Mastering In Nursing Advance Nurse Practice

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Apply information from the Aquifer Case Study to answer the following discussion questions:

· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not? 

· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?

· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

You and Dr. Lee take a few minutes to review Mr. Payne’s chart:

Vital signs:

· Temperature: 98.6° Fahrenheit

· Heart rate: 80 beats/minute

· Respiratory rate: 12 breaths/minute

· Blood pressure: 130/82 mmHg

· Weight: 170 pounds

· Body Mass Index: 24 kg/m2

Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.

Past Surgical History: None

Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,

Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.

Medication:

· metformin 500mg 2 twice daily

· glyburide 5mg 2 twice daily

· amlodipine 2.5 mg daily

· lisinopril 40 mg daily

· simavastin 40 mg daily

Allergies: No known drug allergies.

Can you tell me about your back pain?”

“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.

“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”

“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”

“It’s probably a 7.”

“Have you found anything that improves the pain?”

“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”

“What about positions that make things better or worse?”

“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”

“Have you had back pain before?”

“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”

Review of Systems

Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.

Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.

Back Exam – Standing:

Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.

Back Exam – Seated:

Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.

Pulmonary Exam: His lungs are clear.

Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.

Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:

Pertinent History

Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.

Pertinent Exam Findings

Vital signs: stable

Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.

Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.

You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.

FOLLOW-UP TREATMENT

MANAGEMENT

One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.

MRI report:

1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.

2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.

You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.

You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.

Application: Using Microsoft Project

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Starting a project without a plan is like going on a road trip without any directions. You may progress along the way, but you might not end up at your desired destination. A project plan provides basic information that guides the execution and control of the project. At its most fundamental level, a project plan will describe the “who, what, when, and why” of a project. Microsoft Project is one of the most widely used project planning tools. The ability to understand and create project plans in Microsoft Project enables a project manager to effectively plan and manage project implementations.

In this Assignment, you generate a project plan using Microsoft Project.

To prepare:

  • Review the information in this week’s Learning Resources on using Microsoft Project.
  • Consider how to efficiently schedule tasks in a project plan.
  • Think about how you should sequence tasks that have dependencies.

To complete this Assignment, you will create a Microsoft Project plan for a patient information management system. The primary deliverable for the plan is the patient information management system itself, but it is comprised of many modules. Include the following tasks, subtasks, and timeframes:

1) Create the Admission, Discharge, and Transfer Module (requires subtask I, configuration period: 25 days, training period: 10 days) 

2) Subtask I: Create the Patient Registration Module (requires subtask II, configuration period: 4 days, training period: 4 days)

3) Subtask II: Create the Master Patient Index (configuration period: 4 days)

4) Subtask III: Create the Patient Scheduling Module (requires subtask II, configuration period: 7 days, training period: 15 days)

Required Readings

Biafore, B. (2010). Microsoft Project 2010: The missing manual. Sebastopol, CA: O’Reilly.

  • Chapter 2, “Planning a Project” (pp. 39–57)

 This chapter supplies a brief introduction on project planning. The chapter describes the contents of a project plan along with the process of creating relevant documents.

Coplan, S., & Masuda, D. (2011). Project management for healthcare information technology. New York, NY: McGraw-Hill.

  • Chapter 5, “Change Management” (pp. 193–237)

 In this chapter, the authors review change management knowledge areas. The authors describe a variety of analysis methods applicable to change management processes and outputs.

Project Management Institute. (2013). A guide to the project management body of knowledge (PMBOK guide) (5th ed.). Newtown Square, PA: Author.

  • Chapter 3, “Project Management Processes” (pp. 47–61)

 This chapter supplies information on managing a project that uses networked processes. The chapter describes project management processes related to each phase of a project.

Campbell, R. J. (2008). Change management in health care. The Health Care Manager, 27(1), 23–39. 

Retrieved from the Walden Library databases.

 In this article, the author highlights the work of two leaders in the field of change management. The author demonstrates how the work of these leaders can be applied to health care organizations.

Merrell, P. (2012). Effective change management: The simple truth. Management Services, 56(2), 20–23. 

Retrieved from the Walden Library databases.

 In this article, the author provides six steps for effective change management. The author also supplies supplementary information on the importance of learning activities, measuring success, and managing change management strategies.

Required Media

Laureate Education (Producer). (2013a). Establishing a team [Video file]. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 8 minutes.

 In this video, Dr. Mimi Hassett discusses important considerations when assembling a project team, such as who to include and whom to consult. She talks about how project size, goals, and timelines can impact those decisions, and she also offers examples of how to keep enthusiasm for a project moving forward as the challenges toward completion arise.

Schifalacqua, M., Costello, C., & Denman, W. (2009). Roadmap for planned change, part 1: Change leadership and project management. Nurse Leader, 7(2), 26–29. 

Retrieved from the Walden Library databases.

 In this article, the authors explore the essential elements of change theory and project management. The article details many tools and concepts that assist in managing and planning change at various scales.

Microsoft Corporation. (2012). Getting started: Introduction to project management. Retrieved from http://office.microsoft.com/en-us/project-help/getting-started-introduction-to-project-management-HA010359477.aspx?CTT=3

 Review this web page, which provides an overview of basic project management concepts. It also provides links to other pages which demonstrate how to apply the aforementioned concepts in Microsoft Project 2010.

Implementation Strategies

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Throughout this course, you have been developing a workflow redesign that could be applied in a health care practice setting. However, determining an appropriate workflow redesign is only part of the process. It is much easier to design something on paper than it is to actually make it work effectively within an organization. Nurse informaticists must consider how the workflow redesign can be implemented in a real-world organization. Attention needs to be focused on understanding organizational risks, organizational culture, and the needs of the end user. Implementing a new project may be disruptive. The key is to plan in such a way as to minimize this disruption as much as possible.

In this Discussion, you consider possible implementation strategies for the workflow redesign measure that you selected for your Course Project. (Incomplete Medication Reconciliation)

To prepare:

  • Review the articles in this week’s Learning Resources and reflect on the insights they provide on implementing a workflow redesign project within a health care setting. Also reflect on your past experience with workflow redesign and technology integration. What implementation strategies were applied?
  • Review pages 377–397  (SEE ATTACHED PDF FILE) in the Dennis & Wixom textbook. Identify a specific implementation or conversion strategy that would be appropriate for the workflow redesign you selected for your Course Project. For example, will it be a phased implementation? If so, which applications will be launched first, and why?
  • Consider why the strategy you selected would be appropriate for the scope of your workflow redesign project and your practice setting. Reflect on how it will support the needs of end users.
  • Consider the benefits and drawbacks of applying the implementation strategy you selected. What would the positive outcomes be? What potential challenges or barriers might you encounter?

With these thoughts in mind:

Post by tomorrow  10/18/2016 a minimum of 550 words essay in APA format with 3 references  from the required readings below. Apply the level one headings as numbered below:

1) A summary of the workflow redesign measure you plan to use for Part 3 of your Course Project. (Incomplete medication reconciliation)

2) Describe the implementation (or conversion) strategy you would recommend, and justify why it would be appropriate in your practice setting and for the scope of your workflow redesign.

3) Explain the potential outcomes of this strategy, including benefits and potential obstacles.

Required Readings

Dennis, A., Wixom, B. H., & Roth, R. M. (2015). Systems analysis and design (6th ed.). Hoboken, NJ: Wiley.

  • Chapter 12, “Moving Into Implementation” (pp. 377–397)

In this chapter, the authors explore the process of assigning, initializing, and completing tasks during the information system development phases. They also clarify what occurs in this phase of the process and how to insure the best results.

  • Chapter 13, “Transition to the New System” (pp. 400–424)

The focus of this chapter is on the process of transitioning from one method of collecting and storing information to a new information system. It explores the immediate effect of those changes and how to prepare your organization to profit from the improvements.

Gagnon, M.-P., Ouiment, M., Godin, G., Rousseau, M., Labrecque, M., Leduc, Y., & Abdeljelil, A. B. (2010). Multi-level analysis of electronic health record adoption by health care professionals: A study protocol. Implementation Science, 5, 30–39.

Retrieved from the Walden Library databases.

 In this article, the authors seek to determine the best method for ensuring the adoption of electronic health records (EHR). They review a number of different theoretical frameworks for facilitating the adoption process and then outline a research study to determine which model is most relevant.

Ludwick, D. A., & Doucette, J. (2009). Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics, 78(1), 22–31.

Retrieved from the Walden Library databases.

 The authors of this study conducted a systematic literature review to examine current research on the implementation and use of electronic health records. Their review indicated that some of the key factors in determining the success of an implementation were the design of the interface, project management, and functionality. Data security was also a concern.

van Achterberg, T., Schoonhoven, L., & Grol, R. (2008). Nursing implementation science: How evidence-based nursing requires evidence-based implementation. Journal of Nursing Scholarship, 40(4), 302–310.

Retrieved from the Walden Library databases.

 This article examines the reasons behind persisting ineffective practices in nursing. The authors review relevant strategies for successfully changing behavior and implementing new products.

Optional Resources

Leonard, J. (2011). Implementation. Retrieved from http://igcseict.net/systems_analysis_and_design/implementation_overview.php

Integration of Health Systems

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Note: Before completing this Assignment, please familiarize yourself with the Week 4 Assignment Rubric, located in the Course Information area of the course navigation menu.

Intermountain Healthcare is a high-performing integrated health system with facilities in Utah and Idaho. The health system has a long-standing clinical integration structure that encourages professional collaboration. Despite this, in 1999, many physicians at Intermountain Healthcare found it difficult to fulfill the needs of patients with co-occurring physical and mental health conditions. To efficiently and effectively address this issue, Intermountain Healthcare adopted a mental health integration model in many of its primary care facilities, as well as some of its specialty clinics and partner clinics. The team-based approach has improved the coordination of services, resulting in higher quality care at a savings of cost.

Consider the example above. What advantages does integration afford Intermountain Healthcare? Do other integrated health systems experience similar benefits? Are there disadvantages to integration? If so, what are they?

To prepare for this Assignment,review the information related to vertical and horizontal integration presented in the Learning Resources.

Select one of the following horizontally integrated health systems:

  • National Surgical Hospitals
  • Select Medical Healthcare
  • Sunrise Senior Living
  • Labcorp
  • Quest Diagnostics
  • Pfizer Pharmaceuticals

Also select one of the following vertically integrated health systems:

  • Kaiser Permanente
  • Mayo Clinic
  • Cleveland Clinic
  • MedStar Health
  • Memorial Hermann Healthcare System Houston

As an alternative, you may use Becker’s Hospital Review resource to identify a vertically integrated health system.

Using the Walden Library and credible sources on the Internet, research your selected health systems. Investigate the rationale for pursuing integration and the strategies each health system has used to achieve integration. Note information related to the size of each health system, settings/locations, and types of services it provides.

Based on your research, consider the ways in which the two health systems are similar to and/or different from one another.

Assess the business and health care-related implications of horizontal and vertical integration of your selected health systems. How does integration impact the management of your selected organizations and the patients/consumers they serve, especially in terms of cost, quality, and access?

Consider any applicable insights you have gained through the Discussion for this week.

The Assignment

Write a paper in which you:

  • Compare the horizontally integrated health system and the vertically integrated health system you have selected (e.g., size, settings/locations, and types of services).
  • Explain each health system’s rationale for pursuing integration and the strategies it has used to achieve integration.
  • Assess the business and health care-related implications of integration for your selected health systems, including how integration impacts the patients/consumers the organization serves.

General Guidance on Assignment Length: Your Assignment should be 3–4 pages, excluding a title page and references. Refer to the Week 4 Assignment Rubric for grading elements and criteria. Your Instructor will use the rubric to assess your work.

Required Resources

Readings

  • Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.
    • Chapter 9, “Managed Care and Integrated Organizations” (pp. 361–368)
  • Cohen, A., Klein, S., & McCarthy, D. (2014). Hill Physicians Medical Group: A market-driven approach to accountable care for commercially insured patients. Retrieved from http://www.commonwealthfund.org/~/media/files/publications/case-study/2014/oct/1770_cohen_hill_physicians_aco_case_study.pdf
  • Cutler, D. M., & Morton, F. S. (2013). Special communication: Hospitals, market share, and consolidation. JAMA, 310(18), 1964–1970.
    Retrieved from the Walden Library databases.
  • Sanford, K. D. (2013). Integration requires new roles and responsibilities. Healthcare Financial Management, 67(3), 56–60.
    Retrieved from the Walden Library databases.
  • Summer, L. (2014). Research insights: Integration, concentration, and competition in the provider marketplace. Retrieved from http://www.academyhealth.org/files/publications/AH_R_Integration%20FINAL2.pdf

Use the following resources to select integrated health systems on which to focus for your Assignment. You may also use this list to develop background information as you research health systems in your area for the Discussion.

  • Rodak, S. (2013). 100 integrated health systems to know. Retrieved from http://www.beckershospitalreview.com/lists/100-integrated-health-systems-to-know.html

Vertically Integrated Health Systems

  • Cleveland Clinic. (n.d.). Retrieved March 27, 2015, from http://my.clevelandclinic.org
  • Kaiser Permanente. (n.d.). Retrieved March 27, 2015, from http://kp.kaiserpermanente.org/
  • Mayo Clinic. (n.d.). Retrieved March 27, 2015, from http://www.mayoclinic.org
  • MedStar Health. (n.d.). Retrieved March 27, 2015, from https://www.medstarhealth.org/
  • Memorial Hermann Healthcare System Houston. (n.d.). Retrieved March 27, 2015, from http://www.memorialhermann.org

Horizontally Integrated Health Systems

  • Labcorp. (2014). Retrieved March 27, 2015, from https://www.labcorp.com/
  • National Surgical Healthcare. (n.d.). Retrieved March 27, 2015, from http://www.nshinc.com
  • Pfizer Pharmaceuticals. (n.d.). Retrieved March 27, 2015, from http://www.pfizerrxpathways.com/
  • Select Medical. (n.d.). Retrieved March 27, 2015, from http://www.selectmedical.com
  • Sunrise Senior Living. (n.d.). Retrieved March 27, 2015, from http://www.sunriseseniorliving.com/
  • Quest Diagnostics. (n.d.). Retrieved March 27, 2015, from http://www.questdiagnostics.com/

Virtue Ethics Essay

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Write a 1- 2 page essay addressing the discussion questions posed for the one you selected.  Be sure to clearly identify the news clipping you selected.

Adhere to APA formatting and cite all sources. Review the rubric for further information on how your assignment will be graded.

Find Out More: You may use these and other outside sources to frame your discussion.

  • The Pain of Wrong Site Surgery
  • Judgment Upheld in Arkansas Brain Surgery Lawsuit
  • National Quality Forum

Assignment Discussion Questions

1. Discuss the issues of integrity in this case.

2. Should criminal charges be considered in this case, if accurately reported? Discuss your answer. 

3. Why did you choose to respond to this story?

4. How is integrity displayed in your clinical setting?

Video transcript

 #1 Wrong Operation Doctor (ethics and integrity) Hospitals find it hard to protect patients from wrong-site surgery. Last year a jury returned a $20 million negligence verdict against Arkansas Children’s Hospital for surgery performed on the wrong side of the brain of a 15-year-old boy who was left psychotic and severely brain damaged. Testimony showed that the error was not disclosed to his parents for more than a year. The hospital issued a statement saying it deeply regretted the error and had “redoubled our efforts to prevent” a recurrence. So, what happened? “Health care has far too little accountability for results … . All the pressures are on the side of production; that’s how you get paid,” said Peter Pronovost, a prominent safety expert and medical director of the Johns Hopkins Center for Innovation in Quality Patient Care. He added that increased pressure to quickly turn over operating rooms has trumped patient safety, increasing the chance of error. Kenneth W. Kizer, who coined the term “never event” nearly a decade ago when he headed the National Quality Forum, a leading patient safety organization, said he believes reducing the number of errors will require tougher reporting rules and increased transparency.

Origin, Organization and Performance

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Answer the following questions:

  1. For a hospital to operate efficiently and effectively, the three important influences in its governance, medical staff, board of trustees, and administration, must work together in reasonable harmony. What factors might contribute to tensions among these groups?
  2. As the nursing profession has expanded through advanced degrees, specialization, and clinical practice, nurses’ salaries and responsibilities have also increased. Now, hospitals substitute non-nurses for nurses to perform all but the most technical tasks. What are the implications for the nursing profession? Have nurses lost their traditional role of hands-on patient care and, if so, is that to their advantage or disadvantage?
  3. The traditional management style of hospitals has been hierarchical and internally focused.  What are three important challenges that face hospitals to accommodate new payer and consumer expectations?
  4. The availability of hospital insurance removed an important cost constraint from hospital services and charges. What were some positive and negative consequences of that development?
  5. The organization and practices of modern hospitals reflect the promotion of specialization and sub-specialization by academic health centers. What were the advantages and disadvantages to patients of increasing the number of physicians who limit their activities to narrower fields of practice?
  6. With significant oversupply of hospital beds in the U.S. what is the rationale for taxpayer support of the separate and costly hospital system of the Department of Veterans Affairs?

Health Statistics Part 1 Case

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Required Reading and Resources

Centers for Disease Control and Prevention [CDC]. (2012). Lesson 4: Displaying public health data. In Principles of epidemiology in public health practice [3rd ed.]. Retrieved from www.cdc.gov/ophss/csels/dsepd/ss1978/lesson4/index.html

Cook, A., Netuveli, G., & Sheikh, A. (2004). Chapter 1: Laying the foundations: Measurements and probability. In Basic skills in statistics: A guide for healthcare professionals (pp. 3-14). London, GBR: Class Publishing. eISBN: 9781859591291.

Statistics Learning Centre. (2011, December 13). Types of data: Nominal, ordinal, interval/ratio . Retrieved from http://www.youtube.com/watch?v=hZxnzfnt5v8

Norman, G. R., & Streiner, D. L. (2014). Section the first: The nature of data and statistics: Chapter 1: The basics. In Biostatistics: The bare essentials [4th ed., e-Book]. Shelton, Connecticut: PMPH-USA, Ltd. eISBN-13: 978-1-60795-279-4. Available in the Trident Online Library EBSCO eBook Collection.

Partners in Information Access for the Public Health Workforce. (2016, August 9). Health data tools and statistics. Retrieved from https://phpartners.org/health_stats.html

HOMEWORK ASSIGNMENT:

Part I (approximately 1–1½ pages, total):

Copy and paste the following examples (1-6 below), then respond by classifying each of the following variables as either: nominal, ordinal, interval, or ratio. Provide a brief explanation where indicated.

  1. A researcher studying lifespan      categorizes individuals into single, married, divorced, or widowed. What      type of variable measurement is this?
  2. A cognitive scientist places      her subjects into categories based on how anxious they tell her that they      are feeling: “not anxious,” “mildly anxious,” “moderately anxious,” and      “severely anxious,” and she uses the numbers 0, 1, 2 and 3 to label      categories where lower numbers indicate less anxiety. What type of      variable measurement is this? Are the categories mutually exclusive?
  3. A Physician diagnoses the      presence or absence of disease (i.e., yes or no). What type of variable      measurement is this?
  4. A person weighing 200 lbs. is      considered to be twice as heavy as a person weighing 100 lbs. In this      case, what type of measurement is body weight?
  5. A nurse takes measurements of      body temperature on patients and reports them in units of degrees      Farenheit as part of a study. What type of variable measurement is this?
  6. Patients rate their experience      in the emergency room on a five point scale from poor to excellent (1 =      very poor, 2 = not very good, 3 = neither good nor bad, 4 = quite good,      and 5 = excellent). What type of variable measurement is this? Is the      difference between a 1 and a 2 necessarily the same as the difference      between a 3 and a 4? Explain briefly.

Part II: Statistics (1/2 page)

Given what you’ve learned in this module about the meaning of “statistics,” choose one of the examples from Part I (1-6), and raise a relevant question of your own that could be answered by a statistician. Then without answering your own question, explain how a pattern could be studied or a useful prediction made based on data that are to be collected.

Part III: Quantitative vs. Qualitative Data (approximately 1–1½ pages)

A health scientist wishes to measure how well participants diagnosed with Post Traumatic Stress Disorder are coping. Explain how a variable such as coping could be measured quantitatively or qualitatively.

MOTIVATION AND BEHAVIOR

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You are in charge of developing a team-building activity to improve collaboration and increased communication for your team members. You are the newly promoted manager. Your department is closing for the day so you have four hours together in a team environment.

Review the following details of team members:

  • Rosanna (46) and Mary (20) are two staff members who do not get along. Rosanna is quiet and a loner. Mary is outspoken, and talks about her personal life to friends.
  • Cindy, (35), and Lolita, (40), are part-time staff. They are stressed due to economy. They interact with full time staff, but full time staff think they complain too much and shouldn’t because they are part time
  • Chip is a twenty-three-year-old maintenance worker who works part-time job at night, in addition to full-time role. He is often tired.
  • Samir is fifty-five, works full-time, and cannot wait until retirement.
  • Sarah (52) is a negative department manager who complains. She is a strong informal leader and has influence over the group.
  • Jerry is twenty-four and in graduate school. He has a positive attitude and is not motivated because no one likes to work together.

You need to divide the team into three groups. Remember this is a team-building activity.

  • How will you make the determination which members to put together?
  • Should members, who have a negative attitude, be placed with members who are positive? Why or why not?
  • How will a negative manager affect the overall group dynamic as opposed to a positive leader who wants to see the team develop?
  • How influential can an informal leader be among team members?
  • What barriers to effective teamwork can you anticipate and how will it be addressed?

Submission Details:

  • Your presentation should consist of 12–15 professional color Microsoft PowerPoint slides (not including the title and reference slide) along with detailed speaker notes to include examples to support each slide.
  • Support your responses with examples.
  • Cite any sources in APA format
  • Present the additional information in the Notes section.

MEASURES OF QUALITY

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The Joint Commission and Centers for Medicare and Medicaid Services (CMS) developed quality and safety indicators for various health care systems. These indicators seek to establish accountability for health care organizations through a reporting system, which is available to the public. For this Discussion, explore various accrediting organizations and specific measures that pertain to quality. In your research on accrediting organizations, consider how these quality measures affect quality outcomes, support ethical principles, and influence the delivery of clinical services.
 

To prepare:

  • Select one specific quality indicator      from the Week 2 Discussion and compare it with those outlined in this      week’s Learning Resources (In week 2 discussion, I spoke about nosocomial      infections and pain management as quality indicators).
  • Review the accrediting body standards      that pertain to your organization focusing on those standards that require      your organization to define its quality management program.
  • Consider regulatory requirements at      the state or national level that affect quality outcomes in your      organization.
  • Ask yourself: How do the Centers for      Medicare and Medicaid Services (CMS) restricted reimbursements affect      quality management or improvement efforts at my organization? How do these      standards and regulations influence or support ethical principles and      influence patient care and nursing practice?

By tomorrow Wednesday 12/13/17, write a minimum of 550 words in APA format with at least 3 references from the list below that addresses the level one & two headings as numbered and lettered below:

post a cohesive scholarly response that addresses the following:

1) Choose any measurement and explain the extent to which your chosen measure is affected by CMS driven incentives and disincentives. 

2) From a systems perspective, discuss how this measure affects:

a. Quality outcomes 

b. Supports ethical principles 

c. Influences patient care and nursing practice.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 5: “Data Collection”

Chapter 6: “Statistical Tools for QI”

Park, J., Konetzka, R. T., & Werner, R. M. (2011). Performing well on nursing home report cards: Does it pay off? Health Services Research, 46(2), 531–554. doi:10.1111/j.1475-6773.2010.01197.x

The study in this article evaluates whether or not nursing homes benefit from improvements in quality measures. Four financial outcomes are measured before and after the improvements are enacted. The study shows that the nursing homes that improved quality measures benefitted financially.

Suchy, K. (2010). A lack of standardization: The basis for the ethical issues surrounding quality and performance reports. Journal of Healthcare Management, 55(4), 241–251.

Because performance reports are easily found online, this article supports creating ethical guidelines for the performance reports of the health care industry. It compares nearly ten different organizations that provide performance reporting, and then it proposes an ethical framework and principles for public quality reporting.

Wachter, R. M., & Pronovost, P. J. (2009). Balancing “no blame” with accountability in patient safety. New England Journal of Medicine, 361(14), 1401–1406.

This article addresses the issue of individual accountability in health care organizations. It suggests moving from a culture within health care that does not place blame on individuals to a culture where individuals become more accountable.

Centers for Medicare & Medicaid Services. (n.d.). Quality initiatives: Overview. Retrieved from http://www.cms.gov/QualityInitiativesGenInfo/

Created by the U.S. Department of Health & Human Services, this website overviews quality initiatives that affect the health care industry. It also provides information and downloadable PDFs on the Post-Acute Care Reform Plan and Development of Quality Indicators for Impatient Rehabilitation Facilities (IRF).

Required Media

Video: Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: External quality improvement. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

The presenters in this video discuss various external organizations involved in quality, and examine the enforcement of standards by governmental agencies versus voluntary organizations. This program also addresses the publication of quality information and why organizations should do their own reporting in addition to mandated reporting. Licensing, credentialing, and certification are discussed as they relate to the social compact that health care providers have for quality and safety.

Quality Improvement Initiative

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When attempting to garner support for a quality improvement initiative, it is important to demonstrate how the initiative supports the organization’s mission, vision, and values, as well as external factors that influence an organization’s priorities. Delivering a proposal for a quality improvement initiative requires clear, concise communication of the plan.

By tomorrow Tuesday 01/09/18 by 10 pm, write a minimum of 550 words essay with at least 2 references in APA format. Include the level one headings as numbered below:

1) Choose a QI initiative which has been the subject of focus in any healthcare setting. Explain the rationale that your senior leaders used in selecting this initiative for attention and focus.

2) Explain how adverse events are handled in your organization from the public’s perspective and well as internally.

3) Find a scholarly article or one from the public press, published within the last 5 years which recounts a serious error. Relate this error to any organization with which you have some familiarity.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 11: “Patient Safety and Medical Errors”

Clarke, C. M., & Persaud, D. D. (2011). Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. Journal of Patient Safety, 7(1), 11–18. doi:10.1097/PTS.0b013e31820c98a8

Designed for leaders who want to improve quality care, this article focuses on clinical handovers that occur within acute care facilities. It provides a model for improvement and is intended to be a supplemental resource that can be used with the existing research and literature on this topic.

Sennett, C. (2010). Healthcare reform: Quality outcomes measurement and reporting. American Health & Drug Benefits. Retrieved from http://www.ahdbonline.com/article/healthcare-reform-quality-outcomes-measurement-and-reporting 

The article on this website discusses features of the Patient Protection and Affordable Care Act (PPACA), focusing on the outcomes and implications for quality outcomes measuring and reporting.

Lazarus, I.R. (2011). What will It take? Exploiting trends in strategic planning to prepare for reform. Journal of Healthcare Management, 56(2), 89–93.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Organizational priorities for quality improvement. Baltimore: Author.

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

This video provides an overview of organizational factors that influence quality. Lillee Gelinas discusses the importance of teamwork and enlisting leadership to help move quality initiatives forward. Other topics addressed include the role of stakeholders in improving patient safety and the responsibility of hospital board members in setting the quality and safety agenda.