Category: Nursing homework help

Reply to a classmate post
“How Racist Are You?”
Jane Elliot’s racism awareness method reveals a lot about the dynamics of racism within society. First, the training reveals that most people do not acknowledge the racism that happens every day in society. The discriminated group in this experiment initially does not believe that racism exists (Bryanweb, 2019). They believe that discrimination occurs for every person and that racism is not special in any way. They, however, complain about their discrimination but refuse to accept that this happens every day in society. As the experiment continues, some people choose to walk out while others learn the dynamics of discrimination. I believe this truly reflects how society perceives racism. Those who are privileged do not realize the extent of discrimination. On the other hand, the study by Carter and Murphy (2015) explores these differing perception and add the claim that Whites of low socioeconomic status (SES) are more likely to perceive discrimination claims by minorities as legitimate compared to their high SES counterparts. This finding reveals the variability that exists regarding racism within racial groups.
Additionally, many people do not see the imbalance of power that occurs in discrimination. When blue-eyed people complain that they get discriminated against, they fail to realize the fact that discriminated groups have different power dynamics. For example, some complain that they are discriminated against because of their weight. However, they can do something about their weight unlike their natural skin pigmentation and associated race. I believe the fact that people refuse to acknowledge the presence and effect of racism reveals that society still has a long way to go. There are several racist situations I have observed myself and done nothing about. This is because we often fail to acknowledge the depth of this racism and hence do nothing about it. I believe that the experiment forces people to experience discrimination and hence brings up discussion concerning the need to do something to eliminate racism.
Reference
Bryanweb (2019, August 30). How racist are you? with Jane Elliott (shorter version). YouTube.https://www.youtube.com/watch?v=MJ1BQQpdX2c&ab_channel=bryanweb

Address the following in a reflection of no more than 500 words. Use paragraph format, single or double spaced, APA format not required. Be sure to answer each question in detail to receive full credit.
Discuss your experiences working as part of a team this semester. What went well and where was there room for improvement? How will you use what you learned this semester in future courses and your future career?
How have your views on your professional strengths and areas for improvement changed since the beginning of the semester?

Case #1
• M.R. is a 28-year-old female patient in good health that visits the clinic for the first time. She recently moved to Florida from New York due to work relocation. She admits not visiting her PCP frequently but requires medical clearance for her new clerical position. She is sexually active, unprotected, in a monogamous relationship. ROS and physical examination are unremarkable. What to do?
case #1
• Is there a form to fill? yes or not. If yes, what are the requirements?
• Laboratory work-up: ØRoutine: CBC w/ differential; CMP; U/A ØTitters?
• Is a 12-Lead EKG required?
• Is a CXR necessary?
• Would you do HCG?
• What about other recommendations for screening? Which type of level of care is this?
Requirements
– The discussion must address the topic
– Rationale must be provided
– May use examples from your nursing practice
– Formatted and cited in current APA 7
– Use 3 academic sources, not older than 5 years. Not Websites are allowed.
– Plagiarism is NOT permitted

It is very important for all mental health professionals to take very detailed and thorough historical information from their patients. This information should include an adequate social history, complete medical history, and a full mental status examination with a probable treatment plan.
Describe three reasons it is important to gather detailed and extensive information from any patient before you counsel him/her or make medication suggestions. Use evidence-based research to support your position.
Define malingering. Discuss two ways to differentiate between malingering and a DSM5 diagnosis. Use evidence-based research to support your position.
Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.

Mission Medical Center is a 700-bed hospital in an urban city in the Southwest. Mission is part of a vertically integrated healthcare system with a number of physician medical groups, ambulatory care settings and surgical centers, a psychiatric hospital, an orthopedic specialty hospital, and a children’s specialty hospital. All hospitals are within a 50-mile radius of one another. At Mission Medical Center, the nursing division is organized under a chief nursing officer (CNO) who is also designated chief operating officer (COO) for the medical center.
John has 25 years of experience in nursing leadership, and for the past 10 years he has been the CNO for Mission Medical Center. Six nursing directors report to John and provide supervision and direction to Medical-Surgical Services, Surgical Services, Maternal-Newborn Services, Rehabilitation Services, Intensive and Emergency Services, and Professional Support Services. John meets with the directors once a week for a Nursing Operations Council that focuses on the operational aspects of providing and coordinating patient care with other professional disciplines. Once a month, John meets with the directors and the clinical nurse specialists (CNSs) for the Nursing Executive Council. The purpose of the Nursing Executive Council is to promote the professionalism of nursing, advance strategies and initiatives to improve patient care outcomes, promote research and evidence-based practice, and ensure a healthy work environment that attracts and retains nurses. Mission Medical has been designated as a Magnet organization and is currently working toward redesignation, which is scheduled in approximately 2 years.
As an organization, Mission Medical is very forward-thinking and is considered to be one of the top hospitals in the state. One of the reasons that Mission has earned its reputation is because of its recruitment of top medical specialists, attractive new patient bed tower, state-of-the-art capital equipment for patient care and surgical services, and a strong financial foundation. Whereas Mission Medical has strategically sought to advance its market penetration into competitor territory, it has also ben thoughtfully conservative not to overbuild beyond its financial capacity. The strategy to emphasize excellence in patient care services, excellence in the work environment, and excellence in medical staff has attracted a growing market share of insurers that wish to contract with Mission Medical and individuals in the community who have elected to purchase medical care through the Mission Medical Plan.
At one of the Nursing Executive Council meetings, a discussion ensues about changes that may need to occur as a result of penalties incurred from the Affordable Care Act and stagnation in the 30-day readmission rate over the last few years. John and the directors realize that reimbursement has been strongly tied to patient outcomes, readmissions to the hospital within 30 days, and other operational metrics. Although the nursing-sensitive indicators, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and satisfaction levels of patients, physicians, and nurses are extremely high, the directors realize that they must ensure that every patient is ready to be discharged and able to care for him- or herself at home to prevent readmissions within 30 days of discharge. The directors and clinical nurse specialists discuss a number of ideas. John encourages the open discussion and listens to each of the ideas with interest. While he quietly listens to the input from the nursing leaders, he considers the various organizational structures and processes that might need to change to support some of the ideas. He realizes that he must also encourage nurse leaders to consider how they will measure the effect of the changes that they would like to implement, but he does not want to discourage the open dialogue and freethinking during the initial stages of the discussion.
One of the major points of discussion is about lowering readmissions within 30 days of discharge. Because of the major financial impact that this issue has on the hospital’s bottom line, John and the nurse leaders are keenly interested in any innovative thinking as to how to reduce occurrences. After several hours of open dialogue, John asks the CNSs and the nursing directors to divide into three teams and challenges them to work together in their teams to identify a strategy around reducing admissions. To incentivize the groups, John states that the team with the best idea will be rewarded with a prize for their respective areas. He also tells them that their ideas must include not only the intervention but also methods of measuring the effect of the intervention on reducing readmission rates. He suggests that the directors work with the chief financial officer (CFO) to develop a return on investment (ROI) on their respective ideas. The group agrees that they will reconvene in 1 month for each group to present their ideas.
Three groups return a month later with posters to illustrate their respective plans, formal PowerPoint presentations, and supporting evidence to substantiate their innovative thinking. Group 1 recommends developing a role in each unit for a discharge resource nurse, who would not be counted in the daily staffing, but who would be responsible for reviewing each patient’s status for discharge. The discharge resource nurse would coordinate a patient’s needs with social services, the discharge planner, the physician, and the patient’s family to ensure that all of the resources that the patient needs after discharge would be readily available upon arrival home. In addition, the discharge resource nurse would assess patients’ understanding of their illness each day and their knowledge of their medications, required therapies, and appointments with their primary providers. A significant part of the discharge resource nurse’s role would include patient and family education and assessment of the patient’s readiness for discharge. Group 1 suggests they would measure success by reducing the number of readmissions per quarter from the existing baseline. They estimate that the cost savings from potential losses in reimbursement without the intervention would more than pay for the expense of the new discharge resource nurse position.
Group 2 proposes a very similar intervention; however, they based their proposal on evidence that demonstrated the effectiveness of a patient-centered approach to care in improving patients’ knowledge and ability to care for themselves prior to and after discharge. Group 2 proposes defining “patient-centered care” to be patient empowerment, engagement, and activation in their care. The new definition of patient-centered care would reflect nursing’s involvement in educating the patient and empowering patients with knowledge to be completely engaged in decisions related to their care, and thereby activating patients’ own resources to care for themselves at home. Group 2 presents the notion that every nurse believes that he or she provides patient-centered care without fully understanding the concept or realizing the nurse’s role and responsibility in ensuring patients’ involvement in their own care. The CNSs in Group 2 propose an educational platform for nurses to promote the new definition of patient-centered care and provide standardized educational plans for high-risk conditions that have been correlated with readmissions in the past. The CNSs propose that they would measure the effectiveness of their plan by having patients and/or their families complete a readiness for discharge assessment tool that they had reviewed in the literature and to measure the patients’ knowledge and abilities to follow up with their proposed treatment plan during hospitalization and after discharge.
Group 3 recommends a collaborative, interprofessional approach using team rounding with patients each morning to ensure that patients and family are knowledgeable about the plan of care. In addition to the team rounding, Group 3 suggests changing the unit structure to include a clinical nurse leader (CNL) who would be assigned to approximately 12 patients with a team of primary care nurses. The CNL would be coordinate each patient’s care among the various disciplines and ensure that patients were instructed in self-care and engaged in their care. In addition, the CNL would coordinate with the discharge planner, social services, and other specific disciplines to meet with the patient each day of his or her hospitalization in preparation for discharge. Group 3 also proposes adding a responsibility to the primary nurse’s role to call each of the discharged patients 1 week after discharge to ensure that they are adequately cared for and following up with medications, therapies, and provider appointments. Group 3’s proposal includes the addition of several new positions. They present several studies where the role of the CNL saved money in other organizations and improved patient satisfaction, physician satisfaction, and nurse satisfaction rates as well as patient outcomes.
John invites the CFO, the CEO, and a guest consultant to hear each of the proposals and to provide feedback to each of the teams. It is a time of great excitement because of the competitive nature of the presentations, but also friendly engagement in discussions about the merits of each of the proposals. It is suggested that the best intervention would be a combination of all three proposals with the development of the CNL who would act as a patient care coordinator and a resource nurse to support direct care providers. In addition, it is suggested that the discharge nurse coordinators assume a greater role in assessing patients’ readiness for discharge and that the CNS group and nurse educators assume a greater role in assessing patients’ level of knowledge and ability to care for themselves and to follow up with the proposed treatment plan during hospitalization or after discharge. It is decided that a previously published instrument, the readiness for discharge assessment tool, would be used with all patients to assess their level of empowerment through education, engagement in decision making and planning, and activation of their own skills for self-care. It is also decided that the readiness for discharge tool would be used again in a follow-up phone call by a discharge liaison nurse (new role) who would contact each of the discharge patients for the unit on day 2, day 5, and then weekly for a month after discharge. In addition, the group develops a “Call a Nurse” hotline to facilitate decision making among discharged patients relative to their questions about their health status, follow-up instructions, or care questions.
The CFO offers to work with the directors to estimate the expense of the new positions and the return on the investment for minimizing the number of readmissions each quarter. All participants realize the risks involved in adding new full-time equivalents (FTEs), but also realize the potential loss of revenue that would result from failure to reduce admissions within 30 days of discharge. The CEO and CFO are particularly impressed with the evidence shared from other hospitals that had implemented the CNL role and subsequently reported positive outcomes from having nurses with master’s degrees coordinating the care, discharge, and after-hospitalization experience of a small group of assigned patients. This idea coupled with the other support roles seems to be the best innovation to address the problem of loss of revenue related to readmissions within 30 days of discharge.
Questions:
1. What are your thoughts about John’s approach to using friendly competition among the three groups to motivate them to think creatively about solving the problem?
2. Because the three groups were charged with designing an innovative solution to the problem, how do you think that the morphing of their proposals into a fourth solution affected the nurse leaders’ motivation to think creatively in the future?
3. What barriers, if any, do you think that the nursing leaders will encounter when implementing the final proposal to reduce admission rates?
4. Address what leadership theory is in use.

Post a total of 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to classmates or your faculty member. Substantive responses offer new info and add to the conversation. *Responses are substantive by incorporating literature to support statements. Use one literature resource for your weekly response and in both of your replies to a classmate or faculty. You can use the same source of literature each time or different sources. Check rubric for more details.
Due Thursday
Respond to the following in a minimum of 175 words:
Watch the TED Talks segment “Unintended Consequences of Informed Consent” from the University Library.
As you watch the video, think of other instances where regulations can become a hindrance to progress or advancements.
Summarize why regulations became hindrances in those instances.
*****TEDTalks (2012). Unintended consequences of informed consent [Video segment in TEDTalks: John Wilbanks—Let’s pool our medical data]. (03:36)***
Due Monday
Post 2 replies to classmates or your faculty member. Be constructive and professional.

1. Interoperability can only be achieved when provider organizations do the work necessary to participate. Do provider organizations have the necessary incentives to do that work?
2. Private health information exchanges seem to be growing at a faster pace than public health information exchanges. Public exchanges should arguably offer more value to patients and lower costs to provider organizations. Why the discrepancy?
3. The INPC, originated as a research project, was initially funded by grants and one of the ongoing value propositions is research use of the data. Is research necessarily critical to success of a health information exchange?
4. Establishing and operating a health information exchange requires a variety of investments including computing and network infrastructure, software systems of various types, legal and operational costs. Would you agree that data capture and normalization is the largest investment required?
5. Computing infrastructure, networking technology, software and clinical information standards will continue to evolve rapidly and investments in the technology will depreciate relatively rapidly. What are the core assets of an HIE if not these things?

ANSWER
Do provider organizations have the necessary incentives to participate in health information exchange (HIE)?
There are a number of incentives that can encourage provider organizations to participate in HIE, including:

Improved patient care: HIE can help providers to deliver better care to their patients by giving them access to a more complete picture of the patient’s medical history. This can help providers to identify and avoid potential problems, and to develop more effective treatment plans.
Reduced costs: HIE can help to reduce costs by eliminating the need for providers to duplicate tests and procedures. It can also help to reduce the risk of medical errors and adverse events.
Increased revenue: HIE can help providers to increase revenue by making it easier for them to participate in pay-for-performance programs and other value-based payment arrangements.
However, there are also some challenges that can discourage provider organizations from participating in HIE, such as:

Cost and complexity: Implementing and operating an HIE can be costly and complex, especially for smaller organizations.
Privacy and security concerns: Providers need to be confident that their patients’ data will be safe and secure when it is shared through an HIE.
Lack of interoperability: HIEs need to be interoperable with the electronic health record (EHR) systems that providers use. This is not always the case, which can make it difficult for providers to participate in HIE.
Despite these challenges, the number of provider organizations participating in HIEs is increasing. This is due in part to the incentives listed above, as well as to government regulations that are promoting the adoption of HIE.

Why are private health information exchanges (HIEs) growing at a faster pace than public HIEs, even though public HIEs arguably offer more value to patients and lower costs to provider organizations?
There are a number of reasons why private HIEs are growing at a faster pace than public HIEs. One reason is that private HIEs are typically more flexible and agile than public HIEs. This is because private HIEs are not subject to the same level of government regulations as public HIEs.

Another reason is that private HIEs are often seen as being more innovative than public HIEs. This is because private HIEs are incentivized to develop new products and services that meet the needs of their customers.

Finally, private HIEs are often better funded than public HIEs. This is because private HIEs can generate revenue from the sale of their products and services. Public HIEs, on the other hand, are typically funded by government grants.

Despite the faster growth of private HIEs, public HIEs still play an important role in the healthcare system. Public HIEs can provide access to health information for patients who do not have access to private HIEs. Public HIEs can also play a role in coordinating care for patients who see multiple providers.

Is research necessarily critical to the success of a health information exchange (HIE)?
Research can play an important role in the success of an HIE. Research can help to identify the best ways to implement and operate an HIE. Research can also help to identify the benefits and risks of HIEs.

However, research is not necessarily critical to the success of an HIE. There are many HIEs that are successful without conducting any research. These HIEs are focused on providing a valuable service to their customers, and they are not as interested in conducting research.

Whether or not research is critical to the success of an HIE depends on the goals of the HIE. If the goal of the HIE is to provide a valuable service to its customers, then research is not necessarily critical. However, if the goal of the HIE is to advance the science of HIE, then research is essential.

Would you agree that data capture and normalization is the largest investment required to establish and operate a health information exchange (HIE)?
Data capture and normalization can be a significant investment for HIEs. This is because HIEs need to be able to capture data from a variety of different sources, including EHRs, laboratory systems, and imaging systems. This data can be in a variety of different formats, and HIEs need to be able to normalize the data so that it can be easily shared and used by different providers.

However, data capture and normalization is not the only investment required to establish and operate an HIE. Other investments include computing and network infrastructure, software systems, and legal and operational costs.

The relative size of the investment in data capture and normalization will vary depending on the specific HIE. For some HIEs, data capture and normalization may be the largest investment. For other HIEs, the investment in computing and network infrastructure may be larger.

Much discussion takes place regarding nursing membership on boards of trustees of organizations and systems. Discussions often reflect the historical perception and relationship of nurses to the healthcare organization, a frame of reference that challenges notions of nurses at the governance table. Yet nurses are more than 60% of patient care providers in healthcare organizations, representing the largest single stakeholder group offering healthcare services. Tradition allows that physicians are at the governance table, yet nurses are excluded. As a group, and in recognition of the significance of the profession of nursing in healthcare organizations, it is now time for you to make the argument for nursing representation on your healthcare system’s board of trustees. Respond to the following questions to help construct your argument:
1. What unique value does the nurse representative bring to the board different from what is already present?
2. What area of expertise would you expect the nurse to contribute as a member of the board?
3. What skills and credentials would you suggest the nursing board member bring and how would you make sure this nurse represents the larger community?
4. Which principles of complexity leadership will the good nurse board member fulfill?
5. In what way is the advanced practice nurse involved in boards?

In this discussion, you’ll describe a patient with a mood disorder and the appropriate nursing interventions. Please answer the following questions in your initial posting:
Describe a client from your clinical setting or previous experience who experienced depression or mania. Include a brief history and 3-5 most pertinent medications.
Identify one problem that was not resolved with the treatment regimen. What are the reasons it may not have been successful? Include nursing as well as other team members.
Identify one effective nursing intervention and why you feel it worked.
Overall, do you feel this client was kept safe? Why or why not?
Please provide supporting evidence for your answers.

Changing Factors & S.M.A.R.T.
Discuss examples of internal and external factors that impact an organization and its ability to change
Describe the characteristics of S.M.A.R.T. goals
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.