Relationship importance and Factors of Marital Adjustment

Relationship importance and Factors of Marital Adjustment Over the course of life, people learn to establish different relationships, with different values, expectations and commitments. One of those relationships is the marital relationship. For A good marital relationship marital adjustment is essential. Sinha Mukerjee (1990) defines marital adjustment as The state in which there is an overall feeling in husband and wife of happiness and satisfaction with their marriage and with each other. Locke Wallace (1959) defines marital adjustment as: accommodation of husband and wife to each other at a given time According to Spanier and Cole (1976), marital adjustment is a process, the outcome of which is determined by the degree of: a) troublesome marital differences, b) interpersonal tensions and personal anxiety, c) marital satisfaction d) dyadic cohesion, e) consensus on matters of importance to marital functioning. There are a number of factors that define a healthy marital adjustment. Some of these factors are Factors involved in Marital Adjustment: Wife employment and Marital Adjustment: Blumstein and Schwartz (1983) had earlier found that individuals, particularly wives, reported increased levels of self-esteem, self-concept, and self-worth were positively correlated with employment. Previous research on the relationship be- tween wife employment and marital adjust- ment has produced conflicting results: some investigations report a positive relationship between wife employment and marital adjust- ment (Burke Weir, 1976; Hartley, 1978); others suggest a negative relationship (Bean, Curtis, Marcum, 1977; Gover, 1963); other studies show no relationship (Bahr Day, 1978; Blood Wolfe, 1960). Nathawat and Mathur (1993) did a study in India about marital adjustment and subjective well-being in Indian-educated housewives and working women. Their results indicated that working women had better marital adjustment and subjective well-being. Working women reported high scores on general health, life satisfaction and self-esteem measures lower scores on hopelessness, insecurity and anxiety whereas the housewives had lower scores on negative affect than the working women. Trust and marital adjustment: Relationships are composed of trust, and sharing of intimate thoughts and feelings. They are built upon trust and sharing and they get stronger from these things (Finkenauer, Kerkhof, Righetti, Branje, 2009). According to Regan, Kocan, and Whitlock (1998) Trust is one of the most important component of a loving relationship. Also international studies have found trust to be a critical factor in the success of long-term marriages (Roizblatt et al. 1999; Sharlin 1996). In a longitudinal study, Kristina Moeller and Hakan Stattin (2001) report that adolescents with trustful parental relationships experienced greater satisfaction with their partner relationships in midlife. Quality of life and marital adjustment Psychological Factors: Depression stress (psychological well being) Lower psychological well-being is a major risk factor for relationship distress. Higher rates of relationship problems have been consistently linked to persons suffering from severe psychiatric disorders, including depression, substance abuse, and anxiety disorders (Bradbury, 1998). Many studies link marital conflict to depression (Beach, Arias, OLeary, 1987; OLeary and Beach, 1990). Although the authors propose a bidirectional causal relationship between marital conflict and depression, they suggest that marital conflict is typically a more powerful contributing factor to depression. Marital satisfaction appears to be an important factor of psychological well being. Marital distress has been linked with many psychological difficulties especially depression. (KAUSAR ANSARI.. thesis) . Belongingness and Marital Adjustment: According to Baumeister Leary (1995) Belongingness might have multiple and strong effects on emotional patterns and on cognitive processes. Lack of belongingness or attachments is linked to a variety of ill effects on health, adjustment, and well-being. In a close relationship there is a need to belong and if that need isnt fulfilled then problems may occur. One of the universal institutions is marriage which is accepted to satisfy the need for belongingness. Economics and Marital Adjustment Education and income have also been linked to marital satisfaction and marital conflict, with greater levels of education and income predicting greater marital satisfaction and less conflict. Economic stress has a negative effect on marital satisfaction and a positive influence on relationship dissolution (Johnson Booth, 1990). Economic strain is directly linked to increased couple disagreements and has direct impact on marital adjustment (Kinnunen and Feldt, 2004). Many researches haves been conducted on economic factor in relation to marital adjustment e.g Zedlewski (2002) studied economic factor in relation to family well-being , he found that low family income and limited benefits have negative influences on child and family well-being. Voyandoff (1990) studied economic distress and family relations.   Ross Mirowsky (1992) and Yadollahi (2009) studied that employment of spouses  and the sense of control in various types of stressors of marital life. Diener and Diener (2001) investigated that wealth is related to many positive outcomes in life. Gudmunson, Beutler, Israelsen, McCoy Hill (2007) found that financial problems significantly contributed to lower reported marital satisfaction among married couples. In a study in Finland conducted by Kinnunen and Feldt (2004) concluded that husbands unempl oyment is strongly associated with his marital adjustment. Couples with better economic resources are martially adjusted as compared to those who have limited economic resources. Economic hard times increased rate of martial distress.   (Blekesaunes   2008)   Personality and Marital Adjustment In a study by Bouchard, Sabourin, Lussier, Y. (1999) the relationship of various personality traits with marital adjustment was studied. Personality traits studied were neuroticism, extraversion, openness, agreeableness and conscientiousness. The scale used to measure marital adjustment was dyadic adjustment scale. The results showed that women high in agreeableness and openness were more adjusted. Also males that were high on openness and agreeableness were more martially adjusted. Husbands openness was positively related to their wives marital adjustment. Open individuals may tolerate and respect differences in behavior and thought of partner which would reduce the number of conflicts and increase the consensus between spouses. Kim, Martin, and Martin (1989) and Levine and Henessy (1990) found that personality factors differentiated stable from unstable marriages. Stable marriages were more similar in intelligence, protension, radicalism, tender-mindedness, mutual trust, acceptance, enthusiasm, and genuineness. Personality factors that reduce the likelihood of stability and satisfaction have included the lack of warmth and extraversion (Levine Henessy); passive-aggression (Slavik, Carlson, Sperry, 1998); borderline pathologies (Paris Braverman, 1995); bipolar disorders (Peven Schulman, 1998); feelings of insecurity, unfairness, depreciation, and powerlessness (Begin, Sabourin, Lussier, Wright, 1997); disagreeableness, emotional instability, inconsiderateness, and physical abuse (Botwin et al., 1997; Kosek, 1996; Shackelford Buss, 1997); depression (Cohan Bradbury, 1997; Davila Bradbury, 1997; Fals-Stewart, Birchler, Schafer, Lucente, 1994); neuroticism (Karney Bradbury, 1997; Russell Wells, 1994a ; Russell Wells, 1994b); tension, anxiety, worry, and suspicion (Craig Olson, 1995); hostility, defensiveness, and aggression (Heyman, OLeary, Jouriles, 1995; OLeary, Malone, Tyree, 1994; Newton, Kiecolt-Glaser, Glaser, Malarkey, 1995); and negative affectivity leading to negative attributions (Huston Vangelistic, 1991; Karney, Bradbury, Fincham, OSullivan, 1994). Individual personality traits have also been linked to couples relationship functioning for both men and women. Personality traits of neuroticism, anxiety, and emotional instability have been shown to impair relationship functioning and reduce relationship satisfaction (Watson Clark, 1984). Additionally, personality characteristics of agreeableness and expressiveness have been referred to as individual protective factors, which may enhance marital satisfaction (Bradbury, Campbell, Fincham, 1995). Communication and Marital Adjustment: Communication is necessary for human growth and development also it serves as the essential foundation for marital success and is the facilitating process for an enduring marriage that is satisfying (Robinson Blanton, 1993). Communication within relationships is an important factor, if there isnt communication the relationship suffers. The relationship between marital communication and adjustment is a strong one (Murphy Mendelson 2004). Gottman (1995) in his book indicated that communication could be both productive and destructive to relationships as unhappy couples tend to criticize, disagree, complain, put down, and use excuses and sarcasm. Unrewarding communication patterns lead to the development of relationship distress (Markman, 1979). In contrast, happy couples with marital stability and satisfaction are more likely to use active listening skills, agree, approve, assent, use laughter and humor (Fisher, Giblin, Hoopes, 1982) and possess character virtues of self-restraint, courage, and friendship (Fowers Olson, 1986). Gottman (1995) has suggested that satisfied couples maintain a five-to-one ratio of positive to negative exchanges in interactions Gender also plays an important role in couple communication as there are gender differences in verbal and nonverbal communication with men tending to be more dominant in their interactions and women being more submissive (Tannen, 1990). Emmers-Sommer (2004) studied the effect of communication quality and quantity indicators on satisfaction in relationships. A key term in the study was quality time; this refers to focused, uninterrupted time spent with children, partners, friends, and significant others. Another key term used in the study was quantity time; this refers to frequency of communication or contact. For individuals to reach relationship satisfaction they have to examine the quantity and quality of their disclosures with their partners. Emmers-Sommer (2004) found that quality of communication predicts both relationship satisfaction and intimacy. The quantity of communication, however, was not a predictor for relationship satisfaction. Concealment/Non- disclosure and marital adjustment: Disclosure  as a phenomenon was first investigated by Sidney Jourard (1971). The process was originally defined as telling others about the self. Rosenfeld (1979) explained self-disclosure as the personal information of self that is only available from himself and is not available from other sources. Jorgensen Gaudy (1980) defines self disclosure as: A process by which a marriage partner ex- presses feelings, perceptions, fears, and doubts of the inner self to the other partner, allowing relatively private and personal information to surface in the relationship that normally would not be revealed in the course of day-to-day interaction. The word conceal has been originated from the Latin work Concelare , celare means to hide. Merriam Webster defines concealment as  to prevent disclosure or recognition. Concealment is the activity of hiding information and keeping secrets from other people. Larson and Chastain (1990) explained self concealed personal information as firstly, a subset of private personal information, secondly, it is accessible only to the individual and thirdly it is actively kept from the awareness of others. Thus, self-concealment involves the conscious concealment of private information like feelings, thoughts, actions or events that one perceives as highly intimate, distressing or negative. Even though concealment and disclosure seem the same, there is some difference between self-disclosure and self-concealment. According to Larson and Chastain 1990 the act of revealing personal information is self- disclosure whereas the act of concealing personal information is self-concealment. They argued that self-concealment and self-disclosure are two separate and distinct constructs even though they are related. Effects of concealment/non-disclosure on marital adjustment Feelings of Exclusion People usually resent it when they perceive that another person is keeping secrets from them. The general reaction towards concealment is that of exclusion since in that persons view his right to know is being violated. This level or degree of exclusion felt by a person is higher when these persons are in a close and intimate relationship (Finkenauer, Kerkhof, Righetti, Branje, 2009). Marital relationships are composed of trust, and sharing of intimate thoughts and feelings. They are built upon trust and sharing and they get stronger from these things. Therefore the quality of relationship is influenced adversely when there is a perception of concealment from partner. The perception of concealment effects on relationship quality, the person feels rejected or excluded (Finkenauer, Kerkhof, Righetti, Branje, 2009). The exclusion that is communicated by concealment can be assumed to violate almost all features and values commonly associated with close relationships, including trust, caring, honesty, friendship, companionship, unconditional acceptance, and respect (Finkenauer, Kerkhof, Righetti, Branje, 2009). Psychological effects To keep secrets or deliberately conceal information from others seems to be part of normal development. Even though every person has secrets they can sometimes be a burden. There are different types of secrets people keep like having cheated on an exam, having a disease, sexual orientation or having been sexually molested as a child. Most of these secrets involve stigmatizing or negative information that usually involves the secret keepers themselves. People who conceal negative or distressing information of self from others as compared to the ones who do not, are more depressed, anxious, shy and have low self-esteem.(Kelly, Klusas, Weiss Kenny, 2001) Effects of Disclosure on marital adjustment Self-disclosure and liking The earliest work done on the relationship between disclosure and liking was by Jourard (1959) who found a positive association between liking the other person and disclosing to that person in a sample of nursing students and faculty. A number of studies have been done on this relationship and confirmed that we disclose more to people whom we like. (e.g., Certner,1973, Fitzgerald, 1963; Worthy, Gary, Kahn, 1969) and also we tend to like the people who disclose personal information to us (e.g., Archer, Berg, Runge, 1980; Daher Banikiotes, 1976;Taylor, Gould, Brounstein, 1981). Self-Disclosure and psychological well-being Most of the studies done on the relationship between concealment and psychological well-being have shown the same results which are that higher levels of disclosure are associated with psychological wellbeing and lower levels of disclosure are associated with poorer mental health. Disclosing distressing information helps with the psychological well-being and not disclosing leads to poorer mental health. It is thought that disclosing distressing information helps psychological well-being by reducing the stress of keeping the information to oneself (Ichiyama et al 1993; Cramer, 1999; Barry and Mizrahi, 2005; Hook and Andrews, 2005; Kahn et al 2002). Gender differences and concealment: Concealment is behavior that is more common in males. On the other hand previous studies indicate that females are usually more willing to disclose distressing or personal information. Traditionally, discussing personal problems is a behavior that is considered more appropriate for females than for males (Kahn and Hessling, 2001). Among men, asking for help when faced with psychological problems is often perceived as a weakness (Jourard and Lasakow, 1958; West, 1970; Jourard, 1971; Cozby, 1973; Kelly and Achter, 1995; Kahn and Hessling, 2001). Moreover, traditional sex-role stereotypes suggest that females are more skillful in communicating and also are more concerned with issues of intimacy than are men. So an intimate disclosure by a man may be seen as less appropriate than a similar disclosure by a woman (Collins Miller 1994). All in all men who disclose are generally viewed as maladjusted whereas women who do not disclose may be viewed as maladjusted. (Collins Miller 1994). Age and tendencies towards disclosure/ non-concealment and in terms of age it has been found that young people are more likely to disclose than older people. (Jourard, 1971; Hook and Andrews, 2005). Literature Review: Labels such as satisfaction, adjustment, success, happiness, and quality have all been used in describing the quality of marriage (Fincham, Beach, Kemp-Fincham, 1997) Theories on marital adjustment and disclosure Social penetration theory: Many studies have dealt with self disclosure. One main theory that was a framework for the study is Social Penetration Theory (Altman Taylor, 1987). This theory was a model for the study because it looks at self disclosure as both the depth and the breadth. In this study the depth of self disclosure is an important factor when reaching satisfaction in relationships. Altman and Taylor use an onion as a metaphor for relationship development. They suggest that the onion represents the breadth and depth of self disclosures. On the outer layer of the onion individuals have the breadth of disclosures: a broad aspect of a person such as their tastes, worldview, and studies. As individuals go deeper into the onion, they get to the depth of disclosures meaning they get more detail on aspects of an individual. This represents the degree of a persons disclosure. The main route to deep social penetration is through individuals disclosures. The depth of penetration would represent the degree of personal disclosure. Altman and Taylor (1987) suggest the depth of penetration into the onion model is the degree of intimacy. This study examines the depth of penetration, breadth is equally important in relationships. This theory supports the idea that people who have a high level of depth in their disclosure will be more satisfied in romantic relationships. This theory does not examine the amount of self disclosure as it does the depth of self disclosure. Three competing models of marital disclosure and satisfaction Jorgensen Gaudy (1980) gave models for marital disclosure and satisfaction and according to Spanier (1976) marital satisfaction is a sub category of marital adjustment. According to the linear model of marital relationship, there exists a positive, linear relationship between marital disclosure and marital satisfaction. Marital relationship is characterized by factors like intimacy, trust and caring. Marital disclosure positively impacts these factors and therefore presence of these factors in a marital relationship systematically increase the level of marital satisfaction. Therefore, this model suggests that higher the level of marital disclosure greater will be the marital satisfaction and vice versa. The curvilinear model as opposed to the linear model suggests that a satisfying marital relationship exists only with medium levels of self disclosure. When self disclosure falls on the high or low end of the continuum of self disclosure, marital satisfaction will decrease. This means that too lack of self disclosure is not the only factor that results in low marital satisfaction. Extensive self disclosure might be perceived as nagging or too much complaining which might raise negative feelings of hostility in the spouse which in turn will decrease the marital satisfaction. Hence, according to this model moderate levels of self disclosure are characterized as a key factor in achieving high marital satisfaction. John Gottmans (1999) scientifically validated theory of marriage, based on 25 years of longitudinal research, is one of the leading theories in the study of marital satisfaction. Gottmans theory (1999) states that positive interaction and friendship is the key to marital satisfaction and the prediction of marital stability over time. According to Gottman (1999), a ratio of 5:1 positive to negative interactions is necessary for marital stability. Gottman defines marital stability as a satisfying marital relationship that is not disrupted by separation or divorce. He states, The most important finding was that more positive affect was the only variable that predicted both marital stability and happiness (p. 21). In Gottmans theory (1999), there is a process of what he calls sentiment override in couples. He states, Sentiment override can be either positive or negative. Negative sentiment override means that people have a chip on their shoulder. These types of partners are hypervigilant, looking for slights or attacks by their partner. Positive sentiment override means that even negativity by the partner is interpreted as informative rather than as a personal attack (p. 164). Positive sentiment override creates a milieu in which the partners are more tolerant and accepting of each other, while negative sentiment override creates a set of expectations that ones spouse will behave negatively. Similarly, OLeary and Smith (1991) refer to this phenomenon as cognitive attributional correlates of marital satisfaction. These authors state that distressed couples are less likely to objectively interpret positive behaviors from their spouses as positive and more likely to interpret the intent of their spouses statements more negatively than they were meant to be. Compared to non-distressed couples, dissatisfied spouses make attributions that cast their partners behavior in a negative light and these attributions in turn negatively influence marital satisfaction (Bradbury Fincham, 1990). In summary, according to Gottman (1999) as well as OLeary and Smith (1991) it is not what happens in the marriage, but how the partners perceive and define what has happened that is critical. Gottman posits that 69% of couples problems will be what he calls, perpetual problems, meaning largely unresolvable. He has found that in the case of the perpetual problems, it is important for couples to establish a dialogue, as opposed to a solution in these instances. When couples cannot dialogue about these issues, they often become gridlocked, where each partner becomes frustrated and eventually emotionally disengaged. The role of communication therefore plays an important role in marital satisfaction. Studies examining marital satisfaction vary in design, measurement, and outcomes, leading to a number of explanations accounting for marital satisfaction (Gottman, 1999). Perception of concealment has an adverse effect on marital relationships. Some researches have been carried out related to this issue. In a longitudinal study it was studied how perceiving concealment in close relationships influences marital well-being. The research showed that people in marital relationships who perceive their partner to be concealing information from them had poor relationships, mistrust and conflict between them. In the study it was also discussed that people who conceal information also perceive that the other person is concealing information from them. Perceiving concealment may give the other partner the impression that he/she is not desirable or cannot be trusted; it gives the other person the feelings of being excluded. And the feeling of exclusion may result in feelings of separation or estrangement which may result in marital conflict (Finkenauer et al., 2009). Another study conducted in Belgium has investigated disclosure and secrecy in close, long-term relationships. It showed in the study that secrecy contributed a lot to marital dissatisfaction. The study explains how a person who has a secret avoids a difficult topic rather than facing it to avoid conflict, while the other partner perceives the secrecy as a sign of suspicion, which contributes negatively to marital satisfaction. Another point in the study was that people trying to hide something on the way feel that they have to put on a mask for the other person so he/she doesnt get to know their secret; they have to pretend which may lead to less intimacy and closeness. People who felt comfortable with sharing their emotions and were able to talk about matters were more satisfied with their relationship. One of the questionnaires used to test their study was the Larson and Chastains (1990) Self- Concealment Scale (Finkenauer Hazam, 2000). Low expressiveness leads to dissatisfaction in a marital relationship. Miller et al. (2003) argued that expressive people are less likely to suffer decline in marital satisfaction. They found that spouses expressiveness was positively related to their own and partners affectionate behaviors and this affectionate behavior was in turn related with marital satisfaction. Expressiveness is positively associated with peoples perception of their partners responsiveness. Davidson, Balswick Halverson (1983) did a study on the Affective Self-Disclosure and Marital Adjustment. It was based upon 162 married couples. The study explains that the greater is the discrepancy in partners affective self-disclosure, the lesser is the individuals marital adjustment. READ WHOLE PAPER AND WRITE. Sprecher and Hendrick (2004) examined the relationship between self-disclosure and relationship quality and found a positive relationship between disclosure and relationship quality. Self-disclosure is an indicator of satisfaction in romantic relationships. Levesque, Steciuk, and Ledley (2002) studied how self-disclosure relates to the development of personal relationships, relational intimacy, and relationship dissolution. The results showed that perceived intimacy was strongly associated with level of self-disclosure. Self-disclosure was found to be strongly reciprocal. Levesque et al. 2002 found that the level of self-disclosure strongly influences individual differences between disclosers. HANSEN E.J SCHULDT J.W (1984) did a study on marital self-disclosure and marital satisfaction. The sample for the study was on a sample of 50 married couples of mean age 25 years and mean length of marriage was 3.18 years and mean education was 15 years. Scales used for measuring the variables were Jourards self disclosure questionnaire( jourard and Lasakow, 1958) and Spaniers (1976) Dyadic Adjustment Scale. the results of the study showed that wifes disclosure to husband was positively related to husbands marital satisfaction and husbands disclosure to wife was also positively related to husbands marital satisfaction. One predictor that may have particular importance to marital satisfaction is gender roles. According to Kurdek (2005) there are two classes of theories that explain the position about how men and women experience close relationships in different ways. the first class, that is the biological, posits that males and females in a relationship process events differently at the cardiovascular, endocrinological, immunological, neurosensory, and neurophysiological levels. For example Kiecolt-Glaser Newton (2001) in their research reviewed evidence showing that men are more physiologically sensitive to acute stressors than women and women showed stronger and more durable physiological changes than men in marital conflict. The other class that is the class of social psychological theories posits that both genders differ in ways that are directly relevant to relationship functioning like the structure and content of how the self is constructed, personality traits and socialized roles. The other class that is the class of social psychological theories posits that both genders differ in ways that are directly relevant to relationship functioning like the structure and content of how the self is constructed, personality traits and socialized roles. Other research has also substantiated that marriage disproportionately benefits men, with husbands reporting higher levels of marital satisfaction and well-being than their wives (Bird Fremont, 1991; McRae Brody, 1989; Schumm, Webb, Bollman, 1998). Gender is defined as the socially determined role of an individual that is ascribed as a result of his or her sex (Juni Grimm, 1994). Gender roles influence men and women in every aspect of their lives and relationships (Knox Schacht, 2000). Demographic characteristics including age, race, income, education, length of marriage, and religiosity, have been linked to marital satisfaction and marital conflict (Knox Schacht, 2000). Based on Gottmans (1999) research, length of marriage is also a significant predictor for marital satisfaction and marital conflict. He identifies two critical time periods of vulnerability in the marital trajectory, with the majority of couples divorcing within the first seven years of marriage. Couples who divorce within the first seven years of marriage have relationships characterized by having high levels of marital conflict. Conversely, a second vulnerable time period for the marital trajectory is 16 to 24 years of marriage. This is the next most likely time frame for couples to divorce. These relationships are characterized by spending little time together, lack of communication, and a lack of conflict expression. Gottman (1999) refers to these couples as two ships passing in the night.

Core Competencies Essay

Hamric, Hanson, O’Grady & Tracy (2014) define competencies as â€Å"a broad area of skillful performance.† Competencies include activities implemented by advanced practice nurses while providing direct patient care and the processes, knowledge and skills used in all aspects of advanced practice. There are seven core competencies associated with the advanced practice registered nurse. In addition to the seven core competencies, nurse practitioner education and nurse administrator education have additional competencies needed to become proficient in each of those roles (The American Organization of Nurse Executives (AONE) 2011; The National Organization of Nurse Practitioner Faculties (NONPF), 2012). While there is overlap of some of the competencies the nurse executive role and the nurse practitioner role each have specific skills needed to attain expertise in each role. Nurse executives plan, direct, coordinate and supervise health care delivery. He or she must have expert knowledge regarding patient care delivery, marketing, management, ethics, and human resource management, as well as additional knowledge. Due to the wide range of knowledge needed, nurse executives need to attain expertise in many areas. AONE has outlined five competencies and detailed the skills needed for each (2011). According to AONE communication and relationship-building is a competency that must be mastered in order to cultivate relationships and establish rapport and includes skills such as relationship management, effective communication, influence of behaviors, shared decision making and ability to work with diversity. The professionalism competency includes ethics, evidence-based clinical and management practice, advocacy, and personal and professional accountability (AONE, 2011). The nurse administration works at the executive  level so professionalism must be maintained. Nursing leadership must be upheld by mastery of skills like foundational thinking skills, change management and succession planning. The business skills competency can be met by the nurse administrator upon mastering business management, human resource management, marketing and strategic management and information management and technology (AONE, 2011). The health care system which the nurse executive manages can be a large complex system, such as an acute care hospital that has a level I trauma center, a pediatric unit, labor and delivery unit, cardiac intensive care, and neonatology. Because of this complexity competency of health care environment knowledge must be mastered and includes the skills of clinical practice knowledge, delivery models, health care economics and policy, governance, patient safety, quality improvement and case management (AONE, 2011). According to the National Organization of Nurse Practitioner Faculties (2012), upon graduation from a nurse practitioner program the graduate must possess mine competencies without regard to the population of focus. By mastering these competencies the nurse practitioner will have the skills and knowledge needed to practice independently. NPs provide direct patient care so the competencies and skills needed differ slightly from the competencies needed for nurse administrator. The practice inquiry competencies and the quality competencies are similar in that they both involve using knowledge gained from clinical practice to improve health care quality. Quality competencies include using best evidence to improve clinical practice, evaluating access to care, cost, quality and safety, organizational structure, financing, marketing and policy decisions and their impact on health care quality. Practice inquiry competencies involve applying clinical investigative skills, practice inquiry, analyzing clinical guidelines, generating knowledge from clinical practice and providing leadership while applying new knowledge. The technology and information literacy competencies are related to information literacy skills, literacy in information systems, integrating technologies into clinical practice and the delivery of health to improve health outcomes (NONPF, 2012). To function effectively the NP must understand health care policy and regulations. He or she must be competent in the evaluation of policy and its implication on health care delivery and outcomes and must promote access, quality and equality. All of these skills  fall under the policy competencies (NONPF, 2012). Health delivery systems competencies relate to the development of health care systems, the organizational structure and functions or health delivery systems and applying that knowledge to improve health care d elivery (NONPF, 2012). Along with a clear understanding of policy the NP must have expert knowledge of the independent practice competencies. NONPF list the independent practice competencies skills as the ability to function as a licensed practitioner, exhibiting accountability, managing previously diagnosed and undiagnosed patients and providing patient-centered care while observing cultural diversity and respecting patient decisions. There are some overlapping competencies within the NP and the nurse executive role. Both professions contain a leadership competency and both advanced practice nurses are expected to participate in professional organizations and to initiate change. The NP competency includes advocating for improved access, quality and cost effective health care while the nurse executive competency includes staff support and adapting leadership style (AONE, 2011; NONPF, 2012). The NP scientific foundation competency and the nurse executive knowledge of health care environment competency have areas of overlap such as the use of research to improve practice and decision making and evidence-based practice, and outcome measurement. The nurse executive skill of expert practice of ethics is outlined under the professionalism competency. Hamric et al. (2014, p. 101) state the transition from student to professional APN can be rife with behavioral, attitudinal and value conflicts. Hamric et al. further state that there are phases an APN moves through during role implementation. The first stage laying the foundation, occurs when graduate NPs sit for certification examinations for their specific roles, and look for available positions. The second stage generally last up to three months after the first position and consists of anxiety related to low confidence and low competence. One strategy to facilitate role implementation for all APNs is to develop a structured orientation plan. Although there are numerous practice setting and roles the nurse executive and the NP both benefit when clear expectations, needs, values, goals policies and procedures of the specific agency are made available upon hire (Hamric et al., p. 102). References Hamric, A. B., Hanson,C. M., O’Grady, E. T., Tracy, M. F. (2014) Advanced Practice Nursing: An Integrative Approach, 5th Ed. [VitalSource Digital Version]. St. Louis, MO: Elsevier Saunders. The American Organization of Nurse Executives. 2011. The AONE Nurse Executive Competencies. Retrieved September 11, 2014 from http://www.aone.org/resources/leadership%20tools/nursecomp.shtml The National Organization of Nurse Practitioner Faculties. 2012. Nurse Practitioner Core Competencies April 2011, Amended 2012. Retrieved September 11, 2014 from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf

The Great Challenge For Marginalized Writers Essay

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The Difference Between Emigrate and Immigrate

These two verbs have similar meanings, but they differ in point of view.Emigrate means to leave one country to settle in another. Immigrate means to settle in a country where one isnt a native. ​Emigrate stresses leaving; ​immigrate stresses arriving. For example, from the point of view of the British, you emigrate when you leave England to settle in Canada. From the point of view of the Canadians, you have immigrated to Canada and are considered an immigrant. Emigrate describes the move relative to the place of departure. Immigrate describes it relative to the place of arrival. Examples The film Amreeka tells the story of a Palestinian mother and son who emigrate from the West Bank to Illinois.The modern American Christmas tree originated with German Lutherans and spread to Pennsylvania after they began to immigrate here in the 18th century. Practice Understanding the Difference (a) When my grandparents decided to _____ to the U.S., there was no one waiting for them here.(b) At the end of the Greco-Turkish War of 1919–1922, thousands  of people were compelled to _____  from  Asia Minor to Greece. Answers (a) When my grandparents decided to  immigrate  to the U.S., there was no one waiting for them here.(b) At the end of the Greco-Turkish War of 1919–1922, thousands  of people were compelled to  emigrate  from  Asia Minor to Greece.