The following are directions to write the narrative description of your field project. It should be written in APA (6th edition) format, appropriately noting in-text citations, references, etc. You ma...y attach as appendices any charts, tables, or other materials (labeled with the source identified per APA format).
ASSIGNMENT:
TOPIC: PREVENTION OF OBESITY. AGE 50+

A. Assessment
1. Describe the LA COUNTY community where you performed your fieldwork. In your description, identify each of the following items:
? Geographical area (e.g., county, city, town)
? Area size
? Population size
? Demographics
? Physical and social environment

2. Create a community genogram/profile reflecting the health status of the community. INCLUDE STATISTICS RELATED TO OBESITY (RELATION TO SOCIOECONOMIC STATUS, RACE, HEART DISEASE, STROKE, DIBETIS). SEE ATTACHED SAMPLE OF THE GENOGRAM. MAKE SURE TO INCLUDE INTERPRETATION OF THE GENOGRAM IN THE PAPER.

3. Discuss the health concern you studied in your fieldwork. OBESITY PREVENTION. DISCUSS OBESITY AND HEALTH PROBLEMS RELATED TO OBESITY. MAKE SURE YOU INCLUDE FOLLOWING POINTS:
? Background in relation to Healthy People 2020 (2010) and local public health data that characterizes this health concern
? Data from national, state, and/or local level related to the health concern

MAKE SURE TO ADDRESS FOLLOWING POINTS FOR QUESTION #3

Health Concern and Data

Describe the issue at the national, state, and county (local) levels.Present the historical data at each level. What has been the trend for this problem over the last 20-30 years? Has it gotten better, worse, or plateaued? What are the baselines (where does the issue stand now) at each level? What are the improvement goals for the next 5-10 years? _ How does your county compare on this issue to the state level and the national level? Better, worse, or the same? For national level, be sure to discuss Healthy People 2020. _ Provide data to support your conclusion about the issue. Is the issue getting better, worse, or plateaued? What are the predictions for the future? _ Describe why we are concerned about this issue. What will happen if this issue is left unresolved? What are the consequences for the individual and for the community?

4. Describe the population of interest affected by the health concern (OBESITY) you studied in your fieldwork.
a. Description should include: the population of interest (50+), use demographic information and citing sources such as county data and US census data, i.e., percentage of males and females, socioeconomic states, education level, race/ethnicity, etc.
MAKE SURE FOLLOWING COMPONENTS IN THE DESCRIPTION:
? Gender (MALE AND FEMALE)
? Age (50+)
? Demographics including socioeconomic status and educational level
b. Describe how this health concern is linked to a health inequity for the population of interest. Include data that describes whether there is a sub group or sub groups within your population of interest that is more affected by this issue than others. Example: are men more affected than women or children more affected than adults? Answer the question ?What subgroups are suffering more from this issue??
c. Use data to support your conclusion.

5. Describe the community resources and partners (e.g., mission, activities, Web sites) currently involved with the health concern.
This section describes the results of your field work in detail. Ask: Is this an issue of concern to the community? Is it getting better, worse, or plateaued?
What are the gaps (what is not being done to prevent it)? What can be done to prevent it (what do they recommend?) Any other question you think will help you gain insight into the issue? Cite discussion with individuals and groups as
(personal communication, date). Use APA guidelines.

B. Diagnosis

1. Discuss aspects of the health concern not being addressed despite the efforts of the partners involved.
2. Make an overall statement of the present status of the issue in your county in terms of prevention.
3. What were the indications that the county is trying to work on this issue (strengths)? Where is there still room for improvement (gaps)?

C. Outcomes Identification
1. Describe the ultimate outcome(s) or goal(s) for improvement related to the health concern.
2. List one outcome or goal as if you were proposing a multi-year project such as 3 years or 5 years that a team of community health nurses was going to implement.
3. Explain how you arrived at this goal, using the baselines and improvement targets for this issue from your state level and the national level (Healthy People 2020). Give your citations.

D. Planning
1. Recommend nursing actions to improve the health concern.
Note: Use the Minnesota intervention wheel as an aid in selecting the broad areas for nursing action.PLEASE SEE ATTACHED MINNESOTA INTERVENTION WEEL.
2. Present your plan as if a team of community health nurses was implementing the plan. Part 1: Strategies and objectives . Part 2: The Minnesota Wheel, The 17 public health interventions. Interventions from the Wheel that connect to your objectives. Part 3: Table (like a care plan): Objectives, Nursing actions, Timelines.Objectives Nursing
i3. Explain how you and other nurses might work with the community and the population of interest to improve the health concern. Explain that community health nurses cannot achieve the objectives by nursing action alone. They must partner with the community (community members and institutions within the community) to be successful. Describe who or which entities will partner with the community health nurses to do the actions. Use your knowledge of potential partners gained from your field work. You may want to list each objective again and then explain which partners will assist with each objective and what their role will be. Be specific and assign roles that relate to the actions and objectives described in the previous section.
Note: Select primary and secondary prevention activities only.
4. Discuss potential public and private partnerships that could be formed to implement your recommendations.
5. Discuss the overall objective(s) for implementing these activities.
6. Create a timelines for expected outcomes.

E. Evaluation

1. Explain how you would evaluate whether the efforts to improve the health concern were effective.
? Include in your explanation the tools you might use to do this evaluation.
Include:
Part 1: how will you evaluate progress toward achieving your big outcome or goal?
Part 2: how will you evaluate whether you have achieved the objectives of the plan?

F. Conclusion

1. Reflect on how your perspective of the community?s health and the national, state, and local efforts toward a healthier population has changed as a result of your fieldwork. Up to this point in your paper, you have been writing in the 3rd person (they, he, she, it). You will write the conclusion in the 1st person (I, we) because this is a personal reflection of your field experience.

H. Supplemental Materials
1. Include supplemental materials at the end of your paper.
? Reference pages in APA format

PLEASE ADDRESS ALL QUESTIONS AS A SEPARATE PARAGRAPHS:
PART A: QUESTIONS 1, 2, 3, 4 (a, b, c), 5
PART B: QUESTIONS 1, 2, 3
PART C: QUESTIONS 1, 2, 3
PART D: QUESTIONS 1, 2, 3, 4, 5, 6
PART E: QUESTION 1: ADDRESS PART 1 AND PART 2
PART F  more

1. Use the google search engine to find 1 article on Ludwig Von Bertalanffy's systems theory and 1 credible article on Everett Rogers's diffusion of innovation theory. Use the CINAHL online database to find 1 article on Bertalanffy's theory and 1 article on Rogers's theory. 2. Discuss the relationship between Bertalanffys systems theory and healthcare delivery in the U.S. 3. Discuss the relationship between Roger's diffusion of innovation theory and the change process within healthcare delivery in the U.S. 4. Discuss the relationship between Bertalanffy's systems theory and current nursing practice. 5. Discuss the relation ship between Rogers's diffusion of innovation theory and current nursing practice. 6. Summarize the search strategies you used to acquire information on the specified theories. 7. Include an annotated reference list of the four online resources you found.

qualifed staff who do not keep upt o date with research findings have little other than intuition, outdated teaching, ritual and mythology to guide their practice (waslsh and Ford, 1989) to what extent can nurses deliver evidence based care/

define main ideas withing the title supported from the literature
explore and attemtp an analysis of main issues making case for and against presumptions within the question
explore implications for the nursing role of the competing arguments with reference to the NMX (2002) Code of professional conduct

E-mail will be sent to essaytown attaching chapter 1 and 2 of dissertation proposal that has been completed. Use this information already written to add to and expand on work in detail. Please note,... this a Quantitative Study using Malcolm Knowles Adult Learning Theory as the framework. A discussion about the Millennial generation characteristics towards learning has also been included in Chapter 1. Need to add additional information (Chapter 2 Literature Review) using current literature (scholarly publication articles only within the last 5-6 years) referring to how other area's in Higher Education outside of Nursing used gaming in the classroom (i.e. from business education, physical therapies, etc.). Also need to add more Literature Review on Malcolm Knowles theory -- any research documentation of his Framework (6 assumptions he has) use in higher education? Additional literature on knowledge retention needs to be added to Chapter 2 under new heading "Knowledge Retention". This section needs to discuss research out there in higher education on ways of improving retention of knowledge--- this should specifically relate to gaming use, active learning, discussion/collaboration, and teamwork as a way of increasing knowledge retention. Also needing to be added to Chapter 2 is a section of research literature on generational learning differences specific to the Millennial/Net Generation. Tapscott and Oblinger are some well-known names on this topic. Lastly, a section on Learning Styles can be added to Chapter 2 Literature Review. Learning Styles need to focus on Adult Learners specifically nursing --- try to relate this to gaming use (i.e. studies done have identified nurses as active learners...hands-on....visual, etc.) In addition, please write a summary section at the end of Chapter 2. All research statistics, quotes, references need to be in current APA guidelines. When writing, please try to build that strong case on gaming as an instructional strategy in nursing education in a positive light to enhance immediate knowledge and retention of knowledge. Research articles used in Literature Review should be detailed with the description of the study and findings....also need to add what those findings mean and its implication to THIS Research Proposal.

Please e-mail with any further questions or call at 717-645-6955.
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# 3. Individual Paper Application and Integration of AACN Synergy Care model in Clinical Practice ? 30% (Adapted from Fawcett, 2005). Please see Grading Rubrics at the end of this syllabus.
Each s...tudent will select a nursing practice relevant model or a nursing model developed by one of the nurse theorists. Identify the compatibility of the model with your philosophy of nursing practice. In assisting you to obtain information for the development of your paper, include use of primary resources (up-to-date articles and books written by the theorist), secondary sources, research articles, and clinical practice articles. Excellent resources are the journals; Advances in Nursing Science, Image, and Nursing Science Quarterly. Use the following criteria to guide the development of your nursing models paper. This Paper should be 8 - 10 pages of content excluding figure and reference pages. I will stop grading after the 8-10 pages on content.

1. Provide a synopsis of the theory?s background. What is the historical evolution of the model? What motivated development of the model? On what philosophical beliefs and values about nursing is the model based? What strategies for knowledge development were used to formulate the model? What scholars influenced the model author?s thinking?
2. What is the unique focus of the model?
3. Present an organized overview of the model and its major concepts, including definitions of key terms and major concepts. How are human beings defined and described? How is environment defined and described? How is health defined? How are wellness and illness differentiated? How is nursing defined? What is the goal of nursing? How is nursing practice described? What statements are made about the relations among the four metaparadigm concepts?
4. What theories have been generated from the model? What is the overall contribution of the model to the discipline of nursing? To what extent is the model actually used to guide nursing practice and research? Identify the strengths and weaknesses of the model for nursing practice.
5. Summarize at least one clinical or research study that has tested an aspect of the model or used this model as a conceptual framework.
6. Apply the domains of the model in the real world of nursing practice. Discuss theory-based nursing practice using the model for a chosen patient population. Include QSEN Competencies.
Discuss the application of the model in addressing the priority in patient care in the organizations and work environment, and the potential integration with useful leadership principles to improve patient outcomes.


I am attaching a list of potential references (the references cannot be older than 5 yrs)

(2012). AACN Synergy Model. Retrieved from http://nursing-theory.org/AACN-synergy-model.php

(2012). Retrieved from http://nurisingtheories.info/Virginia-henderson-theory-of-nursing-14-basic-needs

Alligood, M.R., & Mariner Tomey, A. (2010). Nursing Theorists of Historical Significance. In Y. Alexopulos, & H. Bays (Eds.), Nursing Theorists and Their Work (7th ed., p. 56). Maryland Heights, MO: Mosby Elsevier.

American Association of Critical Care Nurses. (2012). The AACN Synergy Model for Patient Care. Retrieved from http://www.aacn.org/WD/Certifications/Docs/SynergyModelforPatientCare.pdf

Four Basic Metapardigm Concepts in Nursing. (2012). Retrieved from http://www.ehow.com/list_6106429_four-basic-metaparadigm-concepts-nursing.html

Gomez, N. J. (Ed.). (2012). Advanced Practice in Nephrology Nursing. Nephrology Nursing: Scope and Standards of Practice. (7th ed., p.3). Pitman, New Jersey: American Nephrology Nurses? Association.

Hardin, S. R., & Kaplow, R. (2005). Introduction to the AACN Synergy Model for Patient Care. In Sullivan, K., & Sekerak, R. (Eds.), Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. (pp. 3-10). Sudbury, MA: Jones and Bartlett.

Kaplow, R., & Reed, K. D. (2008, January-February). The AACN Synergy Model for Patient Care: A Nursing Model as a Force of Magnetism. Nursing Economics, Vol. 26(1), 17-25.
Synergy Model. (2012). Retrieved from http://nursing-theory.org/articles/AACN-synergy-model.php  more

Perform a critique susing a critique standard followed by a summary statement that includes the strengths and weaknesses of the theory and how this theory is applicable to Advanced Nursing Practice roles such as Family Nurse Practitioners. Support the discussion with at least 10 reference 7-8 must be article from current professonal nursing theory databases.
1-level of theory is properly classified using an analysis system and rationale for the classifications. Appropriate criteria for determining internal and external valididy is identified and chosen.
2-entire theory/conceptual model is clearly critiqued in the narrative of the paper
3-organized and presented in an orderly fashion
4-each aspect of the criteria used for the critique are adequatelly addressed
5-strenghts and weaknesses of the theory/conceptual model are described completly
6-syntax, grammar and spelling structure are correct
7-margins,title page follow APA guidelines
references must be from 2006 to now

I WANT WRITER: MGMLEO for this paper please!!!

This is a paper for an RN (Registered Nurse) to BSN (Bachelor of Science in Nursing)program level. This paper is our final semester paper calle...d: "Professional Paper". The topic of this paper is " Application of the Nursing Process to Deliver Culturally Competent Care to African-American Population". You already wrote an excellent paper about this population that focused on their health care needs (I'm sending you the copy of what you previously wrote about it because we have to use some information from there and placed in this paper). This paper is going to be about them (African-American) but is going to analyze more topics about them. Please follow the rubric outline that I will send you by fax before you start writing this paper which especify the points that we have to discuss.
It needs to be written in APA Style (Times New Roman #12)and including: Abstract; Introduction; Citations (limit to a minimun direct quotations); Conclusions; and References (references should be a minimum of 5 and within the last 5 years-see directions sent it in fax). I'm also sending you the copy of chapter# 10 from my text book that we also have to use as a reference for this paper (Spector, Rachel E. (2008). Cultural Diversity in Health and Illness. (7th ed). New York: Pearson Prentice-Hall.
Thank you

LG

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You have learned about the abundance of research literature available to nurses and how to access it. Now you will tap into those resources to find research that is of relevance and value to your own ...practice.

In preparation for this assignment, complete the following:

****Select a topic Hourly rounding to eliminate constant patient use of call bells, reduce patient falls aand increase patient satisfaction

******Formulate a research question that is relevant to your nursing practice and is also of great interest to you.

Gather the literature

Locate FIVE or more full-text research articles that are relevant to your research question. Include at least one systematic review and one integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least three of these articles are available as full-text versions through Walden Universitys library resources.

Prepare to summarize and synthesize the literature

Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to discuss a minimum o fFIVE articles. You may wish to create a literature review summary table, as suggested in Chapter 6 of the Burns & Grove textbook, to help you organize your thoughts.
Column headings MUST include: Author, Type of Study (Qualitative vs. Quantitative), Sample, Design, Theoretic Framework, Data Collection Approach, and Key Findings.

ADDRESS the following:

Synthesize what the studies reveal about the current state of knowledge on this topic. Point out consistencies and contradictions in the literature, and offer possible explanations for inconsistencies.


Provide preliminary conclusions on whether the research provides strong evidence to support a change in practice, or whether further research is needed to adequately address your inquiry.
Note: You are invited to critically evaluate any aspect of these studies??"for example, a studys design, appropriateness of the theoretic framework, or data sampling methods. But it is understood that certain technical aspects of a standard review of literature have not yet been covered in this course. Your conclusion in this review should be preliminary for two reasons. First, five studies are almost certainly not enough to reflect the full range of knowledge on this particular question. Second, you are probably not yet familiar enough with research methodology to be able to evaluate all aspects of the studies.  more

The purpose of this assignment is to encourage students to:

1.Develop information literacy skills.
2.Effectively use APA format in creating a formal paper.
3.Develop clear concise w...riting skills.
4.Increase their knowledge and understanding of nursing informatics.

Directions:

Using that topic and the theoretical framework, write a paper which must be between 15 and 20 pages in narrative, not including the title page and reference page. The paper should follow APA format and include the following sections: abstract, introduction, background, body of the paper, implications and conclusions with future directions.

TOPIC

1. How do computer, information and informatics literacy interrelate and overlap?

The concept of computer, information and informatics literacy are interrelated and overlap as all three concepts are dependent upon on another in order to manipulate information. Computer literacy and information literacy are areas that each individual will have different skill sets in based on training and education. There are several questions with regards to computer literacy that will need to be answered for each individual such as:

At what educational level is the individual with the concept of understanding the functionality of a computer?
Does the individual understand how the use of the computer fits into the environment in which they are working?
Does the individual know how to use a computer?

After these questions have been answered, it will be easier to determine how to introduce the individual to the concept of the computer and its functionality.

Information literacy competencies deal with information retrieval knowledge and skills: knowing when there is a need for information; identifying the information needed to address a given problem or issue; finding the needed information and evaluating it; organizing the information; and using the information effectively to address the problem or issue. (ANA, 2008). Again this concept is dependent on the individuals training and education. At what educational level is the individual with regards to information retrieval? Does the individual know what they are trying to accomplish and what data do they need to accomplish the request?

As we can see the concepts of computer literacy and information literacy are now overlapping and interrelated as the individual will be unable to manipulate and retrieve information without the ability to utilize the computer effectively.

The concept of informatics literacy now is going to integrate computer literacy, information literacy and the concept of nursing. Again, are we dealing with a new graduate nurse or a seasoned nurse of 35 years? How much education has the nurse received regarding computer systems and information literacy? Is the nurse using computerized charting or are they still using paper charting? What is their role in the nursing function? Are they a nurse manager, staff nurse or a nurse educator? There are just a few concepts regarding nursing experience, however, they are quite relevant in anticipating what skill set the nurse may possess with regards to computer, information and informatics literacy. Informatics is conceptual the process of bringing computer literacy, information literacy and nursing together so the nursing function can collect data and make decisions more effectively and efficiently. However, the entire concept is dependent on education and the willingness to be educated.

2. How do the knowledge and skills in each are impact life in general as well as the practice of nursing?

The concept of knowledge and skills in any area will impact life for the individual. The more knowledge and skills one individual possess the more able that individual will be able to contribute more to society as a whole. Computers and computer technology is forever evolving and will continue to do so in the future. As mankind looks for more efficient and expedient ways to perform data and information manipulation, technology will have to be improving. The individuals in our society will have to maintain their education at a level that is conducive for them to perform in the career of their choice. Technology has now entered the career of nursing and is changing expediently by the day as the demands on the health care industry increase daily. Nurses are being introduced to computerized charting, databases, and concepts as simple as Excel spreadsheets. The key is to educate the individual so they can remain a functioning part of the organization. Nurses are now being required to do more and more each day and the introduction of technology is now making the ability to perform those responsibilities easier. Although, there are individuals who resist change and unfortunately they will be unable to remain in the current environment. It is key that all nurses remain flexible and receptive to change and education in technology.

All professions are in the same environment. Physicians are also experiencing a change in their career as technology continues to advance. It is causing them to change how the practice medicine. Education and mentorship is also needed for the physician so they can remain effective in their roles. If individuals decide not to educate themselves in the evolving technological world, they will no longer be considered marketable in the labor force. Change is inevitable and a good thing for society, but we must remember to remain flexible and open minded.

Reference: ANA, Nursing Informatics: Scope & Standard of Practice. 2008, p. 36

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Given:

The ability to acquire accurate and timely information enhances nursing practice and patient outcomes. Search engines and healthcare/nursing databases operate in different ways, and it... is necessary for healthcare professionals to understand how to access and efficiently use both public and professional resources. Because today the general public has greater access to electronic health information, healthcare professionals must be aware of the information their patients are accessing and be proficient at identifying credible sources.

It is also important for healthcare professionals to know how to use professional databases. Nursing practice needs to be based on evidence, and access to healthcare databases assists nurses in identifying best practices. The use of theories from other disciplines also expands the breadth and depth of knowledge available to guide healthcare delivery and nursing practice.

For this task:

For this task, use the Google or Google Scholar search engines to find one credible article on systems theory (original theorist Ludwig von Bertalanffy) and one credible article on diffusion of innovation theory (original theorist Everett Rogers).

Then use the CINAHL online database to find one credible article systems theory and one credible article on diffusion of innovation theory.

Note: See the Web Searching Tips Web link below for help in searching for articles.

Note: Also use the MSN Advanced Nursing Learning Community for tips from your course mentor on searching for these theories as well as a webinar on using key words in searching on these theories.

Task:

Using the four articles found in the given above, write an essay (suggested length of 3??"4 pages) relating systems and diffusion of innovation theories to healthcare delivery and nursing practice. In your essay, be sure to do the following:

A. Discuss the relationship between systems theory and healthcare delivery in the U.S.

B. Discuss the relationship between diffusion of innovation theory and the change process within healthcare delivery in the U.S.

C. Discuss the relationship between systems theory and current nursing practice.

D. Discuss the relationship between diffusion of innovation theory and current nursing practice.

E. Summarize the search strategies you used to acquire information on the specified theories.

F. Include an annotated bibliography (in addition to a complete APA reference list from part I) of the four theory resources you used for your discussion.

Note: An annotated bibliography is a list to which you add (in your own words) other relevant information and comments about the book or article for future reference. For this assignment, your annotations should include Author, Title, Publication date, date retrieved, and URL in APA format plus a summary of the article, an assessment of the article, and your reflection of the value of the article. See the Web links below for more information on annotated bibliographies.

G. If you use sources, include all in-text citations and references in APA format.  more

THIS IS A RESEARCH TOPIC OF INTEREST AND FOR ME IT WILL BE DRG SYSTEM AND ITS IMPLICATION ON NURSING ADMINISTRATION. THIS SHOULD BE A 8 -10 PAGE RESEARCH PAPER ( EXCLUDING TITLE PAGE, MODELS, AND REFERENCES), USING APA FORMAT. PAPERS SHOULD BE RESEARCH/EVIDENCE BASED AND MUST INCLUDE A MINIMUM OF 5 RESEARCH BASED ARTICLES FROM PEER REVIEW JOURNALS. PLEASE KURT LEWIN'S CHANGE THEORY IN THIS PAPER. PLEASE, PLEASE, PLEASE, PAY SPECIAL ATTENTION TO THE APA FORMAT, THIS PROFESSOR IS VERY, VERY PARTICULAR.

Marking criteria:

1. Introduction (10/60)
? Budget presentation on appropriate template (3)
? Budget period clearly stated(2)
? Describes setting in which budget is to be applied ...(5)
2 Budget (45/60)
? Budget is detailed and correct (30)
? Alternative options using opportunity cost analysis are discussed (10)
? Document shows sources of data used for forecasting expenditure (5)
3 Presentation (5/60)
? Uses correct grammer, spelling & punctuation
? Correct application of APA used for in-text citation and for the reference list

Details
Develop a budget for a project, ward, unit or service using a budget template (you may use one from your own organization), in an environment of scarce resources. Consider alternative options using opportunity cost analysis. Annotate the document to show the sources of data used for forecasting the expenditure for the budget period.

I am working in a rehabilitation hospital (Shatin Hospital), which is run by the Hospital Authority, the main provider of public health care in Hong Kong. There is increasing of hospital service demand in HK, due to aging population, lack of hospital bed, shortage of manpower etc. Moreover, the rehabilitation hospital works with a regional acute hospital as a partner in the same territory. The patients will be transferred from the acute hospital and the acute hospital always asks for more bed from my hospital due to their bed crisis. However, Shatin hospital also faces the insufficient manpower and one doctor resigned recently. The opportunity cost for add two extra beds to each wards may not be succed. Therefore, I would like to propose the project to reform one pair of medical and geriatric wards to nurse-led wards.

Background:
Each ward: 25 beds. There are 5 female wards and 5 male wards in M&G department. Each pair of wards has one ward manager, each wards has one doctor, one advance practice nurse and 9 nurses (RN & EN). The aim of the nurse-led ward to manage chronic health problem, chronic wound care, feeding management and end-of-life care.
Financial implications?
Salary of doctor: $56,440/month, registered nurse: $26,960 and 43,383,
The expenditure of one acute bed: $4,680 per day, the fee of A&E is $990
Due to front line nurses are not confident on nurse round and service change, the training sessions need to provide for nurses.
The cost for manpower is same, and it is needed to buy more heel protectors and dressing materials, because there are more patients are bedbound, and the patients who need more wound care.
.
Different headings For the assignment( suggested by lecturer)
1) Proposal title
? Hospital/department/ward/clinic
? Project description
? Location(s) of works, if applicable
2) Justifications for change
a)Justification such as(the following list is not exhaustive)
? What is the service need- and why?
? What are the issues that impact on this need: issues like population growth, change in demographics, in social characteristics, in technology, in public expectation and others may be explored
? What is wrong in the existing practice that needs intervention?
? What changes need to be managed to make the service function well?
? What may happen if the proposal is not implemented?
? How will the proposal change the situation?
? What government policy issues does the proposal address?
? What are the dey anticipated benefits?
? Who benefits? How? When?
? How will the service be managed?
? How are the stakeholders engaged with the proposal?
? Have other agencies that are involved agreed to the proposal?
? The key risks associated with the current proposal. What is the impact of these risks?
? Include statistics, if available
b) Targets and performance indicator
? Please express the above in a specific, measurable, achievable, relevant and timely manner, e.g. KPI
c) Implications if the initiative is not implemented in the coming year and the
years following
d) what are the alternatives you have considered?
e) alternatives explored to re-deploy existing resources
3) Financial implications
A. Capital costs, e.g.
? construction, refurbishment, alteration, e.g. scope of works, work programme, cash flow,
? engineering equipment/medical equipment/furniture (F&E)
- F&E descriptions and quantities
- Justifications, eg consequences of the non-availability of the proposed equipment, mission critical to clinical service
- Medical equipment/Furniture
If new, please provide evidence-based supporting information e.g. an extract of a professional journal.
If additional, please specify the existing equipment quantities, their annual utilization rates, patient caseload per year, any backup arrangements, etc.
Cash flow.
B. Recurrent costs
- Staff training costs, if any
- Cash flow
- Other consumable costs,
C. Fees and income, e.g. suggest fees to the management
D. Appendices
Please include as appendices all calculations, tables and other evidence needed to support your proposal  more

I preferred writer girl
Please just answer the questions straight in acceding order.

1)Discuss the role of the federal, state, and local legislation related to health care?(100)

2) How does the federal, state, and local legislation compare in similarities and differences? Provide two examples. (100)

3) Discuss the steps for using the nursing profession for political strategy.(200 words)

4) How has nursing become more involved and able to influence policy development? Provide two examples.(200 words)

5) How do nurses become involved in the political arena? (100)

6) How is Illinois nursing association organization involved in politics and involved in changing health care laws? (125)

PAPER GUIDELINES
The objective of this assignment is for each student to demonstrate the level of mastery they have achieved as a result of the MAOL program of study. Demonstrating mastery goes be...yond providing solutions or observations and must clearly illustrate your ability to explain theories in the context of your philosophy and personal definition of leadership. The paper should say something complete about your understanding of leadership and how it applies to your personal experience, your work and to the larger world,
To demonstrate their mastery, students will complete a comprehensive paper that is a minimum of 40 pages in length (12 point Times New Roman font, standard 1 margins, does not include title or reference pages) with a reference list of at least twenty-five independent entries (this standard represents and average of 3-5 sources for each of the six core courses covered in the Capstone Seminar. APA 6th edition guidelines will apply.
The following outline should be used to organize your paper using appropriate APA headers and sub-headers in each chapter. Be sure to include a properly formatted title page and reference list with all sources cited properly in the body of each chapter:
Chapter I. Thoughts on Leadership: This chapter provides an introduction to your paper. In it you describe your thoughts on leadership in terms of your definition, management and leadership and what you think leaders do. Include an opening statement to the paper before going into the chapter sections.
1. Definition. Using the literature as support, provide your definition of leadership. Include a description of the components included in that definition. How does your definition compare and contrast with various authors?
2. Management and Leadership. Drawing from the literature, compare and contrast management and leadership.
3. What Leaders Do. This is a section where you pull your thoughts on leadership into a framework or model of some type. For example, you might use Kouzes and Posner Leadership Practices, Robert Greenleafs Servant Leadership, Blakes and Moutons Managerial Grid, Situational, Transformational or any of the many other leadership theories studied in the MAOL program. You are encouraged to synthesize multiple theories to reflect your individual insights about what leaders do. Make sure your personal model/framework reflects your definition.
4. Conclusion. Reinforce the key points of this chapter.
Chapter II. Leadership Theory: This chapter allows you to demonstrate your knowledge of a variety of organizational leadership theories, theorists, concepts and models and relate them to your personal understanding and definition of leadership.
1. Leadership Theory. From the following list, describe and analyze three theories thoroughly, i.e., what the theory proposes, in what context, elements of the theory, how it supports effective leadership in todays organizational settings, potential limitations. Discuss how each of the three selected theories contributes to your philosophy of leadership. Select from:
a. Trait theory
b. Blake and Moutons Leadership Grid
c. Situational Leadership
d. Fiedlers Contingency Theory
e. Path-Goal Theory
f. Leader Member Exchange (LMX) Theory
g. Transformational Leadership
h. Servant Leadership
i. Authentic Leadership
j. Followership
2. Conclusion. Reinforce the key points of this chapter. Link back to your leadership definition from Chapter 1.
Chapter III. Self as Leader: This chapter contains elements of leadership that are directly related to your leadership practice.
1. Core Values. List and describe the main core values that guide your leadership practice. How do these values support effective leadership?
2. Ethical Framework. Using literature (from 601 and other courses) as support, describe your ethical decision making framework. For example, faced with an ethical leadership situation, what would you do and why? How do your core values fit within this framework?
3. Organizational Change Framework. Using at least two theories from literature (i.e., from 615 and other courses) as support, describe an organizational change strategy/process that guides your leadership philosophy and practice, and supports effective leadership.
4. Self Assessment. Using a minimum of three of the several assessments you had access to while in the MAOL program, describe yourself as a leader within the context of these assessments, i.e., Leadership Practices Inventory (LPI), DiSC, Parker Team Player, etc.
5. Conclusion. Reinforce the key points of this chapter. Link back to your leadership definition in Chapter 1.
Chapter IV. Leadership in Context: In this chapter, you provide examples of theories and concepts as applied to a real life situation drawn from your personal/professional leadership experience.
1. Description of Situation. Brief description of the event what happened.
2. Analysis of Situation
a. Systems Perspective (OLCU 602)
b. Organizational Behavior Perspective (OLCU 613)
c. Organizational Development Perspective (OLCU 615)
3. Conclusion. Describe how this application fits within and supports your leadership philosophy (as described in Chapters 1-3).
Chapter V. Final Thoughts. This chapter provides a summary/distillation of what you have learned and what is of most importance to you as a leader.
1. Essence or Major Cornerstones. Based on what youve written, describe the essence or major cornerstones of your leadership philosophy.
2. Evolution of Thinking. How has your thinking changed since you have been on this learning journey?
3. Conclusion. Make a final summary statement about the paper.
References. A list of references in APA 6th edition format.
Instructions for Comprehensive Paper
In general, the comprehensive paper should integrate and connect specific, explicit references to material covered in your courses and your own outside reading, but especially material from the core Organizational Leadership courses required of all students: OLCU 600, OLCU 601, OLCU 602, OLCU 613, OLCU 614 and OLCU 615.
Every effort should be made to use original sources. Most textbooks cite original sources but are not, themselves, an original source of information. Edited books are compilations of original works by an editing author. The purpose is to understand what the theorist is saying, best done through a review of their work and not someone elses interpretation. Combine books and journal articles, as well as a sprinkling of other sources (i.e., appropriate websites).
As this is your capstone course, this paper will bring together the major concepts, theories, and ideas that shape your thinking on organizational leadership as you exit the program. This paper provides you with the opportunity to return to each of the courses you took and revisit the key learning from those courses. Additionally, it allows you to visit authors to whom you were introduced for more in-depth understanding of their work. Finally, it allows you to distill the most meaningful concepts into a comprehensive statement of who you are as a leader.
OLCU 681 presents some extreme challenges in self-leadership. The following milestones are meant to guide you through the writing of the paper. Keep in mind that the cleaner the draft, the easier it is for the reader to provide feedback on content and help you develop your demonstration of mastery. If the reader gets caught up on sentence structure and syntax, spelling and grammatical errors, he/she will not be able to get to the essence of your story please proof-read your drafts and final paper carefully prior to submitting them.  more

It is the director's job to ensure that the unit not only follows the facility's safety policies and procedures, but also complies with government health care regulations. Keeping costs down and bring...ing productivity levels up are a significant part of a critical care director's job.

Nursing EmploymentNursing Career Function
A director of critical care develops programs and processes targeted at improving the speed and quality of health care services. In addition to increasing efficiencies and reducing costs, directors of critical care evaluate staff performance and create systems for measuring departmental and practice goals. For example, directors of critical care act as a liaison between patients and nursing staff by responding to patient and visitor concerns. These professionals work closely with human resources, finance, IT and communications to promote programs and adequately manage hospital units and resources.

Education
Employers prefer candidates with a bachelor's or master's degree. College and university majors that help prepare students for a career as a director in a hospital or other health care setting include health information management and health administration. Hospitals and health care facilities often ask for a registered nurse (RN) license, which requires a degree in nursing and a license through your state's board of nursing.

Skills
Strong planning, problem-solving and interpersonal communication skills are needed as a critical services director. The ability to quickly adapt to changing environments and make decisions under pressure is helpful in stressful and hectic work environments. In addition, directors should be effective leaders and should be able to supervise, train and review the work of other staff members. Most employers require that candidates have an RN license and previous work experience in health care management.

Potential
The Bureau of Labor Statistics (BLS) projects the health management field to grow by 16 percent through 2016. Factors contributing to this growth include pressures to improve the quality of health care services, curb insurance costs and comply with stringent transparency laws in the industry. In addition, the BLS states that hospitals will be the largest employer of health care executives during this time period. However, health care management companies, outpatient care facilities and private practices also hire health services managers to handle tasks such as recruiting and organizational management

Job Description

DIRECTOR OF NURSING III, Critical Care, FT(Job Number: 118447)

Description

24 hr. accountability for ICU, IMCU and Telemetry units.

Qualifications

? BA/BS degree required, masters degree in nursing, business or healthcare required or currently enrolled in Master's program.
? Current Illinois RN license with previous leadership exp. in a critical care unit.
? Minimum 3 years experience in a hospital operations/leadership
? National certification in specialty field preferred.
? Current Illinois RN license.
? Knowledge of appropriate regulatory agency standards to include but not limited to JCAHO, OSHA and IDPH.
? Ability to implement teaching/learning strategies and facilitate group dynamics.
? Excellent customer service and interpersonal skills required.
? Strong leadership, team development, business management, strong written and oral communication skills.
? Tact, positive business demeanor and the ability to establish and maintain rapport with physicians and hospital personnel.
? Ability to communicate effectively in English, both verbally and in writing.
? Ability to use various instruments, machines, tools, equipment and work aids as necessary to perform job duties. EMR exp. a plus

I will also be sending my Resume and more material.




Read more: Job Description for Director of Critical Care | eHow.com http://www.ehow.com/about_7506682_job-description-director-critical-care.html#ixzz1gm0gL4yM  more

Application: Design Considerations and Workarounds
When nurse informaticists are tasked with identifying the most appropriate technology to meet a specific need within a health care setting, ther...e are many questions that must be asked.
Consider the following scenario:
Riverdale Hospital has come under recent scrutiny for their medication procedures. Many times, paper medication records are not up to date or have been misplaced. As a result, patients have increasingly received their medications at the wrong times. Though each nurse is performing to the best of his or her ability, the fast pace of the hospital has caused some to ineffectively manage patient records.
The lead nurse informaticist, Nancy, has decided that a bar code scanner could help streamline the documentation process while also improving patient quality and safety. Nancy knows that when selecting a bar coding system she must not only examine the hardware and software of the system but also consider the various human factors that can positively and/or negatively affect the outcomes of the system implementation. As such, Nancy asked three of the most reputable bar code vendors to bring sample systems to Riverdale Hospital.
In evaluating each system, Nancy role plays the process of scanning a patient?s bar code. She rolls the coding cart into the room to begin her mock demonstration. First, Nancy scans her identification card to gain access to the medication screen. To scan the patient?s bar code identifier, Nancy then pulls the medication cart to the patient so that the attached scanner reaches the bar code on the patient?s wristband. When the scan is complete, the computer displays a screen that houses the patient?s personal information. By navigating the screens, Nancy finds that she can use the computer to track medication administration. In addition, Nancy is able to view applicable vitals and medication history. As Nancy continues to examine this system, she reflects on the other hardware and software facets she should be sure to consider. She also thinks about how human factors will affect this and other vendor systems.
In this Assignment, you consider how hardware, software, and human factors can impact the implementation of an informatics system.
To prepare:
Review Chapter 22, ?The Role of Technology in the Medication-Use Process,? in the course text, Essentials of Nursing Informatics. When examining computerized prescriber order entry (CPOE) systems and bar code-enabled technologies, what hardware, software, and human factors did the authors identify?
Consider how each of these factors can negatively impact patient safety and quality of care.
How might these factors translate to the usability, implementation, and outcomes of other informatics technologies?

When planning and selecting a new informatics system, what steps should informaticists take to ensure the system will address the needs of their health care setting? In addition, how can informatics leaders encourage all nurses to commit to using a new technology?
To complete:

Part 1: Design Considerations
Identify two major design considerations associated with each of the following: hardware, software, human factors. (6 considerations in total)
Describe why informaticists should play close attention to each of these considerations when evaluating an informatics technology. In your description, include the potential dangers each of these pose to patient safety and quality of care.
Part 2: Employee Workarounds
Even with a carefully thought out design and implementation, nurses and other health care employees may adopt workarounds. With this reality in mind:
What benefits and/or consequences do you associate with workarounds?
When selecting an informatics technology, would you opt to purchase a system that mitigates the opportunity for workarounds; or do you believe that workarounds are sometimes necessary? Justify your response.
Note: Your responses should focus on informatics technologies in general, not just bar code scanners as portrayed in the scenario. You may, however, use specific examples such as bar code scanners and other informatics technologies to justify your responses.  more

Objective: Develop an oral presentation on a given nursing, healthcare, or organizational issue suitable for delivery to specified diverse audiences.

Objective: Produce a cogent and persuasiv...e written piece to address a specified nursing, healthcare, or organizational issue appropriate for a given audience.


--------------------------------------------------------------------------------


Introduction:

?Magnet status is an award given by the American Nurses? Credentialing Center (ANCC) to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing? (Center for Nursing Advocacy, 2008, ? 1). As the chief nursing officer (CNO) of a large regional hospital, you and your team have decided that it would be beneficial for your hospital to obtain this status. However, it will take the involvement of all the nursing staff to meet the requirements. You plan to give a presentation to the whole nursing staff and prepare a brief white paper that gives an overview of what Magnet status is and how it is obtained.

Task:

A. Develop a multimedia presentation (e.g., using PowerPoint) (suggested length of 5 slides) on the Magnet process for a large group of nurses who all speak English in which you:
1. Define Magnet status.
2. Discuss the steps necessary to attain Magnet status.
3. Describe principles that are practiced in a Magnet hospital.
4. Discuss how attaining Magnet status could change hospital nurses? routines in terms of time and effort.
5. Explain the benefits of Magnet status.

B. Write a persuasive white paper (suggested length of 3 pages) on Magnet status to be sent to all nursing staff in which you do the following:
1. Discuss the research basis for hospitals attempting to attain Magnet status.

Note: You should include research literature that describes how the process of Magnet status came about and examples of results of hospital studies that moved to Magnet status to support the issue with nurses in this hospital.

2. Discuss the principles the ANCC adheres to when considering a hospital for Magnet Certification.
3. Explain why it is beneficial for a hospital to attain Magnet status.

C. When you use sources, include all in-text citations and references in APA format.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly.
Reference List:

The Center for Nursing Advocacy. (January 2008). What is Magnet status and how?s that whole thing going? Accessed from http://www.nursingadvocacy.org/faq/magnet.html  more

Essay is degree level.
Two selected research papers appropriate to your working area (which is critical care, nursing high dependancey and coronary care patients)should focus on a comparative crit...ical review. The chosen articles are concerned with increasing hand washing compliance (to follow by fax)both are carried out by the same researchers at different times and locations, one being in the US and the other in the UK.
Dose this affect the resrach? Articels included in appendix.
The essay must contain evidence that the writer has knowledge of quantitative and qualitative approaches to researh. Research designs, clinical trials, experimental and quasiexperimental approaches, surveys, ethnographic and phenomenological studies. Data collection and analysis. Validity, reliability and feasibility, trustworthiness and creadibility. Using research in practice, evidenced practice, audit, quality assurance and clinical governance. Practice development research. Ethical issues and procedures in nursing research.
There should be evidence to a critical approach to the review, supported by wider reading from relevent nursing / medical journals and nursing texts books. Reccomendations and reflective practice should be evident. From your list of features for presentation i have chosen.
Tital page
preface
abstract
synopsis
statement of the problem
rational
data collection
subject population
literature review
methology
statistical
analysis
questionnaires
results
discussion
conclusion
recommendations
bibliography, references, works cited
appendix

There are faxes for this order.  more

Please use the directions below to write a 2 page paper and please include a reference page.

Health Literacy
In order to effectively manage their own health, individuals need to have comp...etencies in two areas??"basic literacy and basic health literacy. What is the difference? Basic literacy refers to the ability to read, even simple language. Health literacy is defined as, the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (National Coalition for Literacy, 2009). Unfortunately, according to a Department of Education report on health literacy, only 12% of adults aged 16 and older are considered to have a proficient level of health literacy (U.S. Department of Education, 2006). Acquiring health literacy skills has become more complicated with the explosion of online health information, some credible and some misleading.
In this Discussion, you focus on how to help individuals find credible information on the Internet and develop strategies nurses can use to increase the health literacy of their patients.
To prepare:
Think about the nurses role in improving the health literacy of patients.
Consider the many ways patients access health information, including blogs, social media, patient portals, websites, etc.
Reflect on experiences you have had with patients who self-diagnose using online medical sources.
Using the Internet, the Walden Library, or other trustworthy sources, identify a resource that you could introduce to patients to help them evaluate the credibility of health information found online.
What are some strategies you could employ to improve the health literacy of patients?
Post on or before Day 3 your assessment of the nurses role in improving the health literacy of patients. Then, identify the resource you would recommend to patients for evaluating online health information and why it would be beneficial. Describe additional strategies for assisting patients in becoming informed consumers of online health information.





Quick Guide?to Health Literacy
? Fact Sheets Strategies
@

Resources






U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion




Quick Guide to Health Literacy
Who is the Quick Guide for?
The Quick Guide to Health Literacy is for government employees, grantees and contractors, and community partners working in healthcare and public health fields.
It contains:
A basic overview of key health literacy concepts
Techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy
Examples of health literacy best practices
Suggestions for addressing health literacy in your organization ?These tools can be applied to healthcare delivery, policy, administration, communication, and education activities aimed at the public. They?also can be incorporated into mission, planning, and evaluation at the organizational level. ?If you are new to health literacy, the Quick Guide will give you the information you need to become an effective advocate for improved health literacy. If you are already familiar with the topic, you will find user-friendly, action-oriented materials that can be easily referenced, reproduced, and shared with colleagues. ?How to use the Quick Guide ?The guide is designed to be a quick and easy reference, filled with facts, definitions, helpful tips, checklists, and resources you can use on the job. You can print out the materials and keep them at your desk, share them with colleagues, or bookmark this Web page on your computer. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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About This Guide













About This Guide
The Quick Guide is divided into the following three sections:
1. The first section contains fact sheets on health literacy, including a basic overview of key concepts and definitions and information on health literacy and health outcomes.
2. The second section contains practical strategies for improving health literacy. These include: ? Improve the usability of health information? Improve the usability of health services? Build knowledge to improve decisionmaking? Advocate for health literacy in your organization
3. The final section contains a list of resources, including Web sites, research studies, and additional publications on health literacy.

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Fact Sheet

?
Health Literacy Basics

What is health literacy?
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.1
Health literacy is dependent on individual and systemic factors:
Communication skills of lay persons and professionals
Lay and professional knowledge of health topics
Culture
Demands of the healthcare and public health systems
Demands of the situation/context ?Health literacy affects peoples ability to:
Navigate the healthcare system, including filling out complex forms and locating providers and services
Share personal information, such as health history, with providers
Engage in self-care and chronic-disease management
Understand mathematical concepts such as probability and risk ?Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles. ?In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge?or have misinformation about the body as well as the nature and causes?of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

Health Literacy Basics
Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.
What is literacy?
Literacy can be defined as a persons ability to read, write, speak, and compute and solve problems at levels necessary to:
Function on the job and in society
Achieve ones goals
Develop ones knowledge and potential2 ?The term illiteracy means being unable to read or write. A person who has limited or low literacy skills is not illiterate. ?What is plain language? ?Plain language is a strategy for making written and oral information easier to understand. It is one important tool for improving health literacy. ?Plain language is communication that users can understand the first time they read or hear it. With reasonable time and effort, a plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding.3 ?Key elements of plain language include:
Organizing your information so that the most important points come first
Breaking complex information into understandable chunks
Using simple language and defining technical terms
Using the active voice ?Language that is plain to one set of readers may not be plain to others.3 It is critical to know your audience and have them test your materials before, during, and after they are developed.

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Health Literacy Basics
Speaking plainly is just as important as writing plainly. Many plain language techniques apply to verbal messages, such as avoiding jargon and explining technical or medical terms.
What is cultural and linguistic competency?
Culture affects how people communicate, understand, and respond?to health information. Cultural and linguistic competency of health professionals can contribute to health literacy. Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome.4 Competency includes communicating in a manner that is linguistically and culturally appropriate.5
Healthcare professionals have their own culture and language. Many adopt the culture of medicine and the language of their specialty as a result of their training and work environment. This can affect how health professionals communicate with the public.
For many individuals with limited English proficiency (LEP), the inability to communicate in English is the primary barrier to accessing health information and services. Health information for people with LEP needs to be communicated plainly in their primary language, using words and examples that make the information understandable.
Why is health literacy important?
Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease. Fourteen percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.6 Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.

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Health Literacy Basics
Who is at risk?
Populations most likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English, and people with compromised health status.7 Education, language, culture, access to resources, and age are all factors that affect a persons health literacy skills.
Who is responsible for improving health literacy?
The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Americans. We must engage in skill building with healthcare consumers and health professionals. Adult educators can be productive partners in reaching adults with limited literacy skills.
1 U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington,?DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
2 Public Law 102-73. The National Literacy Act of 1991.
3 Plain Language Action and Information Network. What is Plain Language? Available at www. plainlanguage.gov. Accessed on October 21, 2005.
4 U.S. Department of Health and Human Services. 2001. National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, DC: Office of Minority Health.
5 McKinney J, Kurtz-Rossi S. 2000. Culture, Health, and Literacy: A Guide to Health Education Materials for Adults With Limited English Skills. Boston, MA: World Education.
6 National Center for Education Statistics. 2006. The Health Literacy of Americas Adults: Results From the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education.
7 Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.


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Fact Sheet

?
Health Literacy and Health Outcomes

Choosing a healthy lifestyle, knowing how to seek medical care, and taking advantage of preventive measures require that people understand and use health information. The ability to obtain, process, and understand health information needed to make informed health decisions is known
as health literacy.
Given the complexity of the healthcare system, it is not surprising that limited health literacy is associated with poor health. This fact sheet summarizes key research study findings on the relationship between health literacy and health outcomes.
Use of preventive services
According to research studies, persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots.1 When compared to?those with adequate health literacy skills, studies have shown that patients with limited health literacy skills enter the healthcare system when they are sicker.2
Knowledge about medical conditions and treatment
Persons with limited health literacy skills are more likely to have chronic conditions and are less able to manage them effectively. Studies have found that patients with high blood pressure,3 diabetes,3-5 asthma,6 or HIV/ AIDS7-9 who have limited health literacy skills have less knowledge of their illness and its management.
Rates of hospitalization
Limited health literacy skills are associated with an increase in preventable hospital visits and admissions.10-13 Studies have demonstrated a higher rate of hospitalization and use of emergency services among patients with limited literacy skills.12
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

Health Literacy and Health Outcomes
Health status
Studies demonstrate that persons with limited health literacy skills are significantly more likely than persons with adequate health literacy skills to report their health as poor.10,12,14
Healthcare costs
Persons with limited health literacy skills make greater use of services designed to treat complications of disease and less use of services?designed to prevent complications.1,11-13 Studies demonstrate a higher rate?of hospitalization and use of emergency services among patients with limited health literacy skills.10-13 This higher use is associated with higher healthcare costs.15,16
Stigma and shame
Low health literacy may also have negative psychological effects. One study found that those with limited health literacy skills reported a sense of shame about their skill level.17 As a result, they may hide reading or vocabulary difficulties to maintain their dignity.18

About the research
In producing this fact sheet, the Office of Disease Prevention and Health Promotion relied extensively on both the Institute of Medicine (2004) and the Agency for Healthcare Research and Quality (2004) reports, which include comprehensive reviews of the literature on health literacy and health outcomes. For your convenience, the original studies are cited.
In these studies, health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM) or Test of Functional Health Literacy in Adults (TOFHLA). Both the IOM and AHRQ reports conclude that REALM and TOFHLA are assessments of reading ability, and as such are inadequate measures of health literacy.
Persons with limited health literacy were compared to those?with adequate health literacy. Although an increasing number of studies have linked limited health literacy to poor health, the causal relationship between health literacy and health is unknown.

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Health Literacy and Health Outcomes

1 Scott TL, Gazmararian JA, Williams MV, Baker DW. 2002. Health literacy and preventive health cre use among Medicare enrollees in a managed care organization. Medical Care. 40(5): 395-404.
2 Bennet CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, Seday MA, Sartor O. 1998. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. Journal of Clinical Oncology. 16(9): 3101-3104.
3 Williams MV, Baker DW, Parker RM, Nurss JR. 1998. Relationship of functional health literacy to patients knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine. 158(2): 166-172.
4 Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan G, Bindman AB. 2002. Association of health literacy with diabetes outcomes. Journal of the American Medical Association. 288(4): 475-482.
5 Schillinger D, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90.
6 Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. 1998. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 114(4): 1008-1015.
7 Kalichman SC, Ramachandran BB, Catz SP. 1999. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine. 14(5): 267-273.
8 Kalichman SC, Rompa D. 2000. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 25(4): 337-344.
9 Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. 2000. Health literacy and health-related knowledge among persons living with HIV/AIDS. American Journal of Preventive Medicine. 18(4): 325-331.
10 Baker DW, Parker RM, Williams MV, Clark WS. 1997. The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health. 87(6): 1027- 1030.
11 Baker DW, Parker RM, Williams MV, Clark WS. 1998. Health literacy and the risk of hospital admission. Journal of General Internal Medicine. 13(12): 791-798.
12 Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J. 2002. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health. 92(8): 1278-1283.
13 Gordon MM, Hampson R, Capell HA, Madhok R. 2002. Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy (REALM) score. Rheumatology. 41(7): 750-754.

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Health Literacy and Health Outcomes
14 National Center for Education Statistics. 2006. The Health Literacy of Americas Adults: Results From the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education.
15 Friedland R. 1998. New estimates of the high costs of inadequate health literacy. In: Proceedings of Pfizer Conference Promoting Health Literacy: A Call to Action. October 7-8, 1998, Washington, DC: Pfizer, Inc., 6-10.
16 Howard DH, Gazmararian J, Parker RM. 2005. The impact of low health literacy on the medical costs of Medicare managed care enrollees. The American Journal of Medicine. 118: 371-377.
17 Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. 1996. Shame and health literacy: The unspoken connection. Patient Education and Counseling. 27(1): 33-39.
18 Baker DW, Parker MR, Williams MV, Ptikin K, Parikh NS, Coates W, Imara M. 1996. The health care experience of patients with low literacy. Archives of Family Medicine. 5(6): 329-334.

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Strategies

Improve the Usability of Health Information

Consider the following questions as you develop and deliver health information:
Is the information appropriate for the users?
Is the information easy to use?
Are you speaking clearly and listening carefully? ?Is the information appropriate for the users? ?The information below is a summary of best practices in health communication that can aid in improving health literacy. Many of these concepts are discussed in depth in the National Cancer Institutes Making Health Communication Programs Work (a.k.a. the Pink Book) and in the Centers for Disease Control and Preventions tool CDCynergy. ?Identify the intended users of the health information and services. ?Identify the intended users based?on epidemiology (who is affected?), demographics, behavior, culture, and attitude. This is known as segmentation. ?Be sure the materials and messages reflect the age, social and cultural diversity, language, and literacy skills of the intended users. Consider economic contexts, access to services, and life experiences.1 ?Beyond demographics, culture, and?language, consider the communication capacities of the intended users. Approximately one in six Americans has a communication disorder or difference resulting in unique challenges.2 These individuals will require communication strategies that are tailored to their needs and abilities. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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Attention:
These principles also apply if you are using existing resources. Be sure to select materials that are accurate and appropriate for the intended users.










HEALTH LITERACY

Improve the Usability of Health Information
Evaluate users understanding before, during, and after the introduction of information and services.
Talk to members of the intended user group before you design your communication intervention to determine what information they need to know and how they will use it. Then, pretest messages and services to get feedback.
Test your messages again, after they have been introduced, to assess effectiveness. Refine content when necessary. Use a post-test to evaluate the effectiveness of the information.
Acknowledge cultural differences and practice respect.
Cultural factors include race, ethnicity, language, nationality, religion, age, gender, sexual orientation, income level, and occupation. Some examples of attitudes and values that are interrelated with culture include:
Accepted roles of men and women
Value of traditional medicine versus Western medicine
Favorite and forbidden foods
Manner of dress
Body language, particularly whether touching or proximity is permitted in specific situations1 ?Ensure that health information is relevant to the intended users social and cultural contexts. ?Is the information easy to use? ?Limit the number of messages, use plain language, and focus on action. _,_ ?Keep it simple. The number of messages will depend on the information needs of the intended users. As a general guideline, use no more than four main messages. Give the user specific actions and recommendations. Clearly state the actions you want the person to take. Focus on behavior rather than the underlying medical principles.

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Improve the Usability of Health Information
Use familiar language and an active voice. Avoid long or run-on sentences. Organize similar information into several smaller groups.
Many of the same plain language techniques that make the written word understandable also work with verbal messages, such as avoiding jargon and using everyday examples to explain technical or medical terms the first time they are used.
For more information on plain language, visit www.plainlanguage.gov. Supplement instructions with visuals.
Individual learning styles differ. For many people, visuals are a preferred style, especially for technical information.3 Simple line drawings can help users understand complicated or abstract medical concepts. Make sure to place images in context. When illustrating internal body parts, for example, include the outside of the body.
Use visuals that help convey your message. (Dont just decorate, as this will distract users.) Make visuals culturally relevant and use images that are familiar to your audience. Show the main message on the front of the materials.
Mae written communication look easy to read._-5
Use at least 12-point font. Avoid using all capital letters, italics, and fancy script. Keep line length between 40 and 50 characters. Use headings and bullets to break up text. Be sure to leave plenty of white space around the margins and between sections.
Improve the usability of information on the Internet.
Studies show that people cannot find the information they seek on Web sites about 60 percent of the time.6 This percentage may be significantly higher for persons with limited literacy skills.

For print communication, use captions or cues to point out key information.3

Remember
Refer to the Office of Management and Budget (OMB) Policies for Federal Public Websites for further guidance.

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Improve the Usability of Health Information
Many of the elements that improve written and oral communication can be applied to online information, including using plain language, large font, white space, and simple graphics.7 Other elements are specific to the Internet. These include:
Enhancing text with video or audio files
Including interactive features and personalized content
Using uniform navigation
Organizing information to minimize searching and scrolling
Giving users the option to navigate from simple to complex information ?A critical way to make information on the Internet more accessible to persons with limited literacy and health literacy skills is to apply user- centered design principles and conduct usability testing.

Usability is a measure of several factors that affect a users experience interacting with a product, such as a Web page. These factors include:
How fast can the user learn how to use the site?
How fast can the user accomplish tasks?
Can the user remember how to use the site the next time he or she visits?
How often do users make mistakes?
How much does the user like the site? ?To learn more about usability, visit www.usability.gov.

Are you speaking clearly and listening carefully?
Ask open-ended questions.
Ask questions using the words what or how instead of those that?can be answered with yes or no. For example, Tell me about your problem. What may have caused it? 3 Try asking What questions do you have? instead of Do you have any questions?
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Improve the Usability of Health Information
Use a medically trained interpreter.
Plain English will not necessarily help individuals who do not speak English as their primary language and who have limited ability to speak or understand English. To better ensure understanding, health information for people?with limited English proficiency needs to be communicated plainly in their primary language, using words and examples that make the information relevant to their potentially different cultural norms and values.
Check for understanding.
The teach-back method is a technique that healthcare providers and consumers can use to enhance communication with each other. The person receiving the health information is asked to restate it in their own words??"not just repeat it??"to ensure that the message is understood and remembered. When understanding is not accurate or complete, the sender repeats the process until the receiver is able to restate the information needed.8 Consumers also can be asked to act out a medication regimen.3

Tip: Checking for understanding
Summarize what the patient needs to do. Consider using a handout or written brochure in plain language. Explain what each medication is for, along with the dosage and side effects. Make sure the patient knows where the information is written down.
Then check for understanding:
I want to be sure I didnt leave anything out that I should have told you. Would you tell me what you are to do so that I can be sure you know what is important?
(Source: Doak CC, Doak LG, Root JH. 1996. Teaching Patients With Low Literacy Skills. JB Lippincott Company: Philadelphia, PA.)
Participate in plain language and cultural competency training.
Encourage colleagues to do the same. Consider organizing a training for health professionals and staff in your organization.

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Improve the Usability of Health Information
Example:

developed by the Centers


Easy-to-read flyer

for Disease Control and Prevention. The flyer was developed in multiple
?languages.



??








?

























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Improve the Usability of Health Information

Checklist for Improving the Usability of Health Information
??????????the intended users ?????pre- and post-tests ???????the number of messages ?????plain language???????????respect
???????on behavior????????for understanding????"??????????with pictures??????a medically trained interpreter or translator

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Improve the Usability of Health Information

1 National Cancer Institute. Making Health Communication Programs Work. Washington, DC.?2 National Institute of Deafness and Other Communication Disorders. Improving Health Literacy.
Available at http://www.nidcd.nih.gov/about/what.asp.
3 Doak C, Doak L, Root J. 1996. Teaching Patients With Low Literacy Skills. 2nd Edition. JB Lippincott Co.: Philadelphia, PA.
4 Plain Language Action and Information Network. Available at www.plainlanguage.gov. Accessed on October 21, 2005.
5 American Institute for Research. 1981. Guidelines for Document Designers. Washington, DC. 6 U.S. Department of Health and Human Services. Usability Basics. Available at http://www.
usability.gov/basics/index.html. Accessed on October 13, 2005.
7 Baur CE. 2005. Using the Internet To Move Beyond the Brochure and Improve Health Literacy. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 141-154.
8 Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90.

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Strategies

Improve the Usability of Health Services

Navigation of healthcare and public health systems requires being familiar with the vocabulary, concepts, and processes needed to access health services and information. This includes understanding insurance coverage and eligibility for public assistance, filling out patient information forms, scheduling appointments and follow-up procedures, and locating services.
Strategies to improve the usability of health services include:
Improve the usability of health forms and instructions
Improve the accessibility of the physical environment
Establish a patient navigator program ?Improve the usability of health forms and instructions ?Healthcare and public health systems rely heavily on printed materials, including:
Medical history forms
Insurance forms
Informed consent forms
Patients rights and responsibilities
Test results
Directions to the lab or pharmacy
Hospital discharge and home care instructions
Clinical research protocols and announcements ?These documents, particularly forms which contain blank spaces to be filled in by the user, are often more difficult to understand than regular prose. 1 ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

Improve the Usability of Health Services
Consent forms and other legal documents related to patients rights often contain long sentences and difficult legal terms. It is critical that these forms be translated into plain language. According to recent guidelines prepared by the National Quality Forum, healthcare providers should ask each patient to recount what he or she has been told during the informed consent process to check for understanding.2
Tips for improving the usability of health forms and instructions:
Revise forms to ensure clarity and simplicity.
Test forms with intended users and revis as needed.
Provide plain language forms in multiple languages.
Provide clear information about eligibility for public assistance.
Train staff to give assistance with completing forms and scheduling follow-up care.

Sample informed consent language
Voluntary participation:
You dont have to be in this research study. You can agree to be in the study now and change your mind later. Your decision will not affect your regular care. Your doctors attitude toward you will not change.
New information about risks:
We may learn about new things that may make you want to stop being in the study. If this happens, you will be informed. You can then decide if you want to continue to be in the study.
(Source: Paasche-Orlow MK. 2005. The Challenges of Informed Consent for Low-Literate Populations. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 119-140.)

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Improve the Usability of Health Services
Improve accessibility of the physical environment1
Settings with a large number of signs and postings have a high literacy demand. Maps, directions, signs, schedules, and instructions are posted throughout the healthcare setting to help consumers locate services and information. Many of these signs contain unfamiliar phrases and symbols. This environment can be intimidating and overwhelming for persons with limited health literacy skills. Too often, confusing signs and postings create more work for healthcare staff and cause embarrassment for patients.
Tips for improving the physical environment:
Include universal symbols and clear signage.
Promote easy flow through healthcare facilities.
Train staff to create and maintain a respectful and shame-free environment. ?Establish a patient navigator program ?Patient navigators can help consumers access services and appropriate health information. Patient navigators are health professionals, community health workers, or highly trained patient liaisons who coordinate health care for patients and assist them in navigating the healthcare system. Patient navigators can help patients evaluate their treatment options, obtain referrals, find clinical trials, and apply for financial assistance.


Hablamos Juntos,?with support from?the Robert Wood Johnson Foundation, has developed a set of Universal Symbols in Health Care. Visit www.hablamosjuntos.org to learn more.


Did you know?
Congress recently passed the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005. The bill authorizes $25 million in grants over 5 years to establish patient navigator programs in low-income and rural communities nationwide.
(Public Law 109-18)

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Improve the Usability of Health Services

1 Rudd RE, Renzulli D, Pereira A, Daltroy L. 2005. Literacy Demands in Health Care Settings: The Patient Perspective. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 69-84.
2 Wu HW, Nishimi RY, Page-Lopez CM, Kizer KW. 2005. Improving Patient Safety Through Informed Consent for Patients With Limited Health Literacy. National Quality Forum. Available at http://www. qualityforum.org/docs/informed_consent/webinformedconsentMember+public09-13-05.pdf. Accessed October 13, 2005.

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Strategies

Build Knowledge to Improve Health Decisionmaking

Being an informed consumer of health information requires more than reading ability. People with limited health literacy often lack knowledge or have misinformation about the body and the causes of disease. Without this knowledge, they may fail to understand the relationship between lifestyle factors such as diet and exercise and health outcomes. People with limited health literacy skills may not know when or how to seek care.
Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated, forgotten, or is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.
Strategies to build knowledge and improve health decisionmaking include:
Improve access to accurate and appropriate health information
Facilitate healthy decisionmaking
Partner with educators to improve health curricula ?Improve access to accurate and appropriate health information ?Create mechanisms for sharing and distributing plain language materials among health professionals. ?Healthcare and public health professionals can develop plain language health education materials that can be easily shared among practitioners. Health education materials should be both scientifically accurate and culturally appropriate. Develop partnerships among and across regions, audiences, and fields of interest to facilitate dissemination. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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Build Knowledge to Improve Health Decisionmaking
Health professionals and researchers may want to examine the impact of participatory action and empowerment research strategies for effective diffusion of health information at the community level.1
Work with the media.
Working with the media to improve health literacy involves:
1. Increasing the medias awareness of health literacy issues. Many health stories already have a health literacy angle, but it goes unreported.
2. Making scientific and medical information easier to understand. Be sure the information you give journalists is written in plain language and is suitable for a public audience. When you are working with journalists, emphasize that the provision of health information, especially when it fosters stress and anxiety in the public, does not by itself promote public understanding.
Develop new methods for information dissemination.
Health information seeking on the Internet demonstrates the publics interest in finding health information someplace other than brochures. Personal electronic devices (e.g., cell phones, palm pilots) and talking kiosks could be new methods for delivering health information. Before you create another brochure, consider whether alternate methods for information dissemination could improve communication with your intended users.

Message channels
Channels are the routes of message delivery (such as individual, group, organizational, community, and mass media). Select channels that fit your communication objectives, your budget, and your timeline.
For more information, refer to CDCynergy.

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Build Knowledge to Improve Health Decisionmaking
Facilitate healthy decisionmaking
Research suggests that more information does not necessarily improve decisionmaking and often may undermine it.2 People process and use a limited amount of information when making a decision. As the choice becomes more complex, people adopt simplifying strategies that allow them to consider only some of the information. As a result, they may ignore or limit their search for information.
We know that obtaining accurate, appropriate health information is only one element of healthy decisionmaking. Increased self-efficacy, that is, a persons belief in his or her ability to accomplish a desired task, is a key factor in decisionmaking.3 A high self-efficacy for a task may mean that a person is more likely to try it. The way we package health information and services can greatly increase self-efficacy.
What you can do:
Use short documents that present bottom-line information, step-by-step instructions, and visual cues that highlight the most important information.
Align health information and recommendations with access to services, resources, and support. ?Partner with educators to improve health curricula ?Co-develop adult basic education lessons on health content. ?Adult education includes the instruction of people 16 years of age and older who are not regularly enrolled full-time students. Lessons include reading, writing, arithmetic, and other skills rquired to function in society. Health professionals can work with adult educators to identify the specific skills needed to support health literacy.

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Build Knowledge to Improve Health Decisionmaking
Adult education theory maintains that people want information that is relevant to their lives. According to national surveys, health-related content is likely to engage adult learners.4
Health professionals can partner with adult educators to develop and deliver health lessons, which simultaneously builds health knowledge and reaches adults who may not connect with traditional health outreach methods. Construct lessons in which students use health-related texts like prescription labels, consent forms, health history forms, and health content from the Internet.
Partner with K??"1_ educators to improve health education in schools.
The U.S. educational system is a critical point of intervention to improve health literacy.1 Educators can take advantage of existing skill development and curricula to incorporate health-related tasks, materials, and examples into lesson plans. Many states already have standards for health education that can be enriched to incorporate health literacy skills.
Health professionals can support educators by speaking to elementary and secondary students or helping to organize health-related field trips with local schools.
1 Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. National Academies Press: Washington, DC.
2 California HealthCare Foundation. 2005. Consumers in Health Care: The Burden of Choice. Available at www.chcf.org/.
3 U.S. Department of Health and Human Services. Making Health Communication Programs Work. National Cancer Institute: Washington, DC.
4 U.S. Department of Health and Human Services. 2003. Communicating Health: Priorities and Strategies for Progress. Washington, DC.


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Strategies

Advocate for Health Literacy in Your Organization


Health professionals must commit to advocating for improved health literacy in our respective organizations. We must embed health literacy in our programs, policies, strategic plans, and research activities.
You can advocate for health literacy in your organization.
Make the case for health literacy improvement
Incorporate health literacy into mission and planning
Establish accountability for health literacy activities ?Make the case for health literacy improvement ?Include health literacy in staff training and orientation. ?Training staff will increase awareness of the need for addressing health literacy and improve their skills for communicating with the public. ? Include information on health literacy in staff orientation. ? Make a presentation on health literacy at your next staff meeting. ? Circulate relevant research and reports on health literacy to colleagues. ? Post and share health literacy resources.?Identify specific programs and projects affected by low ?health literacy. ?How can addressing health literacy improve the effectiveness of these programs? What existing or ongoing organizational activities contribute to the improvement of health literacy? How can these activities be recognized and supported? ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

Advocate for Health Literacy in Your Organization
Target key opinion leaders with health literacy information.
Brief senior staff and key decisionmakers on the importance of health literacy. Explain how health literacy relates to the organizations mission, goals, and strategic plan and how it can be incorporated into existing programs. Be specific!
Use the following talking points to make the case for health literacy improvement:
1. Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease.
2. Furthermore, 14 percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and more likely to lack health insurance (28 percent) than adults with Proficient health literacy.
3. There is a mismatch between the reading level of health information and the reading skills of the public. In addition, there is a mismatch between the communication skills of lay people and health professionals.
4. Adults with limited literacy skills are less likely to manage their chronic diseases and more likely to be hospitalized than people with stronger literacy skills. This leads to poorer health outcomes and higher healthcare costs.
5. Peoples ability to understand health information is related to the clarity of the communication. Health professionals skills, the burden of medical jargon, and complicated healthcare delivery systems affect health literacy.
6. The benefits of health literacy improvement include improved communication, greater adherence to treatment, greater ability to engage in self-care, improved health status, and greater efficiency and cost savings to the health system as a whole.
7. Enhancing health literacy does not always require additional resources. It is a method for improving the effectiveness of the work we are already doing.

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Advocate for Health Literacy in Your Organization
Incorporate health literacy into mission and planning
Include specific goals and objectives related to improving health literacy in strategic plans, performance plans, programs, and educational initiatives. Goals and objectives may be population based (for example, achieving Healthy People 2010 Objective 11-2) or specific to the mission of the organization.
Convene a work group to develop a health literacy agenda for your organization.
Seek input and collaboration from a broad cross-section of employees.
Include health literacy in grants, contracts, and memorandums of understanding.
Recommend that all products, including educational materials, forms, and questionnaires, be written in plain language and tested with the intended users. Encourage contractors, grantees, and partners to indicate and evaluate how their activities contribute to improved health literacy.
Incorporate health literacy into Funding Opportunity Announcements (FOAs). These include requests for proposals (RFPs), applications (RFAs), corrections (RFCs), and program announcements (PAs). In addition, provide proposal reviewers with basic health literacy information and training when appropriate.

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Advocate for Health Literacy in Your Organization
Establish accountability
Include health literacy improvement in program evaluation.
Incorporate health literacy objectives into evaluation criteria for programs and projects.
Include health literacy improvement in budget requests.
Designating funding for health literacy activities will hold staff and management accountable and encourage evaluation.
Implement health literacy metrics.
Implementing metrics or measurable objectives for your organization will help establish accountability for health literacy activities. Below are examples of health literacy metrics.
Our organization will:
1. Apply user-centered design principles to 75 percent of new Web pages.
2. Ensure that all documents intended for the public are reviewed by a plain language expert.
3. Provide all new employees with training in cultural competency and health literacy within 6 months of their date of hire.

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Resources

@
To Learn More About Health Literacy

Health Literacy: A Prescription to End Confusion
Released in 2004 by the Institute of Medicine (IOM), this report examines the body of knowledge that applies to the field of health literacy and recommends actions to promote a health-literate society. Available at: www.iom.edu/report.asp?id=19723
Healthy People 2010
Healthy People 2010 is a comprehensive set of disease prevention and health promotion objectives developed to improve the health of te nation. Objectives 11-2 and 11-6 specifically address health literacy. Available at: www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm
The Health Literacy of Americas Adults: Results From the 2003 National Assessment of Adult Literacy (NAAL) This report is the first release of the NAAL health literacy results. The results are based on assessment tasks designed specifically to measure the health literacy of adults living in the United States. Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient.
Available at:
http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483
Communicating Health: Priorities and Strategies?for Progress?This publication provides in-depth action plans for each of the six Healthy People 2010 Health Communication Objectives, including Objectives 11-2 and 11-6 on health literacy.?Available at: http://odphp.osophs.dhhs.gov/projects/HealthComm/
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

To Learn More About Health Literacy
Literacy and Health Outcomes
This report from the Agency for Healthcare Research and Quality (AHRQ) provides a systematic review of the literature on literacy, its relationship to various health outcomes and disparities, and the effectiveness of health literacy interventions.
Available at: www.ahrq.gov/clinic/epcsums/litsum.htm
Bibliography Understanding Health Literacy and?Its Barriers?The National Library of Medicines (NLM) bibliography provides a comprehensive list of health literacy citations from varying disciplines and publications. The bibliography is divided into specific topic areas. Available at: www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
To learn more about improving the usability of health information:
Scientific and Technical Information: Simply Put
This guide from the Centers for Disease Control and Prevention (CDC) will help you translate complicated scientific and technical information into material that captures and keeps the interest of your intended audience.
Available at: www.cdc.gov/communication/resources/simpput.pdf
CDCynergy (CD-ROM)?A multimedia CD-ROM used for planning, managing, and evaluating public health communication programs. The planning model is designed to guide the user through systematically conceptualizing, planning, developing, testing, implementing, and evaluating health communication activities, while promoting accountability and the importance of evaluation.?Available at: www.cdc.gov/communication/cdcynergy.htm

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To Learn More About Health Literacy
Making Health Communication Programs Work
(the Pink Book)
The planning steps in this guide from the National Cancer Institute (NCI) can help make any communication program work, regardless of size, topic, intended audience, or budget. The Pink Book describes a practical approach for planning and implementing health communication efforts.
Available at: www.cancer.gov/pinkbook
Plainlanguage.gov
Designed to improve communication from the Federal Government to the public, this Web site contains excellent tools and examples of plain language.?Visit www.plainlanguage.gov
A Family Physicians Practical Guide to Culturally Competent Care?This guide, developed by the Office of Minority Health (OMH), includes cultural competency curriculum modules designed to equip family physicians with awareness, knowledge, and skills in cultural competency to better treat the increasingly diverse U.S. population. Available at: http://cccm.thinkculturalhealth.org/
National Standards for Culturally and Linguistically Appropriate Services in Health Care?OMH has developed comprehensive standards on culturally and linguistically appropriate services (CLAS) in health care. The CLAS standards provide definitions of culturally and linguistically appropriate services and address organizational structures and policies that help healthcare professionals respond to cultural and linguistic issues presented by diverse populations.
Available at: www.omhrc.gov/assets/pdf/checked/finalreport.pdf

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To Learn More About Health Literacy
Policies for Federal Public Websites
The Office of Management and Budget issued the Policies for Federal Public Websites in 2004. The policies are designed to improve the usability of Federal Web sites.?Available at: www.firstgov.gov/webcontent/policies_and_implementation.shtml
Usability.gov
A resource for usable, useful, and accessible Web sites. This site contains information, guidelines, and checklists for conducting usability testing and user-centered design.?Visit www.usability.gov
To learn more about improving the usability of health services:
Improving Patient Safety Through Informed Consent for Patients With Limited Health Literacy?This report, from the National Quality Forum, is designed to provide an overview of major issues involved in providing informed consent for all patients, particularly those with limited health literacy. Available at: www.qualityforum.org/docs/informed_consent/webinformedc onsentMember+public09-13-05.pdf
Understanding Health Literacy
This comprehensive resource of health literacy research seeks to improve understanding of this public health challenge and to stimulate research focused on reducing or eliminating the literacy barrier?to effective medical diagnosis and treatment. The book includes a chapter on the literacy demands of healthcare settings.
Schwartzberg JG, VanGeest JB, Wang CC, Editors. Understanding Health Literacy. AMA Press. 2005.

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To Learn More About Health Literacy
To learn more about building knowledge to improve health decisionmaking:
Consumers in Health Care: The Burden of Choice
This report by the California HealthCare Foundation presents the latest research on consumer decisionmaking, explores the methods consumers use to make choices, and looks at what influences affect consumer action. The research suggests important implications for the development of effective information tools for consumers. Available at: www.chcf.org/topics/view.cfm?itemid=115327
healthfinder
healthfinder is an award-winning Federal Web site for consumers, developed by the U.S. Department of Health and Human Services and other Federal agencies. Since 1997, healthfinder has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet. healthfinder links to carefully selected information and Web sites from more than 1,500 health-related organizations.
Available at: www.healthfinder.gov

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You are an observer in the emergency department of a major hospital. Your preceptor - a registered nurse (RN) - has been assigned to a newly admitted patient -Tracy Folsom, a 28 year-old female who w...as found lying semi-conscious in the shower by a neighbour. Your role is to observe and reflect on the assessment and interventions your preceptor performs. Your preceptor performs and records the following in the patient's chart:

Primary Survey Observations
Airway Patent
Breathing Shallow
Circulation Skin colour 'pink'
Disability Obeying commands, PEARL


Secondary Survey Observations
Exposure Patient reports feeling cold
Full vital signs Pulse: 94; respiratory rate: 26; temperature:37.9C; blood
pressure: 145/70; SpO2: 95% (room air)
Give comfort measures Patient reassured
History Allergies: Sulphur; Medications: Metoprolol 25mg mane;
Previous medical history: Obese (weight: 111kg;
height:164cm); smoker; alcoholic; atrial fibrillation; ulcerative
colitis; right hemicolectomy and ileostomy; Last meal (time):
unknown; Events: found by neighbour lying semi-conscious
in her shower.
Head-to-toe assessment Patient complains of headache and has blood on her face
from a cut above her right eye and a right facial contusion.
Patient is disoriented to time and place and does not recall
how the injury occured. Complains of severe epigastric pain
radiating to her back that eases in the Fowler's position.
Auscultation and palpation of patient's abdomen performed:
hypoactive bowel sounds in all four quadrants. Abdominal
distension evident. Patient guarding noted during palpation.
Inspect posterior surface No evidence of injury


Nursing Notes
Patient is very anxious, has tears in her eyes and reports experiencing "a lot of pain". Has expressed intent to self-discharge to go home and feed her animals. reports concern that the RSPCA will arrest her. Medical officer reviewed patient and assigned patient a triage score. medical treatment ordered:
* patient to remain nil by mouth (NBM)
*collect blood for laboratory studies (results reveal: elevated amylase; elevated lipase; elevated creatinine clearance ratio)
*intravenous fluids ordered: Normal Saline 500ml bolus then 125ml/hr
*cranial X-Ray, CT (head), and Abdominal Ultrasound ordered


Assignment Questions
1- Critically reflect on whether the primary and secondary assessment conducted by the RN in the case study is appropriate in providing quality patient-focused care. Support your argument with refernce material.

2-Evaluate the appropriateness of the primary and secondary assessment framework in providing quality patient-focused care. Support your argument with reference material.

3- In what ways does providing an empathic and supportive environment contribute to quality outcomes for the patient? Support your argument with reference material.  more

Making a safe Transition
? In October 2012, changes were made in Medicare payment rules. Hospitals are now penalized when a patient returns within 30 days for treatment of the same problem. One o...f the targeted medical diagnoses for this payment change is heart failure (HF). Therefore, it is essential that the interdisciplinary team be utilized to ensure a safe transition between the acute care setting and home for the patient with HF.
Using APA format, write a six (6) to ten (10) page paper (excludes cover and reference page) that addresses the disease management needs of adult patients with HF for a safe transition between the acute care setting and home and the role of the interdisciplinary team in that transition.
A minimum of three (3) current professional references must be provided. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.

The paper will consist of four (4) parts and must be submitted by the close of week 6.
Parts 1, 2, and 3 will focus on a disease management issue for the patient with HF and the role of the interdisciplinary team in this issue.
Part 4 is the evaluation of the effectiveness of the interdisciplinary team in this safe transition to home.

Part 1: Medication Adherence
Part 1 must include the following:
1.
a. Three (3) common classes of medications used to manage HF are beta adrenergic blockers, diuretics and ACE Inhibitors. Why are these medications used to manage HF?
b. What are some common side effects of these classes of medications? Which of these side effects would be reported and why? Which side effects would not be reported and why?
c. Describe any special instructions that would be included with each class of these medications. For example, food-drug interactions and medications that should be avoided.
d. Which health care discipline, in addition to the RN, is best suited to help with medication adherence? How will this team member collaborate with the RN, the patient and the family to help promote medication adherence and a safe transition to home?
Part 2: Dietary Modifications
Part 2 must include the following:
2.
a. What is the role of diet in managing HF? What changes need to be made to the present diet? What role does culture play with diet?
b. What obstacles might be encountered when informing the patient about the changes in diet?
c. Which health care discipline, in addition to the RN, is best suited to help with dietary modifications? How will this team member collaborate with the RN, the patient and the family to help promote healthy eating and a safe transition to home?
Part 3: Physical Activity
Part 3 must include the following:
c.
a. What is the role of physical activity in managing HF?
b. How would the RN promote adherence to a daily physical activity routine?
c. Which health care discipline, in addition to the RN, is best suited to help with physical activity? How will this team member collaborate with the RN, the patient and the family to help promote physical activity and a safe transition to home?
Part 4: Evaluating the Effectiveness of the Interdisciplinary Team
Part 4 must include the following:
d.
a. In detail, describe how the effectiveness of the interdisciplinary team would be evaluated for assisting the patient with adherence to medication therapy, dietary modifications and a physical activity program to prevent readmission to the acute care setting.  more

Students will undertake a report into a key health issue that has been identified from the document Healthy Children- Strengthening Promotion and Prevention Across Australia : Developing a National P...ublic Action Plan for Children 2005- 2008. (Child & Youth Health Intergovernmental Partnership, 2004).
A report is a clearly structured document that identifies and examines a serious issue of importance .A report does not present theories or opinions but presents and analyses information. (Gimenez, 2007)

Choose one issue either Mental Health OR Nutrition and Breastfeeding
Choose a specific age group (infant, or toddler or preschooler or school age or adolescent)
Write the report for the nursing profession that highlights the issue, its contributing factors the impact on the family and recommendations for nursing practice.
Students are expected to make recommendations for nursing practice based on their research that are aligned to health promotion and prevention.
Use the structure provided below to construct the report.

Criteria:

Purpose
Discuss the purpose of this report and why it has been written.
Purpose is clearly and comprehensively presented. Identifies appropriate audience with superior understanding of the Role of the Registered Nurse in Child and Adolescent Health.

Introduction

Briefly describes the health issue for the age group chosen.
Identifies the contributing factors, the affect on the family & recommendations for nursing practice.
Introduction is clear, well constructed and leads the reader to expectations of the report.
The chosen; health issue, age group, contributing factors, the affect on the family & recommendations for nursing practice .are clearly stated and are briefly but clearly defined and linked to relevant sources of literature.

Definition of terms
Define any specific terms used.
Definitions of all specific terms encompasses context of use. Reference provided from relevant literature.

Background
Discuss the significance of the health issue, uses data to support discussion
Sources accessed should include, policy documents Government reports, State or National health research bodies,Refereed Journals etc.
Size, breadth and importance of issue clearly articulated, use of data from a extensive range of sources to support discussion .

Disussion
Presents the health issue, its contributing factors and the effect on the family in detail
Has surpassed the requirements for the body of the report.
Health issue is discussed clearly with superior organisational skill. Applies relevant Primary Health Care language and philosophy.
Contributing factors to the issue are clearly identified, discussed and extend beyond the physical. Effect on the family synthesises all of the determinants of health.
Discussion is supported by an extensive range of relevant and recent literature.

Recommendations
Recommendations for nursing practice address all the determinants of health in a comprehensive and analytic manner. Primary Health Care Philosophy is applied to practice. Synthesises the competency standards for the Registered Nurse in NSW.

Conclusion
Summarise the key points or findings.
Excellent summary of key points made throughout the report Clear and well organised.

Presentation
Report is clearly written
The report presents a logical sequence and coherent flow. The writing style demonstrates use of sophisticated vocabulary and accurate grammar and spelling .

In-text referencing
Ideas are referenced correctly throughout the report including appropriate acknowledgement (referencing) of all the words of others
Please note: all references must be current (within the past 5 years) or be seminal publications.
Reference list has 15 or more references that are relevant to the topic. include books, journal articles, etc..
Referencing in-text (the body of the report) and the reference list is consistently accurate and follows the APA Style.









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This essay will address learning outcomes (LO) one, two, three, four, and five:

LO 1 Demonstrate how biopsychosocial interventions are used in the management of long term health care needs...>
LO 2 Consider the effects of chronic and long term health care needs on the individual, the family and carers.

LO 3 Discuss the use of best available evidence in determining the interventions for individuals with chronic and health care needs.

LO 4 Explore strategies for organising nursing care to safely meet the bio-psycho-social needs of individuals experiencing long term health care requirements (including mandatory)

LO 5 Examine the ethical and legal perspectives associated with long term health care needs


The aim of the essay assignment (CW2):

To enable you to demonstrate your ability in using a variety of sources to develop a critical view of the strategies required to care for an individual who has progressively worsening Type 1 Diabetes Mellitus.

To utilise a bio-psycho-social approach and take into account the legal, ethical, political and economic context of long term health care in the community.

Assignment title:
Managing long term health care needs
Assignment Scenario:
The focus of the scenario will be a patient with Type1 Diabetes Mellitus as a long term condition.

Assignment guidance:
First, analyse the scenario...

Include an introduction that tells the reader what to expect in the essay.
Then discuss the relevant patho-physiology of the conditions and contributory causes.
Provide rationale (reasoning) for appropriate nursing and interprofessional and inter-agency interventions.
Discuss and evaluate ways to enable the patient in the scenario,
1.Prevent complications associated with Type 1 Diabetes
2.Prevent unplanned hospital admissions due to a crisis
3.Promote self care in the community setting.
Describe relevant medicines used; their effects and risks and discuss appropriate medicines management.
Examine the psychosocial impact and practical implications of the disease on the person, relationships, work and future.
Support and reference your work with peer reviewed and evidence based literature. Examine practice guidance and national frameworks that promote best practice.
Demonstrate your understanding of the legal, ethical, political and economic context of care in the local community for people with the long term condition.
Finally, provide a conclusion that shows what you have learned through your study of the care management of the patient in the scenario. (Avoid the use of the first person I)

The assignment must reflect the care management of a patient with the long term condition Type 1 Diabetes Mellitus in the community.

SCENARIO TO BE USED

Mrs Melissa Lee is the 70 year old owner and chief executive of a transport company employing 200 people.Mrs Lee works 3 days a week from 7am till 6pm in the company office. On these days, she gets up at 6am to drive to work, the journey takes 45 minutes.
She is a widower and lives in a large three storey house with her live in housekeeper. Her bedroom is on the second floor and all floors are accessed by stairs.
Mrs Lee has been a Type 1 Diabetic since the age of 11 when she was first diagnosed.Mrs Lee takes 4 injections of Insulin daily.Mrs Lee came to see her Diabetic Specialist Nurse two months ago for her annual review. The following points were noted,
Blood Pressure 160/ 90 mmHg.
Pulse 90 beats per minute
0.5cm ulcerated area on outer upper aspect of big toe, the area appeared red, swollen and infected.
Mrs Lees ankles were noted as swollen and oedematous.
Mrs Lee was complaining that her eyesight is becoming a bit blurred and she is having trouble reading the detail on her Insulin bottles and pen devices.
Weight:60 kg ,Height:152.4 cm ,Body Mass Index Score:25.8

The Nurse swabbed the ulcerated area, and took both blood and urine samples, the Nurse also immediately referred Mrs Lee to the consultant diabetiologist and ophthalmologist for urgent intervention.

Mrs Lee has been diagnosed with Diabetic retinopathy, and microalbuminuria.She also has Hypercholesterolemia and her HBA1c has increased to 9%.The swab revealed the presence of Pseudomonas in the ulcerated area.

Her medications are as follows after consultant review,
1) 6 units of Insulin Aspart 3 times daily before mealtimes.
2) 12 units of Insulin Glargine once a day at bedtime.
3) Enalapril 10mg once a day.
4) Simvastatin 40mg once a day
5) Ciprofloxacin 500mg twice a day

Must address the learning outcomes. Minimum of 20 references (Harvard no page numbers) Need UK references & nursing journals NOT too many US ones

This is for a British university degree -


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Based on Chapter 14 and 15, please answer the following questions (The chapters are from Psychiatric-Mental Health Nursing Evidence-Based Concepts, Skills, and Practices, 7th edition, Wanda K. Mohr. Please, cite this textbook as a reference in addition to 1-2 other sources, APA):

Questions:

1. You have been asked to lead a support group for people that have been diagnosed with breast cancer.
a. List and describe the different leadership styles. Which style do you believe that you would use for this support group?
b. After the first group meeting, you are asked to analyze the different roles that the group members assumed. What are the different roles that group members can assume? Which ones can interfere with group functioning?

2. Sam and Joan have been married for 25 years and have three children, Max who is 23, Janet who is 19, and Sarah who is 15. Janet has just been diagnosed with a mental illness.
a. Describe the objective and subjective burdens each family member may experience.
b. Describe the meaning this diagnosis may have to Janets parents, younger sibling, and older sibling.

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One of the functions of The Joint Commissions for Accreditation of Healthcare Organizations (JCAHO) is to place a stamp of approval and accredits health care organizations to participate in the Medicare/Medicaid program.

Overall ? the JCAHO can be described as a filter that functions to ensure compliance with the rules, regulations, and standards for multiple other regulatory agencies.

1) How do they ensure that performance of their standards occur at the point of care and how do these standards impact nursing leadership and practice at the point of care? Explain your answers!

2) If you work for an organization that is not accredited by the JCAHO - describe the accrediting agency that accredits, regulates, and influences your
organization and how do these standards impact nursing leadership and you at the point of care?

List at least one solution to any opportunities for improvement identified.