NURS-6052N-37, Essent of Evidence-Based Pract.2017

Discussion:-1

Nursing Research and Evidence-Based Practice

In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.

Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).

To prepare:

Consider a recent clinical experience in which you were providing care for a patient.

Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?

What questions have you thought about in a particular area of care such as a procedure or policy?

Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.

Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.

Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

Learning Resources

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 1, “Introduction to Nursing Research in an Evidence-Based Practice Environment”

This chapter provides an introduction to nursing research, its history, and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.

Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice”

The focus of this chapter includes an overview of the key aspects of evidence-based practice, a review of how to identify credible research and appraise its value, and, finally, a discussion on how to take the identified evidence and convert it into a practice.

Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research”

In this chapter, quantitative and qualitative research models are compared and the major steps in each approach are described. Information is also presented on the different sections of a research journal article and how you can identify the research model that was utilized.

Adams, J. S. (2010). Utilizing evidence-based research and practice to support the infusion alliance. Journal of Infusion Nursing, 33(5), 273–277.

This article examines how evidence-based research and practice supports infusion alliances. The text also specifies the increasing challenges that infusion nurses face.

Mallory, G. A. (2010). Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm. Nursing Outlook, 58(6), 279–286.

This article describes strategies for reducing the gap between research knowledge and practice. The article also details how nursing societies could use these strategies to improve the quality of care.

Newhouse, R. P., & Spring, B. (2010). Interdisciplinary evidence-based practice: Moving from silos to synergy. Nursing Outlook, 58(6), 309–317.

In this article, the authors examine the state of interdisciplinary evidence-based practice (EBP). The authors detail efforts to promote interdisciplinary EBP, academic and clinical training regarding interdisciplinary EBP, and strategies that may facilitate EBP translation across disciplines.

Shaheen, M., Foo, S., Luyt, B., Zhang, X., Theng, Y-L., Chang, Y-K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236.

This article reviews a study that sought to determine nurses’ awareness of, knowledge of, and attitude toward EBP. The article also describes factors likely to promote barriers to EBP adoption.

Shivnan, J. C. (2011). How do you support your staff? Promote EBP. Nursing Management, 42(2), 12–14.

This article explores the role of the nurse manager in supporting evidence-based practice. The article also explains barriers and strategies to promote EBP for a nurse manager.

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

Media

Laureate Education (Producer). (2012). Timeline of nursing research. Baltimore, MD: Author.

This multimedia piece features a timeline of major events in nursing research. The timeline highlights how historical events and seminal research have contributed to nursing practice.

Discussion:-2

Literature Searches

An important step in the EBP process is reviewing the current body of literature to better understand the subject or topic in which you are interested. By conducting a review of the literature, you are building foundational knowledge about the topic; later, you can use this background to build new insights. Developing a strong grasp of a topic can only be garnered by taking the time to thoroughly search for relevant information and resources.

For this Discussion, you will practice searching the literature to find evidence on a specific topic.

To prepare:

Choose a simple search term(s) relating to a topic of your PICOT question.

Review the information on the evidence hierarchy discussed in Chapter 2 of the course text, in the article, “Facilitating Access to Pre-Processed Research Evidence in Public Health,” and in the multimedia presentation “Hierarchy of Evidence Pyramid,” found in this week’s Learning Resources.

Review the information on the Walden Library’s website, “Levels of evidence.” Take a few minutes to explore the different types of databases available for each level of evidence and focus on the meaning of filtered and non-filtered resources.

Conduct a literature search in the Walden Library on your selected topic using the databases that you reviewed. Use at least one database for each of the three levels of filtered information and at least one unfiltered database. Record the number of hits that you find at each level of the hierarchy of evidence.

Select one article from the results at each level of the hierarchy. Compare the articles based on the quality and depth of information. What would be the value of each resource if you were determining an evidence-based practice?

Please Provide References

Learning Resources

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.

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.

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.

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.

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.

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

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.

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.

Discussion:-3

Theory, Research, and Evidence-Based Practice

As they explore the world around them, young children often want to know the “why” and “how” of the things they observe. This is similar to what researchers do when they approach a new problem. Researchers develop new theories or build on old ones to explain the “why” of the world around them. They use models and conceptual frameworks to help explain “how” the processes and events they observe occur. Together, theories and models provide an understanding of the world and allow researchers to explore it in meaningful ways.

Virtually all research questions can benefit from the use of an existing theory or model. Researchers should consider their research questions and select the most suitable theory or model, which then serves as a foundation for the research design. The selection of a theory or model is an important part of the research process.

In this Discussion, you focus on the role of theory and models in research and evidence-based practice.

To prepare:

Review the information in Chapter 6 of the course text. Focus on the various conceptual theories and models that are currently used in nursing research.

Select one of the theories or models described that is of interest to you.

Using the Walden Library, search for and identify a research article that uses the theory or model you selected.

Reflect on how the theory or model provides structure to the research study described in the article.

Now, think about an issue in your practice area that you would be interested in exploring through research.

Review this week’s media presentation and consider strategies for locating and identifying a relevant theory or model for a research study.

Please Provide References

Learning Resources

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 6, “Theoretical Frameworks”

In this chapter, you are introduced to the concept of theories, models, and frameworks and how they serve as the foundation for research. The chapter examines key theories for both quantitative and qualitative research. Finally, critiquing frameworks in research reports is detailed.

Cantrell, M. A. (2011). Demystifying the research process: Understanding a descriptive comparative research design. Pediatric Nursing, 37(4), 188–189.

This article discusses the primary aspects of a prominent quantitative research design as used in a specific research study. The author analyzes the advantages and disadvantages of the design, along with the rationale for choosing that design.

Finn, P. (2011). Critical thinking: Knowledge and skills for evidence-based practice. Language, Speech, and Hearing Services in Schools, 42(1), 69–72.

This article responds to the assertion that “rational or critical thinking is an essential complement to evidence-based practice.” The author stipulates how critical thinking is relevant to EBP, what skills and thinking dispositions are important, and how thinking can go wrong.

Tagney, J., & Haines, C. (2009). Using evidence-based practice to address gaps in nursing knowledge. British Journal of Nursing (BJN), 18(8), 484–489.

This article illuminates key barriers to undertaking and implementing nursing research. The authors suggest a framework for improving the implementation of evidence and research.

Media

Laureate Education (Producer). (2012i). Selecting a framework. Baltimore, MD: Author.

This animated video shows the process of selecting a particular research framework. The video follows a specific scenario in which a researcher considers several possible frameworks and selects the most appropriate one.

Discussion:-4

Ethical Dimensions of Research Studies

In the best-selling book, The Immortal Life of Henrietta Lacks (Skloot, 2010), the author highlights the true story of an African-American woman who died in 1951 from cervical cancer. What makes her story unique is that prior to her death, cells from her tumor were removed and successfully grown in a petri dish. This was the first time scientists were able to successfully replicate cells outside the body, and it is estimated that billions of Lacks’ cells have been used in medical research. However, Henrietta Lacks was never asked for permission to take a sample and her family was never made aware of the widespread use of her cells. Although the culturing of her cells has been pivotal for advancing research, strong ethical concerns later arose about using these cells without patient or family approval.

This week’s readings describe historical examples of unethical research, such as a study of syphilis among African-American men in which treatment was withheld and a study in which live cancer cells were injected into elderly patients. Today, stricter controls that seek to protect study participants are placed on researchers, but breaches still occur. Careful attention must be given toward preventing unethical behavior. In this Discussion, you explore ethical considerations and issues in research.

To prepare:

Select a current health-related case involving research ethics. (If none come to mind, browse the Internet to familiarize yourself with recent cases.)

As you review the case that you have selected, reflect on the ethical principles discussed in “What Are the Major Ethical Issues in Conducting Research?” article found in this week’s Learning Resources. Which principles were breached in the case you have identified?

Please Provide References

Learning Resources

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 3, “Key Concepts and Steps in Qualitative and Quantitative Research” (for review)

Chapter 4, “Research Problems, Research Questions, and Hypotheses”

This chapter focuses on the steps in planning a study to generate evidence. These include developing a research question, identifying variables, articulating a problem statement, and generating hypotheses.

Chapter 7, “Ethics in Nursing Research”

In this chapter, the focus is on the ethical dilemmas that occur when planning and conducting research and the ethical principles that have been enacted for protecting study participants.

Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3–14.

This article describes a literature review conducted to determine the most important ethical issues that nurses encounter when undertaking or participating in research. The authors detail the results of the review and make recommendations for solving some of the problems highlighted.

Newcomb, P. (2010). Evolving fairness in research on human subjects. Journal of Child and Adolescent Psychiatric Nursing, 23(3), 123–124.

In this article, the author describes some of the ethical controversies that may arise in conducting research in human subjects, especially with respect to ownership of genes. The author also stresses the importance of educating research subjects and their families about the ultimate purpose of research.

Yakov, G., Shilo, Y., & Shor, T. (2010). Nurses’ perceptions of ethical issues related to patients’ rights law. Nursing Ethics, 17(4), 501–510.

The authors of this article detail a study conducted to determine how nursing staff deal with ethical issues in relation to the law. The article emphasizes the difficulty staff had in distinguishing between legal and ethical problems. The authors make several recommendations to deal with legal and ethical problems.

Delwiche, F. (2008). Anatomy of a scholarly research presentation in the health sciences. Retrieved from http://dana.uvm.edu/Anatomy/

This presentation highlights the primary components of scholarly research articles. The presentation details the distinguishing factors of scholarly journals, the peer-review process, and the definition of “primary literature.”

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html

This website provides the code of ethics for nurses to be used in carrying out their responsibilities. There is also a detailed explanation of each provision.

Document: Literature Review Summary Table Template (Word document)

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

Media

Laureate Education (Producer). (2012a). Anatomy of a research study. Baltimore, MD: Author.

This multimedia piece explains the “anatomy” of both quantitative and qualitative research studies. In addition, there is a brief quiz at the end of the tutorial to measure knowledge about research articles.

Laureate Education (Producer). (2012d). Evidence-based practice and research. Baltimore, MD: Author.

In this video, Dr. Marianne Chulay talks about the significance of evidence-based practice and research in nursing. She explains how nurses should apply research findings to health care decisions to improve outcomes.

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.

N: B EACH OF THE 5 EPISODES TO WATCH (REQIURED MEDIA) FOR THIS ASSIGNGMENT IS DOWNLOADEDN IN WORD FORMAT AS A TRANSCRIPT AND ATTACHED TO THIS ASSIGNMENT.

Learning Objectives

Students will:

· Assess clients presenting with addictive disorders

· Analyze therapeutic approaches for treating clients with addictive disorders

· Evaluate outcomes for clients with addictive disorders

To prepare:

· Review this week’s Learning Resources and consider the insights they provide.

· Review the Levy Family video Episodes 1 through 5.

The Assignment

In a 2- to 3-page paper, address the following:

· After watching Episode 1, describe:

o What is Mr. Levy’s perception of the problem?

o What is Mrs. Levy’s perception of the problem?

o What can be some of the implications of the problem on the family as a whole?

· After watching Episode 2, describe:

o What did you think of Mr. Levy’s social worker’s ideas?

o What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?

· After watching Episode 3, discuss the following:

o What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?

o What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?

o Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.

o Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?

· In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.

o Discuss how you would have responded to this revelation.

o Describe how this information would inform your therapeutic approach. What would you say/do next?

· In Episode 5, Mr. Levy’s therapist is having issues with his story.

o Imagine that you were providing supervision to this therapist, how would you respond to her concerns?

· Support your approach with evidence-based literature. AND INCLUDE INTRODUCTION, CONCLUSION WITH REFERENCES.

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 7, “Motivational Interviewing” (pp. 299–312)

Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Required Media

N: B EACH OF THE 5 EPISODES TO WATCH (REQIURED MEDIA) FOR THIS ASSIGNGMENT IS DOWNLOADEDN IN WORD FORMAT AS A TRANSCRIPT AND ATTACHED TO THIS ASSIGNMENT.

Laureate Education (Producer). (2013c). Levy family: Episodes 1 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 3 [Video file]. Baltimore, MD: Author.

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

Laureate Education (Producer). (2013c). Levy family: Episodes 4 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 5 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 5 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2012c). In their own words [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 23 minutes

Capstone Assignment Directions Capstone Assignment- HIM 305

Thoroughly review capstone scenario to complete this assignment.

Submit an operating budget for HIM department.

Respond to the questions for the capital budget scenario in a Word document.

Write a Request for Proposal (RFP) for the transcription and coding service referenced in the scenario conduct research for samples of request for proposals to assist with this task.

Complete the Excel budget spreadsheets. There will be three tabs- Tab One- lists employee salaries of department employees (yearly). Tab Two-departmental monthly expenses. Tab Three- annual budget for department.

Information for calculating the budget:

Use current dues for AHIMA (refer to AHIMA website for information).

Dues should be calculated for the Director and all credentialed employees in the department.

Director needs to budget to attend AHIMA National Convention. Find the budget information on the AHIMA website. Budget for transportation, registration and hotel. There is $45 a day allowed by organization for food.

Budget for luncheon for the HIP week- 12 employees at $10 per employee.

You must budget for employee education for CEU to maintain professional credentials. Calculate at least 10 CEU per year per coder to allow new information on coding updates to be obtained.

Refer to sample budget sheets for other information you may need.

Project a maximum 5% salary increase.

Project an increase in supplies of 7%.

Project a 5% increase in all other areas, except those discussed in the scenario.

Student Spreadsheet for Capstone

Capstone Case StudyCapstone Scenario- HIM 305

Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital. Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions. It has an emergency department staffed by hospital employees. Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31. In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years. Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30.

Financial Assumptions:

Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.

No major capital projects were anticipated.

In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year.

Coppin State Regional Health Center does not have a large marketing department. It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor. In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients. Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.

The maternity and newborn departments have been very concerned about declining patient satisfaction. They are worried that the current year’s slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges.

The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services. This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.

The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice. The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab. Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.

Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.

The HIM department has recently lost several employees to retirement and promotions with the facility. It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only. Transcription is handled largely by the department, with an outside service processing any overflow.

The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.

These changes would also require the implementation of an Electronic Record System (EHR).

All three departments submitted capital budget requests for the projects described.

Budget Considerations (to be submitted in a Word document with spreadsheets):

What things should be considered in conducting a cost-benefit analysis on each project?

At this point in your decision making which request is most appropriate? Request for Information, Request for Proposal or Request for a Quote? Explain your answer. Develop a request for proposal to send to the transcription and coding services.

If the hospital can only approve one of the proposed projects, which do you think has the best chance of being approved? Why?

If you were the director of the HIM department, how would you justify your department’s project so that it is presented most favorably? What are the benefits to selecting this project?

Cost Benefit Analysis InformationCost-Benefit Analysis

Deciding, Quantitatively, Whether to go Ahead

(Also known as CBA and Benefit-Cost Analysis)

http://www.mindtools.com/pages/article/newTED_08.htm

Imagine that you’ve recently taken on a new project, and your people are struggling to keep up with the increased workload.

You are therefore considering whether to hire a new team member. Clearly, the benefits of hiring a new person need to significantly outweigh the associated costs.

This is where Cost-Benefit Analysis is useful.

Note:

Cost-Benefit Analysis is a quick and simple technique that you can use for non-critical financial decisions. Where decisions are mission-critical or large sums of money are involved, other approaches – such as use of Net Present Values and Internal Rates of Return – are often more appropriate.

About the Tool

Jules Dupuit, a French engineer, first introduced the concept of Cost-Benefit Analysis in the 1930s. It became popular in the 1950s as a simple way of weighing up project costs and benefits, to determine whether to go ahead with a project.

As its name suggests, Cost-Benefit Analysis involves adding up the benefits of a course of action, and then comparing these with the costs associated with it.

The results of the analysis are often expressed as a payback period – this is the time it takes for benefits to repay costs. Many people who use it look for payback in less than a specific period – for example, three years.

You can use the technique in a wide variety of situations. For example, when you are:

Deciding whether to hire new team members.

Evaluating a new project or change initiative.

Determining the feasibility of a capital purchase.

However, bear in mind that it is best for making quick and simple financial decisions. More robust approaches are commonly used for more complex, business-critical or high cost decisions.

How to Use the Tool

Follow these steps to do a Cost-Benefit Analysis.

Step One: Brainstorm Costs and Benefits

First, take time to brainstorm all of the costs associated with the project, and make a list of these. Then, do the same for all of the benefits of the project. Can you think of any unexpected costs? And are there benefits that you may not initially have anticipated?

When you come up with the costs and benefits, think about the lifetime of the project. What are the costs and benefits likely to be over time?

Step Two: Assign a Monetary Value to the Costs

Costs include the costs of physical resources needed, as well as the cost of the human effort involved in all phases of a project. Costs are often relatively easy to estimate (compared with revenues).

It’s important that you think about as many related costs as you can. For example, what will any training cost? Will there be a decrease in productivity while people are learning a new system or technology, and how much will this cost?

Remember to think about costs that will continue to be incurred once the project is finished. For example, consider whether you will need additional staff, if your team will need ongoing training, or if you’ll have increased overheads.

Step Three: Assign a Monetary Value to the Benefits

This step is less straightforward than step two! Firstly, it’s often very difficult to predict revenues accurately, especially for new products. Secondly, along with the financial benefits that you anticipate, there are often intangible, or soft, benefits that are important outcomes of the project.

For instance, what is the impact on the environment, employee satisfaction, or health and safety? What is the monetary value of that impact?

As an example, is preserving an ancient monument worth $500,000, or is it worth $5,000,000 because of its historical importance? Or, what is the value of stress-free travel to work in the morning? Here, it’s important to consult with other stakeholders and decide how you’ll value these intangible items.

Step Four: Compare Costs and Benefits

Finally, compare the value of your costs to the value of your benefits, and use this analysis to decide your course of action.

To do this, calculate your total costs and your total benefits, and compare the two values to determine whether your benefits outweigh your costs. At this stage it’s important to consider the payback time, to find out how long it will take for you to reach the break even point – the point in time at which the benefits have just repaid the costs.

For simple examples, where the same benefits are received each period, you can calculate the payback period by dividing the projected total cost of the project by the projected total revenues:

Total cost / total revenue (or benefits) = length of time (payback period).

Example

Custom Graphic Works has been operating for just over a year, and sales are exceeding targets. Currently, two designers are working full-time, and the owner is considering increasing capacity to meet demand. (This would involve leasing more space and hiring two new designers.)

He decides to complete a Cost-Benefit Analysis to explore his choices.

Assumptions

Currently, the owner of the company has more work than he can cope with, and he is outsourcing to other design firms at a cost of $50 an hour. The company outsources an average of 100 hours of work each month.

He estimates that revenue will increase by 50 percent with increased capacity.

Per-person production will increase by 10 percent with more working space.

The analysis horizon is one year: that is, he expects benefits to accrue within the year.

Costs

CategoryDetailsCost in First YearLease750 square feet available next door at $18 per square foot$13,500Leasehold improvementsKnock out walls and reconfigure office space$15,000Hire two more designersSalary, including benefits

Recruitment costs

Orientation and training$75,000

$11,250

$3,000Two additional workstationsFurniture and hardware

Software licenses$6,000

$1,000Construction downtimeTwo weeks at approximately $7,500 revenue per week$15,000Total$139,750Benefits

BenefitBenefit Within

12 Months50 percent revenue increase$195,000Paying in-house designers $15 an hour, versus $50 an hour outsourcing (100 hours per month, on average: savings equals $3,500 a month)$42,00010 percent improved productivity per designer ($7,500 + $3,750 = $11,250 revenue per week with a 10 percent increase = $1,125/week)$58,500Improved customer service and retention as a result of 100 percent in-house design$10,000Total$305,500He calculates the payback time as shown below:

$139,750 / $305,500 = 0.46 of a year, or approximately 5.5 months.

Inevitably, the estimates of the benefit are subjective, and there is a degree of uncertainty associated with the anticipated revenue increase. Despite this, the owner of Custom Graphic Works decides to go ahead with the expansion and hiring, given the extent to which the benefits outweigh the costs within the first year.

Flaws of Cost-Benefit Analysis

Cost-Benefit Analysis struggles as an approach where a project has cash flows that come in over a number of periods of time, particularly where returns vary from period to period. In these cases, use Net Present Value (NPV) and Internal Rate of Return (IRR) calculations together to evaluate the project, rather than using Cost-Benefit Analysis. (These also have the advantage of bringing “time value of money” into the calculation.)

Also, the revenue that will be generated by a project can be very hard to predict, and the value that people place on intangible benefits can be very subjective. This can often make the assessment of possible revenues unreliable (this is a flaw in many approaches to financial evaluation). So, how realistic and objective are the benefit values used?

Key Points

Cost-benefit analysis is a relatively straightforward tool for deciding whether to pursue a project.

To use the tool, first list all the anticipated costs associated with the project, and then estimate the benefits that you’ll receive from it.

Where benefits are received over time, work out the time it will take for the benefits to repay the costs.

You can carry out an analysis using only financial costs and benefits. However, you may decide to include intangible items within the analysis. As you must estimate a value for these items, this inevitably brings more subjectivity into the process.

Whether used with individuals or families, the goal of cognitive behavioral therapy (CBT) is to modify client behavior. Although CBT for families is similar to CBT for individuals, there are significant differences in their applications. As you develop treatment plans, it is important that you recognize these differences and how they may impact your therapeutic approach with families. For this Discussion, as you compare the use of CBT for families and individuals, consider challenges of applying this therapeutic approach to your own client families.

                                                                   To prepare:

· Review the media, Johnson Family Session 3, in this week’s Learning Resources

and consider the insights provided on CBT in family therapy.

· Reflect on your practicum experiences with CBT in family and individual settings.

N: B. The video for Johnson Family Episode 3 Program Transcript is ATTACHED

        WITH THIS ASSIGNMENT INCASE YOU CAN NOT ACCESS THE VIDEO.





                                                               ASSIGNMENT

Post an explanation of how the use of cognitive behavioral therapy (CBT) in families compares to cognitive behavioral therapy (CBT) in individual settings. Provide specific examples from your own practicum experiences. Then, explain challenges counselors might encounter when using CBT in the family setting. Support your position with specific examples from this week’s media.

                                                               Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

Chapter 12, “Family Therapy” (Review pp. 429–468.)

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Chapter 10, “Cognitive-Behavior Family Therapy” (pp. 166–189)

Chapter 12, “Solution-Focused Therapy” (pp. 225–242)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology & Psychiatry, 54(7), 707–723. doi:10.1111/jcpp.12058

Conoley, C., Graham, J., Neu, T., Craig, M., O’Pry, A., Cardin, S., & … Parker, R. (2003). Solution-focused family therapy with three aggressive and oppositional-acting children: An N=1 empirical study. Family Process, 42(3), 361–374. doi:10.1111/j.1545-5300.2003.00361.x

de Castro, S., & Guterman, J. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital & Family Therapy, 34(1), 93–106. doi:10.111/j.1752-0606.2008.00055.x

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of Family Psychotherapy, 25(2), 132–144. doi:10.1080/08975353.2014.910023

Perry, A. (2014). Cognitive behavioral therapy with couples and families. Sexual & Relationship Therapy, 29(3), 366–367. doi:10.1080/14681994.2014.909024

Ramisch, J., McVicker, M., & Sahin, Z. (2009). Helping low-conflict divorced parents establish appropriate boundaries using a variation of the miracle question: An integration of solution-focused therapy and structural family therapy. Journal of Divorce & Remarriage, 50(7), 481–495. doi:10.1080/10502550902970587

Washington, K. T., Wittenberg-Lyles, E., Oliver, D. P., Baldwin, P. K., Tappana, J., Wright, J. H., & Demiris, G. (2014). Rethinking family caregiving: Tailoring cognitive-behavioral therapies to the hospice experience. Health & Social Work, 39(4), 244–250. doi:10.1093/hsw/hlu031

                                                           Required Media

Laureate Education (Producer). (2013c). Johnson family session 3 [Video file]. Author: Baltimore, MD.

Note: The approximate length of this media piece is 5 minutes.