Effectiveness of Behavior Management in Aged Care: A Report

This project assesses the effectiveness of a behavior management system implemented at Mercy Community Residential Aged Care Service. The primary goal was to train nurses and caretakers to efficiently manage the violent behaviors of elderly residents, often stemming from mental health conditions like dementia and depression. The project involved a detailed analysis of the challenges faced, the development of a training framework, and the evaluation of outcomes. Project methodologies included Gantt charts for scheduling, bottom-up estimation for budgeting, and risk/stakeholder/communication matrices for project management. The project aimed to improve the quality of life for residents by equipping staff with the skills to handle challenging behaviors effectively, reducing the need for external assistance and enhancing the therapeutic environment. The report details the project's phases, methodologies, key findings, and recommendations for continued improvement in aged care behavior management.

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Table of Contents
EXECUTIVE SUMMARY.....................................................................................1
INTRODUCTION...............................................................................................1
BACKGROUND........................................................................................................................ 2
CASE FOR CHANGE................................................................................................................. 2
PROJECT METHODOLOGIES..............................................................................2
DELIVERABLES..............................................................................................16
EVALUATION.................................................................................................17
KEY FINDINGS...............................................................................................19
RECOMMENDATIONS......................................................................................19
BIBLIOGRAPHY..............................................................................................21
APPENDIX.....................................................................................................25
APPENDIX 1........................................................................................................................ 25

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EXECUTIVE SUMMARY
This project is based on the assessment and analysis of the effectiveness of the
behavior management system that has been implemented in Mercy Community
Residential Aged Care Service. The purpose of the approval of this project was to
provide the nurses and the caretakers with training so that they are able to manage
and handle the violent behaviors of the aged people much more efficiently (Bauer et
al., 2014). Furthermore, it is also required to improve of the quality of life of the aged
people who have been admitted in the care home so that they receive proper therapy
and treatment. In most of the times, the aged people often lose patience or are
affected by certain medical conditions, for which, they show violent and rude
behaviors to the nurses who are taking care of them (Testad et al., 2014). While in
some cases, the nurses can bring the situation under control, most of the nurses are
not able to handle the situation and call for help from other nurses and therapists. The
objective of this project is to train the nurses such that they do not require further
assist from other nurses and therapists for managing the behaviors of the aged
people.
INTRODUCTION
Disorder in Mental health is considered to be some common kind of problems in aged
people. The project is mainly undertaken for a large number of reasons. The most of
old aged people who are admitted in residential care settings tend to suffer from one
or many kind of mental health conditions (Cabrera et al., 2015). It also becomes hard
for caretakers to easily manage for the large number of people who are not well
trained in managing the people who exhibit challenging behaviours as a result of
issues of mental health and care at utmost (Sweeney, Danaher & McColl-Kennedy,
2015). The ultimate goal of this project is to provide or give training to large number of
nurses who are mainly involved in dealing with residents along with behaviour
management therapy. It also aims in improving the standard or quality of life to large
number of residents who are living their live based on Mercy community residential
aged services.
Background
In this project a plan has been developed on “behavior management therapy” in
mercy of community care residents. In various community care a large number of
residents are encountering various kinds of mental health problems like depression,
dementia. These medical conditions of the aged people often lead to violent and rude
behavior that also affects the nurses and caretakers of the home (Ballard et al., 2015).
This project was designed in a way that a training framework would be developed that
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will assist the nurses and caretakers in better management of violent behaviors of the
aged people (Rokstad et al., 2015). In addition, the nurses and caretakers would be
taught about various treatment methods and medications that will not only handle
violent behavior but will also enhance the therapy of the aged people and increase the
quality of their lives.
Case for change
Mercy Community Residential Aged Care Service is an aged care home that provides
care and therapy for aged people having various medical conditions like dementia,
delirium, depression and others. At the time of executing the project, there were 197
aged residents of which 28 people were affected by mental health problems
(Isaramalai et al., 2018). There were several nurses and caretakers appointed who
took care of all the patients and some therapists and doctors visited the home from
time to time to provide medications for the patients.
The objectives of the project were as follows.
To study the problems faced by nurses and caretakers regarding behavior
management of aged care home residents
To develop a training framework for the nurses and caretakers
To study the condition after training sessions have been completed
PROJECT METHODOLOGIES
Several project management methodologies were used in order to determine various
aspects of the project like duration, cost, scope and others (Kerzner & Kerzner, 2017).
For executing these methodologies as per the requirements of the project, suitable
project management tools were used. Some of the project management
methodologies used in this project are listed in the following table.
Tool Purpose Assessment
Gantt chart (Microsoft
Project)
This tool was used by the
project team to determine
a suitable duration and
schedule for the project
Gantt chart was effectively
utilized to prepare the
project schedule. Various
activities and deliverables
of the project were added
to the Gantt chart and
linked with each other and
a proper schedule was
obtained as result (Kerzner
& Kerzner, 2017).
Bottom Up Estimation This tool was also used to A resource sheet was
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Tool Purpose Assessment
(Microsoft Project) determine the overall
budget for the project
developed in the Gantt
chart and the resources
were allocated to the
activities; accordingly,
bottom up cost estimation
technique was utilized to
produce estimated budget
for the project (Verzuh,
2015).
Risk Register Matrix This tool helped in
determining the risks
associated with the project
The risk register matrix
was used to identify the
risks and prepare a plan to
address these risks
(Turner, 2016).
Stakeholder Matrix This tool helped in
determining the
stakeholders associated
with the project
The matrix was used to
determine the
stakeholders, their
designations and detailed
role in the project (Walker,
2015).
Communication Matrix This tool helped in
determining the
communication plan
between stakeholders
This matrix used
stakeholder list and
defined the methods and
reasons for communication
with these stakeholders
(both internal and
external) (Schwalbe,
2015).
The uses of these tools are also shown as follows.
Gantt chart was effectively used to determine the schedule of the project shown in the
following table.
Task Name Duration Start Finish Predecessors
Behavior Management
in Aged Care Home 187 days Fri 5/11/18 Mon 1/28/19
Project Discussion
Phase 25 days Fri 5/11/18 Thu 6/14/18
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Identification of the
Problem Area 5 days Fri 5/11/18 Thu 5/17/18
Primary Discussion
regarding Problem 5 days Fri 5/18/18 Thu 5/24/18 2
Identification of
Possible Solutions 3 days Fri 5/25/18 Tue 5/29/18 3
Exchange Ideas
between Team Members 4 days Wed 5/30/18 Mon 6/4/18 4
Reach a Particular
Solution 2 days Tue 6/5/18 Wed 6/6/18 5
Agree on the Same
Goal for Project 2 days Thu 6/7/18 Fri 6/8/18 6
Approval of Project
from Supervisor 4 days Mon 6/11/18 Thu 6/14/18 7
Project Planning
Phase 31 days Fri 6/15/18 Fri 7/27/18
Start Planning for
Project 2 days Fri 6/15/18 Mon 6/18/18 8
Select a Aged Care
Home for Project 2 days Tue 6/19/18 Wed 6/20/18 10
Contact with the
Aged Care Home
Authority
1 day Thu 6/21/18 Thu 6/21/18 11
Get Approval from
the Authority for Project 1 day Fri 6/22/18 Fri 6/22/18 12
Prepare Project
Roadmap 10 days Mon 6/25/18 Fri 7/6/18 13
Identify Project Scope 2 days Mon 7/9/18 Tue 7/10/18 14
Identify the
Objectives of the Project 2 days Wed 7/11/18 Thu 7/12/18 15
Check Feasibility of
Project in terms of budget
2 days Fri 7/13/18 Mon 7/16/18 16
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and time
Prepare Budget Plan 1 day Tue 7/17/18 Tue 7/17/18 17
Prepare Project
Schedule 1 day Wed 7/18/18 Wed 7/18/18 18
Develop Final Project
Plan 5 days Thu 7/19/18 Wed 7/25/18 19
Get Approval from
Supervisor 2 days Thu 7/26/18 Fri 7/27/18 20
Project Initiation
Phase 29 days Mon 7/30/18 Thu 9/6/18
Initiate Project 1 day Mon 7/30/18 Mon 7/30/18 21
Receive Funds for
Project 5 days Tue 7/31/18 Mon 8/6/18 23
Divide Roles between
Team Members 2 days Tue 8/7/18 Wed 8/8/18 24
Allocate Resources
between Team Members 2 days Thu 8/9/18 Fri 8/10/18 25
Gain Access to Online
Library 1 day Mon 8/13/18 Mon 8/13/18 26
Find Suitable Journals
and Books 2 days Tue 8/14/18 Wed 8/15/18 27
Conduct Literature
Review 10 days Thu 8/16/18 Wed 8/29/18 28
Gather Necessary
Reference Data 5 days Thu 8/30/18 Wed 9/5/18 29
Proceed to the Project
Work 1 day Thu 9/6/18 Thu 9/6/18 30
Project Execution
Phase 88 days Fri 9/7/18 Tue 1/8/19
Develop Aged Care
Behavior Management
20 days Fri 9/7/18 Thu 10/4/18 31
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Framework
Provide Training
Schedule for Nurses
Regarding Behavior
Management of Aged
People
2 days Fri 10/5/18 Mon 10/8/18 33
Appoint Training
Personnel 5 days Tue 10/9/18 Mon 10/15/18 34
Conduct 15 days
training for Nurses 15 days Tue 10/16/18 Mon 11/5/18 35
Visit Aged Care Home
for Studying the Effects
of Training
15 days Tue 11/6/18 Mon 11/26/18 36
Collect Data
Regarding Behavior
Management of Aged
People
5 days Tue 11/27/18 Mon 12/3/18 37
Analyze the collected
data 10 days Tue 12/4/18 Mon 12/17/18 38
Prepare Project
Documentation 10 days Tue 12/18/18 Mon 12/31/18 39
Submit Document to
Supervisor 1 day Tue 1/1/19 Tue 1/1/19 40
Receive Grading 5 days Wed 1/2/19 Tue 1/8/19 41
Project Closing 14 days Wed 1/9/19 Mon 1/28/19
Prepare Final Project
Report 10 days Wed 1/9/19 Tue 1/22/19 42
Get Project Report
Approval 2 days Wed 1/23/19 Thu 1/24/19 44
Sign Off from Team
Members 1 day Fri 1/25/19 Fri 1/25/19 45
Close the Project 1 day Mon 1/28/19 Mon 1/28/19 46
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The overall budget of the project was determined using bottom up estimation
technique shown in the following table (Leach, 2014).
Task Name Resource Names Cost
Behavior Management in
Aged Care Home [TOTAL BUDGET] $159,240.00
Project Discussion
Phase $46,000.00
Identification of the
Problem Area
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$9,200.00
Primary Discussion
regarding Problem
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$9,200.00
Identification of Possible
Solutions
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$5,520.00
Exchange Ideas between
Team Members
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$7,360.00
Reach a Particular
Solution
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$3,680.00
Agree on the Same Goal
for Project
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$3,680.00
Approval of Project from
Supervisor
Project Supervisor, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$7,360.00
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Project Planning Phase $19,840.00
Start Planning for Project
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Select a Aged Care Home
for Project
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Contact with the Aged
Care Home Authority
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Get Approval from the
Authority for Project
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Prepare Project Roadmap
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$6,400.00
Identify Project Scope
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Identify the Objectives of
the Project
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Check Feasibility of
Project in terms of budget
and time
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Prepare Budget Plan
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Prepare Project Schedule
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Develop Final Project Plan
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$3,200.00
Get Approval from Team Member 1, Team $1,280.00
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Supervisor Member 2, Team Member 3,
Team Member 4
Project Initiation Phase $25,160.00
Initiate Project
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Receive Funds for Project
Project Budget Manager, Team
Member 1, Team Member 2,
Team Member 3, Team
Member 4
$6,200.00
Divide Roles between
Team Members
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Allocate Resources
between Team Members
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4,Project
Budget Manager, Project
Supervisor
$4,880.00
Gain Access to Online
Library
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Find Suitable Journals and
Books
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Conduct Literature
Review
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$6,400.00
Gather Necessary
Reference Data
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$3,200.00
Proceed to the Project
Work
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Project Execution Phase $55,720.00
Develop Aged Care Team Member 1, Team $12,800.00
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Behavior Management
Framework
Member 2, Team Member 3,
Team Member 4
Provide Training Schedule
for Nurses Regarding
Behavior Management of
Aged People
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$1,280.00
Appoint Training
Personnel
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$3,200.00
Conduct 15 days training
for Nurses Training Staff $9,000.00
Visit Aged Care Home for
Studying the Effects of
Training
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$9,600.00
Collect Data Regarding
Behavior Management of
Aged People
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$3,200.00
Analyze the collected
data
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$6,400.00
Prepare Project
Documentation
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$6,400.00
Submit Document to
Supervisor
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Receive Grading
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$3,200.00
Project Closing $12,520.00
Prepare Final Project
Report
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$6,400.00
Get Project Report
Approval
Project Supervisor, Team
Member 1, Team Member 2,
$3,680.00
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Team Member 3, Team
Member 4
Sign Off from Team
Members
Team Member 1, Team
Member 2, Team Member 3,
Team Member 4
$640.00
Close the Project Project Budget Manager,
Project Supervisor $1,800.00
The risk register used for identification of the risks of the project is shown as follows.
Risk Chance of
Occurrence
Effect on Project Mitigation Plan
Budget High Very High Use bottom up
method, consider
all resource cost
accurately
Schedule Medium High Use Gantt chart to
develop accurate
schedule
(Schwalbe, 2015)
No authorization
for conducting
project in aged
care home
Medium Extreme Meet with authority
and place proposal
and the benefits of
the project
The stakeholder matrix that has been utilized for the determination of stakeholder
roles in the project is as follows.
Name Designation Role in Project
Mr. A Project Supervisor Supervise project, assist
in planning, approval of
project
Mr. B Sponsor Provide sufficient funds
for the project
Mr. C Finance Manager Manage project funds and
allocate funds to the team
members
Mr. D Team Member 1 Execute the project
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according to the plan
Mr. E Team Member 2 Execute the project
according to the plan
Mr. F Team Member 3 Execute the project
according to the plan
Mr. G Team Member 4 Execute the project
according to the plan
Mr. H Trainer Train nurses for behavior
management of aged
people
Finally, the communication matrix for the project is as follows.
Stakeholder Communication
Frequency
Communication
Medium
Reason for
Communication
Project Supervisor During project
discussions
Face to face Gain ideas and
advices for project,
get approval of
project
Sponsor Once, during
project planning
Email Provide budget
requirements for
project
Finance Manager Whenever required Email Ask for allocation
of resources for the
project
Team Member 1 Daily Face to face Team coordination
during project
Team Member 2 Daily Face to face Team coordination
during project
Team Member 3 Daily Face to face Team coordination
during project
Team Member 4 Daily Face to face Team coordination
during project
Trainer Once, during
project execution
Face to face Training
requirements for
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behavior
management
DELIVERABLES
The phase by phase deliverables that were agreed with the supervisor for the project
are shown as follows.
Main Deliverable: Behavior Management in Aged Care Home
Sub-Deliverables:
Identification of the Problem Area
Primary Discussion regarding Problem
Identification of Possible Solutions
Exchange Ideas between Team Members
Reach a Particular Solution
Agree on the Same Goal for Project
Approval of Project from Supervisor
Start Planning for Project
Select a Aged Care Home for Project
Contact with the Aged Care Home Authority
Get Approval from the Authority for Project
Prepare Project Roadmap
Identify Project Scope
Identify the Objectives of the Project
Check Feasibility of Project in terms of budget and time
Prepare Budget Plan
Prepare Project Schedule
Develop Final Project Plan
Get Approval from Supervisor
Initiate Project
Receive Funds for Project
Divide Roles between Team Members
Allocate Resources between Team Members
Gain Access to Online Library
Find Suitable Journals and Books
Conduct Literature Review
Gather Necessary Reference Data
Proceed to the Project Work
Develop Aged Care Behavior Management Framework
Provide Training Schedule for Nurses Regarding Behavior Management of Aged
People
Appoint Training Personnel
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Conduct 15 days training for Nurses
Visit Aged Care Home for Studying the Effects of Training
Collect Data Regarding Behavior Management of Aged People
Analyze the collected data
Prepare Project Documentation
Submit Document to Supervisor
Receive Grading
Prepare Final Project Report
Get Project Report Approval
Sign Off from Team Members
Close the Project
EVALUATION
The following evaluation has been conducted for the project.
Dimension Dimension Assessment
Time 5 weeks were allocated to
prepare a suitable project
plan and get it approved
by the supervisor
The project plan was
completed with the
allocated time frame.
In order to utilize time
efficiently, Gantt chart was
being used to allocate
time to each of the sub-
deliverables of the project
(Turner, 2016). This helped
in the efficient handling of
the project within specified
time period.
Budget A total of $40,000 was
estimated as the overall
budget for the project
The actual expenses far
exceeded the estimated
budget for the project as
during the initial
estimated, several aspects
of the budget like wages of
stakeholders were
inappropriately
determined (Mir &
Pinnington, 2014).
Scope The scope of the project
was to introduce an
efficient training
A suitable and feasible
training framework has
been delivered to the
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Dimension Dimension Assessment
framework for nurses to
manage behaviors of the
aged people in the care
homes
aged care home (Stokes,
2017).
Final Deliverable It was needed to analyze
whether the framework
was helping the nurses in
better behavior
management of the aged
people
As per the analysis post
training, positive results
were gained as it was
found that the nurses
were better handling
behavior of the aged
people (Schwalbe, 2015).
KEY FINDINGS
The key findings from this project are listed as follows.
Aged Care Homes – From the survey of the nearby area, it has been found that there
are six aged care homes within a span of 5 km. In these six aged care homes, there
are 220 nurses appointed for managing the behaviors of the aged people. Again of
these 220 nurses, 152 nurses reported facing rough behavior from the aged people
that they were not able to manage or handle (Fossey et al., 2014). Of the 1110 aged
people living in these homes, 875 were reported to show extreme behavior towards
the nurses. In the organization chosen for the project i.e. Mercy Community Residential
Aged Care Service, the study was specifically conducted on the 197 residents who
were managed by 55 nurses and caretakers.
Extreme Cases – During the project, a survey was conducted to determine how many
patients in the aged care homes show extreme behavior towards the nurses. Since the
project was specific to Mercy Community Residential Aged Care Service, Nudgee-QLD,
the survey was conducted on this particular home only. In this aged care home, there
are 55 nurses and 197 aged people under the care of these nurses (Isaramalai et al.,
2018). As per the survey, all of the nurses reported that they face at least 4 or 5 cases
of extreme behavior from the aged people who are under care in the home. In some
cases, the aged people become so violent that several nurses have to get involved for
managing that particular aged individual.
Post-Training Evaluation – Since, a training framework was provided and conducted,
a study was undertaken some time after the completion of the training (Boersma et
al., 2015). Again, a survey was conducted in which all the 8 nurses reported that they
were much more efficient in handling the behaviors of the aged people and only
reported 1 or 2 cases of violent behavior from the aged people after the training.
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CONCLUSION
Finally, it can be concluded that the proposed training schedule is aimed to deliver the
nurses with better skills of managing the behaviors of the aged patients in the care
home. The training schedule will mainly include skills training for nurses and
caretakers regarding providing the people under care with timely medications,
manage their behaviors and create an environment where they will not exhibit any
hostile behavior. Furthermore, additional therapists will be recruited who will
undertake check-ups on the patients and provide suitable treatments as per
requirement.
RECOMMENDATIONS
Based on the key findings from the project, the following recommendations can be
made.
Appoint Therapists – One of the main problems of the aged care homes is that there
is a lack of therapists in the homes. While there are always nurses present, there are
only temporary therapists who visit the home once or twice a week or in urgent
situations. However, it is recommended a permanent therapist is to be appointed who
will be present in the home all days of the week.
Weekly Schedule for Training – It is recommended that a weekly schedule is to be
prepared for training the nurses of the aged care home. In addition to training
schedule, the nurses will be required to report to the authority at the end of each week
regarding management of violent behaviors from the patients.
Weekly Session with the Aged People – It is also recommended to set up weekly
sessions with the aged people by some therapists. In these sessions, the therapists
will have to make personal chats with aged people trying to understand their problems
without having to show outrageous behavior.
Medications – Periodic anesthetic medications should be given to those particular
residents who often show violent behaviors and medical measures are to be taken to
cure their illnesses.
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APPENDIX
Appendix 1
The final Gantt chart that was developed for determining an appropriate time frame
for the project is shown as follows.
Figure 1: Gantt Chart of the Project
(Source: Created by Author)
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