Solution Description

Proposed Solution

The heart surgery methodology is demonstrated for the help of side effects lethargic to therapeutic treatment or percutaneous transluminal coronary angioplasty (PTCA), especially when all things considered, this task will defer ominous occasions longer than different types of treatment. For angina alleviation, surgery has regularly succeeded where therapeutic or interventional treatment has fizzled or isn't prescribed. For survival, the circumstance is progressively unpredictable. There is general understanding that HEART SURGERY improves forecast in the early post-surgical years in those patients with symptomatic left fundamental coronary course stenosis or stenosis of the three primary coronary vessels, in spite of the fact that this favorable position isn't believed to be noteworthy after 10– 12 years (Merritt et al. 2003). Be that as it may, for most of patients with less serious pathology, the forecast is great without surgery (Merritt et al. 2003). Besides, cardiac surgery has progressed to a point where death rates have declined significantly. Along these lines, with such low demise rates, determination among elective courses of cardiac treatment is progressively being founded on proportions of quality of life (QOL), including minimization of torment and incapacity.

The estimation of treatment result or QOL for the patient is the cornerstone of present-day logical prescription. The significance of treatment result is perceived all through clinical practice, especially when imaginative, obtrusive or exorbitant medicines are assessed, and the death rate is too low to even think about affecting basic leadership (van Dijk et al. 2000). Be that as it may, there is no general assention of the significance of QOL or how it ought to be estimated.

Following cardiac intercession, results have been assessed regarding mortality, and intricacies or repeat of side effects, as they are anything but difficult to gauge (Biancari & Rimpilainen, 2009). Nonetheless, these measures don't give a total evaluation of a person's abilities at home, at work, or in the network (Biancari & Rimpilainen, 2009). Subsequently, the investigation of results of cardiac mediation has been described by changes in the inquiries asked in assessment, changes in the advancements used to respond to these inquiries, and changes in the wellsprings of appraisal data. Results of heart surgery can be assembled into classes that mirror the normal objectives of heart surgery, for example, prolongation of life, decrease of manifestations, improvement in physical, mental and social working, and improvement in professional status (Biancari & Rimpilainen, 2009).

In general, the three early major randomized preliminaries and later investigations show that patients with narrowing of the left fundamental coronary supply route, or triple-vessel ailment and subnormal left ventricular working have an especially poor forecast when treated therapeutically, and advantage from heart surgery. Ongoing examinations propose that the utilization of the left interior thoracic vein to one side foremost diving coronary supply route, and possibly different blood vessel revascularization, improves survival and lessens late cardiac occasions after heart surgery (Miles et al. 2011). Besides, off-siphon heart surgery may offer less early intricacies, especially in those patients with huge comorbidity (Miles et al. 2011).

Coronary supply route sidestep surgery remains a set up type of treatment for coronary corridor infection, and most of coronary surgical methods are performed for different vessel malady. In general, the death rate of coronary vein surgery is low, despite the fact that this advantage is balanced by a confusion rate. Moreover, post-surgical neurocognitive disability is of concern. PCI has dramatically affected heart surgery, capturing the sensational development of surgery during the 1980s and moving the consideration of surgeons to patients with further developed coronary ailment and broad existing together conditions. This has persuaded surgeons to refine coronary revascularization systems so as to augment clinical adequacy, limit costs, and decrease obtrusiveness.

Results of heart surgery have generally been estimated regarding mortality and dismalness; anyway change in accordance with heart surgery is a multidimensional wonder that isn't completely clarified by therapeutic elements. When examining postoperative change in accordance with heart surgery, it is vital to survey different physical, mental and social factors too, which is progressively being perceived in ongoing investigations.

References

Merritt, J. C., Niebauer, M., Tarakji, K., Hammer, D., & Mills, R. M. (2003). Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. The American journal of cardiology, 92(6), 735-736.

van Dijk, D., Nierich, A. P., Eefting, F. D., Buskens, E., Nathoe, H. M., Jansen, E. W., ... & Grobbee, D. E. (2000). The Octopus Study: rationale and design of two randomized trials on medical effectiveness, safety, and cost-effectiveness of bypass surgery on the beating heart. Controlled clinical trials, 21(6), 595-609.

Biancari, F., & Rimpiläinen, R. (2009). Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery. Heart, 95(12), 964-969.

Miles, R. H., Passman, R., & Murdock, D. K. (2011). Comparison of effectiveness and safety of ranolazine versus amiodarone for preventing atrial fibrillation after coronary artery bypass grafting. The American journal of cardiology, 108(5), 673-676.

Source Passage

Source Passage

[Author Name]

[Institutional Affiliation(s)]

Source passage

Technology has become an indispensable part of our society. Due to which online courses are becoming more popular day by day. Due to widespread availability students all over the world are continuing to register in several online courses. People in the past were also in favor of taking online courses due to its several advantages. However, due to the convenience, taking online courses “may soon become a necessity for many students” (Tolman, 2017, p. 583). This is because due to a rapid increase in the economy, school loan rates are also increased forcing them to work full time to bear their educational expenses. However, this rapid increase in online courses is a point of concern for the administration of educational institutes. So they should work more on their policies to make education more accessible (Tolman, 2017, p. 583).

Paraphrasing can be defined as a process in which the work of another person is explained using different words to ensure maximum clarity. That will further facilitate greater understanding. While paraphrasing the above passage the first difficulty I encountered was that I have not read the original source of the material provided. Due to which to grasp the idea from just a few lines and fitting it into the broader discussion was extremely difficult. Also, in summary, one has to get the main idea and express using different words but in paraphrasing, one has to explain every sentence. However, I overcome these difficulties by using the strategies that were taught in the class. Firstly, I read the passage twice to get an idea. Then I started making notes of the key terms used in the passage. After this I started paraphrasing each line and explained the idea presented in each line. Then I compared my work with the original passage to check whether they both are conveying the same idea or not.

References

Tolman, S. (2017). Academic dishonesty in online courses: Considerations for graduate preparatory programs in higher education. College Student Journal, 51(4), 579-584.

Specialty Area Of Practice

Specialty Area of Practice

[Writer]

[Institution]

Specialty Area of Practice

Introduction

With the current influx in the health care designs, the industry is moving forward towards advanced technologies especially by focusing on population health, quality care and services. In this reformed system, the healthcare workforce needs to draw certain amendments and nurses will be liable for changing roles in the care delivery system. Nurses will now be entitled to a significant role therefore it is important for them to specialize in particular fields. Specialization will help them adjust to the contemporary care designs and regulatory policies accordingly. New roles for nurses are now emerging including public health management, patient training, health informatics, analysts, trauma caregivers, infant and elderly care etc. The objective of nursing in true terms can only be achieved in terms of care coordination and inter-professional engagements. New specialization programs have been introduced to address the future oriented health care systems. Nurses are required to improve their practice competencies for better knowledge of patient’s conditions, enhanced work skills and professional attitude.

Area of specialty

There is an extensive scope in the redesigning of primary health care delivery models to enhance easy access to quality services. Registered nurses are subjected to adopt leadership titles on the basis of their commitment with the patients, family, system priorities and the general population expectations ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"UNoACjzd","properties":{"formattedCitation":"(Smolowitz et al., 2015)","plainCitation":"(Smolowitz et al., 2015)","noteIndex":0},"citationItems":[{"id":69,"uris":["http://zotero.org/users/local/OnfrXiA2/items/G8NDLSE3"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/G8NDLSE3"],"itemData":{"id":69,"type":"article-journal","title":"Role of the registered nurse in primary health care: meeting health care needs in the 21st century","container-title":"Nursing Outlook","page":"130-136","volume":"63","issue":"2","author":[{"family":"Smolowitz","given":"Janice"},{"family":"Speakman","given":"Elizabeth"},{"family":"Wojnar","given":"Danuta"},{"family":"Whelan","given":"Ellen-Marie"},{"family":"Ulrich","given":"Suzan"},{"family":"Hayes","given":"Carolyn"},{"family":"Wood","given":"Laura"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Smolowitz et al., 2015). In this contemporary health care model, advanced public health nurses employ a general assessment of health and care. They get to study how different factions of society interact with each other and a health care system. They examine the nature of individuals functioning within a care design and establish ways in which they can improve care quality on a significant scale. Public health nurses are also seen involved with the prevention strategies, awareness campaigns, disease screening processes and immunizing at-risk populations. Public health nurses mainly focus on the examination and treatment provision strategies to the whole community at large ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jmjc2WkI","properties":{"formattedCitation":"(Sellers et al., 2015)","plainCitation":"(Sellers et al., 2015)","noteIndex":0},"citationItems":[{"id":66,"uris":["http://zotero.org/users/local/OnfrXiA2/items/DK9285XB"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/DK9285XB"],"itemData":{"id":66,"type":"article-journal","title":"The Public Health Workforce Interests and Needs Survey: The First National Survey of State Health Agency Employees","container-title":"Journal of Public Health Management and Practice","page":"S13-S27","volume":"21","issue":"Suppl 6","source":"PubMed Central","abstract":"This article describes a nationally representative survey of central office employees at state health agencies to characterize key components of the public health workforce., Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call.","DOI":"10.1097/PHH.0000000000000331","ISSN":"1078-4659","note":"PMID: 26422482\nPMCID: PMC4590524","title-short":"The Public Health Workforce Interests and Needs Survey","journalAbbreviation":"J Public Health Manag Pract","author":[{"family":"Sellers","given":"Katie"},{"family":"Leider","given":"Jonathon P."},{"family":"Harper","given":"Elizabeth"},{"family":"Castrucci","given":"Brian C."},{"family":"Bharthapudi","given":"Kiran"},{"family":"Liss-Levinson","given":"Rivka"},{"family":"Jarris","given":"Paul E."},{"family":"Hunter","given":"Edward L."}],"issued":{"date-parts":[["2015",11]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Sellers et al., 2015). Their focus of interest is investing their efforts in the health care sectors, health insurance corporations and home-based health agencies.

Advanced Public Health Nurses

Just until recently, little efforts were made to focus on understanding the scope of this one of most future oriented field of nursing specialization. Public health practitioners influence the whole public health system by promoting and curating the important contributions and practices for achieving the population outcomes. The literature on public health workforce primarily focused on disease description including correlation between different internal and external factors to the disease, assessing the program interventions and citing the results of the study. In order to meet the contemporary and futuristic public health challenges for the workforce, researchers are focusing to provide them with all the required measurements and skills. The public health specialists and leaders have called for improved research and data collection for understanding all the dynamics of the field ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"DCuCAqvO","properties":{"formattedCitation":"(Fraher, Spetz, & Naylor, 2015)","plainCitation":"(Fraher, Spetz, & Naylor, 2015)","noteIndex":0},"citationItems":[{"id":26,"uris":["http://zotero.org/users/local/OnfrXiA2/items/GH5VDJKG"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/GH5VDJKG"],"itemData":{"id":26,"type":"article-journal","title":"Nursing in a transformed health care system: New roles, new rules","author":[{"family":"Fraher","given":"Erin"},{"family":"Spetz","given":"Joanne"},{"family":"Naylor","given":"Mary D."}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Fraher, Spetz, & Naylor, 2015). The improvement and implementation of general surveys by public health organizations has contributed a lot in the development of workforce.

Traditionally, nursing graduates have been made to focus on critical care and surgical courses more than on population or public health education. This old perception has caused lack of support and understanding of the effective and efficient public health challenges especially for the students taking public health nursing as field specialization ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jA24Yujy","properties":{"formattedCitation":"(Simpson & Richards, 2015)","plainCitation":"(Simpson & Richards, 2015)","noteIndex":0},"citationItems":[{"id":70,"uris":["http://zotero.org/users/local/OnfrXiA2/items/2IIK45PG"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/2IIK45PG"],"itemData":{"id":70,"type":"article-journal","title":"Flipping the classroom to teach population health: Increasing the relevance","container-title":"Nurse Education in Practice","page":"162-167","volume":"15","issue":"3","author":[{"family":"Simpson","given":"Vicki"},{"family":"Richards","given":"Elizabeth"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Simpson & Richards, 2015). Health specialists have plead for reinforced need to shift the focus from disease care to strategies for promotion of health. They have also urged the health care workforce to move on from individual care delivery systems to social as well as cultural dimensions. As the curriculum for public health is still under review to better address the needs of population health, it is really hard to achieve better results sooner.

A skilled public health workforce is the need of the hour for establishing an effective public health care delivery system. However, apart from inconsistent assessment of public health work force, some efforts have been made on the national level to monitor analytically the size, structure, demographics, practice and academic background of individuals working in public health industry. In a survey of 3 years from 2010 to 2013, it was established that the size of local public health work force was in proportion to the size of state despite there was a huge budget cut at health departments during that time period ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"M5j8MBWN","properties":{"formattedCitation":"(Beck & Boulton, 2015)","plainCitation":"(Beck & Boulton, 2015)","noteIndex":0},"citationItems":[{"id":71,"uris":["http://zotero.org/users/local/OnfrXiA2/items/D857QC4X"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/D857QC4X"],"itemData":{"id":71,"type":"article-journal","title":"Trends and characteristics of the state and local public health workforce, 2010–2013","container-title":"American journal of public health","page":"S303-S310","volume":"105","issue":"S2","author":[{"family":"Beck","given":"Angela J."},{"family":"Boulton","given":"Matthew L."}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Beck & Boulton, 2015). Later, the ratio decreased in the following years due to variations in the local jurisdiction’s population size, redistricting, and modified governance frameworks. But, recent findings state that number of public health work force has recently stabilized again, though smaller in size in present, its scope will flourish in future. The integration of health departments with accountable care centers will cause the exceedingly significant role of public health nurses in the delivery of public health services.

Skills and Characteristics of Public Health nurses

Public health nurses are required to adapt an advanced attitude to address the public health competencies. They have to help improve the health status and welfare of the local populations in a global setup by promoting cooperation and principles for provision of best services ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ATf3S847","properties":{"formattedCitation":"(Pettit, McVicar, Knight\\uc0\\u8208{}Davidson, & Shaw\\uc0\\u8208{}Flach, 2019)","plainCitation":"(Pettit, McVicar, Knight‐Davidson, & Shaw‐Flach, 2019)","noteIndex":0},"citationItems":[{"id":72,"uris":["http://zotero.org/users/local/OnfrXiA2/items/KSSH5X8G"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/KSSH5X8G"],"itemData":{"id":72,"type":"article-journal","title":"Releasing latent compassion through an innovative compassion curriculum for Specialist Community Public Health Nurses","container-title":"Journal of advanced nursing","page":"1053-1062","volume":"75","issue":"5","author":[{"family":"Pettit","given":"Ann"},{"family":"McVicar","given":"Andrew"},{"family":"Knight‐Davidson","given":"Pamela"},{"family":"Shaw‐Flach","given":"Adelle"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Pettit, McVicar, Knight‐Davidson, & Shaw‐Flach, 2019). Public health departments and institutions provide opportunities to the nursing scholars for developing skills for critical thinking, best communication and resourceful services to public. For this purpose, service learning approaches create prospects for the developing awareness about civic responsibilities and improving cultural competencies. Globally, public health nurses accomplish skills for providing population based care to culturally sensitive communities.

Public health principles are in practice internationally to make health care workforce provide behavior change interventions. Such brief changes can bring about significant changes in behavior of the patients and the public receiving health care. These behavior interventions can be provided by the health care nurses during their consultation periods. It is an important part of practice because of nurses’ recurrent face to face patient contact and can result in effective and efficient care delivery ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fB7KZCtO","properties":{"formattedCitation":"(Keyworth, Epton, Goldthorpe, Calam, & Armitage, 2018)","plainCitation":"(Keyworth, Epton, Goldthorpe, Calam, & Armitage, 2018)","noteIndex":0},"citationItems":[{"id":73,"uris":["http://zotero.org/users/local/OnfrXiA2/items/M87CA6TB"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/M87CA6TB"],"itemData":{"id":73,"type":"article-journal","title":"Are healthcare professionals delivering opportunistic behaviour change interventions? A multi-professional survey of engagement with public health policy","container-title":"Implementation Science","page":"122","volume":"13","issue":"1","author":[{"family":"Keyworth","given":"Chris"},{"family":"Epton","given":"Tracy"},{"family":"Goldthorpe","given":"Joanna"},{"family":"Calam","given":"Rachel"},{"family":"Armitage","given":"Christopher J."}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Keyworth, Epton, Goldthorpe, Calam, & Armitage, 2018). Public health nurses are also required to gain basic knowledge about public health informatics as the industry is increasingly relying on electronic records, analytical studies and other information technologies. The intricacy and extended details related to public health nursing skills may often be confusing to the graduates.

Public health nursing demand certain competencies for an ideal public health nurse. Such some skills include basic knowledge about application of epidemiological principles in public health. They should demonstrate commitment to social justice and public health principles. They should be responsive to the collaborations with local and global partnerships, and communicate effectively. Public health nurses are also expected to bear strong leadership qualities for field and NGO projects. They should also employ ethical and professional values and culturally suitable behavior ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cDyxKnSa","properties":{"formattedCitation":"(Brown, 2017)","plainCitation":"(Brown, 2017)","noteIndex":0},"citationItems":[{"id":74,"uris":["http://zotero.org/users/local/OnfrXiA2/items/AS4298QK"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/AS4298QK"],"itemData":{"id":74,"type":"article-journal","title":"Linking public health nursing competencies and service‐learning in a global setting","container-title":"Public Health Nursing","page":"485-492","volume":"34","issue":"5","author":[{"family":"Brown","given":"Cynthia L."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Brown, 2017). The requirement for ethical behavior in international health nursing is one of the most important principles so it is necessary to include best practice guides in the curriculums ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NPnS04F4","properties":{"formattedCitation":"(McDermott-Levy, Leffers, & Mayaka, 2018)","plainCitation":"(McDermott-Levy, Leffers, & Mayaka, 2018)","noteIndex":0},"citationItems":[{"id":75,"uris":["http://zotero.org/users/local/OnfrXiA2/items/8E8SAYUE"],"uri":["http://zotero.org/users/local/OnfrXiA2/items/8E8SAYUE"],"itemData":{"id":75,"type":"article-journal","title":"Ethical principles and guidelines of global health nursing practice","container-title":"Nursing outlook","page":"473-481","volume":"66","issue":"5","author":[{"family":"McDermott-Levy","given":"Ruth"},{"family":"Leffers","given":"Jeanne"},{"family":"Mayaka","given":"Jackline"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (McDermott-Levy, Leffers, & Mayaka, 2018).

Conclusion

The health care system is changing rapidly thus demands need for the change in the behaviors and skills of the health care work force. As the concept of population health has recently become a prominent department, the role of public and population health nurses has grown prominently. Local and international communities seek health care assignments earnestly and thus the competencies for public health nurses have become intricate. With the emerging scope of public health, the field of public health nursing for specialization is quite contemporary in terms of roles and transformed health care designs. The institutions providing degrees in public health nursing should keep updating their curriculums as scholars need to work efficiently with technological advancements and global cultural settings. Not only educators, but nursing leaders, policymakers and employers too should mobilize to adjust with the transformed health care systems.

References:

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Beck, A. J., & Boulton, M. L. (2015). Trends and characteristics of the state and local public health workforce, 2010–2013. American Journal of Public Health, 105(S2), S303–S310.

Brown, C. L. (2017). Linking public health nursing competencies and service‐learning in a global setting. Public Health Nursing, 34(5), 485–492.

Fraher, E., Spetz, J., & Naylor, M. D. (2015). Nursing in a transformed health care system: New roles, new rules.

Keyworth, C., Epton, T., Goldthorpe, J., Calam, R., & Armitage, C. J. (2018). Are healthcare professionals delivering opportunistic behaviour change interventions? A multi-professional survey of engagement with public health policy. Implementation Science, 13(1), 122.

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473–481.

Pettit, A., McVicar, A., Knight‐Davidson, P., & Shaw‐Flach, A. (2019). Releasing latent compassion through an innovative compassion curriculum for Specialist Community Public Health Nurses. Journal of Advanced Nursing, 75(5), 1053–1062.

Sellers, K., Leider, J. P., Harper, E., Castrucci, B. C., Bharthapudi, K., Liss-Levinson, R., … Hunter, E. L. (2015). The Public Health Workforce Interests and Needs Survey: The First National Survey of State Health Agency Employees. Journal of Public Health Management and Practice, 21(Suppl 6), S13–S27. https://doi.org/10.1097/PHH.0000000000000331

Simpson, V., & Richards, E. (2015). Flipping the classroom to teach population health: Increasing the relevance. Nurse Education in Practice, 15(3), 162–167.

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E.-M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: Meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130–136.

Spina Bifida

Spina Bifida

Your Name (First M. Last)

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

Spina Bifida

Introduction

Spina bifida is a birth defect which is caused by the incomplete closure of the spine and spinal cord during the early development. In the development of the human brain inside the womb of a mother, the top of the tube develops the brain and the remaining part shapes the spinal cord. It is essentially completed by the 28th day of pregnancy. However, brain disorder can occur in case of a complexity which surfaces the defect spina bifida ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"j7w9aRH6","properties":{"formattedCitation":"(\\uc0\\u8220{}Spina bifida (Split Spine): Causes, Symptoms, Diagnoses, and Treatment,\\uc0\\u8221{} n.d.)","plainCitation":"(“Spina bifida (Split Spine): Causes, Symptoms, Diagnoses, and Treatment,” n.d.)","noteIndex":0},"citationItems":[{"id":457,"uris":["http://zotero.org/users/local/yvjivw9i/items/IFN2JQMI"],"uri":["http://zotero.org/users/local/yvjivw9i/items/IFN2JQMI"],"itemData":{"id":457,"type":"webpage","title":"Spina bifida (Split Spine): Causes, Symptoms, Diagnoses, and Treatment","URL":"https://www.webmd.com/parenting/baby/spina-bifida#1","accessed":{"date-parts":[["2019",5,29]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Spina bifida (Split Spine): Causes, Symptoms, Diagnoses, and Treatment,” n.d.). Spina bifida is the most prominent birth defect which is affiliated with lives in the United States of America (USA). It ranges from mild to severe as the cases of occurrence are rarely the same in two children. The extent of severity depends on the opening located on the spine. It is imperative to deliberate the causes, symptoms, prevention, treatment and prognosis of spina bifida.

Types

It can occur in several forms as spina bifida occulta, occult spinal dysraphism (OSD) and meningocele. In OSD, most of the babies have a dimple in the lower back. Doctors have to utilize specialized test and tools to be sure as all the babies with dimples do not establish OSD. The other common signs are tufts of hair on the small lump and hyperpigmented patches on the back. The spinal cord struggles to grow an inappropriate manner in OSD and manifests in serious problems. The second type is spina bifida occulta. It is present in approximately 15% of healthy people and called hidden spina bifida. It has no symptoms and rarely causes potential harm. An X-ray of the back makes people aware that they have spina bifida occulta ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zCU7xaBN","properties":{"formattedCitation":"(\\uc0\\u8220{}What is Spina Bifida?,\\uc0\\u8221{} n.d.)","plainCitation":"(“What is Spina Bifida?,” n.d.)","noteIndex":0},"citationItems":[{"id":463,"uris":["http://zotero.org/users/local/yvjivw9i/items/2PJAL2JM"],"uri":["http://zotero.org/users/local/yvjivw9i/items/2PJAL2JM"],"itemData":{"id":463,"type":"webpage","title":"What is Spina Bifida?","container-title":"Spina Bifida Association","URL":"https://www.spinabifidaassociation.org/what-is-spina-bifida/","language":"en-US","accessed":{"date-parts":[["2019",5,29]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“What is Spina Bifida?,” n.d.). However, it is necessary to underpin that the diagnosis through an X-ray is deemed an incidental finding because the x-ray is intended for other purposes. In a small group of population with SBO, neurological symptoms and pain may occur. Tethered cord is an insidious complexity which needs the assessment from a neurosurgeon. The third kind is the Meningocele that causes the part of the spinal cord to traverse through the spine as a sac is pushed out. Nerve fluid is present in the sac and causes no nerve damage. However, minor disabilities may occur in minor with these disabilities.

Diagnoses

Three common checks are present for identification of spina bifida in the baby inside the womb of the mother. First, a sample of mother’s blood can be tested to find out the extent of the specific protein called AFP (16 weeks of gestation). In case AFP level is high, it may indicate the presence of spina bifida or another tube defect in the baby. Another prominent technique used for diagnosis is through ultrasound. The tissues in the body are bounced off by high-frequency sound waves and pictures of the baby are made on the monitor. If the baby has spina bifida, a sack poking outside the spine or an open spine will be visible.

Prognosis

Children suffering from spina bifida can also lead proactive lives. Activity, prognosis and participation rely on the severity and number of abnormalities and pertinent environmental factors. A wide range of children with this disorder possess intelligence similar to others and can walk with assistive devices. In case a learning complexity develops, educational and appropriate interventions prove productive.

Signs and Symptoms

All cases which account for the occurrence of spina bifida are not known. Similar to several other complexities, it results from a combination of environmental and genetic risk factors as family history to folate deficiency and tube defect. Spina bifida can cause minor physical symptoms or disabilities. When it is severe, it leads to further critical physical disabilities. It is affected by the location and size of the tube, the skin around the affected area and the spinal nerves coming out of the spinal cord ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qKqsMjpi","properties":{"formattedCitation":"(\\uc0\\u8220{}Spina bifida - Symptoms and causes,\\uc0\\u8221{} n.d.)","plainCitation":"(“Spina bifida - Symptoms and causes,” n.d.)","noteIndex":0},"citationItems":[{"id":461,"uris":["http://zotero.org/users/local/yvjivw9i/items/MGYDKRR7"],"uri":["http://zotero.org/users/local/yvjivw9i/items/MGYDKRR7"],"itemData":{"id":461,"type":"webpage","title":"Spina bifida - Symptoms and causes","container-title":"Mayo Clinic","URL":"https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860","language":"en","accessed":{"date-parts":[["2019",5,29]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Spina bifida - Symptoms and causes,” n.d.). Mobility and walking problems can occur where the factors deciding whether or not a child can walk are dependent on the care received after and before birth. Skin problems can also be found in the c children with spina bifida. They can have wounds on their legs, feet, buttock and back. Blisters or sore can further become critical wounds or foot infections which are hard to cure. Other complexities involve gastrointestinal disorders, depression and urinary tract infections. Learning disabilities may surface in children was difficulty in understanding math, learning and paying profound attention.

Treatment and Outcome

The treatment of spina bifida is dependent on the severity of the complexity. It is treated shortly after or before birth. Children with Meningomyelocele are primarily operated within 2 to 3 days of birth. It prevents the infection and shields the spinal cord from getting more damage. Surgery is used to treat the child and in most of the cases, children are not paralyzed. Several children with the condition grow without complexities but they ought to be checked as they may have other adverse complexities. For children with OSD, they ought to visit a surgeon. A wide range of experts thinks surgery is required in the early stages to keep the brain and nerves from becoming damaged with the passage of time and growth of children. In spina bifida occulta, treatment is not necessary. However, it is key to discuss outcomes related to the prevention of spina bifida. Though there exist no prominent causes, it has bens that women who are old to give birth to babies ought to take folic acid during the three months and before pregnancy.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Spina bifida - Symptoms and causes. (n.d.). Retrieved May 29, 2019, from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860

Spina bifida (Split Spine): Causes, Symptoms, Diagnoses, and Treatment. (n.d.). Retrieved May 29, 2019, from https://www.webmd.com/parenting/baby/spina-bifida#1

What is Spina Bifida? (n.d.). Retrieved May 29, 2019, from Spina Bifida Association website: https://www.spinabifidaassociation.org/what-is-spina-bifida/

Stages Of Dying

Stages of Dying

[Name of the Writer]

[Name of the Institution]

Stages of Dying

Elisabeth Kubler-Ross was the psychiatrist who developed the theory about the stages of grief that an individual may face after losing loved ones. The five stages include; Denial, anger, bargaining, depression, and acceptance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"y2vrOjcN","properties":{"formattedCitation":"(Bregman, 2017)","plainCitation":"(Bregman, 2017)","noteIndex":0},"citationItems":[{"id":710,"uris":["http://zotero.org/users/local/mlRB1JqV/items/WYYTIZ53"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/WYYTIZ53"],"itemData":{"id":710,"type":"article-journal","title":"Dying in Five Stages: Death and Emotions in Kübler-Ross and Her Influence","container-title":"Pakistan Journal of Historical Studies","page":"33-61","volume":"2","issue":"2","source":"JSTOR","abstract":"This essay focuses on the famous “five stages of dying”, an emotion-based psychological understanding of dying presented by Elisabeth Kübler-Ross in her book On Death and Dying (1968). Beginning with previously held views on dying in North America that were shaped by religion, and the increased impact of medicalised death in hospitals as a primary environment for dying, Kübler-Ross offered a framework for understanding the rich emotional experiences of the dying, guiding readers to frame dying as emotional coping with impending loss. The essay then discusses in detail the emotional content of each of the stages, especially anger, depression and acceptance. The influence of this model is documented in the appropriations of it by authors of many post-Kübler-Ross autobiographies where personal experiences of terminal illness, for the most part, support Kübler-Ross' ideas, but also expose its limits. While the role of religion was minimal in the book, this emotion-based model for dying has impacted North American religious ideas as well. Whatever the empirical weaknesses of the five-stages model, it continues to be familiar and popular within society's language about death and dying.","ISSN":"2412-611X","title-short":"Dying in Five Stages","author":[{"family":"Bregman","given":"Lucy"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bregman, 2017). However, these stages can be applied in any life area that is in personal life or professional life.

Denial:

Denial is the first stage in which individuals try to figure out what is actually happening in his life. What should he do, what he can do to avoid the issue? For instance, an individual comes to know that his car is damaged and needs repairing which he cannot afford.

Anger:

Anger is the second stage where the individual lost his control over the situation and show aggression. The emotions of frustration or aggression develops which sometimes make the situation worse. For instance, individual faces traffic jam which impacts the schedule of the whole day, such situation can develop the emotion of anger.

Bargaining:

At this stage, people try to promise in hope of getting something in return. For instance, student bargains to the teacher to forgive for the last time and promise that next time they will submit their work on time. These kinds of promises lie under bargaining.

Depression:

In this stage, individuals find difficult to cope with the issue. They show aggression, frustration but become unable to find the solution. Depression makes easy tasks more difficult. For instance, a person loses his job and unable to find a new one. Besides finding a job, there is nothing he can do which can make him depress ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"O1FnIf0u","properties":{"formattedCitation":"(Stroebe, Schut, & Boerner, 2017)","plainCitation":"(Stroebe, Schut, & Boerner, 2017)","noteIndex":0},"citationItems":[{"id":714,"uris":["http://zotero.org/users/local/mlRB1JqV/items/M6KXJP6B"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/M6KXJP6B"],"itemData":{"id":714,"type":"article-journal","title":"Cautioning Health-Care Professionals","container-title":"Omega","page":"455-473","volume":"74","issue":"4","source":"PubMed Central","abstract":"Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to “prescribe” stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive “persistent complex bereavement-related disorder” as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice.","DOI":"10.1177/0030222817691870","ISSN":"0030-2228","note":"PMID: 28355991\nPMCID: PMC5375020","journalAbbreviation":"Omega (Westport)","author":[{"family":"Stroebe","given":"Margaret"},{"family":"Schut","given":"Henk"},{"family":"Boerner","given":"Kathrin"}],"issued":{"date-parts":[["2017",3]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Stroebe, Schut, & Boerner, 2017).

Acceptance:

Individual tries to solve the issue if he gets the solution in early stage then it is not necessary that he comes to the last stage. For instance, student faces difficulty in assignment after showing anger, stress, and bargaining he somehow manages to complete it then there is no stage of acceptance. However, when an individual has no access to change the situation then he accepts the change with time.

Response to Jaime:

Yes, it is the last week and we have learned so much in the past few weeks. The point that you have raised that life stressors lead to the stages of dying. We have studied earlier that life events change our psychological development which implies that sudden changes or unexpected events can bring these stages of dying in our life. For instance, an individual gets arrested by the police and their parents thinks that their son is innocent. They, therefore, can face the stages of denial, anger, bargaining, and depression ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"d4BvkOjV","properties":{"formattedCitation":"(Mahmood, 2006)","plainCitation":"(Mahmood, 2006)","noteIndex":0},"citationItems":[{"id":711,"uris":["http://zotero.org/users/local/mlRB1JqV/items/UIE3LR8Q"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/UIE3LR8Q"],"itemData":{"id":711,"type":"article-journal","title":"Dr. Elisabeth Kubler-Ross stages of dying and phenomenology of grief","container-title":"Annals of King Edward Medical University","volume":"12","issue":"2","source":"annalskemu.org","URL":"https://annalskemu.org/journal/index.php/annals/article/view/882","DOI":"10.21649/akemu.v12i2.882","ISSN":"2079-0694","journalAbbreviation":"1","language":"en","author":[{"family":"Mahmood","given":"Kaiser"}],"issued":{"date-parts":[["2006"]]},"accessed":{"date-parts":[["2019",6,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Mahmood, 2006). However, if the son is arrested for the crime that he actually committed then parents will come to the stage of acceptance as there will be no other way to handle the situation. The factors discussed including living situation, loss of income, changes in your social life, or losing friends, and more are the events that run our life smoothly, therefore, any negative changes in these life pattern can bring the stages of dying or grief.

Response to Katie:

All five headings are discussed in detail and with some good examples. However, what is these headings or stages and where they come from are not discussed in the starting. The introduction helps to understand what is being discussed in the paper. Besides this, the five stages of dying are well explained with daily life examples. In Daniel stage, example of divorce is so accurate. Breaking of relationship is like someone dying and leaving us forever. It brings the same emotions and experience that a dying person can bring. However, the individual does not misunderstand the emotional discomfort with frustration most of the time. It is actually an emotion of aggression which develops when someone has to face an unexpected situation. For instance, change in schedule due to traffic jam does not bring discomfort it actually develops the aggression for the people responsible for the cause ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9wBSghJC","properties":{"formattedCitation":"(Tyrrell & Siddiqui, 2019)","plainCitation":"(Tyrrell & Siddiqui, 2019)","noteIndex":0},"citationItems":[{"id":712,"uris":["http://zotero.org/users/local/mlRB1JqV/items/2X7UCI8M"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/2X7UCI8M"],"itemData":{"id":712,"type":"chapter","title":"Stages of Dying","container-title":"StatPearls","publisher":"StatPearls Publishing","publisher-place":"Treasure Island (FL)","source":"PubMed","event-place":"Treasure Island (FL)","abstract":"Medical professionals encounter dying patients throughout all disciplines of healthcare. This patient becomes unique as the focus of their care shifts from becoming well to preparing for death. This is a difficult transition for patients, their loved ones, and healthcare providers to undergo. A better understanding of the process of moving toward death allows providers to address the unique needs of their patients and guide them and their loved ones through the process.[1][2][3]","URL":"http://www.ncbi.nlm.nih.gov/books/NBK507885/","call-number":"NBK507885","note":"PMID: 29939662","language":"eng","author":[{"family":"Tyrrell","given":"Patrick"},{"family":"Siddiqui","given":"Waquar"}],"issued":{"date-parts":[["2019"]]},"accessed":{"date-parts":[["2019",6,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Tyrrell & Siddiqui, 2019). All other three stages that are bargaining, depression, and acceptance acquire example which is useful to understand the stages of dying in depth.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Bregman, L. (2017). Dying in Five Stages: Death and Emotions in Kübler-Ross and Her Influence. Pakistan Journal of Historical Studies, 2(2), 33–61.

Mahmood, K. (2006). Dr. Elisabeth Kubler-Ross stages of dying and phenomenology of grief. Annals of King Edward Medical University, 12(2). https://doi.org/10.21649/akemu.v12i2.882

Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning Health-Care Professionals. Omega, 74(4), 455–473. https://doi.org/10.1177/0030222817691870

Tyrrell, P., & Siddiqui, W. (2019). Stages of Dying. In StatPearls. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK507885/

Stakeholder Analysis

Challenges to implementing the Quality improvement plan

Quality of care can be the result of continuous quality improvement, but the implementation of such a program is arduous. The mixed method can identify the challenges and implications of the quality improvement plan. There are four main challenges, the problem, goal, aim, and measurement. These must be in line during the change; CITATION McL04 \l 1033 (McLaughlin, 2004).

The cost during the quality improvement plan is differentiated into four steps,

Prevention cost

Appraisal cost

Internal failure cost

External failure cost

Proposed action step

Making changes in health service is really making changes in a complex system, and this is challenging because of the unique characters of the complex system. To handle the change in the health system it should define the operational time of the change, develop a project to handle the change, the project should be design and plan, new policies and system should be developed to support that change and it should implement. If it is required then it can be evaluated; CITATION Mey12 \l 1033 (Meyers, 2012).

In conflict interest, needs, goals, and values are mix together, each class of stakeholders has different objectives and interest. Sometimes conflict is good for the overall interest of stakeholders to adopt change. Managers need to use a critical pathway to reduce health care variations. Resources should be used when required in an effective way for the betterment of quality management. By using this method the cost will reduce and errors, by providing a systematic approach health care outcomes will be improved; CITATION All02 \l 1033 (Allen, 2002).

The purpose behind the change is to improve the health activities in general and wider primary health-care system. All stakeholders objectives and interest need to consider during change management. which will help the organizations to improve their operations and services.

References

BIBLIOGRAPHY Allen, C. (2002). ( Peers and partners: A stakeholder evaluation of preceptorship in mental health nursing. Nurse Researcher (through 2013),. 9(3), 68.

McLaughlin, C. P. ( 2004). Continuous quality improvement in health care: theory, implementation, and applications. Jones & Bartlett Learning.

Meyers, D. C. (2012). The quality implementation framework: a synthesis of critical steps in the implementation process. American journal of community psychology, 50(3-4), 462-480.

Standards Of Practice

Standards of Practice

[Name]

[Institution]

Author Note

Week 6 | Part 6: Finalizing the Plan

I have considered various options for my nursing specialty, including taking a close look at my selected (or currently preferred) specialty and second-preferred specialty. I have also developed a justification for my selected (or preferred) specialty. Lastly, I have examined one professional organization related to my selected or preferred specialty and considered how I can become a member of this organization.

The results of my efforts are below.

Directions: Complete Step 1 by writing 2-3 paragraphs in the space below comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration - to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision.

Complete Step 2 by writing a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum.

Complete Step 3 by examining and identifying one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization.

Step 1: Comparison of Nursing Specialties

Use the space below to write 2-3 paragraphs comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration - to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision.

Ever since I started my training as a nursing practitioner, there are two specialties that I have been toying with. The first among them is to train as an Adult-Gerontology Nurse Practitioner (AGNP). It is an advanced practice nursing program that focuses on clinically treating patients from an adolescent, to adulthood, right into advanced age. This sort of nurse needs to obtain further specialized education following the certification as a registered nurse. While this is a demanding job, I know I am cut for the job and can handle the responsibilities with ease. It is also accompanied with more independence as a practitioner, and also gives people the opportunity to work outside of physician’s supervision in private practice. While the fact that it pays more than most jobs, the reason I am attracted to this field that it allows a nurse to work across a broad patient population. It is filled with opportunities and additional training it offers will simply enhance this specialization even further ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mbLI67p7","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). These include further specialization in the form of health policy, Diabetes, HIV/AIDS and palliative care.

An AGNP working in acute care is primarily focused on the treatment of illnesses. Thus, most AGNPs working in a hospital setting usually deal with acutely ill patients. This includes working in an ICU i.e. the intensive care unit or the emergency department. Their job also extends towards specialty clinics and labs ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"UFURbgRL","properties":{"formattedCitation":"(Budd, Wolf, & Haas, 2015)","plainCitation":"(Budd, Wolf, & Haas, 2015)","noteIndex":0},"citationItems":[{"id":682,"uris":["http://zotero.org/users/local/0omESN17/items/VW364CQD"],"uri":["http://zotero.org/users/local/0omESN17/items/VW364CQD"],"itemData":{"id":682,"type":"article-journal","title":"Addressing the primary care workforce: A study of nurse practitioner students’ plans after graduation","container-title":"Journal of Nursing Education","author":[{"family":"Budd","given":"Geraldine M."},{"family":"Wolf","given":"Andrea"},{"family":"Haas","given":"Richard Eric"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Budd, Wolf, & Haas, 2015). On the basis of the AGNP competencies, the primary role of an AGNP is to stabilize the patient, keep complications at bay and do everything necessary to restore the patient to maximum health. The various specific tasks that are usually associated with these goals include diagnosis, monitoring, prescription of the right medication as well as a referral to a specialist if necessary ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gIEd2yxc","properties":{"formattedCitation":"(Budd et al., 2015)","plainCitation":"(Budd et al., 2015)","noteIndex":0},"citationItems":[{"id":682,"uris":["http://zotero.org/users/local/0omESN17/items/VW364CQD"],"uri":["http://zotero.org/users/local/0omESN17/items/VW364CQD"],"itemData":{"id":682,"type":"article-journal","title":"Addressing the primary care workforce: A study of nurse practitioner students’ plans after graduation","container-title":"Journal of Nursing Education","author":[{"family":"Budd","given":"Geraldine M."},{"family":"Wolf","given":"Andrea"},{"family":"Haas","given":"Richard Eric"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Budd et al., 2015).

On the other hand, my second priority, in terms of specialties that I believe I will choose to specialize in, in the future is a Psychiatric Mental Health Nurse Practitioner (PMHNP). This type of nursing practitioner is tasked with a diagnosis of symptoms related to mental health and development of a viable treatment plan that is specific to that patient. Furthermore, PMHNPs can also prescribe medication, much like a psychiatrist. They can also evaluate the patient’s condition as well as assess the quality of improvement being rendered ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"L59bYhwx","properties":{"formattedCitation":"(Chapman, Phoenix, Hahn, & Strod, 2018)","plainCitation":"(Chapman, Phoenix, Hahn, & Strod, 2018)","noteIndex":0},"citationItems":[{"id":686,"uris":["http://zotero.org/users/local/0omESN17/items/6P58WF9R"],"uri":["http://zotero.org/users/local/0omESN17/items/6P58WF9R"],"itemData":{"id":686,"type":"article-journal","title":"Utilization and economic contribution of psychiatric mental health nurse practitioners in public behavioral health services","container-title":"American journal of preventive medicine","page":"S243-S249","volume":"54","issue":"6","author":[{"family":"Chapman","given":"Susan A."},{"family":"Phoenix","given":"Bethany J."},{"family":"Hahn","given":"Talia E."},{"family":"Strod","given":"Deborah C."}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Chapman, Phoenix, Hahn, & Strod, 2018).

In terms of employment, only 3.2% of NPs i.e. nurse practitioners choose to work in the field of mental health and psychiatry. Moreover, 48.9%, choose to work in family care and another 18.9% pursue adult care ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pPUxII9s","properties":{"formattedCitation":"(Phoenix, Hurd, & Chapman, 2016)","plainCitation":"(Phoenix, Hurd, & Chapman, 2016)","noteIndex":0},"citationItems":[{"id":687,"uris":["http://zotero.org/users/local/0omESN17/items/L8YPLQSV"],"uri":["http://zotero.org/users/local/0omESN17/items/L8YPLQSV"],"itemData":{"id":687,"type":"article-journal","title":"Experience of psychiatric mental health nurse practitioners in public mental health","container-title":"Nursing Administration Quarterly","page":"212-224","volume":"40","issue":"3","author":[{"family":"Phoenix","given":"Bethany J."},{"family":"Hurd","given":"Manton"},{"family":"Chapman","given":"Susan A."}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Phoenix, Hurd, & Chapman, 2016). This occupation is also regarded as one of the highest-paying jobs in the field of nursing. Nurses that specialize in this field are usually the ones that are willing to work with patients for the span of their lifetime ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6LEz2Iza","properties":{"formattedCitation":"(Chapman et al., 2018)","plainCitation":"(Chapman et al., 2018)","noteIndex":0},"citationItems":[{"id":686,"uris":["http://zotero.org/users/local/0omESN17/items/6P58WF9R"],"uri":["http://zotero.org/users/local/0omESN17/items/6P58WF9R"],"itemData":{"id":686,"type":"article-journal","title":"Utilization and economic contribution of psychiatric mental health nurse practitioners in public behavioral health services","container-title":"American journal of preventive medicine","page":"S243-S249","volume":"54","issue":"6","author":[{"family":"Chapman","given":"Susan A."},{"family":"Phoenix","given":"Bethany J."},{"family":"Hahn","given":"Talia E."},{"family":"Strod","given":"Deborah C."}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Chapman et al., 2018). This certification was formerly known as the Family Mental Health Nurse Practitioner, with nurses also having the opportunity to be regarded as an Adult Psychiatric Mental Health Nurse Practitioner while working with patients age 13 and above. However, both these field come under the common umbrella of the Psychiatric Mental Health Nurse Practitioner (PMHNP) at present.

Step 2: Justification of Nursing Specialty

Use the space below to write a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum.

My primary choice to specialize in the field of Adult-Gerontology Nurse Practitioner (AGNP) stems from the fact that it is capable of providing me with a range of skills I might not be able to adopt otherwise. As opposed to an acute care nurse practitioner, the main focus of an AGNP is on the practice of primary care which deals with prevention of illness along with the promotion of health ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"MkCy9NRn","properties":{"formattedCitation":"(Kennedy-Malone, Martin-Plank, & Duffy, 2018)","plainCitation":"(Kennedy-Malone, Martin-Plank, & Duffy, 2018)","noteIndex":0},"citationItems":[{"id":683,"uris":["http://zotero.org/users/local/0omESN17/items/ZN67DGVH"],"uri":["http://zotero.org/users/local/0omESN17/items/ZN67DGVH"],"itemData":{"id":683,"type":"book","title":"Advanced practice nursing in the care of older adults","publisher":"FA Davis","ISBN":"0-8036-9479-2","author":[{"family":"Kennedy-Malone","given":"Laruie"},{"family":"Martin-Plank","given":"Lori"},{"family":"Duffy","given":"Evelyn"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kennedy-Malone, Martin-Plank, & Duffy, 2018). AGNPs serve as an integral part of the community and are more than capable of working in both community clinics as well as private practices. They aid underserved populations, however, their focus usually remains on nurse practitioner baseline and providing patient-centered quality care. The care they provide is aimed to improve lifelong outcomes of the population they work with ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"RQK2lR0v","properties":{"formattedCitation":"(Budd et al., 2015)","plainCitation":"(Budd et al., 2015)","noteIndex":0},"citationItems":[{"id":682,"uris":["http://zotero.org/users/local/0omESN17/items/VW364CQD"],"uri":["http://zotero.org/users/local/0omESN17/items/VW364CQD"],"itemData":{"id":682,"type":"article-journal","title":"Addressing the primary care workforce: A study of nurse practitioner students’ plans after graduation","container-title":"Journal of Nursing Education","author":[{"family":"Budd","given":"Geraldine M."},{"family":"Wolf","given":"Andrea"},{"family":"Haas","given":"Richard Eric"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Budd et al., 2015). They also take care of rather critical tasks which require taking detailed histories and making health assessments, promoting healthy lifestyle changes among the masses and aid patients in managing chronic diseases like diabetes. I happen to be detail-oriented and have a passion for making sure that I provide the very best care for all those involved.

Above all, nurse practitioners, primarily AGNPs, should be compassionate at their core. They need to be willing to work in close quarters with the patients and come up with the best care possible for them. I believe I have the empathy and the patient necessary to take care of patients in a way that is unique to them. No matter what clinical settings these patients may be subjected to, AGNPs need to be ready to take on all kinds of tasks. They need to work through challenging scenarios in a patient manner, with due diligence and without suffering through burnout. While this is a hard job, I believe that it is just as necessary and given the important nature of the job, I believe I can handle the task with relative ease ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8n57nUUV","properties":{"formattedCitation":"(Kennedy-Malone et al., 2018)","plainCitation":"(Kennedy-Malone et al., 2018)","noteIndex":0},"citationItems":[{"id":683,"uris":["http://zotero.org/users/local/0omESN17/items/ZN67DGVH"],"uri":["http://zotero.org/users/local/0omESN17/items/ZN67DGVH"],"itemData":{"id":683,"type":"book","title":"Advanced practice nursing in the care of older adults","publisher":"FA Davis","ISBN":"0-8036-9479-2","author":[{"family":"Kennedy-Malone","given":"Laruie"},{"family":"Martin-Plank","given":"Lori"},{"family":"Duffy","given":"Evelyn"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kennedy-Malone et al., 2018). AGNPs also need to be emotionally stable, since they are working with patients for the entirety of their life-spans. It is a trying professional, but at the same time it is incredibly rewarding and they should have the ability to whether any and all kinds of storms ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"R3l1x3Ci","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).

AGNPs also need to pay attention to details. This is another reason why I believe that I am perfect for this job, because this job requires me to be diligent enough not to make a single mistake, and my perfectionist nature will certainly ensure that. Strong communication, in a clear tenor with precise use of words, is also essential to effectively communicate with patients. Another thing that makes me perfect for the job is my organizational skills. I can be incredibly organized when I want to be and hence have the capability to be incredibly helpful in my role as AGNP ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2yxGabS2","properties":{"formattedCitation":"(Evans et al., 2018)","plainCitation":"(Evans et al., 2018)","noteIndex":0},"citationItems":[{"id":684,"uris":["http://zotero.org/users/local/0omESN17/items/ZWRXWLYS"],"uri":["http://zotero.org/users/local/0omESN17/items/ZWRXWLYS"],"itemData":{"id":684,"type":"article-journal","title":"Embracing the future for emergency nurse practitioners and specialty practice: Implications for research, clinical practice, education, and health policy","container-title":"Journal of the American Association of Nurse Practitioners","page":"586-591","volume":"30","issue":"10","author":[{"family":"Evans","given":"Dian Dowling"},{"family":"Hoyt","given":"Karen Sue"},{"family":"Wilbeck","given":"Jennifer"},{"family":"Schumann","given":"Lorna"},{"family":"Ramirez","given":"Elda"},{"family":"Tyler","given":"Diane"},{"family":"Agan","given":"Donna"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Evans et al., 2018).

My secondary choice is rather straight forward in this regard. In this role, you can help families, groups, and individuals with various mental issues, and help put them on the road to recovery. This job is intrinsically involved in assessing, diagnosing, and treating individuals with psychiatric disorders. This also includes screening high-risk patients for the potential of psychiatric disorders in the future ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BEJG5Ku1","properties":{"formattedCitation":"(Phoenix et al., 2016)","plainCitation":"(Phoenix et al., 2016)","noteIndex":0},"citationItems":[{"id":687,"uris":["http://zotero.org/users/local/0omESN17/items/L8YPLQSV"],"uri":["http://zotero.org/users/local/0omESN17/items/L8YPLQSV"],"itemData":{"id":687,"type":"article-journal","title":"Experience of psychiatric mental health nurse practitioners in public mental health","container-title":"Nursing Administration Quarterly","page":"212-224","volume":"40","issue":"3","author":[{"family":"Phoenix","given":"Bethany J."},{"family":"Hurd","given":"Manton"},{"family":"Chapman","given":"Susan A."}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Phoenix et al., 2016). Since

As the American Psychiatric Nurses Association notes, an advanced practice psychiatric mental health nurse may prescribe medications and perform psychotherapy, contribute to policy development, and assist in healthcare reform. He or she may own practice or work within communities, hospitals or corporations. Some psychiatric mental health nurse practitioners may function as consultants or liaisons to patients and families with complex issues and concerns.

Psychiatric medicine is always growing and advancing. The reason behind this unprecedented growth can be attributed to the recent rise in mental health awareness in the country. Couple it with access to new forms of treatments and access to new medicine along with advanced screening process, and the entire process has simply become a whole lot more accessible. However, when compared to other sectors of healthcare, mental health still lags far behind. Within the niche of psychiatry alone, nurses have the option to choose from a number of other specializations, which enables them to focus on one thing at a time. Working as a PMHNP requires you to be detail-oriented and pay specific attention to patient care. Thus, there is a good chance that I may have to pore over patient history and story over and over again, but it is definitely worth it ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rb9SryQ4","properties":{"formattedCitation":"(Manning, 2018)","plainCitation":"(Manning, 2018)","noteIndex":0},"citationItems":[{"id":689,"uris":["http://zotero.org/users/local/0omESN17/items/MPPG6EW4"],"uri":["http://zotero.org/users/local/0omESN17/items/MPPG6EW4"],"itemData":{"id":689,"type":"article-journal","title":"Family Nurse Practitioner Student Competencies in Integrated Psychiatric Healthcare","author":[{"family":"Manning","given":"Mark"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Manning, 2018).

Step 3: Professional Organizations

Use the space below to identify and examine one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization.

Since I already hold a bachelor’s degree in nursing, in order to pursue my primary goal of working as an Adult-Gerontology Nurse Practitioner (AGNP), I would preferably apply in the MSN program. There are a number of programs in the US that I can join to specialize as an AGNP, however, most institutes prefers to break the field down into acute care and primary care. This gives students ample opportunities to pursue what they would like to. Upon completion of the accredited program, nurses can go ahead and get approved through a simple board certification to work as an AGNPs. In the US alone, there are a number of different credentials available to pursue this field, but I think I would prefer to go through the American Nurses Credentialing Center (ANCC). It happens to offer AGPCNP-BC board certification for AGNP, along with an AGACNP-BC for the acute care specialty. It requires me to get basic education as AGNP and then I have to pass an exam. This is followed by a continuation of education requirements, which allows us to maintain certification. This is just the first step, following this I would go-ahead to get more than one professional certification according to my field and professional needs.

On the other hand, there are a number of options available to become a mental health nurse practitioners (PMHNP). However, since I already have a bachelor’s degree in nursing. I would prefer to go through the psychiatric mental health nursing practitioner care available through Ohio State University, in Columbus. It allows students to attend both the core courses as well as the specialty courses in the field to complete this degree. It would also require me to complete 16 clinical hours per week in the last 2 semesters of study. This program is affiliated to the American Association of Colleges of Nursing (AACN), thus it fulfills the requirement for advance placement programs necessary.

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.

Budd, G. M., Wolf, A., & Haas, R. E. (2015). Addressing the primary care workforce: A study of nurse practitioner students’ plans after graduation. Journal of Nursing Education.

Chapman, S. A., Phoenix, B. J., Hahn, T. E., & Strod, D. C. (2018). Utilization and economic contribution of psychiatric mental health nurse practitioners in public behavioral health services. American Journal of Preventive Medicine, 54(6), S243–S249.

Evans, D. D., Hoyt, K. S., Wilbeck, J., Schumann, L., Ramirez, E., Tyler, D., & Agan, D. (2018). Embracing the future for emergency nurse practitioners and specialty practice: Implications for research, clinical practice, education, and health policy. Journal of the American Association of Nurse Practitioners, 30(10), 586–591.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2018). Advanced practice nursing in the care of older adults. FA Davis.

Manning, M. (2018). Family Nurse Practitioner Student Competencies in Integrated Psychiatric Healthcare.

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

Phoenix, B. J., Hurd, M., & Chapman, S. A. (2016). Experience of psychiatric mental health nurse practitioners in public mental health. Nursing Administration Quarterly, 40(3), 212–224.

State Or Federal Level Active Bill

State or Federal level active bill

Lower healthcare cost act

The Lower healthcare Cost Act passed out of the Senate in June 2019 with a vote of 20- 3. The act got the support of Senate leadership including the majority leader McConnell and minority leader Schumer. The lower healthcare cost act focuses on drug pricing and medical billing and it also includes provisions about public health officials, healthcare providers, and insurers.

Major provisions of the bill

The bill aims at improving US public health by introducing innovations in prevention programs. For example, in title V of the bill, it highlights the improvement in the exchange of health information. The provisions under this title focused on tobacco, vaccines, and training in indicating the attempts for minimizing the number of health-related issues and health-related costs. Similarly, section 414 of the bill calls for increasing the minimum age for buying tobacco from 18 to 21 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"glkZHlk2","properties":{"formattedCitation":"(Willink, Reed, & Lin, 2019)","plainCitation":"(Willink, Reed, & Lin, 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/b4FJfWUy","uris":["http://zotero.org/users/local/s8f0QVnP/items/GCERH66W"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/GCERH66W"],"itemData":{"id":666,"type":"article-journal","title":"Cost‐Benefit Analysis of Hearing Care Services: What Is It Worth to Medicare?","container-title":"Journal of the American Geriatrics Society","page":"784-789","volume":"67","issue":"4","author":[{"family":"Willink","given":"Amber"},{"family":"Reed","given":"Nicholas S."},{"family":"Lin","given":"Frank R."}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Willink, Reed, & Lin, 2019). Along with this, section 401 of the bill instructs about giving awards to external organizations for conducting evidence-based campaigns at the national level. These campaigns should be based on targeting communities that have a low rate of vaccinations. The section 407 of the bill establishes the grant programs for facilitating the health care providers in training programs that should be focused on reducing and preventing discrimination in the provision of health care services ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"acsELU4g","properties":{"formattedCitation":"(Willink et al., 2019)","plainCitation":"(Willink et al., 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/b4FJfWUy","uris":["http://zotero.org/users/local/s8f0QVnP/items/GCERH66W"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/GCERH66W"],"itemData":{"id":666,"type":"article-journal","title":"Cost‐Benefit Analysis of Hearing Care Services: What Is It Worth to Medicare?","container-title":"Journal of the American Geriatrics Society","page":"784-789","volume":"67","issue":"4","author":[{"family":"Willink","given":"Amber"},{"family":"Reed","given":"Nicholas S."},{"family":"Lin","given":"Frank R."}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Willink et al., 2019).

Legislation and background of the bill

The bill was first presented to the House by Lamar Alexander, R- Tenn, D- Wash, and Patty Murray. These senators have been working on healthcare for quite a reasonable time. The lower health care cost act had been debated in the lower house prior to debating in the upper house ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"T5MhS13z","properties":{"formattedCitation":"(Xu, Shooshtari, & Jung, 2019)","plainCitation":"(Xu, Shooshtari, & Jung, 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/9O9eTLOb","uris":["http://zotero.org/users/local/s8f0QVnP/items/NBYWFV96"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/NBYWFV96"],"itemData":{"id":663,"type":"article-journal","title":"Disparities in cost‐related drug nonadherence under the Affordable Care Act","container-title":"Journal of Pharmaceutical Health Services Research","page":"177-185","volume":"10","issue":"2","author":[{"family":"Xu","given":"Wendy Yi"},{"family":"Shooshtari","given":"Andrew"},{"family":"Jung","given":"Jeah"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Xu, Shooshtari, & Jung, 2019). The legislation was at first limited to improving transparency in health care and reducing the prescription of drug prices. However, the later amendments and drafts additions suggest that the lower health care cost act includes a list of issues that can be found in section by section summary.

History of the bill

The lower healthcare cost act of 2019 is linked to the reforms in health care which started back in 2017. Since the passage of health care reforms back in 2010 by the 111th Congress, the debate has followed a bipartisan format ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"MxHiqdqA","properties":{"formattedCitation":"(Zogg et al., 2019)","plainCitation":"(Zogg et al., 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/ffNYVxNR","uris":["http://zotero.org/users/local/s8f0QVnP/items/8BXAHVRR"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/8BXAHVRR"],"itemData":{"id":665,"type":"article-journal","title":"Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision","container-title":"Journal of the American College of Surgeons","page":"29-43. e1","volume":"228","issue":"1","author":[{"family":"Zogg","given":"Cheryl K."},{"family":"Scott","given":"John W."},{"family":"Bhulani","given":"Nizar"},{"family":"Gluck","given":"Abbe R."},{"family":"Curfman","given":"Gregory D."},{"family":"Davis","given":"Kimberly A."},{"family":"Dimick","given":"Justin B."},{"family":"Haider","given":"Adil H."}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Zogg et al., 2019). The Lower healthcare cost act of 2019 draws from many conservatives’ ideas proposed by the Medicaid and the Heritage Foundation back in the 1980s and 1990s. The cost reduction in health care was first proposed by the Heritage Foundation, but the ideas that time were limited to raising the tax costs and by taxing the health insurance premiums ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XYfmotXW","properties":{"formattedCitation":"(Zogg et al., 2019)","plainCitation":"(Zogg et al., 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/ffNYVxNR","uris":["http://zotero.org/users/local/s8f0QVnP/items/8BXAHVRR"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/8BXAHVRR"],"itemData":{"id":665,"type":"article-journal","title":"Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision","container-title":"Journal of the American College of Surgeons","page":"29-43. e1","volume":"228","issue":"1","author":[{"family":"Zogg","given":"Cheryl K."},{"family":"Scott","given":"John W."},{"family":"Bhulani","given":"Nizar"},{"family":"Gluck","given":"Abbe R."},{"family":"Curfman","given":"Gregory D."},{"family":"Davis","given":"Kimberly A."},{"family":"Dimick","given":"Justin B."},{"family":"Haider","given":"Adil H."}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Zogg et al., 2019). The only issue with such a suggestion remained that they would have affected the employers who were at that time exempted from the income.

Supporters and opponents of the bill

After the 20 -3 vote passed in July of 2019, the bill was combined with the fifty-four previous resolutions of healthcare. The voting trend suggests that there had been no considerable viewpoints against the surprising bill. The senators from the GOP had long remained suggestive of ending the surprise billing that comes for the customers as surprising. However, some Democrats have suggested that ending the surprise element from the medical billing might extend an oily branch to insurers, which must be avoided ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eAwHzmmb","properties":{"formattedCitation":"(Glickman, DiMagno, & Emanuel, 2019)","plainCitation":"(Glickman, DiMagno, & Emanuel, 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/S0xEKJV1","uris":["http://zotero.org/users/local/s8f0QVnP/items/SY4I8RAE"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/SY4I8RAE"],"itemData":{"id":667,"type":"article-journal","title":"Next phase in effective cost control in health care","container-title":"Jama","page":"1151-1152","volume":"321","issue":"12","author":[{"family":"Glickman","given":"Aaron"},{"family":"DiMagno","given":"Sarah SP"},{"family":"Emanuel","given":"Ezekiel J."}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Glickman, DiMagno, & Emanuel, 2019). Their other concerns were related to the financial difficulties that might erupt once the bill is enacted. The financial complexities they referred were mostly related to the company affairs and about companies that work with state-owned healthcare-related institutions.

Position of the key stakeholders

The GOP senators who proposed the bill claims that since medical billing sometimes surprise the end-users, and the government is not a large beneficiary of the medical billing, therefore the surprise element must cut down to a limit. The bill in the early stages as proposed by the stakeholders directed the insurers and the supply companies to adopt a mechanism which remains transparent and accessible ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"k37fgkZ6","properties":{"formattedCitation":"(Brixner et al., 2019)","plainCitation":"(Brixner et al., 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/exeLzOWd","uris":["http://zotero.org/users/local/s8f0QVnP/items/LKBYISEY"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/LKBYISEY"],"itemData":{"id":664,"type":"article-journal","title":"Patient Support Program Increased Medication Adherence with Lower Total Health Care Costs Despite Increased Drug Spending","container-title":"Journal of managed care & specialty pharmacy","page":"1-11","author":[{"family":"Brixner","given":"Diana"},{"family":"Rubin","given":"David T."},{"family":"Mease","given":"Philip"},{"family":"Mittal","given":"Manish"},{"family":"Liu","given":"Harry"},{"family":"Davis","given":"Matthew"},{"family":"Ganguli","given":"Arijit"},{"family":"Fendrick","given":"A. Mark"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Brixner et al., 2019). From the stakeholders’ point of view, the bill calls for more transparency and adoption of clear cut methodologies, when it comes to estimating the expense of healthcare and medicine.

How it impacts the nurse's ability?

The nature of the bill is financial and it does not call for the individual attention by any person related to health care. The bill addresses the financial companies involved in medical billings, and by no means limits or becomes suggestive about the role of nurses. The article by article summary of the bill, however, suggest that the nurse practitioner and the advances of health care practitioners must have the acknowledgments about the health care expenses ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"25iMKG0X","properties":{"formattedCitation":"(Brixner et al., 2019)","plainCitation":"(Brixner et al., 2019)","noteIndex":0},"citationItems":[{"id":"RlSeilKO/exeLzOWd","uris":["http://zotero.org/users/local/s8f0QVnP/items/LKBYISEY"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/LKBYISEY"],"itemData":{"id":664,"type":"article-journal","title":"Patient Support Program Increased Medication Adherence with Lower Total Health Care Costs Despite Increased Drug Spending","container-title":"Journal of managed care & specialty pharmacy","page":"1-11","author":[{"family":"Brixner","given":"Diana"},{"family":"Rubin","given":"David T."},{"family":"Mease","given":"Philip"},{"family":"Mittal","given":"Manish"},{"family":"Liu","given":"Harry"},{"family":"Davis","given":"Matthew"},{"family":"Ganguli","given":"Arijit"},{"family":"Fendrick","given":"A. Mark"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Brixner et al., 2019). This nature of the bill, therefore, suggests that by no way the abilities of the nurses remain impacting by this bill.

What actions nurses can take?

Each person involved in health care comes under a moral obligation to cut down the cost associated with any form of expense which could affect the end-user or the consumer. The nurses were associated with health care remains a stakeholder in deciding about the cost analysis of the expenditures. Since the bill calls for the surprise cut, it does not offer a role which suggests that what actions nurses can take in deciding about the cost analysis of medical billing. The article by article summary of the bill also does not provide explicit attention to the nurses’ role in this wake.

Works Cited:

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Brixner, D., Rubin, D. T., Mease, P., Mittal, M., Liu, H., Davis, M., … Fendrick, A. M. (2019). Patient Support Program Increased Medication Adherence with Lower Total Health Care Costs Despite Increased Drug Spending. Journal of Managed Care & Specialty Pharmacy, 1–11.

Glickman, A., DiMagno, S. S., & Emanuel, E. J. (2019). Next phase in effective cost control in health care. Jama, 321(12), 1151–1152.

Willink, A., Reed, N. S., & Lin, F. R. (2019). Cost‐Benefit Analysis of Hearing Care Services: What Is It Worth to Medicare? Journal of the American Geriatrics Society, 67(4), 784–789.

Xu, W. Y., Shooshtari, A., & Jung, J. (2019). Disparities in cost‐related drug nonadherence under the Affordable Care Act. Journal of Pharmaceutical Health Services Research, 10(2), 177–185.

Zogg, C. K., Scott, J. W., Bhulani, N., Gluck, A. R., Curfman, G. D., Davis, K. A., … Haider, A. H. (2019). Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision. Journal of the American College of Surgeons, 228(1), 29-43. e1.

State Procedure

State Procedure

Student’s Name

Institution

Date

Introduction

In healthcare, all medical practitioners have obligation to abide by all rules, laws, and regulations of healthcare. In the United States, every state has rules or regulations, which provide guidance in the medical practice. However, there are several cases before the judges, which may change the healthcare provision in the United States. The pending cases are Texas V Azar, free contraceptive coverage and West Alabama Women’s Center vs. Miller CITATION Kat18 \l 1033 (Keith, 2018). These cases are before Supreme Court judges and the decisions, which would be made is likely to affect the provision of healthcare services across the country.

The cases, Texas V Azar, are the case taken to Supreme Court by a group of Republic and the attorney general to seek to invalidate the entire healthcare law. The group is making an argument that the law no longer viable because the Congress had eliminated the penalty on people without health coverage. According to the group since there is no penalty, it is needless to have healthcare policy CITATION Noa18 \l 1033 (Levey, 2018). The result of the case is important because it could end up stripping millions of Americans their healthcare coverage. The federal court in Texas is one of the most conservative courts and it is likely to rule in favor of the governors and this will definitely affect millions of people by denying them the healthcare, which most people need.

However, the other essential pending cases are free contraceptive coverage and West Alabama Women V Miller. The free contraceptive is about women pills, which Trump administration had proposed to abolish funding and therefore, the court case against the administration action may go either way CITATION Meg18 \l 1033 (Thielking, 2018). This is likely to affect women across the country. If it goes in favor of the government, it means women would not access free contraceptive, which has been the case in the previous years. It is important to state that Texas V Azar, Free contraceptive and Alabama women V Miller are some of the notable cases, which are likely to affect the healthcare provision in the country.

References

BIBLIOGRAPHY Keith, K. (2018). Judge Hears Oral Arguments In Texas v. United States. https://www.healthaffairs.org/do/10.1377/hblog20180910.861789/full/ , 2-18.

Levey, N. N. (2018). issue: A group of 20 Republican governors and attorneys general is seeking to invalidate the entire healthcare law. They argue that the law no longer can work because Congress last year eliminated a a penalty on people who do not have health coverage. https://www.latimes.com/politics/la-na-pol-obamacare-legal-cases-20180830-story.html , 5-18.

Thielking, M. (2018). 3 court cases to watch in 2018. HEalthcare provision and pending cases , 2-34.

State Regulation

Title page

State regulation

Hello Jelilat,

I like your post because you have conducted a detailed comparison of Connecticut and Texas. I agree that nurses must possess adequate knowledge because they could improve or deteriorate health of patients. I believe that board of nursing exists in most states of America but Connecticut and Texas specifically aim for implementing regulations that will enhance public protection. I agree that by governing nurse practices, that states are able to eliminate wrong nursing practices such as negligence, errors in medications or treatment. The board ensures that the nurses follow adequate standards and principles that are required for performing their role efficiently in the healthcare organizations CITATION Lin17 \l 1033 (Coventry, et al., 2017). Rules and regulations enhance their efficiency and capability of treating patients appropriately CITATION Nic15 \l 1033 (Blazek, 2015).

I agree with the point that the nurse must possess RN license for practicing in Texas and even at other states. Personnel policies are also part of the regulations that highlights the conditions of employment, terms of the contract, leaves, insurance and other benefits. The regulations states that the nurses must possess adequate education and knowledge about the healthcare activities such as the right procedures of screening and X-ray CITATION Lin17 \l 1033 (Coventry, et al., 2017).

I also like the discussion because Jeliat has included the role of nursing regulations in Illinois. Certified Clinical Nurse Specialist and Certified Registered Nurse are essential requirements for the nurses who are aiming to work in the state of Illinois CITATION Nic15 \l 1033 (Blazek, 2015). I think that the regulations are critical because they minimize the risks of causing damages to the health of the patients such as by neglecting the prescription or failing to follow proper instructions. Regulations are important for improving the overall quality of healthcare system and increase satisfaction of the patients.

References

BIBLIOGRAPHY Coventry, L. L., Pickles, S., Sin, M., Towell, A., Giles, M., Murray, K., et al. (2017). Impact of the Orthopaedic Nurse Practitioner role on acute hospital length of stay and cost‐savings for patients with hip fracture: A retrospective cohort study. JAN, 731 (11).

Been-Dahmen, J. M., Hazes, J. D., Staa, A., & Ista, E. (2015). Nurses' views on patient self-management: a qualitative study. J Adv Nurs, 71 (12), 2834-45.

Blazek, N. (2015). NPs important leaders for evidence-based practice, improving patient outcomes. NAPNAP.

McCleery, E., Christensen, V., Peterson, K., Humphrey, L., & Helfand, M. (2014). Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses. PubMed.

Philpot, C., Tolson, D., & Morley, J. E. (2013). Advanced practice nurses and attending physicians: a collaboration to improve quality of care in the nursing home. ournal of the American Medical Directors Associtaion.

Statement Of Purpose For Regis College Post Masters Psychiatric Nurse Practitioner

Statement of purpose for Regis College Post Masters Psychiatric Nurse Practitioner

[Name of the Writer]

[Name of the Institution]

Statement of Purpose for Regis College Post Masters Psychiatric Nurse Practitioner

The Essay is written to provide my statement of purpose for Regis College Post Master Psychiatric Practitioners. It is the programs that I want to choose as it is an ideal field for those who want to acquire advanced nurse practitioners and want to work for the patients by preparing for the nurse practitioner examination. I want to pursue this career because as a girl I was growing up in a small village in Africa. I witnessed people dying in numbers due to poor health care system. One of the reasons for this condition was unprofessional nurses. Most nurses get registered after a short term training at a local clinic or hospital. Through the limited training they got, many lives were lost as medical errors became so rampant. The condition made me choose this profession for the future. I set my goal that I will also acquire a nursing education but through proper way. I wanted to save lives with my polished skills.

I have chosen the psychiatric nurse practitioner certificate for my higher education. This is because I was working as a volunteer at a dual diagnosis treatment centre in California for two years. There I have seen many students with mental illness and substance abuse. Through proper assessment and identification of the problem, they got help by various resources available in the community. This experience increased my nursing passion, especially for mental health. Later I have provided medical management for acute episodic illnesses, injuries, and disease management for stable chronic medical conditions in a remote community. I understand through my experience that in my chosen field that is Psychiatric mental health NP I will be able to specialised nurse to work for the people who need care for mental health. I want to play my role for mental health patients for the rest of my life.

I am well aware of the requirements of my chosen field. It required a strong focus on the study. Students pay twenty hours each week on the study, and I am also able to follow the pattern. I am passionate about my career. Therefore I can put all my focus and hard work on my studies. I am well aware of my personal obligations as well, and I am looking forward to balance my career life and personal life. I have approached online learning as I am currently working at Coalinga State Hospital, due to a lack of facilities and problem here, make me to think about online learning. By acquiring online learning, I can enhance my skills, and also I can accommodate clinical requirements at my workplace. Online learning is suitable for me as I can continue my work along with the studies. It will also help to practice my learning side by side. I am well aware of problems shortage of psychiatric NP at work place, which I can solve easily by preparing for NP examination from online learning.

I have seen myself in the next five to ten years as a well educated ,and professional Psychiatric nurse practitioner. I am clearer about my field and would like to put all my practice focus in it. I need a certificate to register as a professional nurse that I will acquire with my hard work and a good result in the program. As I am working at Coalinga State Hospital and the hospital is always short of Psychiatric Np, after my degree completed I will work here to solve this issue. When I get my certificate, I will help the facility get closer to battling their staffing problem ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"womMItzT","properties":{"formattedCitation":"(\\uc0\\u8220{}Psychiatric NP vs. Psychiatrist,\\uc0\\u8221{} n.d.)","plainCitation":"(“Psychiatric NP vs. Psychiatrist,” n.d.)","noteIndex":0},"citationItems":[{"id":223,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4V836FCD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4V836FCD"],"itemData":{"id":223,"type":"webpage","title":"Psychiatric NP vs. Psychiatrist","URL":"https://www.nursepractitionerschools.com/faq/pmhnp-vs-psychiatrist/","accessed":{"date-parts":[["2019",2,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Psychiatric NP vs. Psychiatrist,” n.d.). Beside filling all these needs, I would be available for my country as well as another country whenever they need me or my skills to help mankind. In future, I will be spending my life on helping the patient professionally.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Psychiatric NP vs. Psychiatrist. (n.d.). Retrieved February 28, 2019, from https://www.nursepractitionerschools.com/faq/pmhnp-vs-psychiatrist/

Statement Of The Problem

Healthcare is a Business

Sean

[Institutional Affiliation(s)]

Author Note

Policy to lawmakers

Healthcare is a Business

An aspiring doctor is educated about medicine in his long and often tiresome days at the medical school. His experience of running a clinic or dealing with the clientele is almost next to none. But as soon as he frames his degree and hangs it on the wall of his workplace, the truth hits him with the speed of a raging bull: "Healing is an art, medicine is a profession, but healthcare is a business" CITATION Leo14 \l 1033 (Leonard Berry, 2014).

To a certain degree, that has been true for many years now, especially after the enforcement of the healthcare reforms. Hospitals and medical groups are now dealing with severe business-related matters CITATION Ros18 \l 1033 (Rosenthal, 2018). They have to deal with certain health-related issues like making contracts for their employees, facing issues in the area of competitive marketing, and most importantly the issue of managing costs and profits of their enterprises.

Seeing that this has become a reality, the lawmakers should of the land must be advised to take some measures to make sure that the doctors do not face difficulties adjusting to this new situation CITATION Pet131 \l 1033 (Kongstvedt, 2013). For one, there should be legislation that caters to a series of emerging issues in healthcare, such as kickbacks, fee-splitting, and other malpractices that are commonplace in the corporate world. Another area of interest should be the advertising and marketing of medical products. Such practices should be strictly regulated by the FTC. Lastly, the doctors that are already present in the field should be compelled to start their training in business and health industry management. True, many institutions are now offering dual MD-MBA programs, but there is still the question of the physicians and surgeons that are already qualified, and need to learn to govern themselves in this business.

References

BIBLIOGRAPHY Kongstvedt, P. R. (2013). Essentials of Managed Health Care. Jones and Bartlett Learning.

Leonard Berry, A. M. (2014). A Healthcare Agenda for Business. MIT Sloan Management Review, 45(4), 1-11. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2443861

Rosenthal, E. (2018). An American Sickness: How Health Care Became Big Business and How You Can Take It Back. Missouri Medicine, 115(2), 128-129.

Statistics Exercise

Statistical analysis

[Enter your name here]

[Enter the name of the institution here]

Introduction

The current analysis has been undertaken to study if a certain psychotherapy program has a positive impact on patients having lower back pain. In order to obtain data for this study, a questionnaire was given to the participants both before and after the therapy. The answers to the questionnaires were recorded and checked for significant differences through statistical tests. The research question to be answered also asks if the therapy has changed the level of disability in patients significantly.

Descriptive Statistics

Ethnicity

Number

Caucasian

76

African American

52

Hispanic

18

Others

8

In the above table, the ethnic distribution of the patients is given which shows that Caucasian people are in a majority among all the patients.

Experimental group

Before

After

Very Severe

34

Very severe

12

Severe

24

Severe

10

Moderate

18

Moderate

32

Mild

2

Mild

24

In the above table, we have shown the number of people with different levels of disability in the experimental group. An experimental group is referred to the one which receives the treatment which is the therapy in this case.

Control Group

Before

After

Very Severe

32

Very severe

30

Severe

26

Severe

28

Moderate

14

Moderate

16

Mild

4

Mild

2

In the above table, we have shown the disability statistics for the control group which is the one that has not received any therapy to improve their condition.

Inferential discussion

The Mann-Whitney test is applied to the data to show if there is any significant difference between the control and the experimental groups. This test is used to analyze differences in case of non- parametric distribution. The dependent variable in this test is continuous or categorical in nature. The test statistic of 0.014 shows that we will reject the null hypothesis and conclude that there is a significant impact of therapy on the disability regarding back pains.

Strategic Alternatives

Strategic Alternatives

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Strategic Alternatives

Response one

Working in healthcare and nursing as a health care administrator, there are several roles and duties to perform such as, creating an understanding of the organization, and monitoring the strategic metrics based on daily activities ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"m3Jgc6mG","properties":{"formattedCitation":"(Krentz, DeBoer, & Preble, 2006)","plainCitation":"(Krentz, DeBoer, & Preble, 2006)","noteIndex":0},"citationItems":[{"id":231,"uris":["http://zotero.org/users/local/smYQhi21/items/L7Z7NYYF"],"uri":["http://zotero.org/users/local/smYQhi21/items/L7Z7NYYF"],"itemData":{"id":231,"type":"article-journal","title":"Staying on course with strategic metrics","container-title":"Healthcare financial management : journal of the Healthcare Financial Management Association","page":"86-93","volume":"60","source":"ResearchGate","abstract":"Providers need to understand the various types of metrics, the importance of each type, and how to use them effectively. Providers should use strategic metrics to monitor implementation of their organization's strategic plan. To overcome obstacles to successful use of strategic metrics, providers should communicate the organization's strategic intent, establish accountability for achieving the targets, and ensure buy-in through review of metrics and involvement of appropriate people.","journalAbbreviation":"Healthcare financial management : journal of the Healthcare Financial Management Association","author":[{"family":"Krentz","given":"Susanna"},{"family":"DeBoer","given":"Aaron"},{"family":"Preble","given":"Sasha"}],"issued":{"date-parts":[["2006",6,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Krentz, DeBoer, & Preble, 2006). Metrics help the administrators to understand, and see a clear image of activities going on inside the organizational environment. However, these are important to measure the effectiveness, performance of employees in the organization, and these will help to target better services for the patients. While performances and effectiveness can be examined by converting them into numbers to analyze the weaknesses during strategic planning.

Response two

Every organization has its vision and goals which must be met, while as a manager, having measurable data can help to ensure and to review the organizational vision. Companies and organizations have their standards, which helps the managers to communicate with the senior management and department. Strategic management helps the managers to follow the process of accountability of their performances as well as the performance of other employees below their designation. However, strategic metrics help to implement the organizational strategic plans and to help in the monitoring of the progress and tactics.

Response three

Strategic metrics create linkages between the execution of plans, creating value, and strategic planning to achieve the organizational goals, and helps to meet the vision ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hVOiff3J","properties":{"formattedCitation":"(Melnyk, Stewart, & Swink, 2004)","plainCitation":"(Melnyk, Stewart, & Swink, 2004)","noteIndex":0},"citationItems":[{"id":228,"uris":["http://zotero.org/users/local/smYQhi21/items/HZHAZ68R"],"uri":["http://zotero.org/users/local/smYQhi21/items/HZHAZ68R"],"itemData":{"id":228,"type":"article-journal","title":"Metrics and performance measurement in operations management: dealing with the metrics maze","container-title":"Journal of Operations Management","page":"209-218","volume":"22","issue":"3","source":"ScienceDirect","abstract":"Metrics provide essential links between strategy, execution, and ultimate value creation. Changing competitive dynamics are placing heavy demands on conventional metrics systems, and creating stresses throughout firms and their supply chains. Research has not kept pace with these new demands in an environment where it is no longer sufficient to simply let metrics evolve over time—we must learn how to proactively design and manage them. The intent of this paper is to convey the importance and need for metrics-related research. An outline of the important characteristics of the metrics research topic is provided. Specifically, we address the functions of metrics; their focus and tense; their operational and strategic contexts; as well as discuss the distinction between metrics, metrics sets and metrics systems. Some initial theoretical grounding for the research topic is provided through agency theory. We conclude with a discussion of the intent and process of the special issue, and introduction of the associated articles.","DOI":"10.1016/j.jom.2004.01.004","ISSN":"0272-6963","title-short":"Metrics and performance measurement in operations management","journalAbbreviation":"Journal of Operations Management","language":"en","author":[{"family":"Melnyk","given":"Steven A"},{"family":"Stewart","given":"Douglas M"},{"family":"Swink","given":"Morgan"}],"issued":{"date-parts":[["2004",6,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Melnyk, Stewart, & Swink, 2004). Strategic metrics also help to create a clear image of the performances, and the progress which is carried out to serve the patients to ensure quality.

Organizations cannot depend upon the metrics solely because there will be chances of miscalculations in the data systems. However, there will be difficulty in using the metrics for employees who are not aware of calculations. The main goal of an organization is to work efficiently and effectively, so organizations and companies have to make proper decisions and strategies.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Krentz, S., DeBoer, A., & Preble, S. (2006). Staying on course with strategic metrics. Healthcare Financial Management : Journal of the Healthcare Financial Management Association, 60, 86–93.

Melnyk, S. A., Stewart, D. M., & Swink, M. (2004). Metrics and performance measurement in operations management: Dealing with the metrics maze. Journal of Operations Management, 22(3), 209–218. https://doi.org/10.1016/j.jom.2004.01.004

Strategic Leadership And Future Delivery Models

Strategic Leadership and Future Delivery Models

Caroline M Waweru

Western Governors University

Improving HCAHPS scores in healthcare.

A. Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey in healthcare facility reveals with evidence that there is a need to improve communication between nurses and patients. There exist limited nurse to nurse communication and patients in plan care discussions. Healthcare future growth and viability depends on patients and nurse safety and satisfaction. To improve patients and nurses satisfaction, there is a need for organizations to make concentrated efforts to change the environment and assure patients and nurses satisfaction. One of the evidence-based strategies to improve nursing communication and involve patients in plan discussion is bedside handoff. Bedside handoff strategy is introduced using Havelock’s change theory and focuses on the implementation of more beds and staffs to improve patient satisfaction on nursing communication. The purpose of this project is to analyze bedside handoff and determine its effectiveness in improving patients and nurses satisfaction for nurses’ communication as evidenced by the HCAHPS scores. HCAHPS is a patient satisfaction survey that helps us hear the voice of our patients and families. A core set of questions are established to determine the HCAHPS score of Stanford Healthcare, which determines that patient satisfaction with the medical staff and their services is 82 percent which is below average.

B.Stanford Healthcare is an Acute Care Hospital located in California. Based on the survey conducted by HCAHPS, the hospital rated four stars out of five. The HCAHPS scores related to nursing communication as evidenced by the study was 82% below the average goal of 85%. This means that the nurses involved patients in the plan care discussion but not to their satisfaction. The average national HCAHPS score of nursing communication in the United States is 80 percent. However, the nursing communication score of Stanford Health Care is 76 percent. This lower percentage indicates that communication between healthcare practitioners and patients and their families is unsatisfactory. There is an immense need for strategies to promote effective communication among patients and healthcare practitioners in order to enhance the efficiency of healthcare services. Other hospitals such as the Kaiser Foundation hospital based in the same state recorded an HCAPHS score of 78%, and Alvarado Hospital Medical Center scored 73% score related to nursing communication. The scores were based on the survey response rates of 24% in Stanford Healthcare, 25% in the Kaiser Foundation and 19% for the Alvarado Medical center (Hospital Compare: medicare.gov). These figures indicate that Stanford Health Care is doing better than Alvarado Hospital Medical Center, but is underperforming as compared to Kaiser Foundation hospital. It is notable to mention that the performance of these three medical centers is less than the average performance of the majority of healthcare centers in the US.

Stanford Hospital is based at 300 Pasteur Drive, Stanford, CA. It is ranked as the best hospital in terms of quality and delivery of health care services in the United States by the US news. It operates locally and internationally in the provision of medical care and Acute Care services for patients. It delivers clinical innovation across its physician offices, virtual care offerings, health plan programs, inpatient services, and specialty health centers. The facility is internationally known for clinical specialties such as organ transplantation, cardiovascular treatment and surgery, neurosciences and cancer diagnosis and treatment. Besides, the hospital is Level I trauma home between San Jose and San Francisco, and it provides coordinated, compassionate care, and personalizes for every patient's basic needs. With almost 2,000 faculty physicians, nearly 1500 registered nurses, 49 operating rooms, 1200 residents and fellows and 613 licensed beds, Stanford hospital commits to delivering quality care to patients (Stanford Health Care).

Environmental and community factors influence on HCAHPS scores

Improving HCAHPS scores is a priority within a healthcare system. However, environmental and community factors such as the cultural, educational and socioeconomic dynamics may hinder the efforts to improve patients and nurse satisfaction towards communication in nursing.

Cultural dynamics: Cultural characteristics such as language preference, race and ethnicity influence HCAHPS scores. The patient population is diversified; hence cultural competence becomes critical in improving HCAHPS scores. For instance, cultural diversity may be characterized with language barriers especially in a hospital where the patient lacks knowledge of the common language. The inability to communicate effectively with the care provider deprives the patients’ participation in the healthcare plan. Thus, comprehension of patient cultural competencies could improve satisfaction scores.

Educational dynamics also influence HCAHPS scores. Technology advancements and improving healthcare prolongs patients' life and increases the burden of chronic illnesses. Poorly educated patients may not understand the technology applied in their care plan. Learning disabilities in patients, motivation, and readiness to learn affects satisfaction scores especially when the patients do not understand the service delivery methods used by nurses and is unwilling to learn. Thus, poor education hinders patients from understanding their care plan, hence patient dissatisfaction.

Socioeconomic dynamics: Social, economic status affects patient’s satisfaction towards nursing communication. Low socioeconomic status patients tend to have a low life expectancy, suffer from chronic illnesses and poor self-reported health compared to high social status patients. Also, their access to healthcare is limited due to coverage and costs and diagnostics tests conducted on them are few. Furthermore, nurses perceive low-class patients as rational, independent, responsible, intelligent and unlikely to comply with the treatment plan. Low-class patients are mostly neglected than high-status patients due to the assumptions of low reimbursement rates and uncooperative with hinders HCAHPS scores improvement in nursing communication since the financially challenged patients are often dissatisfied with nursing services and inability to attend efficiently to them.

The short and long-term financial impact on quality care outcome

Hospital financing impacts the quality and quantity of treatment and care delivered to patients. Specifically, financial incentives to nurses affect the quality of care they provide to patients. Based on recent studies conducted for healthcare facilities in California, fair pricing law contributes to the low quality of patient care. Overall, it can be concluded that the quality of healthcare changes in response to financial incentives. The healthcare organization alters the quality of care depending on economic incentives. When faced with short-term financing, the organization shortens inpatient stays by 9%, reduces the intensity of care, and treats a certain number and group of patients in outpatient instead of the inpatient settings, and often transfer patients to other facilities. The reason is that healthcare lacks the financial strength to hire long-term and professional services and equipment to deliver excellent care.

On the other hand, long-term financial strength influences compliance with changing health regulations, frequent recruitment and retaining of top healthcare providers and facilitates quality care delivery and excellent patient experience. Long-term financing rewards quality and allows patients in the assessment of care provided to them. Thus, funding long-term raises HCAHPS scores related to nursing communication and patients and nurses satisfaction. A long-term financial incentive enhances recruitment and development of healthcare providers with potential and capability to provide quality care and improve patient satisfaction.

C: The potential cause of HCAHPS scores

The nursing communication and discussions to patients and other nurses at Stanford is traditional and rarely involve patients and families in the care plan prescribed. The tradition handoff is consequently conducted at the nursing station in the absence of the patients which excludes their participation and decision regarding the care plan process. The strategy was characterized by poor communication between the patients and nurses and often involved only one party (Wakefield et al., 2012). The poor communication results to the below average satisfaction scores which incur extra health care costs. Thus, the primary cause behind below average HCAHPS scores is that nurse to nurse communication occurs at the reporting desk which limits a patient’s ability to understand their illness and treatment plan prescribed by the healthcare providers. Traditional handoff process contributed significantly to patient’s dissatisfaction.

D. Organizational strategy plan to improve nursing communication HCAHPS scores

Patient satisfaction is a critical element and part of a value based purchase program at Stanford Hospital and other healthcare in California. Improving patient’s satisfaction in regards to nursing communication contributes to nearly 30% of the organization reimbursement. Based on previous studies, nursing reporting in the presence of a patient, or bedside handoff, increases patients participation in the treatment plan, enhance effective communication with nurses, patients and their families, and promote patient’s satisfaction which is a significant element in improving nursing communication HCAHPS scores for the organization (Stanowski, Simpson & White, 2015). Therefore, bedside handoff, especially in shift change is a strategic plan in improving satisfaction in patients related to nursing communication.

A strategic plan enables an organization to look into the future in a systematic and orderly manner to ensure patient satisfaction and community needs. Stanford health care must analyze its internal and external environment to evaluate the effectiveness of its current state. As seen through statistics, the current condition of Stanford is satisfactory for patients and their families, so it should need to improve its communication with patients to provide satisfactory health care. The strategic plan of Stanford Health Care is comprised of three main pillars – to be value-focused, digitally driven and uniquely Stanford. It is notable to mention that by focusing on value, Stanford health care can deliver high-quality care to its patients at a competitive cost. Digital advancements are necessary for a health center to promote effective care. The digital transformation of health care is a proficient way of satisfying patients with quality care.

The evidence-based practice and shared governance lead to higher quality of care and helps in reducing the expenses. The selection of a suitable framework is first to step to integrate evidence-based practice in an institution. Evidence-based practices include the formation of PICOT to identify clinical problems. In PICOT, ‘P’ stands for population or patients based on their sex, and ethnicity. ‘I’ stands for interventions, ‘C' stands for comparison in treatments, ‘O' stands for the desired outcome, and ‘T' stands for timing. An example of PICOT question includes problem: the presence of family, intervention: multidisciplinary ICU rounds, comparison: not being present, outcome: enhance the satisfaction of patient (Wakefield et al., 2012). Shared governance is designed to integrate core values and beliefs. Shared governance can be increased by using different strategies such as allowing teleconferencing, emphasizing accountability, and promoting multidisciplinary involvement.

Shared accountability involves every person in improving care such as healthcare organizations, patients and health plan members, physicians, payers, and the community. There are three strategies that can be implemented in Stanford healthcare in order to improve quality care. These strategies include redesigning care, engaging patients, and aligning financial incentives. Stanford health care needs to redesign care by developing and implementing standards of care based on treatments as it is an effective method to improve health care among patients. Effective communication is essential to engage patients in health care choices to build trust in order to enhance the performance of medical staff. Aligning financial incentive is an effective strategy to reward physicians and medical staff for providing the right care, which will help in improving health care service.

There is an immense need for advanced technology in the Stanford health care to improve nursing practice and patient outcomes. It is beneficial for the higher management of Stanford health care to use a chip or code embedded in certain medical equipment to track them down without wasting much time. Moreover, management should need to invest in the wireless patient monitoring to help nurses in getting an idea about the changes in patient's status. Incorporating new technology needs investment, so stakeholders and investors must invest in integrating new technology in Stanford health care in order to improve health care.

The health care system is enhancing their capabilities to innovation in health care delivery due to urged new payment models and new incentives. The Stanford health care needs to use mobile clinics to go to the patients to provide clinical services in underserved areas. It should need to team up with Independent Transportation Network (ITN) to provide transport to patients who are unable to visit the hospital on their own. These methods will help in enhancing the healthcare services to patients but can place the burden of extra cost.

Stanford should need to focus on certain methods to improve their revenue. Stanford should need to reconsider the number of hired physicians and acquired physician practices in order to reduce out of network revenue leakage. It must need to utilize web-based applications such as Enterprise HIT vendor applications as they are effective for advanced clinical documentation and are inexpensive. Stanford health care also needs to reduce denials and underpayments to save their revenue. Moreover, it is also effective to optimize revenue from physicians’ referrals and orders that can save the revenue of Stanford health care.

E. Implementation plan.

The stakeholders involved were the hospital executive team, nursing staff, nurse managers among others. They were briefed on the likely change and advised identify challenges and develop potential solutions to the issues. Frequent reporting of any identified problem such as ineffective communication, patient handoff timing would keep the stakeholders accountable and involved in the improvement quality plan. It is crucial for all the stakeholders that they have proper realization of all their roles and responsibilities. Board members are established as prominent shareholder in the entire scenario. There is need of proper exploration of the features of quality of healthcare and safety for all the patients. Offering quality healthcare services should be core agenda when it comes to proper attainment of primary responsibilities relevant to the idea of healthcare services.

Nonetheless, it is vital to develop an educational program to train nurse staff and guide them on bedside handoff implementation; observe nurses practice BSR during the change of shifts. Secondly, a communication training program is also critical in teaching learners on the efficient methods to communicate with the high number of diverse patients and include them on the treatment plan. The implementation plan would be based on introduction, situation, background, assessment, recommendation, and question. Introduction part involves introducing an oncoming nurse by the off going nurse (Lehman, 2008). Situation includes patient's details, background; patients' history, medications or testing, Assessment; pending tests, safety check or medication, Recommendation; follow up tests or care plan and finally the question: patient's inquiry. In every stage, the stakeholders undertake a review and reports on every element such as the communication efficiency on medications, inquiry and with nurses to establish deficiencies.

F. Evaluating strategic plan success

One must need to engage individual stakeholders to improve the credibility or funding/authorization organization. One must need to increase the credibility of the evaluation in order to implement the interventions in the health care department to increase care services. Stakeholders needed to be involved in the decision-making process to increase their trust in the medical center and advocate the changes to institutionalize.

The results of the stakeholder evaluation include utility, feasibility, propriety, and accuracy. One must tell who will use these results, and how much efforts are being devoted by the stakeholders in a process. It will also include how accurate the engagement of stakeholders went in the given program.

Audits: Bedside reporting audit tool was used to ensure staffs compliance to the process, including verification that the reporting was conducted at the bedside; engaging oncoming nurse; scripting introduction, situation, background, assessment, recommendation and question; and care review Reporting time audits, measured from beginning to end of reporting, were completed pre and post implementation. The project manager analyzes the scores for the data collected to identify patients’ satisfaction trend and compare mean report on pre-implementation and post-implementation reporting to establish the role of Bedside handoff on both patients and nurses satisfaction.

Satisfaction surveys: Application of both HCAHPS and Press Ganey questions were used to compare four months before implementation and four months of post-implementation. HCAHPS tool measured the element of communication on the satisfaction of patients and nurses. The question focuses on nurse responsiveness to patient's needs, listening to patients' concerns, respect and courtesy, and timeliness in responding to a patient. Currently, the Center of Medicare reported a satisfaction core on communication at 82% below the benchmark of 85% (CMS, 2016). HCAHPS tool reliability is measured through its ability to measure satisfaction consistently and provide different observer results (AHRQ, 2013). The tool would ask discharged patients two questions on their experience during their stay in the organization; How often did the nurses explain health-related information to your understanding? Did the nurses listen carefully to your needs? Press Ganey, on the other hand, focused on questions based on follow up information, nurses' ability to address emotional needs, courtesy among others. The goal of these measures was achieving at least 90% satisfaction score concerning nursing communication. The stakeholder made use of Havelock's theory to facilitate HCAHPS process. Project manager reviewed weekly data collection to identify satisfaction score.

Analysis

The HCAHPS was computed using the mean average since 2016 to compare patient volume each year. Bedside handoff pre and post-implementation satisfaction scores were monitored; hence the primary domain was on nurses’ ability to engage effectively with one another and with patients. The questions targeted the levels of respect and courtesy provided by care providers, and the frequency of care plan explanation, listening and timely responsiveness. Statistical Package for Social Sciences (SPSS) was used to analyze the results. A t-test analysis was used to differentiate satisfaction scores after implementation of bedside reporting. The analysis compared response through selecting the best response on the scale of Likert which is on a scale of always to never. Patient’s rating on courtesy and respect during treatment plan, listening and efficient communication was the primary elements measured and compared to identify satisfaction score with nursing communication. It is notable to mention that communication of nursing with the patients and their families is not satisfactory in Stanford health care. Therefore, certain implications are necessary such as effective communication and advanced technology to increase the satisfaction and healthcare for patients.

Conclusion

Implementation of bedside reporting in Stanford health care shows a positive response on patient’s perception in how nurses deliver care plan hence improving HCAHPS score with nursing communication. Bedside handoff enhances careful listening and respect during treatment and explaining that allows patients and families to understand and engage in the care plan. The strategy implemented using Havelock’s theory ensures that all parties are involved in defining the problem and generating a solution. Improvement of HCAHPS scores in patient satisfaction in regards to nursing communication calls for health care organization to adopt the bedside handoff strategy throughout care policies and units.

References

Agency for Healthcare Research and Quality (AHRQ). (2013). Strategy 3: Nurse bedside shift report. Retrieved from: https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/guide.html

Centers for Medicare & Medicaid Services (CMS). (2016). HCAHPS Executive Insight Letter. Retrieved from: www.hcahpsonline.org/executive_insight

Hospital Compare: Data sources. (n.d.). Retrieved from https://www.medicare.gov/hospitalcompare/details.html?msrCd=prnt1grp1&ID=050760&stCd=CA&stName=California

Lehman, K. (2008). Change management: Magic or mayhem? Journal for Nurses in Staff Development, 24(4), 176-184. doi: 10.1097/01.NND.0000320661.03050.cb

Stanford Health Care (SHC)? (formerly Stanford Hospital & Clinics). (n.d.). Retrieved from https://stanfordhealthcare.org/?kwcid=adwords&campaignid=194581047&adgroup=18258713007&keyword=%2Bstanford%20%2Bhealthcar

Stanowski, A. C., Simpson, K., & White, A. (2015). Pay for performance: Are hospitals becoming more efficient in improving their patient experience? Journal of Healthcare Management, 60(4), 268-284. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26364350

Wakefield, S.D., Ragan, R., Brandt, J., & Tregnago, M. (2012). Coordination of care making the transition to nursing bedside shift reports. The Joint Commission Journal on Quality and Patient Safety, 38(6), 243-254. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22737775

Strategic Organizational Communication Paper

Strategic Organizational Communication Paper

Erika (First M. Last)

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

Strategic Organizational Communication Paper

Introduction

Strategic organizational communication is the purposeful use of communication which assists the company to achieve its strategic goals and objectives (Hallahan, Holtzhausen, Van Ruler, Verčič, & Sriramesh, 2007). There are certain elements of strategic organizational communication which helps evaluating the company’s communications strategy. This paper seeks to evaluate the effectiveness of Walmart’s organizational communications strategy.

Introduction to Walmart

Walmart Inc., operator America’s discount stores which was one of the biggest retailers in world and among largest corporation in the world. Its company headquarters are situated in Bentonville, Arkansas. Sam Walton set its foundation in 1962 Arkansas and targeted its initial development in rural areas, hence dodging direct competition with trading giants like Kmart and Sears. As it took its voyage of growth, the company established new formats of retail, comprising Wal-Mart Supercenters (1988), and Sam’s Club discount warehouses (1983). In time period of opening merchandise Supercenters and combination grocery, Walmart became of the greatest grocery store in the United States of America. Walmart stayed a worldwide leader in the subsequent years. In years of the 2010s it initiated to obtain various businesses of e-commerce, comprising Moosejaw and Jet.com. In 2018, its name was changed to Walmart. Current advertising slogan and mission statement are still the same: "Save people money, live better."

Over the years, Walmart has made a wide range of distinctive procedures, policies, processes, principles and rules. All of them aid to create the culture of behemoth’s corporate. Few of the policies of Walmart include open door policy which states that doors of mangers will be always open for the employees at every level, and Sundown Rule which states that Employees need to respond to all supplier and customer questions on the similar day the queries are received as inter-organizational communication enhances performance of both suppliers and buyers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ak6et5kb4u","properties":{"formattedCitation":"(Paulraj, Lado, & Chen, 2008)","plainCitation":"(Paulraj, Lado, & Chen, 2008)"},"citationItems":[{"id":1628,"uris":["http://zotero.org/users/local/FGhKhGPG/items/CE7VVJKB"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/CE7VVJKB"],"itemData":{"id":1628,"type":"article-journal","title":"Inter-organizational communication as a relational competency: Antecedents and performance outcomes in collaborative buyer–supplier relationships","container-title":"Journal of operations management","page":"45-64","volume":"26","issue":"1","author":[{"family":"Paulraj","given":"Antony"},{"family":"Lado","given":"Augustine A."},{"family":"Chen","given":"Injazz J."}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Paulraj, Lado, & Chen, 2008) . Moreover, through policies like grass roots process Walmart struggles to seizure ideas and suggestions from the front lines and sales floor- and to apply them. Furthermore through policies like three basic beliefs and values Walmart tends to enhance and support the respect for individuals, strive for cornerstones and excellence of the business. In addition, by policies like greeting people, offering help to customers and making eye contact with customers who come within ten feet of workers is a 24/7.

Strategic Communication in Walmart

Walmart is considered as a power house of business and its marketing mix is one of its strength. The company has developed strategic communication practices which contributes to its success. Walmart is known for its cost leadership strategy. As the company’s mission indicates that it aims to sell the low cost products to improve the livings standard of its buyers. Walmart offers variety of products to its customers, through it is a retail business but it attracts customers through its effective customer service. It allows easy one step shopping and home delivery. Walmart aims to be the low cost and price leader in the market and therefore it implements low cost and low price strategy. It generates profit due to its sales in huge volumes. Low cost and price is the main contributor of Walmart’s competitive advantage.

The promotional strategy of Walmart comprises of sales promotions, advertising, and public relations. Company generates sales in huge volumes by offering deals and discounts to its customers. Personal selling is also one of the strategies used at Walmart’s stores. Walmart also uses press release to keep their customers informed of their policies and practices. The promotion is an important element in marketing mix of company which helps it to generate more sales. In addition, the company has intensive distribution strategy and also has a strong e-commerce platform.

Walmart is ranked as one of the most reputed brands and it is also 22nd in the list of most valuable brands by Forbes. Walmart also underwent a transformation of brand reputation management and corporate ethos. Considering the fact that company was criticized for its poor treatment towards employees, it has started to invest in employees’ education and training. Walmart also gives attention to the environmental issues and carbon emissions, while sticking to its principle of providing their customers with low prices. It is also working towards improving its reputation not in the eyes of its customers but also in the eyes of its stakeholders, and communities ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1q0222l431","properties":{"formattedCitation":"(Davis, 2007)","plainCitation":"(Davis, 2007)"},"citationItems":[{"id":1631,"uris":["http://zotero.org/users/local/FGhKhGPG/items/FVCLH5QV"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/FVCLH5QV"],"itemData":{"id":1631,"type":"thesis","title":"Corporate Reputation Management, The Wal-Mart Way: Exploring Effective Strategies in the Global Market Place","author":[{"family":"Davis","given":"Nancy Diana"}],"issued":{"date-parts":[["2007"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Davis, 2007).

Walmart has also used its social media strategy to increase customer engagement (Saravanakumar & SuganthaLakshmi, 2012). This social media strategy of Walmart consisted of sharing corporate news, and sharing information of the ways in which company is helping society. As part of its social media strategy, Walmart has also developed Twitter handles, each of that is targeted at a different audience. For instance, the twitter handle of Walmart’s environmental analysis shows how the company is helping environment and takes part in solving its issues. In this way audience only receives the relevant message, for instance, those interested in knowing Walmart community initiatives get to know about it via Walmart’s environmental awareness. In addition, the social media strategy also involves monitoring of social media conversations to respond to customer queries ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a102n3s77g8","properties":{"formattedCitation":"(Coursaris, Van Osch, & Balogh, 2013)","plainCitation":"(Coursaris, Van Osch, & Balogh, 2013)"},"citationItems":[{"id":1633,"uris":["http://zotero.org/users/local/FGhKhGPG/items/7Z7DSLRM"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/7Z7DSLRM"],"itemData":{"id":1633,"type":"paper-conference","title":"A Social Media Marketing Typology: Classifying Brand Facebook Page Messages For Strategic Consumer Engagement.","container-title":"ECIS","page":"46","author":[{"family":"Coursaris","given":"Constantinos K."},{"family":"Van Osch","given":"Wietske"},{"family":"Balogh","given":"Brigitte A."}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Coursaris, Van Osch, & Balogh, 2013). The social media strategy was very successful and company witnessed growth in social media following.

Walmart is also known for using social media in crisis management. The crisis management by Walmart consists of three steps, according to senior director of global communication at Walmart. These steps involve existence with a purpose, reacting with a purpose and measuring and moving. Walmart’s social media existence is not just for press release but to communicate it purpose to its people along with considering its other goals and objectives. It also believes in sharing stories on social media to build trust among its community. It uses its already set benchmarks to learn about social crisis.

In addition to support effective internal communication with over more than 1 million people, Walmart uses walmartone.com for collaboration and sharing of ideas with its people. It is the form of employee extranet which has categories of communities and conversations, so that even the new comer feels a sense of belonging. This is the platform which provides the opportunity for all the associates at Walmart to get know how of the relevant information as soon as they arrive on the website.

Assessment and Recommendations

As strategic communication involves purposeful communication to meet the strategic objectives of company. This form of communication involves management communication, public relations, effective marketing and advertising. In also involves impressive social media campaigns to maintain a positive relationship with the stakeholders of company and keep them informed of company’s policies and objectives, which is followed by Walmart ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zWgusUst","properties":{"formattedCitation":"(Hallahan et al., 2007)","plainCitation":"(Hallahan et al., 2007)"},"citationItems":[{"id":1625,"uris":["http://zotero.org/users/local/FGhKhGPG/items/NTVRNLBU"],"uri":["http://zotero.org/users/local/FGhKhGPG/items/NTVRNLBU"],"itemData":{"id":1625,"type":"article-journal","title":"Defining strategic communication","container-title":"International journal of strategic communication","page":"3-35","volume":"1","issue":"1","author":[{"family":"Hallahan","given":"Kirk"},{"family":"Holtzhausen","given":"Derina"},{"family":"Van Ruler","given":"Betteke"},{"family":"Verčič","given":"Dejan"},{"family":"Sriramesh","given":"Krishnamurthy"}],"issued":{"date-parts":[["2007"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hallahan et al., 2007). At Walmart, the marketing strategy of 4 Ps enable the company to communicate its strategic objective of “save money, live better”, by the effective product, pricing, placement and promotional strategies.

Walmart is also very successful in managing its good will by communicating its initiatives to protect environment. The company has also been successful in managing the crisis and criticism using its social media platforms such as twitter handles. The strategic organizational communication at Walmart is very effective as it is aimed at having effective communication with its stakeholders, customers and community members. In addition, the company has effective internal communication, successful social media marketing strategy which promotes its image as a positive and caring brand. Walmart can further improve its strategic organizational communication by dealing with the criticism of its employees regarding low wages and poor working conditions. In addition, Walmart can focus on steps to enhance the strategic communication by involving the communities in which they operate.

References

ADDIN ZOTERO_BIBL {"custom":[]} CSL_BIBLIOGRAPHY Coursaris, C. K., Van Osch, W., & Balogh, B. A. (2013). A Social Media Marketing Typology: Classifying Brand Facebook Page Messages For Strategic Consumer Engagement. ECIS, 46.

Davis, N. D. (2007). Corporate Reputation Management, The Wal-Mart Way: Exploring Effective Strategies in the Global Market Place.

Hallahan, K., Holtzhausen, D., Van Ruler, B., Verčič, D., & Sriramesh, K. (2007). Defining strategic communication. International Journal of Strategic Communication, 1(1), 3–35.

Paulraj, A., Lado, A. A., & Chen, I. J. (2008). Inter-organizational communication as a relational competency: Antecedents and performance outcomes in collaborative buyer-supplier relationships. Journal of Operations Management, 26(1), 45–64.

Saravanakumar, M., & SuganthaLakshmi, T. (2012). Social media marketing. Life Science Journal, 9(4), 4444–4451.

STRATEGIC PLAN

Running head: STRATEGIC LEADERSHIP AND FUTURE DELIVERY MODELS.

Strategic Leadership and Future Delivery Models

C163

MSN Program

WGU

Feb 1, 2018

Introduction

In today’s healthcare reform, the focus is directed to the improvement of population health, cost

Reduction and increasing patient’s satisfaction. It can be very challenging and complex. The health

Industries must try to accomplish these three goals. The health industries must also focus on the

Improvement of the employee’s work life in order to meet these goals. Nurses have the greater chance of

Building strong relationships with the patients and their families. Nurses are the best healthcare

Professionals that can collaborate with other health care professionals to assure the effectiveness of

Improving the quality of healthcare(Arungwa, 2015).

HCAHPS has a great impact on financial status of hospitals. The government firmly believes that

They can get more value for the fees paid by the Medicare and Medicaid program for healthcare services.

Value-Based Purchase is a payment system that was implemented by Medicare and Medicaid in order to ensure that they get the value of the money they pay for their healthcare services.

The passing of the Affordable Care Act set the stage for value -Based Purchase system. It is a

Payment system based on the patient’s satisfaction scores. Their goal is to promote the improvement of patient center care and patient satisfaction which eventually leads to better healthcare outcome. These factors also lead to decrease mortality rate. This system is compared to a business model whereas the improvement of the delivery of services leads to positive financial gain. It has been established that the hospitals with the best patient satisfactory scores are most likely the institutions that are financially stable. Compared to most businesses, things that influence their finances positively, becomes a strong reason to drive for success.

A. Summary of chosen hospital.

BWH (Brigham and Women’s Hospital) is the first hospital I choose. It is in the center of Boston, MA. The hospital is an acute care center with also has trauma centers and various emergency

Rooms. The hospital has 793 beds. The hospital accepts all forms of health insurance which includes

Medicaid and Medicare. It is part of a healthcare organization called Partners. The healthcare organization

is nonprofit and participates in the HCAHPS program.

BWH’s clinical departments are, cancer, heart and vascular, lung, neuroscience, orthopedic and

arthritis, primary care, women’s health, anesthesiology, perioperative and pain medicine, dermatology,

emergency medicine, neurology, neurosurgery, obstetrics and gynecology, orthopedic surgery, pathology,

pediatric newborn medicine, physical medicine and rehabilitation, psychiatry, radiation oncology,

radiology and surgery centers.

A1.2017 HCAHPS scores for BWH

Communication with nurses

83%

Communication with doctors

82%

Responsiveness of hospital Staff

67%

Communication about medicines

65%

Cleanliness of the hospital environment

69%

Quietness of the hospital environment

53%

Discharge information

91%

Care transition

56%

Overall rating of the hospital

81%

Willingness to recommend

84%

B1. HCAHPS 2017 scores for the State of MA compared to the national average

HCHAPS Survey Scores

BWH

State of MA average

National Average

Communication with

House

83%

81%

89%

Communication with

Doctors

82%

80%

82%

Responsiveness of hospital staff

67%

65%

70%

Communication about medicines

65%

64%

66%

Cleanliness of the hospital environment

69%

72%

75%

Discharge information

91%

51%

62%

Care transition

56%

53%

53%

Overall rating of the hospital

81%

71%

73%

Willingness to recommend

84%

73%

72%

B2. Comparison to two other hospitals.

CHA (Cambridge Health Alliance) is the major healthcare provider for two cities and surrounding

communities in the State. The services they provide are primary care, specialty care, mental health,

substance abuse services, emergency services, maternity care and behavioral health. The hospital is part

of a community health system and it is location in a convenient neighborhood for the cities and

surrounding the towns. It is a nationally accredited public health department and community health

programs. It is also a teaching hospital.

NBH (New England Baptist Hospital) is a premier regional healthcare provider, specialized in

orthopedic surgeries and the treatment of musculoskeletal disorder and diseases. The hospital is affiliated

with the two major medical schools in the State and it said to be the official hospital for the States

basketball team for the past 30 Years. The hospital serves more than 19,000 people from all walks of life

and ethnic background.

HCAHPS scores compared to two area hospitals

HCAHPS survey Scores

BWH

CHA

NBP

Communication with nurses

83%

77%

87%

Communication with doctors

82%

80%

85%

Responsiveness of hospital staff

67%

63%

76%

Communication about medicines

65%

65%

72%

Cleanliness of the hospital environment

69%

71%

80%

Quietness of the hospital environment

53%

52%

55%

Discharge information

91%

88%

93%

Care transition

56%

51%

66%

Willingness to recommend

84%

66%

91%

B3. Survey response rate compared to two other hospitals.

There are multiple factors that can influence survey responses. The design of the survey, gender,

age, educational level and the cultural beliefs of the responders, can impact the survey results. Survey

design has a greatest impact on the response rate are. The shorter the survey, the more likely that the

survey questions will be answered on a timely manner. Surveys should be short with the goals of the

survey in mind when creating the questions to avoid overloading the responders with unnecessary

questions. The questions asked must be very clear in a simple language and with simple easy instructions.

Informing the responder before sending the survey about the purpose, how long the survey will

take and how their feedback will be used, can give incentive for a valid and quick response. Extending

data collection period over a long period of time such as few weeks or days may result in decrease

response rate.

Internal survey such as inpatient health setting tends to have a much higher response rate than

those distributed externally. Face to face interview in healthcare survey response rate is usually higher

than telephone survey (Ekholm et al., 2010). When given a sense of urgency, responders are likely to response in a timely manner. Internet survey response rates are higher among the highly educated who tend to be computer literate (Diment & Garrett, 2007).

Men and women response differently to survey because of physiological differences in brain

function and structure. Studies have shown that there are differences in the way men and women response

to survey because the diverse ways that each gender thinks, feels and behaves. Therefore, male and

female response can have a significantly impact on survey result. Women require more pain relive

medicines that men because men are less likely to verbalize the need for pain medication. Women are

more likely to ask for pain reliever. Therefore, the male and female response to pain relief survey while in

the hospital will differ. Younger participants and those with higher level of education are more likely to

use the internet and the mobile form of survey. The mail survey questioner remains to be the most preferred method (Sacks, 2009).

B4. Demographic and services provided

BWH (Brigham and Women’s Hospital) is a healthcare provider in Boston, MA. The facility is

an acute general hospital. The institution’s primary function is to provide inpatient diagnostic and

therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a diverse

population group. The hospital treats patients during the acute phase of their illness or injury. Their

hospital stay is characterized by a single episode or a short duration, after which the patient can return to

his or her normal or previous level of activity.

The hospital is an acute care center with also has trauma centers and various emergency rooms.

The hospital has 793 beds. The hospital accepts all forms of health insurance which includes Medicaid

and Medicare. It is part of a healthcare organization called Partners. The healthcare organization is

nonprofit and participates in the HCAHPS survey.

Their clinical departments are, cancer, heart and vascular, lung, neuroscience, orthopedic and

arthritis, primary care, women’s health, anesthesiology, perioperative and pain medicine, dermatology,

emergency medicine, neurology, neurosurgery, obstetrics and gynecology, orthopedic surgery, pathology,

pediatric newborn medicine, physical medicine and rehabilitation, psychiatry, radiation oncology,

radiology and surgery centers.

BWH is committed to the improvement of the health conditions of Boston residents. The

hospital is focused on Boston’s neighborhoods with disproportionately poor health and social indicators.

The hospital is in the center of neighborhoods that are racially and ethnically diverse in Boston and their

healthcare services reflect these communities. It is reported that in 2013, twenty five percent of the

inpatient populations at BWH were non-White. It is also reported that nine percent of both the

inpatient and outpatient population speak languages other than English as their primary language.

BWH has licensed community health centers that are in the most diverse arears of Boston. Most

residents in these locations speak languages other English at home. The patient population of these

community health centers are quite diverse, both ethnically and economically (Institute for patient and

Family-center care).

  B5a. Cultural Dynamics.

Humans are culturally program to the extent that they become resistant to change or to learn other

cultures. If we must change, it is a struggle and the process is usually very slow. People react

differently to crisis according the cultural uniqueness and life experiences. It is an establish fact that

patient’s satisfaction is related to the patient’s experiences either direct or indirect interaction with the health care providers. The delivery of nursing care and patient’s environment has a great impact on the patient’s satisfaction, either negatively or positively. However, patient’s own experiences, expectations of how they believe their healthcare should be delivered and their understanding of their care delivery can influence how they rate their satisfaction.

HCAHPS scores have been liked to demographic factors, size of the hospital and responder’s primary language. The goal is to improve scores, but the priority is to improve the population’s healthcare. In this process, the ability to communicate effectively with patients from diverse backgrounds at their level of understanding is very important. The patients and their families must have a very good understanding of what the healthcare providers are telling them about their illnesses. The hospitals must become vigilant in strengthening their communication process from the highest to the lowest level in order to improve healthcare delivery and patient’s satisfaction. Improving the communication between patients and the healthcare provider can help decrease the rate of readmissions (Budryk, 2015).

Introducing cultural competency training for all healthcare employees can promote effective communication and increase patient’s satisfaction. In the end patient’s health and safety outcomes becomes the critical piece that impact the way they rate their healthcare experiences. Hospitals that has excellent interpreter services tend to decrease adverse events and improve patient’s experience which can also increase HCAHPS scores (Newnum, 2016).

B5b. Educational Dynamics.

The education of populations about the prevention and occurrence of certain illnesses begins with a clear understanding of diseases process. While the goal is to improve scores, the priority is to improve the population’s healthcare. In this process, the ability to communicate effectively with patients from diverse backgrounds at their levels is very important. The patients and their family must to be cared for by the hospitals that provide excellent interpreter services from the front desk to the clinical areas.

Providing an excellent interpreter service will help to increase the patient’s misunderstanding of their illnesses and treatments. Providing clear and meaningful explanations of patient’s conditions and treatments can increase the chances of the patient’s and their families taking charge of their healthcare.

When communication between the care team is transparent, there is a greater chance of the team staying on the same page. The patient that is well educated about their conditions and treatments tend to have positive experience. The commercial that states,” An educated consumer is our best customer fits this concept. Positive experience increases patient’s satisfaction. Increase patient satisfaction leads to increase HCAHPS scores which increase reimbursement. (Murdock & Griffin, 2013).

All patients have the right to receive the proper information about their conditions and treatment options. The proper explanation of patient’s condition and treatment options give them a chance of becoming an active participant in their own care. The patients and their families also become better prepared to care for themselves at home after discharged. When the patients and their families are well informed about their care, the rate of re-admission decreases. Decrease readmission leads to increase patient’s satisfaction and HCAHPS score. Increase HCAHPS scores leads to the increase reimbursement and increases revenue.

B5c.Socioeconomic Dynamics.

Socioeconomic factors represent income, education, and ethnicity of a population. Patient’s income, education and ethnicity have a contributing factor to the development of disease and how people understand their treatment. Studies have showed that patients and their family’s priorities are different across socioeconomic populations and how they perceive the value of their healthcare. Socioeconomic status can affect an individual’s health outcome and the delivery of the care they receive. People in a lower economic bracket tend to have the worst self-reported health, and chronic conditions that leads to a lower life expectancy.

They tend to receive fewer diagnostic tests and medications for many chronic diseases because of limited access to healthcare due to cost and health insurance coverage. Healthcare professionals especially physicians perceive that low socioeconomic population are less likely to comply with their treatment plans or understand their disease process. They are perceived to be less education, less intelligent, less independent and less responsible with their health. They are perceived to be less likely to comply with medical advice and follow up care. Therefore, physicians delay diagnostic tests and prescribe generic medications for these population (Arpey et al., 2017).

Due to the many barriers that interferes with the chance of a quality healthcare, patients in the low socioeconomic group tend to be dissatisfied with the delivery of their healthcare. When healthcare organizations and facilities begin to address the unique healthcare needs of the low socioeconomic population efficiently, the HCAPHS scores will have a better chance of increasing. Increase HCAPHS scores will improve the chance of an increase in VBP fund. Increase in VBP funding means increase revenue for the healthcare organization.

B6. Potential short- and long-term financial impact.

The healthcare industry can be compared to any other service industry which main goal is to perfect customer service by providing excellent service. Superior service of healthcare agency is associated with the reduction of high mortality rate which is the number one goal. In the beginning of the implementation of patient satisfaction survey, the patient’s relationship with their healthcare providers was the number one focus. The early survey results helped to discover that there is a lack of empathy, and unfriendliness between healthcare providers and the patients. The patients were found to be very dissatisfied with their healthcare providers.

When communication between the team is clear, there is a greater chance of the team staying on the same page. The patient that is well educated about their conditions and treatments tend to have positive experience. The commercial that states,” An educated consumer is our best customer fits this concept. Positive experience increases patient’s satisfaction. Increase patient satisfaction leads to increase HCAHPS scores which increase reimbursement payment (Murdock & Griffin, 2013).

The short-term financial impact on the organization. HCAHPS has a financial impact on the hospitals. The financial benefit may decrease or increase depending on the HCAHPS results. The government firmly believes that they can get more value for the money that is paid to the healthcare providers by Medicare and Medicaid program for their services. Value-Based Purchase is a payment system that was implemented by Medicare and Medicaid in order to make sure they get the value of the money they pay for the delivery of healthcare services. This is like the pay by performance system. High HCAHPS scores will lead to increase reimbursement for the organization. Increase reimbursement means increase financial revenue. The lower the HCAHPS scores, the lower the reimbursement which leads to decrease revenue.

The passing of the Affordable Care Act set the stage for value -Based Purchase system which payment is based on the patient satisfaction scores. Their goal is to promote the improvement of patient center care and patient satisfaction which eventually leads to better healthcare outcome. These factors also lead to decrease mortality rate.

Potential long-term financial impact. This payment system is compared to a business model whereas the improvement of the delivery of services leads to positive financial gain. It has been established that the hospitals with the best patient satisfactory scores are most likely the institutions that are financially stable. Compared to most businesses, things that influence their finances positively, becomes a strong reason to drive for success.

The survey’s results clearly point out the way patients perceive the healthcare services that they receive form their providers. Higher scores mean better patient satisfaction, better care and the higher reimbursement payment. Patients like customers prefer to take their business where they are satisfied with the services. Increase patient’s satisfaction scores means improved quality of care and increase reimbursement for the healthcare facility. Poor survey results cause the healthcare facility to forfeit some of their reimbursement payments from Medicare and Medicaid (Carta, 2018).

The potential long-term financial impact on the facility with consistence low HCAHPS scores will result in continuous decrease in revenues. If the decrease in revenue continues, the hospital may have to reduce their services. They may have difficulty keeping up with the latest healthcare technology and treatments. The delivery of their services may reach a mediocre standard. The end results could be poor reputation, decrease inpatient admissions, lower wages and benefits for their employees. If the decrease in revenue continues, the hospital may close their doors for good.

B6a. Impact on quality outcome.

LPatients are like any other customers. They will prefer to take their business where they are satisfied with the services. Increase patient’s satisfaction scores means improved quality of care and better reimbursement for the healthcare facility. Poor survey results may lead to the healthcare facility forfeiting some of their reimbursement payments from Medicare and Medicaid (Carta, 2018).

The potential long-term financial impact on the facility with consistent low HCAHPS scores is decrease in revenues. They may have difficulty keeping up with the latest healthcare technology and treatments. The delivery of their services may reach a mediocre standard which may result in poor healthcare outcome. The end results could be poor reputation for delivery of care, decrease inpatient admissions, lower wages and benefits for their employees. Employees with low wages and fewer benefits tend to be less committed and have low performance rate.

Nurses are affected the most because of staff shortage. Nursing storage could result in the nursing staff been over worked and burn out. Nurses have the greater chance of building strong relationships with the patients and their families. Nurses are the best healthcare professionals that could collaborate with other health care professionals to assure the effectiveness of quality of care (Arungwa, 2015). If the nursing staff becomes over worked, stressed and burn out, they will either leave or decrease their productivity due to low energy related to stress. This can lead to poor quality care outcome, which will lead to lower HCAHPS scores and lower financial reimbursement. If the decrease in revenue continues, the hospital may close their doors or reduce their services which may result in decrease admissions. Low patient’s census can lead to decrease revenue.

C. Cause of lower HCAHPS scores for BWH.

Areas of Lower HCAHPS scores compared to two area hospitals

HCAHPS survey Scores

BWH

CHA

NBP

Responsiveness of hospital staff

67%

63%

76%

Communication about medicines

65%

65%

72%

Cleanliness of the hospital environment

69%

71%

80%

Quietness of the hospital environment

53%

52%

55%

Care transition

56%

51%

66%

The areas that BWH scored less compared to two hospitals in the State are, responsiveness of hospital staff, communication about medications, cleanliness of the hospital environment, quietness of the hospital environment and care transition. The hospital is focused on Boston’s neighborhoods with disproportionately poor health and social indicators. The hospital is in the center of neighborhoods that are racially and ethnically diverse in Boston and their healthcare services reflect these communities. It is reported that in 2013, twenty five percent of the inpatient populations at BWH were non-white. It is also reported that nine percent of both the inpatient and outpatient population speak languages other than English as their primary language.

The cause for low score for responsiveness of hospital staff to the patients could be related to languages and cultural barriers. Humans are culturally program to the extent that they become resistant to change or to learn other cultures. If a person must change, it is a struggle and the process is usually very slow. People react differently to crisis according the cultural uniqueness and life experiences. It is an establish fact that patient’s satisfaction is related to the patient’s experiences either direct or indirect interaction with the health care providers. This can have a great impact on the patient’s perception of how workers should response. When conversing with patient, standing close in a non-threatening way can allow the patient to feel free to say what is exactly on their mind. Certain cultures and people who understands little or no English avoid looking into your eyes when talking to you. They consider direct eye to eye contract to be impolite or disrespectful.

Low score for hospital staff responsiveness may be due to the employee’s low physical energy related to fatigue, low mental engagement and low morale which leads to decrease commitment to the patient care. When employees feel better about their job, they tend to be more engaged and more productive. When they feel unappreciated, their morale is low, and they become less engaged. These attitudes can reflect on how they take their time to respond to the patients and their families. Employees that are burnout, stressed and fatigued tend to have very little compassion for patients.

Hospital call light system that is not very efficient can delay staff response to patient’s call. Delay in answering patient’s call has been associated with inpatient patient frequents falls, code blue events and other medical emergencies. These events can be avoided when call lights are answered on a timely manner. Timely responses to patient’s call light can lead to a trusting relationship between patients and staff. Some of the reasons that patients initiate call light are, toileting assistance, pain medications and intravenous noisy alarms.

The answering of call lights within 4 minutes is meaningful to the patients because they feel secured about their care. Non-professional like nursing assistants do not perceive call lights as being important and requiring immediate attention. The answering of call lights must be a high priority among nursing duties. Call lights should not be just another duty that will prevent the nursing staff from performing a very important duty.

Nurse’s friendly attitude when answering the call lights can encourage the patients and families to call whenever they need help. A negative reaction to answering the call light can discourage the patients and families from using the call light even when they are in desperate need. The elderly, the cognitively impaired, the bed reddened, the critically ill and patients with sensory deficits such as hearing, and vision impairment should be placed close to the nursing stations. The inability of the patient to use the call light can lead to unassisted transfers that may lead to falls.

The factors related to falls are, failure to identify patient care priorities, nursing staff’s misconception about use of call light. These factors can lead to the delay in response to patient’s calls. Use of improved call light technology that is easy to use and can differentiates between emergency calls and high priority calls can help the staff to recognize the need to answer call lights immediately. Frustration over delays in answering call lights is one of the most frequent negative comments that patients make (Tzeng, 2010).

Low score in the area of communication about medications can be caused by brake in communication process. The education of populations about the prevention and occurrence of certain illnesses begins with the patient’s clear understanding of diseases process. While the goal is to improve scores, the priority is to improve the population’s healthcare. In this process, the ability to communicate effectively with patients from diverse backgrounds at their levels of understanding is essential. The patients and their families that speaks little or no English should be cared for by the hospitals that provide excellent interpreter services from the front desk to the clinical areas.

The goal is to improve patient’s understanding about their medications and side effects. The main objective is to increase clinicians and nurses compliance with the explanation of patient’s medications during their entire hospitalization. Nurses should sharpen their skills in identifying the best method that will promote the education of individual patients and their families about their medications.

The care team’s clear communication with patients about their medications can also increase the patient’s knowledge of their treatment plan. The nurses and care team’s effective communication with patients about their medications can promote overall patient’s satisfaction. Patients need to have a full knowledge of the names of their medications, how the medicines work, dosage range, precaution and side effects for safety and quality care. (Al-Abri & Al Balushi, 2014).

Providing an excellent interpreter service will help to increase the patient’s misunderstanding of their illnesses and treatments. Providing clear and meaningful explanations of patient’s medications and treatments can increase the chances of the patient’s and their families taking full charge of their healthcare. People become more engaged in their health care management when they have clear understanding of all aspect of their healthcare. When communication between the care team is transparent, there is a greater chance of the team staying on the same page.

The patient that is well educated about their conditions and treatments tend to have positive experience. The commercial that states,” An educated consumer is our best customer fits this concept. Positive experience increases patient’s satisfaction. Increase patient satisfaction leads to increase HCAHPS scores which increase reimbursement. (Murdock & Griffin, 2013).

Low response score for cleanliness of the environment could be related to the employee burnout, low morale and decrease engagement in their duties. These problems related to burnt out and stress can lead to frequent staff turnover which leads to shortage and untrained staffs. Improperly supervised staff can lead to the production of unacceptable work. Socioeconomic status, ethnicity and cultural diversity can influence the way people define cleanliness. An executive or a very rich family with multiple maids and servants may expect a different level of cleaning service and frequency (Ellis, 2016).

There are also physiological issues associated with patients and families perception of cleanliness. Some patient may view cleanliness be a marker for their safety and quality life. A patient with immunocompromised illness may be highly concern about a clean environment more than other patients. Patient’s pain may be trigged by a certain smell of an item that may bring on an uncontrollable pain. Patient’s stress level may be elevated due to certain environment. For example, a site of bloody gauge or urinal or bed pan can trigger an elevated stress level for some patients. These patients may need an environment that is emotionally soothing and promotes healing. The patients that are suffering from obsessive-compulsive disorders can become very scared and feel unsafe because of fear of the hospital acquired infections. Hospital cleanliness must be a priority in every organization. It should not be just housekeeping staff responsibility. The patients expect every one that is involved in their care to help keep their environment clean (Ellis, 2016).

Low response score to quietness of the hospital also can be related to the patient’s and employee’s socioeconomic status, ethnical and cultural believes. These factors can influence the expectations of the patients and employees of how quiet hospitals and healthcare center’s environment should be. There are significant differences in how other cultures communicate. Some cultures are known for speaking very loudly while other cultures speak very softly. However, patients have their own experiences, and expectations of how they believe their healthcare should be delivered. Their beliefs can influence how they expect healthcare workers to response to them. The ability to communicate effectively with patients from diverse backgrounds at their level of understanding is very important. The hospitals must become vigilant in strengthening their communication process from the highest to the lowest level in order to improve healthcare delivery.

There are multiple activities in the hospital setting that cause increase noise volume. The many interruptions and noise that comes from such things like the call lights that stay ringing for long period of time, overhead speakers, moving carts, telephones, and shouts in the hallway. There are also frequent interruptions for medications, vital signs, meal delivery, fire drills, code blue drills and many other drills. The total sum of all these activities can drive a sick person crazy. Increase noise volume is the most annoyance and has the most negative effect on patient’s rest and comfort level. Lack of proper rest and sleep contributes to slow healing process, decrease strength of the immune system, lower pain tolerance and slow cell regeneration.

Hi tech devices are the contributing factors that has led to high noise volume in the hospital setting. In the hall ways one can hear the loud noise of intercoms, pagers, televisions, medical monitors in ICU, cardiac units and step-down units, buzzers, and bed alarms. Simple sound of a roommate flushing the toilet at night can cause disruptions in a well desire rest and sleep for the other patients. Staff and visitor’s loud conversations and laughers contribute to another source of high level of noise that may cause the patients to have sleep deprivation which can lead to slow ability to heal. According to studies, 42% of patients have reported that their sleep has being interrupted by multiple loud noises.

Hospitals should do all they can to reduce noise level throughout the hospitals especially at sleep hours. The use of hi-tech devices with low noise volume and other interventions should be implemented to reduce the overall noise level in the hospitals. Apart from the significant lack of sleep, noise may place patient’s safety on line. Therefore, the effort to improve patient’s sleep time for proper healing and safety should become a priority for the improvement of patient’s satisfaction and quality healthcare outcome.

Low scores related to care transition. After the patient has been discharged from the hospital, it is very important for the patient to understand their treatment plan. Care transition, hospital discharge, health literacy and the pharmacy services are interrelated. Patients tend to suffer unnecessary adverse events that can be easily avoided after they are discharged from the hospital. When the care transition is not done correctly, hospital readmissions rates increases and can have a negative effect HCAHPS scores. The education of populations about the prevention and occurrence of certain illnesses begins with a clear understanding of diseases process and treatment plans.

While the goal is to improve scores, the priority is to improve the population’s healthcare. In this process, the ability to communicate effectively with patients from diverse backgrounds at their levels is very important. The patients and their families must to be cared for by the hospitals that provide excellent interpreter services from the front desk to the clinical areas for patients that may need the services. Providing an excellent interpreter service will help to decrease the patient’s misunderstanding of their illnesses and treatments. Providing clear and meaningful explanations of patient’s conditions and treatments can increase the chance of the patients and their families to take charge of their healthcare.

When communication between the care team is transparent, there is a greater chance of the team staying on the same page. The patient that is well educated about their conditions and treatments tend to have positive experience. The commercial that states,” An educated consumer is our best customer fits this concept. Positive experience increases patient’s satisfaction. Increase patient satisfaction leads to increase HCAHPS scores which increase reimbursement. (Murdock & Griffin., 2013).

Every patient has the right to receive the proper information about their conditions.The level of literacy of patients about their conditions and treatment plan is the key factors to a smooth and effective care transitions at the time of discharge from hospital. Most patients have expressed that speaking to pharmacy about their medications before discharge has been very helpful. Interventions such as medication reconciliations, inpatients counseling and follow up phone calls can help ease patient’s frustration after discharge. Follow up care with home care agencies, families care givers, outpatient care centers and primary care practitioners can help the care transition to be more effective (Squires, 2018).

D. Organizational Change

The concept of team-based care versus team-based primary care. Team care approach is the bringing of multi-disciplinary healthcare professional and workers to provide care for a patient. It is usually a physician, or a nurse practitioner or physician assistant led team. The patient centered primary care model is described as the relationship-based with the partnership of the healthcare professional and the patient and their families and the care team. It is oriented toward the patient and their families (Schottenfield et al., 2016).

D1. Organizational Change and HCAHPS scores.

The number one phase of performance improvement plan should start with change in the model of care and the setting of goals. The new approach is to change to a new model of care from team-base care to patient centered team-based primary care model. In this model of care, the healthcare team will consist of at least two healthcare providers that will work collaboratively with the patients and their caregivers. The care givers include the clinicians, primary doctors and other doctors involved, pharmacist, therapist, dieticians, social workers, environmental care staff and a clergy staff. The patient and the family will also be a full participant in the team. This model is patient-centered primary care, because it is the making of the primary care to be more comprehensive and reachable for patients and their families. The patient and their family’s needs become the most importance factor. The concept of the care is the partnering with the patients and their families to fully understand and respect every patient’s unique needs. Their cultures, values, and the way they prefer to do things is the foundation of the delivery of their care. In this model, the patient’s and their families are encouraged to learn, manage, and organize their care at the level they choose.

The initiative will be implemented first on the medical units that are in the same building. After the first trail, the evaluation and necessary adjustments will be made. The initiative will advance to other units in the other buildings every six months until the entire hospitals has becomes a full participant in the new model of care concept.

The new initiative should start with the implementation of the change system, the outcome measurement and the formulation of the appropriate improvement plan. The first step to take is the setting of up an eye watch campaign team. The eye watch campaign team members will be volunteers’ staff from members from various units and departments. At least one or two staff members from various departments, patient and family council members. The team will report the systems that they have noted to be ineffective.

The re-education of the staff is the next step. Staff must understand the concept of patient- centered primary care and the goal of improving quality care outcome. The primary goal is to improve patient care experience, promote population health and reduce the cost of healthcare. The healthcare leaders and stakeholders must understand the connection of patient’s satisfaction scores and the quality of care. All the stakeholders must be educated about the concept of value based-payment and how the customer’s satisfaction scores can determine the financial future of the organization. Their level of understanding of the value-based payment system can determine their level of commitment to the change process (Schottenfield et al., 2016).

The patients will be asked to evaluate the delivery of care at least 7 days after they are discharged from the hospital. In the survey, emphasis will be placed on the lower score areas for BWH. Their lower score areas are, responsiveness of the hospital staff, cleanliness, quietness of the hospital environment, discharge and care transition. Improving the patient satisfaction scores in these survey areas will lead to the improvement HCAHPS scores and increase revenue.

Priority to improve the communication between the care team is transparent will be included in the strategic plan. When the communication between the team is greatly improved, the chance of the team staying on the same page is guaranteed. The patient that is well educated about their conditions and treatments tend to have positive experience. The commercial that states,” An educated consumer is our best customer fits this concept. Positive experience increases patient’s satisfaction. Increase patient satisfaction leads to increase HCAHPS scores which increase reimbursement.

Every patient has the right to receive the proper information about their conditions and treatments. People who have easy access to pharmacy system that makes it easy for them to get their medications, become highly knowledgeable about their medications. When the patient understands their treatment regime, their compliancy with their medications increases. They also tend to be satisfied with the delivery of their healthcare which leads to increase HCAHPS scores and increase reimbursement.

The recommendation is to use patient’s satisfaction scores as a measurement for the strategic plan to achieve the short term and long-term goal of improving HCAHPS scores and the quality of care. The patient that feels good about the delivery of their healthcare, tend to comply with the prescribed treatments.

The hospital will evaluate their entire care team and their current model of healthcare delivery. The internal system survey will focus on the evaluation of the entire care team not just an individual’s interactions. The value of care delivery will be measured by the effectiveness of the entire care team not just the clinicians. The improvement in the area of nurse’s communication with patients about their care can promote higher HCAHPS scores, because they spend more time with patients than other healthcare professionals.

The scores for the areas of nursing interactions with patients are likely to be higher than the doctor’s interactions if their communication skills are improved. The nurses spend more time with the patients than any other healthcare professionals, therefore they have more opportunity to educate the patients about their conditions and treatments.Therefore nurses should consider the responsibilities of teaching the inpatients and families about their medications as an important part of their duties. The finale step is the survey of the staff, patient’s and family’s level of the understanding of the change process and their feedback of the program. The process will include continuous studies, evaluations and adjustments of the plan to improve the healthcare delivery services that will meet the needs of the patients, the families and the employees (Arungwa, 2015).

D2.Structure process and outcomes of strategic plan.

A strategic plan to attain quality outcome and boot HCAHPS scores must be implemented. A strategic plan is a project undertaken by an organization for sole purpose of achieving their short and long-term goals. The organization will first look at their current situations, inside and outside the environment. The team will then proceed to the formulation of the objectives and strategies. A change in the model of care delivery must be intimated. The patient center primary team care will be adapted.

Strategic planning steps should include the analysis of the current model of care. The key areas to carefully examine are the external environmental factors such as other hospitals in the area, how much supply power available and the power of the customers. There should be aware of the threat that the patients and families can trade services in order to step up into the latest model of care. Therefor the need to implement the latest suitable model of care in the strategic plan is imperative.

The proposed new model of care must be developed according to the organization’s vision and mission statement. A detailed description of where the organization must be, it values; beliefs and the set goals should be written. The detailed strategies plan should include the best way to achieve the goals.

The goal to attain quality care outcome and increase reimbursement strategic plan should be targeted over a three- to five-year period. The goal is to provide a positive experience that will attract patients. During the first year, a performance improvement team should be created. The performance improvement team members should include the head of quality assurance, head of human resources, staff members from various departments, such as medicine, nursing managers, nurses from clinical care units, outpatient departments, therapy, pharmacy, education department, business office, and patient representatives and senior managers. The process will start with the evaluation of the present model of care and the survey results for the past five years.

The focus will be on the communication methods among staff, patient education tools, internal and external survey procedures and data collections procedures. There will be monthly in-house surveys on communication methods, patient education, pain management, discharge procedures, readmissions data, quietness and cleanliness of the facility. The survey evaluation process will continue for three months. The data reports on incidents such as falls, the patient’s complains, and any other reports should be provided for all units. There will be weekly open forums for all staff from every department for the first three months.

The business and finance department will provide statistics on the hospital’s revenues every six months during the meetings with the upper management. The departmental managers will be responsible for educating their staff on the positive and negative reports. Evidence-based staffing pattern will be established according to the needs of each unit. A yearly hospital-wide mandatory in- service day will be established on two consecutive days for every hospital staff member to attend.

Policies and procedures will be reviewed according to their departmental duties during the two-day in-service. There will be a weekly in-house survey forms for the patients and their families to fill out during the first six months. The data will be documented and presented at the monthly meetings with the performance improvement care team. The initiative will be evaluated every six months and adjustment will be implemented as needed. At the end of each year, a town hall meeting will be held, and all survey results will be shared with the staff. The target date to mark the program’s success will be at the end of threeyears. The achievement of 80% and above in every survey area will be the goal at end of the three years target date.

The constant empowerment, education of the staff and stakeholders and the involvement of every staff in the strategic planning is essential for the success of the program. Every staff member must be aware of the vision, mission, and goals of the organization. Medicine department including fellows, medical interns, medical students, therapist, and pharmacist must be fully oriented to the organization’s vision, missions, and goals. The entire hospital’s departmental managers will provide monthly mandatory in-services and online reading literatures on HCAHPS for their staff and patient representatives.

Employee’s engagement in decision making of policies and procedures can promote the success of the vision of the initiative which is to increase patient’s satisfaction. The employees that are egger to promote the vision should be encouraged to volunteer as members of the transition team. There is a strong coloration between devoted employee and happy satisfied patients. The strategic plan to improve patient satisfaction scores will stand a chance of being successful when there is a meaningful relationship between the patients, staff and their care team. When a meaningful strong team is establishes, the quality care outcome improves, and employee’s satisfaction level also increases (Bickmore & Merkley, 2019).

D3, Improvement organizational quality by incorporating evidence-based practice and shared governance.

Incorporating evidence-base practice and shared governance are the best combination that can improve organization’s quality care outcome. In order to increase chances of the successful improvement of the quality care project, the organization must have a sound evidence-based practice initiative that is suitable for the organization. The improvement initiative must have evidence that it will be beneficial for the organization.

The staff, especially the clinician staff such as nurses and allied health professionals must have the skills to perform their duties effectively. Therefore, re-educating the staff to sharpen their professional skills is very important in the process to improve quality of care. The process begins by educating patients and staff on how important the feedbacks are for the decision making on the improvement plans. The feedbacks from patients and staff will serve as the tool that can help to provide the answers for the improvement of the patient care center and the work place for employees.

D4. Method of incorporating shared accountability among patients, medical providers, payers and personnel.

In shared accountability approach, everyone is involved in improving healthcare. The patient, the health plan provider, healthcare organization, physician, payers and the community, must work together as a team to maintain and improve the health of an individual. The main goal of shared accountability is to improve the value of health care through accountability. The concept of share accountability was design to increase the chance of an effective and low-cost health care. The goal is to improve healthcare which leads to better healthcare deliver and a quality low healthcare cost.

Healthcare cost has risen because of the increase use of health care and even more expensive types of treatments. The rise in healthcare cost can be contributed to the fact that people are living longer, and the population has become sicker with many chronic health conditions. One of the conditions is the rising incidence of obesity especially among children. Also, the increase in the aging population has contributed to the increase in healthcare expenditure. The cost of healthcare is expected to increase as seniors live longer and require more care.

There are many chronic diseases that are associated with aging process and other health risks factors such as chronic diseases. Chronic disease such as type 2 diabetes, cardiovascular disease, hypertension, dyslipidemia, stroke, joint pain and cancer contribute to the high cost of healthcare. Many times, they order more tests and perform more procedures that are not necessary. High technology may have reduced cost in other fields but have added cost healthcare. People in general tend to view more care and newer technique in healthcare as better care.

The approach to better care can be promoted by prevention, wellness and care management program that can help individual stay healthy. Evidence- based medicine suggest a new direction towards wellness practices that leads to better and lower cost of healthcare is population healthcare. Wellness programs engage patients in the management of their health. Therefore, the focus should be redirected towards wellness programs with leads to a change in behaviors for patients, care givers and payers. Wellness programs are not just focus on the treatment but also on prevention of diseases and management of chronic conditions.

Shared accountability approach is imitated to promote better care and better health for the populations which also leads to better management of healthcare cost. The patients, the care givers and the payers are motivated to see the highest values of care. The process involves a commitment to evidence- base care which is supported by physicians and other healthcare givers who are committed to the delivery of the most effective treatments for the patients. In this process, over treatment, under treatment and unnecessary treatment are avoided.

The patient’s involvement in the share accountably is a key factor. Many times, patients are unaware of the risks, benefits and differences in payment or the options their health insurance is offering them. Health insurance does not encourage patients to be more discriminating consumers of care. The healthcare in the share accountable method is transparent, where by the patients and the clinicians make informed decision together.

In shared accountability, stakeholders within the health care system, the members of the healthcare team, the patients and families are expected to contribute to the success of the measures that are imitated for the improvement of healthcare delivery (Zimmerli.2013).

D5. Methods to incorporate technology trends within the healthcare

Medical technology designs have impacted healthcare industries tremendously. The medical technology has been incorporated into the workflow of clinicians which has allowed decision making for the treatment of patient faster. Bedside devices such as vital sign monitor, heart monitors and ventilators has helped healthcare workers to make important decision about their patients at that moment. High technology may have reduced cost in other fields but have added cost in healthcare. People in general tend to view more care and newer technique in healthcare as better care.

Electronic medication administration record system is one of the most important parts of healthcare. One of the most important responsibilities of a nurse is to administer medications safely to the patients. This is done multiple times per day. The incident of medication error is the most reported adverse event is hospitals. Electronic medication recording which is referred to as eMAR allows nurse to manage medication administration efficiently and safely by the reduction of the rate of error (Appari, et al, 2012). Medication error is one of the leading causes of death in the United State. The reported numbers do not even include the undocumented cases.

Medication errors lengthen inpatients hospital stays, increase inpatient expenses, and lead to more than 7,000 deaths annually in the United States. All medications have the potential to cause harm, but a select group of drugs on the high-alert medications list carries a higher risk of causing injuries to patient. The risk of serious injury or death is high even when given correctly (Chu, 2016).The hospitals should incorporate the use of the most effective user friendly eMAR system for the nurses and clinicians.

The use of telehealth will become routine due to the increase use of smartphones and consumers becoming more comfortable with the idea on online visit with their healthcare practitioners. All the States in the US have now approved the use of the remote diagnostic and treatment centers for patients. The insurance companies are now required to cover the cost of the telehealth services. It is predicted that between 50 percent and 70 percent of doctor’s office visit would be replaced by remote monitoring. Consumers now have apple watches that monitor their blood pressures instantly and the information can be texted to their PCP’s phone. The FDA has approved mobile devices that measures heart rhythms and blood glucose level for diabetic patients.

Private health care insurances companies are beginning to seriously investigate the value-based care. This has caused hospitals and healthcare systems to consider the extensive investment in the infrastructure of health IT. It becomes crucial for doctors to be able to electronically access patient’s records easily at any time and in the case of emergency. The patients and their families should be able to also access their medical records electronically at any time .Incorporating electronic health records in health care delivery will promote quick access to patient’s information in times of medical emergencies. Hospitals and the affiliated facilities should be able to access the patient’s record 24/7 when necessary.

Due to the rapid growth in medical technology, the hospitals should strategize for the future by investing in electronic patient care devices that are accurate and saves times. The health care centers should invest in technologies that can impact the hospital’s services and safety which will increase HCAHPS financial reward. Hospitals will have to invest their money wisely in medical technology and they need to be transparent in the process and decision making. The hospital also needs to communicate clearly about cost of services, evaluate the requests for capital equipment and explain to everyone involved on how they prioritize the purchase (Daly, 2018).

D6.Method used to improve care delivery system

The number one process that can enchant the improvement of care delivery is through quality improvement. This is a method that is called QI which is a data-based method that is used to bring about immediate improvement in healthcare delivery. There are always changes in medical practice .The clinicians and managers learn and adapt to new medical knowledge, new technology and new pattern of diseases. QI allows us to make changes systematically. QI measures and assess the effect of a change and gives the information back into the clinical units where adjustments are constantly made until they are satisfied with the results .Facilitating the quality improvement process begins by placing a priority on encouraging communication, staff and patient engagement and stakeholder’s participation. Participation of all parties involved is necessary for success of the QI process.

The implementation of the improvement plan should start on small scale demonstrations. One unit at a time is easier to manage and allows for small test demonstration and refining. The change team should include small group of caregivers, administrators and other staff members who give care to the patient on daily basis. The first step is the identification of a goal or the purpose and the creation of an intervention according to evidence-base practices. The establishment of improvement goals, identification of possible strategies, choosing an intervention and preparing a written plan of action is crucial.

The organization of the writing of the action plan is very important. It is important to clearly, state the goals and strategies that are needed to be implemented in order to achieve the goals. The specification and the identification of the actions needed to put the selected interventions to address the problems is important. The plan must be reviewed with the team and their points of view must be documented. Key questions to ask are, focused areas for improvement, initiatives goals, people that will be affected and how they will be affected, and who will lead and champion the management of the project.

The other important questions are, the resources that are needed, how to overcome possible barriers and how to measure and monitor progress and success in reaching the desire changes for the improvement of the HCAHPS scores. The method selected to measure the success of the project must be clearly linked with the goals and the intervention itself.

D7. Method to improve financial stability

The team must take special time to understand the problems of the facility. The first step to take when you start a financial improvement project in a hospital is to carefully study and understand the history of the facility. The clear understanding of what the facility has been doing, the problems that needs to be corrected and what was missing in the previous improvement effort procedures.

The effect of unhappiness among staff on hospital financial performance: Happy staff, happy patient and great hospital go together. The examination of the level of satisfaction among the staff members is very important. Patient’s satisfaction scores and the staff’s satisfaction correlate. When employees are struggling and unhappy, morale becomes low and turnover rate increase. This becomes a major problem because such work environment causes people to have negative attitudes and such people will not step up to do things correctly.

The facility may end up losing some percent of efficiency when the unhappy staff members and quality of the work production falls below standard. The reduction of the out-of-network revenue leakage can increase revenue. The coordination of patient care across a clinician integrated system network can decrease the chances of denials and under payments. This approach reduces revenue leakage.

It becomes dangerous when some staff just don’t care about their job but only cares about taking the salary and go home. You can be sure that the patient’s satisfaction rate will decrease if the staff members are unhappy. This can lead to low HCAHPS score and decrease financial reimbursement. When the staff members are happy, they tend to perform their duties beyond their expectations and that leads to a satisfied customer. Increased patient’s satisfaction leads to increased HCAHPS score and increase reimbursement and revenue.

Affiliation with other larger organizations to share medical expertise and talent reduce spending on salary for the expertise. Smaller hospital needs to join the bigger hospitals for extra support. The extra support from the bigger hospital can decrease the pressure to perform alone, at a maximum level effectiveness. The small hospitals form an affiliated partnership with another healthcare organization in order to share their top talented medical expertise. This way the small hospital will not have to support the high salary of the specialist on staff by themselves. This method helps the smaller hospital to reduce spending and increase financial reserved.

Hospitals investment in an impatient, outpatient and telepharmacy services promotes increase revenue: The hospitals are accountable for their patient’s even after they have been discharged from the impatient setting for their medications refills. Telepharmacy offers pharmacy services 24/7 to patient after they are discharge. This system assists in the reduction of medication errors and promotes patient’s easy access to the pharmacy services.

Patients who have easy access to their medications become highly knowledgeable about their medications and this increase their compliancy with their medication regime and their plan of care. They also tend to be satisfied with the delivery of their healthcare which leads to increase HCAHPS scores and increase reimbursement. Some of the investments that contribute to the increase of the hospital financial revenue are in house pharmacy and telepharmacy services. The hospital base pharmacy and telepharmacy services will help the hospitals to promote easy access for patients to receive their medications within their healthcare center.

This system decreases medication order errors and provide revenue for facility. The financial benefits from the medications refills will help meet some of the facility’s financial needs. There is also reeducation in emergency room visits and frequent impatient readmission when the patients are connected to all the outside resources that they need after they are discharged.

Hospital readmissions are connected to unfavorable patient outcome and high cost of healthcare. It has been discovered that 20% of all Medicare discharges are readmitted within 30 days. The Medicare payment commission has established the fact that about 12% of the readmission is potentially avoidable. A 10% reduction in these readmissions could save Medicare 1billion .Medicare and Medicaid services has added hospitals rate of readmissions to the public record reporting and reducing hospitals readmission rate has become a national priority. Hospitals are now penalized by Medicare and Medicaid payment system for excessive readmission. To prevent losing some financial benefits from Medicare and Medicaid payment, the hospitals will have to empower patients to manage their health successfully after discharge (Mclivannan et al., 2015).

Patients with the highest risks of readmission are the ones with multiple chronic illnesses and they tend to take more than eight medications. The key to reducing the rate of readmission is to closely monitor these high-risk patients during their impatient admissions and especially after they are discharge home. It becomes crucial to educate the patient and families members with every detail of their discharge orders and treatment plans. It is necessary to create a monitoring system such as post up calls or sending visiting nurses at the patient’s homes for the continuation of education and support.

The mistake involving medications are among the most common healthcare errors: Medication errors lengthen inpatients hospital stays, increase inpatient expenses, and lead to more than 7,000 deaths annually in the United States. All medications have the potential to cause harm, but a select group of drugs on the high-alert medications list carries a higher risk of patient injury. The risk of serious injury or death is high even when given correctly. The hospitals should incorporative the use of the most effective user friendly eMAR system for the nurses and clinicians. The reduction in such events can lead to the hospital’s financial stability (Chu. 2016).

Hospitals paid millions of dollars to patients and their families for lawful and accidental deaths, adverse events leading to falls resulting serious injuries. Medical errors are the third leading cause of death in the United States. The hospitals that are valiant in maintaining patient’s safety will not only reduce the incidents of medical errors but will also prevent significant financial lost. Hospitals can increase their financial benefits when every effort is done to partnership with patients, their families and outside caregivers. The collaborative effort will ensure that the patient’s treatments does not stop after they are discharged from the hospital (Chu, 2016).

Hospitals can secure revenue by the reducing the in out-of-network revenue leakage. This can be done by coordinating patient care across a clinician integrated system network. Reduction in the chances of denials and under payments can be done by alerting the physicians to be aware of the necessity to change patient’s medical necessity requirement promptly. The collection of copays and patient’s payment responsibility prior to or during clinician’s service will reduce the loss of revenue.

E1. Stakeholder’s roles and responsibility

Stakeholders are the individuals or groups of people that operative the success and progress of a company or an organization. They are the individuals who influence important changes in the organizations. Internal stakeholders include silent partners such as shareholders, employees and investors.

The internal stakeholders are usually the financial back bone in the organizations. The have vested interest in the success of the organization because of their financial investment.

The external stakeholders include customers, neighboring businesses, strategic partners, health departments and the community partners such as schools and community health programs and schools. External stakeholders can also be consumers who are representatives and advocates for consumers-friendly, meaningful and quality information data that can help people better informed about their own health. The other external stakeholders are also the health insurance plans.

The role of the internal stakeholders: The stakeholder’s roles vary according to the organization’s structure and line of business. Internal stakeholders are usually the financial back bone in the organization. They have financial interest in the organization and they are the directors and the investors. The internal stakeholders have more influence than the external stakeholders because of their roles in the organization. The main role of the internal stakeholders is voting rights which are based on the number of shares they owed, or the percentage of the company they own. They are usually the broad of directors who are the voters for things like acquisitions, liquidations and the hiring of the key personals. They are also responsible for overseeing the budget and the distribution of profits.

The role of the external stakeholders: They usually do not have financial investment in the organization. They do not participate in voting on decisions making in the company, but they are highly interested in the decisions the company makes. They will meet with the board of directions to review ideas like community concerns and other related regulations issues. They also meet with the board of directors to discuss and review new ideas. Their role is usually in the community, government regulations and environment regulations. They review potential beneficial programs for the people and the community they serve.

E2. Stakeholder’s accountability.

The internal and external stakeholders are both accountable to the organizations the serve, government agencies and the community the organizations serve. However, the internal stakeholders are mostly accountable to the organization and the external stakeholders are directly accountable to the community, ensuring government regulations and the environment. The two groups work together to brainstorm solutions regarding the improvement of the organization’s projects and the community improvements programs. They are both valuable resources for the organizations.

Internal stakeholders can be the healthcare providers that are interested in initiatives to improve the quality of care. They help with the promotion and can be the expertise and resources persons for the deliver quality of care. Internal stakeholders such as employee are supportive of quality improvement strategic plans that are ready to do all they can to improve quality of care delivery.

External stakeholders who are consumer’s representatives, advocates for consumers-friendly environment. They are more involved in communicating meaningful and quality information data that can help people be better informed about their own health. The other external stakeholders are also health insurance agencies. They view the quality of insurance plans and recommend improvement.

The stakeholders accountable is to make sure the decisions the organization arrive at will do no harm to society. They also examine the initiation of projects for the hospital’s community to make certain that they are beneficial to the local society. The stakeholders are accountable to the monitoring of the decisions of the organizations to make sure they put the public’s interest before profit.

The stakeholders find themselves accountable to multiple other stakeholders externally. They are accountable to funding bodies, sponsors, volunteers, staff, clients, communities and their internal partners. They are accountable for the performance and the implementation of projects and to make sure the projects correlates with the vision, mission, values and long-term goals of the organization. This include established measurable outcomes that will clearly outline the actions the organization must take to meet the set goals. They are accountable for the disclosure, the transparency and the creation of business models that will meet the organization’s short-term and long-term financial goals and obligations while striving to achieve the required outcome.

The stakeholders have a difficult choice to make at times. It can be difficult at times for a non-profit organization to stay accountable to everyone for everything. Therefore, leaders of non-profit organization should focus their attention on accountabilities that really matter and the delivery of value to their organizations and other parties involved. Their accountability is not just about compliance with law of the industry’s standards. It is deeply connected to the organizations goals, visions and missions and gaining the trust of the other stakeholders (Huotari et al., 2016).

E3. Training of staff

The HCAHPHS improvement team will conduct a meeting to come up with the plan of approach. The upper management will be invited to a meeting with team. The final decisions will be made by the upper management and HCAHPS team. The nurse managers and departmental supervisors will be responsible for the introduction of the plan to the staff in their department.

An in-service will be conducted by the medicine, nursing, therapy, pharmacy, housekeeping for the education of the staff in their departments on all shift in the first month. Literature and evidence -based articles will be provided on each patient care unit for staff to read and acknowledge that they read the articles. Online educational materials will be sent to the staff via their work emails for reading. There will a time limit for the reading of each article. Posters about HCAHPS will be generated through the hospital for the staff to see and read on a daily base.

E4. Plan implementation

The nursing, medicine, the pharmacy department and the house keeping are the departments that will have the most impact on initiative. The nursing department includes, directors of nursing, nurse managers, nurse case managers, nursing educations and unit base and outpatient nurses. The role of the pre-admission department is the careful screening all potential patients before they are admitted to the facility. The HCAHPS team will consists of staff numbers from all nursing departments, pre-admission and admissions office, all the outpatient and inpatients directors, social workers, medicine, physical therapy, pharmacy, housekeeping , business office, and the patient and family representatives.

The role of nursing education department is to evaluate the current model of nursing care delivery, their skill level and educate as necessary. The structure of each unit should be examined to determine the unit’s readiness to care for the potential patients. The medical doctor's role is to evaluate the patient’s medical records and reports to identify the needs for admissions to the appropriate unit where their health needs can be properly managed. The therapist's role is to also evaluate potential patient's record for their appropriateness for their program and to determine the necessary equipment needed to work with the patient and their family when they are discharged.

The pharmacist will evaluate for special medications and pharmaceutical treatments the potential patient might need and educational materials the patients and staff may need. The delivery of the appropriate care in a timely manner leads to the reduction of patient's hospital days. This also decreases the chance of the reoccurrence of the poor physical condition that leads the patient to readmission within 30 to 40 days after discharge. The goals for the pre-admission team is to decrease readmissions of patients within 30 to 40 days after discharge. This will also decrease unnecessary admissions which leads to the reduction of cost of care delivery, improves quality of care and improve HCAHPS scores. Inappropriate admissions increase the numbers of patient admission days, decrease patient’s satisfaction which results to poor patient care outcome.

The role of nursing is to evaluate the unit staffing pattern, their skill level and structure of the unit to determine their readiness to care for the potential patients. The medical doctor's role is to evaluate the patient’s medical records and reports to identify their ability to tolerate and receive the proper medical treatments that will lead to the improvement of their conditions. The therapist's role is to also evaluate potential patient's record for their appropriateness for the program and to determine the necessary equipment needed to work with the patient and their family in hospital and at home after discharge. The pharmacist will evaluate for special medications and pharmaceutical treatments the potential patient might need.

The stakeholders will be presented with evidence-based articles and documentations of hospitals data of surveys data of HACHPS for the past one to two years. An expert guest speaker on HACHPS concept will be invited in the educational meeting with stakeholders. The team will consist of staff numbers from nursing, medicine, physical therapy, pharmacy, Business office housekeeping and the unit staffing coordinator. The departmental managers such as environmental services will be encouraged to champion and implement the effort. The most important step is the care system executives, trustees and all managers to make a commitment.

Timeline: The imitative project is the change in patient care delivery from team care to patient centered primary care. The first month is the introduction period of the change in pre-the admission process to senior management by the VBP team member. The first week of the second month is the introduction of the initiative to the patient care staff in a town hall meeting. In the first week of the third month, in-service and training of staff will begin. There will an ongoing education series monthly for six months and every three months thereafter. The topic of VBP will be included in the yearly hospital-wide mandatory education day.

The program will be evaluated every three months and changes will be made as needed. At the end of six months, all the survey data will be presented to senior management. The goal percentage for the improvement should be at least 75% by the end of the first year, 85% by the year of the second year, and 95% by the end of the third year. By the end of the first year, readmissions should decrease by 50%. By end of the second year by 70% and end of the third year by 80%. The success rates of the program will be evaluated according to the data of the in-house survey and HCAPHS score to the staff through meeting and the ‘organization’s newsletter and wed site.

Constant empowerment and the educating of the staff and stakeholders must understand every staff for strategic planning. Every staff member must be aware of the vision, mission, and goals of the organization. Medicine department including fellows and medical interns and students, therapist and pharmacist must be fully oriented to the organization's vision, missions, and goals. All departments’ heads must provide monthly mandatory in-services and online reading literature on VBP for the staff (Sare & Ogilvie. 2011).

The stakeholders are the prominent people in the organization and they must understand the HCAHPS relation to hospital’s revenue. The summary will begin by the detail explanation of the HCAHPS and VBP model of Medicare payment that rewards healthcare providers for the quality of care they received.

E5. Evaluation of strategic plan success

The program will be evaluated every three months and changes will be made as needed. At the end of six months, all the survey data will be presented to senior management. The percentage goals for the improvement should be at least 75% to 80% by the end of the first year, 85% to 90% by the year of the second year, and 95% to 100% by the end of the third year. By the end of the first year, readmissions should decrease by 50% to.60% by end of the second year by 70% and end of the third year by 80%. The success rates of the program will be evaluated according to the data of the in-house survey and HCAPHS score. The constant empowerment and the educating of the staff and stakeholders is imperative. The staff and stakeholders must have a clear understanding of the strategic planning. Every staff member must be aware of the vision, mission, and goals of the organization. Medicine department including

Every three days after admission, a patient satisfaction questioner will be given to patients while they are still in the hospital. When a patient is discharged before the third day of admission, the questioner will be mailed to their home address with a return stamped envelope. The data will be documented and will be presented at the monthly meeting with the VBP promoting team and upper management. Monthly surveys on emergency admission within 30 to 40 days of discharge back to the acute care will be conducted. The data on incident reports such as falls, the patient complains, and any other reports will be provided on all units. The units with the highest incidents will be evaluated, and a mandatory in-service will be conducted on that units.

The initiative will be evaluated every six months and adjustment will be implemented as needed. At the end of each year, a town hall meeting will be held, and all survey results will be shared with the staff. The target date to mark the success of the program will be at the end of the third year. When all the departments are involved and fully committed, successes are celebrated by the entire hospitals.

E6. Involvement of stakeholders

It is very important to engage the stakeholders in the project from start to finish .They must be in the right from get go because their views, needs and ideas are those things that shape the service provision. The internal and external stakeholders must be properly identified from the start. The assessment of each stakeholder’s influence and importance is very crucial. The monitoring of the relationship between manage stakeholders is also very important.

The mapping of the stakeholders identifies the target that you need to collect as much information about them as possible. These people should the stake in the companies, therefor knowing how each one will be affected by the proposal is important to know. Knowing who is the most relevant senior position to the project and who have been involved in similar project is very important. Be aware of the names of the stakeholders that comes up frequently when discussing the project with the team. Learning to understand the behavior of each stakeholder will help to pre-assess the impact they will have the strategy, polices and the project. Their behavior pattern will also give an idea of their needs, interest and priority goal for the organization. Their hierarchy in the organization can shed light on important their decision is regarding the project and their ability to link and influence other about the project.

The stakeholders are usually equipped with great wealth of the organization’s structure inside and out. Some may be professional with skills that are vital to the management of the project. They may be lawyers, engineers, accountants with expertise needed to reduce risk taking when managing the project. Their opinions regarding the project should be highly regarded in order to increase the chance of reaching the goal of the project successfully. The stakeholders need to be brief with the changes, results of surveys and to avoid unforeseen events that may hinder the progress of the project. The stakeholders are very busy people which makes meetings with them difficult to arrange.

Be sure the facts and correct data and validate the decisions by referring evidence- base teaching using video presentations. Be specific about the goals and inform them about how you would like them to participate. Have a team member take notes and follow up with the answers to their questions.

It is important to send a brief report to them before setting up the meetings with them. Send presentations, and printed materials that will allow the group to read silently at least 10 minutes before the meetings.

The communication channels should be effective and engaging. The reports must be factual, clear and detailed. The stakeholders will be presented with evidence-based articles and documentation of hospitals data of surveys of admissions and discharges events occurring in the facilities. An expert guest speaker on HCAHPS concept will be invited in the educational meeting with stakeholders (Huotari et al., 2016).

E3. The staff training.

The nurse managers and all departmental supervisors will be responsible for the introduction of the plan to the staff in their department. An in-service will be conducted by the medicine, nursing, therapy, pharmacy, housekeeping for the education of the staff in their departments on all shift in the first month. Literature and evidence -based articles will be provided on each patient care unit for staff to read and acknowledge that they read the articles. Online educational materials will be sent to the staff via their work emails for reading. There will a time limit for the reading of each article. Posters about HCAHPS will be generated through the hospital for the staff to see and read on a daily base all departments’ heads must provide monthly mandatory in-services and online reading literature on HCAHPS for the staff (Sare & Ogilvie, 2011). An expert guest speaker on HCAHPS concept will be invited to educate the staff in a town hall meeting two hours for three days. The attendance will be mandatory for all staff.

The first month is the introduction period of the change in present- centered primary care model to senior management by the HCAHPS team members. The first week of the second month is the introduction of the initiative to the patient care staff in a town hall meeting. In the first week of the third month, in-service and training of staff will begin. There will be an ongoing education series monthly for six months and every three months thereafter. The topic of VBP will be included in the yearly hospital-wide mandatory education day.

F2. Communication of results.

The team leader must communicate with the team members on regular basis at least once a day via text or emails with updates from each other. Sharing status of the project on daily basis can eliminate surprises at the weekly meetings. Team members should motivate other staff members by talking to people seating next to them at breakfast, lunch or dinner about the project. Use flow charts, decision tress, showing progress reports however little, they may be helpful. Use Qi spread sheets to demonstrate progress. Make the progress compelling by showing off the work you have done, improvement made and how it has impacted the healthcare of the people. Have an item that will stand out during the departmental staff meetings to reinforce your message.

At the end of each year, a town hall meeting will be held, and all survey results will be shared with the staff. The target date to mark the success of the program will be at the end of the third year. The business and finance department will present the statistics on the hospital’s revenue every six months during the ongoing meetings with the upper management and the team. The managers will be responsible for educating their staff on the positive and negative reports after the meetings. At the end of each year, a town hall meeting will be held, and all survey results will be shared with the staff. The HCAHPS team will perform an ongoing evaluation, setting of new goals, collecting data and reporting findings to all staff members. The reports will be given to staff by departmental managers, newsletters and via computer generated report systems. The target date to mark the success of the program will be at the end of the third year (Sare & Ogilvie, 2015).

Be sure of the facts and correct data and validate the decisions by referring to evidence- base teaching using video presentations. Be specific about the goals and inform them about how you would like them to participate. Have a team member take notes and follow up with the answers to their questions. It is important to send a brief report to the target ordinance before the meetings starts. This gives them the opportunity to read and familiarized themselves with the topic. Send presentations, and printed materials that will allow the group to read silently at least 10 minutes before the meetings. The communication channels should be effective and engaging. The reports must be factual, clear and detailed. The stakeholders will be presented with evidence-based articles and documentation of hospitals data of surveys of admissions and discharges events occurring in the facilities. An expert guest speaker on HCAHPS concept will be invited in the educational meeting with stakeholders.

The distributions of various duties among the HCAHPS team members makes sharing of the project’s duties easier to handle. The teammates responsible for recording and sending notes and email should proactively facilitate communication among the team members, Each HCAHPS team member should invite one or two work mates at a time to team meetings. This can help build up their knowledge, understanding and increase their motivation for the project their meetings.

Utilize the simplest form of communication stools to inform staff about the project for the purpose of increasing their knowledge. Use of newsletters, hospital generated videos, mounted TV to spread the word about the project. Place the information about the project in the common places, like waiting rooms, hall ways and dining areas. Use these areas as an excellent channel of communication to educate staff, visitors and patients about project (Huotari et al., 2016).

Reference

Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a toll towards quality

improvement. Oman Med J, 29, 3-7. Retrieved from HYPERLINK "http://www.oalib.com/references/8430586" http://www.oalib.com/references/8430586

Appari, A., Carian, E. K., Johnson, M. E., & Anthony, D. L. (2012). Medication administration

quality and health information technology: A national study of US hospitals. Journal of the

American Medical Informatics Association, 19, 360-36. doi: 10.1136/amiajnl-2011-000289

Arpey, N. C, Gaglioti, A.H., & Rosenbaum, M, .E. (2017). How Socioeconomic Status Affects

Patient Perception of Health Care. Stage journals, 8(3), 169-175. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2150131917697439

Arungwa, O.T. (2015). Patient satisfaction: Nurse Role. Nurses’ zone

Retrieved from Thenurseszone.com/patient-sat-nurses-role

Bickmore, A. M., & Merkley, K. (2016). The top five recommendations for improving the patient experience. Retrieved from http://www.healthcatalyst.com/wp-content/uploads/2016/09/Top-Five-Recommendations-for-Improving-Patient-Experience.pdf

Carta, J. (2018). How does patient Satisfaction impact reimbursement?

Retrieved from https://www.accessefm.com/blog/how-does-patient-satisfaction-impact-

Reimbursement

Chu, R. Z. (2016). Simple steps to reduce medication error. Nursing, 46(8), 63-66. Retrieved from

https://journals.lww.com/nursing/fulltext/2016/08000/Simple_steps_to_reduc_medication_errors.16.aspx

Daly, K. (2018). 5 Health IT trends to watch for 2018. Health IT outcomes. Retrieved from https://www.healthitcomes.com/doc/health-it-trends-to-watch-for-in-0001

Ellis, L. (2016). Coming clean on the link between perception of cleanliness and patient’s satisfaction. The center for health design. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439931/

Huotari, P. & Havrdova, Z. (2016). Stakeholders’ roles and responsibilities regarding

quality of care. International Journal of Health Care Quality Assurance, 29(8), 864-876, Retrieved from https://doi.org/10.1108/IJHCQA-06-2015-0070

Manemann, K. (2016). A team-based approach to primary care making all the difference. Healthleaders news. Retrieved from https://www.healthleadersmedia.com/strategy/team-based-approach-care-making-all-difference

Murdock, A. & Griffin, B. (2013). How is patient education linked to patient satisfaction? Nursing2019, Lippincott, Nursing Center. Retrieved from http://www.nursingcenter.com/journalarticle?Article _ID=1550657

Newnum, G. (2019). Could improving limited –English-proficient boots HCAPHS scores? Retrieved from http://blog.cyracom.com/couldlep-patient-outcome-boots-hcahps-scoresimprove-patient-outcome-hcahps-scores/

Sacks, D. (2011). How male and female respondents are different. Retrieved from https://help.surveygizimo.com

Sare, M., & Ogilivie, L. (2015). Strategic planning for nurses changes management inhealthcare. Burlington, MA: Jones and Bartlett.

Schottenfield, L., Petersen, D., Peikes, D., Ricciadi, R., Burak, H., Minelli’s, R., & Ginevra, J. (2016). Creating patient-centered team-based primary care. Retrieved from https://pcmh.ahrq.gov/page/creating-patient-centered-team-based-primary-care

Squires, A. (2018). Strategies for overcoming language barriers in healthcare. Nursing Management (Springhouse), 49(4), 20-27. doi:10.1097/01.NUMA.0000531166.24481.1

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Strategies For Academic Profile

Replies to Classmates (strategies for academic profile)

[Name of Writer]

[Name of Institution]

Dear Tammy

Your insights into the various types of academic profiles are very helpful. I agree with you on the point that portfolios have the potential of helping a nurse in documenting everything they have learned, in theory and practice, as a summary that is an immense help in potential employments. CITATION VCo17 \l 1033 (V Cope, 2017) Through this, I would like to add a point that portfolios also help the student in linking theory with practice. CITATION MGL00 \l 1033 (Landers, 2000) As a fully trained nurse is trained in various cutting-edge techniques that can be crucial to potential employers, a portfolio must have those. It therefore contains academic achievements like the Grade Point Average as well as any practical techniques learned. This crucial link between theory and practice helps the student in forming a sort of photograph of everything that professionally represents them. Other than helping in employments, portfolios help students and professional nurses on a personal level as well. They can prove to be immensely helpful for nurses to track what they have mastered and where more work needs to be done. CITATION SHa01 \l 1033 (S Harris, 2001) The room for improvement when your academic achievements are summarized is endless.

However, I am especially invested in your views about electronic portfolios. The term e-portfolios is relatively new, and the studies conducted on these are also relatively recent. Several types of e-portfolios help students in listing down their abilities using various media. It is quicker and easier to obtain instructor’s feedback on e-portfolios which obviously goes on to help the student’s learning practice. CITATION Chi161 \l 1033 (Chin-Yuan Lai, 2016) You have listed the various benefits from the types of e-portfolios very well. I would like to add that the added bonus of a mobile system to an already trusted portfolio system is a guaranteed win. For example, it allows the nurse to add hyperlinks or proofs of the skills or achievements listed in the e-portfolio. Moreover, as you said, in a world as competitive as ours, nursing with e-portfolios can be a major win.

References

BIBLIOGRAPHY Chin-Yuan Lai, C.-C. W. (2016). Promoting Nursing Students’ Clinical Learning Through a Mobile e-Portfolio. Computers, Informatics, Nursing, 535-543.

Landers, M. (2000). The theory-practice gap in nursing: the role of the nurse teacher. Journal of Advanced Nursing, 1550-1556.

S Harris, G. D. (2001). Reflecting on the use of student portfolios. Nurse Education Today, 278-286.

V Cope, M. M. (2017). Use of professional portfolios in nursing. Nursing Standard, 55-63.

Strength And Weaknesses Related To Leadership In Nursing

Strength and Weaknesses Related to Leadership in Nursing

Name

Affiliation

Date

Strength and Weaknesses Related to Leadership in Nursing

Nursing is one of the most important and vital fields of any society, as healthcare is the backbone of human development. Nursing professionals have to learn and develop the skills to promote the healthcare and better living of human beings. The nurse professionals have to guide the people about the issues of their health, the treatment procedures, as well as about the precautions and safety measures to restore and maintain their health. In order to promote health and well-being in the society, the nurse professionals have to develop the leadership skills, which enable them to perform better in the given circumstances and fulfill their role of health care providers with greater knowledge, experience, and expertise. Being a nurse practitioner, I have developed some skills, and have my strengths and weaknesses as well, which not only provide me the opportunity of helping the humanity but also urge me to overcome my shortcomings and improve my knowledge and skills to serve the ailing patients in a better way. Developing the leadership skills may have been a critical part of the nursing professional; however, it has enabled me to perform better, while being aware of the professional challenges and opportunities.

Personal and professional accountability is a crucial part of the life of each and every person, irrespective of their association with the field of nursing. Analyzing my strengths and weaknesses, according to the perspective of personal and professional accountability, I think I am a very accountable person. One of my most important strength is that I never try to put off my work and accomplish all the assigned tasks before the due time. I also try my best to guide the juniors around me, while learning and taking inspirations from the seniors. Another positive aspect in this regard is that I keep seeking the opportunities of improving my skills and knowledge, in order to provide better care and guidance to the patients. My weakness in this regard is that if I happen to make some mistake, while providing the guidance to patients or handling any other professional task, I develop a fear of doing the same task for the next few days and try to resist it, instead of accepting the challenge and doing it in a better way.

Career planning is also one of the most important aspects of the life of each and every individual. My strength in the perspective of career planning is that I am eager to continue my education, after completing the bachelor program. I think that there is much more to learn and the bachelor degree is not enough to provide me the guidance to establish a career in the field. I want to learn the advanced skills and knowledge, which would not help me to improve my expertise but would also enable me to provide better guidance and care to the patients. My weakness in this regard is that I often get too much indulged in the practical work and do not give enough time to my studies and, sometimes ignore my career aspirations as well, in order to deal with the routine duties and responsibilities. However, I am striving hard to maintain the balance of my life and give more importance to the things which would help me in building my career (Fischer, 2016).

The balance of human life, which includes personal and professional engagements, can be maintained through following some rules and maintaining the discipline of life. My strength in this aspect is that I am quite a disciplined person and prefer to follow the set rules and principles. I always regard the ethics of the profession and give my best to whatever work I am assigned. The only weakness, I think, is that I have to learn some advanced leadership skills, as I am comparatively new to the profession and still have a lot to learn.

In terms of reflective practice, my strength is that I always follow the footsteps of my seniors and try to learn more and more from their routine practice, even the things that just depict their style of getting the work done. In addition to it, I also try to learn from my seniors to maintain the discipline and accept the challenges of the profession. Decision making is one of the most crucial aspects of the field of nursing, and I regard it as one of the most important strengths that I have developed the skill of making the rational decision, keeping in view the circumstances, as well as the future consequences of the decision. My weakness in this regard is that I still have to learn a lot and polish my skills, in order to become an expert in the field.

In order to advocate for change in the workplace, I would utilize my current leadership skills. I would advocate the practice of evaluating the staff while highlighting their shortcomings and providing them the chance to learn from their weaknesses and improve their performance. One personal goal for my leadership growth is to ensure the practice of evidence-based health care. The plan to achieve that goal is to motivate the staff and team members to explore the new researches in the field, as well as lead their own research, which would help them to know the modern technology, strategies, and means, and apply them to their practice (Scully, 2015).

Nursing is one of the most important fields of human society, as it ensures the healthcare development and well-being of human beings. Leadership is an important part of the profession because it is crucial for providing better facilities and guidance to the patients, who rely on the nurse practitioners and health care staff in the most critical moments of their life. I intend to improve the strengths and get rid of the weaknesses, which I have developed while working in the field and become a more knowledgeable and reliable professional.

References

Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of advanced nursing, 72(11), 2644-2653.

Scully, N. J. (2015). Leadership in nursing: The importance of recognizing inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), 439-444.