Quantitative And Qualitative Research Discussion

Healthcare and Nursing

Your Name (First M. Last)

School or Institution Name (University at Place or Town, State)

Goldzweig, G., Baider, L., Andritsch, E., Pfeffer, R., & Rottenberg, Y. (2017). A dialogue of depression and hope: Elderly patients diagnosed with cancer and their spousal caregivers. Journal of Cancer Education, 32(3), 549-555.

The research question to be solved in the article is what the relationship is between psychological stress, depression, social support and hope in a group of elderly patients diagnosed with cancer and their spousal caregivers at home. The article is a qualitative study because it used the interviews to collect data from elderly patients. The target of the research study is the health care teams that can use the results of the study to address the specific needs of individuals within the dyads of patients and their spouses. The research study demands that a more comprehensive understanding of the patients will give the professionals more insight to improve their communication with patients and their spouses. The research study was not able to sue large sample due to the inclusion criteria, and it is the first step towards understanding the psychological vulnerability of elderly patients ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ail8jrfmi","properties":{"formattedCitation":"(Goldzweig, Baider, Andritsch, Pfeffer, & Rottenberg, 2017)","plainCitation":"(Goldzweig, Baider, Andritsch, Pfeffer, & Rottenberg, 2017)"},"citationItems":[{"id":1030,"uris":["http://zotero.org/users/local/FGhKhGPG/items/W92FICV3"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/W92FICV3"],"itemData":{"id":1030,"type":"article-journal","title":"A dialogue of depression and hope: Elderly patients diagnosed with cancer and their spousal caregivers","container-title":"Journal of Cancer Education","page":"549-555","volume":"32","issue":"3","author":[{"family":"Goldzweig","given":"Gil"},{"family":"Baider","given":"Lea"},{"family":"Andritsch","given":"Elisabeth"},{"family":"Pfeffer","given":"Raphael"},{"family":"Rottenberg","given":"Yakir"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Goldzweig, Baider, Andritsch, Pfeffer, & Rottenberg, 2017). There was no pilot study conducted before the research. The data was gathered between May 2013 and May 2015 and to collect data patients were approached during their regular medical evaluation. Participants were interviewed after getting informed written consent. Data were analyzed statistically using the multiple linear regression model to predict the level of stress among patients and their caregivers.

The study focuses on the psychological support for elderly cancer patients to increase hope and reduce anxiety among them. Positive psychological byproducts help cancer patients ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"asra0a81hu","properties":{"formattedCitation":"(Litzelman, Blanch-Hartigan, Lin, & Han, 2017)","plainCitation":"(Litzelman, Blanch-Hartigan, Lin, & Han, 2017)"},"citationItems":[{"id":1032,"uris":["http://zotero.org/users/local/FGhKhGPG/items/3CJRCMK2"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/3CJRCMK2"],"itemData":{"id":1032,"type":"article-journal","title":"Correlates of the positive psychological byproducts of cancer: role of family caregivers and informational support","container-title":"Palliative & supportive care","page":"693-703","volume":"15","issue":"6","author":[{"family":"Litzelman","given":"Kristin"},{"family":"Blanch-Hartigan","given":"Danielle"},{"family":"Lin","given":"Chun Cheih"},{"family":"Han","given":"Xuesong"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Litzelman, Blanch-Hartigan, Lin, & Han, 2017).The article has implication for the medical team including the nurses to gain information about the patient’s life history and look beyond medical symptoms and involve family caregivers and support old patients effectively. It also applies that all the partner’s patients, caregivers, and medical team to involve in decision making regarding patients treatment. Hope acts as a protective psychological factor ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2fmao6gcqe","properties":{"formattedCitation":"(Peh, Kua, & Mahendran, 2016)","plainCitation":"(Peh, Kua, & Mahendran, 2016)"},"citationItems":[{"id":1033,"uris":["http://zotero.org/users/local/FGhKhGPG/items/7PAYP45L"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/7PAYP45L"],"itemData":{"id":1033,"type":"article-journal","title":"Hope, emotion regulation, and psychosocial well-being in patients newly diagnosed with cancer","container-title":"Supportive Care in Cancer","page":"1955-1962","volume":"24","issue":"5","author":[{"family":"Peh","given":"Chao Xu"},{"family":"Kua","given":"Ee Heok"},{"family":"Mahendran","given":"Rathi"}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Peh, Kua, & Mahendran, 2016).

The research findings have implications for the medical team including the nurses to provide older patients with psychological support. To reduce the impact of this severe illness like cancer professionals have to look beyond medical symptoms and integrate family caregivers to provide effective medical support to older patients. All the partners must involve the parties in decision making.

References

ADDIN ZOTERO_BIBL {"custom":[]} CSL_BIBLIOGRAPHY Goldzweig, G., Baider, L., Andritsch, E., Pfeffer, R., & Rottenberg, Y. (2017). A dialogue of depression and hope: Elderly patients diagnosed with cancer and their spousal caregivers. Journal of Cancer Education, 32(3), 549–555.

Litzelman, K., Blanch-Hartigan, D., Lin, C. C., & Han, X. (2017). Correlates of the positive psychological byproducts of cancer: role of family caregivers and informational support. Palliative & Supportive Care, 15(6), 693–703.

Peh, C. X., Kua, E. H., & Mahendran, R. (2016). Hope, emotion regulation, and psychosocial well-being in patients newly diagnosed with cancer. Supportive Care in Cancer, 24(5), 1955–1962.

Quantitative Nursing Research Critique

Quantitative Nursing Research Critique

Lisa

[Institutional Affiliation(s)]

Quantitative Nursing Research Critique

The article, “Discovering Self: Childbearing Adolescents’ Maternal Identity”, was authored by Macintosh & Callister and it aims at expanding the limited data available on how an adolescent’s sense of self is impacted by the motherhood (Macintosh & Callister, 2015). The title of the article evidently reflects what the study is all about. In addition, it further highlights that the aim of the study is to enhance maternal outcomes and support self-perceptions. The phenomenon being studied in this research article is about the feelings of a teen experiencing motherhood, which impacts their sense of self (Macintosh & Callister, 2015). Since the study seeks to unearth the views, feelings, and opinions of teen mothers, it requires a qualitative study. Qualitative study is more helpful when it comes to obtaining in-depth information.

As mentioned by the authors in the article, this qualitative study has used ethnographic data collection and the data collection period extended to about seven months. The ethnographic methods aim at exploring the cultural and social view of the participants in comparison with the outsider’s view. A researcher is able to obtain this information by performing the qualitative analysis of the participant’s behavior. In technique requires that the researchers enter into the world of participants to better understand those ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"WcdZMiEH","properties":{"formattedCitation":"(Denzin & Lincoln, 2008)","plainCitation":"(Denzin & Lincoln, 2008)","noteIndex":0},"citationItems":[{"id":967,"uris":["http://zotero.org/users/local/orkqtrjP/items/YHMLPA7F"],"uri":["http://zotero.org/users/local/orkqtrjP/items/YHMLPA7F"],"itemData":{"id":967,"type":"article-journal","title":"Introduction: The discipline and practice of qualitative research.","author":[{"family":"Denzin","given":"Norman K."},{"family":"Lincoln","given":"Yvonna S."}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Denzin & Lincoln, 2008). The data was collected from 9 teen mothers from one child clinic and no single method was used as part of this study. The techniques employed for this research study involves interviews, observations and taking notes of data. Using all these techniques ensure that all the relevant data pertaining to the phenomenon is obtained.

As part of the interviews, open-ended questionnaires were used to allow the participants to share their thoughts and feelings freely. Furthermore, the methods used in the study were appropriate to obtain the required information needed for this study. Data saturation is referred to as the situation when the data shared with the researchers become repetitive (LoBiondo-Wood & Haber, 2013). Researchers generally continue to obtain information until no new data is emerging from the participants. This study also kept on collecting data until data was saturated. The study also employed two professional qualitative researchers to increase credibility and trustworthiness. Saturation is important in qualitative research since it tells the researchers how many interviews are enough (LoBiondo-Wood & Haber, 2013). The researchers have not included any statement declaring their role in the study or the statement of stance. However, it does not seems to impact the credibility of the study findings.

The data analysis process used by the researchers is denoted as narrative content analysis. This method revealed themes in the process of becoming a teen mother. Data analysis divided the results into three stages, pregnancy news, body loss and visualizing child in the arms (Macintosh & Callister, 2015). The analysis was being done as the data was collected using the narrative method. In order to achieve credibility and trustworthiness, two qualitative research experts were involved in the study that ensured data saturation. In addition to this, the privacy of participants was made a priority by using the pseudo names. The key findings of the study hold a significance in terms of improving the nursing practices with the adolescent mothers based on the changes in self-perception they are experiencing owing to motherhood. As reported by the participants, changes in self were observed with the pregnancy confirmation, physical changes observed in the body and visualizing a child with them. They started thinking about body loss and child’s future and growth. It fills a gap in literature and the level of evidence is revealed by making a reference to previous studies about the topic. It is worth mentioning that the study was conducted on the patients in one clinic only but nurses can draw learnings based on the findings while taking care of teen moms.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Denzin, N. K., & Lincoln, Y. S. (2008). Introduction: The discipline and practice of qualitative research.

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY LoBiondo-Wood, G., & Haber, J. (2013). Methods and critical appraisal for evidence-based practice. Nursing Research: Text and Study Guide Package, 290.

Macintosh, J., & Callister, L. C. (2015). Discovering Self: Childbearing Adolescents’ Maternal Identity. MCN: The American Journal of Maternal/Child Nursing, 40(4), 243–248.

Question

Question

Your Name (First M. Last)

School or Institution Name (University at Place or Town, State)

Question

Foreign policies are a set of self-interest strategies opted by a state to safeguard its national interests. Foreign policies of every nation take into consideration the physical and mental security of the people, territory and critical infrastructure of the state. Bioweapons, Pandemics and emerging disease are a threat to global and national security. Thus public health comes under the radar of foreign policy. The elected representatives of any country are responsible for public health since the health of the people is linked with the progress and development of a country. Therefore it is required to formulate such foreign policies which address the issues of public health. Based on this introduction this paper aims to discuss the ways in which foreign policy influence the public health issues and the agencies linked to it.

Bioweapons used during the time of war and conflict is one of the greatest public health issues. The use of bioweapons creates a detrimental impact on the citizens since they create serious injuries and death in the targeted areas. This is a point of concern for the government and the issue can be cratered by effective foreign policies. Containment of the use of biological weapons possessed by belligerent countries through efficient foreign policies is the way in which foreign policy influence public health. One example of this the Biological Weapons Convention between USA and USSR which banned the use of toxic weapons in 1975 (Mikulak, 2017). Hence this shows the influence of foreign policy on the public health issue.

Another public health issue is increased substance abuse. In American society, the use of drugs by teenagers is increasing on a daily basis. This is an area of concern for public health agencies because rehabilitation of people suffering from substance abuse is a challenging issue. Behavioural health agencies like the California Council of Community Behavioral Health Agencies (CBHA) deals with patients of substance abuse and collaborate with the federal government for the establishment of effective public policies. Such agencies provide data and insight about public health issues and the raise or decrees in the number of patients. This helps the federal government in determining foreign policies. For example tightening the security of the Mexican boarders because of the infiltration of drug mafia (Payan, 2016) is a foreign policy which addressed the issue of public health.

The last most prominent public health issue is obesity which is very common in India. Increased rate of obesity in Asian countries is due to the raised penchant of the people towards western food. This is an area of concern for healthcare agencies. This issue can be solved by such foreign policies which will limit the number of fast food outlets in the country. One potent example is the green revolution which promotes the use of green vegetables and fruits (Conway, 2019).

So to conclude, the above discussion sufficiently proves that foreign policies greatly influence public health issues around the world in a different manner like signing of MOUs for containment of weapons, strict immigration laws and advocating revolutions related to public health.

References

Conway, G. (2019). The doubly green revolution: food for all in the twenty-first century. Cornell University Press.

Mikulak, R. P. (2017). Bugs and gas: Agreements banning chemical and biological weapons. AIP Conference Proceedings, 1898, 030008. AIP Publishing.

Payan, T. (2016). The Three US-Mexico Border Wars: Drugs, Immigration, and Homeland Security: Drugs, Immigration, and Homeland Security. ABC-CLIO.

Question

Healthcare and Nursing

Questions

Name

Affiliation

Date

Healthcare and Nursing

Questions

Question 3:

Using the Haddon Matrix to analyze the risks for the scenario of a young female driver facing injuries, after a drunk driving scene highlights some of the most important points. In the pre-crash scenario, the human factors involved included the point of excess consumption of alcohol, driving under the influence of alcohol and not fastening the seat belt. The vehicle and equipment factor for the pre-crash scenario is that the female driver was driving an older model compact vehicle. The environmental factors involved in the pre-crash scenario is the road did not have proper lighting and it was dry as well.

The human factors involved in the crash scenario according to Haddon matrix include the point that due to being under the influence of alcohol and not wearing the seat belt, the female driver was not able to manage a road curve properly and became the victim of an accident. The vehicle and equipment factor in the crash scenario is that due to being an old model, the brake pads of the vehicle were broken and were not able to provide enough support that the female driver could take the round curve soundly, due to which she became the victim of the accident. The environmental factor in the crash scene is that the light on the road was not enough that the female driver could judge the distance of the curve and manage her speed accordingly (Runyan, 2015).

The human factor in the post-crash scenario is that she did not get the timely first aid, as she was discovered shortly after the accident, due to which she remained in a coma. The vehicle and equipment factor in the post-crash scenario is that due to being the old model, the vehicle did not have the airbags which could have minimized the injuries of the victim. The environmental factor in the post-crash scenario is that the due to the unfavorable circumstances of lighting and dry road, the first aid could not reach to the driver on time, which increased her suffering and resulted in her comatose state (Goniewicz, Goniewicz, Pawłowski, & Fiedor, 2016).

Question 5:

The case study of Susan and her nine-year-old daughter Lisa highlights that the mother and daughter are exposed to the features of the social, economic and physical environment which create the health risk to them. This paper will explore the social, economic and physical environment features leading to health risk.

One of the most important features of health risk to Susan and her daughter is the social environment. One of the most important point in this regard is that Susan is a single parent and does not have the support of her husband, in order to provide better living opportunities to her daughter. Ironically, her husband was abusive, so it was quite important to distance him from Lisa so that he does not cause any harm to her. After separation, Susan has not received the compensation for the expenses of her daughter, from her father, which means she is on her own to bring her up. Susan's family has also cut off ties with her, as they opposed her decision of leaving her husband so she is at risk for not having the social support of her family. Moreover, her new neighbors also slammed the door on her face, so she cannot a treaty on them in any kind of situation, due to which she is practically alone and all of these scenarios can give rise to the health risks of depression, stress and anxiety (Baum, 2016).

Another important feature of health risk to Susan and Lisa is the economic environment. Due to having to fulfill the responsibility of her daughter, Susan is working for two cleaning companies. She does not earn enough to meet the needs of her daughter and her own as well. She is also not educated enough to get some good employment and she does not have enough time and energy to study again to improve her educational status and look for better-paying jobs. The lack of economic facilities can cause a number of health issues and the most important out of them are stress and depression which can be accompanied by physical health issues as well. Moreover, due to poor income, Lisa cannot get the bicycle, or join the netball after the school, which can lead to poor confidence and anti-social behavior in her. Another important issue in this regard is that Susan does not have enough energy to cook something after her work hours, so she buys food for the two of them from an inexpensive takeaway, which can also give rise to physical health issues like indigestion and food poisoning etc. (de Andrade, Pellegrini Filho, Solar, Rígoli, de Salazar, Serrate, & Atun, 2015).

Another important feature of health risk to Susan and Lisa is the physical environment. The mother and daughter are living in an industrial area, which is right next to a busy highway. Due to the pollution of the industries, the atmosphere, as well as fresh air of the area is quite polluted. It has already started hosing its impact on the health of both Susan and Lisa, as Susan has developed frequent headaches and Lisa has developed asthma (Hood, Gennuso, Swain, & Catlin, 2016). The mother and daughter are exposed to the great health risk of developing influenza, measles, whooping cough and lung cancer due to inhaling the polluted air. All of these circumstances shed light on the fact that the mother and daughter are exposed to a number of health risks due to their social, economic and physical environment features.

References

Baum, F. (2016). The new public health (No. Ed. 4). Oxford University Press.

de Andrade, L. O. M., Pellegrini Filho, A., Solar, O., Rígoli, F., de Salazar, L. M., Serrate, P. C. F., ... & Atun, R. (2015). Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. The Lancet, 385(9975), 1343-1351.

Goniewicz, K., Goniewicz, M., Pawłowski, W., & Fiedor, P. (2016). Road accident rates: strategies and programmes for improving road traffic safety. European journal of trauma and emergency surgery, 42(4), 433-438.

Hood, C. M., Gennuso, K. P., Swain, G. R., & Catlin, B. B. (2016). County health rankings: relationships between determinant factors and health outcomes. American journal of preventive medicine, 50(2), 129-135.

Runyan, C. W. (2015). Using the Haddon matrix: introducing the third dimension. Injury prevention, 21(2), 126-130.

Quiz

HSH744/HSH944 EPIDEMIOLOGY 1

ASSIGNMENT 2 (30% OF TOTAL MARK)

Due date: 5 pm, 17 May 2019

Instructions

Please note: this assessment task must be all your own work. Please do not discuss questions and answers in detail with your fellow students.

Assignments must be submitted on-line via the DSO dropbox facility before 5 pm on Friday 17 May 2019. Assignments must be submitted in a Microsoft Word document or a pdf.

This assignment is worth 30% of the final mark for HSH744 and the marks allocated for each question are shown.

Some of the questions require calculations. The formula you use and your calculations should be included with your answers. If the final answer is incorrect, assessors can determine whether this is because of a simple calculation error (small loss of marks) or because of an incorrect formula or incorrect figures.

Students should ensure that they keep a spare copy of their work

70104031877000Student Name:

70104021907500Student ID Number:

Questions

For questions 1 to 6, identify the type of study being described from the descriptions provided (6 marks)

A questionnaire was posted to 20,000 Australian adults aged between 18 and 69 years whose addresses were randomly selected from the electoral roll. They were asked about their marital status, occupation, education level, and current income.

Cross-sectional study

Ecological study

Prospective cohort study

Retrospective cohort study

Case-control study

Randomised controlled trial

2 In an effort to reduce the incidence of STIs among inner-city residents, researchers undertook a video-based educational program on condom acquisition among men and women seeking services at a large sexual health clinic in the South Bronx, New York. A total of 3,348 African-American and Hispanic men and women patients were randomly assigned to receive: video-based education; video plus an interactive education session; or usual care.

Cross-sectional study

Ecological study

Prospective cohort study

Retrospective cohort study

Case-control study

Randomised controlled trial

A history of alcohol use was obtained from all patients entering a hospital who have oesophageal cancer and was compared with alcohol use histories of patients with appendicitis who enter the same hospital.

Cross-sectional study

Ecological study

Prospective cohort study

Retrospective cohort study

Case-control study

Randomised controlled trial

In 2015, an investigator performed a computerised search of records for the 40 community dental clinics across metropolitan Melbourne to identify children who had attended the dental service between 2000 and 2005. From these records, he identified children who had fluoride varnish applied to their teeth and a comparable group not treated with fluoride varnish. After obtaining ethics approval, the children, were invited to attend for free dental examinations to detect any evidence of tooth decay.

Cross-sectional study

Ecological study

Prospective cohort study

Retrospective cohort study

Case-control study

Randomised controlled trial

3105150675240What type of study is presented in this graph?

Cervical cancer death rate (per 100,000 person-years)

Incidence of HPV per 10,000 women

Cross-sectional study

Ecological study

Prospective cohort study

Retrospective cohort study

Case-control study

Randomised controlled trial

A group of researchers were interested in the impact of puberty on the development of mental health problems in adolescents. They recruited 5,000 children in grade 5 from 100 primary schools in the Melbourne metropolitan area and followed them annually for the next five years. They measured hormone levels and conducted screening test for anxiety and depression at each follow-up.

Cross-sectional study

Ecological study

Prospective cohort study

Retrospective cohort study

Case-control study

Randomised controlled trial

A longitudinal study was conducted with a sample of 2,500 people aged 40 to 69 years. Of these people, 270 reported that they had diabetes at the start of the study. The measure you could calculate from the information provided is (1 mark):

Point prevalence

Period prevalence

Cumulative incidence

Incidence rate

Prevalence rate ratio

A study of 26,870 Indian women aged 50-69 years aimed to assess the effects of yoga on hip fractures in adult Indian women. The study found 849 women reported a hip fracture over the next five years. The measure you could calculate from the information provided is (1 mark):

Point prevalence

Period prevalence

Cumulative incidence

Incidence rate

Prevalence rate ratio

Which of the following is a disadvantage of cohort studies? (1 mark)

Not suited for the study of common diseases because only small numbers of subjects would be required.

Not suited when the time between exposure and disease manifestation is short, as this would reduce the follow-up time required.

Only allow a single exposure and outcome to be studied

Maintaining high rates of follow-up can be difficult.

Expensive to carry out because intense follow-up of cases is usually required.

Which of the following features should apply to a screening programme (1 mark)

There should be a low prevalence of pre-clinical (early stage) disease

We don’t need to understand the natural history of the disease as screening will allow us to study this in detail

The disease should be severe, relatively common and perceived as a public health problem

There should be a low prevalence of pre-clinical (early stage) disease

The test should identify at least 50% of the cases

General practitioners need to be able to administer the test.

The advantages of Case Control studies are (1 mark):

Relatively quick and cheap to conduct

Can investigate a wide range of possible risk factors

Useful for very common diseases

Can employ expensive or time-consuming tests

Both a and b

All of a, b, c and d

Each of a, b and d

In general, screening should be undertaken for diseases with the following feature(s) (1 mark):

Diseases with low prevalence in identifiable subgroups of the population.

Diseases for which case-fatality rates are low.

Diseases that are readily diagnosed and for which treatment efficacy has been shown to be equivocal in evidence from a number of studies.

Disease with a natural history that can be altered by medical treatment.

None of the above.

If there is an epidemic it means that a disease: (1 mark)

Requires a high level of medical intervention

Is habitually present in human populations

Affects a large number of countries simultaneously

Occurs clearly in excess of the expected numbers

Is prevalent among animals.

Read this study description and answer the following question (1 mark)

When studying risk factors for Alzheimer’s disease (AD), a form of dementia found mainly in older people, exposure to head trauma in the past was investigated. Of 100 AD cases, only four recalled any head trauma, but of the 100 age-matched controls (without AD), there were 20 people who remembered some form of trauma to the head.

Based on the information provided we can conclude that head trauma does not increase the risk of subsequent onset of Alzheimer’s Disease The most likely source of error or bias in this study is:

Confounding

Selection bias

Measurement bias

Lack of power

None of the above

Which of the following is not a possible cause of measurement bias (1 mark):

Misclassification of exposure status

Misclassification of outcome status

Loss to follow-up

Recall bias

Observer bias

Read this study description and answer questions 16 to 20 (1 mark each)

Researchers in the USA investigated whether rural adults consumed at least five servings per day of combined fruits and vegetables. They used a survey where a random sample of households was selected and data were collected from one randomly selected adult in each household. Analysis revealed that in comparison to non-rural US adults, rural adults were less likely to consume five or more daily servings of fruits and vegetables (OR=0.861, 95% CI 0.860-0.862). Further analysis revealed that US rural adults consuming at least five daily servings of fruits and vegetables were more likely to be female, non-Caucasian, married or living with a partner, living in a household without children, living in a household whose annual income was > $35,000, and getting at least moderate physical activity.

The outcome of interest in this study is (choose 1)

The gender of the study participants

The marital status of the study participants

The household annual income of study participants

The consumption of fruit and vegetables by study participants

Each of a., b., and c. is correct

None of the above is correct

The study factors of interest include (choose 1)

The gender of the study participants

The marital status of the study participants

The household annual income of study participants

The consumption of fruit and vegetables by study participants

Each of a, b, and c is correct

None of the above is correct

The study results were reported as (choose 1)

Odds ratios

Risk Ratios

Prevalence rates

Incidence rates

Attributable risks

The study found that in comparison to non-rural US adults, rural adults were less likely to consume five or more daily servings of fruits and vegetables. This result should be treated with caution, as it is likely to be due to chance variability in the data. (choose 1)

True

False

State the reason for your answer to question 19.

The data maybe biased depending on the samples selected for the study. For instance, the availability of fruits of vegetables depends on the place and adults from rural areas are the ones who have high prevalence of serving fruits and vegetables since they are readily available in the farms.

Melbourne has been selected for a major sporting event. The event will run over seven days. Sporting teams are expected to arrive in Melbourne during the week preceding the start of the event. A very large number of domestic and international visitors are expected for this event. You are asked to advise on a health surveillance system particularly to detect outbreaks of infectious diseases. What are two of the main infectious disease hazards you would be concerned about? (2 marks)

The waterborne infection hazards

The airborne infection hazards

The surveillance system has been designed to collect comprehensive health data for the period covering the event – that is the data collection will commence when the sporting teams start to arrive and run until the final day of the event. Is this a good way to design the system? Why? (3 marks)

No, it would not be a good way to design the health data collection system. The surveillance system should be designed to screen the patients and collect data before they get to the sporting event. Doing this will detect a person with a communicable disease that will pose risks to the others in the community and hence will help the personnel to reduce the cases of infectious hazards

A large-scale, randomized, controlled trial of an educational program to prevent work- associated low back injury found no long-term benefits associated with training. Four thousand postal workers were randomly assigned to the training versus no training groups, and analysed using an ‘intention to treat’ approach after 5 years of follow-up (Daltroy et al. New England J Med 1997 337:5;322-8). The ‘intention to treat’ analysis means that (1 mark):

The analysis compared workers who underwent training with those who did not undergo training regardless of which group they were randomised to

The analysis compared workers who were randomised to training with those who were not randomised to training regardless of whether or not they were actually trained

The analysis excluded workers who were randomised to training but who were not actually trained

The analysis excluded workers who were not randomised to training but who actually did undergo training

Read this study description and answer questions 24 to 25 (1 mark each)

CONTEXT: A relative paucity of data exists on the possible health effects of using cellular telephones.

OBJECTIVE: To test the hypothesis that using handheld cellular telephones is related to the risk of primary brain cancer.

DESIGN AND SETTING: Case-control study conducted in 5 US academic medical centres between 1994 and 1998 using a structured questionnaire.

PATIENTS: A total of 469 men and women aged 18 to 80 years with primary brain cancer and 422 matched controls without brain cancer.

MAIN OUTCOME MEASURE: Risk of brain cancer compared by use of handheld cellular telephones, in hours per month and years of use.

CONCLUSIONS: Our data suggest that use of handheld cellular telephones is not associated with risk of brain cancer, but further studies are needed to account for longer induction periods, especially for slow-growing tumours with neuronal features.

Why might hospitals have been chosen as one of the sources of controls for this study?

(choose 1)

Hospital based controls are easy, convenient and relatively cheap to obtain

Controls who are also hospital patients may be more representative of hospitalized cases than controls selected from general population

Controls are already under medical care and so may be less likely to suffer adverse effects from participating in the study

Controls are confined to hospitals and so are less likely to be lost to follow-up than controls selected from another source

Answers a. and b. are both correct

Answers a., b. and d. are all correct

The study investigated different histological types of brain tumors. The table below shows the results for glioblastomas.

Cases

Controls

Used cellular telephones

29

76

Did not use cellular telephones

215

346

Total

244

422

Calculate the appropriate effect measure for exposure to cellular telephones among cases relative to controls to one decimal place. (1 mark)

In calculating the measure of odd ratio in this case, it is the cases of used cellular telephones over controls.

Odd ratio: 29/76 = 0.4

You are comparing heart disease rates between two cities. In the first city, the crude incidence rate is 4 per 1,000 and the age standardized incidence rate is 3.5 per 1,000. In the second city, the crude incidence rate is 5 per 1,000 and the age standardized incidence rate is 3.5 per 1,000. What do you conclude (choose 1)(1 mark)

The age-specific risk of heart disease is higher in the second city compared to the first

The age-specific risk of heart disease is lower in the second city compared to the first

The second city has an older population than the first city

The second city has a younger population than the first city

A study of traffic safety in a large Australian city showed that 61% of those involved in accidents last year had more than 10 years driving experience, 21% had 6 to 10 years driving experience and 17% had 1 to 5 years driving experience. Traffic experts concluded that experience seems to make drivers complacent and careless. Which of the following states why this conclusion is not justified? (1 mark)

The rates are not standardized for age differences

The data are incomplete because of unreported accidents

A comparison needs to be made with similar data on drivers not involved in accidents

No test of statistical significance has been made

Prevalence is used when incidence is required

End of assignment questions

Quiz

Q1*

Which of the following behaviours MOST reflect a person-centred approach by nurses?

Respecting patients' individual rights and values

Designing quality care processes that align with healthcare policies

Developing meaningful friendships with patients

Upholding the preferences and needs of medical officers

Q2*

When practicing in a person-centred manner, nurses should:

make decisions for and on behalf of patients

view patients as experts and partners in healthcare decision making

involve patients' families in all healthcare decisions

insist that patients make autonomous healthcare decisions

Q3*

Which of the following statements is correct? Person-centred care increases:

patient length of stay

healthcare costs

patient satisfaction

nursing burnout

Q4*

Mrs Dobson is a 77 year old woman admitted to hospital for asthma. Why is educating Mrs Dobson about her medications an example of person-centred care?

Patient education is a requirement of the National Open Disclosure policy

Patient education helps patients make informed decisions about medications

Patient education ensures that patients follow medication orders

Patient education is a priority for confused older people

Q5*

From the list below, identify TWO situations when nurses should advocate for patients?

When patients refuse to listen to advice about their treatment plan

When patients do not understand what they have been told about their prognosis

When the nurse believes that patient care is not safe

When the nurse believes that the patient’s decision about their treatment plan is incorrect

Q6*

What are the MOST common causes of adverse patient outcomes?

Poor communication and teamwork

Staff shortages and skill mix

Medication calculation and administration errors

Poor technical and procedural skills

Q7*

From the list below, identify THREE skills that are essential to therapeutic communication?

Ensuring all patients receive equal care

Expressing sympathy for the patient

Gaining the patient’s trust

Expressing empathy for the patient

Establishing rapport with the patient

Establishing rapport with staff

Q8*

Which of the following is an example of therapeutic communication by a nurse with a person who is anxious about having a minor surgical procedure?

"Oh dear, it's worrying isn't it. I'm glad it's you and not me."

"I've had major surgery which was terrible. Fortunately you are only having a minor procedure."

"I'm glad you trusted me enough to tell me how you are feeling"

"Don't worry. It will be over before you know it."

Q9*

Which of the following non-verbal communication skills should be used when interviewing a patient?

Maintaining an open posture with legs and arms crossed

Maintaining indirect eye contact

Sitting squarely facing the patient

Providing space by leaning backwards away from the patient

Q10*

One of the parents in the Emergency Department shouts at the triage nurse and demands to know why his daughter hasn’t been seen. What should the nurse say?

"I can see that you are worried about your daughter – let me check on the wait time for you."

"There are sicker children than your daughter so please calm down and wait your turn."

"This is a Zero Tolerance workplace. I will call security if you shout at me."

"I'm sorry, but we are very busy today. You will just have to wait like everyone else."

Q11*

YasminaShahid, 20 years old, came to Australia as an asylum seeker 18 months ago. She has been admitted to hospital with abdominal pain and is the only female in a four bed room. Yasmina explains that sharing a hospital room with males is against cultural beliefs and she asks whether she can change rooms. Which of the following statements is MOST correct?

Yasmina's cultural needs should be respected and supported.

An equitable approach to health care means that Yasmina's request should not be given priority over the needs of other patients.

Migrants need to adapt to Australian cultural norms so Yasmina's request is unreasonable.

Quality healthcare takes priority over a person's cultural beliefs.

Q12*

From the list below, identify THREE questions that the nurse should ask Yasmina when undertaking a cultural assessment?

Why did you come to Australia?

What does your illness mean to you?

Have you ever been in an Australian hospital before?

What did your doctor say is wrong with you?

How are healthcare decisions made in your family?

Do you have a particular religious faith?

Q13*

Which of the following comments suggests that a healthcare professional is culturally competent?

"To me all patients are human beings and their culture, ethnicity or race do not matter. I provide equal care for everybody."

"I believe that respecting people’s cultural beliefs does not mean I always have to agree with them."

"I believe that migrants should adapt to the way we do things here and should not expect special treatment."

"I am trying to memorise the cultural practices of the migrant groups in my area so that I don’t have to ask people about their individual cultural needs and values."

Q14*

Mr Daniel Lester is a 60-year-old Aboriginal man who was admitted with end-stage kidney disease. You are committed to providing culturally safe care to Mr Lester. Which of the following statements is FALSE?

Cultural safety is a concept developed in New Zealand by nurses working with Māori people

Cultural safety requires healthcare professionals to be self-aware and reflective

Cultural safety means respecting the cultural values of the patient

Cultural safety means being tolerant of differences between different ethnic groups

Q15*

Why might an Aboriginal Liaison Officer be asked to see Mr Lester?

To provide culturally safe nursing care to Mr Lester

To organise a discharge plan for Mr Lester

To provide emotional and cultural support to Mr Lester and his family

To ensure Mr Lester has a clear understanding of hospital rules about visiting hours.

Q16*

A nurse becomes concerned about a patient’s clinical deterioration and requests a clinical review using the acronym ISBAR to structure the telephone call. From the list below, identify FIVE correct components of ISBAR.

Signs and symptoms

Recommendation

Identification

Breathing

Response

Allergies

Situation

Background

Indication

Assessment

Q17*

Identify from the list below, THREE characteristics of effective healthcare teams.

Shared commitment to a common goal

Mutual respect and trust

Hierarchical leadership

Top down communication

Shared decision making in critical situations

Effective and timely communication

Q18*

During an emergency situation the following communication occurs. Doctor: Give 40 mg Furosemide IV push. Nurse: 40 mg Furosemide IV push? Doctor: That’s correct What is this communication technique called?

Two-challenge rule

Closed loop communication

Check-back

Call out

Q19*

PACE is an acronym for graded assertiveness. Which of the following represent the FOUR elements of PACE?

Action – e.g. "Let's take a different approach?"

Alert – e.g. "I think that will cause…"

Plan – e.g. "I have a better plan for this situation …"

Challenge – "Your approach will harm…"

Emergency action – e.g. "STOP what you are doing!"

Explain – e.g. "Can you explain why you have made that decision?"

Probe – e.g. "Can you tell me why you want to do that?"

Concerns – "I feel a little concerned about what you are doing …"

Q20*

Which of the following is NOT a characteristic of an effective nursing manager of an Emergency Department?

The ability to make autonomous decisions when required

High level situational awareness in critical situations

The ability to empower team members to question practice decisions

The determination to assume full responsibility during resuscitation situations

Q21*

Joel Andrews, 36 years old, was admitted to hospital with pneumonia. Joel's current observations are: Temperature 39°C Pulse rate 128 beats/min Respiratory rate 26 per minute Blood pressure 100/60mmHg Oxygen saturation 90% on a Hudson mask at 6 L/min Which of the following statements is CORRECT in regards to Joel's observations?

He is tachypnoeic, bradycardic and hypoxic

He is febrile, tachycardic, and tachypnoeic

He is hypertensive, hypoxic and dyspnoeic

He is febrile, bradycardic and hypoxic

Q22*

Mr Lee is a 75 year old man who is day 2 following a bowel resection. In handover you hear that Mr Lee has hypervolaemia. What signs and symptoms are typical of hypervolaemia?

Oliguria and elevated haematocrit levels

Poor skin turgor and dry mucous membranes

Hypotension and tachycardia

Tachycardia and hypertension

Q23*

Mr Lee's serum sodium is 128mmol/L and his serum potassium is 3.0mmol/L. Mr Lee is:

Hypernatraemic and hyperkalaemic

Hyponatraemic and hypokalaemic

Hypernatraemic and hypokalaemic

Hyponatraemic and hyperkalaemic

Q24*

Aiden O'Brien is brought into the Emergency Department (ED) following a motor vehicle accident. Aiden's Glasgow Coma Scale (GCS) is 8. What does this indicate?

Mild head injury

Moderate head injury

Severe head injury

No head injury

Q25*

You are asked to conduct a primary trauma survey. Which of the following statements BEST characterises a primary trauma survey?

Rapidly assessing and stabilising any compromise to a patient's airway, breathing and circulation

Performing a head to toe physical examination to determine the extent of the trauma

Rapidly obtaining a set of vital signs on a patient

Obtaining an accurate history of the mechanism of a patient's injury

Q26*

From the list below, identify the THREE MOST credible sources of evidence to inform nursing practice.

Health information websites

Health department policy directives

Clinical expertise

Empirical studies

Newspaper articles

Patient preferences

Q27*

The infection control Clinical Nurse Consultant on your ward explains that the rate of intravenous (IV) cannula site infections on your ward has increased significantly over the last 18 months. He asks for volunteers to work with him on a quality improvement project to review and update the relevant policy and procedure. What is an appropriate FIRST step in this process?

conduct a randomised control trial of IV dressing products

search for recent systematic reviews on the topic of IV cannula management

conduct a survey to elicit staff views about IV management

interview patients to collect qualitative data about their experiences of having an IV

Q28*

Your Nurse Unit Manager tells you that she has received the 2016-2017 patient satisfaction audit results and that your ward rated highly in every category except "Patient satisfaction with pain management". She asks you to design a study exploring orthopaedic patients' experiences of post-operative pain. Which of the following research methods is MOST appropriate for this study?

interviews with staff to collect qualitative data

interviews with patients to collect qualitative data

an online survey to collect quantitative data

a randomised control trial

Q29*

Which of the following is considered to be the HIGHEST level of evidence?

Systematic reviews

Case studies

Randomised controlled trials

Quasi-experimental studies

Q30*

What does the term RELIABILITY mean when used to describe a research instrument?

Whether the reporting of the results from the instrument is appropriate

Whether the instrument can be easily understood by participants

Whether the content of the instrument is appropriate

Whether the instrument consistently measures what it is intended to measure

Q31*

Which of the following is a CORRECT definition of an adverse event?

An unintentional or unexpected event that could have resulted in injury or death

A situation in which there was significant potential for harm, but no incident occurred

A deliberate deviation from standard operating procedures, standards or rules

Unintended injury or illness resulting from healthcare

Q32*

Open disclosure refers to the open discussion of an incident that resulted in an adverse event. Which TWO of the following are elements of the Australian Open Disclosure Framework?

An expression of regret to the patient

Identification of who was responsible for the adverse event

A factual explanation of what happened

An explanation of potential legal actions

Q33*

James Reason's "Swiss Cheese Model" is one model for conceptualising the human and systems factors that can lead to errors. Which of the following descriptors is an element of this model?

The more holes in the cheese the more likely it is that an error will be caught

Each hole in the cheese represents a defensive layer in the process

Each hole in the cheese represents an opportunity for a process to fail

When the holes in the cheese line up it is less likely that an error will be caught

Q34*

Which of the following factors is LEAST likely to have a negative impact on patient safety:

Environmental noise and clutter

The use of electronic medical records

Staff stress levels

A culture of workplace bullying

Q35*

Which of the following are elements of the ABCDEGH clinical assessment and documentation mnemonic?

Electrocardiograph, Fluids and Glucose

Airway, Breathing and Disability

Airway, Circulation and Drugs

Exposure, Holistic assessment and Disorientation

Q36*

What is the MAIN principle of antimicrobial stewardship?

To increase the prophylactic use of antimicrobial medications

To prevent adverse consequences of antimicrobial use

To promote the timely prescription of antimicrobial medications to at risk patients

To reduce inappropriate antimicrobial use

Q37*

When providing discharge education to a patient recently diagnosed with hepatitis C, the nurse knows that their teaching has been effective when the patient states:

"I will warn my friends to get vaccinated against this disease"

"I know I can no longer drink any alcohol"

"I will be much more careful where I eat"

"I will use barrier protection during sex"

Q38*

While commencing a blood transfusion the nurse experiences a sharps injury. What should the nurse do?

See staff health or the emergency department for assessment of the risk of transmission of blood-borne viruses

See a medical officer for a prescription of antibiotics to prevent colonisation

Squeeze the site of injury until blood flows freely to expel potential contaminants

Swab the site of injury with chlorhexidine solution to prevent infection from occurring

Q39*

A patient has a wound swab taken and Staphylococcus aureus is identified. Would the doctor prescribe antibiotics?

No, because Staphylococcus aureus is not resistant to antibiotics

Yes, because Staphylococcus aureus is the most serious community-based infection

Yes, because wounds colonised with Staphylococcus aureus are unlikely to heal

No, not unless there are local signs of infection such as pain, pus and redness

Q40*

Which microorganism is not destroyed by alcohol hand rub?

Enterobacter species

Clostridium Difficile

Staphylococcus aureus

Klebsiella pneumonia

Q41*

For nurses to administer medications a valid prescription is required. From the list below identify THREEcomponents of a valid prescription.

the dose of the drug to be administered

the trade name of the drug

patient's allergy status

the generic name of the drug

the signature of the patient

the route of administration

Q42*

From the list below identify THREE medications classified as HIGH-RISK.

Analgesic medications

Chemotherapeutic agents

Antipsychotic medications

Insulin preparations

Potassium

Antihypertensive medications

Q43*

Which of the following is a correct definition of a medication side effect?

A preventable medication incident that leads to, or has the potential to lead to, harm to the patient.

A medication error that was detected and corrected before it reached the patient.

A response to a medication that is harmful and unintended and occurs at normal doses.

An unintended effect of a drug that is usually predictable and may be harmless or potentially harmful

Q44*

When administering a Schedule 4D medication which of the following is MOST correct?

Two registered nurses must check out, administer and sign for the medication.

Two staff members, one of whom must be a registered nurse, must witness administration of the medication.

Two nurses, one of whom may be a nursing student, must check out and witness administration of the medication.

Two staff members, one of whom must be a registered nurse, must check out and sign for the medication.

Q45*

When preparing to administer a patient’s digoxin you note that the dose prescribed is 125mg and the dose in stock is 250 micrograms. Which THREE of the following actions are appropriate in this situation?

Check the patient's digoxin levels before administering the medication

Check the patient's pulse before administering the medication

Administer 2 digoxin tablets

Document this as a 'near miss' in the incident management reporting system

Administer ½ a digoxin tablet

Contact the prescribing doctor

Refuse to administer the digoxin

Quiz Excercise

This week we are focusing on the tools that these models may employ to bring about improvement.  We will walk through the attempts a hospital made to improve the discharge process.  This is an exercise so you are not penalized for choosing a “wrong” answer, but rather you can use it as a test of your understanding of the concepts. 

You will recall Carla's story that we read at the beginning of this class. For this exercise we will spend time thinking about the events related to Carla's Discharge.

The hospital had an established discharge process which included:

Nurse reviews the written discharge instructions with the patient

Follow up care is arranged with primary care physician. (In Carla's case the initial plan was to have Carla follow up with her PCP to monitor her INR to make sure Carla is on the right dose of medication)

Discharge Summary is sent to Primary Care Doctor

This process did not meet Carla's needs so the nurse and the social worker had to improvise alternative plans.

As it was inconvenient for Carla to see Primary Care – plan to have it done at dialysis as Carla will be there

When it was realized that Carla had not been evaluated by a nutritionist to advise Carla on what foods to avoid when taking warfarin, a referral was made to the nutrition department.

It is clear there were several failures associated with Carla's care including:

Carla lost the written instructions given to her and there was no alternative means for her to find the necessary information

No communication with dialysis doctor who was to assume responsibility for checking Carla's INR

No monitoring of INR was performed

Carla did not have nutrition consult.

Using the information we have learned in the course thus far, let us see how perhaps some of these issues could have been avoided using a Quality Improvement Approach.

1.Carla's initial discharge plan involved Carla following up with her primary care physician rather than with provider that would be more convenient.  Carla had often noticed that it seemed care was arranged for the convenience of her providers rather than her needs.  Which of the six dimensions of quality does this issue represent?

Safety

Efficacy

Patient Centeredness

Timeliness

2.The IOM specified that care should be Patient Centered, that is respectful to patients’ values, preferences, and expressed needs. Scheduling an appointment for Carla that did not take into her needs is an example of care not meeting the patient's preferences. 

Carla was also discharged without a clear plan to monitor her INR. Carla had written information, which was misplaced, and no one informed the physician who was to assume responsibility for her care.

Which of the IOM six dimensions of care was this related to?

Equitable

Efficient

Patient Centered

Safety

3.The IOM describes the quality dimension of safety as avoiding harm to patients from the care that is intended to help them. The failure to have robust processes that led to a failure in the management of Carla's warfarin is a safety failure.

The hospital had recognized this failure a few years earlier, when there had been several incidents of patients admitted with elevated INRs after being discharged on warfarin without an appointment to get their INR checked.  At that time, the quality department decided to do a quality improvement project to manage this issue.  

A team was assembled which included a "warfarin nurse," a representative of the medical staff, a quality advisor, and a few other stakeholders. The team decided the aim of their project was "to improve the handling of warfarin."

That was an acceptable aim statement

 True

 False

To improve the quality of process involving patients with elevated INRs.

4.That AIM statement as written provides a very general overview of the project, but an AIM statement should be more specific.  It should include clear goals about what is to be accomplished and by when.  And, as Don Berwick has noted, "some" is not a number and "soon" is not a time.

The team decided to gather some information to get a better description of the problem. The hospital had a process whereby any patient who was started on warfarin was to receive a consult by a warfarin nurse who would educate the patient about warfarin use and arrange for appropriate follow up to monitor the INR.  Parts of the referral forms were to be completed by the ordering physician, other parts by the ward nurse. The referral form also included advice on how to dose warfarin based on best practice guidelines.

Referral forms were reviewed by a clerk and incomplete forms were sent back to the referring provider for additional information. Often, no action was taken on these returned referrals and therefore patients were not seen by the warfarin nurse.

To get a better understanding of the problem, the team decided to perform an audit to determine how many forms were incomplete and what elements were missing.

This audit is an example of a qualitative tool.

 True

 False

5.The team prospectively audited all referrals over three weeks and identified the number of complete and the number of incomplete referrals. This is an example of quantitative data, that is it provides numeric measurements.

The team reviewed all the incomplete forms. During the audit, it was also noted that many of the referrals contained dosing errors that were not consistent with the dosing algorithm that had been developed by the hematology department and pharmacy. It was decided that dosing errors were outside the scope of this QI project, but the team made a note of the finding with the idea this could be addressed in a later project.

The rationale for using a three-week time period was that this was a sufficient sample size from which to calculate a statistically valid p-value.

 True

 False

6. This is false.  Remember getting a sample size sufficient to obtain a p-value is usually associated with a research function.  For an improvement project like this, the goal is to get "just enough" data.

Speaking of which, the team completed the audit and documented the missing elements from the incomplete referrals. 53% (24/45) had major omissions. The team further quantified which elements of the form were incomplete

Patient Name and Address

8

Contact Phone

19

Ward

1

Consultant

4

Prescriber detains

5

Indication

2

Desired INR

1

Desired duration

12

Underlying Medical Conditions

17

Medications

16

Date of next appointment

22

Creatinine, Weight, Aspirin

20

The best way to visualize this data would be in

A fishbone diagram

A bar chart

A scatter diagram

A line graph

7.A bar chart is the best way to display this data as it allows a quick visual comparison of different types of data.

The team was also interested to see if there was a pattern as to who was not filling out the forms correctly. They were hoping to concentrate their efforts in that area in order to separate the vital few from the trivial many.  The best type of tool for this issue is independent

A line graph

A pareto chart

A scatter diagram

A survey

8. The chart that shows you the "biggest bang for your buck" is the Pareto Chart.  This chart shows that 80% of the problems were on the acute medical ward, the neurology unit, the pulmonary and cardiology ward.  The team decides to focus their efforts there.  They decide to survey the providers in these units to see if they could identify some of the barriers to providing complete information.  A survey is a qualitative tool

True

 False

A survey can be qualitative or quantitative, the one discussed above is qualitative

9. Surveys are qualitative tools that can be used to generate ideas, determine problems, and clarify processes.  The feedback from the providers included a number of qualitative statements:

No training on use of forms

Unclear who was responsible to complete different parts of the forms

Forms included information on the back were used for the prescribing of loading and maintenance doses- but the information was in text format that took time to understand.

No formal teaching on process for managing patients beyond issue of dosing. (no information on nutrition consults)

Form had too many sections- takes too much time to complete

Providers don’t have access to some information required- for example providers have no way of knowing who will be checking INR

Transferring medication list to form too time consuming

Too much information required

The team decided they needed a structured brainstorming approach to categorize the problems that were being identified.  A good tool for this purpose is

Surveys

Scatter Diagram

Fishbone diagram

Pareto chart

10. A fishbone diagram (or Ishikawa diagram) helps focus brainstorming into categories and helps identify where improvement efforts might be focused.  

After discussion, the team decided the forms were poorly designed- creating a lot of wasted effort.  They wanted to implement an improvement plan.  What model might be the most helpful in eliminating waste and streamlining processes?

Six Sigma

Lean

5 Whys

PDSA

 improve the capability of their business processes.

11. The goal of LEAN is to eliminate waste, defined as any action that does not add value from the customer's perspective. The customer in this instance would be the providers completing the form. The team, working with the providers re-designs the form to make it easier to complete. In addition, the team re-designs the dosing flow chart-- eliminating the text and putting it the form of a flow chart.  Additional information is added including important drug-drug, drug-food interactions.  Now that the team has a new form, they should immediately share it with the entire hospital.

True

 False

Pilot testing, to check for suitability and improvements

12. Although the team may be excited about the new form, there may be additional improvements that can be made. Therefore, before implementing the new forms in all areas of the hospital, the team will want to run a series of tests to see if additional improvements can be made. 

This type of approach is referred to as rapid cycle improvement.

 True

 False

13. A rapid cycle test allows the QI team to make a series of small changes and test them quickly.

After several iterations of the form, the staff then conducted an audit. They again looked at 3 weeks’ worth of referrals and documented the missing elements on the incomplete chart.  The data this time looked appears below. The results suggest that the new form was an improvement over the old form because there were fewer omissions.

True

 False

14.After Carla's tragic outcome, members of the hospital patient safety committee reviewed the "warfarin nurse" referral process to try and learn why Carla did not have a consult by the warfarin nurse. They learned that a referral was never sent.  The committee realized that there was a subset of patients who were not included in the quality improvement project because the measure chosen only addressed patients who had had a form completed. Therefore, although the measure of monitoring incomplete referral forms improved the process of obtaining information on patients referred for a warfarin nurse consult, it did not "catch" patients who were started on warfarin and needed a consult but did not have a referral sent. Therefore, the measure chosen did not completely measure the quality failures associated with warfarin management.

This is a problem with measurement...

Reliability

Specificity

Validity

Sustainability

15. Validity refers to the fact that your measure is capturing the information that you believe you are measuring. Looking at referral forms is a valid measure of how well the forms are completed, but, as the patient safety committee learned, it is not a valid measure of how well all patients who were started on warfarin are being treated.  The patient committee began considering how they could work with pharmacy to create a process whereby all patients started on warfarin would have a referral by the warfarin nurse.

The patient safety committee also noted that there were several instances of communication failure in the discharge process that they felt were related to readmission rates.  The committee evaluated several of those failures to see if there was a relationship between the type of failure and the readmission rate

The best tool to demonstrate a relationship between 2 variables is

a driver diagram

a fishbone diagram

a pareto chart

a scatter diagram

16. A scatter gram identifies correlation between 2 variables. A scatter gram revealed a positive correlation between the time it took providers to write a discharge summary and the 30 day readmission rate. Although the scatter gram cannot say that the delay in writing a discharge summary was the cause of the readmission, the committee noted the average time for a discharge summary to be written was 29 days. The committee learned that this was because the cut-off day for writing a discharge summary was 60 days and many providers did not consider it a high priority.  As part of a quality improvement project, a benchmark goal set the expectation that the discharge summary would be completed within 24 hours after discharge. 

The best tool to monitor the progress of this improvement project would be

A fishbone chart

A line chart

A bar chart

A pareto chart

17. A line chart shows illustrates a measurement over time.  Next week we will be looking at 2 versions of the line chart-- that is, a run chart and a control chart.  

Please check true below to indicate you have completed this assignment and to get credit

 True

 False

Radial Vs Femoral Artery

Title

Authors’ Name

Degrees

E-mail Address

Affiliation

Radial Vs. Femoral Artery

Arterial lines are significant in providing care to patients whose conditions are worse. There are two locations for arterial line placement one is femoral, and the other is radial arteries. The choice for either option depends completely on the provider, and there is no proper guidance available for it. Older studies suggested that femoral artery was superior to the radial artery for monitoring blood pressure, but as the medical practices and the era was quite different from the present era, therefore, it is important to reinvestigate the femoral artery access in today's environment. So in this study, the failure rates of both radial and femoral arteries were determined, and it was then proofed that radial arterial lines have higher failure rates than femoral lines.

To perform this experiment, a study was conducted from 2012-2016, and in this study, all the arterial lines were placed in adult patients at a single institution. Although the specific cause for arterial lines failure was not determined in this study, the arterial lines were placed for titration of vasopressor agents. Research assistants were given training on how to extract data from the hospital's electronic database including the age of the patient, line removal time and also whether the removal was due to failure or not. Results were compiled into a database, and also a pilot quality improvement study was performed on every 20th patient in the study. The principal investigators reviewed the data to ensure that the data acquisitions were right between all the research assistants or not. After confirming the precision of the data acquisition, the research assistants reviewed the total data, and the obtained data was then kept it in a spreadsheet. The arterial failure was determined by nursing interviews and the data that was available with them about the patients. The arterial failure information obtained was inaccuracy, blockage, site issue and also accidental removal.

In total 272 arterial lines were evaluated over both prospective and retrospective arms of the study. The retrospective line examined 304 arterial lines, but only 196 lines met the criteria for analysis of three and half years. The secondary outcomes evaluated include time and cause of failure. From the data, it was found that the primary cause of failure for the radial lines was accidental removal which was 40%. No radical lines removed due to a site issue. There were total 11 deaths in the femoral cohorts with none of them occurring in patients with prior femoral lines failure. The total three deaths that were attributed to radial line failures, there was a total of seven deaths in the radial cohorts.

The present study suggested that femoral lines fail far less than radial arterial lines and when they fail it occurs later in the patient treatment. If it is determined that arterial line failure rates could be reduced from 30% to 5% simply by favoring femoral over radial sites, then that would be quite helpful in patient’s care and also lower the cost to the healthcare system ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"42VXLT7u","properties":{"formattedCitation":"(Greer et al., 2018)","plainCitation":"(Greer et al., 2018)","noteIndex":0},"citationItems":[{"id":617,"uris":["http://zotero.org/users/local/4C6u8dIT/items/HCSVMVL5"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/HCSVMVL5"],"itemData":{"id":617,"type":"article-journal","title":"Radial Arterial Lines Have a Higher Failure Rate than Femoral","container-title":"Western Journal of Emergency Medicine","page":"364","volume":"19","issue":"2","author":[{"family":"Greer","given":"Matthew R."},{"family":"Carney","given":"Scott"},{"family":"McPheeters","given":"Rick A."},{"family":"Aguiniga","given":"Phillip"},{"family":"Rubio","given":"Stephanie"},{"family":"Lee","given":"Jason"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Greer et al., 2018).

References ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY

Greer, M. R., Carney, S., McPheeters, R. A., Aguiniga, P., Rubio, S., & Lee, J. (2018). Radial Arterial Lines Have a Higher Failure Rate than Femoral. Western Journal of Emergency Medicine, 19(2), 364.

RE: Discussion - Week 1

Discussion Post

Opioids are the drugs that act directly on the rewards system of brain; after their consumption, they block pain receptors and release such hormones that give off highly relieving effects. In other words, Opioids are pain relievers that directly work on our nervous system in order to treat somatic symptoms of pain. When we contemplate their mechanism of action thoroughly, we come to know that patients that are prescribed with Opioids are prone to get drug dependence, for that matter, they start abusing drugs through either taking larger dosages or taking smaller ones too frequently. As a result, our brain learns to work on the same mechanisms and when drug isn’t being taken, the person is stroked by a massive urge to use it at any cost. With the passing time, the drug tolerance is developed that leads the person to take drug in larger amounts, the outcome becomes too obvious; mortality. For the evidence based adversities associated with Opioids use, various governments of US struggled to lessen their impact in many ways. The administrative agenda of current president suggests that Opioids demand and over prescription must be avoided along with the education of common people about its potential ramifications (Burton, 2019). The previous President Obama focused on the eradication of supply-chain that works at domestic and international levels in order to reduce drug devastation whereas ex President Bush emphasized on the development and execution of evidence based interventions for struggling patients (NCSSLE, 2019; Felter, 2019). Moving to the resource allocation, Trump administration exceeds the other two administrations of Obama and Bush with $7 billion, $1 billion and $600 million respectively (Burton, 2019, NCSSLE, 2019; Felter, 2019). The approach of President Trump on this issue encapsulates SUPPORT act that includes research and management interventions, President Obama approved the utilization of Naloxone that reverses the drug effects and helps gain drug independence whereas Bush emphasized on the interventions regarding school and institutional level education (Burton, 2019, NCSSLE, 2019; Felter, 2019).

References

Burton, M. T. (2019). Trump Administration to Launch New Opioid-Addiction Initiative. The Wall Street Journal. Retrieved from https://www.wsj.com/articles/trump-administration-to-launch-new-opioid-addiction-initiative-11555625054

Fact Sheet: Obama Administration Takes More Actions to Address the Prescription Opioid and Heroin Epidemic (2019). National Center on Safe Support Learning Environment. Retrieved from https://safesupportivelearning.ed.gov/resources/fact-sheet-obama-administration-takes-more-actions-address-prescription-opioid-and-heroin

Felter, C. (2019). The U.S. Opioid Epidemic. Council on Foreign Relations. Retrieved from https://www.cfr.org/backgrounder/us-opioid-epidemic

RE: Discussion - Week 1

Discussion Post

Name

Institution

Discussion Post

My willingly selected population problem is HIV that if left untreated may lead the individual to acquire AIDS (Acquired Immune Deficiency Syndrome). It is referred to as an umbrella of symptoms originating from the development of compromised immune system. Estimations propound that approximately 3.6 million people are living with HIV-AIDS worldwide (CDC, 2019). For such massive public perpetuation, government takes this issue to undergo policy making following the agenda setting. Out of 45 USA presidents, the policy makings and practical efforts of only three presidents would be embraced thorough discussion in terms of administrative agenda, allocation of financial resources and particular approach to this issue; Donald Trump, Barack Obama, George W. Bush. Starting from the administrative agenda, Trump administration aims to develop advanced strategies driven by current technology in order to combat this epidemic (HIVG, 2019). It centralized its focus on the advancement of antiretroviral medications and other prevention strategies through focusing more on the utilization of research and laboratory testing. The Obama administration attempted to increase the number of people to avail healthcare facilities and education of the patients for self preventive and management activities (ONAIDSP, 2018). The president Bush developed President’s Emergency Plan for AIDS Relief (PEPFAR) in order to treat affected individuals, prevent newly born individuals from this menace and execute sufficient research to eradicate this issue (IAVIR, 2017). As far as the allocation of resources is concerned, the Trump administration surpassed the other two governments as evident from the amount allocated for HIV AIDS prevention and management; $291 million followed by the Barak and Bush administrations; $19.4 billion and $12 billion respectively (HIVG, 2019; ONAIDSP, 2018; IAVIR, 2017). Moving to the approach towards HIV AIDS, the trump administration focused more on the infected areas, research and advancement of technologies; president Obama emphasized the collaboration of governmental and non-governmental stakeholders in order to develop effective treatment plans whereas Bush administration approached PEPFAR for addressing associated healthcare concerns (HIVG, 2019; ONAIDSP, 2018; IAVIR, 2017).

References

Statistics overview (2019). Center o Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/hiv/statistics/overview/index.html

What is ‘Ending the HIV Epidemic: A Plan for America’? (2019). HIV.govt. Retrieved from https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview

National HIV/AIDS Strategy (2018). ONAIDS Policy. Retrieved from https://obamawhitehouse.archives.gov/administration/eop/onap/nhas

The Bush’s war on AIDS (2017). IAVI Reports. Retrieved from https://www.iavireport.org/easyblog/entry/bush-s-war-on-aids

RE: Discussion - Week 10 Standard Of Practice

Standards of Practice

[Name]

[Institution]

Author Note

Standards of Practice

Dear Jane,

I liked your post, and the details you have shared were certainly helpful. While I have my own career aspirations and am well aware of what I would like to pursue in my future. At the same time, I must admit that I have not gone into technical nuiances of my field as you have. Thus, thank you for giving me ideas regarding a few things I should bring into consideration regarding my future.

I also believe that my strengths lie in patient care rather than administration and I would certainly be more beneficial to the system as an Adult-Gerontology Nurse Practitioner (AGNP) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xVskmzMW","properties":{"formattedCitation":"(Blackwell & Neff, 2015)","plainCitation":"(Blackwell & Neff, 2015)","noteIndex":0},"citationItems":[{"id":681,"uris":["http://zotero.org/users/local/0omESN17/items/CBT4M5PE"],"uri":["http://zotero.org/users/local/0omESN17/items/CBT4M5PE"],"itemData":{"id":681,"type":"article-journal","title":"Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States","container-title":"Journal of the American Association of Nurse Practitioners","page":"552-557","volume":"27","issue":"10","author":[{"family":"Blackwell","given":"Christopher W."},{"family":"Neff","given":"Donna Felber"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Blackwell & Neff, 2015). As an AGNP, I will not only get to work with a team in a collaborative manner, but I also get to work with a range of different patients in different phases of their life ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aPW2cP2z","properties":{"formattedCitation":"(Miller, 2019)","plainCitation":"(Miller, 2019)","noteIndex":0},"citationItems":[{"id":685,"uris":["http://zotero.org/users/local/0omESN17/items/VK7AIGBL"],"uri":["http://zotero.org/users/local/0omESN17/items/VK7AIGBL"],"itemData":{"id":685,"type":"article-journal","title":"Setting or Patient Care Needs: Which Defines Advanced Practice Registered Nurse Scope of Practice?","container-title":"The Journal for Nurse Practitioners","author":[{"family":"Miller","given":"Kenneth"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Miller, 2019). I agree with you on another point mentioned in your discussion post, that it makes more sense for this population to serve as an adult gero primary. This fact is rather prevalent, considering that by the end of the decade, the number of people 65 years of age and above are going to surpass the number of 5-year-olds in the country CITATION OHA18 \l 1033 (OHA, 2018). I also believe that it will only be in my own best interests if I choose to join a nurse’s association as well. You speak highly of the HPNA, i.e. the Hospice and Palliative Nurse’s Association, I believe I might do well if I also choose to collaborate with them. Add in the fact that they hold conferences, which seems like an awesome opportunity to meet with like-minded people and learn new things, which will definitely prove to be helpful in advancing my training and education in the field ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hyxQsfYK","properties":{"formattedCitation":"(CHAGHARI, SAFFARI, EBADI, & AMERYOUN, 2017)","plainCitation":"(CHAGHARI, SAFFARI, EBADI, & AMERYOUN, 2017)","noteIndex":0},"citationItems":[{"id":701,"uris":["http://zotero.org/users/local/0omESN17/items/6W6XYJM7"],"uri":["http://zotero.org/users/local/0omESN17/items/6W6XYJM7"],"itemData":{"id":701,"type":"article-journal","title":"Empowering education: A new model for in-service training of nursing staff","container-title":"Journal of Advances in Medical Education & Professionalism","page":"26","volume":"5","issue":"1","author":[{"family":"CHAGHARI","given":"MAHMUD"},{"family":"SAFFARI","given":"MOHSEN"},{"family":"EBADI","given":"ABBAS"},{"family":"AMERYOUN","given":"AHMAD"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Chaghari, Saffari, Ebadi, & Ameryoun, 2017).

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Blackwell, C. W., & Neff, D. F. (2015). Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States. Journal of the American Association of Nurse Practitioners, 27(10), 552–557.

Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A. (2017). Empowering education: A new model for in-service training of nursing staff. Journal of Advances in Medical Education & Professionalism, 5(1), 26.

Miller, K. (2019). Setting or Patient Care Needs: Which Defines Advanced Practice Registered Nurse Scope of Practice? The Journal for Nurse Practitioners.

BIBLIOGRAPHY OHA. (2018). A State of Decay, Vol. IV. Retrieved from Oral Health America: http://nhoralhealth.org/blog/wp-content/uploads/2018/05/AStateOfDecay2018_OHA-Vol.-4.pdf

RE: Discussion - Week 3

Quiz

RE: Discussion - Week 7

Title page

Discussion week 7

I agree with the post of Weldon that stresses on early diagnosis of sepsis. Weldon has stated that the nurses must possess awareness about sepsis because it allow them to take adequate actions for identifying the symptoms and diagnose the disease. This is effective for minimizing the negative outcomes (Griffiths et al., 2018). The post highlights the significance of S.Res. 175-116th Congress (2019-2020), a policy presented by Senator Tammy Baldwin. I agree that Sepsis is one of the prominent cause of readmission of the patients at hospitals. This is due to the delayed response from the staff, resulting in severity of the patient’s condition. The post has identified the solutions for overcoming this issue. I believe that providing awareness to the patients and nurse is equally important for minimizing the risks of readmission. Nurses having knowledge on sepsis would be able to provide guidance to the patients and the family that improve the scope of recovery. I also agree that most of the problems faced by the patients of sepsis is due to lack of nurse knowledge. In such situations they are unable to take appropriate measures for providing guidance to the patients or family members (Olans, 2016).

I agree that sepsis is expensive treatment and readmission puts financial burden on the families of patients. By providing training and knowledge to the nurse they would be able to take timely actions and respond to the nurses in right manner. I think that by educating nurses the healthcare institutes can help nurses to offer better guidance to the patients. The state must be able to take better decision and implement policy for maximizing welfare of patients and reducing the rates of readmission. This will need professionally competent and skilled nurses.

References

BIBLIOGRAPHY Griffiths, P., Recio‐Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., et al. (2018).

Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. An International Journal of Medicine, 102 (8), 513–521. Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The Critical Role of the Staff Nurse in Antimicrobial Stewardship—Unrecognized, but Already There. CLINICAL PRACTICE.

Siriwardena, A. N. (2009). Using quality improvement methods for evaluating health care. Quality in Primary Care, 17, 155–9. . J Adv Nurs , 74 (7), 1474–1487.

RE: Discussion - Week 7

Title page

Discussion week 7

I agree with the post of Norman that provides brief overview on House of Representatives Bill 2581 that explain nurse-staffing standards. I agree with the viewpoints that nurse staffing is not adequate at hospitals that cause inconvenience to the patients. Lack of staff remains one of the prominent issues faced by the patients in hospitals of America. Delayed response from nurses is also the common at emergency departments due to high turnover. I agree with the issue of registered nurse shortage as identified in the post. I think the states must allow competent and skilled nurses to take role of physicians for addressing needs of more patients CITATION Pet183 \l 1033 (Griffiths, et al., 2018).

Norman has managed to support the claims with literature as numerous studies explain positive relationship between staffing ratios and enhanced patient care. Staffing ratios also impacts the quality of care including better work conditions for the nurses. I also agree that nurse-to-patient ratio are effective for reducing mortality rates. Availability of adequate nurse staff will allow patients to receive appropriate care for infections, burns and diseases (Griffiths et al., 2009).

I think that the House of Representatives Bill 2581 has addressed the issue of overcoming nurse shortage at hospitals and healthcare institutes. The bill will explain a minimum staffing ratios that hospitals will have to maintain (Olans, 2016). The acceptance of the bill will also allow hospitals to manage nurse shortage at the emergency departments. I agree that such measures will enhance the quality of care because patients will receive timely response from the staff nurse. Adding more nurses will also improve the interaction between patient and nurse because each nurse will give more time to patients.

References

BIBLIOGRAPHY Griffiths, P., Recio‐Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., et al. (2018). References Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. An International Journal of Medicine, 102 (8), 513–521.

Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The Critical Role of the Staff Nurse in Antimicrobial Stewardship—Unrecognized, but Already There. CLINICAL PRACTICE.

Siriwardena, A. N. (2009). Using quality improvement methods for evaluating health care. Quality in Primary Care, 17, 155–9. . J Adv Nurs , 74 (7), 1474–1487.

RE: Discussion - Week 8

Title page

Discussion week 8

I like the post of Traci because she provides in-depth view on the professional role of nurses and how they can improve the quality of care. I agree that nurses must be involved in the process of policy making regarding healthcare services and improving patient satisfaction (Aronson, 2009). I think nurse have significant experience of handling patients with different illnesses. They can write their experiences that will provide better opportunities for creating effective policy. Their experiences can be used for overcoming the weaknesses of healthcare such as delays in responding the patients, improper equipment or medication errors.

I also agree that professional nurses face many challenges in clinical settings such as timely responding to the patients when turnover is high. Nurses must be able to use their knowledge and information for addressing the patients in appropriate manner (Olans et al., 2016). It is important for the policy makers to understand how nurses can help them in identifying imitations of the healthcare system. I think there are many ways in which healthcare organizations can take benefit of nurse experiences. They can provide them opportunity to take part in healthcare seminars and workshops for promoting awareness on specific health issue faced by patients (Siriwardena, 2009). Having adequate knowledge of state legislation will allow registered nurse to take better role. The state and law regulations must provide better opportunities to nurse. It is important to educate nurse and provide adequate training so they could take adequate care of patients. Nurses must also be involved in patient advocacy and provide education to patients about illness and treatment. I agree that advanced practitioner nurse hold adequate experience and skills that will allow them to handle patients with more perfection.

References

Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. An International Journal of Medicine, 102 (8), 513–521.

Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The Critical Role of the Staff Nurse in Antimicrobial Stewardship—Unrecognized, but Already There. CLINICAL PRACTICE.

Siriwardena, A. N. (2009). Using quality improvement methods for evaluating health care. Quality in Primary Care, 17, 155–9.

RE: Discussion - Week 8

Title page

Discussion week 8

I like the post of Pamela that identifies the role of nurse and its impact on quality of care. I agree that it is important for RN’s and APRN’s to take leadership positions in healthcare institutes. Self-sufficient and competent nurse is capable of taking adequate care of the patients that results in maximization of welfare (Aronson, 2009). I agree with the viewpoints of Pamela stating that effective communications are required for establishing positive relationship between nurse and clients. This allow nurse to identify the issues such as pain and discomfort. I think the post provides adequate evidence for supporting the claims as it mentions the findings of American Nurse Today (Siriwardena, 2009). It states that nurse lacking awareness about their professional legal roles are unable to take advantage of the available opportunities.

I also agree that nurses must be involved in policy making because they directly engage with the patients. Their experience of handling patients with diverse backgrounds make them more efficient in addressing their individual needs (Olans et al., 2016). Involving them in policy making will help healthcare institutes to offer enhanced care to the patients. This will also allow institutes to overcome weaknesses that undermines the quality of care. I agree that the advocate nurse must join professional organizations because it will provide them better opportunities for building professional skills and competency. They must also be trained about their professional and moral obligations. I think the quality of care and the scope of practice must consider the moral responsibility of the nurse. This is an effective way of minimizing errors and promoting health without disparity. I also think that the healthcare institutes must hire competent and skilled nurses who are capable of taking professional roles.

References

Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. An International Journal of Medicine, 102 (8), 513–521.

Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The Critical Role of the Staff Nurse in Antimicrobial Stewardship—Unrecognized, but Already There. CLINICAL PRACTICE.

Siriwardena, A. N. (2009). Using quality improvement methods for evaluating health care. Quality in Primary Care, 17, 155–9.

Re: Topic 4 DQ 2

Title page

Metacognition

Metacognition is a process of assessing how one processes feelings and thoughts. This is the best method of encouraging students to establish self-awareness skills. Examination of thought process allows reframing their way of thinking that helps them in adapting to new situations. Students after realizing how they learn create situations that promote learning CITATION Kim12 \l 1033 (Tanner, 2012). It is an essential variable for promoting learning and skepticism. Metacognitive awareness improves students overall performance. It is an effective tool for enhancing memory, attention level, problem-solving skills, social cognition, and personal development. Evidence suggests that metacognition is linked to high intelligence and academic outcomes. Having knowledge of one's strengths and weaknesses will permit them to monitor their learning strategies and assessing readiness for specific tasks CITATION Sae14 \l 1033 (Rahman, Yasin, Salamuddin, & Surat, 2014).

The academic experience is inadequate for articulating research skills set, so learners at a doctoral level need to establish high-order thinking competency. It is important for doctoral learners to understand their metacognitive processes because of its higher-level thinking and additional knowledge in the learning process. Doctoral learners can develop better memory skills and work through problems in an innovative way that will make them successful in academic and professional careers. Reflecting on learning processes will provide awareness about the learning process. As research skills are a key factor for exploring students success at the doctoral level, appropriate use of metacognition functions by learners will allow them to build research skills. Metacognitive is crucial because the learners improve planning and monitoring skills, required for evaluating the research problem and establishing problem statement for the project. The methodology will allow them to write dissertation research by comprehending a large amount of data. Metacognition will be used to plan, monitor and access one's understanding of the research problem. This will allow learners to overcome their confusions and develop retrospective assessment ability.

References

Rahman, S., Yasin, R. M., Salamuddin, N., & Surat, S. (2014). The Use of Metacognitive Strategies to Develop Research Skills among Postgraduate Students. Asian Social Science, 10 (19).

Tanner, K. D. (2012). Promoting Student Metacognition . CBE Life Sci Educ, 11 (2), 113–120.

Re: Topic 5 DQ 2

Topic 5 DQ 2

[Name of the Writer]

[Name of the Institution]

Topic 5 DQ 2

There are certain measures that determines the validity and reliability of any research. The argument is supported by the fact that scholars and especially those who are working for their post graduate research provide give due account to their conclusions. Further the academic research comprises of the conclusion that is based on some evidence. It is experienced that without evidence or following the requirements a conclusion cannot be generated. Most of the researchers have found that those researches that contains no basis for their research or paper lead to the vagueness. These papers will not be included in the reputed international journal.

The second important aspect of any research requires the determination of where the author has taken material to support the topic. For example empirical articles have various elements along with methodology that contribute for effectiveness and singularity. Sometimes a check list reflects what is incorporated in the research and what is not. So a text that has no support through the evidence or other aspects, will be left to open debate. Worth of these papers is mostly limited. It is not wrong to say that without well supported document there is no basis for any conclusions (Byrns, 2010). 

At the graduate level of education or even below than that, there is considerable amount of conclusions required to support the topic like healthcare and diabetes. As we consider diabetes can be reduced through a systematic exercise and it is well supported by scholars across the academic world. The conclusion must be backed by the well documented and reputed sources because the entire paper or any research is all together delimited in the conclusion section. Any such attempt to left conclusion without the evidence will be considered as fail and vague (Heck, & Minner, 2009).

References

Byrns, G. E. (2010). Assessment of the conclusion validity for empirical research studies

published in the journal of speech, language, and hearing research (Doctoral dissertation, Texas A & M University).

Heck, D., & Minner, D. (2009). Codebook for standards of evidence for empirical

research. Horizon Research, Inc, Chapel Hill, NC.

Real World Negotiation (3 Different Encounters)

Real World Negotiations

[Author Name]

[Institutional Affiliation(s)]

Real World Negotiations

Scenario 1

Being an accountant specialist, I have to manage all the transactions and patients records. The secondary function of this job is to safeguard patients’ data as this data is highly confidential. While I was maintaining the records, I felt that there is a need to keep a secure backup for all the records so that in an emergency, all the data can be accessed. For this purpose, I requested my manager to allow me to create a backup of all the data so that during an emergency, I can use that. At first, he denied but I explained to him the importance of data backup and its benefits. After learning about the immense benefits of the data, he allowed me to maintain a backup of all the records. Sometimes, it is better to explain to other people your perspective regarding specific issues rather than making an issue (Bazerman & Valley, 2000). This will help in maintaining a peaceful workplace.

Scenario 2

I took an imminent deadline for maintaining the patient's fall prevention records that I recognized, I was not successfully capable to encounter. I orally communicated this information to my director and he decided to communicate with the customer to extend the deadline. Unfortunately, he fails to recall the discussion and was distressed that my portion of the plan was not completed as per the deadline. I peacefully reminded him of that spoken settlement- associated with the customer and procured accountability for not meeting the deadline. Also, I offered them an extra follow-up next after the project to mark up for the neglected deadline. I also proposed to my director that in the future, it would be better to communicate with each other my plans and assignments in writing. After a hectic week, the customer was pleased and my director and I took an improved understanding of the way by which we would interconnect with each other in the future. Cooperating includes working organized and respectfully to resolve conflicts and negotiating needs that everyone sacrifices a little, he or she is looking to achieve an agreement (Brett & Thompson, 2016).

Scenario 3

Being an accountant specialist at a hospital, my job is to not only manage the financial needs of my patients but also to protect their privacy. Once I met with a customer who pretended to be a close relative of a patient who was admitted a few days back at our hospital. He wanted to know some details of the financial records of the patient. So as per procedure, I demanded the identity card to verify the details but he refrained to provide the card. He then again changed the story and told me that I am not a relative but a friend. According to the law, I am not allowed to share details of patients with any other person so I immediately said no (Anderson, 1996). However, this does not go well with him and he started to create a scene in front of everyone that made the situation more difficult to handle. I tried to explain to him the legal requirements due to which I am bound to conceal the patient’s information yet he was stuck to his demand and resisted understanding my position. So, at last, I simply asked the security to handle that person as it was difficult for me to go outside my duty and to disclose someone’s personal documents. Escaping the conflict is occasionally a wise option, but it’s best to handle the situation as it originates. Accepting the law and avoiding the conflict in a worst-case scenario is a way of maintaining peace rather than arguing with that person (Cao & Clark, 2018).

References

Anderson, R. (1996). Clinical system security: interim guidelines. BMJ, 312(7023), 109-111.

Bazerman, M. H., Curhan, J. R., Moore, D. A., & Valley, K. L. (2000). Negotiation. Annual review of psychology, 51(1), 279-314.

Brett, J., & Thompson, L. (2016). Negotiation. Organizational Behavior and Human Decision Processes, 136, 68-79.

Cao, K., Lazaridou, A., Lanctot, M., Leibo, J. Z., Tuyls, K., & Clark, S. (2018). Emergent communication through negotiation. arXiv preprint arXiv:1804.03980.