Change Management Plan to Reduce Medication Errors

Change Management Plan to Reduce Medication Errors Assignment 2 Change Management Plan: reducing medication errors by building a dual medication error reporting system with a ‘no fault, no blame’ culture Introduction Medication errors in hospitals are found to be the most common health-threatening mistakes made in Australia (Victoria Quality Council, n.d.). Adverse events caused by medication errors can affect patient care, leading to increased mortality rates, lengthy hospital stays and higher health costs (Agency for Healthcare Research and Quality, 2012). Although it is absolutely impossible to eliminate all medication errors as human errors can occur, reporting errors is fundamental to error prevention. â€Å"Ramifications of errors can provide critical information to inform the modification or creation of policies and procedures for averting similar errors from harming future patients† (Hughes, 2008, p. 334). Thus, it highlights the importance of change management to provide a reporting system for effective error reporting. In this paper, the author is going to explore current incident-reporting systems and discuss the potential benefit of a dual medication-error reporting system, wit h a ‘no fault, no blame’ culture through a literature review, followed by a clear rationale for the necessity of a change management plan to be in place. Lippitt’s Seven Steps of Change theory will be demonstrated in detail with clear strategies suggested for assessing the plan outcomes. Finally, the main issues will be summarised with an insightful conclusion. Discussion Medicines are the most common treatment used in the Australian healthcare system, which can make great contributions in relieving symptoms and preventing or treating illness (Australian Commission on Safety and Quality in Health Care, 2010). However, because medicines are so prevalently used, incidences of errors associated with the use of medicine are also high (Aronson, 2009). Over 770,000 people are harmed or die each year in hospital due to adverse drug events, which can cost up to 5.6 million dollars per year per hospital. Medication errors account for one out of 854 inpatient deaths and it is notable that the number of medication error-related death is higher than motor vehicle accidents, breast cancers and AIDS mortality (Hughes, 2008). Reporting enables a platform for errors to be documented and analysed to evaluate causes and create strategies to improve safety. A qualitative study (Victoria Quality Council, n.d) was conducted to survey the current medication error reporting systems in both metropolitan and rural hospitals in Victoria. Most hospitals prefer the report to be named as it allows follow-up of the incidents, whereas only a small proportion of hospitals use anonymous reporting to alleviate the barrier of reporting yet the correlation with actual errors has been low. In addition, a majority of hospitals acknowledged that near misses are supposed to be recorded but are rarely documented (). It is clear that errors and near misses are key to improve safety, so they should be reported regardless of whether an error resulted in patient harm. A near-miss error that has the potential to cause a serious event does not negate the fact that it was and still is an error. Reporting near misses is invaluable to reveal hidden danger. Hughes (2008) pointed out that the majority believes a mandatory, non-confidential incident report system could lead to and encourage lawsuits thus a reduced frequency of error reports resulted. A voluntary and confidential reporting system is preferred, which encourages the reporting of near misses and generates accurate error reports. However there is concern that with voluntary reporting, the true frequency of both errors and near misses could be much higher than what is actually reported (White, 2011). Thus, it can be concluded that a dual system combining both, mandatory and voluntary mechanisms might improve reporting. Although nurses should not be blamed or punished for medication errors, they are accountable for own actions. Therefore, reporting errors should not attribute blamed individuals but to ‘hold providers accountable for performance† and â€Å"provide information that leads to improved safety† (Hughes, 2008). Individuals and organisations attention needs to be drawn toward improving the error reporting system, which means to ‘ focus on a bad system more than bad people’ (Wachter, 2009). Reporting of errors should be encouraged by creating a ‘no fault no blame’ culture. Rationale: Medication errors can occur as a result of human mistakes or system errors. Every medication error can be associated with more than one error-producing condition, such as staff being busy, tired and engaging in mutule tasks (Cheragi, Manoocheri, Mohammadnejad Ehsani, 2013). Nurses are mostinvolvedat themedication administrationphase and are the last people involved in the drug delivery system. It becomes the nurses’ responsibility to double check prior to the administration of medication and to capture any potential drug error that might be made by the prescribing doctor or pharmacy. Whether the nurse is the source or an observer of a medication error, organisations rely on nurses as front-line staff to report medication errors (Hartnell, MacKinnon, Sketris, Fleming, 2012). When things go wrong, the most common initial reaction is to conceal the mistake. Not surprisingly, most errors are only reported when a patient is seriously harmed or when the error could not be easily covered up (Hughes, 2008). Reporting potentially harmful errors before harm is done, is as important as reporting the ones that harm patients. The barriers to error reporting can be attributed to the workplace culture of blame and punishment. Blaming someone does not change those contributing factors and a similar error is likely to reoccur. Adverse drug events caused by medication errors are costly, preventable and potentially avoidable (Australian Commission on Safety and Quality in Health Care, 2009). Thus, it is essential that interventions to be implemented must ensure a competent and safe medication delivery system. To do so, change is needed; to adopt a dual medication error reporting system with a ‘no fault, no blame’ culture in Holmesglen Hospital. Change Management Plan: The Nursing role has evolved to match the ongoing growth of the Australian health-care delivery system. There is a trend for nurses to take responsibility for facilitating positive change in areas related to health (Steanncyk, Hancock Meadows, 2013). Nurses play the role of change agents which is vital for the effective provision of quality healthcare. There are many ways to implement changes in the work environment. Lippitt’s Seven Steps of Change theory is one of the approaches believed to be more useful as it incorporates a detailed, step by step plan of how to generate change (Mitchell, 2013). There are seven phases in the theory: Phase 1: The Change management plan begins at this phase to provide a detailed diagnosis of what the problem is. No matter what reporting procedures are in place, they may capture only a fraction of actual errors (Montesi Lechi, 2009). Reporting medication errors remain dependent on the nurses’ decision making, and the nurses may be hesitant or avoidant to report errors due to fear of consequences. A combination of mandatory and voluntaryreport system is suggested with a ‘no fault no blame’ approach to reduce cultural and psychological barrier (Hughes, 2008). Both statistical review and one to one informal interviews can help to identify areas that need attention and improvement. An open door policy and disclosure preferences for nurses who want to express their concerns, either to a nurse unit manager, a nurse in charge, a supervisor, a senior or a nurse representative or a colleague are all suitable. This approach can be effective in exploring and uncovering deep-seated emotions, motivations and attitudes when dealing with sensitive matters (). Statistical review, such as RiskMan reviews, is a useful tool to capture and classify medication errors (Riskman, 2011). Holmesglen hospital are conducting bi-monthly statistic reviews to gather information on the contributing factors of medication errors, by aiming to target system issues that could contribute to the error made by individuals, and make a change at organisational levels. For example, if medication errors are constantly caused by staff who are distracted or exhausted, staffing lev els and break times will be reviewed. Phase 2: At this stage, motivation and capacity to change are assessed. It involves small group activities such as staff meetings or medication in-services and all nursing staff are invited. Feedback can be given either directly (face to face) or in-directly (survey) and nursing staff knowledge, desire and skills necessary for the change as well as their attitude for change are assessed. Staff motivation can be reflected through rates of meeting attendance, number of submitted surveys, or number of staff who actively participated in the meeting discussion. Nurses who have good insight and are actively involved in the meeting are the ‘driving forces’ which will facilitate the process of change management; nurses who are hesitant or adverse to change are the resisting forces, in which force-field analysis can be used to counter this resistance (Mitchell, 2013). Force-field analysis is a framework for problem solving. For example, with the health budget crisis we face today in Australia, many hospitals and units may have financial restrains and are incapable of maintaining the flow of the change process. In the meetings, financial issues can be brought up at organisational levels that making change is necessary for both better patient outcomes and reducing unnecessary healthcare costs. Phase 3: With the motivation and capacity levels addressed, determining who the change agent is and whether the change agent has the ability to make a change. Change agents can be any enthusiastic person who has great interest, has a genuine desire and commitment to see positive change. Daisy is a full time associated nurse unit manager (ANUM) employed by Holmesglen hospital for some years. As she has a background of being a pharmacist, part of her role includes providing drug advice to nurses. During her weekly medication review, Daisy noticed that medication errors have been frequently occurring but there is little correlation with the actual reports submitted. Daisy decided to run in-service sessions and all nurses are invited to attend. Daisy discussed her change management plan with the nurse unit manager who also expressed interest and agreed to provide human resources and reasonable financial support. Another four ANUM also expressed interest and commitment. It has been arrang ed that two ANUM to attend the in-service at each time. Phase 4: The in-service is designed to be running for 6 months from September 15th 2014 to March 15th 2015 on monthly basis. Daisy will be holding the in-service and other ANUM will provide assistance in implementing the change plan. The in-service will consist of two parts and run for two hours. The first hour will be a review of the performance of the last month along with relevant statistics. The second hour will be self-reflection and discussion. All participants will be paid for attendance and encouraged to complete an anonymous survey monthly. Phase 5: Daisy is the leader of the change agents responsible for conducting in-services, collating information regarding medication safety, and summarising data with the assistance of ANUM. Meanwhile, Daisy and all the ANUM are the senior staff responsible for providing supervision and support to junior staff and other nurses. A monthly summary report of performance is submitted to the leader for review and monthly meetings are held among senior groups to review the effectiveness of the change management plan and adjust and modify the current plan if needed. Phase 6: A communication folder will be used to update nurses about past meetings. A drop box is available in the staff room for anonymous suggestion and complaints, which can only be accessed by Daisy and the other 4 ANUM. All suggestions and complaints will be responded with two weeks of submission in written form and available in the staff room for all staff to read in the feedback section in the communication folder. Phase 7: The change management plan will be evaluated at the end of the 6 month period the 30th of March 2015, to determine whether the change management plan has been effective. The evaluating process can be done through audit or feedback. The change agent will withdraw from the leader position after the final meeting but still work on the ward to provide ongoing consultation. The four ANUM will take over the role to ensure a good standard is maintained. The drop box will remain available for any further issues identified in the work place. Clear strategies for assessing the plan outcomes As previously mentioned, a final evaluation will be conducted after the final in-service utilising two main approaches to assess the plan outcome auditing and feedback. Auditing includes internal review and an external audit; feedback consists of nursing staff feedback and patients report. An internal review will be conducted four times through the following year. The ANUM are assigned to conduct the review. The Review includes comparing the medication charts with the incident reports to assess any correlation. For example, an omitted dose is considered a reportable mediation error and an incident report should exist correlatively. An external medication audit will be conducted by an external professional to provide a true and fair reflection of the situation (). It can occur annually, not only to assess the plan outcome, but to also monitor practices and identify areas for improvement. Frequency of auditing will depend on the rate of staff changing. However, every newly employed nurse will be given a printout to familiarise themselves with the change that has been made with an open-door policy encouraging queries. If significant non-compliance is identified in the auditing, it is suggested that the first phase of change management plan should be repeated to assess the necessity for modification of the current plan (Australian Commission on Safety and Quality in Health Care, 2014a). The drop box will still be available for anyone who experiences or witnesses medication errors, or have a better suggestion to improve practice. Submission is anonymous and confidential. Only the ANUM have access. Public feedback will be given to complaints and suggestions in a timely manner and in the form of a printout for all staff to read. Patients can be a source of reporting medication errors as some of them know what their regular medications are. Also, new side effects experienced by patients can reflect the inappropriate use of medication. Conclusion-highlight main issues 250 Need to be completed Barriers to report errors must be breached to accomplish a safer medication administration system. Reporting medication errors and near misses through an established reporting system can provide opportunities to reduce similar errors in the further nursing practice and alleviate costs involved in such adverse events. Several factors are necessary in the change management plan: a leader that is motivated and committed to make a change; a reporting system that makes nursing staff feel safe;

The Great Mystery of the Pyramids Essay -- History, Building and Const

The Great pyramids of Egypt are undoubtedly one of the most recognized and admired landmarks in the world. Built to pay tribute to gods and pharaohs, the pyramids were of great importance to the Egyptians, and the mystery of their construction continues to amaze us today. Many theories pertaining to how the pyramids were built have been suggested, however, none are as well supported or intelligible as the heave-ho method of quarrying and cutting limestone. Joseph Davidovits’ theory disproving this, in which states the pyramids were moulded, is not plausible. Substantial physical evidence which is consistent with the Egyptologists’ portrayal of the heave-ho method has been found. The entire process of building a pyramid with this method is possible, as demonstrated by thorough experiments and analysis of the Egyptian culture. Indisputably, the Great Pyramids of Giza were constructed by quarrying limestone, and the use of ramps, sleds, and cutting tools, owing to the inge nuity and strength of highly organized Egyptian workers. Joseph Davidovits, a French chemist, has proposed that the pyramids were formed using a special concrete mixture, and then poured into wooden moulds where it hardened (Alt. theory #3).While Davidovits claims to have explained aspects of pyramid construction which the heave-ho theory could not, the mould theory has many faults, rendering it weak and improbable. Firstly, the stones used in building the pyramids were of diverse shapes (Article 5). The shape of the stones would be uniform if they were created in moulds of exact dimensions. If each stone was created in a uniquely fashioned mould, it would account for the diversity in shape. However, building thousands, or even hundreds, of moulds would have been e... ...gods they worshiped. In spite of the efforts of other theorists trying to refute this process, there is a very low number of faults in the heave-ho method. Most of the improbabilities and doubts can be explained with proven experiments, as well as examining the Egyptian lifestyle. In conclusion, the heave-ho method is the strongest and most practical theory of pyramid construction, due to the weakness of other theories, significant physical evidence, and how possible it is to achieve. This method irrefutably shows how the hardworking and inventive Egyptians used abundant resources to create magnificent pyramids, by working in highly organized teams, and using tools and machines such as chisels, hammers, and ramps. The actual process of how the pyramids were built may never become known to us; however, the heave-ho method is the closest idea we have to the truth. The Great Mystery of the Pyramids Essay -- History, Building and Const The Great pyramids of Egypt are undoubtedly one of the most recognized and admired landmarks in the world. Built to pay tribute to gods and pharaohs, the pyramids were of great importance to the Egyptians, and the mystery of their construction continues to amaze us today. Many theories pertaining to how the pyramids were built have been suggested, however, none are as well supported or intelligible as the heave-ho method of quarrying and cutting limestone. Joseph Davidovits’ theory disproving this, in which states the pyramids were moulded, is not plausible. Substantial physical evidence which is consistent with the Egyptologists’ portrayal of the heave-ho method has been found. The entire process of building a pyramid with this method is possible, as demonstrated by thorough experiments and analysis of the Egyptian culture. Indisputably, the Great Pyramids of Giza were constructed by quarrying limestone, and the use of ramps, sleds, and cutting tools, owing to the inge nuity and strength of highly organized Egyptian workers. Joseph Davidovits, a French chemist, has proposed that the pyramids were formed using a special concrete mixture, and then poured into wooden moulds where it hardened (Alt. theory #3).While Davidovits claims to have explained aspects of pyramid construction which the heave-ho theory could not, the mould theory has many faults, rendering it weak and improbable. Firstly, the stones used in building the pyramids were of diverse shapes (Article 5). The shape of the stones would be uniform if they were created in moulds of exact dimensions. If each stone was created in a uniquely fashioned mould, it would account for the diversity in shape. However, building thousands, or even hundreds, of moulds would have been e... ...gods they worshiped. In spite of the efforts of other theorists trying to refute this process, there is a very low number of faults in the heave-ho method. Most of the improbabilities and doubts can be explained with proven experiments, as well as examining the Egyptian lifestyle. In conclusion, the heave-ho method is the strongest and most practical theory of pyramid construction, due to the weakness of other theories, significant physical evidence, and how possible it is to achieve. This method irrefutably shows how the hardworking and inventive Egyptians used abundant resources to create magnificent pyramids, by working in highly organized teams, and using tools and machines such as chisels, hammers, and ramps. The actual process of how the pyramids were built may never become known to us; however, the heave-ho method is the closest idea we have to the truth.

Culture Shock & Insatiable Emptiness Essay

Culture is one aspect of a person’s individuality that is deeply entrenched in him after years of socialization and learning the ways, beliefs, thoughts and world view of one society or any group of people. When one is uprooted from the familiarity of the culture that he has internalized, the consequence involves disorientation, anxiety, and other host of psychological and even physiological imbalance. Such is the experience described by Evelyn Lau in her essay Insatiable Emptiness. In her vivid and poetic descriptions, she tells how she violently coped with the changes that were occurring within her adolescent body and how her negative response to these changes affected the stability of her health for eight years. The case of Lau’s maladjustment to her bodily changes and the way people around her, specifically her mother, reacted to her maturing body can be considered a form of culture shock. As a child, Lau says that she had been accustomed to the way her body looked: â€Å"I had been thin and healthy, with flat belly and limbs† (495). The image of her as a slender girl was instilled in her mind and became the identity that she appropriated for herself. However, this familiarity with her body was undermined by the natural, adolescent changes that occurred within her. At age 11, Lau got her first period and the hormonal imbalance brought unwanted changes in her breasts and hips. She began to see her natural metamorphosis as something that must be hidden, â€Å"terrible workings† which she must immediately expel out of her body (496). Because she was unprepared for the changes occurring within her, she reacted negatively to it, wanting to return to the familiar image of her body. Lau says that she â€Å"longed to make [her body] translucent, pared down, clean as a whistle† (496). When Lau describes the sensation she felt after vomiting food out of her stomach, she refers to it as a feeling of being â€Å"clean and shiny inside, like a scrubbed machine† (495). This is the sensation she got addicted to. Despite the unpleasant experience of forcing food out of her body and the foul taste of acid passing through her mouth, not to mention the detrimental effects of acid on her oral cavity, Lau got fixated on vomiting. The unpleasant activity became pleasurable in her mind because psychologically, she made herself believe that the act of vomiting purges her body of the unwanted changes that was occurring within her and that this act also brings her back to the familiar, internalized image of herself as a slender girl. What worsened her misperception of the natural adolescent changes was the negative response of her family, specifically her mother, to these changes. Instead of being a support in understanding her situation, her mother ridiculed Lau for her growing breasts and her insatiable appetite. Lau says that her mother’s actions â€Å"convinced [her] there was something wrong with [her] body† (496). Lau’s mother was a very controlling woman. Lau believes that her mother’s actions were motivated by the reality that as Lau was becoming a full grown woman, her mother began to see her daughter grew distant from her. Lau was becoming a separate part of her mother and her mother did not want Lau to be different and unfamiliar. As a result, her mother put Lau on strict diets, ridiculed her body and downgraded her by saying that she will never amount to anything because she was just like her weak father. In this sense, Lau mother’s also experience culture shock because the unfamiliar caused her to have an imbalance of perception. After eight years of suffering from bulimia, Lau’s body took the toll of her abusive behavior. Her and her mother’s failure to adjust to the novel experience of adolescent changes led her to a behavior that weakened her body and resulted to irreversible consequences. Lacking the encouragement and assurance that she needed, Lau resorted to a violent behavior directed toward herself. She feigned self-esteem when her insides were corroding with incessant self-hatred. She became withdrawn and obsessive for control just like her mother. Controlling the changes in her body is a manifestation that Lau wanted things to stay as they were because the changes she encountered was too shocking for her to accept. Being withdrawn, violent to oneself and obsessive for control are just few of the negative responses to culture shock. If not reversed, altered or mediated, these behaviors, as seen in Lau’s narrative, can result to a maladjusted person who is unprepared to meet any further changes. To some extent, I can relate to Lau’s experience because I too have undergone culture shock when I first encountered university life. Although my experience was not as violent or traumatic as Lau’s, I also responded negatively to the unfamiliar territory, to some degree. I was only about 18 when I first stepped in the halls of the university. To me, it was a totally different world, bustling with chaotic energy that my adjusting self was unprepared to match. I was caught in the wave of fast-paced change that I began to be negative about the unfamiliar experience during my first few months in the university. Being in a place stripped of the comforts of home and the certainty of the place where I grew up in was just like being fish out of water. There were discomforts and at times, severe bouts of anxiety. When I look back at those few months of nervously finding my way through this new environment, I remember it to be one huge blur, an indistinct rush of unfamiliar faces, behavior, ways and manners. The university I attended was set in a sprawling hectare of land with buildings so far apart it was so easy to get lost. The vast space which I discovered alienated me and I knew then that I needed some company. However, I found out that it was not as easy to blend in an environment whose unfamiliarity seemed hostile. It seemed to me back then that I was traversing dangerous grounds, a foreign territory whose internal rules and codes of conduct I did not understand. I was tentative when I introduced myself to others or try to make connections that would give me bearing as I was being hurled from one strange experience to another. What compounded my confusion and anxiety was the fact that I was an immigrant and being in the minority put me in constant check of myself whether I was rightly blending in or I was sticking out too much. Although diversity is one of the things they hail in the university, I could not help but see my foreignness to be at fault, somehow, to the anxiety I was experiencing. Like Lau, I had mistaken the anxieties from culture shock to be something that is accountable to my behavior or being and not to the fact that the unfamiliarity was unnerving to me. As a result, I became withdrawn for the first few months. I cruised the university halls by myself, aware of my alienation with the crowd. My social disengagement stressed me out, and I found it hard to initially cope with my academic load. The method of teaching and learning in the university was another factor in my brief alienation and to me the whole culture of independent study and fast-paced instruction shocked me. Although I had been oriented and prepared for university education in terms of studying skills and habits, the initial encounter with the actual thing was disorienting. I was managing my classes on my own, without the aid of peers. Professors hurled academic requirements to us by truckloads and I had to keep myself afloat in the torrent of term papers and coursework. When I came to the point that things got too big for me to handle, I sought help. I remember in Lau’s essay that she too sought help for her condition, but backed away because she had to wait in line. I think it is her failure to get early professional help which led to her aggravated addiction. In my experience, the perspective and advice of a person outside the eye of the storm of culture shock are valuable. I was able to positively adjust through the aid the student services made available for people going through the same confusion and anxiety. Culture shock, as seen in both my experience in my early days in the university and in Lau’s transforming body, can be experienced on many levels. It does not only refer to disorientation to a culture in the conventional definition involving race and nationality. It may also pertain to any confusion brought about by the intrusion of an unfamiliar behavior, image, or environment. Whatever the source of culture shock is, it is clear that the experience is temporal and must be dealt with positively. Reference Lau. E. (2006). Insatiable Emptiness. In Reinking, J. , Osten, R. Cairns, S. and Fleming, r (Eds. ) Strategies for Successful Writing: A Rhetoric, Research Guide, Reader and Handbook, Third Canadian Edition (pp. 495-499). Canada: Pearson Education.

Analysis Of The Book Twilight By Stephenie Meyer Essay

Pg.1 CHAPTER 1 -- INTRODUCTION ‘Twilight’, Stephenie Meyer’s debut novel, states the story of Isabella â€Å"Bella† Swan, a gawky seventeen-year old girl who falls in love with a vampire, Edward Cullen. Though Edward is deeply in love with Bella he battles his natural instinct to kill her. As a vampire he is hard-wired to think Bella and other humans as his prey. Stephenie Meyer got her idea for the book from a dream she had about a girl and her vampire lover having a conversation while sitting in a meadow. Meyer recalls in her interview â€Å"I was so intrigued by the nameless couple’s story that I hated the idea of forgetting it (also the vampire was just so darned good-looking that I didn’t want to lose the mental image). I put everything that I possibly could on the back burner and sat down at the computer to write--something I hadn’t done in so long.† This novel contains some recurring motifs that have been popular in story telling over time--this includes â€Å"forbidden love† and â€Å"beauty and the beast†. Forbidden love based on many famous tales are Shakespeare’s ‘Romeo and Juliet’, Nathaniel Hawthorne’s ‘The Scarlet Letter’. Similarly, we often see tales of women falling in love with beastly or monstrous men. Example is the fairytale of â€Å"Beauty and the Beast†, elements of this story line also appears in Charlotte Bronte’s â€Å"Jane Eyre† and Emily Bronte’s â€Å"Wuthering Heights†. Twilight is a forbidden love story. This is becauseShow MoreRelatedThe Stereotypical Gender Ring : Bella Swan s Indifference Vs. Rosalie Hale s Proactivity932 Words   |  4 PagesCulture Research Proposal and Thesis October 5, 2015 Entering the Stereotypical Gender Ring: Bella Swan’s Passivity vs. Rosalie Hale’s Proactivity For my research project I have decided to choose a character from a popular book series, Twilight which was written by Stephenie Meyer. The forbidden love story between a plain human girl and a gorgeous vampire boy sparked the hearts of millions, but the singular character I’m conducting my research on is Rosalie Hale. While Bella Swan, the main characterRead MoreReview Of The Lady With The Toy Dog 1134 Words   |  5 Pages The thought that a fictitious movie like Twilight is actually affecting women seems almost bizarre. You may wonder how it’s even possible that we can be so easily influenced by what some consider an â€Å"aimless series of vampire books†. However, it’s a proven fact that our brains react to fiction tales and they can indeed impact us in ways we could only imagine. A study was done in 2009 at the University of Toronto in Canada testing the hypothesis that art can cause significant changes in the experienceRead MoreEssay on Nicholas Sparks; The Author of Romance1967 Words   |  8 Pagesfrom being a relative unknown to being a writer with a book deal and $1 million movie rights contract (Bio Channel). Once again, though, Sparks triumph gave way to devastation when his father was killed at the age of 54 in an automobile accident.. The book, later titled Message in a Bottle, was inspired by his parents relationship. Skeptical that hed really made it as a writer, Sparks continued to sell pharmaceuticals while he wrote the book. He finally retired from sales in February 1997, whenRead MoreResearch on Time Management3882 Words   |  16 Pagesmay be aided by a range of skills, tools, and techniques used to  manage  time when accomplishing specific tasks, projects and goals. This set encompasses a wide scope of activities, and these include pla nning,  allocating,  setting goals, delegation, analysis of time spent,  monitoring, organizing, scheduling, and prioritizing. Initially, time management referred to just business or work activities, but eventually the term broadened to include personal activities as well. A time management system is a