Milestone 1: Caring for Populations Milestone Community Windshield Survey Guidelines

Caring for Populations

Milestone 1: Caring for Populations Milestone Community Windshield Survey Guidelines

Updated 4/27/2017

Purpose

The purpose of this assignment is to complete a direct observational assessment of a community in your area. This windshield survey will be the initial step in uncovering a community health problem in your area and identifying community dynamics. This problem will be further assessed in the following two assignments.

Course Outcomes

This assignment enables the student to meet the following course outcome.

CO2: Assess the health needs of individuals, families, aggregates, and communities using demographic and epidemiological data to identify population health risks. (PO 4)

Due Date

Submit your completed windshield survey form by 11:59 p.m. MT Sunday of Week 2.

Points: 150 points

Directions

  1. Download the Community Windshield Survey form (Links to an external site.)Links to an external site.. Type your name and answers directly onto this Word document. Your form does not need to follow APA formatting; however, you are expected to use a professional writing style with complete sentences, accurate grammar, and correct spelling. If references are used, they must be cited in the text and the complete reference should be included in the reference box in APA format. References are optional.
  2. Watch Caring for Populations project overview and Milestone 1 tutorial (click this link or copy and paste it into your browser): http://www.brainshark.com/devry/CourseProjectandMS1_2016. (Links to an external site.)Links to an external site.
  3. Save the form by clicking Save as and adding your last name to the file name; for example, NR443 Windshield Survey Form_Smith.
  4. Submit the completed form by Sunday, 11:59 p.m. MT at the end of Week 2.
  5. Length: The completed form should be three to four pages in length (not including any optional references).

Guidelines

Below are the requirements needed for successful completion of the Windshield Survey Form.

  1. Introduction to the Community: Identify the community you will be using for this assignment with the city and state and provide a brief, one paragraph description of the community. Your community should be the area where you live or the area surrounding your work setting. The community must include a residential area and be broad enough to answer the survey questions. You do not need to include demographic data.
  2. Windshield Survey: Assess your community by doing a windshield survey. Information about the components of a windshield survey is located in your textbook, Nies & McEwen (2015) on page 98 (Box 6-2). Drive through the area and report your observations by describing each of the following six areas using a majority of the questions from each category of Box 6-2 as your guide (one to two in depth paragraphs for each category). Be sure to include what you observed related to each of these categories, and also include any significant items that are missing in your community because this may be equally important in identifying a community health problem.
    1. Community vitality
    2. Indicators of social and economic conditions
    3. Health resources
    4. Environmental conditions related to health
    5. Social functioning
    6. Attitude toward healthcare

Note: It is helpful to conduct this assessment at least two different times: during the day or evening, on a weekday and/or on the weekend. If possible, plan on asking someone to drive during your survey so that you can take notes.

  1. Vulnerable population: Identify an aggregate or vulnerable population in your community based on your observations. What did you observe about this population? See Units five (5) and six (6) in Nies and McEwen (2015) for examples of vulnerable populations and aggregates.
  2. Conclusion: Provide a summary of your findings. Describe several potential community health problems for the vulnerable population that you identified.
  3. References: The purpose of this assignment is to document your observations of your community. Outside sources are not required. However, if sources are used, these sources must be cited within the form (Author, year) and listed in the reference section in APA format (see APA resources for help with formatting).

Best Practices in Completing the Form

The following are best practices in preparing this project.

  • Make sure all elements of the form are included.
  • Review directions and grading rubric below thoroughly.
  • Cite any outside references as above (these are optional).
  • Use a professional writing style with complete sentences.
  • Proofread prior to final submission.
  • Check for spelling and grammar errors prior to final submission.
  • Abide by the Chamberlain academic integrity policy.

**Academic Integrity Reminder**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Please see the grading criteria and rubrics on this page.

 (Links to an external site.)Links to an external site.

Rubric

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NR443_Milestone1CriteriaRatingsPts

This criterion is linked to a Learning OutcomeIntroduction of Community

view longer description

Community is identified and adequately described.20.0 pts

Community is identified and briefly described.18.0 pts

Community identified but description is insufficient.16.0 pts

Community not identified and description is insufficient.8.0 pts

Community is not identified or described.0.0 pts

20.0 pts

This criterion is linked to a Learning OutcomeWindshield Survey

view longer description

Community is assessed and findings adequately cover the six categories listed on form.75.0 pts

Community is assessed in all categories but findings inadequate in one or two categories.66.0 pts

Community is assessed but findings missing in one or two categories or inadequate in three or four categories.60.0 pts

Community is assessed but findings missing in three or four categories or inadequate in five or more categories.29.0 pts

Community is not assessed.0.0 pts

75.0 pts

This criterion is linked to a Learning OutcomeIdentification of an aggregate or vulnerable population

view longer description

Thoroughly describes aggregate or vulnerable population with detailed observations about this population.20.0 pts

Adequately describes aggregate or vulnerable population but observations about the population are brief and missing some details.18.0 pts

Adequately identifies aggregate or vulnerable population but observations about the population are missing.16.0 pts

Minimally describes aggregate or vulnerable population and observations about the population are missing.8.0 pts

Aggregate or vulnerable population are not described.0.0 pts

20.0 pts

This criterion is linked to a Learning OutcomeConclusion

view longer description

Conclusion includes a brief summary of the windshield survey findings and satisfactory identification of community health problems.20.0 pts

Conclusion includes a brief summary of findings and identification of some community health problems.18.0 pts

Conclusion includes a brief summary of findings or identification of health problems.16.0 pts

Conclusion present but does not include a brief summary and problem identification missing.8.0 pts

Conclusion not done.0.0 pts

20.0 pts

This criterion is linked to a Learning OutcomeMechanics

view longer description

Excellent mechanics with minimal errors of the following: -correct grammar and spelling -writes logically in complete sentences -any references used are cited in text -all references listed in reference box using basics of APA formatting (hanging indent not needed)15.0 pts

Good mechanics considering the elements listed in first column.13.0 pts

Fair mechanics considering the elements listed in first column.12.0 pts

Poor mechanics considering the elements listed in first column.6.0 pts

Very poor mechanics such that assignment is difficult to read.0.0 pts

15.0 pts

Total Points: 150.0

PreviousNext

Investigate safeguards and decision‐making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers.

NR360 INFORMATION SYSTEMS IN HEALTHCARERequired Uniform Assignment: We Can, but Dare We?PURPOSEThe purpose of this assignment is to investigate smartphone and social media use in healthcare and to app

NR360 INFORMATION SYSTEMS IN HEALTHCARE

Required Uniform Assignment: We Can, but Dare We?

PURPOSE

The purpose of this assignment is to investigate smartphone and social media use in healthcare and to apply professional, ethical, and legal principles to their appropriate use in healthcare technology.

Course OutcomesThis assignment enables the student to meet the following course outcomes.

  • CO #4: Investigate safeguards and decision‐making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers. (PO 4)
  • CO #6: Discuss the principles of data integrity, professional ethics, and legal requirements related to data security, regulatory requirements, confidentiality, andclient’s right to privacy. (PO 6)
  • CO #8: Discuss the value of best evidence as a driving force to institute change in the delivery of nursing care (PO 8)DUEDATESee Course Schedule in Syllabus. The college’s Late Assignment Policy applies to this activity.TOTAL POINTSPOSSIBLEThis assignment is worth a total of 240 points.Requirements
  1. Research, compose, and type a scholarly paper based on the scenario described below, and choose a conclusion scenario to discuss within the body of your paper. Reflect on lessons learned in this class about technology, privacy concerns, and legal and ethical issues and addressed each of these concepts in the paper, reflecting on the use of smartphones and social media in healthcare. Consider the consequences of such a scenario. Do not limit your review of the literature to the nursing discipline only because other health professionals are using the technology, and you may need to apply critical thinking skills to its applications in this scenario.
  2. Use Microsoft Word and APA formatting. Consult your copy of the Publication Manual of the American Psychological Association, sixth edition, as well as the resources in Doc Sharing if you have questions (e.g., margin size, font type and size (point), use of third person, etc.). Take

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advantage of the writing service SmartThinking, which is accessed by clicking on the link called the Tutor Source, found under the Course Home area.

  1. The length of the paper should be four to five pages, excluding the title page and the reference page. Limit the references to a few key sources (minimum of three required).
  2. The paper will contain an introduction that catches the attention of the reader, states the purpose of the paper, and provides a narrative outline of what will follow (i.e., the assignment criteria).
  3. In the body of the paper, discuss the scenario in relation to HIPAA, legal, and other regulatory requirements that apply to the scenario and the ending you chose. Demonstrate support from sources of evidence (references) included as in‐text citations.
  4. Choose and identify one of the four possible endings provided for the scenario, and construct your paper based on its implications to the scenario. Make recommendations about what should have been done and what could be done to correct or mitigate the problems caused by the scenario and the ending you chose. Demonstrate support from sources of evidence (references) included as in‐text citations.
  5. Present the advantages and disadvantages of using smartphones and social media in healthcare and describe professional and ethical principles to the appropriate use of this technology, based on facts from supporting sources of evidence, which must be included as in‐text citations.
  6. The paper’s conclusion should summarize what you learned and make reflections about them to your practice.
  7. Use the “Directions and Assignment Criteria” and “Grading Rubric” below to guide your writing and ensure that all components are complete.
  8. Review the section on Academic Honesty found in the Chamberlain Course Policies. All work must be original (in your own words). Papers will automatically be submitted to TurnItIn when submitted to the Dropbox.
  9. Submit the completed paper to the “We Can, but Dare We?” Dropbox by the end of Week 3. Please refer to the Syllabus for due dates for this assignment. For online students, please post questions about this assignment to the weekly Q & A Forums so that the entire class may view the answers.

Preparing for the Assignment

BACKGROUND

Healthcare is readily embracing any technology to improve patient outcomes, streamline operations, and lower costs, but we must also consider the impact of such technology on privacy and patient care. This technology includes the use of social media applications, such as Facebook, Instagram, MySpace, Twitter, and LinkedIn on smartphones.

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In healthcare today, smartphones are widely used for communication, efficiency, and care. Obviously, a variety of issues (ethical, professional, and legal) from both the personal and hospital perspectives

must be considered. SCENARIO

You are a nurse in the emergency room, working the Friday 7 p.m. to 7 a.m. shift, and your evening has been filled with the usual mix of drunken belligerent teens, wailing babies, chronic obstructive pulmonary disease (COPD) exacerbations, falls, fractures, and the routine, regular congestive heart failure (CHF) patients. Your best friend is texting you from the concert that you had to miss tonight because you were scheduled to work, and you respond to her between care of patients, jealous that she is there and you are not. “What a jerk to torture me like this!” you think to yourself.

It is now 2 a.m., and the medics radio once again, notifying you of an incoming motor vehicle accident victim, ETA of 5 minutes. You sigh and opt to use the restroom, rather than getting that much‐needed cup of coffee, and prepare a room for your next patient. The medics roll in and begin to fill you in. The patient is a 28‐year‐old male, a passenger on a bus that was involved in a crash, leaving the vehicle overturned after rolling over an embankment. There were several fatalities among the bus passengers, and “this victim has remained unconscious, though his vitals are currently” . . . and as you start to focus on the patient, you take a second look. Can it be? It is! The lead singer, Jerod, from the band “Blue Lizards,” who you have adored since you first heard his voice! The band had just left the concert that you had missed last evening when the accident occurred. You quickly text your best friend . . . “Can youbelieve?” and she responds with “Yeah, right. PROVE IT.” So you quickly snap a picture with your smartphone, when alone with the patient, and send it to her. Can’t hurt, right? Celebrities are “public property,” and that’s a part of their life, right? Just for good measure, you snap a few more pictures of the unconscious singer in various stages of undress and then a shot of his home address, phone number, and demographic information from his electronic health record. You sit your phone down on the bedside table for a minute as you continue your assessment of the patient.

At 7:00 a.m., you drag your tired body home and straight to bed after a long but eventful night.

What happens next? Choose an ending to the scenario, and construct your paper based on those reflections:

  1. You are the following nurse on the day shift and discover the night nurse’s phone on the bedside table. While trying to figure out to whom it belongs, you open the phone and see thephotographs taken the night before. Holy moly! What a find, and nobody could trace you to the photos.
  2. You receive a call from the gossip paper the Gossip Gazette, offering you $20,000 for the photos you have taken (courtesy of your best friend). Your identity would never be revealed, and you desperately need a new car and are behind on some bills.
  3. You go on Facebook, on your day off, and talk about the night you had at work and how youdidn’t really feel as bad having to miss the concert, because you actually got to meet Jerod in person and even “Got his number!” You then post a picture of Jerod on Facebook and

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Instagram, figuring that most of your contacts would never recognize him anyway. It’s your day off and your personal time, so no harm, no foul, right?

4. You receive a message the next morning from a peer at work that there is a big investigation being conducted at work due to a HIPAA violation and that it involved a celebrity who had been admitted to the hospital. The word is that legal action is being taken against the hospital due to some photos that were sold to the Gossip Gazette. Knowing that the photo you sent is safe with your best friend, you reach for your smartphone, but it is nowhere to be found.

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Directions and Assignment Criteria

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Assignment Criteria

Points

%

Description

Introduction 40 points

40

17%

Catches the attention of the reader States the purpose of the paper

Provides a narrative outline of the paper (i.e., the assignment criteria).

HIPAA, Legal, & Regulatory Discussion40 points

40

17%

Discussion the following as they apply to the use of cellphones and social media in healthcare: o

HIPAA/regulatory requirementso Other legal requirements appropriate to the

use of this technologyDemonstrate support from sources of evidence included as in‐text citations.

Scenario Ending & Recommendations 50 points

50

21%

Choose and identify one of the four possible endings provided for the scenario.Make recommendations about what should have been done and what could be done to correct or mitigate the problems caused by the scenario and the ending you chose.

Demonstrate support from sources of evidence included as in‐text citations.

Advantages and Disadvantages 50 points

50

21%

Discuss at least two (2) advantages and two (2) disadvantages of using smartphones and social media in healthcare

Describe professional and ethical principles to the appropriate use of this technologyDemonstrate support from sources of evidence included as in‐text citations.

Conclusion and Reflections 30 points

30

12%

Summarize what you learnedMake reflections about lessons learned to your practice.

Scholarly Writing and APA Format30 points

30

12%

Title page, running head, & page numbers are correct. Use Microsoft Word and APA (6th ed.) formatting Length is 4‐5 pages (excludes title & reference pages).

At least 3 references are used, listed in APA format References match in text citations in APA format Spelling, grammar, & mechanics are correct.

Total

240

100%

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Grading Rubric

NR360 INFORMATION SYSTEMS IN HEALTHCARE

Assignment Criteria

Outstanding or Highest Level of Performance

A (92–100%)

Very Good or High Level of Performance

B (84–91%)

Competent or Satisfactory Level of Performance

C (76–83%)

Poor, Failing or Unsatisfactory Level of Performance F

(0–75%)

Introduction 40 points

The student catches the reader’s attention, states the paper’s purpose, and provides a narrative outline of the paper’s body.

35–40 points

One of the following is missing or inadequate: attention‐catching statement(s), paper’s purpose, or a narrative outline of the paper’s body.

30–34 points

Two of the following are missing or inadequate: attention‐catching statement(s), paper’s purpose, or a narrative outline of the paper’s body.

26–29 points

Three of the following are missing or inadequate: attention‐catching statement(s), paper’s purpose, or a narrative outline of the paper’s body.

0–25 points

HIPAA, Legal, & Regulatory Discussion 40 points

The discussion of the following as they apply to the use of cellphones and social media in healthcare, is thoroughly addressed:

  • HIPAA/regulatory requirements
  • Other legal requirements appropriate to the use of this technologyDemonstrated support from sources of evidence included as intext citations.35–40 points

The discussion of the following as they apply to the use of cellphones and social media in healthcare, is lacking in one or more component:

  • HIPAA/regulatory requirements
  • Other legal requirements appropriate to the use of this technologyorSupport is not demonstrated adequately from sources of evidence included as in‐text citations.30–34 points

The discussion of the following as they apply to the use of cellphones and social media in healthcare, is lacking in one or more component:

  • HIPAA/regulatory requirements
  • Other legal requirements appropriate to the use of this technologyandSupport is not demonstrated adequately from sources of evidence included as in‐text citations.26–29 points

The discussion of the following as they apply to the use of cellphones and social media in healthcare, is lacking both components: •HIPAA/regulatory requirements • Other legal requirements appropriate to the use of this technology

and

Support is not demonstrated adequately from sources of evidence included as in‐text citations.

0–25 points

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Scenario Ending & Recommendations 50 points

Included all of the following elements sufficiently:• Identify one of the four possible endings provided for the scenario.

Included all of the following elements but did not develop at least one area substantively :• Identify one of the four possible endings provided for the scenario.

Included all of the following elements but did not develop at two or more area substantively : • Identify one of the four possible endings provided for the scenario.

Did not included the following elements substantively :• Identify one of the four possible endings provided for the scenario.

• Made recommendations about what should have been done. • Made recommendations about what could be done to correct or mitigate the problems caused by the scenario and the ending chosen.• Demonstrated support from sources of evidence included as intext citations.

45‐50 points

• Made recommendations about what should have been done. • Made recommendations about what could be done to correct or mitigate the problems caused by the scenario and the endingchosen.Or• Did not demonstrated support from sources of evidence includedas in‐text citations.

40‐44 points

• Made recommendations about what should have been done. • Made recommendations about what could be done to correct or mitigate the problems caused by the scenario and the endingchosen.Or• Did not demonstrated support from sources of evidence includedas in‐text citations.

36‐39 points

• Made recommendations about what should have been done. • Made recommendations about what could be done to correct or mitigate the problems caused by the scenario and the ending chosen.Or• Did not demonstrated support from sources of evidence includedas in‐text citations.

0‐35 points

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Advantages and Disadvantages 50 points

Met all of the following criteria: •Discussed at least two (2) advantages and two (2) disadvantages of using smartphones and social media in healthcare

• Described professional and ethical principles to the appropriate use of this technology• Demonstrated support from sources of evidence included as intext citations.

45‐50 points

Did not meet one of the following criteria:• Discussed at least two (2) advantages and two (2) disadvantages of using smartphones and social media in healthcare

• Described professional and ethical principles to the appropriate use of this technology• Demonstrated support from sources of evidence included as intext citations.

40‐44 points

Did not meet two or more of the following criteria:• Discussed at least two (2) advantages and two (2) disadvantages of using smartphones and social media in healthcare

• Described professional and ethical principles to the appropriate use of this technology• Demonstrated support from sources of evidence included as intext citations.

36—39 points

Did not meet Three or more of the following criteria:• Discussed at least two (2) advantages and two (2) disadvantages of using smartphones and social media in healthcare

• Described professional and ethical principles to the appropriate use of this technology• Demonstrated support from sources of evidence included as intext citations.

0‐35 points

Conclusion and Reflections 30 points

Met the following criteria substantively:• Summarized what you learned •Made reflections about lessons learned to your practice.

25‐30 points

Did not meet at least one of the following criteria substantively: • Summarize what you learned •Make reflections about lessons learned to your practice.

20‐24 points

Did not meet either of the following criteria substantively: • Summarize what you learned •Make reflections about lessons learned to your practice.

16‐19 points

Did not include a formal conclusion paragraph

0–15 points

Scholarly Writing and APA Format 30 points

The following points

• 6 points • 4 points

• 2 point • 6 points• 6 points

are achieved by successful implementation of each scholarly writing/APA element:

Title page, running head, & page numbers are correct. Use Microsoft Word and APA (6th ed.) formatting

Length is 4‐5 pages (excludes title & reference pages). At least 3 references are used, listed in APA format References match in text citations in APA format

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• 4 points Spelling/mechanics & grammar are correct.• 2 point Scholarly writing style is used

Total Points Possible = /240 Points

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5. Using the numbers in the contingency table, calculate the percentage of antibiotic users who tested positive for candiduria.

Please see below and contact

Exercise 29

Calculating Simple Linear Regression

Simple linear regression is a procedure that provides an estimate of the value of a dependent variable (outcome) based on the value of an independent variable (predictor). Knowing that estimate with some degree of accuracy, we can use regression analysis to predict the value of one variable if we know the value of the other variable (Cohen & Cohen, 1983). The regression equation is a mathematical expression of the influence that a predictor has on a dependent variable, based on some theoretical framework. For example, in Exercise 14, Figure 14-1 illustrates the linear relationship between gestational age and birth weight. As shown in the scatterplot, there is a strong positive relationship between the two variables. Advanced gestational ages predict higher birth weights.

A regression equation can be generated with a data set containing subjects’ x and y values. Once this equation is generated, it can be used to predict future subjects’ y values, given only their x values. In simple or bivariate regression, predictions are made in cases with two variables. The score on variable y (dependent variable, or outcome) is predicted from the same subject’s known score on variable x (independent variable, or predictor).

Research Designs Appropriate for Simple Linear Regression

Research designs that may utilize simple linear regression include any associational design (Gliner et al., 2009). The variables involved in the design are attributional, meaning the variables are characteristics of the participant, such as health status, blood pressure, gender, diagnosis, or ethnicity. Regardless of the nature of variables, the dependent variable submitted to simple linear regression must be measured as continuous, at the interval or ratio level.

Statistical Formula and Assumptions

Use of simple linear regression involves the following assumptions (Zar, 2010):

1. Normal distribution of the dependent (y) variable

2. Linear relationship between x and y

3. Independent observations

4. No (or little) multicollinearity

5. Homoscedasticity

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Data that are homoscedastic are evenly dispersed both above and below the regression line, which indicates a linear relationship on a scatterplot. Homoscedasticity reflects equal variance of both variables. In other words, for every value of x, the distribution of y values should have equal variability. If the data for the predictor and dependent variable are not homoscedastic, inferences made during significance testing could be invalid (Cohen & Cohen, 1983; Zar, 2010). Visual examples of homoscedasticity and heteroscedasticity are presented in Exercise 30.

In simple linear regression, the dependent variable is continuous, and the predictor can be any scale of measurement; however, if the predictor is nominal, it must be correctly coded. Once the data are ready, the parameters a and b are computed to obtain a regression equation. To understand the mathematical process, recall the algebraic equation for a straight line:

y=bx+a 

where

y=the dependent variable(outcome) 

x=the independent variable(predictor) 

b=the slope of the line 

a=y-intercept(the point where the regression line intersects the y-axis) 

No single regression line can be used to predict with complete accuracy every y value from every x value. In fact, you could draw an infinite number of lines through the scattered paired values (Zar, 2010). However, the purpose of the regression equa­tion is to develop the line to allow the highest degree of prediction possible—the line of best fit. The procedure for developing the line of best fit is the method of least squares. The formulas for the beta (β) and slope (α) of the regression equation are computed as follows. Note that once the β is calculated, that value is inserted into the formula for α.

β=n∑xy−∑x∑yn∑x 2 −(∑x) 2   

α=∑y−b∑xn  

Hand Calculations

This example uses data collected from a study of students enrolled in a registered nurse to bachelor of science in nursing (RN to BSN) program (Mancini, Ashwill, & Cipher, 2014). The predictor in this example is number of academic degrees obtained by the student prior to enrollment, and the dependent variable was number of months it took for the student to complete the RN to BSN program. The null hypothesis is “Number of degrees does not predict the number of months until completion of an RN to BSN program.”

The data are presented in Table 29-1. A simulated subset of 20 students was selected for this example so that the computations would be small and manageable. In actuality, studies involving linear regression need to be adequately powered (Aberson, 2010; Cohen, 1988). Observe that the data in Table 29-1 are arranged in columns that correspond to 321the elements of the formula. The summed values in the last row of Table 29-1 are inserted into the appropriate place in the formula for b.

TABLE 29-1

ENROLLMENT GPA AND MONTHS TO COMPLETION IN AN RN TO BSN PROGRAMStudent IDxyx2xy(Number of Degrees)(Months to Completion)1117117229418301700419195016006111111701500801200911511510112112111141141211011013117117140200015294181621242417114114182104201911711720211422sum Σ2026730238

The computations for the b and α are as follows:

Step 1: Calculate b.From the values in Table 29-1, we know that n = 20, Σx = 20, Σy = 267, Σx2 = 30, and Σxy = 238. These values are inserted into the formula for b, as follows:

b=20(238)−(20)(267)20(30)−20 2   

b=−2.9 

Step 2: Calculate α.From Step 1, we now know that b = −2.9, and we plug this value into the formula for α.

α=267−(−2.9)(20)20  

α=16.25 

Step 3: Write the new regression equation:

y=−2.9x+16.25 

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Step 4: Calculate R.The multiple R is defined as the correlation between the actual y values and the predicted y values using the new regression equation. The predicted y value using the new equation is represented by the symbol ŷ to differentiate from y, which represents the actual y values in the data set. We can use our new regression equation from Step 3 to compute predicted program completion time in months for each student, using their number of academic degrees prior to enrollment in the RN to BSN Program. For example, Student #1 had earned 1 academic degree prior to enrollment, and the predicted months to completion for Student 1 is calculated as:

y ̂ =−2.9(1)+16.25 

y ̂ =13.35 

Thus, the predicted ŷ is 13.35 months. This procedure would be continued for the rest of the students, and the Pearson correlation between the actual months to completion (y) and the predicted months to completion (ŷ) would yield the multiple R value. In this example, the R = 0.638. The higher the R, the more likely that the new regression equation accurately predicts y, because the higher the correlation, the closer the actual y values are to the predicted ŷ values. Figure 29-1 displays the regression line where the x axis represents possible numbers of degrees, and the y axis represents the predicted months to program completion (ŷ values).

FIGURE 29-1  REGRESSION LINE REPRESENTED BY NEW REGRESSION EQUATION.

Step 5: Determine whether the predictor significantly predicts y.

t=Rn−21−R 2   ‾ ‾ ‾ ‾  √  

To know whether the predictor significantly predicts y, the beta must be tested against zero. In simple regression, this is most easily accomplished by using the R value from Step 4:

t=.638200−21−.407  ‾ ‾ ‾ ‾ ‾  √  

t=3.52 

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The t value is then compared to the t probability distribution table (see Appendix A). The df for this t statistic is n − 2. The critical t value at alpha (α) = 0.05, df = 18 is 2.10 for a two-tailed test. Our obtained t was 3.52, which exceeds the critical value in the table, thereby indicating a significant association between the predictor (x) and outcome (y).

Step 6: Calculate R2.After establishing the statistical significance of the R value, it must subsequently be examined for clinical importance. This is accomplished by obtaining the coefficient of determination for regression—which simply involves squaring the R value. The R2 represents the percentage of variance explained in y by the predictor. Cohen describes R2 values of 0.02 as small, 0.15 as moderate, and 0.26 or higher as large effect sizes (Cohen, 1988). In our example, the R was 0.638, and, therefore, the R2 was 0.407. Multiplying 0.407 × 100% indicates that 40.7% of the variance in months to program completion can be explained by knowing the student’s number of earned academic degrees at admission (Cohen & Cohen, 1983).The R2 can be very helpful in testing more than one predictor in a regression model. Unlike R, the R2 for one regression model can be compared with another regression model that contains additional predictors (Cohen & Cohen, 1983). The R2 is discussed further in Exercise 30.The standardized beta (β) is another statistic that represents the magnitude of the association between x and y. β has limits just like a Pearson r, meaning that the standardized β cannot be lower than −1.00 or higher than 1.00. This value can be calculated by hand but is best computed with statistical software. The standardized beta (β) is calculated by converting the x and y values to z scores and then correlating the x and y value using the Pearson r formula. The standardized beta (β) is often reported in literature instead of the unstandardized b, because b does not have lower or upper limits and therefore the magnitude of b cannot be judged. β, on the other hand, is interpreted as a Pearson r and the descriptions of the magnitude of β can be applied, as recommended by Cohen (1988). In this example, the standardized beta (β) is −0.638. Thus, the magnitude of the association between x and y in this example is considered a large predictive association (Cohen, 1988).

324

SPSS Computations

This is how our data set looks in SPSS.

Step 1: From the “Analyze” menu, choose “Regression” and “Linear.”

Step 2: Move the predictor, Number of Degrees, to the space labeled “Independent(s).” Move the dependent variable, Number of Months to Completion, to the space labeled “Dependent.” Click “OK.”

325

Interpretation of SPSS Output

The following tables are generated from SPSS. The first table contains the multiple R and the R2 values. The multiple R is 0.638, indicating that the correlation between the actual y values and the predicted y values using the new regression equation is 0.638. The R2 is 0.407, indicating that 40.7% of the variance in months to program completion can be explained by knowing the student’s number of earned academic degrees at enrollment.

Regression

The second table contains the ANOVA table. As presented in Exercises 18 and 33, the ANOVA is usually performed to test for differences between group means. However, ANOVA can also be performed for regression, where the null hypothesis is that “knowing the value of x explains no information about y”. This table indicates that knowing the value of x explains a significant amount of variance in y. The contents of the ANOVA table are rarely reported in published manuscripts, because the significance of each predictor is presented in the last SPSS table titled “Coefficients” (see below).

The third table contains the b and a values, standardized beta (β), t, and exact p value. The a is listed in the first row, next to the label “Constant.” The β is listed in the second row, next to the name of the predictor. The remaining information that is important to extract when interpreting regression results can be found in the second row. The standardized beta (β) is −0.638. This value has limits just like a Pearson r, meaning that the standardized β cannot be lower than −1.00 or higher than 1.00. The t value is −3.516, and the exact p value is 0.002.

326

Final Interpretation in American Psychological Association (APA) Format

The following interpretation is written as it might appear in a research article, formatted according to APA guidelines (APA, 2010). Simple linear regression was performed with number of earned academic degrees as the predictor and months to program completion as the dependent variable. The student’s number of degrees significantly predicted months to completion among students in an RN to BSN program, β = −0.638, p = 0.002, and R2 = 40.7%. Higher numbers of earned academic degrees significantly predicted shorter program completion time.

327

Study Questions

1. If you have access to SPSS, compute the Shapiro-Wilk test of normality for months to completion (as demonstrated in Exercise 26). If you do not have access to SPSS, plot the frequency distributions by hand. What do the results indicate?

2. State the null hypothesis for the example where number of degrees was used to predict time to BSN program completion.

3. In the formula y = bx + a, what does “b” represent?

4. In the formula y = bx + a, what does “a” represent?

5. Using the new regression equation, ŷ = −2.9x + 16.25, compute the predicted months to program completion if a student’s number of earned degrees is 0. Show your calculations.

6. Using the new regression equation, ŷ = −2.9x + 16.25, compute the predicted months to program completion if a student’s number of earned degrees is 2. Show your calculations.

328

7. What was the correlation between the actual y values and the predicted y values using the new regression equation in the example?

8. What was the exact likelihood of obtaining a t value at least as extreme as or as close to the one that was actually observed, assuming that the null hypothesis is true?

9. How much variance in months to completion is explained by knowing the student’s number of earned degrees?

10. How would you characterize the magnitude of the R2 in the example? Provide a rationale for your answer.

329

Answers to Study Questions

1. The Shapiro-Wilk p value for months to RN to BSN program completion was 0.16, indicating that the frequency distribution did not significantly deviate from normality. Moreover, visual inspection of the frequency distribution indicates that months to completion is approximately normally distributed. See SPSS output below for the histograms of the distribution:

2. The null hypothesis is: “The number of earned academic degrees does not predict the number of months until completion of an RN to BSN program.”

3. In the formula y = bx + a, “b” represents the slope of the regression line.

4. In the formula y = bx + a, “a” represents the y-intercept, or the point at which the regression line intersects the y-axis.

5. The predicted months to program completion if a student’s number of academic degrees is 0 is calculated as: ŷ = −2.9(0) + 16.25 = 16.25 months.

6. The predicted months to program completion if a student’s number of academic degrees is 2 is calculated as: ŷ = −2.9(2) + 16.25 = 10.45 months.

7. The correlation between the actual y values and the predicted y values using the new regression equation in the example, also known as the multiple R, is 0.638.

8. The exact likelihood of obtaining a t value at least as extreme as or as close to the one that was actually observed, assuming that the null hypothesis is true, was 0.2%. This value was obtained by looking at the SPSS output table titled “Coefficients” in the last value of the column labeled “Sig.”

9. 40.7% of the variance in months to completion is explained by knowing the student’s number of earned academic degrees at enrollment.

10. The magnitude of the R2 in this example, 0.407, would be considered a large effect according to the effect size tables in Exercises 24 and 25.

330

Data for Additional Computational Practice for the Questions to be Graded

Using the example from Mancini and colleagues (2014), students enrolled in an RN to BSN program were assessed for demographics at enrollment. The predictor in this example is age at program enrollment, and the dependent variable was number of months it took for the student to complete the RN to BSN program. The null hypothesis is: “Student age at enrollment does not predict the number of months until completion of an RN to BSN program.” The data are presented in Table 29-2. A simulated subset of 20 students was randomly selected for this example so that the computations would be small and manageable.

TABLE 29-2

AGE AT ENROLLMENT AND MONTHS TO COMPLETION IN AN RN TO BSN PROGRAMStudent IDxyx2xy(Student Age)(Months to Completion)1231752939122495762163241757640842696762345311696149663111961341732151,024480833121,089396933151,0894951034121,1564081134141,1564761235101,2253501335171,2255951439201,521780154091,6003601642121,7645041742141,7645881844101,9364401951172,601867202411576264sum Σ67726724,0059,089

331

EXERCISE 29 Questions to Be Graded

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.”

1. If you have access to SPSS, compute the Shapiro-Wilk test of normality for the variable age (as demonstrated in Exercise 26). If you do not have access to SPSS, plot the frequency distributions by hand. What do the results indicate?

2. State the null hypothesis where age at enrollment is used to predict the time for completion of an RN to BSN program.

3. What is b as computed by hand (or using SPSS)?

4. What is a as computed by hand (or using SPSS)?

332

5. Write the new regression equation.

6. How would you characterize the magnitude of the obtained R2 value? Provide a rationale for your answer.

7. How much variance in months to RN to BSN program completion is explained by knowing the student’s enrollment age?

8. What was the correlation between the actual y values and the predicted y values using the new regression equation in the example?

9. Write your interpretation of the results as you would in an APA-formatted journal.

10. Given the results of your analyses, would you use the calculated regression equation to predict future students’ program completion time by using enrollment age as x? Provide a rationale for your answer

(Grove 319-332)

Grove, Susan K., Daisha Cipher. Statistics for Nursing Research: A Workbook for Evidence-Based Practice, 2nd Edition. Saunders, 022016. VitalBook file.

The citation provided is a guideline. Please check each citation for accuracy before use.

Exercise 35

Calculating Pearson Chi-Square

The Pearson chi-square test (χ2) compares differences between groups on variables measured at the nominal level. The χ2 compares the frequencies that are observed with the frequencies that are expected. When a study requires that researchers compare proportions (percentages) in one category versus another category, the χ2 is a statistic that will reveal if the difference in proportion is statistically improbable.

A one-way χ2 is a statistic that compares different levels of one variable only. For example, a researcher may collect information on gender and compare the proportions of males to females. If the one-way χ2 is statistically significant, it would indicate that proportions of one gender are significantly higher than proportions of the other gender than what would be expected by chance (Daniel, 2000). If more than two groups are being examined, the χ2 does not determine where the differences lie; it only determines that a significant difference exists. Further testing on pairs of groups with the χ2 would then be warranted to identify the significant differences.

A two-way χ2 is a statistic that tests whether proportions in levels of one nominal variable are significantly different from proportions of the second nominal variable. For example, the presence of advanced colon polyps was studied in three groups of patients: those having a normal body mass index (BMI), those who were overweight, and those who were obese (Siddiqui, Mahgoub, Pandove, Cipher, & Spechler, 2009). The research question tested was: “Is there a difference between the three groups (normal weight, overweight, and obese) on the presence of advanced colon polyps?” The results of the χ2 test indicated that a larger proportion of obese patients fell into the category of having advanced colon polyps compared to normal weight and overweight patients, suggesting that obesity may be a risk factor for developing advanced colon polyps. Further examples of two-way χ2 tests are reviewed in Exercise 19.

Research Designs Appropriate for the Pearson χ2

Research designs that may utilize the Pearson χ2 include the randomized experimental, quasi-experimental, and comparative designs (Gliner, Morgan, & Leech, 2009). The variables may be active, attributional, or a combination of both. An active variable refers to an intervention, treatment, or program. An attributional variable refers to a characteristic of the participant, such as gender, diagnosis, or ethnicity. Regardless of the whether the variables are active or attributional, all variables submitted to χ2 calculations must be measured at the nominal level.

410

Statistical Formula and Assumptions

Use of the Pearson χ2 involves the following assumptions (Daniel, 2000):

1. Only one datum entry is made for each subject in the sample. Therefore, if repeated measures from the same subject are being used for analysis, such as pretests and posttests, χ2 is not an appropriate test.

2. The variables must be categorical (nominal), either inherently or transformed to categorical from quantitative values.

3. For each variable, the categories are mutually exclusive and exhaustive. No cells may have an expected frequency of zero. In the actual data, the observed cell frequency may be zero. However, the Pearson χ2 test is sensitive to small sample sizes, and other tests, such as the Fisher’s exact test, are more appropriate when testing very small samples (Daniel, 2000; Yates, 1934).

The test is distribution-free, or nonparametric, which means that no assumption has been made for a normal distribution of values in the population from which the sample was taken (Daniel, 2000).

The formula for a two-way χ2 is:

χ 2 =n[(A)(D)−(B)(C)] 2 (A+B)(C+D)(A+C)(B+D)  

The contingency table is labeled as follows. A contingency table is a table that displays the relationship between two or more categorical variables (Daniel, 2000):ABCD

With any χ2 analysis, the degrees of freedom (df) must be calculated to determine the significance of the value of the statistic. The following formula is used for this calculation:

df=(R−1)(C−1) 

where

R=Number of rows 

C=Number of columns 

Hand Calculations

A retrospective comparative study examined whether longer antibiotic treatment courses were associated with increased antimicrobial resistance in patients with spinal cord injury (Lee et al., 2014). Using urine cultures from a sample of spinal cord–injured veterans, two groups were created: those with evidence of antibiotic resistance and those with no evidence of antibiotic resistance. Each veteran was also divided into two groups based on having had a history of recent (in the past 6 months) antibiotic use for more than 2 weeks or no history of recent antibiotic use.

411

The data are presented in Table 35-1. The null hypothesis is: “There is no difference between antibiotic users and non-users on the presence of antibiotic resistance.”

TABLE 35-1

ANTIBIOTIC RESISTANCE BY ANTIBIOTIC USE Antibiotic UseNo Recent UseResistant87Not resistant621

The computations for the Pearson χ2 test are as follows:

Step 1: Create a contingency table of the two nominal variables: Used AntibioticsNo Recent UseTotals Resistant8715 Not resistant62127 Totals142842←Total n

Step 2: Fit the cells into the formula:

χ 2 =n[(A)(D)−(B)(C)] 2 (A+B)(C+D)(A+C)(B+D)  

χ 2 =42[(8)(21)−(7)(6)] 2 (8+7)(6+21)(8+6)(7+21)  

χ 2 =666,792158,760  

χ 2 =4.20 

Step 3: Compute the degrees of freedom:

df=(2−1)(2−1)=1 

Step 4: Locate the critical χ2 value in the χ2 distribution table (Appendix D) and compare it to the obtained χ2 value.

The obtained χ2 value is compared with the tabled χ2 values in Appendix D. The table includes the critical values of χ2 for specific degrees of freedom at selected levels of significance. If the value of the statistic is equal to or greater than the value identified in the χ2 table, the difference between the two variables is statistically significant. The critical χ2 for df = 1 is 3.84, and our obtained χ2 is 4.20, thereby exceeding the critical value and indicating a significant difference between antibiotic users and non-users on the presence of antibiotic resistance.

Furthermore, we can compute the rates of antibiotic resistance among antibiotic users and non-users by using the numbers in the contingency table from Step 1. The antibiotic resistance rate among the antibiotic users can be calculated as 8 ÷ 14 = 0.571 × 100% = 57.1%. The antibiotic resistance rate among the non-antibiotic users can be calculated as 7 ÷ 28 = 0.25 × 100% = 25%.

412

SPSS Computations

The following screenshot is a replica of what your SPSS window will look like. The data for subjects 24 through 42 are viewable by scrolling down in the SPSS screen.

413

Step 1: From the “Analyze” menu, choose “Descriptive Statistics” and “Crosstabs.” Move the two variables to the right, where either variable can be in the “Row” or “Column” space.

Step 2: Click “Statistics” and check the box next to “Chi-square.” Click “Continue” and “OK.”

414

Interpretation of SPSS Output

The following tables are generated from SPSS. The first table contains the contingency table, similar to Table 35-1 above. The second table contains the χ2 results.

Crosstabs

The last table contains the χ2 value in addition to other statistics that test associations between nominal variables. The Pearson χ2 test is located in the first row of the table, which contains the χ2 value, df, and p value.

Final Interpretation in American Psychological Association (APA) Format

The following interpretation is written as it might appear in a research article, formatted according to APA guidelines (APA, 2010). A Pearson χ2 analysis indicated that antibiotic users had significantly higher rates of antibiotic resistance than those who did not use antibiotics, χ2(1) = 4.20, p = 0.04 (57.1% versus 25%, respectively). This finding suggests that extended antibiotic use may be a risk factor for developing resistance, and further research is needed to investigate resistance as a direct effect of antibiotics.

415

Study Questions

1. Do the example data meet the assumptions for the Pearson χ2 test? Provide a rationale for your answer.

2. What is the null hypothesis in the example?

3. What was the exact likelihood of obtaining a χ2 value at least as extreme or as close to the one that was actually observed, assuming that the null hypothesis is true?

4. Using the numbers in the contingency table, calculate the percentage of antibiotic users who were resistant.

5. Using the numbers in the contingency table, calculate the percentage of non-antibiotic users who were resistant.

6. Using the numbers in the contingency table, calculate the percentage of resistant veterans who used antibiotics for more than 2 weeks.

416

7. Using the numbers in the contingency table, calculate the percentage of resistant veterans who had no history of antibiotic use.

8. What kind of design was used in the example?

9. What result would have been obtained if the variables in the SPSS Crosstabs window had been switched, with Antibiotic Use being placed in the “Row” and Resistance being placed in the “Column”?

10. Was the sample size adequate to detect differences between the two groups in this example? Provide a rationale for your answer.

417

Answers to Study Questions

1. Yes, the data meet the assumptions of the Pearson χ2:

a. Only one datum per participant was entered into the contingency table, and no participant was counted twice.

b. Both antibiotic use and resistance are categorical (nominal-level data).

c. For each variable, the categories are mutually exclusive and exhaustive. It was not possible for a participant to belong to both groups, and the two categories (recent antibiotic user and non-user) included all study participants.

2. The null hypothesis is: “There is no difference between antibiotic users and non-users on the presence of antibiotic resistance.”

3. The exact likelihood of obtaining a χ2 value at least as extreme as or as close to the one that was actually observed, assuming that the null hypothesis is true, was 4.0%.

4. The percentage of antibiotic users who were resistant is calculated as 8 ÷ 14 = 0.5714 × 100% = 57.14% = 57.1%.

5. The percentage of non-antibiotic users who were resistant is calculated as 7 ÷ 28 = 0.25 × 100% = 25%.

6. The percentage of antibiotic-resistant veterans who used antibiotics for more than 2 weeks is calculated as 8 ÷ 15 = 0.533 × 100% = 53.3%.

7. The percentage of resistant veterans who had no history of antibiotic use is calculated as 6 ÷ 27 = 0.222 × 100% = 22.2%.

8. The study design in the example was a retrospective comparative design (Gliner et al., 2009).

9. Switching the variables in the SPSS Crosstabs window would have resulted in the exact same χ2 result.

10. The sample size was adequate to detect differences between the two groups, because a significant difference was found, p = 0.04, which is smaller than alpha = 0.05.

418

Data for Additional Computational Practice for Questions to be Graded

A retrospective comparative study examining the presence of candiduria (presence of Candida species in the urine) among 97 adults with a spinal cord injury is presented as an additional example. The differences in the use of antibiotics were investigated with the Pearson χ2 test (Goetz, Howard, Cipher, & Revankar, 2010). These data are presented in Table 35-2 as a contingency table.

TABLE 35-2

CANDIDURIA AND ANTIBIOTIC USE IN ADULTS WITH SPINAL CORD INJURIES CandiduriaNo CandiduriaTotalsAntibiotic use154358No antibiotic use03939Totals158297

419

EXERCISE 35 Questions to Be Graded

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/statistics/ under “Questions to Be Graded.”

1. Do the example data in Table 35-2 meet the assumptions for the Pearson χ2 test? Provide a rationale for your answer.

2. Compute the χ2 test. What is the χ2 value?

3. Is the χ2 significant at α = 0.05? Specify how you arrived at your answer.

4. If using SPSS, what is the exact likelihood of obtaining the χ2 value at least as extreme as or as close to the one that was actually observed, assuming that the null hypothesis is true?

420

5. Using the numbers in the contingency table, calculate the percentage of antibiotic users who tested positive for candiduria.

6. Using the numbers in the contingency table, calculate the percentage of non-antibiotic users who tested positive for candiduria.

7. Using the numbers in the contingency table, calculate the percentage of veterans with candiduria who had a history of antibiotic use.

8. Using the numbers in the contingency table, calculate the percentage of veterans with candiduria who had no history of antibiotic use.

9. Write your interpretation of the results as you would in an APA-formatted journal.

10. Was the sample size adequate to detect differences between the two groups in this example? Provide a rationale for your answer.

(Grove 409-420)

Grove, Susan K., Daisha Cipher. Statistics for Nursing Research: A Workbook for Evidence-Based Practice, 2nd Edition. Saunders, 022016. VitalBook file.

The citation provided is a guideline. Please check each citation for accuracy before use.

Each exercise has 10 questions at the end which says Questions to be graded.I need those questions to be answer.

identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

NEED ASSISTANCE WITH ANSWERING RESPONSE TO MY POST BELOW POST A. ALSO I NEED TO RESPOND TO POST B AND C WITH FEEDBACK WITH ADDITIONAL COMMENTS AND OR ASKING QUESTIIONS. EACH POST REQUIRES 2 REFERENCE INCLUDING THE WEBSITE ATTACHED.

https://www.congress.gov/

THIS IS MY POST:

In simple terms, healthcare policy refers to plans, discussions, and actions that are established on to achieve specific goals of healthcare in any setting. One of the healthcare policies that have caused significant debate is the Affordable Care Act (ACA). ACA has faced a lot of opposition since Trump came into leadership (Congress.gov, 2019). Trump has always been fighting the ACA stating that it doesn’t meet the healthcare needs of the Americans. Trump is aiming at replacing the ACA with the Graham-Cassidy. Graham-Cassidy is supposed to permit the insurers to discriminate against the people with existing states and remarkably reduced insurance subsidies for the Americans in the middle and low-income classes.

Reliable research establishes that there is some logic in Trump’s decision. Dismantling the ACA is expected to provide an opportunity for the Americans to enjoy better healthcare services.  The ACA has various shortcomings which need to be addressed if it must meet the healthcare needs of all the Americans (McCarthy, 2018). Research establishes that ACA has led to increasing in the cost of care to many Americans. Diseases that had been ignored in the past started to be treated after the implementation of the ACA. Treatment of some chronic illnesses which had been ignored prior to the implementation of the ACA led to the increased cost of care due to the need to cater to them. The fact that the ACA requires Americans to cater to services that don’t benefit them shows that it is ineffective; such services include maternity care.  Moreover, ACA led to multiple losses to various insurance companies and Americans after it canceled insurances for over 30 million people as their policies didn’t meet the 10 essentials of the ACA.  It is worth noting that the move by the ACA in 2013 to increase the income taxes for the majority of Americans was much ravaging because it led to double taxation among many Americans, who had to pay for the Medicare (Amadeo, 2019).

It is worth noting that dismantling the ACA will lead to inefficiencies in healthcare. There are many Americans who rely on the ACA to meet their care needs; Such Americans include the poor and the middle-class individuals. Dismantling the ACA is, therefore, likely to result in significant problems for the poor. However, the Graham-Cassidy policy seems to be better as it advocates for the healthcare needs of both the poor and the rich. Equality should be the basis of medication in healthcare (McCarthy, 2018).

 References

Amadeo, K. (2019). 10 Pros and Cons of Obamacare. Retrieved from https://www.thebalance.com/obamacare-pros-and-cons-3306059

Congress.gov. (2019). Congress.gov | Library of Congress. Retrieved from https://www.congress.gov/

McCarthy, M. (2018). Trump calls on Congress to replace “unsustainable” Affordable Care Act. BMJ, j1145. doi: 10.1136/bmj.j1145

INSTRUCTIONS: I NEED TO RESOPOND TO THIS COMMENT:

Shannon,

You identify the ongoing challenges related to ACA and the current debate that continues about health care coverage. Related to the Graham-Cassidy plan, what are the key advantages and disadvantages that have been identified? What approach would you use to gain support of key stakeholders related to proposed changes and policy development to address the issues related to this or other policies that require change?

POST B:

For this week’s discussion, we needed to find one proposed health policy. Going away from nursing and focusing on my other passion of being an EMT, I found a policy dealing with those who are first responders.

On 05/16/2019, a new policy named H.R.2812 or Protecting America’s First Responders Act was introduced. The sponsor of this bill is Representative Bill Pascrell JR a democrat out of New Jersey and Charles “Chuck” Grassley from Iowa (Congress n.d.). The goal is to provide payment of death and disability benefits for any first responder that becomes seriously injured or completely disabled in the line of duty.

The original version of this bill dated back to 1968 and was called the Omnibus Crime Control and Safe Streets Act of 1968 (Congress n.d.). As of May 2019, the bill has passed in the Senate and goes to the house next for consideration where there is a 98% chance of it being enacted on (Protecting America’s First Responders Act n.d.). 

As a first responder, I feel that this is a valuable bill and seems to have a larger amount of support to pass it into law. As a volunteer for my local rural Wisconsin town, we get up at all times of night, and from the moment I get in my vehicle till the time I get back into bed my life is in danger. We are a completely volunteer and give my time to help our local community. We don’t ask for anything in return but continue to serve our community. I feel strongly that this bill will pass as first responder compensation has been in the news lately. On June 11, 2019, former Daily Show host Jon Stewart went to capitol hill to rant about the need to protect our first responders from 9/11. Alongside him was a Luis Alvarez, a detective that spent six months digging through ground zero and later developed cancer. Luis died on 6/29/2019 18 days after sitting alongside Jon Stewart. The saying I live by, “if we don’t protect our first responders, who will protect us?”

Reference: 

Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

Protecting America’s First Responders Act (S. 1208). (n.d.). Retrieved July 9, 2019. from https://www.gotrack.us/congress/bills/116/s1208

POST C:

Main question post: Senate Bill 773: Telehealth Innovation and Improvement Act of 2019 is proposed legislation designed to require and facilitate the Center for Medicare and Medicaid Innovation (CMI) to initiate telehealth utilization policies and services into their healthcare reform model (U.S. Congress, n.d.). The proposed expanded telehealth services requirement would allow for participating hospitals to test the utilization of telehealth services under the direction of CMI. By evaluating the effectiveness of telehealth programs and the quality of care, Medicare could expand coverages of these services and further billing practices according to accountable care organizations and bundled payment programs (Burch, 2017). This bill was introduced in the Senate on March 13th, 2019 and is currently sponsored by Senator Cory Gardner (R-CO) and co-sponsored by Gary Peters (D-MI) (U.S. Congress, n.d.). The bill is in its initial stages and has not reached any formal committee activity level.

Telehealth can aid in providing access to healthcare services to many people across the country. With the Accountable Care Act’s expansion of healthcare coverage for millions of Americans, the increased demand on the healthcare system has not been fully accounted for which includes increased wait times to see primary care providers, impacted emergency departments and home health and mental health services. By utilizing telehealth technology to offset the burden of an impacted system; monitoring, follow-up, and preventable services may not only be a viable cost-saving solution but a profitable one as well. Data has shown that telehealth has decreased hospitalizations by the early detection and intervention of exacerbations of chronic disease such as hyperglycemia, hypertension, congestive heart failure, and respiratory distress syndromes. However, payor sources, including Medicare and Medicaid Services (CMS), have conflicting definitions of what telehealth is and how it should and could be reimbursed (Burch, 2017). By taking the lead in defining the parameters around telehealth reimbursement, CMS has an opportunity to improve access and evolve the healthcare model and control the narrative. CMI can be at the forefront of the future of healthcare by adopting organizational policies and supporting innovation and creating a culture of progression (Klein, 1996).

According to Burch (2017), practitioners should look beyond reimbursement to the actual value of telehealth; patient safety, chronic care management, access to care, and reduced hospital admissions. Medicare’s bundled payment plan makes the physicians or home health agencies responsible for episodic care for 60 to 90 days after a procedure, surgery, or hospitalization, and in some cases telehealth can reduce the number of visits to the provider and provide cost savings through monitoring and early intervention (Burch, 2017). Progressive, forward thinking is required to solve the current impacted, costly, and inefficient healthcare system we have in the United States. One way to accomplish this is through telehealth. Hospital systems and providers should start to familiarize themselves with telehealth and various other technologies to streamline their practice, unfortunately however, until there is an agreed upon reimbursement model for these services it is not likely to occur. Support for SB 773 is paramount in improving quality healthcare through telehealth and forcing CMS and their innovation department to lead the way into the future of healthcare.

References

Burch, S. G. (2017). The power and potential of telehealth what health systems should know. Healthcare Financial Management, 71(2), 46-49.

Klein, K. J. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055-1080. doi:10.5465/AMR.1996.9704071863

U.S. Congress. (n.d.). Current Legislation. Retrieved July 8, 2019, from Congress.gov: https://www.congress.gov/bill/116th-congress/senate-bill/773/text?q=%7B%22search%22%3A%5B%22health+care%22%5D%7D&r=135&s=2

POST B/C NEED A FOLLOW UP RESPONSE AS WELL (FEEDBACK)

Healthcare Case Study – Southeast Medical Center

Healthcare Case Study – Southeast Medical Center

Review the Southeast MedicalCenter case study found on page 92 of the course text.  Of therecommendations found on pages 100-101, select the three which you considerto be the highest priority/most important to the case.  Justify yourreasoning.  Support your opinion with a minimum of two outside scholarlyresources.  Write a three- to five-page paper (excluding title andreference pages) with your selected recommendations and justifications. Thepaper must be in APA format.

Southeast Medical Center Case Study

Review the Southeast Medical Center case study found on page 92 of the coursetext. Of the recommendations found on pages 100-101, select the three whichyou consider to be the highest priority/most important to the case. Justifyyour reasoning. Support your opinion with a minimum of two outside scholarlyresources

In-Depth Case Study: SoutheastMedical Center

The following case study involvinga large organized delivery system exemplifies many of the issues describedearlier in this chapter.

History and Evolution

Southeast Medical Center (SMC; apseudonym) was established as a public hospital in the 1920s, just before theDepression. Located in the Southeast, a $1 million bond financed the 250-bedfacility. Major expansion projects in the 1950s increased the hospital’s sizeto 600 beds. Formal affiliation with the local university’s College ofMedicine residency program in the 1970s further expanded capacity. Thus, SMCbecame a public academic health center and subsequently assumed multiplemissions of patient care, teaching, and research. Capital improvementprograms were conducted during the 1970s, and in 1982, a massive renovationand construction project ($160 million) added 550 beds to the facility. Inthe 1980s, a 59-bed freestanding rehabilitation center was opened adjacent tothe hospital, and a physicians’ office building was constructed next to thehospital. Medical helicopters were also acquired in 1989, expanding SMC’strauma services. In addition to serving as a regional provider for trauma,SMC also furnishes burn, neonatal, and transplant care for the region.

Responsibility for governance ofSMC has shifted over the years. In the early years of operation, a hospitalboard ran SMC. In the 1940s, the city was given direct control over the hospital.In the 1980s, the state legislature created a public hospital authority (tobe appointed by the county commission) to govern the hospital. In the 1990s,the hospital’s board of trustees voted to turn operations of the hospitalover to a private, not-for-profit corporation (501c-3), the SMC Corporation.However, oversight for charity care remained with the county’s hospitalauthority. The SMC Corporation is directed by a 15-member board of directorsand essentially manages the organized delivery system through a leasearrangement with the county hospital authority.

Today, SMC is a private,not-for-profit academic health center that is accredited by JCAHO. It alsoserves as the primary teaching hospital for the local university.Approximately 1100 private and university-affiliated attending physicians andmore than 400 resident physicians in the university’s College of Medicineresidency program serve the community’s medical needs. SMC also serves as theclinical site for associate, baccalaureate, and graduate nursing programs forthe university and community colleges.

SMC serves as a regional andinternational referral service with more than 800 acute care beds. SMC hasestablished community centers in a variety of locations, which has createdincreased access. In addition to specialized medical services, SMC iscommitted to providing community resources for education, information, andprograms aimed at helping residents stay fit and healthy. Four out of tenpatients that passed through the SMC’s door came from outside the county.

SMC also operates an HMO healthplan for charity care patients. In 1991, the County Commission establishedthe SMC Health Plan to operate as a Medicaid HMO or insurance healthcare planfor the poor. The plan reimburses SMC on a case-by-case basis for medicalservices, but it also negotiates discounted rates and costs with thehospital. During the early 1990s SMC’s payment from the health plan droppedsubstantially. In 1996, the program was under a freeze by the state and couldnot enroll participants for more than a year.

Thus, SMC is not just thehospital—it is a comprehensive organized delivery system that also includesfacilities distinct from the hospital (i.e., SMC Health Plan). In addition,SMC ambulatory care centers are located throughout the county. SMC was theonly public hospital in a metropolitan area with a population of one millionor more that received no public subsidy. Most citizens believe that SMC wassubsidized by their taxes. In 1971, the County Commission agreed tosupplement hospital revenues with property taxes. In 1985, the countycommissioners passed a quarter-percent sales tax to fund indigent care. Thetax was repealed in 1987. In 1991, the county instituted a one-half percentsales tax to fund indigent care at all hospitals in the county, includingSMC.

In sum, while SMC receives nopublic subsidy, it does receive a portion of the half-cent sales tax whichdepends on the preferences of the county commissioners each year. Unlike adirect subsidy, no public money is ever guaranteed.

As an academic health center (AHC)SMC has multiple, conjoined missions of teaching, research, and patient care.While providing patient care for approximately 40% of the nation’s poor, AHCsare struggling to find a competitive position in today’s rapidly changinghealthcare environment. Until recently, they have enjoyed a privilegedposition atop the healthcare pyramid as a niche provider of tertiaryservices. With the growth of managed care and reductions in governmentfunding, the ability of AHCs to compete is being drastically undercut.

It is widely recognized thatmultiple missions of teaching, research, and patient care contribute to theproduction of costly clinical services that are inconsistent with the demandfor less expensive services in today’s healthcare environment. The majorityof the services that AHCs provide are now available elsewhere, such as localcommunity hospitals and specialty private medical practices. Furthermore, itis estimated that roughly 70% of their clinical services can be providedelsewhere at a lower cost. It is believed, for example, that AHCs areapproximately 30% more expensive, on a case-mix-adjusted basis, than theirnonteach-ing competitors.

As a result, AHCs are losingground to other hospitals and medical practices. They have become providersof a small number of expensive high-tech services involving unique andcomplex care. However, they continue to be the predominant providers of thenation’s charitable care. As an AHC, SMC reflects these trends. For example,SMC’s organ transplant center and burn unit are unique high-cost servicesthat account for fewer than 2% of the patients treated at SMC each year.

(Wolper pages 92-94)

Wolper, Lawrence F.. HEALTH CAREADMINISTRATION 5E VITALBOOKS, 5th Edition. Jones & Bartlett Publishers,

pg.100-101

Managerial Implications andRecommendations

The jury is still out on thefuture of organized delivery systems. It is unclear whether the many problemsand issues identified here and elsewhere are due to a flawed strategy, flawedimplementation (leadership), or both. Clearly, multiprovider integration hasnot worked well either in American industry or in health care. The point isnot to lay blame when systems struggle or collapse. Rather, we need toidentify managerial processes or methods that will enhance the probabilitythat systems will survive and prosper. The overriding goal of systems shouldbe to provide maximum value to the healthcare customer.145

The fundamental question is, Whattypes of systems, networks, and alliances are best able to competeeffectively and deliver cost-effective care? At this time, however, there isno definitive answer to this question, because there is almost no evidenceassociating different types of organized arrangements with successfulperformance or failure.

The future of healthcare systemsis highly speculative, given the volatility of markets and future initiativesfor healthcare reform. As the governments role in health care expands, thesesystems become more vulnerable to shifts in government policy.

It seems likely that mostmultiprovider healthcare systems will emerge successfully from their “growingpains” and continue to solidify their position in the healthcare market aslong as they are virtually integrated rather than vertically integrated.

Health care will be purchasedprimarily on a local or regional basis. Quality and value will beincreasingly important to patients who once again have a choice of provider.Fewer resources will be available to deliver care, and the delivery of healthcare will continue to shift from acute care to ambulatory settings. Barrynoted the importance of a system CEO being a “change agent” in this futureenvironment:

Those who can understand andembrace change; those who can transform traditional but key values totomorrow’s environment; those who can educate their boards of trustees,medical communities, and the community at large; and those who can “rightsize” the production activities of their organizations, and provide both highquality and cost-effective services will be the winners of tomorrow.146

Recommendations

Healthcare executives inmultiprovider healthcare systems need to allow flexibility for memberinstitutions to respond to specific local markets while providing a clearlyarticulated and well understood vision for the system.

Each system should develop a detailedmission statement and set of behavioral norms (i.e., culture) shared by eachfacility within the system in order to enhance cohesiveness.

Each system should develop aformal strategic plan for the system with input and a high degree of interactionamong the corporate office and institutions in all geographic regions.

Each system should develop andimplement explicit measures for quality of care, patient satisfaction,efficiency, and community benefit, and then provide these data to purchasersand other key stakeholders.

Each system should develop andorganizational structure that is simple, lean, flat, responsive, customer-driven,risk-taking, and focused.

Governance at the corporate levelshould be strategic in nature, whereas governance at the institutional levelshould be operational in nature and focused on local community/region needsand concerns.

Systems should provide formal andinformal education for those responsible for governance at all levels in thesystem.

Systems should provide a cleardefinition of governance roles, responsibilities, and authority among thesystem and institutional boards of its component parts.

Systems should provide theleadership required for the individual units of a system to think in terms ofoverall system performance rather than just in terms of the particular unit’sperformance.

Only institutions that fit aparticular culture and strategy should be invited to join or remain a memberof the system.

Systems should align physicianincentives and achieve clinical integration.

Systems should develop informationsystems to support the integration of clinical and managerial information.

Systems should use their missionand values as a guide in making difficult trade-off decisions.

Systems should change their incentivestructures to reflect concern for performance of the system as a whole, notjust the individual components.

Systems should own fewer facilitiesand contract for most services so that they are virtually integrated ratherthat vertically integrated.

Systems should buy or contract forservices only if the additions will add value to the systems’ customers andare compatible with the existing mission, values, goals, and culture.

Systems should allow theindividual operating units within the system to have sufficient autonomy tobe responsive to the needs of their local customers.

Systems should focus on core competenciesrather than trying to be all things to all system components.

Systems should not allow successto breed complacency.  Each integrativestep must be evaluated for system wide effects.

Systems should focus on qualityrather than the size of the program or system being integrated.

Systems should focus on qualityrather than quantity of physician integration.

Systems should placehigh-performing executives in key positions to implement their integrationplan.

Systems should target selectedpatient populations and payers.

(Wolper 100-102)

Wolper, L.F. HealthcareAdminstration 5E Vitalbooks, 5th Edition. Jones & BartlettPublishers.

California Coast University HCA 200 Final exam

California Coast University HCA 200 Final exam

Question

1. The medical model includes all of the following except:

a. illness and disease require treatment.

b. focus is diagnosis.

c. focus is on disease prevention.

d. focus is on treatment.

2. The ability to stay in business for a health care facility is based on the facility’s _________.

a. sustainable competitive advantage

b. reimbursement rates

c. business plan

d. business viability

3. Focus areas of Healthy People 2020 and patterns of disease in the population direct research efforts. Research can be directed at all of the following except _________.

a. cure

b. control

c. prevention

d. the study of rural road traffic patterns

4. The Patient Protection and Affordable Care Act _________.

a. helps increase the number of people who are uninsured

b. allows the market to drive costs up

c. seeks to improve health care delivery performance

d. is surveying Americans about their health care utilization patterns

5. Sustainable competitive advantage is described by all of the following except:

a. varies from business to business.

b. depends on the objectives the firm is trying to achieve.

c. helps a business maintain its position in the marketplace.

d. allows the market to drive costs up.

6. All of the following are categories of health occupations except:

a. service occupations.

b. professional and related occupations.

c. management, business, and financial occupations.

d. labor union officials.

7. Accounting __________.

a. creates the product or service

b. tracks the flow of money in and out of a business

c. uses technology to manage information

d. includes the product, price, promotion, and distribution to the customer

8. Information technology __________.

a. creates the product or service

b. tracks the flow of money in and out of a business

c. includes the product, price, promotion, and distribution to the customer

d. uses technology to manage information

9. Shareholders may exist in which business ownership configuration?

a. corporation

b. partnership

c. sole proprietorship

d. collaboration

10. A decrease in unemployment and interest rates occurs during the following portion of the economic cycle __________.

a. prosperity

b. recession

c. depression

d. recovery

11. Profit is __________.

a. money collected from patients and insurance companies for health care services rendered.

b. the price paid when an individual or business borrows money.

c. revenue minus costs.

d. lacking during times of prosperity.

12. The Hill Burton Act __________.

a. is part of the Social Security Act

b. prohibits referrals to clinical lab services where the provider has a financial interest

c. involved the federal government funding construction of private facilities pursuant to a Certificate of Need

d. provides for health insurance portability and protects the privacy of health records5

13. The Stark I law __________.

a. contains special provisions to protect laid-off workers and to encourage electronic records technology

b. prohibits referrals to clinical lab services where the provider has a financial interest

c. involved the federal government funding construction of private facilities pursuant to a Certificate of Need

d. provides for health insurance portability and protects the privacy of health records

14. A market economy is described by all of the following except which of the following?

a. It is also called a private system.

b. It is called a free enterprise system.

c. It has competition as its central feature.

d. It is not concerned with profit.

15. Third-party payers are covered by both state and federal regulations. Two of the federal regulations are ________ and _________.

a. COBRA; PPO

b. ERISA; HIPAA

c. COBRA; EPO

d. ERICA; HIPAA

16. An enrollment period is a _________.

a. binding contract between the payer and the employee

b. binding contract between the payer and employer

c. time when employees can utilize benefits

d. time when employees can change providers

17. If an employee decides to take advantage of an insurance benefit being offered to them they are known as a/an _________.

a. actuary

b. enrollee

c. subscriber

d. policy holderFinal Examination

18. With EPOs all of the following are true except:

a. patients must select their care providers from those in the network.

b. patients may choose their physician or hospital.

c. if the patient chooses to go outside the network the services are not covered.

d. they are regulated by state insurance law.

19. All of the following are true except:

a. 22 states insist on mental health parity.

b. all 50 states mandate breast cancer screening.

c. 16 states mandate payment of prenatal care.

d. 44 states require external review of health plan decisions.

20. HIPAA regulates all of the following except:

a. portability.

b. coverage on a family plan until 26 years old.

c. access.

d. mandated benefits.

21. Prepaid health plans _________.

a. are attractive to employers because they know in advance what the cost of providing health care will be

b. all involve an IPO

c. are attractive to the service provider because the number of patients is fixed and a certain revenue level is guaranteed

d. Both a and c are correct.

22. Office of Personnel Management administers this program __________.

a. Medicare

b. FEHBP

c. Medicaid

d. SCHIP

23. Which of the following people may be eligible for workers’ compensation?

a. Julie has an accident on her way to work.

b. Jan hurt herself while vacationing at the resort where she works as a cook.

c. Steve fell in the restaurant parking lot on his lunch break.

d. Scott heard an odd popping noise as he transferred a patient from the bed to the chair

24. Which of the following are likely eligible for Medicaid?

a. the indigent

b. children

c. the elderly

d. the wealthy

25. Medicaid eligibility is __________.

a. decided on a federal level

b. decided on a state level

c. the same for all states

d. determined based on education

26. All of the following are true about compliance programs except:

a. all claims submitted for payment must have appropriate documentation.

b. providers should receive regular training to stay current with Medicare and Medicaid regulations.

c. they are mandatory under the Patient Protection and Affordable Care Act.

d. upcoding is encouraged.

27. All of the following describe the 2010 Patient Protection and Affordable Care Act regarding fraud and abuse except:

a. there will be enhanced oversight of new providers.

b. there will be provider screening.

c. a database to share information across states and federal programs is being developed.

d. penalties for false claims will be decreased.

28. When providers feel that financial incentives are inadequate, they may opt out of _________.

a. CHAMPUS

b. SCHIP

c. Medicaid

d. FEHBP

29. Emergency medicine physicians specialize in the diagnosis and treatment of __________.

a. diseases and disorders of the stomach and intestine

b. changes in organs, tissues, and cells

c. acute illness or injury

d. diseases and disorders of the mind

30. Pathologists specialize in __________.

a. diagnosing disease by studying changes in organs, tissues, and cells

b. diseases and disorders of the mind

c. diseases and disorders of the stomach and intestine

d. acute illness or injury

31. The health professional responsible for planning patient care is the ___________.

a. LPN

b. CNA

c. CRNA

d. RN

32. Nurses in this setting focus on disease prevention through community education.

a. hospitals

b. public health agencies

c. long-term care facilities

d. medical offices

33. Work schedules, supply ordering, and record maintenance are duties of the __________.

a. LPN

b. staff nurse

c. nurse supervisor

d. NP

34. The use of NPs is increasing in the __________ setting.

a. primary care

b. specialty

c. surgical

d. pathology

35. The median net income for physicians per year in primary care is __________.

a. $50,000

b. $100,000

c. $150,000

d. $186,000

36. A CTRS is a __________.

a. Certified Tumor Registry Specialist

b. Certified Therapeutic Recreation Specialist

c. Credentialed Therapist of Respiratory Service

d. Certified Therapist of Respiratory Service

37. Which eye care professional makes prescription eyeglasses?

a. Optometrist

b. Ophthalmic lab technician

c. Dispensing optician

d. Ophthalmologist

38. All of the following are true about dieticians except:

a. they provide medical nutrition therapy to patients.

b. a master’s degree is required to practice.

c. they may be employed in wellness programs.

d. they may practice in teaching settings.

39. All of the following are true about podiatrists except:

a. they provide 39% of all foot care.

b. they must graduate from an accredited college of podiatric medicine.

c. they must complete a hospital residency.

d. average salaries are $200,000.

40. Of the following, which position requires an associate’s degree to practice?

a. Dentist

b. Dental hygienist

c. Dental assistant

d. Dental lab technician

41. Clinical chemistry technologists ___________.

a. analyze the chemical and hormonal contents of body fluids

b. examine bacteria and other microorganisms

c. focus on the human immune system

d. examine cells for signs of cancerFinal Examination

42. The CEO is hired by the __________.

a. governing board

b. medical staff

c. administration

d. state Board of Health

43. This hospital area is responsible for entering initial personal and insurance data.

a. medical records

b. ancillary services

c. nursing

d. admitting Department

44. Security and maintenance are part of the __________ area of the organizational chart.

a. facilities support

b. nursing support

c. general patient support

d. administrative support

45. All of the following are utilization measures except:

a. average daily census.

b. rates of infection.

c. capacity.

d. average length of stay.

46. All of the following are examples of public hospitals except:

a. Veteran’s Administration hospitals.

b. state psychiatric hospitals.

c. county hospitals.

d. hospitals owned by corporations.

47. Long-term care is anything greater than __________ days.

a. 7

b. 21

c. 30

d. 90

48. The chief of the medical staff is described by all of the following except:

a. leads the medical staff.

b. elected by the other medical staff members.

c. always the chief of cardiology.

d. interacts with the board and the management team.

49. Outsourcing is __________.

a. buying goods or services from another provider rather than performing them by the business.

b. a utilization measure.

c. a quality measure.

d. mandated by Medicare.

50. Staffing ratios in long-term care are __________ in hospitals.

a. greater than

b. less than

c. equal to

d. No data has been collected for this.

51. The average age of all assisted living residents is __________.

a. 80

b.100

c 60

d. 84

52. When Diane and Steve return from vacation, Steve’s mom expresses her desire to get out more. Diane wants to return to work as opposed to being a full-time caregiver for her mother-in-law. Which care option should they explore, excluding total out-of-home care?

a. adult day care

b. respite care

c. assisted living

d. ICF care

53. A LTC system that would provide physical, social, mental health, and financial support would be considered ___________.

a. aging in place

b. spending down

c. a continuum of care

d. IADL

54. Medical power of attorney refers to a(n) ___________.

a. individual who is able to select the proper attorney for a malpractice case

b. individual given health care decision power for another person who is deemed incapable of making decisions.

c. automatic power which any caregiver has for the care decisions of another

d. a power only the Veteran’s Administration may grant

55. All of the following are IADL except:

a. managing money

b. grocery shopping

c. bathing

d. housekeeping

56. All of the following are primary disease processes that affect the elderly except:

a. arthritis.

b. athletic injuries.

c. cancers.

d. dementias.

57. Which of the following is not an ethical or political issue related to LTC?

a. power of attorney

b. guardianship

c. end-of-life care

d. the passage of the Hill-Burton Act

58. Violent events usually precede this disorder.

a. agoraphobia

b. obsessive compulsive disorder

c. posttraumatic stress disorder

d. generalized anxiety disorder

59. Because of its substantial role in financing mental health services, __________ has significant influence regarding the design of mental health service delivery.

a. Medicaid

b. Medicare

c. Blue Cross/Blue Shield

d. private insurance13

60. The discovery in the late 20th century that there was a biochemical basis for some of the major categories of mental illness led to all of the following changes except from __________.

a. residential care to outpatient talk therapy

b. treatments relying on drug therapy to somatic and physical treatments

c. physical or somatic treatments to treatments relying on drug therapy

d. the institutional model of care to a general delivery and business model

61. Which of the following is not a category of human resource components in mental health care?

a. specialty mental health sector

b. home health sector

c. general medical/primary care sector

d. human services sector

62. Deinstitutionalization of people committed to psychiatric hospitals and changes in psychiatric treatment led to all of the following except:

a. self-help programs.

b. drop-in centers.

c. case-management services.

d. fewer treatment options.

63. Among the public payers of mental health care, __________ pays the most.

a. Medicaid

b. Medicare

c. state and local agencies

d. Department of Veterans Affairs

64. Which of the following is not a possible risk factor for mental illness?

a. family history

b. lack of social support

c. inability to read

d. strong support system

65. Connecting family history, high-fat diet, and smoking to cardiovascular disease is a(n) __________ measure.

a. mortality

b. incidence

c. prevalence

d. risks

66. This agency maintains national health statistics.

a. Food and Drug Administration

b. Department of Health and Human Services

c. Health Resources and Services Administration

d. Centers for Disease Control and Prevention

67. This agency works to provide health care to people who live in areas where health care is not readily available.

a. Centers for Disease Control and Prevention

b. Department of Health and Human Services

c. Health Resources and Services Administration

d. Centers for Medicare and Medicaid Services

68. Public health focuses on ___________.

a. prevention issues

b. curative medical care

c. foundation support

d. environmental health

69. Epidemiologists investigate all of the following except:

a. where a disease outbreak occurred.

b. who is affected by a disease.

c. how a disease affected a victim.

d. the genetic material of a bacterium.

70. Functions of county and city health departments do not include ___________.

a. adult and child immunizations

b. communicable disease control

c. raising funds for the American Cancer Society

d. community assessment

71. Policy development is ___________.

a. the collective decision about what actions are most appropriate for the health of the state or nation.

b. making sure the necessary actions are actually taken.

c. the study of the history of a disease and its distribution throughout a society.

d. the use of surveillance data to determine changes in the number of infected persons so the appropriate action can be taken when infection rate gets too high.

72. This legislation required drug safety testing.

a. 1962 Amendment to the Food, Drug, and Cosmetic Act

b. Food, Drug, and Cosmetic Act of 1938

c. Food and Drug Act of 1906

d. 1959 Kefauver Senate hearings

73. Several hundred people participate in this drug-testing phase.

a. Phase II

b. Phase I

c. Phase III

d. Phase IV

74. Gene correction research is being used in the treatment of ___________.

a. HIV/AIDS

b. multiple sclerosis

c. SARS

d. Parkinson’s disease

75. The medical technology industry employs about ___________ people.

a. 256,000

b. 423,000

c. 591,000

d. 725,000

76. All of the following are true about ELSI except:

a. it stands for ethical, legal, and social issues.

b. in the U.S. the program is part of the Human Genome Project (HGP) budget.

c. in the U.S. 3-5% of the HGP budget is devoted to this.

d. ELSI is concerned with cost/benefit issues in pharmaceuticals.

77. Medications that consumers can buy for themselves without a prescription are:

a. generic drugs.

b. over-the-counter drugs.

c. investigational drugs.

d. disease-specific drugs.

78. All of the following are true about an IND except:

a. it is submitted to begin clinical tests on human subjects.

b. it is first approved by an Institutional Review Board.

c. IND stands for investigational new drug application.

d. if it is approved, phase I testing begins.

79. The FDA does not require which of the following in direct-to-consumer advertising?

a. accuracy

b. claims must be supported by substantial evidence

c. information must reflect a balance of risks and benefits

d. the cost of the drug compared to other drugs must be stated

80. The government’s role in prevention is all of the following except:

a. research.

b. funding.

c. informing.

d. marketing products.

81. All of the following are true about the NIH except:

a. it has 25 different centers.

b. it controls a research budget of $30 billion/year.

c. it has 75 buildings on 300 acres.

d. it only approves prevention research.

82. Which of the following is not a department of DHHS?

a. National Eye Institute

b. National Institutes of Health

c. Food and Drug Administration

d. Indian Health Services

83. In 2006 the life expectancy in the U. S. was __________ years.

a. 85

b. 71

c. 67

d. 77 17

84. Cigarette smoking is responsible for __________ deaths per year.

a. 156,000

b. 443,000

c. 610,000

d. 750,000

85. All of the following are smoking cessation treatments found to be effective except:

a. counseling.

b. prescription non-nicotine medication.

c. surgical intervention.

d. over-the-counter and prescription nicotine replacement products.

86. Which of the following is not true about worksite-based programs for health promotion and disease prevention?

a. In one survey, 72% of employers provided education in lifestyle behaviors.

b. Plans to help employees quit smoking cost $0.89 to $4.92 per smoker compared to treating smoking-related illness at $6 to $33 per smoker.

c. For every $1 spent on wellness programs the employer saves $10 in health insurance costs.

d. In some programs employees receive monetary incentives to complete health assessments or participate in weight management or tobacco cessation programs.

87. In Rights theory, health care is described as a __________.

a. basic human and citizen right

b. resource to be allocated where it will do the most good

c. right for only the few

d. resource for only the most disadvantaged

88. All of following are cultural values in America except:

a. group superiority.

b. humanitarianism.

c. science and technology.

d. equal health care for all.

89. Research suggests that those who are not health literate experience almost __________% more hospitalizations than their health literate counterparts.

a. 15

b. 30

c. 40

d. 50

90. Kantian theory ___________.

a. tells people they ought to treat others as they want to be treated themselves

b. views health care as a basic right

c. implies that health care resources should be allocated where they will do the most good

d. states that each person is to have an equal right to basic liberties

91. The life expectancy in Sweden is __________ years.

a. 85

b. 81

c. 67

d. 77

92. Countries that meet the test for justice and fairness for their health care systems include all of the following except:

a. Great Britain.

b. United States.

c. France.

d. Japan.

93.All of the following are false about the REALM except it ___________.

a. is used to assess cultural competency

b. asks patients to define medical terms

c. stands for Rapid Estimate of Adult Literacy in Medicine

d. has not been used to assess health literacy

94. In Mexico, health care is delivered by all of the following except:

a. public institutions.

b. state and federal governments.

c. Ayurevedic practitioners.

d. private hospitals.

95. All of the following are true about the Mexican Social Security Institute (IMSS) except it __________.

a. was founded in 1900.

b. is purpose is to provide public health to all Mexican citizens.

c. was founded in 1943.

d. operates its own clinics and hospitals for insured workers.

96. This system of care provision in Mexico that covers 3% of the population caters to the wealthy and tourists and makes high quality care accessible in the:

a. public system.

b. comprehensive system.

c. private system.

d. universal system.

97. All of the following are positive advances that have occurred within the Mexican health care system except:

a. catastrophic health cost has been reduced by 9%.

b. life expectancy is now 80.

c. malaria cases have dropped 60%.

d. Mexican children now receive the same vaccinations as Canadian children.

98. Which of the following does not describe the Canadian health care delivery system?

a. It is described as a mixed system.

b. It is possible to have completely private health care.

c. The vast majority of care is provided through a single payer model.

d. It is described as a market economy model.

99. _________% of health care in Canada is funded publicly and delivered privately.

a. 25

b. 75

c. 50

d. 80

100. Which of the following is not a role of the Canadian federal government?

a. pay for dentistry

b. provide funds to deliver services to the provinces

c. deliver services to special groups such as veterans and First Nations and Inuit people

d. provide public health, health promotion programs, and health care research

7. How do you think you have made out in life – better or worse than what you hoped for?

homework

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Home › Developmental Psychology › Erik Erikson

Erik Erikson

by Saul McLeod published 2008, updated 2013

Erik Erikson (1950, 1963) proposed a psychoanalytic theory of psychosocial development comprising eight stages from infancy to adulthood. During each stage, the person experiences a psychosocial crisis which could have a positive or negative outcome for personality development.

Erikson’s ideas were greatly influenced by Freud, going along with Freud’s (1923) theory regarding the structure and topography of personality. However, whereas Freud was an id psychologist, Erikson was an ego psychologist. He emphasized the role of culture and society and the conflicts that can take place within the ego itself, whereas Freud emphasized the conflict between the id and the superego.

According to Erikson, the ego develops as it successfully resolves crises that are distinctly social in nature. These involve establishing a sense of trust in others, developing a sense of identity in society, and helping the next generation prepare for the future.

Erikson extends on Freudian thoughts by focusing on the adaptive and creative characteristic of the ego, and expanding the notion of the stages of personality development to include the entire lifespan.

Like Freud and many others, Erik Erikson maintained that personality develops in a predetermined order, and builds upon each previous stage. This is called the epigenic principle.

The outcome of this ‘maturation timetable’ is a wide and integrated set of life skills and abilities that function together within the autonomous individual. However, instead of focusing on sexual development (like Freud), he was interested in how children socialize and how this affects their sense of self.

Psychosocial Stages

Erikson’s (1959) theory of psychosocial development has eight distinct stages, taking in five stages up to the age of 18 years and three further stages beyond, well into adulthood. Erikson suggests that there is still plenty of room for continued growth and development throughout one’s life. Erikson puts a great deal of emphasis on the adolescent period, feeling it was a crucial stage for developing a person’s identity.

Like Freud, Erikson assumes that a crisis occurs at each stage of development. For Erikson (1963), these crises are of a psychosocial nature because they involve psychological needs of the individual (i.e. psycho) conflicting with the needs of society (i.e. social).

According to the theory, successful completion of each stage results in a healthy personality and the acquisition of basic virtues. Basic virtues are characteristic strengths which the ego can use to resolve subsequent crises.

Failure to successfully complete a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self.  These stages, however, can be resolved successfully at a later time.

1. Trust vs. Mistrust

Is the world a safe place or is it full of unpredictable events and accidents waiting to happen? Erikson’s first psychosocial crisis occurs during the first year or so of life (like Freud’s oral stage of psychosexual development). The crisis is one of trust vs. mistrust.

During this stage the infant is uncertain about the world in which they live. To resolve these feelings of uncertainty the infant looks towards their primary caregiver for stability and consistency of care.

If the care the infant receives is consistent, predictable and reliable, they will develop a sense of trust which will carry with them to other relationships, and they will be able to feel secure even when threatened.

Success in this stage will lead to the virtue of hope. By developing a sense of trust, the infant can have hope that as new crises arise, there is a real possibility that other people will be there are a source of support. Failing to acquire the virtue of hope will lead to the development of fear.

For example, if the care has been harsh or inconsistent, unpredictable and unreliable, then the infant will develop a sense of mistrust and will not have confidence in the world around them or in their abilities to influence events.

This infant will carry the basic sense of mistrust with them to other relationships. It may result in anxiety, heightened insecurities, and an over feeling of mistrust in the world around them.

Consistent with Erikson’s views on the importance of trust, research by Bowlby and Ainsworth has outlined how the quality of the early experience of attachment can affect relationships with others in later life.

2. Autonomy vs. Shame and Doubt

The child is developing physically and becoming more mobile. Between the ages of 18 months and three, children begin to assert their independence, by walking away from their mother, picking which toy to play with, and making choices about what they like to wear, to eat, etc.

The child is discovering that he or she has many skills and abilities, such as putting on clothes and shoes, playing with toys, etc. Such skills illustrate the child’s growing sense of independence and autonomy. Erikson states it is critical that parents allow their children to explore the limits of their abilities within an encouraging environment which is tolerant of failure.

For example, rather than put on a child’s clothes a supportive parent should have the patience to allow the child to try until they succeed or ask for assistance. So, the parents need to encourage the child to becoming more independent whilst at the same time protecting the child so that constant failure is avoided.

A delicate balance is required from the parent. They must try not to do everything for the child but if the child fails at a particular task they must not criticize the child for failures and accidents (particularly when toilet training). The aim has to be “self control without a loss of self-esteem” (Gross, 1992). Success in this stage will lead to the virtue of will.

If children in this stage are encouraged and supported in their increased independence, they become more confident and secure in their own ability to survive in the world.

If children are criticized, overly controlled, or not given the opportunity to assert themselves, they begin to feel inadequate in their ability to survive, and may then become overly dependent upon others, lack self-esteem, and feel a sense of shame or doubt in their own abilities.

3. Initiative vs. Guilt

Around age three and continuing to age five, children assert themselves more frequently. These are particularly lively, rapid-developing years in a child’s life. According to Bee (1992) it is a “time of vigor of action and of behaviors that the parents may see as aggressive”.

During this period the primary feature involves the child regularly interacting with other children at school. Central to this stage is play, as it provides children with the opportunity to explore their interpersonal skills through initiating activities.

Children begin to plan activities, make up games, and initiate activities with others. If given this opportunity, children develop a sense of initiative, and feel secure in their ability to lead others and make decisions.

Conversely, if this tendency is squelched, either through criticism or control, children develop a sense of guilt. They may feel like a nuisance to others and will therefore remain followers, lacking in self-initiative.

The child takes initiatives which the parents will often try to stop in order to protect the child. The child will often overstep the mark in his forcefulness and the danger is that the parents will tend to punish the child and restrict his initiatives too much.

It is at this stage that the child will begin to ask many questions as his thirst for knowledge grows. If the parents treat the child’s questions as trivial, a nuisance or embarrassing or other aspects of their behavior as threatening then the child may have feelings of guilt for “being a nuisance”.

Too much guilt can make the child slow to interact with others and may inhibit their creativity. Some guilt is, of course, necessary, otherwise the child would not know how to exercise self control or have a conscience.

A healthy balance between initiative and guilt is important. Success in this stage will lead to the virtue of purpose.

4. Industry (competence) vs. Inferiority

Industry versus inferiority is the fourth stage of Erik Erikson’s theory of psychosocial development. The stage occurs during childhood between the ages of five and twelve.

Children are at the stage where they will be learning to read and write, to do sums, to do things on their own. Teachers begin to take an important role in the child’s life as they teach the child specific skills.

It is at this stage that the child’s peer group will gain greater significance and will become a major source of the child’s self esteem. The child now feels the need to win approval by demonstrating specific competencies that are valued by society, and begin to develop a sense of pride in their accomplishments.

If children are encouraged and reinforced for their initiative, they begin to feel industrious and feel confident in their ability to achieve goals. If this initiative is not encouraged, if it is restricted by parents or teacher, then the child begins to feel inferior, doubting his own abilities and therefore may not reach his or her potential.

If the child cannot develop the specific skill they feel society is demanding (e.g. being athletic) then they may develop a sense of inferiority. Some failure may be necessary so that the child can develop some modesty. Yet again, a balance between competence and modesty is necessary. Success in this stage will lead to the virtue of competence.

5. Identity vs. Role Confusion

The fifth stage is identity vs. role confusion, and it occurs during adolescence, from about 12-18 years. During this stage adolescents search for a sense of self and personal identity, through an intense exploration of personal values, beliefs and goals.

The adolescent mind is essentially a mind or moratorium, a psychosocial stage between childhood and adulthood, and between the morality learned by the child, and the ethics to be developed by the adult (Erikson, 1963, p. 245)

During adolescence the transition from childhood to adulthood is most important. Children are becoming more independent, and begin to look at the future in terms of career, relationships, families, housing, etc. The individual wants to belong to a society and fit in.

This is a major stage in development where the child has to learn the roles he will occupy as an adult. It is during this stage that the adolescent will re-examine his identity and try to find out exactly who he or she is. Erikson suggests that two identities are involved: the sexual and the occupational.

According to Bee (1992), what should happen at the end of this stage is “a reintegrated sense of self, of what one wants to do or be, and of one’s appropriate sex role”. During this stage the body image of the adolescent changes.

Erikson claims that the adolescent may feel uncomfortable about their body for a while until they can adapt and “grow into” the changes. Success in this stage will lead to the virtue of fidelity.

Fidelity involves being able to commit one’s self to others on the basis of accepting others, even when there may be ideological differences.

During this period, they explore possibilities and begin to form their own identity based upon the outcome of their explorations. Failure to establish a sense of identity within society (“I don’t know what I want to be when I grow up”) can lead to role confusion. Role confusion involves the individual not being sure about themselves or their place in society.

In response to role confusion or identity crisis an adolescent may begin to experiment with different lifestyles (e.g. work, education or political activities). Also pressuring someone into an identity can result in rebellion in the form of establishing a negative identity, and in addition to this feeling of unhappiness.

6. Intimacy vs. Isolation

Occurring in young adulthood (ages 18 to 40 yrs), we begin to share ourselves more intimately with others. We explore relationships leading toward longer term commitments with someone other than a family member.

Successful completion of this stage can lead to comfortable relationships and a sense of commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression. Success in this stage will lead to the virtue of love.

7. Generativity vs. Stagnation

During middle adulthood (ages 40 to 65 yrs), we establish our careers, settle down within a relationship, begin our own families and develop a sense of being a part of the bigger picture.

We give back to society through raising our children, being productive at work, and becoming involved in community activities and organizations.

By failing to achieve these objectives, we become stagnant and feel unproductive. Success in this stage will lead to the virtue of care.

8. Ego Integrity vs. Despair

As we grow older (65+ yrs) and become senior citizens, we tend to slow down our productivity, and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life.

Erik Erikson believed if we see our lives as unproductive, feel guilt about our past, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness.

Success in this stage will lead to the virtue of wisdom. Wisdom enables a person to look back on their life with a sense of closure and completeness, and also accept death without fear.

Critical Evaluation

Erikson’s theory has good face validity. Many people find that they can relate to his theories about various stagesof the life cycle through their own experiences.

However, Erikson is rather vague about the causes of development. What kinds of experiences must people have in order to successfully resolve various psychosocial conflicts and move from one stage to another? The theory does not have a universal mechanism for crisis resolution.

Indeed, Erikson (1964) acknowledges his theory is more a descriptive overview of human social and emotional development that does not adequately explain how or why this development occurs. For example, Erikson does not explicitly explain how the outcome of one psychosocial stage influences personality at a later stage.

However, Eriskon stressed his work was a ‘tool to think with rather than a factual analysis’. Its purpose then is to provide aframework within which development can be considered rather than testable theory.

One of the strengths of Erikson’s theory is its ability to tie together important psychosocial development across the entire lifespan.

Although support for Erikson’s stages of personality development exists (McAdams, 1999), critics of his theory provide evidence suggesting a lack of discrete stages of personality development (McCrae & Costa, 1997).

View the complete article as a PDF document

How to cite this article:

McLeod, S. A. (2013). Erik Erikson. Retrieved from www.simplypsychology.org/Erik-Erikson.html

References and Further Reading

Bee, H. L. (1992). The developing child. London: HarperCollins.

Erikson, E. H. (1950). Childhood and society. New York: Norton.Erickson, E. (1958). Young man Luther: A study in psychoanalysis and history. New York: Norton.

Erikson, E. H. (Ed.). (1963). Youth: Change and challenge. Basic books.

Erikson, E. H. (1964). Insight and responsibility. New York: Norton.

Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton.

Erikson, E. H., Paul, I. H., Heider, F., & Gardner, R. W. (1959). Psychological issues (Vol. 1). International Universities Press.

Gross, R. D., & Humphreys, P. (1992). Psychology: The science of mind and behaviour. London: Hodder & Stoughton.

Freud, S. (1923). The ego and the id. SE, 19: 1-66.

McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100.

McCrae, R. R., & Costa Jr, P. T. (1997). Personality trait structure as a human universal. American Psychologist, 52(5), 509.

Article Content

Introduction Psychosocial Stages 1. Trust vs. Mistrust 2. Autonomy vs. Shame 3. Initiative vs. Guilt 4. Industry vs. Inferiority 5. Identity vs. Role Confusion 6. Intimacy vs. Isolation 7. Generativity vs. Stagnation 8. Ego Integrity vs. Despair Critical evaluation References

Further Information

Psychosexual Stages of Development Erikson – why was he important? Article on Psychosocial Stages

Erikson vs. Maslow

Submit by 2359 Saturday of Week 3.

Name:

Date:

Overview: Life Review Interview

This assignment provides the opportunity to develop one-to-one interactions with an elder who resides in the community. The focus is to develop and refine skills in communication and to examine successful aging through the lived experiences of an elder.

Completing this assignment will enable you to conduct a Life Review with an older adult, understand the significance of the individual’s life story, identify possible legacies and their importance to the older adult, and describe the degree of ego integrity reached by the older adult. You will also reflect upon the process of conducting a Life Review. Only your initial reflection statements about the interview process must be submitted during Week 3.

Contact the older adult the day before the interview to remind him/her about it and to answer any questions about the process that may have arisen. Be sure to review the guidelines and guiding questions before the interview session. Be prompt and professional.

All information of a sensitive nature that is shared with you must be kept confidential unless your have the older adult’s permission to share it with others. The Interview Consent Form offers assurance and informs the older adult that the information is kept within the bounds of the course faculty and, where appropriate, with peers in the class. In all written work and discussions, the older adult must be identified by initials only to protect privacy.

This document includes guidelines to help you prepare for and conduct the interview, but you are not required to submit answers to the interview questions. Only your initial reflection statements in Part C must be submitted during Week 3.

Performance Objectives:

  • Apply gerontologic nursing principles and standards in nursing practice across the continuum of elder care.
  • Use current evidence and theories in care of older adults.
  • Conduct a personal interview with an older adult for the purpose of documenting Life Review.

Rubric

Use this rubric to guide your work on the assignment, “Life Review Interview.”

Levels of Achievement

Criteria

Novice

Competent

Proficient

Week 3 Assignment 2 Reflection upon interview. Write 3 reflective statements

Weight 75.00%

0 %

0 to 1 reflective statement or statements are not reflective of student’s thoughts/feelings

50 %

2 reflective statements are submitted

100 %

3 statements are submitted that reflect the student’s thoughts and feelings (not the interview subject’s)

APA Format is used. Correct spelling, puntuation and grammar are used

Weight 25.00%

0 %

more than 2 errors

50 %

1-2 errors

100 %

No errors

A. Preparing for the interview:

  1. Be able to explain the purpose and length of the visits (The interview should not exceed two hours. If you are unable to complete the interview in two hours, then schedule another meeting).
  2. If you have not done so, ask the elder to sign the Interview Consent Form. (It is helpful to take two copies so that you can leave a copy with the elder.)
  3. Reflect upon how you can incorporate therapeutic communication skills in your interview.
  4. Review the Interview Guide. The elder does have the right to refuse to answer any question – please honor that right.

B. Conducting the interview:These questions can serve as a guide during the interview. You are not required to submit the answers to the questions, so you will not be graded upon completion of this section.

Brief Biography

Age:

Gender:

Race/Ethnicity:

Distinguishing characteristics of the individual:

Childhood

1.            What was life like for you as a child?

2.            What were your parents like?  What were their strengths and weaknesses?

3.            Did you have any brothers or sisters?  If so, tell me what each was like.

4.            Did someone close to you die when you were growing up?

5.            Do you ever remember being very sick?

6.            Was religion a large part of your life?

Adolescence

1.            What things stand out in your memory about being a teenager?

2.            Who were the important people for you (parents, brothers, sisters, friends, teachers, those you were especially close to, those you admired, those you wanted to be like)?  Tell me about them.

3.            Did you go to school?  What was its meaning to you?

4.            Did you work during those years?

5.            What were the pleasant things about your adolescence?

6.            What was the most unpleasant thing about your adolescence?

Family and Home

1.            What was the atmosphere in your home?

2.            Who were you closest to in your family?

3.            Who in your family were you most like?  In what way?

Adulthood

1.            Now I’d like to talk to you about your life as an adult, from when you were in your 20s up to today.  Tell me of the most important events that happened in your adulthood.

2.            What was life like for you in your 20s and 30s?

3.            Tell me about your work.  Did you enjoy work?  Did you earn an adequate living

4.            Did you marry?

            If [No], why not?

            If [Yes], on the whole, would you say you had a happy or an unhappy marriage?

            Were you married more than once?

5.            What were some of the main difficulties you encountered during your adult years?

a.    Did someone close to you die?  Go away?

b.    Were you ever sick?  Have an accident?

c.    Did you move often?  Change jobs?

d.    Did you ever feel alone?  Abandoned?

e.    Did you ever feel needy?

Summary Questions

1.            On the whole, what kind of life do you think you have had?

2.            What would you say have been the three main satisfactions in your life?  Why were they satisfying?

3.            Everyone has had disappointments.  What have been the main disappointments in your

life?

4.            What was the hardest thing you had to face in your life?  Please describe it.

5.            What was the happiest period of your life?  What about it made it the happiest period? 

6.            What was the proudest moment in your life?

7.            How do you think you have made out in life – better or worse than what you hoped for?

8.            Let’s talk a little about you as you are now.  What are the best things about the age you are now?

9.            What are the worst things about being the age you are now?

10.          What are the most important things to you in your life today?

11.          What do you hope will happen to you as you grow older?

12.          What do you fear will happen to you as you grow older?

13.          Have you enjoyed participating in this review of your life?

C. Reflective statements:Record three different/separate reflective statements about the interview as soon as possible after its completion. You will expand upon your reflection in your final paper during Week 4. Only record your personal reflections. How did you feel about the conversation? Did it cause you to think about how you or your loved ones are aging? Any changes you might want to make in your lifestyle? Parts of the interview that were particularly significant or upsetting to you? These are some examples of reflective statements, however you may have others as well.

QuizNote: It is recommended that you save your response as you complete each question.Question 1 (1 point) The act that places controls on labor unions and the relationships between unions and their

QuizNote: It is recommended that you save your response as you complete each question.Question 1 (1 point) The act that places controls on labor unions and the relationships between unions and their

Quiz

Note: It is recommended that you save your response as you complete each question.

Question 1 (1 point)

The act that places controls on labor unions and the relationships between unions and their members

Question 1 options:

A) 

Fair Labor Standards Act

B) 

Labor–Management Reporting and Disclosure Act

C) 

Equal Pay Act

D) 

Civil Rights Act

Question 2 (1 point)

Liability for discrimination

Question 2 options:

A) 

is limited to males

B) 

can not be applied in hospitals

C) 

is very easy to prove

D) 

can be applied in situations in which discriminatory practices can affect the ability of a nonemployee to obtain a job with a third party

Question 3 (1 point)

A whistleblower

Question 3 options:

A) 

 is one who reveals wrongdoing by employees (e.g., those who take extra coffee breaks)

B) 

is one who reveals wrongdoing (e.g., financial improprieties) within the organization

C) 

is one who reveals financial responsibilities that are within the law and ethical standards required of organizations

D) 

reports managers for harassment to the local newspaper

Question 4 (1 point)

Employers have a responsibility to

Question 4 options:

A) 

treat employees with dignity and respect

B) 

 intimidate employees in the workplace

C) 

abuse employees

D) 

communicate veiled threats to employees in the workplace

Question 5 (1 point)

Healthcare professionals have a clear legal and moral obligation to

Question 5 options:

A) 

provide confidential information with any hospital employee that requests it

B) 

adhere to the organization’s privacy and confidentiality policies

C) 

share confidential information with their families

D) 

share confidential information with their volunteers

Question 6 (1 point)

Dr. Gray has applied for medical staff privileges at your hospital. What database would you research to determine if he has been denied medical staff privileges at another hospital?

Question 6 options:

A) 

State Administrative Data Bank

B) 

MEDPAR file

C) 

National Practitioner Data Bank

D) 

Healthcare Integrity and Protection Data Bank

Question 7 (1 point)

Which statement is true about when a family member can be provided with PHI?

Question 7 options:

A) 

The family member is directly involved in the patient’s care.

B) 

The family member is a health care professional.

C) 

The patient’s mother can always receive PHI on their child.

D) 

The family member lives out of town and cannot come to the facility to check on the patient.

Question 8 (1 point)

Keith is director at a medical center that includes a daycare center and has several employees who have young children. He knows that it is important to be familiar with the provisions of the Family Medical Leave Act (FMLA), which includes all the following provisions EXCEPT

Question 8 options:

A) 

that it provides up to 12 weeks of unpaid leave annually.

B) 

that both men and women qualify under the FMLA.

C) 

that it covers leave to care for a spouse, child, or parent.

D) 

ensuring any job the employee is qualified for upon return.

Question 9 (1 point)

Example/s of intentional tort(s)

Question 9 options:

A) 

battery, negligence                             

B) 

invasion of privacy, malpractice                            

C) 

battery, slander

D) 

negligence

Question 10 (1 point)

Emma Grace is a transcriptionist. Her productivity level, as determined by line count per day, has dropped significantly over the past 2 weeks. As a result, there is a backlog in transcription of history and physical reports and surgical reports. Several doctors and the operating room supervisor have complained. An appropriate initial course of action for the Supervisor of Transcription is to

Question 10 options:

A) 

fire the transcriptionist immediately.

B) 

suspend the transcriptionist without pay for 3 days.

C) 

counsel the transcriptionist privately.

D) 

refer the matter to the Human Resources Department.

Question 11 (1 point)

Puget Sound Health System has set hiring goals and taken steps to guarantee equal employment opportunities for members of protected groups (e.g., American Indians, veterans, etc.). It is complying with

Question 11 options:

A) 

Civil Rights Act.

B) 

Minority Hiring Act.

C) 

Equal Pay Act.

D) 

Affirmative Action.

Question 12 (1 point)

Professional liability policies vary in

Question 12 options:

A) 

periodically vary in coverage exclusions for home insurance

B) 

broadness and exclusions from coverage, as well as, the company’s interpretation of the language of the contract

C) 

interpretations a company places on the language of the contract is based on the company’s for-profit or non-profit status

D) 

exclusions from coverage but not in scope of coverage

Question 13 (1 point)

Federal laws generally take precedence over state laws

Question 13 options:

A) 

when there is a conflict between the state and the federal laws, state laws are applicable when state regulations are more rigid than federal legislation

B) 

when there is a conflict between the state and the federal laws, state laws are not applicable when state regulations are more rigid than federal legislation

C) 

when there is a conflict between the state and the federal laws, state laws are applicable when state regulations are more rigid than federal legislation, an arbitrator must decide which law should take precedence

D) 

state laws always take precedence over federal laws

Question 14 (1 point)

Yanique is the new administrator at a mental health facility. She discovers that one of her staff members has shared her password with a coworker. This action violates policies and procedures and is the first occasion of difficulty with this employee. Disciplinary action should be taken by

Question 14 options:

A) 

referring the action to Human Resources.

B) 

waiting for another occurrence to act.

C) 

immediately dismissing the employee.

D) 

asking for guidance from Human Resources and then acting.

Question 15 (1 point)

The process of structuring or restructuring the health care system in terms of financing, purchasing, delivering, measuring, and documenting a broad range of health care services and products is generally referred to as

Question 15 options:

A) 

group practice

B) 

managed care

C) 

preferred provider organization

D) 

vertically integrated delivery system

Question 16 (1 point)

A process whereby a third-party payer evaluates the medical necessity of a course of treatment

Question 16 options:

A) 

nursing review

B) 

management review

C) 

utilization review

D) 

quality review

Question 17 (1 point)

Whenever a managed care organization possesses significant market share

Question 17 options:

A) 

antitrust implications can arise

B) 

greed can falter

C) 

malpractice is likely to occur

D) 

corporate liability is likely to occur

Question 18 (1 point)

Rachel’s work performance has diminished over the last 2 weeks. In addition, she has uncharacteristic mood swings and has exhibited difficulty concentrating. She is also having difficulties with tardiness and attendance. As her supervisor, you meet with Rachel to discuss your concerns. She reveals that she is struggling financially. What action should you take?

Question 18 options:

A) 

Terminate her.

B) 

Refer her to the Employee Assistance Program.

C) 

Assure her that as long as she can perform her job acceptably, her personal life is none of your concern.

D) 

Put her on probation

Question 19 (1 point)

When analyzing discipline problems, which of the following should be considered?

Question 19 options:

A) 

the prior performance of the employee in question

B) 

the prior performance of the employee in question

C) 

the seriousness of the problem

D) 

all answers apply.

Question 20 (1 point)

The National Labor Relations Act (NLRA), which serves as the foundation for U.S. labor laws and collective bargaining, is also known as

Question 20 options:

A) 

the Wagner Act.

B) 

the Fair Labor Standards Act.

C) 

the Family and Medical Leave Act.

D) 

the Equal Pay Act.

Question 21 (1 point)

A pharmacist who submits Medicaid claims for reimbursement of brand name drugs when less expensive generic drugs were actually dispensed has committed the crime of:

Question 21 options:

A) 

Product’s liability

B) 

Perjury

C) 

Fraud

D) 

Criminal negligence

Question 22 (1 point)

Unlike binding arbitration, the decision of a screening panel is

Question 22 options:

A) 

not arbitrary and is not imposed as a condition precedent to trial

B) 

conducted in lieu of a trial

C) 

not binding and is imposed as a condition precedent to trial, whereas arbitration is conducted in lieu of a trial

D) 

binding and is imposed as a condition precedent to trial

Question 23 (1 point)

The doctrine that provides that a court can hold a person causing an injury, concurrently with another person, equally liable for the entire judgment awarded is

Question 23 options:

A) 

joint and several liability

B) 

respondent superior

C) 

no-fault

D) 

independent contractor

Question 24 (1 point)

Valuable components of a risk management program include

Question 24 options:

A) 

sympathetic care after accidental injury to a patient

B) 

preparation of incident reports

C) 

prompt identification and investigation of specific incidents of patient injuries and, when possible, intervention and the training and education of employees and clinicians to assist in reducing exposure

D) 

definition of the cause of each incident

Question 25 (1 point)

Continuous quality improvement is an approach to

Question 25 options:

A) 

improving the quality of care on a continuing basis 

B) 

reducing quality while increasing the number of patients attended to 

C) 

long term care management 

D) 

peer review

Question 26 (1 point)

The ultimate successes of Continuous Quality Improvement requires commitment by the

Question 26 options:

A) 

organization’s leadership

B) 

administration and governing body

C) 

medical staff and nursing staff

D) 

at every level of the organization organization.

Question 27 (1 point)

Mandatory requirements for participation in The Joint Commission’s accreditation program

Question 27 options:

A) 

National Quality Forum

B) 

National Patient Safety Goals Quality Task Force

C) 

Advisory Commission

D) 

National Committee on QualityAssurance

Question 28 (1 point)

The Leapfrog Group and its members work together to

Question 28 options:

A) 

promote improvements in the safe delivery of health care by collecting and providing healthcare consumers with the necessary information to make informed health care decisions

B) 

increase preventable medical mistakes and reduce the quality and affordability of health care

C) 

promote improvements in the safe delivery of health care

D) 

collecting and providing healthcare consumers with the necessary information to make health uninformed care decisions

Question 29 (1 point)

The most widely discussed and debated unique patient identifier is the

Question 29 options:

A) 

Unique Physician Identification Number (UPIN).

B) 

patient’s social security number.

C) 

patient’s date of birth.

D) 

patient’s first and last names.

Question 30 (1 point)

The Occupational Safety and Health Act of 1970, the Americans with Disability Act, and the Vocational Rehabilitation Act are all federal legislation designed to

Question 30 options:

A) 

keep the workplace safe and accessible to all employees and customers.

B) 

prevent sexual harassment.

C) 

protect child labor.

D) 

ensure equal pay for equal work.

Question 31 (1 point)

Ty Ngynn is Assistant Director in Information Services. He has made an appointment with the Director of Human Resources to discuss his recent trip to the state HIM meeting with his Director, Wendy Richards. During the trip, Wendy repeatedly asked Ty to her room, suggesting they work on new plans for the department. When Ty declined, Wendy suggested it might not be worthwhile for him to attend future state meetings. The HR Director should

Question 31 options:

A) 

explain that off-site events are outside the scope of the HR Department.

B) 

explain that it is the Director’s right to select who attends professional meetings.

C) 

provide Ty with additional training on resisting unwanted advances.

D) 

take the complaint seriously and begin a sexual harassment investigation.

Question 32 (1 point)

Which of the following employees is exempt under the Fair Labor Standards Act?

Question 32 options:

A) 

an health care administrator who manages a department and is involved with planning and decision-making activities 90% of the time

B) 

the department secretary who spends 100% of her time performing clerical duties for the Director of Health Information Services

C) 

an RHIA who performs record analysis and coding 90% of the time and who supervises three employees

D) 

a file clerk who spends 100% of the time on filing activities

Question 33 (1 point)

An amendment to the Civil Rights Act of 1964 that extends the 180-day statute of limitations previously applied to the filing of an equal-pay lawsuit refers to the

Question 33 options:

A) 

Americans with Disabilities Act.

B) 

Lilly Ledbetter Fair Pay Act.

C) 

Age Discrimination in Employment Act.

D) 

Family and Medical Leave Act.

Question 34 (1 point)

You work in a unionized organization and have filed a grievance. Which of the following will most likely take place?

Question 34 options:

A) 

The facility policies and procedures for prompt and fair action on any grievance will be followed.

B) 

The time from complaint to resolution should be no longer than 90 days.

C) 

The grievance procedure regulations stipulated in the union contract will be followed.

D) 

You can be terminated for registering a grievance.

Question 35 (1 point)

One of your new employees has just completed orientation, receiving basic HIPAA training. You are now providing more specific training related to her job. She asks whether the information she provided during the hiring process, as well as benefits claims, are also protected under HIPAA. Which of the following can you assure her that the Human Resources Department protects?

Question 35 options:

A) 

benefits enrollment

B) 

Employee Assistance Program contacts

C) 

OSHA information

D) 

all personal health information (PHI)

Question 36 (1 point)

The Office of Inspector General, established in the Department of Health and Human Services in 1976, investigates cases of

Question 36 options:

A) 

criminal mischief

B) 

Medicare and Medicaid fraud

C) 

criminal negligence

D) 

patient abuse

Question 37 (1 point)

Physician assistant who intentionally injects a patient with a lethal dose of a medication resulting in the patient’s death is guilty of

Question 37 options:

A) 

misdemeanor

B) 

negligence                          

C) 

fraud

D) 

murder

Question 38 (1 point)

The unwanted removal of life-support equipment can be considered the crime of

Question 38 options:

A) 

petty theft

B) 

murder

C) 

battery

D) 

assault

Question 39 (1 point)

If a health care provider shows reckless disregard for the safety of his patients and intentional indifference to any injury that could follow his act(s), he could be charged with or sued for

Question 39 options:

A) 

assault

B) 

criminal negligence

C) 

battery

D) 

civil negligence

Question 40 (1 point)

A sworn statement from a witness that can be used as evidence at a trial is called a

Question 40 options:

A) 

counter suit

B) 

pleading

C) 

claim

D) 

deposition

Question 41 (1 point)

Price fixing is considered a per se violation of the antitrust laws. Price fixing occurs when two or more competitors come together to decide on a price that will be charged for services or goods. The per se rule here applies to

Question 41 options:

A) 

price fixing and group boycotts

B) 

horizontal market allocation and price fixing

C) 

group boycotts

D) 

tying

Question 42 (1 point)

Credentialing should include at a minimum

Question 42 options:

A) 

privileges not requested

B) 

current in competency        

C) 

geographical location

D) 

privileges requested and current competency

Question 43 (1 point)

To help hospitals move toward a culture of safety, they need to

Question 43 options:

A) 

discourage patients from questioning their care

B) 

 ensure that accountability and responsibility is fluid as to who is responsible for monitoring an organization’s safety initiatives.

C) 

involve the medical staff in the development and implementation of systems that are designed to create a culture of safety

D) 

educate a few staff members as to their individual roles in establishing and maintaining a safe environment for patients within six months prior to appointment to a safety committee

Question 44 (1 point)

A physician takes the health records of a group of HIV-positive patients out of the hospital to complete research tasks at home. The physician mistakenly leaves the records in a restaurant where they are read by a newspaper reporter who publishes an article that identifies the patients. The physician can be sued for:

Question 44 options:

A) 

Slander

B) 

Willful infliction of mental distress

C) 

Libel

D) 

Invasion of privacy

Question 45 (1 point)

The EMTALA regulations include all of the following except which?

Question 45 options:

A) 

Transfers of non-stabilized patients must only occur under certain specific conditions.

B) 

Every patient arriving at the emergency department must receive an appropriate “medical screening exam.”

C) 

If an emergency medical condition exists, the hospital must treat and stabilize that condition or transfer the patient.

D) 

Non-Medicare indigent patients must be transferred to the nearest level-1 trauma center.

Question 46 (1 point)

A hospital is reviewing the quantity and type of resources being used in the provision of chemotherapy treatments. This is an example of:

Question 46 options:

A) 

FOCUS-PDCA review

B) 

Accreditation review

C) 

Medication reconciliation

D) 

Utilization management review

Question 47 (1 point)

The Joint Commission measures that are standardized metric tools that provide an indication of an organization’s performance are called

Question 47 options:

A) 

Measures of Central Tendency

B) 

Vital Statistics Measures

C) 

Core Performance Measures

D) 

Performance Improvement Measures

Question 48 (1 point)

The Uniform Health-Care Decisions Act ranks the next-of-kin in the following order for medical decision-making purposes:

Question 48 options:

A) 

Adult sibling, adult child, spouse, parent

B) 

Parent, spouse, adult child, adult sibling

C) 

Spouse, parent, adult sibling, adult child

D) 

Spouse, adult child, parent, adult sibling

Question 49 (1 point)

An Health Care professional who releases health information that he or she knows will result in genetic discrimination is violating the ethical principle of

Question 49 options:

A) 

Autonomy

B) 

Beneficence

C) 

Justice

D) 

Nonmaleficence

Question 50 (1 point)

New equipment has just been purchased for a Health Information Services Department. Prior to its arrival and placement in the department, it is important for the manager to adhere to the rules and regulations governed by

Question 50 options:

A) 

OSHA

B) 

FMLA

C) 

SSA

QuizNote: It is recommended that you save your response as you complete each question.Question 1 (1 point) The act that places controls on labor unions and the relationships between unions and their

Quiz

Note: It is recommended that you save your response as you complete each question.

Question 1 (1 point)

The act that places controls on labor unions and the relationships between unions and their members

Question 1 options:

A) 

Fair Labor Standards Act

B) 

Labor–Management Reporting and Disclosure Act

C) 

Equal Pay Act

D) 

Civil Rights Act

Question 2 (1 point)

Liability for discrimination

Question 2 options:

A) 

is limited to males

B) 

can not be applied in hospitals

C) 

is very easy to prove

D) 

can be applied in situations in which discriminatory practices can affect the ability of a nonemployee to obtain a job with a third party

Question 3 (1 point)

A whistleblower

Question 3 options:

A) 

 is one who reveals wrongdoing by employees (e.g., those who take extra coffee breaks)

B) 

is one who reveals wrongdoing (e.g., financial improprieties) within the organization

C) 

is one who reveals financial responsibilities that are within the law and ethical standards required of organizations

D) 

reports managers for harassment to the local newspaper

Question 4 (1 point)

Employers have a responsibility to

Question 4 options:

A) 

treat employees with dignity and respect

B) 

 intimidate employees in the workplace

C) 

abuse employees

D) 

communicate veiled threats to employees in the workplace

Question 5 (1 point)

Healthcare professionals have a clear legal and moral obligation to

Question 5 options:

A) 

provide confidential information with any hospital employee that requests it

B) 

adhere to the organization’s privacy and confidentiality policies

C) 

share confidential information with their families

D) 

share confidential information with their volunteers

Question 6 (1 point)

Dr. Gray has applied for medical staff privileges at your hospital. What database would you research to determine if he has been denied medical staff privileges at another hospital?

Question 6 options:

A) 

State Administrative Data Bank

B) 

MEDPAR file

C) 

National Practitioner Data Bank

D) 

Healthcare Integrity and Protection Data Bank

Question 7 (1 point)

Which statement is true about when a family member can be provided with PHI?

Question 7 options:

A) 

The family member is directly involved in the patient’s care.

B) 

The family member is a health care professional.

C) 

The patient’s mother can always receive PHI on their child.

D) 

The family member lives out of town and cannot come to the facility to check on the patient.

Question 8 (1 point)

Keith is director at a medical center that includes a daycare center and has several employees who have young children. He knows that it is important to be familiar with the provisions of the Family Medical Leave Act (FMLA), which includes all the following provisions EXCEPT

Question 8 options:

A) 

that it provides up to 12 weeks of unpaid leave annually.

B) 

that both men and women qualify under the FMLA.

C) 

that it covers leave to care for a spouse, child, or parent.

D) 

ensuring any job the employee is qualified for upon return.

Question 9 (1 point)

Example/s of intentional tort(s)

Question 9 options:

A) 

battery, negligence                             

B) 

invasion of privacy, malpractice                            

C) 

battery, slander

D) 

negligence

Question 10 (1 point)

Emma Grace is a transcriptionist. Her productivity level, as determined by line count per day, has dropped significantly over the past 2 weeks. As a result, there is a backlog in transcription of history and physical reports and surgical reports. Several doctors and the operating room supervisor have complained. An appropriate initial course of action for the Supervisor of Transcription is to

Question 10 options:

A) 

fire the transcriptionist immediately.

B) 

suspend the transcriptionist without pay for 3 days.

C) 

counsel the transcriptionist privately.

D) 

refer the matter to the Human Resources Department.

Question 11 (1 point)

Puget Sound Health System has set hiring goals and taken steps to guarantee equal employment opportunities for members of protected groups (e.g., American Indians, veterans, etc.). It is complying with

Question 11 options:

A) 

Civil Rights Act.

B) 

Minority Hiring Act.

C) 

Equal Pay Act.

D) 

Affirmative Action.

Question 12 (1 point)

Professional liability policies vary in

Question 12 options:

A) 

periodically vary in coverage exclusions for home insurance

B) 

broadness and exclusions from coverage, as well as, the company’s interpretation of the language of the contract

C) 

interpretations a company places on the language of the contract is based on the company’s for-profit or non-profit status

D) 

exclusions from coverage but not in scope of coverage

Question 13 (1 point)

Federal laws generally take precedence over state laws

Question 13 options:

A) 

when there is a conflict between the state and the federal laws, state laws are applicable when state regulations are more rigid than federal legislation

B) 

when there is a conflict between the state and the federal laws, state laws are not applicable when state regulations are more rigid than federal legislation

C) 

when there is a conflict between the state and the federal laws, state laws are applicable when state regulations are more rigid than federal legislation, an arbitrator must decide which law should take precedence

D) 

state laws always take precedence over federal laws

Question 14 (1 point)

Yanique is the new administrator at a mental health facility. She discovers that one of her staff members has shared her password with a coworker. This action violates policies and procedures and is the first occasion of difficulty with this employee. Disciplinary action should be taken by

Question 14 options:

A) 

referring the action to Human Resources.

B) 

waiting for another occurrence to act.

C) 

immediately dismissing the employee.

D) 

asking for guidance from Human Resources and then acting.

Question 15 (1 point)

The process of structuring or restructuring the health care system in terms of financing, purchasing, delivering, measuring, and documenting a broad range of health care services and products is generally referred to as

Question 15 options:

A) 

group practice

B) 

managed care

C) 

preferred provider organization

D) 

vertically integrated delivery system

Question 16 (1 point)

A process whereby a third-party payer evaluates the medical necessity of a course of treatment

Question 16 options:

A) 

nursing review

B) 

management review

C) 

utilization review

D) 

quality review

Question 17 (1 point)

Whenever a managed care organization possesses significant market share

Question 17 options:

A) 

antitrust implications can arise

B) 

greed can falter

C) 

malpractice is likely to occur

D) 

corporate liability is likely to occur

Question 18 (1 point)

Rachel’s work performance has diminished over the last 2 weeks. In addition, she has uncharacteristic mood swings and has exhibited difficulty concentrating. She is also having difficulties with tardiness and attendance. As her supervisor, you meet with Rachel to discuss your concerns. She reveals that she is struggling financially. What action should you take?

Question 18 options:

A) 

Terminate her.

B) 

Refer her to the Employee Assistance Program.

C) 

Assure her that as long as she can perform her job acceptably, her personal life is none of your concern.

D) 

Put her on probation

Question 19 (1 point)

When analyzing discipline problems, which of the following should be considered?

Question 19 options:

A) 

the prior performance of the employee in question

B) 

the prior performance of the employee in question

C) 

the seriousness of the problem

D) 

all answers apply.

Question 20 (1 point)

The National Labor Relations Act (NLRA), which serves as the foundation for U.S. labor laws and collective bargaining, is also known as

Question 20 options:

A) 

the Wagner Act.

B) 

the Fair Labor Standards Act.

C) 

the Family and Medical Leave Act.

D) 

the Equal Pay Act.

Question 21 (1 point)

A pharmacist who submits Medicaid claims for reimbursement of brand name drugs when less expensive generic drugs were actually dispensed has committed the crime of:

Question 21 options:

A) 

Product’s liability

B) 

Perjury

C) 

Fraud

D) 

Criminal negligence

Question 22 (1 point)

Unlike binding arbitration, the decision of a screening panel is

Question 22 options:

A) 

not arbitrary and is not imposed as a condition precedent to trial

B) 

conducted in lieu of a trial

C) 

not binding and is imposed as a condition precedent to trial, whereas arbitration is conducted in lieu of a trial

D) 

binding and is imposed as a condition precedent to trial

Question 23 (1 point)

The doctrine that provides that a court can hold a person causing an injury, concurrently with another person, equally liable for the entire judgment awarded is

Question 23 options:

A) 

joint and several liability

B) 

respondent superior

C) 

no-fault

D) 

independent contractor

Question 24 (1 point)

Valuable components of a risk management program include

Question 24 options:

A) 

sympathetic care after accidental injury to a patient

B) 

preparation of incident reports

C) 

prompt identification and investigation of specific incidents of patient injuries and, when possible, intervention and the training and education of employees and clinicians to assist in reducing exposure

D) 

definition of the cause of each incident

Question 25 (1 point)

Continuous quality improvement is an approach to

Question 25 options:

A) 

improving the quality of care on a continuing basis 

B) 

reducing quality while increasing the number of patients attended to 

C) 

long term care management 

D) 

peer review

Question 26 (1 point)

The ultimate successes of Continuous Quality Improvement requires commitment by the

Question 26 options:

A) 

organization’s leadership

B) 

administration and governing body

C) 

medical staff and nursing staff

D) 

at every level of the organization organization.

Question 27 (1 point)

Mandatory requirements for participation in The Joint Commission’s accreditation program

Question 27 options:

A) 

National Quality Forum

B) 

National Patient Safety Goals Quality Task Force

C) 

Advisory Commission

D) 

National Committee on QualityAssurance

Question 28 (1 point)

The Leapfrog Group and its members work together to

Question 28 options:

A) 

promote improvements in the safe delivery of health care by collecting and providing healthcare consumers with the necessary information to make informed health care decisions

B) 

increase preventable medical mistakes and reduce the quality and affordability of health care

C) 

promote improvements in the safe delivery of health care

D) 

collecting and providing healthcare consumers with the necessary information to make health uninformed care decisions

Question 29 (1 point)

The most widely discussed and debated unique patient identifier is the

Question 29 options:

A) 

Unique Physician Identification Number (UPIN).

B) 

patient’s social security number.

C) 

patient’s date of birth.

D) 

patient’s first and last names.

Question 30 (1 point)

The Occupational Safety and Health Act of 1970, the Americans with Disability Act, and the Vocational Rehabilitation Act are all federal legislation designed to

Question 30 options:

A) 

keep the workplace safe and accessible to all employees and customers.

B) 

prevent sexual harassment.

C) 

protect child labor.

D) 

ensure equal pay for equal work.

Question 31 (1 point)

Ty Ngynn is Assistant Director in Information Services. He has made an appointment with the Director of Human Resources to discuss his recent trip to the state HIM meeting with his Director, Wendy Richards. During the trip, Wendy repeatedly asked Ty to her room, suggesting they work on new plans for the department. When Ty declined, Wendy suggested it might not be worthwhile for him to attend future state meetings. The HR Director should

Question 31 options:

A) 

explain that off-site events are outside the scope of the HR Department.

B) 

explain that it is the Director’s right to select who attends professional meetings.

C) 

provide Ty with additional training on resisting unwanted advances.

D) 

take the complaint seriously and begin a sexual harassment investigation.

Question 32 (1 point)

Which of the following employees is exempt under the Fair Labor Standards Act?

Question 32 options:

A) 

an health care administrator who manages a department and is involved with planning and decision-making activities 90% of the time

B) 

the department secretary who spends 100% of her time performing clerical duties for the Director of Health Information Services

C) 

an RHIA who performs record analysis and coding 90% of the time and who supervises three employees

D) 

a file clerk who spends 100% of the time on filing activities

Question 33 (1 point)

An amendment to the Civil Rights Act of 1964 that extends the 180-day statute of limitations previously applied to the filing of an equal-pay lawsuit refers to the

Question 33 options:

A) 

Americans with Disabilities Act.

B) 

Lilly Ledbetter Fair Pay Act.

C) 

Age Discrimination in Employment Act.

D) 

Family and Medical Leave Act.

Question 34 (1 point)

You work in a unionized organization and have filed a grievance. Which of the following will most likely take place?

Question 34 options:

A) 

The facility policies and procedures for prompt and fair action on any grievance will be followed.

B) 

The time from complaint to resolution should be no longer than 90 days.

C) 

The grievance procedure regulations stipulated in the union contract will be followed.

D) 

You can be terminated for registering a grievance.

Question 35 (1 point)

One of your new employees has just completed orientation, receiving basic HIPAA training. You are now providing more specific training related to her job. She asks whether the information she provided during the hiring process, as well as benefits claims, are also protected under HIPAA. Which of the following can you assure her that the Human Resources Department protects?

Question 35 options:

A) 

benefits enrollment

B) 

Employee Assistance Program contacts

C) 

OSHA information

D) 

all personal health information (PHI)

Question 36 (1 point)

The Office of Inspector General, established in the Department of Health and Human Services in 1976, investigates cases of

Question 36 options:

A) 

criminal mischief

B) 

Medicare and Medicaid fraud

C) 

criminal negligence

D) 

patient abuse

Question 37 (1 point)

Physician assistant who intentionally injects a patient with a lethal dose of a medication resulting in the patient’s death is guilty of

Question 37 options:

A) 

misdemeanor

B) 

negligence                          

C) 

fraud

D) 

murder

Question 38 (1 point)

The unwanted removal of life-support equipment can be considered the crime of

Question 38 options:

A) 

petty theft

B) 

murder

C) 

battery

D) 

assault

Question 39 (1 point)

If a health care provider shows reckless disregard for the safety of his patients and intentional indifference to any injury that could follow his act(s), he could be charged with or sued for

Question 39 options:

A) 

assault

B) 

criminal negligence

C) 

battery

D) 

civil negligence

Question 40 (1 point)

A sworn statement from a witness that can be used as evidence at a trial is called a

Question 40 options:

A) 

counter suit

B) 

pleading

C) 

claim

D) 

deposition

Question 41 (1 point)

Price fixing is considered a per se violation of the antitrust laws. Price fixing occurs when two or more competitors come together to decide on a price that will be charged for services or goods. The per se rule here applies to

Question 41 options:

A) 

price fixing and group boycotts

B) 

horizontal market allocation and price fixing

C) 

group boycotts

D) 

tying

Question 42 (1 point)

Credentialing should include at a minimum

Question 42 options:

A) 

privileges not requested

B) 

current in competency        

C) 

geographical location

D) 

privileges requested and current competency

Question 43 (1 point)

To help hospitals move toward a culture of safety, they need to

Question 43 options:

A) 

discourage patients from questioning their care

B) 

 ensure that accountability and responsibility is fluid as to who is responsible for monitoring an organization’s safety initiatives.

C) 

involve the medical staff in the development and implementation of systems that are designed to create a culture of safety

D) 

educate a few staff members as to their individual roles in establishing and maintaining a safe environment for patients within six months prior to appointment to a safety committee

Question 44 (1 point)

A physician takes the health records of a group of HIV-positive patients out of the hospital to complete research tasks at home. The physician mistakenly leaves the records in a restaurant where they are read by a newspaper reporter who publishes an article that identifies the patients. The physician can be sued for:

Question 44 options:

A) 

Slander

B) 

Willful infliction of mental distress

C) 

Libel

D) 

Invasion of privacy

Question 45 (1 point)

The EMTALA regulations include all of the following except which?

Question 45 options:

A) 

Transfers of non-stabilized patients must only occur under certain specific conditions.

B) 

Every patient arriving at the emergency department must receive an appropriate “medical screening exam.”

C) 

If an emergency medical condition exists, the hospital must treat and stabilize that condition or transfer the patient.

D) 

Non-Medicare indigent patients must be transferred to the nearest level-1 trauma center.

Question 46 (1 point)

A hospital is reviewing the quantity and type of resources being used in the provision of chemotherapy treatments. This is an example of:

Question 46 options:

A) 

FOCUS-PDCA review

B) 

Accreditation review

C) 

Medication reconciliation

D) 

Utilization management review

Question 47 (1 point)

The Joint Commission measures that are standardized metric tools that provide an indication of an organization’s performance are called

Question 47 options:

A) 

Measures of Central Tendency

B) 

Vital Statistics Measures

C) 

Core Performance Measures

D) 

Performance Improvement Measures

Question 48 (1 point)

The Uniform Health-Care Decisions Act ranks the next-of-kin in the following order for medical decision-making purposes:

Question 48 options:

A) 

Adult sibling, adult child, spouse, parent

B) 

Parent, spouse, adult child, adult sibling

C) 

Spouse, parent, adult sibling, adult child

D) 

Spouse, adult child, parent, adult sibling

Question 49 (1 point)

An Health Care professional who releases health information that he or she knows will result in genetic discrimination is violating the ethical principle of

Question 49 options:

A) 

Autonomy

B) 

Beneficence

C) 

Justice

D) 

Nonmaleficence

Question 50 (1 point)

New equipment has just been purchased for a Health Information Services Department. Prior to its arrival and placement in the department, it is important for the manager to adhere to the rules and regulations governed by

Question 50 options:

A) 

OSHA

B) 

FMLA

C) 

SSA

D) 

CMS

D) 

CMS

Analysis and Identification of the Problem: What do you believe Daniel's problem(s) are? What might be the nursing diagnoses? Use the following for identification.

Daniel is a 16 year old boy who is an identical twin. He and his brother Jeff are very close and do most things together. While Daniel excels at sports he believe his brother is much better at most everything. Daniel, his brother, and their two sisters live with their parents in the Midwest. Recently Daniel has been feeling more tired than usual. He thought it was because of his schedule and school work, which he is fairly good at. He gets mostly Bs, but his grades have been slipping of late. One day he fainted while getting ready for a game. His coach called his parents to let them know Daniel was taken to the Emergency Room. While there the doctor decided to admit Daniel to the hospital for observation. At the time he was running a slight fever, his breathing was shallow, and he was sweating. He was also very sleepy and his blood pressure was high. He did have some abnormal laboratory work, but his doctor was not too concerned at present. Daniel also stated that he felt achy.

You are assigned to take care of Daniel today and when you walk into his room, his mother and brother Jeff are there. Daniel appears to be sleeping. In your written assignment, respond to the following questions applying the nursing process:

Assessment: What type of objective and subjective data can you collect with what you know? How will you collect these data? What further evidence do you need?

Analysis and Identification of the Problem: What do you believe Daniel’s problem(s) are? What might be the nursing diagnoses? Use the following for identification.

Planning: Identify two goals and one nursing intervention for each, based on your nursing diagnoses.

While you will not be able to implement or evaluate, how well do you think your nursing interventions might help with Daniel’s care.

Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues.

Select a global health issue affecting the international health community. Briefly describe the global health issue and its impact on the larger public health care systems (i.e., continents, regions, countries, states, and health departments). Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues. 

Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question. Select a global health issue affecting the international health community. Briefly describe the global health issue and its impact on the larger public health care systems (i.e., continents, regions, countries, states, and health departments). Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues.