Fall Risk Assessment and Geriatric Care in Elderly Patients

by Herman Bailey | Jul 24, 2023 | Essays | 0 comments

Is this woman a fall risk, and if so why do you think so?

Yes, I believe that woman is a fall risk. According to the information given, an analysis of the standard Morse Fall Scale there are vivid factors that have significantly contributed to her facing the fall risk. Despite not having the patient’s medical history we can deduct from the information provided that she presents an immediate risk of falling. Moreover, the patient is bed-bound. However, her mental status onset affects the patient and thus makes her attempt to leave her bed. The major contributors to her falling risk, such as the long-term CVA which is associated with paralysis on her right side, difficulty in hearing with no administered hearing aids to assist, as well as the fact that the patient is left unattended for an entire day. Furthermore, the patient was experiencing onset confusion which is closely associated with changes in her overall mental status.

What clues were there to her UTI diagnosis that might have prevented her hospitalization if identified early enough?

Issues such as dehydration, pneumonia as well as the changes in her mental status were the clues that were concerning her diagnosis of UTI and may as well have caused challenge towards early hospitalization.

What indicators of Frailty does this patient have?

As per the information provided on the patient the indicators of frailty include; weakness, weight loss, as well as the fact that the patient was bedbound and had quit eating quite recently.

What Geriatric Syndromes does she exhibit?

The patient exhibits the following geriatric syndromes aging; considering she was eighty-two years old and the onset confusion, as well as changes in her mental status, indicate dementia. Moreover, the negligence by her caretaker by leaving her unattended the entire day is a factorabout geriatric syndromes. Nevertheless, the fact that the patient is a significant falling risk is a geriatric syndrome. The last of the indicators of the geriatric syndrome is her contractures of both her hips and hands.

What do you think are contributing factors to her pressure ulcers and what might be done to prevent them in the future?

The primary contributors to her pressure ulcers include her lack of freedom to move around because she is bedbound. Amongst other ulcer contributing factors are her poor nutrition status, weight loss as well as dehydration; incontinence of her bowel and bladder, the hip and hand contractures, and the paralysis of her right side. Moreover, she might be experiencing pain.

Prevention of pressure ulcers in the future may involve an effective implementation of the following interventions; repositioning of the patient every couple of hours in her bed as well as wheelchair, encouraging a healthier diet, the significant increase in the intake of fluids as well as calories, vast motioning exercises and initiating a supplements diet. Moreover, better management of her urinating schedule, as well as utilization of creams for protecting skin barriers as well as keeping her skin clean and dry, could help significantly.

What do you think nursing should do to prevent the patient from entering the downward spiral of the geriatric cascade after she is admitted to the hospital?

Geriatric cascade is more often than not defined as the dependence increase progression. Moreover, it results from extending bed rest time while in the hospital. Therefore, efficiently implementing interventions focused on enabling the patient to be engaged as well as mobile is the most recommended way of preventing the patient from entering a downward spiral.

When she is ready for discharge from acute care, what issues should be addressed in discharge planning?

When the patient is ready to be discharged from acute care, the critical issue that should be included in her discharge plan is the patient’s education on her medications, scheduling of her prescriptions as well as stressing caution on reiteration when standing after having sat down.

What services might she require upon discharge?

Upon discharge, the patient requires at least once a week home health nursing services for checking in as well as to ensure adequate monitoring of her medication compliance. The patient also needs consideration for a social worker referral, particularly because the patient is elderly, and at the age of eighty-two abides alone as thus could significantly benefit from assistance.

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Herman Bailey

With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.

The Impact of Caregiver Burden on Family Caregiving

by Herman Bailey | Jul 24, 2023 | Essays | 0 comments

Abstract

This paper gives deep insight on caregivers’ burden with the bias on the clinical aspects of it. the paper has looked into various literature and the most outstanding point about caregivers’ burden is that it can be reduced when they receive support both from the healthcare professionals as well as their families. The majority of the burden that caregivers face is often psychological as it is cumbersome for them to strike a balance between their roles as caregivers and also their position in the family and at the workplace.

Introduction

The majority of the patients have family members that are offering some degree of care as well as support when it comes to individuals of different ages suffering from chronic illness or some sort of disabilities. This care which can be seen as informal to some extent can be considered in scope, duration as well as intensity. According to Abdollahpour et al (2014), caregiving in the family raises safety concerns in two ways that are supposed to be a concern for the nurses no matter the setting. To begin with, caregivers are now and then referred to as ‘secondary patients’, who deserve as well as need guidance and protection. The study that supports caregivers-as-client view protecting put more weight on protecting family caregivers’ health as well as safety because there demands caregiving put them at a higher risk for injuries together with unfavorable events. Secondly, the family caregivers are usually voluntary providers who usually need more support to enable them to become more proficient, a safe volunteer worker with the focus on protecting their family from harm in a better way.

Description of the clinical analysis of caregiver burden

As a community nurse, I came across a caregiver who was taking care of patients with a series of conditions. The caregiver herself opened up to me on the series of responsibilities that she has, first was to maintain the residence. Surviving on a limited financial budget as well as managing a series of health conditions her own. Falling short of physical presence required for a support system, she had to bear the entire burden of her husband’s short but extreme outpatient care which entailed: driving, preparation of meals, cleaning, organizing the medicine and oxygen as well as other related activities by herself lacking. With all this, she is still hoping the transplant turns out to be successful while being faced with multiple uncertainties the major one being the one on her husband’s survival. While asked she slightly complained but her face showed severe emotional distress, considerable fatigue, sleep deficiency as well as challenges in maintaining her focus and energy in the entire process of transplant.

I noticed the caregiver had failed to follow the dosage of drugs as prescribed citing the pressure that the task entails. This hurt the health of patients as though there was an improvement but it was noted to be extremely gradual. Psychologically the caregiver was vulnerable with a high likelihood of causing harm to the patient. Her level of aggressiveness was a concern together with the way she was easily irritable.

Step 3 – Relevance of Topic/ Situation to You Personally and Professionally

This topic highlights the plight that the caregivers go through, to the caregivers the common assumptions are that though it’s a hard task one gets used to it. But this topic has highlighted and given insights on how entailing the role of caregiver is and it also highlights the challenges they are likely to face or the ones that they should anticipate in the future.

The paper also provides the better side of the healthcare workers as they tend to offer support to the caregivers and reduce the level of stress that they might be going through. Most of the issues that caregivers face are psychological, therefore the topic tries to link the psychological issues as part of the burden that caregivers take as the topic goes hand in hand.

Identification, Discussion, and Analysis of 3 Issues of the Concept Within the Clinical Situation

The threat of elder abuse

The existence of cognitive-behavioral problems and dementia puts the recipient of care in danger for abusive behaviors towards the caregiver. Abandonment may also take place, including urinary incontinence, nutritional neglect together with access to food, falls, and unmanaged pain. Neglect of the caregiver may also occur because the dementia patient is not able to converse and the caregiver is also not capable of comprehending or know how to handle nutritional intake as well as pain management (Reinhard, n.d). Chappell, Dujela, and Smith (2015) discovered that counseling, as well as support for caregivers that face disrupting behavior from their family members due to illness, will decrease the degree of stress over their multiyear caregiving responsibility.

Caregiver spends considerable time engaging with the recipient of care, and at the same time offering care in a vast range of activities. The interaction of the healthcare professional with the patient is usually limited while caregiving can last from the shortest period of time, mostly after the hospitalization of the patient to more than forty years of constant care to a patient with a chronic illness. The devotion needed to deal with a recipient who has a chronic illness can be daunting to the mind. This has got serious psychological effects on both the caregiver and the recipient of care which might end up damaging both of them psychologically.

Medication errors

Regarding the skills together with the familiarity of the caregiver, an essential case in point of the probable to hurt patient is the administration of medications by the caregivers. A considerable number of community-based elders rarely recollect receiving any directives on how they are supposed to use their medications. They usually depend on the members of their families for help in taking the drugs (Reinhard, n.d).

According to the study conducted by Travis and colleagues, it was discovered that caregivers only manage one to 14 medication daily have the complexity of keeping track of many prescriptions, and due to the nature of their tight schedule, they are prone to miss doses (Chappell, Dujela, & Smith, 2015). Their roles of monitoring for the toxic or severe effects within the members of the families who are incapable of reporting like diarrhea, vomiting, dehydration, and any situations they see an emergency. Caregivers need to have significant knowledge to be able to identify both atypical and classical severe effects of the drugs they may see as the condition of their family members’ changes and also help in creating critical thinking abilities that would enhance them to administer possible problems (Reinhard, n.d).

Having the required skills to manage the condition of the patient will also minimize the emergencies as the skilled caregiver will be able to identify when the condition gets worse and when to give the emergency drugs to the patient when need be. The problem comes when the illness is prolonged as fatigue and normalization of condition may make the caregiver miss essential aspects or assume some of the required symptoms for proper diagnosis. Proper training about the condition and also being able to keenly follow up on the patient’s progress would tackle this concern as the caregiver would easily identify an emergency and offer the patient the drugs as advised.

The perspective of harm

The family members of the caregivers can be exposed to two categories of risk; situational and preventable risks, to begin with, even though they usually have good intentions in addition to hard work, if caregivers lack essential skills as well as knowledge to execute their work, they may end up harming their loved ones unintentionally. Such injuries are normally related directly to shortage or deficiency of skills as well as competence which can be enhanced by providing the caregiver with necessary education together with support. For instance, according to a recent study which established that patients had numerous unfavorable outcomes when they are managed by untrained caregivers whom they depend on in terms of enteral nutrition or tube feeding the challenges that they experience include the displacement of tube, the clogging of the tube, dehydration as well as an infection. This leads to a strainful caregiving situation as well as a readmission in the hospital.

The second fear is that the fact that the work of a caregiver is extremely demanding, this can put them at risk of engaging in behaviors that may be harmful towards the receiver of the care, especially among the individuals with cognitive impairment. Caregivers who are depressed have a higher probability of harming their spouses, caregivers who are more likely to be depressed in the course of caring for their spouses with physical impairment or considerable cognitive are more probable to engage in abusive or neglect behaviors like yelling and screaming, use of physical force or threatening to abandon, withholding meals, or even handling the patient roughly.

In an overview, family members may be defied to find the ability or capacity to provide care, nonetheless, Fulmer discovered those caregivers with poor health or whose incomes are a loan or the ones with the dysfunctional situation are the ones more likely to have limited ability to offer the needed care. They might also not be able to understand the standard for quality and might not offer the level of care that is required

Review the literature

According to Allred (2013), healthcare professional lack of unambiguous concentration to caregivers is a huge gap in healthcare and it’s even more embarrassing considering it’s been more than two decades with documented potential risks of family caregiving. As it currently stands caregivers happen o be secreted patient themselves, due to the adverse mental and physical health consequences from the nature of their work is both emotionally and physically demanding as most of them tend to pay little attention to their own health and healthcare at large (Hsiao & Tsai, 2015).

Declines in both physical health as well as premature death amongst the caregivers in totality have been reported. Reinhard (n.d) discovered that family caregivers face a considerable negative physical cost as the illness of the patient progresses, the caregiver who was elderly particularly the elderly spouses with the experience of caregiving which is stressful have a higher mortality rate at 63% in comparison to the non-caregiver who are at the same age group. The most current, study indicated that elderly husbands, as well as wives who take care of their spouses, have ended up being hospitalized for severe illness and they end up having increased chances of them dying ahead of time.

The deterioration in caregivers’ health can be specifically linked with caregivers who see themselves as laden. Caregiver burden, as well as caregiver strain, can be easily connected to caregiver’s individual poor health status, amplified health-risk behaviors (for instance smoking), and an elevated abuse of drugs which have been prescribed to them (Reinhard (n.d), Many scholars have highlighted the fact that caregivers are often at risk of fatigue as well as sleep interruptions, reduced immune functioning, increased in the level of insulin and pressure, modified influenza shots, altered lipid profile, wound taking time to heal as well as a higher risk for cardiovascular disease.

Burton and colleagues investigated the relationship between the provision of care by members of the family and their health maintenance and behavior. These scholars discovered the fact that, with an increased height of caregiving activities, and the likelihood of caregiver neither having rest, nor have enough time for exercise, and in fact not recovering from illness were also so high (Reinhard, n.d),. Furthermore, caregivers had a higher probability of forgetting their prescriptions for their individual chronic conditions. Offering care creates a danger to the general health of the caregivers, which can interfere with their capability to maintain to be caregivers. If it’s inevitable for caregivers to continue providing care, a reprieve from the distress as well as the burden of maintaining the necessary care ought to be measured.

Both exceedingly negative and positive outcomes of offering care may be present concurrently. It is reasonable that the positive consequences, like rewards together with approval, may caution the pessimistic effects of caregiving. The positive facets of caregiving are vital some scholars are now using a caregiver rewards scale to better have a comprehensive insight into the experiences of caregivers. On the other hand, other scholars are surveying the positive aspects of care as the affinity between the patient and caregiver grows. Whitmore, Crooks, & Snyder (2017), established that preparedness and mutuality did not minimize some of the tension on the caregiver. Picot and colleagues worked basically with the caregivers who were of African American descent and discovered that rewards seen professed by caregivers were more vital than coping.

A caregiver who tries to strike a balance between caregiving and other activities, for instance, family, work, and relaxation may find it cumbersome to keep the attention on the positive portion of caregiving and usually experience more negative responses, like an amplified sense of burden (Roper et al, 2014). Despite the amount of care offered, caregivers may happen to be progressively more distressed if they are not able to contribute to more valued interests as well as activities. More than half of adult children that offer parent care are underemployment. Hence caregiving functions can hurt work functions as caregivers acclimatize the obligation of employment to manage as well as meet the demands of care. Employed caregivers record missed days, as well as interruptions at work, which has an overall negative effect on their productivity at work. They have a problem when it comes to maintaining work functions and at the same time providing support to family members (Ruiz & Ortega, 2019).

According to Reinhard (n.d), Low household and personal incomes, as well as restricted financial resources, can have an increased chance of a caregiver risk for negative results, specifically if there are considerable out-of-pocket costs for care recipient desires. The unemployed caregivers or the ones with low income may face more distress because they have limited resources to meet the demands for care. According to Allred (2013), generally, financial concerns predominantly distress for caregivers during the treatment periods which appear to belong and the limited resources become washed-out as those with restricted resources.

The caregiver burden, as well as symptoms depressive, is the major common negative result of offering care for the elderly as well as chronically ill. Caregiver burden can be described as a negative response to the impact of offering care on the caregiver’s occupational, social as well as personal roles and attempt to be a predecessor to depressive symptoms (Reinhard, n.d). Whether a negative outcome is developed by the caregiver appears to be directly linked to the care recipient’s incapacity to execute ADLs, either because of the physical limitation or cognitive status. If the recipient of the care wanders (linked with Alzheimer’s disease) or portrays the behavior which is considered to be unsafe, the caregiver has to be at attention and on-call for supervision 24 hours every day. The regular concern for managing disruptive behaviors (including walking in the street, abusing pills by taking it in excess, cursing and yelling, and many more) also negatively influences the caregivers (Juntunen et al, 2018).

Care recipient’s cognitive, functional, and emotional status envisages caregiver burden as well as depression. This may be apparent in feelings of isolation as well as loneliness, fearfulness as well as being simply worried, as the demands of caregiving restrict their individual time. Care recipient behavior like yelling, screaming and swearing are connected with augmented caregiver clinical depression. The depression of the caregiver may also have a somatic module, like fatigue, insomnia, anorexia, and exhaustion (Thompson, 2015).

According to Thompson (2015), Caregivers could suffer serious vacillation in sleep patterns over time, which may impact depression and aggravate symptoms of chronic illness. Management of pain is an obstinate problem for caregivers that result in considerable caregiver distress, as caregivers help with both pharmacologic and nonpharmacologic pain management policies.

Caregivers are approximated to be around 15 million people and they offer around $202 billion of free care to the older adults who suffer from cognitive impairment because of neurodegenerative diseases, progressive chronic conditions that can lead to disturbance in behavior, memory, and orientation. Approximately 80 percent of the caretakers are family members (Allred, 2013). These caregivers are usually overwhelmed caring for older people who are suffering from several chronic conditions that happen to be complicated by cognitive impairment. Older adults with cognitive impairment that originated from dementia have higher occasions of hospitalization as compared to older adults without a dementia diagnosis.

The efficiency of managing the symptoms linked to cognitive impairment has been linked to the lower caregiver burden. According to Abdollahpour et al, (2014), the healthcare professionals have been on hand in getting involved to ensure a smooth transition of the patient to the subsequent setting of care and could use self-efficacy evaluation tool together with other clinical assessment to further focus on offering post-hospitalization transformation or transition plan to the patient needs as well as the caregivers.

Caregivers are also linked to the existence of delirium amongst patients with cognitive impairment during the hospitalization period after alteration for multiple other vital clinical factors. Nevertheless, the use of pharmacological as well as non-pharmacological interventions in the course of hospitalization has been discovered to reduce delirium, particularly amongst high-risk patients like the ones with cognitive impairment.

Discussion/ Analysis of How Your Future Practice Maybe influenced

Considering the majority of the study on caregiving remains to be expressive, there still exist numerous gaps that are evidence-based research to endorse patient quality care and safety as secondary as well as caregivers as providers to susceptible policies for future study

By caregiving being a day out a function that varies as the needs of the care receiver change, it is not well comprehended through cross-sectional research designs. It is important to note that longitudinal and descriptive designs are employed to follow the necessary care requirements over the line of illness course. The longitudinal study currently has matched intervals between observations like 3, 6, 9, or 12 months, devoid of concerns for the protocol of treatment or phase of disease or the demands of care. Future research should take notice of the time points that may be better portray the trajectory of the disease like a time of original diagnosis, protocols alterations, as well as points of disease exacerbation or in other words, decline. An extraordinary focus on safety, the risk for negative results as well as severe effects for both the care recipient and caregiver should be acknowledged.

The key variable that needs to be included in the future includes the type and the phase of the disease as well as the treatments because they will relate to the kinds of continuing therapy. This range of therapies will be linked to the requirements of the patients as well as the assistance with self-care in addition to the ability of the patient to execute other usual daily activities. Are the demands bestowed upon the caregiver too much in a way that it could put at risk his or her health?

A study that uses cautiously selected beginning associates is required so that disparity in care demands can be well comprehended. It will put as in a far better position to depict how the course of the disease and linked treatment as well as happenings through care that is palliative in nature. Undesirable patient care, as well as caregiver situations like medication errors, subsequent hospitalization, and falls, can be noticed over a given time

Conclusion or Summary

Caregivers in the family are signs with significant partners in the plan of care for patients mostly the ones suffering from chronic illness. Healthcare personnel should b worried about various issues that affect patients’ quality of care as well as safety as a family has over-relied on caregivers. progress can be attained through communication as well as caregiver support to fortify the competence of the caregiver in addition to teaching them new skills that will improve the safety of the patient. Preceding interventions and research have indicated the fact that the outcome of the caregiver is more improved when the healthcare practitioners are involved though more research is needed to be conducted on the area. Nurses play a core role in helping family caregivers to be more confident as well as competent as they enter the route of the healthcare process.

References

Abdollahpour, I., Nedjat, S., Noroozian, M., Salimi, Y., & Majdzadeh, R. (2014). Caregiver Burden. (Journal of geriatric psychiatry and neurology.)

Allred, D. (2013). Caregiver burden and sibling relationships in families raising children with disabilities.

Bevans, M., & Sternberg, E. M. (2012, January 25). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304539/

Chappell, N. L., Dujela, C., & Smith, A. (January 01, 2015). Caregiver Well-Being: Intersections of Relationship and Gender. Research on Aging, 37, 6, 623-45.

Hsiao, C.-Y., & Tsai, Y.-F. (June 01, 2015). Factors of caregiver burden and family functioning among Taiwanese family caregivers living with schizophrenia. Journal of Clinical Nursing, 24, 1546-1556.

Juntunen, K., Salminen, A.-L., Törmäkangas, T., Tillman, P., Leinonen, K., & Nikander, R. (October 01, 2018). Perceived burden among spouse, adult child, and parent caregivers. Journal of Advanced Nursing, 74, 10, 2340-2350.

Reinhard, S. C. (n.d.). Supporting Family Caregivers in Providing Care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2665/

Roper, S. O., Allred, D. W., Mandleco, B., Freeborn, D., & Dyches, T. (January 01, 2014). Caregiver burden and sibling relationships in families raising children with disabilities and typically developing children. Families, Systems and Health, 32, 2, 241-246.

Ruiz, F. M. D., & Ortega, G. A. M. (January 01, 2019). Evaluation of the perceived health of caregivers of patients in mild-to-moderate stage Alzheimer’s disease. Perspectives in Psychiatric Care, 55, 1, 87-94

Thompson, K. (2015). Paid formal caregivers and caregiver burden: A quantitative study.

Whitmore, R., Crooks, V. A., & Snyder, J. (January 01, 2017). A qualitative exploration of how Canadian informal caregivers in medical tourism use experiential resources to cope with providing transnational care. Health & Social Care in the Community, 25, 1, 266-274.

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Herman Bailey

Enhancing Lung Cancer Treatment for Elderly Patients: Geriatric Oncology Strategies

by Herman Bailey | Jul 24, 2023 | Essays | 0 comments

Introduction

From case study C, Harold is a widowed farmer, he 75 years old, and has been diagnosed with advanced non-small-cell lung cancer with metastasis of the spinal bone (stage IV). He lives with his son on a farm in the countryside. Harold initially had an x-ray on his chest followed by an ultrasound-guided bronchoscopy before being diagnosed. A scan of the bone also reveals multiple metastasis sites. He also has tested negative for the EGFR mutation. Moreover, he also has other comorbidities, of congestive cardiac failure and chronic obstructive airways disease. His performance score was 2 in The Eastern Cooperative Oncology Group (ECOG). He was to start a treatment regimen of gemcitabine days 1, 8, and 15 repeated every 4 weeks and vinorelbine days 1 and 8 repeated every 3 weeks for his treatment.

The goals and rationale of the choice of treatment prescribed for Harold.

Lung cancer according to Lung Cancer (2018) is the uncontrolled growth of abnormal cells in both or one of the lungs. As they grow, they can form tumors in the lungs and interfere with the lung’s function in the provision of oxygen into the body. Lung cancer is the leading cause of Cancer-related adult mortality in many countries particularly smokers (Stinchcombe & Socinski, 2009; Younes, Schutz, & Gross, 2010).In western countries, the second most common malignancy in Non-small cell lung cancer (NSCLC), and this signifies about 85% of all lung cancer cases among the elderly (Owonikoko et al., 2007). The majority of the NSCLC occurs in individuals aged 65 years and above (Noone & Garshell, 2010), and there’s an increasing incidence rate among the elderly because of the rise in life expectancy. Cancer diagnosis and treatment have implications on the physical, psychological, and social functioning of a patient during the treatment phase and in the longer term. Cancer as well as its treatment can result in a wide range of psychological and physical problems that do not disappear with time. Some of these problems come up after or during cancer treatment and continue to manifest in a long-term, chronic manner. Regardless of what is presented late effects and long-term effects of cancer can have negative effects on the quality of life of the survivors of cancer. Some of the long-term effects include numbness, fatigue, pain, no parties with related weakness, sexual or cognitive difficulties cover, and elevated depression or anxiety (Stein, Syrjala & Andrykowski, 2008).

Even though it is acknowledged that the patients that are older when placed under cytotoxic chemotherapy, may experience more toxicity compared to the younger patients (Azzoli, Baker & Temin, 2009), research should address pediatric infections and resistant organisms in Aseptic Technique for peripheral IV insertion. There are much evidence suggests that chemotherapy is superior even to this particular setting of the patients (Meoni, Cecere, Lucherini, 2013). A growing number of published trials over the past few years which assessed the effectiveness of gemcitabine and platinum-based doublet in elderly patients with NSCLC (Comella et al., 2004; Lim, Lee, & Song, 2013; Pereira et al, 2013) and the findings from recent meta-analysis indicates that doublets are more tolerable and effective compared to single-agent chemotherapy for treating of the elderly patients with NSCLC with a good status of performance (Xu, Chang, Wang, & Qi, 2013). In patients with metastatic/ advanced disease or elderly patients with advanced NSCLC, improving their life quality is important. therefore, the main treatment goal in the case study is to improve the quality of life and also to extend life expectancy for Harold.

The therapy options, that is; targeted therapy, irradiation, chemotherapy, and surgery, are normally applied by the molecular signature and TMN staging (Adjei, 2008). A combination of first-line chemotherapy is usually applied to get maximum effectiveness. For the first-line therapy, chemotherapy based on cisplatinum combined with radiotherapy is superior to chemotherapy or radiotherapy alone (Gewanter et al., 2010; Mantovani et al., 2006). Several agents have been used besides cisplatinum, for instance, gemcitabine, vinorelbine, docetaxel, paclitaxel, and irinotecan. According to (Gewanter et al., 2010; Mantovani et al., 2006)), in squamous cell carcinomas gemcitabine is usually considered as the first choice and that may explain the rationale behind the prescription of gemcitabine for patient Harold. The distinct mechanism of action and the generous single-agent activity could be one of the bases underlying the rationale for adding vinorelbine to gemcitabine when providing treatment to patients with relapsed NSCLC. In their study, which compared single-agent Vinorelbine therapy with vinorelbine plus gemcitabine, Frasci et al (2000) Observed vinorelbine plus gemcitabine therapy demonstrated improvements in both median lengths of survival and quality of life.

Metastatic bone tumors particularly occur at higher rates in cancers of the lung, prostate, breast, and kidney and this accounts for about 75% of all cancer patients (Tofe, Francis, & Harvey, 1975). Many lung cancer patients are usually in their advanced stages of the cancer disease during the diagnosis time. Even though it is stated that metastasis of the bone from lung cancer takes place in between 14% to 40% of the patients, its clinical characteristics have not been described clearly (Johnston, 1970). When offering treatment to the skeletal metastasis condition, it is imperative to understand the prognostic factors and prognosis after the skeletal metastasis to determine the treatment plan. Six factors were proposed by Ferrell, Jennifer, Temin (2017) that predicted the survival of spinal metastatic tumors. They include the quantity of bone metastasis of the extra spinal, general condition, quantity of vertebral body metastases, cancer primary site, major internal organs metastasis, and the spinal cord palsy severity. The malignancy grade of the primary tumors, number of bone metastases, and the vital organs visceral metastases are also reported to be important prognostic factors ( Ripamonti, Bandieri & Roila, 2011; Tomita et al., 2001). Sugiura, Yamada, Sugiura, Hida, & Mitsudomi (2008) conducted a study to test various chemotherapy regimens for 267 patients. Among them, the researchers administered vinorelbine ditartrate and gemcitabine hydrochloride to 11 patients. They then studied the survival rate cumulatively after prognostic factors and bone metastases for patients with bone metastases as a result of lung cancer. The survival rate was calculated overall embarrassed on the presence or absence of an EGFR inhibitor. The arrangement combination showed positive results and that might explain their rationale for its dosage in the case study of Harold who also had a bone tumor.

(Part 2 of the question) – In planning the management for your chosen case study, identify one important nursing consideration throughout or after the active treatment phase. Justify the selection of this nursing case study. Explore the available research supporting nursing practice for this consideration.

Nursing Considerations during the active treatment phase by using available research to support nursing practice for this consideration.

In planning the management of cancer, EdCan (2018) outlines factors and variables that should be taken into account in determining the treatment plan. The aim of cancer treatment may be for curing, controlling, palliation of symptoms, or prolongation of life. The factors include tumor, treatment, and individual factors. Other variables include the assessment tools, performance scales, and the psycho-oncology outcomes database.

During the active treatment phase, one important nursing consideration that the paper has identified is an assessment of comorbid and geriatric conditions of the patient in guiding the treatment (Chernecky & Murphy-Ende, 2009). The paper has settled on this important nursing consideration because continuing treatment of comorbid conditions such as heart disease, pulmonary disease, and diabetes may lead to drug interaction when chemotherapy is introduced, for the elderly like Harold. Chronic diseases such as liver or renal diseases may change the pharmacodynamics and pharmacokinetics of chemotherapeutic agents. These changes in addition to modifications in drug metabolism, absorption, distribution, and excretion lead to more toxicities among the elderly cancer patients (Chernecky & Murphy-Ende, 2009; Itano et al, 2016).

As a consequence, older adults have a lesser likelihood of receiving optimal chemotherapy dosages compared to the younger patients due to complications and toxicities (EdCan, 2018). Careful evaluation of the common conditions as well as compromised functions of the organs and how these factors may consequently lead to subsequent sub-optimal doses of treatment among the elderly patients need to be studied further. In some scenarios where there are altered organ functions, it is significant to consider supportive care and palliation as the best source of management for the elderly patients instead of sub-optimal curative treatment levels.

The geriatric oncologist has proposed a comprehensive Geriatric Assessment (CGA) Tool to determine which elderly cancer patients can accrue some benefits from treatment and which patients may get more benefits when placed under palliative care (Itano et al, 2016). This multidimensional tool includes an assessment of instrumental activities of daily living, physical functioning including daily living activities, cognitive performance, common conditions, nutritional status, psychological status, current medications review, social support, and the existence of geriatric syndromes (Itano et al, 2016).

Another nursing consideration is the functional status of the patient. As the age of the patient advances, it results in loss of physical function and this can result in disability. According to Extermann (2017), for those aged, between 65 to 74 years over 60% of that population have some disability, and often report some conditions that are disabling. Because of that, patients with few or no ADL limitations may be able to tolerate full treatment doses but should be having frequent monitoring identifying potential adverse events. However, Maione et al (2005) reported that global performance status, quality of life, and in prognosticators for the elderly patient survival. Among the elderly cancer patients, disability and losses in physical functions are associated with functional reserve losses, which, in the presence of chemotherapy, raises the likelihood of this elderly patient’s toxic side effects (Chernecky & Murphy-Ende, 2009).

The practice of oncology nurses in different settings include acute care hospitals, private oncologist offices, ambulatory care clinics, home healthcare agencies, radiation therapy facilities, and community agencies. They practice with other oncologic disciplines such as radiation oncology, surgical oncology, pediatric oncology, gynecologic oncology, and medical oncology. The roles of the oncology nurses vary from the focus of the intensive in the transplantation of the bone marrow to the focus of the community of cancer screening, prevention, and detection,n. Some of the roles include the following as discussed by (Chernecky & Murphy-Ende, 2009):

Patient assessment

The nurses are expected to be experts in conducting assessments on the patient’s emotional and physical status, health practices, past health history, and both the patient and its families’ knowledge of the disease and consequent treatment. The oncology nurses review the plan of treatment with the oncologist. moreover, they are aware of the outcomes that are expected and possible complications and assess the patient’s general emotional and physical status independently. An oncology nurse is also expected to be aware of the general complications and results of all relevant pathology, laboratory, and imaging studies. conducting an assessment on the patient’s understanding of the cancer disease and the treatment that is proposed is fundamental in formulating a plan of care and allaying any anxiety. the preparation of the patient improves compliance with the programs of treatment and may also impact the outcomes of the treatment as well (Itano et al, 2016)

Patient education

The nurses are better placed in developing the report required for effective educational efforts with the passions families as well as the patient. Family and patient education begins before therapy and progresses during and after therapy. Such educations include unstructured and structured educational experiences for helping the patients in coping with the diagnosis, symptoms, and long-term adjustments (Chernecky & Murphy-Ende, 2009; Itano et al, 2016).

Coordination of care

The oncology nurses also play a critical role in coordinating complex and multiple technologies currently employed in cancer diagnosis and treatment. This coordination entails direct care of the patient, medical record documentation, symptom management, participation in therapy, referrals organization to other health care providers, education of both the patient and the family, cancelling throughout the diagnosis and fill,ow-up therapy (Itano et al, 2016)

Direct patient care

The majority of the oncology nurse says provide direct care to the patient which involves chemotherapy. the nation Health and Medical Research Council (NHMRC), Cancer Australia, and Cancer Council Australia have developed guidelines to bring together evidence that is best available for underpinning scientifically valid recommendations for the diagnosis and prevention of cancer as well as treatment care for the patients (Australia, 2018). They provide written policies for certification for chemotherapy, antineoplastic drug administration in all routes, safe drug disposal and handling, management of reactions such as allergic reactions, and documentation methods. One of the important responsibility of the nurses that are involved in the chemotherapy delivery is to ensure that the correct health to ensure the safety of prescribed drugs. This paper discuss the recall of tetrazepam drug and dose are administered to the right patient by the correct route. The provided guidelines on how to ensure safer healthcare and to prevent medical errors (Chernecky & Murphy-Ende, 2009). Additionally, EdCan (2018) developed a module in collaboration with Cancer Australia with an object to develop nurse skills and knowledge to support care assessment, screening, and referral.

Symptom management

Daily, the oncology nurses are challenged to handle numerous symptoms from the patient suffering from cancer as well as their families as a result of the treatment. The nurses help in the symptoms evaluation as well as the initiation of interventions (Chernecky & Murphy-Ende, 2009). Antineoplastic agents are chemotherapy agents and are used in the treatment of metastatic cancers. EdCan (2018) indicated that the antineoplastic agents are classified according to their cycle activity or structure. Traditionally they are divided by their mechanism action or origin. The main groups include antimetabolites, alkylating and alkylating like agents, plant alkaloids, antitumor antibiotics, hormonal agents, and miscellaneous agents.

Conclusion

In summary, the paper explored the rationale and the goal of the treatment choice that was prescribed for patient Harold who is 75 years and was diagnosed with advanced non-small-cell lung cancer with metastasis of the spinal bone (stage IV). The arguments for the goals and rationale was on the prescribed treatment regimen of gemcitabine days 1, 8, and 15 repeated every 4 weeks and vinorelbine day 1 and 8 repeated every 3 weeks. The paper found out the treatment was based on the goal of the treatment, tumor, patient patient-related as well as treatment treatment-related The paper was identified one important nursing consideration throughout the active treatment phase and justified its selection. These included the assessment of the comorbid and geriatric conditions in guiding the treatment as well as the functional status of the patient. Some of the roles of the patient during active treatment the patient in include; Patient assessment, Patient education, coordination of care, directing the patient care, and management of symptoms.

References

Adjei, A. A. (2008). K-ras as a Target for Lung Cancer Therapy. Journal of Thoracic Oncology: Official Publication of the International Association for the Study of Lung Cancer, 3 (6), S160–S163.

Australia, C. (2018). Cancer.org.au. Retrieved 18 April 2018, from https://www.cancer.org.au/health-professionals/clinical-guidelines/lung-cancer.html

Azzoli, C. G., Baker, S., & Temin, S. (December 20, 2009). American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer. Journal of Clinical Oncology, 27, 36, 6251-6266.

Cancer Australia. (2018). Affected by cancer | Cancer Australia. Canceraustralia.gov.au. Retrieved 18 April 2018, from https://canceraustralia.gov.au/affected-cancer

Chernecky, C. C., & Murphy-Ende, K. (2009). Acute care oncology nursing.

Comella, P., Frasci, G., Carnicelli, P., Massidda, B., Buzzi, F., Filippelli, G., … Cioffi, R. (2004). Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients. British Journal of Cancer, 91 (3), 489–497.

EdCan. (2018). Cancer supportive care principles | can. Edcan.org.au. Retrieved 21 April 2018, from http://edcan.org.au/edcan-learning-resources/supporting-resources/supportive-care

EdCan. (2018). Classification of antineoplastic agents | EdCaN. Edcan.org.au. Retrieved 21 April 2018, from http://edcan.org.au/edcan-learning-resources/supporting-resources/antineoplastic-agents/classification

EdCan. (2018). Principles of treatment strategy to business models and onto tactics. Long range planning | EdCaN. Edcan.org.au. Retrieved 21 April 2018, from http://edcan.org.au/edcan-learning-resources/supporting-resources/cancer-treatment-planning/principles

Extermann, M. (August 30, 2017). Studies of Comprehensive Geriatric Assessment in Patients with Cancer. Cancer Control, 10, 6, 463-468.

Ferrell, B. R. . T., Jennifer S.; Temin, S. S., & J., T. (2017). Integration of Palliative Care into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Oncology Practice, 13(2), 119–121. Retrieved from http://ascopubs.org/doi/pdf/10.1200/JOP.2016.017897.

Frasci, G., Lorusso, V., Panza, N., Comella, P., Nicolella, G., Bianco, A., … De Lena, M. (2000). Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 18 (13), 2529–2536.

Gewanter, R. M., Rosenzweig, K. E., Chang, J. Y., Decker, R., Dubey, S., Kong, F.-M., … Movsas, B. (2010). ACR Appropriateness Criteria: nonsurgical treatment for non-small-cell lung cancer: good performance status/definitive intent. Current Problems in Cancer, 34 (3), 228–249.

Itano, J., Brant, J. M., Conde, F. A., & Saria, M. G. (2016). The core currThe corneum for oncology nursg.

Jonursingn, A. D. (1970). Pathology of metastatic tumors in bone. Clinical Orthopaedics and Related Research, 73 , 8–32.

Lim, K.-H., Lee, H.-Y., & Song, S.-Y. (2013). Efficacy and feasibility of gemcitabine and carboplatin as first-line chemotherapy in elderly patients with advanced non-small-small-cellcer. Chinese Medical Journal, 126(24), 4644–4648.

Lung Cancer. (2018). Lung Cancer 101 | Lungcancer.org. Lungcancer.org. Retrieved 20 April 2018, from https://www.lungcancer.org/fd_formation/publications/163-lung_cancer_101/265-what_is_lung_cancer

Maione, P., Perrone, F., Gallo, C., Manzione, L., Piantedosi, F., Barbera, S., Cigolari, S., … Cazzaniga, M. (January 01, 2005). Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 23, 28, 6865-72.

Mantovani, C., Novello, S., Ragona, R., Beltramo, G., Giglioli, F. R., & Ricardi, U. (2006). Chemo-radiotherapy in lung cancer: state of the art with focus on the elderly population. Annals of Oncology: Official Journal of the European Society for Medical Oncology / ESMO, 17 Suppl 2, ii61–ii63.

Meoni, G., Cecere, F. L., Lucherini, E., & Di, C. F. (July 01, 2013). Medical treatment of advanced non-small-small-cellcer in elderly patients: A review of the role of chemotherapy and targeted agents. Journal of Geriatric Oncology, 4, 3, 282-290.

Noone, H., & Garshell, K. (2010). SEER Cancer Statistics Review, 1975-2010 – Previous Version – SEER Cancer Statistics Review. Seer.cancer.gov. Retrieved 17 April 2018, from http://seer.cancer.gov/csr/1975_2010/

Owonikoko, T. K., Ragin, C. C., Belani, C. P., Oton, A. B., Gooding, W. E., Taioli, E., & Ramalingam, S. S. (2007). Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and results database. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 25 (35), 5570–5577.

Pereira, J. R., Cheng, R., Orlando, M., Kim, J.-H., & Barraclough, H. (December 01, 2013). Elderly Subset Analysis of Randomized Phase III Study Comparing Pemetrexed Plus Carboplatin with Docetaxel Plus Carboplatin as First-Line Treatment for Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer. income taxes and personal revenues. However, as much as the healthcare system in Canada is social and universal, the plan does not cater for Drugs in R&d, 13, 4, 289-296.

Ripamonti, C. I., Bandieri, E., & Roila, F. (2011). Management of cancer pain: ESMO Clinical Practice Guidelines. Annals of Oncology, 22(6), vi69-77. Retrieved from https://academic-oup-com.ezp.lib.unimelb.edu.au/annonc/article-pdf/22/suppl_6/vi69/759163/mdr390.pdf

Stein, K. D., Syrjala, K. L., & Andrykowski, M. A. (June 01, 2008). Physical and psychological long-term and late effects of cancer. Cancer, 112, 2577-2592.

Stinchcombe, T. E., & Socinski, M. A. (2009). Current Treatments for Advanced Stage Non-Small Cell Lung Cancer. Proceedings of the American Thoracic Society, 6 (2), 233–241.

Sugiura, H., Yamada, K., Sugiura, T., Hida, T., & Mitsudomi, T. (2008). Predictors of Survival in Patients With Bone Metastasis of Lung Cancer. Clinical Orthopaedics and Related Research, 466(3), 729.

Tomita, K., Kawahara, N., Kobayashi, T., Yoshida, A., Murakami, H., & Akamaru, T. (2001). Surgical Strategy for Spinal Metastases. Spine, 26 (3), 298–306.

Xu, C.-A., Chang, Z.-Y., Wang, X.-J., & Qi, H.-Y. (2013). Doublets versus single-agent therapy as first-line therapy for elderly patients with advanced non-small-cell lung cancer? A systematic review of randomized controlled trials. International Journal of Clinical Practice, 67 (11), 1118–1127.

Younes, R. N., Schutz, F. A. B., & Gross, J. L. (2010). Preoperative and pathological staging of NSCLC: a retrospective analysis of 291 cases. Revista Da Associacao Medica Brasileira, 56 (2), 237–241.

5/5 - (14 votes)

Herman Bailey

Advancements in Hydrologic Research and Sustainable Water Resource Management in Africa

by Herman Bailey | Jul 24, 2023 | Essays | 0 comments

Write the best suited topic of less than 60 characters for this essay, Then write H1 tag (different from the topic) and 5 most relevant keywords deliminated to be targeted for SEO. Then write a meta description of 160 characters for the article:

Spending the early years with my family in Nigeria, an African country rich in natural resources game me an opportunity of understanding how my country is rich. From my little village where I came from, the environment is green with tall trees, most of the locals practiced agriculture, there is wildlife, and plenty of water. However, this is no more as water resources are being deforested, rivers are running dry and the population of Nigeria is increasing rapidly.

I have an excellent academic track so far and I am expecting to improve on it given that I have identified my niche in “Sustainable Resource Management.” I am applying for a second Master’s degree because I would like to continue till my PhD in the field giving the evident need of Climate Conservation and I would like to take up a position in my country in address that need. However, my MBA is a 90 unit-credit which is not enough for applying for a Doctorate.

Preserving Biodiversity: Addressing Environmental Impacts

by Herman Bailey | Jul 24, 2023 | Essays | 0 comments

Introduction

Endangered species are defined as species that are facing the risk of going extinct. This is as a result of an abrupt reduction in its population or the loss of its habitat. Almost 99% of species that are threatened are so as a result of various human activities like deforestation of agricultural land. As early as the 21st century, it was noted that the biggest threat to biodiversity is human beings (Early et al., 2016). Recently, there has been a great reduction in the population of amphibians all over the world. They have been known for their global indication of environmental health. However, they have experienced the highest decline in population as compared to the rest of the population. Amphibians include frogs, newts, tadpoles, salamanders, and many more. The research that was done by the International Union for Conservation of Nature’s Red List process shows that these animals are really affected and they do not survive tough environmental conditions. Amphibians are very sensitive when it comes to environmental changes and are majorly at risk when it comes to the destruction of habitats, climate change, and pollution.

Conclusion

The environmental impacts are the major cause of plant and animal extinction. The effects it has been more than we human beings think. Something needs to be done faster and sooner before it is too late for everyone. We might not see it but if we are not careful our future generation will not have much of beautiful nature to enjoy. To reduce pollution, companies, and factories that manufacture products should find ways of recycling their wastes instead of realizing them directly to the environment. Releasing wastes directly into water bodies has diverse effects on aquatic plants and animals and if we are not very careful fish and other aquatic animals will no longer be there. We should be like plants and animals; plants make their own food which feeds herbivores who are then fed on by the carnivores and through excretion, they release their waste which when decomposes, assists new plants to grow. The environment needs to be taken care of by everyone so that we can have a beautiful nature and the health of everyone can be safe.

References

Corbera, E., Brown, K., & Adger, W. N. (2011). The equity and legitimacy of markets for ecosystem services. Development and Change, 38(4), 587-613.

Collins, J. P., Crump, M. L., & Lovejoy III, T. E. (2009). Extinction in our times: global amphibian decline. Oxford University Press.

Early, R., Bradley, B. A., Dukes, J. S., Lawler, J. J., Olden, J. D., Blumenthal, D. M., … & Sorte, C. J. (2016). Global threats from invasive alien species in the twenty-first century and national response capacities. Nature Communications, 7, 12485.

Newsome, D., Moore, S. A., & Dowling, R. K. (2012). Natural area tourism: Ecology, impacts, and management (Vol. 58). Channel view publications.

Pounds, J. A., Bustamante, M. R., Coloma, L. A., Consuegra, J. A., Fogden, M. P., Foster, P. N., … & Ron, S. R. (2011). Widespread amphibian extinctions from epidemic disease driven by global warming. Nature, 439(7073), 161.

5/5 - (11 votes)

Herman Bailey

Choosing the Right Project Manager: Essential Factors to Consider

by Herman Bailey | Jul 24, 2023 | Essays | 0 comments

Background Information:

XYZ Corporation is a leading global solutions provider with over 120,000 employees. XYZ provides services, systems, products and solutions within five business sectors consisting of aerospace systems, electronics systems, information systems, shipbuilding and technical services to both the U.S. government and commercial customers worldwide. The vision of the corporation is to become the leading provider of systems and technologies to their customers while establishing themselves as a top global defense and technology contractor.

XYZ divides its business units into sectors. These sectors consist of Aerospace Systems, Electronic Systems, Information Systems, Shipbuilding and Technical Services. The mission of the Aerospace Systems sector is to provide manned and unmanned aircraft, space technology systems, missile systems and advanced technologies to their customers. This sector contains projects valued at approximately billion dollars and is supported by a team of 24,000 employees. These employees develop and provide products including space satellites projects, space science projects, manned and unmanned aircraft systems, laser projects, and advanced technology projects for their customers.

The Aerospace Systems sector is organized in a project oriented environment that operates within a matrix organization to support the multiple projects that are concurrently in operation and within the various stages of the project life cycle. Each project requires a project manager and corresponding support staff to facilitate the technical, cost and schedule reporting requirements of each project.

Problem Statement:

Due to the absence of a formal project management selection program within the Aerospace Systems sector, there is an inconsistency in the quality of the developed skills and experience of the existing project managers currently assigned throughout the organization. This has contributed too many of the organization’s projects completing behind schedule and over budget which impacts the performance goals of the organization resulting in a loss of revenue for the company.

Evidence of the Problem:

Through conversations with various project team leaders and meetings and discussions held with some of the sector’s project managers over the past several months, issues emerged concerning the competence and abilities of the sectors project managers. Deficient characteristics and skills pertaining to project managers as expressed by employees from these discussions includes the selection process of the project managers, the communication skills of the project manager, and the lack of people and business skills pertained by current project managers.

Currently, only employees with engineering backgrounds can be considered for project managers. Within this pool of employees, new project managers are selected for the sector projects based upon their technical ability and on their prior job performance on previous projects. Also taken into consideration by the executive management is the employee’s ranking among the other employees within their classification. However, the employee ranking can tend to be subjective as the employee ratings are often biased towards manager’s favorites or personal relationships.

Also, by limiting the project manager selection to only those employees with engineering backgrounds, the organization is eliminating potentially very good project manager candidates from other areas of the business. This process reduces the overall growth and capabilities of the project management office. There are employees who are not part of the engineering discipline that have the technical aptitude and the ability to become project managers but will never be provided with the opportunity within the current system.

The current process has some limitations. Since project managers are selected based on their technical background within engineering, there are many assigned project managers who have not developed the necessary skills required to be a successful project manager. Some of the areas of concern that have occurred due to the absence of a formal project management selection process include:

Communication: Often, the project manager is very conscientious about communicating frequently with the customer to discuss the status and progress of the project. Unfortunately, many project managers forget to communicate regularly with the project team to keep them informed about any concerns and issues that the company and customer are focused on as they relate to the current phase of the project. These communication skills include oral, written and non-verbal. There was an issue a few years ago on one of our satellite programs where the customer and the project manager were discussing a new funding profile for the project for the next fiscal year. The project manager, though communicating with the customer, forgot to share this information with the project team. As a result, the project was slow to react to the new budget profile and was over target on the cost projections for the next fiscal year.
People: One of the strengths of a technically competent engineer is the ability to focus on acquiring solutions for/or solving a specific technical issue for the project. However, this focused attention can sometimes affect the engineer’s ability to work within the team environment and can interfere with the employee’s development of people skills. These include working with the team members to solve problems rather than working alone, the ability to actively listen to other team members, understanding and expressing your thoughts to the team, seeking advice and opinions from others, coaching other team members and learning how to identify and relate to each member of the team. We had a research and development project led by a new project manager who was a lead technical designer. This project was his first assignment as a project manager and it was evident from his first week on the job that he was overwhelmed. He had no idea how to talk to the team, what tasks to do first and how the work should get done. He managed the project team through anger and threats and operated a closed door policy for the team. His management style and direction led to team members withholding important project information to the project office that ultimately delayed the project completion date from the fear of how the project manager would react and treat the bearer of “bad news”.
Project Planning: Most project managers understand the need for a project schedule but few recognize the mechanics and value that the project schedule can provide. One of the areas of concern is the understanding and calculation of the project schedule’s total float or slack and the impact it has on the project’s critical path. One of our project managers did not understand the definition of “total float” nor had any knowledge of how it is applied to the project. Another project issue that affects the schedule is the project manager’s ability to control the volume of changes that occur during the project which often result in the restructuring and rescheduling of the project plan which could impact the project’s delivery. It is important to have a documented change control process for managing the changes that occur during the project’s life cycle.
Business Management: Some of the organization’s project managers do not fully comprehend the terminology and use of the earned value system. We had an engineering project that was led by a technical competent project manager. This project manager concealed his lack of business knowledge by saying he understood the financial data presented to him but he never questioned the validity of the data or what was behind the numbers. The completed project met the customers’ technical specifications but the project completed nearly a year behind schedule and vastly over budget. The ability of the project manager to understand the concepts and definitions of earned value management will better prepare them to access the team’s progress during each reporting period. Also, the project manager’s understanding of the earned value system will enable them to provide better insight on the project’s performance to the company and to the customer and will enhance the ability to access the impacts of any cost overruns that may have occurred on the project.
Subcontract Management: Many of the cost overruns that have occurred on previous projects in our company have been caused by the poor oversight of the project’s major subcontracts. This has created cost overruns on projects and schedule delays to key project deliverables. On a development contract for a new engine, the company issued a contract to a vendor to produce a critical piece of hardware for the project. The company, through the acceptance of the project manager, agreed with the cost, scope and schedule bid by the vendor. However, during the course of the project, the vendor suffered some delays in the manufacturing and assembly of the hardware resulting in a six month delay to the contract delivery. The project was unable to revise a plan to accommodate the hardware slip which resulted in the late delivery of the product to the customer. One factor contributing to the project’s late delivery was the project manager’s lack of subcontract management oversight of the vendor which could have provided early warning indicators that the vendor was having trouble.
Training: New project managers are assigned to projects without any training provided by the organization. All experiences are learned on the job and through consultation with other project managers. Many new project managers are over whelmed by the complexity, demands and responsibilities imposed by the project. Very few new project managers are able to complete their first assigned project and are either replaced or transferred to other projects or new proposals for the company.

Nature of the Problem of Leadership:

Leadership can be defined as the process where an individual attempts to influence a group of people to accomplish an objective or a set of goals while directing the group in a manner that makes them more cohesive as a unit. As one goal gets completed, additional goals are added thus creating a continuous process for the leader to manage. Leaders apply their knowledge, skills and personalities to this process. Leadership characteristics have been discussed and documented throughout history from Plato in Greece to Confucius in China. As early as 500 B.C., Confucius listed the virtues of effective leaders and identified four elements that were keys to his beliefs: Jen (love), Li (proper conduct), Xiao (piety) and Zhang rong (the doctrine of the mean). Notice that three of the virtues are emotional and only one (Li) is managerial. Confucius’s leadership theory has formed the basis of Chinese government for over 2,500 years (Turner; Muller, 2005).

Today, modern leadership discussions and principles share concepts from the ancient discussions. According to the U.S. Army, there are four major factors effecting leadership: Leaders, Followers, Communication and Situation. A leader must understand who they are they must have the confidence to trust in their ability to lead others. They must also recognize that the followers are the ones who will determine if the leader is deemed successful. If the followers lack confidence in their leaders it is unlikely they will be inspired to perform on the job. Thus, a leader should get to know each member of their staff and understand the factors that influence them. Since there are many different types of people, there are different management styles the leader must engage in order to reach each person. Also, leaders lead through communication. Often, the leader communicates through two-way, non verbal methods. The ability of the leader to communicate can affect their relationship with the team members. Lastly, the leader should understand that all situations are different and what worked in one scenario may not necessarily work in another. The leader must use their judgment and knowledge to determine the best course of action for each situation. There are various forces at work (senior management, the skill levels of the project team, functional staff managers and the project organization) that will affect the leadership of the project manager (U.S. Army, 1983).

In my experiences I’ve found that anyone can take and use power and act like a leader. However, it takes skill to use leadership. Leadership inspires others to help achieve a goal while power forces others to complete a goal. I’ve worked with many managers who have led through power. One was compelled to complete an assignment because you had to, not because you wanted to. The teams under this type of leadership were not cohesive and were not supportive of one another or of the team’s goals. Many people operated out of self preservation and were unwilling to support the other team members. Consequently, the project managers that led through power were not very successful and the project manager was often replaced before the project was completed.

Research on leadership as it relates to project management has implied that successful project managers have the ability to multi-task and navigate the many competing demands placed on them during the life of the project. These demands include events that can affect the past, present and future activities of the project. The ability of the project manager to visualize the relationships between past, present and future project events can be characterized as temporal skills. Temporal skills are time related skills to specific past, present and future events and are abilities required by leaders in order to perform specific tasks. Temporal skills are not found in leadership books because it is generally assumed they are possessed by all leaders. However, since each individual has a different temporal chemistry, not all project managers are equipped with these skills. Those who lack these skills may not be able to perform some of the leadership tasks effectively (Thoms, Pinto, 1999).

Successful project managers have the ability to look forward in the project and help to create the future instead of reacting to it. An important feature of project leadership to consider is that due to the nature of the job, project managers are required to operate in each of the three time-oriented (past, present and future) modes (Table 1). Project leaders need the past orientation to engage in problem solving and team member evaluations. And the project leaders use present time orientation to manage the parallel tasks occurring in the project while controlling the project schedule. Lastly, it is vital for the project manager to possess the future time orientation skills to develop and maintain the project vision while developing contingency plans for future unseen problems (Thoms, Pinto, 1999).

Nature of Project Manager Selection:

XYZ specializes in large, complex and often unique projects which are highly technical and often feature newly developed innovations, components and assemblies. These high profile projects require mature and experienced project managers. Unfortunately, very few of the company’s project managers possess the skill set and well-rounded experience required to mange these complex engineering, manufacturing and development projects. As a result, the project manager is often replaced during the life cycle of the project either at the request of the customer or by the company itself for failure to meet the project’s requirements or customer expectations.

Since the Project Manager has the responsibility for the project’s cost, schedule and technical performance, the selection of new project managers should not be based solely upon the qualifications and experience of an individual’s engineering technical experience. The company should also proactively take into consideration the individuals experience and performance in working and interfacing with the business, procurement, manufacturing and quality assurance teams. Also, the executive management should empower the Project Manager to take the initiative to perform any actions necessary to complete the project successfully. These actions include the authority to make design decisions during the development phase of the project, and the ability to control the requirements, budget, schedule, resources, and product quality of the project.

Characteristics of Good Project Managers:

Through the development and implementation of a formal project manager selection process, the company can promote more balanced and experienced employees as project managers. The company can also develop an approach to standardize and distribute company acceptable and proven processes derived by current project managers from previous projects to all future project managers for implementation and use on their project. This formal selection process will help to provide process commonality across all sector projects. Also, training modules in various subjects can be made available for new project managers to provide information and consultation on the important characteristics required by the project.

A study was conducted of American project managers to determine what characteristics make an effective project manager. Some of the effective characteristics of a project manager defined by the study include: leading by example, having a vision for the project, being technically competent, being a good communicator, being a good motivator, and supporting the project team members (Zimmerer; Yasin, 1998). The most important characteristic found in the study was the willingness of the project manager to lead by example, while focusing on the project’s goals and being committed to the project’s challenges prior to asking the project team members to agree to the same (Pinto, 2007).

Increased studies and research examining the traits and abilities associated with effective project leadership skills have changed the perspective of leadership. While technical and organizational skills are still regarded as important, the concept of emotional intelligence has been suggested as the more meaningful measurement of a leader’s effectiveness. Emotional intelligence can be defined as the leaders’ ability to understand the effectiveness of the emotional and relational interactions between a leader and their staff.

Five elements have been identified that characterize emotional intelligence; self-awareness, self-regulation, motivation, empathy, and social skill. A project manager who possesses these traits can develop relationships with the project team members that are critical to guiding an effective team. Self-awareness represents the understanding of one’s own strengths and weaknesses, ego needs, drives and motives. One who is self-aware has a clear perspective of one’s self and being self-aware does not imply that one is excessively self-centered or self-involved. Self-regulation refers to a leaders’ willingness to keep themselves under control. This includes thinking before acting. Effective leaders are those who have developed self-regulation techniques (ability to reflect upon events, responding after thoughtful consideration, and avoiding impulsive reactions). Effective leaders are often highly motivated people that are self driven to achieve their potential. These people recognize that in order for them to be successful, they need to work with the project team members to help them generate their maximum performance. Two common traits regarding motivation among effective leaders include the identification of clear markers to monitor and demonstrate progress and the consistent strive for greater challenges. Empathy relates to a leaders’ wiliness to consider the feelings of other team members while making informed decisions. Lastly, social skill refers to a leaders’ ability to manage relationships with others. Having a good social skill is more than being friendly; it is about “friendliness with a purpose”. Social skill is the ability to move people in a desired direction. Thus emotional intelligence is a concept that reflects an important point. Most of the critical project management skills that define effective leadership are not related to either technical skills or analytical ability. More importantly, a greater emphasis is placed on the self-management skills as reflected in emotional intelligence. It has been stated that “project management is first and foremost a people management challenge” (Goleman, 1998).

All newly selected project managers provide some levels of knowledge, skills and abilities they have acquired through their career. However, competencies within the various disciplines are the result of years of experience built up over time through on the job work experience and lessons learned. When someone switches from a project team position to a project manager position they are often faced with a sufficient amount of change. Their special technical qualifications decrease in importance and management skills, including interpersonal skills, become more critical (Strohmeier, 1992).

Competency Characteristics:

Common competency characteristics found among project managers include knowledge and skill. Knowledge includes the information an individual contains within a specific area or discipline and skill represents the ability to perform any required task. Knowledge and skill are competencies that are developed and assessed through training and experience. A competency model (Fig. 1) or an attribute based framework for project managers was developed to reconcile the performance based approaches to competency and to provide a means to identify and measure various aspects of competence against standards. The model acknowledges that competence can be inferred from attributes (including knowledge, skills, experience, personality traits, attitudes and behaviors). This is represented in the model by the input competencies knowledge, skill and core personality. The performance based competence input relies on the use of practices performed in the workplace (Crawford, 2005).

Competence can be defined as the combination of skills, abilities and knowledge applied to adequately perform a specific task. The competency model shown if Figure 1 contains attribute based and performance based inferences of competence. The attribute based competencies include knowledge, skills and core personality characteristics. The knowledge and skills boxes pertain to the knowledge, training, skills, experience and abilities that a project manager brings to the project and are identified as input competencies. The core personality characteristics box, identified as personal competencies, provides the human performance skills and represents the factors affecting the project manager’s capability to manage the project. The performance based competency is represented by the demonstrable performance box and relates to the technical skills possessed by the project manager to perform the project management duties and activities to the performance level required by the project. Demonstrable performance is identified as output competencies in the model. The input, personal and output competencies combine to define the competence of a project manager.

The competency model addresses the various aspects of competence (input, personal and output) that are discussed in literature and presented in project management standards. Measurements regarding competencies require identified standards from which one can measure against. As identified in the model, only knowledge and demonstrable performance have identified standards. These include the APM Body of Knowledge and the PMBOK for knowledge and the Australian National Competency Standards for Project Management and the United Kingdom’s National Vocational Qualification (NVQ) framework for demonstrable performance (Crawford, 2005).

Project Manager Human Skills:

Many of Northrop’s projects are classified as research and development contracts and contain areas of high technical complexity, high schedule and cost risk, high probabilities for unknown occurrences and a high degree of uncertainty. Project managers work with a large staff do get the work accomplished even though they have little management control them. A study conducted by Katz suggested that the effective programmatic skills required to be a successful project manager can be split into three developable skills. These are the human skill, the conceptual skill and the technical skill (El-Sabaa, 2001).

The Human Skill is used to define the project manager’s ability to work effectively as a group leader and to foster a cooperative work effort within the project team he leads. This skill can be demonstrated by observing the manner which the project manager perceives, recognizes and behaves toward the attitudes of his superiors, equals and subordinates. In effect, the human skill can be considered the people skill. It has identified that people management is an important skill for a project manager since much of the project manager’s time is spent communicating with different parties (Wateridge, 1997). A project manager who has highly developed human skill is one who is sensitive to the needs and motivations of the people within his project team and is skillful in communicating with others in their own context.

One of the human skills, interpersonal skill, can be defined as the feelings and behaviors that exist within an individual that affect and influence the interactions with others. Project managers are often challenged by the task of motivating others during difficult circumstances. The project team members maybe stressed, overworked, frustrated and overwhelmed by the steady flow of deadlines and changes that occur during the phases of the project. The project manager must rely on his interpersonal skill to inspire the project team to stay focused on the current project goals and expectations. The project manager must utilize his experience and have confidence in his own abilities and of the abilities of the project team to successfully complete the project (Jeffery, 1985).

Another important human skill for a project manager is the ability to maintain a positive attitude and optimistic outlook for the project team. Martin Seligman at the University of Pennsylvania has made a career of studying optimism and reasons that negative thinking in a work environment is a predictor of task failure. The belief that optimism can be learned creates an opportunity to provide training to project managers (Dolfi; Andrews, 2007). Many projects go through periods where budget constraints, technical problems, late supplier deliveries, resource shortages or compressed schedules have impacted the performance and attitude of the project team. The ability of the project manager to maintain a positive outlook and slant towards the given situation helps to lessen the added stress absorbed by the project team. However, the project manager should remember that being optimistic about a situation still requires some type of action rather than doing nothing.

Leadership Skills:

A learned human skill valuable to all project managers is leadership. Leadership abilities inherent or obtained through experiences are vital to the selection of the project manager. These leadership competencies should be factored into the selection and assignment of project managers. The selection board should select the candidate whose competencies best fits the type of project being assigned (Muller; Turner, 2009).

Important leadership skills include vision, communication, integrity and passion. Vision represents the ability of the project manager to visualize what he wants from the project and the projection of how to accomplish the near term goals of the project. The project manager must be able to convey the project view to the entire project team. The ability of the project manager to gain the involvement of the team members towards his vision is when the entire project team begins to operate as a unit. An effective project manger recognizes that decisions made without participation from top management can significantly affect the likelihood of their vision becoming reality (Morton, 1983).

Communication Skills:

Communication is probably the most important skill of a project manager. Since communication is an integral part of the leadership skills, the project manager loses his ability to lead without it. A project manager needs to communicate with various people at different levels and should be able to articulate and be concise, fair and able to be understood. They also need to be good listeners and to be able to read both verbal and nonverbal messages (Pettersen, 1991).

Good communication skills for project managers to learn include negotiation and persuasion techniques. These qualities help to provide openness and relativity for the project. The project manager is involved with many negotiations that occur throughout the project life cycle. Some situations that can arise which require the skills of the project manager include changes or issues to the project scope, cost or schedule; those involving the contract terms and conditions; or involving resource availability and utilization (Edum-Fotwe; McCaffer, 2000).

Also, a project manager must have integrity to be successful. The actions of the project manager set an example for the rest of the project team to follow. The project manager is responsible for setting the standards (ethically and morally) for the project team and must lead by example. The project manager should have the ability to apply communication skills relating to the understanding of emotions that can affect the project team. This ability is important in leadership contexts for knowing how and when to use it can help to stimulate the creativity, optimism and excitement among the project team (Clarke, 2009).

Lastly, a project manager needs to have a passion for the job. A project manager without passion is one that lacks dedication. The project manager has to be passionate about the project and he should be enthusiastic about it and possess a positive attitude. Only by portraying these traits will the project team follow and respect the decisions of the project manager. It is important for the project manager to remember that not all project team members contributing to the project share a common objective for the project and some may believe the project manager is not engaged in the day-to-day problems (Wearne, 2008). A project manager without passion will lose the trust and respect of the project team. The project manager needs to engage in the project and present a feeling of commitment and optimism to the project team. Kendra and Taplin state that ‘‘for organizations to be successful with the adoption of project management, they need to establish a shared set of values and beliefs (a project management culture) that aligns with the social and technical aspects of project management to achieve the organization’s business objectives” (Thomas; Mengal, 2008).

According to Katz, an effective administrator must develop his own personal point of view toward human activity, so that he would: (a) recognize the feelings and sentiments which he brings into a situation; (b) have an attitude about his own experiences which will enable him to re-evaluate and learn from them; (c) develop ability in understanding what others, by their actions and words (explicitly or implicitly), are trying to communicate to him; and (d) develop ability in successfully communicating his ideas and attitudes to others (El-Sabaa, 2001).

Research has identified and/or described the importance of communication by a project manager to their project team, including discussions relating to the project goals and the monitoring and feedback of the project data. Also, the results of research studies confirmed the overall value of communication in managing projects. Pinto also found that project performance on task outcomes, budget, schedule, level of performance, and likelihood of usage by clients, improves with project managers who actively communicate with team members (Henderson, 2004).

Project Manager Conceptual Skills:

The conceptual skill can be defined as the project manager’s ability to obtain a global perspective on the entire project. It includes the recognition by the project manager of how the various functions and pieces of the project depend upon one another and how changes in any one section could affect all of the other areas of the project. Thus, the conceptual skill can be referred to as the organizational skill. The conceptual skill also contains the visualization of the relationship between the project and the goals and objectives defined by the company. Project leadership encompasses the ability to manage a team. Skills in managing relationships are critical for the project manager to achieve stakeholder satisfaction for all phases of the project (Pant; Baroudi, 2006).

Another important conceptual skill for a project manager to have concerns the ability to think logically. Logical thinking is a leaned skill. There are many situations for a project manager where the ability to think logically is an important asset. Logical thinking is the ability to think in terms of causes and effects. This implies that logical thinking is sequential thinking and therefore means following a train of thought. It is based on the analysis and interpretation of a set of events and then predicting what will happen if the same conditions or events continue to occur. This skill enables the project manager to proactively respond to potential problems before they can impact the project and plan for contingencies to help mitigate their impact if the problems are realized.

Project Manager Organizational Skills:

One of the organizational skills that is important for a project manager to understand and recognize relates to the needs and perceptions of the project stakeholders. The stakeholders play an important role in the success of the project. The communication plan developed by the project manager needs to include the expectations and perceptions of the project’s stakeholders. Unfortunately, stakeholder perceptions of project management are based on prior experience with other projects, other project managers and different organizations. There is a general understanding for the need and importance for the project manager to possess a good communication skill. The communication skill is used to gain agreements from all stakeholders on the project success criteria and to establish effective communication channels between the project manager, organization and the customer (Stevenson; Starkweather, 2009). Therefore, the project manager should develop a communication plan that relies on open communication channels, reminds the stakeholders that this not the old project but a new and different project with a different set of requirements and to provide accurate and timely information to the stakeholders that meet their expectations and needs.

Project Manager Business and Technical Skills:

The technical skill implies that the project manager has an understanding and proficiency in a specific area involving methods, processes, procedures or techniques. To be successful, the project manager should possess the knowledge and experience required by the project they are to be managing. The technical skill involves the knowledge and experience in the use of the required tools and techniques of a specific discipline including engineering, business, planning and management.

Business skills include accounting, finance, budgeting, forecasting and contracts. Since the project manager is ultimately responsible for the development, control and management of the project’s budgets and cost estimates, the project manager should possess some basic knowledge of finance and accounting principles, forecasting techniques and contract management.

It is common for project managers to work within compressed timelines, adhere to locked delivery dates, work with tight schedule margins, manage multiple resources across the organization and meet the project deliverables on time and within budget. As a result, planning is often acknowledged as the most important activity for the project manager to get engaged with. In order to meet the needs, requirements and customer expectations of the project, the project manager should possess some experience in the use and applications of schedule management.

The duties of the project manager are vast and all project managers must be able to simultaneously manage the project’s work scope, budget, schedule and resources in support of the project requirements and the needs of the customer. The project manager should have the technical skills required as the project team leader to provide solutions to the difficult issues and technical problems that will occur during the project. It is therefore recommended that the project manager is diligent in building a project staff that best compliments his own skills and expertise to mange for project success. A project manager should try to create an “atmosphere conducive to achievement”. In other words, create an environment where the project team can successfully perform the work (Lynne Thomas; Buckle-Henning, 2007).

Project Manager Selection – Bibliography

Anderson, S.D. (1992), “Project quality and project managers.” International Journal of Project Management, 138-144.

Clarke, N. (2009), “The impact of a training programme designed to target the emotional intelligence abilities of project managers.” International Journal of Project Management, doi:10.1016/j.ijproman.2009.08.004.

Crawford, L. (2005) “Senior management perceptions of project management competence.” International Journal of Project Management, 23, 7-16.

Dolfi, J. and Andrews, E.J. (2007) “The subliminal characteristics of project managers: An exploratory study of optimism overcoming challenge in the project management work environment.” International Journal of Project Management, 25, 674-682.

Edum-Fotwe, F.T. and McCaffer, R. (2000), “Developing project management competency: perspectives from the construction industry.” International Journal of Project Management, 18, 111-124.

El-Sabaa, S. (2001), “The Skills and career path of an effective project manager.” International Journal of Project Management, 19, 1-7.

Eskerod, P. (2010), “Action learning for further developing project management competencies: A case study from an engineering consultancy company.” International Journal of Project Management, 28, 352-360.

Goleman, D. (1998) “What Makes a Leader?” Harvard Business Review, 76 (6), 92-102.

Henderson, L.S. (2004), “Encoding and decoding communication competencies in project management – an exploratory study.” International Journal of Project Management, 22, 469-476.

Jeffery, P. (1985), “Project managers and major projects.” International Journal of Project Management, Vol. 3, No. 4.

Morton, G.H.A. (1983), “Become a project champion.” International Journal of Project Management, Vol. 1, No. 4.

Muller, R. and Turner, R. (2009), “Leadership competency profiles of successful project managers.” International Journal of Project Management, doi:10.1016/j-ijproman.2009.09.003.

Pant, I. and Baroudi, B. (2008), “Project management education: The human skills imperative.” International Journal of Project Management, 26, 124-128.

Pettersen, N. (1991), “What do we know about the effective project manager?” International Journal of Project Management, Vol. 9, No 2.

Pinto, J.K. (2007), Project Management: Achieving Competitive Advantage. Leadership and the Project Manager, (Page 123-125).

Stevenson, D.H. and Starkweather, J.A. (2009), “PM critical competency index: IT execs prefer soft skills.” International Journal of Project Management, doi:10.1016/j-ijproman.2009.11.008.

Strohmeier, S. (1992), “Development of interpersonal skills for senior project managers.” International Journal of Project Management, Vol. 10, No.1.

Thomas, J. and Mengel, T. (2008), “Preparing project managers to deal with complexity – Advanced project management education.” International Journal of Project Management, 26, 304-315.

Thomas, J.L. and Buckle-Henning, P. (2007), “Dancing in the white spaces: Exploring gendered assumptions in successful project managers’ discourse about their work.” International Journal of Project Management, 25, 552-559.

Thoms, P. and Pinto, J.K. (1999), “Project Leadership: A Question of Timing.” Project Management Institute, Vol. 30, No. 1, 19-26.

Turner, R.J. and Muller, R. (2005), “The Project Manager’s Leadership Style as a Success Factor on Projects: A Literature Review.” Project Management Journal, 36,2.

U.S. Army. (1983), Military Leadership. Washington, DC: U.S. Government Printing Office, (FM 22-100).

Wateridge, J. (1977), “Training for IS/IT project managers: a way forward.” International Journal of Project Management, Vol. 15, No.5, 283-288.

Wearne, S. (2008), “Stakeholders in excellence in teaching and learning of project management.” International Journal of Project Management, 26, 326-328.

Zeynep, I., Arditi, D., Dikmen, I. and Birgonul, M.T. (2009), “Impact of corporate strengths/weaknesses on project management competencies.” International Journal of Project Management, 27, 629-637.

Zimmerer, T.W. and Yasin, M.M. (1998), “A leadership profile of American project managers.” Project Management Journal, 29 (1), 31-38.

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