Case Study 1:

Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”

Post 1-2 page paper of a comparison of the model used for the interdisciplinary geriatric teams at your current practicum site to models used at other sites. Then, explain how the role of the advanced practice nurse differs according to the site of care. Finally, explain how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric teams at your practicum site.

Discussion: Workflow Modeling

Workflow modeling is widely used throughout many different types of businesses, including health care organizations, to visually summarize the steps of complex processes and systems. When constructing a workflow model, it is important to ensure that the model accurately reflects the actual steps in a process.

In this Discussion, you consider a case study of a health care clinic and its process for ordering medical supplies. You then examine a workflow model that is meant to reflect that process and analyze the model’s accuracy based on the information in the case study. You also analyze the importance of accurate workflow modeling and consider strategies for creating accurate workflow models for health care processes.

Case Study:

Deerborne Dialysis is a local dialysis clinic that is part of a larger health care network, Buckeye Health. Buckeye Health executives have recently been examining the processes by which organizations within the network manage their supplies. Deerborne Dialysis was identified as an exemplary model of efficient supply management, and Buckeye Health executives have requested a workflow model of how Deerborne Dialysis handles their supply management process.

Sharon is the nurse who oversees the process of ordering and stocking supplies for Deerborne Dialysis. She knows the process well and developed a description of the steps in the supply management process. First, Sharon conducts a daily check of the supplies in the storage room. If there is a supply that is running low, Sharon submits an order to the medical supplier. When the clinic receives the shipment, Sharon unpacks the shipment and cross-checks the supplies that were shipped with the supplies that were ordered. If there is a discrepancy, the entire shipment must be returned to the medical supplier, who then rushes a new shipment to the clinic to be received the next day. If there is no discrepancy, or once the new shipment is received, unpacked, and cross-checked, Sharon stocks the shelves in the storage room and gives the supply bill to the clinic’s accountant, who ensures that the medical supplier receives payment.

Sharon has created the following workflow model to reflect the steps she goes through to manage the clinic’s inventory of supplies:

To prepare:

• Review the case study above and examine the workflow model that is meant to reflect the process described in the case study.
• Identify problems with the workflow model. How could the model be revised to be more accurate, clear, and effective?
• Reflect on the importance of creating an accurate workflow model of health care processes. What are the challenges involved in workflow modeling? What are the consequences of inaccurate workflow models?
• Consider strategies that you can use to ensure that workflow models are effective and accurate.

With these thoughts in mind:

Postby tomorrow 9/27/16 a minimum of 550 words essay in APA format with 3 references (References must come from the list provided in the instruction area), addressing the level one headings as numbered below:

1) A summary of at least three specific problems you identified in the workflow model.

2) Describe how the model could be revised to address those problems.

3) Analyze the importance of accuracy and clarity in workflow modeling, and describe at least one strategy you plan to use to ensure that the workflow models you create are accurate and clear.

Required Readings

Dennis, A., Wixom, B. H., & Roth, R. M. (2015). Systems analysis and design (6th ed.). Hoboken, NJ: Wiley.

• Chapter 5, “Process Modeling” (pp. 153–186)

 This chapter introduces the most common process-modeling techniques. In particular, there is emphasis on the data flow diagram and how it is developed and used.

Helmers, S. (2011). Microsoft Visio 2010 step by step. Sebastopol, CA: O’Reilly.

• Chapter 3, “Adding Sophistication to your Drawing” (pp. 69–110)

 This chapter focuses on creating a diagram that is both professional and accurate. Topics covered include adding and using text boxes, inserting fields, and grouping shapes.

• Chapter 4, “Drawing the Real World: Flowcharts and Organization Charts” (pp. 111–142)

 The focus of this chapter is creating accurate flowcharts and organization charts. It explains how to create and use swimlanes. It also covers the development of organization charts and how they can be stylized.

• Chapter 5, “Adding Style, Color, and Themes” (pp. 143–170)

 This chapter demonstrates how to change the color, types of lines, and over all format of a drawing. It also covers the use of Visio themes.

Benyoucef, M., Kuziemsky, C., Rad, A. A., & Elsabbahi, A. (2011). Modeling healthcare processes as service orchestrations and choreographies. Business Process Management Journal, 17(4), 568–597.

Retrieved from the Walden Library databases.

 Remodeling health IT systems for optimal health care delivery requires an assessment of both the health care organization and the usability of the available technology. This article evaluates ways of combining web-service-based health care processes to best suit the needs of service-specific health care organizations.

Unertl, K. M., Weigner, M. B., Johnson, K.B., & Lorenzi, N. M. (2009). Describing and modeling workflow and information flow in chronic disease care. Journal of American Medical Informatics Association, 16(6), 826–836.

Retrieved from the Walden Library databases.

 This article evaluates how workflow and work practices in chronic disease care can be improved through the use of informatics tools. It also focuses on studies that discern potential real-world benefits of health information technology (HIT).

Vankipuram, M., Kahol, K., Cohen, T., & Patel, V. L. (2011). Toward automated workflow analysis and visualization in clinical environments. Journal of Biomedical Informatics, 44(3), 432–440.

Retrieved from the Walden Library databases.

 In this article, the authors offer a framework for improving workflow analysis. It combines cognitive decision making, movement, and interaction and communication. The authors used a combination of qualitative and quantitative research practices to gather the data for analysis.

Required Media

Laureate Education, Inc. (Executive Producer). (2012d). A workflow diagram. Baltimore, MD: Author.

 This multimedia piece continues to build on the scenario introduced in Week 1. In this segment, the health care facility creates a workflow diagram with assessment that maps the current workflow.

Only USE THE REFERENCES THAT ARE INCLUDED IN THE DIRECTIONS BELOW.

Part 1 is the document labelled Part 1.

The Rubric that needs to be copied at the end of the paper is labelled usw1_nurs_5051

 

Application Assignment 2: Part 2 – Developing an Advocacy Campaign

To prepare:

• Review Chapter 3 of Milstead, J. A. (2012). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publisher In the first assignment, you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as
• necessary using any feedback from your first paper.
• Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.
• Consider how you could influence legislators or other policymakers to enact the policy you propose.
• Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended.

To complete:

Part Two will have 4 pages of content plus a title page and references. Part Two will address the following:

• Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.
• Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources.
• Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.
  • Summarize obstacles that could arise in the legislative process and how to overcome these hurdles.
  • Paste the rubric at the end of your paper.

Required Readings

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

• Chapter 7, “Health and Behavior” (pp. 119–144)
  
  This chapter discusses the role of behavior on health and describes behavioral risk factors and potential community-based interventions.

Backer, E. L., Geske, J. A., McIlvain, H. E., Dodendorf, D. M., & Minier, W. C. (2005). Improving female preventive health care delivery through practice change: An Every Woman Matters study. Journal of the American Board of Family Practice, 18(5), 401–408.

Retrieved from the Walden Library databases.

This article informs the Assignment as an example of a health program that was not successful. You will conduct additional research on this topic to determine current advocacy programs that have been more effective.

Hancock, C., & Cooper, K. (2011). A global initiative to tackle chronic disease by changing lifestyles. Primary Health Care, 21(4), 24–26.

Retrieved from the Walden Library databases.

This article details the efforts of the C3 Collaborating for Health charity. In particular, C3 focuses on minimizing the risk factors of poor dieting, smoking, and low physical activity.

Schwartz, S. M., Ireland, C., Strecher, V., Nakao, D., Wang, C., & Juarez, D. (2010). The economic value of a wellness and disease prevention program. Population Health Management, 13(6), 309–317.

Retrieved from the Walden Library databases.

The authors of this article detail a study that sought to determine the economic consequences of a disease prevention program conducted by the Hawaii Medical Service Association.

Tengland, P. (2010). Health promotion and disease prevention: Logically different conceptions? Health Care Analysis, 18(4), 323–341.

Retrieved from the Walden Library databases.

This article investigates the differences and causal connections between health promotion and disease prevention.

Word count: 1,800 (+10% penalty will apply for non-adherence) – you cannot answer this paper in less than 1800 words. No work will be marked after 1980 words.

The purpose ofthisassignmenttaskis toidentifytheprinciplesofprofessional nursing practice, outlinetheethical andlegal frameworksforprofessional practice and apply the Ethical Decision Making Framework to a complex scenario to establish an ethically and legally sound decision. Remember toincorporate evidenced-basedpracticeinrelationtoquality patientcare.YouMUSTincludeinyourreferencing 4(four)ormore ofthefollowing;

·         Health PractitionerRegulation NationalLawAct 2010(WA)

·         NMBA Registered Nurse Standards for Practice 2016

·         NMBA NationalCode of Conduct for theRegistered Nurse2008

·         NMBA Codeof EthicsforRegistered Nurses2008

·         NMBA NationalFrameworkfortheDevelopmentof Decision Making Framework:  Scopeof Nursing Practice (2007)

·         NMBA ProfessionalBoundaries2010

Relevant Acts and Laws relating to the subject and health care practitioners – remember ALL your work must be referenced.

Use theModel for EthicalDecisionMaking (included in your instructions, available on Blackboard) to determine themost favorable outcome of your chosen scenario.

General Instructions

There should be attention to spelling grammar and punctuation, this work is an academic paper and needs to reflect your ability to analyse, reflect and articulate in the written form. Take time to study the marking guide to assist you with your focus. Note that there is no requirement for an introduction or a conclusion. There should be evidence of critical thinking. Citations within text and reference list should conform to APA 6^th ed format.

If you feel that you require assistance with your academic writing skills there are many facilities on campus and online to support you. Below is the link to access what is available.

http://life.curtin.edu.au/learning-support/writing-skills.htm

Include a marking guide with your work. Put your name in full on your uploaded document; Surname first.

Using theModel for EthicalDecisionMaking (Kerridge, Lowe and McPhee, p85 2005) to determine themost favorable outcome:

Modelfor EthicalDecision-Making

•     Pleaseusetheseheadingswhenwritingyourcasestudy

·         The word count provided is only an example – it also shows the weighting of the importance of each section.

1.Clearlystatetheproblem: this should not be any more than 150 words (this is like an introduction)

Considertheproblemwithinitscontext; ethical, medical,socialandlegal considerations.

This should be a very brief summary of the issues as you see it – extract the issues:

o   What is the ethical ISSUE-what is the decision about?

o   What is the medical condition, just state this in a few lines

o   What is the social situation of the patient -is the person dependent, do they have support?

o   What appear (prima facie) to be the legal issues? Is it assault; is it the application of an Advanced Directive or informed consent for example?

Example: The medical issues for this patient (Mr S) are; Diabetes type1, depression and Heart Failure. The ethical issue for Mr S is that he is concerned about the lack of autonomy and justice when he is in hospital. Mr S’s social situation is that he lives with his wife and one daughter, he states he is a Catholic. The legal issues for Mr S are namely consent, guardianship and refusal of treatment. These issues will be explored throughout this paper. (80 WORDS – you don’t have to put the word count in each section just at the end of your work – this is just an example for you).

2.Get thefacts: this should not be any more than 350 words

Here you need to find out what are the facts of the case;  – what is the medical condition & history, examination, relevant tests (investigations), define the medical condition what is the pathophysiology of the condition/s – use scientific references

o   What is the prognosis?

o   What are the implications of the condition/s -for example is it acute, chronic, and degenerative? What type of progression or prognosis might be expected?

o   Are there any alternative treatments?

o   What social factors might have an influence – family input, social interaction

3.Considerthefourprinciples: this should not be any more than 250 words

o   You need to define each principle and relate the principle to the patient

o   Autonomy: whatarethe patient’spreferences?

o   Beneficence:whatbenefitscanbe obtainedforthepatient?

o   Non-maleficence:whatarethe risksandhowcantheybeavoided?

o   Justice:howarethe interestsofdifferentpartiesto be balanced?

4.Identifyethical conflicts: this should not be any more than 200 words

What are the ethical conflicts? To promote autonomy are we in conflict with beneficence (Autonomy vs Beneficence).

Explainwhytheconflictsoccur relating this to the patient andhowtheymayberesolved.

Ref the NMBA Code of Ethics / ICN Code of Ethics in this section

5.ConsidertheLaw: this should not be any more than 450 words

Identifyrelevantlegal conceptsandlawsandhowtheymightguidemanagement.

·         Consider: the Practice Standards – how they apply to the case study ie (NMBA Registered Nurse Standards for Practice 2016).

o   How does duty of care apply to the patient?

·         How does the Practice Standards relate to the Act?

·         You need to use the Acts (legislation) that apply to the case study for example:

o   Consent to Treatment – Age of Majority Act

o   Human Tissue and Transplant Act

6.Makingthe ethicaldecision:this should not be any more than 250 words

o   Clearlystatethe clinical ethicaldecisionand justifyiteg:

o   Specifyhowguidingprincipleswere balancedand why (i.e.justifythe decision). Use the information that you have in the Law and Get the Facts section to support your decision. MUST Reference

o   Takeresponsibilityforthedecision&providealternativemanagement – reference this!

7. Evaluate the decision and discuss the legal relevance and importance of accurate documentation: this should not be any more than 150 words

·         Identify how you would evaluate your decision-what is our fundamental tool for establishing the efficacy/outcome of an action/decision? – here you will research what does the literature say about evaluation – also use the NMBA Registered Nurse Standards for Practice 2016

o   State where you would document and why it is a fundamental practice in healthcare. Here you will research what the literature say about evaluation – also use the NMBA Registered Nurse Standards for Practice 2016.

Tip for 7. – Review Kozier and Erb’s Fundamentals of Nursing 2008 Vol 1 – Evaluating p 245 and Documentation and reporting Chapter 15 p255

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Further information:

·         A minimum of 18 references are required for this assessment.

·         Review the marking rubric when doing your assessment.

·         Good luck

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CASE SCENARIOS

SELECT ONE CASE SCENARIO AND APPLY THE MODEL FOR ETHICAL DECISION-MAKING

Case Study 1                          Mr. Alphonse

Mr Alphonse Martinez[1] a retired Italian man, married, his wife also retired and they have two grown up sons who still live at home. They are a close family who go to church every Sunday. Mr Alphonse had just recently made an Advanced Health Directive (AHD) that stated if he had another serious heart attack that he was not to be resuscitated. His wife and two sons were opposed to his Advanced Directive and instructed the staff to take no notice of the AHD.

Alphonse has been discharged from the coronary care unit (CCU) and placed in a step-down cardiac ward following his myocardial infarction (MI). While he had been in CCU the staff had felt that he had exaggerated his chest pain. That is, when they asked him to rate his pain from 0 – 10 he sometimes stated that it was 12 or 14. In response staff reacted in a rather disapproving manner.

During the first evening on the cardiac ward Alphonse asked Mark, one of the student nurses on clinical practice, to contact the hospital priest to come and see him and give him the last rites. Mark did so immediately and then went back to sit with Mr Alphonse.

Later Mark’s clinical supervisor (RN) called him to one side and asked why he was sitting with Mr Alphonse. Mark (student nurse) replied that Mr Alphonse was anxious and so he was sitting with him. The RN asked Mark “do you think you could be making him more anxious by sitting with him?” Mark replied that he didn’t think so, and he was only doing so until the priest came.

The RN then asked why the priest was coming, and Mark said that Mr Alphonse had asked for the priest, and so he had contacted him to come. The RN then said to Mark, “did you not think you should have told me what you had done” With that Mr Alphonse’s buzzer went and, turning to go back into the room, the RN and Mark saw Mr Alphonse have a cardiac arrest.

Despite vigorous and sustained effort Mr Alphonse could not be resuscitated.

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Case Study 2                                   Miss Mary-Jane

Mary-Jane is 14 years old; her parents are newly separated and they both work. She has three younger siblings and Mary-Jane does a lot of the child minding. She has been complaining of abdominal pain, moderate now severe and has some vaginal spotting (bleeding) for the past 24 hours. She presents to the emergency department at her local hospital with her parents who are concerned that their daughter is so unwell. Mary-Jane is looking pale, sweaty, light headed, nauseated and has some stomach bloating. You have taken her base line observations on admission and they are: temperature 37.8C, pulse 118bpm, BP 90/50, Respirations 28bpm, shallow breathing.  A possible diagnosis would be an ectopic pregnancy, and to rule this out a pregnancy test is essential. As the student nurse together with the Registered Nurse caring for Mary-Jane consider the legal and ethical issues, one being consent and the other confidentiality, these and others will need to be considered for Mary-Jane.

What are the rules surrounding mandatory reporting of sexual abuse?

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[1]Alphonse Martinez (Hawley, G. (p 212, 2007). Ethics in clinical practice: An interprofessional   approach. London.   Pearson Education Ltd.