A performance evaluation is a regular analysis of the job performance of an employee and the overall contribution to an organization. It evaluates employees’ skills, achievements and lacking. The performance assessment process of employees is essential for organizations to boost the productivity of employees and improve their results. Employees are less motivated in government and private hospitals. Employees and organization did not meet each other expectations. Victor Vroom develops theory of expectancy in 1964 which applied in this scenario. Vroom stated that three major factors determine the person motivation: expectancy, instrumentality and valence. Performance appraisal used as motivational tool and it is necessary for staff sustainability. Organization should do performance evaluation of employees and give feedback according to their work. Motivation is very important to enhance employee organizational commitment, resulting in higher productivity levels. Rewards are also some of the key strategies to strengthen the motivation of employees to use their best capabilities to develop innovative ideas that could improve organizational performance.

Due to the rise of unhealthy lifestyles among the young population, there is a need to develop a tool to assess their health-promoting behavior. Despite the importance of this issue, few studies have explored the Health-Promoting Lifestyle Profile (HPLP) among students, and literature from the East African region for this particular group is even more scarce. Objective. The main aim of this study was to validate a four-factor structure measurement model of the Health-promoting lifestyle Profile-II (HPLP-II) based on CFI, SRMR, and RMSEA among Kenyan undergraduate students Design. The study design was a cross-sectional analytical, that utilized quantitative methods Setting. The study was conducted in Kakamega County, located in Western Kenya. Analysis. Data were analyzed through confirmatory factor analysis, which was conducted using robust maximum likelihood estimation. The factor model was tested for validity and construct validity. Main outcome measures. Subscales physical activity, nutrition, interpersonal relationship and stress management of the Health-Promoting Lifestyle Profile II Results. After omission of some items due to high correlation with variables in the same factor, a final 34 item model was analyzed. The overall 34-item tool had a Cronbach’s alpha of 0.79 indicating good reliability. The factors physical activity, stress management, nutrition, and interpersonal relationship had Cronbach coefficients of 0.70, 0.80,0.81 and 0.83 respectively. All the correlations were below the recommended cut-off point of 0.85, which indicated that the four-health promoting behavior factors achieved good discriminant validity. The RMSEA index was less than .08, RMSEA = 0.07, 90% CI = [0.07, 0.08], which is indicative of a good model fit. The SRMR was between .05 and .08, SRMR = 0.08, which implies that the model fits the data adequately, however the CFI (CFI=0.81 which is less than 0.9) and chi-square goodness of fit test (was significant χ2(318) = 686.69, p < .001,

An accreditation plan can improve an organizational facilities and services regarding patient care and provides quality improvement skills. In my case scenario, I conceptualized an idea about accreditation of private well-established health care setting. The Kurt Lewin’s theory insights a framework of change at the accreditation level, which will be achieved by the application of the transformational leadership style. Transformational leadership style works as guider, motivator, collaborative and bind with sustain the change management mission. The accreditation requires an international standard of practices and high quality of patient care in an organization. The accreditation requirement is fulfilled in the context of organizational cultural and environmental values, beliefs and delivery of services. In the case scenario presented an idea by the reflection on its organizational change. The private health care organization had accreditation capabilities. All essential and standardized equipment and performing procedural guidelines and following protocols. Kurt Lewin’s theory give directions to such these kind of organizations in the context of change at the level of accreditation.

The Aspergillosis of the Paranasal sinuses is a well-recognized form of fungal infection, the involvement of the pituitary gland by aspergillosis is extremely rare. In which the main pathogen of the fungal seller is aspergillus classes. The pituitary infectious fungi consisted of different groups and dimorphic fungi. The leading pathogen of fungal seller abscess is the type of aspergillus. The possible route of infection through sphenoid sinus with a thin seller roof. A pituitary tumor differentiates through its size. Pituitary tumors undesirably are known to grow in the sphenoid bone, cavernous sinus, mid-nasal ductus, and left cerebral hemisphere. In our case presentation patient presented with pituitary macroadenoma, which diagnosed through magnetic resonance imaging. Presented with nasal mass, and acromegaly features headache. Right eye vision loss. Through endoscopy, biopsy report shows the nasal fungal infection. Surgical treatment, the trans-sphenoidal procedure will be planned as recommended in literature reviews.

Provides reliable contact information about patient care and safety. Analysis of the lack of reports between hospital and emergency room personnel indicates incomplete or lack of general information. Nurses play an important role in dissemination and dissemination of information by using nurse directives. Sharing information in a hospital affects patient safety and treatment plans and delivery based on this information. Test modifications that were used for the comfort of patients entering the ambulance for several days decided to participate in this study. Sample size should take into account sales that occur evenly throughout the month, with each change and day of the week. Documenting the content of the reports submitted will affect breastfeeding practices. You can also use the standard login format and technology to improve content delivery.

Valvular heart diseases affects millions of patients worldwide, and the burden is rising as the population ages. Severe valvular heart disease is associated with significant morbidity and mortality, claiming over 50,000 lives annually in the USA [1]. Coumadin (generic name: warfarin) is an anticoagulant, which stops the formation of blood clots and makes blood thinner (less viscous). As for Vitamin K, it helps the process of blood clotting. In other words, warfarin has the opposite effect to Vitamin K. Warfarin is a widely used and cheap drug which decreases the risk of thrombosis or embolism in patients with diseases such as atrial fibrillation (AF), venous thrombo-embolism, and mechanical heart valve surgeries. Treatment with warfarin requires close monitoring with regular tests of PT-INR for better outcome of patients [2]. The purpose of the study is to shorten and simplify the process for the testing and prescription of warfarin by introducing point of care analysis (POC). The aim was also to evaluate changes in time and cost related to the new processes. Effective management of warfarin therapy is frequently challenged by its difficult pharmacology and adverse effects. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients regarding self-testing and self-management of accurate dose according to INR value. Point of care INR monitoring has shown beneficial impacts on the risk of thromboembolic events, anticoagulation control, patient satisfaction, and quality of life [3].

Introduction: The neuroendocrine neoplasms (NENs) are comparatively infrequent and mixed tumors which comprise 2% of all malignancies, with an incidence of <200,000 population. Gastrointestinal neuroendocrine carcinomas are diagnosed rarely. While gastric carcinoma is third principal reason of death in men and fifth in women especially in Eastern Asia. Case Report: We, herein, present a patient of 30 years and male who was presented to OPD having complaints of diarrhea, hot flushes, dizziness, dyspepsia and anorexia. A Core Biopsy of left par aortic region was made. The findings showed that patient was suffering from neuroendocrine neoplasm/paraganglioma. Initially, lesions can be managed by endoscopic excision of accessible tumors and endoscopic monitor. Discussion: Abdominal neuroendocrine carcinomas are also rare and accounting for less than 10% of gastric neoplasms and such rareness has made it tough to accurately recognize their organic nature and to identify ideal treatment choices. Conclusion: As we described a patient of intermittent gastric neuroendocrine carcinoma, a well-managed description of these cancers/tumors should be discussed globally and historically. Diagnostics and therapeutic managements must be evaluating in large clinical studies.

Ethical decision-making in an organization is an important process. Decision-making requires careful assessment and analysis of all possible alternatives. It is the management executives ' duty at all levels. In this case study, patient suffered due to medical harm and ethical committee did not provide justice to patient. Ethical decision-making model apply on this scenario. James Rest (1994) developed theoretical framework for understanding the process of ethical decision making. His model has four components: moral awareness, moral motivation, moral judgement and moral action. Thomas Jones gave moral intensity model in 1991. Jones concluded that the moral features, which he collectively called moral strength, affect ethical decision-making. Jones conceptualized his model so that moral strength could impact each of the Rest's Four Component Model components. Organization leaders faces moral complex situation, their consciousness of the moral conflict, their decisions on choices and consequences, and their ability to act are significantly affected by the particular aspects of the moral situation. The priniciple of ethical decision making must be followed while taking a decision.

Nursing profession is full of hazards. Health care worker faced all kind of hazards including biological, non-biological hazards, physical environmental, electrical, chemical hazards. A health care professional are at risk of these hazards. Among physical hazards back pain is more common. WHO provide a modal in 2010 for healthy work place. There are four avenues of this modal are: The physical work environment 2. The psychosocial work environment 3. Personal health resources in the workplace 4. Enterprise community involvement. There are many reasons for these hazards like Poor work organization, lack of awareness and competency of dealing with the equipment, heavy work load, lack of proper rest, poor diet, strict manager. Sufficient literature review is given for these hazards and their managements. In this study we discuss what are common hazards that are faced by health care worker and how they control.

Background: Critical thinking is a key element in the field of education. Where many studies have been published regarding the importance of critical thinking while practicing or studying nursing in hospital settings or academic environment, this project indicates the development of critical thinking in nursing students at all levels of their nursing program. Objective: The purpose of the study is to enhance critical thinking in the nursing students to improve clinical practice and judgment. Methodology: A sample of 20 nursing students participated. A questionnaire tool regarding Knowledge, Attitude and Practice of nursing student to enhance critical thinking was used for pre and post-test evaluation. In implementation phase, participants presented with different critical thinking skill development presentations which were based on clinical scenarios. Results: The result analyzed was 18 out 20 participants strongly agreed that critical thinking development workshop enhanced the skill in patient care. The critical thinking assessment too was further assessed over the time period for their consistency and sustainability on utilizing the critical thinking strategy. Conclusion: The enhancement in critical thinking in nursing students is a necessary development in one’s ability ultimately improving patient care outcomes and quality indicators.

Every year, over 250,000 patients have cardiac surgery and the incidence of cardiac arrest. When treated quickly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. Many of health care providers found this was disorganised and they would have performed better if they had well defined roles. Objectives: The aim of the study is to assess the level of knowledge among novice nurses regarding cardiac advance life support surgery (CALS) in cardiac surgery intensive care unit (CICU) and Cardio pulmonary department (D1 department) of Aga khan university hospital. Material and Methods: The descriptive cross-sectional study done. The 15 nurses were selected as sample to assess knowledge. Results: Novice nurses were not aware about (CALS). Moreover we developed module for nurses for future education and awareness about CALS the later study will help to assess the efficacy of CALS module. Conclusion: The study helps to make module of CALS for nurses taking care of patient underwent open heart surgery.

Introduction: The mean of patient’s length of stay in the Emergency Department is considered to manage the patient’s crowing. This paper measures the length of stay and factors that could potentially influence on patient’s stay in emergency department. Objective(s): To reduce length of stay and early disposition of patient in in patient area for continuity of care. Design: Prospective study design used and evaluate intervention to improve patient safety. Settings: Emergency Department of a Tertiary Hospital Lahore Pakistan Methodology: By using the change theory of management we identify the factors which impact on Length of stay Educate and motivate staff, we developed and implemented Nurse physician hand over checklist as well as developed LOS tool in emergency, furthermore staff reviewed patient and gave reminder to consultant a fro early bed vacation. Moreover we empowered our nursing staff. Results: After implementation of kut Lewis model, there is huge fluctuation in the graph through march 2018 to January 2019 and it significantly increased in the month of February 2019 and the emergency length of stay dropped from 4.1 to 5 hours after we reviewed our process, retrained staff in the month of February after training and followup results dropped dramatically to 3 hours by March until April 2019. Conclusion: In conclusion, all factors directly impact on patient length of stay for this purpose management developed some strategies against this to overcome this issue. These strategies really help especially the bed management team played very important role on it.

Background: Gestational Diabetes Mellitus is considered to be a significant problem among pregnant women in Egypt. Aim: To evaluate the effect of educational protocol to improve pregnant women practices about gestational diabetes mellitus. Design: A quasi-experimental design was used. Setting: The outpatient diabetic clinic at Zagazig university hospital. Sample: A purposive sample of eighty pregnant diabetic women. Tools: Two tools were used in the study, Tool (1): Contained two parts; (1) demographic characteristics, (2) History about reproductive profile during pregnancy, Tool (2): Included two parts, assessment of knowledge of pregnant women about DM, and assessment of practice of pregnant women about DM. Results: The mean age of the pregnant women were 32.04 ± 9.36 years, also it was revealed that the total knowledge scores improved from 31.35% to 58.20%, with a highly significant difference (p=0.0044) for the participants, additionally, the overall increase in adequate practices improved from 56 to 78.5% after the implementation of the protocol sessions, with a significant difference (p=0.0106). Conclusion: The implementation of educational protocol for pregnant women was effective and enhanced their practices, and knowledge regarding the gestational diabetes mellitus. Recommendation: The study recommended that further studies for pregnant women with gestational diabetes mellitus should be applied in all health care centers.