Dietary Diversity And Nutrition Status Health And Social Care Essay

Dietary Diversity And Nutrition Status Health And Social Care Essay Low birthweight (LBW) is defined as a body weight at birth less than 2500grams. Its main causes include prematurity (born before 37 weeks gestation) in developed countries and Intrauterine Growth Retardation IUGR (restrained foetal growth) in developing countries (ACN/SCN, 2000). Relationship between health of mother and child has also been established, maternal nutritional and health status is an important determinant of childs health and nutritional outcome. LBW infants end up undernourished and stunted children, adolescents and finally women of childbearing age. The main indicators of LBW infants include maternal stunting, low pre-pregnancy weight and low pregnancy weight gain. Thus generational stunting continues (Victoria et al, 2008). Households vary in definition and composition, especially in Africa. Households here in Africa mostly includes the extended family members both in definition and composition. This serves as social support network here and so adds income into the household if the members are economically active or if economically inactive, increases dependency ratio in the household. Mother and child pair nutritional status reflects household dynamics, availability of food, care of mother and child. It can also reflect gender segregation in household food allocation etc. The state of food insecurity 2001 defines Food security [as] a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life (SOFI, 2002). Its three building pillars include availability, accessibility and stability of food. Availability entails physical presence of food in the household or area concerned; accessibility is concerned with the ability to acquire adequate amount of food and stability means constancy of food access which can be chronic or transitory. Chronic food insecurity exists when food supplies are persistently insufficient to supply adequate nutrients for all individuals. Transitory food insecurity occurs in the presence of temporary decline in access to adequate food because of instability in food production, food prices or income shortfalls. It is also necessary that available food meet the nutritional needs o f the household members, bringing in the component of food utilization. Resource poor subsistence farmers, landless households, pastoral household, female-headed household and urban poor are more vulnerable to food crisis (UN millennium project, 2005; FEWSNET, 2011). During the study period, coastal state of the Bayelsa, delta, Rivers and some portions of Jigawa in Northeast will experience moderate food insecurity. The coastal states will be affected by Niger-Delta crisis and potential pre-election tension. Pipeline vandalization, will continue to contribute to local water pollution, creating fish shortages among others. Flooding in the Northeast state of Jigawa will reduce household stock (Millet) causing food insecurity, with low cereal prices, above-average increase in tuber production. The Convention on Biological Diversity (CBD) defines biodiversity as the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems. In other words, it is the variety of life on earth at all levels, from genes to worldwide populations of the same species. The different Levels of biodiversity include ecosystem containing rich biodiversity, species and communities of species and different genotypes, and this includes agricultural biodiversity. All components of agricultural biodiversity relevant to food and agriculture and support the ecosystem that agriculture occurs is important (FAO, 2008). Thus, dietary diversity becomes important as a means of protecting the ecosystem. Dietary diversity can be defined as the number of different foods or food groups consumed over a given reference period, usually 1-2 week. Dietary diversity has been shown to improve nutritional status (Kant et al, 2000; Kiokia and Golden, 2004; Gibson et al, 2000). Thus, it also can aid in combating hidden hunger, and thus double burden. Dietary diversity is a reflection of household food security because depicts accessibility, availability of foods and to some extent stability. Hoddinott and Yohannes analysis of evidence from 10 countries links dietary diversity to household access of calorie and by extension food security (2002). Traditional food systems abound, and are currently going extinct because they are underutilized. The diet is shifting more towards an energy-dense based diet categorized by westernized and processed food, bringing with it the advent of non-communicable diseases like diabetes, coronary heart disease etc. Nutrition education aims to persuade individuals to make meaningful changes in their dietary behaviour. Studies have noted the importance and role in nutrition status and adequacy (Favin and Griffiths, 1999; Tarvinder et al, 2007; Mansour et al, 1994). In view of that, importance of nutrition education cannot be overemphasized in this scope, especially as traditional foods are available in its varieties but less consumed/sought-after. It becomes imperative that nutritional content and thus importance of these foods are once again extolled so that they can be consumed for optimum health. Biologically active substances have been found in traditional foods and functional foods include flavonoids etc. Information technology has opened lots of doors for education and knowledge in the world, which can be harnessed for promotion of nutrition education. Information technology used in education includes access devices, networking and communicating technologies, storage devices and e-learning platform (India policy brief, 2010). They pose great potential for acquiring knowledge especially at the subjects comfort. Phones have been used for teacher training with positive results among other things, MMS examples of teaching, audio lectures, SMS for reminders, motivational messages and short assessment questions etc. were used (ADB/Pouezevara and Khan, 2007). STATEMENT OF PROBLEM There is a dearth of information on the relationship between dietary diversity and nutrition status in Nigeria. There is also little information on shift of food consumption from traditional to processed western foods together with a gap in the quantification of the effect of nutrition education in enhancing dietary diversity. OBJECTIVES GOAL Optimize nutrition status of mother and child through dietary diversity and nutrition education SPECIFIC OBJECTIVES To identify the available foods in the surrounding/environment/locality and determine the neglected and underutilized local foods/species To identify the prevalence of malnutrition of mother and child To assess the dietary diversity in the food consumed by the mother-child and factors affecting it. To Investigate association between dietary diversity and nutritional status To ascertain the influence of nutrition education on nutritional status of mother and child. JUSTIFICATION Prevalence of malnutrition in Nigeria is currently high, especially in Under-Five. Currently, 41% of under-fives are stunted, 23% underweight and 14% wasted (NDHS, 2008). High Under-Five Mortality Rate propels continuous childbearing and with is accompanied maternal mortality due to nutrient depletion (El-Ghannam, 2005). Improved maternal health importantly pre-pregnancy status is vital for adequate growth and development of new foetus and to break intergenerational disease and poverty that can arise from poor health status during the first 1000 days (ACC/SCN, 1992). Lack of adequate nutrition education has led to improper feeding techniques of growing child, especially the under-fives. Traditional food systems are gradually becoming extinct and non-existent. The bulk of foods consumed are shifting base to western-influenced and processed foods (Bioversity International, 2006). High incidence of NCDS in developing countries and increase of double burden has been linked to monopoly in consumption of food and lack of dietary diversity. At the beginning of the 1960s, about 40% of the developing countries were chronically undernourished. Many developing countries have achieved 2700kcals. This high energy combined with an increasingly sedentary lifestyle has led to an increase in obesity and NCDS. The composition of the diet change to mainly high energy and fat etc. (Josef and Prakash, 2004). METHODOLOGY ANALYSIS OF OBJECTIVES Objective Variable Type of analysis To identify the available foods in the surrounding/environment/locality and determine the neglected and underutilized local foods/species Foods from Market survey, FGD and KII vs foods from DD Questionnaire To identify the prevalence of malnutrition of mother and child BMI, stunting, wasting and underweight To assess the dietary diversity of mother and child DDS of mother and child Computation To Investigate association between dietary diversity and nutritional status DDS and BMI/nutritional status indices Cross-tabulation To determine factors affecting dietary diversity DDS and socio-demographic, economic and household factors Cross-tabulation To ascertain the influence of nutrition education on dietary diversity DDS before and after nutrition education Paired T-test STUDY DESIGN The study will be a cross-sectional and descriptive study. STUDY LOCATION The study will be conducted in Anambra state. Anambra state is located in the south-east zone of Nigeria, with its state capital being Awka. On a longitude of 6 20 00N and latitude of 7 00 00E, the state has 21 Local Government areas. It has a land area of 4,416km2 and a population of 4,177,848, made of 2,117,984 males and 2,059,844 females (NPC, 2006). With a population of 473,248, Children Under -five account for about 11.35% of the Anambra state population. Onitsha North and South, Awka North and South and Nnewi North and South are all urban area in the state. Idemili, Oyi, Anaocha, Ogabru and Dunkofia are peri-urban, while the remaining Local governments are rural. With a population size of 369,972 (NPC, 2006), Aguata LGA is the 2nd largest LGA in terms of size and the largest LGA in terms of number of constituting communities 15 communities. The local government has the presence of a prison in Ekwulobia and the renowned Igbo-ukwu museum that houses artefacts and monuments from pre-colonial era. Like all other LGA in Anambra state, Aguata has its own share of ecological disasters, the most prominent being the Ekwulobia Oko erosion site. Other small-sized erosion sites abound in different communities in the LGA. The Staple food consumed here is mostly cassava and yam, eaten as fufu, garri, abacha etc. green leafy vegetables and fruits are also abundantly found. The planting season, marks the beginning of the annual year (Igu aro), and peaks during the harvest season. Map of Anambra State The study will be conducted in Uga, a town in Aguata LGA of Anambra state, in South East Nigeria. With a landmass of about 3790km2, it also has about 100,000 inhabitants. Uga shares its borders with Akokwa, Nkpologwu, Amesi, Umuchu and Ezinifite. The town is made of 4 villages namely Oka, Umueze, Umuoru and Awalasi. These villages have different clan, an average of 6 clans per villages. They include Oka, made up of Okwuowerre, Umuikpa, Umueziama, Amaeke, Okohia and Umucheke. Umueze is made of Umucheke, Ezihe, Umu-umeonye, Umudim and Umuonyike. Umoru village is made of Imishii, Umudieleke, Umuezekpoko and Umori. Awalasi village is made of Umunocha, Umuchiaku, Umuakabo, Umudim, Umuosu, Okwu, Agbako and Umuoweri. The community Uga, has 2 streams/waterbodies, namely, Obizi and Agwazi. While the former is potable and serves as a tourist site, its a taboo to fetch from the latter or visit. The population is predominantly Igbos with few settlers from other tribes. Almost every household has some form of garden or subsistence/small-scale farming; most of the food/fruits available in the market come from subsistence farming. Land tenure is mainly through inheritance and few by purchase. STUDY POPULATION Mothers with under-5 children in the study community. SAMPLE SIZE For the main study, all mothers with their youngest under-5 children in the town will be used. For the Key Informant Interview, The oldest individual in each clan will be used. A total of 24 subjects will be interviewed For the focus Group discussions, each group will have a minimum of 6 and maximum of 8 members in each of the 4 villages, comprising of both sexes. SAMPLING PROCEDURE A three-stage sampling technique will be used to select respondents/mother-child pair for the questionnaire survey. Firstly, Anambra state, will be purposively selected because food systems are eroded with language, an indicator of culture. The Igbo culture is the fastest eroding culture among all the 3 major tribes in Nigeria. Legend also has Anambra State as the origin of Igbo people in the South-Eastern part of Nigeria. Secondly, Aguata LGA with its headquarters at Ekwulobia will be purposively selected because in the local government, urban and rural communities are found. Its headquarters, Ekwulobia, serves as the entry point to numerous communities and Local Government. Its proximity to Federal Polytechnic, Oko and Federal College of Education (Technical), Umunze, makes it a key point and central access area. While the headquarters remains urban, the surrounding communities, the study area- Uga included are still rural. It will be strategic to study the effects of the spills of urban development in the dietary practice of these rural communities. Thirdly using a table of random numbers, Uga was chosen as the study area and all villages in Uga town will be used for the study. SAMPLE SELECTION SELECTION OF QUESTIONNAIRE RESPONDENTS All the women living in the community with a child under-five years of age who consent to participate will be included in the study. Already participating women will also be asked for referrals of other mother-child pair. SELECTION OF FOCUS GROUP DISCUSSION Using the help of research assistants, through non-probability sampling, 6-8 males and females aged 60 and above will be selected from each village and used for the focus group discussion. SELECTION OF KEY INFORMANT INTERVIEW the oldest person in each clan/village irrespective of gender will be used in Key Informant Interview. The individuals must be mentally acute despite disabilities/ infamy. MEASUREMENT INSTRUMENT Food/Market Survey Questionnaire Focus Group discussion guide Key informant interview guide FAOs 16-item Individual Dietary Diversity Questionnaire for mothers and children aged 36-59 months Demographic Health Surveys 21-item Dietary Diversity Questionnaire for children Under 36 months Socio-demographic characteristics questionnaire for the mother. USIAD/FAOs 3-item Household Hunger Scale Food Frequency Questionnaire VARIABLES Socio-demographic characteristics Mothers DDS before the intervention Childs DDS before the intervention Mothers DDS after the intervention Childs DDS after the intervention HFIAS Score Nutritional status of child Nutritional status of mother Family dynamics and household characteristics Food Variety Score (FVS) Pattern of consumption COMMUNITY ENTRY Entry will be done through the different religious bodies (Christianity and traditional) and the community leaders. The community leaders include Uga Town Union, the Igwe and his council and also the individual village unions. They will be acquainted with the different objectives of the study and its advantages for the community members. They will also be requested to disseminate the information to the community members to get their cooperation. DATA COLLECTION Quantitative questionnaires will be used to collect baseline information from the communities. The questionnaires will be administered by twenty four (24) fieldworkers (research assistants). The research assistants will be selected one from each clan with at least a secondary school education. All of them will speak English and the local Igbo dialect of the community fluently. The research assistants will be carefully trained by the researcher. The study objectives, methods and questionnaires will be discussed with special emphasis on interpretation of result, Dietary Diversity Score (DDS) and nutritional status. Proficiency of the research assistants will be verified through role play and pre-testing. The research assistant will be supervised by the lead researcher through field monitoring to check quality. The Key Informant Interview (KII) and Focus Group Discussions will be conducted by the lead researcher and a note taker using the KII and FGD guides. The interview will be recorded, with the permission of the subjects. BASELINE As a means of assessing the current situation, baseline information of the study communities will be conducted. For this phase of the study a short food identification questionnaire, Appendix A will be used to document all foods encountered in the native nearby Igbo markets. Any new food and fruit type (species) or variety will be photographed with a digital camera and information about it will be gathered. Information to be gathered include trade name, local name, name of market sold, source of food/fruit, type of buyers, season when available and (recipe). Scientific and family name will be added following correct identification through books, internet and knowledgeable people in relevant departments of the University of Ibadan. All food items encountered will be classified into food groups. Since dietary diversity involves biodiversity food of plant and animal origin, aquatic and forest resources also found will be documented. MARKET SURVEY The market survey will be conducted on the 4 native Igbo market days Eke, Orie, Afor and Nkwo. Each communitys market operates on a given market day, example, Orie for Uga community, Nkwo for Umuchu community etc. A market survey of proximal markets to the study area will also be conducted. They include Orie-Uga, Nkwo-Uchu and Eke-Ekwulobia. These 3 markets fall on different Igbo market days (Orie, Nkwo, Eke), leaving out only one market day, Afor. Focus Group Discussions (FGD) and key-informant interviews (KII) will be carried out for foods not sold in the market, but consumed in the community. FOCUS GROUP DISCUSSION Focus groups discussions will be facilitated in (different churches) each village to be used in the study by the lead researcher with a note-taker present. The use of FGD guide Appendix B will be employed and also a camcorder for recording and camera for photographs. Each FGD will have a minimum of 6 members and a maximum of 8 members. The purpose of the FGD is to learn about foods that are underutilised in the environment. The discussion will be conducted in native Igbo language dialect of the community. KEY INFORMANT INTERVIEWS The KII guide Appendix C will be used to conduct the KII. Respondents will be asked foods, farming systems and varieties of foods that are currently underutilised. They will also be asked about the source, harvest season, recipe of those foods and use. The interview will be conducted in the native Igbo language dialect. ANTHROPOMETRIC MEASUREMENTS Baseline anthropometric measurements will be taken of the mother (BMI) and child (Stunting, Wasting and Underweight). For the weights, electronic scales will be used. CHILDREN For children 0 to 23 months, their weights will be taken using the children weighing scale. Children 24 to 59 months and all mothers will be weighed using the electronic scale, after they have emptied their bladder. All weights will be measured to the nearest 0.1kg. For all weight measurements, the balance will be placed on a level hard surface and adjusted to zero balance before measurement. The subject will stand in the centre of the scale and looking straight. Light clothing will be advised in the absence of nudity. For the heights, children and infants less than 85cm will have recumbent length measured using a wooden measuring board (WHO, 1995). The infants heels will touch against the footboard, shoulders touching the baseboard and the crown of head touching headboard. Stadiometer will be used for children longer than 85cm. The subject will stand straight, looking ahead with the head, shoulder blades, buttocks and heels touching the plane. For weight-for-age and height-for-age, exact date of birth will be used. WHO Anthro v3.2.2 will be used to calculate weight-for-age, height-for-age and weight-for-height. The WHO standard Z-scores will be used. MOTHERS Body Mass Index (BMI) also called Quetelets Index calculated as weight (kg)/height (m2) will be used to assess the nutritional status of the mothers. The weights will be measured using the electronic scale, after they have emptied their bladder with the scale on a hard surface and adjusted to zero balance. The mothers heights will be measured with a Stadiometer. The subject will stand straight, looking ahead with the head, shoulder blades, buttocks and heels touching the plane. The classification of mothers BMI will be according to WHOs recommendation (2000) as shown below Classification BMI (kg/m2) Underweight Normal range 18.50 24.99 Overweight >= 25.00 Pre-obese 25.00 29.99 Obese I 30.00 34.99 Obese II 35.00 39.99 Obese III >= 40.00 HOUSEHOLD HUNGER SCALE (HHS) Food Insecurity Score (FIS) will be found using the Household Food Insecurity Access Scale (HFIAS), Appendix G. The HFIAS is 9-item access and frequency-of-occurrence instrument developed by USAID and FAO, with a recall of 4 weeks/30 days/1 month. The general occurrence questions cover domains that include anxiety about household food supply, variety and preferences of type of food and insufficient food intake and physical consequences. If the access question occurs, then the frequency of the domain question is asked and coded as often, sometimes and rarely. The maximum HFIAS for a household is 27, i.e., a situation where frequency of occurrence of all questions is often (3) and the least HFIAS is (0). The higher the HFIAS, the higher the food insecurity; the lesser the HFIAS, the lesser the food insecurity. DIETARY DIVERSITY Dietary diversity of mother and child will be assessed. The interview will be conducted on an Eke day, which is not preceded by a weekend. This is necessary as Eke day precedes an Orie day, which is the market day and dietary habits are synonymous with festive day. Also, Eke day is the only day without a proximal market to the community. MOTHER The 16-item FAOs Dietary Diversity Questionnaire, Appendix D will be used from which Individual Dietary Diversity Score (IDDS) for the mothers will be calculated. The food groups include cereals, vitamin A rich vegetables and tubers, white tubers and roots, dark green vegetables, other vegetable, vitamin A rich fruits, other fruits, organ meat(iron-rich), flesh meats, eggs, fish, legumes, nuts and seeds, milk and milk products, oils and fat, sweets and coffee/tea. To calculate Individual dietary diversity score (IDDS), the last two items sweets and coffee/tea are left out, while the others items each has a point. The mean IDDS, percentage consuming each food group and terciles as a measure of distribution of scores will be calculated. The Food Frequency Questionnaire (FFQ), Appendix H, will be used to calculate the Food Variety Score (FVS) and the consumption patterns of the mothers. Different varieties of food will be listed and scored. Their consumption will be noted as never, once a month, more than once a month, once a week, more than once a week, everyday and more than once everyday. CHILDREN For children more than 3 years, as with the mothers, FAOs 16-item individual dietary diversity questionnaire, Appendix D will be used, for foods eaten in the last 24 hour. The food groups include cereals, vitamin A rich vegetables and tubers, white tubers and roots, dark green vegetables, other vegetable, vitamin A rich fruits, other fruits, organ meat(iron-rich), flesh meats, eggs, fish, legumes, nuts and seeds, milk and milk products, oils and fat, sweets and coffee/tea. To calculate Individual dietary diversity score (IDDS), the last two items sweets and coffee/tea are left out, while the others items each has a point. The 21-item dietary diversity questionnaire, Appendix E, used in Demographic Health Surveys (DHS) will be used for children less than 3 years. The items on the questionnaire range from water, breastmilk, infant formula, green leafy vegetables, organ meats, fish etc. The IDDS will be calculated over 21 items. The mean IDDS, percentage consuming each food group and terciles as a measure of distribution of scores will be calculated. SOCIO DEMOGRAPHY Socio-demographic characteristics of the household will be collected, using Appendix F. Demographic characteristics of the mother will include Education, Age at marriage, current age, Childs date of birth, marital status, parity, religion. Economic information will include job, monthly earning, Access to farm, livestock ownership, food access market or farm production. Household details will also be collected, and they include type of household nuclear or extended, number of dependents in the family, number of household members, source of income and total household income. CLASSIFICATION OF UNDERUTILIZED SPECIES Underutilized and neglected food species and groups will be identified from the Dietary Diversity Questionnaire in comparison with the market research earlier carried out. MAPPING The map of the town Uga, will be digitized, using the nutritional status and dietary diversity. This will help monitor trends in nutritional status and DDS. DATA PROCESSING Data entry, computation and analysis will be done with SPSS v 17. Quality will be ensured through quality checks associated with data entry processes, double entry and further data cleaning through generation of descriptive analysis after data entry. DATA ANALYSIS Characteristics of the sample average mothers age, average childs age, mothers education, parity, occupation of mother, average household income, average DDS. Prevalence of malnutrition will also be assessed, stunting, wasting and underweight of the children and BMI of the mother. This will be done through Frequency distributions for qualitative variables and descriptive analysis for quantitative variable. DDS and nutritional status of mother (BMI) through cross-tabulation DDS and nutritional status of child (Stunting, wasting and underweight) through cross-tabulation with each indices. HFIAS and nutritional status of mother HFIAS and nutritional status of child Nutritional status of mother and nutritional status of child through cross-tabulation of mothers status with each individual nutritional index. Effect of socio-demographic, household characteristics and economic differentials on DDS and anthropometric measurements. A model for interactions of quantitative will be generated linear and logistic regression, the MIXED procedure for quantitative response variables (BMI and DDS) and the GLIMMIX procedure for dichotomous response variables. INTERVENTION Nutrition Education will be conducted in different ways to enhance the consumption of underutilised foods. Underutilized food/fruits/species that has been thus categorised will be promoted through nutrition education. A food/fruit/specie will be said to be underutilized if it is readily available in the environment but its consumption is low. Firstly, food and nutrient information of underutilized foods will be sent to the phones of mothers as a daily SMS in the native Igbo dialect for 30 days. A single food/fruit will be highlighted each day, including the different ways in which it can be consumed. Recipes will also be included, to enable the mothers attempt otherwise new foods. Using mass media e.g. posters, handbills and stickers, general awareness will be created on the underutilised foods in the town. The posters and stickers will be distributed on the towns market day Oye-Uga and at the different religious places in the town. Copies will also be made available to the participating women. Face -to -face nutrition discussion will be held for mothers in the clan with the lowest Dietary Diversity Score that correlates with low nutritional status of the Mother-Child pair. It will be held in the village hall, assessable to everybody. The discussion will seek to bring to the fore the underutilized food in the community, and the different recipes for preparation of the foods. ENDLINE/EVALUATION The IDDS of both mother child pair will be assessed again to calculate the post-intervention practise. This will help ascertain if the intervention impacted knowledge to the mother as evidenced by the post-intervention IDDS. ETHICAL CONSIDERATION Ethical clearance will be sort from the Health Ethical Review Committee (HREC) of the University College Hospital (UCH) Ibadan. EXPECTED OUTCOME It is expected that at the end of the study, adequate knowledge on importance of dietary diversity will be garnered by the mothers and visible in their feeding practice, of both themselves and their children. TIMELINE FOR THE STUDY Week 1 2 3 4 5 6 7 8 9 10 11 12 Activity/Month Month 1 Month 2 Month 3 Community Entry Recruitment of Research Assistants and Training Market Survey Key Informant Interview Focus Group Discussion Administration of Questionnaire Analysis of Baseline Data Intervention Collection of Endline Data Analysis of Endline Data BUDGET

Case Study Analysis on an Organisation Essay

Organisational change is something that occurs throughout an organisation’s life cycle and effects the entire organisation rather than one part of it. Employing a new person is one example. Change is increasing due to a number of forces including globalisation led by rapidly advancing technologies, cultural diversity, environmental resources and the economy; therefore the ability to recognise the need for change as well as implement change strategies effectively, in a proactive response to internal and external pressures is essential to organisational performance. Internal changes can include organisational structure, process and HR requirements and external changes involve government legislation, competitor movements and customer demand (Wood et al, 2010). Change does not need to be a painful process, as it may seem when observing the amount of failed change management initiatives with reports as low as 10% of researched success rates (Oakland & Tanner, 2007), when successful change management strategies are utilised and planned, including effective communication strategies, operational alignment, readiness to change and implementation, which all lower and overcome resistance (Wood et al, 2010). There is a great amount of literature on the negative aspects and difficult management with employees resisting change, however Wood et al (2010) challenge this notion by questioning the change management process as people do not resist change itself but aspects of the change that affects them personally such as fear of the unknown, status, remuneration and comfort. Resistance to these changes is a healthy reaction and can be managed effectively in the beginning by ensuring communication and using one of the change initiatives described here. Background Information Truelocal is based in Sydney, with small sales branches in Brisbane and Melbourne. It employs over 150 staff, an increase of approximately 50% over the past two years. It was founded in 2005 by NDM as part of an expanding operation of online websites to provide across the board consumer services, including news and magazine websites; online sport and weather information; and shopping comparison search engine, web-based recruitment, and travel search engine solutions [http://www. ewsdigitalmedia. com. au, accessed 25/08/2010]. As the world shifted into what is often referred to as the ‘digital info age’, consumer demand for online media as a way to source information significantly increased and demand for printed media decreased putting pressure on newspaper companies to expand to producing news and information online in digital format. This included News Corporation which decreased its newspaper operations and increased its digital expansion. As an employee at Truelocal for over six years, I have acquired this information presented here through interviews with management, company information and my own observations internally within the organisation’s sales department working in the roles of sales executive, account manager and senior retention account manager. The Need for Change – Management & Structure Truelocal needed to align its culture, values and structure with the parent company in order to meet strategic growth goals not long after it was founded. Wood et al (2010) describe the work of an author, Noel Tichey on managing strategic change. Experts use three fundamental sets of change in their approach; technical design, political allocation and culture/ideological mix problems. It is one of these problems that become a pressing issue at any one time of which then initiates the change. In Truelocal’s case there were a number of changes evolving and at this time it was culture problems. NDM has been growing in size since its establishment in 2006 with a number of acquired website operations, each operating as a separate business unit with the support of HR, Finance, IT, Commercial Operations and other support services provided by the parent company (NDM). A decision was made to align the organisation in terms of operations, culture and strategy so it could concentrate on innovation and performance to achieve its goal of becoming the number one provider of online information in Australia. As a result NDM redesigned its organisational structure as Truelocal and most of the other business units merged together in one location. Not long after this relocation, Truelocal began flattening out the company structure lead by a new management team and CEO. It has since been under constant change to achieve it’s goal to continue growth (both in number of staff and performance) and excel as a high performing and innovative company with an agenda of being the second largest online directory service in Australia after it’s competitor Sensis (Yellow pages online). Wood et al (2010) explain the performance gap is a desire to move from one less desired state to another. This can be seen by the increased performance after the change occurred and culture change was implemented. What changed Fundamental changes that occurred were a shift from the existing vertical, bureaucratic structure to a horizontal structure and change in specialist functioning of divisions creating a professional, corporate environmental culture that was customer focused. The existing culture was a casual attitude towards dress requirements, starting and finishing times, breaks, informal communication expression and channels and many staff were employed as friends of existing staff rather than based on competency and job skills. Some managers had their partners working for them and a few were family members. There didn’t appear to be any dress code and people came and left work at varying times. Additionally management employed more skilled staff, retrained existing staff and created processes of which procedures were then put in place. One of the ways these objectives were achieved was by the reduction of management layers resulting in more direct reporting. Wood et al (2010) explain as organisational size increases, the more interconnections and less direct communication between people takes place (Wood et al, 2010). Change Process When management at Truelocal uplifted existing management and reporting structures, staffs were initially left without direction, reporting channels, processes and goals were not clearly communicated causing a lot of uncertainty. Consequently many staff resigned as they felt upset and confused about what was happening. Truelocal however, retained some of the more experienced staff with new career development propositions and new managers were encouraging and open about future improvements that were to take place within the organisation. One of the ways Truelocal could have managed this change is by using the Freeze/Unfreeze concept; Wood et al (2010) explains Kurt Lewin, a famous organisational Psychologist’s three-force phase, which is needed for any organisation to be motivated to bring about the change of which are; 1) Unfreezing focuses on preparing people for change. This is a critical part of the change phase prior to implementation by analysing and influencing resistance and need to change. A common tool that is used at this stage is called Force Field Analysis, this measures these forces. ) Changing of people; tasks; structure; technology. Ideally the organisation will be completely unfrozen, ready for change and its goals made clear. It is recommended that staff are not perceived to have a sense of high or low security at this stage in order to avoid resistance. 3) Refreezing is the evaluation and reinforcement of the changes that took place. The new managers were recruited by Truelocal for their exp erience in organisational transformation within the type of professional, high performing, corporate environment the organisation desired and who worked at their competitor company. These managers were expected to manage the entire change process themselves. Change agents are people or groups who take responsibility for the change of behaviours and existing patterns in a supportive manner (Wood et al, 2010). The perceived risks however, are the responsibility of the organisation’s leader who decides on the direction of the change (Oakland & Tanner, 2007). Planned changes that took place were; Structure – change in organisational design by reporting systems, operational processes and size of teams, while roles were redefined by definition, job title and remuneration. Tasks – Most jobs were redesigned including more responsibility for staff in management roles and multi functional tasks for other staff. One of these job designs is called job enrichment, which is the increase and deepening of motivating factors built into a job (Wood et al, 2010). Some of these enrichments used by new management were increased responsibility and accountability, less control and more freedom in the job and more recognition. People – improvement of recruitment and selection process by advertising formal job vacancies on the organization’s intranet and incentives for staff to nominate candidates who were then formally interviewed by a number of managers. Additionally training sessions for new staff, coaching and certification courses were made available. Carless (2005) describes her research on the compatibility of job-person-organisation-environment fit. She believes a person must assess their attributes and personality with the job and organisational characteristics, which is likely to improve job satisfaction and adjustment to the environment. Culture – organisational values and beliefs were communicated from the parent company of which staff was rewarded when their behaviour displayed these values. Recognition was given in addition at meetings and performance appraisals. This is the observable culture, however as Wood et al (2010) explain, shared meanings and stories are other powerful aspects of culture and this can be observed at Truelocal by the high turnover of staff by both stories and norms that communicate the need to work hard to perform in the job or leave. Cultural symbols include trophies for ‘employee of the month’ awarded to the highest performer. These symbols serve to transmit cultural meaning (Wood et al, 2010). In the sales department a large subculture can be observed. Wood et al (2010) explain strong subcultures are often found in high performance task forces where people share similar values and backgrounds. This subculture included men between the ages of 22-30 yrs that have no formal education, drink alcohol excessively, and are passionate about technology, highly materialistic and view women as sex objects, which can often be observed by their language and behaviour. Moreover this culture is likely to be influenced by the national culture of which the organisation is embedded (Wood et al, 2010). In fact this subculture existed in the old culture before the restructure of which the company held ‘diversity training’ focused on discrimination and fairness within the workplace resulting in terminations. According to The Economist (2008), in the economic downturn companies need ‘Generation Y’ as hungry 25-35 year olds without commitment, for marketing and product innovation with emerging technologies, able to put in the time and energy to help them deal with recession hazards, especially in sales. Strategy – operations and planning were clarified at monthly and quarterly meetings including product changes. These were addressed by department managers regularly and CEO meetings irregularly, to engage staff. Wood et al (2010) explain leadership has changed from the traditional trait and behaviour approaches to transformational, charismatic, visionary focus and is separate from management. The leadership team at Truelocal formally includes the CEO and parent company (NDM) leaders. Their leadership function can be observed by their language and behaviours they use a transformational and visionary change approach. Objectives – specific performance targets were set allowing staff to earn a higher commission by overachieving set targets, recognition and prizes to increase motivation consistently. Purpose – both the CEO and the parent company made organisational goals clearly communicated vision and clarified progress regularly. Recognition was given for the contribution of each department and each business unit to the overall success of the organisation. These changes were managed by senior staff using a combination of change strategy approaches as explained by Wood et al (2010) that include a forced approach of top down command, one way communication, coercive reward and punishment approach, rationalisation approach and shared decision making, empowered approach. Of these approaches no single approach was concluded best by researchers on organisational change and it is advised that more commonly a combination will occur, however guidelines are offered to change agents and managers (Wood et al, 2010); – consider use of expert consultants – communicate the need for change feedback from employees – avoid changing for the sake of change – study organisational change and structures From this perspective Truelocal management took the right approach by varying the way they managed the change. Change Results The facilitation of clearer and faster communication channels enabled staff to work more efficiently and g et things done faster, along with improved technology. Further benefits of this structure were people collaborating in teams, using initiative and increased spontaneous communication while rules, procedures and close supervision were reduced as described in (Tushman, Anderson & O’Reilly, 1997). Wood et al (2010) describe the matrix structure is common in large organisations wanting to improve customer responsiveness. Truelocal’s reporting structure utilised this organisational design as part of the change, for example the finance manager reports to the CEO of Truelocal and to the Commercial Director of NDM, however Wood et al (2010) note each organisation’s structure is unique and there is no single observed design. This change is described by Wood et al (2010) as radical. Radical changes are fundamental reorientations and transformational, often initiated by the arrival of a new CEO. Culture & Performance Change Since the change occurred, Truelocal’s sales department recorded a growth rate of 15% per full time employee (FTE). Some strategies used were; – Performance appraisal review (PAR) – staff are asked to grade themselves on their performance and their use of company values of which are discussed by their managers. For example one of the values is ‘Impact’ and an employee is asked how much impact they contributed to the organisation since the last performance review and they are required to give examples of this behaviour. These PARs are held quarterly and annually. Reward and remuneration – staff are given targets according to their job level and experience with incentives to over achieve. These targets are called Key Performance Indicators (KPIs). The person’s job is broken into task components of which each component consists of a target behaviour that is rewarded. Remuneration is based on the overall percent age of KPI achievement. – Recognition – employee of the month award was created by encouraging staff to use an online submission for their preferred co-worker who had gone over and above their job requirement displaying one of the company values. In addition the company awards the sales department with the person with the highest dollar value in sales and yearly a larger reward of which one year was a new car. Similarly a newsletter recognises new sales people who achieve early in their job. All of these reinforcements are called extrinsic which are rewards given to someone by another person’s valued outcome and because they are environmentally impactful are valued in influencing behaviour through the law of effect (Wood et al, 2010). Cultural change can take years according to Wood et al (2010); however effective cultural change strategies can be used to shorten the timeframe. One of which is explained by Oakland & Tanner (2007), it is important to align the culture to support the desired change in behaviour. For example Truelocal needed a professional, customer focused culture which required staff to develop professional skills and behaviour. The result was all departments undertook a full training programme designed to increase awareness in communication, with a focus on questioning and empathy. Conclusion Truelocal is a young company and part of the larger and still relatively new parent organisation, NDM, operating under the global News Corporation. The industry it operates in, digital media is one of the fastest growing and changing environments globally. It changed from a structure and culture of casual, unprofessional work practices managed within a more bureaucratic structure that was under performing to a transformational, high performing, innovative and professional culture that is customer focused. Truelocal achieved its goal of growth, productivity and change in culture, however many staff were lost in the process and not much planning appeared to be in place. It is unclear as to the lack of planning, communication or use of external consultant in the case of radical change that occurred. One assumption might be due to budgetary restrictions as the company has been running at a loss since it started, reporting a loss this year of over one hundred million. Apart from the successful change management strategies that were used by the change agents, in particular the motivational strategies used by nominated change managers, numerous other approaches were identified that may benefit the organisation for managing future changes more effectively. Reference List Carless, S. A. (2005). Person-job fit versus person-organisation fit as predictors of organisational attraction and job acceptance intentions: a longitudinal study. Journal of Occupational and Organisational Psychology. 78 (3), 411-429. Generation Y goes to work (2008, December 30). The Economist (US). Retrieved from http://www. economist. com/business/displaystory. cfm? story_id=12863573 Oakland, J. S. , & Tanner, S. (2007). Successful change management. Total Quality Management, 18 (1-2), 1-19. Tushman, M. L. , Anderson, P. C. & O’Reilly, C. (1997). Technology cycles, innovation streams and ambidextrous organisations: organisaiton renewal through innovation streams and strategic change. Managing strategic innovation and change. Oxford University Press, NY. 2-23. Wood, J, Zeffane, R. , Fromholtz M. , Wiesner R. , Creed A. , Schermerhorn J. , Hunt J. , & Osborn R. , (2010). Organisational Behaviour, Core concepts & applications. 2nd Ed. John Wiley & Sons, Australia, Ltd. Milton Qld.

Bachelor of Science nurses (BSN) vs Associate degree nurses (ADN) Essay

More and more workplaces are requiring their employees to have a baccalaureate degree. Is there really a difference in the level of care a patient will receive from nurse with an associate’s degree of Nursing versus a Bachelor of Science degree in nursing? According to many studies and research they say there is a difference between the two. â€Å"In the baccalaureate nursing practice incorporates the roles of assessing, critical thinking, communicating, providing care, teaching, and leading. The caring professional approach includes the values of autonomy, altruism, human dignity integrity, and social justice with unconditional regard for all people (Grand Canyon Philosophy, 2011).† â€Å"Currently, data suggests that approximately 50% of the nursing staff on a given unit are Bachelor of Science nurses (BSNs). The other 50% of the staff may be composed of associate degree nurses (ADNs) with less academic training with more or less professional experience in caring for complex or critical patients in today’s environment (Sexton, 2008).† BSNs are a better-rounded individual. BSN programs include more science based classes and liberal arts, whereas the ADN programs have a basic science background and more focused on the skills and clinical portion of nursing. Many nurse leaders recommend BSN training for entry into practice because studies indicate better patient outcomes, better nurse satisfaction, and greater longevity in the workplace for BSNs as compared with their colleagues with less academic training (differentiating workplace). There have been studies completed that compare the mortality rate of patients that were taken care of by nurses with their ADN versus BSN. According to the fact sheet Creating a More Highly Qualified Nursing Workforce they found that â€Å"a 10-point increase in the percentage of nurses holding a BSN within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients (Creating a More Highly Qualified Workforce, 2103).† All nurses sit for the same N-CLEX-RN licensing examination. â€Å"New nurses pass the licensing exam at the same rate does not mean all nurses are prepared equally for practice (Creating a More Highly Qualified Workforce,  2103).† The N-CLEX exam just tests for the minimum knowledge one needs to become a registered nurse. ADNs and BSNs have the same skill level but BSNs I believe have better critical thinking skills, which in turn cause them to be better at problem solving in a patient care situation. At my current job I was trying to think of some situations where it would be better to have my BSN and where it would improve patient care. I work for an ophthalmologist at an eye surgery center. Our patient population can range from kids to the elderly. We take care of the elderly more so than any other age range. We do surgery once a week, mostly cataract surgery. Other procedures are performed but not as frequently as the cataracts. I work as a pre-op nurse mostly but occasionally will do post-op or work in the operating room. On the days I’m not working in surgery I work in creating quality improvement studies, benchmarking, infection control, and do things with risk management. I have been doing this job for two and half years now. Prior to this job I was a floor nurse that worked in rehab with patients that had just got out of the hospital that weren’t quite ready to go home. My friend told me that she knew a job opening that she thought would be good for me, which is the job I have now. This job was something I had never done or knew nothing about. It was a job that I said I would never want to do. I always wanted to be a nurse because of the patient care aspect and helping patients when they were at their worst helping them to get better. If I had my BSN this would make me better at my job. I have to put together quality improvement studies. I was never been taught anything about quality improvement while in school for my ADN. I have had to learn as I go. Another thing I have to do is write up incident reports. From those incident reports I have to look for trends. If there are trends I have to write up a plan or start a study to keep other patients from experiencing the same situations that put them at risk, which promotes better patient care. If I had my BSN I would have learned about all this and would be able to better care for the patients. Right now I don’t understand why I have to do all that I do and how it makes me take better care of the patients. Having my BSN would allow me to understand this and let me know why we do this. There are many advantages in having a BSN versus an ADN. It makes sense why most workplaces are requiring a bachelor’s degree now a days. It makes the nursing working in the field better-rounded and better able to take care of their patients in all aspects. References Carroll, C. A., Cox, K. S., Hunt, C. E., Sexton, K. A., & Teasley, S. L. (2008). Differentiating the Workplace Needs of Nurses by Academic Preperation and Years in Nursing. Jouranl of Professional Nursing, 28, 105-108. Doi:10.1016/j.profnurs..2007.06.021 Fact Sheet: Creating a M Highly Qualified Nursing Workforce. (2013). Retrieved from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf Grand Canyon University College of Nursing Philosophy. (2011). Retrieved from https://lc-ugrad1.gcu.edu/learningPlatform/content/content.html?operation=viewContent&contentId=68ec9ae6-1809-49f7-886b-a80e82621fcf

Defining Omitted Variables Bias

Omitted variables bias (or sometimes omitted variable bias) is a standard expression for the bias that appears in an estimate of a parameter if the regression run does not have the appropriate form and data for other parameters. For example, many regressions that have wage or income as the dependent variable suffer from omitted variables bias because there is often no practical way to add in a workers innate ability or motivation as an explanatory variable. As a result, the estimated coefficients on variables such as education as likely to be biased because of the correlation between educational attainment and unobserved ability. If the correlation between education and unobserved ability is positive, omitted variables bias will occur in an upward direction. Conversely, if the correlation between an explanatory variable and an unobserved relevant variable is negative, omitted variables bias will occur in a downward direction.