ALL ANSWERS TO THESE QUESTIONS HAVE TO BE 200 WORDS IN LENGTH.

1.  Discuss how an automated answering system may be effectively utilized, and discuss the differences between this system and an answering service.

2.  Outline the major differences between new and established patients and how healthcare professionals should handle each patient type.
3.  Describe the pros and cons of using stream scheduling.

When you wake in the morning, you may reach for your cell phone to reply to a few text or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.

From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.

As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare. In this Discussion, you will consider these risks and rewards.

To Prepare:

• Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.
• Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.

How did the ideology of Manifest Destiny contribute to the Mexican War of 1846? Why did the Mexican War of 1846 take place? Was the war necessary? Was it beneficial to the United States? What does this war tell us about this period of American history? Was it God’s plan that the United States extend from the Atlantic to the Pacific, or were imperialists looking for a way to defend what they planned to do anyway?

Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation based on the Teaching Work Plan and present the information to your community.

Options for Delivery

Select one of the following options for delivery and prepare the applicable presentation:

1. PowerPoint presentation – no more than 30 minutes
2. Pamphlet presentation – 1 to 2 pages
3. Poster presentation

Selection of Community Setting

These are considered appropriate community settings. Choose one of the following:

1. Public health clinic
2. Community health center
3. Long-term care facility
4. Transitional care facility
5. Home health center
6. University/School health center
7. Church community
8. Adult/Child care center

Community Teaching Experience Approval Form

Before presenting information to the community, seek approval from an agency administrator or representative using the “Community Teaching Experience Approval Form.” Submit this form as directed in the Community Teaching Experience Approval assignment drop box.

General Requirements

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

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

1. Title page
2. Introduction section
3. A comparison of research questions
4. A comparison of sample populations
5. A comparison of the limitations of the study
6. A conclusion section, incorporating recommendations for further research

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.

You are required to submit this assignment to LopesWrite

What are social determinants of health?  Explain how social determinants of health contribute to the development of disease.  Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an example of the steps a nurse can take to break the link within the communicable disease chain.

To Prepare:

• Read the articles by Sikka, Morath, & Leape (2015);  Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016)  provided in the Resources.
• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
• Consider the impact that EBP may have on factors impacting  these quadruple aim elements, such as preventable medical errors or  healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

• Patient experience
• Population health
• Costs
• Work life of healthcare providers

  The Quadruple Aim: care, health, cost and meaning in work

  Rishi Sikka,1 Julianne M Morath,2 Lucian Leape3

  1Advocate Health Care, Downers Grove, Illinois, USA 2Hospital Quality Institute, Sacramento, California, USA 3Harvard School of Public Health, Boston, Massachusetts, USA

  Correspondence to Dr Rishi Sikka, Advocate Health Care, 3075 Highland Avenue, Suite 600, Downers Grove, Il 60515, USA; rishi.sikka@advocatehealth.com

  Received 5 March 2015 Revised 6 May 2015 Accepted 16 May 2015

  To cite: Sikka R, Morath JM, Leape L. BMJ Qual Saf 2015;24:608–610.

  In 2008, Donald Berwick and colleagues provided a framework for the delivery of high value care in the USA, the Triple Aim, that is centred around three over- arching goals: improving the individual experience of care; improving the health of populations; and reducing the per capita cost of healthcare.1 The intent is that the Triple Aim will guide the redesign of healthcare systems and the transition to population health. Health systems glo- bally grapple with these challenges of improving the health of populations while simultaneously lowering healthcare costs. As a result, the Triple Aim, although ori- ginally conceived within the USA, has been adopted as a set of principles for health system reform within many organi- sations around the world. The successful achievement of the

  Triple Aim requires highly effective healthcare organisations. The backbone of any effective healthcare system is an engaged and productive workforce.2 But the Triple Aim does not explicitly acknow- ledge the critical role of the workforce in healthcare transformation. We propose a modification of the Triple Aim to acknow- ledge the importance of physicians, nurses and all employees finding joy and meaning in their work. This ‘Quadruple Aim’ would add a fourth aim: improving the experience of providing care. The core of workforce engagement is

  the experience of joy and meaning in the work of healthcare. This is not synonym- ous with happiness, rather that all members of the workforce have a sense of accomplishment and meaning in their contributions. By meaning, we refer to the sense of importance of daily work. By joy, we refer to the feeling of success and fulfilment that results from meaning- ful work. In the UK, the National Health Service has captured this with the notion of an engaged staff that ‘think and act in a positive way about the work they do, the people they work with and the organ- isation that they work in’.3

  The evidence that the healthcare work- force finds joy and meaning in work is not encouraging. In a recent physician survey in the USA, 60% of respondents indicated they were considering leaving practice; 70% of surveyed physicians knew at least one colleague who left their practice due to poor morale.2 A 2015 survey of British physicians reported similar findings with approximately 44% of respondents reporting very low or low morale.4 These findings also extend to the nursing profession. In a 2013 US survey of registered nurses, 51% of nurses worried that their job was affect- ing their health; 35% felt like resigning from their current job.5 Similar findings have been reported across Europe, with rates of nursing job dissatisfaction ranging from 11% to 56%.6

  This absence of joy and meaning experi- enced by a majority of the healthcare workforce is in part due to the threats of psychological and physical harm that are common in the work environment. Workforce injuries are much more frequent in healthcare than in other industries. For some, such as nurses’ aides, orderlies and attendants, the rate is four times the indus- trial average.7 More days are lost due to occupational illness and injury in health- care than in mining, machinery manufac- turing or construction.7

  The risk of physical harm is dwarfed by the extent of psychological harm in the complex environment of the health- care workplace. Egregious examples include bullying, intimidation and phys- ical assault. Far more prevalent is the psy- chological harm due to lack of respect. This dysfunction is compounded by pro- duction pressure, poor design of work flow and the proportion of non-value added work. The current dysfunctional healthcare

  work environment is in part a by-product of the gradual shift in healthcare from a public service to a business model that occurred in the latter half of the 20th

  EDITORIAL

  608 Sikka R, et al. BMJ Qual Saf 2015;24:608–610. doi:10.1136/bmjqs-2015-004160

  http://crossmark.crossref.org/dialog/?doi=10.1136/bmjqs-2015-004160&domain=pdf&date_stamp=2015-09-09

  http://www.health.org.uk/

  http://qualitysafety.bmj.com

  century.8 Complex, intimate caregiving relationships have been reduced to a series of transactional demand- ing tasks, with a focus on productivity and efficiency, fuelled by the pressures of decreasing reimbursement. These forces have led to an environment with lack

  of teamwork, disrespect between colleagues and lack of workforce engagement. The problems exist from the level of the front-line caregivers, doctors and nurses, who are burdened with non-caregiving work, to the healthcare leader with bottom-line worries and disproportionate reporting requirements. Without joy and meaning in work, the workforce cannot perform at its potential. Joy and meaning are generative and allow the best to be contributed by each individual, and the teams they comprise, towards the work of the Triple Aim every day. The precondition for restoring joy and meaning is

  to ensure that the workforce has physical and psycho- logical freedom from harm, neglect and disrespect. For a health system aspiring to the Triple Aim, fulfill- ing this precondition must be a non-negotiable, endur- ing property of the system. It alone does not guarantee the achievement of joy and meaning, however the absence of a safe environment guarantees robbing people of joy and meaning in their work. Cultural freedom from physical and psychological harm is the right thing to do and it is smart economics because toxic environments impose real costs on the organisation, its employees, physicians, patients and ultimately the entire population. An organisation focused on enabling joy and

  meaning in work and pursuit of the Triple Aim needs to embody shared core values of mutual respect and civility, transparency and truth telling and the safety of the workforce. It recognises the work and accom- plishments of the workforce regularly and with high visibility. For the individual, these notions of joy and meaning in healthcare work are recognised in three critical questions posed by Paul O’Neill, former chair- man and chief executive officer of Alcoa. This is an internal gut-check, that needs to be answered affirma- tively by each worker each day:2

  1. Am I treated with dignity and respect by everyone, everyday, by everyone I encounter, without regard to race, ethnicity, nationality, gender, religious belief, sexual orientation, title, pay grade or number of degrees?

  2. Do I have the things I need: education, training, tools, financial support, encouragement, so I can make a con- tribution this organisation that gives meaning to my life?

  3. Am I recognised and thanked for what I do? If each individual in the workforce cannot answer

  affirmatively to these questions, the full potential to achieve patient safety, effective outcomes and lower costs is compromised. The leadership and governance of our healthcare

  systems currently have strong economic and outcome motivations to focus on the Triple Aim. They also need to feel a parallel moral obligation to the

  workforce to create an environment that ensures joy and meaning in work. For this reason, we recommend adding a fourth essential aim: improving the experi- ence of providing care. The notion of changing the objective to the Quadruple Aim recognises this focus within the context of the broader transformation required in our healthcare system towards high value care. While the first three aims provide a rationale for the existence of a health system, the fourth aim becomes a foundational element for the other goals to be realised. Progress on this fourth goal in the Quadruple Aim

  can be measured through metrics focusing on two broad areas: workforce engagement and workforce safety. Workforce engagement can be assessed through annual surveys using established frameworks that allow for benchmarking within industry and with non-healthcare industries.9 Measures should also be extended to quantify the opposite of engagement, workforce burn-out. This could include select ques- tions from the Maslach Burnout Inventory, the gold standard for measuring employee burn-out.10 In the realm of workforce safety, metrics should include quantifying work-related deaths or disability, lost time injuries, government mandated reported injuries and all injuries. Although these measures do not com- pletely quantify the experience of providing care, they provide a practical start that is familiar and allow for an initial baseline assessment and monitoring for improvement. The rewards of the Quadruple Aim, achieved within

  an inspirational workplace could be immense. No other industry has more potential to free up resources from non-value added and inefficient production practices than healthcare; no other industry has more potential to use its resources to save lives and reduce human suffering; no other industry has the potential to deliver the value envisioned by The Triple Aim on such an audacious scale. The key is the fourth aim: creating the conditions for the healthcare workforce to find joy and meaning in their work and in doing so, improving the experience of providing care.

  Contributors All authors assisted in the drafting of this manuscript.

  Competing interests None declared.

  Provenance and peer review Not commissioned; externally peer reviewed.

  REFERENCES 1 Berwick DM, Nolan TW, Whittington J. The triple aim: care,

  health and cost. Health Aff 2008;27:759–69. 2 Lucian Leape Institute. 2013. Through the eyes of the

  workforce: creating joy, meaning and safer health care. Boston, MA: National Patient Safety Foundation.

  3 NHS employers staff engagement. http://www.nhsemployers. org/staffengagement (accessed 4 May 2015).

  4 BMA Quarterly Tracker Survey. http://bma.org.uk/working- for-change/policy-and-lobbying/training-and-workforce/

  Editorial

  Sikka R, et al. BMJ Qual Saf 2015;24:608–610. doi:10.1136/bmjqs-2015-004160 609

  http://dx.doi.org/10.1377/hlthaff.27.3.759

  http://www.nhsemployers.org/staffengagement

  http://www.nhsemployers.org/staffengagement

  http://www.nhsemployers.org/staffengagement

  http://bma.org.uk/working-for-change/policy-and-lobbying/training-and-workforce/tracker-survey/omnibus-survey-january-2015

  http://bma.org.uk/working-for-change/policy-and-lobbying/training-and-workforce/tracker-survey/omnibus-survey-january-2015

  http://bma.org.uk/working-for-change/policy-and-lobbying/training-and-workforce/tracker-survey/omnibus-survey-january-2015

  tracker-survey/omnibus-survey-january-2015 (accessed 4 May 2015).

  5 AMN Healthcare 2013 survey of registered nurses. http://www. amnhealthcare.com/uploadedFiles/MainSite/Content/ Healthcare_Industry_Insights/Industry_Research/2013_ RNSurvey.pdf (accessed 4 May 2015).

  6 Aiken LH, Sermeus W, Van Den HeedeKoen, et al. Patient safety, satisfaction and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 2012;344:e1717.

  7 US Department of Labor Bureau of Labor Statistics. Occupational injuries and illnesses (annual) news release.

  Workplace injuries and illnesses 2009. 21 October 2010. http://www.bls.gov/news.release/archives/osh_10212010.htm (accessed 4 May 2015).

  8 Morath J. The quality advantage, a strategic guide for health care leaders. AHA Press, 1999:225.

  9 Surveys on Patient Safety Culture. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality- patient-safety/patientsafetyculture/index.html (accessed 4 May 2015).

  10 Maslach C, Jackson S, Leiter M. Maslach burnout inventory manual. 3rd edn. Palo Alto, CA: Consulting Psychologists Press, 1996.

  Editorial

  610 Sikka R, et al. BMJ Qual Saf 2015;24:608–610. doi:10.1136/bmjqs-2015-004160

  http://bma.org.uk/working-for-change/policy-and-lobbying/training-and-workforce/tracker-survey/omnibus-survey-january-2015

  http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf

  http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf

  http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf

  http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf

  http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf

  http://dx.doi.org/10.1136/bmj.e1717

  http://www.bls.gov/news.release/archives/osh_10212010.htm

  http://www.bls.gov/news.release/archives/osh_10212010.htm

  http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html

  http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html

  http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html
  • The Quadruple Aim: care, health, cost and meaning in work
    • References

An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

1. On the initial home visit by the nurse, what assessments should be made?
2. The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
3. During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?

Among various stakeholders, the registered nurse is an advocate for patients, their health and the care delivered to them. There is a need to evaluate the health status of vulnerable populations, to assess nursing’s role in health initiatives, and to find ways that we can help improve health. This presentation enables students to assess the role of organized efforts to influence health care delivery, and the contributions of medical technology, research findings, and societal values on our evolving health care delivery system.

This presentation will examine the role of the nurse as a health professional and leader.

1.      Choose a high-risk risk population

2.      Address a health care need for this population

3.      What resources are provided for this population

4.      What are the economic priorities, challenges, and issues for this population

5.      What are the major ethical, societal, professional, and legal system-level issues confronting providers, insurers, public policymakers, and organizations regarding the care for this population

6.      How could nursing intervene or advocate to improve the health care delivery for this population

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title and reference slide, with detailed speaker notes on content slides and recorded audio comments for Introduction, Recommendations, and Conclusion slides.

Here is another resource to help you to add audio to the introduction, recommendation and conclusion slides: https://support.office.com/en-us/article/record-a-slide-show-with-narration-and-slide-timings-0b9502c6-5f6c-40ae-b1e7-e47d8741161c

Please practice doing this before the due date.

Use at least four scholarly sources and make certain to review the module’s Signature Assignment Rubric before starting your presentation. This presentation is worth 400 points for quality content and presentation.

Sultz, H. A. & Young, K. M. (2011). Health Care USA: Understanding its organization and delivery.  In T. Reilly (Eds.). Sudbury, MA: Jones & Bartlett Learning.

PICOT is utilized by the health care community to identify and study a nursing or medical practice problem. Consequently, PICOT examples that may provide insight into the use of the PICOT process, may not be relevant to nursing practice as they are based on a medical practice problem.
Describe the difference between a nursing practice problem and a medical practice problem. Provide one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice problem.

https://journals.lww.com/nursing/fulltext/2014/02000/To_make_your_case,_start_with_a_PICOT_question.7.aspx

Please, respond to the following discussion by using one reference from peer-reviewed Nursing Journal not older than 5 years. APA required without cover page. (one paragraph)

The relationship between national and global health and nursing leadership is extremely important. Health equity is essential for people to have the opportunity to live productive and healthy lives and achieve their full potential (Huber, 2018). Sadly, in the global and national health arenas, this is not so, and there are grave disparities in access to healthcare. The nurse leader has a duty and responsibility to advocate in his or her area of expertise. It is imperative that nurse and healthcare leaders address these disparities at not only on a national level but also on a global one Huber, 2018).

For instance, on a national level, one example is the undocumented population. Health disparities often occur due to lack of health insurance and access to healthcare (Huber, 2018). In the United States alone there are more than 12 million individuals without access to healthcare, many with chronic or long-term ailments (Sorrell, 2017). Lack of decent health coverage is an ethical issue because adequate healthcare is a basic human right and need (Sorrell, 2017). Healthcare should be fair, safe and impartial, and should improve the health of the population (Huber, 2018). One of the drawbacks is that healthcare and nursing leaders have lack of guidance concerning the authorization and delivery of healthcare to this population (Sorrell, 2017).

How should the nursing leader advocate for these immigrants?  Nurse leaders and other healthcare providers need to publicly recommend and support policies that provide lasting and impartial health provisions for these individuals (Sorrell, 2017).  Nurse leaders need to join with lawmakers and organizations such as the Center on Health Equity Action for System Transformation or the Health Equity Task Force to help develop a health equity centered system (Families USA, 2019).

Provide a meaningful response to at least two of your peers’ posts.  Also include your discussion some citations to support your statements. It is good to have opinions, but always best to have some evidence-based information to back up your points.

First peer:The community nurse’s role consists of many things when assisting patients, families and the community as a whole. They help provide screenings for cancers such as mammograms, STI testing, and treatments measures for communicable diseases and management for some long term diseases such as diabetes. Research, screenings, treatment measures and educating the patient, families and the community the nurse serves accounts for the nurses’ responsibilities. Research may consist of figuring out why certain diseases are affecting the communities and to what extent and how to treat. Research also includes networking and finding the funding needed to support research and help pay for the cost to provide screenings, treatments as well as resources such as flyers, brochures, and videos to help educate.

First peer: The community nurse’s role consists of many things when assisting patients, families and the community as a whole. They help provide screenings for cancers such as mammograms, STI testing, and treatments measures for communicable diseases and management for some long term diseases such as diabetes. Research, screenings, treatment measures and educating the patient, families and the community the nurse serves accounts for the nurses’ responsibilities. Research may consist of figuring out why certain diseases are affecting the communities and to what extent and how to treat. Research also includes networking and finding the funding needed to support research and help pay for the cost to provide screenings, treatments as well as resources such as flyers, brochures, and videos to help educate.

Second peer: Community health nurses focus on long- and short-term care for disease prevention, community health nurses focus on presenting materials in a clear and understandable format. Public health nurses advocate on the local, state, and federal level to provide better access to health care, protect funding for public health programs, and reduce or eliminate health disparities. Community nurses cross-cultural, language, and literacy boundaries to shape the health and well-being of children and adults.  As a community health nurse is an excellent way to combine a love of nursing and a love of your community.  Community nurses often work in community health centers offering treatment and advice to members of the community. Community health nurses can also help provide the necessary care in communities that lack easily accessible healthcare.   Barriers or challenges the nurse would need to overcome to achieve these goals is Higher poverty rates, which can make it difficult for participants to pay for services or program. Cultural and social norms surrounding health behaviors, Low health literacy levels and incomplete perceptions of health, Limited affordable, reliable, and public transportation options.

Let us think a bit further out into your career and say you have been working at your current job position a year. You have a yearning to apply to another unit in the same facility or you are moving to another state, or you just want to try another nursing career field. How do you give up this current job eloquently, without hard feelings or “burning bridges”? Do you see the importance of writing a resignation letter and tell why you do or do not think it is important?

Discuss why EBP is an essential component of the practice of a BSN-prepared RN. Identify two ways in which you will continue to integrate evidence into your practice and encourage it within your work environment. What obstacles could challenge this plan, and what steps will you take to minimize their impact?

View the scenario called “Critical Decision Making for Providers” found in the Allied Health Community media (https://lc.gcumedia.com/hlt307v/allied-health-community/home.html).

In a 750‐1,200 word paper, describe the scenario involving Mike, the lab technician, and answer the following questions:

1. What were the consequences of a failure to report?
2. What impact did his decision have on patient safety, on the risk for litigation, on the organization’s quality metrics, and on the workload of other hospital departments?
3. As Mike’s manager, what will you do to address the issue with him and ensure other staff members do not repeat the same mistakes?

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

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

This assignment uses a grading rubric. 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 LopesWrite. Refer to the directions in the Student Success Center. Only Word documents can be submitted to LopesWrite.

Please provide proper citation with page numbers of the material you are referencing in your Main Post.
Please write 1 paragraph for each of the following (total 3 paragraphs) and each paragraph shall be no less than 3 sentences and no more than 6 sentences.

1. Discuss one of the following: STEMI, Non-STEMI; congestive heart failure; murmurs; ventricular tachycardia; asystole
2. What is a safe treatment plan for a patient with Atrial Fibrillation?
3. What is a safe treatment plan to reduce a patient’s bilateral lower extremities pitting edema?

Stakeholder support is necessary for a successful change proposal project implementation. Consider your internal stakeholders, such as the facility, unit or health care setting where the change process is situated, and your external stakeholders, like an individual or group outside the health care setting. Why is their support necessary to the success of your project, and how you will go about securing that support?  (Topic is infection control, and mentorship will be in a NY elementary school).

Please include in-text citations, and references must be no older than 5 years.

As you engage in your practicum experience, develop your journal entry, and prepare for the Discussion, keep the following questions in mind:

• What is the role of leadership in the change process—specifically as it relates to your practicum setting and the change you have identified? What are some facilitating and inhibiting factors with regard to leadership and this issue? Refer to leadership and change theory.
• What opportunities and challenges could arise based on your personal leadership style as well as your role within your practicum setting? Consider the results of the DiSC, which you completed in NURS 8300.

Websites for references

American Nurses Association (ANA) Policy and Advocacy. Here you can find state legislative issues the ANA is promoting across the country. http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy

Florida Nurses Association-Nursing, Advocacy, Engagement http://cqrcengage.com/fln/home?0

Florida Center for Nursing (FCN) and the Action Coalition (FL-AC) https://www.flcenterfornursing.org/FL-ActionCoalition.aspx

Follow the steps outlined below to write a letter that will be emailed to your Congressperson or Senator to express your view on an issue in nursing that is negatively impacting or will negatively impact health care. The letter/email should reflect professionalism and be proof-read. It is recommended that you write your letter on a Word document which you will then copy and paste into the email.

Address the following in about 4 paragraphs to include:

1. Introduce yourself; state the issue that you will address in the letter that is causing the problem. Include bill information if applicable.

2. Your opinion on this issue. Why is your issue important for you as a registered nurse? Research the issue to support your argument. Include current socioeconomic, political, or ethical issues surrounding the problem as well as the implications of the problem for patients, nursing or nursing practice.

3. Restate your purpose for writing the letter. Ask the Congressperson/Senator to help to take action to address the issue.

4. Ensure that you thank the Congressperson/Senator (MY STATE SENATOR IS MARCO RUBIO

For your written assignment, find three advertisements. These can be  videos, radio ads, print ads, interactive media, or any other sort of  media used for advertising purposes. For each advertisement, provide a ½ page analysis that answers the following questions:

• Summarize the advertisement, the apparent demographic it is aimed at, and the product it is pitching.
• What are the arguments being made? Are they explicit or only implied?
• Are the arguments being forwarded cogent? Why or why not?
• What sorts of devices, rhetorical, language, or other are employed to either enhance or distract the audience from the message?

Provide at least Five Targeted Questions you would ask the patient to build his or her health history and to assess his or her health risks.

“CASE STUDY #1”

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has ahx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Note: REMEMBER AT LEAST THREE REFERENCES AND APA FORMAT

Now that Barbara has an understanding of the factors that influence clinic performance, it is time to set priorities and develop a preliminary strategy. A clear strategy helps to focus energy and resources, establish organizational direction, and strengthen operations where there are opportunities for improvement.

For this project assignment on UCCO, complete a 2-page report to describe a high-level strategy with associated action items for, to include the following concepts:

• Based on the results of the SWOT analysis, what should Barbara recommend as an overall strategy?
• How will the selection of the chosen EHR system contribute to the strategy? Further explain why it was the best choice.
• On what basis should she develop actions items? What should the action items be, as they directly relate to the strategy?
• What should the recommended outcomes and/ or long-term goals be, based on the action items?
•  APA formatted reference page

Purpose

This week’s graded discussion topic relates to the following Course Outcome (CO).

• CO 1: Apply leadership concepts, skills, and decision making in the provision of high-quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO 2)

Discussion

Healthcare reform is a term that is ever present in our practice settings and will not disappear any time soon.

Review the article below and answer the following questions.

Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. . doi:10.1016/S2155-8256(17)30097-https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S2155825617300972&site=eds-live&scope=site (Links to an extern

1. Select one of the four challenges and expand on how your workforce has responded to the change.
2. How have these challenges affected the access to care for your patients?
3. What can you do to decrease the effect on your patients? Provide a specific example.

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

• Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
• Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
• Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

• Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
• Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
• Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

From the previous discussion:

The healthcare environment is significantly growing, which explains the reason for the existing significant issues. Improving the quality of healthcare requires a strong emphasis on critical aspects such as leadership, cost of care, skills and service delivery, technology, as well as patient management practices. A significant health care issue currently has been technological disruption. Substantial changes in the healthcare industry that are being undertaken are dependent on technology. This provides a unique platform where it is more accessible to attain better health outcomes across different settings.

Quality has been a critical measure in the delivery of quality healthcare outcomes. The integration of different results has aimed at providing a unique system where it would be easier to improve healthcare outcomes. The ability to incorporate technology in monitoring patient development offers a strong emphasis on essential processes which help maintain a unique level of engagement within a healthcare setting. Within my healthcare organization, patient information has been stored using healthcare information management systems compared to previous documentation of patient information in healthcare files (Engelhardt, 2017).

Management of healthcare information has become a critical factor which provides a strong consideration on critical processes which help create a reliable system. The inclusion of health information management systems has integrated vital processes which help identify important concepts which help manage patient information. Storage of patient details provides a strong consideration on specific aspects which help improve the level of commitment among healthcare providers (Sultan, 2015).  The health information management system that has been put in place identify specific measures which focus on ensuring that there is quick information retrieval of patient information.  Accessing patient information within a healthcare context requires authorization from a patient or when reviewing the patient situation.

The impact of technology disruption in my workplace

Integration of technology in healthcare is aimed at controlling healthcare errors. It is a crucial aspect to consider primarily based on previous errors in healthcare delivery.  The use of technology is aimed at improving efficiency in the delivery of healthcare. In my workplace, management of patient health information is a significant improvement to the storage of health information which has been a considerable challenge, especially retrieval of patient files. The use of technology has made it possible to access patient information from a cloud-based database quickly (Schwamm, 2014).

Conclusion

The use of technology has also created challenges, especially concerning the common cyber threats. The fact that we deal with sensitive patient information, they are at a higher risk of falling victims to intruders who target such information.   The present risks are significant. Thus, integration of vital information security risks will help in controlling the current risks through the development of robust techniques. The techniques are integrated into the healthcare industry to protect patient information. Thus, management of these risks has been a significant aspect to consider in ensuring that there is a better level of implementation of healthcare outcomes. Thus, technology disruption is having both positive and negative influence in healthcare.

References

Engelhardt, M. A. (2017). Hitching healthcare to the chain: An introduction to blockchain technology in the healthcare sector. Technology Innovation Management Review, 7(10).

Schwamm, L. H. (2014). Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Affairs, 33(2), 200-206.

Sultan, N. (2015). Reflective thoughts on the potential and challenges of wearable technology for healthcare provision and medical education. International Journal of Information Management, 35(5), 521-526.

or

Increased workload on nurses is one of the stressors facing nurses and is a significant problem all over the world. It includes multiple factors such as work environment, condition of the client or consumer, characteristics of the providers, nursing interventions, to name a few.  Contributing further to the already heavy nursing workload are an inadequate supply of nurses, decreased patient length of stay, complex patients, increased demand for nurses, and increased overtime had added to already demanding work of nurses and eventual nursing burnout. As a result, the nurse-patient ratio, which has been used commonly in measuring the workload of the nursing workforce, has been increasing (Vaidya, 2018).

reference:

Vaidya, A. (2017, September 21). Increasing nurse’s workload by 1 patient ups odds of patient

death by 7%. Clinical Leadership and Infection Control. Retrieved from

https://www.beckershospitalreview.com/quality/increasing-nurse-s-workload-by-1-patient-ups-odds-of-patient-death-by-

7.html

Looking Ahead

The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.

rubic:

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

·   Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).–Levels of Achievement:Excellent 23 (23%) – 25 (25%)
The response accurately and thoroughly describes in detail the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate, clear, and detailed data to quantify the impact of the national healthcare issue/stressor selected.
Good 20 (20%) – 22 (22%)
The response describes the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate data to quantify the impact of the national healthcare issue/stressor selected.
Fair 18 (18%) – 19 (19%)
The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague or inaccurate.

The response includes vague or inaccurate data to quantify the impact of the national healthcare issue/stressor selected.
Poor 0 (0%) – 17 (17%)
The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague and inaccurate, or is missing.

The response includes vague and inaccurate data to quantify the impact of the national healthcare issue/stressor selected, or is missing.Feedback:

·   Provide a brief summary of the two articles you reviewed from outside resources, on the national healthcare issue/stressor and explain how the healthcare issue/stressor is being addressed in other organizations.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
A complete, detailed, and specific synthesis of two outside resources reviewed on the national healthcare issue/stressor selected is provided. The response fully integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the summary provided.

The response accurately and thoroughly explains in detail how the healthcare issue/stressor is being addressed in other organizations.
Good 24 (24%) – 26 (26%)
An accurate synthesis of at least one outside resource reviewed on the national healthcare issue/stressor selected is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the summary provided.

The response fails to integrate any resources to support the summary provided.Feedback:

·   Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected and explain how they may impact your organization both positively and negatively. Be specific and provide examples.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
A complete, detailed, and accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively that is vague and inaccurate, or is missing. Does not include any examples.Feedback:

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.

Principlism, especially in the context of bioethics in the United States, has often been critiqued for raising the principle of autonomy to the highest place, such that it trumps all other principles or values. How would you rank the importance of each of the four principles? How do you believe they would be ordered in the context of the Christian biblical narrative? Refer to the topic overview and other topic study materials in your response.

Write a 1-page paper that addresses the following:

• Explain your diagnosis for the patient, including your rationale for the diagnosis.
• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Discussion: Working With Children and Adolescents Versus Adults

Infant, childhood, and adolescent development are a continual interplay between nature (genetic or biologic predisposition) and nurture (environmental experiences). The nature/nurture continuum and debate will always be a part of your career as a PMHNP.  Knowing common developmental milestone is important in the role as a child provider. Not only is it essential to the diagnostic process, but it is also important to the interdisciplinary interactions with other mental health professionals. The study of normal developmental processes, however, is only one tool that allows the mental health professional to understand the child being evaluated. There are many different assessment instruments and interviewing techniques that PMHNPs can have in their toolkit when working with children and adolescents.

In this Discussion, you examine the differences in assessing and treating children and adolescents versus adults. You take into consideration your own clinical experiences, as well as your experiences in your clinical rotation, and the information from the readings thus far.

Post your answers to the following:

• Explain why a developmental assessment of children and adolescents is important.
• Describe two assessment instruments and explain why they are used for children and adolescents but not adults.
• Describe two treatment options for children and adolescents that may not be used when treating adults.
• Explain the role parents play in assessment and treatment.

• Assignment Overview
• Assignment Details:

Discussion: Diversity and Health Assessments
May 2012, Alice Randall wrote an article for The New York Times on  the cultural factors that encouraged black women to maintain a weight  above what is considered healthy. Randall explained�from her  observations and her personal experience as a black woman�that many  African-American communities and cultures consider women who are  overweight to be more beautiful and desirable than women at a healthier  weight. As she put it, �Many black women are fat because we want to be�  (Randall, 2012).
Randall�s statements sparked a great deal of controversy and debate;  however, they emphasize an underlying reality in the healthcare field:  different populations, cultures, and groups have diverse beliefs and  practices that impact their health. Nurses and healthcare professionals  should be aware of this reality and adapt their health assessment  techniques and recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic,  spiritual, lifestyle, and other cultural factors that should be taken  into considerations when building a health history for patients with  diverse backgrounds. Your Instructor will assign a case study to you for  this Discussion.

CASE STUDY:

EB is a 68-year-old black female who comes in for  follow-up of hypertension. She has glaucoma and her vision has been  worsening during the past few years. She lives alone and is prescribed  four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL  200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily ). She  brings in her medication bottles and she has some medication bottles  from the previous year full of medications. She is missing one  medication she had been prescribed and says she may have forgotten it at  home. Her BP in clinic today is 182/99 with HR of 84.

To prepare:
� Reflect on your experiences as a nurse and on the information  provided in this week�s Learning Resources on diversity issues in health  assessments.
� By Day 1 of this week, you will be assigned a case study by your  Instructor. Note: Please see the �Course Announcements� section of the  classroom for your case study assignment.
� Reflect on the specific socioeconomic, spiritual, lifestyle, and  other cultural factors related to the health of the patient assigned to  you.
� Consider how you would build a health history for the patient.  What questions would you ask, and how would you frame them to be  sensitive to the patient�s background, lifestyle, and culture? Develop  five targeted questions you would ask the patient to build his or her  health history and to assess his or her health risks.
� Think about the challenges associated with communicating with  patients from a variety of specific populations. What strategies can you  as a nurse employ to be sensitive to different cultural factors while  gathering the pertinent information?
Post an explanation of the specific socioeconomic, spiritual,  lifestyle, and other cultural factors associated with the patient you  were assigned.

Explain the issues that you would need to be sensitive to  when interacting with the patient, and why.

Provide at least five  targeted questions you would ask the patient to build his or her health  history and to assess his or her health risks.

NOTE: THIS IS THE LINK TO DOWNLOAD THE BOOK

https://www.sendspace.com/file/wd7quh

Is there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.
• Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
• Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: An Introduction to Clinical Inquiry

Create a 4- to 5-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you used keywords to search on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four peer-reviewed articles you selected.

Part 2: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

• The full citation of each peer-reviewed article in APA format.
• A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
• A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
• A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
• A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.