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Chapter 7: Transcultural Perspectives in the Nursing Care of Adults Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2016 Wolters Kluwer • All Rights Reserved 1 Cultural Influences on Adulthood #1 Developmental tasks are transitions that occur in a normal successful adulthood. A health/illness situational crisis refers to changes or turmoil as individuals struggle to cope with a sudden life-threatening illness. Transitions: health or illness events that require an individual to make modifications in his/her lifestyle Copyright © 2016 Wolters Kluwer • All Rights Reserved 2 Cultural Influences on Adulthood #2 Physiologic development Hormonal changes Menopause, loss of sexual potency Psychosocial development Stages of life Divorce, remarriage, career changes Copyright © 2016 Wolters Kluwer • All Rights Reserved Cultural Influences on Adulthood #3 Each culture has specific chronologic standards for appropriate adult behavior. Social age: Culture defines what is considered an appropriate behavior in each stage of the life cycle. Young adult (teens, 20s, 30s): independence, role changes Middle adult (40s, 50s): career, family matters Copyright © 2016 Wolters Kluwer • All Rights Reserved 4 Question #1 Is the following statement true or false? Midlife adulthood is often a time of stress, dissatisfaction, and unrest. Copyright © 2016 Wolters Kluwer • All Rights Reserved 5 Answer to Question #1 False Rationale: Adulthood is not always a tumultuous, crisis-oriented state; many middle aged persons welcome the space, time, and independence that middle age often brings. Midlife can be a time of challenge, enjoyment, and satisfaction for many persons. Copyright © 2016 Wolters Kluwer • All Rights Reserved 6 Cultural Influences on Adulthood #4 Developmental tasks; responses to life situations encountered by all persons experiencing: Physiologic Psychological Spiritual Sociologic changes Erikson’s generativity versus stagnation Copyright © 2016 Wolters Kluwer • All Rights Reserved Cultural Influences on Adulthood #5 Adult life transitions influenced by culture: Career success Social and civic responsibility Marriage and raising children Changing roles and relationships Copyright © 2016 Wolters Kluwer • All Rights Reserved Question #2 Which of the following would not be considered a social and/or civic responsibility? Serving on the board of a women’s shelter Donating blood Attending religious ceremonies Volunteering at a food bank Copyright © 2016 Wolters Kluwer • All Rights Reserved Answer to Question #2 C. Attending religious ceremonies Rationale: Social and civic duties include participation in those activities in adulthood that contribute to the “good of society.” Some cultures emphasize activities and contributions within the cultural group. For example, in some groups, religious obligations are given priority over civic responsibilities. Cop.

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Hormonal changes
Menopause, loss of sexual potency
Psychosocial development
Stages of life
Divorce, remarriage, career changes
Copyright © 2016 Wolters Kluwer • All Rights Reserved
Cultural Influences on Adulthood #3
Each culture has specific chronologic standards for appropriate
adult behavior.
Social age: Culture defines what is considered an appropriate
behavior in each stage of the life cycle.
Young adult (teens, 20s, 30s): independence, role changes
Middle adult (40s, 50s): career, family matters
Copyright © 2016 Wolters Kluwer • All Rights Reserved
4
Question #1
Is the following statement true or false?
Midlife adulthood is often a time of stress, dissatisfaction, and
unrest.
Copyright © 2016 Wolters Kluwer • All Rights Reserved

5
Answer to Question #1
False
Rationale: Adulthood is not always a tumultuous, crisis-oriented
state; many middle aged persons welcome the space, time, and
independence that middle age often brings. Midlife can be a
time of challenge, enjoyment, and satisfaction for many
persons.
Copyright © 2016 Wolters Kluwer • All Rights Reserved
6
Cultural Influences on Adulthood #4
Developmental tasks; responses to life situations encountered
by all persons experiencing:
Physiologic
Psychological
Spiritual
Sociologic changes
Erikson’s generativity versus stagnation
Copyright © 2016 Wolters Kluwer • All Rights Reserved
Cultural Influences on Adulthood #5
Adult life transitions influenced by culture:
Career success
Social and civic responsibility

Marriage and raising children
Changing roles and relationships
Copyright © 2016 Wolters Kluwer • All Rights Reserved
Question #2
Which of the following would not be considered a social and/or
civic responsibility?
Serving on the board of a women’s shelter
Donating blood
Attending religious ceremonies
Volunteering at a food bank
Copyright © 2016 Wolters Kluwer • All Rights Reserved
Answer to Question #2
C. Attending religious ceremonies
Rationale: Social and civic duties include participation in those
activities in adulthood that contribute to the “good of society.”
Some cultures emphasize activities and contributions within the
cultural group. For example, in some groups, religious
obligations are given priority over civic responsibilities.
Copyright © 2016 Wolters Kluwer • All Rights Reserved
Health-Related Situational Crises #1
Situational transitions often occur when a serious illness is
diagnosed or other traumatic events occur to individuals and

their families.
Caregiving occurs when an unpaid person, usually a family
member, helps another family member who has a chronic illness
or disease.
Culture and ethnicity can influence beliefs, attitudes, and
perceptions related to caregiving.
Copyright © 2016 Wolters Kluwer • All Rights Reserved
11
Health-Related Situational Crises #2
HIV/AIDS and the African American Community
considerations:
Prevention challenges
Influential factors
Poverty
Denial
Drug use
Homophobia/concealment of behavior
Copyright © 2016 Wolters Kluwer • All Rights Reserved
Health-Related Situational Crises #3
Culturally competent nursing care
Health promotion strategies and nursing interventions for
African American women:
“Stroke belt”
“High blood”
“Nerves”

Copyright © 2016 Wolters Kluwer • All Rights Reserved
13
Question #3
Is the following statement true or false?
“High blood” is a term frequently used by the African American
culture in the rural South to identify the condition referred to by
the medical term hypertension.
Copyright © 2016 Wolters Kluwer • All Rights Reserved
14
Answer to Question #3
False
Rationale: “High blood” is an illness condition that is
associated with African American culture in the rural South.
Many health care professionals make the wrong assumption that
“high blood” is the same as high blood pressure or
hypertension; although there are similarities, the cultural
explanation of “high blood” is different from the biomedical
explanation of high blood pressure or hypertension.
Copyright © 2016 Wolters Kluwer • All Rights Reserved

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This website stores cookies on your computer. These cookies are used to collect information about how you interact with our website and allow us to remember you. We use this information in order to improve and customize your browsing experience and for analytics and metrics about our visitors both on this website and other media. To find out more about the cookies we use, see our Privacy Policy. If you decline, your information won’t be tracked when you visit this website. A single cookie will be used in your browser to remember your preference not to be tracked.AcceptDecline Chapter 15: Nursing and Global Health Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2016 Wolters Kluwer • All Rights Reserved 1 Introduction to Global Health #1 Global health: the challenges to and opportunities for health and well-being that transcend national borders, have broad socioeconomic and political impact, and are best addressed by coordinated, multinational efforts. Regardless of where nurses work, global health issues will have an impact on their work to some degree. Example: 2014 Ebola outbreak Copyright © 2016 Wolters Kluwer • All Rights Reserved 2 Introduction to Global Health #2 Lack of Human Resources for Health Globally Three major processes contribute to the shortage of health care workers, including nurses: insufficient supply inadequate distribution migration Copyright © 2016 Wolters Kluwer • All Rights Reserved Introduction to Global Health #3 International nurses working in global health will frequently encounter local complementary and integrative health and traditional remedies, including Traditional Birth Attendants (TBAs): a person whose cultural role it is to attend to women before, during, or after childbirth Traditional Healers: community members who are recognized for their ability to use physical, spiritual, and/or herbal modalities to treat illness Copyright © 2016 Wolters Kluwer • All Rights Reserved Question #1 Is the following statement true or false? Utilizing Traditional Birth Attendants in communities optimizes better outcomes for mother and child. Copyright © 2016 Wolters Kluwer • All Rights Reserved Answer to Question #1 False Rationale: Maternal and neonatal mortality is higher when the only birth attendant is a TBA. Historically, this has been due to a lack of sterile or clean technique or a lack of knowledge regarding prevention of common childbirth complications. Global health nurses often train TBAs in evidence-based maternity care in order to reduce maternal and neonatal mortality. Copyright © 2016 Wolters Kluwer • All Rights Reserved Introduction to Global Health #4 There are large disparities in health and well-being at the global level, which result from complex political and economic processes. Over the past 50 years, significant efforts have been made to improve the well-being of people living in low-income countries. Maternal and child heal ...

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Chapter 12: Cultural Diversity in the Health Care Workforce Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2016 Wolters Kluwer • All Rights Reserved 1 Diversity in the Nursing Workforce #1 Workplace diversity is the collective, all-inclusive mixture of human differences and similarities that provides an organization with a large pool of people with knowledge, skills, and abilities required for the accomplishment of organizational goals and objectives. Creating a more diverse health care workforce has value for the people being served and the health care organization from the perspective of its employees and leaders. Copyright © 2016 Wolters Kluwer • All Rights Reserved 2 Diversity in the Nursing Workforce #2 Nursing has become increasingly diverse in age, gender, race, ethnicity, national origin, and educational preparation. Nurses from minority backgrounds account for 19% of the RN workforce. Men represent 9.6% of the nursing workforce. Men in nursing attain higher wages and faster promotions than do women. Currently employed RNs are nearing or have exceeded retirement age, fewer RNs between 36 and 45 years old. Copyright © 2016 Wolters Kluwer • All Rights Reserved 3 Nursing is in the midst of a period of substantive transformation that is influenced by the following three trends: 1. An aging population of Baby Boomers who are now experiencing manifestations of the aging process and retirement from the health care and other workforces 2. Passage of the Affordable Care Act (ACA) of 2010 that provides health insurance to millions of people in the United States who previously were uninsured 3. Increased educational preparation for nurses Diversity in the Nursing Workforce #3 Copyright © 2016 Wolters Kluwer • All Rights Reserved 4 Diversity in the Nursing Workforce #4 Barriers to diversity include: Inadequate K-12 education systems for students from minority and economically disadvantaged populations Insufficient financial aid Faculty shortages Societal stereotypes Negative attitudes and behaviors in the workplace Copyright © 2016 Wolters Kluwer • All Rights Reserved Diversity in the Nursing Workforce #5 Strategies to increase diversity: Increase the number of underrepresented minorities in the health professions pipeline. Corporate culture: Shared values, beliefs, meaning, and understanding are components of the corporate culture. Organizational climate usually measures perceptions or feelings about the organization or work environment. Copyright © 2016 Wolters Kluwer • All Rights Reserved 6 Diversity in the Nursing Workforce #6 Strategies to increase diversity (cont.): Diversity management: systematic and planned commitment by organizations to recruit, retain, reward, and promote a heterogeneous mix of employees Organizational inclusion: degree to which individuals feel they are part of critical organizational processes by work group involvement, abi.

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Chapter 8 Religion and the Restoration of Health in Africa: A Case Study of the Traditional Akan People of Ghana Samuel Awuah-Nyamekye Introduction Sound health, no doubt, is the soul of every human society, for no human society can thrive if her people are afflicted with ill-health. For this reason, the Akan of Ghana prioritise matters that border on sound health. But among the Akan as is the case in traditional African societies, the line between their secular and religious activities is indistinguishable (Parrinder, 1961; Mbiti, 1969; Opoku, 1978.) This makes the hold of religion on the Akan and, for that matter,traditional Africans, very strong. In the worldview of the traditional Akan2 of Ghana, apote or apomuden (health or well-being) is not only understood as the absence of diseases and afflictions or misfortunes but also, it includes the presence of good relationship between humans and the spirit beings on one hand and good interpersonal relationship on the other, for the Akan one cannot claim there is good health or well-being while the people in the community are at each other’s throat. That is, a good mental framework is inclusive of health in the Akan milieu (Opoku, 1978, Kwame Gyekye, 1996; Awuah- Nyamekye, 211). This mind-set is very common among many African cultures (Gwyneth,. 1994; Makinde 1988:6). This worldview thus, gives direction to the Akan in all their activities including health and its restoration. This also explains the reason why usually the etiology of almost all diseases has supernatural underpinnings (Field, 1961; Foster, 1976). It must, however, be emphasised that in 2 By traditional Akan people, I mean those Akan who generally still keep and live to the customs and traditions of their forebears, particularly their indigenous spirituality (African Traditional Religion) in spite of the influence of impinging religions such as Christianity and Islam 181 Mawere, Munyaradzi, and Awuah-Nyamekye, Samuel, eds. Between Rhetoric and Reality : The State and Use of Indigenous Knowledge in Post-Colonial Africa. Cape Town: Langaa RPCIG, 2015. Accessed March 26, 2018. ProQuest Ebook Central. Created from uwinnipeg on 2018-03-26 20:20:15. C op yr ig ht © 2 01 5. L an ga a R P C IG . A ll rig ht s re se rv ed . spite of the supernatural etiology of ill-health among the Akan, they also at some point acknowledge the ‘Germ Theory’ or the ‘naturalistic’ causes of illneses as Foster (1976)puts it. Notwithstanding this reality, and paradoxically, the Akan still find it very difficult to de-couple spirituality and therapeutic practices. It is against this background that this chapter argues that among the traditional Akan, religion and medicine are inseparable realities. Literature on health care delivery in Ghana is quite extensive but those on how the local concepts of illness may affect people’s choices of health care model are scarce. Th.

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CHAPTER 7 Managing Financial Operations Revenue cycle (billing and collections) Receivables management Cash and marketable securities management Inventory (supply chain) management Operational monitoring and control Copyright 2009 Health Administration Press 7 - ‹#› Financial Operations Financial operations involves the day-to-day oversight of such tasks as billing and collections (revenue cycle), cash management, and inventory management. The specifics are highly dependent on the type of provider (e.g., hospital versus medical practice versus nursing home). Thus, the focus here is on fundamental concepts as opposed to details. Copyright 2009 Health Administration Press 7 - ‹#› The Revenue Cycle The revenue cycle is defined as all activities associated with billing and collecting for services. In general, revenue cycle management should ensure that patients are properly categorized by payer, correct and timely billing takes place, and correct and timely payment is received. The revenue cycle includes the activities listed on the next slide. Copyright 2009 Health Administration Press 7 - ‹#› The Revenue Cycle (cont.) Before-service activities: Insurance verification Certification of managed-care patients Patient financial counseling At-service activities: Insurance status verification Service documentation/claims production After-service activities: Claims submission Third-party follow-up (if needed) Denials management Payment receipt and posting Monitoring and reporting: Monitoring Review and improvement Copyright 2009 Health Administration Press 7 - ‹#› The Revenue Cycle (cont.) In revenue cycle management, each of the identified activities is closely monitored to ensure that the correct amount of reimbursement is collected on each patient, reimbursements are collected as quickly as possible, and the costs associated with the revenue cycle are minimized consistently with rapid and correct collections. Two important keys to good revenue cycle management are information technology and electronic claims processing. Copyright 2009 Health Administration Press 7 - ‹#› Receivables Management If a service is provided for cash, the revenue is immediately received. If the service is provided on credit, the revenue is not received until the receivable is collected. Receivables management, which falls under the general umbrella of the revenue cycle, is extremely important to healthcare providers. Why? Copyright 2009 Health Administration Press 7 - ‹#› Accumulation of Receivables Suppose Valley Clinic contracts with an insurer whose patients use $2,000 in services daily and who pays in 40 days. The clinic will accumulate receivables at a rate of $2,000 per day. However, after 40 days, the receivables balance will stabilize at $80,000: Receivables = Daily sales × Average collection period = $2,000 × 40 = $80,000 Copyright 2009 Health Administration Press 7 - ‹#› Cost of Carrying Receiva.

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CHAPTER 7 Primate Behavior What is Meant By Behavior? • Anything organisms do that involves action in response to internal or external stimuli. • The response of an individual, group, or species to its environment. • Such responses may or may not be deliberate and they aren't necessarily the results of conscious decision making. Ecological Perspective • Pertains to relationships between organisms and all aspects of their environment • Temperature • Predators • Vegetation • Availability of food and water • Types of food • Disease organisms • Parasites Behavioral Ecology Focuses on the relationship between behaviors, natural environment, and biological traits of the species. Based on the assumption that animals, plants, and microorganisms evolved together. Behaviors have evolved through the operation of natural selection, or Some behaviors are influenced by genes and are subject to natural selection the same way physical characteristics are. The Evolution of Behavior Behavior constitutes a phenotype  Individuals whose behavioral phenotypes increase reproductive fitness pass on their genes at a faster rate. Genes do not code for specific behaviors, but they do code for biological factors that impact behavior, i.e. hormone levels, intelligence Species vary in their limits and potentials for learning and behavioral flexibility, set by genetic factors. Natural selection acts on genetic factors shaped by ecological, the same as it does physical characteristics Social Structure • The composition, size, and sex ratio of a group of animals. • The social structure of a species is, in part, the result of natural selection in a specific habitat, and it guides individual interactions and social relationships. Why Are Primates Social? • Group living exposes animals to competition with other group members, so why not live alone? • Costs of competition are offset by the benefits of predator defense provided by associating with others. • Group living evolved as an adaptive response to a number of ecological variables. Some Factors That Influence Social Structure • Body Size • Larger animals are better able to retain heat and their overall energy requirements are less than for smaller animals • This means they need fewer calories per unit of body weight. Some Factors That Influence Social Structure • Metabolism • The chemical processes within cells that break down nutrients and release energy for the body to use. • Basal Metabolic Rate (BMR) and Diet • Smaller animals generally have a higher BMR than larger ones. • This means smaller primates require an energy-rich diet high in protein, fats, and carbohydrates (fruit, and insects). Some Factors That Influence Social Structure • BMR and Diet • Nutritional needs have evolved along with BMR and body size • Benefits are considered in terms of energy (calories) obtained from food .

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Chapter 7 Medical Care Production and Costs (c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Short-Run Production Function of the Representative Medical Firm Assumptions of short-run production: Medical firm produces a single output of medical services, q Only two medical inputs exist: nurse-hours, n, and a composite capital good, k Quantity of capital is fixed at some amount (c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Short-Run Production Function of the Representative Medical Firm Medical firm faces an incentive to produce as efficiently as possible Medical firm possesses perfect information regarding the demands for its product (c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Short-Run Production Function of the Representative Medical Firm Production function: Identifies different ways nurse-hours & capital can be combined To produce various levels of medical services (c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Short-Run Production Function of the Representative Medical Firm Each level of output produced by - Several different combinations of the nurse and capital inputs Each combination – assumed to be technically efficient – maximum amount of output that is feasible given the state of technology (c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Short-Run Production Function of the Representative Medical Firm Law of diminishing marginal productivity At first, total output increases at an increasing rate After some point, it increases at a decreasing rate Total product curve, TP Depicts total output produced by different levels of the variable input, holding all other inputs constant (c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classro.

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Chapter 7 Evaluating HRD Programs Werner © 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Learning Objectives Define evaluation and explain its role in HRD Discuss the various types of evaluation information available and compare the methods of data collection Explain the role of research design in HRD evaluation Describe the ethical issues involved in conducting HRD evaluation © 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Learning Objectives (cont.) Identify and explain the choices available for translating evaluation results into dollar terms Calculate a utility estimate for a target organization. Discuss how technology impacts HRD evaluation © 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Questions to Consider How do you evaluate training and HRD? What measures can be used to evaluate training? Is there one best way to evaluate training? What should be considered as one prepares to evaluate HRD? What are the ethical issues involved in evaluating HRD? How can the value of HRD be expressed in terms of costs and benefits, or dollars and cents? © 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Key Terms Training effectiveness: benefits receive from training Training evaluation: process of determining training effectiveness Training outcomes: measures to evaluate training effectiveness Evaluation design: data will be collected and which data will be collected for training evaluation Copyright © 2017 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Training and HRD Process © 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Evaluation Can Help identify a program’s strengths and weaknesses assess what features of training content and context matter identify which trainees benefited gather information for marketing training determine financial benefits and costs © 2017 .

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CHAPTER 7INTEREST RATES AND BOND VALUATIONCopyright © 2019 M.docx

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CHAPTER 7 Friendship THE NATURE OF FRIENDSHIPFRIENDSHIP ACROSS THE LIFE CYCLEDIFFERENCES IN FRIENDSHIPFRIENDSHIP DIFFICULTIESFOR YOUR CONSIDERATIONCHAPTER SUMMARY I get by with a little help from my friends. John Lennon Take a moment and think about your two best friends. Why are they such close companions? Why do you think of them as friends? You probably like but don't love them. (Or, at least, you're not “in love” with them, or you'd probably think of them as more than just “friends.”) You've probably shared a lot of good times with them, and you feel comfortable around them; you know that they like you, too, and you feel that you can count on them to help you when you need it. Indeed, the positive sentiments you feel toward your friends may actually be rather varied and complex. They annoy you sometimes, but you're fond of them, and because they're best friends, they know things about you that no one else may know. You like to do things with them, and you expect your relationship to continue indefinitely. In fact, if you look back at the features that define intimacy (way back on page 2), you may find that your connections to your best friends are quite intimate, indeed. You may have substantial knowledge of them, and you probably feel high levels of trust and commitment toward them; you may not experience as much caring, interdependence, responsiveness, and mutuality as you do with a romantic partner, but all three are present, nonetheless. So, are friendships the same as but just less intimate than our romantic partnerships? Yes and no. Friendships are based on the same building blocks of intimacy as romances are, but the mix of components is usually different. Romances also have some ingredients that friendships typically lack, so their recipes do differ. But many of the elements of friendships and romances are quite similar, and this chapter will set the stage for our consideration of love (in chapter 8) by detailing what it means to like an intimate partner. Among other topics, I'll describe various features of friendship and question whether men and women can be “just friends.” Page 214 THE NATURE OF FRIENDSHIP Our friendships are indispensable sources of pleasure and support. One study of unmarried young adults found that over one-third of them (36 percent) considered a friendship to be their “closest, deepest, most involved, and most intimate” current relationship (Berscheid et al., 1989). A larger proportion (47 percent) identified a romantic relationship as their most important partnerships, but friendships were obviously significant connections to others. And they remain so, even after people marry. Another study that used an event-sampling procedure1 to track people's interactions found that they were generally having more fun when they were with friends than when they were alone or with family members, including their spouses. The best times occurred when both their spouses and their friends were present, but if it was one or.

CHAPTER 7FriendshipTHE NATURE OF FRIENDSHIPFRIENDSHIP ACROSS T.docx

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Chapter 7: Lean Thinking and Lean Systems McGraw-Hill Education Copyright © 2018 by The McGraw-Hill Companies, Inc. All rights reserved. * Copyright © 2018 by The McGraw-Hill Companies, Inc. All rights reserved. * The lean systems chapter begins with a broad orientation to lean and its elements with an historical perspective of its development. Then each element is discussed in detail in separate sections. The discussion includes situations in which elements of lean have been successfully applied, as well as situations in which they may not be applicable (e.g. smoothing the master production schedule in services). The chapter concludes with discussion on implementation of lean systems and how lean concepts can be applied to all business disciplines (manufacturing, services, government, etc.). Chapter 7 Learning ObjectivesLO 7.1 Describe the origins and evolution of lean thinking.LO 7.2 Describe the five tenets of lean thinking and the seven forms of waste in a lean system.LO 7.3 Explain how a stabilized master schedule is achieved for repetitive manufacturing.LO 7.4 Design a kanban system for a lean system.LO 7.5 Explain how setup time, lot size, layout and maintenance are related to lean thinking.LO 7.6 Differentiate how employees, quality, and suppliers are unique in lean systems.LO 7.7 Explain how to implement a lean system. 7-* Here are our Learning Objectives for this course. Between these videos, the textbook, supplemental readings, assignments and Discussion Boards, you will end the course with some new skills and many new insights. * Evolution of LeanToyota Production System (TPS)Developed in Japan following WWII (limited resources)Also known as Just-in-Time (JIT) manufacturingCame to U.S.- 1981 at Kawasaki motorcycle plant in Lincoln, NebraskaLean ProductionTerm coined in late 1980sPopularized in 1990s by Womack, Jones & Roos’ “The Machine That Changed the World” 7-* Copyright © 2018 by The McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2018 by The McGraw-Hill Companies, Inc. All rights reserved. After WWII the U. S. system of mass production was the envy of the world. Mass production – the production of standardized discrete products in high volume by means of repetitive manufacturing technologies – was the norm. Materials were purchased in large batches, and machines were made to run faster to reduce unit costs. * Lean TenetsCreate product/service value from customer perspectiveReduce waste - mudaIdentify, study, improve the value streamObserve the process - gembaEnsure simple, smooth, error-free flowDetermine takt timeProduce only what is pulled by customerUse kanbansStrive for perfectionHold kaizen events, 5S, 5 Whys 7-* Copyright © 2018 by The McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2018 by The McGraw-Hill Companies, Inc. All rights reserved. Lean thinking is built around five tenets that include specific concepts, principles, and techniques to organize and deliver value t.

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1. Chapter 7: Transcultural Perspectives in the Nursing Care of Adults Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2016 Wolters Kluwer • All Rights Reserved 1 Cultural Influences on Adulthood #1 Developmental tasks are transitions that occur in a normal successful adulthood. A health/illness situational crisis refers to changes or turmoil as individuals struggle to cope with a sudden life-threatening illness. Transitions: health or illness events that require an individual to make modifications in his/her lifestyle Copyright © 2016 Wolters Kluwer • All Rights Reserved 2 Cultural Influences on Adulthood #2 Physiologic development

2. Hormonal changes Menopause, loss of sexual potency Psychosocial development Stages of life Divorce, remarriage, career changes Copyright © 2016 Wolters Kluwer • All Rights Reserved Cultural Influences on Adulthood #3 Each culture has specific chronologic standards for appropriate adult behavior. Social age: Culture defines what is considered an appropriate behavior in each stage of the life cycle. Young adult (teens, 20s, 30s): independence, role changes Middle adult (40s, 50s): career, family matters Copyright © 2016 Wolters Kluwer • All Rights Reserved 4 Question #1 Is the following statement true or false? Midlife adulthood is often a time of stress, dissatisfaction, and unrest. Copyright © 2016 Wolters Kluwer • All Rights Reserved

3. 5 Answer to Question #1 False Rationale: Adulthood is not always a tumultuous, crisis-oriented state; many middle aged persons welcome the space, time, and independence that middle age often brings. Midlife can be a time of challenge, enjoyment, and satisfaction for many persons. Copyright © 2016 Wolters Kluwer • All Rights Reserved 6 Cultural Influences on Adulthood #4 Developmental tasks; responses to life situations encountered by all persons experiencing: Physiologic Psychological Spiritual Sociologic changes Erikson’s generativity versus stagnation Copyright © 2016 Wolters Kluwer • All Rights Reserved Cultural Influences on Adulthood #5 Adult life transitions influenced by culture: Career success Social and civic responsibility

4. Marriage and raising children Changing roles and relationships Copyright © 2016 Wolters Kluwer • All Rights Reserved Question #2 Which of the following would not be considered a social and/or civic responsibility? Serving on the board of a women’s shelter Donating blood Attending religious ceremonies Volunteering at a food bank Copyright © 2016 Wolters Kluwer • All Rights Reserved Answer to Question #2 C. Attending religious ceremonies Rationale: Social and civic duties include participation in those activities in adulthood that contribute to the “good of society.” Some cultures emphasize activities and contributions within the cultural group. For example, in some groups, religious obligations are given priority over civic responsibilities. Copyright © 2016 Wolters Kluwer • All Rights Reserved Health-Related Situational Crises #1 Situational transitions often occur when a serious illness is diagnosed or other traumatic events occur to individuals and

5. their families. Caregiving occurs when an unpaid person, usually a family member, helps another family member who has a chronic illness or disease. Culture and ethnicity can influence beliefs, attitudes, and perceptions related to caregiving. Copyright © 2016 Wolters Kluwer • All Rights Reserved 11 Health-Related Situational Crises #2 HIV/AIDS and the African American Community considerations: Prevention challenges Influential factors Poverty Denial Drug use Homophobia/concealment of behavior Copyright © 2016 Wolters Kluwer • All Rights Reserved Health-Related Situational Crises #3 Culturally competent nursing care Health promotion strategies and nursing interventions for African American women: “Stroke belt” “High blood” “Nerves”

6. Copyright © 2016 Wolters Kluwer • All Rights Reserved 13 Question #3 Is the following statement true or false? “High blood” is a term frequently used by the African American culture in the rural South to identify the condition referred to by the medical term hypertension. Copyright © 2016 Wolters Kluwer • All Rights Reserved 14 Answer to Question #3 False Rationale: “High blood” is an illness condition that is associated with African American culture in the rural South. Many health care professionals make the wrong assumption that “high blood” is the same as high blood pressure or hypertension; although there are similarities, the cultural explanation of “high blood” is different from the biomedical explanation of high blood pressure or hypertension. Copyright © 2016 Wolters Kluwer • All Rights Reserved

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