Assessment 1 Instructions: Locating Credible Databases And Research

Assessment 1 Instructions: Locating Credible Databases And Research

Create a 1-2-page resource that will describe databases that are relevant to EBP around a diagnosis you chose and could be used to help a new hire nurse better engage in EBP.

Evidence-based practice (EBP) integrates the best evidence available to guide optimal nursing care, with a goal to enhance safety and quality. EBP is crucial to nursing practice because it incorporates the best evidence from current literature, along with the expertise of the practicing nurse. The concern for quality care that flows from EBP generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise. To gain the knowledge, you require a good understanding of how to search for scholarly resources, as well as identify which databases and websites are credible for the purposes of implementing evidence-based changes in practice. Assessment 1 Instructions: Locating Credible Databases And Research

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Demonstration of Proficiency

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

  • Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
    • Explain why the sources selected should provide the best evidence for the chosen diagnosis.
  • Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
    • Describe the best places to complete research and what types of resources one would want to access to find pertinent information for the diagnosis within the context of a specific health care setting.
  • Competency 4: Plan care based on the best available evidence.
    • Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis.
  • Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
    • Describe communication strategies to encourage nurses to research the diagnosis, as well as strategies to collaborate with the nurses to access resources.
    • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for providing patient-centered, competent care based on current evidence-based best practices. You will be required to do research, analysis, and dissemination of best evidence to stay abreast of these best practices. Understanding where to go to find credible sources and locate evidence, as well as which search terms to use, is the foundation of incorporation of best practices. Assessment 1 Instructions: Locating Credible Databases And Research

Scenario

You are supervising three nurses working on the medical-surgical floor of a local teaching hospital. This hospital is nationally recognized as a leader in education and has a computer lab with an online library where staff has access to medical research databases (that is, CINAHL, PubMed, Medline, and Cochrane library) and online sources of all hospital policies, procedures, and guidelines, and computers at nurse workstations that also have access to these resources. (For this scenario, use the Capella University Library to simulate the hospital’s online library.) You have given the nurses their patient assignments and you have all participated in shift report. A new nurse who just completed orientation and training a week ago approaches you and tells you that one of the assigned patients has a diagnosis he or she is very unfamiliar with. Knowing that patient-centered care based on best practices is imperative to positive patient outcomes, you want to assist this nurse to find research that can be utilized to provide the best care for this patient. Describe how you would communicate with this nurse to encourage him or her to research the diagnosis. Assume you will assist in the quest to locate evidence, then describe where you would go within the facility and what resources you would look for. These resources may include websites, journals, facility policies or guidelines, or any other sources of online information.

You may choose the diagnosis for the patient in this scenario. Choose something you would find interesting to research or that applies to a clinical problem you would be interested in addressing. Create a list of at least five sources that could be used to find evidence, with the best source listed first, and explain why the sources you chose are best to find evidence for the diagnosis you chose and the clinical scenario. You are only evaluating the sources of evidence (database, website, policy database or website, et cetera). You are not actually completing a search and selecting evidence. Consider the following examples: a nursing journal in CINAHL may not be the best source of evidence for information on how to administer medications through a central-venous catheter, whereas a hospital policy database found on a website may not be the best source of information on caring for a patient with a rare chromosomal abnormality.

Preparation

To help ensure you are prepared to complete this assessment, review the following resources related to the Capella library. These resources will provide you an overview of the types of tools, resources, and guides available in the library. This may be useful in forming a better understanding of the library to apply to the hypothetical situation laid out in the scenario of this assessment.

Remember, it is also appropriate to look toward databases and resources outside of the Capella library, such as organizational policies, professional organizations, and government health care resources.

You are encouraged to complete the Evaluating the Credibility of Evidence activity. This activity offers an opportunity to practice evaluating the credibility of evidence. These skills will be necessary to complete Assessment 1 successfully and is for your own practice and self-assessment. Completing this activity is also a way to demonstrate course engagement.

Instructions

The purpose of this assessment is to understand where to find evidence that can be applied to clinical scenarios and to learn effective communication and collaboration with clinical staff during the process of evidence location. As a baccalaureate-prepared nurse, you will not only use research for self-improvement in your clinical role, but you will also serve as a mentor to supervised nursing staff. Therefore, you will need to be able to communicate and collaborate effectively to guide them toward resources to find research, as well as support them through the initial evidence location process. In doing so, nurses can gain access to evidence that can be analyzed and utilized to stay current on best practices. This allows them to provide safe, patient-centered care and improve patient outcomes.

For this assessment:

  • Describe your role as a baccalaureate-prepared nurse supervising clinical staff nurses with regard to communication and collaboration in locating evidence for application to a nursing practice scenario.
  • Compile a list of five online databases or other online sources (that is, websites, journals, facility policies or guidelines, et cetera) that can be used to research evidence to apply to this scenario and describe to which of these you would direct a nurse colleague to search for evidence.
  • Describe where you might go in the clinical setting to complete this research and how you would access the desired, relevant research within research databases or other online sources.

Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you will know what is needed for a distinguished score.

  • Describe communication strategies to encourage nurses to research the diagnosis, as well as strategies to collaborate with the nurses to access resources.
  • Describe the best places to complete research and what types of resources you would want to access to find pertinent information for the diagnosis within the context of a specific health care setting.
  • Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis.
  • Explain why the sources of online information selected should provide the best evidence for the chosen diagnosis.
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. Assessment 1 Instructions: Locating Credible Databases And Research

Note: While you are not selecting and evaluating specific evidence to help with the clinical diagnosis, you should still be citing the literature and best practices to support your description of your communication and collaboration approach. Additionally, it is appropriate to cite best practices related to EBP and evaluating databases to support your explanation as to why you selected the five sources of online information that you did.

Submission Requirements

Your assessment should meet the following requirements:

  • Length of submission: 1–2 pages (not including the reference page) description of communication, collaboration, and evidence location process, including a list of databases or other sources with description of why they are appropriate for clinical scenario diagnosis (that is, something that would be useable in professional practice for other nurses). Be sure to include an APA-formatted reference page at the end of your submission.
  • Number of references: Cite a minimum of three sources of scholarly or professional evidence that supports your findings and considerations. Resources should be no more than five years old.
  • APA formatting: References and citations are formatted according to current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course. Assessment 1 Instructions: Locating Credible Databases And Research

Patient-Centered Practice Problem Related To Quality Assignment

Patient-Centered Practice Problem Related To Quality Assignment

Identify a measurable patient-centered practice problem related to quality or safety and relevant to your practice setting that you will also focus on in your Capstone Paper and post a brief description of the problem and an explanation of why you selected it. Explain how the conversation you had with the key leader in your practice setting impacted your decision to address this particular practice problem. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from your practice area and describe the data that is available.

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You will not be collecting any data during the practice experience project; you will use data already available to you in your workplace or other practice setting. Think about the different kinds of data that is shared with you in your work area. For example, data may include patient satisfaction scores, medication error rates, fall, CLABSI or CAUTI rates. Analyzing the data available to you is how you will identify that a quality problem exists. Data identifies potential areas for improvement and monitors the effectiveness of any changes. It is important to obtain baseline data before beginning a quality improvement project and to analyze results during and at the end of a project. 

Note: The practice problem must be related to patient outcomes. (Staffing cannot be your main practice problem for the completion of the Practice Experience Project and Capstone Paper.)

Note: If you use the same practice problem that was presented in the Week 1 Discussion on quality theories, keep in mind that you must be much more specific in this post and explain how it is relevant to your setting and nursing practice. Patient-Centered Practice Problem Related To Quality Assignment

Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Create a 5-10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve the outcomes for a patient and examine how remote collaboration provided benefits or challenges to designing and delivering the care.

As technologies and the health care industry continue to evolve, remote care, diagnosis, and collaboration are becoming increasingly more regular methods by which nurses are expected to work. Learning the ways in which evidence-based models and care can help remote work produce better outcomes will become critical for success. Additionally, understanding how to leverage EBP principles in collaboration will be important in the success of institutions delivering quality, safe, and cost-effective care. It could also lead to better job satisfaction for those engaging in remote collaboration. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

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Demonstration of Proficiency

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

· Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

1. Reflect on which evidence was most relevant and useful when making decisions regarding the care plan.

. Competency 3: Apply an evidence-based practice model to address a practice issue.

2. Explain the ways in which an EBP model was used to help develop the care plan.

. Competency 4: Plan care based on the best available evidence.

3. Propose an evidence-based care plan to improve the safety and outcomes for a patient.

. Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

4. Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

4. Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style.

Professional Context

Remote care and diagnosis is a continuing and increasingly important method for nurses to help deliver care to patients to promote safety and enhance health outcomes. Understanding best EBPs and building competence in delivering nursing care to remote patients is a key competency for all nurses. Additionally, in some scenarios, while you may be delivering care in person you may be collaborating with a physician or other team members who are remote. Understanding the benefits and challenges of interdisciplinary collaboration is vital to developing effective communication strategies when coordinating care. So, being proficient at communicating and working with remote health care team members is also critical to delivering quality, evidence-base care. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Scenario

The Vila Health: Remote Collaboration on Evidence-Based Care simulation provide the context for this assessment.

Instructions

Before beginning this assessment, make sure you have worked through the following media:

Vila Health: Remote Collaboration on Evidence-Based Care .

You may wish to review  Selecting a model for evidence-based practice changes. [PDF]  and  Evidence-Based Practice Model s, which help explain the various evidence-based nursing models.

For this assessment, you are a presenter! You will create a 5–10-minute video using Kaltura or similar software. In the video:

. Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in the Vila Health Remote Collaboration on Evidence-Based Care media scenario.

. Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decision about the plan you proposed

. Wrap up your video by identifying the benefits of the remote collaboration in the scenario, as well as discuss strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaboration challenges you observed in the scenario.

Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform your video. Important: You are required to submit an APA-formatted reference list of the sources you cited specifically in your video or used to inform your presentation.

The following media is an example learner submission in which the speaker successfully addresses all competencies in the assessment.

Exemplar Kaltura Reflection .

9. Please note that the scenario that the speaker discusses in the exemplar is different from the Vila Health scenario you should be addressing in your video. So, the type of communication expected is being model, but the details related to the scenario in your submission will be different.

Make sure that your video addresses the following grading criteria:

. Propose an evidence-based care plan to improve the safety and outcomes for a patient based on the Vila Health Remote Collaboration on Evidence-Care media scenario.

. Explain the ways in which an EBP model was used to help develop the care plan.

. Reflect on which evidence was most relevant and useful when making decisions regarding the care plan.

. Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

. Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style.

Refer to  Using Kaltura [PDF]  as needed to record and upload your video.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact  DisabilityServices@Capella.edu  to request accommodations. If, for some reason, you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.

Additional Requirements

Your assessment should meet the following requirements:

. Length of video: 5–10 minutes.

. References: Cite at least three professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.

. APA reference page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video. Be sure to format the reference page according to current APA style.

Remote Collaboration and Evidence-Based Care

Providing evidence-based care can be a challenge in any medical situation (Schmidt & Brown, 2017). However, it can be more challenging especially when the care is being provided remotely. Health care professionals should, therefore, collaborate with other health care personnel in different geographical regions to provide evidence-based quality care to patients who live in rural areas or have difficulties accessing a health care facility (Hardin, Kilian & Spykerman, 2017). This paper, therefore, discusses how health care professionals collaborate remotely and virtually to provide evidence-based care for patients.

Proposing an evidence-based care plan to improve the safety and outcomes for a patient based on the Vila Health Remote Collaboration 

Evidence-based care plans provide nurses with important clinical information and best clinical practices that have greater potential to improve patient outcomes and minimize errors by standardizing the provision of care. Caitlyn visited Vila Health Facility and was diagnosed with cystic fibrosis. Cystic fibrosis is a type of genetic disorder. It occurs as a result of a mutation of the protein gene that is present in the body cells that secretes mucus. This particular protein gene is called cystic fibrosis transmembrane conductance regulator (CFTR). Cystic fibrosis primarily affects the gastrointestinal, reproductive and respiratory tracts.

Evidence based-care plans that are implemented should improve the safety and outcomes of patients. An evidence-based nursing care plan for patients with cystic fibrosis should include maintenance of adequate oxygenation, coming up with measures to eliminate pulmonary secretions, emphasizing the significance of adequate dietary and fluid intake, ensuring adequate nutrition, and preventing further complications.

Oxygen therapy should be administered to a patient. Supplemental oxygen will assist in maintaining adequate oxygenation. The work of breathing will be decreased. Calorie expenditure will also be reduced. The patient will then be relieved of dyspnea. This will increase comfort. The nurse administering care to Caitlyn should set a goal of maintaining the percentage of oxygen saturation to be higher than 90%. This is likely to translate to positive patient outcomes. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Several measures can be used to clear pulmonary secretions. The most common effective measure is administering airway clearance therapy to the patients. This will decrease the work of breathing and improve pulmonary function. Caitlyn will then be able to maintain an open and clear airway. This will result in normal depth and rate of respiration, normal breath sounds, and an airway that is free of pulmonary secretions, with a cough that is effective. If all these are achieved, then the patient safety and outcomes will have been enhanced.

It is also important for a nurse to ensure that the patient’s nutrition is adequate. The nurse should encourage the patient to take food that is nutritious. Adequate nutrition is likely to increase appetite and weight. The patient will also be free of signs or symptoms of mal-absorption. This will also translate to improved patient outcomes.

There are several ways in which a nurse can prevent complications of cystic fibrosis. The nurse can assess the patient’s knowledge concerning nutritional requirements, pathophysiology and genetics of the disease, and recommendations for controlling the infection. The patient should be able to verbalize the process of the disease, goals of therapy administered and treatment recommendations. This will finally result in improved patient safety and outcomes that is characterized by improvement in infection and suppression of bacterial growth. The cough will decrease and mucus production will shift to baseline. Positive patient outcomes will also be characterized by normal white blood cell count and normothermia.

Explaining how an EBP model was used to help develop the care plan

The Iowa Model for Evidence-Based Practice was used to help develop the care plan. This is because this particular evidence-based practice model helps in promoting quality care by ensuring the implementation of an evidence-based care plan. The model was used to develop the evidence-based care plan by better addressing the issue concerning patient-centric care for nurses at all practice levels and guiding them through a multiphase, collaborative and team-based process. The path starts with a clinical “trigger” that identifies a problem concerning the provision of care. It also includes decision points with evaluative feedback loops when suggesting and implementing a practice change about the provision of care. The Iowa model outlines the characteristics of a standardized evidence-based care plan that should be implemented by nurses in all clinical settings. The phases of the Iowa model include in are inter-professional team formation; review, critique and synthesis of evidence; implementation of the change via piloting; ongoing evaluation; and dissemination of results. All these processes were also used when proposing the evidence-based care plan.

The evidence that was most relevant and useful when making decisions regarding the care plan included positive results of patient-centered care, culturally competent care and patient education. These pieces of evidence informed the choice of the evidence-based care plans. This is because these pieces of evidence provided accurate and reliable information concerning how care plans can be used to improve the outcomes and safety of patients. The shreds of evidence also provided information on the care plan that is cost-effective.

Identifying the benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team

There are several benefits of interdisciplinary collaboration in remote settings. It leads to improvement in patient experiences and satisfaction. Medical errors are also reduced. This, in turn, improves the health outcomes of patients. Health care costs are also reduced. It also promotes coordination of care within the remote settings. Patients living in remote areas can access care.

There are various strategies to mitigate the challenges of interdisciplinary collaboration. Hierarchical structures that discourage interdisciplinary collaboration should be done away with (Supper et al., 2015). Professionals should be trained in interdisciplinary collaboration (Reeves et al., 2017). The interdisciplinary team should not be too large or too small. Interdisciplinary team members should be provided with enough resources as they work in remote areas. These resources can include financial resources and modern reliable technological equipment. The commitment of interdisciplinary collaborative team members should be emphasized. All these strategies are likely to mitigate the challenges faced by an interdisciplinary collaborative team tasked to work in remote areas. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Conclusion

Coordinating care can be challenging especially when a patient lives far from his/her care provider or when many health care providers are distant from each other. As discussed, nurses need to come up with evidence-based care plans. This is likely to quickly improve patient outcomes and safety. Modern technologies are necessary to provide quality evidence-based care to patients when care teams and patients are not in the same geographical location. Nurses and other health care personnel should develop creative solutions when challenges arise so that care planning for remote patients is as outcome-based and comprehensive as that for patients nearby or on-site.

Reflection Questions

How was remote collaboration used to improve the quality and safety of the care being provided in the scenario?

The patient was able to interact with a remote specialist and other health care providers via video-conferencing. The professional was able to remotely monitor the health status of the patient. The data obtained was used by the professional to suggest changes in a patient’s treatment and advise the patient to seek care. This resulted in an improvement in the safety and quality of the care being provided.

In what ways was evidence-based practice being effectively applied to help the patient in the scenario? Were there opportunities for improvement? If so, what were they?

The evidence-based practice was being effectively applied to help the patient in the scenario. EBP was used to keep the knowledge of the nurse up to date. This ensured that the nurse was able to deliver the care that is up to date. EBP was also used to enhance clinical judgment. The clinical decisions that were made by the health care professional were sound. EBP augmented the existing provider-patient decision-making process. The care provider-patient decision-making process was therefore made to be effective and efficient.

References

Hardin, L., Kilian, A., & Spykerman, K. (2017). Competing health care systems and complex patients: An inter-professional collaboration to improve outcomes and reduce health care costs. Journal of Interprofessional Education & Practice7, 5-10.

Lemberger, O., & Rossetti, J. (2018). An Integrative Review of Cross-Industry Global Innovation: Evidence-Based Strategies for Nursing Practice.

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6).

Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses. Jones & Bartlett Learning.

Supper, I., Catala, O., Lustman, M., Chemla, C., Bourgueil, Y., & Letrilliart, L. (2015). Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. Journal of Public Health37(4), 716-727.

Remote Collaboration and Evidence-Based Care

 

Evidence-based care can be a challenge in any medical situation, but particular challenges present themselves when care is being provided remotely. In order to provide quality care to patients who live in rural settings or have difficulty with transportation to a care site, health care professionals must sometimes collaborate with other professionals in different ZIP codes or even time zones.

 

In this activity, you will observe how health care professionals collaborate remotely and virtually to provide care for a patient in Valley City, North Dakota.

 

 

 

 

Valley City Regional Hospital

 

The Patient Presents

 

Dr. Erica Copeland and Virginia Anderson, a pediatric nurse, discuss Caitlynn, who came into the ER last night and has now been admitted to the pediatric unit.

 

Dr. Copeland and Nurse Anderson discuss Caitlynn, who came into the ER last night and has now been admitted to the pediatric unit.

Dr. Copeland starts the conversation.

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Dr. Copeland: Nurse, can you give me an update on Caitlynn? I know she’s two years old and she’s been admitted for pneumonia. Does she have any history of breathing problems?

Virginia Anderson: Yes, this is her second admission for pneumonia in the last six months. She had a meconium ileus at birth.

Dr. Copeland: All right. Is she presenting with any other symptoms?

Virginia Anderson: She has decreased breath sounds at the right bases and rhonchi scattered in the upper lobes. Respirations are 32 and shallow with a temp of 101.

Dr. Copeland: What have we done for her so far?

Virginia Anderson: The respiratory therapist administered nebulized aerosol and chest physiotherapy. After the aerosol she had thick secretions.

Dr. Copeland: I see her weight is 20.7 pounds, and there’s been some decreased subcutaneous tissue observed in her extremities?

Virginia Anderson: Correct. I noticed this too, so she might have some malabsorption of nutrients.

Dr. Copeland: Have we done a sweat chloride test yet?

Virginia Anderson: Yes, and the results were 65 milliequivalents per liter. Also, the mother reports that when she kisses her, she tastes salty.

Dr. Copeland: All right. Well, I think it’s fair to say we might be dealing with cystic fibrosis here. Let’s get her started on an IV with piperacillin, and keep an eye on her temperature. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Collaboration Begins

Later, the diagnosis is confirmed: Caitlynn has cystic fibrosis. Dr. Copeland, Virginia Anderson, and Rebecca Helgo, the hospital’s respiratory therapist have a sort consult, where they realize that Caitlynn’s care will not be easy.

Dr. Copeland, Virginia Anderson, and Rebecca Helgo have a short consult.

Dr. Copeland starts the conversation.

Dr. Copeland: Let’s talk about Caitlynn Bergan. Her mother, uh, [checks notes] Janice, has been informed of her diagnosis. I didn’t realize this when she first came in, but she doesn’t live in Valley City; she’s in McHenry.

Rebecca Helgo: That’s a tough drive during winter. They’re over an hour away, aren’t they?

Dr. Copeland: That’s right. It was a toss-up between coming here or going to Jamestown, but I guess the father — Doug — thought Valley City was the better choice. Anyway, I’ve put her on Pancrease enzymes and we’ll be recommending a high-protein, extra-calorie diet along with the fat-soluble vitamins — A, D, E, and K. I’ll update her pediatrician on her condition, and order dornase alfa. Let’s see how she does with the breathing treatments. How are those going?

Rebecca Helgo: Quite well, actually. She’s too young to get her to do the huff breaths, but we’re keeping the secretions thin and manageable with the aerosol treatments. I am concerned about her day-to-day treatment, though. She’ll be back here with pneumonia if the parents can’t stay on top of that. She’s at risk for impaired gas exchange and respiratory distress, which will cause her anxiety and more distress, and that’s not going to help her stay well.

Dr. Copeland: How well do you think the parents will be able to handle the treatment?

Virginia Anderson: That might get tricky. I gather that the mother and father are still married but separated. We’ll need to make sure that at least one of them gets the education they need. But they both work, and trips here aren’t the easiest choice. We should get social services consult to coordinate services and identify some assistance for the family in McHenry.

Rebecca Helgo: I can do some education here, and then do a Skype consult with one or both of them once she’s been discharged and is back home.

Dr. Copeland: It sounded like both parents work long hours. Are you going to be able to schedule times that work?

Rebecca Helgo: I may have to do some after-hours appointments. We’ll have to sort that out.

Virginia Anderson: She’s had one bowel obstruction already, so I think we need to help them monitor for DIOS too. Does the pediatrician’s office have a telemedicine relationship with us? That might be helpful in preventing unnecessary trips here.

Dr. Copeland: Let’s find out a bit more and see what our options are. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Consulting With the Pediatrician

Later that day, Dr. Copeland and Virginia Anderson talk to Dr. Benjamin, Caitlynn’s pediatrician, about how his office can coordinate with the hospital on Caitlynn’s care

Dr. Copeland and Virginia Anderson talk to Dr. Benjamin about how his office can coordinate with the hospital on Caitlynn’s care.

Dr. Copeland greets Dr. Benjamin.

Dr. Copeland: Hello, Dr. Benjamin. I’m sorry to be meeting under such circumstances, but I hope we can work with you to help the Bergans handle Caitlynn’s care. On the line with me is Virginia Anderson, the nurse assigned to Caitlynn while she’s here.

Dr. Benjamin: Hello to both of you. Yes, it’s unfortunate. This is the first case I’ve seen among my own patients.

Dr. Copeland: Are you familiar with the CF protocol?

Dr. Benjamin: I am, but I’d love to get any more details that relate to Caitlynn. She’s done with most of her immunizations, but she’s still needs her HAV and influenza, of course. I’m also not sure where to order some of the pancreatic enzymes and medications you listed.

Virginia Anderson: We can help with all that. Do you have telemedicine access to Valley City?

Dr. Benjamin: No, but we do have it with Cooperstown Medical Center. We kind of have to in a town of less than 100 people.

Dr. Copeland: We may be able to use Skype on a more informal basis for consults between us, but it might be good to get connected with Valley City on your telemedicine equipment. If the parents bring Caitlynn to you with symptoms, and you’re not sure whether the hour-long trip is necessary, we can do a telemedicine appointment and make sure.

Dr. Benjamin: All right. It sounds like we might see them often initially, and I understand that bowel obstructions and pneumonia are two possible complications. We can handle some of those issues here, but assuming they have trouble during working hours, I assume we can reach you by phone?

Dr. Copeland: You or your staff can send me a text. If we need to talk further, we can set up a call, but if not, text is the quickest way to get my attention, and the easiest way for me to respond between things.

Virginia Anderson: And I’m available via text as well if you’re having trouble reaching Dr. Copeland or if it’s a question I can field.

 

The Care Plan Continues

 

To address some of the questions that came up during the consult, Virginia meets with Madeline Becker, the social worker at the clinic in McHenry.

Virginia and Marta Simmons meet with Madeline Becker, the social worker at the clinic in McHenry.  Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Virginia starts the conversation.

Virginia Anderson: Hi, Madeline, this is Virginia Anderson at Valley City Regional Hospital. I’m on the line with Marta Simmons, our social worker here at the hospital.

Madeline Becker: Hi, both of you.

Marta Simmons: Madeline, we’re calling because Virginia is working on a care plan for a child from McHenry, a Caitlynn Bergan. She’s here after a bout of pneumonia and she’s been diagnosed with cystic fibrosis. We wanted to talk to you about resources there for some of the issues the Bergans are going to be dealing with.

Madeline Becker: Of course. I got the documentation you emailed earlier. Fortunately, the Bergans are both employed and have good insurance through Doug’s new job. But as you may have heard, he was unemployed for some time, so money is tighter than it might seem.

Virginia Anderson: We’ve talked to Janice and she isn’t sure what her insurance covers as related to the breathing and other treatments Caitlynn is likely to need.

Madeline Becker: I can do some initial work on that. I’ll need a release from Janice to get detailed information, but I should be able to get general coverage information. What other resources might they need? McHenry is pretty small, as I’m sure you’re aware.

Marta Simmons: The main issue is going to be the stress of caring for a child with a chronic illness. Even a group that helps members deal with grief would be helpful. Children with CF live much longer than they used to, but it’s still a difficult condition.

Madeline Becker: There isn’t a group like that here, but there is one in Sheyenne. I mean, it’s more for parents in grief already, parents who have lost a child, but it’s a sizable group, relatively speaking. I’m sure there will be some parents who understand what it’s like to have a child with a difficult condition.

Virginia Anderson: All right, that helps. Now, we’re going to provide as much education as we can before Janice takes Caitlynn home, but what kind of resources are there in McHenry? If she doesn’t have home Internet access, does the library offer it? Is there a library?

Madeline Becker: No, the closest library is in Cooperstown.

Marta Simmons: Well, we’ll talk to the Bergans’ pediatrician and see if they might be able to help if they need materials and can’t get them easily at home. This is progressive and lifelong, and they’re going to need some support as they learn to deal with it.

 

 

Respiratory Therapist Consult on Skype

 

A few days after Janice an Caitlynn go back to McHenry, Janice calls to talk to someone about whether she’s doing Caitlynn’s chest physiotherapy correctly. Virginia and Rebecca, the respiratory therapist, call her back on Skype to answer her questions.

 

Virginia and Rebecca call Janice, on Skype, to answer her questions.

 

Virginia Anderson starts the conversation.

 

Virginia Anderson: Hi, Janice, thanks for contacting us! We’re getting back to you about Caitlynn. With me on the line is Rebecca Helgo, the respiratory therapist who helped you out when you were here.

Rebecca Helgo: Hi, Janice.

Janice: [sounding stressed] Hi.

Virginia Anderson: Janice, how is it going with Caitlynn?

Janice: Well, that’s why I called, actually. Not so good. I mean, not bad, but I guess I’m not remembering everything you told me when we practiced the physiotherapy, the chest physiotherapy.

Virginia Anderson: That’s okay, Janice. I know this feels overwhelming. Caitlynn’s condition is an extensive one, and we’re here to help you manage it. We’ll continue to be here as you’re figuring this out, okay?

Rebecca Helgo: That’s right, Janice. I know you’ll get the hang of it, but in the meantime there’s a lot to learn. So you had some questions about the chest physiotherapy? What’s going on?

Janice: Okay, if you can see on the camera, Caitlynn has these red marks on her ribs here. Is that a symptom of something?

Rebecca Helgo: Can you get the camera just a bit closer?

Janice: How’s that?

Rebecca Helgo: Okay, very good. Yes, those look like marks from the percussion. Are those over her last two ribs?

Janice: I think so.

Rebecca Helgo: That’s one thing you’ll have to remember: You don’t want to do the percussion on her last two ribs on either side, her backbone, or her breastbone. And when you do it anywhere else, you don’t want to leave red marks. So if you see those, that’s a hint that you’re doing the percussion just a bit too hard.

Virginia Anderson: Don’t worry, you haven’t hurt her that I can see. Plus, you’re obviously really staying on top of things and you’re following the recommended treatment procedures for Caitlynn, and I really want to praise you for that. So, is she acting like that area is hurting her? Or can you tell?

Janice: No, it doesn’t seem like it’s hurting her at all.

Rebecca Helgo: She should be fine, then.

Virginia Anderson: And remember, Janice, if you continue to have trouble with this, we’ve got other options. There’s a vest that vibrates the child if percussion isn’t getting the job done. And you won’t have to do exactly this forever. As she gets older and can learn how to do huff coughs, you’ll be doing less work and she’ll be doing more.

Janice: Okay. Thank you, that makes me feel better. I couldn’t get hold of my pediatrician and I was just getting worried.

Rebecca Helgo: Good, that’s what we’re here for.

Virginia Anderson: Janice, should we review the signs and symptoms of respiratory distress? We’re happy to go over anything you need to feel more confident about monitoring Caitlynn.

Janice: I think I remember those. I feel like I check for them every hour.

Rebecca Helgo: [chuckles] That’s understandable. Well, remember to check with Dr. Benjamin or me or Virginia if you need to. Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Conclusion

Congratulations! You have completed this activity.

 

As you saw in this activity, coordinating care can be a challenge when the patient lives far from her provider or when multiple providers are distant from each other. Many technologies may be necessary in order to provide quality evidence-based care to patients when care teams and patients are not in the same location. Nurses and other health care professionals must find creative solutions when problems arise, so that care planning for remote patients is just as comprehensive and outcome-based as that for patients nearby or on site.

 

As you work on your assignment, consider these questions:

 

How was remote collaboration used to improve the quality and safety of the care being provided in the scenario?

 

In what ways was evidence-based practice being effectively applied to help the patient in the scenario? Were there opportunities for improvement? If so, what were they? Assessment 4 Instructions: Remote Collaboration and Evidence-Based Care

Assessment 4 Instructions: Final Care Coordination Plan Content

Assessment 4 Instructions: Final Care Coordination Plan Content

For this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1. Present the plan to the patient in a face-to-face clinical learning session and collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan.

NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.

Care coordination is the process of providing a smooth and seamless transition of care as part of the health continuum. Nurses must be aware of community resources, ethical considerations, policy issues, cultural norms, safety, and the physiological needs of patients. Nurses play a key role in providing the necessary knowledge and communication to ensure seamless transitions of care. They draw upon evidence-based practices to promote health and disease prevention to create a safe environment conducive to improving and maintaining the health of individuals, families, or aggregates within a community. When provided with a plan and the resources to achieve and maintain optimal health, patients benefit from a safe environment conducive to healing and a better quality of life.

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This assessment provides an opportunity for you to apply communication, teaching, and learning best practices to the presentation of a care coordination plan to the patient. Assessment 4 Instructions: Final Care Coordination Plan Content

You are encouraged to complete the Vila Health: Cultural Competence activity prior to completing this assessment. Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.

Demonstration of Proficiency

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

  • Competency 1: Adapt care based on patient-centered and person-focused factors.
    • Design patient-centered health interventions and timelines for care delivered through direct clinical interaction that is logged in the CORE ELMS system.
  • Competency 2: Collaborate with patients and family to achieve desired outcomes.
    • Evaluate learning session outcomes and the attainment of mutually agreed-upon health goals, in collaboration with a patient.
  • Competency 3: Create a satisfying patient experience.
    • Evaluate patient satisfaction with the care coordination plan and progress made toward Healthy People 2020 goals and leading health indicators.
  • Competency 4: Defend decisions based on the code of ethics for nursing.
    • Make ethical decisions in designing patient-centered health interventions.
  • Competency 5: Explain how health care policies affect patient-centered care.
    • Identify relevant health policy implications for the coordination and continuum of care.

Preparation

In this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1 and communicate the plan to the patient in a professional, culturally sensitive, and ethical manner.

To prepare for the assessment, consider the patient experience and how you will present the plan. Make sure you schedule time accordingly.

Note: Remember that you can submit all, or a portion of, your plan to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback. Assessment 4 Instructions: Final Care Coordination Plan Content

Instructions

Note: You are required to complete Assessment 1 before this assessment.

For this assessment:

  • Complete the preliminary care coordination plan you developed in Assessment 1.
  • Present the plan to the patient in a face-to-face clinical learning session. Communicate in a professional, culturally sensitive, and ethical manner.
  • Collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan.

Reminder: The time you spend presenting your final care coordination plan must be logged in the CORE ELMS system. The total time spent in securing individual participation in this activity in Assessment 1 and presenting your plan in this assessment must be at least three hours. The CORE ELMS link is located in the courseroom navigation menu.

Please be advised that the Volunteer Experience form requires that you provide the name and contact information for at least one individual with whom you worked as part of your direct clinical activity. Your faculty may reach out to this individual to verify that you have accurately documented and completed your clinical hours.

Document Format and Length

Build on the preliminary plan document you created in Assessment 1. Your final plan should be 5–7 pages in length.

Supporting Evidence

Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2020 resources. Cite at least three credible sources.

Grading Requirements

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

  • Design patient-centered health interventions and timelines for care delivered through direct clinical interaction that is logged in the CORE ELMS system.
    • Address three patient health issues.
    • Design an intervention for each health issue.
    • Identify three community resources for each health intervention, so the patient may make an informed decision about what resources to use. Assessment 4 Instructions: Final Care Coordination Plan Content
  • Make ethical decisions in designing patient-centered health interventions.
    • Consider the practical effects of specific decisions.
    • Include the ethical questions that generate uncertainty about the decisions you have made.
  • Identify relevant health policy implications for the coordination and continuum of care.
    • Cite specific health policy provisions.
  • Evaluate learning session outcomes and the attainment of mutually agreed-upon health goals, in collaboration with the patient.
    • What aspects of the session would you change?
    • How might revisions to the plan improve future outcomes?
  • Evaluate patient satisfaction with the care coordination plan and progress made toward Healthy People 2020 goals and leading health indicators.
    • What changes would you recommend to improve patient satisfaction and better align the session with Healthy People 2020 goals and leading health indicators?
Additional Requirements

Before submitting your assessment, proofread your final care coordination plan to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan.

You must submit your hours to the CORE ELMS system before you can complete this assessment and course.

Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course. Assessment 4 Instructions: Final Care Coordination Plan Content

Collaborative Learning Community (CLC) Assignment

Collaborative Learning Community (CLC) Assignment

Nursing theories are tested and systematic ways to implement nursing practice. Select a nursing theory and its conceptual model. Prepare a 10‐15 slide PowerPoint in which you describe the nursing theory and its conceptual model and demonstrate its application in nursing practice. Include the following:

  1. Present an overview of the nursing theory. Provide evidence that demonstrates support for the model’s efficacy in nursing practice. Explain how the theory proves the conceptual model.
  2. Explain how the nursing theory incorporates the four metaparadigm concepts.
  3. Provide three evidence‐based examples that demonstrate how the nursing theory supports nursing practice. Provide support and rationale for each. Collaborative Learning Community (CLC) Assignment

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Questions:

1. Explain how the nursing theory incorporates the four metaparadigm concepts.

2. Provide three evidence-based examples that demonstrate how the nursing theory supports nursing practice. Provide support and rationale for each.

The theory that my group choose was:

Hildegard Peplau’s Interpersonal Relations Theory

Hildegard Peplau’s interpersonal relations theory is referred to as psychodynamic nursing, which refers to the understanding of one’s behavior. Peplau’s (1909-1999) work was a major contribution to mental health laws and defined nursing as an interpersonal process of therapeutic interactions between an ill individual in need of health services and an educated nurse trained to recognize and respond to those needs (Peplau, 1952). She considered the person to be an organism that desires to reduce tension or anxiety. The environment is not clearly defined but is made up of existing forces outside of the person. Health is defined as forward movement of the human process toward creative and productive community living. Nursing is a therapeutic interpersonal process existing in four phases: orientation, identification, exploitation, and resolution (see Figure 2.5). Collaborative Learning Community (CLC) Assignment

The nurse has a variety of roles that include stranger, teacher, resource, counselor, technical expert, and leader (Creasia & Friberg, 2011). This theory can be explained as the understanding of the interpersonal relationship between the patient and the nurse. Peplau recognized that such a relationship does exist, and the nurse is not just a messenger between the physician and patient.

Figure 2.5
Hildegard Peplau’s Interpersonal Relations Theory

The figure presents Hildegard Peplau's interpersonal relations theory. The theory starts with orientation, moves to identification, proceeds to exploitation, and ends with resolution.

Lecture:

Nursing Theory

A theory is a collection of statements that explain a relationship between two or more ideas. Theory maintains a central role in the evolution of the nursing discipline. It is something all nurses use in their daily practices, whether known or not. Relatively new, nursing theory is a structure of purposeful and systematic ideas that help to organize disciplinary thinking and influence practice. Much discussion and debate have occurred regarding the various theory definitions. Levine (1995) promoted acceptance of nursing theory, which she called the intellectual life of nursing. She identified that students often fail to embrace nursing theory and do not fully grasp the importance of nursing theory and its relevance for practice and education. Collaborative Learning Community (CLC) Assignment

Understanding nursing theory strengthens the focus of care by guiding nursing practice. It may help to think about nursing theories as various lenses used to view different perspectives of known nursing phenomena. For example, Dorothy Orem’s self-care deficit theory focuses on assisting others in managing self-care to maintain or improve human function at an effective level (Orem, 1995). Also, Sister Callista Roy’s adaptation theory explains how individuals are in constant interaction with a changing environment and that the individual must adapt to change to have a positive response (Creasia & Friberg, 2011).

Example of Dorothy Orem’s Self-Care Deficit TheoryAn elderly man recently received a total hip replacement. During the discharge process, the registered professional nurse educates the patient about many things, including activity restrictions, medications, and wound care. The nurse also reviews activities of daily living, such as showering and toileting. The nurse realizes that the patient’s balance may be altered and discusses fall precautions with the patient. Detailed discharge instructions are an example of moving the patient from a state of dependence on others for care to a state of independence and self-care.Example of Sister Callista Roy’s Adaptation TheoryThe school nurse receives a phone call from a parent of an eighth-grade female student stating that the student recently suffered a femoral fracture from a trampoline injury that required open reduction internal fixation. She has successfully recovered to the point that she can return to class next week. The nurse realizes that because of the full-leg cast the student will be excused from physical education class and likely will require assistance with mobilization and toileting. Based on the student’s age, psychosocial issues are likely to be involved due to an altered self-concept related to body image. Her balance may be altered as well. Ultimately, the student demonstrated a positive attitude and adapted well to this life-altering event.Nursing theory is present in day-to-day interactions with patients. The core values derived from theoretical assumptions can serve as a foundation upon which to build practices. The goal of applying theory is to improve practice.

The nursing profession is an art and science involving a complex mix of many parts. Nurses are expected to perform the science of nursing through medical and technical competencies, such as nursing skills, academic knowledge, and professional performance. Nurses must become lifelong learners and engage in continuing education throughout their careers to maintain those nursing skills and competencies. Included in the science of nursing are theories, conceptual models, and research that is specific to nursing. The art of nursing requires a foundation of nursing skills, academic knowledge, and professional performance. It is difficult to define or measure the art of nursing other than by looking at the pronounced noticeability of its absence. Treating patients with dignity and respect, being cognizant of nonverbal cues, and using active listening and communication skills are all qualities patients and families value highly. Nurses should strive to find a balance between the science and the art of nursing in their practices (Palos, 2014). Collaborative Learning Community (CLC) Assignment

Nursing is a knowledge-based discipline and profession that incorporates a body of knowledge to guide its practice (Smith & Parker, 2015). Because nursing is a profession, nurses are required to meet specific educational qualifications. Education is systematically obtained from colleges and universities that ultimately produce knowledge-based professional nurses who can practice autonomously. The following characteristics define the meaning of a professional (Creasia & Friberg, 2011):

  • Formal education required
  • Lifelong mission, recognized as life work
  • Encompass knowledge
  • Service to society
  • Practice autonomously
  • Practice guided by ethics
  • Professional culture and values
  • Compensation received

Metaparadigm

Theories are built upon a foundation of concepts. Theoretical statements compose a theory. The concepts incorporated into theoretical statements include areas of interest to the discipline. For nursing theory, these concepts include person, environment, health, and nursing, also referred to as metaparadigm. The metaparadigm includes basic assumptions regarding the theory and highlights areas vital to the nursing discipline and ultimately patient care (see Figure 2.3).

Figure 2.3
Metaparadigm of Nursing Concepts

The figure presents a model of four nursing metaparadigm concepts: Nursing, which is defined by the nursing actions; Person, which is defined by the recipients of care; Health, which is defined by person; and Environment which is defined by internal and external factors.

Note. Adapted from “Nursing Metaparadigm Concepts,” by CJT Consulting & Education, 2017.

Person refers to the patient, client, individual, family, community, or group. These are the recipient(s) of said nursing care. Environment includes external and internal space associated with the person. Health encompasses all areas of, or lack of, the person(s) wellbeing. As the final metaparadigm component, nursing expresses the goal of nursing that is specific to the theory (McEwen, 2007).

Conceptual Models

Theories can be categorized according to their complexity. These categories include practice theories, midrange theories, and grand theories (also referred to as conceptual models). Conceptual models explain a particular way of thinking, or a mental picture of how the theory fits together, according to the theorist. A conceptual model is the organizing structure that defines the theory.

Types of Theories

Nursing theories are categorized by their level of complexity and are identified as practice theories, midrange theories, or grand theories.

Practice Theory

The purpose of nursing theory is to improve nursing practice, and the lives of patients, families, and communities served by nursing practice. Practice theory defines the delivery of nursing care in specific situations related to practice, incorporating “nurses’ clinical wisdom” (McEwen, 2007) by answering clinical questions. Practice theory is limited in scope in that it focuses on specific areas of nursing, such as a specific patient population or a certain type of nursing practice. Nursing interventions and actions in response to patient-specific needs are often prescribed. Practice theory offers a specific framing of how nurses handle situations within their scope of practice (Levine, 1995). Scenarios of practice theories are often reviewed in nursing journals that focus on management of disease or journals that discuss nursing interventions related to specific patient populations (Creasia & Friberg, 2011).

General System Theory

General system theory is a broad theory that specifies any system being studied as composed of smaller subsystems and also a part of a larger subsystem. It suggests that a system is a set of interrelated parts that are constantly interacting with the environment to attain a common goal (Creasia & Friberg, 2011). In other words, a system is more than the sum of its parts (Boettcher, 1996). When studying the circulatory system, for example, one cannot simply study the components of blood, but must also include the cardiovascular system, the vascular system, respiratory system, and so on to understand how the circulatory system functions.

Change Theory

Change theory is one of the most commonly used theories related to nursing education and patient learning. This theory’s governing principle is that by using certain motivating factors, patients feel empowered and desire to change unhealthy habits. By setting goals and offering incentives, learning and change occur for the patient.

Kurt Lewin (1890-1947), commonly referred to as the father of psychology, was known for his life space or field theory. Kurt Lewin’s field theory states that human behavior is related to both the individual and the environment. Lewin explored human behavior by performing field research. The concepts of driving forces, restraining forces, and equilibrium were used by Lewin to explain human behavior (McEwen, 2007). Lewin believed that desired change in human behavior could occur by first identifying the undesired behavior, then understanding the cause of such behavior, and what forces would need to be strengthened or weakened to bring about change (Burnes & Cooke, 2013). This theory can be applied to many areas of nursing, including mental health, or any area that desires improved health outcomes based on patient compliance with prescribed regimens.

Coping/Adaptation Theory

The ability to cope requires the body to adapt continually to a changing environment. Richard Lazarus (1922-2002) was a psychologist and author who was best known for his theoretical work related to coping. Developed in 1984, Richard Lazarus’s theory of stress, coping, and adaptation centers on how an individual copes with stressful situations (see Figure 2.4).

The theory focuses on various psychological responses to stress that are considered negative, such as emotional distress, anxiety, depression, anger, and fear, to name a few. Lazarus saw these responses as coping mechanisms. Stress is viewed as more than a stimulus causing a response. Nurses can apply this theory to assess the effects of stress on the individual patient. Physical and psychological responses to stressors can occur (Smith & Parker, 2015). For example, an individual working in a stressful environment may develop emotional distress that causes disruptive outbursts and chronic overeating. Physical responses may include high blood pressure and obesity. Another example would be soldiers returning to civilian life and experiencing post-traumatic stress disorder.

Figure 2.4
Richard Lazarus’s Theory of Stress, Coping, and Adaptation

The figure outlines of Richard Lazarus's theory of stress, coping, and adaptation. The theory starts with a stressor, which leads to a primary appraisal ("Is this harmful, threatening, or challenging?") and positive or negative emotions. This leads to a secondary appraisal, "Can I cope with the stress?" and "What are the alternatives?" This can lead to two answers: "Yes, I can cope," with "I experience minimal stress" or "No, I can't cope," with "I experience a lot of stress."

Midrange Theory

Midrange theories are not as complicated as grand theories. Midrange theories contain fewer concepts, are easier to use, and usually contain single applications that can be applied to a variety of practice settings. Collaborative Learning Community (CLC) Assignment

Hildegard Peplau’s Interpersonal Relations Theory

Hildegard Peplau’s interpersonal relations theory is referred to as psychodynamic nursing, which refers to the understanding of one’s behavior. Peplau’s (1909-1999) work was a major contribution to mental health laws and defined nursing as an interpersonal process of therapeutic interactions between an ill individual in need of health services and an educated nurse trained to recognize and respond to those needs (Peplau, 1952). She considered the person to be an organism that desires to reduce tension or anxiety. The environment is not clearly defined but is made up of existing forces outside of the person. Health is defined as forward movement of the human process toward creative and productive community living. Nursing is a therapeutic interpersonal process existing in four phases: orientation, identification, exploitation, and resolution (see Figure 2.5).

The nurse has a variety of roles that include stranger, teacher, resource, counselor, technical expert, and leader (Creasia & Friberg, 2011). This theory can be explained as the understanding of the interpersonal relationship between the patient and the nurse. Peplau recognized that such a relationship does exist, and the nurse is not just a messenger between the physician and patient.

Figure 2.5
Hildegard Peplau’s Interpersonal Relations Theory

The figure presents Hildegard Peplau's interpersonal relations theory. The theory starts with orientation, moves to identification, proceeds to exploitation, and ends with resolution.

Note. Adapted from “Developmental States of the Nurse-Client Relationship: Peplau’s Interpersonal Relations Theory,” from Effective Communication in Nursing: Theory and Best Practice, by Southeastern University.

Imogene King’s Theory of Goal Attainment

The central concept of Imogene King’s theory of goal attainment is that personal, interpersonal, and social systems all interact together to reach a common goal (see Figure 2.6).

Imogene King (1923-2007) views the person as the patient in the nurse-patient relationship. Internal and external environments both generate stressors. Health is defined as the patient’s ability to function in societal roles. The focus of nursing is to help the patient maintain health so the patient can perform the duties related to the patient’s current role (King, 1981). For example, to ensure that an elderly patient who lives alone and has no transportation can receive hemodialysis three days a week, it would be necessary to incorporate the family in discharge planning.

Figure 2.6
Imogene King’s Theory of Goal Attainment

The figure presents Imogene King's theory of goal attainment, showing the relationship among social systems (society), interpersonal systems (groups), and personal systems (individuals).

Note. Adapted from A Theory for Nursing: Systems, Concepts, Process, by I. M. King, 1981, p. 145.

Madeleine Leininger’s Cultural Care Theory

In Madeleine Leininger’s cultural care theory, she believed that cultural competency improved nursing practice. Madeleine Leininger’s (1925-2012) cultural care theory (see Figure 2.7) focuses on the analysis of different cultures to better understand their ideas of health, their behaviors, and their thoughts regarding nursing care (Creasia & Friberg, 2011).

The metaparadigm concept of Person is prominent in this theory, with its focus on better understanding of people and their cultural differences. Persons are not only referred to as human beings, but families, groups, and communities that contribute to their cultural background. The environment is where the individuals live, and it has an impact on a person’s ability to perform self-care. Leininger defined health as “a state of wellbeing that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways” (Leininger, 1991, p. 48). The goal of nursing is to support individuals to maintain or improve their health in a culturally competent way. An example of providing culturally competent care would be respecting the belief of a severely anemic patient who refuses blood products based on the patient’s religion as a Jehovah’s Witness.

Figure 2.7
Madeleine Leininger’s Cultural Care Theory

The figure is a visual representation of Leninger's Sunrise Model.

Note. Adapted from “The Sunrise Model: A Contribution to the Teaching of Nursing Consultation in Collective Health,” by L. Pereira de Melo, 2013, in American Journal of Nursing Research, 1(1), 20-23. Copyright 2013 by the Science and Education Publishing.

Midrange Theory Metaparadigm Concepts

Table 2.1 compares the midrange theories of Peplau, King, and Leininger and presents the midrange theoretical principals related to the metaparadigm concepts of nursing for deeper understanding.

Table 2.1
Midrange Theory Metaparadigm Concepts

Midrange Theorist

Person

Environment

Health

Nursing

Hildegard Peplau: Interpersonal Relations Theory

Viewed humans as organisms

Existing forces outside of the individual

Forward movement of human process toward creative and productive community living

Therapeutic interpersonal process

Imogene King: Theory of Goal Attainment

Patient in a nurse-patient relationship

Internal and external environments generate stress

Patient’s ability to function in current role

Assist the patient in maintaining health

Madeleine Leininger: Cultural Care Theory

Human beings, families, groups, communities

Where individuals live impacts ability for self-care

State of culturally defined well-being

Provide culturally competent support

Note. (Creasia & Friberg 2011; King, 1981; Leininger, 1991; Peplau, 1952)

Grand Theory

Lewin stated that exploring a variety of nursing theories could provide the nurse with new insights into patient care. The term grand theory indicates that the theory has a broad scope, including general concepts. The nature, purpose, and goals are broad (McEwen, 2007). Sister Callista Roy developed a grand theory in 1976 that is considered to be an adaptation model focusing on the human response and adaptation to a constantly changing environment. Grand theories typically are complicated and abstract and are not easily understood (Kolcaba, 2001). Collaborative Learning Community (CLC) Assignment

Nightingale’s Environmental Theory

Florence Nightingale’s environmental theory presents disease as a reversible process achieved by altering the patient’s environment. Nightingale believed that individuals are in control of their own lives and desire good health. Also, the individual should be viewed as a holistic, multidimensional being, composed of biological, psychological, and spiritual components who possesses the ability to recover from disease if the environment allows. The environment is the most crucial concept in this theory (see Figure 2.8). Poor environmental factors lead to sickness and disease. Environmental factors include fresh air, sunlight, clean water, adequate food supply, efficient drainage, good hygiene, low noise, adequate temperature, and a clean environment. The environment is external; however, it can affect the individual in sickness or health. Nursing is a service intended to relieve pain and suffering.

It is the professional nurse’s responsibility to alter the patients’ environment to affect change in their health. The goal of nursing should be to promote the reparative process by manipulating the environment. Environmental change is needed for optimal health (Zborowsky, 2014).

Figure 2.8
Florence Nightingale’s Environmental Theory

The figure demonstrates Florence Nightingale's environmental theory, which centers on the client. Around the client are factors that can affect how the patient recovers, which are noise, air, nutrition, light, bedding, variety, health of houses, hope and advice, cleanliness, and ventilation. The nurse, who surrounds everything, is the one who can alter and change these factors to benefit the client.

Note. Adapted from “Nightingale’s Environmental Theory Conceptual Framework,” by Nurselabs.com, 2014.

Rogers’s Science of Unitary Human Beings Theory

Martha Rogers’s science of unitary human beings theory was first publicized in 1970 in her publication, An Introduction to the Theoretical Basic for Nursing. She claimed that nursing was a science and an art. Her work began in the 1960s when she theorized that humans are dynamic energy fields that react with the environment and are continually changing. She viewed the individual as a whole energy field constantly in motion, with language and thought that are sensitive and emotional (see Figure 2.9).

Health is valued and occurs when living in harmony with the environment (Rogers, 1970).

Figure 2.9
Martha Rogers’s Science of Unitary Human Beings Theory

The figure is a visual representation of Rogers's Science of Unitary Human Beings Theory.Example of Science of Unitary Human Beings TheoryA pediatric patient is hospitalized over the Christmas holiday. The patient’s mother, father, and two younger siblings are in the room as the nurse enters to assess the patient. The nurse feels that the atmosphere is very somber and wants to do something to improve the energy in the room. She mentions that she would be glad to bring in some Christmas DVDs if they are interested in watching movies. They agree, and when she enters the room an hour later, the family is laughing, enjoying a movie. The energy has changed in the room, and it feels more positive and cheerful.This illustration is a three-panel comic strip. The first panel shows a client who looks unhappy while in bed with a visitor sitting next to him. In the second panel, a nurse has entered and asks the client, "Would you like a Christmas movie? I can bring you one." The final panel shows a Christmas tree on the television screen and the client looking happy.

Orem’s Self-Care Deficit Theory

Dorothea Orem’s self-care deficit theory, developed during the years of 1959-2001, focuses on assisting others in managing self-care to maintain or improve human function at an effective level (Orem, 1995). Orem’s three-part theory includes self-care, self-care deficit, and nursing systems (see Figure 2.10).

Self-care is ideally performed by individuals to maintain health and well-being. Self-care deficit requires nursing assistance. Nursing systems define how the nurse will meet the individual’s needs. Orem’s theory states that the individual should be in an appropriate environment to receive care. The environment is external; however, for Orem’s theory, the environment and individual are bound together, and they function as one unit. Individual health is a condition in which humans are structurally and functionally complete. Health is considered physical, psychological, interpersonal, and social (Orem, 1995). The nursing focus should be to maintain health or to return the individual to the previous state of health by assisting with self-care to sustain life and maintain health (Current Nursing, 2012).

Figure 2.10
Orem’s Self-Care Deficit Theory

The figure shows Dorothea Orem's self-care deficit theory, which is made up of three parts: self-care, self-care demands, and self-care agency. However, if there is a deficit, the nursing agency will be in charge of handling it.

Grand Theory Metaparadigm Concepts

Table 2.2 compares the grand theories of Nightingale, Rogers, and Orem and presents the grand theoretical principals related to the metaparadigm concepts of nursing (person, environment, health, and nursing) for deeper understanding.

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Table 2.2
Grand Theory Metaparadigm Concepts

Grand Theorist

Person

Environment

Health

Nursing

Nightingale: Environmental Theory

  • Holistic and multidimensional
  • Can recover from disease if environment allows

Poor environment leads to sickness and disease.

Goal is optimal health.

Responsibility to alter the patient’s environment

Rogers: Science of Unitary Human Beings

  • Whole
  • Not reducible
  • Energy field
  • Synergistic human beings
  • Constantly reacting
  • Exchanging matter and energy with humans
  • Valued
  • Occurs when living in harmony with environment
  • Accepting of change

Viewed as a science and an art

Orem: Self-Care Deficit Theory

Individuals perform self-care to maintain health and well-being

External environment and individual bound together

Health is viewed as structurally and functionally complete

  • Assist with self-care
  • Help maintain or return to previous state of health. Collaborative Learning Community (CLC) Assignment
Note. (Orem, 1995; Rogers, 1970; Zborowsky, 2014; Current Nursing, 2012).

Future of Nursing

It is estimated that the future need of the nursing workforce will increase greatly in coming years. In fact, it is projected that the supply of professional nurses will increase from 3.5 million to 3.95 million by the year 2020; however, this supply will not meet the predicted demand, as more than 4.14 million nurses will be needed at that time. The increased need is partly because more than 70 million baby boomers will soon reach retirement age (Carnevale, Smith, & Gulish, 2015). The aging population will result in more elderly patients who are ill, seeking treatment, and requiring hospitalization and surgeries. Nursing shortages are commonplace across the United States. Nurses are leaving the profession because of retirement, inadequate wages, and stressful work environments related to insufficient staffing and long work hours. Hiring and retaining professional nurses is challenging for many employers. Although there has been an increase in students interested in entering the profession, nursing schools have had to turn students away because of a lack of faculty and facilities to educate them (Health Resources and Services Administration, 2017).

The IOM report, The Future of Nursing: Leading Change, Advancing Health (IOM, 2010), prioritizes the following areas of nursing: transforming practice, transforming education, and transforming leadership. The IOM report identifies several needs for the nursing workforce as it faces the complexity and challenges in today’s health care field. The future of nursing is changing and evolving. It is the duty of all nurses, from entry level to highly experienced, to embrace the changes and ensure that all patients are offered competent, safe, quality, compassionate care (IOM, 2010).

Reflective Summary

Professional nurses understand that nursing history defines the nurse’s role in current practice. Nursing’s rich history before Christianity, in the Middle Ages, during the 1700s, and through the 21st century have shaped the nursing profession. Many nurse leaders have contributed to this history, including pioneers such as Florence Nightingale, Lillian Wald, Clara Barton, and Linda Richards, who have paved the way for future generations of nurses.

Nursing is a knowledge-based discipline and profession that incorporates a body of knowledge to guide its practice (Smith & Parker, 2015). Through the years, professional nurses have identified theories that attempt to explain relationships between nursing care and the patient. These theories are categorized according to their complexity and can be referred to as practice theories, midrange theories, and grand theories or conceptual models. The scope and status of nursing education have dramatically changed from the days of nurse training programs in the late 19th and early 20th centuries. Many nursing education delivery models have evolved. Today, nurses can earn degrees at several levels, with several delivery methods available. The IOM report, The Future of Nursing: Leading Change, Advancing Health (IOM, 2010), emphasizes the transformation of practice, education, and leadership as priorities that will allow the nursing profession to continue to evolve through the 21st century and beyond. Collaborative Learning Community (CLC) Assignment

Environmental Factors And Health Promotion Presentation: Accident Prevention And Safety Promotion For Parents And Caregivers Of Infants

Environmental Factors And Health Promotion Presentation: Accident Prevention And Safety Promotion For Parents And Caregivers Of Infants

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

The growth, development, and learned behaviors that occur during the first year of infancy have a direct effect on the individual throughout a lifetime. For this assignment, research an environmental factor that poses a threat to the health or safety of infants and develop a health promotion that can be presented to caregivers.

Create a 10-12 slide PowerPoint health promotion, with speaker notes, that outlines a teaching plan. For the presentation of your PowerPoint, use Loom to create a voice over or a video. Include an additional slide for the Loom link at the beginning, and an additional slide for references at the end.

In developing your PowerPoint, take into consideration the health care literacy level of your target audience, as well as the demographic of the caregiver/patient (socioeconomic level, language, culture, and any other relevant characteristic of the caregiver) for which the presentation is tailored.

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Include the following in your presentation:

  1. Describe the selected environmental factor. Explain how the environmental factor you selected can potentially affect the health or safety of infants.
  2. Create a health promotion plan that can be presented to caregivers to address the environmental factor and improve the overall health and well-being of infants.
  3. Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.
  4. Offer examples, interventions, and suggestions from evidence-based research. At least three scholarly resources are required. Two of the three resources must be peer-reviewed and no more than 6 years old.
  5. Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource. Environmental Factors And Health Promotion Presentation: Accident Prevention And Safety Promotion For Parents And Caregivers Of Infants

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

Refer to the resource, “Loom,” located in the Student Success Center, for additional guidance on recording your presentation.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Environmental Factors And Health Promotion Presentation: Accident Prevention And Safety Promotion For Parents And Caregivers Of Infants

 

Questionable Medical History Conducted Case Study

Questionable Medical History Conducted Case Study

Read the “Questionable Medical History Conducted Case Study,” located in Chapter 10 of the textbook. You are a health care administrator and have come across a case study from a community hospital. In order to prevent this incident from occurring in your practice setting, prepare a 10-15 slide PowerPoint educational presentation for your staff. Include the following in your presentation:

  1. Describe the ethical issues and principles that were violated in this case.
  2. Describe the potential legal issues of concern.
  3. What tools or resources should this organization pursue in order to ensure high quality history and physical (H&P)?
  4. Explain whether negligence has occurred in this case.
  5. Explain which requirements meet the criteria for determining negligence in court.
  6. Describe how this situation can be prevented in your practice setting.

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Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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 not required to submit this assignment to LopesWrite. Questionable Medical History Conducted Case Study

Medical Terminology Mod 2 Course Project Paper

Medical Terminology Mod 2 Course Project Paper

In this course project assignment, you are presented with clinical notes for two different patients. These progress notes have been recorded as SOAP notes. A SOAP note is a common method of documenting a patient’s visit with a healthcare provider. These notes are saved in a patient’s medical record and will be used for treatment, billing, and other activities to monitor the patient’s health over time.

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SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. Each of these components is used to record a vital part of the patient’s visit.

  • Subjective: Includes the patient’s complaints and states the patient’s symptoms in his or her own words
  • Objective: Includes information that the provider can measure, such as vital signs, weight, or findings from a physical exam
  • Assessment: Includes a differential diagnosis or summary of signs and symptoms
  • Plan: Includes treatments performed, follow-up appointment information, referrals, or other orders

You will be exploring the medical terminology used in these SOAP notes and will be asked to interpret the meanings of various words and abbreviations.

To complete this assignment, do the following:

  1. Download the clinical notes for the two patients:

    Kay Salisbury Clinical Notes  (I have attached it below)
    Virginia Thompson Clinical Notes (I have attached it below)

  2. Download, complete, and submit the document below. This document contains questions you will answer regarding the clinical notes for each patient.

    Module 02 Course Project Assignment Template (I have attached it below)

PLEASE USE A BLANK WORD DOCUMENT TO ANSWER THE QUESTIONS ON THE COURSE PROJECT QUESTIONS DOCUMENT. Medical Terminology Mod 2 Course Project Paper

 

Benchmark – Evidence-Based Practice Assignment

Benchmark – Evidence-Based Practice Assignment

Take a moment to review the details of this assignment below and gather any necessary files. Once you’re ready to submit your assignment, move on to Step 2.

Assessment Description

Throughout this course you will be developing a formal, evidence-based practice proposal.

The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals are submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed, but they should be between 3,500 and 5,000 words. The cover sheet, abstract, references page, and appendices are not included in the word count. Benchmark – Evidence-Based Practice Assignment

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Section headings and letters for each section component are required. Responses are addressed in narrative form in relation to that number. Evaluation of the proposal in all sections is based upon the extent to which the depth of content reflects graduate-level critical-thinking skills.

This project contains six formal sections:

  1. Section A: Problem Description
  2. Section B: Literature Support
  3. Section C: Solution Description
  4. Section D: Change Model
  5. Section E: Implementation Plan
  6. Section F: Evaluation of Process

Each section (A-F, to be completed in Topics 1-5) will be submitted as separate assignments so your instructor can provide feedback for revision (refer to each Topic for specific assignments).

The final paper will consist of the completed project (with revisions to all sections), title page, abstract, reference list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms.

Refer to the “EBP Implementation Plan Guide” and the “Evidence-Based Practice Project Proposal Format” in Class Resources as tools for developing your proposal.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required for the final paper.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Benchmark – Evidence-Based Practice Assignment

You are not required to submit this assignment to LopesWrite.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MS Health Administration

3.5: Promote knowledge, skills, and abilities consistent with current health care best practices across service lines.

4.1: Apply evidence-based systems thinking to ensure optimal operational processes and integrative administrative, clinical, and business management. Benchmark – Evidence-Based Practice Assignment

 

Benchmark SWOT Analysis Paper

Benchmark SWOT Analysis Paper

Use the SWOT Analysis worksheet provided to complete this assignment.

Review the SWOT Analysis PowerPoint® prior to completing this assignment.

Based on the review of the Stevens District Hospital Strategic Planning Scenarioconduct a SWOT analysis to generate a list of perceived strengths, weaknesses, opportunities, and threats for the hospital.

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  • Strengths and weaknesses are traits internal to the hospital (i.e., strong physician loyalty to hospital, aging building, and availability of financial resources).
  • Opportunities and threats are external to the hospital, such as a mall facility available for lease or a competitor hospital opening two physician practices in your market.

Write a 700- to 1,050-word analysis that incorporates the key components of a SWOT analysis for the scenario described in Week 1 to generate a list of perceived strengths, weaknesses, opportunities, and threats. The analysis will include the following:

  • Analyze the purpose of conducting the analysis in the context of the scenario.
  • Analyze the limitations and advantages of conducting a SWOT analysis on your own (vs. with a group of stakeholders).
  • Use the table provided to record your analysis of the information from the strategic planning scenario and generate two factors for each of the SWOT categories (strengths, weaknesses, opportunities, and threats).

Cite at least 1 peer-reviewed, scholarly, or similar reference to support your assignment.

Format your assignment according to APA guidelines.

SWOT Analysis
Based on review of the performance analysis of Stevens District Hospital, consider what you perceive to be the strengths, weaknesses, opportunities and threats for this hospital.
• Strengths and weaknesses are traits internal to the hospital, i.e. strong physician loyalty to hospital, aging building, and availability of financial resources.
• Opportunities and threats are external to the hospital, such as a mall facility available for lease or a competitor hospital opening two physician practices in your market.
SWOT Analysis
Review the SWOT Analysis PowerPoint® prior to completing this assignment.
Based on the review of the Stevens District Hospital strategic planning scenario, conduct a SWOT analysis to generate a list of perceived strengths, weaknesses, opportunities, and threats for the hospital.
• Strengths and weaknesses are traits internal to the hospital (i.e., strong physician loyalty to hospital, aging building, and availability of financial resources).
• Opportunities and threats are external to the hospital, such as a mall facility available for lease or a competitor hospital opening two physician practices in your market. Benchmark SWOT Analysis Paper
Write a 700- to 1,050-word analysis that incorporates the key components of a SWOT analysis for the scenario described in Week One to generate a list of perceived strengths, weaknesses, opportunities, and threats. The analysis will include the following:
• Analyze the purpose of conducting the analysis in the context of the scenario.
• Analyze the limitations and advantages of conducting a SWOT analysis on your own (vs. with a group of stakeholders).
• Use the table provided to record your analysis of the information from the strategic planning scenario and generate two factors for each of the SWOT categories (strengths, weaknesses, opportunities, and threats).
Cite at least 1 peer-reviewed, scholarly, or similar references to support your assignment.
Submit your assignment. Benchmark SWOT Analysis Paper
Table 1: SWOT Analysis
Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived strength (internal)

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived strength (internal)

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived weakness (internal)

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived weakness (internal)

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived opportunity (external)

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived opportunity (external)

 

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived threat (external)

Analysis of existing information from Stevens District Hospital strategic planning scenario Perceived threat (external)

Strategic Planning Scenario

Background

Stevens District Hospital is a 162-bed acute care hospital that is qualified as a not for profit facility. The hospital was originally a county-owned facility and its status was transferred to an independent facility three years ago. The hospital receives no external funding from government agencies for operations. The hospital is accredited by The Joint Commission and received reaccreditation during their triannual survey last year. The hospital has an aggressive quality management program and a low volume of medical malpractice claims. The hospital is located in Jefferson City, which is a city of 50,000 with 80,000 in the regional market. The hospital provides a general range of acute care services, including medical/surgical, rehab, and emergency care.

Current Performance Analysis

Mission and Vision

Our mission: To improve health by providing high-quality care, a comprehensive range of services, and exceptional service.

Our vision: Stevens District Hospital and its affiliates will be the health care provider of choice for physicians and patients. Our five year vision is to create a large, multispecialty physician practice system that would include at least six family practice physicians and specialists in cardiology, oncology, and women’s services. Currently, the hospital employs three family practice physicians, one obstetrician, one medical oncologist, and one non-invasive cardiologist. Benchmark SWOT Analysis Paper

Previous Strategic Plan Review

Goal Accomplishments
Increase market share by recruiting three family practice physicians. The hospital was able to recruit only one family practice physician to increase primary care market this past year. The limited number of state medical school graduates makes local recruitment difficult.

 

Improve quality HCAHPS scores in all six criteria to a baseline of the 85th percentile.

 

The hospital improved HCAHPS scores in four of six criteria. Lagging elements in HCAHPS scores are inpatient patient satisfaction and primary care patient satisfaction.

Market Forces Affecting the Hospital

Volumes

Patients

The continued growth of chronic disease will require changes to the care management model.

Percent of Population by Age

  Five Years Ago Five Years From Now
Under 18 24 18
18 to 44 46 32
45 to 65 26 30
Over 65 4 20

More than 53 percent of residents have at least some college education, with just over 29 percent having an associate, bachelor’s, or graduate degree. More than 90 percent of residents have at least a high school diploma.

The average unemployment rate in the county is 9.9 percent:

Market Share Distribution Percentage With a Major Competitor

  Five Years Ago Last Year
Stevens District Hospital 48 35
Competitor 30 43
Out of County Hospitals 22 22

 

 

Patient Origin by Zip Code

96101 is Stevens District Hospital zip code

94963 is major competitor hospital zip code

Increases in the percent of population with chronic disease and contributing factors will change significantly over the coming five years.

 

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Payment

There will be continued focus on pay for performance and increased wellness programs. The Affordable Care Act is creating more covered lives; however, there are often high deductibles.

The median household income for county residents is $59,548. On average, households in the county earn more than the state median household income of $44,446 and more than the national average of $53,650. The addition of a new automotive manufacturing plant to the local market this coming year is projected to add 1,500 production line jobs and 300 administrative jobs by year end. Median income for the production positions is estimated at $45,000 and will provide health, vision, and dental insurance benefits. Benchmark SWOT Analysis Paper

Current Payer Mix
Projected Payer Mix 5-years

 

 

Percentage of Population by Insurance

 

 

As part of your review of this data, consider that a portion of the population will become Medicare eligible, the addition of manufacturing positions that include benefits will increase commercial insurance coverage, and changes from the Affordable Care Act will increase the number of patients in the market with insurance coverage.

Employers

There is expected growth in large employers with the addition of the automotive factory in the northwest sector of the county.

Physicians

The continued shortage of medical staff, especially in orthopedics, oncology, and primary care, will require increased recruitment efforts.

Competitors

Hanover County Hospital, which is the other hospital in the county, has an updated facility that has drawn more market share to its facility.

Competitor Key Areas of Competition New Programs and Facilities Risk to Market Share
Primary Competitors
Hanover County Hospital ·         Facility upgrade

·         Quality scores

·         Significant renovation of core hospital to update aesthetics

·         Added new wide-bore MRI machine last year

·         Reaches the 95th percentile in five of six HCAHPS categories

·         Drawing patients to newer facility

·         Accommodates heavier patients

·         Patient perception of higher quality and patient satisfaction

Medical Center in County South of Stevens ·         Physician clinics

·         Financial stability

·         E-visits with specialists

·         Low debt and high cash on hand

·         Drawing patients out of primary and specialty care at Stevens

·         Ability to cash flow projects

Secondary Competitors
Retail Pharmacy Instant Clinic ·         Low acuity office visits ·         Pharmacy added instant clinic in north end of county 6 months ago ·         Loss of patients from primary care physicians’ practices

 

 

Technology

A competing hospital has added e-visits for physician practices, which is causing a shift of patients to the competitor hospital’s physician practices.

Regulatory Changes

Health care reform through the Affordable Care Act has increased the number of patients with some form of insurance payment. These patients are now seeking care in greater numbers from a primary care physician. Stevens District Hospital struggles with accommodating patient scheduling requests to establish care with a primary care physician. Benchmark SWOT Analysis Paper

Plan

Planning Components Explanation

  Goal Objective Actions
Definition Organization goals that cover broad strategic issues, such as quality, finances, growth Broad action items that address organizational goals, such as increasing market share, increased use of technology, increased physician satisfaction Action item that meets an objective, such as implementing EMR, renovating physician lounge, increasing marketing for specific products
Examples ·         Improve HCAHPS scores by 5%

·         Improve operating margin by 3%

·         Increase market share in 96103 zip code by 5%

·         Improve emergency department patient satisfaction survey by 5%

·         Grow urgent care visits by 10%

·         Implement urgent care center in north zip code

·         Purchase tablets for physicians for EMR rounding

Measurement ·         % increase in operating margin

·         % change in market share

 

 

·         % change in ED satisfaction survey

·         % change in urgent care visits

·         Number of patient visits at new urgent care center

·         % increased use of EMR

Financial Summary

 This year  Last year
Operating Revenues
Net revenues from services to patients            343,737,280           344,726,245
Other operating revenues              16,846,309             20,311,534
Total operating revenues            360,583,589           365,037,779
Operating Expenses
Salaries and benefits            192,053,379           182,853,245
Supplies and other expenses            130,173,477           135,560,131
Depreciation              18,969,799             20,644,157
Interest                 2,695,623               2,226,437
Foundation                    628,184               1,182,308
Total operating expenses            344,520,462           342,466,278
Income from operations              16,063,127             22,571,501