Internship Report:

o 1 - Background of the organization/work unit. ??" Home health care marketing for home health and hospice

o 2 - Identification and synopsis of the problem.
Problem- doctors referring patients to home health when they dont particularly need it. Also home heath companies keeping patients on service when they dont need it. HIPAA violations pertaining to home health

o 3 ??" Research Method/Process


o 4 ??" Description of potential solutions
Having Medicare watch these companies more closely. Etc..

o 5 - Conclusion

Analyze the interrelationships among key stakeholders, professional organizations, and health care professionals within the home health care organization.

Use the outline as a guide:
II. Stakeholders, Professional Organization, and Health Care
Professional within the home health organization
A. Stakeholders
1. Person(s) being cared for
2. Person(s) directly involved in care
a) Friends/family,
b) Health and social professionals
c) Volunteer organizations
3. Individuals interested in care that observe care infrequently or
remotely; those that do not have direct input to regular care program
4. Outsiders potentially affected by home care system
B. Professional Organizations
1. National Association for Home Care and Hospice (NAHC)
2. Home Health Care Nurses Association (HHNA)
3. American Association of Healthcare Administrative Management
(AAHAM)
4.Other State/Local regulatory bodies
C. Different Health Care Professionals
1. Licensed personnel
2. Registered Nurse
3. Home Care Aide
4. Social Worker
D. Rehabilitation Service Professionals
1. Physical and Occupational therapist
2. Speech and Language Pathologists
3. Dieticians


Need 2-3 PP slides with detailed speaker notes. With atleast 700 word analysis.

Needs to be a PROCESS ANALYSIS essay on how to be or perform as a home health aide nurse

NOTE: I need the first page of each reference so it can be attached to my paper.

This paper should research marketing practices and principles used in home health care. The findings should explain important principles of marketing, how marketing can be implemented in home care, by whom, how marketing efforts are organized, the tools used, and how the results of marketing projects are assessed. ( SHOULD INCLUDE AT LEAST THREE CURRENT PUBLISHED SOURCES)

In addition: The paper should include an interview from an individual working in the home health care field. In particular, this person should state whether or not the theories of marketing are being put into action where this person is employed. What problems he or she faces, how they solve them and their perception of the value and future of marketing in the home health care field.

In addition, The paper should include how the marketing process is physically integrated into the agency's daily operations and how it can be seen in the community.

Purpose: to explore a community / public health topic through current research relating to your practicum experience.

HOME HEALTH CARE NURSE AND DIABETIC PATIENT(S)!!

Directions:
#1) Select and explore a population-focused topic / problem / issue relevant to Public Community Health in your practicum experience. (My 8 hour practicum was Home Health Care / Caring for DIABETES).
#2) Based on Level's of Prevention Pyramid, identify and discuss primary, secondary, and tertiary levels of prevention.
#3) Develop a policy statement relevant to the selected topic / problem / issue.

Objectives:
#1) Apply critical thinking skills to the exploration and development of a paper that addresses a Public Health Community Health Topic / Problem / Issue.
#2) Analyze and Synthesize literature on the topic / problem / issue.

Directions Continued:
1) Write a 3-4 page paper, (must include a REFERENCE PAGE as page # 5).
2) Must be APA FORMAT
3) Three Peer Reviewed REFERENCES are to be listed; three (3) references MUST be from Nursing Journals. (MUST INCLUDE THESE JOURNALS WITH YOUR PAPER!!!)
4) Journal References should be within the last 5 years.

GRADING CRITERIA: (40 points total)

Introductory Section (4 points)

1 General Discussion of the topic (diabetic patient) / problem / issue (2 points)
2 Description of your interest in the selected topic / problem / issue (2 points)

Main Section (14 points)

1 Provide an in depth exploration of TWO (2) dimensions of the topic / problem / issue that you select. Dimensions explored may be , i.e. physiological, psychological, socio-cultural, developmental or spiritual ( 6 points).
2 Identify and discuss TWO (2) Public Health Nursing / Community Health Nursing INTERVENTIONS at the levels of Primary, Secondary, and Tertiary as they relate to the topic / problem /issue explored (6 points)
3 Discuss the impact of this topic / problem / issue on the Community (2 points)

Summary / Conclusion (5 points)

1 State Conclusion based on your analysis and synthesis of information is more research or inter-professional teamwork needed for interventions, etc? (3 points)
2 Based on your summary, make one (!) policy recommendation that you think would positively influence the status of your public health topic / problem / issue (2 points)

References(4 points)

1 At least three (3) current references (from within the past five years) from PEER REVIEWED NURSING JOURNALS (1 point)
2 References cited correctly in APA Format throughout the paper (3 points)

APA Style Format (9 points total)

I Title Page (4 points) Includes:
a) Running Head (1 point)
b) Upper half page includes:
I) Centered title in upper and lower case letters (no more than 12 words in length)
II) Author's Name: First Name, Middle Initial and Last Name (1 point)
III) Institutional Affiliation (1 point)

II Throughout Paper (3 points)
a) Doubled space plain text ( 1 point)
b) Times Roman 12 font (1 point)
c) All pages numbered (1 point)

III Reference Page (2 Points)
a) Word "Reference" (without quotes) centered at top of reference page (1 point)
b) Listed references are listed in alphabetical order ( 1 point)

IV General Paper Writing (4 points Total)
a) Logical organization (1 point)
b) No more than two (2) grammatical errors (1 point)
c) No more than two (2) misspelled words (1 point)
d) Length of paper NO MORE than 4 pages (plus a reference page) (1 point)

Report on HOME HEALTH NURSING.
APA style.Double spaced,using 12-point font size.
Writing about:
(1)Job Description.
(2)Education and Certification.Length of time and approximate cost of the education required.Intitutions offering the program. List dgrees or certifications earned.
(3)Emplyment.Job availability (what and where?)Salaries-Entry level and with experience. Numbers of jobs advertised in the Sunday Herald.
(4)Professional Activities. Local/State/National Professional Organizations(cost to joint as a student)Professional journals with address to obtain and cost. Is continuing educational available and expected in the profession. Continuing education units (CEUs). How many and often?
(5)Conclusion/Reflection. Reflect on how you see yourself "fitting" into this profession. What did you discover in the exploration of this field? What did you find meaningful and important to you?
Reference page in APA.Citing all references.

Business name: Passion Home Health, LLC

Basic Business Idea in my Organization for a service or program
Company name: Passion Home Health, LLC
Erna Leahey (Owner)
Address : P.O. Box 2018 Camarillo, California 93011
Phone : 310-592-0904

Idea: Better strategy for beak relief for care giver co-workers
Care giver industry
Non-standard work hours
Break patterns different from most other businesses.
Workers still regulated by state controls


State law mandatory breaks
? 15 minutes for every three hours worked
? 30 minutes after 5.5 -6 hours worked


Strategy for coverage
? Possibly hire additional care givers as ?floaters?

Long term goal
? Train/Cross train individuals to be acquainted with different clients
? Prepare for long term and flexible employee by giving available hour to choose

Short term goal
? Stagger schedule start and end of shifts for overlap coverage
Short term goal.


This program service is for Passion Home Health, LLC which is based in California. The reason for this program to meet the company?s long run goal of superb service while facing an abundant of clients and patients and a shortage of caregivers.

In this market, caring service is the business and competition is fierce. Training and having the right people in place is the key to a successful care giving business.
































Business Plan includes:


Executive Summary (one page, 200 - 250 words).

Clear Description of the program or service proposed (include definitions for each element of the program or services).

Goals for the Program or Service (include how they tie into meeting overall organizational goals

Justification and rationale for the program or services

Market analysis and (what demand there is for the product or service

Competitive analysis (what are others in the community offering in this area and how does it compare to what the organization is offering).

Marketing strategy for the program or services.


Organizational structure and management and key personnel (required management and staffing full time positions; and who reports to whom including higher administration


Financial analysis and budget (identify any assumptions; include operating budget and any capital budget requirements; include expected revenues if applicable and cover a one year operating period) ALL IN NARRATIVE FORM. Provide a Budget Worksheet


Summary of Business Plan

Citations from various sources including scholarly publications
(minimum of 5 references)

Appropriate APA format

Accurate grammar, spelling, punctuation

Length 12 - 15 pages (excluding Title, Executive Summary and Reference pages)

Application: Understanding Expenditures and Sources of Funds for Health Services Organizations

Choose one of the following settings to be the focus of your Application Assignment: Hospital care, physician and clinical services, home health care, drugs, or nursing homes.

Review Exhibit 7.7 on page 183 of Understanding the U.S. Health Services System. What percentage of health services expenditures does this type of setting receive?


Next, look at Exhibit 7.9 on pages 184??"185. What sources of funds does this type of setting typically receive?


Then look at Exhibit 7.8 on page 183 and review the information on expenditure trends for this setting. Based on the information presented in the Learning Resources throughout this course, consider explanations for the trends in personal health services expenditures from 1960 to 2007.


Compare the data for this setting with the data for at least one other setting, and consider similarities and differences between them.
With this in mind, write a 1- to 2-page paper in which you:

Summarize your findings and analysis as indicated above


Explain potential implications for health care administrators in the setting you have chosen
Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this week's Learning Resources and additional scholarly sources as appropriate. Refer to the Pocket Guide to APA Style to ensure your in-text citations and reference list are correct.

Canada

Write a 3-5 page essay, comparing the U.S. health care system with the health system of your choosing (PLEASE NOTE: The main body of the paper should be 3-5 pages minimum in length. This page count does not include the title/cover page, abstract, table of contents, or references). The written paper is to be prepared in accordance with the following guidelines and must contain all of the following components:
TITLE PAGE (Follow APA guidelines)
ABSTRACT- Limit the abstract to 150 words. Do not repeat the title at the beginning of the abstract and do not cite references in it. Avoid abbreviations. Include the purpose of the article, main findings, and principle conclusions. Although the abstract is at the beginning of the paper, it is often easier to write the paper and then go back and write your abstract.
TABLE OF CONTENTS
INTRODUCTION (overview of the topic - usually one to two paragraphs)
REVIEW OF LITERATURE ??" Write an overview of the background and development of the US health care system as well as the background and development of the health care system of the nation you choose. Be sure to review the 4 basic components of health services delivery: financing, insurance, delivery, and payment and how they function in each the US system vs. the other system (see pgs. 5-7 of the textbook for more information).
o Reference citations must be present within the body of the paper and should be included for all information obtained from an outside source. All reference citations should have a corresponding full reference listed on the reference page. In order to add depth to your paper, I fully anticipate students using supplemental references (journal articles, web sources, and books) in addition to the text book. Please note that Wikipedia is not considered a scholarly source for use in academic papers- Please avoid using it ?
DISCUSSION - analysis of the information presented in the review of literature. Compare and contrast the features of the US health care system and the system of the nation/country you choose. Discuss how the system components impact health professionals as well as patients (positively and/or negatively).
CONCLUSION - Based on information presented in discussion
RECOMMENDATIONS - student's personal thoughts or suggestions for change. Identify any system features that you would like to see incorporated into the US system.
REFERENCES: Students are responsible for the accuracy and completeness of references and must follow the APA guidelines for citations.
***Please note: Papers must include headings for each of the sections listed above. Headings should centered and capitalized.
Additional information:
Manuscript Preparation: Assignment should be prepared in Microsoft Office as a .doc or .docx file. The manuscript shall be typewritten double-spaced with 1" margins on all four sides. The pages are to be numbered consecutively, beginning with the first page of text. The page number should in the upper right hand corner of each page. The font for the type should 12 point Times Roman or Times New Roman.

Text Requirements: The cover page should contain the title and authors names. The abstract should be on a separate page. The Table of Contents should be on a separate page. The main text should begin on a separate page and be not less than 3-5 pages double-spaced pages. You may exceed 3-5 pages of text for the body of your paper. However, papers that are shorter in length will have points deducted.

Illustrations (optional): If tables, graphs, figures, etc., are included they should be appropriately identified.

Assignment Submission: Submit as an attached document under the Written Assignment tab. Click on View/Complete Assignment: Written Assignment #1. Scroll down to attach local file and upload your Word Document. Click submit.
* Please refrain from emailing assignments to the instructor.
***Some APA resources have been placed in the Course materials section for your convenience. Here you will find information on writing a title page, how to paraphrase, how to cite references within the paper etc.

The book:

Delivering Healthcare in America.

A Systems Approach

F O U R T H E D I T I O N
Leiyu Shi, DrPH, MBA, MPA Professor, Johns Hopkins School of Public Health Co- Director, Johns Hopkins Primary Care Policy Center for the Underserved Johns Hopkins University Baltimore, Maryland

Douglas A. Singh, PhD, MBA Associate Professor, School of Public and Environmental Affairs Indiana University South Bend South Bend, Indiana

Jones and Barlett Publishers
Sudbury ,Massachusetts.
Boston,London,Toronto,Singapore.

Context: Canada:Canada implemented its national health in-surance system referred to as Medicare under the Medical Care Act of 1966. Currently, Medicare is composed of 13 provincial and territorial health insurance plans sharing basic standards of coverage as defined by the Canada Health Act ( Health Canada 2006). The bulk of financing for Medicare comes from general provincial tax revenues; the federal government provides a constant amount that is independent of actu-al expenditures. The public pays for nearly 70 percent of total health care expenditures in Canada. The remaining 30 percent, paying for supplementary services such as drugs, dental care, and vision care, is financed pri-vately ( Canadian Institute for Health Infor-mation 2005). Provincial and territorial departments of health have the responsibili-ty to administer medical insurance plans, de-termine reimbursement for providers, anddeliver certain public health services. Prov-inces are required by law to provide reason-able access to all medically necessary services and to provide portability of bene-fits from province to province. The program provides comprehensive coverage, but ex-cludes dental care. Coverage for home health care and prescription drugs varies across the provinces. To cover these exclusions, many Canadians have supplemental coverage through private insurance provided by em-ployers. Patients are free to select their providers ( Akaho et al. 1998). Several prov-inces have established contracts with providers in the United States for certain specialized services. However, contrary to popular per-ceptions, few Canadians have to obtain health care services in the United States due to waiting times or unavailability of technol-ogy in their own country ( Katz et al. 2002). Nearly all the Canadian provinces ( On-tario being one exception) have resorted to regionalization by creating administrative districts within each province. The objective of regionalization is to decentralize authori-ty and responsibility to more efficiently ad-dress local needs and to promote citizen participation in health care decision- making ( Church and Barker 1998). The majority of Canadian hospitals are operated as private nonprofit entities run by community boards of trustees, voluntary organizations, or mu-nicipalities, and most physicians are in pri-vate practice ( Health Canada 2006). Most provinces use global budgets and allocate set reimbursement amounts for each hospital. Physicians are paid fee- for- service rates ne-gotiated between each provincial govern-ment and medical association ( MacPhee 1996; Naylor 1999). Over the years, federal financial support to the provinces was drastically reduced. Un-der the increasing burden of higher costs,certain provinces, such as Alberta and On-tario, have started small- scale experimenta-tion with privatization. However, in 2003, the Health Council of Canada, comprised of rep-resentatives of federal, provincial, and terri-torial governments, as well as health care experts, was established to assess Canadas health care system performance and establish goals for improvement. The Councils 2003 First Ministers Accord on Health Care Re-newal created a five- year, $ 16 billion Health Reform Fund targeted to improving primary health care, home care, and catastrophic drug coverage ( Health Council of Canada 2005).

The actually title is "Support Methods In Healthcare: How technology has changed medicine".

1.One topic in the paper could be talking about the Electronic Health Record(EHR). Good, bad, solution to problems, how the country will implement the EHR, how this effect doctors, nurses, insurance company, all medical staff, and how will patient care be effected.
2.Technology effect in home health care
3.Technology effect call centers.
4.Technology how it has effect healthcare system
5. How will the patients information be safe on Electronic Health Records.

Writer Assco 5522.. The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

Note: This is an individual assignment. Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation to accompany the teaching plan and present the information to your community. Select one of the following options for delivery of the presentation:
1.PowerPoint presentation ? no more than 30 minutes
2.Pamphlet presentation ? 1 to 2 pages
3.Poster presentation

Appropriate community settings include:
?Public health clinic
?Community health center
?Long-term care facility
?Transitional care facility
?Home health center
?University/School health center
?Church community
?Adult/Child care center

Before presenting information to the community, seek approval from an agency administrator or representative.

Upon receiving approval from the agency, submit the "Community Teaching Experience Form" to the college Office of Field Experience at

Note: If you need assistance or have questions regarding this direct care experience, please contact the college Office of Field Experience at (602) 639-7058.

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This is a research proposal paper that must be in APA style, must follow either the quantitative or qualitative research proposal guidelines as shown in "The practice of nursing research:conduct, critique,& utilization" by Nancy Burns and Susan Grove 3rd edition, pages 708 or 711.
The topic to be researched is the use of Advanced Practice RN's(APRN) in the home health care arena. This proposal will be used to give support to the need for establishing the use of APRN in the home care agency, because home care patients are being released quicker and sicker from hospitals, that the future trend in health care will see more and more patients recieving cares in their homes rather than hospitals, that home care nurses must be equipped to handle this type of client and advanced practice nurses will be a good fit...APRN's will SAVE $$$ by their expert skills in managing complex cases and being a resource for other home care staff members.
The articles I've found are as follows:

Mitty, E. (1998) Integrating advanced practice nurses in home care.Nurse Health Care Perspective nov-dec 19, (6) 264-70

Dahl, J (2002) APN spells success for a heart failure program
Nurse Manage feb 33, (2) 46-8.

Frantz, A (1999) Exploring expert cardiac home care nurse competence Home Healthcare nurse Nov-dec 17, (11) 706-17

Franz, A (2001) recovering from CAGB are you current
Home Healthcare nurse july 19 (7) 417-24

Portillo (1998) graduate program: advanced practice nurses in the home AACN Clionical Issues aug 9 (3) 355-61

Hemstrom, M (2000) the clinical specialist in community health Public Health Nurse sept-oct 17 (5) 386-91

Morgan, M (1999) a physician/advanced practice nurse home visiting program. N J Med sept 96 (9) 51-3

Paul, S (2000) Impact of a nurse-manged heart failure clinic
American Journal of Crit care march 9 (2) 140-6

thanks...

I hope everyone enjoyed the time off for the holidays. Now it is back to work for us. In regards to the team task this week, a possible topic from our weekly focus we can debate on in our paper is the use of labor unions in the change process. There is most likely sufficient information to argue for both sides. Let me know what you all think. See below:

The use of labor union in change process

Change process is difficult both on the employees and management; I believe that labor union can make the process a little bit easier for both parties. Change will bring some changes that the labor union can negotiate on behalf of the employers and no one will be afraid of being singled out by the management. The fact is that, when an organization have a labor union to work with, they can partner together to facilitate change easier. When the organization knows that change is required, it can disseminate this information to the leadership of the union and the union can then pass the information along to the employees. When everyone is on the same page, it improves the chances of the organization getting through the change. It will be a win-win situation.


Simpler Negotiations
As an employer, one of the advantages of dealing with a labor union is that it simplifies the negotiations process. When you deal with a labor union, you do not have to negotiate with multiple employees. You simply talk to the head of the labor union and the head of the union speaks for all of the workforce. By doing this, you can negotiate faster and more efficiently without having to worry about meeting with many different employees.
Employee Satisfaction
Another advantage of dealing with labor unions is that it can improve employee satisfaction. When employees deal with unions, they may be more satisfied because they have a voice to speak to the employer. They get higher wages on average and better benefits packages. When you meet the needs of the employees better, they will be more satisfied in their jobs and will be willing to work harder for you. This could lead to higher productivity and better quality production.
Less Turnover
Another advantage of labor unions for organizations is that they lead to less turnover. When you have a workforce that is comprised of labor union members, they will not leave their jobs as frequently. They have to pay dues to be a part of the union, and they typically do not want to lose their position in the organization. When you have lower levels of turnover, it saves your business money in the long run by not having to train as many new employees.
Easier to Make Changes
Businesses regularly have to undergo change if they want to stay at the forefront of their industry. When a business has a labor union to work with, they can partner together to facilitate change easier. When the employer knows that change is required, it can disseminate this information to the leadership of the union and the union can then pass the information along to the employees. When everyone is on the same page, it improves the chances of the company getting through the change.

Reference:
U.S. Bureau of Labor Statistics; The Effect of Unions on Employee Benefits -- Recent Results From the Employer Costs for Employee Compensation Data; John W. Budd; June 2005

Economic Policy Institute; How Unions Help All Workers; Lawrence Mishel, et al.; August 2003



Points well taken. Thanks for sharing. You have added to our discussion and learning. Are there some potential data analysis problems when using compound or complex questions? Are such questions harder to answer in a meaningful way? Would you want the consultant to be certified by a respected professional organization?

Complex questions are subjected to ambiguity and different interpretations by different people. Different employees can read different meanings to a single complex question. There are a number of ways that complex questions can be misinterpreted in the real world. A major error can be performing multiple comparisons. It may be helpful to consider some aspects of statistical thought which might lead many people to be distrustful of it. Complex questions live room for probabilistic perspective. This is in contrast to the way non-mathematicians often cast problems: logical, concrete, often dichotomous conceptualizations are the norm: right or wrong, large or small, this or that and this is a big problem when analyzing the data.
There are a lot of reasons I would want to engage a certified consultant in my organization project. First, these people will have the evidence of successful track records which will be found in client testimonials, references, and repeat business associations. They will adhere to the highest ethical standards, they have more experience in their field of expertise, they have life-long professional education and they also have a reference network for challenging client problems, so my organization can worry less about failure. USED




Additionally, many non-mathematicians hold quantitative data in a sort of awe. They have been lead to believe that numbers are, or at least should be, unquestionably correct. Consider the sort of math problems people are exposed to in secondary school, and even in introductory college math courses: there is a clearly defined method for finding the answer, and that answer is the only acceptable one. It comes, then, as a shock that different research studies can produce very different, often contradictory results. If the statistical methods used are really supposed to represent reality, how can it be that different studies produce different results? In order to resolve this paradox, many naive observers conclude that statistics must not really provide reliable (in the nontechnical sense) indicators of reality after all. And, the logic goes, if statistics aren't "right", they must be "wrong". It is easy to see how even intelligent, well-educated people can become cynical if they don't understand the subtleties of statistical reasoning and analysis.
? A history of results and excellent performance. Evidence of a successful track record is found in client testimonials, references, and repeat business, all of which are required to maintain their CMC? certification.
? Adherence to the highest ethical standards of the profession. Your CMC? has successfully completing both written and oral ethics examinations covering commitments to the client, to fiscal responsibility, to the public, and to the profession.
? Experience in the field. A minimum of three years of continuous consulting and successful results are required for certification.
? Life-long professional education. Your CMC? takes advantage of IMC USA's national conferences, local workshops, topical research, the Academy for Professional Development, newsletters, and other chapter-level offerings.
? A reference network for challenging client problems. They can utilize IMC USA's national database, local chapter reference sources, and the combined wisdom of the knowledge management created and maintained within IMC USA membership. USED




Thanks for sharing your response. I think that you made some valid points. Might employees be afraid of managers because of management's behavior? Might employees move into being silent because they have been punished for speaking up? Might employees be silent because it is not safe to speak-up? What do these dynamic have to do with organizational structure?


There is every probability that employees that had been intimidated by the management will be afraid to speak up and may imbibe the culture of silence. Line and staff organizational structure may the perfect structure where this can happen. This is because managers of line and staff have authority over their subordinates and can punish them as they so wish if they determine so. Besides, the decision-making process is slower in this type of organizational structure because of the layers and guidelines that are typical to it, so upper management hardly learn of lower level employees complaints.




I want to thank you for reading and responding to my post. As a potential change manager, what would you do if the allocation of resources were too few to make the plan successful? Might the rationale for the allocation be a starting point? Can management sometime plan a change hat it wants to fail?

Define goals and criterias: I will look at the profitability, risks and value to customers.
I will compare the criterias and choose the most important ones.
I will take a second look at the alternatives.
I will priortize projects against the organization objectives.
I will calculate priorities.
I will order projects by benefits and cost ratio.
I will cut project from the bottom until I meet the budget.
There is always a second best decision in any situation, instead of failing, I will switch to the second best project to save allocations and resources.





Develop Part I of a comprehensive plan to implement an organization change.
Choose an issue from your workplace and create a plan for a proposed change to resolve the issue. (I work in home health care setting).
Your change proposal must be something you might actually implement in your workplace. Iwant issue related to Long-term care.
Part I of your plan focuses on assessment of the change issue and planning for the proposed change.
Prepare a 1,050- to 1,400-word plan with the following:
? Examine the need in the organization for your proposed change.
? Examine organizational and individual barriers to your proposed change.
? Identify factors that might influence your proposed change.
? Summarize factors influencing organizational readiness for your proposed change.
? Identify the theoretical model that relates to your proposed change.
? Identify internal and external resources available to support your change initiative.
Use the University Library to conduct a search for current peer-reviewed literature that provides data to support your change application.
Format your plan consistent with APA guidelines.

Vulnerable Populations ? Part II
Paper includes the following:
? Details of the potential financial impact on the vulnerable population. Consider the following:
o The impact of changes in age groups, ethnicity, gender, and socioeconomic and education level
o Health or illness trends, such as disease morbidity and mortality within the population
o Health care service needs, such as acute care, long-term care, nursing home, home health, and hospice
? Description of the funding that is being used to assist this population.
? Description of the system impact due to the vulnerable population. How does this population affect delivery systems in the United States?
? Analysis of the issues and challenges of this vulnerable population. What are some potential solutions to address the needs of this population?
? Evaluation of the overall risk to the U.S. health care system if the rates of the vulnerable population continue to rise at 2?3% over the next 5 years as the Patient Protection and Affordable Care Act of 2010 is enacted.
? The paper is 1,400 to 1,750 words in length.
? The introduction provides sufficient background on the topic and previews major points.
? The conclusion is logical, flows, and reviews the major points.
? The paper?including the title page, reference page, tables, and any appendixes?is consistent with APA guidelines as directed by the facilitator. The paper is laid out with effective use of headings, font styles, and white space.
? Rules of grammar, usage, and punctuation are followed; spelling is correct.

Use India or China as country for case study (whichever best fits at your discretion)
Use either Home Health Aide or Certified Nursing Assistant role as profession being changed
Use either universal health care or availability of health care or no health care as global trend (whichever best fits at your discretion)

This assignment gives you an opportunity to explore how your professional field is evolving in response to one of the global trends that weve examined in this course, and to learn about the status of your career field from the courses you took in your major. Thinking about the global issues that weve covered and the world region that youve been following this semester, you need to develop a topic that includes a specific global trend or issue that is changing how your professional field is practiced in another country

WRITTEN ASSIGNMENT:
Write an 8 paper, divided into four sections:
1. Introduction: introduce your main topics and your main thesis regarding them

2. Global trend: identify your trend, explain its causes and its global scope, discuss any factors or responses that oppose the trend, and analyze its impact upon your professional field.

3. Case study: using one specific country, describe how this global trend is affecting your professional field or practice in that country. How do the local conditions in that countrypolitics, economics, culture, environmentaffect how this trend plays out in your field?

4. Conclusion: based on your research, what can we say about the future prospects for this trend, as it plays out in your professional field and in your case study country?


ASSESSMENT:
A successful paper for this project will:
Be well-organized and clearly written, with a thesis statement that guides the content of the paper.

Integrate information from at least 8 published sources (articles found on Lexis-Nexis and ProQuest or on reliable web sites), from professionally-appropriate publications.

Show a thorough understanding of the global trend involved.

Include analysis of the political, economic, cultural and historical context of the case study country as appropriate.

Show appropriate expertise in your professional field.

This is a CLC assignment.
Choose a nursing problem from your current practice setting, and identify a possible solution to that problem. The nursing problem that we choose on which you have to write the power point on is: HOW WORK PLACE DEMANDS INFLUENCES PATIENT SAFETY"
Conduct a search of the literature related to this problem.
Analyze and critically appraise evidence-based literature to support the solution to the identified problem. A minimum of (5) articles must be identified. This may include guidelines from the National Guideline Clearinghouse, Joanna Briggs Institute, or a review from the Cochrane Database of Systematic Review.
Prepare a 10-minute (8-10 slides; no larger than 5 MB) PowerPoint presentation related to the problem, evidence appraisal, and practice implications.
Include the following components into the presentation:
1. Present the nursing practice problem with the PICO question.
2. Discuss your appraisal of the literature that addresses the problem.
3. Present the proposed practice changes from an integration of the findings.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

The PICO statement will provide a framework for your Capstone Project (The project students must complete during their final course in the RN-BSN program of study). Review the PICO article "Evidence-Based Practice, Step by Step: Asking the Clinical Question" (2010)
The first step of the EBP process is to develop a question from a practice problem. Start with the patient and identify the clinical problems or issues that arise from clinical care. (AT LEAST 10 PICO QUESTIONS AND ANSWERS ARE NEEDED.) THANKS
Review the PICO article "Evidence-Based Practice, Step by Step: Asking the Clinical Question" (2010) along with the PICO PowerPoint.
Following the PICO format, write a PICO statement in an area of interest to you, which is applicable to your proposed Capstone Project.



AJN, American Journal of Nursing
Issue: Volume 110(3), March 2010, pp 58-61
Copyright: ? 2010 Lippincott Williams & Wilkins, Inc.
Publication Type: [Feature Articles]
DOI: 10.1097/01.NAJ.0000368959.11129.79
ISSN: 0002-936X
Accession: 00000446-201003000-00028
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[Feature Articles]
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Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice
Stillwell, Susan B. DNP, RN, CNE; Fineout-Overholt, Ellen PhD, RN, FNAP, FAAN; Melnyk, Bernadette Mazurek PhD, RN, CPNP/PMHNP, FNAP, FAAN; Williamson, Kathleen M. PhD, RN
Author Information
Susan B. Stillwell is clinical associate professor and program coordinator of the Nurse Educator Evidence-Based Practice Mentorship Program at Arizona State University in Phoenix, where Ellen Fineout-Overholt is clinical professor and director of the Center for the Advancement of Evidence-Based Practice, Bernadette Mazurek Melnyk is dean and distinguished foundation professor of nursing, and Kathleen M. Williamson is associate director of the Center for the Advancement of Evidence-Based Practice.
Contact author: Susan B. Stillwell, [email protected].

Abstract
This is the third article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.
The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Ask the Authors" call-ins every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with May's Evidence-Based Practice, Step by Step.


To fully implement evidence-based practice (EBP), nurses need to have both a spirit of inquiry and a culture that supports it. In our first article in this series ("Igniting a Spirit of Inquiry: An Essential Foundation for Evidence-Based Practice," November 2009), we defined a spirit of inquiry as "an ongoing curiosity about the best evidence to guide clinical decision making." A spirit of inquiry is the foundation of EBP, and once nurses possess it, it's easier to take the next step?to ask the clinical question.1 Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes.
In the last installment, we gave an overview of the multistep EBP process ("The Seven Steps of Evidence-Based Practice," January). This month we'll discuss step one, asking the clinical question. As a context for this discussion we'll use the same scenario we used in the previous articles (see Case Scenario for EBP: Rapid Response Teams).
In this scenario, a staff nurse, let's call her Rebecca R., noted that patients on her medical?surgical unit had a high acuity level that may have led to an increase in cardiac arrests and in the number of patients transferred to the ICU. Of the patients who had a cardiac arrest, four died. Rebecca shared with her nurse manager a recently published study on how the use of a rapid response team resulted in reduced in-hospital cardiac arrests and unplanned admissions to the critical care unit.2 She believed this could be a great idea for her hospital. Based on her nurse manager's suggestion to search for more evidence to support the use of a rapid response team, Rebecca's spirit of inquiry led her to take the next step in the EBP process: asking the clinical question. Let's follow Rebecca as she meets with Carlos A., one of the expert EBP mentors from the hospital's EBP and research council, whose role is to assist point of care providers in enhancing their EBP knowledge and skills.
Types of clinical questions. Carlos explains to Rebecca that finding evidence to improve patient outcomes and support a practice change depends upon how the question is formulated. Clinical practice that's informed by evidence is based on well-formulated clinical questions that guide us to search for the most current literature.
There are two types of clinical questions: background questions and foreground questions.3-5 Foreground questions are specific and relevant to the clinical issue. Foreground questions must be asked in order to determine which of two interventions is the most effective in improving patient outcomes. For example, "In adult patients undergoing surgery, how does guided imagery compared with music therapy affect analgesia use within the first 24 hours post-op?" is a specific, well-defined question that can only be answered by searching the current literature for studies comparing these two interventions.
Background questions are considerably broader and when answered, provide general knowledge. For example, a background question such as, "What therapies reduce postoperative pain?" can generally be answered by looking in a textbook. For more information on the two types of clinical questions, see Comparison of Background and Foreground Questions.4-6
Ask the question in PICOT format. Now that Rebecca has an understanding of foreground and background questions, Carlos guides her in formulating a foreground question using PICOT format. TABLE. Comparison of...PICOT is an acronym for the elements of the clinical question: patient population (P), intervention or issue of interest (I), comparison intervention or issue of interest (C), outcome(s) of interest (O), and time it takes for the intervention to achieve the outcome(s) (T). When Rebecca asks why the PICOT question is so important, Carlos explains that it's a consistent, systematic way to identify the components of a clinical issue. Using the PICOT format to structure the clinical question helps to clarify these components, which will guide the search for the evidence.6, 7 A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently.5-8
To help Rebecca learn to formulate a PICOT question, Carlos uses the earlier example of a foreground question: "In adult patients undergoing surgery, how does guided imagery compared with music therapy affect analgesia use within the first 24 hours post-op?" In this example, "adult patients undergoing surgery" is the population (P), "guided imagery" is the intervention of interest (I), "music therapy" is the comparison intervention of interest (C), "pain" is the outcome of interest (O), and "the first 24 hours post-op" is the time it takes for the intervention to achieve the outcome (T). In this example, music therapy or guided imagery is expected to affect the amount of analgesia used by the patient within the first 24 hours after surgery. Note that a comparison may not be pertinent in some PICOT questions, such as in "meaning questions," which are designed to uncover the meaning of a particular experience.3, 6 Time is also not always required. But population, intervention or issue of interest, and outcome are essential to developing any PICOT question.
Carlos asks Rebecca to reflect on the clinical situation on her unit in order to determine the unit's current intervention for addressing acuity. Reflection is a strategy to help clinicians extract critical components from the clinical issue to use in formulating the clinical question.3 Rebecca and Carlos revisit aspects of the clinical issue to see which may become components of the PICOT question: the high acuity of patients on the unit, the number of cardiac arrests, the unplanned ICU admissions, and the research article on rapid response teams. Once the issue is clarified, the PICOT question can be written.
Because Rebecca's issue of interest is the rapid response team?an intervention?Carlos provides her with an "intervention or therapy" template to use in formulating the PICOT question. (For other types of templates, see Templates and Definitions for PICOT Questions.5, 6) Since the hospital doesn't have a rapid response team and doesn't have a plan for addressing acuity issues before a crisis occurs, the comparison, or (C) element, in the PICOT question is "no rapid response team." "Cardiac arrests" and "unplanned admissions to the ICU" are the outcomes in the question. Other potential outcomes of interest to the hospital could be "lengths of stay" or "deaths."
Rebecca proposes the following PICOT question: "In hospitalized adults (P), how does a rapid response team (I) compared with no rapid response team (C) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a three-month period (T)?"
Now that Rebecca has formulated the clinical question, she's ready for the next step in the EBP process, searching for the evidence. Carlos congratulates Rebecca on developing a searchable, answerable question and arranges to meet with her again to mentor her in helping her find the answer to her clinical question. The fourth article in this series, to be published in the May issue of AJN, will focus on strategies for searching the literature to find the evidence to answer the clinical question.
Now that you've learned to formulate a successful clinical question, try this exercise: after reading the two clinical scenarios in Practice Creating a PICOT Question, select the type of clinical question that's most appropriate for each scenario, and choose a template to guide you. Then formulate one PICOT question for each scenario. Suggested PICOT questions will be provided in the next column.
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Case Scenario for EBP: Rapid Response Teams TABLE. Templates and...
You're a staff nurse on a busy medical?surgical unit. Over the past three months, you've noticed that the patients on your unit seem to have a higher acuity level than usual, with at least three cardiac arrests per month, and of those patients who arrested, four died. Today, you saw a report about a recently published study in Critical Care Medicine on the use of rapid response teams to decrease rates of in-hospital cardiac arrests and unplanned ICU admissions. The study found a significant decrease in both outcomes after implementation of a rapid response team led by physician assistants with specialized skills.2 You're so impressed with these findings that you bring the report to your nurse manager, believing that a rapid response team would be a great idea for your hospital. The nurse manager is excited that you have come to her with these findings and encourages you to search for more evidence to support this practice and for research on whether rapid response teams are valid and reliable.
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Practice Creating a PICOT Question
Scenario 1: You're a recent graduate with two years' experience in an acute care setting. You've taken a position as a home health care nurse and you have several adult patients with various medical conditions. However, you've recently been assigned to care for hospice patients. You don't have experience in this area, and you haven't experienced a loved one at the end of life who's received hospice care. You notice that some of the family members or caregivers of patients in hospice care are withdrawn. You're wondering what the family caregivers are going through, so that you might better understand the situation and provide quality care.
Scenario 2: You're a new graduate who's accepted a position on a gerontology unit. A number of the patients have dementia and are showing aggressive behavior. You recall a clinical experience you had as a first-year nursing student in a long-term care unit and remember seeing many of the patients in a specialty unit for dementia walking around holding baby dolls. You're wondering if giving baby dolls to your patients with dementia would be helpful.
What type of PICOT question would you create for each of these scenarios? Select the appropriate templates and formulate your questions.
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REFERENCES
1. Melnyk BM, et al. Igniting a spirit of inquiry: an essential foundation for evidence-based practice. Am J Nurs 2009;109(11):49?52. [Context Link]
2. Dacey MJ, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med 2007;35(9):2076?82. [Context Link]
3. Fineout-Overholt E, Johnston L. Teaching EBP: asking searchable, answerable clinical questions. Worldviews Evid Based Nurs 2005;2(3):157?60. 360 Link esolver [Context Link]
4. Nollan R, et al. Asking compelling clinical questions. In: Melnyk BM, Fineout-Overholt E, editors. Evidence-based practice in nursing and healthcare: a guide to best practice. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 25?38. 360 Link esolver [Context Link]

5. Straus SE. Evidence-based medicine: how to practice and teach EBM. 3rd ed. Edinburgh; New York: Elsevier/Churchill Livingstone; 2005. [Context Link]
6. Fineout-Overholt E, Stillwell SB. Asking compelling questions. In: Melnyk BM, Fineout-Overholt E, editors. Evidence-based practice in nursing and healthcare: a guide to best practice [forthcoming]. 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams and Wilkins. [Context Link]
7. McKibbon KA, Marks S. Posing clinical questions: framing the question for scientific inquiry. AACN Clin Issues 2001;12(4):477?81. [Context Link]
8. Fineout-Overholt E, et al. Teaching EBP: getting to the gold: how to search for the best evidence. Worldviews Evid Based Nurs 2005;2(4):207?11. [Context Link]


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started need help please Introduction (please remove this line when editing)Home health visits can be a useful method of identifying potential and actual health issues. Visiting the patient?s home may provide the opportunity to identify issues which may not be readily apparent at a medical office. The home health visit is to help promote the patient?s health maintenance; limit further disability, and increase baseline health. The visiting nurse will be able to build a caring, professional, trusting, patient focused relationship. The home health nurse will be able to assist the patient by identifying, procuring and providing education for interventional items. The nurse will be able to facilitate the communication of identified patient needs, in the home, to interdisciplinary members of the health care team (Liebel, Powers, Friedman, & Watson, 2012).Problem #1. (Please remove line when editing)The patient has been prescribed oxygen for home use by her physician. The patient states the she has not arranged oxygen in her home because it will cost her more money. The nursing intervention is to find out the total associated cost and arrange oxygen delivery and then provide education regarding safety and use. The use of oxygen will improve the patient?s respiratory function and improve her quality of life (Criner, 2012). Conclusion (please remove this line when editing)There were several issues that were identified only because a home health visit was done in Mrs. Fishers home. The home health nurse in this case scenario has the ability and resources to make positive changes which will promote improved health for this patient and reduce further disability. The visiting nurse can build a caring, trusting, professional patient focused relationship with the patient and with multiple visits continue to evaluate the effectiveness of interventions and make alternative interventions if needed. Home health visits, when appropriately performed, can be a useful method of identifying potential and actual health issues this will aid the health team in providing effective and appropriate interventions.1)Identified and prioritized at least four problems from the simulated home visit with Salle Mae.2)Summarized each problem identified with evidence to substantiate findings (assessment data).3)Identified and discussed at least four medical and/or nursing interventions to meet client needs.4)Provides rational for interventions identified. Discussion of rationale includes support from outside resources (current evidence-based literature). Tripping hazards, cloudy mind, misses husband, depressed, lonely,dehydration, not using home oxygentionMs. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain.Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.Hospital Discharge Instructions?Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.?Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O2 at 2 liters per nasal prongs PRN.?Prescriptions given at discharge:oDigoxin 0.25 mg once a dayoLasix 80 mg twice a dayoCalan 240 mg once a day ?Order written to continue other home meds.Sallie Mae?s Home Medication List?Zocar 50 mg once a day?Minipres 1 mg once a day?Vasotec 10 mg twice a day?Prilosec 20 mg once a day?Furosemide 40 mg once a day?Effexor 37.5 mg at bedtime?Lanoxin 0.125 mg every other day?Multivitamin once a day?Potassium 40 mEq once a day?Ibuprofen 400 mg q 4 hours as needed for pain?Darvocet N 100 mg q 4 hours as needed for pain?Nitroglycerin ointment, apply 1 inch every dayIdentify and prioritize 4 problems and 4 interventionsProblem 1 ? provide assessment data in paragraph form (20 words)Problem 2 ? provide assessment data in paragraph form (20 words)Problem 3 ? provide assessment data in paragraph form (20 words)Problem 4 ? provide assessment data in paragraph form (20 words)Intervention 1 ? describe and discuss rationale (90 words, include reference)Intervention 2 ? describe and discuss rationale (90 words, include reference)Intervention 3 ? describe and discuss rationale (90 words, include reference)Intervention 4 ? describe and discuss rationale (90 words, include reference)Introduction (~150 words) and conclusion (~100 words)ReferencesCriner, G. J. (2012). Ambulatory Home Oxygen: What Is the Evidence for Benefit, and Who Does It Help?. . Respiratory Care, 58(1), 48-64. http://dx.doi.org/10.4187/respcare.01918Liebel, D., Powers, B., Friedman, B., & Watson, N. (2012). Barriers and facilitators to optimize function and prevent disability worsening: a content analysis of a nurse home visit intervention. . Journal Of Advanced Nursing, 68(1), 80-93. http://dx.doi.org/10.1111/j.1365-2648.2011.05717.x

For references, please include 2 government sites and 18 peer reviewed articles. Please have at least one citation in each paragraph.
Requirement: The state of Virginia is attempting to integrate services for people needing long-term care. Using and organization chart or list, identify all the departments and programs run by the state that potentially are related to long-term care and thus should be involved in the integration effort. Describe how this initiative should be orchestrated (i.e., the process for coordinating this change). Outline services and financing programs that should be involved; participation may be phased over time. Explain how the integration should be implemented at the local client level and how staff and offices will be prepared to accomplish integration.
Some examples of types of services in long-term care are: palliative, assisted, and home health, but there are many others.

Purpose: The purpose of this assignment is to give you the opportunity to synthesize and apply knowledge you have gained from all your courses, toward the completion of a comprehensive community project. In addition, this project will serve as a measure of your ability to think critically, communicate effectively, and plan therapeutic nursing interventions. You will select a community to study and in which you will complete your assessment. This will serve as the Practice Learning Environment. The Windshield Survey portion of your assessment should be completed by driving around the community. The Windshield Survey is comprised of general qualitative observations that give you a snapshot of the community. Follow the guide in the Stanhope text (7th edition pg 355) to briefly address the major elements of the survey. You are to use the same community you will be using to complete the Cultural Assessment and the Health Education Plan. You can then utilize the data for all three assignments. The demographic data can be obtained online, through the public library, county or township administration buildings. All information needed for this project is in the public domain and easily accessible. This paper should not exceed twenty pages of text. Appendices, tables and references are not included in those twenty pages. This paper will be completed in sections on specified dates and submitted in the end in its entirety. Please access Student Resources button for more information.

SECTION I: Definition of Community (5 points)
Identification and history: Give a brief description of the area to be assessed in terms of geographic location and population size. Describe how the community developed. Describe significant trends and events related to current function and characteristics. (example ?" was this a manufacturing community that has suffered plant closings and job loss? Describe the impact.) (5 points)

SECTION II: Assessment (25 points)
Description and characteristics of community) Windshield Survey See Table 15-5 on page 355 in Stanhope textbook (10 points)

Community resources for helping families in the community achieve optimal level of wellness. Many of the resources can be listed as an appendix. Use your narrative to summarize and analyze the special strengths and deficits of the listed areas. Include citizen knowledge about resources and utilization or access problems. (8 points)

Health Resources
Type of services available: health department, private MD, dentist, hospital clinic, pharmacy, health promotion, mental health
School and occupational health services
Official and voluntary services
Self help and support groups
Service organizations, faith-based programs
Citizen safety and protective services
Police and fire
Shelters for victims of abuse
Others: neighborhood watch etc.

Services of senior citizens senior centers, meals on wheels, transportation, day care, long term care.

Community welfare services beyond city/state aid as provisions for emergency food, shelter and clothing.

Recreation

Biostatistics (7 points)
Present the following data in table form. This section of your text should consist of a summary and analysis of the significant findings of your tabled data. Since statistical data is meaningful only when related to trends or as compared to state and national norms, all data should be represented in your tables in this manner with illustration of comparison.
Demographic data: dependency ratio <18 and >65 years, ethnic characteristics, median educational level, unemployment rate, per capita income and percent of families living under the poverty level.
Vital statistics birth and death rates, mortality for leading causes of death, infant mortality
Health statistics morbidity of major communicable diseases (AIDS, STDs, TB) incidence of child abuse and neglect, teenage pregnancy, other disease identified by community as significant, incidence of crime.

SECTION III: Analysis and Diagnosis of Problems and Assets: (25 points)

Community Identified Health Needs and Assets : (10 points)

Students should interview a number of community residents, leaders and health care professionals regarding their perceptions of prevailing health needs, concerns, issues and assets of their community.)This section should include at least three interviews. Interview data can be summarized by individual response and placed in an appendix. The text of your paper will summarize and analyze the interviews addressing areas such as concerns expressed most frequently or noted by particular segments of the community (i.e. youth, elderly physicians, young families).

The following list suggests persons you should include in your interview process: Health care providers including school or occupational health nurses, home health and hospital nurses, mental health workers; clergy, police and fire personnel; city officials, educators, youth, elderly; business and professional people; people of the street, shoppers; informal leaders.

Problem or Asset Identification/ Community Diagnosis (15 points)

This is your opportunity to analyze and synthesize the data in order to develop a prioritized community problem list. Be able to support your conclusions with assessment data found in the body of your paper. Diagnoses of the community should not be limited to needs or problems. Positive statements about coalitions, groups, etc. could be made in which case the nursing role would be to maintain and enhance the situation.

In this section you must analyze all the data you have presented in the above sections, and establish a prioritized community problem /diagnosis list of at least five problems. Identify rationale and criteria you used in prioritizing the list. Use chapter 15 in Stanhope as a key reference for your criteria (See pages 361 & 367 Table 15-7). Provide support for each diagnosis Indicate any community action currently directed on behalf of each problem area. Most of this section should have been covered in your community resource section.

Select one identified Health Promotion problem you have identified in this section to use in your Health Education Plan assignment (See guidelines and rubric for Health Education Plan in Assignments).

SECTION IV: Planning, Implementation, and Evaluation: (25 points)

This is a key section of this paper. In this section you are to make recommendations for feasible community nursing interventions for each of the problems you identified. You are to develop a desired goal and outcome objective for each diagnosis and a feasible plan of action. Include in this section what community organizations you would involve in these interventions.

Also address at least two health policy implications derived from your analysis. For example ?" if you find that increased lead levels are a problem in this community, what implications would this have for health policy makers in the community? Could it be that more dollars for lead screening should be required? or expanding medical assistance coverage for better follow up? What about expanding Head Start dollars to include lead prevention?

Crucial to the plan is the evaluation of its effectiveness. Develop a strategy for evaluating the effectiveness of your recommended goals and outcomes. What outcome measures would you use?

Pages 366 ?" 370 in Stanhope present excellent examples in table form to use guides.



There are faxes for this order.

You are outside counsel to the Marcus Welby Healthcare Corporation, which among its other operations owns a durable medical equipment (DME) subsidiary, which sells equipment for home use such as crutches, wheelchairs, and oxygen concentrators. You learn that the subsidiary has had certain business practices about which you have some question under the Medicare and Medicaid Anti-Fraud and Abuse provisions:

Salesmen regularly offer home health agency employees a premium whenever their clients order DME from the subsidiary.
The subsidiary offers rebates to patients who use its equipment.
The subsidiary pays hospital and home health agency personnel for assisting its patients in learning how to use its products.
Some arterial blood gas test results may have been massaged a bit by the DME in order to facilitate Medicare payment for oxygen concentrators.
What advice would you give?


Customer is requesting that (FreelanceWriter) completes this order.

choose an issue from your workplace and create a plan for a proposed change to resolve the issue.
workplace - long term home health care; issue - intake department is lacking in organizing referrals and relating appropriate material to the visiting nurse prior to home visit (most referrals are obtained from nursing rehab facilitites).

Part 1 of the plan focuses on assessment of the change issue and planning for the proposed change

prepare a 1000 word plan with the following:

A) examine the needin the organization ofr your proposed change
B) examine organizational and individual barriers to your proposed change
C) identify factors that might influence your proposed change
D) summarize factors influencing organizational readiness for your proposed change
E) identify the theoretical model that relates to your proposed change
F) indentify internal and external resources available to support your change initiative

use at least 3 current peer-reviewed sources that support your change application


PLEASE TAKE NOTE THIS ASSIGNMENT CONSIST OF 3 PARTS. WOULD LIKE TO REQUEST THE SAME WRITER FOR THE PARTS II AND PART III. THANKS

Resource: Risk and Quality Management Assessment Summary Grading Criteria and Sample Executive Summary located in the Center for Writing Excellence

Risk and quality management provide different methods, tools, and techniques to health care organizations to ensure that they provide quality health care. Leaders in a health care organization have hired you as a consultant to help assess the organization?s current status and define a future plan for providing quality health care.

Select an organization type in the health care industry as the basis for this assignment. The organization may be your employer or a health care organization of particular interest to you. Types of health care organizations include, but are not limited to, the following:

a. Hospital
b. Nursing facility
c. Emergency medical services
d. Managed care organization
e. Home health care
f. Community health department or provider


Research the key concepts of risk and quality management in health care and the factors that influence risk and quality management for your chosen type of organization.

Research the relationship between risk management and quality management.

Write a 1,375 words put heading for each question answered in which you complete the following:

? Describe your chosen organization.
? Describe the purpose of risk and quality management in health care organizations in general and in your chosen organization.

? Describe the key concepts of risk and quality management in your chosen organization.

? Explain steps the organization may take to identify and manage their risks.

? Identify at least three typical or actual risks in the organization. Describe how the risks might negatively affect the quality.

? Identify at least three internal and external factors that influence quality outcomes in the organization. Describe how these factors might negatively affect quality outcomes for the organization.

? Outline at least three of the organization?s long-term goals and at least three short-term goals.

? Identify at least three fundamental risks and quality management policies that should be implemented and how they will influence health outcomes.

? Explain the relationship between risk management and quality management in the organization and how these two disciplines complement each other.

Include at least four peer reviewed sources, two from the University Library and two from either the course textbooks or this week?s Electronic Reserve Readings. You may use additional CREDIBLE sources; however, you MUST use the four sources previously stated. Prepare a reference list of all resources and websites used in your research. DO NOT USE WIKIPEDIA OR DICTIONARIES!!

Format with APA 6TH edition guidelines.

A critical incident usually represents an identified problem confronting you as a nurse and your role as a decision maker.The analysis of the incident requires the application of principles of menagement and sound judgement.Many times to formulate the ''right '' answer for a problem is not as important as how you come to the solution and the reasoning you use to arriveat a recommended course of action. For this assignment you are to formulate a two to three page paper utilising critical incident analysis to a situation or experience in the work place.Diagram your problem with several alternatives,pros and cons of each and choice.Then discuss the problem as follows:
1 .Clearly identify a problem that you have confronted in the workplace.Describe status of problem at one point in time.Identify all the factors /players who are involved with the problem and their rolein the workplace.Identify what,when, where,why,who.Make sure it is the problem you have addressed and not just a symptom of the problem you are identifying.

state the problem in one sentence

2. Specify any alternatives to the problem.Identify all logical alternatives with it's pros and cons.Consider if the problem was not addressed at this time,would it eventually go away?What risk is involved with implementing each alternetive? Describe fully how each alternative will affect the outcome.

Draw diagram

3. Make a choice.Which of your identified alternatives did you choose in approaching the problem based on the information you have gathered?Why did you choose this alternative? Specify the ethical principle that you applied in making this decision and explainwhy you used this principle.

4. Implement your choice. Describe fully what happened when you implemented your choice ,the results obtained ,the skills required in your decision of how to handle the problem.

5. Consider the feedback issue.Identify fully what you would do differently next time if you encounter this same or similar problem?

Personal Evaluation :What did you learn from this paper's step -by-step approach to problem solving?How can you utilize this type of analysis in yourrole as a nurse?Be complete.

Professional presentation of paper.Number and label each section you address,proper grammar,in folder,no abbreviations or''slag''e.g.,''nurse tech''.Do not identify people or placesby name-use initials.Answer all questions for each section.

At work I had a patient that was having two decubital wounds stage four on her sacral area and she was parallyzed from the waist down and she was having lace in her head and pubical area.She was discharged home with the home health care visits but she and her husband refuse eny type of visits by the nurse or going to a nursing home.She needed a IV antibiotiks but without nursing supervision at home she was not able to qure from the infection and she was not able to stay in the hospital any loger .So I think that we can use this problem and name it:deficient knowledge related to the disease process .-OR you can ude something different if it has more sence.

Risk Management Assessment Summary


Leaders in a health care organization have identified risk management as an opportunity for improvement for the upcoming year. The organization has hired you as a consultant to help assess the organization?s current status and define the future plan for addressing risks.


? Select an organization type in the health care industry as the basis for this assignment. The organization may be your employer or a health care organization of particular interest to you. Types of health care organizations include, but are not limited to, the following:


o Hospital, nursing facility, physician office, emergency medical services, managed care organization, home health care, community health department or provider, pharmacy, laboratory, drug manufacturer, medical device manufacturer, durable medical equipment supplier, and electronic medical records software suppliers

? Research the key concepts of risk management in health care and the factors that influence risk management for your chosen type of organization.
? Write a 1,050- to 1,400-word paper in which you complete the following:
o Describe the purpose of risk management in health care organizations in general and in your chosen organization in particular.

o Explain key steps this organization may take to identify and manage their risks.

o Identify three typical or actual risks in your chosen organization. Describe how each risk might negatively affect your organization and its stakeholders.

o Summarize the types of education, training, or policies that would help this type of organization mitigate these risks.


? Include at least four sources, two from the University Library and two from either the course textbooks or this week?s Electronic Reserve Readings. Prepare a reference list of all resources and websites used in your research.

2 pages with 2 references from peer review journals paraphase only no direct quotes cite references in the text Read the article on hypertension that I have uploaded and the do a crosspost to the article written below try to bring up new material must be able to go through turnit in need 250- 500 words please
crosspost to follig paper:
Hypertension, a significant health problem in the United States, has detrimental economic consequences on health care. Even with technological advances and cost-effective analysis, the treatment of hypertension continues to be a burden. This paper summarizes the key issues surrounding the economics of hypertension.

Hypertension affects nearly one-third of the American adult population and is responsible for nearly 50% of heart disease and 75% of strokes worldwide (Stason, 2009). In modernized and wealthy countries, hypertensive disorder is among the top three leading causes of death that are directly related to a particular cause (Alcocer & Cueto, 2008). In poverty stricken areas, hypertension is the most common cause of death.

Hypertension cost the U.S. over $69 billion in 2008 (American Heart Association, 2008). Most of these dollars were spent on resource utilization. When compared to non-hypertensive people, people who are hypertensive are more likely to use extra healthcare resources including emergency room visits, home health visits, and inpatient visits (Alcocer & Cueto, 2008).

Most studies only investigate the economic impact of hypertension as a primary disease or diagnosis. However, many disease states such as diabetes, ischemic heart disease, and cerebrovascular disease are directly attributable to hypertension. Therefore, the costs related to hypertension as a secondary diagnosis should also be included to keep from underestimating the true economic burden of hypertension (Wang, Zhang, & Ayala, 2010). For example, many admissions have a primary diagnosis of cerebrovascular disease directly related to hypertension. In turn, approximately 13% of the total cost of hospitalization for a primary diagnosis related to hypertension goes to treating the hypertension itself (Wang, Zhang, & Ayala, 2010).

Various methods are used to evaluate the most cost effective method of treating hypertension. One study, the Hypertension Optimal Treatment (HOT) Study, compared the cost of various antihypertensive medications with progressively lower diastolic blood pressures (Hansson et al., 1998). As diastolic blood pressure goals decreased, the cost of the medicine regimen increased. However, the lower target blood pressures did not offset economic cost by reducing cardiovascular hospitalizations. The study concluded that the more aggressive method of hypertension treatment was not necessarily cost-effective in the long run.

Conversely, a second analysis of the cost-effectiveness of strict versus moderate control of hypertension in a patient with type 2 diabetes concluded differently. For people diagnosed with type 2 diabetes, aggressive treatment of hypertension resulted in marked cost reduction and improved health outcomes when compared to those with moderately controlled hypertension (The CDC Diabetes Cost-effectiveness Group, 2002). Aggressive treatment of hypertension in these patients achieved a cost savings of approximately $2,000 per diabetic patient per year.

Even though the diagnosis and treatment of hypertension has made marked progress, economic challenges are still present. By analyzing the cost-effectiveness of various approaches to therapy and regimens for treatment, the health care provider can assist the patient in making the most economical treatment choice.


References

Alcocer, L. & Cueto, L. (2008). Hypertension, a health economics perspective. Therapeutic Advances in Cardiovascular Disease, (2)3, 147-155. doi:10.1177/1753944708090572

American Heart Association. (2008). Heart disease and stroke statistics ??" 2008 update. Circulation, 117, e25-e146. doi:10.1161/CIRCULATIONAHA.107.187998

Hansson, L., Zanchetti, A., Carruthers, S., Daholf, B., Elmfeldt, D., Julius, S., Menard, J., Rahn, K., Wedel, H., & Westerling, S. (1998). Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomized trial. The Lancet, 351, 1755-1762. doi:10.1016/S0140-6736(98)04311-6

Stason, W. (2009). Hypertension: A policy perspective, 1976-2008. Journal of the American Society of Hypertension, 3(2), 113-118. doi:10.1016/j.jash.2008.12.001

The CDC Diabetes Cost-effectiveness Group. (2002). Cost-effectiveness of intensive glycemic control, intensified, hypertension control, and serum cholesterol level reduction for type 2 diabetes. Journal of the American Medical Association, 287, 2542-2551. Retrieved from http://scholar.google.com
There are faxes for this order.