed at modification of previously accepted treatment methods.The intervention outcomes noted in this study are purposeful to this author?s study in developing a plan/protocol for symptom-triggered pharmacotherapy.

Day, E., Patel, J., & Georgiou, G. (2004). Evaluation of symptom-triggered front-loading

detoxification technique for alcohol dependence: A pilot study. Psychiatric Bulletin, 28(11),

407-410.

Evaluates a symptom-triggered front-loading alcohol detoxification technique. Subtopics include patient and health care worker satisfaction related to the study topic and process, and a defined process for a patient assessment tool. The problem/purpose of the study and the significance to patient careare well stated.This is a simple randomized controlled trial, with a small sample size (23). New information related to different types of intervention and discussion related to a variation in drug therapy is purposeful to author?s study. Information related to health care worker satisfaction is of interest for future considerations related to this author?s project.
Driessen, M., Lange, W., Junghanns, K., & Wetterling, T. (2005). Proposal of a comprehensive

clinical typology of alcohol withdrawal: A cluster analysis approach. Alcohol and

Alcoholism, 40(4), 308-313.

Evaluates alcohol withdrawal symptomatology and the opportunity for clustering of withdrawal symptoms based on severity. Each phase of the study is clearly defined. The significance of the identification of alcohol withdrawal and appropriate treatment is clearly indicated. Hierarchical cluster analysis and discriminate analysis is applied to the research subjects (sample size of 217). The clustering process discussed may be beneficial in the development of a withdrawal identification process, helping to define the various stages of alcohol withdrawal so as to better provide the appropriate intervention.
Hardern, R., & Page, A. V. (2005). An audit of symptom triggered chlordiazepoxide treatment of

alcohol withdrawal on a medical admissions unit. Emergency Medicine Journal, 22, 805-6.

This brief article is based on information obtained using a 2-tailed Mann-Whitney U test for comparisons. The trial process uses symptom-triggered pharmacological intervention and the the CIWA-Ar assessmentin an inpatient setting. The conclusion contains information related to time for resolution of symptoms, length of stay, duration of treatment, and staff benefits. Though this article is brief, it provides statistically sound information related to symptom-triggered treatment and outcomes of that treatment. This information provides further validity for data obtained in other articles, related to pharmacological intervention.
Lussier-Cushing, M., Repper-DeLisi, J., Mitchell, M., Lakatos, B. E., Mahmoud, M., & Lipkis-

Orlando, R. (2007). Is your medical/surgical patient withdrawing from alcohol.Nursing2007,37(10), 50-55.

Gives a brief overview of the impact of alcohol abuse/withdrawal on adult patients in the United States. It also includes general information related to the physiology of alcohol abuse. Of the most interest is the discussion related to the interaction with patients and the identification of abuse/withdrawal; and to the nursing care requirements/suggestions for these patients.This article does not provide any significant information related to formulation of a process change, but does include information on nursing care which could become part of an extended education process.

McKay, A., Koranda, A., & Axen, D. (2004). Using a symptom-triggered approach to manage

patients in acute alcohol withdrawal. MedSurg Nursing, 13(1), 15-21, 31.

Provides substantial background on a symptom-triggered approach to the pharmacological management of AWbased on the physiology of AW. Also provides significant discussion related to education on the management of AW. Provides this author with substantial information on the impact and significance of AW. The clinical management piece provides significant direction on education processes that will help in the development of an educational piece to the process change plan.
Myrick, H., & Anton, R. F. (1998).Treatment of alcohol withdrawal.Alcohol Health and

Research World, 22(1), 38-43.

Examines the actual detoxification of patients with a primary diagnosis of alcohol withdrawal (AW).Focuses on the clinical features of AW, supportive care for AW, treatment settings for detoxification, and pharmacological versus nonpharmacological interventions.Provides significant information on supportive care as well as nonpharmacological therapies, both of interest as they relate to nursing education and patient care. Additional information on the clinical features of AW is also of interest and benefit.
O?Brien, C. P. (2008). The CAGE questionnaire for detection of alcoholism.A remarkably useful but simple tool.Journal of the American Medical Association, 300(17), 2054-2056.

Discusses the significance and simplicity of the CAGE questionnaire in detecting alcoholism and identifying those at risk for alcohol withdrawal. O?Brien also makes note that there is a significant issue related to physician tendency to overlook alcoholism in diagnostic consideration. Gives this author additional information related to the use of the CAGE tool and insight into the opportunity for change in the process of identifying patients at risk for alcohol withdrawal.
Saitz, R., Mayo-Smith, M.S., Roberts, M. S., Redmond, H.A., Bernard, D. R., & Calkins,

D.R.(1994). Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. The Journal of the American Medical Association, 272(7), 519-523.

Discusses individualized treatment for alcohol withdrawal, focusing on symptom-triggered treatment/therapies versus standard fixed-scheduled treatment.Conclusions related to the specific treatment are significant to author?s study as they relate to symptom-triggered treatment.
Saitz, R. (1998). Introduction to alcohol withdrawal.Alcohol Health and Research World, 22(1),

5-12.

Examines and discusses the mechanisms of alcohol withdrawal (AW), the clinical features of AW, and the management and treatment of AW. Also suggests possible future studies related to all of these aspects of AW, as well as specifics related to treatment settings, methods, clinical practice, and the use of evidence-based practice in treatment. Provides this author with extensive clinical information related to AW and information related to different interventions using a variety of medications. A discussion related to medical conditions easily confused with AW is informative but more directed to physicians.
Wetterling, T., Weber, B., Depfenhart, M., Schneider, B., & Junghanns, K. (2006). Development

of a rating scale to predict the severity of alcohol withdrawal syndrome. Alcohol and

Alcoholism, 41(6), 611-615.

Focuses on the development of a rating scale to predict the severity of alcohol withdrawal syndrome.Evaluates the clinical feasibility of a single assessment tool or process, the LARS (Luebeck Alcohol Withdrawal Risk Scale).Limitations are noted related to concurrent medical conditions of the subjects, as well as to treatment required for ethical reasons. Proposes further studies to validate the findings of this study as there are no known comparison scales.Provides additional information related to the development of an assessment toolas part of author?s study even though the study itself is weak from a validation standpoint.
Williams, D., Lewis, J., & McBride, A. (2001). A comparison of rating scales for the alcohol- withdrawal syndrome. Alcohol and Alcoholism, 36(2), 104-108.

Addresses a comparison of rating scales for AWS.Uses literature to identify rating scales for AWS and then compares their content and ease of application. Concludes that trials designed to assess reliability and validity are necessary to improve the measure of any scale. Difficult to read/comprehend and providesthis author with little new significant/useful information.
Wojtecki, C. A., Marron, J., Allison, E. J., Kaul, P., & Tyndall, G. (2004). Systematic ED

assessment and treatment of alcohol withdrawal syndromes: A pilot project at a Veterans Affairs Medical Center. Journal of Emergency Nursing, 30(2), 134-140.

Discusses a project led by a multidisciplinary team to address the patient safety concerns related to the management of alcohol withdrawal. Goals include: identify an evidence-based practice guideline for pharmacological management of alcohol withdrawal (AW); identify a standardized clinical assessment tool to guide assessment and treatment; and educate staff on the selected process. Helps to provide some of the framework for the process change discussed in author?s paper. It also provides some direction as to staff education.

References
Chaney, M., & Gerard, J. C. (2003). Improving care of patients with alcohol withdrawal in a
community hospital. Joint Commission Journal on Quality and Safety, 29(2), 94-97.

Crumpler, J., & Ross, A. (2005). Development of an alcohol withdrawal tool: a quality care

initiative. Journal of Nursing Quality Care, 20(4), 297-301.
Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire.JAMA, 252(14), 1905-7.
Frisch, N. C., & Kelley, J. H. (2002). Nursing diagnosis and nursing theory: exploration of factors inhibiting and supporting simultaneous use. Nursing Diagnosis, 13(2), 53-61.
Hartsell, Z., Drost, J., Wilkens, J. A., & Budavari, A. I. (2007).Managing alcohol withdrawal in hospitalized patients.Journal of American Academy of Physicians Assistants, 20(9), 20-25.
Lussier-Cushing, M., Repper-DeLisi, J., Mitchell, M., Lakatos, B. E., Mahmoud, M., & Lipkis-

Orlando, R. (2007). Is your medical/surgical patient withdrawing from alcohol.Nursing2007,37(10), 50-55.
McKay, A., Koranda, A., & Axen, D. (2004). Using a symptom-triggered approach to manage

patients in acute alcohol withdrawal. MedSurg Nursing, 13(1), 15-21, 31.

Melynk, B. M., & Fineout-Overholt, E. (2005).Evidence-based practice in nursing and health care: A guide to best practice. Philadelphia: Lippincott Williams & Wilkens.
Myrick, H., & Anton, R. F. (1998).Treatment of alcohol withdrawal.Alcohol Health and

Research World, 22(1), 38-43.
National Cancer Institute. (1998). Foundations of applying theory in health promotion practice Retrieved on May 11, 2011 from:http://www.orau.gov/cdcynergy/soc2web/Content/activeinformation/resources/Theory_at_Glance.pdf
O?Brien, C. P. (2008). The CAGE questionnaire for detection of alcoholism.A remarkably useful but simple tool.Journal of the American Medical Association, 300(17), 2054-2056.
Patch, P. B., Phelps, G. L., & Cowan, G. (1997). Alcohol withdrawal in a medical-surgical setting: The ?too little too late? phenomenon. MedSurg Nursing, 6, 79-89.
Phillips, S., Haycock, C., & Boyle, D. (2006). Development of an alcohol withdrawal protocol: CNS collaboration exemplar. Clinical Nurse Specialist, 20(4), 190-198.
Research Utilization Support and Help (RUSH) (2001).Developing an effective dissemination plan. Retrieved June 7, 2009, from http://www.researchutilization.org/matrix/resources/depd/
Saitz, R. (1998). Introduction to alcohol withdrawal.Alcohol Health and Research World, 22(1),

5-12.
Stanley, K. M., Amabile, C. M., Simpson, K. N., Couillard, D., Norcross, E. D., & Worrall, C. L. (2003).Impact of an alcohol withdrawal syndrome practice guideline on surgical patient outcomes.Pharmacotherapy, 23(7), 519-523.
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357.
Wojtecki, C. A., Marron, J., Allison, E. J., Kaul, P., & Tyndall, G. (2004). Systematic ED

assessment and treatment of alcohol withdrawal syndromes: A pilot project at a Veterans Affairs Medical Center. Journal of Emergency Nursing, 30(2), 134-140..

APPENDIX A

CASA GRANDE REGIONAL MEDICAL CENTER
CAGE Questionnaire
The CAGE is a brief questionnaire for detection of alcoholism. It is to be administered to all patients with a documented or verbalized history of alcohol abuse, or to all patients exhibiting early signs of alcohol withdrawal.
Score 0 for NO and 1 for YES.
A total score of 2 or more is considered clinically significant
and requires further assessment, using the CIWA-Ar.

Score
1 Point Score
0 Points
1. Have you ever felt you should cut down on your drinking? YES NO
2. Have people annoyed you by criticizing your drinking? YES NO
3. Have you ever felt bad or guilty about your drinking? YES NO
4. Have you ever had a drink first thing in the morning to steady your nerves to get rid of a hangover? (eye-opener) YES NO
POINTS
TOTAL =

APPENDIX C

CASA GRANDE REGIONAL MEDICAL CENTER
Alcohol Withdrawal Protocol* (Patient Sticker)
* Requires bedside assessment and/or written orders
by the physician for implementation.

1. Complete CIWA-Ar assessment every 1 hour until score is less than 10, and then reassess every 4 hours.

2. For CIWA-Ar score of 10-20:
Give Lorazepam 1 mg ___ orally ____ intramuscularly ____intravenously
every 1 hour until score is less than 10.

3. For CIWA-Ar score greater than 20:
Give Lorazepam 2 mg ___ orally ____ intramuscularly ____ intravenously
every 1 hour until score is less than 10.

4. If CIWA-Ar score has not decreased after 4 consecutive doses of Lorazepam, contact the physician.

5. Call physician stat if there is delirium tremens.

6. Give Thiamine 100 milligrams in 100 ml. NS, to infuse over 1 hour every 24 hours x 3 doses.

7. Multivitamins orally daily.

8. Baseline labs to include: (check all applicable)

0 CMP with magnesium

0 CBC with differential

0 Liver enzymes

9. Complete I&O every 4 hours or per unit protocol.

10. Discontinue protocol when CIWA-Ar is less than 10 for 48 hours.

11. Other medications:
a.
b.
c.

Physician Signature: Date:

APPENDIX E

CASA GRANDE REGIONAL MEDICAL CENTER
System Wide Policy and Procedure Manual
Nursing Department
Chapter

D Section

H Subject:
ALCOHOL WITHDRAWAL PROTOCOL Date

1 of 2

I. PURPOSE The purpose of this policy is to direct the process for identifying the patient at risk for AW and utilizing the AW protocol when initiated via physician order.

II. POLICY STATEMENT The goal of CGRMC is to minimize the effects of AW in a safe, humane and proactive manner while the patient is hospitalized.

III. DEFINITIONS AW: Alcohol Withdrawal
CAGE: Standardized questionnaire used to determine possible alcohol abuse.
CIWA-Ar: Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised

IV. PROCEDURE A. The CAGE questionnaire (attached) will be initiated when a history of alcohol abuse is verbalized or documented. The CAGE questionnaire will be initiated when a previous history of AW is documented or verbalized.

B. The CIWA-Ar (attached) assessment will be complemented when the patient scores 2 or greater on the CAGE questionnaire or manifests early symptoms of AW, including ALOC, tremors, anxiety, diaphoresis, and increased heart rate and blood pressure.

C. The CGRMC AW protocol will be initiated upon a physician?s order when the patient scores 10 or greater on the CIWA-Ar assessment.

D. Assessments and interventions will be completed by a licensed nurse per established protocol (attached).

E. Nursing documentation will be completed on the Alcohol Withdrawal Assessment/Flowsheet (attached) and in Cerner as per policy.

SA GRANDE REGIONAL MEDICAL CENTER
System Wide Policy and Procedure Manual
Nursing Department
Chapter

D Section

H Subject:
ALCOHOL WITHDRAWAL PROTOCOL Date
Issued
6/2009 Date
Revised
Page

2 of 2

V. REFERENCES None

VI. ATTACHMENTS CAGE
CIWA-Ar
Alcohol Withdrawal Protocol
Alcohol Withdrawal Assessment/Flowsheet

Signature: Date:

Title:

Signature: Date:

Title:

Signature: Date:

Title:

Signature: Date:

Title:

APPENDIX F

CASA GRANDE REGIONAL MEDICAL CENTER
Alcohol Withdrawal Education Program
Pre- and Post-Test
1. Alcoholism affects approximately 15 million adults in the United States. True False
2. An estimated 20-50% of all hospital admissions are related to the effects of alcoholism. True False
3. 15-20% of all hospitalized patients are dependent on alcohol. True False
4. Approximately 25% of patients withdrawing from alcohol have seizures. True False
5. GI upset, insomnia, tachycardia, or hypotension may be early signs of alcohol withdrawal. True False
6. Symptoms of alcohol withdrawal can manifest as soon as 6 hours after the patient?s last drink. True False
7. Alcohol withdrawal cannot be confirmed until the patient displays significant agitation, confusion, DT, or seizure activity. True False
8. Lorazepam is the drug of choice in treating patients with hepatic compromise. True False
9. Symptom-triggered drug treatment regimens are less effective than fixed dose regimens because of the inconsistency of dosing. True False
10. Early intervention in alcohol withdrawal can decrease the amount of drugs required in the treatment of alcohol withdrawal. True False

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HRM 445 ENTIRE COURSE

HRM 445 Week 1 Individual Assignment Employer-Employee Relationship Paper

Write a 750- to 1,050-word paper in which you identify and discuss the employer-employee relationship. Make sure you include the following points:

The point at which a prospective applicant becomes an employee
The difference between a contractor and an employee
The legal implications and obligations of the employer–employee relationship
The laws that address the employer–employee relationship

Format your paper consistent with APA guidelines.

HRM 445 Week 1 DQS

DQ 1

Define the employer/employee relationship and define an employer/independent contractor relationship; compare and contrast the concept of an employee versus an independent contractor.

DQ 2

Describe and explain three legal issues or three common areas of potential legal liability employers face in the hiring process(includes the recruitment, interview and hiring processes). Why do each of these issues/areas present a legal problem/issue for employers? How can an employer avoid legal liability in each of these areas? If possible, avoid discussing an issue/area mentioned by another student in class. Fully explain your answer.

DQ 3

What criteria should employers use, evaluate and take into account in making a decision to hire an applicant or to promote an employee? Should criteria such as personality, appearance, whether the applicant or employee is a “good fit” for the position (and for the organization-if the person is a job applicant) play a role in such decisions? Fully explain your answer

HRM 445 Week 2 Individual Assignment Hiring Situation Paper

Select three situations from the list below.

Situation one: The application process requires an employee to complete an online application, submit some additional documents, and take a written exam. The applicant does not indicate on the application any need for accommodations during the hiring process. The applicant comes into the office to submit paperwork and take the test. Based on the applicant’s physical situation, the applicant may need assistance. At no time does the applicant request assistance.

Situation two: You receive a request to fill a department head position. In looking at the current demographics, the department heads are 95% male and 5% female. You have three well-qualified applicants: a white male who is a disabled veteran, a Hispanic male, and a white female.

Situation three: You are recruiting for a medical facility that provides both inpatient and outpatient care in Niagara Falls, NY. You have difficulty locating nurses in the United States, but you have received several applications for qualified individuals who reside in Canada.

Situation four: You are hiring for a call center that is located across the street from a day care, five blocks from a private school, and is next to a church. The position requires the individual to receive inbound calls only. The individual will have access to personal information that could expose the caller to identity theft if the information is misused.

Situation five: You work for a company that has a service contract with the U.S. Department of Defense to provide nursing staff for a military hospital. As part of that contract, you are to provide 50 nurses and 100 nursing assistants. Of these nurses, four are nurse practitioners who will be responsible for the controlled substances on the unit. You are permitted to have three administrative staff onsite to support and manage the contract. The contract requires each employee who has patient contact to receive a physical exam and to complete a drug test. Your company requires any employee handling financial matters to have a drug test and a polygraph test. You are requested to review the legality of the tests administered to employees and to make recommendations to ensure compliance.

Write a 700- to 900-word paper that discusses the three selected scenarios. In your discussion, include the laws that address the particular hiring situation and what an employer must do to comply.

Format your paper consistent with APA guidelines

HRM 445 Week 2 DQS

DQ 1

What are the similarities and differences among the constitutional, statutory, and common laws protecting employee privacy? Identify areas in which an employee’s privacy can be compromised. What can an employer do to ensure the employee’s privacy is protected? Fully explain your answer to all subparts of this discussion question

DQ 2

2. What are some legal issues that can arise for employers in the areas of employee retention, the management of employee performance, and the employee appraisal process? Fully explain what the legal issues are and how an employer can address the issues so that they do not create a legal problem.

DQ 3

3. When it comes to termination of employees, there are individual employee terminations and there are layoffs of one or more employees or sometimes layoffs of large groups of employees.

a. Relative to an individual employee termination (that is not part of a layoff), what should an employer consider in terminating an employee?

b. When an employer makes a decision to lay off a certain number of employees, what are some methods and considerations that are used by employers in determining which employees should be laid off that help an employer avoid violation of the law and legal consequences?/

HRM 445 Week 3 Individual Assignment Employee Privacy Memos

Select three scenarios from the following list:

Situation 1: A recent report from the store’s loss prevention director identifies that losses have increased by 10%, but actual customer traffic has remained steady, and, on a few days, decreased slightly. Store management is concerned with employee theft. A number of the women in the store carry large handbags that can easily conceal merchandise. The store also employs both male and female students who bring their backpacks, which is another way employees can remove merchandise without detection. The store director has decided that all female employees are required to carry their personal items in a company-issued clear vinyl bag.

Situation 2: The CEO read in recent business news that the average time employees spend working is 6.5 hours. The report identified personal e-mail use, online browsing, and phone calls as primary sources for detractors from work time. The CEO now wants e-mails and phones calls to be monitored, not for quality control, but to discover work-related violations and abuse.

Situation 3: Your organization has just merged with another company. The state in which the main office is located does not have a concealed gun law. One of the new locations has a concealed gun law. The company banned firearms and weapons of any kind from the property, which includes the parking lot. You are concerned that employees may leave firearms and weapons locked in their cars now that guns are prohibited from the physical premises. The CEO wants random searches of cars.

Situation 4: With health care costs rising, some organizations are using genetic testing in the preemployment, postoffer medical exams. The organizations claim the tests are for employee safety (employees with a specific illness may be affected by the chemicals produced during product production); in reality, some of the organizations are attempting to reduce their risk of incurring higher health care premiums by avoiding individuals with potential health issues. The executive team at your organization is considering a similar action.

Situation 5: An organization provides lockers for employees to store personal items securely. The employees are required to provide their own personal lock. The company, as part of their risk management program, wants to begin random and regular searches of the lockers.

Situation 6: The board of directors and CEO are filling some vacancies on the executive team. As part of the executive perks, the organization provides comprehensive insurance, which requires a medical history.

Situation 7: The organization has done drug testing for some time; however, they want to switch to a method that detects past use. Some say that a hair follicle test can detect drug use up to three months prior. Some employees became aware of this through the company grapevine and threatened to shave their heads. Your CEO suggested requiring blood tests from those who did not provide a hair follicle.

Situation 8: Through a postoffer, preemployment physical exam, the employee is noted to have a health issue that is not inhibiting the person from performing the essential functions of the job, but could raise the organization’s insurance premium.

Situation 9: An employee is injured while on the job. The employee is up for a promotion in another area of the company. The supervisor wants all the information related to the injury.

Situation 10: The supervisor comes to your office and wants to see the employee’s file. You provide the supervisor the file. The supervisor asks for the results from the drug test, the medical follow-up for the work-related injury a year ago, and the employee’s legal right to work in the United States.

Write a 350-word memorandum for each selected scenario in which you clearly state the challenge and risk to the organization, the laws that govern the situation, and a course of action to ensure compliance. For each situation, select a different audience for your memo from the following list:

Employee
Executive leadership
Management

Be sure to include in-text citations in your memo, as appropriate, using APA format and include a list of references.

HRM 445 Week 3 Learning Team Assignment Supervisory Training Presentation

Develop an organization’s supervisory training that includes a 10- to 15-slide Microsoft® PowerPoint® presentation. Your team must identify and discuss the laws that affect the retention of employees, management of employee performance, and the termination of employees. In the presentation, identify at least one or two laws other than Title VII of the Civil Rights Act and its subsequent amendments for each area. Your presentation must also include a discussion of the legal challenges presented in each stage of employment (retention, performance management, and termination).

Please remember not to crowd your slides. If graphics are included, they must be appropriate to the presentation and slide topic.

Include detailed speaker notes. Be sure to include in-text citations in your speaker notes. Include a references slide at the end of your presentation.

Cite sources consistent with APA guidelines.

HRM 445 Week 3 DQS

DQ 1

What are some employee work–life issues that you have seen challenge your organization or an organization with which you are familiar? How did your organization resolve these challenges? What would you have done differently and why? Identify the particular laws that influenced your response.

DQ 2

Do you believe there should be an English-only rule regarding language in the workplace? Why or why not? If the executive of your organization approached you about creating an English-only environment at work, how would you respond? Explain the rationale behind your response.

DQ 3

You read chapter 10 in your text about employers providing a reasonable accommodation to those who are disabled and providing a reasonable accommodation to employees because of their religion. What are some major issues that employers need to consider when it comes to the issue of reasonably accommodating a disabled person or providing a reasonable accommodation to someone of a particular religion? Fully explain your answer.

HRM 445 Week 4 Individual Assignment Work–Life and Diversity Challenges Executive Summaries

Management has approached you on a number of work–life and diversity challenges. You have been asked to evaluate the situation and provide a recommendation that is legally compliant.

Select two of the following work–life and diversity issues.

The employee began working on January 1. It is July 15, and the employee requires time off for a family emergency.

The employee has worked 10 years for the company. Six months ago, the employee returned from a family medical leave of 10 weeks and is now requesting another 3 weeks. The company does not have an extended leave policy.

The company provides a variety of work situations to include flexible schedules and telecommuting. The company has customer service positions available in all work situations: in-house 8 a.m. to 5 p.m., flexible schedule, and telecommuting. An employee who has a customer service position is required to be in-house from 8 a.m. to 5 p.m. is now asking to be switched to a telecommuting position because the employee lacks sufficient childcare.

You are hiring for a position that requires a person to work irregular hours, be on call, and travel, but you have not had much success with employees that do not have familial commitments. The supervisor has narrowed it to four candidates and asks for your guidance. Applicant one is a male candidate who meets the minimum qualifications and has received positive references. Applicant two is a male candidate who exceeds the qualifications and has exemplary references. In checking one of the references for the second candidate, the reference stated, “Despite being a single father with three school-aged children, he was an outstanding performer.” Applicant three is female who exceeds the qualifications (but not to the degree applicant two does) and has received positive references. Applicant four is a female, self-identified single parent of young teenagers who matches the qualifications of applicant two and has positive references.

An employee has worked a steady schedule of 7 a.m. to 3 p.m. for over 2 years. The employee decided to go to school in the evening, checking with his supervisor who said it would be no problem because the employee worked during the day. The plant manager is changing the production plan, which will result in changing shifts. The supervisor who told this employee to attend school now has to place this employee on the evening shift.

The company is approaching the holiday season. The company has employees of Jewish, Islamic, and Christian faiths and the owners of the company are of the Christian faith. Because of the diverse faiths within the organization, and out of respect for each belief, the company refers to the days in December as the holiday season. During the scheduled holiday break, which begins on December 24th and ends on January 1st, the company must maintain a skeleton crew. The supervisor must decide which two of the six employees to schedule:

Employee 1: Programmer—a single female of the Jewish faith
Employee 2: Programmer—a single female of the Islamic faith
Employee 3: Programmer—a married woman, no children, of the Christian faith
Employee 4: Senior Programmer—married man, three children, of the Jewish faith
Employee 5: Programmer Intern—a single man, two children, of the Christian faith
Employee 6: Lead Programmer—a married man, two children, of the Islamic faith

An employee is injured. The employee contacts his supervisor stating that he is unsure how long he will be out, but would let you know his status after his doctor’s appointment in a week. Three weeks pass and the employee has not contacted the supervisor nor returned the supervisor’s two calls. You contact the employee via a certified letter. After 10 days, the employee is terminated. The employee challenges his termination under FMLA.

Dan began working for your organization part-time over a year and a half ago, averaging 30 hours a week. Emma, his wife who also works for the organization, shares with you that they are in the process of adopting a child and will need to take some time off, at first sporadically, then, when the adoption is final, at least 2 weeks. Dan and Emma would like to take their leave at the same time.

Diane has worked full time for your organization for 1 year. She shares with you that she was recently diagnosed with an illness, and to stabilize her health medically, she needs to take off 1 1/2 days a week for 12 weeks for treatment. She does not anticipate needing more time, but there may be a chance. In the third week, she was absent the entire week.

The Desert Sun is a company that serves communities on the Mexican-American border. To serve their clientele effectively, they require their frontline personnel to be bilingual. The primary language of some of the individuals that Desert Sun hired is Spanish; English is their second language. The company realizes that not all employees are bilingual and are considering an English-only policy in all areas except the frontline service.

Write a 350-word executive summary for each issue you choose, in which you do the following:

Analyze the issue presented in the scenario, citing any relevant laws or regulations.
Provide a recommendation and solution that is legally compliant.
Explain how you would advise the employee of management’s decisions.
Discuss the employee’s legal rights and responsibilities.
Include any other information you deem appropriate in communicating to the employee.

Be sure to include in-text citations in your summary, as
appropriate, using APA format and include a list of references
at the end of each summary.

HRM 445 Week 4 Learning Team Assignment Court Case Application Paper

Select a case from your reading as a team.
Write a 1,400- to 1,750-word paper based on the case your team chose that includes the following information:

Provide the facts of the case, citing references appropriately.

Summarize the court ruling and accompanying opinions.

Each team member must provide an application of the case to his or her own organization or to an organization with which he or she is familiar.

Summarize the similarities and differences found in each team member’s application to the organizations. Make sure you include the implications for businesses not complying with the case law.

Format your paper consistent with APA guidelines.

HRM 445 Week 4 DQS

DQ 1

What is the difference between a policy and a procedure? What purpose do policies serve? Why do companies develop policies? Identify and discuss three characteristics of a legally compliant policy. Fully explain your answer.

DQ 2

Identify three HR systems or programs. What laws do you think are most important for an HR professional to take into consideration when developing these systems or programs?

DQ 3

Identify the parts of the HR system that are addressed in this week’s reading. What part of the HR system do you think your organization or an organization with which you are familiar is most strong? In which part of the HR system do you think this organization is most weak? What recommendations would you make to strengthen this area of the organization?

HRM 445 Week 5 Individual Assignment Roles of the HR Professional Paper

Write a 700- to 1,050-word paper in which you compare the operational and strategic roles of the HR professional in sustaining a legally compliant work environment. Address the following areas:

Operational Role

Employee advocate
Reducing costs and risks
Role in legal proceedings
Providing functional services

Strategic Role

Developing a competitive advantage through talent and knowledge management
Aligning HR and HR related programs to support the organization’s mission and goals

Format your paper consistent with APA guidelines.

HRM 445 Week 5 Learning Team Assignment Legally Compliant Policy Paper

Address one of the two noncompliant policies as a Learning Team:

Policy 1: Access to Personnel Files

Information for employees relating to their employment will be kept in one file.

Personnel files are the property of Company XYZ. Supervisors and management officials who have verifiable reasons to review the files may do so. Employees may review their files at any time during business hours. Information in the personnel file will be retained and maintained by the HR department and will not be disclosed without a release of information or judicial order.

Employees who question the accuracy of information in their personnel file can request the removal through HR.

Policy 2: Employee Conduct and Rules

The purpose of this policy is to provide both management and employees some basic guidelines in governing employee behavior, to ensure consistency in the quality of production, and to ensure fair treatment of all employees.

Employees found in violation of the following can be subject to immediate discharge:

Actions infringing on the rights of other employees
Consuming alcohol or illicit drugs on the premises
Working under the influence of alcohol or illicit drugs
Falsifying information and official documents
Behaving in a gross, obscene, or immoral manner
Sabotaging the organization’s revenue efforts
Stealing or misappropriating funds or property
Defacing property
Fighting
Possessing a weapon
Being arrested or convicted of an offense outside of work that could negatively affect the image of the organization

The employee will first receive a written warning for other disciplinary actions that do not warrant immediate dismissal, such as sleeping on the job, disregarding department rules, insubordination, and so forth. If the employee repeatedly commits the same offense, the employee may be subject to discharge.

Finally, employees who commit infractions—such as having poor hygiene, disregarding safety practices, annoying or harassing other employees, or damaging property through improper use—will first receive an oral reprimand, then a formal written reprimand, and finally a written reprimand, at which time the employer must decide whether or not to terminate the employment relationship.

Employees who are on probation (first 90 days of employment) can be discharged immediately without cause.

Write a 1,400- to 1,750-word paper that analyzes the policies addressed in the case. Include the following information:

Identify the challenges the policy, in its present state, brings to the HR professional and the organization.

Describe the legal risks that result from these challenges.

Identify and discuss the verbiage that makes this policy noncompliant, including the laws that address the area in question.

Develop a new policy that ensures the organization is legally compliant.

Summarize how the new proposed policy supports either the strategic or operational role in maintaining a compliant work environment.

Format your paper consistent with APA guidelines.

HRM 445 Week 5 DQS

DQ 1

How do the operational roles and the strategic roles of a human resources department differ in sustaining a legally compliant work environment? Do you think one can exist without the other? Why or why not? In developing your answer, be sure to define/distinguish the difference between the operational roles of the HR department versus the strategic roles of the HR department at a company. Fully explain your answer.

DQ 2

What are the HR professional’s responsibilities in: (i) the union organizing process; and in (ii) the collective bargaining process that occurs between a union and a company? Which of these responsibilites are classified as operational roles and which of these responsibilites are classified as strategic roles? Fully explain your answer.

DQ 3

What are the HR professional’s strategic and operational roles in creating and sustaining a safe and healthy work environment? Fully explain your answer.

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Consider a random walk where steps are decided based on coin tosses. A head is a positive step and a tail is a negative step. After 16 steps, the random walker finds himself at the same position as where he started.In how many ways, can this be done?

Number of combinations= N!/NH!NT!

Number of combinations=16!/(8!*8!)

Number of combinations=12870

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