Group Management for Just Culture

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The concept of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible; they make mistakes. In a just culture, ‘hazardous’ human behavior such as staff errors, near–misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems—not to identify and punish the individual. Group Management for Just Culture
—Pepe & Caltado, 2011

This Discussion examines the opportunities of managers in working with groups to promote change that facilitates the delivery of safe, high–quality care.

To Prepare

  • Review the information on just culture presented in the Learning Resources.
  • For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).
  • Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.
  • Compare the findings of the Regulatory Decision Pathway  to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?
  • Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?
  • How might role conflict and/or ambiguity have contributed to the situation?

Post a description of an adverse event in your organization and your analysis of the issue using the Regulatory Decision Pathway. Explain how role conflict or ambiguity might have influenced this situation. Apply the principles of just culture as you explain how you, as the group’s manager, would handle the situation.

**************Below is a paper to use as reference!!!!!!!!!

PLEASE USE THIS AS A REFERENCE ONLY.

Adverse Event

            Adverse events are a part of the healthcare environment and how an event is dealt with can affect patient safety.  The regulatory pathway and just culture are a means of improving the quality of care and safety culture (Russell & Radtke, 2014).  Health care employees need to trust in their organization that an adverse event can be reported so that the organization and employee can learn from the event, and that it is not just a means to place blame. Group Management for Just Culture

            An adverse event that took place in the cardiac catheterization lab was a procedure was done on the wrong patient.  A patient that was to have a pacemaker instead ended up having a diagnostic catheterization.  This event involved a patient identification issue by the nurse.  The hospital’s patient identification policy and time out policy were not adhered to by the nurse and then the catheterization team.   The incident was reported to the state, and there were several event meetings with the nurse and physician.  As a result of the investigation, all staff in the catheterization lab were re-educated to the patient identification and time out policy.  All staff had to sign an individual affidavit that they understood the policy.  The nurse was given a written warning.  This event would not have happened if the nurse and catheterization team had adhered to policy. 

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Regulatory Decision Pathway

 Using the regulatory decision pathway, the nurse did not intend to harm the patient deliberately.  The nurse asked the patient if she was Ms. X and the patient said yes.  The identification policy is to check the patient’s identification band for name and medical record number against a second identifier.  This was not done.  There were no significant circumstances involving the system that led to the error.  The nurse did not conceal the error or falsify the record.  The nurse did not disregard or consciously take a substantial risk.  She thought she had the correct patient.  There were no similar or serious errors by this nurse.  A reasonably prudent nurse would not have done the same in similar circumstances as the patient identification policy would have been adhered to.  According to the regulatory decision pathway, this was at-risk behavior by the nurse (Russell & Radtke, 2014).

            The catheterization team which included the physician, nurse, physician assistant, and technician contributed to this adverse event.  The team did not follow the time out process policy where everything stops, and patient identification is reconfirmed with other parameters.  Again, following the regulatory decision pathway, the catheterization team demonstrated at-risk behavior.  At-risk behavior involves unsafe practice and carelessness which is shown by the nurse and catheterization team not adhering to policy (Russell & Radtke, 2014). Group Management for Just Culture

Role Conflict

 The cardiac catheterization lab is very fast-paced, and the nurses can feel the stress of the workload.  The procedure area and recovery room was very busy and crowded that day.  Role conflict could have contributed to the situation as there is constant pressure to keep moving.  Role conflict could have contributed in the time-out process not taking place in the procedure room.  Nurses have to initiate the time out process when the physician arrives, and some physicians are not very cooperative in the process.  Since the adverse event, patient identification and the time out policy are strictly adhered to.

Just Culture

 Quality improvement and work environment improvement are a part of just culture (Lockhart, 2015).  Just culture is safety issues, improving processes, and not about punishing individuals (Pepe & Cataldo, 2011).  As the group’s manager using the principles of culture, I would have done firm counseling stressing the significance of the incident, but as this was the nurse’s  first risky behavior, I would not have done a formal written warning with the threat of being fired if it happens again.   Doing a staff meeting and re-educating the policies was appropriate.  Patient identification and the time out process are now part of the cardiac catheterization lab’s monthly quality assurance surveys.  All new employees are well educated in the two policies and must sign an attestation that they understand by the end of orientation.  This adverse event led to improved processes in the cardiac catheterization lab which is the goal of just culture (Pepe & Cataldo, 2011). Group Management for Just Culture     

TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

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  Discussions

1. Electronic Health Records

Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.

In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records. TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

To prepare

Review the implementation of EHRs in an organization. Reflect on the various approaches used.

If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?

Reflect on the reactions of others during the implementation process. Were concerns handled effectively?

If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.

Search and indicate examples of effective and poor implementation of EHRs.

RESOURCES

Required Readings

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. 

Chapter 15, “The Electronic Health Record and Clinical Informatics”

This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.

Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.

The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.

Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160. TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.

Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.

This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provides insights on change management, the reasons people resist change, and the ways to establish a culture that is more open to change initiatives.

Gruber, N., Darragh, J., Puccia, P. H., Kadric, D. S., & Bruce, S. (2010). Embracing change to improve performance. Long-Term Living: For the Continuing Care Professional, 59(1), 28–31.

This text describes the implementation of a new electronic health record system at a 105-bed hospital related-facility. The authors highlight five key elements that were deemed necessary for a successful EHR implementation. 

Hyrkäs, K., & Harvey, K. (2010). Leading innovation and change. Journal of Nursing Management, 18(1), 1–3.

According to the authors, the health care field is in need of more effective leaders who understand innovation, who appreciate diversity and change, and who can foster and implement innovation and creativity. The authors describe how nurse leaders can be instrumental in embracing and disseminating innovation throughout the health care system and provide scaffolding for subsequent articles in this issue of the journal.

Mooney, B. L., & Boyle, A. M. (2011). 10 steps to successful EHR implementation. Medical Economics, 88(9), S4–6, S8–S11.

The authors of this article describe the incentives and requirements for electronic health records (EHRs) outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act. The authors then provide 10 steps for health care leaders and organizations to follow when implementing EHRs.

Murphy, J. (2011). Leading from the future: Leadership makes a difference during electronic health record implementation. Frontiers of Health Services Management, 28(1), 25–30.

In this article, the author examines the causes behind the increasing complication of EHR implementations. In addition, the author explores the role of leadership in guiding successful EHR implementations. 

Required Media

Laureate Education (Producer). (2012b). Electronic health records. Baltimore, MD: Author. 

In this video, Katie Skelton, Richard Rodriguez, Carina Perez, Shannon Mori, and Carmen Ferrell describe how their hospital implemented an electronic health record. They also outline the general considerations, benefits, and support measures related to electronic health records. TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

2. Successful Implementation of Electronic Health Information Technology

Since the inception of the HITECH Act, health organizations have faced increased pressure to update their health information technology (HIT) resources.

As discussed last week, many believe that the increased use of electronic health records and the quick and efficient communication afforded by HIT can lead to improved quality of patient care. Yet there are significant costs associated with implementing such systems.

What can organizations do to ensure that the correct system is selected and that the system will be appropriate for those required to use it? Who should be involved in those decisions?

This week introduces the systems development life cycle and discusses how it can guide an organization through the complexities of adopting a new HIT system. 

In this Discussion, you are asked to consider the role of nurses in the SDLC process.

To prepare:

Review the steps of the systems development life cycle.

Think about your own organization, or one with which you are familiar, and the steps the organization goes through when purchasing and implementing a new HIT system.

Consider what a nurse could contribute to decisions made at each stage when planning for new health information technology. What might be the consequences of not involving nurses?

Reflect on your own experiences with your organization selecting and implementing new technology. As an end user, do you feel you had any input in the selection or and planning of the new HIT system?

RESOURCES

Required Readings

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

Chapter 10, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making”

This chapter explains the systems development life cycle and explores various methods of applying it. The chapter also examines the importance of interoperability in implementing HITECH.

Chapter 11, “Administrative Information Systems”

This chapter provides an overview of agency-based health information systems. The text also details how administrators can use core business systems in their practice.

Boswell, R. A. (2011). A physician group’s movement toward electronic health records: A case study using the transtheoretical model for organizational change. Consulting Psychology Journal: Practice and Research, 63(2), 138–148.

The authors of this article present a case study on an EHR implementation in a multispecialty physician group. The case study attempts to determine actions that promote successful EHR implementation and the pros and cons of implementation.

Hsiao, J., Chang, H., & Chen, R. (2011).A study of factors affecting acceptance of hospital information systems: A nursing perspective. Journal of Nursing Research, 19(2), 150–160.

The focus of this article is to determine what factors are most important in predicting the acceptance of new health information technology. The results of the study indicated that self-efficacy, top management support, and the quality of information retrieved are the most important determinants of the willingness of nurses to adopt and use a new technology TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011). Electronic nursing documentation as a strategy to improve quality of patient care. Journal of Nursing Scholarship, 43(2), 154–162.

This article summarizes a literature review of the relationship between electronic health records (EHRs) and quality of patient care. The article identifies deficiencies in existing research regarding the daily interactions of nurses, patients, and electronic documentation, and it provides a comparison between electronic and paper-based documentation and its effect on quality of care.

Nurse leaders discuss the nurse’s role in driving technology decisions. (2010). Virginia Nurses Today, 18(1), 8–9.

This article summarizes a roundtable held with a number of nursing executives to discuss the role nurses should take in the selection and adoption of new technologies for health care. The executives concluded that the nurses’ goals should be to select technology that will further their ability to provide safe, quality care to their patients.

Page, D. (2011). Turning nurses into health IT superusers. Hospitals & Health Networks, 85(4), 27–28.

This article highlights the importance of involving nurses with all phases of the decision and implementation process surrounding new health information technology. The author stresses the importance of communication in the process as well as defining success.

Swab, J., & Ciotti, V. (2010). What to consider when purchasing an EHR system. hfm(Healthcare Financial Management), 64(5), 38–41.

In this article, recommendations are given for purchasing health information technology. These include selecting the appropriate vendor, carefully considering the cost of both new equipment and personnel, and involving clinicians in decisions.

Required Media

Laureate Education (Producer). (2012g). Systems development life cycle. Baltimore, MD: Author.

The systems development life cycle (SLDC) provides a framework for all of the steps necessary to implementing a new technology or process within an organization. This video explains the SDLC and how it is used in the health care field.

Optional Resources

Agency for Healthcare Research and Quality. (2005). A toolkit for redesign in health care. Retrieved from http://www.ahrq.gov/legacy/qual/toolkit/index.html

This website supplies strategies for reconfiguring and transforming a hospital’s care processes. The text breaks down the redesign process into a series of steps.

3. Understanding Workflow Design

As you explored last week, the implementation of a new technology can dramatically affect the workflow of an organization. Newly implemented technologies can initially limit the productivity of users as they adjust to their new tools. Such implementations tend to be so significant that they often require workflows to be redesigned in order to achieve improvements in safety and patient outcomes.

However, before workflows can be redesigned, they must first be analyzed. This analysis includes each step in completing a certain process. Some systems duplicate efforts or contain unnecessary steps that waste time and money and could even jeopardize patient health care TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

By reviewing and modifying the workflow, you enable greater productivity. This drive to implement new technologies has elevated the demand for nurses who can perform workflow analysis.

In this Discussion, you explore resources that have been designed to help guide you through the process of workflow assessment.

To prepare:

· Take a few minutes and peruse the information found in the article “Workflow Assessment for Health IT Toolkit”.

o As you check out the information located on the different tabs, identify key concepts that you could use to improve a workflow in your own organization and consider how you could use them.

o Go the Research tab and identify and read one article that is of interest to you and relates to your specialty area.

RESOURCES

Required Readings

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

  • Chapter 14, “Nursing Informatics: Improving      Workflow and Meaningful Use”

         This chapter reviews the reasons for conducting workflow analysis and      design. The author explains specific workflow analysis and redesign      techniques.

Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43–61.

Retrieved from the Walden Library databases.

In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.

Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.

Retrieved from the Walden Library databases. 

This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.

U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.

Document: Sample Workflow of Answering a Telephone in an Office (Word document)

Required Media

Laureate Education (Producer). (2012f). System design and workflow. Baltimore, MD: Author. 

This video provides an overview of how workflow modeling can be used in a health care setting to target areas for revising current practices and procedures. The video also shows how technology and informatics can be used to improve workflow efficiency and increase the quality of care.

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4. Using Health Information Technology as a Source of Evidence-Based Practice

Before the digital revolution, health information technology supplied very limited support for evidence-based practice. If nurses wanted to be informed about cutting-edge research, their best bet was to either subscribe to leading journals or make periodic trips to the library. With the establishment of research databases, however, nurses became empowered to learn about and facilitate interdisciplinary and translational research. Databases are just one example of how health information technology supports evidence-based practice.

To prepare:

· Read the following scenario from the text (McGonigle & Mastrian, 2015, p. 445):

Twelve-hour shifts are problematic for patient and nurse safety, and yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (Board on Health Care Services & Institute of Medicine, 2004) published a report that referred to studies as early as 1988 that discussed the negative effects of rotating shifts on intervention accuracy. Workers with 12-hour shifts realized more fatigue than workers on 8-hour shifts. In another study done in Turkey by Ilhan, Durukan, Aras, Turkcuoglu, and Aygun (2006), factors relating to increased risk for injury were age of 24 or less, less than 4 years of nursing experience, working in the surgical intensive care units, and working for more than 8 hours.

· Consider how the resources identified in the scenario above could influence an organization’s practice.

· Select an issue in your practice that is of concern to you. Using health information technology, locate at least three evidence-based practice resources that address your concern and that could possibly inform further action.

RESOURCES

Required Readings

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

  • Chapter 23, “Research: Data      Collection, Processing, and Analytics”

The authors of this chapter relate nursing research to the foundation of knowledge model. The chapter assesses informatics tools for collecting data, storing information, and processing and analyzing data.

  • Chapter 25, “Translational      Research: Generating Evidence for Practice”

In this chapter, the authors differentiate evidence-based practice and translation research. They also describe models used to introduce research findings intro practice.

Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D., & Francis, J. (2010). Use of health information technology to advance evidence-based care: Lessons from the VA QUERI program. Journal of General Internal Medicine, 25(Suppl. 1), S44–S49. 

This article presents a study that evaluated the role of health information technology (HIT) in the Department of Veteran Affairs’ Quality Enhancement Research Initiative. The authors convey their findings on how HIT provided data and information to aid implementation research, and how implementation research helped further HIT development. Additionally, the text details methods of overcoming common HIT barriers to implementation research.

Jamal, A., McKenzie, K., & Clark, M. (2009). The impact of health information technology on the quality of medical and health care: A systematic review. Health Information Management Journal, 38(3), 26–37. 

This text details a study that reviews the published evidence concerning the impact of health information technology (HIT) on the quality of health care. The study investigated the use of HIT in medical care and allied health and preventive services. The authors primarily focus on the impact of electronic health records, computerized provider order-entry, and decision support systems.

Umscheid, C. A., Williams, K., & Brennan, P. (2010). Hospital-based comparative effectiveness centers: Translating research into practice to improve the quality, safety and value of patient care. JGIM: Journal of General Internal Medicine, 25(12), 1,352–1,355.

This article revolves around the usage of the hospital-based comparative effectiveness (CE) center model. The authors highlight the model’s benefits and the increasing usage of CE evidence. The article also reviews solutions to overcoming many of the challenges to operating hospital-based CE centers.

Optional Resources

Chlan, L., Tracy, M. F., & Grossbach, I. (2011). Pulmonary care. Achieving quality patient-ventilator management: Advancing evidence-based nursing care. Critical Care Nurse, 31(6), 46–50.

5. HITECH Legislation

In order for organizations to receive the incentives offered through the HITECH legislation, they must be able to demonstrate that they are using the technology in meaningful ways. The following criteria for meaningful use must be evident to qualify for EHR incentives (U.S. Department of Health & Human Services, 2012). The technology must:

· Improve quality, safety, and efficiency, and reduce health disparities

· Engage patients and families

· Improve care coordination

· Improve population and public health

· Ensure adequate privacy and security protections for personal health information

For this Discussion, you consider the impact of the meaningful use criteria of the HITECH legislation on the adoption of health information technology. TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

To prepare:

· Review the Learning Resources on the HITECH legislation and its primary goals.

· Reflect on the positive and negative impact this legislation has had on your organization or one with which you are familiar.

· Consider the incentives to encourage the use of EHRs. Focus on the definition of meaningful use and how it is measured.

· Reflect on how the incentives and meaningful use impact the quality of patient care.

· Find an article dealing with one of the criteria to qualify for meaningful use and how it has been successfully met.

RESOURCES

Required Readings

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

  • Chapter 9, “Legislative Aspects of Nursing      Informatics: HITECH and HIPAA”

         This chapter explores two pieces of legislation that dramatically impact      nursing informatics: the Health Information Technology for Economic and      Clinical Health Act of 2009 and the Health Insurance Portability and      Accountability Act of 1996.

Arlotto, P. (2010). 7 strategies for improving HITECH readiness. hfm(Healthcare Financial Management), 64(11), 90–96. 

This article reviews seven strategies to help prepare for the implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). The central point of the article focuses on demonstrating meaningful use of electronic health records.

Begum, R., Smith Ryan, M., Winther, C. H., Wang, J. J., Bardach, N. S., Parsons, A. H., & … Adams Dudley, R. (2013). Small Practices’ Experience With EHR, Quality Measurement, and Incentives. American Journal Of Managed Care, 19eSP12–8.

This article presents a study of clinician’s attitudes toward the use of financial incentives for the implementation of electronic health records in small practices.

Brown, B. (2010). The final rules for meaningful use of EHRs. Journal of Health Care Compliance, 12(5), 49–50. 

In this article, the author poses four questions pertaining to the EHR system in the United States. In particular, the article examines Medicare and Medicaid incentive payments and the ways the meaningful use of certified EHRs will be verified.

Classen, D. C., & Bates, D. W. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365(9), 855–858. 

This article details the challenges of meeting the meaningful use standards in order to receive the benefits legislated under the HITECH Act. The authors specify the requisites for achieving benefits with EHRs, the relationship between meaningful use and commercial EHRs, and the tools needed to evaluate EHRs after implementation.

Kempfert, A. E., & Reed, B. D. (2011). Health care reform in the United States: HITECH Act and HIPAA privacy, security, and enforcement Issues. FDCC Quarterly, 61(3), 240–273.

The authors of this article examine HITECH, in addition to the impact of the privacy rules under the Health Insurance Portability and Accountability Act (HIPAA). The article details the potential negative repercussions of failing to comply with HIPAA and HITECH.

Murphy, J. (2010b). Nursing informatics. The journey to meaningful use of electronic health records. Nursing Economic$, 28(4), 283–286. 

This article reviews HITECH and the background leading up to its passage. The author also details the financial incentives intended to assist health care providers in purchasing and implementing HIT and EHR systems.

Optional Resources

U.S. Department of Health & Human Services. (2011). Health IT home. Retrieved from http://www.healthit.gov/ 

U.S. Department of Health & Human Services. (2012). Regulations and guidance. Retrieved from http://www.healthit.gov/policy-researchers-implementers/health-it-rules-regulations TRANSFORMING NURSING AND HEALTH CARE THROUGH TECHNOLOGY

PICOT STATEMENT AND LITERATURE SEARCH

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    Details:

The first step of the EBP process is to develop a question from the nursing practice problem of interest.

Select a practice problem of interest to use as the focus of your research.

Start with the patient and identify the clinical problems or issues that arise from clinical care.

Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project.

The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study). PICOT STATEMENT AND LITERATURE SEARCH

Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem.PICOT STATEMENT AND LITERATURE SEARCH

Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.

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Suggestions for locating qualitative and quantitative research articles from credible sources:

  1. Use a library database such as CINAHL Complete for your search.
  2. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
  3. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.

To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.

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

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

COLLABORATIVE DECISION MAKING

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BE SURE TO FOLLOW ALL INSTRUCTION, SPELL CHECK AND MAKE SURE APA CITATIONS ARE DONE ACCORDINGLY. 

Details:

Attend a committee meeting in your health care organization. If you are not currently employed in a health care setting, you may elect to attend a committee meeting at another company, a community center, a local school, local chamber of commerce or other professional organization. COLLABORATIVE DECISION MAKING

Observe the interactions between committee members and the process used by the committee to arrive at decisions.

In 500-750 words, (DO  O EXCEED WORD COUNT) describe the function of the committee and the roles of those in attendance. Describe your observations of the interactions between members of the committee and determine whether the process used to arrive at decisions is a form of shared governance.

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A minimum of THREE academic references from credible sources are required for this assignment.

Submit the completed “Collaborative Committee Meeting Verification Form” with the assignment. – THIS PORTION OF THE ASSIGNMENT WILL BE DONE BY ME.

Prepare this assignment according to the APA guidelines.

This assignment uses a grading rubric. SEE RUBRIC ATTACHMENT. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. SIMILARITY INDEX SHOULD NOT EXCEED 15%. COLLABORATIVE DECISION MAKING

Early Onset Schizophrenia

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            Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning.

These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms.

Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest. Early Onset Schizophrenia

In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.

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                                                    To Prepare for this Assignment:

· Review the Learning Resources concerning early-onset schizophrenia.

The Assignment (2 pages):

· Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.

· Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.  

Note: (1)To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

            (2) DO NOT FORGET TO INCLUDE INTRODUCTION,CONCLUSION AND   

                  REFERENCES

                                                                Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

  • Chapter 31, “Child Psychiatry” (pp. 1268–1283)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  • “Schizophrenia Spectrum and      Other Psychotic Disorders” Early Onset Schizophrenia

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

NURSING COURSE PROJECT

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This is a continuation of the Course Project presented in Week 2.

Before you begin, review the Course Project Overview document located in the Week 2 Resources area.

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow.

For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources NURSING COURSE PROJECT. 

· Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.

· Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible.

Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.

· Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.

· Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

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To complete:

Write a 3- to 4-page literature review that includes the following:

· A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

o Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

· Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

· Your literature review summary table with all references formatted in correct APA style

Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary.

Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies NURSING COURSE PROJECT

Epidemiology and Communicable Disease

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Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance completing this assignment.

Communicable Disease Selection

Choose one communicable disease from the following list:

  1. Chickenpox
  2. Tuberculosis
  3. Influenza
  4. Mononucleosis
  5. Hepatitis B
  6. HIV
  7. Ebola
  8. Measles
  9. Polio
  10. Influenza Epidemiology and Communicable Disease

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Epidemiology Paper Requirements

Address the following:

  1. Describe the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
  2. Describe the determinants of health and explain how those factors contribute to the development of this disease.
  3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle). Are there any special considerations or notifications for the community, schools, or general population?
  4. Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
  5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.
  6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

A minimum of three peer-reviewed or professional references is required.

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

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

 Please refer to the directions in the Student Success Center.

NRS427V-RS-CommunicableDiseaseChain.doc Epidemiology and Communicable Disease

REPORT ON HEART ATTACK

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A 60-year-old man is brought to the ER by ambulance because of slurred speech and left side weakness. His wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms. He is right handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50. He currently is unable to move his left arm and leg. He had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes. REPORT ON HEART ATTACK

Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes. He is taking a baby aspirin a day an ACE inhibitor, and statin as well. He does have a history of alcohol use and smoking in the past but stopped after his heart attack. His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, o2 sat is 97% on room air.

Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side. The neck is supple, there is no jugular vein distension, and there are no bruits.

The lungs are clear heart sounds regular without murmurs, and abdomen is normal. The limbs are not well perfused distally. The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick. He shows loss of awareness and attention with respect to objects or stimuli on his left side. He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well.

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There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation. He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.

  • What are two questions you would ask this patient?
  • Identify the subjective data for this patient.
  • Identify the objective data for this patient.
  • What is the likely diagnosis?

Your response should include evidence of review of the course material, websites, and literature through proper citations using APA format. REPORT ON HEART ATTACK

FACILITATING EASIER ACCESS TO CONSUMERS COMPLAINTS AND ENFORCEMENT

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Assignment Requirements

Imagine that you are a sophomore at Premier College. Over the past few months, you have not been well due to increased amounts of academic pressure and found yourself unable to concentrate in class or sleep well at night. You went to the student medical center for evaluation and, after consulting with the staff doctor, you were issued a prescription for the treatment of depression. FACILITATING EASIER ACCESS TO CONSUMERS COMPLAINTS AND ENFORCEMENT

A few days later, one of your professors tells you that he too has had to take medicine for depression in the past. You ask him how he knew about your situation, and he replied that all student medical records are available to every instructor and staff member at Premier College. Hearing this, you feel that your privacy rights have been violated.

That afternoon you research privacy rights on the Internet and learn that filing a HIPAA privacy complaint to the OCR had been a tedious process before July 2009. On July 27, 2009, the Secretary of Health and Human Services (HHS) delegated to the Director of OCR the authority to administer and enforce the HIPAA Security Rule.

This action improved HHS’ ability to protect individuals’ health information by combining the authority for administration and enforcement of federal standards for health information privacy and security. Those standards are outlined in the HIPAA legislation. With the new regulation, the process of filing a privacy complaint has become simpler and more effective.

Then you research the steps involved with filing a privacy complaint with the OCR (http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html), download the Health Information Privacy Complaint form at (http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf), and complete the form. While working on the form, you realize some sections are critical to your case and must be addressed carefully.

You decide to write about your experience in a paper for your Legal Issues in Information Security class. For this assignment: FACILITATING EASIER ACCESS TO CONSUMERS COMPLAINTS AND ENFORCEMENT

1.     Identify the early iterations of the HIPAA act and how the law has been modified to facilitate easier access to consumer complaints and enforcement.

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2.     Describe the overall process of submitting a health information privacy complaint to the OCR.

3.     Identify specific sections of the complaint form that need critical attention while completing the form.

4.     Analyze a few situations that can occur if the critical sections are not well identified.

5.     Draft a brief summary, collating all your findings.

Required Resources

·       Access to the Internet

·       http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

·      http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf

Submission Requirements

§  Format: Microsoft Word

§  Font: Arial 10-point size, Double-space

§  Citation Style: APA

§  Length: No more than 500 words

Evaluation Criteria and Rubric

1.     Did the student identify early iterations of the HIPAA act and how the law has been modified to facilitate easier access to consumer complaints and enforcement?

2.     Did the student identify specific sections of the form that need critical attention while filing the complaint?

Did the student analyze the situations that one gets into if the critical sections are not well identified? FACILITATING EASIER ACCESS TO CONSUMERS COMPLAINTS AND ENFORCEMENT

Best wound care approach for patients with foot ulcers

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(Or it can be a different topic, but needs to be approved first)

During this lesson, you will use the PICOT questioning format/formula to develop an answerable research question. All elements are listed below:

· P: Population/disease (age, gender, ethnicity, disorder)

· I: Intervention or variable of interest (exposure to a disease, risk behavior, prognostic factor)

· C: Comparison (a placebo or “business as usual” such as no disease, absence of risk factor, or prognostic factor B)

· O: Outcome (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)

· T: Time (the time it takes to demonstrate an outcome; e.g., the time it takes for the intervention to achieve an outcome or how long participants are observed) Best wound care approach for patients with foot ulcers

prepare an evidence-based practice (EBP) presentation on a topic of your choice that is relevant to advanced nursing practice education, leadership, quality improvement, or change

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Your presentation should include:

1. Identification of an advanced practice nursing issue or practice problem of concern

2. Design a research question using the PICOT format

3. A brief literature review and findings related to best practices with at least three scholarly resources cited in APA (6th ed.) format

4. Plan, Do, Study, Act Process that could be used

5. Any implications that the investigation might have for nursing practice

Rubric:

The presentation includes an appropriate   topic identification related to an advanced practice nursing issue or   practice problem of concern. The topic is clearly stated in the introduction,   developed and explained well through the literature review, and there is an   appropriate conclusion statement.

PICOT Question Design

Population is fully defined and present in   the research question. Includes specific interventions, identifies   comparisons, and presents appropriate outcomes in a timely manner for the   question. Overall, a well-built question using the PICOT method Best wound care approach for patients with foot ulcers.

Literature Review

Includes a brief overview of the literature   in the presentation and includes relevant details.

Plan/Do/Study/Act Process

Presentation includes a description of the   study, study design, rationale, and inclusion of sampling information that   the student is using.

Implications to Nursing

The significance and applicability to   nursing is included and well presented.