Incomplete fusion of the nasomedial or intermaxillary process during the fourth week of embryonic development

/in /by

Question

1. In Parkinson disease (PD), the basal ganglia influences the hypothalamic function to produce which grouping of clinical manifestations?

Inappropriate diaphoresis, orthostatic hypotension, constipation, and urinary retention

Asymmetric, regular, rhythmic tremors with slow alternating flexion and extension contractions

Involuntary contractions of skeletal muscles that impair active and passive movement

Bradykinesia of chewing, swallowing, and articulation

Question 2. Which is a characteristic of brainstem death?

Vegetative state

Comatose

Apnea

Locked-in syndrome

Question 3. With receptive dysphasia (fluent), the individual is able to

respond in writing, but not in speech.

speak back, but not comprehend speech.

comprehend speech, but not respond verbally.

respond verbally, but not comprehend speech.

Question 4. The body compensates to a rise in intracranial pressure by first displacing

cerebrospinal fluid (CSF).

arterial blood.

venous blood.

cerebral cells.

Question 5. Dementia is characterized by

deficits in attention and coherence of thought.

easy distractibility and poor concentration.

loss of recent and remote memory.

irritability, agitation, and restlessness.

Question 6. Which dyskinesia involves involuntary movements of the face, trunk, and extremities?

Paroxysmal

Tardive

Hyperkinesia

Cardive

Question 7. Vomiting is associated with CNS injuries that compress which anatomic location(s)?

Vestibular nuclei in the lower pons and medulla oblongata

Floor of the third ventricle

Vestibular nuclei in the midbrain

Diencephalon

Question 8. Cognitive operations cannot occur without the _____ functioning.

pons

medulla oblongata

reticular activating system

cingulate gyrus

Question 9. What are the initial clinical manifestations noted immediately after a spinal cord injury?

Headache, bradycardia, and elevated blood pressure

Confusion, irritability, and retrograde amnesia

Loss of deep tendon reflexes and flaccid paralysis

Hypertension, neurogenic shock, and tachycardia

Question 10. Which clinical manifestation is characteristic of cluster headaches?

Aura before the headache with photophobia and nausea and vomiting

Severe unilateral tearing, burning, or temporal pain

Gradual onset of bilateral pain with sensation of a tight band around the head

Throbbing headache with intermittent burning sensation

Question 11. A man who sustained a cervical spinal cord injury 2 days ago suddenly develops severe hypertension and bradycardia. He reports severe head pain and blurred vision. The most likely explanation for these clinical manifestations is that he is

experiencing acute anxiety.

developing spinal shock.

developing autonomic hyperreflexia.

experiencing parasympathetic areflexia.

Question 12. The most severe diffuse brain injury caused by rotational acceleration is most likely to be located in the

diencephalon to the brainstem.

medial portion of the brainstem.

entire brainstem.

diencephalon.

Question 13. Which neurotransmitter is reduced in people with schizophrenia?

Dopamine

Gamma-aminobutyric acid (GABA)

Acetylcholine

Serotonin

Question 14. Which is a positive symptom of schizophrenia?

Blunted affect

Auditory hallucinations

Poverty of speech

Lack of social interaction

Question 15. Hypothalamic-pituitary-adrenal (HPA) system abnormalities exist in a large percentage of individuals with

schizophrenia.

major depression.

mania.

panic disorder.

Question 16. The life-threatening problems associated with myelomeningocele include

upward displacement of the cerebellum into the diencephalon.

motor and sensory lesions below the level of the myelomeningocele.

downward displacement of the cerebellum, brainstem, and fourth ventricle.

encephalitis causing generalized cerebral edema and hydrocephalus.

Question 17. The neural groove closes dorsally during the _____ week of gestational life.

second

fourth

eighth

twelfth

Question 18. Anterior midline defects of neural tube closure cause developmental defects in the

brain and skull.

spinal cord.

vertebrae.

peripheral nerves.

Question 19. Which statement is false regarding the pathophysiology of acute pancreatitis?

Pancreatic acinar cells metabolize ethanol, which generates toxic metabolites.

Injury to the pancreatic acinar cells permits leakage of pancreatic enzymes that digest pancreatic tissue.

Acute pancreatitis is an autoimmune disease in which IgG coats the pancreatic acinar cells so they are destroyed by the pancreatic enzymes.

When gallstones are present, bile flows into the pancreas, contributing to attacks.

Question 20. The desire to eat is stimulated by

agouti-related protein (AgRP).

alpha-melanocyte–stimulating hormone (?-MSH).

cocaine- and amphetamine-regulated transcript (CART).

peptide YY (PYY).

Question 21. The most common manifestation of portal hypertension induced splenomegaly is

leukopenia.

thrombocytopenia.

erythrocytopenia.

pancytopenia.

Question 22. Incomplete fusion of the nasomedial or intermaxillary process during the fourth week of embryonic development causes

cleft palate.

sinus dysfunction.

cleft lip.

esophageal malformation.

Question 23. At 2 or 3 weeks of age, an infant who has been fed well and gained weight begins to vomit for no apparent reason. The vomiting has gradually become more forceful. These symptoms may be indicative of which disorder?

Esophageal atresia

Congenital aganglionic megacolon

Pyloric stenosis

Galactosemia

Question 24. Hepatitis _____ in children is primarily associated with blood transfusions.

A

B

C

D

Question 25. Meconium _____ is an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine.

cecum

ileus

obstruction

vivax

Capstone Project: Milestone 2

/in /by

Review the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.

Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Outline (Links to an external site.)Links to an external site.. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.

The format for this proposal will be a paper following the Publication manual of APA 6 th edition.

The paper is to be four- to six-pages excluding the Title page and Reference page.

As you organize your information and evidence, include the following topics.

Introduction: Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association(2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.

Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.

Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.

Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.

Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.

Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.

Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.

Rubric

NR451_Milestone2_2NR451_Milestone2_2CriteriaRatingsPtsThis criterion is linked to a Learning OutcomeIntroductionIntroduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.)25.0 ptsIntroduction to the plan is nursing focused, and evidence-based. Potential interventions clearly identified.22.0 ptsIntroduction to the plan is missing one of the elements listed in the first column.20.0 ptsIntroduction to the plan is missing two elements listed in the first column.10.0 ptsIntroduction lacks evidence to support need for change and/or potential solution is not evidenced-based.0.0 ptsIntroduction is missing.25.0 pts

This criterion is linked to a Learning OutcomeChange Model OverviewAn overview of the ACE Star model as a guide for change is given. Scope of the problem is identified. Stakeholders are identified. Team members and their roles and practice area are identified and discussed. State how nurses should use this model as a guide to facilitate change.50.0 ptsOverview of the ACE Star model is given. Scope of problem is identified. Rationale for change is present. Stakeholders are identified. Practice area, team members and role are discussed.44.0 ptsAll elements in the first column are included but discussion of one or more items lacks details.40.0 ptsOverview is missing one of the elements from the first column.19.0 ptsOverview of the ACE Star model is given. Scope of problem is not identified. Rationale for change is not present. Stakeholders are not identified. Practice area, team members and role are not discussed.0.0 ptsChange Model Overview is missing all elements of the first column.50.0 pts

This criterion is linked to a Learning OutcomeEvidenceEvidence is provided thru basic information that indicates a change is needed. For example, there have been 6 urinary tract infections over the last two months and there were none present the last two years at the same time period. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use?50.0 ptsEvidence summary is thoroughly provided with information of the current problem in the work setting indicating a change is needed. Interventions discovered in Evidence Summary are used in planning for change.44.0 ptsEvidence summary contains all elements in the first column, however, one or more items lacks detail.40.0 ptsEvidence is vaguely provided through information of the current problem in the work setting indicating a change is needed. Some of the interventions discovered in Evidence Summary are used in planning for change.19.0 ptsEvidence is provided through information of the current problem but is not convincing. Interventions discovered in Evidence Summary are not used in planning for change.0.0 ptsEvidence summary is not provided.50.0 pts

This criterion is linked to a Learning OutcomeTranslationActivities to achieve the final steps of change are fully described. What is needed to achieve? How do you translate what information you have gathered into practice? Include measurable outcomes. How do you inform staff? What is your plan of action to pilot the plan? What is the timeline?50.0 ptsActivities to achieve final steps of change are fully described. Ways to translate evidence into practice are discussed (outcomes). Methods to inform staff, activities planned for plan of action and timeline are discussed.44.0 ptsActivities to achieve final steps of change are adequately described.40.0 ptsActivities to achieve final steps of change are briefly described.19.0 ptsMinimal description of the activities to achieve final steps of change.0.0 ptsActivities for final change plan are missing. Translation of evidence into practice is missing.50.0 pts

This criterion is linked to a Learning OutcomeConclusionClear, solid summary of the key points, ACE Star model and steps of the change plan are included; ways to sustain the change plan are described.25.0 ptsDetailed summary of main points using ACE Star model. Ways to sustain plan are thoroughly described.22.0 ptsSummary of main points/model is brief. Ways to sustain plan are briefly described.20.0 ptsSummary of main points/model is vague. Ways to sustain plan are vaguely described.10.0 ptsSummary of main points/model OR ways to sustain plan are not described.0.0 ptsSummary is missing. There is no plan to sustain change.25.0 pts

This criterion is linked to a Learning OutcomeMechanicsAPA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors25.0 ptsAPA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors22.0 ptsTwo to three errors in elements from the first column.20.0 ptsFour to five errors in elements from the first column.10.0 ptsSix to seven errors in elements from the first column.0.0 ptsMore than seven errors.25.0 pts

Total Points: 225.0

Creating and managing a diverse workforce

/in /by

Discussion: Diversity in the Workplace

Creating and managing a diverse workforce is a process, not a destination.

—R. Roosevelt Thomas, Jr.

What concepts come to mind when you think of diversity? What kinds of diversity exist in your workplace? How does diversity impact communication, working relationships, productivity, and patient care?

In the workplace, focusing on differences can create divisiveness. Nurse managers should approach diversity as a way to highlight, communicate, and build on the commonalities of their workforce. Modeling this behavior can encourage appreciation for diversity and create a more positive workplace environment. When managing a diverse workforce, nurse managers should never make assumptions about an individual’s motivations, goals, or work ethic based upon personal traits such as age, gender, race, or culture. Nurse managers should strive to facilitate an inclusive environment for all.

To prepare

Review the article, “Diversity within Nursing: Effects on Nurse-Nurse Interaction, Job Satisfaction, and Turnover.” Examine Figure 1 on p. 218. Determine how these and other diversity issues might impact the interaction of nurses in the workplace.

Consider situations in your current organization or one with which you are familiar in which obvious diversity exists. How do these types of diversity issues affect the daily work environment?

Examine this week’s Learning Resources to identify strategies for finding commonalities among workers. How might these strategies also help to increase appreciation of diversity within the workplace?

Post an explanation of how diversity-related issues impact your current organization or one with which you are familiar. If you do not believe there are any issues related to diversity, explain how this workplace instills a culture of acceptance and positivity. Conclude your posting by describing at least two commonalties everyone in this workplace shares and at least one new strategy you could implement to increase appreciation of both differences and similarities.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Appraise a colleague’s strategy by providing insight into whether or not this strategy could effectively mitigate diversity issues. Support your comments by using authentic examples and references to this week’s Learning Resources.

Suggest an additional strategy a colleague could use to mitigate diversity issues.

Required Readings

Beheri, W. H. (2009). Diversity within nursing: Effects on nurse-nurse interaction, job satisfaction, and turnover. Nursing Administration Quarterly, 33(3), 216–226. 

Retrieved from the Walden Library databases.

Beheri’s article examines the effects of diversity in nursing. The study found that nurses who are satisfied with their jobs and have a higher level of education are more likely to tap into the potential offered by cultural diversity.

Collins-McNeil, J., Sharpe, D., & Benbow, D. (2012). Performance potential. Aging workforce: Retaining valuable nurses. Nursing Management, 43(3), 50–51. 

Retrieved from the Walden Library databases.

Due to the increasing connectivity between patient safety and government-sponsored financial incentives, it is important for nurse managers to understand the specific language used by finance. This article examines the importance of this topic.

Harton, B. B., Marshburn, D., Kuykendall, J., Poston, C., & Mears, D. A. (2012). Self-scheduling: Help or hindrance? Nursing Management, 43(1), 10–12. 

Retrieved from the Walden Library databases.

This article discusses the possibility of allowing nurses to create their own schedules to boost retention.

Outten, M. K. (2012). From veterans to nexters: Managing a multigenerational nursing workforce. Nursing Management, 43(4), 42–47. 

Retrieved from the Walden Library databases.

The author of this article addresses the need for effective management of a multigenerational workforce. Increased nurse turnover and interpersonal conflict are some of the consequences of overlooking this type of diversity.

Wisotzkey, S. (2011). Will they stay or will they go? Insight into nursing turnover. Nursing Management, 42(2), 15–17. 

Retrieved from the Walden Library databases. 

In this article, the author focuses on creating a work environment that will decrease the effects of nurse turnover. The author states that organizational commitment has the most direct effect on these turnover rates.

Optional Resources

 Manion, J. (2009). Managing the multi-generational nursing workforce: Managerial and policy implications (White Paper). Retrieved from International Centre for Human Resources in Nursing website: http://www.hrhresourcecenter.org/node/2377

 Hatcher, B. J. (Ed.). (2006). Wisdom at work: The importance of the older and experienced nurse in the workplace (White Paper). Retrieved from National Academy on an Aging Society website: http://www.agingsociety.org/agingsociety/links/wisdomatwork.pdf

 Chambers, P. D. (2010). Tap the unique strengths of the millennial generation. Nursing, 40(2), 48–51. Retrieved from http://journals.lww.com/nursing/Citation/2010/02000/Tap_the_unique_strengths_of_the_millennial.18

How sensitive care is expressed through choice of words, maintaining a distance that is culturally appropriate, and utilizing other techniques to negotiate through established social and cultural values

/in /by

Health conditions, including heart disease and respiratory infections, have no borders. What happens in one part of the world has ripple effects through the other parts, including the United States. Technology has created an even smaller world, with nurses in instant contact and eager to share information.

You and your nursing colleagues live and work around this shrinking professional world. Your nursing experience working with diverse populations presents a rich opportunity to share your international health perspectives. This exercise is a growth opportunity in terms of how we see ourselves, the world, and how we interact with our patients during the health interview and health assessment process.

In this week’s Discussion, your stories will illustrate relevant social and cultural differences among yourselves and your patients. The collective experience will expand your individual nursing knowledge; improve upon our cultural humility and perspectives, in order to foster social and culturally-sensitive health interviews and assessments. This, in turn, contributes to safer and higher quality outcomes for your patients. Consider how your sensitive care is expressed through choice of your words, maintaining a distance that is culturally appropriate, and utilizing other techniques to negotiate through established social and cultural values. This leads to patient trust and comfort and a respectful nurse-patient relationship.

a 2-paragraph response (at least 250–350 words) to one of the options below. Develop and post cohesive paragraphs, and use evidence to support your ideas.

Practicum Professional Experience Plan

/in /by

Section 2: Practicum Professional Development Objectives

Refer to the instructions in Week 1 to create practicum professional development objectives that meet the requirements for this course.

Objective 1: Analyze three common barriers to effective communication, then compare and contrast two effective resolution strategies as defined in evidence-based literature.

Objective 2: Contrast units that have success with retention and recruitment of novice nursing staff and those who have high turnover; identifying factors of influence and comparing to peer reviewed literature.

Assignment 1:

Practicum Professional Experience Plan (PPEP)Success comes from knowing that you did your best to become the best that you are capable of becoming.

— John Wooden, My Personal Best: Life Lessons from an All-American JourneyAs you considered in this week’s Discussion, your experiences in the practicum can provide a vital avenue for professional development.For this Assignment, you develop a Practicum Professional Experience Plan (PPEP) to outline how your involvement in the practicum will contribute to your growth as a professional and allow you to hone your specialization knowledge and skills. The PPEP consists of two or three objectives related to professional development that you will address during your Practicum Experience.Note: In the practicum manual these are referred to as your individualized learning objectives.To prepare:As necessary, review the information related to developing objectives provided in this week’s Learning Resources.Revisit the objective(s) you crafted for this week’s Discussion, and reflect on the ideas exchanged in this forum. Refine the objective(s) as needed, making sure they reflect the higher-order domains of Bloom’s Taxonomy (i.e., Application level and above). Note: You will be developing two to three professional development objectives for this assignment.Think more deeply about areas for which you would like to gain application-level experience and/or continued professional growth. How can your experiences in the practicum help you achieve these aims?Discuss your professional aims and your proposed practicum professional development objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.Download and save the Practicum Professional Experience Plan Form provided in this week’s Learning Resources.

To complete your Practicum Professional Experience Plan:Record the required information in each area of the Professional Practicum Experience Plan, including two or three objectives you will use to facilitate your professional development during the practicum.

Objective 3: Develop and prioritize a one-month productivity expense report that will be used to budget upcoming expenditures and incorporate a balanced unit financial statement in accordance with previous budgets and evidence based literature.

Resources

Cipriano, P. F., & Murphy, J. (2011). The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 286–289.

Note: Retrieved from the Walden Library databases. “Technology tools will continue to revolutionize how we plan, deliver, document, review, evaluate, and derive the evidence about care” (p. 289). This article examines how nurses can use information technology to transform nursing and redesign the health care system. It focuses on the use of technology to promote quality and notes that technology can also be used to address challenges in education, research, leadership, and policy.McKimm, J., & Swanwick, T. (2009). Setting learning objectives. British Journal of Hospital Medicine, 70(7), 406–409.

Note: Retrieved from the Walden Library databases. This article clarifies the terminology associated with learning objectives and explains how learning objectives relate to professional development and the transformation from novice to expert. It also introduces common pitfalls when setting learning objectives and provides suggestions for avoiding them.Murphy, J. (2011). The nursing informatics workforce: Who are they and what do they do? Nursing Economic$, 29(3), 150–153.

Note: Retrieved from the Walden Library databases. The author examines the nursing informatics workforce, explaining that professionals in this well-established specialty area can play an integral role in transforming health care.Sørensen, E. E., Delmar, C., & Pedersen, B. D. (2011). Leading nurses in dire straits: Head nurses’ navigation between nursing and leadership roles. Journal of Nursing Management, 19(4), 421–430.

Note: Retrieved from the Walden Library databases. “Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity” (p. 421). In this article, the authors examine how individuals in key professional roles negotiate between and apply nursing and leadership skills.

Essentials Of Evidence-Based Practice

/in /by

Course Project: Part 1—Identifying a Researchable Problem

One of the most challenging aspects of EBP is to actually identify the answerable question.

—Karen Sue Davies

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.

To prepare:

Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.

Review the section beginning on page 71 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.

Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.

Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?

Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:

Write a 3- to 4-page paper that includes the following:

A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

The 5 questions you have generated and a description of how you analyzed them for feasibility

Your preliminary PICOT question and a description of each PICOT variable relevant to your question

At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

Reference:

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

Required Readings

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice” (Review pages 14–31)

Chapter 5, “Literature Reviews: Finding and Critiquing Evidence”

In this chapter, you focus on conducting a literature review. Topics include how to identify the relevant literature on a given topic and then how to critique the strengths and weaknesses of the literature that you have found. Finally, the chapter examines how to synthesize the research findings into a written literature review.

Houde, S. C. (2009). The systematic review of literature: A tool for evidence-based policy. Journal of Gerontological Nursing, 35(9), 9–12.

Retrieved from the Walden Library databases.

This article emphasizes the importance of systematic reviews of literature. The authors present an overview of resources that may assist in conducting systematic reviews.

Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.

Retrieved from the Walden Library databases.

This article reviews the features of the TREAD Evidence-Based Practice Model. In particular, the authors of this article stress how the model emphasizes the use of standardized critical appraisal tools and Level I evidence.

Robeson, P., Dobbins, M., DeCorby, K., & Tirilis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health, 10, 95.

Retrieved from the Walden Library databases.

This article describes a hierarchy of pre-processed evidence and how it is adapted to the public health setting. The authors identify a range of resources with relevant public health content.

Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9, 2014, from http://academicguides.waldenu.edu/content.php?pid=183871&sid=2950360

Barker, J. (n.d.) Basic search tips and advanced Boolean explained. Retrieved August 3, 2012, from http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Boolean.pdf

This resource provides a graphical representation of different approaches to research and gives examples of each.

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

This article reviews the frameworks commonly used to assist in generating answerable research questions. The author recommends considering the individual elements of the frameworks as interchangeable (depending upon the situation), rather than trying to fit a situation to a specific framework.

Walden University Library. (2012). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=523225

This guide provides a listing of evidence-based clinical resources, including systematic reviews and meta-analyses, critically appraised topics, background information and expert opinions, and unfiltered resources.

Indiana State University. (n.d.). Database search strategies. Retrieved July 6, 2012, from http://libguides.indstate.edu/content.php?pid=118904&sid=1065428

In this resource, the most common types of database searches are highlighted. It includes topics such as nesting searches, phrase searches, and using synonyms of key words in the search.

Library of Congress Online Catalog. (2008). Boolean searching. Retrieved from http://catalog.loc.gov/help/boolean.htm

This web page provides a basic overview of Boolean searches and provides simple examples of key search terms.

Walden University. (n.d.b.). Searching and retrieving materials in the research databases. Retrieved August 10, 2012, from http://academicguides.waldenu.edu/foundationscoursedocs/SearchingRetrieving

This resource provides tips for searching in the Walden Library. It includes a guide to keyword searches, an explanation of Boolean searches, and tips on locating specific journals or articles.

Document: Course Project Overview (Word document)

Note: You will use this document to complete the Project throughout this course.

Media

Laureate Education (Producer). (2012e). Finding resources for EBP. Baltimore, MD: Author.

Note: The approximate length of this media piece is 6 minutes.

In this video, Dr. Marianne Chulay identifies sources where nurses can find evidence to support their practices. She provides several examples of resources that provide specific information about best practices in health care.

Accessible player

Laureate Education (Producer). (2012f). Finding sources of evidence. Baltimore, MD: Author.

Note: The approximate length of this media piece is 9 minutes.

Dr. Kristen Mauk explains the process of performing a literature review in this video. She provides advice for nursing students in browsing databases and analyzing sources of evidence.

Accessible player

Laureate Education (Producer). (2012g). Hierarchy of evidence pyramid. Baltimore, MD: Author.

This multimedia piece explains the hierarchy of evidence pyramid. The piece offers definitions and key information for each level of the pyramid.

Nurses Working to Improve the Socioeconomic Status of Impoverished Citizens Through Government Actions

/in /by

Week 2: Political, Ethical, and Economical
Influences on Health

As you examined in Week 1, the disparity of available health care staffing is varied throughout the world. Often, countries with the greatest disease burden have the fewest health care professionals available to care for their populations. This week extends the premise further to analyze the influence of politics, ethics, economics, environment, and culture on the public’s health in the global arena. Through health care policy and advocacy efforts, nurses act as change agents to improve the quality of care and quality of life for poor and disenfranchised populations.

Ethics in nursing practice and health care is a vitally important issue on the global health care front. A nurse’s responsibility toward a patient or a population can be viewed as an act that supports the preservation of human rights, dignity, and social justice. Nurses can address these needs in several ways, such as through political avenues, and by educating the community on disease prevention and proven methods to safeguard good health. By communicating a population’s vulnerability to specific ailments and diseases, nurses can be found working to promote health, prevent illness, and assist in recovery from many health problems.

This week you will examine how politics and economics influence health and health care. You will also consider ethical dilemmas when promoting health for a population.

Learning Objectives

Students will:
  • Evaluate how politics and economics influence health and health care
  • Analyze political or economic system’s influence on health
  • Analyze government intervention for a health care system
  • Analyze approaches for mitigating outbreaks in relation to nursing practice*

*The Assignment related to this Learning Objective is introduced this week and submitted in Week 3.

Photo Credit: [Image Source]/[Image Source]/Getty Images

Learning Resources

Required Readings

Holtz, C. (2013). Global health care: Issues and policies (2nd ed.). Burlington, MA: Jones & Bartlett.

  • Chapter 4, “Global Perspectives of Economics and Health Care” (pp. 91–122)
  • Chapter 6, “Ethics of End-of-Life Care from a Global Perspective” (pp. 139–156)

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.

  • Chapter 8, “Public Health Policy” (pp. 167–187)

Public Health Nursing: Population-Centered Health Care in the Community, 9th Ed. by Stanhope, M., & Lancaster, J. Copyright 2015 by Elsevier Health Science Books. Reprinted by permission of Elsevier Health Science Books via the Copyright Clearance Center.

Levine, R. (2007). Case studies in global health: Millions saved. Sudbury, MA: Jones & Bartlett.

  • Case 9, “Improving the Health of the Poor in Mexico” (pp. 65–72)
Required Media

Laureate Education. (Producer). (2010d). Public and global health: Political, ethical, and economical influences on health [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 11 minutes.

TED. (2015b). Why your doctor should care about social justice. Retrieved from https://www.ted.com/talks/mary_bassett_why_your_doctor_should_care_about_social_justice

Note: The approximate length of this media piece is 14 minutes.

Dr. Mary Bassett (Health Commissioner of New York City) discusses why physicians, nurses, and other health care professionals should not keep silent about health care disparities, based on her insights from her work in Zimbabwe.

Writing Resources and Program Success Tools

Document: AWE Checklist (4000) (Word document)

This checklist will help you self-assess your writing to see if it meets academic writing standards for this course.

Walden University. (n.d.). Walden templates: General templates: APA course paper template with advice (6th ed.). Retrieved May 20, 2016, from http://academicguides.waldenu.edu/ld.php?content_id=7980455

Dr. Mary Bassett (Health Commissioner of New York City) discusses why physicians, nurses, and other health care professionals should not keep silent about health care disparities, based on her insights from her work in Zimbabwe.

Discussion: Nurses Working to Improve the Socioeconomic Status of Impoverished Citizens Through Government Actions

The influence of poverty on health is a problem that transcends national borders. This week’s readings discussed some of the political, economic, and ethical issues that lead to health disparities in developed and developing countries. In addition, in this week’s first media presentation, Dr. Mancuso and Dr. Huijer shared insights on working within political systems to bring about positive changes in health care. Think about the importance of nurses in addressing these needs and in bringing about change.

To prepare for this Discussion:

  • Review the case study “Improving the Health of the Poor in Mexico.” Then, prepare your response to the following questions:
    • How do politics and economics influence health and health care?
    • What might the benefits be of awarding the mothers cash grants?
    • What social problems might be created by giving the mothers cash grants?
    • Do you think the resources were ethically distributed? (Think about stereotyping.)
    • What changes do you think should be made to the program, if any?
    • If the program were to be discontinued for any reason, what could you, as a nurse, say that might help to maintain funding?
    • Do you think a similar program might work in your community? Why or why not?
By Day 3

Post your response to the following prompts:

Explain how politics and economics may influence health and the health care system from your own perspective. Analyze whether the political and/or economic systems play a major role in your or your family’s access to health and explain why. Then, describe how government intervention might benefit a health care system. Be specific and provide examples.

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 250–350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

Public Health Issues

/in /by

Question 1 Besides being important public health issues and motivating people to action, what purpose do the Healthy People 2020 objectives serve?

  1. Measure the impact of prevention activities
  2. Provide monetary worth to the nation
  3. Replace other tools
  4. Identify people needing secondary health services

Question 2 A group of health care providers are attempting to define health. What can occur during this discussion?

  1. Terms and meanings may be challenged.
  2. Categories of health will be listed.
  3. Ambiguity will be resolved.
  4. Achieves a full acceptance by all parties

Question 3 Which is an obligation of a person who is assuming the sick role?

  1. Seek help and following it to promote recovery.
  2. Stay away from others to prevent them from becoming ill.
  3. Follow health orders without question.
  4. Appear to be sick.

Question 4 According to Suchman, what does assuming the sick role mean to a person?

Select all that apply.

  1. Seeks help and shares the problem with family and friends
  2. Goes under the control of a physician who plans a treatment of care
  3. Seeks scientific confirmation that something is wrong
  4. Becomes aware that something is wrong and responds emotionally

Question 5 Within the Healthy People 2020 document, what characteristics contribute to health disparity in the United States?

Select all that apply.

  1. Race
  2. Religion
  3. Gender
  4. Age
  5. Unemployment/underemployment

Question 6 Which actions or behaviors exemplify health maintenance?

Select all that apply.

  1. Having an annual physical with a healthcare provider
  2. Complying with immunization schedules
  3. Eating balanced meals
  4. Regular exercise
  5. Having health insurance

Question 7 A patient says, “The doctors say I’m healthy, but I still don’t feel well.” What can the nurse infer from this statement about the patient’s definition of health?

Select all that apply.

  1. The patient equates being healthy with feeling well.
  2. The patient’s definition of health includes more than the absence of physical symptoms.
  3. Since the patient does not feel well, disease must be present.
  4. The patient believes that a disease is still present.
  5. The patient is experiencing pain.

Question 8 Which phases would a person experience during an illness trajectory?

  1. Symptoms, diagnosis, treatment, rehabilitation
  2. Symptoms, diagnosis, rehabilitation, treatment
  3. Rehabilitation, treatment, recovery, symptoms
  4. Diagnosis, treatment, symptoms, rehabilitation

Question 9 Why would health care providers refer to Healthy People 2020 when providing patient care?

  1. It provides a plan to continue to improve the health of everyone in the United States.
  2. It supports policies which provide monetary incentives to states who reach the benchmark goals.
  3. It serves as a monitoring system that evaluates the health of all citizens.
  4. It is mandated legislation that will result in a healthier population by 2020.

Question 10 While hospitalized, a patient enters the stage of patient status. What behavior will the nurse observe in this patient?

  1. The person shifts into the role as it is determined by society.
  2. The illness is now socially recognized and identified.
  3. Symptoms are being experienced, leading to a diagnosis.
  4. The patient does all that can be done to recover from his or her illness.

Question 11 How would the definition of health differ between a beginning nursing student and a graduate nursing student?

Select all that apply.

  1. Health for the graduate nurse is more technical.
  2. Health for the graduate student is more abstract.
  3. Health becomes more tangible for the graduate nurse.
  4. Health for the beginning nurse is a complex integration of parts.
  5. Health becomes easier to define for the graduate nurse.

Question 12 Which statement exemplifies Rosenstock’s belief about health as an elusive concept?

Seeking medical care evolves in distinct stages.

Question 13 The nurse determines that a patient is in the onset stage of an illness. What did the nurse observe in the patient?

  1. The first symptoms of a given problem are experienced.
  2. There is a gradual resumption of normal roles and activities.
  3. The sick role becomes that of being a patient.
  4. The disease is identified and socially sanctioned.

Question 14 What would be the result of ambivalence during the dependent-patient role stage?

  1. Create barriers that interfere with the treatment and willingness to comply.
  2. Warrant further confirmation sought from family and friends about what is happening.
  3. Have the person become aware that something is wrong.
  4. Cause additional burdens to family and friends of the person at this time.

Question 15 Which statement exemplifies how a nursing student views health?

  1. Entered the health care profession with a culturally based concept of health
  2. Forces patients to accept the medical definitions of health
  3. Accepts the prevailing definition of health and applies it to individual patients
  4. Must share the patient’s views of health and illness

Question 16 While reviewing the Healthy People 2020 document, the nurse identifies what as being the main objectives of the program?

Select all that apply.

  1. Address the relationship between health status and biology, behavior, services, social factors, and policies.
  2. Emphasize an ecological approach to disease prevention and health promotion.
  3. Ensuring all Americans have health insurance
  4. Eliminating childhood diseases
  5. Ensuring all Americans have one physical each year

Question 17 Why would the nurse review health status determinants when assessing a patient?

Select all that apply.

  1. Learn the patient’s lifestyle.
  2. Understand the patient’s environment.
  3. Identify how to measure progress.
  4. Ability to motivate action
  5. Identify ways to reduce health care costs.

Question 18 A patient comes to a health care provider concerned about a family history of diabetes. The provider addresses the patient’s concerns and suggests interventions to diminish the patient’s chances of developing the disease. What is this action considered?

  1. Perceived benefits
  2. Demographic variables
  3. Perceived seriousness
  4. Sociopsychological variables

Question 19 Which illness trajectory would be seen in a person with cancer?

  1. presenting symptoms, followed by treatment and recovery.
  2. acute illness, unstable status, deterioration, and recovery.
  3. diagnosis, treatment, unstable status, death.
  4. presenting symptoms, followed by diagnosis and treatment

Question 20 After learning about a health problem, a patient is reluctant to take action. Which barriers could be influencing this patient’s decision about taking action?

Select all that apply.

  1. Cost
  2. Availability
  3. Time
  4. Social class
  5. Use of Jargon

Nursing Finances

/in /by

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.

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.

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).

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:

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

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.

References:

Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and Bartlett Learning.

Chapter 14, “Trend Analysis, Common Sizing, and Forecasted Data” (pp. 149-160)

The focus of this chapter is the use of trend analysis and forecasting to develop future budgets and make financial decisions about capital purchases, programs, and personnel.

Chapter 15, “Using Comparative Data” (pp. 161-173)

In this chapter, you are introduced to the criteria for identifying other health care organizations that are comparable to your own. Data from these organizations can then be used to evaluate your own organizational performance.

Chapter 19, “Estimates, Benchmarking, and Other Measurement Tools” (pp. 223-231)

In this chapter, you continue exploring the concept of financial benchmarking. The chapter focuses on the importance of benchmarking for identifying performance gaps.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.

Retrieved from the Walden Library databases.

Chapter 5, “Working Capital Management” (pp. 187–231)

This chapter examines the concept of working capital. The authors explore the specifics of current assets and the management of the working capital cycle.

Chapter 11, “Responsibility Accounting” (pp. 468–497)

Review: This chapter explores the trend toward the decentralization of health care organizations and the challenges this presents. This chapter also describes responsibility centers, or organizational units intended to achieve specific tasks.

Mulva, S., & Dai, J. (2009) Health care facility benchmarking. HERD, 3(1), 28–37.

Reprinted by permission of Sage Publications via the Copyright Clearance Center.

This article describes a national health care facility’s benchmarking program. It is designed to compare measures of capital project performance.

Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance

Skills you need to advance in your healthcare management career

/in /by

Key Assignment Final Paper – Report of Findings to Mr. Magone, CEO, Healing Hands Hospital and the “Future of Healing Hands” Task Force

Continue to use the scenario to assist you with this assignment.
There are two parts to this assignment:

Part 1:

Using your instructor’s and peers’ feedback and suggestions from Week 4, complete your final draft of the Key Assignment, Report to the Future of Healing Hands Task Force. Add the following analysis to complete your paper from Week 4 and then submit the entire paper including the analysis for this assignment:

 Mr. Magone and the senior leadership of Healing Hands Hospital understand the importance of evaluating operational performance in the healthcare industry and its impact not only on patient satisfaction but also maintaining sound financial management. This is increasingly important in the era of value-based care including Medicare’s Quality Payment Program.  Both qualitative and quantitative analysis of data related to patient care is needed.  This data includes average length of stay, readmission rates, mortality rates and compliance with standard of care guidelines. 


In addition, Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans and the need to demonstrate improved quality of care delivered to the hospital’s patients. As part of the Task Force you have been asked to research and analyze data regarding 1) length of stay and 2) hospital acquired infections and the impact of both metrics on the hospital budget and reimbursement. As reimbursement payments become increasingly linked to quality of care, it is important for Healing Hands Hospital to continue to improve in these areas. You have been asked to help the Chief Financial Officer  and Chief Nursing Officer evaluate these aspects of patient care as part of your report to Mr. Magone and the Task Force. Submit a 7-10 page paper incorporating your unit 1-4 Individual Project topics including the analysis of how Healing Hands Hospital compares to other hospitals in the nation, state and region in:

  • Average length of stay
  • Hospital acquired infection rate 

    Describe how these statistics impact the organization’s budget and reimbursement opportunities in the future.  Be sure to include how Medicare reimbursement will be impacted.
    For your research, remember to use the hospital that you chose to represent Healing Hands Hospital and use data for the same state and region for comparison in your analysis.  Put your data for comparison in a table or graph in your paper.

For the final paper reference list, be sure to include a minimum of 3 reference sources besides the textbook identifying where you found your data on hospital statistics and add this to your references for the other sections of your final paper from the previous week’s assignments.  Document your references using APA format.

Part 2: 

Being asked to be part of the Task Force was recognition of your abilities and value to Healing Hands Hospital.  When you started to work on the Task Force, you were not an expert in all of the aspects of the healthcare industry on which you were asked to report. Your manager, Ms. Woods, the Chief Operating Officer, recognizes this and that you had not previously had the opportunity to present to the Chief Executive Officer and other members of the executive team.   She tells you that this is a good opportunity to develop skills as a professional and expand your expertise level in the healthcare field.  She is curious about how you feel about the opportunity and what skills you feel you already had and those that you developed in this process.  She also would like to know what skills you feel you still need to develop to continue to advance in your healthcare management career.  Write a 2-3 paragraph memo to Ms. Woods that answers her questions and reflect on your professional development through the work that you did for the Task Force (as a part of this course) and how you will continue to maintain your acquired skills and knowledge base.

Please submit your assignment.

For assistance with your assignment, please use your text, Web resources, and all course materials