Walden Finance and Economics in Health Care Discussion Response

Walden Finance and Economics in Health Care Discussion Response

RE: Discussion – Week 3

COLLAPSE

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Financial accounting reports are elements in the financial management of an organization created to effectively manage the business. Because the healthcare industry is a service industry, reports are generated to financially account for the different types of service is provided.

Accrual and Cash Flow Accounting

In cash basis accounting, revenue is recorded in a company’s financial statement (books) only after cash is received, and expenses when cash is paid out. (Baker, Baker & Dworkin, 2018). Cash basis accounting is used for small businesses generating $5 million or less of sales per year. Cash receipts and expenditures are relatively random in timing, thus reported results can vary between unusually high and low profits. (Accounting Tools, 2019). In accrual accounting, revenues are recorded when earned, not when payment is received; and expenses are recorded when they are incurred. (Baker, Baker & Dworkin, 2018) or resources used. Accrual accounting is used by larger companies, and is required for tax reporting when sales exceed $5 million. Accrual accounting more efficiently match revenues and expenses in the same reporting period. It keeps tract of revenue generated and resources used as well as cash flow, matches revenues with the resources used to generate those revenues, and the financial statements provide a broader picture of the provider’s operation, so that the true profitability of an organization can be discerned (Accounting Tools, 2019; Zelman, McCue & Glick, 2009).

Accounting Tools (2019) gives an example of how the statements differ: A company sells $10,000 of supplies to a customer in March, which pays the invoice in April. Under the cash basis, the seller recognizes the sale in April, when the cash is received. Under the accrual basis, the seller recognizes the sale in March, when it issues the invoice. Another company buys $500 in supplies in May, which it pays for in June. Under the cash basis, the buyer recognizes the purchase in June, when it pays the bill. Under the accrual basis, the buyer recognizes the purchase in May, when it receives the supplier’s invoice.

Recording Daily Used Item

Getting a patient ready for an invasive procedure, like an esophagogastroduodenoscopy (EGD), requires establishing an intravenous access for sedation. This requires the use of IV fluid, IV tubing, syringe, and a starter kit. This requires obtaining each item from the hospital’s medical supplies (the department maintains an inventory of supplies based on a par level). All the items listed above are a part of hospital inventory of medical supplies used in its day to day operation. Medical supplies are considered resources owned by the hospital (assets). Cost of these supplies should be recorded in the balance sheet in the assets column as they are part of the hospital’s inventory.

Impact of Cash Flow Issues

The cash flow statement summarizes a healthcare organization’s transactions into total receipts and payments as generated over a specific period from investments and capital assets. It shows how much cash came into the organization and how much went out. Organizations use cash flow statement to forecast the ability to generate sufficient cash flows from future activities -long term planning. (Cole-Ingait, n.d.) The organization for whom I am employed receives funding from the Department of Veterans Administration and has an accrual accounting system. Accounts receivable and accounts payable impacts cash flow because funding and payments for services rendered are usually not executed in a timely manner due to budgetary constraints. Accrual basis statements are often not able to be converted into cash flow of accounting for a financial period due to late payments or non-payments. Conversely, private health care providers affiliated with the VA encounter unpredictable cash-flow cycle due to complicated governmental payment methodologies, and reimbursement issues. Some of these organizations (using accrual accounting) that have accepted veterans referred by the VA are becoming reluctant to accept new referral usually due to nonpayment or underpayment.

Cash flow issues like provider reimbursement can result in lengthy settlement process which inhibits them from reconciling cash flow statements and can contribute to cash flow uncertainties. Cash flow uncertainties can ultimately result in decreased health care services for veterans and patients in general.

References

Accounting Tools. (2019). Cash basis vs. accrual basis accounting. Retrieved from: https://www.accountingtools.com/articles/cash-basi…

Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and Bartlett Learning.

Cole-Ingait, P. (n. d). Importance of a Cash Flow Statement in a Healthcare Organization. Retrieved from: https://yourbusiness.azcentral.com/importance-cash-flow-statement-healthcare-organization-27536.html.

Zelman, W., McCue, M & Glick, N. (2009). Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts and Applications (3rd ed.) John Wiley & Sons, Inc. ProQuest Ebook Central. Accessed on June 6, 2019 from: http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=468630.

Florida National Nursing Management in Isaac Behavior Case Scenario Discussion

Florida National Nursing Management in Isaac Behavior Case Scenario Discussion

Isaac has worked as a staff nurse on the telemetry floor for over 15 years. He holds seniority in the unit. His patient

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care is satisfactory; however, his interpersonal behaviors are becoming an increasing issue for his coworkers. He throws papers around the unit, gives short answers to questions, and seems generally miserable. He tells the staff that they are lazy and stupid. He is constantly questioning their decisions. You have come from another local hospital in the role of the assistant nurse manager. Based on your observations, you have met with Isaac informally and discussed his behaviors, but they have not changed. Now three new nurses have already come to you saying that this unit is a great match for them, except for one problem. Although they have not identified Isaac by name, they have told you that one of the nurses is extremely abusive verbally, and they have been calling in sick on the days they are scheduled to work with this person.

1. What are your responsibilities as an assistant nurse manager in regard to Isaac’s behavior problem?

2. What is the next step in dealing with Isaac’s behaviors?

3. How will you, as the manager, have Isaac develop more effective people skills?

This is your first position as a nurse manager. The holidays are rapidly approaching, and the hospital policy states that each unit will negotiate holiday coverage individually. You are already getting requests via e-mail and on Post-it notes for holiday time. Several staff members have come to you stating that they “never” seem to get their requests for holidays. Discussion among the staff members is creating dissension and conflict.

1. Discuss the potential impact of this problem on you and the unit staff.

2. Describe a minimum of one positive consequence and one negative consequence of this conflict.

3. Select a model of conflict resolution and explain how you, as a nurse manager, might resolve this conflict.

 

Requirements:

-APA Format.

-Introduction or abstract page

-Summary or Conclusion page

-Four Pages Minimum, not included Introduction or abstract, Conclusion or Summary , and Bibliographic pages.

-Completely unacceptable Copy and Paste from Internet, or other resources.

– Bibliographic have to be in APA Format, minimum 3 references citations with 3 years old or less.

HUM101 Chamberlain College of Nursing Critical Reasoning Evaluating Arguments

HUM101 Chamberlain College of Nursing Critical Reasoning Evaluating Arguments

Jennifer Del Corio 02/13/2019 Week 6 Assignment: Evaluating Arguments The first two steps in evidence-based

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practice are to identify knowledge gaps and formulate relevant questions. In this writing exercise, you will be doing just that, across three types of inductive reasoning. In addition, you will be applying evaluation techniques to determine how credible, authoritative, and reliable the arguments are. For each exercise, address the following: Identify the type of inductive argument and any features of the way the argument is constructed that you find relevant. Explain how convincing you think the argument is. Does it have sufficient evidence to allow you to suggest that she move forward with the idea or does the argument have knowledge gaps? What questions need to be answered to close these gaps? Does the argument contain any information that adds to its authority, credibility, or reliability? Chapter 8 Exercise 8.9 Example 7 Among people who use multiple dietary supplements, fish oil/omega-3 supplements now top multivitamins in popularity. The conclusion is based on 6,012 responses collected in November from a sampling of subscribers to our free e-newsletter. Fish oil/omega-3 supplements were used by 74% of respondents, followed in popularity by multivitamins, which were used by 72% ConsumerLab.com First let’s break down this claim Premise: Of the 6,012 respondents to an e-newsletter online survey Fish oil/omega-3 supplements were used by 74% of respondents. : Fish oil/omega 3 supplements are the most popular. Issue: Whether Fish oil/Omega 3 is the most popular supplement. Sample: The 6,012 respondents to an e-newsletter online survey Target: All subscribers of an e-newsletter written by ConsumerLab.com Feature/Conclusion: Responses that fish oil/omega-3 supplements was their go to supplement. Identify the type of inductive argument and any features of the way the argument is constructed that you find relevant. This is an analogical argument because the claim compares 2 things each of the following claims draws an analogy providing percentages. Explain how convincing you think the argument is. I believe this argument is true because of the ways they presented the facts from the data acquired from the survey done. Although, the sample group was very limited to just the subscribers of ConsumerLab.com, and the survey was done only for one month. Does it have sufficient evidence to allow you to suggest that she move forward with the idea or does the argument have knowledge gaps? Yes, is does have sufficient evidence that can be built upon, allowing for the expansion of a sample group but does have some gaps. What questions need to be answered to close these gaps? The gaps can be closed by obtaining information of why they choose one supplement over another? Does the argument contain any information that adds to its authority, credibility, or reliability? Yes, the argument does contain information that adds credibility due the subjective components of providing percentage values. Chapter 8 Exercise 8.9 Example 10 For-profit hospices do not focus on the best interests of their patients. In one study assessing the impact of ownership status on care provided to patients, researchers found that patients receiving care from for-profit hospices received a narrower range of services than patients from non-profit hospices. The narrower range of services meant that patients with for-profit hospices were not receiving as much counseling services, medications, and personal care.—Carlson, Gallo, and Bradley, “Ownership Status and Patterns of Care in Hospice” Chapter 9 Exercise 9.9 Example 1 The University of Hawaii at Manoa is a lot like the University of Colorado at Denver. They are both public, coeducational universities located in the capital city of their state, and they both have student populations of approximately 20,000 students. Since 64% of the students at the University of Hawaii are of Asian or Pacific Island descent, approximately the same number of students at the University of Colorado at Denver are of Asian or Pacific Island descent. Chapter 10 Exercise 10.9 Example 1 Recently researchers compared 286 depressed workers with 193 others who were not depressed. Since only the depressed workers had such problems as fatigue, lack of motivation, and trouble managing their usual workload, researchers concluded that depression was the cause of their problems at work. American Journal of Health Promotion
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Appraisal Synopsis

Appraisal Synopsis

ARTICLE Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service

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Use Carmen Caicedo, PhD, RN ABSTRACT This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number Carmen Caicedo, Assistant Professor of Nursing, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL. Funded by Florida Nurses Foundation 2012 Undine Sams and Friends, Research Grant (District 5 Charitable Trust) for dissertation study. Conflicts of interest: None to report. Correspondence: Carmen Caicedo, PhD, RN, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, AHC 3, Room 326, 11200 SW 8th St, Miami, FL 33199; e-mail: ccaicedo@fiu.edu. 0891-5245/$36.00 Copyright Q 2016 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. Published online January 28, 2016. http://dx.doi.org/10.1016/j.pedhc.2015.12.003 590 Volume 30 Number 6 of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. J Pediatr Health Care. (2016) 30, 590-598. KEY WORDS Children with special health care needs, medically complex, medical technology–dependent, health-related quality of life, pediatric nurse practitioner Approximately 11.2 million children in the United States (15.1%) have special health care needs (Centers for Disease Control and Prevention, 2014). A small but growing subset of children with special health care needs (CSHCN) are dependent on medical technology or procedures to sustain life (Simon et al., 2010). They require a higher level of care and care coordination both in the hospital and in community settings (Houtrow, Okumura, Hilton, & Rehm, 2011; Kuo, Cohen, Agrawal, Berry, & Casey, 2011). Advanced practice nurses (APNs; e.g., pediatric nurse practitioners [PNPs] and clinical nurse specialists) are in a unique position to provide high-quality care across care settings (Aruda, Griffin, Schartz, & Geist, 2015; Martyn, Martin, Gutknecht, & Faleer, 2013), comprehensive care coordination (Looman et al., 2013), and advocacy for CSHCN and their families because of their specialized Journal of Pediatric Health Care training and knowledge of health and regulatory issues (Lindeke, Krajicek, & Patterson, 2001). Current literature examines the types of medical complexities in CSHCN by describing the types of health consequences, such as the need for prescription medications (Simon, Mahant, & Cohen, 2012); functional difficulties (Lollar, Hartzell, & Evans, 2012); use of medical technology for children cared for at home (Mendes, 2013); and the need and use for multiple health care services (Kuo et al., 2011). Although the magnitude of health care costs for these children is great (Cohen et al., 2012), limited information on child health and functioning and health care service use for medically complex, technology-dependent children is available in the literature (Rehm, 2013). No national data are available on the type of complex health care or medical technology used by this group of CSHCN (Carnevale, Rehm, Kirk, & McKeever, 2008; Spratling, 2015). Existing evidence suggests that children who require complex medical health care and are dependent on medical technology have poorer health-related quality of life (HRQOL) compared with chronically ill children who are not dependent on technology (Houtrow et al., 2011; Kuo et al., 2011). PNPs are positioned across care settings to establish partnerships with CSHCN and their families to optimize health care outcomes (Borgmeyer, Gyr, Jamerson, & Henry, 2008; Brennan & McEnhill, 2011; Egerton, 2012; Ellington, 2013; Evangelista et al., 2011; Golden, 2014; Hendricks-Ferguson, Akard, Madden, Peters-Herron, & Levy, 2015; Okuhara, Faire, & Pike, 2011) and improve care coordination for this growing vulnerable population (Lindeke, Leonard, Presler, & Garwick, 2002). This study attempts to fill the knowledge gap by examining demographic information, condition severity, and the types of care and services needed as reported by the parent/guardian caregivers of medically complex, technology-dependent children. This information will help PNPs in all areas of service delivery and care coordination to improve the health and functioning outcomes of this population. The purpose of this study was to describe child health, functioning, and health care service use of medically complex technology-dependent children and to describe the differences by condition severity (moderately disabled, severely disabled, and vegetative state). number of routine and acute care office visits (for both primary and specialty physicians), emergency department visits, hospitalizations, nursing health care service visits, physical and occupational therapy sessions, and speech pathology sessions; (c) the number of medications, medical technology devices (MTDs), and assistive devices used by medically complex, medical technology–dependent CSHCN; and (d) condition severity (moderate disability, severe disability, and vegetative state). Data were collected monthly for 5 months. METHODS Study Design and Sample This longitudinal descriptive study used a convenience sample of medically complex, technology-dependent children. Recruitment and data collection took place from March 2011 to March 2013. Data collected included (a) child health and functioning (child HRQOL), which includes physical health and psychosocial health (both mental [emotional] health and functioning [social, school participation]); (b) health care service use, including the Demographic The child’s date of birth, gender, race/ethnicity, and diagnosed health conditions were collected using the Pediatric Quality of Life (PedsQL) Family Information Form (Varni, Seid, & Kurtin, 2001). www.jpedhc.org CSHCN inclusion/exclusion criteria CSHCN ages 2 to 21 years who had a complex medical condition with dependence on MTDs or procedures to maintain life were included in the study. CSHCN with only a behavioral or mental health disorder, such as attention deficit/hyperactivity disorder or autism without other medical conditions requiring complex medical health care, were excluded from the study. Parent inclusion/exclusion criteria Primary caregivers or parents aged 18 years or older who spoke English or Spanish and were responsible for the care of an eligible CSHCN were included in the study. Parents or guardians with any major physical or mental disability that prevented them from participating in the study or completing the instruments were excluded. Procedures After receiving Institutional Review Board approval from the university and permission from the key administrators, families were recruited from local pediatric primary and specialty physician practices, medical day care settings, and long-term/residential care settings in South Florida. Clinical site contacts spoke with families who met the inclusion criteria. Interested families were contacted by telephone by the principle investigator (PI). A home visit or recruitment site visit was scheduled for interested families; at this visit the study purpose was reviewed, questions were answered, and written signed consent and baseline data were obtained from the child’s parent or guardian. Data were collected monthly for five consecutive months (in person or by telephone) from the same parent. Instruments Child physical health and functioning Child health and functioning were measured using the PedsQL Generic Core Module 4.0 Parent-Proxy Report (Varni, Burwinkle, Seid, & Skarr, 2003). Each parent or November/December 2016 591 guardian caregiver (called parents) completed a parentproxy report that assessed the parent’s perception of their child’s health and functioning. The 23-item PedsQL Generic Core Module was designed to measure child physical health (eight items), mental health, including emotional functioning (five items) and social participation (five items), and school participation (five items). The instructions asked how much of a problem each item had been during the previous month using a 5-point response scale (0 = never a problem to 4 = almost always a problem). Items were reverse-scored and transformed to a 0-100 scale (0 = 100 to 4 = 0). The total Generic Core Module or HRQOL Score was computed as the sum of all 23 items (physical health, emotional functioning, social, and school functioning scales) over the number of items answered. Physical health was computed as the sum of the eight items in the physical health scale over the number of items answered. Psychosocial health was computed as the sum of the items in the emotional, social, and school functioning scales over the number of items answered. Higher scores indicated better HRQOL and functioning. The internal consistency reliability for this study was Cronbach’s a, 0.88 to 0.97, which is consistent with the literature and demonstrated good internal consistency (parent report = 0.90) with construct validity in the healthy children group and children with acute or chronic health conditions group (Varni & Limbers, 2009; Varni, Limbers, & Burwinkle, 2007). Because condition severity of CSHCN varied widely, this study measured the level of condition severity with the use of three categories (moderate disability, severe disability, and vegetative state) from the Glasgow Outcome Scale as determined by the PI. Moderate disability was indicated for children who were independent for their age but physically or cognitively disabled, thus requiring a modified physical, social, psychological, or vocational milieu. Severe disability was indicated for children with total dependence on others for managing a normal or modified environment. Vegetative state was indicated for children who were totally dependent with no perception of their environment (Pettigrew, Wilson, & Teasdale, 2003). Medications, medical technology, and assistive device use by the child were described by the parent by type and use each month. Health care service use included the parent’s monthly report of the number of routine and acute doctor office visits (including primary and specialty physicians), emergency department visits, and hospitalizations, along with the number of hours per week of nursing health care services, physical therapy (PT), occupational therapy (OT), and speech pathology (SP) therapy. Data Analysis Descriptive statistics were used to examine parentreported child characteristics including age, gender, 592 Volume 30 Number 6 race (White only, Black only, and other), and ethnicity (Hispanic or non-Hispanic); general health status reported by the parent (excellent, good, fair, or poor); condition severity reported by the PI (moderate disability, severe disability, or vegetative state); and functional limitations (independent for age, needs help, or dependent). Continuous variables are reported as means and standard deviations (SDs), and categorical variables are reported as frequencies and percentages over the 5 months. All the assumptions, such as mutually exclusive groups, homogeneity of variance, normal distribution, and homogeneity of regression needed for the valid use of analysis of variance (ANOVA) were verified. Differences among the condition severity groups were identified for the dependent variables using v2 or ANOVA as appropriate. Post-hoc comparisons were conducted using Bonferroni tests. RESULTS Sample A total of 84 medically complex technology-dependent children were recruited. Data were collected on a total sample of 76 children over 5 months. The recruitment rate was 69% of the parents from the clinical site contacts, with 26 parents refusing to participate or not responding to the initial telephone call from the PI. Eight CSHCN were lost to follow-up after the first interview: four were unable to be contacted, one moved out of the area, one parent refused to continue, and one child and one parent died. Characteristics of the CSHCN are presented in Table 1. Most of the children were younger than 11 years, male, and Hispanic. Most were severely disabled, yet in good to excellent general health as described by their parent. Most CSHCN experienced neurologic issues (e.g., seizures, cerebral palsy, and genetic disorders), breathing or respiratory problems (e.g., chronic lung disease and asthma and dependent on oxygen or a ventilator), and/or feeding/swallowing problems. Fewer than half of the children (42%, n = 35) were diagnosed with their first condition before 2 months of age, with diagnosis occurring at an average of 9.9 months (SD, 28.6; range, birth to 5½ years). The average age of the children was different across condition severity groups [F (2, 81) = 10.7, p = .05]. Post-hoc comparisons using the Bonferroni method indicated that the average age for the moderate disability group was significantly different (younger) than for both the severely disabled and vegetative group. However, the average ages of the children in the severely disabled and vegetative groups were not significantly different. No differences in gender or race/ethnicity were found across condition severity groups. Journal of Pediatric Health Care TABLE 1. Characteristics of the children by condition severity Parent report Age, years 2-5 6-11 12-17 18-21 Gender Male Female Race/ethnicity Hispanic White non-Hispanic Black non-Hispanic General health status Excellent Very good Good Fair Poor Total N = 84 Moderate disability n = 24 a 10.1 (6.2) 29 (35) 20 (24) 19 (22) 16 (19) 6.0 (4.1) 16 (67) 6 (25) 1 (4) 1 (4) a Severe disability n = 44 11.0 (6.1) 10 (23) 13 (30) 12 (27) 9 (20) a Vegetative state n = 16 a 13.8 (6.1) 3 (18) 1 (6) 6 (38) 6 (38) Test statistic F = 10.7* v2 = 60.5* v2 = 0.35 47 (56) 37 (44) 13 (54) 11 (46) 24 (54) 20 (46) 10 (63) 6 (37) 37 (47) 19 (25) 22 (27) 10 (42) 3 (13) 11 (45) 20 (45) 10 (23) 9 (21) 7 (44) 6 (37) 2 (13) 11 (13) 17 (20) 28 (33) 19 (23) 9 (11) 5 (21) 4 (17) 10 (42) 4 (17) 1 (4) 3 (7) 10 (23) 13 (28) 12 (28) 6 (14) 3 (19) 3 (19) 5 (31) 3 (19) 2 (13) v2 = 7.8 v2 = 6.1 Note. Values are listed as n (%) except where indicated. a M (SD). *p < .05. Parent-Reported General Health Status Overall, parents perceived general health status as good to excellent for 66% of the children. Parents rated the children’s health as good to excellent for 79% (n = 19) in the moderately disabled group, 59% (n = 26) in the severely disabled group, and 69% (n = 11) in the vegetative group. Overall, the poorest general health status was reported for 33% of the children (n = 28): 21% (n = 5) in the moderately disabled group, 41% (n = 18) in the severely disabled group, and 31% (n = 5) in the vegetative group. No significant difference in overall general health status was found across condition severity groups. Child Health and Functioning The parent-proxy report described children as having problems in the following areas: walking, 78% (n = 65); hurts and pains, 74% (n = 62); running, 72% (n = 61); bathing, 71% (n = 60); low energy level, 67% (n = 56); participating in sports or playing, 64% (n = 54); and doing chores or picking up toys, 64% (n = 54). Emotional functioning reported by parent-proxy showed that children had problems in the following areas: being angry, 86% (n = 72); being sad or blue, 62% (n = 52); being afraid or scared, 60% (n = 50); having trouble sleeping, 53% (n = 45); and worrying, 38% (n = 32). Children also were reported as having problems in the following areas: doing the same things as their peers, 65% (n = 55); keeping up with others, 63% (n = 53); making friends, 34% (n = 29); getting along with others, 32% (n = 27); and getting teased, 28% (n = 24). Parents further reported that children had www.jpedhc.org problems in the following areas: missing school when not feeling well, 76% (n = 64); keeping up with schoolwork, 73% (n = 61); forgetting, 70% (n = 59); paying attention in class, 67% (n = 56); and missing school for doctor or hospital appointments, 55% (n = 46). Parent-proxy report on child health and functioning is presented in Table 2. Child HRQOL was different across condition severity groups [F (2, 73) = 7.5, p = .001]. Post-hoc comparisons using the Bonferroni method indicated that the HRQOL score for the vegetative group was significantly different (lower) than that for both the severely disabled and moderately disabled groups. However, the HRQOL scores of the severely disabled group and the moderately disabled group were about the same. The Physical Health Score was different across condition severity groups [F (2, 59.0) = 21.7, p = .001]. Post-hoc comparisons using the Tamhane test indicated that the Physical Health Score for the vegetative group was significantly different (lower) than that for both the severely disabled and moderately disabled groups. There was no difference in the Psychosocial Health Score across condition severity groups. Functional Limitations The majority of children needed help or were dependent on help for activities of daily living (ADLs) because of physical or cognitive problems. Fifty-seven percent of children (n = 48) needed help with mobility (v2 = 5.0, p < .01); 43% (n = 36) ambulated without help; 39% (n = 33) were bed bound and unable to balance sitting up; and 18% (n = 15) were independent November/December 2016 593 TABLE 2. Parent-proxy report on child health and functioning by severity Total N = 84 Parent proxy HRQOL score Physical health summary score Psychosocial health summary score Moderate disability n = 24 Severe disability n = 44 Vegetative state n = 16 63.1 (29.1) 68.5 (23.5) 69.9 (24.9) 49.7 (26.3) 46.3 (27.8) 74.2 (20.8) 28.6 (17.5) 22.8 (9.0) 64.7 (27.3) 49.5 (27.9) 48.1 (28.5) 71.3 (23.2) Test statistic F = 7.5** F = 21.7* F = 0.93 Note. HRQOL, health-related quality of life. Values are listed as M (SD). *p < .05. **p < .01. with some assistive device, including a wheelchair or a walker. Other functional limitations were as follows: 89% of children (n = 75) needed help with feeding (v2 = 58.4, p < .001) with modified diets such as pureed or thickened liquids, or they were unable to feed themselves as a result of physical and/or cognitive problems and had swallowing or chewing difficulties requiring gastrostomy tube feedings; 92% (n = 77) needed help bathing (v2 = 25.3, p < .001); 64% (n = 50) needed help with grooming (v2 = 27.6, p < .001) and 87% (n = 73) needed help with dressing (v2 = 32.6, p < .001); and 85% (n = 71) needed help with toileting, including use of diapers for incontinence, catheterizations, or assistance cleaning up or dressing before and after toilet use (v2 = 31.5, p < .001). Significant differences in functional limitations were found across condition severity groups. Children in the vegetative group required total assistance with ADLs, whereas more children in the moderately disabled group were independent with ADLs than were children in the severely disabled group. Medications Ninety-two percent of children (n = 77) received multiple prescribed daily medications (Table 3), with an average of 5.5 (SD, 3.7). Forty percent of children (n = 31) received up to four different medications; 34% (n = 26) received five to six medications; and 26% (n = 20) received seven or more medications. The number of different medications received by the children was different across condition severity groups [F (2, 76) = 3.9, p = .025]. Post-hoc comparisons indicated that the average number of medications received by the moderate disabled group was significantly different (less) than that received by both the severely disabled and vegetative groups. However, the average number of medications received by the severely disabled and vegetative groups was not significantly different. Medical Technology Devices MTDs (Table 4) were used to sustain and/or monitor bodily functions daily for 74% of children (n = 62), with an average of 4.2 MTDs (SD, 2.9) and a range of 1 to 11 devices. The number of MTDs used by children daily was different across condition severity groups [F (2, 59) = 10.3, p = .001]. Post-hoc comparisons indicated that the number of MTDs used by the moderately disabled group was significantly different (lower) than that used by both the severely disabled and vegetative groups. However, the number of MTDs used by the severely disabled and vegetative groups was not TABLE 3. Daily medications by condition severity Parent report Children receiving medications No. of daily medications Types of medications Respiratory Gastrointestinal Cardiac Seizure Sedation, pain, spasms Allergy Renal Skin Immunosuppressive Total N = 84 Moderate disability n = 24 Severe disability n = 44 Vegetative state n = 16 77 (92) 5.5 (3.7)a 20 (83) 3.6 (2.2)a 41 (93) 6.0 (4.1)a 10 (63) 6.5 (3.6)a 49 (64) 43 (56) 11 (14) 30 (39) 29 (38) 21 (28) 8 (10) 19 (25) 6 (8) 13 (54) 5 (21) 4 (17) 6 (25) 2 (8) 7 (29) 2 (8) 1 (4) 1 (4) 27 (61) 29 (66) 5 (11) 15 (38) 18 (45) 12 (30) 6 (14) 15 (34) 4 (9) 9 (56) 9 (56) 2 (17) 9 (56) 9 (56) 2 (13) 0 3 (19) 1 (6) Test statistic v2 = 6.3* F = 3.9* v2 = 1.9 v2 = 18.3** v2 = 0.27 v2 = 8.5* v2 = 16.7** v2 = 0.86 v2 = 2.4 v2 = 8.9* v2 = 0.71 Note. Values are listed as n (%) except where indicated. a M (SD). *p < .05. **p < .01. 594 Volume 30 Number 6 Journal of Pediatric Health Care TABLE 4. Medical technology devices used daily by condition severity Parent report Children using an MTD daily No. of MTDs Types of MTD Tracheostomy Ventilator Oxygen Suction machine Pulse oximetry Apnea monitor Nebulizer Gastrostomy tube Total N = 84 Moderate disability n = 24 Severe disability n = 44 Vegetative state n = 16 62 (74) 4.2 (2.9)a 16 (67) 1.8 (1.0)a 30 (68) 4.9 (3.0)a 16 (100) 5.4 (2.7)a v2 = 8.3* F = 10.3** 15 (24) 7 (11) 12 (19) 27 (44) 19 (31) 6 (10) 43 (69) 40 (64) 2 (13) 1 (6) 1 (6) 3 (19) 3 (19) 0 13 (81) 4 (25) 9 (30) 2 (7) 6 (20) 16 (53) 10 (33) 3 (10) 23 (77) 24 (80) 4 (30) 4 (30) 5 (31) 8 (50) 6 (38) 3 (19) 7 (44) 12 (75) v2 = 3.6 v2 = 9.9** v2 = 8.5* v2 = 11.0* v2 = 16.3* v2 = 6.9* v2 = 0.09 v2 = 22.5* Test statistic Note. MTD, medical technology device. Values are listed as n (%) except where indicated. a M (SD). *p < .05. **p < .01. significantly different. The different types of MTDs were significantly different across condition severity groups and were related to assisting the children in breathing and eating. Assistive Devices Assistive devices (Table 5) were used to improve independence with functional activities by 73% of children (n = 61), with an average of 4.3 assistive devices (SD, 2.7; range, up to 7 devices). The number of assistive devices used by children daily was different across condition severity groups [F (2, 59) = 4.3, p = .001]. Post-hoc comparisons indicated that the average number of assistive devices used by the moderately disabled group was significantly different (lower) than that used by both the severely disabled and vegetative groups. However, the number of assistive devices used by the severely disabled and vegetative groups was not significantly different. Health Care Service Use Primary care pediatricians In the previous 12 months, all of the children had been seen by their primary care physician (PCP). Sixty-three percent of the children (n = 53) were seen for a routine TABLE 5. Assistive devices used daily by condition severity Parent report Children using assistive devices No. of assistive devices Type of assistive devices Wheelchair/mobility aids AFO Splints Vision Hearing Communication device Helmet Stander Bath chair Mechanical bed Lift Adaptive utensils Trunk brace Potty chair Total N = 84 Moderate disability n = 24 Severe disability n = 44 Vegetative state n = 16 61 (73) 4.3 (2.7)a 10 (42) 2.1 (1.9)a 35 (80) 4.5 (2.9)a 16 (100) 5.0 (2.4)a v2 = 24.5** F = 4.3** 40 (53) 34 (40) 26 (31) 12 (14) 5 (6) 15 (18) 3 (4) 14 (21) 30 (40) 29 (38) 16 (21) 3 (4) 4 (5) 3 (5) 2 (8) 3 (13) 3 (13) 3 (13) 0 1 (4) 0 1 (4) 0 1 (4) 0 0 0 0 26 (65) 23 (52) 15 (34) 7 (16) 4 (9) 13 (30) 3 (8) 10 (25) 19 (48) 19 (48) 10 (25) 3 (8) 4 (10) 3 (8) 12 (75) 8 (50) 8 (50) 2 (13) 1 (6) 1 (6) 0 3 (25) 11 (92) 9 (75) 6 (50) 0 0 0 v2 = 32.1** v2 = 15.1** v2 = 10.8** v2 = 0.29 v2 = 2.5 v2 = 10.0* v2 = 2.8 v2 = 4.4 v2 = 30.4** v2 = 20.1** v2 = 12.8** v2 = 2.8 v2 = 3.8 v2 = 2.8 Test statistic Note. AFO, ankle-foot orthotic. Values are listed as n (%) except where indicated. a M (SD). *p < .05. **p < .01. www.jpedhc.org November/December 2016 595 well-child care visit; 30% (n = 25) were seen once; 24% (n = 20) were seen twice; and 9% (n = 8) were seen up to four times. Fifty-three percent of the children (n = 48) were seen by their PCP for an acute care visit; 37% (n = 31) were seen once, 17% (n = 14) were seen twice, and 4% (n = 3) were seen three times for an acute care visit. No differences in routine and acute care PCP office visits were found during the study period across condition severity groups (Table 6). Specialty physicians Eighty-two percent of the children (n = 69) visited specialty physicians, with an average of 8.2 visits (SD, 4.6) during the study period. Moderately disabled children had an average of 6.2 visits (SD, 4.6); severely disabled children had an average of 8.9 visits (SD, 4.5); and vegetative children had an average of 9.3 visits (SD, 4.2). Thirty-eight percent of children (n = 32) were seen by at least five specialists; 32% (n = 22) were seen by between 6 to 10 specialists; and 30% (n = 21) were seen by up to 11 specialists during the study period. Types of specialty physicians used by more than 50% of the children included neurology, gastrointestinal/genitourinary, pulmonary, orthopedic, dentist, and ophthalmology. No overall differences in the number or type of specialty physicians seen during the study period were found across condition severity groups. Emergency department visits Thirty-seven percent of children (n = 31) were seen in an emergency department; 18% (n = 15) were seen once, 12% (n = 10) were seen twice, and 7% (n = 6) were seen four times. Forty-six percent of the children (n = 39) were hospitalized; 32% (n = 27) were admitted once, 10% (n = 8) were admitted twice, and 4% (n = 4) were admitted three or more times. No differences in the number of emergency department visits were found across condition severity groups. Nursing health care services Nursing health care services were provided for 65% of the children (n = 55), with an average of 73.1 hours per week (SD, 74.7; range, 0 to 168 hours). Thirteen percent of children (n = 11) received up to 40 hours of nursing health care per week; 17% (n = 14) received 41 to 120 hours; and 36% (n = 30) received 121 hours or more hours per week. Differences were found in the number of nursing health care hours per week across condition severity groups [F (2, 42.4) = 10.5, p = .001]. Post-hoc comparisons using the Tamhane test indicated that the number of nursing health care hours per week for the moderate disability group was significantly different (lower) than that of both the severely disabled and vegetative groups. However, the number of nursing health care hours per week for the severely disabled and vegetative groups were not significantly different. PT services PT services were provided for 55% of the children (n = 46) with an average of 2.1 hours per week (SD, 5.2; range, 0 to 5 hours). No differences in the number of PT hours per week were found across condition severity groups. OT services OT services were provided for 46 of the children (54.8%), with an average of 1.9 hours per week (SD, 5.0; range, 0 to 5 hours). No differences were found in the number of OT hours per week across condition severity groups. SP services SP services were provided for 41% of the children (n = 34), with an average of 1.7 hours per week (SD, 5.1; range, 1 to 3 hours per week). No differences were found in the number of SP hours per week across condition severity groups. TABLE 6. Health care services by condition severity Total N = 84 Per month Routine care visits Specialty visits Acute care visits Urgent care visits Emergency department Hospital admissions Hours per week Nursing health care Physical therapy Occupational therapy Speech pathology Moderate disability n = 24 Severe disability n = 44 Vegetative state n = 16 1.0 (0.08) 5.9 (4.8) 1.0 (0.40) 0.11 (0.62) 0.29 (0.61) 0.17 (0.36) 0.98 (0.10) 4.3 (4.2) 0.90 (0.29) 0.17 (0.82) 0.29 (0.62) 0.08 (0.24) 1.0 (0.07) 7.0 (4.9) 1.0 (0.51) 0.09 (0.60) 0.30 (0.66) 0.18 (0.39) 1.0 (0.0) 5.5 (4.8) 1.0 (0.0) 0.06 (0.25) 0.28 (0.48) 0.25 (0.41) F = 1.3 F = 2.6 F = 0.80 F = 0.16 F = 0.003 F = 1.1 73.1 (74.7) 2.1 (5.2) 1.9 (5.0) 1.7 (5.1) 25.4 (57.7) 2.9 (9.1) 3.1 (9.2) 2.8 (9.2) 81.5 (75.7) 1.9 (2.6) 1.5 (1.4) 1.4 (1.6) 121.5 (54.4) 1.5 (1.0) 1.3 (1.1) 0.62 (1.1) F = 10.5** F = 0.41 F = 0.97 F = 1.0 Test statistic Note. Values are listed as M (SD). **p < .01. 596 Volume 30 Number 6 Journal of Pediatric Health Care Ninety-five percent of the children received both PT and OT. However, 4% of parents reported that PT and OT needs were not met. SP was provided to 88% of the children, yet 6% of parents reported that SP needs were not met. Thirty-two percent of parents (n = 27) reported that their child had a need for treatment or counseling for an emotional, developmental, or behavioral problem. DISCUSSION This study describes child health, functioning, and health care service use of medically complex, technology-dependent children in South Florida over a 5-month period and describes differences by condition severity groups. Technology-dependent children are a growing subset of CSHCN. Many of these children have higher levels of condition severity, which may include an increased number of prescription medications, limited functional abilities with or without assistive devices, and an elevated health care service use reflecting the complex medical conditions and the intensive health care needs of the children. Increasing numbers of PNPs are providing care for CSHCN and improving their health and functioning outcomes (Borgmeyer et al., 2008; Egerton, 2012; Ellington, 2013; Evangelista et al., 2011; Hendricks-Ferguson et al., 2015). Parent-reported perceptions of the overall general health status were good to excellent with no differences across condition severity groups. This finding may be attributed to a well-managed medical health care routine coordinated by the contributions of the PNP because of their specialized training and knowledge of health and regulatory issues. IMPLICATIONS FOR POLICY, RESEARCH, AND PRACTICE PNPs are in a unique position to assist parent/guardian caregivers who are faced with the challenges of caring for their children because PNPs are able to provide comprehensive care coordination across care settings with multiple disciplines. In clinical practice, PNPs will increasingly encounter medically complex, technologydependent children with higher levels of condition severity, www.jpedhc.org PNPs are in a unique position to assist parent/ guardian caregivers who are faced with the challenges of caring for their children because PNPs are able to provide comprehensive care coordination across care settings with multiple disciplines. more prescription medication use, more functional limitations, and elevated health care service use. The APN care coordinator role is necessary to help improve the health and functioning of medically complex technology-dependent children and to help improve care coordination with the parent/guardian caregivers. I thank Dr. Dorothy Brooten, PhD, FAAN, for her reviews and comments on the manuscript drafts. REFERENCES Aruda, M., Griffin, V., Schartz, K., & Geist, M. (2015). Evolving role of pediatric nurse practitioners. Journal of the American Association of Nurse Practitioners. Advance online publication http:// 10.1002/2327-6924.12289 Borgmeyer, A., Gyr, P., Jamerson, P., & Henry, L. (2008). Evaluation of the role of the pediatric nurse practitioner in an inpatient asthma program. Journal of Pediatric Health Care, 22(5), 273-281. Brennan, J., & McEnhill, M. (2011). Use of nurse practitioners in pediatric kidney transplant: A model for providing comprehensive care to children and families. Progress in Transplantation, 21(4), 306-311. Carnevale, F., Rehm, R., Kirk, S., & McKeever, P. (2008). What we know (and do not know) about raising children with complex continuing needs. Journal of Child Health Care, 12(1), 4-6. Centers for Disease Control and Prevention. (2014). 2009-2010 National Survey of Children with Special Health Care Needs. Retrieved from http://www.cdc.gov/nchs/slaits/cshcn.htm Cohen, E., Berry, J., Camacho, X., Anderson, G., Wodchis, W., & Guttmann, A. (2012). Patterns and costs of health care use of children with medical complexity. Pediatrics, 130, e1463-e1470. Egerton, L. (2012). Role of pediatric nurse practitioners. Emergency Nurse, 20(4), 30-34. Ellington, E. (2013). Telepsychiatry by ARNPs: An answer to the shortage of pediatric providers? Issues in Mental Health Nursing, 34, 719-721. Evangelista, J., Connor, J., Pintz, C., Saia, T., O’Connell, C., Fulton, D., & Hickey, P. (2011). Pediatric nurse practitioner managed cardiology clinics: Patient satisfaction and appointment access. Journal of Advanced Nursing, 68(10), 2165-2174. Golden, J. (2014). A nurse practitioner patient care team: Implications for pediatric oncology. Journal of Pediatric Oncology Nursing, 31(6), 350-356. Hendricks-Ferguson, V., Akard, T., Madden, J., Peters-Herron, A., & Levy, R. (2015). Contributions of advanced practice nurse with a DNP degree during palliative and end of life care of children with cancer. Journal of Pediatric Oncology Nursing, 32(1), 32-39. Houtrow, A., Okumura, M., Hilton, J., & Rehm, R. (2011). Profiling health and health related services for children with special health care needs with and without disabilities. Academic Pediatrics, 11, 508-516. Kuo, D., Cohen, E., Agrawal, R., Berry, J., & Casey, P. (2011). A national profile of caregiver challenges among more medically complex children with special health care needs. Archives of Pediatric & Adolescent Medicine, 165(11), 1020-1026. Lindeke, L., Krajicek, M., & Patterson, D. (2001). PNP roles and interventions with children with special needs and their families. Journal of Pediatric Health Care, 15, 138-143. Lindeke, L., Leonard, B., Presler, B., & Garwick, A. (2002). Familycentered care coordination for children with special needs across multiple settings. Journal of Pediatric Health Care, 16, 290-297. Lollar, D., Hartzell, M., & Evans, M. (2012). Functional difficulties and health conditions among children with special health needs. Pediatrics, 129(3), e714-e744. November/December 2016 597 Looman, W., Presler, E., Erickson, M., Garwick, A., Cady, R., Kelly, A., & Finkelstein. (2013). Care coordination for children with complex special health needs: The value of the advanced practice nurse’s enhanced scope of knowledge and practice. Journal of Pediatric Health Care, 27(4), 293-303. Martyn, K., Martin, J., Gutknecht, S., & Faleer, H. (2013). The nurse practitioner workforce: Meeting the health care needs of children. Journal of Pediatric Health Care, 27(5), 400405. Mendes, M. (2013). Parents’ descriptions of ideal home nursing care for their technology-dependent children. Pediatric Nursing, 39(20), 91-96. Okuhara, C., Faire, P., & Pike, N. (2011). Acute care pediatric nurse practitioner: A vital role in pediatric cardiothoracic surgery. Journal of Pediatric Nursing, 26, 137-142. Pettigrew, L., Wilson, J., & Teasdale, G. (2003). Reliability of ratings on the Glasgow Outcome Scales from in-person and telephone structured interviews. Journal of Head Trauma Rehabilitation, 18(3), 252-258. Rehm, R. (2013). Nursing’s contribution to research about parenting children with complex chronic conditions: An integrative review, 2002 to 2012. Nursing Outlook, 61(5), 266-290. Simon, T., Berry, J., Feudtner, C., Stone, B., Shen, X., Bratton, S., . Srivastava, R. (2010). Children with complex chronic conditions 1. 2. 3. 4. 5. 598 in inpatient hospital settings in the United States. Pediatrics, 126(4), 647-655. Simon, T., Mahant, S., & Cohen, E. (2012). Pediatric hospital medicine and children with medical complexity: Past, present, and future. Current Problems in Pediatric Adolescent Health Care, 42(5), 113-119. Spratling, R. (2015). Defining technology dependence in children and adolescents. Western Journal of Nursing Research, 37(5), 634-651. Varni, J., Burwinkle, T., Seid, M., & Skarr, D. (2003). The PedsQL 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics, 3(6), 329-341. Varni, J., & Limbers, C. (2009). The pediatric quality of life inventory: Measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatric Clinics of North America, 56, 843-863. Varni, J., Limbers, C., & Burwinkle, T. (2007). Parent proxy-report of their children’s health-related quality of life: An analysis of 13,878 parents’ reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5(2), 1-10. Varni, J., Seid, M., & Kurtin, S. (2001). PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales in healthy and patient populations. Medical Care, 39(8), 800-812. Evidence-Based Practice in Nursing: Bridging the Gap Between Research and Practice Volume 21, Issue 1, Pages 53–56 Noreen Brady, Linda Lewin Mastering the Preceptor Role: Challenges of Clinical Teaching Volume 20, Issue 3, Pages 172–183 Catherine Burns, Michelle Beauchesne, Patricia Ryan-Krause, Kathleen Sawin An Integrative Review of Adolescent Smoking Cessation Using the Transtheoretical Model of Change Volume 26, Issue 5, Pages 336–345 Lisa M. Robinson, Sara R. Vail Child Sexual Abuse: Consequences and Implications Volume 24, Issue 6, Pages 358–364 Gail Hornor Reactive Attachment Disorder Volume 22, Issue 4, Pages 234–239 Gail Hornor Volume 30 Number 6 Journal of Pediatric Health Care
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Reasons to agree or disagree with the Healthy People 2020 National Agenda.

Reasons to agree or disagree with the Healthy People 2020 National Agenda.

APA format exposing Reasons to agree or disagree with the Healthy People 2020 National Agenda.

my opinion

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Florida National Managing Employees & Resolving Nursing Workplace Conflicts Discussion

Florida National Managing Employees & Resolving Nursing Workplace Conflicts Discussion

Isaac has worked as a staff nurse on the telemetry floor for over 15 years. He holds seniority in the unit. His patient

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care is satisfactory; however, his interpersonal behaviors are becoming an increasing issue for his coworkers. He throws papers around the unit, gives short answers to questions, and seems generally miserable. He tells the staff that they are lazy and stupid. He is constantly questioning their decisions. You have come from another local hospital in the role of the assistant nurse manager. Based on your observations, you have met with Isaac informally and discussed his behaviors, but they have not changed. Now three new nurses have already come to you saying that this unit is a great match for them, except for one problem. Although they have not identified Isaac by name, they have told you that one of the nurses is extremely abusive verbally, and they have been calling in sick on the days they are scheduled to work with this person.

1. What are your responsibilities as an assistant nurse manager in regard to Isaac’s behavior problem?

2. What is the next step in dealing with Isaac’s behaviors?

3. How will you, as the manager, have Isaac develop more effective people skills?

This is your first position as a nurse manager. The holidays are rapidly approaching, and the hospital policy states that each unit will negotiate holiday coverage individually. You are already getting requests via e-mail and on Post-it notes for holiday time. Several staff members have come to you stating that they “never” seem to get their requests for holidays. Discussion among the staff members is creating dissension and conflict.

1. Discuss the potential impact of this problem on you and the unit staff.

2. Describe a minimum of one positive consequence and one negative consequence of this conflict.

3. Select a model of conflict resolution and explain how you, as a nurse manager, might resolve this conflict.

 

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American Jewish University Combatting Moral Distress in Nursing Questions

American Jewish University Combatting Moral Distress in Nursing Questions

Combatting Moral Distress

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Moral resilience has been defined as “the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks” (Rushton, 2016a, p. 112a). Moral resilience is an evolving concept and other definitions have focused on “the ability and willingness to speak and take right and good action in the face of an adversity that is moral/ethical in nature” (Lachman, 2016, p. 122).

I would like to believe that nurses have innate and learned capacities that can be used to combat the negative of forces of moral distress, burnout, compassion fatigue, and incivility that plagues our nursing profession.

As a result of this one course in Ethics, you have been given some tools to develop critical thinking skills, use ethical decision making models to strengthen and clarify your values. I believe all of you will need to be on an intentional journey to use and leverage these skills to keep your nursing practice resilient and meaningful.

How do you see yourself cultivating moral resilience within yourself, with your colleagues and the organizations where you will work? What specific interventions can you envision for yourself as you continue your journey in the socialization of becoming a nurse? What contributions do you intend to create to make meaningful and sustainable change in your role as a nurse?

THIS IS A APA FORMAT NOT A POWERPOINT-Legg Calve Perthes Disease

THIS IS A APA FORMAT NOT A POWERPOINT-Legg Calve Perthes Disease

THIS IS A APA FORMAT NOT A POWERPOINT-Legg Calve Perthes Disease. FOUR PAGES PLUS A REFERENCE PAGE WHICH EQUALS FIVE PAGES. THIS IS NOT A POWERPOINT I AM REQUESTING A APA FORMAT PAPER

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Academy of Healing Arts Massage and Facial Skin Care Combating Moral Distress

Academy of Healing Arts Massage and Facial Skin Care Combating Moral Distress

Combatting Moral Distress

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Moral resilience has been defined as “the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks” (Rushton, 2016a, p. 112a). Moral resilience is an evolving concept and other definitions have focused on “the ability and willingness to speak and take right and good action in the face of an adversity that is moral/ethical in nature” (Lachman, 2016, p. 122).

I would like to believe that nurses have innate and learned capacities that can be used to combat the negative of forces of moral distress, burnout, compassion fatigue, and incivility that plagues our nursing profession.

As a result of this one course in Ethics, you have been given some tools to develop critical thinking skills, use ethical decision making models to strengthen and clarify your values. I believe all of you will need to be on an intentional journey to use and leverage these skills to keep your nursing practice resilient and meaningful.

How do you see yourself cultivating moral resilience within yourself, with your colleagues and the organizations where you will work? What specific interventions can you envision for yourself as you continue your journey in the socialization of becoming a nurse? What contributions do you intend to create to make meaningful and sustainable change in your role as a nurse?

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NURS120 Los Angeles College Medical Terminology Worksheet

NURS120 Los Angeles College Medical Terminology Worksheet

Course: NURS 120 WEEK 2 TERMINOLOGY WORKSHEET: GASTROINTESTINAL & DIABETES Student Name:

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_______________________________________________________________________________ Define the following terms. Submit your work in a Word document to the drop-box provided in Blackboard. Make sure to include your name on your paper. This terminology is due on the first day of the week assigned. -opathy -itis -megaly hepathemathypohypercholegastric enteral ascites melena eructation dyspepsia occult bruit exogenous endogenous intrinsic hormone esophagogastroduodenoscopy basal prandial Page 1 of 1 Course: NURS 120 WEEK 3 TERMINOLOGY WORKSHEET: INTEGUMENTARY & MUSCULOSKELETAL Student Name: _______________________________________________________________________________ Define the following terms. Submit your work in a Word document to the drop-box provided in Blackboard. Make sure to include your name on your paper. This terminology is due on the first day of the week assigned. -ocytes -emia -oma -osis -centesis dermaosteoarthroAlopecia Pruritus Cyanosis Crepitus Jaundice Icteric Ecchymosis Petechiae Purpura Hyperemia Nevus Wheal Embolism Ossification Reduction & Fixation Immobilization Page 1 of 1 Course: NURS 120 WEEK 4 TERMINOLOGY WORKSHEET: RENAL Student Name: _______________________________________________________________________________ Define the following terms. Submit your work in a Word document to the drop-box provided in Blackboard. Make sure to include your name on your paper. This terminology is due on the first day of the week assigned. NephroCystoPyeloHydroGlomerulo-lithiasis PolyCystoscopy Glomerular filtration rate Calculus ileal conduit stenosis stricture urosepsis lithotripsy nephrosclerosis diversion ostomy anuria oliguria uremia azotemia Page 1 of 1 Course: NURS 120 WEEK 5 TERMINOLOGY WORKSHEET: RESPIRATORY Student Name: _______________________________________________________________________________ Define the following terms. Submit your work in a Word document to the drop-box provided in Blackboard. Make sure to include your name on your paper. This terminology is due on the first day of the week in which content is covered. PneumoCyanoThoraRhinSinuAdventitious Compliance (pulmonary) Fremitus Respiration Ventilation Crepitus Rhonchi Wheezes Dyspnea Orthopnea Crackles Hypoventilation Hyperventilation Tachypnea Bradypnea Biots Agonal Obstructive Reactive P