Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course Practicum Reflective Journal.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

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1. New practice approaches
2. Intraprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Population health concerns
6. The role of technology in improving health care outcomes
7. Health policy
8. Leadership and economic models
9. Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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 Turnitin Practicum Reflective Journal.

Looking Ahead: Application Assignment: Expense Forecasting and Financial Analysis Cycle

You will begin this assignment in Week 9 and it will be due by Day 7 of Week 10.

Throughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel Expense Forecasting and Benchmarking.

Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.

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Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 3 assignment
Show all your calculations and formulas in the spreadsheet.
Answer any questions included with the problems (as text in the Excel spreadsheet).

A title and reference page are NOT needed in this assignment.  Put your name and assignment at the top of the Excel spreadsheet.

For those not comfortable with the use of Microsoft Excel, this week’s Optional Resources suggest several tutorials.

To prepare:

• Review the information in the Week 9 and 10 Learning Resources dealing with expense forecasting, profit and loss, break-even analysis, and benefit and cost ratio analysis. Focus on how they are calculated and how they can be used in decision making.
• View the following tutorial videos, provided in this week’s Learning Resources.
  • Week 10 Application Assignment Tutorial: Benefit Cost Ratio
  • Week 10 Application Assignment Tutorial: Breakeven Analysis
  • Week 10 Application Assignment Tutorial: Expense Forecasting
  • Week 10 Application Assignment Tutorial: Profit and Loss Scenario

Use the Week 10 Application Assignment Template, provided in this week’s Learning Resources, to complete this assignment.   Carefully examine the information in each of the scenarios and provide the necessary calculations. Using this information will help you answer the questions. Note: All the scenarios will be submitted as one document. Each scenario will be on a different tab in the spreadsheet Expense Forecasting and Benchmarking.

Expense Forecasting

In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities 

Expense Forecasting Scenario

Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.

Annualization for Fixed:  (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts

Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.

Financial Analysis Cycle

Marginal Profit and Loss Statement Scenario

You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units a year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.

Questions:

1. Develop a marginal profit and loss statement for this business opportunity.Based on that analysis, should this opportunity be pursued? Expense Forecasting and Benchmarking

Break-Even Analysis Scenario

You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.

Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation?  Explain your decision.

Benefit/Cost Ratio Analysis Scenario

You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.

Questions: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions:

• What is meant by  benefit/cost ratio, average payback period and ROI  and why are the all  important to understand when purchasing new equipment?
• Based on this information, would you pursue this opportunity?
• Explain your decision  in 250-500 words in the text box below Expense Forecasting and Benchmarking.

Informatics can be used for improving health outcomes not only for individual patients, but also for whole groups of patients with similar conditions. This is often referred to as the dual nature of informatics. Technologies, such as electronic health records (EHRs) and clinical decision support (CDS) systems, can provide insights and guidance for health care professionals at the point of care. In addition, data warehousing and mining allow health care organizations to use the vast amount of information stored in EHRs to make predictions and diagnoses for other patients with similar conditions The Dual Nature of Informatics.

In this Discussion, you examine the dual nature of informatics. First, you review a scenario and consider the patient information to be collected and recorded at the point of care. Then, you decide how this information could be aggregated for population health and future use.

Consider the following scenario:

Mrs. Jones has come into your office stating that she has been experiencing frequent dizzy spells. She also reports that she has been unable to eat anything substantial over the last few days due to extreme nausea. The last time Mrs. Jones was in your office, the physician had suggested she start walking around the block or bicycling around the neighborhood to get her activity level up. Mrs. Jones admits that she did very little of that after a “ flip-flop” feeling of her heart scared her. You know that her symptoms could be a result of many conditions. Following the prompts on your informatics system, you begin to gather more specific information about Mrs. Jones’ symptoms and health history The Dual Nature of Informatics.

To prepare:

• Based on the scenario, what information would you want to immediately gather about Mrs. Jones?  
• With that in mind, compile a list of patient questions you would like an EHR documentation screen to have.
• How might the information derived from these questions help you provide high-quality care to Mrs. Jones?
• Once this information is collected, what alerts might be critical to the evaluation of Mrs. Jones?
• Review this week’s media presentation, Dual Nature of Informatics Systems, and reflect on the movement towards more transparent data and meaningful use. How might the data entered about an individual patient help to build preventative care and treatment for whole populations?
• Refer back to your list of patient questions. Of these questions, which would generate data that could be aggregated for use with a larger group of patients? (Note: When developing your questions, consider the whole patient.)

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Post on Tuesday 06/06/2016 a minimum of 550 words in APA format with 4 references

1) A description of the ideal EHR documentation screen that you would like to have at the point of care for all patients and why.

2) Explain how information gathered at the point of care with an individual patient can be aggregated to help provide high quality care to a larger population of patients.

Required Resources

Readings

• Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
  • Chapter 1, “Historical Perspectives of Nursing Informatics”
    
    In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records.
• Liaw, S.-T., & Boyle, D. I. R. (2010). Primary care informatics and integrated care. Studies in Health Technology and Informatics, 151, 255–268.
  Retrieved from the Walden University databases The Dual Nature of Informatics.
  
  This article discusses how the health care field can be reformed by increasing access to information across organizations and professionals. The authors of the article justify the need for this reform and provide guidance on how it can be achieved.
• Mitchell, J. K. (2011). Nursing informatics 101: Using technology to improve patient care. ONS Connect, 26(4), 8–12.
  Retrieved from the Walden Library databases.
  
  The emergence of nursing informatics in health care is the main topic of this article. New trends in informatics are discussed, as well as the certification process, nurse education, and the implementation of new systems to support patient care.
• Morath, J. (2011). Nurses create a culture of patient safety: It takes more than projects. Online Journal of Issues in Nursing, 16(3).
  Retrieved from the Walden Library databases.
  
  The author of this article emphasizes the need for nurses to develop skills for improving care and embracing new health care innovations. The author also describes the connection between individual nursing practice and the system-wide success of informatics.
• Reiner, B. I. (2011). Improving healthcare delivery through patient informatics and quality centric data. Journal of Digital Imaging, 24(2), 177–178.
  Retrieved from the Walden Library databases.
  
  In this article, the author analyzes the impact of the movement towards digitized medical data on patient care. The author discusses how this movement places more responsibility and empowerment on the patient. Media
• Laureate Education, Inc. (Executive Producer). (2012b). Dual nature of informatics systems. Baltimore: Author. 
  
  Note: The approximate length of this media piece is 7 minutes.
  
  In this week’s media presentation, Gail Latimer, Dr. Patricia Button, and Dr. Roy Simpson discuss one of the most important aspects of informatics: the collection and aggregation of health information. The electronic health record (EHR) is discussed, as well as the nurse’s roles in working with EHR systems The Dual Nature of Informatics.  

Question 1.1. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry? (Points : 0.4)        “Stem cells can help correct autoimmune diseases and some congenital defects.” HUMAN HEALTH CARE QUIZ         “Stem cells can be used to regenerate damaged organs should the need ever arise.”         “Stem cells can be used as a source of reserve cells for the entire blood production system.”         “Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”  Question 2.2. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child’s recurrent infections? (Points : 0.4)      Antibody production by plasma cells is compromised because of impaired communication between B and T cells.         The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.         The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.         The child lacks the antigen presenting cells integral to normal B-cell antibody production. ORDER A FREE-PLAGIARISM PAPER HERE  Question 3.3. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)        Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.         Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.         Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.         Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.  Question 4.4. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 0.4)        The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.         Viruses are killing some of his B cells and becoming incorporated into the genomes of others.         The EBV inhibits the maturation of white cells within his peripheral lymph nodes.         The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.  Question 5.5. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 0.4)        The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.         Her liver and spleen are both enlarged.         Blood work reveals an increased white blood cell count.         Chest auscultation reveals crackles in her lower lung fields bilaterally HUMAN HEALTH CARE QUIZ.  Question 6.6. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 0.4)        A mild parasitic infection         A severe bacterial infection         A mild viral infection         A severe fungal infection  Question 7.7. Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? (Points : 0.4)        A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use         A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM         A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells         A 9-year-old girl who has a diagnosis of IgA deficiency  Question 8.8. Which of the following statements most accurately conveys an aspect of lymphatic system activity? (Points : 0.4)        B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.         B cells and macrophages are released from the bone marrow in their completed state.         Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.         Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.  Question 9.9. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 0.4)        Hypocoagulation         Iron and ferritin deficiencies         Splenomegaly and hepatomegaly         Neutropenia  Question 10.10. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 0.4)        Impaired immune function         Acid-base imbalances         Impaired thermoregulation         Fluid imbalances HUMAN HEALTH CARE QUIZ