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Information Systems and Changing Organizational Culture

Information Systems and Changing Organizational Culture

Information Systems and Changing Organizational Culture

The Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (2011) notes that “the nursing profession is the largest segment of the nation’s health care workforce.” Nursing’s three million–plus members are known for their ability to react quickly and efficiently on the front lines of patient care. This agility is lost, however, when the nursing profession fails to evolve with the field of information technology. Have you witnessed any unintentional barriers that have excluded nurses from quickly adopting and accepting informatics systems?

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Those nurses who apply strategies developed by change management experts can help expedite the adoption process by positively addressing staff concerns and implementation challenges. In this Discussion, you explore change leadership strategies through a role-playing activity.
Reference:
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health [Consensus report]. Retrieved from the Institute of Medicine of the National Academies website: http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
To prepare:

  • Review      the Learning Resources, focusing on the findings of the TIGER Leadership      Collaborative.
  • Consider      the TIGER Nursing Informatics Competencies model from a leadership      standpoint.
  • Engage      in the following role play: Your practice setting has appointed you to      lead the implementation of a new information technology initiative. As you      plan for this undertaking, you consider the various challenges that this      implementation may bring to your practice.

 

  • Select       an information technology initiative that your practice could benefit       from (i.e., a new information system, point-of-care service, robotics       machinery, mobile devices, glucometers, smart pumps etc.).
  • What       change management strategies might you utilize to facilitate a quick and       successful implementation?
  • What       potential barriers might the initiative bring to the practice? What       leadership strategies could shift the culture toward a smooth transition?

write a minimum of 550 words essay in APA format with at least 3 references. Include the level one headings as numbered below:

post a cohesive response that addresses the following:

1) Briefly identify your practice setting (hospital setting) and the information technology initiative you selected. Provide a rationale for your selection. (i.e., a new information system, point-of-care service, robotics machinery, mobile devices, glucometers, smart pumps etc.).

2) Evaluate the potential barriers to implementing your hypothetical initiative.

3) Identify the change management strategies that you would use to facilitate a successful implementation. Identify key resources that you would need to promptly overcome potential barriers.

4) Appraise the leadership strategies that you would employ to establish a culture that supports the new information technology initiative. Reference the TIGER Informatics Competencies where appropriate.

Required Readings

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

Chapter 2, “Strategies for Culture Change”

Chapter 9, “Leadership Collaborative”

Chapter 10, “Challenging Leadership Status Quo”

Chapters 2 and 10 discuss the theories, models, and trends of technology. Chapter 9 details TIGER’s strides in the realms of education and basic competency requirements to better prepare nurses in informatics principles.

Caballero Muñoz, E., & Hullin Lucay Cossio, C. M. (2010). Engaging clinicians in health informatics projects. Studies in Health Technology and Informatics, 151,195-206.

The authors of this article break down the implementation, planning, and design phases of informatics projects into specific management categories. Each category consists of factors that can help to integrate clinician’s work flow needs.

Liaw, S. T., & Gray, K. (2010). Clinical health informatics education for a 21st century world. Studies in Health Technology and Informatics, 151, 479-491.

This article examines the educational and competency requirements put into place by the American Medical Informatics Association.

T.I.G.E.R. Technology Informatics Guiding Education Reform. (2011). Informatics competencies collaborative team. Retrieved from https://web.archive.org/web/20150910131244/http://www.thetigerinitiative.org/docs/tigerreport_informaticscompetencies.pdf

Use this website to acquire the informatics competencies as outlined by the TIGER collaborative. Useful links, resources, and learning objectives can be easily located, as they are categorized into the competencies of basic computer, information literacy, and information management.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Transforming nursing and healthcare through technology: Information systems and changing culture. Baltimore, MD: Author.

Note: The approximate length of this media piece is 7 minutes.

This week’s media presentation provides real-world examples of doctors, nurses, and general staff changing their standard methods and procedures to reap the benefits of new technology systems.

Optional Resources

Simpson, R. L. (2009). Innovations in transforming organizations. Nursing Administration Quarterly, 33(3), 268-272.

Stanton, M. P., & Barnett Lammon, C. A. (2008). The “wins” of change: Evaluating the impact of predicted changes on case management practice. Professional Case Management, 13(3), 161-168.

Szydlowski, S., & Smith, C. (2009). Perspectives from nurse leaders and chief information officers on health information technology implementation. Hospital Topics, 87(1), 3-9.Bottom of Form

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Health Information Technology Project

Health Information Technology Project

Health Information Technology Project

In previous Discussions and Applications, you have explored various aspects of health information technology systems: the historic development of HIT, how data flows across HIT systems, and standards and interoperability requirements including specific terminologies used in your practice setting. In this Application Assignment, you will have the opportunity to further develop your analysis skills by closely examining the implementation of a health information technology system. As a Doctorally prepared nurse, you may find yourself in the position of leading a HIT project team; to be an effective leader and move health information technology projects forward in your organization, you must be able to logically and critically analyze the many aspects and challenges of implementing such a system and then present your insights in a succinct and professional manner. This exercise provides an opportunity to hone those skills. Health Information Technology Project

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Carefully review the project requirements below and plan your time accordingly. Be sure to refer to the standards of nursing informatics practice as you develop this Application, which serves as your Major Assessment for this course.

To prepare:

  • Investigate      a health information technology (HIT) system or health information      technology application in your area of interest. The health information      technology system/application may be in any setting where health care      information is developed or managed. You may choose your system or      application from any organization or virtual environment.
  • Examples       of health information technology systems or health information technology       applications that are acceptable include but are not limited to:
  • Consumer        health applications
  • Clinical        information systems
  • Electronic        medical record (EMR) systems in hospitals or provider offices (SELECT THIS or)
  • Home        health care applications
  • School        health applications
  • Patient        portal/personal health record (or SELECT THIS)
  • Public        health information systems
  • Telehealth        (i.e., from facility to home)
  • Simulation        laboratories
  • Health        care informatics research and development centers
  • Discuss      your proposed health information technology system/application with your      Instructor before proceeding with your final selection. You may visit a      health care organization in person or virtually in order to make your      final choice about the health information technology system or health      information technology application of interest.
  • Choose      the best strategy to gain information about your selected information      technology system/application. Some ways to gather information include      virtual visits; vendor demonstrations; on-site visits; interviews via      face-to-face, phone, or teleconference. You must conduct at least one      interview for this project.
  • Complete      a literature search to gather information about your selected information      technology system. You may also need to review related scholarly articles      to help answer the questions presented below.

NOTE: In your submitted report, do not share proprietary information, personal names, or organization names without permission.

To complete:

Your deliverable is a 12- to 15-page scholarly report, not counting the title page or references. Include an introduction ending with a purpose statement and a conclusion. A successful report should leave the reader with confidence in understanding the answers to all the questions listed below. Graphics may be used to illustrate key points.

Organization Information

1) Briefly describe the health information technology system/application and the organization type (hospital, clinic, public health agency, health care software company, government health information website, private virtual health information site, etc.). Health Information Technology Project

2) Is the health information technology system/application clinical, administrative, educational, or research related?

3) What were the key reasons for the development of this health information technology system/application, i.e., what made the organization believe this system/application was needed? How did this organization determine those needs? Did the organization use specific tools to conduct needs assessments, staff opinions, or workflows?

4) How did the organization determine that this specific system/application could fulfill its predetermined needs?

5) Who manages this health information technology system/application and where are they located within the organization’s administrative structure?

Information System Application Design and Development

1) Many health care systems have multiple independent entities that work together toward the common goal of providing high-quality care. How did—and do—the various stakeholders make decisions related to this health information technology system/application? Were the end users involved in the development of this health information technology system/application?

2) How are individuals trained to use the health information technology system/application?

3) How are security issues addressed? How does this health information technology system/application support a legally sound health care record?

4) Where did initial funds for this health information technology system/application come from?

5) Who manages the budget for this health information technology system/application?

6) Have organizational or political issues impacted the ongoing funding for this health information technology system/application?

7) What are the arrangements for planned or unplanned downtime?

8) How are health information technology system/application upgrades scheduled or planned?

9) How has the health information technology system/application changed in response to health care reform and related legislation?

10) What suggestions could you make regarding changes needed to support health care reform and related legislation?

Innovative Aspects of the System

1) How does the health information technology system/application utilize technology innovations?

2) What technology innovations would you recommend for this organization? What innovations presented in this course, or found through your own research, could this organization benefit from?

3) What innovations could further promote evidence-based practice and efficiency within this organization?

End Product

Your report is a scholarly paper and needs to include a minimum of 10 citations from peer-reviewed journals. Every statement made in a scholarly report must be supported by a reference. Be very cautious when stating your opinion, or using terms suggesting absolute facts, or values, as these must be supported by references. Note that textbooks, including the course texts, are composed of information cited from other sources (see the reference section in the course textbooks). With this in mind, there should be an adequate number of appropriate references (a minimum of 10). Please note that primary sources are to be used. Peer-reviewed journal articles should make up the bulk of your references (90%). If referring to a book, be sure to include all information in APA style, including specific page numbers when necessary. Note that an article referred to in a book is a secondary source. More on this topic is available in the APA Publication Manual and in the  Writing Center. See also “Policies on Academic Honesty” listed at the website.

A superior paper demonstrates breadth and depth of knowledge, and critical thinking appropriate for doctoral level scholarship. The report must follow APA Publication Manual guidelines (6th edition) and be free of typographical, spelling, and grammatical errors. This Application is the Major Assessment for this course. You will submit this document by Week 9.

REQUIRED READINGS

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

  • Review      Chapter 16, “Personal Health Record: Managing Personal Health”

This chapter focuses on the future of personal health records and consumerism, as well as the initiatives being developed to strengthen health literacy in the patient population. The nurse’s role in the development of personal health records is also discussed.

Reti, S. R., Feldman, H. J., Ross, S. E., & Safran, C. (2010). Improving personal health records for patient-centered care. Journal of the American Medical Informatics Association, 17(2), 192–195.

Several key elements that designers and practitioners need to be aware of when developing patient-centered electronic health records are outlined in this article.

Schneider, J. M. (2010). Electronic and personal health records: VA’s key to patient safety. Journal of Consumer Health on the Internet, 14(1), 12–22.

This article begins with a brief overview of the benefits and challenges of EHRs and moves into an exemplary example of the record systems currently being used at the VA.

Wagner, P. J., Howard, S. M., Bentley, D. R., Seol, Y., & Sodomka, P. (2010). Incorporating patient perspectives into the personal health record: Implications for care and caring. Perspectives in Health Information Management, 7(Fall), 1–12.

Within this study, the authors integrate patients into a preexisting personal health record system to analyze the overall feelings that patients have about its design and usability options.

Madsen, M. (2010). Knowledge and information modeling. Studies in Health Technology and Informatics, 151, 84-103.

Within this article, the overall design models of information systems are linked to the metastructures, data, information, knowledge, and wisdom.

Peleg, M. (2011). The role of modeling in clinical information system development life cycle. Methods of Information in Medicine, 50(1), 7-10.

The author of this article discusses the role of conceptual modeling in health information technology systems and how it has been an effective component of system development. Health Information Technology Project

Philip, A., Afolabi, B., Adeniran, O., Oluwatolani, O., & Ishaya, G. (2010). Towards an efficient information systems development process and management: A review of challenges and proposed strategies. Journal of Software Engineering and Applications, 3(10), 983-989.

This article examines the phases and methodologies found within the Systems Development Life Cycle (SDLC), and proposes a framework for establishing the crucial roles that participants must play during the SDLC.

Schlotzer, A., & Madsen, M. (2010). Health information systems: Requirements and characteristics. Studies in Health Technology and Informatics, 151, 156–166.

Use this article to examine the importance of focusing on sound design, interoperability of systems, and fulfillment of user needs when developing an effective database.

Munih, M., & Bajd, T. (2010). VI.3. Rehabilitation robotics. Studies in Health Technology and Informatics, 152, 353–366.

In this article, the authors delve into the future of rehabilitation by examining the ways that virtual reality and robotics will transform exercise and management systems used by physical therapists.

Nolan, R. P., Upshur, R. E., Lynn, H., Crichton, T., Rukholm, E., Stewart, D. E., . . . Chen, M. H. (2011). Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial. The American Journal of Cardiology, 107(5), 690–696.

The authors outline a clinical study that examined the benefits of telehealth counseling. They also analyze motivational interviewing as an agent to change daily behaviors and attitudes of those with cardiovascular disease.

Singh, R., Mathiassen, L., Stachura, M. E., & Astapova, E. V. (2010). Sustainable rural telehealth innovation: A public health case study. Health Services Research, 45(4), 985–1004.

This qualitative study examines previous telehealth implementations in efforts to improve future developments and sustainability in rural areas.

Stewart, S., Hansen, T. S., & Carey, T. A. (2010). Opportunities for people with disabilities in the virtual world of second life. Rehabilitation Nursing, 35(6), 254-259.

Use this article to examine the physical and emotional benefits that virtual realities can bring to people with disabilities. Health Information Technology Project

Cisco. (n.d.). Industry solutions: Healthcare.

Retrieved October 14, 2011, from http://www.cisco.com/web/strategy/healthcare/index.html

Investigate the ways that Cisco Industry Solutions is working to bridge the gap between communication and technology for health care environments.

Massachusetts Institute of Technology. (n.d.). MIT media lab.

Retrieved October 14, 2011, from http://www.media.mit.edu/

View various technology integration stories in the field of health care at this website

McKesson Corporation. (2011). ROBOT-Rx. Retrieved from http://www.mckesson.com/en_us/McKesson.com/For%2BPharmacies/Inpatient/Pharmacy%2BAutomation/ROBOT-Rx.html 

The McKesson Coporation illustrates how an automated, robotic system is revolutionizing the process of medication storage and dispensing.

Powell, J., Inglis, N., Ronnie, J., & Large, S. (2011). The characteristics and motivations of online health information seekers: Cross-sectional survey and qualitative interview study. Journal of Medical Internet Research, 13(1), e20.

View excerpts from the online questionnaires and follow-up interviews used in this study to identify common themes around motivation, challenges, strategies, and benefits regarding individuals’ use of the Internet to gather health information.

Health on the Net Foundation. (2011).

Retrieved from http://www.hon.ch/

Health on the Net Foundation provides consumers with navigation safety tips and the ability to search only those websites that adhere to the credibility standards of the HONcode.

The PEW Charitable Trusts. (2011). Health.

Retrieved from http://www.pewtrusts.org/our_work_category.aspx?id=184

At this website you can find information about the consumer-centered health initiatives that the PEW group is working to challenge and improve. Health Information Technology Project

Robert Wood Johnson Foundation. (2011). Publications and research. Retrieved from http://www.rwjf.org/en/research-publications.html 

Use this website to view a wide variety of research-driven publications with topics ranging from obesity to medical malpractice.

  • attachment

    GradingRubric.doc

    Major Assessment #5

    Doctorate in Nursing Practice NURS 8210

    Rubric

    Health Information Technology Project Evaluation

    Program LO: 3

    3: Educator / Consultant

    DNP Essential: 4

    4: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care

    (Scroll down for table)

    ASSIGNMENT PROMPT Target

    5 points

    Acceptable

    3 points

    Unacceptable

    1 point

    Score/Level
    Abbreviated Research Proposal Paper

    Part 1: Information on Organization

    (5 points)

    Program LO: 3

    DNP Essential: 4

    Exemplary quality.

    Content is of a professional portfolio quality; addresses every major subsection in the assignment description of health information technology system/application and the organization type; key reasons for development of this health information technology system/application; management and administrative structure of health information technology system/application using advanced critical thinking skills; does not summarize or paraphrase the content of the literature review, rather demonstrates content mastery using examples and/or personalized reflections about the content of the literature review; demonstrates an applied level of understanding through personalized reflections about the content area. Excels in meeting expectations for graduate level work.

    Fully meets expectations for LO 3

    Fully meets expectations for Essential 4

    Well-developed, good quality work. Content is of a professional portfolio quality; addresses at least 80% of the major subsections in the assignment using adequate critical thinking skills; includes some summarizing or paraphrasing of literature review; demonstrates content mastery using examples and/or personalized reflections about the content of the literature review; demonstrates an applied level of understanding through personalized reflections about the content area. Fully meets expectations for graduate level work.

    Meets expectations for LO3

    Meets expectations for Essential 4

     

    Superficially developed, unacceptable quality.

    Content needs substantial revision for it to be of a professional portfolio quality; addresses less than 50% of the major subsections in the assignment using weak critical thinking skills; consists primarily of a summary of main ideas from the literature review; does not demonstrate an applied level of understanding. Lags behind expectations for graduate level work.

    Insufficient to meet expectations for LO 3

    Insufficient to meet expectations for Essential 4

     
    Part 2: Information System Application: Design

    (5 points)

    Program LO: 3

    DNP Essential: 4

    Exemplary quality.

    Content is of a professional portfolio quality; addresses every major subsection in the assignment clearly and succinctly addresses how stakeholders worked together to design and fund the system application including a detailed description of who manages the budget, and any organizational or political challenges that impacted the initial or ongoing funding of the system/application and how these challenges were addressed using advanced critical thinking skills; does not summarize or paraphrase the content of the literature that supports this section, rather demonstrates content mastery using examples and/or personalized reflections about the content of the literature; demonstrates an applied level of understanding through personalized reflections about the content area. Excels in meeting expectations for graduate level work.

    Fully meets expectations for LO3

    Fully meets expectations for Essential 4

    Well-developed, good quality work.

    Content is of a professional portfolio quality; addresses at least 80% of the major subsections in the assignment using adequate critical thinking skills; addresses how stakeholders worked together to design and fund the system application including a description of who manages the budget, and any organizational or political challenges that impacted the initial or ongoing funding of the system application and how these challenges were addressed; includes some summarizing or paraphrasing of literature that supports this section; demonstrates content mastery using examples and/or personalized reflections about the content of the literature; demonstrates an applied level of understanding through personalized reflections about the content area. Fully meets expectations for graduate level work.

    Meets expectations for LO 3

    Meets expectations for Essential 4

     

    Superficially developed, unacceptable quality.

    Content needs substantial revision for it to be of a professional portfolio quality; addresses less than 50% of the major subsections in the assignment using weak critical thinking skills; consists primarily of a summary of main ideas from the literature that supports this section; does not demonstrate an applied level of understanding. Lags behind expectations for graduate level work.

    Insufficient to meet expectations for LO 3

    Insufficient to meet expectations for Essential 4

     
    Part 3: Information System Application: Implementation

    (5 points)

    Program LOs: 3

    DNP Essential: 4

    Exemplary quality.

    Content is of a professional portfolio quality; addresses every major subsection in the assignment; identifies key security issues and provides a detailed description on how the issues have been addressed; provides an in-depth portrayal of management of health information technology system, including quality of health care records, training of users, and planning for downtime and scheduled updates; includes a thoughtful analysis of system changes in response to health care reform/legislation and well-reasoned recommendation of additional changes needed using advanced critical thinking skills; does not summarize or paraphrase the content of the literature review, rather demonstrates content mastery using examples and/or personalized reflections about the content of the literature review; demonstrates an applied level of understanding through personalized reflections about the content area. Excels in meeting expectations for graduate level work.

    Fully meets expectations for LO 3

    Fully meets expectations for Essential 4

    Well-developed, good quality work.

    Content is of a professional portfolio quality; addresses at least 80% of the major subsections in the assignment using adequate critical thinking skills; identified security issues and described how they have been addressed; provides an overview of management of health information technology system, including quality of health care records, training of users, and planning for downtime and scheduled updates; describes system changes in response to health care reform/legislation and recommendation of additional changes needed; includes some summarizing or paraphrasing of literature review; demonstrates content mastery using examples and/or personalized reflections about the content of the literature review; demonstrates an applied level of understanding through personalized reflections about the content area. Fully meets expectations for graduate level work.

    Meets expectations for LO 3

    Meets expectations for Essential 4

    Superficially developed, unacceptable quality.

    Content needs substantial revision for it to be of a professional portfolio quality; addresses less than 50% of the major subsections in the assignment using weak critical thinking skills; consists primarily of a summary of main ideas from the literature review; does not demonstrate an applied level of understanding. Lags behind expectations for graduate level work.

    Insufficient to meet expectations for LO 3

    Insufficient to meet expectations for Essential 4

     
    Part 4: Innovative Aspects of the System

    (5 points)

    Program LO: 3

    DNP Essential: 4

    Exemplary quality.

    Content is of a professional portfolio quality; addresses every major subsection in the assignment; provides a succinct description of the role of innovation in the health information technology system/application and thoughtful recommendations for additional use of innovations using advanced critical thinking skills; does not summarize or paraphrase the content of the literature review, rather demonstrates content mastery using examples and/or personalized reflections about the content of the literature review; demonstrates an applied level of understanding through personalized reflections about the content area. Excels in meeting expectations for graduate level work.

    Fully meets expectations for LO 3

    Fully meets expectations for Essential 4

    Well-developed, good quality work.

    Content is of a professional portfolio quality; addresses at least 80% of the major subsections in the assignment; provides a description of the role of innovation in the health information technology system/application and recommendations for additional use of innovations using adequate critical thinking skills; includes some summarizing or paraphrasing of the literature review; demonstrates content mastery using examples and/or personalized reflections about the content of the literature review; demonstrates an applied level of understanding through personalized reflections about the content area. Fully meets expectations for graduate level work.

    Meets expectations for LO 3

    Meets expectations for Essential 4

     

    Superficially developed, unacceptable quality.

    Needs substantial revision to be worthy of a professional portfolio; addresses less than half the major subsections in the assignment using weak critical thinking skills; consists primarily of a summary of main ideas from the literature review; does not demonstrate an applied level of understanding. Lags behind expectations for graduate level work.

    Insufficient to meet expectations for LO 3

    Insufficient to meet expectations for Essential 4

     
    Part 5: End Product

    (5 points)

    The majority of references are from scholarly journals, support the topic well, and are current. All sources are peer reviewed. Minimum of 7 citations used. Paper stays within page requirements. APA format is used correctly throughout.

    Report leaves the reader with confidence in understanding the informatics system; graphics are used to illustrate key points.

    Excels in meeting expectations for graduate level work.

     

    Most references are from scholarly journals and support the topic. Most references are fairly current. All sources are peer reviewed. Minimum of 7 citations used. The paper stays within page requirements. APA format is used with minimal errors.

    Report leaves the reader with confidence in understanding the informatics system; graphics are used to illustrate key points.

    Meets expectations for graduate level work.

     

    References are not sufficient or are mostly from the lay literature or out of date. Sources identified are a combination of peer reviewed and nonpeer reviewed. Fewer than 7 citations used. The paper is either too long or too short. Weak writing quality and/or little evidence of correctness of APA format.

    Report does not leave the reader with confidence in understanding the informatics system; graphics are minimally used or not used to illustrate key points.

    Work lags behind expectations for graduate level work.

     

     

    Health Information Technology Project Assignment:

    Write a 12- to 15-page (plus references) paper that includes the following:

    Organization Information (5 points)

    · Briefly describe the health information technology system/application and the organization type (hospital, clinic, public health agency, software company, government health information website, private virtual health information site, etc.).

    · Is the health information technology system/application clinical, administrative, educational, or research related?

    · What were the key reasons for development of this health information technology system/application?

    · Who manages this health information technology system/application and where are they located within the organization’s administrative structure?

    Information System Application: Design (5 points)

    · Many health systems have multiple independent entities that work together toward a common goal of providing health care. How did the various stakeholders work together to make decisions related to this health information technology system/application? Were the end users involved in the development of this health information technology system/application. Health Information Technology Project

    · How was this health information system/application initially funded?

    · Have organizational or political issues impacted the ongoing funding for this health information technology system/application?

    · Who manages the budget for this health information technology system/application?

    Information System Application: Implementation (5 points)

    · How are security issues addressed; how does this health information technology system/application support a legally sound health care record?

    · How are individuals trained to use the health information technology system/application?

    · What are the plans for planned or unplanned downtime?

    · How are health information technology system/application upgrades scheduled or planned?

    · How has the health information technology system/application changed in response to health care reform and related legislation?

    · What suggestions could you make regarding changes needed to support health care reform and related legislation?

    Innovative Aspects of the System (5 points)

    · How are technology innovations being used in the health information technology system/application?

    · What technology innovations could you recommend for this organization?

    End Product (5 points)

    · The paper is 12- to 15-page report.

    · The report leaves the reader with confidence in understanding the informatics system.

    · Graphics are used to illustrate key points.

    · The report is a scholarly paper and includes a minimum of 7 citations from peer-reviewed journals.

    · Appropriate APA format is used.

    *Note: Up to 5 points (20%) may be deducted for grammar and APA style errors.

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Discussion 28 Paper: Adjectives

Discussion 28 Paper: Adjectives

Discussion 28 Paper: Adjectives

Provide examples of the adjectives mentioned in the workshop.

  • attachment

    NCLEXStrategiesmodule2ongoing-Copy.pptx

    NCLEX Strategies: Getting ready

    By: Guillermo Londono RN, MSN/MHA

    Dean / Director of Nursing at Censa International College (CIC)

    June 5, 2017

    NCLEX Strategies

    Objectives:

    More Strategy learning aids:

    Critical thinking

    Strategy steps:

    What is the question really asking?

    Look for hints:

    The adjectives

    The phrase further teaching

    The phrase client understands

    Reword the question

    Find clues if any

     

    NCLEX Strategies

    Getting ready Strategies

    The NCLEX-RN exam is not a test about recognizing facts.

    You must be able to correctly identify what the question is asking.

    Do not focus on background information that is not needed to answer the question.

    The NCLEX-RN exam focuses on thinking through a problem or situation.

    NCLEX Strategies

    The anatomy of an NCLEX-RN question:

    Item: the entire question and answer

    Stem: the actual question, what is being asked

    Options: possible responses

    Correct answer: the correct answer

    Distractors: incorrect answers

    NCLEX Strategies

    Stem:

    The stem will have a few characteristics that you must consider.

    Complete sentence

    Incomplete sentence – becomes complete with the correct answer

    Positive – asks a question regarding what is true

    Negative – asks a question regarding what is false.

     

    Note of caution:

    Be very careful with these negative questions.

    These tend to be missed more often simply because students fail to read the entire question.

    ALWAYS read the entire stem carefully and completely.

    NCLEX Strategies

    Look for these words when determining if the stem is negative:

    Except

    Not/is not

    Never

    Further/ needs further

    Least

    Avoid/avoided

    Contraindicated

    Ineffective

    There are a few app questions in particular that are missed on a daily basis by users and it is always due to reading the question incorrectly.

    These are not difficult questions, but they are consistently missed. Here are some examples:

    7

    NCLEX Strategies

    Example question: “A patient is admitted to the hospital with an INR of 3.9, history of a GI bleed, and osteomyelitis. The patient is complaining of bone pain, so the nurse prepares to administer morphine. Which route should be avoided?”

     

    A. PO

     

    B. IV

     

    C. IM

     

    D. SQ

     

    How would you answer this question?

    With an elevated INR of 3.9, the patient is at risk for bleeding. Muscles are highly vascular and should be avoided due to the bleeding risk

     

    8

    NCLEX Strategies

    Example question #2: A patient is diagnosed with an infection caused by the hepatitis A virus. Which statement, if made by the patient, would indicate the patient needs further teaching about the infection?

    A. “It’s important for me to remember to wash my hands after I use the bathroom.”

    B. “I might get liver cancer someday because I have this infection.”

    C “Before I take any over-the-counter medicines I should call the clinic.”

    D “I will wash raw fruits and vegetables thoroughly before I eat them.”

     

    9

    NCLEX Strategies

    Remember, the NCLEX-RN exam is testing your ability to think critically.

    Critical thinking for the nurse involves the following:

    Observation

    Deciding what is important

    Looking for patterns and relationships

    Identifying the problem

    Transferring knowledge from one situation to another

    Applying knowledge

    Discriminating between possible choices and/or courses of action

    Evaluating according to criteria established

     

    NCLEX Strategies

    More Strategy learning aids:

    The first step to correctly answering NCLEX-RN exam questions is to find out what each question is really asking.

    Read each question carefully from the first word to the last word.

    Read them carefully and slowly pace.

     

    Second step: Look for hints in the wording of the question stem.

    The adjectives most, first, best, primary, and initial indicate that you must establish priorities.

    The phrase further teaching is necessary indicates that the answer will contain incorrect information.

    The phrase client understands the teaching indicates that the answer will be correct information. Discussion 28 Paper: Adjectives

     

     

    NCLEX Strategies

    3. Reword the question stem in your own words so that it can be answered with a yes or a no, or with a specific bit of information. Discussion 28 Paper: Adjectives

    Begin your questions with what, when, or why. We will practice this strategy with some examples.

    4. If you can’t complete previous step, read the answer choices for clues.

     

    Clues

    NCLEX Strategies

    Class Activity #1- A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?

    “Six lesions noted on buttocks at various stages of healing.”

    “Multiple lesions on buttocks due to child abuse.”

    “Lesions on buttocks due to unknown causes.”

    “Several lesions on buttocks caused by cigarettes.”

     

    NCLEX Strategies

     

    Example question

    A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?

    “Six lesions noted on buttocks at various stages of healing.”

    “Multiple lesions on buttocks due to child abuse.”

    “Lesions on buttocks due to unknown causes.”

    “Several lesions on buttocks caused by cigarettes.”

     

    The first step to correctly answering NCLEX-RN exam questions is to find out what each question is really asking.

    1-Read the question stem carefully.

    NCLEX Strategies

     

    Example question

    A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?

     

    2-Look for hints in the wording of the question stem.

    The adjectives

    The phrase further teaching

    The phrase client understands

    Most appropriately tells you that you need to select the best answer.

    NCLEX Strategies

     

    Example question

    A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?

    1.“Six lesions noted on buttocks at various stages of healing.”

    2.“Multiple lesions on buttocks due to child abuse.”

    3.“Lesions on buttocks due to unknown causes.”

    4.“Several lesions on buttocks caused by cigarettes.”

     

     

    3-Reword the question stem in your own words.

    “What is the best charting for this situation?”

    NCLEX Strategies

    Example question

    A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?

    1.“Six lesions noted on buttocks at various stages of healing.”

    2.“Multiple lesions on buttocks due to child abuse.”

    3.“Lesions on buttocks due to unknown causes.”

    4.“Several lesions on buttocks caused by cigarettes.”

     

    4- Because you were able to reword the question, the fourth step is unnecessary

    You didn’t need to read the answer choices for clues.

    NCLEX Strategies

    Example question

    A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?

    1.“Six lesions noted on buttocks at various stages of healing.”

    2.“Multiple lesions on buttocks due to child abuse.”

    3.“Lesions on buttocks due to unknown causes.”

    4.“Several lesions on buttocks caused by cigarettes.”

     

    Explanatory notes

    The Reworded Question: “What is good charting?”

    Step 1. Do not look at any of the answer choices except for answer choice (1). Thoughtfully consider each answer choice individually.

    Step 2. Read answer choice (1). Does it answer the question, “What is good charting for this situation?”

    (1) “Six lesions noted on buttocks at various stages of healing.” Is this good charting? Maybe. Leave it in for consideration.

    Step 3. Repeat the process with each remaining answer choice.

    (2) “Multiple lesions on buttocks due to child abuse.” Is this good charting? No, because the

    nurse is making a judgment about the cause of the lesions.

    3) “Lesions on buttocks due to unknown causes.” Is this good charting? Maybe. Leave it in for consideration.

    (4) “Several lesions on buttocks caused by cigarettes.” Is this good charting? No. The question does not include information about how the lesions occurred.

    Step 4. Answer choices (1) and (3) remain.

    Step 5. Reread the question to make sure you have correctly identified the Reworded Question. This question asks you to identify good charting.

    Step 6. Which is better charting? “Six lesions noted on buttocks at various stages of healing,” or “Lesions due to unknown causes”? Good charting is accurate, objective, concise, and complete. It must reflect the client’s current status. The correct answer is (1).

    Some students will select answer (3), thinking, “How can I be sure about the stages of healing?” But the purpose of this question is to test your ability to select good charting.

    Select the answer choice that shows you are a safe and effective nurse. Remember, questions on the NCLEX-RN® exam are not designed to trick you. Stay focused on the question.

     

    19

    NCLEX Strategies

    Class Activity #2- A construction worker is admitted to the hospital for treatment of active tuberculosis (TB). The nurse teaches the client about TB. Which of the following statements by the client indicates to the nurse that further teaching is necessary?

    “I will have to take medication for 6 months.”

    “I should cover my nose and mouth when coughing or sneezing.”

    “I will remain in isolation for at least 6 weeks.”

    “I will always have a positive skin test for TB.”

     

    The correct answer is (c). You “know” this is the correct answer because you’ve eliminated the other three answer choices. The client does not need to be isolated for 6 weeks. The client’s activities will be restricted for about 2–3 weeks after medication therapy is initiated.

    21

    NCLEX Strategies

    Class Activity #3: Apply the previous steps to answer the following question.

    A woman admitted to the hospital in premature labor has been treated successfully. The client is to be sent home on an oral regimen of terbutaline (Brethine). Which of the following statements by the client indicates to the nurse that the client understands the discharge teaching about the medication?

    “As long as I take my medication, I can be sure I will not deliver prematurely.”

    “It is important that I count the fetal movements for one hour, twice a day.”

    “I may feel a rapid heartbeat and some muscle tremors while on this medication.”

    “Bed rest is necessary in order for the medication to work properly.”

     

    If you are focused on the question, you will select (C).

    22

    NCLEX Strategies

    Strategy review:

    1-Read the question stem carefully.

    The first step to correctly answering NCLEX-RN exam questions is to find out what each question is really asking.

    2-Look for hints in the wording of the question stem.

    The adjectives

    The phrase further teaching

    The phrase client understands

    3-Reword the question stem in your own words.

    “What is incorrect (or wrong) information about TB?”

    4-You didn’t need to read the answer choices for clues.

    Think of priority, ABC, and safety.

     

    NCLEX Strategies

    Objectives:

    More Strategy learning aids

    Critical thinking

    Strategy steps:

    What is the question really asking?

    Look for hints:

    The adjectives

    The phrase further teaching

    The phrase client understands

    Reword the question

    Find clues if any

  • attachment

    NCLEXStrategiesthenursingprocessandsafety.pptx

    NCLEX Strategies: Getting ready (The Nursing Process)

    By: Guillermo Londono RN, MSN/MHA

    Dean / Director of Nursing

    July 1, 2017

     

    Objectives:

     

     

     

     

     

     

    Recognizing Priority Questions key words

    You will recognize priority questions on the NCLEX-RN exam because they will ask you what is the:

    “best,”

    “most important,”

    “first,”

    or “initial response” by the nurse.

     

     

    NCLEX Strategies

     

     

     

     

     

     

    Recognizing Priority Questions

    Students will be caring for clients who have multiple problems and needs.

    Students must be able to establish priorities by deciding which needs take precedence over the other needs.

    Example: Students probably recognized the baby’s jerky movements as an indication of hypoglycemia.

     

    NCLEX Strategies

     

     

     

     

     

     

    Recognizing Priority Questions

    Don’t forget that an important part of the assessment process is validating what you observe.

    Students must complete an assessment before you analyze, plan, and implement nursing care.

    The critical thinking required for priority questions is for you to recognize patterns in the answer choices.

    By recognizing these patterns, students will know which path you need to choose to correctly answer the question.

     

    NCLEX Strategies

     

     

     

     

     

     

    Recognizing Priority Questions

    There are three strategies to help you establish priorities on the NCLEX-RN exam:

     

    Maslow strategy

    Nursing process strategy

    Safety strategy

    NCLEX Strategies

     

     

     

     

     

     

    We will outline each strategy, describe how and when it should be used, and show you how to apply these strategies to exam-style questions.

    By using these strategies, you will be able to eliminate the second-best answer and correctly identify the highest priority.

     

    6

    Strategy Two: Nursing Process (Assessment versus Implementation)

     

    Strategy Two: Nursing Process

     

     

     

     

     

     

     

    7

    Strategy Two: Nursing Process (Assessment versus Implementation)

    A second strategy that will assist you in establishing priorities involves the assessment and implementation steps of the nursing process.

    On the NCLEX-RN exam, you will be given a clinical situation and asked to establish priorities.

    The possible answer choices will include both the correct Assessment and Implementation for this clinical situation.

    How do you choose the correct answer when both the correct assessment and implementation are given?

    NCLEX Strategies

    Think about these two steps of the nursing process.

     

     

     

     

     

     

    As a nursing student, you have been drilled so that you can recite the steps of the nursing process in your sleep—assessment, analysis, planning, implementation, and evaluation. In nursing school, you did have some test questions about the nursing process, but you probably did not use the nursing process to assist you in selecting a correct answer on an exam.

     

     

     

    8

    Assessment keywords

    adaptations

    ascertain

    assess

    check

    collect

    communicate

    determine

    find out

    gather

    identify

     

    inform

    inspect

    monitor

    nonverbal

    notify

    observe

    obtain information

    perceptions

    question

    verify

     

     

     

     

     

     

     

    Strategy Two: Nursing Process (Assessment versus Implementation)

    Assessment is the process of establishing a data profile about the client and his or her health problems.

    The nurse obtains subjective and objective data in a number of ways:

    talking to clients, observing clients and/or significant others

    taking a health history, performing a physical examination

    evaluating lab results

    collaborating with other members of the health care team.

    NCLEX Strategies

     

     

     

     

     

     

    Strategy Two: Nursing Process (Assessment versus Implementation)

    Once you collect the data, you compare it to the client’s baseline or normal values.

    On the NCLEX-RN exam, the client’s baseline may not be given, but as a nursing student you have acquired a body of knowledge. Discussion 28 Paper: Adjectives

    On this exam, you are expected to compare the client information you are given to the “normal” values learned from your nursing textbooks.

    It is essential that you complete the assessment phase of the nursing process before you implement nursing activities.

    This is a common mistake made by NCLEX-RN exam takers: don’t implement before you assess.

    NCLEX Strategies

    Assessment is the first step of the nursing process and takes priority over all other steps.

    REMEMBER

     

     

     

     

     

     

    Strategy Two: Nursing Process (Assessment versus Implementation)

    Implementation is the care you provide to your clients.

    Implementation includes:

    assisting in the performance of activities of daily living (ADLs).

    counseling and educating the client and the client’s family.

    giving care to clients, and supervising and evaluating the work of other members of the health team.

    NCLEX Strategies

     

     

     

     

     

     

    Implementation Keywords

    action

    assist

    change

    counsel

    delegate

    dependent

    facilitate

    give

    Implement

    independent

    inform

    instruct

     

     

    interdependent

    method

    motivate

    perform

    procedure

    provide

    refer

    strategy

    supervise

    teach

    technique

    treatment

     

     

     

     

     

     

     

    Strategy Two: Nursing Process (Assessment versus Implementation)

    Nursing interventions may be independent, dependent, or interdependent.

    Independent interventions are within the scope of nursing practice and do not require supervision by others.

    Instructing the client to turn, cough, and breathe deeply after .

    Dependent interventions are based on the written orders of a physician.

    On the NCLEX-RN exam, you should assume that you have an order for all dependent interventions that are included in the answer choices.

     

    NCLEX Strategies

     

     

     

     

     

     

    This may be a different way of thinking from the way you were taught in nursing school.

     

    Many students select an answer on a nursing school test (that is later counted wrong) because the intervention requires a physician’s order. Discussion 28 Paper: Adjectives

    Everyone walks away from the test review muttering, “Trick question.”

    It is important for you to remember that there are no trick questions on the NCLEXRN exam.

    You should base your answer on an understanding that you have a physician’s order for any nursing intervention described.

     

    Interdependent interventions are shared with other members of the health team. For instance, nutrition education may be shared with the dietitian. Chest physiotherapy may be shared with a respiratory therapist.

    14

    Strategy Two: Nursing Process (Assessment versus Implementation)

    The following strategy

    Utilize the assessment and implementation phases of the nursing process.

    It will assist you in selecting correct answers to questions that ask you to identify priorities.

     

    NCLEX Strategies

     

     

     

     

     

     

    Strategy Two: Nursing Process (Assessment versus Implementation)

     

    STEP 1: use the Nursing Process (Assessment vs. Implementation) strategy.

    Read the answer choices to establish a pattern.

    If the answer choices are a mix of assessment/validation and implementation

    STEP 2- Refer to the question to determine whether you should be assessing or implementing.

    If after Step 2 you find that, for example, it is an assessment question, eliminate any answers that clearly focus on implementation.

    STEP 3- Eliminate answer choices, and then choose the best answer (PRIORITY).

    NCLEX Strategies

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Class activity #3: Apply, analyze and use critical thinking

    A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?

    Immobilize the affected limb with a splint and ask him not to move.

    Make a thorough assessment of the circumstances surrounding the accident.

    Put him in semi-Fowler’s position for comfort.

    Check the pedal pulse and blanching sign in both legs.

     

    NCLEX Strategies

     

     

     

     

     

     

    Strategy Two: Nursing Process (Assessment versus Implementation)

    Practice question.

    A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?

    Immobilize the affected limb with a splint and ask him not to move.

    Make a thorough assessment of the circumstances surrounding the accident.

    Put him in semi-Fowler’s position for comfort.

    Check the pedal pulse and blanching sign in both legs.

    NCLEX Strategies

    Assessment vs. Implementation

    The answer choices are a mix of assessment/validation and implementation

     

     

     

     

     

     

    The words “ first action” tell you that this is a priority question.

     

    The Reworded Question: What is the highest priority for a fractured femur?

     

    Step 1. Read the answer choices to establish a pattern.

     

    The answer choices are a mix of assessment/validation and implementation. Use the Nursing Process (Assessment vs. Implementation) strategy. Discussion 28 Paper: Adjectives

    19

    Strategy Two: Nursing Process (Assessment versus Implementation)

    Practice question.

    A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?

    Immobilize the affected limb with a splint and ask him not to move.

    Make a thorough assessment of the circumstances surrounding the accident. (eliminate)

    Put him in semi-Fowler’s position for comfort (no respiratory distress)

    Check the pedal pulse and blanching sign in both legs. (eliminate)

     

    NCLEX Strategies

    Eliminate answer choices, and then choose the best answer.

     

     

     

     

     

     

    Step 3. Eliminate answer choices, and then choose the best answer.

     

    Eliminate answers (2) and (4) because they are assessments. This leaves you with choices (1) and (3).

    Which takes priority: immobilizing the affected limb, or placing the boy in a semi-Fowler’s position to facilitate breathing?

    The question does not indicate any respiratory distress.

    The correct answer is (1), immobilize the affected limb.

     

    Some students will choose an answer involving the ABCs without thinking it through. Students, beware. Use the ABCs to establish priorities, but make sure that the answer is appropriate to the situation. In this question, breathing was mentioned in one of the answer choices. If you thought of the ABCs immediately without looking at the context of the question, you would have answered this question incorrectly.

    20

    Strategy Two: Nursing Process (Assessment versus Implementation)

    A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?

    Immobilize the affected limb with a splint and ask him not to move.

    Make a thorough assessment of the circumstances surrounding the accident (eliminate)

    Put him in semi-Fowler’s position for comfort.

    Check the pedal pulse and blanching sign in both legs (eliminate)

     

    NCLEX Strategies

    Determine whether you should be assessing or implementing.

    The words “ first action” tell you that this is a priority question.

    Implementation

     

     

     

     

     

     

    Step 2. Refer to the question to determine whether you should be assessing or implementing. According to the question, the nurse has determined that the boy has a possible fracture.

     

    This implies that the nurse has completed the assessment step. It is now time to implement. Discussion 28 Paper: Adjectives

    21

    Strategy Three: Safety

    Nurses have the primary responsibility of ensuring the safety of clients.

    This includes clients in health care facilities, in the home, at work, and in the community.

    Safety includes:

    meeting basic needs (oxygen, food, fluids, etc.)

    reducing hazards that cause injury to clients (accidents, obstacles in the home)

    decreasing the transmission of pathogens (immunizations, sanitation).

     

    NCLEX Strategies

     

    Remember that the NCLEX-RN exam is a test of minimum competency to determine that you are able to practice safe and effective nursing care. Discussion 28 Paper: Adjectives

    Always think safety when selecting correct answers on the exam.

    When answering questions about procedures, this strategy will help you to establish priorities.

     

    23

    Strategy Three: Safety

     

    STEP 1- Are all the answer choices implementations? If so, use the Safety strategy.

    STEP 2- Can you answer the question based on your knowledge? If not, continue to Step 3.

    STEP 3- Ask yourself, “What will cause the client the least amount of harm?” and choose the best answer.

    NCLEX Strategies

     

    Strategy Three: Safety

    Practice question

    A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?

    Institute measures to minimize crying.

    Perform postural drainage every 2 hours.

    Cough and deep-breathe every hour.

    Give ice cream as tolerated.

    NCLEX Strategies

    Step 1- Are all the answer choices implementations?

    YES

     

    The Reworded Question: What should you do after a tonsillectomy?

    Step 1. Are all the answer choices implementations? Yes.

     

    Step 2. Can you answer the question based on your knowledge of a tonsillectomy? If not, continue to Step 3.

     

    Step 3. Ask yourself, “What will cause the client the least amount of harm?”

     

    Answer choice (1), minimizing crying, will help prevent bleeding. Keep in consideration. Answer choice (2), postural drainage, may cause bleeding. Eliminate. Answer choice (3), coughing and deep-breathing, may cause bleeding. Eliminate. Answer choice (4), giving ice cream, may cause the child to clear his throat, causing bleeding. Eliminate. The correct answer is (1). The nurse must prevent postoperative hemorrhage, a complication seen after this type of surgery. Crying would irritate the child’s throat and increase the chance of hemorrhage.

     

    26

    Strategy Three: Safety

    Practice question

    A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?

    Institute measures to minimize crying.

    Perform postural drainage every 2 hours.

    Cough and deep-breathe every hour.

    Give ice cream as tolerated.

     

    NCLEX Strategies

    Step 2. Can you answer the question based on your knowledge of a tonsillectomy?

    If not, continue to Step 3. Discussion 28 Paper: Adjectives

     

    The Reworded Question: What should you do after a tonsillectomy? Step 1. Are all the answer choices implementations? Yes.

     

    Step 2. Can you answer the question based on your knowledge of a tonsillectomy? If not, continue to Step 3.

     

    Step 3. Ask yourself, “What will cause the client the least amount of harm?”

     

    Answer choice (1), minimizing crying, will help prevent bleeding. Keep in consideration. Answer choice (2), postural drainage, may cause bleeding. Eliminate. Answer choice (3), coughing and deep-breathing, may cause bleeding. Eliminate. Answer choice (4), giving ice cream, may cause the child to clear his throat, causing bleeding. Eliminate. The correct answer is (1). The nurse must prevent postoperative hemorrhage, a complication seen after this type of surgery. Crying would irritate the child’s throat and increase the chance of hemorrhage. Discussion 28 Paper: Adjectives

     

    27

    Strategy Three: Safety

    Practice question

    A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?

    Institute measures to minimize crying.

    Perform postural drainage every 2 hours (cause bleeding)

    Cough and deep-breathe every hour (cause bleeding)

    Give ice cream as tolerated (cause bleeding)

     

     

    NCLEX Strategies

    Step 3. Ask yourself, “What will cause the client the least amount of harm?”

     

    28

Uncategorized

Wk2 Discussion Nur6001 Paper

Wk2 Discussion Nur6001 Paper

Wk2 Discussion Nur6001 Paper

Online Learning Strategies:  Completing courses in the absence of a physical classroom and frequent face-to-face contact can be challenging, even for those who are comfortable with technology and the online environment. You need to be able to plan and manage your time well, particularly since there is no structured “class time”; communicate clearly and effectively where there is no visual or nonverbal feedback; and use technology effectively.

ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE

This Discussion provides you with an opportunity to think about your skills in the above areas, to explore strategies for successful online learning, and exchange strategies with your colleagues.

To prepare:

•Review this Week’s assigned readings from the Walden e-Guide and the document, “Technical Tips for Learning at Walden,” in the Learning Resources. •Review this week’s media program, “Tips for Effective Online Composition and Communication.”

•Think about some strategies you have used, or read about, that may be beneficial for effective planning, time management, communication, and technology use. •Consider how the strategies you have identified can contribute to being a successful online learner.

Post a description of at least one strategy for each of the following areas related to online success: planning, time management, communication, and technology use.

Explain how/why you think use of each strategy will contribute to your success as an online learner.  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.

  • attachment

    DiscussionRubric6050.rtf

    Rubric Detail for Discussion Posts

    Main Posting: Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.–

    Levels of Achievement:

    Outstanding Performance 44 (44%) – 44 (44%)

    Thoroughly responds to the discussion question(s) is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. supported by at least 3 current, credible sources

    Excellent Performance 40 (40%) – 43 (43%)

    Responds to the discussion question(s) is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 75% of post has exceptional depth and breadth supported by at least 3 credible references

    Competent Performance 35 (35%) – 39 (39%)

    Responds to most of the discussion question(s) is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of post has exceptional depth and breadth supported by at least 3 credible references

    Proficient Performance 31 (31%) – 34 (34%)

    Responds to some of the discussion question(s) one to two criteria are not addressed or are superficially addressed is somewhat lacking reflection and critical analysis and synthesis somewhat represents knowledge gained from the course readings for the module. post is cited with fewer than 2 credible references

    Room for Improvement 0 (0%) – 30 (30%)

    Does not respond to the discussion question(s) lacks depth or superficially addresses criteria lacks reflection and critical analysis and synthesis does not represent knowledge gained from the course readings for the module. contains only 1 or no credible references

    Main Posting: Writing–

    Levels of Achievement:

    Outstanding Performance 6 (6%) – 6 (6%)

    Written clearly and concisely Contains no grammatical or spelling errors Fully adheres to current APA manual writing rules and style

    Excellent Performance 5.5 (5.5%) – 5.5 (5.5%)

    Written clearly and concisely May contain one or no grammatical or spelling error Adheres to current APA manual writing rules and style

    Competent Performance 5 (5%) – 5 (5%)

    Written concisely May contain one to two grammatical or spelling error Adheres to current APA manual writing rules and style

    Proficient Performance 4.5 (4.5%) – 4.5 (4.5%)

    Written somewhat concisely May contain more than two spelling or grammatical errors Contains some APA formatting errors

    Room for Improvement 0 (0%) – 4 (4%)

    Not written clearly or concisely Contains more than two spelling or grammatical errors Does not adhere to current APA manual writing rules and style

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Educational Brochure Assignment Paper

Educational Brochure Assignment Paper

Educational Brochure Assignment Paper

Create a 4-page brochure that provides information about integrative/holistic nursing services that can be provided to healthcare facilities. Select a type of facility for which you would like to design this brochure (Medical-Surgical floor at a busy hospital). Incorporate the modalities you have learned in this course (Healing touch, Acupuncture, aromatherapy, Tai-Chi, homeopathy… ect) Be creative!

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Attached is an example of a brochure to base this off of.

  • attachment

    Brochureweek10exampleonly.pdf

    Meditation & Relaxation

    Tranquility Spa Holistic healing and wellbeing spa

    Phone: 1-888-555-2525

    Fax: 1-888-555-2524

    www.tranqilityspa.com Reference:

    Dossey, B.M., & Keegan, L. (Ed. 6) (2013). Holistic nursing: A Handbook For Practice. Burlington, MA: Jones & Bartlett Learning. Reiki (2015). Retrieved from reiki.org. About Art Therapy (2013). Retrieved from http://www.arttherapy.org/upload/wha tisarttherapy.pdf

    Tranquility pictures (2015). Retrieved from google.com

     

    • Massage Therapy • Energy Therapy • Acupuncture and

    Acupressure Therapy • Guided Meditation

    (Mon-Fri 8 am-10 am) • Dietician consults by

    appointment • Art Therapy

    Be involved in the process of developing an awareness of the sacredness of yourself and all of nature (Dossey & Keegan, 2013)

     

     

     

    How we aid you in fulfilling your tranquil wholeness

    Our facility focuses on how you want to find healing and fulfillment. We offer a variety of therapies that aid in holistic health. Here is brief look into the therapies we offer. Start with one or contact our office for package deals. There is no right therapy, there is just what works for you.

    Massage therapy: the use of hands to apply pressure to the skin for the physical and psychological effect that can cause relaxation, improve circulation, and stimulates cells that aide in waste drainage (Dossey & Keegan, 2013). Our message therapists are trained in many techniques. They will specialize your treatment based upon your needs for massage therapy.

    Energy therapy: Reiki is practiced by a skilled professional and is the practice of transferring life force energy using laying hands. All energy is present in energy fields and a Reiki professional can help in manipulating that energy to remove negative energy and revive the energy within the participant leaving a renewed healthy energy field (reiki.org, 2015).

    Acupuncture and Acupressure. There are over 600 energy points running along different pathways in the body. By accessing these points congestion is release and energy is restored and able to flow (Dossey & Keegan, 2013)

    Guided meditation: meditation strengthens neurological circuits that calm a part of the brain and increases activity in the brain associated with positive emotions and happiness (Doseey & Keegan, 2013) Our professionals help you get there in session and teach you tools to use on your own.

    Art therapy helps reduce negative stress, achieve personal insight, resolve conflicts, and improve personal overall wellbeing (arttherapy.org, 2013).

     

     

     

     

    Our sessions take between 1-2 hours a piece. Art therapy can be done individual or in a class setting. Please call or visit the website for the art therapy schedule. Our facility is developed to provide you with a safe and calm environment to learn and to grow. All of our therapies are performed onsite and instructors aim at teaching these skills to be done at home as well.

     

    We offer acupressure, meditation and energy therapy classes once a month. Try our services to see which works best for you and take your skills home for yourself and your family.

    Our onsite dietician can help you build a diet plan that works best for you lifestyle and goals. Our dietician specializes in herbal medicine and food for energy.

    We advise all of our patients seeking alternative therapies to discuss them with their primary physician before adding or beginning a new health regimen. Please confirm with your doctor before starting any new dietary regimen and herbal supplement program provided by our dietician.

     

    • Meditation & Relaxation
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Nursing 6541 Case Scenario

Nursing 6541 Case Scenario

Nursing 6541 Case Scenario

You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign. Nursing 6541 Case Scenario

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Questions

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Nursing 6541 Case Scenario

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Assignment Wk4 Essay Discussion

Assignment Wk4 Essay Discussion

Assignment Wk4 Essay Discussion

Details:

This assignment requires you to interview one person and requires an analysis of your interview experience.

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Part I: Interview

Select a patient, a family member, or a friend to interview. Be sure to focus on the interviewee’s experience as a patient, regardless of whom you choose to interview.

Review The Joint Commission resource found in topic materials, which provides some guidelines for creating spiritual assessment tools for evaluating the spiritual needs of patients. Using this resource and any other guidelines/examples that you can find, create your own tool for assessing the spiritual needs of patients.

Your spiritual needs assessment survey must include a minimum of five questions that can be answered during the interview. During the interview, document the interviewee’s responses. Assignment Wk4 Essay Discussion

The transcript should include the questions asked and the answers provided. Be sure to record the responses during the interview by taking detailed notes. Omit specific names and other personal information through which the interviewee can be determined.

Part II: Analysis

Write a 500-750 word analysis of your interview experience. Be sure to exclude specific names and other personal information from the interview. Instead, provide demographics such as sex, age, ethnicity, and religion. Include the following in your response:

  1. What went well?
  2. Were there any barriers or challenges that inhibited your ability to complete the assessment tool? How would you address these in the future or change your assessment to better address these challenges?
  3. How can this tool assist you in providing appropriate interventions to meet the needs of your patient?
  4. Did you discover that illness and stress amplified the spiritual concern and needs of your interviewee? Explain your answer with examples.

Submit both the transcript of the interview and the analysis of your results. This should be submitted as one document. The interview transcript does not figure into the word count.

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 Turnitin. Please refer to the directions in the Student Success Center.

This benchmark assignment assesses the following competencies:

CONHCP Program Competencies for the RN-BSN:

5.2: Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.

  • attachment

    rubricsclass413week4BenchmarkAssignment.docx

    Benchmark Assignment – Spiritual Needs Assessment and Reflection 

      1 Unsatisfactory 0.00% 2 Less Than Satisfactory 65.00% 3 Satisfactory 75.00% 4 Good 85.00% 5 Excellent 100.00%
    70.0 %Content  
    40.0 %Tool for Assessing the Spiritual Needs of Patients CONHCP: 5.2 Tool for assessing the spiritual needs of patients show little to no relevance to the experiences of patients. A transcript of the interview is either missing or not relevant. Tool for assessing the spiritual needs of patients is present but lacks focus on experiences of patients. A clear transcript of the interview is provided. Tool for assessing the spiritual needs of patients is present and focuses on experiences of patients. A clear transcript of the interview is provided. Tool for assessing the spiritual needs of patients is present and focuses on experiences of patient. The tool uses reliable methods for gathering data. A clear transcript of the interview is provided. Tool for assessing the spiritual needs of patients is present and focuses on experiences of patients. The tool uses effective methods for gathering data that produces the results intended. A clear transcript of the interview is provided.  
    30.0 %Analysis of Interview Experience An analysis of the interview experience shows little to no relevance to the assignment instructions. An analysis of the interview experience is included but addresses a few of the points included in the assignment instructions. An analysis of the interview experience is included and addresses most of the points included in the assignment instructions. An analysis of the interview experience is included and addresses all of the points included in the assignment instructions. An analysis of the interview experience is included and addresses all of the points included in the assignment instructions. The analysis shows a deep understanding of the connections.  
    20.0 %Organization and Effectiveness  
    7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. They are descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.  
    8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.  
    5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Writer is clearly in command of standard, written, academic English.  
    10.0 %Format  
    5.0 %Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.  
    5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.  
    100 %Total Weightage  
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Nursing: Leading as a General Manager

Nursing: Leading as a General Manager

Nursing: Leading as a General Manager

need a minimum of 100 words for each of the assignments on both A and B

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UNIT 1

A

The Plucknette article suggests that there are considerable differences between being a leader and being a manager. Is it possible or desirable to be both? Chapter 2 of the Management textbook suggests that the four functions of management are planning, organizing, leading, and controlling. Provide one challenge posed by serving as a leader and one challenge posed by serving as a manager in each of these functions?

B

What roles do leadership and innovation play within each of the four management functions? Provide an example of how to integrate leadership into at least two management functions.

RESOURCES

Textbook

1. Management

Read Chapters 1-2 and 15 in Management. 

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

e-Library Resource

1. 4 Differences Between Managers and Leaders

Read “4 Differences Between Managers and Leaders,” from Plucknette, from Plant Engineering (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=100432256&site=eds-live&scope=site

UNIT 2

A

Provide an example of a challenge you have experienced in the workplace leading a cross-functional team or as part of a cross-functional team. How was this challenge solved? Would you have approached the challenge differently? If so, how?

B

Organizations are increasingly transcending country boarders and physical space limitations. What are some effective strategies to motivate dispersed team members in a virtual setting? What are some emerging trends that deal with this challenge in your field? Provide an example. Nursing: Leading as a General Manager

RESOURCES

Textbook

1. Management

Read Chapters 14, 16, and 18.

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

e-Library 1. AlphabResource

Read “Alphabet Soup,” by Kotler, from Marketing Management (2006).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=20545160&loginpage=Login.asp&site=ehost-live&scope=site

2. Big Data: Prospects and Challenges

Read “Big Data: Prospects and Challenges,” by Moorthy, from Vikalpa: The Journal for Decision Makers (2015).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=101862951&site=eds-live&scope=site

3. Change Management Dashboard: An Adaptive Approach to Lead a Change Program

Read “Change Management Dashboard: An Adaptive Approach to Lead a Change Program,” by Vaccarezza and Razzi, from People and Strategy(2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=97590298&site=ehost-live&scope=site

4. How to Lead an Effective Virtual Team

Read “How to Lead an Effective Virtual Team,” by Lepsinger and DeRosa, from Ivey Business Journal (2015).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=103632907&site=eds-live&scope=site

5. Managing Virtual Team Work in IT Projects: Survey

Read “Managing Virtual Team Work in IT Projects: Survey,” by El-Sofany and Alwandani, from International Journal of Advanced Corporate Learning (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=99924583&site=eds-live&scope=site

6. The Digital Market-Sphere (DMS): Modeling Virtual Transactons and Transvectons

Read “The Digital Market-Sphere (DMS): Modeling Virtual Transactons and Transvectons,” by Carter and Parameswaran, from Marketing Management Journal (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=82541875&site=ehost-live&scope=site

7. The Ins and Outs of Marketing in the Digital Age

Read “The Ins and Outs of Marketing in the Digital Age,” by Cody from Chain Drug Review (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=95911701&site=ehost-live&scope=site

8. Three Digital Marketing Megatrends for 2015

Read “Three Digital Marketing Megatrends for 2015,” by Friedein, from Marketing Week (2015).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=100529063&site=ehost-live&scope=site

UNIT 3

A

An individual manager’s ability to make ethical decisions is influenced by many factors, such as individual traits and corporate culture. Applying conscious capitalism principles typically starts with a plan from the CEO and requires the plan to be implemented through various management levels and all employees. What role does ethics play in conscious capitalism and how do the ethics of conscious capitalism impact management tactics within an organization?

B

Post a draft of your Strategic Management and Socially Conscious Organization Presentation assignment to the Main Forum. Read two classmates’ presentations and provide feedback to your peers about their presentations. Are there areas that need adjustments?

RESOURCES

Textbook

1. Management

Read Chapters 3-5, 8, and 13 in Management. Review Chapter 15 in Management. 

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

e-Library Resource

1. Chapter 2: Conscious Capitalism and the Heroic Spirit of Business 

Read “Chapter 2: Conscious Capitalism and the Heroic Spirit of Business,” by Mackey and Sisodia, from MMR (2013).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=89907744&site=eds-live&scope=site

2. Conscious Capitalism: Leaders and Organizations With a World View

Read “Conscious Capitalism: Leaders and Organizations With a World View,” by Legault, from Integral Leadership Review (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=77553816&site=eds-live&scope=site

3. On the Ethics of Management Research: An Exploratory Investigation 

Read “On the Ethics of Management Research: An Exploratory Investigation,” by Frechtling, from Journal of Business Ethics (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2012-07831-003&site=eds-live&scope=site

4. Questions of Ethics in Public Sector Management: The Case Study of Hong Kong

Read “Questions of Ethics in Public Sector Management: The Case Study of Hong Kong,” by Luk, from Public Personnel Management (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2011579553&site=eds-live&scope=site

5. Taking Responsibility for Corporate Social Responsibility: The Role of Leaders in Creating, Implementing, Sustaining, or Avoiding Socially Responsible Firm Behaviors

Read “Taking Responsibility for Corporate Social Responsibility: The Role of Leaders in Creating, Implementing, Sustaining, or Avoiding Socially Responsible Firm Behaviors,” by Jones, Mackey, Whetten, from Academy of Management Perspectives (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=96303909&site=eds-live&scope=site

6. Turning Corporate Social Responsibility-Driven Opportunities in Competitive Advantages: A Two-Dimensional Model

Read “Turning Corporate Social Responsibility-Driven Opportunities in Competitive Advantages: A Two-Dimensional Model,” by Calabrese, Costa, Menichini, Rasati, and Sanfelice, from Knowledge and Process Management (2013).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=85652504&site=eds-live&scope=site

UNIT 4

A

What are the major elements of strategic planning? Refer to HBS case reprint, Southwest Airlines: In a Different World. What elements of strategic planning are present in the case study? Based on the case study, what are the major challenges of strategic planning, especially for large, complex organizations like Southwest airlines? What challenges does strategic planning on such a large scale pose for leaders?

B

What have you experienced or what do you anticipate as the most challenging aspect of strategic planning in your field of interest? What do you think can be done to improve strategic planning processes in your own organization or field?

RESOURCES

Textbook

1. Management

Read Chapters 7 and 8 in Management. 

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

2. Southwest Airlines: In a Different World

Read Harvard Business School (HBS) case reprint, Southwest Airlines: In a Different World (2013).

http://gcumedia.com/digital-resources/harvard-business-school-press/2010/southwest-airlines_in-a-different-world_ebook_1e.php

Electronic Resource

1. Overview of the Strategic Planning Process

Watch “Overview of the Strategic Planning Process,” by Virtual Strategist (2012), located on the YouTube website.

https://www.youtube.com/watch?v=sU3FLxnDv_A

2. Strategic and Operational Planning

Read “Strategic and Operational Planning,” located on the Taugher Change Catalyst Consulting website.

http://www.taugher.com/strategic-planning.htm

e-Library Resource

1. Management Use of Strategic Tools for Innovating During Turbulent Times

Read “Management Use of Strategic Tools for Innovating During Turbulent Times,” by Tassabehji, from Strategic Change (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=inh&AN=14829855&site=eds-live&scope=site

2. Strategic Intent 

Read “Strategic Intent,” by Hamel and Prahalad, from Harvard Business Review (2005).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=17602384&site=ehost-live&scope=site

3. Strategy Execution A Four Step Process

Read “Strategy Execution: A Four Step Process,” by Morgan, from MWorld (2010).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=bth&AN=55728021&site=ehost-live&scope=site

Other

1. SWOT Analysis 

Review the “SWOT Analysis” template in preparation for the Strategic Planning: SWOT Analysis assignment.

LDR-620-R-SWOTAnalysis.docx

MODULE 5

A

In “Business Model Innovation in Practice,” Euchner and Ganguly (2014) discuss the challenge of implementing innovations within organizations that are naturally resistant to change. They present a systematic approach for integrating innovations to increase the likelihood of acceptance and success. Review their five-step approach and discuss how the four functions of management (planning, organizing, leading and controlling) can be leveraged within in their suggested approach to assist organizations in implementing successful innovations.

B

What do you anticipate will be the greatest challenge of operationalizing strategy across various business functions? Do you think the challenges change depending on the circumstances? Provide an example within your field.

RESOURCES

Textbook

1. Management

Read Chapter 11 in Management. Review Chapters 7 and 8.

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

Electronic Resource

1. Business Model Innovation in Practice

Read “Business Model Innovation in Practice,” by Euchner and Ganguly, from Research Technology Management (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ofs&AN=99206628&site=eds-live&scope=site

2. Stakeholder Analysis 

Read “Stakeholder Analysis,” located on the Mind Tools website. In addition, view the video “Stakeholder Analysis Video: Stakeholder Management and Power Interest Grid Example” that accompanies the article.

https://www.mindtools.com/pages/article/newPPM_07.htm

3. Strategy Mapping Overview

Watch “Strategy Mapping Overview,” by Knowles (2013), located on the YouTube website.

https://www.youtube.com/watch?v=8l6PgjxZ_I4

e-Library Resource

1. Business Ethics and the Development of Intellectual Capital

Read “Business Ethics and the Development of Intellectual Capital,” by Su, from Journal of Business Ethics (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ofs&AN=93596469&site=eds-live&scope=site

2. Corporate Social Responsibility: A Real Options Approach to the Challenge of Financial Sustainability

Read “Corporate Social Responsibility: A Real Options Approach to the Challenge of Financial Sustainability,” by Bosch-Badia, Montilor-Serrats, and Tarrazon-Rodon, from PLoS One (2015).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102969920&site=eds-live&scope=site

3. Innovation Agendas: The Ambiguity of Value Creation

Read “Innovation Agendas: The Ambiguity of Value Creation,” by Daniel and Klein, from Prometheus (2014)

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4. Intellectual Capital Approach to Modern Management Through the Perspective of a Company’s Value Added

Read “Intellectual Capital Approach to Modern Management Through the Perspective of a Company’s Value Added,” by Survilate, Tamosiuniene, and Shatrevich, from Business: Theory and Practice (2015).

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5. Stakeholder Analysis 

Read “Stakeholder Analysis,” by Gilstein, from Salem Press Encyclopedia (2013).

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MODULE 6

A

Return to HBS case reprint, “Southwest Airlines: In a Different World.” The case study makes it clear that a significant shift in organizational strategy requires collaboration across multiple departments, or functions, within a business. Review the case and discuss how you think Southwest’s plan to serve La Guardia would impact two primary business functions (e.g., marketing, operations, human resources, finance, accounting, and IT). Consider how coordinating efforts of the two functions to successfully serve La Guardia might affect management and decision making. How integral is collaboration among business functions to the success of Southwest’s plan? Cite specifics from the case in your response. Nursing: Leading as a General Manager

B

Provide an example in which managerial decision making has positively or negatively affected you? How did the personal decision-making styles used by managers apply to the situation? What is your take away from the example you provided after your reading about managerial decision making in this topic?

RESOURCES

Topic: Tactical Planning (Continued)
Textbook

1. Management

Read Chapters 9 and 12 in Management. Review Chapters 7 and 8.

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

2. Southwest Airlines: In a Different World

Review Harvard Business School (HBS) case reprint, “Southwest Airlines: In a Different World”(2013).

http://gcumedia.com/digital-resources/harvard-business-school-press/2010/southwest-airlines_in-a-different-world_ebook_1e.php

e-Library Resource

1. (How) Does the HR Strategy Support an Innovation Oriented Business Strategy? An Investigation of Institutional Context and Organizational Practices in Indian Firms

Read “(How) Does the HR Strategy Support an Innovation Oriented Business Strategy? An Investigation of Institutional Context and Organizational Practices in Indian Firms,” by Fang and Saini, from Human Resource Management (2010).

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2. Big Data: An Innovative Way to Gain Competitive Advantage Through Converting Data into Knowledge

Read “Big Data: An Innovative Way to Gain Competitive Advantage Through Converting Data into Knowledge,”

by Bhadani, from International Journal of Advanced Research in Computer Science (2015).

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3. Outsourcing: A Strategic Risk? 

Read “Outsourcing: A Strategic Risk?” by Relph and Parker, from Management Services (2014).

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4. Practicing Human Resource Strategy: Understanding the Relational Dynamics in Strategic HR Work by Means of a Narrative Approach 

Read “Practicing Human Resource Strategy: Understanding the Relational Dynamics in Strategic HR Work by Means of a Narrative Approach,” by Kaudela-Baum and Endrissat, from German Journal of Research in Human Resource Management (2009).

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5. Responsible Leadership and Stakeholder Management: Influence Pathways and Organizational Outcomes

Read “Responsible Leadership and Stakeholder Management: Influence Pathways and Organizational Outcomes,” by Doh and Quigley from the Academy of Management Perspectives (2014).

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6. The Relationship Between Intellectual Capital With Economic Value Added and Financial Performance

Read “The Relationship Between Intellectual Capital With Economic Value Added and Financial Performance,” by Salehi, Enayati, and Javadi, from Iranian Journal of Management Science: A Quarterly (2014).

http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=96560290&site=eds-live&scope=site 

MODULE 7

A

An organization’s landscape can be expansive and complex. Most organizations rely heavily upon information technology as a way to achieve outcomes. Conduct a needs assessment on your current organization or a familiar organization. Evaluate the cross-functionality of departments to identify gaps or opportunities for more effectively utilizing information technology to improve collaboration, efficiency, and communication. Recommend improvements based on your assessment. Include an explanation of the benefits in your proposal. Nursing: Leading as a General Manager

B

Respond to the “Apply Your Skills: Case for Critical Analysis: Email Adventure,” located at the end of Chapter 17 in the Management textbook.

RESOURCES

Textbook

1. Management

Read Chapters 10 and 17 and the Appendix in Management. 

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

Electronic Resource

1. Communications Planning: Getting the Right Messages Across in the Right Way

Read “Communications Planning: Getting the Right Messages Across in the Right Way,” located on the Mind Tools website.

https://www.mindtools.com/CommSkll/CommunicationsPlanning.htm

2. Creating Adaptive Organizations

Read “Creating Adaptive Organizations,” by Kenney (2010), located on the American Management Association (AMA) website.

http://www.amanet.org/training/articles/Creating-Adaptive-Organizations.aspx

3. The Adaptive Organization: Fostering Change in Five Areas

Read “The Adaptive Organization: Fostering Change in Five Areas,” by Kenney (2010), located on the American Management Association (AMA) website.

http://www.amanet.org/training/articles/The-Adaptive-Organization-Fostering-Change-in-Five-Areas.aspx

e-Library Resource

1. Complexity Leadership Generates Innovation, Learning, and Adaptation of the Organization

Read “Complexity Leadership Generates Innovation, Learning, and Adaptation of the Organization,” by Geer-Frazier, from Emergence: Complexity and Organization (2014).

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2. The Adaptability of Management Models Across Cultures

Read “The Adaptability of Management Models Across Cultures,” by Yuksel and Durna, from International Journal of Economic and Administrative Studies (2015).

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UNIT 8

A

From the perspective of a general manager in your field, which of the organizational control methods outlined in Chapter 19 of the Managementtextbook do you think would be the most universal? What does organizational control look like in your sphere of influence?

B

Consider your Strategic Plan: Presentation video assignment. Write a brief description on how you plan to organize and present your Strategic Plan or share a draft of your video. Provide feedback to your peers about their initial plans for their videos. Are there areas that need adjustments? Nursing: Leading as a General Manager

RESOURCES

Topic: Evaluation
Textbook

1. Management

Read Chapter 19 in Management. 

http://gcumedia.com/digital-resources/cengage/2013/management_ebook_11e.php

Electronic Resource

1. How to Share a Private YouTube Video 

Watch “How to Share a Private YouTube Video,” located on YouTube.

https://www.youtube.com/watch?v=Rm3EMH3-H4c

e-Library Resource

1. Change the Incentives, Engage the Whole Organization

Read “Change the Incentives, Engage the Whole Organization,”by Winston, from Supply Chain Management Review, (2014).

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Uncategorized

Community Nursing Discussion Questions

Community Nursing Discussion Questions

Community Nursing Discussion Questions

Chapter 1  Opening the Door to Health Care in the Community

Chapter 2  Community and Population Health: Assessment and Intervention

ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE

Read chapter 1 and 2 of the class textbook and review the attached Power Point presentations, once done answer the following questions:

1.  In your own words and using the proper evidence-based references please define the following terms;

a.  Community health nursing

b.  Community based nursing

c.  Population focus care

d.  Public Health nursing

2.  Discuss any relationship between Community health nursing and Public Health Nursing and mention and discuss any relationship between both terms.

3.  Discuss the concept of community assessment and why is the purpose of it and how  beneficial it is for the community health nurse.

4.  Mention and discuss at least 2 community health frameworks/models.

– Assignments must be presented in an APA format, word document, Arial 12 font attach the forum in the discussion board call “week 1 discussion questions”.

– A minimum of 2 evidence-based references must be cited according to APA and  two replies to any of your peers posting sustained with the proper references are required.

– A minimum of 500 words excluding the first and references page are required. Community Nursing Discussion Questions

  • attachment

    Chapter1.ppt

    Chapter 1
    Opening the Door to Health Care in the Community

    Forces for Change

    • Public health needs in response to:
    • Bioterrorist threats
    • Natural disasters
    • Community-driven system
    • Nursing shortage

    Health

    • Defined by World Health Organization (WHO)
    • Originally defined in 1948 as a “state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”
    • WHO expanded the definition in 1986 to include a community concept, “the extent to which an individual or group is able on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope with the environment”

    Historical Insights

      • Florence Nightingale
      • Founder of modern professional nursing
      • Developed first school of nursing
      • Directive was to manipulate the patient’s environment to allow nature to take its course in the healing process
      • Mid to late 1800s
      • Process of contagion between human hosts and the environment better understood

     

    Historical Insights (cont.)

    • 20th century
    • Medical discoveries and interventions
    • Late 20th century
    • Obligation to providing healthy environment for all
    • U.S. healthcare system considered sophisticated despite:
    • High infant mortality rates
    • 25th in life expectancy
    • Limited access to health care
    • Only industrialized nation without guarantee of access to health care

    Historical Insights (cont.)

    • 21st century
    • Focus on quality and efficiency
    • Affordable Care Act of 2010
    • Essentials of Baccalaureate Nursing Education for Entry Level Community/Public Health Nursing Practice
    • Recommendations regarding entry level in community health nursing practice

    Public Health Versus
    Community Health

    • Roles for nurses in the community
    • Public health nursing
    • Community health nursing
    • Quad Council of Public Health Nursing Organization
    • American Public Health Association
    • Association of Community Health Nurse Educators

    Communities & Populations Defined

    • Community
    • Group of people who share something in common and interact with one another who may exhibit a commitment with one another and may share a geographic boundary
    • Population
    • Group of people who have at least one thing in common and who may or may not interact with one another

    Acute Care Versus Community Health Nursing

    • Acute care setting
    • Provider control
    • Predictable routine
    • Maintenance of hospital policy
    • Resource availability
    • Collegial collaboration and consultation
    • Controlled patient compliance
    • Standardization of care

    Acute Care Versus Community Health Nursing (cont.)

    • Community based
    • Familiar and comfortable environment
    • Routine less determined by the nurse or health professional
    • Diverse resources
    • Autonomy and choice in health decisions

    Healthcare Reform and Reinvention of Systems of Care

    • President Truman proposed national health insurance
    • 1960s introduced Medicare and Medicaid
    • Nursing’s Agenda for Health Care Reform
    • Managed care
    • Care management
    • Transition planning

    From Hospital to Community

    • Move back to community setting
    • Home care
    • Hospice
    • Outpatient treatment clinics
    • Outpatient surgeries
    • Identified connection between prevention and keeping population healthy

    Cure and Prevention

    • Centers for Disease Control and Prevention (CDC)
    • 1977 analysis
    • Health field elements identified:
    • Lifestyle
    • Human biology
    • Environment
    • Health care
    • Benefit versus cost

    Cure and Prevention (cont.)

    • Healthy People
    • Two overarching goals
    • Increase years of healthy life
    • Eliminate health disparities
    • Four enabling goals
    • Promoting healthful behaviors
    • Protecting health
    • Achieving access to quality health care
    • Strengthening community prevention

    Influences on Community Health

    • Culture
    • Leininger
    • Giger & Davidhizar
    • Purnell & Paulanka
    • Environment
    • Nightingale Notes on Nursing
    • Ethics
    • ANA Code of Ethics for Nurses with Interpretive Statements

    Epidemiology

    • Science of public health
    • Epidemiological model or triangle
    • Host
    • Agent
    • Environment
    • Levels of prevention
    • Primary
    • Secondary
    • Tertiary

    Epidemiology (cont.)

    • Measuring a community’s health
    • Health statistics
    • Birth rates
    • Infant mortality rates
    • Incidence and prevalence rates for various disease and age groups
  • attachment

    Chapter2.ppt

    Chapter 2
    Community and Population Health: Assessment and Intervention

    Communities and Population

    • Community as patient
    • Community and population
    • Define boundaries
    • Differences
    • Community-focused intervention
    • Interaction

    Health of Communities and Populations

    • Healthy communities
    • Status
    • Structure
    • Process
    • Community competency
    • Individual competency

    Health of Communities and Populations (cont.)

    • World health Organization (WHO)
    • Healthy Cities
    • Essentials skills for BSN nurse
    • Population assessment
    • Population-level interventions
    • Community assessments

    Community Assessment Frameworks

    • WHO
    • Community empowerment
    • Community as Partner Model
    • Community core
    • Eight interacting community subsystems
    • Community stressors/boundaries
    • Normal level of defense
    • Flexible line of defense
    • Lines of resistance

    Community Assessment Frameworks (cont.)

    • General Systems Model for Community Assessment and Intervention
    • Interacting subsystems
    • Suprasystem
    • Target system and boundaries
    • Community process

    Using the Nursing Process for the Community

    • Conducting a community assessment
    • Population assessment
    • Primary informants
    • Gaining entry into the community
    • Kauffman’s five phases
    • Impressing
    • Behaving
    • Swapping
    • Belonging
    • Chilling out

    Using the Nursing Process for the Community (cont.)

    • Collecting data
    • Seven methods
    • Informant interviews
    • Observation
    • Secondary analysis of existing data
    • Constructed surveys
    • Focus groups
    • Community forums
    • Windshield surveys

    Using the Nursing Process for the Community (cont.)

    • Community diagnosis
    • Risk of
    • Among
    • Related to
    • Planning and prioritization phase
    • Priorities established
    • Goals and objectives identified
    • Community-focused interventions

    Using the Nursing Process for the Community (cont.)

    • Implementation phase
    • Action phase
    • Role of community health nurse
    • Social change and community action
    • Lay advisors
    • Focus groups
    • Policy legislation
    • Mass media
    • Media advocacy
    • Education

    Using the Nursing Process for the Community (cont.)

    • Evaluation
    • Formative evaluation
    • Summative evaluation
Uncategorized

Assignment: Describing Statistical Test

Assignment: Describing Statistical Test

Assignment: Describing Statistical Test

See attached the article for the word message. Please follow the  instructions down below.

ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE

Write a 205-word message in which you:

  • Describe the statistical tests used. 
  • Summarize the key findings and address the authors’ interpretations of the finding.
  • attachment

    article1.pdf

    Consider the following hypothet- ical scenario and results that are formatted in evidence-based

    practice (EBP) language such as those that you might see in the Cochrane Collaboration,1 a primary resource for evidence-based systematic reviews.

    Scenario: How effective is a daily dose of 500 mg of vitamin C in the prevention of ulcers on the heels of bedridden elderly clients? Results: With an NNT of 5, vitamin C is effective (OR, 0.10; 95% CI, 0.05-0.20).

    If there are some abbreviations or values in this situation that are un- familiar to you, you will find explana- tions and examples in this article that will help you in reading, interpreting, and understanding them as you use evidence-based literature for your best practices. Nurses always rise to the occasion to learn the latest research information that may improve patient care and outcomes. Assignment: Describing Statistical Test

    An obstacle to involvement in EBP is lack of skill in understanding the ‘‘bottom line’’ of systematic reviews and accompanying risk-related num-bers. 2-4

    Content and research experts conduct systematic reviews using strict criteria for inclusion of primary re- search studies and statistical analysis.

    5

    The Cochrane Collaboration is a major resource for more than 1,000 system- atic reviews of randomized clinical trials for the effects of healthcare inter- ventions created through collaboration of more than 50 worldwide review and methods teams.6

    The systematic review teams basi- cally seek the response to 1 question: how many people have a bad outcome in the experimental group compared with the control group? Bad outcomes refer to the undesirable outcomes in a study, such as development of a heel ulcer. Noteworthy in EBP statistics is the simplicity of using a head count rather than group averages. Even when individual study results are not statisti- cally significant, if the experimental group has fewer bad outcomes than the control group, the nurse or other pro- vider might want to apply the results anyway. Seven terms and their abbre- viations and formulas are common in the reported results,7,8 as summarized in Table 1. In this article, hypothetical examples and their derivations de- scribe these 7 terms. At the end, you can derive these values for a clinical scenario toward a better understanding when teaching these terms to others.

    Absolute Risk Reduction Absolute risk reduction (ARR) is the absolute arithmetic difference (abso- lute means that one ignores plus and minus signs) in percentages of bad outcomes between the experimental and control groups. Absolute risk reduc- tion means that more people in the control group than in the experimen- tal group develop a bad outcome. To calculate the ARR, you need to know just 2 things: the experimental event rate (EER), or the percentage of the bad outcome in the experimental group; and the control group event rate (CER), or the percentage of the bad outcome in the control group. Let us look at an ex- ample: 13% of patients with diabetes receiving intensive insulin therapy (the experimental group) develop neuro- pathy (the bad outcome), whereas 38% of the patients in the control group receiving usual insulin therapy develop neuropathy. ARR = |EER j CER| or |13% j 38%| = 25%. Therefore, the ARR of giving patients with diabetes intensive insulin therapy in terms of development of the bad outcome of neuropathy is 0.25, or 25%. By simply having a head count of the incidence of occurrence of an outcome when you know the number of the total involved, there is some tangible evidence that a practitioner might consider using in the development of practice guidelines. Assignment: Describing Statistical Test

    Number Needed to Treat Number needed to treat (NNT) is the number of patients who need to be treated to obtain 1 additional good outcome for a patient that would not have occurred without the treatment. The best NNT would be 1, where every patient in the experimental group treated had a good outcome while no one in the control group had a good outcome. However, this NNT is not very realistic, and NNTs of 2 to 5 are indicative of effective treatments. The formula for NNT is 1/ARR. For the insulin therapy example, the NNT is 1/0.25, or 4. This NNT means that the practitioner would need to treat 4

    16 Volume 32 & Number 1 & January/February 2007 Nurse Educator

    Nurse Educator

    Nurse Educator Vol. 32, No. 1, pp. 16-20

    Copyright ! 2007 Wolters Kluwer Health |

    Lippincott Williams & Wilkins

    How to Read, Interpret, and Understand Evidence-Based Literature Statistics

    Dorette Sugg Welk, PhD, RN

    To implement best practices through research utilization, nurses need to read, interpret, and understand literature formatted with evidence-based practice language and statistics. Hypothetical examples highlight 7 terms and their formulas. A scenario to personally calculate such evidence-based practice statistics can be used to enhance personal effectiveness and to teach others.

    Author Affiliations: Nursing Faculty On- line, University of Phoenix, Phoenix, Ariz; Faculty Emeritus, Bloomsburg University, Bloomsburg, Pa. Correspondence: 94 Hemlock Lane, Bloomsburg, PA 17815 (welk@email.phoenix.edu).

    Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.

    Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.

     

     

    patients with intensive insulin therapy to achieve 1 additional patient with a positive outcome (does not develop neuropathy).

    Evidence-based practice language is more about risk rather than solid numbers. If a practitioner had a large diabetic population, an NNT of 4 would be good news, and the practi- tioner might choose to use the inten- sive therapy with more patients. When reading evidence-based reports, the lower the NNT, the lower the risk based on the review team’s synthesis of numerous research studies involv- ing, for example, the intensive versus routine insulin therapy. In studies, for example, of disease prevention or the use of educational strategies, an NNT of 20 or more might be good news for the practitioner because the precise- ness of a ‘‘bad outcome’’ is less control- lable than in direct disease situations. Context for interpretation is always an important consideration.

    Absolute Risk Increase The absolute risk increase (ARI) is the opposite of risk reduction and occurs when more patients in the treatment group compared with the control group develop a bad outcome. In the insulin

    therapy example, ARI would mean that more people in the intensive insulin therapy group developed neuropathy (the bad outcome) than those in the control group. The formula for ARI is |CER j EER|, and application of the formula follows in the example below, where it is used in determining the number needed to harm (NNH). Assignment: Describing Statistical Test

    Number Needed to Harm Number needed to harm is the number of patients that, if given the experimen- tal treatment, would result in the harm of 1 additional patient compared with patients in the control group. ‘‘Harm’’ sounds rather alarming, but it relates to an outcome as simple as a sore throat or the ultimate negative outcome of a patient death despite a treatment antici- pated improving health.

    Let us look at an example: adults in the experimental group (n = 100) receive vitamin C tablets to determine if the vitamin C reduces work absences related to common cold symptoms; the control group (n = 100) receives pla- cebo candy only. The ‘‘bad outcomes’’ of sore throat and nausea occur in 90% of the adults in the experimental group who develop at least 1 adverse effect and in 80% of adults in the control

    group who develop at least 1 adverse effect.

    Because the bad outcome occurred more often in the experimental group than in the control group, the ARI calculation applies: |CER j EER| = |80% j 90%| = 0.10, or 10%. There is a 10% increased risk of a sore throat or nausea when taking the vitamin C tablets. The formula for NNH is 1/ARI, or 1/0.10 = 10. In other words, the practitioner needs to treat 10 adults with vitamin C tablets to lead to 1 additional person who develops adverse symp- toms. If the researcher found that over- all work absences decreased, the researcher might construe that this NNH of 10 is worth the risk of a sore throat or nausea; if work absences were not different between the groups, the researcher may not recommend an NNH of 10 as acceptable in practice. The practitioner interprets both NNT and NNH in the context of the actual practice setting. Assignment: Describing Statistical Test

    95% Confidence Intervals A 95% confidence interval (CI) is an attempt to quantify the uncertainty in measurement. In the vitamin C study, it is possible that nausea incidents were related to a gastrointestinal virus and

    Table 1. 7 Evidence-Based Practice Terms, Abbreviations, and Formulas

    Term and Definition Abbreviation Formula

    Absolute risk reduction: the absolute arithmetic difference (ignore plus and minus signs) in rates of bad outcomes between the experimental and control groups

    ARR |EER j CER|

    Number needed to treat: the number of patients who need to be treated to obtain 1 additional good outcome for a patient that would not have occurred without the treatment

    NNT 1/ARR

    Absolute risk increase: occurs when more patients in the experimental group develop the bad outcome compared with the control group

    ARI CER j EER

    Number needed to harm: the number of patients that, if they were given the experimental treatment, would result in 1 additional patient being harmed compared with patients in the control group

    NNH 1/ARI

    95% Confidence interval: the interval of values between which one is 95% sure that the true value of the population lies

    95% CI T1.96 � the square root of [CER � (1 j CER)]/N of the control group + [EER � (1 j EER)]/N of the experimental group

    Risk or relative ratio: the ratio of risk in the experimental group to the risk in the control group

    RR EER/CER

    Odds ratio: the ratio of odds in favor of having the bad outcome in the experimental group to the odds in favor of having the bad outcome in the control group

    OR For EER, bad outcomes/good outcomes; for CER, bad outcomes/good outcomes. Calculate the ratio of the above 2 answers

    EER indicates experimental event rate; CER, control group event rate.

    Nurse Educator Volume 32 & Number 1 & January/February 2007 17

    Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.

    Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.

     

     

    not the vitamin C. A 95% CI is calcu- lated to give the interval of values between which one is 95% sure that the true value of the population lies. In a repeat of the study, the 95% CI provides the range in which the researcher would expect the results to fall.9 Calculation requires that one knows the EER, the CER, and the number of persons in each group. The formula8 is T1.96 � the square root of [CER � (1 j CER)]/N of the control group + [EER � (1 j EER)]/N of the experimental group. Online calculators quickly assist in determining CIs and ranges for NNH and NNT.10 Many calculators show an NNT label, but if the experimental group exhibits more bad outcomes, the results present as

    NNH accordingly. In the vitamin C example, the 95% CI is 0.20% to 19.80%. The 95% CI range for NNH is 1/0.20 to 1/19.8, or 5 to 505.

    The wide range of 5 to 505 occurs because both groups developed an adverse effect at a fairly equal rate (80% in the control group compared with 90% in the experimental group). Such a wide range for NNH makes it difficult to feel ‘‘confident’’ about the effectiveness of an experimental treatment. If the experimental group responses had been 80% for an adverse effect in the vitamin C group compared with only 40% in the placebo group, the 95% CI would have been much narrower, and an NNH of 10 would seem more useful to the practitioner in

    deciding about using the tablets. It is important to look at the 95% CI value for any EBP statistic when considering the credibility of the evidence it further defines. Assignment: Describing Statistical Test

    Risk or Relative Ratio The risk or relative ratio (RR) is the ratio of the percentage of the bad outcome in the experimental group to the percentage of the bad outcome in the control group. The use of ratios contributes important information to EBP because it takes into consideration that some bad outcomes occur in both groups where considering these pro- portions adds to the evidence. The formula is RR = EER/CER.

    Figure 1. A calculation example for EBP terms.

    18 Volume 32 & Number 1 & January/February 2007 Nurse Educator

    Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.

    Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.

     

     

    Let us look at an example in the intensive versus regular insulin therapy study with neuropathy as the bad out- come: 13% of the patients in the experi- mental group developed neuropathy compared with 38% in the control group. Therefore, RR = 0.13/0.38 = 0.34, or 34%. This RR means that the person receiv- ing intensive insulin therapy still has a 34% chance (34 times out of 100) or risk of developing neuropathy when compared with the control group. The fact that only 13% did develop the neuropathy with intensive insulin ther- apy (the ARR) does not give the practi- tioner the same evidence as also considering the higher incidence in the control group and its likeliness in the population. When discussing pos- sible treatment options, it would be the 34% relative risk value that the practi- tioner would share with the patient.

    Odds Ratio An odds ratio (OR) is equivalent to saying, ‘‘taking all things into consider- ationI.’’ Odds ratio is the ratio of the

    odds in favor of having the bad out- come in the experimental group to the odds in favor of having the bad out- come in the control group. There are 3 steps: determine the experimental group odds (bad outcome occurs/good outcome occurs), determine the con- trol group odds (bad outcome occurs/ good outcome occurs), and calculate the ratio of these 2 ratio values.

    Let us look at an example: for simplicity of calculations, let us say that N = 10 and there are 5 patients in each group. The researcher finds that the experimental group odds are 1 bad outcome/4 good outcomes = 0.25. The control group odds are 4 bad outcomes/1 good outcome = 4. The OR = 0.25/4 = 0.0625 = 6.25%. This OR means that the odds of developing a bad outcome are 6.25% when given the experimental treatment. By adding the component of good outcomes, the OR goes beyond the RR and gives the broadest picture. Odds ratios greater than 1 are indicative of a harmful exposure to the experimental group treatment, whereas ORs less than 1 are

    indicative of a nonharmful exposure (eg, in the latter case, the patients do not develop neuropathy).

    9

    Interpreting the Opening Scenario Let us look again at the scenario presented at the beginning of this article and interpret it. Assignment: Describing Statistical Test

    How effective is a daily dose of 500 mg of vitamin C in the prevention of ulcers on the heels of bedridden elderly clients? Results: With an NNT of 5, vitamin C is effective (OR, 0.10; 95% CI, 0.05-0.20).

    The NNT of 5 means that the practitioner would need to treat 5 patients with 500 mg of vitamin C daily for 1 additional patient to have a positive outcome of not developing a heel ulcer. Although we do not directly see the original research stud- ies, we know that the systematic review team found more studies where the vitamin C was effective in the experi- mental groups. The OR of 0.10 means

    Table 2. Answers to the Practice Scenario

    Question Formula Calculation and Interpretation

    1. What are the odds of the experimental group developing heel ulcers?

    A/B 10/40 = 0.25, or a 25% odds of developing a bad outcome of an ulcer compared with a good outcome (non-ulcer)

    2. What are the odds of the control group developing heel ulcers?

    D/E 15/35 = 0.43, or a 43% odds of developing a bad outcome of an ulcer compared with a good outcome (non-ulcer)

    3. What are the odds of patients with diabetes older than 65 years developing heel ulcers when padded devices are applied for their prevention compared with those not using padded devices?

    (A/B)/(C/D) 10/40 divided by 15/35 = 0.25/0.43 = 0.58, or a 58% odds of developing a heel ulcer for patients with diabetes older than 65 years wearing a padded device.

    4. What is the experimental event rate (EER)? A/C 10/50 = 0.20, where the bad outcome (ulcer) occurs 20% of the time in this study

    5. What is the control event rate (CER)? D/F 15/50 = 0.30, where the bad outcome (ulcer) occurs 30% of the time in this study

    6. What is the absolute risk reduction (ARR) when wearing padded devices?

    (ARR = |EER j CER| = |(A)/(C) j (D)/(F)|

    |0.20 j 0.30| = |0.10|, where the use of padded devices reduces the risk of developing a heel ulcer by 10%

    7. What is the number needed to treat with padded devices for 1 additional patient to have a good outcome (not developing heel ulcers)?

    1/ARR 1/0.10 = 10, which means that 10 patients need to be treated to achieve 1 additional positive outcome where no ulcer occurs with the use of padded devices

    8. What is the risk ratio of developing a heel ulcer in this study?

    EER/CER 0.2/0.3 = 0.667 = 0.67, or a 67% risk of developing a heel ulcer when using a device compared with the control group, who did not use any device

    Note: Because the 2 groups in this hypothetical study were fairly close in their incidence of the bad outcome (10 compared with 15), we are not surprised to see that the risk of heel ulcer development is fairly high. Situations in which the control group has a much greater incidence of a bad outcome compared with the experimental group will result in a much reduced RR.

    Nurse Educator Volume 32 & Number 1 & January/February 2007 19

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    that those receiving vitamin C still have a 10% chance of developing heel ulcers. The small range for the 95% CI of 5% to 20% gives the reader good confidence that the OR of 0.10 credibly reflects the true value for the population.

    A Scenario to Calculate Consider the hypothetical scenario and related questions in Figure 1. The grid cells contain hypothetical numbers of incidence of individuals who met the category criteria in the research study. Table 2 contains the answers. Assignment: Describing Statistical Test

    Conclusion Evidence-based practice statistics are commonly reported in terms of RRs and risk reductions and increases. They come from the simple knowledge of the proportion of individuals who develop a bad outcome in the experi-

    mental group compared with those who do so in the control group. A review of EBP terms, abbreviations, and applied examples gives the reader practice skills for research utilization and decisions about best practices. Working through a hypothetical exam- ple enhances the reader’s personal effectiveness to read, interpret, and apply evidence-based literature in any teaching, mentoring, or practice setting.

    REFERENCES

    1. The Cochrane Collection. Available at: http://www.cochrane.org. Accessed March 11, 2006.

    2. Gerrish K, Clayton J. Promoting evidence- based practice: an organization approach. J Nurs Manag. 2004;12:114-123.

    3. Crawford P, Brown B, Anthony P, Hicks C. Reluctant empiricists: community mental health nurses and the art of evidence- based praxis. Health Soc Care Commun- ity. 2002;10(4):287-298.

    4. Melynk BM. Strategies for overcoming barriers in implementing evidence-based practice. Pediatr Nurs. 2002;28(2):159-161.

    5. Mulrow CD, Cook DJ, Davidoff F. Sys- tematic reviews: critical links in the great chain of evidence. Ann Intern Med. 1997;126(5):389-391.

    6. Melynk BM, Fineout-Overholt E, Stone P, Ackerman M. Evidence-based practice: the past, the present, and recommenda- tions for the millennium. Pediatr Nurs. 2000;29(1):77-80.

    7. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence- Based Medicine: How to Practice and Teach EBM. Edinburgh: Churchill Living- stone; 2000.

    8. Gibbs LE. Evidence-Based Practice for the Helping Professions: A Practical Guide With Integrated Multimedia. Bel- mont, Calif: Wadsworth Publishing; 2002.

    9. NSW Therapeutic Assessment Group, Inc. Evidence-based practice. Part 3: Applying research evidence to decision making. Tagnet Bulletin. Available at: http://www.ciap.health.nsw.gov.au/ n s w t a g / p u b l i c a t i o n s / n e w s l e t t e r / tagnet_6.ptd. Accessed March 11, 2006.

    10. GraftPad Software. QuickCalcs: Online calculators for scientists. Available at: h t t p : / / g r a p h p a d . c o m / q u i c k c a l c s / NNT1.cfm. Accessed March 12, 2006.

    20 Volume 32 & Number 1 & January/February 2007 Nurse Educator

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