Connecting Eligible Immigrant Families to Health Coverage

Connecting Eligible Immigrant Families to Health Coverage

Read the report Connecting Eligible Immigrant Families to health Coverage and Care.
Write a one page post offering solutions to the problem from the nurse’s standpoint.

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Cost Savings Analysis

Cost Savings Analysis

Assessment Instructions

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PREPARATION
Prepare a spreadsheet of cost savings data showing efficiency gains attributable to care coordination, and report your key findings in an executive summary, 3–4 pages in length.

As the senior care coordinator in your organization, your manager has asked you to examine and report on how care coordination can generate cost savings, improve outcomes, enhance the collection of evidence-based data, and improve health care quality. She would like you to compile cost savings data in a well-organized spreadsheet and present your key findings in an executive summary.

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

REQUIREMENTS
Determine how care coordination can reduce costs. Compile your cost savings data in a spreadsheet, using Microsoft Excel or suitable application of your choice. Your spreadsheet should contain at least four cost-saving elements that you will discuss in your executive summary. Identify the cost saving element, current costs, and anticipated savings.

If you elect to use an application other than Excel, check with your instructor to avoid potential file compatibility issues. Report key findings from your analysis in an executive summary.

Executive Summary Format and Length
Format your executive summary using APA style.

Use the APA Style Paper Template, linked in the Required Resources. An APA Style Paper Tutorial is also provided (linked in the Suggested Resources) to help you in writing and formatting your executive summary. Be sure to include:
A title page and reference page. An abstract is not required.
A running head on all pages.
Appropriate section headings.
Your summary should be 4–5 pages in length, not including the title page and references page.
Supporting Evidence
Cite 4–5 sources of credible scholarly or professional evidence to support your cost savings analysis.

Analyzing Cost Savings
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your analysis addresses each point, at a minimum. You may also want to read the Cost Savings Analysis Scoring Guide to better understand how each criterion will be assessed.

Describe ways in which care coordination can generate cost savings.
What are your primary sources of information?
Are your conclusions substantiated by the data?
What assumptions, if any, underlie your analysis?
Explain how care coordination can promote improved health consumerism and effect positive health outcomes.
What evidence do you have to substantiate your claims?
Describe at least five ways in which care coordination efforts can enhance the collection of evidence-based data and improve quality through the application of an emerging health care model.
Choose any emerging health care model.
Present cost savings data and information clearly and accurately.
Support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
Additional Requirements
Be sure that you have used the APA Style Paper Template to format your executive summary and that your document includes:

A title page and references page.
A running head on all pages.
Appropriate section headings.
In addition, be sure that:

Your summary is approximately 4–5 pages in length, not including the title page and references page.
You have cited at 4–5 sources of relevant and credible scholarly or professional evidence to support your analysis.
Portfolio Prompt: You may choose to save your spreadsheet and executive summary to your ePortfolio.

Chapter 23 – ASSIGNMENT

Chapter 23 – ASSIGNMENT

JONA Volume 44, Number 7/8, pp 388-394 Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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THE JOURNAL OF NURSING ADMINISTRATION Care Redesign A Higher-Quality, Lower-Cost Model for Acute Care Pamela T. Rudisill, DNP, RN, NEA-BC, FAAN Carlene Callis, BS, MHA Sonya R. Hardin, PhD, RN, CCRN, NP-C Jacqueline Dienemann, PhD, RN, NEA-BC, FAAN Melissa Samuelson, DNP, RN, NEA, BC OBJECTIVE: The aims of this study were to design, pilot, and evaluate a care team model of shared accountability on medical-surgical units. BACKGROUND: American healthcare systems must optimize professional nursing services and support staff due to economic constraints, evolving Federal regulations and increased nurse capabilities. METHODS: A redesigned model of RN-led teams with shared accountability was piloted on 3 medical/surgical units in sample hospitals for 6 months. Nursing staff were trained for all functions within their scope of practice and provided education and support for implementation. RESULTS: Clinical outcomes and patient experience scores improved with the exception of falls. Nurse satisfaction demonstrated statistically significant improvement. Cost outcomes resulted in reduced total salary dollars per day, and case mixYadjusted length of stay decreased by 0.38. CONCLUSION: Innovative changes in nursing care delivery can maintain clinical quality and nurse and patient satisfaction while decreasing costs. Healthcare systems in the United States must bridge the transition from volume to value-based models. Components required to succeed include clinical integration, implementation of technology, and clinical performance improvement with operational efficiencies to manage financial constraints.1 Nursing services encompass the majority of the workforce in today’s acute care hospitals.2 Historically, models of care have been based on a mix of registered nurses (RNs) and unlicensed assistive personnel (UAP) with occasional reference to licensed practical nurses (LPNs) and the assignment of workload. Evidence supports that patient needs are best met by planned skill mix and recognition that nurses are knowledge workers and need to be utilized in that manner.3,4 Models-of-care redesign that embeds improving efficiency and increasing accountability to patients’ clinical outcomes requires a cultural transformation.1 All major changes in care design should be evaluated for their evidence-based and desired changes. The purpose of this study was to evaluate a pilot implementation of a shared accountability delivery model for medical-surgical patients that allowed licensed nurses and UAP to practice at their full authority through delegation and collaboration in RN-led teams. Author Affiliations: Senior Vice President and Chief Nursing Officer (Dr Rudisill), Community Health Systems, Franklin; and Assistant Vice President Strategic Resource Group, Vice President Strategic Planning American Group (Ms Callis), HCA, Nashville, Tennessee; Professor (Dr Hardin), College of Nursing, East Carolina University, Greenville, North Carolina; and Professor Emeritus (Dr Dienemann), School of Nursing, UNC Charlotte and Nurse Researcher Carolinas Medical Center University, North Carolina; and Chief Nursing Executive (Dr Samuelson), Poplar Bluff Regional Medical Center, Missouri. Community Health Systems is a registered trade name of Community Health Systems Professional Services Corporation. The authors declare no conflicts of interest. Correspondence: Dr Rudisill, Community Health Systems, 4000 Meridian Blvd, Franklin, TN 37067 (pamela.rudisill@hma.com or pam_rudisill@chs.net). DOI: 10.1097/NNA.0000000000000088 388 Background The healthcare system in the United States is in a state of rapid and unprecedented change with pressures to improve clinical quality and patient health and increase patient satisfaction, while curtailing costs. The Institute of Medicine report5 cites 10 recommendations to ensure better health, higher-quality care, and lower costs. One recommendation was to optimize operations by continually improving healthcare operations to reduce waste, streamline care delivery, and focus on activities that improve patient health. The primary challenge of delivering care in acute settings is managing increasingly JONA Vol. 44, No. 7/8 July/August 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. complex patients with shorter lengths of stay (LOSs) while ensuring integration of care upon discharge and beyond. Recent studies demonstrate that lowering costs is dependent on increasing patient safety rather than changing nursing salary or staffing expenses.6 Nursing factors influencing patient outcomes include number of hours per patient-day (number of staff), quality of work environment, educational level of nurses, and mix of skills among nursing staff. These factors interact among each other with varying effects on patient outcomes.7-11 Increasingly, nurse satisfaction is related to recognition that RNs are knowledge workers whose time should be utilized in decision making regarding patient care and safety.4 team realized several approaches underutilized RN delegation, did not utilize LPNs at all, and did not require RNs, UAPs, or LPNs to practice to their full scope. We did identify 1 computer simulation model utilizing the RN, LPN, and UAP, which incorporated principles of the lean to enhance the role of the RN, LPN, and UAP in the care delivery of patients.20 Lean is a concept adapted from manufacturing to streamline processes, reduce cost, and improve care delivery. Each process must add value or be eliminated as waste (or muda in Japanese) so that ultimately every step adds value to the process.21 The simulation demonstrated that teams of RN, LPN, and UAP assigned in a mix to fit patient acuity of a group of patients wasted less time than patient allocation assignments. Nursing Care Delivery Models Delivery of nursing care has traditionally been delivered in 1 of 4 ways.12-14 Shirey14 discusses the advantages and disadvantages of various models. The earliest model is patient allocation or total patient care with groups of patients assigned to 1 nurse with no UAPs. Because of shortages during and after World War II, task or functional nursing was emphasized, allocating more complex care to RNs and routine care to UAPs. Team nursing evolved with RNs as leaders of UAPs for a group of patients. Primary nursing identified 1 nurse to assume 24-hour responsibility for a patient with communication to RNs, LPNs, and UAPs who participated in care throughout the patient stay. This model of care has been coined relationship-based care.12 One new, novel approach is to expand primary care to coordinating care after discharge, with the RN assuming care as the primary nurse for readmissions.14,15 This model of care fits in the new modes of accountable care transition coordination. The recent Institute of Medicine report on the future of nursing16 advocates for RNs to perform to their fullest potential and to become effective leaders and partners in the organization. This parallels the American Organization of Nurse Executives guiding principles for the role of the nurse in future patient care delivery.17 These position statements call for new innovative models of nursing care delivery. In 2005, Partners Healthcare in Boston, Massachusetts, conducted a search of innovative nursing care delivery models for adult, acute care patients that integrated technology, support systems, and new roles to improve quality, efficiency, and cost. They identified over 40 models that shared common elements of an elevated RN role, sharpened focus on the patient, smoothed patient transitions and handoffs, leveraged technology, driven by results that were measured systematically, and used for feedback to improve the innovations.18 A few new models emerged requiring shared accountability.19 In reviewing these models, our Development of Novel Nursing Care Redesign We decided to develop a shared accountability model utilizing RN-led teams with LPNs and UAPs, functioning to their fullest potential, matching the skillmix potential to meet the patient’s needs. We piloted the model on medical-surgical units in 3 community hospitals in 3 states. The goals were to improve clinical quality of care and nurse job satisfaction through use of accountable teams and balanced caregiver workload while controlling or reducing costs. JONA Vol. 44, No. 7/8 July/August 2014 Methods The pilot was implemented on 1 medical-surgical unit at each of 3 hospital sites in Alabama, Tennessee, and Mississippi. Each hospital differed in overall bed size and urban/rural market location. The leadership in administration (chief executive officer, chief nursing officer) was supportive and knowledgeable of lean principles, the purpose of the nursing care redesign, and the importance of evaluation. Our 1st step was to review the scope of practice for RNs, LPNs, and UAPs in each state where we planned to pilot the program (Alabama, Tennessee, and Mississippi). We then reviewed the job descriptions at the hospitals and found that all legal functions were not included. Policies, competencies, and job descriptions were revised for the LPN and UAP to ensure highest level of practice. To ensure patient safety, education was developed and provided to UAPs and LPNs to achieve competencies in all functions. Examples of the enhanced competencies for the UAPs included simple dressing change, oxygen setup, performing blood sugars, discontinuing Foley catheters, and discontinuing peripheral intravenous lines. The LPN-enhanced competencies varied the most among the selected states. Some included administering intravenous medications and starting intravenous lines. 389 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. In order to assess level of patient needs, an acuity tool was needed that was valid, efficient, portable between units, reliable, and maintainable.22 Duke University Hospital System had designed and evaluated a tool beginning in 2003 that assesses patient’s acuity based on the complexity of care or instability of a patient’s health status. Nurses used it with a personal digital device. In time, it had been modified to reduce input while maintaining validity for multiple settings. Patients are assessed on 6 patient factors and 4 nursing care demand factors, resulting in 1 of 4 levels of complexity of care. The results are to ensure balance of workload with competency level of staff and patient acuity. The tool was used with permission (e-mail communication, August 2012, November 2012, August 2013). The Morse falls risk assessment23 and Braden skin care assessment24 were added to the tool. No formal evaluation of the modified tool has been made. New processes adopted were bedside shift report for all caregivers of the team and formal bed huddles for teams to be done at a minimum of every 4 hours with new acuity assessment, daily patient goals, and expected LOS review, as well as any identified patient safety issues (Figure 1). The clinical outcome data chosen for evaluation were based on existing methodologies and collection practices reported to the Centers for Medicare & Medicaid Services and other national organizations. These included falls per 1,000 patient-days, falls with injury severity of greater than 1, rate of hospital-acquired pressure ulcers, medication errors per 10,000 doses, number of sentinel events, and number of near misses. Unit LOS; rate of readmissions for congestive heart failure (CHF), myocardial infarction (MI), and pneumonia within 30 days; and core measure scores were also collected. Cost was based on average LOS and cost per patient-day. Patient satisfaction used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data across the 8 domains.25 New survey questionnaires on nurse and physician satisfaction were developed for the specific medical-surgical units that reflected key elements on the model design and based on the hospital-wide surveys performed by Press Ganey.25 Preimplementation Institutional review board approval was received from the University of North Carolina at Charlotte, Charlotte, NC. Materials were prepared, and site coordinators were trained in data collection of patient outcomes and confidentiality processes to distribute and collect questionnaires. Upon collection, data and questionnaires were forwarded to the office of the corporate chief nurse executive for data entry. Original forms were stored in a locked cabinet. To establish a baseline for all key metrics prior to implementation, the following were collected: (1) 390 nurse/staff and physician satisfaction, (2) patient outcomes and patient safety indicators, (3) financial information, and (4) patient satisfaction. For the clinical outcome and financial metrics, data for the same 6 months of the planned pilot in the previous year were used. Each pilot hospital assumed responsibility for implementing the education in new skills and verifying that all UAPs and LPNs had mastered the identified competencies prior to initiating the model. Job descriptions were updated. RNs’ job expectations shifted to focus on decision making for delegation and assurance of quality, patient teaching, patient care coordination, and collaboration with other health professionals. Each team had an RN leader and either 2 UAPs or 1 LPN and 1 UAP. Patient assignments were for that shift. Each job description was reviewed to ensure clarity of role function. An 8-hour course for all the nursing staff on the pilot medical-surgical units at the 3 hospitals was designed and led by the research team. The course began with an overview of the new delivery model and job descriptions for RNs, LPNs, and UAPs. The new acuity tool was reviewed, and its purpose to share workload fairly discussed. The plan to assess patient care needs and review in huddles every 4 hours to maintain equity was reviewed. Delegation and collaboration were then discussed with case examples. Emphasis was placed on each person working to their enhanced scope of practice and to share accountability for patient outcomes. This was followed by a simulation exercise where staff was assigned teams with case scenarios. Nurses left expressing enthusiasm for their new roles. Implementation and Evaluation The new model was introduced, and all staff was provided support to comply. When turnover occurred during the 6 months of the study, categories of new hires were chosen to support the model implementation. At the end of the 6-month period, all metrics were collected and measured against the established baseline. Findings Nurse satisfaction showed the most statistically significant improvement in comparison to all other measures included in the study. Forty-four nurses (86%) completed the presurvey, and 36 (69%) completed the postsurvey. A paired-samples test was performed to identify any significant change from the implementation of the new care model. While all responses demonstrated a positive trend, 6 items showed statistically significant improvement: teamwork among coworkers, appropriate delegation, sense of accomplishment in their work, enjoyment coming to work, satisfaction with JONA Vol. 44, No. 7/8 July/August 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Figure 1. Bed huddle. workload, and satisfaction with job (Table 1). Patient satisfaction showed slight improvement according to the HCAHPS scores in 3 of the 8 domains. JONA Vol. 44, No. 7/8 July/August 2014 Within the 8 domains, physician communication resulted in a statistically significant improvement at P = 0.013 when an analysis of variance was performed. 391 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Table 1. Paired-Samples Test Nurse Survey Paired Differences 95% Confidence Interval of the Difference Pre-Post Response Items (n = 36) Pair Pair Pair Pair Pair Pair 1: good teamwork 2: delegation appropriate 3: sense of accomplishment 7: enjoy coming to work 9: satisfied with workload 11: satisfied with job Mean SD SE Mean Lower Upper t df P (2-Tailed) 0.69444 0.75000 0.41667 0.47222 0.68571 0.44444 1.26083 1.25071 0.99642 1.13354 1.47072 1.25230 0.21014 0.20845 0.16607 0.18892 0.24860 0.20872 0.26784 0.32682 0.07953 0.08869 0.18050 0.02073 1.12105 1.17318 0.75381 0.85576 1.19093 0.86816 3.305 3.598 2.509 2.500 2.758 2.129 35 35 35 35 34 35 .002 .001 .017 .017 .009 .040 P e 0.05. Most clinical quality indicators showed signs of improvement, including core measures, hospital-acquired pressure ulcers, medication errors, near misses, and CHF, MI, and pneumonia readmissions. Independent t tests of samples were performed to examine the difference between the mean of incidence of indicator before and after the intervention. Although improved, none were statistically significant (Table 2). A composite core measure score for the hospitals, excluding elements of care provided in the emergency department, revealed improvements in the pilot hospitals. Financially, the pilot resulted in reductions in costs. Cost reduction was realized through the use of proper discharge of lower-acuity patients, proper work allocation, and staffing-mix allocations resulting from workload rebalancing. Based on analysis on each unit, using year-over-year comparison, case mixYadjusted LOS decreased by 0.39 days on average for all 3 units. In addition, the ALOS average for the 3 units was below the mean LOS by 0.38. In addition, all 3 units resulted in reductions in salary per patient-day of approximately 2% to 3%. One of the 3 units proved to be the best comparative model, as it had the most stability in its workforce and adhered closely to the staffing workload balance guidelines. This unit reported an equivalent decrease in RN hours to the increase in LPN and UAP hours (a rebalance of approximately 5.0 full-time equivalents). Improving the Environment of the Workplace Although the study did not set out to improve the workplace environment, the achievements in this area Table 2. Independent-Samples Test of Quality Indicators Levene Test for Equality of Variances Equal Variances Assumed or Not Assumeda Decubitus ulcer CHF readmit PN readmit Acute MI readmit Fall rate Fall injury (1) (2) (1) (2) (1) (2) (1) (2) (1) (2) (1) (2) F P 4.484 .042 2.254 .142 0.297 .589 4.321 .045 0.446 .509 11.102 .002 t Test for Equality of Means t 1.112 1.112 1.671 1.671 1.219 1.219 1.087 1.087 0.122 0.122 j1.458 j1.458 95% Confidence Interval of the Difference df P (2-Tailed) Mean Difference SE Difference Lower Upper 34 17 34 29.643 34 33.971 34 24.808 34 32.337 34 17 .274 .282 .104 .105 .231 .231 .284 .287 .903 .903 .154 .163 0.41056 0.41056 0.5 0.5 0.33333 0.33333 0.22222 0.22222 0.11278 0.11278 j0.11111 j0.11111 0.36922 0.36922 0.29918 0.29918 0.2735 0.2735 0.20435 0.20435 0.92281 0.92281 0.07622 0.07622 j0.3398 j0.36844 j0.108 j0.11131 j0.22248 j0.2225 j0.19306 j0.1988 j1.7626 j1.76616 j0.26601 j0.27192 1.16091 1.18955 1.108 1.11131 0.88914 0.88916 0.6375 0.64325 1.98815 1.99171 0.04379 0.0497 Abbreviations: CHF, chronic heart failure; MI, myocardial infarction; PN, pneumonia. P e 0.05. a (1) Equal variances assumed, (2) equal variances not assumed. 392 JONA Vol. 44, No. 7/8 July/August 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. deserve special recognition. It was noted by all 3 pilot sites that the engagement in innovation, education, and new tools and methodologies brought about an excitement to the workplace, which resulted in improved job satisfaction and caregivers reporting a feeling of significance and value. For example: The care redesign resulted in an almost immediate and significant improvement in patient, physician, and staff satisfaction. The improvement in teamwork has been remarkable. The unit went from the most challenging unit for nurses to work, and therefore, a unit to avoid, to the unit where most med/surg nurses want to work. (Hospital chief executive officer) Participating in the care redesign pilot gave a focus and spotlight to the unit for the physicians and staff. We worked diligently on turning around the culture and motivating the staff toward embracing change and the new processes. (Hospital chief nursing executive) The teamwork that occurs with the UAP having a higher skill allows the licensed nurse to spend more time with patients. (Hospital staff nurse) Limitations Several limitations were associated with doing research in a natural setting. For example, 1 site lacked optimal staffing, and turnover in nursing leadership occurred at another. There was an omission to include physicians in the education about the model that resulted in some confusion. This may have impacted physician response rate before and after implementation. A limitation was that 13 physicians (76%) completed the preimplementation survey, and only 6 (35%) completed the post- implementation survey. This was too small of a sample to statistically evaluate the perspective of physicians on the units where the intervention was implemented. Future studies are needed with a larger sample of medical-surgical units for a longer period to rule out the Hawthorne effect for increased satisfaction and possibly allow for changes in clinical outcomes to reach significance over time. Discussion This novel, shared accountability model for medicalsurgical units that emphasized utilization of RN, LPN, and UAP full scope of practice had promising initial findings. Results suggest that positive clinical outcomes, along with nurse job satisfaction, can be obtained while providing cost savings. The findings are similar to other results reported by Hall et al10 and Fairbrother et al,26 who reported on new care delivery models with advanced nurse responsibility and team shared accountability. However, Tran et al19 found that job satisfaction declined because of the delegation required. They also differ from Aiken et al7 regarding improvement in clinical outcomes; that study found the key variable to be increase in the RN-to-patient ratio. These preliminary findings in our study support further investigation on the use of these innovations. Conclusion Nursing has a crucial role in shaping the future of healthcare delivery. It is imperative that innovation to engage nurses in leadership for better health, better care, and less costs be ongoing. This model is 1 example to further evidence-based delivery models of care maximizing the skills of the existing workforce. References 1. VanLare JM, Conway PH. Value-based purchasingVnational programs to move from volume to value. N Eng J Med. 2012; 367(4):292-295. 2. The US nursing workforce: trends in supply and educationVresults in brief. Health Resources and Services Administration Web site. April 2013. http://bhpr.hrsa.gov/healthworkforce/reports/nursing workforce/nursingworkforcebrief.pdf. Accessed September 3, 2013. 3. Dubois C, Singh D. From staff-mix to skill-mix and beyond: towards a systematic approach to health workforce management. Hum Resou Health. 2009;7:87. 4. Duffield C, Gardner G, Catling-Paull C. Nursing work and the use of nursing time. J Clin Nurs. 2008;17:1269-1274. 5. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press; 2013. 6. Mark BA, Jones CB, Lindley L, Ozam YA. An examination of technical efficiency, quality and patient safety in acute care nursing units. Policy Polit Nurs Pract. 2009;10(3):180-186. JONA Vol. 44, No. 7/8 July/August 2014 7. Aiken LH, Cimiotti JP, Sloane DM, Smith HI, Flynn L, Neill DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011;49:1047-1053. 8. Shamliyan TA, Kane RI, Mueller C. Duval S, Wilt TJ. Cost savings associated with increased RN staffing in acute care hospitals: simulation exercise. Nurs Econ. 2009;27(5):302-331. 9. Kalisch BJ, Lee KH. Nurse staffing levels and teamwork: a cross sectional study of patient care units in acute hospitals. J Nurs Scholarsh. 2011;43(1):82-88. 10. Hall LM, Doran D, Pink GH. Nurse staffing models, nursing hours, and patient safety outcomes. J Nurs Adm. 2004;34(1):41-45. 11. Hughes I, Chang Y, Mark B. Quality and strength of patient safety climate on medical-surgical units. J Nurs Adm. 2012; 42(10):S27-S35. 12. Duffield C, Roche M, Diers D, Catling-Paull C, Blay N. Staffing, skill mix, and the model of care. J Clin Nurs. 2010;19:2242-2251. 13. Kalisch B, Schoville R. It takes a team. Am J Nurse. 2012;112(10): 50-54. 393 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 14. Shirey MR. Nursing practice models for acute and critical care: overview of care delivery models. Crit Care Nurs Clin North Am. 2008;20:365-373. 15. Chaboyer W, Wallis M, Duffield C, et al. A comparison of activities undertaken by enrolled and registered nurses on medical wards in Australia: an observational study. Int J Nurs Stud. 2008;45:1274-1284. 16. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011. 17. American Organization of Nurse Executives. Guiding Principles for the Role of the Professional Nurse in Future Patient Care Delivery. 2010. http://www.aone.org/resources/PDFs/AONE_ GP_for_Role_of_Nurse_Future.pdf. Accessed September 7, 2012. 18. Kimball B, Cherner D, Joyn J, O’Neil SE. The quest for new innovative care delivery models. J Nurs Adm. 37(9):392-398. 19. Tran DT, Johnson M, Fernandez R, Jones S. A shared model vs a patient allocation model of nursing care delivery: comparing nursing staff satisfaction and stress outcomes. Int J Nurs Pract. 2010;16:148-158. 20. Swick M, Doulaveris P. Application of simulation technology to enhance the role of the professional nurse. J Nurs Adm. 2012;42(2):95-102. 21. Institute for Healthcare Improvement. Going Lean in Healthcare IHI Innovation Series White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2005. www.IHI.org. Accessed April 1, 2014. 22. Diaz S, George M, Sullivan M, Swan S. HCIS Evaluation of acuity systems. 2003. www.learningace.com/doc/1536674. Accessed September 3, 2013. 23. Prevention of falls in hospitals: a toolkit for improving quality of care. 2013. www.AHRQ.gov/legacy/research/ltc/fallpxtoolkit/ fallpxtook13h.htm. Accessed March 31, 2014. 24. Prevention plus home of the Braden scale. 2009. www.bradenscale .com. Accessed March 31, 2014. 25. Press Ganey Associates, Inc. http://www.pressganey.com/ oursolutions/patientsvoice.aspx. Accessed September 7, 2012. 26. Fairbrother G, Jones A, Rivas K. Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemp Nurse. 2010;15(2):202-220. The Journal of Nursing Administration Instructions for Authors Instructions for Authors can be found online at the address below. To ensure that your manuscript is in compliance with new submission procedures, you should read this document carefully before manuscript preparation. All manuscripts must be submitted electronically through this system. Please visit http://JONA.EdMgr.com. 394 JONA Vol. 44, No. 7/8 July/August 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Oral Presentation Defense Responses

Oral Presentation Defense Responses

The purpose of this assignment is to demonstrate that you have mastered the topic/concepts you have researched and can engage in meaningful, scholarly dialog and/or debate with your peers while also offering a unique

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contribution to the subject.

For this assignment, you will:

Select three (3) questions submitted by your peers and/or your instructor from the discussion board to address formally and in detail for this assignment.
Choose questions of intellectual substance; each response should be 2 paragraphs in length.
Include the questions above your responses.
Present the question in bold text and your response beneath in regular APA style text. You do not need to identify the person who submitted the question.
Your responses should be organized, comprehensive, and well written.
Use citations and a reference page when appropriate to include supporting evidence; however, your responses should be unique and indicative of your own understanding of the subject.
Include a title page.

nursing research

nursing research

APA FORMAT REFERENCE NOT MORE THAN FIVE (5) YEARS OLD. Critical Appraisal of a Quantitative Study

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Assignment Guideline and Rubric The goals of this assignment are to: • • • Assist students in understanding the basic process of conducting a literature review/critical appraisal. Assist students in understanding the beginning process of conducting an evidence-based practice review. Provide students with the beginnings of scientifically based knowledge on a selected procedure/topic related to nursing research. Steps of the process: • • • Select a topic with instructor’s approval. Important because some articles that have been shown to me are not research quantitative nor qualitative research studies that have come from refereed journals.Article can be quantitative or qualitative and preferably from a nursing research journal. (Please submit article to me by end of the day on Monday because I must critique it in order to be able to evaluate your critique.) Appraise the article critically using the guidelines provided in Chapter 12.This is the information provided in the syllabus.. Prepare a presentation to facilitate where a/the group member(s) discuss aspects of the critique. (See guidelines/questions below.)Power point is suggested because it may provide creativity and generate audience interest. Information to include in the report (see examples on pages 433-442) Research Problem and Purpose Why is the problem significant to nursing? • Will the study problem and purpose generate or refine knowledge for nursing practice? Literature Review • • • How current is the literature review? Does the literature review provide rationale and direction for the study? Is a clear, concise summary presented of the current empirical and theoretical knowledge in the area of study? Study Framework • • • Is the framework/theoretical basis presented with clarity? If a map or model is presented, is it adequate to explain the phenomenon of concern? If a proposition from a theory is tested, is the proposition clearly identified and linked to the study hypotheses? Research Objectives, Questions, or Hypotheses • • • Are the objectives, questions, or hypotheses expressed clearly? Are the objectives, questions, or hypotheses logically linked to the research purpose and framework? Are the research objectives, questions, or hypotheses linked to concepts and relationships from the framework? Variables • • • Do the variables reflect the concepts identified in the framework? Are the variables clearly defined? Is the conceptual definition of a variable consistent with the operational definition? Method/Design .What type of research is it? Explain. How were study subjects selected? Are any subjects excluded from the study based on age, socioeconomic status, or race, without a sound rationale? If more than one group is used, do the groups appear equivalent? Are the rights of human subjects protected? Is the setting used in the study typical of clinical settings? Measurements What are the instruments that were used to measure variables and if they are scales and questionnaires did the investigator(s) clearly describe them, especially the reliability/validity of the instruments? If data were collected by observation as in qualitative studies are the phenomena to be observed clearly identified and defined? Is interrater and intrarater reliability described? Are the techniques for recording observations described? Interviews Do the interview questions address concerns expressed in the research problem? Are the interview questions relevant for the research purpose and objectives, questions, or hypotheses? Physiological Measures Are the physiological measures or instruments clearly described? Are the methods for recording data from the physiological measures clearly described? Data Collection and Analysis Is the data collection process clearly described? Is the training of data collectors clearly described and adequate? Are the results presented in an understandable way? Interpretation of Findings • • • Are findings discussed in relation to each objective, question, or hypothesis? Are the findings clinically significant? Do you believe that there are limitations that the investigator(s) did not identify? Evaluation • • • • • • • What do you determine are the major strengths/weaknesses of the study? To what populations can the findings be generalized? What questions emerge from the findings, and are these identified by the researcher? What future research can be envisioned? Can the study be replicated by other researchers? How do findings inform your practice as a nurse? When the findings are examined based on previous studies, what is now known and not known about the phenomenon under study? That is, are the findings consistent with those from previous studies? Does the author indicate the implication of the findings for practice? What are the implications of the findings for nursing practice? NURS 400 – INTRODUCTION TO NURSING RESEARCH Rubric for evaluation of research critique NURS 400 – INTRODUCTION TO NURSING RESEARCH Rubric for evaluation of research critique TITLE OF ARTICLE: Value % CRITERIA % STRUCTURE Evaluation of overall Critique Introduction (10%) Title of article How was article selected Purpose of the study Paper logically arranged to address main points of criteria for critique: (70%) Statement of the problem Hypotheses Theoretical framework Literature review Variables Operational definition(s) Sample Instruments Data collection and analysis Results Summary: (10%) 90% COMMENTS Earned Conclusions/How do findings inform nursingpractice? APA Where necessary uses APA format correctly (5%) 10% Uses correct grammar, spelling, punctuation, and capitalization. Article critiqued is from peer reviewed journal (5%) FINAL GRADE 100%100% 8 days ago REQUIREMENTS American Journal of Nursing Science 2015; 4(2-1): 66-73 Published online January 26, 2015 (http://www.sciencepublishinggroup.com/j/ajns) doi: 10.11648/j.ajns.s.2015040201.22 ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online) Assessment of quality of life and fatigue among haemodialysis patients Tsiamis Georgios1, Alikari Victoria1, *, Fradelos Evangelos2, Papapetrou Savvas3, Zyga Sofia1 1 Department of Nursing, University of Peloponnese, Sparta, Greece State Mental Hospital of Attica “Daphne”, Athens, Greece 3 Dr of Social Psychology, Educator of Nursing Department, University of Peloponnese, Sparta, Greece 2 Email address: tsmgeorge@gmail.com (Tsiamis G. ), vicalikari@gmail.com (Alikari V. ), evagelosfradelos@hotmail.com (Fradelos E. ), spapapetrou@yahoo.com (Papapetrou S.) , zygas@uop.gr (Zyga S.) To cite this article: Tsiamis Georgios, Alikari Victoria, Fradelos Evangelos, Papapetrou Savvas, Zyga Sofia. Assessment of Quality of Life and Fatigue among Haemodialysis Patients. American Journal of Nursing Science. Special Issue: Mental Health Care: Aspects, Challenges and Perspectives. Vol. 4, No. 2-1, 2015, pp. 66-73. doi: 10.11648/j.ajns.s.2015040201.22 Abstract: Fatigue is one of the most common symptoms of haemodialysis patients and is associated with poor quality of life. Purpose: To investigate the levels of fatigue and its correlation with quality of life of haemodialysis patients. Results: Of the 134 haemodialysis patients, the majority of patients (52,9%) seemed to have low rates of fatigue (10
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Applying Current Evidence Based Practice Guidelines

Applying Current Evidence Based Practice Guidelines

Unit 6 Assignment template. Please fill in the requested information. Please submit to the Dropbox when you have

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completed your Assignment. https://www.guidelines.gov/summaries/summary/46939/clinical-practice-guideline-for-the-diagnosis-and-management-ofacute-bacterial-sinusitis-in-children-aged-1-to-18-years Pediatric Client with Acute Bacterial Sinusitis List the clinical criteria that List Criteria for List Criteria for List Criteria for must be present to support this Persistent Severe Onset of Worsening diagnosis in pediatric patients Symptoms. Symptoms. Symptoms. from newborn to 21 years of age. Categorize clinical signs and symptoms by: Persistent Symptoms, Severe Onset, or Worsening Symptoms. When would imaging studies be indicated? What is the recommended Antibiotic for Child with No Known Allergies? Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information). What is the second line Recommended Antibiotic for Child with allergy to PCN Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information). When is Referral indicated? What additional medications and or treatment strategies are recommended for treatment or symptomatic control What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic When is outpatient 72 hour “observation” acceptable? What modifications would be needed for the following children: Four year old who is otherwise healthy Child with immune deficiency Child with two prior sinus infections Child with cystic fibrosis What other conditions would modify these treatment recommendations?
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Texas board of nursing rules

Texas board of nursing rules

N3375 Health Policy & Legal Aspects Module 3: Reflection Assignment – Peer Review Submit by 2359 (CT) Saturday

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of Module 3. Name: Date: Overview: Peer Review In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPELTE BOTH PARTS. Refer to your course readings and lectures as you complete the assignment. Performance Objectives: • Apply the Minor Incident Rule to specific incidents. • Describe the due process protections for a nurse who is peer-reviewed. Rubric Use this rubric to guide your work on the assignment, “Peer Review.” Task Accomplished Proficient Needs Improvement Part 1 Reflects upon applications of Rule 217.16 (Total 50 points) List the correct criteria, accurately explains application of criteria clearly, and arrives at correct decision. (50 points) Lists the correct criteria, accurately explains application of at least two criteria, and arrives at correct decision. (40 points) Incorrectly lists criteria, or inadequately explains at least two applications of criteria, or arrives at incorrect decision. (25 point) Part 2 Reflects upon applications of Rule 217.19 (Total 50 points) Correctly judges and clearly explains each violation, or correctly states that no violation occurred. (50 points) Correctly judges and explains at least one violation, or correctly states that no violation occurred. (40 point) Incorrectly judges whether violations occurred. (25 points) ©2015 UTA School of Nursing 1 N3375 Health Policy & Legal Aspects Part 1: Applying Rule 217.16 Minor Incidents Read the following scenario and then answer the questions that follow You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager. Should Nurse A be reported to the BON? Apply the Minor Incident Rule to reach and support your decision A. Criteria. First, review your learning about minor incidents – those which are NOT reportable to the BON. In the first column of the table, list the 4 criteria that are essential in determining if an incident is not “minor.” Criteria that determine an incident is NOT minor (Rule 217.16) Explanation of whether or not the facts determine that the incident is NOT minor B. Minor Incident? Apply the facts of the case to each criterion above. In the second column of the table, record your explanation as to whether the facts support or do not support each of the criteria. C. Your Decision. Record whether, as a member of the Peer Review Committee (PRC), you would vote to report or not report Nurse A to the Board of Nursing. (Insert an X in the box that reflects your decision.) Report ©2015 UTA School of Nursing Not report 2 N3375 Health Policy & Legal Aspects Part 2: Applying Rule 217.19 Incident-Based Peer Review Read the following scenario and then reflect upon the actions it portrays. Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.” You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.” Applying Rule 217.19, what, if any, violations of the rule occurred in the above scenario? NOTE: If your state has its own rule regarding incident-based peer reviews, identify the rule in your responses, and apply it to the scenario instead. A. No, the scenario does not describe violations of Rule 217.19. Explain which parts of the scenario might cause questions, but why they are not violations of Rule 217.19. You will lose major points if explanation with critical thinking is not provided. (If you believe that violations did occur, leave this space blank and proceed to the next section.) B. Yes, violations occurred. First, review your learning about incident-based peer review. In the first column of the table, list the criteria from Rule 217.19 that were violated. In the second column, explain how each criterion was violated. Which part of the rule was violated? (Subsection number and letter OR descriptive phrase) (Rule 217.19) ©2015 UTA School of Nursing Explanation of violation 3 N3375 Health Policy & Legal Aspects Submitting Your Assignment: • Click the word Assignment in the Module. • Click on the words Module 3 Assignment. The assignment submission document will open. • Go to 2. Assignment Materials-Submission. Click Browse and navigate to your Desktop where you saved your paper. Select the final version of your paper to upload from your computer. • When you’ve selected your paper, click Attach Files and your saved assignment document should appear in the submission box just above the Attach Files button. • Click Submit at the bottom of the Assignment Submission screen and your saved document assignment will appear the gradebook with a green exclamation point that alerts your Academic Coach that your assignment is ready for grading. ©2015 UTA School of Nursing 4 N3375 Health Policy & Legal Aspects Module 3: Reflection Assignment – Peer Review Submit by 2359 (CT) Saturday of Module 3. Name: Date: Overview: Peer Review In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPELTE BOTH PARTS. Refer to your course readings and lectures as you complete the assignment. Performance Objectives: • Apply the Minor Incident Rule to specific incidents. • Describe the due process protections for a nurse who is peer-reviewed. Rubric Use this rubric to guide your work on the assignment, “Peer Review.” Task Accomplished Proficient Needs Improvement Part 1 Reflects upon applications of Rule 217.16 (Total 50 points) List the correct criteria, accurately explains application of criteria clearly, and arrives at correct decision. (50 points) Lists the correct criteria, accurately explains application of at least two criteria, and arrives at correct decision. (40 points) Incorrectly lists criteria, or inadequately explains at least two applications of criteria, or arrives at incorrect decision. (25 point) Part 2 Reflects upon applications of Rule 217.19 (Total 50 points) Correctly judges and clearly explains each violation, or correctly states that no violation occurred. (50 points) Correctly judges and explains at least one violation, or correctly states that no violation occurred. (40 point) Incorrectly judges whether violations occurred. (25 points) ©2015 UTA School of Nursing 1 N3375 Health Policy & Legal Aspects Part 1: Applying Rule 217.16 Minor Incidents Read the following scenario and then answer the questions that follow You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager. Should Nurse A be reported to the BON? Apply the Minor Incident Rule to reach and support your decision A. Criteria. First, review your learning about minor incidents – those which are NOT reportable to the BON. In the first column of the table, list the 4 criteria that are essential in determining if an incident is not “minor.” Criteria that determine an incident is NOT minor (Rule 217.16) Explanation of whether or not the facts determine that the incident is NOT minor B. Minor Incident? Apply the facts of the case to each criterion above. In the second column of the table, record your explanation as to whether the facts support or do not support each of the criteria. C. Your Decision. Record whether, as a member of the Peer Review Committee (PRC), you would vote to report or not report Nurse A to the Board of Nursing. (Insert an X in the box that reflects your decision.) Report ©2015 UTA School of Nursing Not report 2 N3375 Health Policy & Legal Aspects Part 2: Applying Rule 217.19 Incident-Based Peer Review Read the following scenario and then reflect upon the actions it portrays. Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.” You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.” Applying Rule 217.19, what, if any, violations of the rule occurred in the above scenario? NOTE: If your state has its own rule regarding incident-based peer reviews, identify the rule in your responses, and apply it to the scenario instead. A. No, the scenario does not describe violations of Rule 217.19. Explain which parts of the scenario might cause questions, but why they are not violations of Rule 217.19. You will lose major points if explanation with critical thinking is not provided. (If you believe that violations did occur, leave this space blank and proceed to the next section.) B. Yes, violations occurred. First, review your learning about incident-based peer review. In the first column of the table, list the criteria from Rule 217.19 that were violated. In the second column, explain how each criterion was violated. Which part of the rule was violated? (Subsection number and letter OR descriptive phrase) (Rule 217.19) ©2015 UTA School of Nursing Explanation of violation 3 N3375 Health Policy & Legal Aspects Submitting Your Assignment: • Click the word Assignment in the Module. • Click on the words Module 3 Assignment. The assignment submission document will open. • Go to 2. Assignment Materials-Submission. Click Browse and navigate to your Desktop where you saved your paper. Select the final version of your paper to upload from your computer. • When you’ve selected your paper, click Attach Files and your saved assignment document should appear in the submission box just above the Attach Files button. • Click Submit at the bottom of the Assignment Submission screen and your saved document assignment will appear the gradebook with a green exclamation point that alerts your Academic Coach that your assignment is ready for grading. ©2015 UTA School of Nursing 4

Professional boundaries and Challenge-Reflective JOURNAL

Professional boundaries and Challenge-Reflective JOURNAL

Reflective Journal Module 4: Professional Boundaries and Challenges: Identify 3 key points from this module.Reflect

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on why each point is important, how it impacts on your work experience or nursing practice, and how will you change your practice in the future based on each key area.

Place Key Point in this column:

Answer each question below with at least 3-4 well written sentences using critical thinking.

Key Point 1

Why it is important? at least 3-4 well written sentences using critical thinking
How does it impact my work/nursing practice? at least 3-4 well written sentences using critical thinking
How will I change my practice? at least 3-4 well written sentences using critical thinking
Key Point 2

Why it is important? at least 3-4 well written sentences using critical thinking
How does it impact my work/nursing practice? at least 3-4 well written sentences using critical thinking
How will I change my practice? at least 3-4 well written sentences using critical thinking
Key Point 3

Why it is important? at least 3-4 well written sentences using critical thinking
How does it impact my work/nursing practice? at least 3-4 well written sentences using critical thinking
How will I change my practice? at least 3-4 well written sentences using critical thinking

Health Organization Case Study

Health Organization Case Study

Max Points: 200

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Details:

Research a health care organization or a network that spans several states within the U.S. (Example: United Healthcare, Vanguard, Banner Healthcare, etc.).

Harvard Business Review Online and Hoover’s Company Records, found in the GCU Library, are useful sources. You may also find pertinent information on your organization’s webpage.

Review “Singapore Airlines Case Study.”

Prepare a 1,000-1250-word paper that focuses on the organization or network you have selected.

Your essay should assess the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade, and include a strategic plan that addresses issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction. Provide a comparison to the health care organization or network and the Singapore Airlines. Include any cultural issues that may influence the practices listed above.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

NRS451V.R.SingaporeAirlinesCaseStudy_Student_02-04-13.docx

 

Apply Rubrics
Health Organization Case Study
1
Unsatisfactory
0.00%

2
Less than Satisfactory
75.00%

3
Satisfactory
79.00%

4
Good
89.00%

5
Excellent
100.00%

80.0 %Content

30.0 %Case study assesses the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade

Case study assesses the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade is not provided.

Case study assesses the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade is offered; however, relevant information is missing as indicated in the assignment instructions.

Case study assesses the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade meets the basic criteria for the assignment as indicated in the assignment instructions.

Case study assesses the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade meets all criteria for the assignment, as indicated in the assignment instructions, and is offered in detail.

Case study assesses the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

10.0 %Case study includes a strategic plan that addresses issues pertaining to network growth

Case study including a strategic plan that addresses issues pertaining to network growth is not provided.

Case study including a strategic plan that addresses issues pertaining to network growth is provided; however, relevant information is missing as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to network growth; meets the basic criteria for the assignment as indicated by the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to network growth; meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

Case study including a strategic plan that addresses issues pertaining to network growth; is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

10.0 %Case study includes a strategic plan that addresses issues pertaining to nurse staffing

Case study including a strategic plan that addresses issues pertaining to nurse staffing is not offered.

Case study including a strategic plan that addresses issues pertaining to nurse staffing is provided; however, relevant information is missing as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to nurse staffing meets the basic criteria for the assignment as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to nurse staffing meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

Case study including a strategic plan that addresses issues pertaining to nurse staffing is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

10.0 %Case study includes a strategic plan that addresses issues pertaining to resource management

Case study including a strategic plan that addresses issues pertaining to resource management is not provided.

Case study including a strategic plan that addresses issues pertaining to resource management is provided; however, relevant information is missing as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to resource management meets the basic criteria for the assignment as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to resource management meets all criteria for the assignment, as indicated by the assignment instructions, and is provided in detail.

Case study including a strategic plan that addresses issues pertaining to resource management is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

10.0 %Case study include a strategic plan that addresses issues pertaining to patient satisfaction

Case study including a strategic plan that addresses issues pertaining to patient satisfaction is not provided.

Case study including a strategic plan that addresses issues pertaining to patient satisfaction is provided; however, relevant information is missing as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to patient satisfaction meets the basic criteria for the assignment as indicated in the assignment instructions.

Case study including a strategic plan that addresses issues pertaining to patient satisfaction meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

Case study including a strategic plan that addresses issues pertaining to patient satisfaction is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

5.0 %Essay provides comparison between health care organization or network and Singapore Airlines

A comparison between a health care organization or network and Singapore Airlines is not presented.

An incomplete comparison between a health care organization or network and Singapore Airlines is presented.

A summary comparing a health care organization or network and Singapore Airlines is presented. There are inaccuracies; more information is needed.

A discussion is presented comparing a health care organization or network and Singapore Airlines. Minor detail is needed for clarity.

A detailed and clear discussion is presented comparing a health care organization or network and Singapore Airlines.

5.0 %Cultural issues that may influence practices are discussed

Cultural issues influencing proposed practices are not presented.

Cultural issues influencing proposed practices are referenced. More information is needed to establish how they influence the proposed practices. There are inaccuracies.

Cultural issues influencing proposed practices are summarized. Some information or support is needed to establish how these influence the proposed practices.

Cultural issues influencing proposed practices are discussed. General information and support is provided to establish how these influence the proposed practices.

Cultural issues influencing proposed practices are thoroughly discussed. Detailed information and support is provided to establish how these influence the proposed practices.

15.0 %Organization and Effectiveness

5.0 %Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

15.0 %Organization and Effectiveness

5.0 %Paragraph Development and Transitions

Paragraphs and transitions consistently lack unity and coherence. .No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

15.0 %Organization and Effectiveness

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

5.0 %Format

2.0 %Paper Format (use of appropriate style for the major and assignment)

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

3.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)

No reference page is included. No citations are used.

Reference page is present. Citations are inconsistently used.

Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present.

Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.

In-text citations and a reference page are complete. The documentation of cited sources is free of error.

 

The Interview

The Interview

The medical interview serves several functions. It is used to collect information to assist in diagnosis of the present

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illness, to understand the patient’s values, to assess and communicate prognosis, to establish a therapeutic relationship and to reach agreement with the patient about further diagnostic procedures and therapeutic options. The interview also offers an opportunity to influence patient behaviors.

Discuss the following:

What does it means to document accurately and appropriately?
What are the documenting guidelines? When is it appropriate to use abbreviations?
What is the difference between subjective and objective data?
What does it mean to demonstrate clinical reasoning skills?
How can you use clinical reasoning to plan the organization of a comprehensive exam?
How will you document variations of normal and abnormal assessment findings?
What factors influence appropriate tools and tests necessary for a comprehensive assessment?
Reflect on personal strengths, limitations, beliefs, prejudices, and values.
How will these impact your ability to collect a comprehensive health history?
How can you develop strong communication skills.
What interviewing techniques will you use to interview the patient to elicit subjective health information about their health history?
What relevant follow-up questions will you use to evaluate patient condition?
How will you demonstrate empathy for patient perspectives, feelings, and sociocultural background?
What opportunities will you take to educate the patient?
Your postings should be qualitative and provide substantive depth that advances the discussion. Answers all questions with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources. Outside resources should not be older than 5 years.