1- I can totally see where there would be tension between these two, especially in…

  

 
 

1-  I can totally see where there would be tension between these two, especially in today’s world.  I am no expert on religion or science for that matter, but I do feel like some of the tension is unnecessary.  I feel that the two can work to benefit our patients by balancing them with the needs of the patient.  Let’s take my kids for instance, if they were sick with some known treatable disease there would be no other option in my mind to treat them with science and medicine that has been proven to work.  I wouldn’t only pray for them to get better and not do anything about it, but I would pray for them and do whatever was necessary to help my family deal with the stress and worry of a child being sick.  Here we have used them both to our benefit and they each serve a different purpose and effectiveness.  Thanks again for your post! 

 
 

2-My perception of the tension between science and religion is founded at first glance and then not when looked at more closely.  Science and religion can coincide in health care if respected for their own strengths and limitations.  I feel that a healthy balance of both can benefit our patients providing different needs when they’re needed.  I have seen with my own eyes CRP markers drop in an infant receiving antibiotic treatment and I have also seen an infant that wasn’t supposed to live by scientific probability actually make it and thrive with prayer being the only obvious intervention.  So, trying to single out one over the other as more effective than the other seems less beneficial than trying to work them both in when the patient requires such help.

I feel that science is good for some of the more usual cases and things we feel we can help with its information, and I also feel that we can use religion to help a patient with their mental aspects of  healing.  We can quantify an improvement in a patient through lab levels and such, but it's hard to do the same with religion and how a patient uses that tool as comfort or however they use it in their lives.  “Some observational studies suggest that people who have regular spiritual practices tend to live longer. Another study points to a possible mechanism: interleukin (IL)-6. Increased levels of IL-6 are associated with an increased incidence of disease. A research study involving 1700 older adults showed that those who attended church were half as likely to have elevated levels of IL-6. The authors hypothesized that religious commitment may improve stress control by offering better coping mechanisms, richer social support, and the strength of personal values and worldview” (NCBI, 2001).  In this example we see the benefits were surveyed to be founded, but the exact workings aren’t exactly known.  The great thing about science is that usually we have some tangible results that are repeatable and there’s safety to be found in that.  The great thing about religion is that we can have faith in whatever we believe in and that’s all that’s needed.  It's our faith and belief that drives the comfort in religion.

I understand how people will want one to win over the other and I feel that it depends on the person and how they view it.  I feel that there doesn’t need to be this tension because they both can serve separately but benefit the patient when both are utilized.  If you have multiple tools in the box, why not use a variety of them and pick whichever is most appropriate for the task at hand?  Each tool has their own specialty and doesn’t mean one has to be better than the other or tension between the two, they just need to work for the purpose they’re intended. 

Reference

Puchalski, C. 2001.  The role of spirituality in health care.  Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305900/

 

 
 

3-I was able to develop a greater understanding of the tension between science and religion based on the article, the role of spirituality in health care and the lecture notes this week. I have always believed in God and often pray in silence for my patients or families in the Peds ED. Many times, it will be for something as small as obtaining an IV on a patient that has been deemed a “hard stick.” However, what I refrain from doing is addressing my patients' spiritual beliefs throughout their stay. My thoughts include “what if they don’t believe?”, “will they be offended?”  Today there is often tension in any conversation. Politics, healthcare, beliefs in God, what to post on your social media account, etc.. Everyone has an opinion but verbalizing that opinion can cause tension with your closest family member. Specific to healthcare in the West, scientism and relativism has exacerbated the perceived tension between scientism and religion ("Worldview Foundations of Spirituality and Ethics", 2018) . If we base all healthcare beliefs off scientism and relativism, there is no room for hope or belief that God (or the patient's higher power) has any room for preforming a miracle or comforting the patient in their time of need. As Puchalski (2001) said, “Healing can be experienced as acceptance and peace with one’s life. This healing, I believe is at its core spiritual.” Patients need to understand the science and reality behind any diagnosis, whether acute or chronic. However, they need the opportunity to heal as a whole person which includes their spirituality. “It is critical that we as physicians and health care providers listen to all aspects of our patients’ lives that can affect their decision making and their coping skills” (Puchalski, 2001).  

I believe that it is important to have a balance between science and religion without the tension. One were our patients can express their spirituality and we can be honest with our professional knowledge and offer our presence and compassion at the same time.  

Reference:  

Puchalski C. M. (2001). The role of spirituality in health care. Proceedings (Baylor University. Medical Center) , 14 (4), 352-7.  

Worldview Foundations of Spirituality and Ethics. (2018). Retrieved from https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?viewPage=current&operation=innerPage&currentTopicname=Worldview Foundations of Spirituality and Ethics&topicMaterialId =a52bac38-a38a-4edc-8747-efe8f3c85261&contentId=6775b54b-52b8-4bb1-b4de-a5bd34e39a90&

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Pamela Keeme Reimbursement Methodologies1) Focus on Payment Methodologies and discuss the various payment systems. Demonstrate understanding of fee…

 Pamela Keeme 

Reimbursement Methodologies

1) Focus on Payment Methodologies and discuss the various payment systems. Demonstrate understanding of fee for service, cost based, and prospective payment systems. Just like coding systems are different, payment methodologies for inpatient hospital, outpatient hospital, and professional claims are also different. Many commercial payers follow the lead of Medicare once it has implemented a specific payment system(Aalseth, P. 2015). 

Fee For Service- This is the most traditional, simple payment system. For this payment system, a service is billed using a CPT or ICD procedure code. The payer has a fee schedule with a set reimbursement amount for each service it covers. The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Most physician services are paid according to a fee schedule. Clinical laboratory services are paid based on a laboratory fee schedule, and ambulance services are paid on an ambulance fee schedule.

Cost Based or Reasonable Cost- Under this payment system, providers or facilities submit an annual cost report that details the expenses of running their businesses. There are extensive rules for completing this cost report. Examples are: data on bed utilization, salaries by cost center, expenses by cost center, indirect costs related to items such as medical education, cost-to-charge ratios, capital expenditures, and other items. In most cases the facility has been receiving periodic interim payments from the payer throughout the year, and the cost report is then used to "settle" or reconcile the costs to the payments already received. For Medicare, the cost reports are submitted to the Fiscal Intermediary (FI), which reviews and/or audits the cost report and then submits it to the CMS for reporting. PIP (periodic interim payments) are available to inpatient hospitals, skilled nursing facility services, hospice services, and critical access hospitals. These facilities are supposed to self-monitor their PIP payments to make sure they are not receiving overpayments or they can be penalized if overpayment exceeds 2% of the total in two consecutive fiscal reporting periods.

Prospective Payment System- In order to change hospital behavior to encourage more efficient management of medical care, Medicare introduced hospital inpatient prospective payment in 1983. Using a system that was developed in the 1970s by Yale University, reimbursement to hospitals was based on diagnosis-related groups (DRGs). Data already appearing on the claim form are used to assign each patient discharge into a DRG: Examples are Principal diagnosis, Complications and comorbidities (CCs), Surgical procedures, Age, Gender, and Discharge disposition (died, transferred, went home). Once a DRG has been assigned, the determination of the reimbursement amount can start. Each DRG has a relative weight assigned to it. Patients in a given DRG are assumed to have similar conditions, receive similar services, and use similar amounts of hospital resources. The prospective payment system is based on paying the average cost to treat patients in that DRG. The DRG weights are adjusted annually. The more complex the DRG, the higher the weight.

2) Explain medical necessity and how it impacts payment- To determine medical necessity, it involves comparing the procedure being billed to the diagnosis submitted. If you receive a denial notice from the payer that the procedure was "not medically necessary", it means that your payer does not think the procedure or test was justified for the diagnosis given. Medicare carriers publish what are known as "Local Coverage Determinations" (LCDs) that contain lists of diagnosis codes that validate procedures. If your diagnosis is not on the list, your claim will be rejected. If the provider of the service knows in advance that a service is likely to be deemed not medically necessary, he or she can ask the patient to sign an Advance Beneficiary Notice (ABN) in which the patient acknowledges the possibility the claim will not be paid and agrees to be financially liable for the charge. 

3) What has been the effect of payment methods on coding? Medical billing procedures have been much more effective since the advent of the CPT medical coding system. Developed by the AMA, the CPT system was designed to help facilitate and standardize medical billing practices. The coding system consists of alpha-numerical codes which are designated to describe the various services and treatments a doctor or medical facility performs on their patients. These codes are entered into a database system which is used for billing insurance companies, Medicare and Medicaid. Through the use of this billing system, medical professionals are better able to keep track of their financial records and receipt of their medical payments(findacode.com). 

Aalseth, P. (2015). Medical Coding. What It Is and How It Works. Second Edition. Burlington, MA. Jones & Bartlett Learning

https://www.findacode.com/articles/the-impact-of-coding-system-on-medical-billing

Post 2

 Richard Matos Week 4 – Payment MethodologiesCOLLAPSE

Fee for service is a method in which doctors and providers receive payment for services provided and the most traditional payment mechanism.  Services are billed using a CPT or ICD code, The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Laboratory and ambulance services are paid on a laboratory and ambulance fee schedule. (Aalseth P.T., 2015).

Under Reasonable Cost or Cost Based providers and facilities present a detail report of the expenses of running their hospitals or clinics.  The reports include bed utilization data, salaries, expenses by cost center, medical education, cost to charge ratio, capital expenses, and other items. (Aalseth P.T, 2015). 

In order to control the cost of Medicare, Medicaid, and other insurance programs, Medicare introduced Hospital inpatient prospective system in 1983.  Reimbursement will be based on Diagnosis-Related Group (DRG'S).  Data already appearing on the claim form are used to assign each patient discharge into a DRG; Principal diagnosis, Complication, and comorbidities, surgical procedures, age, gender, and discharge disposition.  Once a DRG has been assigned, the determination of the reimbursement amount can start. (Aaselth P.T., 2015).

Medical necessity involves comparing the procedure billed to the diagnosis submitted. Local  Coverage Determinations are a list of diagnosis codes that validates procedures such as X-rays, EKG's and others. If the procedure billed was not on the list the claim will be rejected.  

Since the implementation of DRG's coding made a difference in reimbursement.  Coders were elevated out of the dark and into the financial limelight. Medical records departments were turned into health information management departments.  The potential dollars to be made was an incentive to coders to use the right codes. (Aaselth P.T., 2015) 

Reference

Aalseth, P.T. (2015). Medical Coding, what is it and how it works, (2nd ed.) Sudbury, MA: Jones & Bartlett Learning

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4-Evidence based practice research has changed the field of nursing in many ways. It is…

  

4-Evidence based practice research has changed the field of nursing in many ways. It is one of the key principles in medicine today adhering to standards for high quality and safety, all while focusing on patients’ needs. Old practices may not work and need to change, evidence-based practice provides the latest research in improving these practices.

In emergency nursing, evidence-based practice is used daily. One very common practice is infection control. “This includes keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practicing correct handwashing” (Arkansas State University, 2016). Even though the emergency is very fast paced, nurses in my facility are very aware of infection control and make efforts to improve their infection control practices daily. Another evidence-based practice used frequently in the ED, is oxygen use in patients with COPD. “Despite the belief by some that providing oxygen to these patients can create serious issues such as hypercarbia, acidosis or even death, the evidence-based protocol is to provide oxygen to COPD patients. This practice can help prevent hypoxia and organ failure. Giving oxygen, which is the correct treatment based on the evidence, can enhance COPD patients’ quality of life and help them live longer” (Arkansas State University, 2016). It is very important that nurses know that giving to much oxygen can increase their respiratory drive, causing more distress, but some oxygen is key to helping improve the patients’ status.

Reference:

Arkansas State University (2016, December 20). 4 Examples of Evidence-Based Practice in

Nursing. Retrieved from https://degree.astate.edu/articles/nursing/examples-of-evidence-based-practice-in-nursing.aspx

 

5-Evidence-based practice is something that is embedded into our minds. During my first quarter of nursing school we were required to write down interventions for all nursing diagnoses and were required to cite evidence as to why we do the nursing interventions that we do. As nurses it is important to know the WHY as to why we do what we do. Evidence-based practice changes everyday because science and studies are frequently changing.

As nurses, we practice numerous nursing interventions daily. For bedridden patients who cannot move on their own, we are required to turn them at least every 2 hours because research shows that by turning these patients, the chances of developing bed sores are greatly decreased. We had a patient on our unit for about 6 months who was not able to move on his own and he did not develop a single bed sore because frequent turning was practiced. Other common evidence-based practice interventions include scrubbing the IV and central line hubs with alcohol for 10-15 seconds to prevent CLABSI. Washing your hands with soap and water before and after entering a patient's room is the number one method of preventing the transmission of disease. We practice evidence-based interventions numerous times a day and we probably do not even realize that we are doing it because it becomes second nature to us such as something as simple as raising the head of the bed, picking out the correct blood pressure cuff, or grabbing some ice to apply to our patient's knee, etc.

Arkansas State University states that nurses have room for improvement when it comes to EBP. They state the follo wing are some areas where nurses could better adhere to EBP:

  • Communication      involving changes in a patient’s status.
  • Soft      skills that improve patient interaction.
  • Training      and onboarding new nurses.
  • Shift      scheduling and the effect on care.

References:

Arkansas States University. 2018. Evidence-Based Practice in Nursing. Retrieved from https://degree.astate.edu/articles/nursing/examples-of-evidence-based-practice-in-nursing.aspx

 
 

6-From the perspective of a nurse, research or
evidence based practices are of vital importance when it comes to determining
the best course of action to take with clients, and determining which route to
take with an intervention plan. For instance, when examining an individual's
symptoms or ailment, using evidence based practices can show the best steps to
take in order to provide the patient with the most in depth and intensive
treatment options which can be afforded to them (Melnyk & Fineout-Overholt,
2011).

           When
treating a patient with a number of symptoms which do not have an immediately
known cause, using evidence based practices can assist in determining which
specific ailment the patient is suffering from. By using research that
highlights similar symptoms the specific condition can be examined in more
detail which could lead to new treatment methods being devised (Koehn &
Lehman, 2008).

           The
benefits of evidence based practice are not limited only to the treatment of
patients, but can also be utilized in how to properly communicate and interact
with patients, and can prove vital in establishing connections with them as
well (Melnyk & Fineout-Overholt, 2011). For instance, when handling a
patient who is being difficult in their treatment methods, using the best
evidence based practices can give insight into ways to interact with the client
that can lead to more positive breakthroughs in their recovery (Koehn &
Lehman, 2008).

           Overall,
evidence and research based practices give nurses the ability to utilize a wide
range of resources to determine which course of action is the correct step to
take in ensuring that their patients receive the best cares possible (Koehn
& Lehman, 2008).

'

References

Koehn, M. L., & Lehman, K. (2008). Nurses' perceptions
of evidence-based nursing practice. Journal of Advanced Nursing, 62(2).
Retrieved from
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2007.04589.x

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based
practice in nursing &        healthcare:
A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams             & Wilkins.

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Section 3: Quality Measurement and AssessmentPneumonia 30 day readmission is the quality improvement issueThink about…

  

Section 3: Quality Measurement and Assessment

Pneumonia 30 day readmission is the quality improvement issue

Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:

· What is the overall purpose, or aim, of doing this work?

· What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?

· What value would this work add to the organization?

· How would this work improve practice and create outcomes with impact?

Consider how addressing this quality improvement issue would align with the organization’s mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.

With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3.

To complete:

Write a 3- to 5-page paper that includes:

· An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization

· An overview of the current situation with regard to this quality improvement issue in the organization

· A description of measures and indicators

· A presentation on data related to this issue, including:

· Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data

· Methods for collecting and analyzing data in the future, including when you would do this

· A description of realistic, evidence-based targets

Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. 

Section 4: Quality Improvement Strategies

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine’s report “Crossing the Quality Chasm,” a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions “will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved.” Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

· Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.

· Recall the performance targets that you identified for Section 3 (in Week 6). What does the recommendation that performance-driven planning should “begin with the end in mind” suggest given your established goals?

· Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization’s strengths and weaknesses related to the performance gaps you identified in Section 3 (Week 6).

· Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Throughout this course you have been considering the relationship between structure, process, and outcomes as it relates to health care quality. Looking at outcomes, alone, may not tell the “whole story.” For instance, if you are concerned with improving fall rates, evaluating the process—related activities or practices—can help you identify factors that contribute to outcomes and develop strategies for improving them.

For this section of your Course Project, you create a process map to examine a current process related to your quality improvement issue. You will use the results of the process mapping to redesign a process to help minimize or close the performance gap(s). As you proceed, keep in mind the importance of maintaining a patient-centered focus so the patient experience is not negatively affected by any changes in process.

To prepare:

· Review the instructions provided in the Learning Resources for creating a process map.

· With your quality improvement issue in mind, as well as the other work you have completed on your Course Project thus far, think about how creating a process map could help you to better understand your quality improvement issue and redesign an associated process.

· Create a process map using Microsoft Word or PowerPoint.

· Refine the strategies for promoting systems-level change to minimize or close the performance gap(s) that you began to think about in Week 7. As part of this, identify a way to redesign at least one process based on your analysis of the process map that you have created.

To complete:

· Write a 2- to 3-page paper in which you describe quality improvement strategies that you selected related to your quality improvement issue.

· Finalize your process map, which will be submitted along with the paper.

Process map help

https://www.isixsigma.com/tools-templates/process-mapping/practical-guide-creating-better-looking-process-maps/

Provides detailed description of how to create a process map

http://www.miltonkeynesccg.nhs.uk/resources/uploads/files/NHS%20III%20Handbook%20serviceimprove.pdf

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In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that…

  

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.

Case 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 a hx 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."

 

Case 2

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion. She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Case 3

MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking "pot" and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.

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.

· Select one of the three case studies. Reflect on the provided patient information.

· Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.

· 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

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. 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.

 This work should have Introduction and conclusion

– This work should have at 3 to 5current references (Year 2013 and up)

– Use at least 2 references from class Learning Resources

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

CLASS LEARNING RESOURCES

**Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

  • Chapter 1, “The History and      Interviewing Process” (pp. 1-20)

This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

  • Chapter 2, “Cultural      Competency” (pp. 21–29)

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

**Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

  • Chapter 2, “Evidenced- Based Health Screening”      (pp. 6-9)

**Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi: 10.3109/02770903.2014.906605

Retrieved from the Walden Library Databases.

The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.

**Centers for Disease Control and Prevention (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

This website discusses cultural competence as defined by the Center for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website. 

**United States Department of Human & Health Services. Office of Minority Health. (2016). A physician's practical guide to culturally competent care. Retrieved from https://cccm.thinkculturalhealth.hhs.gov/

From the Office of Minority Health, the Website offers CME and CEU credit and equips health care professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.

**Espey, D., Jim, M., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(S3), S303-S311. 

The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.

**Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian J Trop Med Public Health., 47(1):109-20.

The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers.

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Discussion: Scholarly Writing and PlagiarismAs a nurse embarking on an advanced degree, you are developing…

                       Discussion: Scholarly Writing and Plagiarism

As a nurse embarking on an advanced degree, you are developing the characteristics of a scholar-practitioner, which includes strong communication skills. Writing in a scholarly manner involves supporting your thoughts with evidence from the literature and appropriately using APA formatting.

One of the challenges of scholarly writing is paraphrasing the thoughts of others in your work. Paraphrasing, and correctly citing the original author for his or her ideas, allows you to take the ideas of others, summarize them, and incorporate them into your own writing. 

When summarizing the ideas of others, it is important to avoid plagiarizing (copying the words and ideas of others as though they were your own). In addition to expanding your knowledge of APA, this week’s Learning Resources help you to distinguish between paraphrasing and plagiarizing.

                                             To prepare:

Think about the sometimes subtle difference between plagiarizing and paraphrasing.

Read the following paragraphs, which were written by Patricia O’Conner:

A good writer is one you can read without breaking a sweat. If you want a workout, you don’t lift a book—you lift weights. Yet we’re brainwashed to believe that the more brilliant the writer, the tougher the going.

 

The truth is that the reader is always right. Chances are, if something you’re reading doesn’t make sense, it’s not your fault—it’s the writer’s. And if something you write doesn’t get your point across, it’s probably not the reader’s fault—it’s yours. Too many readers are intimidated and humbled by what they can’t understand, and in some cases that’s precisely the effect the writer is after. But confusion is not complexity; it’s just confusion. A venerable tradition, dating back to the ancient Greek orators, teaches that if you don’t know what you’re talking about, just ratchet up the level of difficulty and no one will ever know.

 

Don’t confuse simplicity, though, with simplemindedness. A good writer can express an extremely complicated idea clearly and make the job look effortless. But such simplicity is a difficult thing to achieve because to be clear in your writing you have to be clear in your thinking. This is why the simplest and clearest writing has the greatest power to delight, surprise, inform, and move the reader. You can’t have this kind of shared understanding if writer and reader are in an adversary relationship. (pp. 195–196)

Source: O’Conner, P. (2003). Woe is I: The grammarphobe’s guide to better English in plain English. New York: Riverhead Books.

Paraphrase this passage from O’Conner using no more than 75–100 words. Remember that paraphrasing means summarizing the essence of the original text. It does not mean creating a thesaurus-based revision of the author’s original words or copying the piece, or any part of it, word for word. For this activity, do not use any direct quotes.

Turn your paraphrase into Grammarly and SafeAssign.

Review your reports.

Review the other tools, resources, and services available to you through the Walden Writing Center that support your growth as a scholarly writer.

Consider which of these resources you find to be most useful.

Review learning resources on APA formatting rules and information within the Walden Writing Center on APA

Post a description of your experience of using Grammarly and SafeAssign and share at least one insight you gained about paraphrasing and avoiding plagiarism as a matter of academic integrity.  

Recommend at least one other online resource that supports scholarly writing, and explain your rationale. Lastly, share two APA formatting rules with the class and a specific page number in the APA manual where this rule can be located

Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course.

                        Learning Resources- Required Readings

American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

Chapter 4, “The Mechanics of Style”

Chapter 6, “Crediting Sources”

Chapter 7, “Reference Examples”

Walden University requires all students to use the 6th edition of APA formatting. These three chapters present an overview of how to properly use APA formatting and provide numerous examples as a guide.

Chapter 1, “Writing for the Behavioral and Social Sciences” 

Section 1.10, “Plagiarism and Self-Plagiarism”

Chapter 3, “Writing Clearly and Concisely”

Chapter 6, “Crediting Sources” (Quoting and Paraphrasing) 

Section 6.01, “Plagiarism”

Section 6.02, “Self-Plagiarism”

These sections of the publication manual cover the principles of expository writing, properly crediting sources, and present strategies for avoiding the pitfalls of plagiarism.

Document: APA Basics Checklist: Citations, Reference List, and Style (PDF)

 

This document provides helpful information and links to APA resources available through the Writing Center.

Document: Citing a Discussion Posting in APA Style (Word document)

 

The information in this document focuses on how to cite a Discussion posting or response in APA style.

Document: Citing a Laureate Video in APA Style (PDF)

 

The information in this document focuses on how to cite a course media program in your text as well as create an entry for a reference list in APA style.

Document: Common APA Style and Formatting Challenges (PDF)

Document: Introduction to Scholarly Writing: Plagiarism and Academic Integrity (Word document)

 

This document supplements the information on plagiarism and academic integrity presented in the related video program.

Walden University. (2012e). Walden University: Plagiarism. Retrieved from http://writingcenter.waldenu.edu/63.htm

Walden University. (2012d). Walden University: APA style. Retrieved from http://writingcenter.waldenu.edu/APA.htm 

 

Walden University offers a wide range of APA resources from a video tutorial to citation guidelines and includes information on other APA style issues.

 

Plagiarism, even when unintentional, constitutes academic dishonesty and can jeopardize your professional reputation. Review the information and resources presented by the Walden Writing Center for avoiding plagiarism.

Walden University. (n.d.). Grammarly. Retrieved from http://academicguides.waldenu.edu/writingcenter/grammarly

 

 Grammarly is a valuable tool all Walden University are encouraged to use. You will this resource as you prepare for this week’s Discussion

IMPORTANT: CHECK THE MEDIA PRESENTATION VIDEOS ATTACHED BELLOW TO COMPLETE THE DISCUSSION QUESTION

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Comment 1Independent variables is a variable that is manipulated or varied by the researcher, and…

Comment 1

Independent variables is a variable that is manipulated or varied by the researcher, and the dependent variable is the measurement of the response to the independent variable (Rutgers University Library, 2018). The independent variables of my project would be the age, sex, training, and degree of the nurses and other health care staff. The dependent variables would be formulating questions to further research-based knowledge, use the databases to find out relevant knowledge, and participate in the implementation of research-based knowledge in practice Boström, Rudman, Ehrenberg, Gustavsson, & Wallin, 2013).

I need to collect both the independent and dependent variables because I need to see the relationship between the nurses and health care staff, and their knowledge and abilities to carry out the EBP project. In order to determine the effectiveness of the EBP project, a study must be done. The independent variables would be manipulated by giving them the knowledge and resources to provide better quality care. Better quality care would improve and decrease incidences of pressure ulcers. The dependent variable would determine if the project was successful or not.

Comment 2

My EBP project is focusing on staff retention of newly hired nurses on the nights shift. The dependent variable that I will be measuring is the reduction of nurse turnover after use of mentor/mentee program in first three months of employment. The independent variable is the three-month time frame and the use of nurses in research.

An article from Sarikas, (2018) describes the independent and dependent variable relationship like this. The independent variable is what I want to change (i.e. use of mentor/mentee program). The dependent variable is what changes (i.e. rate of new nurse turnover).

Collection of the dependent variables will show the success or lack of success in implementing the use of a mentorship program that will reduce the rate of newly hired nurse turnover. This information will show an improvement in nurse confidence and job satisfaction which will affect patient satisfaction. If the nurses are happy the patients will benefit through more confident and patient centered care. The independent variable would be the implementation of the mentorship program that will promote nurse satisfaction over a three-month period.

Comment 3 DQ 2

Statistical significance and clinical significance are vital is determining how effective different studies are. Studies have shown that clinical significance is difficult to define and has different meanings. According to Polit (2017), one definition is “the degree of improvement experiences by patients (e.g., the amount of pain reduction among patients with cancer)” (p. 18). Another definition is “the absence of change (e.g., the absence of deterioration in spirometry test values among patients with idiopathic pulmonary fibrosis” or there is change, “the amount of change that would be clinically significant might depend on what the “baseline” value is” (p. 18). Statistical significance is defined as the way “to indicate that the result of a statistical analysis probably are not attributable to chance or serendipity, at a specified level of probability” (Polit, 2017, p. 18). A major difference between clinical significance and statistical significance, statistical significance is affected by sample size; whereas, clinical significance relies on patient-reported outcomes, such as quality of life and pain to determine the effectiveness of interventions.

I can use clinical significance to support positive outcomes in my project by ensuring that staff and management are aware of the guidelines of the project. I would also try to motivate the staff to implement the change in patient care by informing them how engaging in the interventions would improve patient outcomes. It would also improve staff outcomes because the patients would have less instances of pressure ulcer development, and the nurses and other staff can focus on other parts of patient care. Other types of care would include medication administration and ADLs. The company would also save money on the supplies needed to heal and treat pressure wounds. The company could use the money they save on other supplies, improve the facility, or give back to the employees.

Comment 4

Clinical significance is defined as a subjective explanation of a research result as practical or useful for the patient and likely to affect provider behavior and statistical significance deals with the probability that a research result is accurate according to Thompson (2017).

Clinical significance (CS) can also be know as clinical importance or practical importance. CS relates to the research results effect on patient outcomes relating to pain, treatment effects, or comfort. CS is a subjective decision that tells us how effective the research may be to patients,

Statistical significance (SS) tells us the chance that research is a chance finding, according to Thompson (2017). SS is based on the sample size and depending on how large the sample is, most can be statistically significant.

Clinical significance can be used to support outcomes in my EBP by showing the value in retaining staff and investing in supporting and maintaining newly hired nurses through mentorship programs. Breaking down the financial savings associated with hiring and training nurses only to have them leave the job or transfer to other departments or shifts is expensive and developing or maintaining a mentorship program will show the value involved in nurse retention.

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Assignment: Adaptive ResponseAs an advanced practice nurse, you will examine patients presenting with a variety…

Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

  • Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
  • Identify the  pathophysiology of the disorders presented in each of the three scenarios, including their  associated alterations. Consider the adaptive responses to the alterations.
  • Review the examples of  “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease  (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified  from the scenarios. Use the examples in the media as a guide to construct a  mind map for the disorder you selected. Consider the epidemiology, pathophysiology,  risk factors, clinical presentation, and diagnosis of the disorder, as well as  any adaptive responses to alterations.
  • Due 12/9/2018 by 12 noon.

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Length: At least 3 5 typed, double-spaced pages, not including the title page and reference page….

  1. Length: At least 3–5 typed, double-spaced pages, not including the title page and reference page.
  2. Font and font size: Times New Roman, 12 point.
  3. APA Template: Use the APA Style Paper Template as the paper format and the APA Style Paper Tutorial for guidance. 
  4. Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
  5. References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
  6. APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.

  

For this assessment, you will develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

  1. Access the Ethical Case Studies attached to review the case study you may use for this assessment
    • Note: The case study may not supply all of the information you may need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
  2. Identify the case study you selected, briefly summarize the facts surrounding the case study, and identify the problem or issue in the case study that presents an ethical dilemma or challenge and describe that dilemma or challenge.
    • Use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) found in the Ethical Decision-Making Model media piece in the Resources to analyze the ethical issues.
  3. Analyze the factors that contributed to the problem or issue.
    • Identify who is involved or affected by the problem or issue.
    • Describe the factors that contributed to the problem or issue and explain how they contributed.
    • In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation.
      • Cite and apply the journal article as evidence to support your critical thinking and analysis of the case.
      • Assess the credibility of the information source.
      • Assess the relevance of the information source.
  4. Discuss the effectiveness of the communication approaches present in the case study.
    • Describe how the health care professional communicated with others.
    • Describe the communication and communication strategies that were applied, both in creating and in resolving the problems or issues presented.
    • Assess instances where the professional communicated effectively or ineffectively.
  5. Discuss the effectiveness of the approach used by the professional related to any problems or issues involving ethical practice in the case.
    • Describe the actions taken in response to the ethical dilemma or challenge presented in the case study.
    • Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
    • Discuss the key lessons this case provides for health care professionals.
  6. Apply ethical principles to a possible solution to the proposed problem or issue from the case study.
    • Describe the proposed solution.
    • Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
    • Discuss how likely it is the proposed solution will foster professional collaboration.
  7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
    • Determine the proper application of the rules of grammar and mechanics.
  8. Write using APA style for in-text citations, quotes, and references.
    • Determine the proper application of APA formatting requirements and scholarly writing standards.
    • Apply the principles of effective composition.
    • Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Attached is the case study.

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Create a 4-6 page annotated bibliography and summary based on your research related to best…

 Create a 4-6 page annotated bibliography and summary based on your research related to best practices addressing a current health care problem or issue  

 

For this assessment, you will research best practices related to a current health care problem.  To explore your chosen topic, you should use the first two steps of the Socratic Problem-Solving Approach as described on Campus to aid your critical thinking.

  

The Socratic Method is a teaching style in which teachers ask students questions designed to stimulate more complete thinking and deeper insight. It also relates to the steps of performing scientific research. When the Socratic approach is applied, students are prompted to look more closely at your ideas, question your assumptions and accepted premises, and view your choices through a rigorous lens.

TOPIC: MEDICATION ERRORS

  

A medication error is a preventable adverse effect of a patient taking the wrong medication or dosage, whether or not it is evident or harmful to the patient. Medication errors can be a source of serious patient harm, including death.

Potential Intervention Approaches:

  • – Medical staff education
  • – Packaging improvements
  • – Patient medication safety      training
  1. View the Assessment Topic and Write a brief overview of the selected topic. In your overview:
    • Describe the health care problem or issue.
    • Describe your interest in the topic.
    • Describe any professional experience you have with this topic.
  2. Conduct a search for scholarly or academic peer-reviewed literature related to the topic and describe the criteria you used to search for articles, including the names of the databases you used.
    • You will want to access the applicable Undergraduate Library Research Guide related to your degree (found at the NHS Learner Success Lab) for tips to help you in your search.
    • Use keywords related to the health care problem or issue you are researching to select relevant articles.
  3. Assess the credibility of the information sources you find.
    • Determine if the source is from an academic peer-reviewed journal.
    • Determine if the publication is current.
    • Determine if information in the academic peer-reviewed journal article is still relevant.
  4. Select four current scholarly or academic peer-reviewed journal articles published during the past three to five years that relate to your topic.
  5. Explain the relevance of the information sources.
    • Describe how the health care problem or issue is addressed in each source.
    • Discuss what kind of contribution each source provides on your selected topic.
  6. Analyze the scholarly literature or academic peer-reviewed journal articles using the annotated bibliography organizational format.
    • The purpose of an annotated bibliography is to document a list of references along with key information about each one. The detail about the reference is the annotation. Developing this annotated bibliography will create a foundation of knowledge about the selected topic.
    • List the full reference for the source in APA format (author, date, title, publisher, et cetera) and use APA format for the annotated bibliography.
    • Make sure the references are listed in alphabetical order, are double-spaced, and use hanging indents.
    • Follow the reference with the annotation.
  7. In your annotation:
    • Identify the purpose of the article.
    • Summarize the source:
      • What are the main arguments?
      • What topics are covered?
    • Include the conclusions and findings of the article.
    • Write your annotation in a paragraph form. The annotation should be approximately 150 words (1 to 3 paragraphs) in length.
  8. In a separate paragraph or two at the end of the paper, summarize what you learned from your research.
    • List the main points you learned about.
    • Summarize the main contributions of the sources you chose and how they enhanced your knowledge about the topic.

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