FOR SURAYA ONLY

Research study

Evidence of Aspiration Risk is the research study I have chosen to review.  The goal of conducting any research experiments is to accurately test a hypothesis in an unbiased format and derive valid trustworthy results.  The internal validity of a study is the proven relationship between the independent variable and the outcome of the study (Polit & Beck, 2017).  If the findings of a study can be explained in a way other then it is being presented, the internal validity of the study is automatically weakened.  Quasi-experimental studies have a higher risk of issues with internal validity than other research designs (Polit & Beck, 2017).  Researchers must plan to prevent any possible ambiguity or threats to the internal validity of their study by using control mechanisms such as selection biases.

Questioning the Internal Validity

I read the “Methods” section of the aspiration risk-reduction study as instructed in this week’s discussion post instructions, and I immediately had questions.  Before reading the entire study, my thoughts were: What was the age (or age range), gender, and comorbidities of all of the patients involved? Did they all have the same vent settings? How sedated were they? Was there a suctioning schedule followed for both groups? Was the same suction equipment used in all of the patients? What method was used to determine their target feeding goal? Were they all bolus fed through the feeding tube or around the clock fed? Did they all receive free water flushes? Were the feedings held based on residual? How often was residual checked? Did any of them have a diagnosis of upper GI bleed? Were they all on a peptic ulcer prevention drug? In which part of the lung was pneumonia found? Did they only consider the right upper lobe “aspiration pneumonia”?

These are just to name a few of the questions that I had surrounding this study.  After reading the entire study many of the questions I mentioned above were answered.  However, I still found that some of the specific questions I had were not addressed.  Had the researcher discussed some of the variables that could have impacted the outcome it would have strengthened the internal validity of the study.   Additionally, of the data described in this study does question the internal validity as both groups that were monitored and compared for aspiration were treated differently.  The usual care group did not address guidelines regarding head of the bed elevation, nor did the nurses have formal training regarding insertion of small-bowel feeding tubes, and the gastric residual volumes were not regulated.  Whereas the Aspiration Risk-Reduction Protocol (ARRP) group had guidelines to follow for all of the above (Metheny, Davis-Jackson, & Stewart, 2010).   Because this is an older study and I am very familiar with the CDC “VAP Bundle”, and it is fairly common knowledge that keeping the head of the bed up helps prevent pneumonia and aspiration.  With all of the variables in this study, the external validity is questioned, meaning how can this research pinpoint what was most effective. With that said, despite my personal experience and additional questions, I feel that the findings do concur with current practice as it related to keeping the head of the bed up.  However, have never seen feeding tubes placed in the small bowel below the pylorus.

Failing to consider validity

Statistical validity is the relationship between variables which can be simply described as the hypothesized cause and effect. Where construct validity is the inferences made from the specific settings, outcomes, or treatments, and external validity helps determine if the results of the study can be applied to various people, settings, and treatment  (Polit & Beck, 2017).  If any area of validity in a study is in question, that can potentially compromise the overall validity of the study, leaving the learner to question all aspects of the research.

References

Metheny, N., Davis-Jackson, J., & Stewart, B. (2010). Effectiveness of an aspiration     

risk-reduction protocol. Nursing Research, 59(1), 18-25.

doi:10.1097/NNR.0b013e3181c3ba05

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

NURS 6241: STRATEGIC PLANNING IN HEALTH CARE ORGANIZATIONS – Discussion 8 (Grading Rubic and Media Attached)

Discussion: Developing a Balanced Scorecard

How does a group gauge whether the strategic changes they implement are creating sound business results?

The effective use of a balanced scorecard can facilitate alignment between strategic initiatives and day-to-day operations. The balanced scorecard may serve as a valuable tool for monitoring progress and assessing the outcomes of a strategic plan and provide a practical means of communication.

In this Discussion, you examine the use of a balanced scorecard to measure performance related to finances, customer/client satisfaction, internal processes, and learning and growth.

To prepare:

Review the information in the Learning Resources, including this week’s media presentation, focusing on the development of performance metrics for a strategic plan. See Figure 8-6: Design your Balanced Scorecard in the Sare and Ogilvie course text.

With your Course Project in mind, think about how you would develop a balanced scorecard to measure performance, including the processes you would use to gather appropriate data.

Consider how the use of a balanced scorecard reflects the importance of being able to evaluate progress, assess the impact of planned change on performance, and determine if the costs are justified in terms of the outcomes.

Post an explanation of your plan for creating a balanced scorecard as part of your Course Project, including the processes you would use to gather data to measure performance. Explain how the use of this balanced scorecard would enable you to evaluate progress, assess the impact of your proposed change, and determine if the costs are justified in terms of the outcomes.

Read a selection of your colleagues’ responses. (I will send the peer responses on the handshake private message)

Respond to at least two of your colleagues on two different days by offering suggestions for further developing their balanced scorecards. Ask questions to peer responses at the end of every response. Cite your responses.

Required Readings

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

Chapter 8, “Overview of Strategic Planning Theories: Strategic Planning Architecture” (pp. 147–166)

 Fields, S. A., & Cohen, D. (2011). Performance enhancement using a balanced scorecard in a patient-centered medical home. Family Medicine, 43(10), 735–739.

Copyright 2011 by Society of Teachers of Family Medicine. Reprinted by permission of Society of Teachers of Family Medicine via the Copyright Clearance Center.

The authors discuss using a balanced scorecard for quality improvement in patient-centered medical homes.

 Groene, O., Brandt, E., Schmidt, W., & Moeller, J. (Aug 2009). The balanced scorecard of acute settings: Development process, definition of 20 strategic objectives and implementation.International Journal for Quality in Health Care, 21(4), 259–271.

Copyright 2009 by Oxford University Press – Journals. Reprinted by permission of Oxford University Press – Journals via the Copyright Clearance Center.

In this article, the authors discuss the use of a balanced scorecard as a tool for strategic planning in hospitals. The article includes an example of a strategy map, timeline, and balanced scorecard.

 Jeffs, L., Merkley, J., Richardson, S., Eli, J., & McAllister, M. (2011). Using a nursing balanced scorecard approach to measure and optimize nursing performance. Nursing Leadership, 24(1), 47–58.

Copyright 2011 by Longwoods Publishing Corporation. Reprinted by permission of Longwoods Publishing Corporation via the Copyright Clearance Center.

 Kollberg, B., & Elg, M. (2011). The practice of the balanced scorecard in health care services.International Journal of Productivity and Performance Management, 60(5), 427–445.

Retrieved from the Walden Library databases.

The authors look at the use of a balanced scorecard for health care performance management in Sweden.

Lupi, S., Verzola, A., Carandina, G., Salani, M., Antonioli, P., & Gregorio, P. (2011). Multidimensional evaluation of performance with experimental application of balanced scorecard: A two year experience. Cost Effectiveness and Resource Allocation, 9(1), 7.

Retrieved from the Walden Library databases.

This article examines the application of a balanced scorecard within a unit in a hospital to compare performance results and goal achievement.

 Balanced Scorecard Institute. (2013). Balanced scorecard basics. Retrieved fromhttp://www.balancedscorecard.org/BSCResources/AbouttheBalancedScorecard/tabid/55/Default.aspx

View the information on this website to learn about balanced scorecards.

 Mountain State Group. (n.d.) Balanced scorecards for small rural hospitals: Concept overview and implementation guidance. Retrieved March 13, 2013, fromhttp://www.ruralcenter.org/sites/default/files/Final%20BSC%20Manual%2010.18F.pdf

 The Scarborough Hospital. (2013). Balanced scorecard. Retrieved fromhttp://tsh.to/pages/Balanced-Score-Card

This website provides an example of a balanced scorecard.

 Sunnybrook Health Sciences Centre. (2013). Balanced scorecard. Retrieved fromhttp://sunnybrook.ca/scorecard/index.asp#sr

This website provides an example of a balanced scorecard.

Required Media

Laureate Education (Producer). (2013a). The balanced scorecard approach [Video file]. Retrieved from the https://class.waldenu.edu

Note:  The approximate length of this media piece is 3 minutes.

Dr. Carol Huston discusses the elements and use of a balanced scorecard as a strategic planning evaluation tool.

Assignment OverviewThis assignment is intended to demonstrate your comprehension of the main principles of health informatics, as well as the primary applications of health informatics in healthcare o

Assignment Overview

This assignment is intended to demonstrate your comprehension of the main principles of health informatics, as well as the primary applications of health informatics in healthcare organizations.

For this assignment, you will read a case study that presents difficulties associated with implementing a new computer system in a professional setting. Based on the scenario described in the case study and assignment details, you will create a short PowerPoint presentation.

Assignment Details:

Perform the following tasks:

· Complete the reading assignment and the interactive lesson before attempting this assignment.

· To complete this assignment:

o Review the case study and select one of the committee roles.

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

§ Your selection as a member on the committee 

§ Identification one or more issues, related to your role on the committee

§ Identification of probable cause(s) of identified issue(s)

§ Proposed recommendations to resolve the identified issues 

§ Reference slide – list of academic references, using APA style 

Ø Case Study

Read the following case study

A good friend of yours is director of nursing at a 220-bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, resulting from this change has been the rapid introduction of new computer systems. The goal is to bring the hospital “up to speed” within 3 years. At present, the Computerized Physician Order Entry (CPOE) is being implemented. The general medical and surgical units went live last month. The ICU, pediatrics, and obstetrics units are scheduled to go live next month. The plan is to work out any kinks or problems on the general units and then go live in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices and others are looking into this option. However, three physicians have not commented during this process but are clearly resisting. For example, after performing rounds and returning to their offices they called the unit with verbal orders. After being counseled on this behavior, they began to write the orders on scraps of paper and put these in the patient’s charts or leave them at the nurses’ station. When they were informed that these were not “legal orders,” they began smuggling in order sheets from the non-activated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders. The nurses feel caught between the hospital’s goals and the need to maintain a good working relationship with these physicians. 

You suggest to your friend (director of nursing) to create an informal committee to review the issues surrounding the CPOE implementation. The committee would determine methods to address these issues, prior to implementing CPOE within the ICU, pediatrics, and obstetrics units. Your friend appreciates the suggestion and forms a small committee with the following members:

· Taylor Terrific, RN – a nurse practitioner

· Dr. Dudley Do-Right – a physician who uses the CPOE system routinely and correctly

· Dr. Frank Burns – a physician who rarely, if ever, uses the CPOE system

The director of nursing asks each committee member to create a short PowerPoint presentation for the committee. The presentation would identify issues that occurred during CPOE implementation, identify potential causes of such issues, and list specific recommendations, based on strong rationale and research, to resolve the identified issues prior to the next CPOE implementation. Each committee member will have a unique perspective, based on their position (i.e., nurse, physician).

PowerPoint Presentation

Directions:

1. Review the case study and select one of the committee roles.

2. Download the PowerPoint template (Week 2 Assignment Template). 

· The link to this template can be found in your Blackboard course in Week 2.

3. Select one of the following roles on the committee 

· Taylor Terrific, RN – a nurse practitioner

· Dr. Dudley Do-Right – a physician who uses the CPOE system routinely and correctly

· Dr. Frank Burns – a physician who rarely, if ever, uses the CPOE system

4. Use the PowerPoint template to create slides that:

· Identify one or more issues, related to your role on the committee

· Identifies probable cause(s) of identified issue(s)

· States proposed solutions or processes to address the identified issues

§ Solutions are supported by specific rational and research.

· Includes a reference slide – a list of academic references, using APA style 

5. Ensure to support the content of your slides by the case study, research from your text, or the LRC.

6. Submit the Week 2 Assignment via Blackboard by clicking on the “Week 2 Assignment” link. 

7. Include the proper file naming convention: 

· CMP105_wk2_assn_jsmith_mmddyyyy

Note: The PowerPoint template for this assignment is located within the Assignment section on Blackboard.

Practicum Project Methodology and Evaluation

Week 4 – Discussion

Top of Form

Practicum Project Methodology and Evaluation

Consider the following scenario:

With a clear conception of her Practicum Project goal and objectives, Sandra was optimistic that she was on the right track. Then she started to consider the methodology for her project and realized how much she still needed to figure out. She began to think about the theories and concepts she had examined in her program of study and how they might inform her methodology. The biggest challenge, she discovered, was in mapping the strategies that would help her achieve each objective. How would she decide what would be most effective? What barriers were likely to arise? She also realized that she needed to think about evaluation early in order to establish appropriate criteria and make sure she could assess the evidence related to the process, impact, and outcomes of her project. She wondered how she might use formative evaluation to develop and improve the project, as well as how she could use summative evaluation following the implementation of the project to determine if it had been successful.

Consider the models, theories, and concepts you have examined in your program of study as they relate to your project. Which of these can be applied to the development of methodology to help you achieve the project objectives? Which ones can be used to help you establish criteria and methods of evaluation for your project?

In this Discussion, you examine and propose the methodology for your Practicum Project, as well as evaluation methods. The insights you gain through this Discussion should be integrated into your Practicum Project Plan, which is due in Week 5.

To prepare:

• Reflect on the Practicum Project goal and objectives you developed in Week 3.
• Refer to the Practicum Project Plan (PPP) Overview document as needed for information related to the assignment.
• Consider the models, theories, and concepts you have examined in your program of study as they relate to your project. How can this information be applied to the development of the methodology and evaluation for your project?
• Review the information on methodology in the Learning Resources, and conduct additional research to facilitate your analysis for your project. Evaluate the who, what, how, where, and when associated with each objective: Who will make what change, by how much, where, and by when? Consider the methods you could use to meet each objective. Devise your methodology in as much detail as possible to identify how you could meet each objective. For example, identify which professional organizations or regulatory bodies you would consult (by viewing their websites or contacting them directly) to gather evidence.
• Review the information on formative and summative evaluation in this week’s Learning Resources, and conduct additional research to facilitate your analysis for your project. How could you evaluate achievement of your Practicum Project objectives using formative and/or summative evaluation? Begin to develop an evaluation plan for your Practicum Project.

By tomorrow 3/21/17, post a minimum of 550 words in APA format with 3 references from the list below. Include the levels headers as numbered below:

1)      Post a brief summary of your Practicum Project focus, including the goal and objectives of your Practicum Project (to serve as a reminder for your colleagues).

2)      Explain your selected methodology, and justify your selection. Include a detailed explanation of how you could meet each objective using this methodology.

3)      Also explain your evaluation plan, noting at which points during your Practicum Project formative and/or summative evaluation will occur.

Required Readings

Reminder: Review resources from previous courses as necessary.

Black, P. (2010). Formative assessment. In P. Peterson, E. Baker, & B. McGaw (Eds.), International encyclopedia of education (3rd ed., pp. 359–364). St. Louis, MO: Elsevier.Note: Retrieved from the Walden Library databases.

 This article outlines the history of formative assessment and its application and use as an evaluation tool.

Duers, L. E., & Brown, N. (2009). An exploration of student nurses’ experiences of formative assessment. Nurse Education Today, 29(6), 654–659.Note: Retrieved from the Walden Library databases.

 This article compares formative and summative assessment and presents examples of the application of formative assessment in nursing education.

Gantt, L. T. (2013). The effect of preparation on anxiety and performance in summative simulations. Clinical Simulation in Nursing, 9(1), e25–e33.Note: Retrieved from the Walden Library databases.

This article provides an example of how formative and summative evaluation is used in a nursing simulation lab. The article discusses strategies for improving nurses’ performance on summative evaluations and explores the use of formative evaluation as a strategy for improving performance on summative evaluations.

Pellegrino, J. W. (2010). Technology and formative assessment. In P. Peterson, E. Baker, & B. McGaw (Eds.), International encyclopedia of education (3rd ed., pp. 42–47). St. Louis, MO: Elsevier.Note: Retrieved from the Walden Library databases.

 The author discusses the importance of formative assessment and examines how technology can be used to support the assessment process.

Substantial cross posts peer response. This cross posts provide new or supplemental information to the original posting or raise additional areas for discussion.  Be sure to include at least one refer

Substantial cross posts peer response.

This cross posts provide new or supplemental information to the original posting or raise additional areas for discussion. 

Be sure to include at least one reference in each crosspost as well. APA formatting with reference citations. References should be timely, published within the previous five (5) years.

Discussion cross posts should elaborate upon the ideas and content found in the readings/keynotes by adding details, examples, a different viewpoint, or other relevant information. 

The cross posts should provide original insights or responses which integrates multiple views. (Just saying ditto, I agree, or restating the original post is not considered elaboration.) 

There should be evaluation and feedback which assesses the accuracy, reasonableness, or quality of idea, and provides constructive feedback to classmates.

Listed below is the discussion post you must respond to in 250-350 words max 

                                     Affordable Health Care Costs

One of the most pressing issues in health care is how to develop policies that make the cost of health care affordable to the citizens. The major issues when devising health care costs is the quality of health care, make health care accessible to more people, and ensure that the health providers receive benefits from their professional commitment. The logistics, in this case, is how to coordinate the different players in the health care system. These players include health care providers, insurance, and the government. Thus, health care providers have to develop mechanisms that ensure that they provide an affordable health care program that is cost-effective. The main approach that health care providers should ensure that they develop internal control systems that minimize costs (Hussey & Kennedy, 2016). For instance, they can hire young nurses who require lower wage rates in order to reduce the overall labor costs that are inadvertently passed over to the patients (Cherry & Jacob, 2016). In addition, to ensure that they minimize costs for the citizens they can minimize repetitive procedures that end up incurring unnecessary costs on the patients. Further, the adaption of technology can help in the data management of the population to provide health-related services and to provide preventive mechanisms to ailments.

The health insurance providers, on the other hand, have to be involved in the development of healthcare policies such as Medicaid and other policies that have been developed in the past. The development of these policies should be geared to improve the medical welfare of the citizens rather than the capitalistic approach of profit maximization. This concept should accommodate as many as all to ensure that every working-class individual has access to the health care covers (Cherry & Jacob, 2016). The significance of health care covers is to ensure that health care programs are affordable to a large population. In addition, it is aimed to minimize the immediate cost burden that the patients may find too huge to settle within a given time period.

The government acting as the health care regulator should ensure that health care products are available, as well as a sufficient health care workforce. To facilitate this, the government has to increase its health care spending and financing. To help the nursing informatics to develop new solutions and to be effective in health care delivery, the government can train the different health workers in nursing and health care fields at subsidized costs (Berg & Dickow, 2014). Further, it can subsidize the costs of health care products such as medicine to ensure that they are available.

In conclusion, the health care system can achieve affordable health care to all citizens by using a multi-faceted approach that includes all partners. Also, the issue of cost minimization while optimizing on results is key to achieving the desired ends of economics and strategy in health care. The significance of dealing with affordable health care in nursing informatics is to ensure that citizens have access to quality health care.