assignment 10

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assignment 10

1. In the last century, what historical, social, political, and economic trends and issues have influenced today’s health-care system?

2. What is the purpose and process of evaluating the three aspects of health care: structure, process, and outcome?

3. How does technology improve patient outcomes and the health-care system?

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4. How can you intervene to improve quality of care and safety within the health-care system and at the bedside?

2. Select one nonprofit organization or one government agencies that influences and advocates for quality improvement in the health-care system. Explore the Web site for your selected organization/agency and answer the following questions: •

What does the organization/agency do that supports the hallmarks of quality? •

What have been the results of their efforts for patients, facilities, the health-care delivery system, or the nursing profession? •

How has the organization/agency affected facilities where you are p

​Population affected by disabilities.

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​Population affected by disabilities.

Chapter 21 Populations Affected by Disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Most people whose lives do not end abruptly will experience disability. – Nies & McEwen (2015) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Doing a Self-Assessment      What comes to mind when you think of someone with a disability? Picture yourself as a person with a disability. Imagine yourself as a nurse with a visible disability, or a client receiving care from a nurse with a disability. Think about living in a family affected by disability. What is the experience of living with disability within your community? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Definitions for Disability Disability is the interaction between individuals with a health condition and personal and environmental factors. – World Health Organization, 2012 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by

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Saunders, an imprint of Elsevier Inc. 4 WHO International Classification of Functioning, Disability, and Health    Disability is an umbrella term covering impairments, activity limitations, and participation restrictions (individual level). An impairment is a problem in body function or structure—activity limitation or participation restriction (micro level). A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role (macro level). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Table 21-1 Characteristic Definition Measurability Illustrations Level of analysis Impairment Disability Physical deviation from May be objective and measurable normal structure, function, physical organization, or development Objective and measurable May be objective and measurable Micro level (e.g., body organ) Individual level (e.g., person) Handicap Not objective or measurable; is an experience related to the responses of others Not objective or measurable; is an experience related to the responses of others Spina bifida, spinal Cannot walk Reflects physical and cord injury, amputation, unassisted; uses psychological and detached retina crutches and/or a characteristics of the manual or power person, culture, and wheelchair; blindness specific circumstances Macro level (e.g., societal) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 National Agenda for Prevention of Disabilities (NAPD) Model Figure 21-1 Reprinted with permission from Pope AM, Tarlov AR, editors: Disability in America: toward a national agenda for prevention, Washington, DC, 1991, Institute of Medicine, National Academy Press. Copyright © 1991 by the National Academy of Sciences. Courtesy National Academy Press, Washington, DC. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Quality of Life Issues       Transportation to a needed service Cost of care Appointment challenges Language barriers Financial issues Migrant/noninsured issues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Models for Disability 1. Medical model—a defect in need of cure through medical intervention 2. Rehabilitation model—a defect to be treated by a rehabilitation professional 3. Moral model—connected with sin and shame 4. Disability model—socially constructed Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Disability: A Socially Constructed Issue   Disability is a complex, multifaceted, culturally rich concept that cannot be readily defined, explained, or measured (Mont, 2007). Whether the inability to perform a certain function is seen as disabling depends on socio-environmental barriers (e.g., attitudinal, architectural, sensory, cognitive, and economic), inadequate support services, and other factors (Kaplan, 2009). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 “Medicalization” Issues  Nurse needs to differentiate … ➢ A person who has an illness and becomes disabled secondary to the illness versus … ➢ A person who has a disability, but may not need treatment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 “Medicalization” Issues (Cont.)  Nurse’s interaction with PWD and families ➢ Approach on an eye-to-eye level ➢ Listen to understand ➢ Collaborate with the person/family ➢ Make plans and goals that meet the other’s needs and draw on strengths and improve weaknesses ➢ Empower and affirm the worth and knowledge of the person/family with a disability ➢ Promote self-determination and allow choices Note: PWD = persons with disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Historical Perspectives       Long history of institutionalization/segregation Often viewed as sick and helpless In the 20th century, special interest groups emerged to advocate for PWD (e.g., ARC) Tragedies include Hitler’s euthanasia program Deinstitutionalization began in 1960s-1970s Stereotypical images still common in literature and media; these images influence prevailing perceptions of disability Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Historical Context for Disability  Early attitudes toward PWD ➢ Set apart from others ➢ Viewed as different or unusual ➢ Documented in carvings and writings ➢ Infanticide or left to die (not in Jewish culture) ➢ Viewed as unclean and/or sinful ➢ Served as entertainers, circus performers, and sideshow exhibitions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Historical Context  18th and 19th century attitudes ➢ No scientific model for understanding and treating ➢ Disability seen as an irreparable condition caused by supernatural agency ➢ Viewed as sick and helpless ➢ Expected to participate in whatever treatment was deemed necessary to cure or perform  Industrial Revolution stimulated a societal need for increased education ➢ ➢ If not third-grade level = feeble-minded Special schools established in early 1800s Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Historical Context (Cont.)  20th century attitudes ➢ ➢ ➢ ➢ ➢ Special interest groups were formed First federal vocational rehabilitation legislation passed in early 1920s Involuntary sterilization of many with intellectual disabilities ARC (Association for Retarded Children) began to advocate for children with intellectual disabilities—today is Association for Retarded Citizens ARC is “world’s largest community-based organization of and for people with intellectual and developmental disabilities” (ARC, 2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Historical Context (Cont.)  20th century attitudes ➢ One of the most horrendous tragedies under Hitler’s euthanasia or “good death” program • Killed at least 5000 mentally and physically disabled children by starvation or lethal overdoses • Killed 70,274 adults with disabilities by 1941 • Over 200,000 people exterminated because they were “unworthy of life” ➢ Deinstitutionalization movement in 1960s and 1970s • Community-based Independent Living Centers established Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Historical Context (Cont.)  Contemporary conceptualization ➢ Stereotypical images remain common in literature and media • Population portrayed as a burden to society or from pity/pathos or heroic “supercrip” perspectives • “just as the paralytic cannot clear his mind of his impairment, society will not let him forget it.” (Murphy, 1990, p. 106) ➢ Societal stigma still exists • Teasing or bullying often occurs in schools • Rehabilitation Act of 1973 and American with Disabilities Act of 1990 prohibit “disability harassment” Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Characteristics of Disability  Americans with Disabilities Act (ADA) of 1990 and Rehabilitation Act of 1973 defined disability according to limitations in a person’s ability to carry out a major life activity. ➢  Major life activities: ability to breathe, walk, see, hear, speak, work, care for oneself, perform manual tasks, and learn U.S. Census Bureau (2006) defines disability as long-lasting physical, mental, or emotional condition that creates a limitation or inability to function according to certain criteria. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Examples of Disabilities        Physical disabilities Sensory disabilities Intellectual disabilities Serious emotional disturbances Learning disabilities Significant chemical and environmental sensitivities Health problems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Measurement of Disability  Survey of Income and Program Participation (SIPP) ➢ Functional activities ➢ Activities of daily living (ADLs) ➢ Instrumental activities of daily living (IADLs)  American Community Survey (ACS) ➢  Surveys for disability limitation in six areas that affect function or activity (sensory, physical, mental/emotional, self-care, ability to go outside the home, employment) Other organizations also collect disability data Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Prevalence of Disability     In 2010, approximately 18.7% of civilian noninstitutional population aged 5 years and older had a long-lasting condition or disability. Of those with a disability, 12.6% had a “severe” disability. Prevalence varies by race, age, and gender. It is important for health care policymakers and health care providers to recognize that the prevalence of disability is increasing. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Prevalence of Disability in Children  Approximately 15.2% of households with children have at least one child with a special health care need (disabling condition). – National Survey of Children with Special Health Care Needs (2009/2010)  A disability is defined by a communication-related difficulty, mental or emotional condition, difficulty with regular schoolwork, difficulty getting along with other children, difficulty walking or running, use of some assistive device, and/or difficulty with ADLs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Recommendation for the Nurse  Listen to parental concerns ➢ ➢ ➢  “Something is not right” Establishes an important bond with parents Nurse can serve as an intermediary Regularly assess for key developmental milestones ➢ Compare with predicted values ➢ Work with team of resource providers on IEP  Be cognizant of disability within the context of culture and aging Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Legislation Affecting People with Disabilities  Individuals with Disabilities Education Act (IDEA) (1975); reauthorized in 1997, 2004 ➢ ➢ Ensured a free appropriate public education (FAPE) in the least-restrictive setting to children with disabilities based on their needs Parents, students, and professionals join together to develop an Individualized Education Program (IEP), including measurable special educational goals and related services for the child. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008  ADA: Landmark civil rights legislation that prohibits discrimination toward people with disabilities in everyday activities ➢ ➢ Guarantees equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications Provides protections to people with disabilities similar to those provided to any person on basis of race, color, sex, national origin, age, and religion Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008 (Cont.)  ADA (Cont.) ➢ ➢ Refers to a “qualified individual” with a disability as a person with a physical or mental impairment that substantially limits one or more major life activities or bodily functions, a person with a record of such an impairment, or a person who is regarded as having such an impairment. Qualifying organizations must provide reasonable accommodations unless they can demonstrate that the accommodation will cause significant difficulty or expense, producing an undue hardship. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Ticket to Work and Work Incentives Improvement Act (TWWIIA)    Increases access to vocational services; provides new methods for retaining health insurance after returning to work Increases available choices when obtaining employment services, vocational rehabilitation services, and other support services needed to get or keep a job Became law in 1999, amended in 2008 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Public Assistance Programs  Cash assistance ➢ ➢    Supplemental Security Income—SSI Social Security Disability Insurance—SSDI Food stamps Public/subsidized housing Costs associated with disability ➢ Gaps in employment, income, education, access to transportation, attendance at religious services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Health Disparities in Quality and Access  Disparities are caused by … ➢ Differences in access to care ➢ Provider biases ➢ Poor provider-patient communication ➢ Poor health literacy  Persons with disabilities experience … ➢ ➢  Higher rates of chronic illness Increased risks for medical, physical, social, emotional, and/or spiritual secondary issues People with intellectual disabilities are ➢ Undervalued and disadvantaged Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Systems of Support for People With Disabilities Figure 21-2 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 The Experience of Disability   PWD may be largest minority group in the United States Different experiences, depending on … ➢ ➢ ➢  Temporary disability Permanent disability from accident or disease Disability from progressive decline of a chronic illness Benchmark event is acceptance of the label of “disabled” Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Children With Disabilities (CWD)  Family and caregiver responses ➢ ➢  Redefine image and expectations for child and self Sibling response influenced by age, coping, peer relationships, parents, impact on family Levels of parental adjustment ➢ ➢ ➢ ➢ The ostrich phase Special designation Normalization Self-actualization Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Family Research Outcomes      Established various benefits, amid challenges Families with satisfying emotional support experience fewer potentially negative effects of unplanned or distressing events. Parents may grieve the loss of idealized or expected child over time. Supportive relationship is needed. Empowerment and enabling decision making on behalf of CWD is important. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Knowledgeable Client  A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. Knowledgeable Nurse  The nurse who has information about the disability and the available community and governmental resources. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Strategies for the CH Nurse       Do not assume anything. Adopt the client’s perspective. Listen to and learn from client. Gather data from the perspective of the client and family. Care for the client and family, not for the disability. Be well informed about community resources. Become a powerful advocate. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Dealing With Ethical Issues     Spiritual perspectives Quality of life (QOL) and justice perspectives Proper use of scientific advances Self-determination, deinstitutionalization, and disability rights Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37 When the Nurse Has a Disability    Education programs and employers must provide reasonable accommodations for qualified students and nurses. Technical aspects of nursing tend to discriminate; nursing should emphasize “humanistic” capacities. Type of setting influences functionability. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 38 Nurses Can … … become familiar with a variety of ethical frameworks for decision making. … help the patient and family access needed information to make informed decisions. … help educate the public on health care issues. … participate in the development of institutional policies and procedures related to disability. … take a position on an ethical issue. … work to influence government policies and laws. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39 Chapter 23 Rural and Migrant Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Rural Populations    The largest rural population in history of United States is now. 75% of counties are classified as rural; they contain only 20% of the U.S. population Number/size of rural counties are highest … ➢ ➢ ➢  in the South (35%) in the Midwest and West (23%) in the Northeast (19%) Census data ➢ ➢ ➢ 20% of nation’s children under 18 15% of nation’s elderly More than 50% of nation’s poor Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Rural Populations (Cont.)  Economic base is shifting ➢ ➢ ➢ Agriculture is the “food and fiber system” All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included Poverty in rural areas greater than in urban areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Rural Populations (Cont.)     Poverty continues to be greater in rural America than in urban areas. Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas. Greater diversity among residents: a country of immigrants historically and today. Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Health Disparities Among Rural Americans       Only 10% of U.S. physicians practice in rural areas Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings) More often assess their health as fair or poor More disability days resulting from acute conditions More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates Higher number of unintentional injuries Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Defining Rural Populations  Population size ➢  Rural = towns with population of less than 2500 or in open country [farm/nonfarm] Density ➢ ➢ Rural = fewer than 45 persons per square mile Frontier = less than 6 people per square mile Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Defining Rural Populations (Cont.)  The Rural-Urban Continuum uses population and adjacency to metropolitan areas ➢ Core Based Statistical Areas (CBSAs) • Metropolitan areas = county with at least one urbanized area of 50,000 or more people • Micropolitan area = area contains a cluster of 10,000 to 50,000 persons • Outside CBSAs = noncare areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Describing Rural Health and Populations   Differ in complex geographical, social, and economic areas Disparities include key indicators of health: ➢ Employment ➢ Income ➢ Education ➢ Health insurance ➢ Mortality ➢ Morbidity ➢ Access to care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Rural Health Disparities: Context and Composition  Context: characteristics of places of residence ➢  Geography, environment, political, social, and economic institutions Composition: collective health effects that result from a concentration of persons with certain characteristics ➢ Age, education, income, ethnicity, and health behaviors – Braveman (2010) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Context: Health Disparities Related to Place  A downward spiral may exist: ➢ people leave → services are lost → tax base becomes insufficient → fewer services are provided → long distances to get health care → jobs become scarce and more people leave → the cycle continues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Context: Health Disparities Related to Place (Cont.)     Access to health care (#1 priority) Fewer primary care physicians General health services lacking Health insurance coverage … ➢ Varies according to race and ethnicity; age and residence (rural or urban) ➢ Influences health patterns ➢ May create financial barriers to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Composition: Health Disparities Related to Persons  Income and Poverty ➢ ➢ ➢ ➢ ➢ One of the most important indicators of the health and wellbeing of all Americans, regardless of where they live. Regional differences—highest in the South Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites Family composition—female-headed families have highest rates Children—among the poorest citizens in rural America Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Composition: Health Disparities Related to Persons (Cont.)  Health risk, injury, and death ➢  Risk factors ➢    Higher rates of obesity, smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents; lower rates of seat belt use Age, education, gender, race, ethnicity, language, and culture Education and employment Occupational health risks Perceptions of health (gender, race, ethnicity) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Agricultural Workers  Accidents and injuries caused by: ➢ Environmental conditions ➢ Geographic isolation and working alone ➢ Use of agricultural machinery ➢ Delayed access to emergency or trauma care  Acute and chronic illnesses: ➢ Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss, hypertension ➢ Chemical exposure (pesticides, herbicides, etc.) ➢ Secondary conditions related to demanding farm work Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Migrant and Seasonal Farm Workers (MSFW)  Health Disparities ➢ ➢  Poorest health and the least access Low income and migratory status Cultural, linguistic, economic, and mobility barriers ➢ ➢ Minimal or no preventive care • Mobile clinic sites form a central link to health services Migrant Health Program (MHP) bases services on enumeration of MSFW • Migrant and Seasonal Farm Worker Enumeration Profile Study (MSFWEPS) (2000) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 “Thinking Upstream” Concepts applied to Rural Health    Attack community-based problems at their roots Emphasize the “doing” aspects of health Maximize the use of informal networks Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Rural Health Care Delivery System  Health care provider shortages ➢ ➢ ➢ Rural shortages likely to become worse Need to “grow their own” Telemedicine • Cost-effective alternative to face-to-face care • Telehealth includes telephones, fax machines, email, and remote monitoring • Telemedicine permits two-way, real-time, interactive communication between patient and provider Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Rural Health Care Delivery System (Cont.)  Managed care in the rural environment ➢ ➢ Possible benefits: • Potential to lower primary care costs • Improve the quality of care • Help stabilize the local rural health care system Risks • Probable high start-up and administrative costs • Volatile effect of large, urban-based, for-profit managed care companies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Community-Based Care  A myriad of services provided outside the walls of an institution ➢    Home health and hospice care, occupation health programs, community mental health programs, ambulatory care services, school health programs, faith-based care, elder services (adult day care) Community participation in decisions about health care services Focus on all three levels of prevention An understanding that the hospital is no longer the exclusive health care provider Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Home Care and Hospice  Nurse case management and development of local resources ➢ ➢ ➢ ➢ Often hospital based in rural areas Use county extension services as a bridge for outreach services Improve home care for these patients and provide support for their families A partnership between the public health nurse and county extension service could provide support, as well as information groups and caregiving classes, for the important informal provider network. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Faith Communities and Parish Nursing     A strong sense of community, family life, and religious faith Integrating nursing expertise and faith-based knowledge to provide holistic care to members of congregations Involved in case management and coordination of services Collaboration with other organizations to extend limited rural community health resources Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Informal Care Systems     Evolve from self-reliance and self-help traits of rural residents Include people who have assumed the role of caregiver based on their individual qualities, life situations, or social roles Provide direct help, advice, or information Need to identify and combine informal services with formal systems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Rural Public Health Departments Public health nurses are often the core providers of public health services in rural areas. ➢ ➢ Collaboration of services is key—need to develop partnerships with other heath provider agencies. Environmental health, maternal and child health, and communicable disease control are the three highestpriority programs. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Rural Mental Health Care    Lack of specialized mental health providers in rural areas. Most services provided by primary care providers without adequate preparation or support. Perceived stigma prevents individuals from seeking mental health services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Emergency Services Getting patients from the place of injury to the trauma center within the “golden hour” is frequently not possible because of distance, terrain, climatic conditions, and communication methods. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Emergency Services (Cont.)  Challenges faced by rural EMS systems ➢ ➢ ➢ ➢ ➢ Shortage of volunteers and lower levels of training Training curricula that often do not reflect rural hazards (e.g., farm equipment trauma) Lack of guidance from physicians Lack of physician training and orientation to EMS Also contributing to difficult public access for emergency care: • Low population density • Large, isolated, or inaccessible areas • Sever weather • Poor roads • Lower density of telephone/communication methods Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Emergency Preparedness in Rural Communities  Challenges in rural areas: ➢ ➢ ➢ ➢ Resource limitation • Human, financial, and social capital Separation and remoteness • Longer response times Low population density • Impacts funding Communication • Warning systems often absent or neglected in remote areas; burden on individuals Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Legislation and Programs Affecting Rural Public Health  Programs that augment health care facilities and services ➢ ➢ ➢ ➢ Community Health Centers (CHC) program Migrant Health Clinic (MHC) program and the Migrant Health Program (MHP) Medicare’s Rural Hospital Flexibility (RHF) grant program Primary care cooperative agreements Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Rural Community Health Nursing “CH nursing along the rural continuum” Nonmetropolitan Areas Metropolitan Areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Rural Nursing … … is the practice of professional nursing within the physical and sociocultural context of sparsely populated communities. It involves the continual interaction of the rural environment, the nurse, and his or her practice. Rural nursing is the diagnosis and treatment of a diversified population of people of all ages and a variety of human responses to actual (or potential) occupational hazards or actual or potential health problems existent in maternity, pediatric, medical/surgical and emergency nursing in a given rural area. –– Bigbee (1993), Lee & Winters (2004), Rosentahl (2005), Williams et al. (2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Characteristics of Rural Nursing Should rural nursing practice be designated as a specialty or subspecialty area because of factors such as isolation, scarce resources, and the need for a wide range of practice skills that must be adapted to social and economic structures? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Characteristics of Rural Nursing (Cont.)  Positive aspects ➢ ➢ ➢ ➢ ➢ ➢  Ability to provide holistic care Know everyone well Develop close relationships with the community and with coworkers Enjoy rural lifestyle Autonomy and professional status Being valued by the agency and community Negative aspects ➢ Professional isolation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 The newcomer practices nursing in a rural setting, unlike the more experienced nurse, who practices rural nursing. Somewhere between these extremes lies the transitional period of events and conditions through which each nurse passes at her or his own pace. It is within this time zone that nurses experience rural reality and move toward becoming professionals who understand that having gone rural, they are not less than they were, but rather, they are more than they expected to be. Some may be conscious of the transition, and others may not, but in the end, a few will say, “I am a rural nurse.” – Scharff (1998, p. 38) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Rural Health Research  Research agendas must address: ➢ The capacity of rural public health to manage improvements in health ➢ Information technology capacity in rural communities ➢ Developing and monitoring performance standards in rural public health ➢ Developing leadership and public health workforce capacity within rural public health ➢ Interaction and integration of community health systems, managed care, and public health in rural America – Berkowitz, Ivory, & Morris (2002) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Capacity of Rural Public Health to Manage Improvements in Health   Healthy People 2020 objectives and intervention strategies Information Technology in Rural Communities ➢ ➢ ➢ ➢ EHR and reimbursement Preparedness strengthens infrastructure Continuing education and advanced education Telehealth impact on public health • Skills via distance learning? • Costs and infrastructure of IT? • Gaps in epidemiology and surveillance capacity? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Performance Standards in Rural Public Health   National Public Health Performance Standards Program (NPHPSP) describe an optimal level of performance by public health systems regardless of location. Used to improve collaborations among key public health partners, educate participants about public health, strengthen the network of public health partners, identify strengths and weaknesses, and provide benchmarks for public health practice improvements Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Leadership and Workforce Capacity for Rural Public Health     IOM report (2003)—preparing public health workforce for 21st century CDC Public Health Improvement Initiative (2012)—accreditation support Medicaid impact on interaction and integration of community health systems, managed care, and public health New models of health care delivery for rural and frontier areas being tested Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37
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role and scope

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role and scope

After reading Chapter 8 in the book attached please follow the instructions

1. Describe a clinical experience that was troubling to you. Describe what bothered you about the experience and what could have you done differently utilizing critical thinking.

2. Describe how patients, families, individual clinicians, health care teams, and systems can contribute to promoting safety and reducing errors.

3. Describe factors that create a culture of safety.

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Your answers should be at least 4 paragraphs for EACH question. Include more than 3 reference to justify your answers.

please respond to the following post.

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please respond to the following post.

please respond to the following post with a long paragraph add citations and references.

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The theoretical foundations of qualitative and quantitative methods are very different, but many researchers believe both methods should be used in the research study to increase validity and reliability. What advantages or disadvantages do you see in using both types of methods in a nursing study? Support your answer with current evidence-based literature.

Quantitative Research Paper: Eating Disorders

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Quantitative Research Paper: Eating Disorders

Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative

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study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Method of Study: • Were qualitative methods appropriate to answer the research questions? • Did the author identify a specific perspective from which the study was developed? If so, what was it? • Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? • Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. • Did the author evaluate or indicate the weaknesses of the available studies? • Did the literature review include adequate information to build a logical argument? • When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? © 2016. Grand Canyon University. All Rights Reserved. Results of Study • What were the study findings? • What are the implications to nursing? • Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. 2 Quantitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Methods of Study • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted? • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant. • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses? Results of Study • What is the researcher’s interpretation of findings? 3 • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers? • Was there a coherent logic to the presentation of findings? • What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing? • What suggestions are made for further studies? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Reference Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier. 4 Running Head: EATING DISORDERS Eating Disorders Social Factors Among Teens with Eating Disorders 1 EATING DISORDERS 2 Eating disorders are very common among human beings. However, many people have always delayed treatment of the cases of eating disorders even though they are aware that therapy brings goods results. Family-based treatment has always been recommended for adolescents and children who have eating disorders such as nervosa. Confronting the eating disorder is always the first step in recovering from the eating disorder (Voelker, Reel & Greenleaf, 2015). Some people suffering from the eating disorders always ignore the fact that they need help. Teenagers who have accepted that they need help are taking the biggest step in the recovery from the eating disorders. People should also learn to help people whom they love who are suffering from the eating disorders by advising them to seek help. Seeking professional help is always the best way to recover from the eating disorders. This is because many professionals who have specialised in eating disorders have the skills and experience to help the people recover from the diseases. Ways in which the findings might be used in nursing practice From the research, the finding can be used in the nursing practise to help people suffering from the eating disorders recover from the disease. Using the PICOT statement on eating disorders, nurses can exploit social networks and the social media in general to impact positive body image in dealing with the eating disorders. Nurses can use the social media and social networks to support people suffering from eating disorders (Boon, Zainal & Touyz, 2017). For example, there are websites such as Proud2Bme and Recovery Warriors which bring people with different disorders affecting their bodies and images such as eating disorders. Bringing these people together helps them know that they are not alone in the struggle. These sites help people by empowering them, encourages them to be optimistic and confident. Therefore, nurses can start blogs on eating disorders where they teach people on how to fight eating disorders and the importance of living a healthy life. EATING DISORDERS 3 Many people with similar problems will come together and share their experiences. Some of the experiences may include how others recovered from the eating disorders and the different types of disorders are suffering from. It will encourage other people to work hard to recover from the eating disorders. The blogs are also a source of inspiration to many people as they will be able to more about other people who were suffering from eating disorders worse than their diseases but they recovered from it (Fogelkvist, Parling, Kjellin & Gustaf, 2016). People who are not suffering from the diseases will be encouraged to be careful with their eating patterns and they will ensure that they eat healthy to avoid the risk of contracting diseases related to eating disorders. From the qualitative study, nurses can use the findings which included teens having disorders having difficulties in building proper social networks, teens suffering from eating disorders losing friends upon admission or diagnosis and the effects on the parents of the children suffering from the eating disorders. Nurses can ensure that the help the teen with eating disorders build proper social networks by encouraging them seek recovery from the eating disorders first (Holland & Tiggemann, 2016). Nurses can also help them alleviate their self-esteem by encouraging to make friends with people who have accepted them the way they are. Teen suffering from the eating disorders should not struggle to make friendship with people who reject them. However, they should try to be social with everybody because they cannot be rejected by everybody. To be more comfortable and build more social networks, teens suffering from eating disorders should ensure that they build social relationships mostly with people with similar conditions so that they help each other by encouraging each other to develop healthy eating habits. Nurses should also encourage parents to promote healthy eating habits among their children by ensuring that they eat healthy foods in the right amount. Nurses should connect with parents with children suffering from eating disorders and they should help the parents EATING DISORDERS 4 monitor their children in the recovery stage. The parents should monitor their children’s diet and attitudes to food, their children’s shape, weight and body image, common comorbidities such as depression and anxiety disorders and other predisposing factors. Nurses should always help the parents solve these problems whenever they are present in the children (Leonidas & dos Santos, 2014). Nurses should help the parents in taking care of their children with eating disorders by advising them on healthy foods to give to their children and also provide solutions to other problems related to eating disorders. The corporation between nurses and parents with the aim of doing away with eating disorders is one of the best ways of preventing children from suffering from eating disorders because the parents will take preventive actions to ensure that their children are not suffering from eating disorders. Ethical considerations associated with the conduct of the study Studies conducted on the field of eating disorders are very important for the improvement of treatment methods and the results for people suffering from eating disorders. The disease is very complex and delicate, the research should be conducted sensitively and carefully (Patel, Tchanturia & Harrison, 2016). The studies are always regulated by ethic principles endorsed to protect volunteers, participants and other people involved in the research. Some ethical consideration associated with conduct of the study include the application of fundamental principles of people’s lives. Because this research involved investigating people with eating disorders, applying the fundamental ethical principles is very important to protect the right of privacy. Any confidential information collected during the study should be kept safe and secure because the information is made available to people, some individuals may take advantage of the situation and use the information against the participants. The confidential ma be used to hurt or damage the reputation or image of the participant. Therefore, it very important to keep participants’ confidential information private and secure. EATING DISORDERS 5 Application of the principles of research. The fundamental ethical principles of research involve prioritizing the safety and the privacy of the participants. Participants should not be exposed to any thing which may be harmful to them during and even after the research. Upholding moral responsibilities is also very important during the study. Researchers should be responsible and ensure that they do not interfere with the participants. They should also ensure that they are responsible for their actions and it any mistake is done during the process, they should take responsibility and correct the mistake by providing solutions to the mistakes they make (Salafia, Jones, Haugen & Schaefer, 2015). Handling sensitive study information is a task that should not be assumed lightly. If any sensitive research data is mishandled, it may cause ethical dilemmas which may destroy even the integrity of the research. Sensitive study information should be handled appropriately by ensuring that only the authorized people can access the information and the data should be stored safely. Research in the field of eating disorders has several ethical issues that should be not be taken lightly because violation of the ethical principles may cause problems to the participants during the study or after the study. EATING DISORDERS 6 References Boon, E., Zainal, K. A., & Touyz, S. W. (2017). Perceptions of eating disorder diagnoses and body image issues in four male cases in Singapore. Journal of Eating Disorders, 5(33). Retrieved from https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-0170159-x Fogelkvist, M., Parling, T., Kjellin, L., & Gustaf, S. A. (2016). A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. Journal of Eating Disorders, 4(29). Retrieved from https://jeatdisord.biomedcentral.com/articles/10.1186/s40337016-0120-4 Holland, G., & Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body image, 17, 100-110. Leonidas, C., & dos Santos, M. A. (2014). Social support networks and eating disorders: an integrative review of the literature. Neuropsychiatric disease and treatment, 10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039404/ Patel, K., Tchanturia, K., & Harrison, A. (2016). An exploration of social functioning in young people with eating disorders: A qualitative study. PloS one, 11(7), e0159910. Salafia, E. B., Jones, M. E., Haugen, E. C., & Schaefer, M. K. (2015). Perceptions of the causes of eating disorders: a comparison of individuals with and without eating disorders. Journal of Eating Disorders, 3(32). Retrieved from https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0069-8 Voelker, D. K., Reel, J. J., & Greenleaf, C. (2015). Weight status and body image perceptions in adolescents: current perspectives. Adolescent health, medicine, and therapeutics, 6, N149–158. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554432/
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Arterial Blood Gas Interpretation

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Arterial Blood Gas Interpretation

Student ADA Version of the Arterial Blood Gas Interpretation Pre-Assessment Anatomy Backward effects of left-sided heart failure include: A. B. C. D. Pulmonary congestion Jugular vein distention Dependent edema in the legs

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Bounding pulses Anatomy In performing a physical assessment, the nurse notes the patient has a “barrel” configuration to the chest. This is a consequence of: A. B. C. D. Reduced intrapleural pressures Bronchial airway expansion Increased vital capacity Increased residual lung volume Anatomy Ausculation of the chest reveals bilateral fine crackles in the bases bilaterally, indicating: A. B. C. D. Right-sided heart failure Left-sided heart failure Pneumonia Acute respiratory distress syndrome Biology The signs and symptoms of anemia are all related to what common pathophysiologic feature of the condition? A. B. C. D. Increased oxygen consumption by tissues Decreased blood oxygen content Vasodilation A shift in the oxyhemoglobin dissociation curve © 2013. Grand Canyon University. All Rights Reserved. Biology In addition to hypertension, preeclampsia is characterized by: A. B. C. D. Nausea and vomiting Fatigue and lower back pain Protein in the urine and edema Retinal changes and rates in the lungs Biology Common manifestations of bacterial pneumonia include all of the following except: A. B. C. D. Fever Productive Cough Tachypnea Hyperinflation Biology Closed drainage systems work to re-expand a lung after pneumothorax by: A. B. C. D. Re-establishing the normal negative intrapleural pressure. Creating a positive pressure in the pleural space Removing excess fluid from the pleural space so that there is room for lung expansion. Pulling oxygen into distal air sacs to re-expand lung tissue Biology Patients with chronic renal failure usually exhibit: A. B. C. D. Bradycardia Hypokalemia Hypocalcemia Hematomas Biology The diet of a patient in end-stage kidney disease is restricted in all of the following except: A. Fluid B. Potassium C. Protein D. Calories Anatomy Which of the following is true of the biological functions of progesterone? A. B. C. D. Progesterone is the most important hormone associated with pregnancy. Progesterone directs male sexual characteristics. Levels of progesterone increases if the egg is not fertilized. Levels of progesterone remain stable if the egg is not fertilized. Anatomy Which of the following is true of the biological functions of testosterone? A. B. C. D. Testosterone is not secreted by the ovaries. Testosterone is needed for development of female secondary sexual characteristics. Testosterone stimulates ovulation. Testosterone is needed for development of male secondary sexual characteristics. Anatomy Which of the following is true of the biological functions of estrone? A. Estrone is required for proper development of male secondary sexual characteristics. B. Level of estrogen degreases if the egg is not fertilized. C. Estrone is required for proper development of female secondary sexual characteristics. D. Estrone affects only the reproductive organs. Biology What is the function of hemoglobin? A. Hemoglobin is the protein in red blood cells that is responsible for carrying oxygen to the cells of the body. B. Hemoglobin is a lipid in red blood cells that is responsible for carrying oxygen to the cells of the body. C. Hemoglobin is a protein in white blood cells that is responsible for carrying oxygen to the cells of the body. D. Hemoglobin is a protein in red blood cells that is not responsible for carrying carbon dioxide to the cells of the body. Biology Why is heat an effective means of sterilization? A. Heat is an effective means of sterilization because it destroys the proteins of microbial life forms, including fungi, bacteria, and viruses. B. Heat is an effective means of sterilization because it destroys the proteins of anaerobic microbial life forms, including fungi, bacteria, and viruses. C. Heat is an effective means of sterilization because it destroys the lipids of microbial life forms, including fungi, bacteria, and viruses. D. Both (B) and (C). Chemistry: List the enzymes whose levels are elevated in the blood serum following an MI. A. B. C. D. CPK, LDH, AST, and SGOT LDH, AST, and SGOT CRE, AST, and ALT None of the above Chemistry What is the physiological function of gluconeogenesis? A. Gluconeogenesis is production of glucose from noncarbohydrate molecules in times when blood glucose levels are low. This ensures proper function of brain and red blood cells, which only use glucose as fuel. B. Gluconeogenesis is production of glucose from noncarbohydrate molecules in times when blood glucose levels are high. This ensures proper function of brain and white blood cells, which only use glucose as fuel. C. Gluconeogenesis is production of glucose from carbohydrate molecules in times when blood glucose levels are low. This ensures proper function of brain and red blood cells, which only use glucose as fuel. D. None of the above Chemistry What effect does glycogen metabolism have on glucose levels? A. Glycogen metabolism traps glucose within liver cells and increases storage of glucose in the form of glycogen. These processes decrease blood glucose levels. B. Glycogen metabolism traps glucose within liver cells and increases storage of glucose in the form of glycogen. These processes increase blood glucose levels. C. Glycogen metabolism releases glucose within liver cells and increases storage of glucose in the form of glycogen. These processes decrease blood glucose levels. D. None of the above Chemistry Carbon monoxide binds tightly to the heme groups of hemoglobin and myoglobin. How does this affinity reflect the toxicity of carbon monoxide? A. Since carbon monoxide binds the heme groups of hemoglobin, it is easily removed or replaced by oxygen. As a result, the effects of oxygen enhancement result in what divers call the “bends.” B. Because carbon monoxide binds the heme groups of hemoglobin, it is easily removed or replaced by oxygen. As a result, the effects of oxygen deprivation result in suffocation. C. Because carbon monoxide binds tightly to the heme groups of hemoglobin, it is not easily removed or replaced by oxygen. As a result, the effects of oxygen deprivation result in suffocation. D. None of the above Pathophysiology Which of the following may be a reason to order an ABG on a patient? A. B. C. D. The patient suddenly develops shortness of breath An asthmatic is starting to show signs of tiring A diabetic has developed Kussmaul’s respirations All of the above Pharmacology How do sulfa drugs selectively kill bacteria while causing no harm to humans? A. Folic acid is a vitamin required for the synthesis of a coenzyme needed to make the amino acid methionine and the purine and pyrimidine nitrogenious bases for DNA and RNA and folic acid is produced by humans. B. Sulfa drug binds to the enzyme, no product is formed, folic acid is made and the biosynthesis of methionine and nitrogenous bases increases. C. Humans are not harmed because they do not synthesize their own folic acid. It is obtained in the diet. D. None of the above Pharmacology What occurs when glycogen metabolism is stimulated by insulin? A. Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. B. Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also stimulates removal of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase. C. Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also stimulates uptake of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase. D. All of the above Pharmacology What is the medical application of cortisone? Cortisone is used to treat: A. B. C. D. Rheumatoid arthritis, asthma, gastrointestinal disorders, and a variety of skin conditions. Kidney disease, high blood pressure, and osteoporosis. Muscle disorders, tuberculosis, and thyroid disorder. All of the above Anatomy Oxygen saturation is likely to be lowest when an asthmatic with a diagnosis of pneumonia is positioned: A. B. C. D. In a high Fowler position Lying on the left side Lying on the right side Lying supine with the head of the bed flat Chemistry Laboratory test results indicative of thrombocytopenia, in addition to a low platelet count, would be: A. B. C. D. Increased PT Prolonged bleeding time and poor clot retraction. Increased aPTT Decreased RBC count. Pharmacology The purposes of epinephrine injection include all of the following except: A. B. C. D. Stabilizing mast cell membranes. Relaxing bronchial smooth muscle. Supporting arterial blood pressure. Blocking histamine receptors. Pharmacology Therapeutic interventions focused on increasing the oxygen supplied to the heart and decreasing the heart’s demand for oxygen include: A. B. C. D. Antiplatelet drugs Anticoagulants Morphine sulphate Thrombolytic drugs Pharmacology An intervention that would contribute toward the healing of a peptic ulcer is: A. B. C. D. Steroid administration Blocking or neutralizing of acid secretion Surgical removal of the ulcer Intravenous nutritional support Pharmacology Aspirin and NSAIDs are causative factors for the development of peptic ulcer disease because they: A. B. C. D. Increase acid secretion Allow proliferation of H. pylori Damage the mucosal barrier Alter platelet aggregation Pharmacology Your patient is interested in trying medication to improve low mood/depression. All of the following medications might be appropriate except: A. B. C. D. Selective serotonin reuptake inhibitors Amitriptyline Serotonin and norepinephrine reuptake inhibitors Benzodiazepines
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HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

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HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

Scenario
The long-term care center has 225 beds and provides the highest level of patient care, according to ongoing Department of Health Services annual surveys. The Director of the long-term center has the overall
responsibility of ensuring the continuing high level of quality outcomes while also concurrently keeping
the facility as risk free as practical. You and the Director have just returned from an annual Long-Term
Care Association symposium where you were both introduced to some new groundbreaking initiatives
regarding the differences between risk management and quality improvement. HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

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Earlier in the week, the Director called for a meeting of the center’s department managers, including the
Quality Assurance Nurse and the Manager of Risk Management. After briefing them on the symposium
talking points, your Director asks you to come up with a working plan and strategy for how the facility will use both of the concepts you have introduced to arrive at a more centralized and standardized
approach. Overall, the desired outcomes focus on adopting a new approach to higher quality with fewer
risk factors for the organization.
Later that week, the Manager of Risk Management, the Manager of Nursing Quality Assurance, and a
representative from Human Resources met to formulate a new plan to reduce the litigation exposure
while concurrently increasing the quality of patient outcomes. They set about the complex set of tasks
with the expectation that you, as the Director’s designated facilitator, will be closely reviewing their final
recommendations.
Provide a 250-word executive summary of the research project and recommended plan of action that
you will provide to the Director.
Address the following:
Questions:
1. What is the necessary background information needed to complete your executive summary?Who
are the stakeholders?
2. How do the facility’s current Continuous Quality Improvement (CQI) outcomes correspond with the
current litigation prevention systems?
3. What factors within the nursing units are the most critical to consider when examining higher quality
outcomes?
4. What factors within the nursing units are the most critical to consider when examining lower litigation
adverse actions and operational impact?
5. What future steps must be taken to accomplish this directive? HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

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HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

HOME CARE SCENARIO: Quality Improvement through Risk Management Scenario The long-term care center has 225 beds and provides the highest level of patient care, according to ongoing Department of Health Services annual surveys. The Director of the long-term center has the overall responsibility of ensuring the continuing high level of quality outcomes while also concurrently keeping the facility as risk free as practical.

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You and the Director have just returned from an annual Long-Term Care Association symposium where you were both introduced to some new groundbreaking initiatives regarding the differences between risk management and quality improvement. Earlier in the week, the Director called for a meeting of the center’s department managers, including the Quality Assurance Nurse and the Manager of Risk Management. After briefing them on the symposium talking points, your Director asks you to come up with a working plan and strategy for how the facility will use both of the concepts you have introduced to arrive at a more centralized and standardized approach. Overall, the desired outcomes focus on adopting a new approach to higher quality with fewer risk factors for the organization. Later that week, the Manager of Risk Management, the Manager of Nursing Quality Assurance, and a representative from Human Resources met to formulate a new plan to reduce the litigation exposure while concurrently increasing the quality of patient outcomes. HCA 460 Grand Canyon University Home Care Scenario Questions Discussion. They set about the complex set of tasks with the expectation that you, as the Director’s designated facilitator, will be closely reviewing their final recommendations. Provide a 250-word executive summary of the research project and recommended plan of action that you will provide to the Director. Address the following: Questions: 1. What is the necessary background information needed to complete your executive summary?Who are the stakeholders? 2. How do the facility’s current Continuous Quality Improvement (CQI) outcomes correspond with the current litigation prevention systems? 3. What factors within the nursing units are the most critical to consider when examining higher quality outcomes? 4. What factors within the nursing units are the most critical to consider when examining lower litigation adverse actions and operational impact? 5. What future steps must be taken to accomplish this directive? …HCA 460 Grand Canyon University Home Care Scenario Questions Discussion

NURS6221 Evaluating Performance Management Systems Assignment

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NURS6221 Evaluating Performance Management Systems Assignment

NURS6221 Evaluating Performance Management Systems: Explain the concept of “performance management” that guided your interview and the interviewee’s responses

Week 7 Assignment (Module 3)

Note: You will begin this Assignment in Week 5 and it will be due by Day 7 of Week 7. Plan your time accordingly.

Depending on your experience in healthcare, and other fields as well, you may be familiar with a performance management system or primarily with one aspect of assessing performance, the annual performance review. As a critical distinction from the annual review, performance management goes beyond a list of skills to rate or expected behaviors to check off, to a larger consideration of goals to reach and specific improvement strategies to implement.

Photo Credit: Getty Images/iStockphoto

Gaining understanding and perspective on a nurse executive’s role in performance management is the purpose of this Module 3 Assignment. To help inform your thinking and both the opportunities and challenges of performance management, you will gain firsthand information through an interview with a nursing professional whose responsibilities include those you will assume as a nurse executive.

Follow the guidelines for this Assignment as provided in the overview documents. You are encouraged to give yourself adequate time to reflect on your interviewee’s responses, the better to support you in assuming this aspect of the work of a nurse executive. NURS6221 Evaluating Performance Management Systems Assignment

To Prepare:

Review the Learning Resources on performance management for support in preparing for your interview with the human resources nurse manager.

Access and review the Performance Management System Interview Guidelines and Questions document for guidance on selecting a nurse executive to interview, and on planning, conducting, and analyzing the interview responses.

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Note: You are required to complete and submit Page 2 of this Guidelines document in a Word file identified as “Interviewee Profile and Confirmation Signature.” Be sure to obtain the full signature of your nurse executive interviewee to confirm the individual’s participation. Initials and/or only first or last name are not sufficient.

Access and review the Performance Management System Interview Matrix Summary Template. Consider how you can use this matrix to help organize information and conclusions from your interview.

When you have completed the interview, reflect on the results, including background information on the professional, the healthcare organization, and performance management system. As needed, follow up with your interviewee by phone or e-mail to clarify answers and conclusions.

Assignment:

Part 1: Interview Matrix Summary

Complete the Performance Management System Interview Matrix Summary, provided with the Assessment materials, to create a visual summary of the information gathered through your interview with the nurse executive.

Part 2: Interview Reflection

In a separate Word document, write 2–3 pages that reflect on the interview and your overall impressions. Include the following points in your reflection:

Briefly describe the professional you interviewed, including title, years of experience, and his/her healthcare organization (e.g., size, location, special services). Note: Be mindful of your interviewee’s privacy in the details you provide. NURS6221 Evaluating Performance Management Systems Assignment

Explain the concept of “performance management” that guided your interview and the interviewee’s responses.

Evaluate the healthcare organization’s performance management system for effectiveness, drawing on the interviewee’s assessment and your own observations and conclusions.

Describe characteristics and/or factors that stand out to you as contributing to the system’s strengths and weaknesses.

Describe actions, strategies, or approaches that you would recommend to address weaknesses in the system..

Your Module 3 Assignment continues this week. As you prepare for your interview or reflect on the conversation you have held, draw on the information and insights you gain on performance reviews, what can make them particularly challenging, and how to promote a system for performance improvement that is inherently positive in its view of assessment and critique, and which communicates that assurance to employees. NURS6221 Evaluating Performance Management Systems Assignment

Evaluating Performance Management Systems: Explain the concept of “performance management” that guided your interview and the interviewee’s responses

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To Prepare:

If you have not yet conducted your interview with a nurse executive on the performance management system in the individual’s healthcare organization, do so as soon as possible.

Following the interview, reflect on the results, including background information on the professional, the healthcare organization, and performance management system. Consider how you would summarize information gained in the interview using the Matrix Template and your Reflection paper to provide a thorough description of the performance management system.

Consider strengths and weaknesses of the system, as described by the interviewee and from your own analysis.

Review the Learning Resources for supporting information to help in your understanding and evaluation of this performance management system and strategies and approaches for addressing its weaknesses.. NURS6221 Evaluating Performance Management Systems Assignment

NURSFPX 4050 Fundamental Principles of Care Coordination Paper

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NURSFPX 4050 Fundamental Principles of Care Coordination Paper

  • Develop a 20-minute presentation for nursing colleagues highlighting the fundamental principles of care coordination. Create a detailed narrative script for your presentation, approximately 4–5 pages in length, and record a video of your presentation.Nurses have a powerful role in the coordination and continuum of care. All nurses must be cognizant of the care coordination process and how safety, ethics, policy, physiological, and cultural needs affect care and patient outcomes. As a nurse, care coordination is something that should always be considered. Nurses must be aware of factors that impact care coordination and of a continuum of care that utilizes community resources effectively and is part of an ethical framework that represents the professionalism of nurses. Understanding policy elements helps nurses coordinate care effectively.This assessment provides an opportunity for you to educate your peers on the care coordination process. The assessment also requires you to address change management issues. You are encouraged to complete the Managing Change activity.Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.

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    DEMONSTRATION OF PROFICIENCY

    By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

    • Competency 2: Collaborate with patients and family to achieve desired outcomes.
      • Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes. NURSFPX 4050 Fundamental Principles of Care Coordination Paper
    • Competency 3: Create a satisfying patient experience.
      • Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
    • Competency 4: Defend decisions based on the code of ethics for nursing.
      • Explain the rationale for coordinated care plans based on ethical decision making.
    • Competency 5: Explain how health care policies affect patient-centered care.
      • Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
    • Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
      • Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation. Script and reference list are not submitted. NURSFPX 4050 Fundamental Principles of Care Coordination Paper

    PREPARATION

    Your nurse manager has been observing your effectiveness as a care coordinator and recognizes the importance of educating other staff nurses in care coordination. Consequently, she has asked you to develop a presentation for your colleagues on care coordination basics. By providing them with basic information about the care coordination process, you will assist them in taking on an expanded role in helping to manage the care coordination process and improve patient outcomes in your community care center.To prepare for this assessment, identify key factors nurses must consider to effectively participate in the care coordination process.You may also wish to:

    • Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
    • Allow plenty of time to rehearse your presentation.

    Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking Tutoringfor feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

    Recording Equipment Setup and Testing

    Check that your recording equipment and software are working properly and that you know how to record and upload your presentation. You may use Kaltura (recommended) or similar software for your audio recording. A reference page is required. However, no PowerPoint presentation is required for this assessment.

    • If using Kaltura, refer to the Using Kaltura tutorial for directions on recording and uploading your video in the courseroom.

    Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@capella.edu to request accommodations.

    INSTRUCTIONS

    Complete the following:

    • Develop a presentation for nursing colleagues highlighting the fundamental principles of care coordination. Include community resources, ethical issues, and policy issues that affect the coordination of care. To prepare, develop a detailed narrative script. The script will be submitted along with the video.
    • Record a video of your presentation. NURSFPX 4050 Fundamental Principles of Care Coordination Paper

    Note: For this assessment, develop your audio script, then record your presentation. You are not requiredto deliver your presentation to an actual audience but you certainly could.

    Presentation Format and Length

    Create a detailed narrative script for your presentation, approximately 4–5 pages in length. Include a reference list at the end of the script.

    Supporting Evidence

    Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your presentation. Include your source citations on a references page appended to your narrative script. Watch the example video in your course room to hear how citations are referenced.

    Grading Requirements

    The requirements outlined below correspond to the grading criteria in the Care Coordination Presentation to Colleagues Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

    • Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
      • Provide, for example, drug-specific educational interventions, cultural competence strategies.
      • Include evidence that you have to support your selected strategies.
    • Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
    • Explain the rationale for coordinated care plans based on ethical decision making.
      • Consider the reasonable implications and consequences of an ethical approach to care and any underlying assumptions that may influence decision making.
    • Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
      • What are the logical implications and consequences of relevant policy provisions?
      • What evidence do you have to support your conclusions?
    • Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation. Script and reference list are not submitted.
      • Fine tune the presentation to your audience.
      • Stay focused on key issues of import with respect to the effects of resources, ethics, and policy on the provision of high-quality, patient-centered care.
      • Adhere to presentation best practices. NURSFPX 4050 Fundamental Principles of Care Coordination Paper
    Additional Requirements

    Submit both your presentation video and script. The script should include a reference page. See Using Kaltura for more information about uploading multimedia files. You may submit the assessment only once, so be sure that both assessment deliverables are included.Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

  • SCORING GUIDE

    Use the scoring guide to understand how your assessment will be evaluated.

NURSFPX 4050 Fundamental Principles of Care Coordination Paper

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Care Coordination Presentation to Colleagues Scoring Guide NONPERFORMANCE BASIC PROFICIENT DISTINGUISHED Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes. Does not outlines strategies for collaborating with patients and their families to achieve desired health outcomes. Outlines strategies for collaborating with patients and their families to achieve desired health outcomes. Outlines effective strategies for collaborating with patients and their families to achieve desired health outcomes. Outlines effective, evidence-based, and culturally sensitive strategies for collaborating with patients and their families to achieve desired health outcomes. Ensures the strategies are well-supported by credible evidence. Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patientcentered care. Does not identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care. Identifies aspects of change management not relevant to the patient experience, emphasizes patient expectations, or identifies aspects of the patient experience with minor impact on the quality of care. Identifies the aspects of change management that directly affect elements of the patient experience essential to the provision of highquality, patientcentered care. Identifies the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care. Focuses on aspects of care highly valued by patients, and distinguishes between patient experience and patient satisfaction. CRITERIA CRITERIA NONPERFORMANCE BASIC PROFICIENT DISTINGUISHED Explain the rationale for coordinated care plans based on ethical decision making. Does not explain the rationale for coordinated care plans based on ethical decision making. Explains the rationale for coordinated care plans based on ethical decision making, but reaches conclusions based on a simplistic, biased, or cursory examination of the issue. Explains the rationale for coordinated care plans based on ethical decision making. NURSFPX 4050 Fundamental Principles of Care Coordination Paper.  Explains the rationale for coordinated care plans based on ethical decision making. Identifies the logical implications and consequences of an ethical approach to care, and articulates underlying assumptions that guide decision making. Identify the potential impact of specific health care policy provisions on outcomes and patient experiences. Does not identify policies affecting the provision of health care. Identifies policies affecting the provision of health care. Identifies the potential impact of specific health care policy provisions on outcomes and patient experiences. Identifies the potential impact of specific health care policy provisions on outcomes and patient experiences. Draws logical, evidence-based conclusions from an insightful interpretation of relevant and significant policy provisions. Raise awareness of the nurse’s vital role in the Does not address the nurse’s role in the coordination and continuum of care. Addresses the nurse’s role in the coordination and Raises awareness of the nurse’s vital role in the coordination Raises awareness of the nurse’s vital role in the coordination and continuum of care. Clearly CRITERIA coordination and continuum of care in a videorecorded presentation. NONPERFORMANCE BASIC continuum of care. Resources: Care Coordination • As you read through the following articles, it is important to consider how you can convey the principles of care coordination clearly to your colleagues. Remember that some staff nurses and nursing managers may feel more comfortable focusing on direct patient care and completing tasks while turning over care coordination to social workers and case or care managers. However, care coordination belongs to all nurses, and changing health care systems, legislation, and budgetary restrictions are placing staff nurses in roles where they are more involved or lead care coordination. As a BSN nurse, it is your role to assist and lead care coordination and determine how you can help nursing colleagues understand care PROFICIENT DISTINGUISHED and continuum of care in a videorecorded presentation. establishes the importance and relevance of the nurse’s role in an engaging, and memorable presentation appropriate for the audience and well-supported by error-free slides that enhance key points and adhere to visual design best practices. coordination as a powerful way to improve patient outcomes. • • • Bean, M. (2017). The importance of care in a value-based world: Best practice approaches from Spectrum Health. Retrieved from https://www.beckershospitalreview.com/quality /the-importance-of-care-coordination-in-avalue-based-world-lessons-learned-byspectrum-health.html Care redesign survey: Strengthening the postacute care connection. (2016). Retrieved from https://catalyst.nejm.org/strengthening-postacute-care-connection/ What is care coordination? (2018). Retrieved from https://catalyst.nejm.org/what-is-carecoordination/ Multimedia Recording and Academic Resources • A variety of writing resources are available in the NHS Learner Support Lab, linked in the courseroom navigation menu. Effective Presentations The following resources will help you create and deliver an effective presentation. • o o • o • Conquering Death by PowerPoint: The Seven Rules of Proper Visual Design. This video is a primer on presentation design. Approximate run time: 45:00 Creating a Presentation: A Guide to Writing and Speaking. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage. Microsoft Office Software. o • o • o This Campus resource includes tip sheets and tutorials for Microsoft PowerPoint. PowerPoint Presentations Library Guide. This library guide provides links to PowerPoint and other presentation software resources. SoNHS Professional Presentation Guidelines [PPTX]. This presentation is designed as a model to help you develop professional-quality PowerPoint presentations. Scholarly Writing and APA Style Use the following resources to improve your writing skills and find answers to specific questions. • • Academic Honesty & APA Style and Formatting. APA Module. Library Research Use the following resources to help with any required or self-directed research you do to support your coursework. • • • • BSN Program Library Research Guide. Capella University Library. Journal and Book Locator Library Guide. Library Research and Information Literacy Skills ePortfolio Use the following resource to understand how to save your assessments to ePortfolio: • Online ePortfolio Guidelines [PDF]. Additional Resources for Further Exploration • You may use the following optional resources to further explore topics related to the competencies. They will help you to think about the connection between patient care and care coordination. • Bachman, S. S., Comeau, M., & Jankovsky, K. M. (2015). The care coordination conundrum and children and youth with special health care needs [PDF]. Available from http://cahpp.org/ Khera, N., Martin, P., Edsall, K., Bonagura, A., Burns, L. J., Juckett, M., . . . Majhail, N. S. (2017). Patient-centered care coordination in hematopoietic cell transplantation. Blood Advances, 1(19), 1617–1627. • … NURSFPX 4050 Fundamental Principles of Care Coordination Paper