Refinement of a Nursing Concern into an Evidence-based Practice Proposal Using the Research ProcessOverview
Research is mainly used to generate new knowledge or for the validation of existing knowledge based on a theory. Evidenced-based practice (EBP) is the translation of evidence and applying the evidence to clinical decision-making. Most of the evidence used in EBP stems from research. However, EBP will go beyond the use of research and it will include clinical expertise together with patient preference and values. EBP will make use of the evidence developed or knowledge discovered using research to determine the best evidence that can be used or implemented in clinical practice. Research and EBP go hand in hand in that while one will generate new knowledge, the other will make practical use of the knowledge and make use of the knowledge by implementing it into clinical practice. EBP is supported by research since any new clinical practice has to be backed up by information and data that is discovered using research.
Unlike research, EBP is not concerned with the development of new knowledge or the validation of existing knowledge. The main purpose of EBP is to make use of the best evidence available in order to make patient care decisions. There is also consideration given by EBP that the best evidence is not always based on research results. The opinion of leaders and experts can also be
used in EBP. EBP encourages the nurses to be asking questions on how they can improve healthcare delivery.
EBP has assisted the nursing profession in numerous ways. Nursing education has been changed because of EBP and colleges and universities have had to change their BSN program in order to incorporate EBP. The programs encourage critical thinking skills and nursing students are encouraged to consider clinical, religious, cultural, and socioeconomic backgrounds of the patients as well as using the relevant scientific research available. EBP has led to an increased interest in and emphasis on nursing research. EBP has also improved patient outcomes in that nurses can now use current research to assist them in minimizing complications that are associated with chronic illness and prevent additional disease or illness.
I am the Cardiovascular Services Educator for CVICU and CVSD at my facility and my MSN program specialty track is Education. I have chosen as my area of interest and nursing concern: Mandatory education and in-services for critical care nurses who provide care to patients with central venous catheter lines (CVLs) in order to help decrease the rate of infections. I feel that using current evidence-based practice will support not only my current position as an educator but also my future position as a mastered prepared nurse educator. When educating nurses an interdisciplinary targeted educational approach can be selected utilizing an education program centered on EBP. These education programs should include central-line insertion and maintenance bundles, teamwork, and optimizing patient safety through supplies and hand hygiene. By doing this, these practices have great potential for decreasing the incidence of CLABSIs in the acute care hospital setting (Raup, Putnam, & Cantu, 2013).
Since EBP aims at hardwiring current knowledge into common care decisions it will improve the care...
Medication Reconciliation Evidence-Based Practice and the Procedural Education of Nurses Medication reconciliation is a critical issue in healthcare reform. Today, improvement in this area of treatment could have a transformative effect on the current practices of nursing and medicine administration. The discussion, literature review and research tests that are conducted hereafter will outline the implications of medication reconciliation; justify the call for improvement in this treatment area; and offer support for the
Healthcare IMPROVING PATIENT SAFETY WITH EVIDENCE-BASED RESEARCH My workplace is currently experiencing the need for improvement is in the area of enforcing and communicating hospital policies/procedures regarding care of patients requiring special attention. This is illustrated by a recent incident of an elderly cancer patient admitted for unexplained dizziness but then falling and sustaining injuries when left unattended in the hospital. Fortunately, we have a nursing supervisor who is the epitome of
Learning in adults is most effectual when the environment is both participative and interactive. Another important characteristic is that learners obtain instantaneous feedback. Teaching methods that necessitate a learner to think though data or information and come to a conclusion or forecast an outcome are more valuable than is reading or lecture. "The minute-to-minute care and monitoring of critically ill patients requires nurses to collect, analyze, and react to
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]…EffectivePoliciesandProceduresCanAffectTruancyRate50PoliciesandproceduresperceivedbyschoolleaderstoreducetruancyinapubliccharterschoolAlixDesulmeB.A(St.ThomasUniversity)2004M.S(St.ThomasUniversity)2006AProposalPresentedinPartialFulfillmentOftheRequirementsfortheDegreeofDoctorofEducationUniversityofNewEnglandOctober15,2017Chapter1IntroductionStudenttruancyisagrowingproblemintheUnitedStates.Overthelasttwentyyearsthetruancyrateshavegrownnationwidewiththehighestratesininnercities(Jacob&Lovett,2017).Researchindicatesthatstudenttruancyleadstopotentialsociallydeviantbehaviorinadulthood(Dronkers,Veerman,&Pong,2017).Manystudentswhoareabsentforprolongedperiodsaremorelikelytoperformpoorlyacademically,riskingfailureinclassesandfacingdisciplinaryaction.Characteristicsofschoolswithhightruancyratesareuseofonlypunitivetruancyprograms,lackofalternativestudyoptionsforsuspendedstudents,andlackofcounselingandtutoring(Bye,2010).Thereareschoolsthathavebeendoingwellinmaintaininglowtruancyrates,however.Thoseschoolsgivestudentstheoptionfortutoring,allowdistancelearningforsuspendedstudents,andtakeonamixtureofpunitiveandnon-punitivemeasures(Duarte&Hatch,2014).Withanationalrankingof764andaFloridarankingof66,CharterSecondarySchoolisconsideredoneofthebesthighschoolsinthestateregardingstudentattendanceratesandoverallschoolparticipation.Theschoolhasalowtruancyamongminoritystudents,whichisanotableanddistinctivequality,makingitananomalyinthesurroundingarea.Suchaqualitywillbeanalyzedindepthinthispaperalongwiththevariouspossiblereasonsforthestudents’willingnesstoattendclassregularlyandwhatmethodsareemployedbyschoolstafftokeeptheschoolenvironmentpositivebecausetruancyratesaresolowcomparedtootherschoolsintheareaandnationwide.Firstestablishedin2005,CharterSecondarySchoolofMiamiShoreisapubliccharterschoolbuiltontheBarryUniversityCampus,sittingon5acresofproperty.ItisinMiamiShore,anareaofFlorida.Thecurrentenrollmentnumberstandsat599andthecampustypeissuburban.TheschoolmascotaretheHawks.Rate‘A’asacollegepreparatoryschool,theschoolholdsamunicipalcharterviaVillageofMiamiShoresthatservesstudentsfromgrades6-12(CharterSecondarySchoolofMiamiShores,2007).Initsearlyhistory,CharterSecondarySchoolwasoriginallyamiddleschoolestablishedin1997underthename,MiamiShores/BarryUniversityCharterSchool.ThenineportablestructuresthatcomprisedtheschoolservedasanalternativeforMiamiShorestudentsthatwouldotherwiseattendHoraceMannMiddleSchool(CharterSecondarySchoolofMiamiShores,2007).However,after8years,theschoolsecuredmorefundingandin2005,renamedtheschool.TheschoolgainedapermanentstructurethankstothedonationsgivenbythecitizensofMiamiShoresandadditionalfundsfromtheNorthDadeMedicalFoundation.DCSdrawsfundsfromtwoseparatestreams.OnepartofthefundingcomesfromabondissueapprovedbyVillageresidentsandalargetwo-yeargrantgivenbytheNorthDadeMedicalFoundationforFY2006and2007.DCSraisestheremainderofitsoperatingexpensesfromthestatethroughitsFTEfunding(asetamountforeachstudentintheclassroomperday)andthroughthecollectionofstudentfeesforsuchthingsasmaterialsandtrips(CharterSecondarySchoolofMiamiShores,2007).Theschoolhas31full-timeteachersforastudentpopulationof598studentsthatreflectaratiooflessthan20studentsperteacher(19:1)(USNEWS,2017).Thepercentageofeconomicallydisadvantagedstudentsliesat33%withminorityenrollmentof83%.AlthoughclassattendanceishighandthepercentageofstudentswhotestedforAPexamsat81%,thepercentageofstudentswhopasstheAPexamsis47%,orlessthanhalf.EnglishandMathematicproficiencylevelslieat70%and68%respectively,whichisabovethedistrictandnationwideaverage(USNEWS,2017).WithaCollegeReadinessIndexof48.8,theschoolhasroomforimprovement.Whilestudentsearnaveragetestscores,overall,studentswhoattendDoctorsperformbetterthanstudentsatotherschoolsinitsdistrict.ThedistrictaverageforEnglishproficiencyis50%andMathematicproficiencyat37%.Thedistrictaverageforcollegereadinessisat44.7andthisisoutof113schoolsand113,242students(USNEWS,2017).Withagraduationrateof98%,CharterSecondarySchoolofMiamiShoreshasalotgoingforitregardingpositiveaspectsandstudentinterest.UnderstandingtheReasonsforTruancyThereareseveralreasonsfortruancyandtheyareoftencomplexandvaried.Somepertaintoanegativeschoolenvironment,studentbehavior,familyeconomicstatus,mentalhealthproblems,tonameafew.Anegativeschoolenvironmentcancauseproblemsforstudentswishingtolearn.UnlikeCharterSecondarySchool,classroomsacrosstheMiamioftenhavelargeclassroomsforexample,makingitdifficultforstudentstopayattentioninclassandreceiveattentionnecessaryforunderstandingthecurriculum(Losen,2015).Ifforexample,astudenthasquestionsorneedsexamplesforaspecificassignmentinclass,theteachermaynothavethetimeorpatiencetodealwiththatstudentwhenheorshemustdealwith29otherstudentsallneedingthesamelevelofattention.Manyschoolsacrossthecountryhavestrictpoliciesregardingdisruptivestudentbehaviorthatcouldlandastudentundersuspensionoreven,expulsion.Severalfactorscouldcausedisruptivebehavioramongstudents(Losen,2015).Onecommonreasonispoverty.“…highlevelsofpovertyhaveanegativeeffectonschoolbehavior.Thisisattributedlargelytothechronicandacutestressexperiencedbystudentslivinginpoverty.Theexposureisassociatedwithexternalizingbehaviorsthataredisruptiveinschoolsettings”(Hutcheson,2014,p.1).Studentsfacingpovertymaybepartofanunstablehousehold.Theymayendureproblematicandabusiveparents,andhavetodealwithlackofresources.Thesestudentsneedachanceeverynowandthentolearnfromtheirmistakesandreceivethehelpandresourcesthatcouldmakeapositivedifferenceintheirlives.Instead,theyaresuspendedorexpelledandnotgivenachancetoimprove.Highratesofsuspensioncanlendtoahigherrateoftruancy.“ThebifactorstructurereflectedageneralfactorofProblemsinBehavioralEngagementandtwogroupfactors:ProblemsinSocialEngagementandProblemsinAcademicEngagement”(Barghausetal.,2016,p.154).Researchersnotestudentsoftenmaynothaveproblemsacademically,butinsteadsocially.Theymaynotfeelcomfortableengagingwithotherstudents’duetofearofjudgementorinabilitytoproperlysocialize.Providingstudentswiththetoolstobothengagesociallyandacademicallycanallowforahigherpercentageofacademic-basedpositiveoutcomes.Studentinterestmayalsoplayakeyroleintruancy(Dronkers,Veerman,&Pong,2017).Thisisbecausesuspensionsandexpulsionsmayimpactstudentinterestinanegativeway.Whenstudentsreceivesuspensions,theyhavenoaccesstotheschoolwork.Whenthesuspensionends,dependingonhowlongthetimeoutofschoolwas,theymayhaveincreaseddifficultycatchingupwiththeclass.Ifthereisnooptiontocompleteschoolwork,andtheycannotgotoschoolorcontacttheteacherforassignments,itmayputthesekindsofstudentsatanautomaticdisadvantage.Thisisespeciallythecaseiftheyhaveahardtimeacademicallyalready.Tofallbehindinschoolworkwhenthestudenthasexperiencedlowgradescouldsetbackastudentandcouldendupinhavingfailuresinclasses.Byexploringincentivetheoryofmotivationandresearchshowingtheconnectionbetweenexpulsion/suspension,interest,andtruancy,thehopeistoofferclarityinwhytruancyratesarehighandwhatcanbedonetocounteractit.Theseproblems:negativeschoolenvironment,studentbehavior,familyeconomicstatus,mentalhealthproblem(Dronkers,Veerman,&Pong,2017)(Dembo,Wareham,Schmeidler,Briones-Robinson,&Winters,2014)mustbeaddressedfortruancyprogramstobeeffective.Thescopeoftheproblemsassociatedwithtruancyislarge.Forthepurposeofthisstudy,thespecificfocuswillbeschool-basedpoliciesandproceduresthatmaymitigateorreducetruancy.Withoutapropersynthesisofthereasonssurroundingtheproblem,therewillbelimitedunderstandingabouthowtoapproachthestudy.Therefore,itisimportanttostatethescopeofproblemtodefinethefocusandimprovethequalityofthestudy.StatementoftheProblemTruancyratesintheUnitedStatesareagrowingproblem(Monahan,VanDerhei,Bechtold,&Cauffman,2014).Whetherastudentisabsentduetoasuspensionorbecausetheywillinglychoosetobeabsent,theproblemhasbecomeworthyofresearchandpossibleintervention.Truancyratesarehigherinschoolswithlowsocio-economicstatus(Dembo,Wareham,Schmeidler,Briones-Robinson,&Winters,2014).Theproblemaddressedbythestudyis:Educationalleadersmayhaveimplementedpoliciesandproceduresinpubliccharterschools,butdocumentationaboutwhicharemosteffectiveandwhytheyareislargelyabsent.Currentpolicieshaveenabledhighertruancyratesduetothezero-toleranceaspectthatenablesharsherandstricterpunishmentofstudentbehavior.“Sincethe1990’s,implementationofzerotolerancepoliciesinschoolshasledtoincreaseduseofschoolsuspensionandexpulsionasdisciplinarytechniquesforstudentswithvaryingdegreesofinfractions”(Monahan,VanDerhei,Bechtold,&Cauffman,2014,p.1110).Whenstudentsaresuspended,orexpelledfortheirbehavior,theymayhaveatoughertimecatchingupinschoolandsucceedingintheiracademicendeavors.Thiscanleadtootherproblemsdownthelineasstudentsmatureandbecomeadults.Researchsuggeststheexperienceofsuspensionofexpulsioncouldleadtoillegalbehaviorthatisassociatedwithacriminalrecord.“Beingsuspendedorexpelledfromschoolincreasedthelikelihoodofarrestinthatsamemonthandthiseffectwasstrongeramongyouthwhodidnothaveahistoryofbehaviorproblemsandwhenyouthassociatedwithlessdelinquentpeers”(Monahan,VanDerhei,Bechtold,&Cauffman,2014,p.1110).Whenschoolsexpelandsuspendstudents,addingtothetruancyratesoftheschool,negativebehaviorsmayincrease.Thezerotolerancepoliciesofschoolshavebecomethemaincauseforconcerninthesegrowingcasesofsuspensionandexpulsion.Therefore,policiesneedtobechangedtoaddressthisproblem.Todoso,onemustexamineschoolslikeCharterSecondarySchooltodeterminewhatstepstotaketomakeapositivechange.Althoughtruancydoesnotdirectlyleadtocrime,itoftenhasahighcorrelation.PurposeoftheStudyThepurposeofthestudyistounderstandschoolleaders’perspectivesaboutwhethereffectivepoliciesandproceduresreducetruancyandimprovestudentattendance.ByinterviewingkeystaffinCharterSecondarySchool,apubliccharterschoolwithlowtruancylevels,informationoneffectivepoliciesandprocedurescanbegathered.Thesefindingsmayprovideabetterunderstandingofwhatschoolleadersinotherschoolscandotoimprovetruancy.Attendanceplaysalargepartinfacingsuspensionandperformingwellacademically.Researchabouttruancyreductionsuggestsstudentswithmoreattendanceoptionsmaybeabletoovercomedifficultiesthatcontributetotruancy.Effectiveschoolpoliciesthatimproveattendancemaycontainprocessesandoptionsthatprovidesuchsupportandvariability.Withoutunderstandingsuchaspects,littlehelpcouldbegeneratedandimplementedtohelpstudentsinneedandhelpthemavoidhightruancyrates.Thisareaofresearchwillbeexploredintheinterviewsectionandresults.CharterSecondarySchoolhasbetterattendanceandbetteracademicperformancecomparedtoalltheotherschoolsinthedistrict(onaverage).Furthermore,mostofthestudentsareminorityornon-white.Thisschoolisaperfectstartingpointforinvestigationintoeffectiveschoolpolicies.Alookintoothersuccessfulschoolsshouldprovideameasureofeffectivenessneededtounderstandbetterwhatstrategiescanimproveattendance.Itcanalsoshowhowotherschoolshandlethingslikeminoritymajorityandlocationofschoollikeanurban,rural,orsuburbansetting.ResearchQuestions1.Whatmaybethecauseoftruancyinstudents?2.Howdoesincentivetheoryplayaroleinunderstandingschooltruancy?3.Whataretheeffectsofpunitiveornon-punitivetruancyprogramsonstudents?4.Whataresuccessfultruancyprogramsdoingthathasledtoreductionintruancy?5.Whyaresometruancyprogramsunsuccessfulatreducingtruancy?Theresearchneedstodelveintounderstandingthereasonsbehindtruancy.Fortheretobesolutionstothenationwidetruancyproblem,researchmustbedirectedtowardsevidencethatexplainsmotivationsbehindtruancybehaviorandwhataspectsoftruancyprogramshelpeliminatesuchbehavior.Bydevelopingaclearideaofschooltruancyandwhystudentsbecometruant,thehopeistodevelopevidence-basedpracticesthatreduceschooltruancyinstudents.Amyriadofschoolprogramsexistsfortruancy,buttherealityis,notmanyareeffective.QualitativeStudiesandInterviewsThestudyisaqualitativeonethatfocusesontheuseofinterviewstocollectqualitativedata.“Theinterviewhastodaybecomeoneofthemostwidespreadknowledge-producingpracticesacrossthehumanandsocialsciencesingeneralandincriticalpsychologymorespecifically”(Brinkmann,2014,p.1008).Interviewscanrangefromformalinterviewsorinformalinterviews.Theycanbedoneface-to-face,overthephone,orovertheinternet.Formalinterviewshaveastructuretothemwheretheresearcherasksaquestionandtheparticipantanswers.However,ininformalinterviews,therecanbediscussionanddoesnothavetosticktothequestionsasked.Mostqualitativeinterviewshavesomestructuretothemandarelabeled,‘semi-structured’.“Mostqualitativeinterviews,however,aresemi-structured.Inasemi-structuredinterview,theresearcherprovidessomestructurebasedonherresearchinterestsandinterviewguidebutworksflexiblywiththeguideandallowsroomfortherespondent’smorespontaneousdescriptionsandnarratives”(Brinkmann,2014,p.1008).Thereisaneedtounderstandfromthestafforschoolleader’sperspectivesthatworkatCharterSecondarySchoolwhythepoliciesattheschoolwork.Tounderstandwhatimprovementshavebeenmadeandwhatkindofschoolenvironmentsuchpoliciespromote,thiscangiveagoodpictureofwhatisbeingdonetoachievepositiveoutcomesforthestudentpopulationattending.Similarstudiesusinginterviewshavegatheredasignificantamountofinsightfulinformationthatallowsfortheabilitytoanswerimportantquestions.Usingfixedeffectsregressionsandcontrollingfortruancypeergroupeffects,weobservethattruancy(measuredasbothadiscretedummyvariableandacontinuouscountmeasure)positivelycorrelatestoearlyschoolleaving.Atruanthasa3.4percentagepointshigherriskofleavingschoolwithoutaqualification(DeWitte&Csillag,2012,p.549).Thepoliciessurroundingtruancyprogramsandhowacademicstaffreactallowforthemesdiscoveredthroughtheinterviewprocesstothenbecomparedtothemesfoundintheliteraturereviewtoseeifthereisauniversalthemeorconceptbeingappliedthatleadstosuccessfulacademicperformancebystudentsandgoodattendancerecords.Itisimportanttoallowstudentsandstafferstogivetheiropinionsaswellasenablediscussionofwhatcausedthepositiveornegativeopinion.Thiswillallowforeasieranalysisofresponses.Conceptualframework:Organizationalstructuresandleaders’visionTheideathattruancyisacomplexproblemallowsforfocusonthevariousnarrativesincorporatedinattemptsatunderstandingandresolvingtheproblem.Somanydifferentavenuespointtopotentialsolutions,however,experiencedenotesnegativeorpositiveoutcomes.Therefore,theleaders’visonoftheselectedschoolandofsuccessfultruancyprograms,willallowforascopeofwhatmaybevaluabletowardsreductionofstudenttruancyrates.Withintheconceptualframeworkliesthetheoreticalframework,incentiveandmotivation.Animportanttheorythatwillbeexploredinthispaperistheincentivetheoryofmotivation.“…peoplearepulledtowardsbehaviorsthatofferpositiveincentivesandpushedawayfrombehaviorsassociatedwithnegativeincentives.Theincentivetheorysuggeststhatpeoplearemotivatedtodothingsbecauseofexternalrewards”(Rehman&Haider,2013,p.141).Ifstudentsareincentivizedtoattendclassbyreceivingareward,thismaybeacrucialpartmissinginschoolswithhightruancyratesandmayexplainthedownwardspiralofsomestudentswhentheyarepunishedseverelyforbeingabsent.CharterSecondarySchoolhasnon-academicawardsthattheygiveouttostudentswhoarerespectfulandhavegoodattendancerecords.Thesecouldbeincentivesforstudentstocontinueattendingclass.Theschool’sattendanceprocedureisstrict,butallowsforevaluationofthereasonsbehindastudent’sabsence.Suchconsiderationforastudentallowsforroomforthestudenttoresolvehisorherproblemsandcontinuegoingtoschool.Onerule,isthatifastudentmissesanxamountofdays,theywillhavethesameamountofdaystomakeuptheassignment.Althoughthismaybedifficulttoaccomplish,itdoesleavesomewiggleroomforstudents,thusincreasingtheirmotivationtocontinuefollowingtherulesoftheschool.AssumptionsThemainassumptionthatguidesthisstudyisthattruancypoliciesandproceduresarethecornerstoneforreductionintruancyrates.Otherassumptionsincludethenotionthathigherratesoftruancyleadtopooreracademicperformance.Whenstudentsfailtoattendclassvoluntarily,theyputthemselvesatgreaterriskofperformingpoorlyinschool.Thiscanhappenduetotheirinabilitytokeepupinschoolandlackofmotivationtocompleteassignments.Theymaybeunwillingtoattendschoolduetomentalhealthproblems,anunstablehomelife,orphysicalhealthconditions.Anotherassumptionisthatstudentslivinginpovertyandminoritystudentsmayhaveamoredifficulttimewithschoolduetoaturbulenthomelifeanddealingwithinstitutionalizedracism.Althoughthisisnotatopicthatwillbecoveredin-depthinthispaper,itisimportanttorecognizethedifficultiesthatcomefromlackofresourcesandpotentiallybeingaminority,andseehowthatcouldaffecttruancyrates.Thiscouldlendtocreationandimplementationofevenmoreeffectiveschoolpoliciesthatcanultimatelyreducetruancyratesandmaintainthemlowinthefuture.LimitationsThestudywillbelimitedtoonepubliccharterschool.theDoctorsChartersSchool.Thisisbecauseoftheneedtounderstandwhattheschooldoesandthencomparethatinformationtoothersuccessfulschools.Anotherlimitationisthenumberofpeopletointerviewforthestudy.Becausetheinterviewisqualitativeandin-person,notmanypeoplecanandwillbeavailabletoanswerquestions.ThestudyisalsolimitedtotheschoolswithintheUnitedStates.TheliteraturereviewwillonlyexaminehowAmericanschoolshandletruancyandpolicesthateitherdecreaseorincreasetruancyrates.Thefinallimitationisparents.Althoughparentalopinionmaybehelpful,itwouldbebettertoleavetheinterviewstostudentsandstafferswithparentsgivingpermissiontothestudenttospeak.Nootherlimitationsarenoted.ScopeoftheStudyThestudyisqualitative,andwilluseinterviewswithschoolstafftocollectdata.InterviewtranscriptswillbeanalyzedtoidentifyunderlyingthemesfromrespondentsoftheCharterSecondarySchool.Byaskingquestionsthehopeistounderstandwhateffectivepoliciesareinplacethatallowsforbetterattendanceratesthanotherschoolsinthedistrict.Interestingly,theschoolalsofaresbetterregardingacademicscoresandhasahighgraduationrate.Iflocationplaysapart(itisinasuburbanarea),thisshouldbeexploredviatheinterviewquestionstogainabetterunderstandingofallaspectsofeffectivepolicywithintheschool.Theliteraturereviewprovidesafoundation,theinterviewsprovidethedata.Asidefromthequalitativeinterviews,theliteraturereviewwillserveasacomparativeguidetonotonlybasesomeofthequestions,butalsocomparethedatagarneredfromtheinterviews.Ifothersuccessfulschoolshavesimilarpoliciesinplace,thiscouldserveasapotentialstandardthatcanappliednationallytohelpdecreasetruancyinallschoolsthroughoutthecountry.Theliteraturereviewwillalsoservetoprovideexamplesofpoliciesinschoolwithhightruancyratestoseewhatshouldnotbedone.Theresultswillalsobediscussedwithinthecontextofpotentialmodificationthatcanbemadetohelpimproveattendanceratesandacademicsuccessofstudentsevenfurther.Ultimately,itisimportanttoacknowledgewhatCharterSecondarySchoolhastoofferandseewhetherthatcanserveasagaugeforotherschoolsinthedistrict,anymaybe,inthecountry.Althoughthequalitativestudyissmall,onlyincludingsixstudentsandfourstaffmembersfromtheschool,itmayprovidethekindofinsightthatcannotbegatheredelsewhere.Useofdatabasesavailabletohighlightnationwidetruancyratesmayalsobeused,againasacomparativetool.SignificanceThestudycanbeanimportantstepinlearningwhatisworkableforschoolsaimedatreducingtruancyamongstudentsandwhatisnot.Furthermore,findingsmayleadtothisschoolandothersstandardizingeffectiveprogramsandpolicies.PublicschoolsacrosstheUnitedStatesneedtoknowthattheycanhavetheknowledgetoimprovetheirstudentpopulationsacademicprogressandattendance.First,however,theyneedtoseetheinformationthatprovescertainpolicyimplementationsworkandareworththetime,money,andeffort.Likeevidence-basedpracticeinnursing,staffneedtoseeevidenceofpoliciesthathavealreadybeenenabledandimplementedthathaveledtothesuccessofstudentsandtheimprovedratesofattendance.WhileithelpsseeingthestatisticsofasuccessfulschoollikeCharterSecondarySchool,itisevenmoresignificantifschoolsseethestepsittooktoreachthatlevelofsuccess.Thenthatcollectedinformationcanbecomparedtootherschoolsastoidentifywhatcoreprinciplesandactionshavebeenusedtoachievesuchapositiveresult.Growthandpositiveoutcomescanonlycomefromtestedandapprovedpractices.Theconceptualframeworkwillworkasaguidetoseeandunderstandifassumptionsandhypothesescanbeprovenordisprovenviacomparisonandanalysis.Researchersneedtocontinuetheirpursuitofinformationandanalysistoofferpotentialguidelinesanddirectionsforschoolsthatneedit.ThegrowingproblemoftruancyintheUnitedStatesrequiresathoughtfulandconsiderateassessmentofongoingissues.Theseissueswillcontinuetoremainprevalentunlessactionistaken.Actioncannotbetakenunlessthereissoundresearchandevidencebehindit.Lastly,studiesliketheonehereoffersananchorpointtoinvestigateotheraspectsofschoollife,schoolenvironment,andstudentbehavioralproblems.Ifstudentshaveproblemsduetostruggleswithsexuality,genderidentity,orevenpoliticalaffiliation,thiscouldalsobeinvestigatedinfuturestudies.Theresultscouldthenbeusedtospearheadchangesinpoliciesinthenearfuture,leadingtocontinueprogressiontowardsasafeandpositiveschoolenvironment.DefinitionofTermsThetermsutilizedinthisstudyaredetailedbelow.TruancyWhenastudentstaysawayfromschoolwithoutasufficientreason;canbealsolabeledasabsenteeism.Dayssuspendedmaybeincludedintruancyrates.CharterSchool(intheUnitedStates)apubliclyfundedindependentschoolestablishedbycommunitygroups,parents,orteachersunderthetermsofacharterwithnational/localauthority.ExpulsionMeaningpermanentwithdrawing/exclusion,whenastudentisbannedorremovedfromaschoolsystem/universityduetoconsistentviolationsofaninstitution\\\'srules.However,itcanalsobeforasingleoffenseoffittingharshnessinextremecases.SuspensionRegardingschools,suspension(a.k.a.temporaryexclusion)isanobligatoryleavegiventoastudentasamethodofpenaltythatcanlastanywherefromasingledaytoaslongasseveralweeks,whereastudentcannotattendschoolorstepfootinsidetheschool(Kaufman&Kaufman,2013).ConclusionInconclusion,truancyratesareagrowingprobleminUnitedStatesschools.CharterSecondarySchoolisoneschoolthataimstoreducetruancyratesandhavedonesoaccordingtorecentstatistics.ByexploringCharterSecondarySchool’sschoolpoliciesandotherschoolpoliciesthatincreaseordecreasetruancyratesinFloridathestudyhopestounderstandwhatmaycausetruancyinschoolsandwhatreducesit.Ifbetterandimprovedhandlingofstudentissuesisthesolutiontotruancy,itneedstobeexplored.Thenextsectionisaliteraturereview.TheliteraturereviewwillfocusonimportantpoliciesalreadyinplaceinotherschoolsandhowthesepoliciescouldbesimilarordifferenttoCharterSecondarySchoolalongwiththenegativeeffectsofhightruancyratesandthecauseoftheseratesinschools.Thenextsectionallowsonetoseethroughrecentliterature,thesignificanceoftruancyandhowitconnectsschoolmeasureswithstudentbehavior.Someschoolstakepunitivemeasurestowardstruancy,otherstakenon-punitive,andstillmoretakeamixtureofboth.Whyaresuchmeasuresadopted?Theaimistounderstandthisandwhystudentsaretruant.Thereareseveralfactorsthatcanbeatplayfromenvironmenttomentalhealth,andsoforth.Theliteraturereviewwillbringintocontextmoreoftheseaspects.Withsomanyschoolsthroughoutthecountryexperiencinghightruancyrates,whatdoesCharterSecondarySchooldothatenableshighattendanceamongitsstudentpopulation?Whatpolicieshastheschooladoptedtosupportapositiveenvironmentthatmotivatesstudentstoattendschoolandlearn?Chapter2LiteratureReviewRoadmap:Thisliteraturereviewwillfocusonseveralkeytopicsbecausemanyreasonscontributetotruancy.Theseare:addressingschooltruancy,school-basedprograms,punitive/non-punitivetruancyprograms,studentandfamilycharacteristics,parentalengagement,tacklingtheschooltruancyproblem,typesofprogramslikeschool-basedprograms,problemswithcurrenttruancyprograms,characteristicsofsuccessfultruancyprograms,andtheoreticalframework:IncentiveTheoryofMotivation.Thehopeistoilluminatethewaytowardsunderstandingtheproblemofschooltruancyandwaystoreduceit.(Ican’tincludenaturaldisastersasIfeelthatisitsowntopicandtooextensivetojustbrieflycover.)Introduction:AddressingSchoolTruancyStudenttruancyhasbecomeamajorissueschoolstrytotackle.Therefore,toimprovetruancytheneedarisestoresearchandcultivateworthwhilestrategiestoreducenegativebehaviorsthatleadtotruancy.However,thereisalsoaneedtounderstandwhystudentsaretruantinthefirstplace.Povertyandnegativeschoolenvironmentareissuesthathaveraisedconcernforthelikelihoodoftruancyinstudents.Thissectionhopestoilluminatetheissueofstudenttruancy.Itbecomesdifficulttoidentifythecostsofbenefitsofvariousmeasures.Thosethatfallintothepunitivedisciplineisnecessarybecausetraditionalistviewsbelieveadherencetorulesleadstopositiveoutcomes.Thoseinthecampofnonpunitivedisciplinedesiretodemonstratehowgivingstudents’optionscanleadtobetterresultsnotjustintruancyrates,butthepersonalgrowthofthestudent.Withallthestrategiesandmethodsavailable,itcanbedifficultforschoolleadstodeterminewhatmixtureofpunitiveandnonpunitivedisciplinewillwork.Thedesireistoshowthesuccessofprogramsand/orschoolsthathaveenabledareductionintruancyratesaswellaspoliciesineffectthatincreasetruancyratestodemonstratehowtoimprovestudenttruancy.School-basedProgramsAsidefromcreatingastrongerconnectiontocommunity,anotherwayschoolscanandhavehelpeddecreasetruancyratesisthroughtruancyreporting.Truancyreportingallowsstudentstobeassessedtoseeiftheyarehigh-risk.Becausetruancycanhaveaprofoundlynegativeeffectonstudentsinthelongterm,schoolshavebegunbecomingmorestringentontruancyreporting.“Atruanthasa3.4percentagepointshigherriskofleavingschoolwithoutaqualification”(DeWitte&Csillag,2012,p.549).Theresearchersnotethatbecausetruancyreportingallowsforbetterassessmentofat-riskyouth,itcanprovideameansofidentifyingpotentialproblemswithstudentearlyon.Thismakestruancyreportingapreventativemeasure.Suchapreventativemeasureappearstohavepositiveeffectsonstudentsatrisk.“.Theideaisstraightforward:ifstudentsarebettermonitoredwithrespecttotruancy,schoolscanidentifymoreeasilystudentsatrisk.Theresultsindicatethatimprovedtruancyreportingsignificantlyreducesschooldropoutby5percentagepoints”(DeWitte&Csillag,2012,p.549).Tojumpstarttheprocessofhelpingstudents,schoolsmustfigureoutwaystohelpstudentsconnecttotheircommunity.Then,apreventativemeasureusedtohelpidentifyat-riskyouth,sotheycanhaveinterventionsthatcanleadtopositiveeducationaloutcomes(DeWitte&Csillag,2012).Schoolsliketheoneusedforthisstudyandthoselikeit,alreadyhaveinplacearobusttruancyreportingprotocol.Theruleswithinthisprotocolshowthatstudentscannotbeabsentmorethanafewdaysortheschoolwillbeinvolvedandwillcontactthestudent’shousehold.Moreresearchshouldbededicatedtohowpreventativemeasurescanexpandtoincludeotherwaystoassessforat-riskbehavior.Thiscanincludelatenessforclass,missedhomeworkassignments,andsoforth.Ifthiscanbedone,thismayfurtherallowforagreaterassessmentofpotentialtruancyproblemsinthefuture.Applyingresearchtopracticeispopularinhealthcare,perhapsitcanalsobecomepopularineducationasmoreinformationcomesoutonhotbuttontopicslikestudenttruancy.PunitivePunitivemeasuresfortruancycanbeseenthroughtheintroductionofthird-partypolicinginschools.“Third-partypolicingisanapproachtocrimepreventionandcontrolinvolvingthepolicepartneringwithorganizationsorindividualstopreventorreducecrimeproblems”(Nitschke,Mazerolle,&Bennett,2014,p.5211).Relyingonavailablecriminal,regulatory,orcivillawsandrules(legallevers)thatallowthirdpartiestotakeaccountability,partially,forcontrolofcrime,itcreatesanenvironmentwhereapprehensionofproblemstudentsisfeasible.Thismayhelpschoolsdealwiththegrowingdelinquencyinstudents,butmayalsomakeiteasierforstudentstobecomepartofthecriminaljusticesystematanearlyage.Punitivemeasurescanalsobecostlier.Thisisbecausepunitivemeasureslikeexpulsionorsuspensioncanfurtherincreasethelikelihoodofstudentsbeingtruantandperformingpoorlyacademically(Shelton,2014).Studentsmustbeguidedtowardsapositiveoutcomeandthatmeansreducingthebeliefthatpunitivemeasureswillkeepstudentsfrombeingtruant.Althoughshort-termresultsmayindicatereduction,thelong-termeffectscouldbemorenegativeandlong-lasting(Shelton,2014).Sheltonmentionedthatstudentswhofacepunitivemeasuresmayhaveahigherchanceofcommittingcrimesversusthosewhofacednon-punitivemeasures.Whilesomeresearchsuggestspolice-interventionregardingtruancycanhelpstudentsinthatparentsaremoreawareofwhathappenstothem,therearestillmanyfactorstoconsiderinrelationtoefficacy.Forexample,police-interventionmayleadtohigherparentalawareness,butalsoincreasedpotentialfortruantstudentstoendupinthejuvenilecriminaljusticesystem(Mazerolle,Bennett,Antrobus,&Eggins,2017).Amixtureofbothpunitiveandnon-punitivemeasuresmaybemostbeneficialintacklingtheproblemoftruancy.Non-PunitivePunitivemeasuresfortruancyhavetheirplaceinschools.However,researchshowsnon-punitivemeasuresarealsousefulandofferachanceforstudentstoimproveandremovesomeofthestigmaattachedtopastmistakes.Successfulprotocolsintegrateflexibilityintostandardmethodstohelptheschool,family,andstudent.Suchprogramsunderstandindividualstudent’sneedsanddowhateverisessentialtoassistthefamilyandstudentinvolvedintruancy(Mallett,2015).OnestudyinAustraliaaimedtounderstandtruancyandtheeffectsoftruancytogenerateprogramsthatallowedforeffectivemeasuresatreducingtruancyratesamongstudents(Taylor,Gray,&Stanton,2016).Thisshowsthatwithproperresearch,non-punitiveoptionsarefeasible.However,theymustbedoneinconjunctionwithsignificantresearchthatallowsabetterunderstandingoftheneedsofstudentswhoparticipateintruancy.Theexpectationisthatnon-punitivemeasuresaremoreeffectivethanpunitivemeasures.However,ifthereisnosignificantdifference,non-punitivemeasuresmustbeassessedforefficacy.Haight,Chapman,Hendron,Loftis,&Kearney(2014),demonstratedhownon-punitivemeasureslikeatruancyprogrammaynotworkifakeyprocessisnotimplemented.Meaning,ifthereisnoskill-buildingaspecttotheprogramliketutoring,thechancefortruancytodecreasedeclines.StudentCharacteristicsTruancycanhavealastingimpactonthelifeofastudent.“Schooldropouthasbeenextensivelystudiedintheliteratureasacorrelateofnegativelifeoutcomes.Aprecursortoschooldropoutistruancy,theunexcusedorillegitimatestudentabsencefromschool”(Rocque,Jennings,Piquero,Ozkan,&Farrington,2016,p.592).Studentsmaybeabsentortruantduetoamultitudeofreasons.Researchersidentifiedthroughafewexaminedstudies,thatstudentswhoareoftenmoretruantthanothers,maybemoreinvolvedincrime.Suchinvolvementpointstothenegativecorrelationoftruancyandlaterlifeoutcomeslikedelinquencyandcrime.Theresearchersalsostatetruancycanleadtoproblemdrinking.“Resultsindicatethattruancyhaslong-lastingassociationswithnegativelifeoutcomes,especiallyfornon-violentcrimeandproblemdrinking”(Rocque,Jennings,Piquero,Ozkan,&Farrington,2016,p.592).Ifaddictiveorcriminalbehaviorleadstotruancyandtruancycanfurtherleadtoaddictiveorcriminalbehavior,itseemsacyclethatjustfeedsitselfwithnegativeoverallbehavior.Thisisimportanttoknowbecausestudentsexperiencingaddictionproblemsorbecominginvolvedindelinquentbehaviorcanreceivehelptonotonlykeepthemfromengaginginsuchriskyactionswhilealsopositivelycontributingtoreductionintruancyrates.Essentially,thenotionthatfortheretobeareductionintruancyrates,schoolsmusthelpstudentsdealwiththenegativebehaviorstheyareengagingin,outsideofschool.Thesenegativebehaviorscouldcomebecauseofnegativeexperiences.Frombullyingtopooracademicperformance,studentsoftenexperiencestressthatcouldbedetrimentaltotheiracademicsuccess.Birkett,Russell,&Corliss,(2014)observetherolesexual-orientationdisparitieshaveonstudentsinrelationtoacademicachievementandtruancy.Throughtheutilizationofpoolinformation,theyidentifiedbeingpartoftheLGBTgroupaffectedratesoftruancyandacademicperformance.“LGBT-identifiedyouthsreportedsignificantlyelevatedoddsoftruancyandlowgrades(oddsratios?=?1.6–3.2;allP?
Healthcare Innovation Healthcare is one of those industries and fields of work where the promotion of innovation and change management is key. It is also one of those fields where managing that change through tried-and-true practices such as evidence-based practice and so forth is a must. One change that is changing nursing a lot, especially when it comes to the advanced levels of nurses, is the flattening of the hierarchy that
components of value-based purchasing (VBP) that are most pertinent to the U.S. Department of Veterans Affairs (VA) based on its vital mission to provide high-quality health care services to the nation's veterans while identifying opportunities to reduce costs and improve efficiencies in ways that promote improved clinical outcomes in measurable ways. The study also describes the three departments of a VA medical center that will be most important in
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