Nursig care plan

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5 pages care plan

Nursig care plan

Case Study

Answer the questions related to the information provided in the case study

Your research must be appropriately referenced using APA guidelines. The total word limit for your responses is approximately1,500 words (+/- 10%).

As this unit is not directly assessed in the clinical workplace, both assessment tasks need to reflect a simulated clinical work environment demonstrating critical thinking applied to clinical conditions.

Case Study

William Smith is a 68 year-old man who was transferred to the Palliative Care ward three days ago from a surgical ward. He was admitted on 26/01/2013 for excision of a sacral abscess which had been causing him a lot of pain.  After surgery his future management was assessed and it was decided that he would be transferred to the Palliative Care ward as he could not be discharged home. 

Social History

·        Mr Smith lives alone in a unit with 23 stairs. He is unable to care for himself and refuses any home help. 

·        According to his daughter who was contacted by the Social Worker, Mr Smith has a past history of domestic violence and abuse towards his former wife and children. His son and daughter are finding it hard to visit him even at this end stage of his life and have stated that they are not willing to care for him at home.

·        Mr Smith identifies himself as an indigenous Australian (a person of Aboriginal or Torres Strait Islander descent).  He was born in Arnhem Land but moved firstly to a rural township in the Northern Territory before settling in his current home in a metropolitan city at age 65 to be nearer to his estranged children.

·        He has a past history of alcohol abuse until his admission to hospital on 26/01/2013.

Medical History

·        Mr Smith has a past history of a primary Ca lung with liver and bone metastases.

·        He also has a past history of COPD as he was a heavy smoker ( > 20 cigs a day for 45 years).

Physical Assessment on admission

·        Mr Smith has dyspnoea, ascites, pruritus and bone pain (moderate to severe at times).

·        He is very thin as he has been anorexic for several weeks. According to a neighbour, he lived on beer and baked beans with an occasional meal at the club when he could be taken there by a friend. 

·        His skin is stretched over his distended abdomen and bony prominences.

·        He is not able to walk unaided further than from the bed to the bedside chair.

·        He requires oxygen at all times.

29/01/2013 – Palliative Care Unit Admission Assessment

·        Mr Smith is receiving regular analgesia for pain.

·        He had not been ordered an aperient for several days and has not had his bowels opened since admission to hospital on 26/01/2013 and he is feeling very uncomfortable.

·        He refuses to eat much as he doesn’t like the food in hospital. His fluid intake is low and he is showing signs of possible dehydration. His urine output needs to be monitored.

·        Mr Smith is also complaining of stomatitis – he has poorly fitting dentures and evidence of mouth ulcers.

·        He also suffers from hiccups which can last for 20 minutes at a time. 

·        He is complaining of nausea and vomiting.  His weight loss is marked (5kg since admission 26/01/2013). 

·        Mr Smith can be incontinent of urine at night.

·        Mr Smith is finding it very hard to sleep at night and falls asleep for long periods during the day.

·        He has been talking a little about his children and speaks about his former behaviour towards his wife and children with regret. He often asks if his children are going to visit him.

06/02/2013

Mr Smith has now been on the Palliative Care ward for a week.  He has deteriorated in the past few days and is now bed bound.

·        He is able to roll from side to side for PAC.

·        His skin is intact apart from a small pressure ulcer (0.2 x 0.1cm) on his sacrum.

·        He is extremely sensitive to soap because of an increase in ascites and consequent pruritus.

·        He needs assistance with personal hygiene (sponge in bed).

·        He refuses to wear his dentures now as his mouth is extremely painful. He has been ordered Nilstat and Bonjela (anaesthetic mouth gel) with limited effect as he doesn’t like the taste.

·        His breathlessness has increased and he is having 4/24 Ventolin nebs.

·        He is ordered soft diet, encourage fluids. Mr Smith likes ginger beer which he says helps his hiccups (next-door neighbour brought some in) 

·        BNO for several days. Microlax enema and Agarol 10ml given with effect. 

·        Can be incontinent of urine at times – pad in situ. 

·        Current analgesia is oral (Oxycontin 100mg bd and Tramadol 50mg bd) – Mr Smith states this regime is “holding pain at present”.  Pain score  2 -3/10.

·        He can be confused and agitated at times.

·        Mr Smith has requested a visit from the Social Worker to try to organise a visit with his children. He is very depressed about the current situation.

·        Daily TPR and BP and girth measurement.

PART A: Analyse the information given in the case study and answer the following questions. NUMBER EACH QUESTION IN YOUR SUBMISSION

Review the following document to assist your responses to questions 1 – 2:

Queensland Health (2011) Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying

http://www.health.qld.gov.au/atsihealth/documents/sorry_business.pdf

.

1.  Could Mr Smith’s culture influence his pain assessment?  Why?  What strategies could you employ to ensure that you are adequately addressing Mr Smith’s pain?

2   Consider Mr Smith’s social and medical history. 

a. Reflect on any judgements and prejudices that you may have when caring for Mr Smith. 

b. Review the following professional Australian nursing standards:

http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx

Code of Ethics for Nurses

Code of Professional Conduct for Nurses

EN Competency Standards

Outline the standards / codes that relate to non-judgemental nursing care in this situation.

3.   Compile a list of questions you would ask Mr Smith as part of an holistic health assessment.  These questions should be framed to enable collection of information on:

a. physical health status including pain assessment

b. mental and emotional status

c. social and cultural issues

4.  Mr Smith asks you about planning for his future.  He states that he does not want to be resuscitated. Provide Mr Smith with a brief description (with APA referencing) of the following and apply it to this scenario:

a. Advanced Health Directive

b. Enduring Power of Attorney

c. Organ Donation

5: Suggest alternative strategies (complimentary therapies) other than pharmaceutical pain management that could help Mr. Smith’s pain.

6.List appropriate referrals for Mr Smith to other members of the multi-disciplinary team.  Provide a rationale and a description of the service for each referral.

7: What support / referral could be offered to Mr Smith’s family?

8. Outline the pathophysiology of the following conditions ensuring you relate back to Mr Smith and his clinical presentation and diagnosis. Include within your answer the possible management strategies and rationale for these symptoms:

a. Anorexia related to cancer (NOT Anorexia Nervosa)

b. Ascites

c. Dyspnoea

d. Hiccups

     Note: Pathophysiology is not signs and symptoms. Pathophysiology explains the processes within the body that result in the signs and symptoms of a disease.

9. Consider Mr Smith’s deterioration.  What data provided about Mr Smith’s condition on 06/02/2013 would assist in determining if Mr Smith is at end of life?

b. R: Identify the Rule: Please document the language of the rule(s) and its elements that is/are being applied to answer the question. Provide the citation from the source of the rule language.

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Case Study Directions This case study analysis applies the material that has been covered in Chapters 9 – 15 of the Showalter text. Please read the following case study thoroughly and use the foll

Case Study Directions

This case study analysis applies the material that has been covered in Chapters 9 – 15 of the Showalter text. Please read the following case study thoroughly and use the following format (I.R.A.C.) when answering the questions posed throughout the case study:

  1. a. I: Identify the Issue
  2. b. R: Identify the Rule: Please document the language of the rule(s) and its elements that is/are being applied to answer the question. Provide the citation from the source of the rule language.
  3. c. A: Apply the rule to the fact pattern
  4. d. C: Conclude with a recommendation to the physician or dentist.

Please complete the case study with the assistance of your text and any other research sources that you may find useful. All writing and editing must be your own without any assistance from any other person in the course. Complete the case study individually and without the assistance of your colleagues in HEA 513. All written text must be your work and yours alone.

Please use subheadings throughout the text to identify the case as well as the logical steps in the analysis. Please complete the case study with a maximum of five (5) pages, single-spaced, 12 pt font, with APA 6th Ed formatting. Provide citations for all rules and cases used in the case study. Please include a title page and separate reference page. The title page and reference page do not count towards the five (5) page maximum. Please include your first name and last name in the file name upon submission. For instance, save the file in this manner:

FIRSTNAME_LASTNAME HEA 513 Case Study II.docx

Please submit the case study to a dropbox on D2L no later than 11:59 PM ET on May 11. No late submissions of the case study will be accepted.

Please use your text reading to assist you. 2

Case Study II

You have graduated from West Chester University and are now an administrator in a large orthopedic practice in Philadelphia, PA. There is strong demand for the orthopedic services and most of the patients that receive services are privately insured. You are aware that the senior physician’s wife is an excellent physical therapist at the local hospital. The senior physician has stated that his wife is opening her own physical therapy practice just a few blocks away from the orthopedic practice. The physician states that it will be very convenient for the patients of the orthopedic practice to see his wife at her new practice given its proximity and quality care.

Although he has not asked you to consider the matter, you feel that this arrangement and potential referrals deserve a closer look. You take it upon yourself to do some independent research. After all, the physical therapist is a close friend and was a classmate in undergraduate school. You are aware she is the best in the business.

In your research, you also discover that the senior physician will be investing in his wife’s new physical therapy practice and will share in the financial profits as well as the losses. The physical therapy office will also use the same organization as the orthopedic practice to generate bills and submit claims to payers. The services provided at the physical therapy office will serve a critical need of the orthopedic practice as it will allow patients to recover from their surgeries as well as possibly avoid procedures that could be best treated by therapeutic services.

Both the senior physician and his wife have no intention of breaking any laws and are unaware of any health care regulations that they may be breaking.

What advice do you give to the senior physician and his wife?

Another friend is a dentist who has a large geriatric practice with nursing home patients throughout Chester County. The dentist typically visited the residents and conducted routine dental examinations in an office specifically set up by the nursing home. As part of the routine exam and without the request of an attending physician or because of any medical concern, the dentist would also conduct an oral cancer screening. The dentist would then bill Medicare for both the routine dental exam and the oral cancer screening.

In his own mind, the dentist never knowingly presented a false claim to be reimbursed by Medicare. But, he also deliberately never researched any of the laws or regulations to determine if conducting the additional oral screening was within a routine exam description. He openly bragged to his colleagues at the latest dental conference in Las Vegas that he also did not care whether he was breaking any law because he had not been caught yet and the pay was generous from Medicare and TRICARE. He bragged that if he “didn’t know it was wrong, it could not be breaking the law” and he was not going to take any additional measures to find out. 3

You recently became aware of your friend’s actions because your loved one is a resident at one of the homes where the dentist’s visits.

What advice would you give to the dentist after reading Chapter 15 of Showalter and consulting the case United States v. Lorenzo.

In another scenario, you have a friend, Robert Baratheon, who is a physician, and whose ex-wife, Cersei Lannister, owns a durable medical equipment supply company, Lannister Home Care, in King of Prussia. Dr. Baratheon can refer patients to the durable medical supply store where they obtain their hospital beds, walkers, crutches, oxygen bottles, and motorized scooters, among other supplies. The patients receive a special discount when they are referred to Lannister Home Care and they greatly appreciate the savings. Many of the patients would not be able to afford their purchases without this discount and this referral pattern has saved the patients tens of thousands of dollars.

In turn, Lannister Home Care gives a monthly bonus to your physician friend based on the sales that the patients referred by his practice generate in equipment and supplies. Your friend is under the impression that the monthly bonus is given to him because he provides patients a list of all durable medical equipment stores in the area. In his mind, there is no overt referral to Lannister Home Care. However, the bonus increases and decreases based on the number of patients that come from his practice. The Dr. Baratheon never sees these increases and decreases in the bonus because his billing manager intentionally never reveals it to him and he never knows to ask. He just assumes that all is being lawfully run. Lannister Home Care bills Medicare or the patient’s health insurance company if the item is covered by the patient’s insurance plan.

What advice do you give to your friend, Dr. Baratheon?

In 2005, another physician friend, Jaime Lannister (twin brother to Cersei) who lives in Westeros became one of the owners of a 50-bed physician specialty hospital that specializes in knee, hip, and shoulder replacement surgeries. He is a member of a group of physicians who own 100% of the hospital and perform all their replacement surgeries in the hospital. The group of physicians hires all the staff and has purchased all the equipment at fair market value. Your friend sees all his patients at a separate office and refers all patients that require replacement surgeries to the hospital that is owned by the physician group, of which he is a full member.

What advice do you have for your physician friend after the Affordable Care Act went into effect in 2010?

In another case in Miami, FL, Euron Greyjoy, owns and operates a purported addiction treatment center and home for recovering addicts. He is the leader of a scheme involving recruiting addicted patients to move to South Florida for opioid abuse treatment. Mr. Greyjoy sends out patient recruiters to Emergency Rooms and Medication Assisted Treatment facilities throughout the US. The recruiters identify patients that seem to be 4

wealthy and paying for their treatment out of their own pocket or are covered by private insurance or Medicaid.

The addicts are lured to South Florida with promises of permanent cures of their opioid addiction. They are shown flyers of beautiful large resorts with white sandy beaches where they will receive treatment. They were offered beach-side facilities with spa-like luxury. Amenities included golf therapy and rap music education. Some promise near-painless detoxification from even the worst opiate addictions.

All their travel expenses are covered to South Florida. They are urged to bring all insurance documentation with them and are met at the airport to be chauffeured to the “treatment” facility.

The patients and the patient recruiters are then offered kickbacks in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs. The patients never receive the promised addiction treatment services, but Mr. Greyjoy and his co-conspirators submitted claims to the federal government for $141 million in false billings for services including home health care, mental health services, and prescriptions.

Mr. Greyjoy has come to you for advice regarding his business. What are your recommendations for Mr. Greyjoy and upon what law(s) are they based?

Gathering, Analyzing, and Summarizing Research Literature IV

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Gathering, Analyzing, and Summarizing Research Literature IVIntroductionThis week you will gather the last four articles pertinent to your research problem and discuss attributes surrounding the probl

Gathering, Analyzing, and Summarizing Research Literature IV

Introduction

This week you will gather the last four articles pertinent to your research problem and discuss attributes surrounding the problem and your investigation of the problem.  You will again present the studies as a synthesized review in the discussion board.  Your completed synthesized Literature Review assignment is due in Workshop Six day seven.

Upon successful completion of this assignment you should be able to:

  • Summarize research literature pertinent to a nursing problem.

Resources

  • Textbook: Research Design: Qualitative, Quantitative, and Mixed Method Approaches (2018), Chapter 2, 4
    • PowerPoint: Chapter 2 Review of the Literature  
    • File: Chapter 2 Review of the Literature, Notes 
    • PowerPoint: Chapter 4 Writing Strategies & Ethical Consideration
    • File: Chapter 4 Writing Strategies & Ethical Consideration, Notes  
  • Textbook: Practical Research: Planning and Design (2016): Chapter 3, 13
    • PowerPoint: Chapter 3 Review of Related Literature 
    • PowerPoint: Chapter 13 Plan & Prep Final Report
  • Textbook: Preparing Literature Reviews: Qualitative and quantitative approaches (2016), Chapters 3, 4, and 5
  • Website: IWU Off Campus Library Services
  • Website: An Evidence Based Practice Toolkit for Nursing 
  • Website: Cochrane Library 
  • Website: Agency for Healthcare Research and Quality
  • Website: How to Conduct a Literature Search http://0-apastylecentral.apa.org.oak.indwes.edu/learn/browse/TUT-10 and/or http://media.indwes.edu/media/Lit+Search+-+how+to+in+OCLS/0_7dn204mb
  • File: Sample Spreadsheet of Articles Reviewed 
  • File: Spreadsheet of Research Articles Reviewed 
  • File: Spreadsheet of Research Study Analysis 
  • File: Synthesized Summary-Draft 2.12.2018.docx
  • Website: How to Write a Literature Review https://www.youtube.com/watch?v=t2d7y_r65HU   and https://www.youtube.com/watch?v=2IUZWZX4OGI Part Ihttps://www.youtube.com/watch?v=UoYpyY9n9YQ Part IIhttps://www.youtube.com/watch?v=FK6Lsl1tcm0  Part III

Background Information

Research questions often change during the search for current research articles related to the problem.  According to Ling Pan (2016), a search which nets a large number of articles may warrant a narrowing of the question; and a search which nets only a handful of articles may call for a broader question.  There may be other influences as well, i.e., when a previously thoroughly researched topic is now outdated.  Some problems may be acknowledged in the literature, yet there are no current studies addressing the problem or subproblems.  Do not hesitate to contact the OCLS reference librarian, Jule Kind as needed.   Be sure and use the databases in the OCLS and request help so that you get the literature you need.  Also, it is not uncommon to revise the study question as needed to better target the problem.

Instructions

  1. Read chapters 2 and 4 in Research Design, chapters 3 and 13 in Practical Research: Planning and Design, and chapters 3, 4, and 5 in Preparing Literature Reviews: Qualitative and Quantitative Approaches. Review all materials listed.
  2. Navigate to the threaded discussion and post your quantitative research question.
  3. This discussion has three components:
    1. Gathering Research Literature IV
      1. In the OCLS, find four research studies which pertain to your topic/problem/ research question.  (Your search results should provide additional articles.  Save this search as you will be reviewing a total of 16 articles over the course of this class.)  Ensure that your articles are within the past 4 or 5 years.  If you cannot find more than 25 current articles related to your problem / question on this first search, let your instructor know immediately. 
      2. Complete the information requested on the spreadsheet entitled, Spreadsheet of Articles Reviewed for four articles and attach it to this discussion.  The completed spreadsheet with 16 articles will be due with your final synthesized Literature Review due in Workshop Six day seven.
    2. Analyzing Research Literature IV – Complete the information requested on the spreadsheet entitled, Spreadsheet of Research Study Analysis for each of the four studies for this week and attach to this discussion.
    3. Summarizing Research Literature IV
      1. Use the template entitled, Synthesized Summary-Draft 2.12.2018, to compare and contrast this week’s studies/articles on the points of research question, variables, study design, use of a theory, sample population, statistics, findings, and other key points as pertinent to your study. The synthesis should use scholarly and scientific writing with use of APA style. Copy and paste your synthesized summary into the discussion board.  Please do not attach.
      2. Your full synthesized Literature Review of a minimum of 16 articles will be due in Workshop Six day seven.

Navigate to the threaded discussion here.

Assessment Criteria

Criteria

15 Points

12 Points

9 Points

6 Points

Quality

Your postings are well developed and answers provide clear evidence of critical thinking.

Your questions or observations add greater depth to the discussion by introducing new ideas.

Your postings show some development and some critical thinking is evident in your answers.

Your questions and observations add to the discussion by expanding the ideas of others.

Your postings show nominal development and only the beginnings of critical thinking.

Your contributions (questions or observations) do not clearly add to the discussion.

Your postings show no development and are mostly a reiteration of what the textbook or others have said.

Your questions and observations detract from the discussion.

Criteria

6 points

5 Points

3 Points

0 Points

Timeliness

Your initial posting to the question or topic assigned in the workshop activity is made by day five of the workshop.

Your initial posting to the question or topic assigned in the workshop activity is made by the day six of the workshop.

Your initial posting to the question or topic assigned in the workshop activity is made by day seven of the workshop.

No initial post was made.

Criteria

9 Points

6 Points

3 Points

0 Points

Interaction

You respond to a minimum of two other classmates as well as all follow-up faculty questions directed to you. 

You are clearly collaborative by taking the initiative to respond to classmates’ questions, providing clarification and insight on issues in the discussion. 

You respond to two classmates and some of the faculty follow-up questions directed to you. 

You are collaborative in some situations and show some initiative in workshop discussions.

You respond to two classmates but do not respond to faculty follow-up questions directed to you. 

You show little initiative in discussions and your presence is not collaborative.

You do not respond to the postings of others in the discussion. 

Criteria

25 Points

19 Points

14 Points

9 Points

Spreadsheet of Articles Reviewed

Information for all four studies is complete. Accurate. Current. Well targeted. Peer reviewed.

Few missing items or information not fully reflective of the article. Current. Closely targeted. Peer reviewed.

Missing items. Or less than four articles.  Information not fully reflective of the article. Outdated. Marginally targeted. Peer reviewed.

Information incomplete or less than four articles.  Information not fully reflective of the article. Outdated. Does not address topic.

Criteria

25 Points

19 Points

14 Points

9 Points

Spreadsheet of Research Study Analysis

Information for all four studies is complete. Accurate. Current. Well targeted. Peer reviewed.

Few missing items or information not fully reflective of the article. Current. Closely targeted. Peer reviewed.

Missing items. Or less than four articles.  Information not fully reflective of the article. Outdated. Marginally targeted. Peer reviewed.

Information incomplete or less than four articles.  Information not fully reflective of the article. Outdated. Does not address topic.

Total Points

8

need response to this discussion 2 pages APA format and 3 references 1 from walden university library please say that you retrived it from the library I will pay 10 dollars. are you interested I think I already sent this to you

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need response to this discussion 2 pages APA format and 3 references 1 from walden university library please say that you retrived it from the library I will pay 10 dollars.  are you interested I think I already sent this to you

Transforming Nursing and Healthcare Through Information Technology

Workflow is very important in any institution and in order to have workflow be smooth, it must be understood and respected by all coworkers throughout the organization. “Workflow is the sequence of physical and mental tasks performed by various people within and between work environments. It can occur at several levels (one person, between people, across organizations) and can occur sequentially or simultaneously” according to the U.S. Department of Health and Human Services (DHHS) (n.d.b., para. 1). In order for an organization to flow properly with optimal patient outcomes, an organization must understand and abide by the organizations protocols and policies while having a consistent work day ahead of them.

            When analyzing a workflow process that is in need for improvement, it is necessary to conduct benchmarking. According to DHHS (n.d.b.), “Benchmarking is a process of evaluating metrics or best practices from other organizations (either related or unrelated to your own) and then applying them to your organization” (para. 1). By evaluating the effectiveness of other organizations workflows, I can better understand the appropriate systems needed in our organization. I use flowsheets on a daily basis in the ICU when admitting patients with DKA, Septic Shock or Stroke. These flowsheets outline the steps to take in managing the care of these illnesses. It is very concise and easy to follow which facilitates efficient, time managed patient care. To increase the workflow on other units I will meet with the managers of the floors and provide copies of these flowsheets to create a better workflow throughout the rest of the hospital. According to DHHS (n.d.b.), “flowcharts provide meaningful visualization of the workflows and convey the anticipated sequence of activities and tasks that will occur postimplementation, identify who will most perform what activities and tasks, and no longer include unnecessary or non-value-added activities and tasks” (para. 1). By using a health IT application, our institution can assess adherence to practice standards and assess which provider practices needs to be improved on (DHHS, n.d.b., para. 4). By having an electronic medical record, patient care becomes more effective and efficient.

“Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care” according to Chen, Garrido & Chock (2009, para. 1). The hospital in this study examined the efficiency of implementing a EHR system on ambulatory care from the initation of the system in 2004 to 2007. During this study, there was a 26.2% decrease in office visit rates, 25.3% decrease in primary care setting visits, and 21.5% decrease in specialty care areas (Chen, Garrido & Chock, 2009, para. 6). Scheduled telephone visits increased eight-fold and secure messaging increased to six-fold. This illustrates that incorporating a EHR system increased efficiency of care by decreasing patients need for hospital visits. Patients started to use the telephone system as a way of communicating with their doctors to manage their care better. This in return saves time and optimizes patient goal outcomes while improving workflow.

The information learned in the research article can be used at my current employment to increase workflow. In the ICU the healthcare team does not incorporate telephone updates with patients. Rather than telling patients to follow up in the office with their primary care provider, this article illustrated how phone interviews can improve patient self-care management. Also, I think it would be beneficial if our ICU team sent over a treatment review of care that took place in the hospital. If secured email was used to communicate patient care goals and treatment to primary care providers, more efficient and time critical care would be a result. It important to include competent workflow into the organization to provide the best care possible. According to DHHS (n.d.b.), “Research assessing health IT implementations demonstrates that delays in patient care, billing, and communication are likely to occur if workflow is not taken into account. This is generally due to the fact that clinical and practice management requirements are overlooked or oversimplified” (p. 1). Increased workflow creates more efficient patient care and time saved.

References

Chen C, Garrido T, Chock D, et al. (2009). The Kaiser Permanente electronic health record: transforming and

streamlining modalities of care.

U.S. Department of Health & Human Services. (n.d.b.). Workflow assessment for health IT toolkit. Retrieved

from https://healthit.ahrq.gov/health-it-tools-and-resources.

Explain the results and the impact of those results on family and friends.

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ASSIGNMENT

Personal Health and Wellness

___________________________________

DISCUSSION BOARD

The Aging Process

The aging process is a complex interaction of genetic and environmental factors; therefore each individual ages differently. For example, changes in body composition, body weight, and body systems are common effects of aging. It is essential for those who are aging to maintain a healthy lifestyle to reduce the risk of disease and infection. However, the end result of aging inevitably is death. Appropriate preparation for death contributes to well-being of family and friends and brings peace of mind to the dying.

For this Discussion, consider the impact of aging on personal health and wellness and the importance of preparing for death. To prepare for this Discussion:

  • Review Chapter 14 in Health: The Basics, 10th edition. Pay particular attention to aging and preparing for death.
  • Complete the Chapter 14 Personal Health Assessment “Are You Afraid of Death?” in Health: The Basics, 10th edition.
  • Think about preparing for death.
  • Review the media “Dimensions of Health Wheel.” Select two dimensions of health and consider how the aging process might affect each of them.

With these thoughts in mind:

Select one of the two Discussion Questions.

By Day 4, post a brief description of the two dimensions of health you selected. Then explain how the aging process might affect those dimensions. Finally, describe one strategy you might recommend to improve or enhance the two dimensions of health you selected for someone who is aging.

OR

By Day 4, post an example of a situation in which preparation for death was either adequately planned or inadequately planned. Explain the results and the impact of those results on family and friends. Finally, explain how this situation might influence your own preparations for death and dying.

________________________________________________________________________

PROJECT

Refer to the Final Project Guidelines and submit your Final Project by Day 7.

  • Doucument: Final Project Guidelines (.pdf document)Note: This document provides guidlines and requirements for your final project.

___________________________________

RESOURCES

  • Donatelle, R. J. (2013). Health: The basics, 10th edition. San Francisco, CA: Pearson Benjamin Cummings.
    • Chapter 12, “Reducing Your Risk of Cardiovascular Disease and Cancer”
    • Chapter 13, “Protecting against Infectious and Noninfectious Diseases”
    • Chapter 14, “Preparing for Aging, Death, and Dying”
  • Meetoo, D. (2008). Chronic diseases: The silent global epidemic. British Journal of Nursing (BJN), 17(21), 1320–1325. Retrieved from the Walden Library databases.
  • Luepker, R. V. (2011). Cardiovascular disease: Rise, fall, and future prospects. Annual Review of Public Health, 32, 1–3. Retrieved from the Walden Library databases.
  • Document: Final Project Guidelines (.pdf document)Note: This document provides guidlines and requirements for your final project.

Media

  • Laureate Education, Inc. (Executive Producer). (2012). Personal Health and Wellness: Dimensions of Health Wheel [Multimedia], Baltimore, MD: Author.
    • Dimension of Health: Week 5

Optional Resources

  • Phelan, E. A., Anderson, L. A., LaCriox, A. Z., & Larson, E. B. (2004). Older adults’ views of “successful aging” — How do they compare with researchers’ definitions? Journal of The American Geriatrics Society, 52(2), 211–216. Retrieved from the Walden Library databases.
  • Emanuel, L., Bennett, K., & Richardson, V. E. (2007). The dying role. Journal of Palliative Medicine, 10(1), 159–168. Retrieved from the Walden Library databases.

HEALTHCARE SYSTEMS AND QUALITY OUTCOMES – Discussion 9 (Grading Rubic and Media Attached)

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NURS 6231: HEALTHCARE SYSTEMS AND QUALITY OUTCOMES – Discussion 9 (Grading Rubic and Media Attached)

Discussion: Using Evaluation Tools to Assess Quality Improvement Efforts

Evaluation is a critical component of any quality improvement plan. This week, you examine evaluation tools that can be used to monitor quality improvement efforts, and consider how to appropriately measure outcomes. In addition, you explore the value of metrics for communicating this information.

Also this week, you continue to develop your Course Project by synthesizing your analysis and recommendations into an action plan for a quality improvement initiative.

Like most other things in life, outcomes are the bottom line with respect to measurement of success along the path of quality improvement. However, without a careful analysis of the link between access, process, and structure of care, improvements in outcomes seem unattainable.

—Sadeghi, Barzi, Mikhail, & Shabot, 2013

In this Discussion, you consider how to collect and analyze qualitative and quantitative data to evaluate the results of quality improvement initiatives. In addition, you discuss the significance of evaluation and how you, as a nurse leader-manager, can contribute in an organization to the large-scale goal of facilitating quality improvement.

To prepare:

Review methods for measuring and evaluating quality improvement efforts presented in the Learning Resources. Pay particular attention to how and why it is important to measure outcomes.

Select one evaluation tool and analyze its benefits and relevance for the quality improvement plan you are developing for your Course Project.

Consider how you, as a nurse leader-manager, can use the results from the evaluation to support the organization’s overarching goals for quality improvement.

Post a brief description of the evaluation tool that you selected. Explain the benefits of applying this tool as part of your quality improvement plan in the Course Project. Also explain how you could use the results from the evaluation to support the organization’s overarching goals for quality improvement.

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:

Suggest an alternative evaluation tool and support your suggestion with evidence from current research literature.

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

Validate an idea with your own experience and additional resources.

Required Readings

Hickey, J. V., & Brosnan, C. A. (2017). Evaluation  of health care quality in for DNPs (2nd  ed.). New York, NY: Springer Publishing Company.

Review Chapter 3, “Conceptual Models for Evaluation in Advanced Nursing Practice” (pp. 61-86) (assigned in Week 3)

Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.

Review Chapter 8, “Quantifying the Quality Performance Gaps” (pp. 161–177) (assigned in Week 6)

The authors focus on performance measures with particular focus on the relationship between financial and quality performance.

Review Chapter 9, “Closing the Gaps” (pp. 179–194) (assigned in Week 7)

This chapter explains how to utilize data collected during the evaluation stage in order to improve the quality of health care.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Retrieved from https://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

This report outlines the Institute of Medicine’s (IOM’s) six aims to improve the quality of health care. Review this information through the lens of evaluation. (Assigned in a previous week.)

 Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard—Measures that drive performance. Harvard Business Review, 70(1), 71–79.

Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/51234252/51234314/2e0c84fdce3c69ab0253b5cbc9db9988

In this seminal article, the authors introduce the use of a new performance measurement system called the balanced scorecard. The balanced scorecard provides a comprehensive framework for leaders and managers to align strategic objectives with performance measures.

 Kaplan, R. S., & Norton, D. P. (1996). Linking the balanced scorecard to strategy. California Management Review, 39(1), 53–79.

Retrieved from the Walden Library databases.

In this early follow-up article, Kaplan and Norton further explain research on the use and application of the balanced scorecard.

 Balanced Scorecard Institute. (2012). What is the balanced scorecard? Retrieved from http://www.balancedscorecard.org/BSCResources/AbouttheBalancedScorecard/tabid/55/Default.aspx 

 Institute for Healthcare Improvement. (2012b). The IHI triple aim. Retrieved from http://www.ihi.org/offerings/Initiatives/TripleAim/Pages/default.aspx

Optional Resources

 Marr, B. (2012). What is a balanced scorecard? Retrieved from http://www.ap-institute.com/Balanced%20Scorecard.html

Please use the below links:

https://www.ap-institute.com/kpi-white-papers/what-is-a-modern-balanced-scorecard
http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx
http://www.balancedscorecard.org/Resources/About-the-Balanced-Scorecard
https://services.hbsp.harvard.edu/services/proxy/content/51234252/51234314/2e0c84fdce3c69ab0253b5cbc9db9988

What is the literacy level of our patient population?

/in /by

Lincoln, Ch. 5 & 6Ch. 5.Disparities in healthDid the statistics surprise you? Who are the people in your patient/client population? Do they reflect the statistics? What questions do you need to ask

Lincoln, Ch. 5 & 6

Ch. 5.

Disparities in health

  1. Did the statistics surprise you?
  2. Who are the people in your patient/client population?
  3. Do they reflect the statistics?
  4. What questions do you need to ask during an assessment?

Trust & Mistrust

  1. Have you ever been in a situation with a HCP where trust was an issue?
  2. Think of your patients and their histories, are there issues of trust?
  3. In what way could you initiate a dialogue about trust and treatment?

Thoughts on previous experience

  1. Think about a positive encounter with someone different from yourself- what aspects made it that way?
  2. A negative encounter, what do you think made it that way?
  3. What would you do differently?

From the patient’s perspective

  1. How easy is it for your patients to “navigate” through your facility?
  2. Are you familiar with the cultural beliefs and healthcare practices of your patients?
  3. Are there flexible clinic appointments at your facility?
  4. Is transportation readily available to your patients?
  5. What would you change at your facility to improve access to resources?

Education

  1. Have you had the opportunity to discuss influences of history, past and current, on healthcare decisions?
  2. Does your institution provide educational seminars on the cultural characteristics of ethnic and cultural groups?
  3. Are there discussions that help you understand the ways in which language and culture may influence healthcare behaviors and practices?
  4. If so, what are you and your institution doing to narrow and eventually eliminate those disparities?

Research

  1. Think about your patient population, where do you see healthcare disperities?
  2. If given the opportunity to discover way to eliminate disparities where would your research be focused?
  3. How would you disseminate your finding?
  4. How would you design your program?
  5. How would you orient it to educate both patients and HCPs?

Ch. 6.

Thinking outside of the box

  1. In what ways can we increase access to care?
  2. Are our hours of operation meeting the needs of our patient/patient population?
  3. Have our interpreters received medical and cultural training?
  4. Do we involve the community in our decision-making process?
  5. Does our educational material meet the learning needs of our patients?
  6. Does our staff reflect the diversity of our patient population?

Health insurance

  1. Have you ever gone without health insurance?
  2. What was your greatest concern or fear during that time?
  3. Think about your patient population, what percent are uninsured?
  4. What resources are in place within your organization to meet these needs?

Language

  1. Have you ever been traveling in a foreign country, gotten sick and sought medical care?
  2. How did you get your message across to the HCP in that situation?
  3. What is the predominate language of your patients spoken at your site?
  4. Do you speak another language? If not, which one would you like to learn?
  5. Is there a translator class offered by your organization?
  6. What percentage of HCPs is bilingual and bicultural?

Education and Literacy

  1. What is the literacy level of our patient population?
  2. Does our education material match the literacy level of our patients?
  3. How do you encode and take in information?

Summary: The purpose of the weekly reflective journal exercises is to allow for analysis, synthesis and evaluation of nursing theory using guided questions. Reflection has been referred to as a process that happens internally, privately or in isolation (Hill & Watson, 2011).  Also a useful definition of reflection has been referred to as the examination of an issue of concern, as a consequence of experience, creating clarity and meaning in terms of self, and which results in a change of perspective ( Boyd & Fales, 1983).

What does the doctrine of professional discretion protect?

/in /by

 Which of the following are not goals of meaningful use (MU)?A. Improve quality, safety, and efficiency and reduce health disparities.B. Maintain privacy and security of patient information.C. Impro

1. Which of the following are not goals of meaningful use (MU)?

A. Improve quality, safety, and efficiency and reduce health disparities.

B. Maintain privacy and security of patient information.

C. Improve care coordination, and population and public health.

D. Disengage family members from patient care.

2. What’s the difference between EHR and EMR?

A. EMR contains only legal documents and forms filled out by the patient and the EHR is the provider progress notes, telephone encounters, lab results, and imaging.

B. EHR is an aggregate of all of the patient’s health record and EMR is an electronic patient record from each physician and hospital.

C. EMR is an aggregate of all of the patient’s health records and EHR is an electronic patient record from each physician and hospital.

D. EHR contains only legal documents and forms filled out by the patient and EMR is the provider progress notes, telephone encounters, lab results, and imaging.

3. Which of the following is an acceptable use of the internet at work?

A. Checking your bank account to ensure your pay check has been directly deposited.

B. Locating contact information for a local dental clinic for a patient.

C. Searching Amazon for a Boss’ Day gift.

D. Facebook messaging another employee on their day off for a patient related issue.

4. What nonprofit industry group and consumer reporting agency maintains a database of medical information exchanged by the life, health, and disability insurers that make up its membership?

A. CCHIT

B. Electronic Health Organization

C. Medical Systems Care

D. Medical Information Bureau

5. If a patient believes his or her rights have been violated, that patient may file a complaint with

A. HHS.

B. CMS.

C. AHIMA.

D. OCR.

6. How can a new patient be entered into SimChart for the Medical Office (SCMO)?

A. Searching the patient demographics

B. In the billing module

C. In the patient dashboard

D. Using the find patient link

7. Which of the following is not considered legal documents included in the EHR?

A. Do not resuscitate (DNR)

B. HIPAA forms

C. Medical Records Release

D. Superbills

8. Medical offices submitting claims electronically are called

A. HIPAA entities.

B. covered claims.

C. covered entities.

D. electronic carriers.

9. Ralph is having a colonoscopy and brings paperwork to excuse him from work with pay. Which of the following protects the information disclosed in this paperwork?

A. Safeguards

B. Authorization

C. Minimum necessary standard

D. Minimal disclosure

10. A patient that’s deceased would be considered

A. empty patient record.

B. inactive patient.

C. closed patient record.

D. deceased patient registry.

11. If a patient requests a log of disclosure of their PHI, each disclosure must include all of the following except

A. the description of enclosed PHI.

B. the name and address of who received the PHI.

C. the date of disclosure.

D. the name of who released the PHI.

12. Which of the following is a basic skill needed in order to operate an EHR?

A. Disorganization.

B. No prior computer skills.

C. Knowledge of basic medical terminology.

D. Minimal interpersonal skills.

13. When accompanying a patient to an exam room, the MA commonly documents the patient’s

A. chief complaint.

B. billing information.

C. diagnosis.

D. plan of treatment.

14. Which of the following is considered a third-party payer?

A. Healthcare Facility

B. Insurance company

C. Patient

D. Patient’s family

15. A/An _______ is the electronic trail that is tied to a username and password in an EHR.

A. authentication

B. security watch

C. network surveillance

D. audit trail

16. Which of the following is not considered advantages of EHR?

A. Decreased efficiency

B. Improved quality and continuity of care

C. Better security

D. Improved documentation

17. Amy signs a/an _______ form to allow test results to be discussed with her husband.

A. consent

B. authority

C. authorization

D. record release

18. A list of each employee’s access to the EHR is an example of _______ safeguards.

A. administrative

B. physical

C. technical

D. privacy

19. What does the doctrine of professional discretion protect?

A. Patients involved in child protective service cases.

B. Providers involved in malpractice lawsuits.

End of exam 

C. Mentally or emotionally ill patients.

D. Elderly patients with dementia living in nursing home facilities.

20. Which of the following is a core objective added to stage two of meaningful use requirements?

A. Use of secure electronic messaging when communicating with patients

B. Provide clinical summaries for patients at each visit

C. Incorporating clinic lab test results into EHR as structure data

D. Documenting smoking and alcohol use

Describe your approach to identifying and analyzing peer-reviewed research.

/in /by

Architect Daniel Libeskind is credited with saying “To provide meaningful architecture is not to parody history, but to articulate it.” The suggestion is that his work does not copy the efforts of

Architect Daniel Libeskind is credited with saying “To provide meaningful architecture is not to parody history, but to articulate it.” The suggestion is that his work does not copy the efforts of others but relies on it.

Understanding the work of others is critically important to new work. Contributions to the nursing body of knowledge can happen when you are able to analyze and articulate the efforts of previous research. Research analysis skills are therefore critical tools for your toolbox.

In this Assignment, you will locate relevant existing research. You also will analyze this research using a tool helpful for analysis.

To Prepare:

Reflect on the strategies presented in the Resources this Module’s Learning Resources in support of locating and analyzing research.

 Read one peer-reviewed research article focused on a topic in your specialty field that interests you.

Review the article you selected and reflect on the professional practice use of theories/concepts described by the article.

The Assignment:

Using the “Module 4 | Part 4” section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identified. Be sure to include the following:

Your topic of interest:  The effect of anxiety and depression on completion/withdrawal status in patients admitted to substance abuse detoxification program.

 References

Araujo, L., Goldberg, P., Eyma, J., Madhusoodanan, S., Buff, D. D., Shamim, K., & Brenner, R. (1996). The effect of anxiety and depression on completion/withdrawal status in patients admitted to substance abuse detoxification program. Journal Of Substance Abuse Treatment, 13(1), 61–66. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=8699544&site=ehost-live&scope=site

A correctly formatted APA citation of the article you selected, along  A correctly formatted APA citation of t 

  • A correctly formatted APA citation of the article you selected, along with link or search details.
  • Identify a professional practice use of the theories/concepts presented in the article.
  • Analysis of the article using the “Research Analysis Matrix” section of the template
  • Write a 1-paragraph justification stating whether you would recommend this article to inform professional practice.
  • Write a 2- to 3-paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following:
    • Describe your approach to identifying and analyzing peer-reviewed research.
    • Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research.
    • Identify at least one resource you intend to use in the future to find peer-reviewed research.

Note: Add your work for this Assignment to the original document you began in the Module 1 Assignment, which was built from the Academic Success and Professional Development Plan Template.he article you selected, along with link or search details.

Identify a professional practice use of the theories/concepts presented in the article.

Analysis of the article using the “Research Analysis Matrix” section of the template

Write a 1-paragraph justification stating whether you would recommend this article to inform professional practice.

Write a 2- to 3-paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following:

Describe your approach to identifying and analyzing peer-reviewed research.

Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research.

Identify at least one resource you intend to use in the future to find peer-reviewed research.

Note: Add your work for this Assignment to the original document you began in the Module 1 Assignment, which was built from the Academic Success and Professional Development Plan Template.The effect of anxiety and depression o K., & Brenner, R. (1996). The effect of anxiety and depression on completion/withdrawal status in patients admitted to substance abuse detoxification program. Journal Of Substance Abuse Treatment, 13(1), 61–66. Retrieved from https://&AN=8699544&site=ehost-live&scA correctly formatted APA citation of the article you selected, along with link or search details.

Identify the at least five stakeholders and briefly describe the situation from their perspective.

/in /by

We will use case analysis to extend our examination of patient autonomy with one of the earliest cases surrounding patient rights and patient autonomy. Although the case of Terri Schiavo have tested t

We will use case analysis to extend our examination of patient autonomy with one of the earliest cases surrounding patient rights and patient autonomy. Although the case of Terri Schiavo have tested the balance of decision making when patients may no longer speak for themselves.

Instructions

Before writing your case analysis, make sure you have gone through the readings associated with the Schiavo Case Analysis. The articles listed below are provided to assist you with completing the assignment.  While you are welcome to use other sources as well, it is not necessary.

  • The Module Notes of Modules 1 – 4
  • Cyranoski, D. (2012). The mind reader. Nature, 456, 178-180.
  • Deveterre text: pages 277-288.
  • Ditto, P.  (2006). What would Terri want? On the psychological challenges of surrogate decision making. Death Studies. 30(2), 135-148.  Retrieved on October 13, 2010 from Academic Search Premier database
  • Fins, J. (2009). Brain injury: the vegetative and minimally conscious states. Garrison, NY: The Hastings Center, Bioethics Briefing Book. Retrieved from http://www.thehastingscenter.org/Publications/BriefingBook/Detail.aspx?id=2166
  • Mathes, M. (2005). Terri Schiavo and end-of-life decisions: Can law help us out?  MEDSURG Nursing. 41(3), 200-202.  Retrieved on October 13, 2010 from Academic Search Premier database.
  • Perry, J., Chruchill, L. R. & Kirshner, H.S.  et al. (2005).  The Terri Schiavo case: Legal, ethical, and medical perspectives. Annals of Internal Medicine. 143(10), 744-748.  Retrieved on October 13, 2010 from Academic Search Premier database.
  • Preston, T.  & Kelly, M. (2006).  A medical ethics assessment of the case of Terri Schiavo. Death Studies. 30(2), 121-133. Retrieved on October 13, 2010 from Academic Search Premier database.
  • Swetz, Keith M. Burkle, Christopher, & Berge , K. et al.  (2014) Ten common Questions (and their answers ) on Medical Futility. Mayo Clinic Proceedings. 89.7 943 – 59. http://search.proquest.com.vlib.excelsior.edu/docview/1545042509?pq-origsite=360link

After reviewing the case study articles, respond to the following questions in a short essay no more than 700 – 800 words.

  1. Provide a brief introduction of the Terri Schiavo case.
  2. Identify at least two ethical issues that relate to this dilemma.
  3. Identify the at least five stakeholders and briefly describe the situation from their perspective.
  4. Analyze the dilemma from the perspective of the healthcare professional, applying one of the frameworks that are discussed in the module or one that you may use in your professional work. Be sure to address each element.
  5. Identify a more recent case involving patient decision making when they are no longer able.  After providing a brief introduction to the case, identify some of the similarities and differences. In what ways has Schiavo’s case impacted this case?  Explain what types of policies, procedures, standards have been put in place to assist in preventing such a dilemma.
  6. Briefly discuss what you have learned from your exploration of the Terri Schiavo case. Has the case influenced your view of advanced directives?  Presuming you have not already, are you now considering completing your own advance directives? Why or Why Not?

Your case analysis will be between 700 – 800 words. It will include the following:

  • A title page with the title of the case, your name, and date
  • Double-spaced, Times New Roman 12-point font
  • APA formatted inline citations as appropriate
  • A bibliography of references used