NURS 6050: Politics and the Patient Protection and Affordable Care Act

Welcome to NURS 6050: Policy and Advocacy for Improving Population Health

Politics and the Patient Protection and Affordable Care Act
Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society. NURS 6050: Politics and the Patient Protection and Affordable Care Act.

Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape. NURS 6050: Politics and the Patient Protection and Affordable Care Act.

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To Prepare:
Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).
Consider who benefits the most when policy is developed and in the context of policy implementation.

Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA. NURS 6050: Politics and the Patient Protection and Affordable Care Act Then, explain how analyses of the votes views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria. NURS 6050: Politics and the Patient Protection and Affordable Care Act.

Dashboard and Health Care Benchmark Evaluation – South Dakota

Please reference to South Dakota benchmarks.

Review the performance dashboard for a health care organization, as well as relevant local, state, and federal laws and policies. Then, write a report for senior leaders in the organization that communicates your analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement.

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Maintaining standards and promoting quality in modern health care are crucial, not only for the care of patients, but also for the continuing success and financial viability of health care organizations. In the era of health care reform, health care leaders must understand what quality care entails and how quality in health care connects to the standards set by relevant federal, state, and local laws and policies. An understanding of relevant benchmarks that result from these laws and policies, and how they relate to quality care and regulatory standards, is also vitally important Dashboard and Health Care Benchmark Evaluation – South Dakota.

Health care is a dynamic, complex, and heavily regulated industry. For this reason, you will be expected to constantly scan the external environment for emerging laws, new regulations, and changing industry standards. You may discover that as new policies are enacted into law, ambiguity in interpretation of various facets of the law may occur. Sometimes, new laws conflict with preexisting laws and regulations, or unexpected implementation issues arise, which may warrant further clarification from lawmakers. Dashboard and Health Care Benchmark Evaluation – South Dakota Adding partisan politics and social media to the mix can further complicate understanding of the process and buy-in from stakeholders.
How many health care laws can you name that affect your practice in your current or future workplace? How do they impact your daily work? How many regulatory agencies oversee the types of services your health care organization provides? Which regulatory agencies apply to your workplace setting? Are you familiar with the process of complying with those agencies in order to maintain certification? Dashboard and Health Care Benchmark Evaluation – South Dakota You might be overwhelmed as you consider these broad questions.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend or family member, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
What local, state, or federal health care policies or laws set benchmarks and standards reflected in performance dashboards common in your professional area of practice?

What are the potential challenges or opportunities for health care organizations or interprofessional teams in meeting prescribed performance benchmarks and standards? Factors you might consider include the organization’s mission, its size and resources, operational policies and procedures, and the population the organization serves.
Preparation
For this Dashboard and Health Care Benchmark Evaluation Simulation Paper assessment, you may choose one of the following three options for a performance dashboard to use as the basis for your benchmark evaluation.

Option 1: Dashboard and Health Care Benchmark Evaluation Simulation Dashboard and Health Care Benchmark Evaluation – South Dakota

If you decide to use one of the simulation dashboards for your evaluation, review both dashboards, as well as the relevant local, state, and federal laws and policies linked in each dashboard. Choose one of the dashboards and consider the metrics within it that are falling short of the prescribed benchmarks.

Option 2: Actual Dashboard From a Professional Practice Setting

If you choose an actual dashboard from a professional practice setting for your evaluation, be sure to add a brief description of the organization and setting that includes:

The size of the facility that the dashboard is reporting on.
The specific type of care delivery.Dashboard and Health Care Benchmark Evaluation – South Dakota
The population diversity and ethnicity demographics.
The socioeconomic level of the population served by the organization.
Note: Ensure that your data is Health Insurance Portability and Accountability Act (HIPAA) compliant. Do not use any easily identifiable organization or patient information.

Option 3: Hypothetical Dashboard Based on a Professional Practice Setting

If you have a sophisticated understanding of dashboards that are relevant to your own practice, you may also construct a hypothetical dashboard for your evaluation, based on that setting. Your hypothetical dashboard must present at least four different metrics, at least two of which must be under-performing the relevant benchmark set forth by a federal, state, or local laws or policies. In addition, be sure to add a brief description of the organization and setting that includes: Dashboard and Health Care Benchmark Evaluation – South Dakota

The size of the facility that the dashboard is reporting on.
The specific type of care delivery.
The population diversity and ethnicity demographics.
The socioeconomic level of the population served by the organization.
Note: Ensure that your data is HIPAA compliant. Do not use any easily identifiable organization or patient information. Dashboard and Health Care Benchmark Evaluation – South Dakota

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Report Requirements

Structure your Dashboard and Health Care Benchmark Evaluation Simulation Paper report in such a way that it would be easy for a colleague or supervisor to locate the information they need. Be sure to cite relevant local, state, or federal health care laws or policies when evaluating metric performance against prescribed benchmarks. Cite an additional 2–4 credible sources to support your analysis and evaluation of the challenges in meeting the benchmarks, the potential for performance improvement, and your advocacy for ethical action.

Note: The tasks outlined below correspond to grading criteria in the scoring guide.

In your report, be sure to:

Evaluate dashboard metrics against the benchmarks set by local, state, or federal health care laws or policies.
Which metrics are below the mandated benchmarks in the organization? Evaluate weaknesses within the entire set of benchmarks.
What are the local, state, or federal health care laws or policies that set these benchmarks?
Analyze challenges that meeting prescribed benchmarks can pose for the organization or for an interprofessional team.
What are the specific challenges or opportunities that the organization or interprofessional team might have in meeting the benchmarks? For example, consider: Dashboard and Health Care Benchmark Evaluation – South Dakota
The strategic direction of the organization. Dashboard and Health Care Benchmark Evaluation – South Dakota
The organization’s mission.
Available resources:
Operational and capital funding.
Physical space.
Support services (any ancillary department that supports a specific care unit in the organization, such as a pharmacy, cleaning services, and dietary services).
Cultural diversity in the organization.
Cultural diversity in the community. Dashboard and Health Care Benchmark Evaluation – South Dakota
Organizational processes and procedures.
How might these challenges be contributing to benchmark underperformance?
Evaluate a benchmark underperformance in the organization or interprofessional team that has the potential for greatly improving overall quality or performance.
Which metric is underperforming its benchmark by the greatest degree?
Which benchmark underperformance is the most widespread throughout the organization or interprofessional team?
Which benchmark affects the greatest number of patients?
Which benchmark affects the greatest number of staff?
How does this underperformance affect the community the organization serves?
Where is the greatest opportunity for improvement in the overall quality or performance of the organization or interpersonal team—and ultimately in patient outcomes?
Advocate for ethical action in addressing the benchmark underperformance that has the potential for greatly improving overall quality or performance. Dashboard and Health Care Benchmark Evaluation – South Dakota
At which group of stakeholders should your advocacy be directed? Which group could be expected to take the appropriate action to improve the benchmark metric?
What are some ethical actions that the stakeholder group could take that support improved benchmark performance?
Why should the stakeholder group take action?
Communicate your findings and recommendations in a professional and effective manner.
Ensure that your report is well organized and easy to read.
Write clearly and logically, using correct grammar, punctuation, and mechanics.
Integrate relevant sources to support your arguments, correctly formatting source citations and references using current APA style.
Did you cite relevant local, state, or federal health care laws or policies when discussing the mandated benchmarks?
Did you cite an additional 2–4 credible sources to support your analysis, evaluation, and advocacy? Dashboard and Health Care Benchmark Evaluation – South Dakota

In this Benchmark – Effective Approaches in Leadership and Management assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

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Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct. Benchmark – Effective Approaches in Leadership and Management.
Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue. Benchmark – Effective Approaches in Leadership and Management.
Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.
Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Benchmark – Effective Approaches in Leadership and Management.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1: Exemplify professionalism in diverse health care settings.

1.3: Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.

3.4: Demonstrate professional standards of practice. Benchmark – Effective Approaches in Leadership and Management.

The Importance of Nursing Informatics and the Multidisciplinary teams

As a healthcare professional, it is imperative to have excellent communication skills. Nurses should always know what is going on with their patients, too many times; nurses miss urgent orders due to a lack of communication. Nursing informatics is essential; having computerized charting makes it easier for the nurse to check orders and to know the plan of care.

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According to YoeniTo, improve the quality of nursing care, we developed and evaluated an Electronic Medical Record (EMR) program designed to maximize productivity and efficiency in our nursing documentation system. Electronic medical records are useful communication tools that can alert anyone on the interdisciplinary team of the patient\’s progress. An electronic document can share relevant patient information among care providers to coordinate care, aid in decision-making, and achieve improvements in quality (Burnett, 2016). Benefits of EMRs are they provide a virtual state of the art multidisciplinary rounding record, so when doctors are not available, they can log on and access what every interdisciplinary team discussed. EMRs increases efficiency\’s, reduce readmit rate due to patient having access to their medical records online, decreases in readmissions, and have fewer mistakes and redundancies then paper charting. However, I believe that the patients should always have a physician on call available to answer patients\’ questions to cut down on unnecessary ER visits. The Importance of Nursing Informatics and the Multidisciplinary teams

Consistently getting team members together, for instance, requires constant coordination; with the electronic medical record, doctors can pull up labs and diagnostic tests with patients and families. Computers have proven to be a great communicator between teams in the health care setting. Nursing informatics provides a haven for better patient care when dealing with Large multidisciplinary teams and deliver better outcomes for patients.

References:

Burnett, M. (2016). Does Use of an Electronic Display of a Discharge Clinical Summary Improve the Perceived Quality of Multidisciplinary Discharge Rounds and Care Coordination?. On-Line Journal of Nursing Informatics, 20(1). The Importance of Nursing Informatics and the Multidisciplinary teams

yoenyi@samsung.co.kr, E. (n.d.). Retrieved from https://synapse.koreamed.org/search.php?where=aview&id=10.4258/jksmi.2000.6.4.87&code=0088JKSMI&vmode=PUBREADER

Please responde to Deana Gil ‘s post below offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.
please and add 3 refrences with your response.
Nurses must be able to provide safe care and treatment to patients. Most of my career was working in a Level one Trauma Center Emergency Department (ED) in downtown Phoenix, Arizona. In the ED,

we had one system that we used for charting, and the rest of the hospital had a different charting system. If our patient was admitted to the hospital, we had to print off the ED visit note and send it with

the patient for the nurses receiving the patient. This created problems. Just a few of these were: if the patient had medications that were ordered in the ED, but were not given for whatever reason, the

receiving nurse was not aware unless the sending nurse specifically gave it in report, if the patient had STAT lab orders, the ED nurse would not see these as the admitting providers would put them in the

inpatient admitting orders, and at times the admitting provider would discontinue medications that the ED nurse had orders to give by the ED provider before sending them to the floor. The Importance of Nursing Informatics and the Multidisciplinary teams

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By getting input from ED staff, providers, and inpatient nurses, the nurse informaticist (NI) advocated for the team to administration. They helped implement the ED charting system that was the same

system that the rest of the hospital had. The NIs include staff in change decisions to ensure the change would not have negative effects on the workflow and to increase staff buy-in (Tyler, 2019, p. 19). The

NI\’s trained a staff member on each shift to be a superuser and helped during the transition to the new program. As stated by Tyler (2019), \”The informatics nurse is essential to the success of super users

in any organization\” (p. 19). The super users had direct communication with the NI\’s and were able to alert them to issues or ideas for a smoother process recommended by the staff.

NI\’s trained the providers and the ED staff on using the new system. When the providers needed changes in the system for different documentation within the system, the NI collaborated with the charting

company, and the changes were made. The Importance of Nursing Informatics and the Multidisciplinary teams

One strategy recommendation for improvement would be to have the NI come to the unit once a week for any suggestions or complaints and have a suggestion box for those that may be busy or not

present when the NI was there. The form placed in the box would have an answer section that would go back to the person that wrote it with a week return response timeframe.

Nursing informatics have the benefit of their ability to interact with various clinicians, clinical practice knowledge and can relate to staff with the experience the workflow change (Mastrian & McGonigle,

2018, p. 257). As we rely on technology in so many aspects of our lives, NI\’s are a necessity in healthcare. The use of NI\’s and their specialty will enable hospital staff to have the most recent evidence-based

practice, patient safety with alerts and check-offs in the electronic medical record (EMR), and track specific trends good and bad for change and education. Nursing executives can use nursing informatics to help with things like budgeting tools and trending costs and savings (McGonigle, Hunter, Sipes, & Hebda, 2014, p. 324).

References

Mastrian, K. G., & McGonigle, D. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett.

McGonigle, D., Hunter, K., Sipes, C., & Hebda, T. (2014). Why nurses need to understand nursing informatics: Everyday informatics the official voice of perioperative nursing the official voice of perioperative

nursing. AORN Journal, 100(3), 324-327. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.aorn.2014.06.012

Tyler, D. D. (2019). A day in the life of a nurse informaticist. Journal of Informatics Nursing, 4(1), 18-20. Retrieved from https://ezp.waldenulibrary.org/login? The Importance of Nursing Informatics and the Multidisciplinary teams

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Tyler, D. D. (2019). A day in the life of a nurse informaticist: Organizational change. Journal of Informatics Nursing, 4(2), 18-20. Retrieved from https://ezp.waldenulibrary.org/login?

qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2291990769%3Facc The Importance of Nursing Informatics and the Multidisciplinary teams

Hospital Acquired Pneumonia Discussion: Organizational Policies and Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

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For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue. Hospital Acquired Pneumonia.
To Prepare:
• Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1. NOTE: The national healthcare issue/stressor I addressed in module 1 is “HOSPITAL ACQUIRED PNEUMONIA. So, you are going to use this topic to answer questions related to this discussion.
• Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined. Hospital Acquired Pneumonia

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

Required Readings
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only
Note: Review all, with special attention to “Provision 6” (pp. 23–26) Hospital Acquired Pneumonia.

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html Hospital Acquired Pneumonia

Hospital-Acquired Pneumonia

Description of the National Healthcare Issue/Stressor

Hospital-acquired pneumonia (HAP) refers to pneumonia that a patient develops within a hospital setting after at least 48–72 hours after being admitted (Pássaro et al.; 2016). HAP is the second leading hospital-acquired infection and cause of death among critically sick patients. HAP is allied to an elevated rate of mortality and morbidity, as well as increased healthcare costs (Torres-García et al., 2019). According to Min et al. (2018), the incidence of HAP worldwide is 5–20 cases per 1000 admissions. The high prevalence of HAP indicates the need to address the issue.

In my healthcare organization, HAP is common among patients in the ICU, and notably patients who are mechanically ventilated. Similarly, the rate of HAP is also relatively high in patients within the medical-surgical ward and the general ward. In the organization, HAP in all units leads to an increased rate of morbidity and mortality, longer period of hospital stays, as well as increased costs for both the patient and the organization. This is consistent with other organizations where hospital-acquired infections like HAP are associated with a high mortality rate, a prolonged period of hospitalization, as well as higher healthcare costs (Pássaro et al., 2016) Hospital Acquired Pneumonia.

In the organization, the rate of HAP is particularly high among older adults, patients in the ICU, as well as patients with prolonged use of antibiotics and glucocorticoids. The high incidence of HAP among patients with lengthy use of glucocorticoids is allied to the reduced immunity that makes individuals susceptible to infections. Similarly, long-term use of antibiotics is a major risk factor for hospital-acquired pneumonia due to resistance to antibiotics. In my healthcare organization, HAP is associated with an increased rate of mortality, admission to the ICU, and an increased period of hospital stay. Besides, the organization, being a government agency, spends a lot of money on financing the treatment and care of HAP.

Summary of the Two Articles

According to Brett et al., (2019), HAP is allied to elevated morbidity and mortality rate and also increased medical costs. HAP is also a leading factor for transfer to the ICU and results in a prolonged hospital stay. Risk factors associated with HAP include advanced age, a longer period of hospital stay, being a male, dysphagia, numerous comorbidities, as well as chronic obstructive pulmonary disease (Brett et al., 2019). Brett et al. (2019) further indicate that poor oral hygiene causes a buildup of dental disease, which is a significant risk factor in HAP. Accordingly, Brett et al. (2019) explain that improved oral hygiene is effective in decreasing the rate of HAP. Other strategies that can reduce the rate of HAP include early mobilization, effective hand hygiene, proper management of dysphagia, and prevention of viral infections (Brett et al., 2019) Hospital Acquired Pneumonia.

Again, Deng et al. (2019) explain that HAP is a very common hospital-acquired infection and a leading cause of death among hospitalized patients. Multi-drug-resistant organisms (MDROs) are attributed to the numerous cases of HAPs, and particularly within the ICU and emergency departments (Deng et al., 2019). Wide usage of broad-spectrum antibiotics is attributable to bacterial resistance, one of the risk factors for HAP.

Strategies used to Address HAP

The study by Brett et al. (2019) demonstrates that interventions such as improved oral care, increased movement, and mobility, as well as dysphagia management, are effective in preventing HAP. The study indicates that improved oral care is an important modifiable risk factor for HAP. Comprehensive oral care facilitated by nurses is effective in preventing HAP as it prevents the buildup of dental plaque, which is a significant risk factor in HAP.

Increased mobilization is also an intervention that can be used in preventing HAP, especially among patients with acute ischemic stroke. The intervention involves turning the patient from “supine position to right and left lateral resting position” after every two hours and passively mobilizing the four limbs. This intervention is effective in reducing the rate of HAP. The mobilization intervention also integrates pre-operative patient education, breathing exercises, as well as pre-operative physiotherapy (Brett et al.; 2019). Brett et al. (2019) further explain that proper management of dysphagia and particularly among post-stroke patients, is essential in reducing the rate of HAP. This intervention includes nurses screening patients for dysphagia and implementing the appropriate interventions. The reason is that dysphagia is the leading cause of aspiration pneumonia. After all, food or liquids can enter the airway when patients have difficulties in swallowing and hence introduce bacteria to the lungs. Therefore, effective management of dysphagia can prevent aspiration pneumonia Hospital Acquired Pneumonia.

Preventing and treating infections caused by multi-drug-resistant organisms can go a long way in preventing HAP (Deng et al., 2019). Long-term use of antibiotics is a significant risk factor for HAP as a result of organisms’ resistance to antibiotic therapy. Interventions used to address the issue of multi-drug resistance include relieving the inflammatory reactions among patients, improving organisms’ clearance, reducing the period of mechanical ventilation, treating patients’ immunity, and increasing the success rate of ventilator weaning (Deng et al., 2019).

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References

Brett M, Russo P, Cheng A, Andrew S, Rosebrock H, Curtis S, Robinsion S & Kiernan M. (2019). Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review. Infection, Disease & Health, 24(4), 229 – 239. Hospital Acquired Pneumonia.

Deng, D., Chen, Z., Jia, L, Bu J, Ye M, Sun L, Gen Y, Wen Z, Chen G & Fang B. (2019). Treatment of hospital-acquired pneumonia with multi-drug resistant organism by Buzhong Yiqi decoction based on Fuzheng Quxie classical prescription: study protocol for a randomized controlled trial. Trials, 20(817).

Min, J. Y., Kim, H. J., Yoon, C., Lee, K., Yeo, M., & Min, K. B. (2018). Hospital-Acquired Pneumonia among Inpatients via the Emergency Department: A Propensity-Score Matched Analysis. International journal of environmental research and public health, 15(6), 1178. https://doi.org/10.3390/ijerph15061178.

Pássaro, L., Harbarth, S. & Landelle, C. (2016). Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control, 5(43 (20).

Torres-García, M., Pérez Méndez, B. B., Sánchez Huerta, J. L., Villa Guillén, M., Rementería Vazquez, V., Castro Diaz, A. D., López Martinez, B., Laris González, A., Jiménez-Juárez, R. N., & de la Rosa-Zamboni, D. (2019). Healthcare-Associated Pneumonia: Don’t Forget About Respiratory Viruses. Frontiers in pediatrics, 7(168) Hospital Acquired Pneumonia.