The risk for respiratory distress syndrome (RDS) decreases for premature infants

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1. Question : Hemolytic disease of the newborn (HDN) can occur if the mother:

2. Question : Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication?

3. Question : If the sinoatrial (SA) node fails, then at what rate (depolarizations per minute) can the atrioventricular (AV) node depolarize?

4. Question : What is the ratio of coronary capillaries to cardiac muscle cells?

5. Question : Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?

6. Question : What process allows the kidney to respond to an increase in workload?

7. Question : Which type of antibody is involved in type I hypersensitivity reaction?

8. Question : Causes of hyperkalemia include:

9. Question : What is the first stage in the infectious process?

10. Question : Which statement is true concerning the IgM?

11. Question : An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?

12. Question : What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn?

13. Question : Which cardiac chamber has the thinnest wall and why?

14. Question : What is the direct action of atrial natriuretic hormone?

15. Question : What is the primary site for uncomplicated local gonococci infections in men?

16. Question : Which statement concerning benign tumors is true?

17. Question : Which of the following is classified as a megaloblastic anemia?

18. Question : Apoptosis is a(an):

19. Question : What is the functional unit of the kidney called?

20. Question : Which hepatitis virus is known to be sexually transmitted?

21. Question : The glomerular filtration rate is directly related to which factor?

22. Question : Decreased lung compliance means that the lungs are demonstrating which characteristic?

23. Question : What is the most common cause of iron deficiency anemia (IDA)?

24. Question : Which drug may be prescribed orally for outbreak management of herpes simplex viral (HSV) infections?

25. Question : In a normal, nonmutant state, an oncogene is referred to as a:

26. Question : What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

27. Question : Fetal hematopoiesis occurs in which structure?

28. Question : Deficiencies in which element can produce depression of both B- and T-cell function?

29. Question : Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganisms?

30. Question : Which hormone is synthesized and secreted by the kidneys?

31. Question : Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome?

32. Question : Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man?

33. Question : During an IgE-mediated hypersensitivity reaction, which leukocyte is activated?

34. Question : What is the life span of platelets (in days)?

35. Question : What is the role of caretaker genes?

36. Question : Which blood cell type is elevated at birth but decreases to adult levels during the first year of life?

37. Question : Which term is used to identify the movement of gas and air into and out of the lungs?

38. Question : In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity?

39. Question : Which substance has been shown to increase the risk of cancer when used in combination with tobacco smoking?

40. Question : Which statement concerning exotoxins is true?

41. Question : Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?

42. Question : Research supports the premise that exercise has a probable impact on reducing the risk of which cancer?

43. Question : What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?

44. Question : What is the fundamental physiologic manifestation of anemia?

45. Question : Between which months of age does sudden infant death syndrome (SIDS) most often occur?

46. Question : What is the purpose of the spirometry measurement?

47. Question : Carcinoma in situ is characterized by which changes?

48. Question : The drug heparin acts in hemostasis by which processes?

49. Question : The coronary ostia are located in the:

50. Question : Blood vessels of the kidneys are innervated by the:

51. Question : Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized?

52. Question : Which statement best describes a Schilling test?

53. Question : What is the major concern regarding the treatment of gonococci infections?

54. Question : What is the action of urodilatin?

55. Question : How is most carbon dioxide (CO2) in the blood transported?

56. Question : The most common site of metastasis for a patient diagnosed with prostate cancer is which location?

57. Question : Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction?

58. Question : Which immunoglobulin (Ig) is present in childhood asthma?

59. Question : The Papanicolaou (Pap) test is used to screen for which cancer?

60. Question : The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation?

Dissemination of Scholarship Related to the Practicum Project

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According to Freemantle and Watt (1994), “effective dissemination encompasses more than just the distribution and diffusion of information. It involves the processes by which target groups become aware of, receive, accept and utilize information.” (p. 133).

Think about your Practicum Project. Which groups would find your project findings, conclusions, and recommendations most valuable? Why? How might your focus differ if you were delivering a presentation at a professional conference versus at your practicum site? What would you emphasize if you were publishing an article in a peer-reviewed journal related to your specialization as opposed to in an online forum with a wider healthcare readership?

In this Discussion, you analyze your Practicum Project in terms of conventional means of scholarly dissemination: presentations, posters, and publication.

To prepare:
  • Reflect on your Practicum Project.
  • Speak with various individuals, especially those in your practicum setting, about presentations or poster sessions they have given and/or publications they have authored. Ask which organizations or journals they would recommend you consider for dissemination based on your Practicum Project topic.
  • Consider the following questions related to dissemination:
    • Who is your target audience? Who would be most interested in your project findings, conclusions, and recommendations? Consider how the needs or dispositions of the intended audience may inform your choice of dissemination method.
    • Which method of dissemination would you choose to convey the findings, conclusions, or recommendations from your Practicum Project? What are the relative benefits and challenges of giving a presentation, sharing your findings through a poster session, and/or publication?
    • Consider various nursing, health care, informatics, and leadership and management organizations and journals. What is one organization or journal you would select for your presentation or publication?
    • What are some potential challenges? Evaluate what you could do to promote the possibility that your presentation, poster, or manuscript would be accepted.
  • Conduct a search of the literature using the Walden Library and other reliable sources. Locate two or more articles published in peer-reviewed journals within the last five years that relate to your Practicum Project. These articles should demonstrate the significance of the topic for nursing leadership and management or nursing informatics. Note: These articles may also help you determine if your project findings are related to an area that will contribute to a more comprehensive literature base.
By Day 3

Post a brief description of your Practicum Project, including the anticipated outcomes and implications for nursing practice in your specialty area. Explain why your results warrant dissemination. Describe your target audience, and explain which method of dissemination you would use as well as the organization or journal you would choose for sharing findings related to your Practicum Project. Support your response with at least two citations from the literature.

Read a selection of your colleagues’ responses.

Intervention Presentation On Diabetes profile

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Based on the summary of research findings identified from the Evidence-Based Project—Paper on Diabetes that describes a new diagnostic tool or intervention for the treatment of diabetes in adults or children, complete the following components of this assignment:

Develop a PowerPoint presentation (a title slide, 6-12 slides, and a reference slide; no larger than 2 MB) that includes the following:

  1. A brief summary of the research conducted in the Evidence-Based Project – Paper on Diabetes.
  2. A descriptive and reflective discussion of how the new tool or intervention may be integrated into practice that is supported by sound research.

While APA format 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.

You are not required to submit this assignment to LopesWrite, unless otherwise directed by your instructor. If so directed, refer to the Student Success Center for directions. Only Word documents can be submitted to LopesWrite.

How current issues, such as the Affordable Care Act, affect break-even analysis

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Evaluating financial statements and using financial analysis methods is a critical part of the decision to make capital investments. The goal of capital management is to acquire and maintain sufficient working capital and assets. This helps an organization meet operating and expense obligations, while also keeping a sufficient cash flow. It is also a way to confirm that capital purchases and agreements are made with ethical standards. This part of your project will require you to complete two (2) article reviews and report on your findings. Then, you will apply your findings to how capital decisions can be made in your specific case; as well as comparing your viewpoint to the authors’ and recent ethical scandal. Keep in mind that you will use your article analysis to either support or disprove the purchase of an information system in the final portion of your project.

Submit a minimum 3-page report that:

· Discusses why is it more difficult for healthcare companies to get expansion financing in the today’s economic climate and financial issues with expansions.

· Describes why healthcare companies need to look beyond their banks to secure financing.

· Explains the importance of making a good case for expanding healthcare providers’ methods of calculating break-even analysis.

· Discuss non-financial factors do the authors believe need to be included in break-even analysis?

· Explain how current issues, such as the Affordable Care Act, affect break-even analysis.

· Summarizes the authors’ viewpoints and apply the concepts to your case. Also include a summary of your viewpoint in comparison to the authors’. Be sure to specifically address the methods that influence capital investments and decision-making; and explore methods of analyzing capital investments (Payback, Net Present Value, and Internal Rate of Return). This report will serve as your Capital Management section of your project.

· Analyze the key points of the Enron Scandal and specifically address how professionalism and ethics influence decision-making. How do unethical standards impact an organization’s performance and capital investments? Reference the concepts of embezzlement and losses. Explain how you maintain ethical standards in relation to Code of Ethics.

· Include an APA formatted reference page to include at least three (3) academic sources, such as a book or an academic scholarly journal, to support your topic. You should reference your academic sources by including at least three (3) in-text citations. You can use the articles outlined in the instructions, as well as information found on the Enron Scandal. Academic scholarly journals can be accessed through the Rasmussen Online Library.

Article Review #1
Read the article Expanding Credit Lines in Order to Expand which discusses the challenges related to expansion financing. 

· Discuss why is it more difficult for healthcare companies to get expansion financing in the current economic situation?

· Explain the 2 major issues with the Caribbean expansion the turnaround company found and why do you think they were brought up?

· Describe why healthcare companies need to look beyond their banks to secure financing?

Article Review #2
Read the article The New Break-Even Analysis which looks at expanding how healthcare providers look at break-even analysis and includes some non-financial considerations. 

· Do you think the authors make a good case for expanding healthcare providers’ methods of calculating break-even analysis? Why or Why Not?

· Discuss non-financial factors do the authors believe need to be included in break-even analysis?

· Explain how the Affordable Care Act affect break-even analysis?

Ethical Scandal
The ‘Enron Scandal’ involving acts of embezzlement is one of the most well-known financial, ethic scandals in modern day history. Perform a web search of the Enron Corporation Scandal to find more information.

Use the following websites on ethics to help support your course of action in upholding ethical standards.

· Five Top Ethical Issues in Healthcare

· American College of Healthcare Executives (ACHE) Code of Ethics

Clinical problems or issues that arise from clinical care

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 Details:

Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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. Please refer to the directions in the Student Success Center.

Music Therapy for Dialysis Patients

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Respond to the post bellow, using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from  the classroom or from your own review of the literature in the Walden  Library.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

                                           Main Post

                          Music Therapy for Dialysis Patients

             The research article that I selected was conducted to see if music  therapy was a good non-pharmacological intervention to manage  hemodialysis patient’s anxiety, stress, and depression. The researchers  recognized that these patients experience anxiety, stress, and  depression due to their dire health issue of end-stage renal disease.  There were 40 subjects who were receiving dialysis and 20 subjects  received music therapy.  Blood pressures and pulses were taken before  and after music therapy. The randomized control group was given  pre-tests, post-tests, and Depression Anxiety Stress Scale Tool (DASS). 

                                       Data & Results

The  data that was collected that lead to their final conclusion was  comparing the vital signs collect before and after music therapy,  demographic survey, DASS, pre and post-tests. The researchers completed a  paired t-test and design table with the data to determine the  effectiveness of the experiment. According  to Fernandas & D’silva   (2019), “To find the association between depression, anxiety and stress  level with selected demographic variables, chi-square test or likelihood  ratio test used” (p. 128). Their conclusion stated that the group that  received music therapy did have a reduction in anxiety, stress, and  depression levels. According to Fernandas & D’silva  (2019), “In the  present study the investigator made an attempt to relieve stress,  anxiety, and depression among haemodialysis patient by providing music  therapy and results shows that there was a significant difference in  depression, anxiety and stress level among the experimental and control  group” (p. 129).

                                 Conclusion & Weakness

The  researchers were able to formulate their conclusion by analyzing the  data and using careful calculations that they collected from their  research. The weakness of the study I believe is that the subjects  weren’t select randomly. The participants were selected by assessing if  they liked or showed interest in music. The dialysis patients that were  interested in music received music therapy. 

                                    Additional Research

I  do believe that further research should be completed to prove the  benefits of music therapy for a dialysis patient. Further studies should  be randomized. I also think one-way researchers could add to testing is  measuring cortisol in saliva. According to Choi, Kim, & Yang  (2014), “Salivary cortisol concentration serves as a biomarker of psychological stress. Cortisol measurements should be carried out in real time”. 

                                            References

Choi,  S., Kim, S., Yang, J. S., Lee, J.H., Joo, C., & Jung, H. (2014).  Real-time measurement of human salivary cortisol for the assessment of  psychological stress using a smartphone. Sensing and Bio-Sensing Research., 2, 8-11. 

Fernandes,  S. T., & D’silva, F. (2019). Effectiveness of Music Therapy on  Depression, Anxiety, and Stress among Haemodialysis Patients. International Journal of Nursing Education, 11(1), 124–129. https://doi-org.ezp.waldenulibrary.org/10.5958/0974-9357.2019.00024.2

Proposal for a wellness education program for a specific population

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Overview

Develop a 5–7-page proposal for a wellness education program for a specific population. Integrate aspects of culture, CAM and spirituality, and linguistics into the program. Explain how to market the program to the population, and explain the ethical, legal, and economic factors that can affect the health of the population.

Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.

Health care initiatives focus on changing demographics and emerging health problems. Among the challenges faced by health care professionals are cultural and linguistic competence and the role they play in the ability to provide effective care. Health care professionals need to develop skills in conducting gap analyses within their own communities, design effective health education and wellness programs to address those gaps, and remain mindful that effective care depends on the ability to build trust within the community being served.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

· Competency 1: Explain the principles and concepts of disease prevention and health promotion for diverse and vulnerable populations. 

. Explain how educating a population about health promotion and disease prevention benefits the health and wellness for a population. 

· Competency 2: Develop evidence-based health promotion and disease prevention initiatives for diverse and vulnerable populations. 

. Integrate linguistic and cultural considerations, CAM, traditional medicine, holistic health, and spirituality into an evidence-based wellness plan for a population. 

· Competency 4: Examine the ethical, legal, and economic factors related to health disparities in diverse and vulnerable populations. 

. Describe the ethical principles that can affect preventative care and health promotion.

. Explain how local laws, federal laws, and the Affordable Health Care Act can affect preventative care and health promotion.

. Explain the economic impact of clinical prevention and health promotion related to health disparities for a population.

· Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the health care professions. 

. Write content clearly and logically, with correct use of grammar, punctuation, APA formatting, and mechanics.

Assessment Instructions

Preparation

Your team has succeeded in demonstrating the need for a health promotion and disease prevention initiative for the population identified by your Windshield Survey assessment. Now you need to develop a proposal for a wellness education program that will help bridge the gaps in health care service delivery.

Use the Capella library and the Internet to find scholarly and professional resources that will help you propose a wellness education program for the health concern of your population. Find at least four resources to use in this assessment. You may also want to review the previous assessments you completed in this course.

Requirements

Based on your Windshield Survey and Organizational Evaluation assessments, complete the following:

· Design an evidence-based wellness program to address the primary health concern of the population that integrates: 

. Cultural considerations: Will you need to consult with someone from the population on how to approach the delivery of your program?

. CAM, traditional medicine, holistic health, and spirituality considerations.

. Linguistic considerations: Will you need interpreters or translators for either written or oral presentations?

. Educational considerations: What will be the best way to educate the population?

· Describe how you will market or advertise the wellness program. 

. What are the benefits the program offers the population?

. Will you need incentives to ensure participation and completion of the program?

· Explain the ethical, legal, and economic factors that impact the health and wellness of the population. For example: 

. The ethical considerations (such as justice, non-malfeasance, and duty) that can affect preventative care and health promotion.

. Local laws, federal laws, and the Affordable Health Care Act that can affect preventative care and health promotion.

. The potential economic impact of clinical prevention and health promotion related to health disparities of your population.

The format for this assessment should be a professional proposal. If possible, ask about the format used for proposals in your organization and follow that. Follow APA formatting for your in-text citations and references.

Additional Requirements

· Include a title page and reference page. The completed assessment should be 5–7 pages in length, not including a title page and a reference page.

· Reference at least four current scholarly or professional resources.

· Use current APA format for citations and references.

· Use Times New Roman font, 12 point.

· Double space.

How staff training is linked to any update in healthcare technology for Best Hospital staff

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Case Study

Read the following case study:

Best Hospital is a 325-bed suburban community hospital that has just merged with a local major academic medical center, the University of Excellence Medical Center (UEMC). There are 15 hospitals in the UEMC system, ranging from small rural hospitals with 50 or fewer beds to large multiple-specialty tertiary referral hospitals. Two hospitals in the system have achieved magnet status and several hospitals are working to achieve this status. Within the UEMC system, a high value is placed on collaboration with the schools of the health professions at the University of Excellence (UE). 

Best Hospital has a long history of association with local universities, functioning mainly as a site for student clinical experiences. For example, undergraduate students enrolled at the UE College of Health Professions often complete a portion of their clinical work at the hospital. Each year the hospital hires a number of graduates from this program. Several nurses in first-level management positions at the hospital are enrolled in the master’s program.

The vice-president for clinical practice at Best Hospital is a PhD-prepared nurse who has been appointed to the faculty at the UE School of Nursing. Your current position is director of staff development at Best Hospital. You are responsible for the educational programming of all clinical staff. Over the past 2 years, Best Hospital has been fully involved in meeting Meaningful Use criteria. As director of staff development, you have played the major leadership role in developing and implementing all related educational programs. 

The health professional schools at UE are working together to revise their curricula to integrate informatics throughout. The goal is to develop an interprofessional approach that incorporates informatics across and throughout the different educational programs within these schools. The schools have requested a meeting with clinical leaders from the hospital to gain a practical perspective on what information should be included in the curricula. The vice-president for clinical practice has included you on the list of leaders to attend the meeting. She asked that each person attending the meeting prepare a short presentation on how they engage their staff in the continuous education process with respect to ever-changing healthcare technology. 

PowerPoint Presentation

Directions:

1. Review the case study.

2. Download the provided PowerPoint template to create a presentation that includes:

· An overview process map on how staff training is linked to any update in healthcare technology for Best Hospital staff

· Examples of computerized teaching tools used within staff training, including:

o List of learning tools typically used within staff training

o How you determine which tools to use (rationale)

o How such tools are used within the training process

· Support of continuous learning by staff (3 slides)

o Existing support mechanisms and processes

o How continuous learning is linked to professional development

o Examples of how learning is offered for diverse learning styles of staff

· Ensure that your presentation is free of spelling and grammar errors.

The social and economic factors that influence women and children’s ability to be healthy

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Just like on the midterm, the way this final works is that I have provided you 5 questions, one per week’s topic. You need to answer the questions to the best of your ability. I will randomly be selecting 2 questions to grade, and then you will have the choice of which 3rd question you want me to review. After everyone has submitted their final exams (on Wednesday morning 8AM of Finals Week), you will be allowed to go into Moodle and select the question number you want me to grade.

Responses will be graded based on 3 things .

1) How thoroughly and thoughtfully you explained the answer.

2) How feasible and creative your response was in terms of solutions, or options for solving problems. 3) How cleanly written it is. Please no typos and no grammatical mistakes.

You must provide links for all of your sources if you reference anything besides your textbook. You all know what reliable sources are, so make sure anything you are referencing is from a reliable, credible source.

*Hint: Each response should probably be at least ½ a page if you are answering thoroughly. Less than ½ a page means you probably didn’t provide enough detail.

Week 6 question

Do people choose their own health, particularly their own nutrition and physical activity? Whether you think the answer is yes, no, or somewhere in between, make a case for your answer. Build your case referencing at least 4 different factors that influence health from Chapters 13,14, and 16. Be specific and think about psychosocial factors and policies, systems, and environmental factors that are relevant to your response.

Week 7 question

Where does the U.S. rank in terms for infant and maternal mortality? Thinking about these rankings, explain the quote “maternal child health is not a health problem, it is a social problem with health consequences.” What are some of the social and economic factors that influence women and children’s ability to be healthy? What are some things that can be done to improve the health of women and children? What we can learn from tobacco prevention efforts to improve maternal and child health? What specific strategies could we use from tobacco? Or, are there things we could learn from other countries?

Week 8 question

Explain, in your own words, what the 3 levels of prevention are. Pick a specific mental health or injury area and discuss how we could intervene at each of the three levels of prevention to improve health outcomes. How would the strategies need to be different for each of the different levels of prevention? What is at least 1 thing that you think we can do to reduce stigma surrounding mental health or surrounding seeking help for mental health issues?

Week 9 question

In your own words, explain the differences and the relationship between medical care and public health. Why are the two sometimes in conflict with each other? How could we change our current system (either the medical care system or the public health system) to improve health outcomes for everyone in our society (Please provide at least 2 specific examples of changes we could make)? Are there any potential unintended consequences of making these changes?

Week 10 question

Which is the fastest growing age group in U.S. society? What are the potential effects as this big group of people ages? What are some of the challenges we will be facing with the younger generations not being as healthy at an earlier age? Can our focus simply be on trying to help people live longer, or do we also need to be focusing on improving quality of life? What are some specific strategies we can implement to help people age healthily? How can we strengthen public health efforts in the future to support older people and society as a whole?

Extra credit:

Please pick one of the news stories below and answer the following questions about it.

1. How/why is this topic a public health issue?

2. Who is most affected by the issue?

3. What are the larger societal implications of the issue, and what happens if things don’t change?

4. What do you think are some of the upstream prevention strategies that we could be implementing to address this problem?

5. What do you think are some of the policy, systems, or environmental changes that could be made to address the problem?

Story 1: The Opioid Crisis is Surging in Black, Urban Communities

Story 2: What If We Treated Gun Violence Like A Public Health Crisis?

Story 3: Increased Hours Online Correlate With An Uptick In Teen Depression, Suicidal Thoughts

Story 4: Scientists Start To Tease Out The Subtler Ways Racism Hurts Health

Story 5: Is There a Ticking Time Bomb Under the Arctic?

Ways in which culture can cause barriers of communication with patients with low literacy

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Culture can cause barriers when communicating with patients with low literacy. 

1) Explain what low literacy is and why it’s important as a healthcare professional to know about it.

2) List 3 ways in which culture can cause barriers of communication with patients with low literacy. Then, for each one, explain how you would overcome the barrier or “plain language can be used”.

250 words minimum, APA format, include references and in text citations.

Communication

Skills

for the

Health Care

Professional

Concepts, Practice, and Evidence

Gwen van Servellen

CHAPTER 13

© 2009 Jones and Bartlett Publishers

Chapter 13
Communicating with Patients of Low Literacy

© 2009 Jones and Bartlett Publishers

Objectives

  • The problem of low literacy in the United States
  • Differences between literacy and functional health literacy
  • Relationship of education and functional health literacy
  • Barriers to health literacy
  • Relationship of low health literacy and poor health outcomes

© 2009 Jones and Bartlett Publishers

Objectives Continued

  • Populations at risk for health low health literacy
  • Assessing level of health literacy in patients
  • Ways providers can assess and enhance health literacy
  • Importance of using “plain language”
  • Dealing with shame related to low literacy
  • Ways systems of care deter or promote health literacy

© 2009 Jones and Bartlett Publishers

Health Literacy as a Foundation for Patient Safety and Quality Care

  • Health literacy involves both patient and providers ability to understand each other
  • Must be viewed in the context of culture and health disparities

© 2009 Jones and Bartlett Publishers

Problem of Literacy in the U.S.

  • Illiteracy as a national epidemic (Young, 2004)
  • Health illiteracy, the hidden handicap (Glassby, 2002)
  • Illiterate patients frequently feel ashamed to reveal their illiteracy and may not engage in dialogue

© 2009 Jones and Bartlett Publishers

Functional Health Literacy

  • Refers to the skills and knowledge necessary to understand illness and treatment and to navigate the health care system
  • Literate patients
  • Empower patients to be active participants
  • More likely to initiate and sustain important self-management behaviors
  • Receive better quality health care

© 2009 Jones and Bartlett Publishers

Functional Health Literacy and Quality Care Outcomes

  • Cumulative evidence that health literacy is associated with
  • Better health status
  • Better treatment adherence
  • Lower levels of morbidity and mortality
  • Lower use of hospitalization
  • Better use of preventive health services
  • Lower costs of health care services

© 2009 Jones and Bartlett Publishers

Healthy People 2010

  • Health literacy includes ability to understand
  • Instructions on prescription drug bottles
  • Appointment slips
  • Medical education brochures
  • Medical directions and consent forms
  • How to navigate complex health care systems

© 2009 Jones and Bartlett Publishers

Barriers to Health Literacy

  • Individual level, e.g. education, health status
  • Patient-provider factors, e.g. continuity of relationship, trust and satisfaction with the relationship, shared cultural understandings
  • System related factors, e.g. number, length and quality of encounters, whether patient-centered care delivery system

© 2009 Jones and Bartlett Publishers

Elements of Systems More Likely to Promote Health Literacy

  • Constructs reading materials using plain language with illustrations
  • Tests and evaluates appropriateness of materials for many different groups
  • Provider encounters exceed 6-10 minutes
  • Advocacy for health literacy
  • Providers skills in assessing
  • Opportunities to conduct feedback loop
  • Population-based literacy best-practice program

© 2009 Jones and Bartlett Publishers

Assessing Health Literacy

  • REALM and REALM-R
  • TOFLA and S-TOFLA
  • SAHLSA-50
  • NVS (Newest Vital Sign)

© 2009 Jones and Bartlett Publishers

Assessing Health Literacy (cont’d)

  • Communication assessments
  • Avoids asking for help; quiet and unassuming
  • Reserves questions until leaving the provider
  • Asks then withdraws the question
  • Misses appointments
  • Non-adherence to treatment plan
  • Comes with companions to interpret
  • Delays making decisions and asks for things in writing

© 2009 Jones and Bartlett Publishers

Improving Patient Health Literacy

  • Develop a “gestalt” of the patient
  • Assess health literacy
  • Avoid shaming
  • Comprehension may be even at 1st grade level; may not know how to read
  • Use brief and simple language
  • Slow the pace to the patient
  • Deliver messages in context known and valued by patient

© 2009 Jones and Bartlett Publishers

Improving Patient Health Literacy (cont’d)

  • Repeat materials
  • Use meaningful visuals; draw pictures
  • Use patient’s concepts of medical terms
  • Tell stories to embellish points
  • Use feedback loop, teach-back and close the loop

© 2009 Jones and Bartlett Publishers

Summary

Improving health care literacy requires first, communicating in the language of the patients we serve but then helping them adapt other means to describe their health and concerns. They need to understand us and us, them.

© 2009 Jones and Bartlett Publishers