Advanced Practice Nursing
Advanced Practice N's in the Home Health Care Arena

Identification of the phenomenon.

There is an urgent need for APN services in the home health care environment. That is the pivotal position this paper proposes to pursue. In a general sense, it is clearly evident that there is an urgent need for quality home care that exceeds the minimum expectations of patients and their families; this need exists because excellence and integrity in the delivery of home health care can help erase (and overshadow) the negative publicity perpetuated by incidents of malpractice, of gross incompetence, and of scandalous acts of patient abuse at the home care level. There can be no equivocation on the issue of the existing demand by consumers for the highest quality of service available when it comes to home health care; the cost of health care has been going up and up, and hence, the…...

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References

Centers for Medicare & Medicaid Services (2002). Home Health Care: Improving

Quality, Tightening Standards.  http://www.cms.hhs.gov .

Fischer, Linda (1997). Lessons in Home Health. RN, 60, 55-57.

Head, Barbara J. Ph.D., R.N.; Maas, Meridean, Ph.D., R.N., FAAN; & Johnson,

Pathophysiology
Asthma is a respiratory tract disease reported to afflict about 300 million persons worldwide and is projected to increase (CCHMC, 2010). It is characterized by chronic and recurring inflammation and obstruction of the airways, expressed by wheezing or coughing. It was reported to be the leading chronic ailment among children (AsthmaCure, 2010). About 50% of cases subside when these children reach age 13 or 14. In the meantime, those who are stricken must contend with current knowledge that symptoms remain totally incurable. Nonetheless, these can be substantially controlled with adequate and proper education, treatment and management plan set up by a supervising physician. An important part of the success is sufficient knowledge about the disease and faithful adherence to the treatment and management plan (AsthmaCure).

Discharge and Education Plan

This includes the treatment plan itself and the correct use of the nebulizer and metered dose inhaler for home use by the…...

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BIBLIOGRAPHY

AsthmaCure (2010). Some facts and statistics about asthma. AsthmaCure.com.

Retrieved on July 20, 2014 from http://www.asthmacure.com/2010/12/asthma-facts-statistics

CCHMC (2010). Management of acute exacerbation of asthma in children. Health Policy & Effectiveness Program Evidence-Based Guideline. Retrieved on July 20, 2014 from http://www.cincinnatichidrens.org/workarea/downloadAsset%3Fid%3D87871

Kovesi, T., et al. (2010). Achieving control of asthma in pre-schoolers. Canadian Medical

Home care 1) How are incidents of abuse, neglect, exploitation or injury reported internally?
The agency seeks to promptly respond and solve issues of abuse, neglect, exploitation and injury. It is the responsibility of the client/member to report any incident to the agency through the administrative office or through the immediate supervisor. Members are given contact information like agency phone numbers, email address, and fax. Incidents must be reported immediately in order to allow the agency to respond to the situation immediately. It is the responsibility of the supervisory board to assess any incidents and come up with a reasonable solution to the situation. Members are allowed to verbally communicate any incidents as well. Family members can walk into the agencies premises within 24 hours of an incident and report it. Any incident is recorded in the Incident Report DD-191 form.
The form captures details of the type of incident that took place,…...

ContractsPart 1Summary of the Facts: Monica (the plaintiff) enters a race dubbed Pioneer Trail Ultramarathon, whereby the first price set by Rocky Mountain Races, Inc. (the defendant), the race sponsor, is $10,000. As per the rules set by Rocky Mountain Races, Inc., competitors must run all the way to the peak of Pinnacle Mountain, from the Blackwater Canyon floor. Monica wins the race but is offered a prize of $1,000 by the Rocky Mountain Races, Inc., instead of the advertised first price of $10,000. It is important to note that Rocky Mountain Races, Inc. rules of participation permit it to adjust race terms at any point. Monica sues for breach of contract.Legal Issues Involved: Does a valid contract exist between Monica and Rocky Mountain Races, Inc.? Monica ought to prove that a valid contact existed between her and Rocky Mountain Races, Inc., that the contracts terms were breached, and that…...

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References

Miller, R.L. (2014). Business Law: The First Course – Summarized-Case Edition. Stamford, CT: Cengage Learning.

The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
Conclusion

The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge care,…...

egistered nurses are both qualified, educated, and certified to provide a high quality of various care services that an individual may need in a home setting or elsewhere. Hence, providing these practitioners with the power to certify and provide home care is a solution to an overwhelming problem that has plagued the health care environment in recent years. Nursing practitioners, as a result of the nature of their work, are closely connected to the needs of individual patients. This means that they, more than many other health care providers and institutions, are able to assess the needs of individuals, their households, and the level of care they require. This places them in a position to accurately determine the need and/or of such individuals to obtain long-term home care and when such home care becomes unviable. As such, registered nurses who serve individuals in the home setting are able to…...

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References

AARP Public Policy Institute. (2013). FAQs. Retrieved from:  http://assets.aarp.org/rgcenter/ppi/ltc/ltss_faq.pdf 

Brassard, A. (2011). Removing Barriers to Advanced Practice Registered Nurse Care: Home Health and Hospice Services. AARP Public Policy Institute. Retrieved from:  http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/removing-barriers-advanced-practice-registered-nurse-home-health-hospice-insight-july-2012-AARP-ppi-health.pdf 

Doty, P. (2000, June). Cost-Effectiveness of Home and Community-Based Long-Term Care Services. U.S. Department of health and Human Services. Retrieved from:  http://aspe.hhs.gov/daltcp/reports/2000/costeff.htm 

Lynch, M., Estes, C., and Hernandez, M. (2007, June). Long-Term Care Policy Option Proposal: Consumer Controlled Chronic, Home, and Community Care for he Elderly and Disabled. Georgetown University Long-Term Care Financing Project: Working Paper No. 4. Retrieved from:  http://ltc.georgetown.edu/forum/4lynch061107.pdf

The emphasis is on normal, everyday activities provided for residents. According to the authors, however, little research has been conducted to investigate the actual effect of such activities and settings upon residents. The assumption is that such settings have a better effect that traditional institutions, but there is little empirical research to support this.
Hence, Verbeek et al. (2010) conducted a study to compare small-scale living with regular care in nursing homes in the Netherlands. Interestingly, they found no significant difference between the quality of life experienced by residents in traditional institutional settings and those in small-scale living facilities. Furthermore, there was also no significant difference in the job satisfaction levels of nursing staff between both types of institution was found. Another important aspect, namely neuropsychiatric symptoms and agitation were also significantly similar for both institution types. According to the authors, a difference was found in the satisfaction level of…...

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References

Gaugler, J.E. (2005, Mar.). Family Involvement in Residential Long-Term Care: A Synthesis and Critical Review. Aging and Mental health, Iss. 9, vol. 2. Retrieved from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247412/ 

Lyness, J.M., Yu, Q., Tang, W., Tu, X., and Conwell, Y. (2009, Dec.). Risks for Depression Onset in Primary Care Elderly Patients: Potential Targets for Preventive Interventions. American Journal of Psychiatry. Retrieved from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2982671/ 

Simonazzi, a. (2009, Jun). Home care and cash transfers. Effects on the elderly care-female employment trade-off. Retrieved from: http://www.aiel.it/bacheca/SASSARI/papers/simonazzi.pdf

Verbeek, H., Zwakhalen, S.M.G., Van Rossum, E., Ambergen, T, Kempen, G.I.J.M., and Hamers, J.P.H. (2010, Nov.). Dementia Care Redesigned: Effects of Small-Scale Living Facilities on Residents, their Family Caregivers, and Staff. American Medical directors Association. Retrieved from: http://www.unimaas.nl/hcns/websiteVW/publications/Publication%20scans/Verbeek.%20Dementia%20care%20redesigned.pdf

Leisure World Business Plan
Startup living-assistance firm Leisure World is seeking to enter into the long-term care market as a provider of in-home caregivers. The company will seek to market itself as an alternative to the nursing home, and will use daytime television advertising as its primary mode to reaching a target of families with aging loved ones. Expenses for the organization will include insurance and certification costs, material resources, labor and advertising. Management will proceed from a top-down approach.

Description of the business

Leisure World is an alternative to nursing and long-term care facilities. For many families, the decision to find assistance for care with aging loves ones can be an extremely difficult one, both financially and emotionally. Relegating a family member to a nursing home can be both heartbreaking for the family and psychologically devastating to a loved one who must now endure the end stages of life in an unfamiliar…...

The majority of communities in Alaska are separated by vast distances and the distance from many communities to the nearest medical facility is equivalent to the distance from New York to Chicago (Indian Health Service Alaska Area Services, 2011).
A study funded by AOA examined issues affecting access to home- and community-based long-term-care services among AI/ANS. Study results indicated that home healthcare was one of the most frequently needed services among AI/ANS. Further, 88% of the services sometimes, rarely, or never met the need, and 36% of services were rarely to never available (Jervis, Jackson & Manson, 2002). Only twelve tribally operated nursing homes exist in the U.S., and these rely predominantly on funding from Medicaid and tribal subsidies. Many tribes would like to have nursing homes but are blocked by state certificate-of-need requirements, Medicaid licensing requirements, and lack of commercial financing. The lack of alternate medical resources, whether private…...

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References

Alaska Area Indian Health Service. (2011). Indian Health Service. Retrieved from http://www.

ihs.gov/FacilitiesServices/areaOffices/alaska/.

Goins, R.T. & Spencer, S.M. (2005). Public health issues among older American Indians and Alaska natives. Generations, 29(2), 30-33.

Indian Health Service Alaska area services. (2011). Indian Health Service. Retrieved from  http://www.ihs.gov/FacilitiesServices/areaOffices/alaska/dpehs/documents/area.pdf .

Vignola began his career as an architect in ologna and supported himself by painting and making perspective templates for inlay craftsmen, later traveling to Rome to work and study. His talent and skill was utilized by the papacy, including Pope Julius III and the papal family of the Farnese. He worked with Michelangelo and was deeply influenced by his style.
It is believed that Cardinal Gianfrancesco Gambara commissioned Vignola to design the Villa Lante in 1566. The first casino was completed immediately, but the second one was not finished until after 1587 when the Cardinal passed away. The two casini differ mainly in the style of frescoes. The first casino uses a riotous highlight of color used to highlight the architecture, while the second casino was done in a more classical style of fresco and plaster sculpture combination.

The gardens of the Villa Lante incorporate water features in "a visual and…...

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Bibliography

Coffin, D.R. 2003. Pirro Ligorio: The Renaissance Artist, Architect, and Antiquarian. Pennsylvania: Penn State Press.

Lees, Frederick. 1997. The Chateau de Vaux-le-Vicomte. Architectural Record. pp. 413-433.

Pater, Peter. 1976. Renaissance Rome. California: University of California Press.

Rogers, Elizabeth Barlow. 2001. Landscape Design: A Cultural and Architectural History. New York: Harry Abrams, Inc.

This gives Toronto investors a competitive advantage in mining investing, which will be reflected in a home bias. As Van Nieuwerburgh & Veldkamp (2007) explain, home investors have a bias because they have information that non-home investors do not have. These information asymmetries persist, even with today's global information pipelines. The cost of information can be quite high, despite the relatively rapidity of its diffusion among global investors.
There are other potential explanations. Campbell and Kraussl (2007) posited that international investing carries with it the perception of increased downside risk. This can come from time zone differences, speed of information diffusion or translation issues in non-English-speaking markets. hatever the concern, it is reasonable that international investing suffers as a result of increased perceived risk, even if that perception is not born out by reality.

Another possible explanation is that investors are irrational. hile the rational investor may understand that international diversification…...

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Works Cited:

Coval, J. & Moskowitz, T. (1999). Home bias at home: Local equity preference in domestic portfolios. Journal of Finance. Vol. 54, 6, 2045-2073.

Van Nieuwerburgh, S. & Veldkamp, L. (2007). Information immobility and the home bias puzzle. NBER Working Paper. Retrieved November 27, 2009 from  http://pages.stern.nyu.edu/~lveldkam/pdfs/homebias.pdf 

Campbell, R. & Kraussl, R. (2007). Revisiting the home bias puzzle: Downside equity risk. Journal of International Money and Finance. Vol. 26, 7, 1239-1260.

Ahearne, A., Griever, W. & Warnock, F. (2004). Information costs and home bias: An analysis of U.S. holdings of foreign equities. Journal of International Economics. Vol. 62, 2, 313-336.

Patient Centered Medical Homes (PCMH) are often confused as being actual "homes" for patients to be admitted in and given medical treatment and care. PCMH is actually a health care model based on which health care is provided to patients, under the supervision of physicians. The PCMH model of health care provides patients with continuous, comprehensive medical care, in order to increase the chances of achieving the goal of benefitting the patient with as much attention and medical care in order to maximize his/her health outcomes.
Over the years the PCMH model of health care has become widely adopted and preferred. This is because of the philosophy and approach that the model adopts in organizing and delivering the health care initiatives. The PCMH model is based upon delivering medical care and attention to patients with team-based health and medical experts that are focused strongly on the quality and the safety of…...

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Bibliography

109-432, P.L. (2006, December 20). TAX RELIEF AND HEALTH CARE ACT OF 2006. Public Law 109-432 (109th Congress) .

Backer, L.A. (2009). Building the Case for the Patient-Centered Medical Home. Family Practice Management 16 (1), 14-18.

De Geest, S., Moons, P., Callens, B., Gut, C., Lindpaintner, L., & Spirig, R. (2008). Introducing advanced practice nurses/nurse practitioners in health care systems: a framework for reflection and analysis. Swiss Medical Weekly (138), 621-628.

NASHP. (2013, April). Medical Home & Patient-Centered Care. Retrieved from The National Academy for State Health Policy:  http://www.nashp.org/med-home-map

Innovative Nursing Care Delivery Models a.This website detailed profiles 24 successful innovative nursing care delivery models. These profiles developed part a research project conducted Health Workforce Solutions LLC (HWS) funded obert Wood Johnson Foundation (WJF).
Innovative nursing care model: The Care Transitions Intervention

Innovative nursing care model

I chose the Care Transitions Intervention Model on which to focus because of the increasing importance of geriatric care in the field of nursing. Although my organization serves the needs of persons of all ages, elderly patients are an increasingly large proportion of the patient base. The Model stresses the need for the empowerment and self-care even of patients with high-risk conditions. The Care Transitions Intervention Model allows elderly patients the maximum amount of mobility and autonomy possible given the limits of the patient's condition and enables them to stay in a home setting as long as possible. As its name suggests, the model facilitates…...

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References

Care Transitions Intervention. (2013). Innovative Care Models. Retrieved:

http://www.innovativecaremodels.com/care_models/12

Kurt Lewin Change Model. (2013). Change Management Coach. Retrieved:

 http://www.change-management-coach.com/kurt_lewin.html

Strategic Management of a Healthcare Facility in St. Louis
In the late 1800's and early 1900's St. Louis was a major center for automotive and other heavy manufacturing but the industrial restructuring of the Midwest during the latter half of the century has resulted in consistent economic decline of the St. Louis region. Today however as the rest of the country faces a slowing economy this region is showing new signs of growth. [Kotkin, 2002] Due to changing socio-demographics, the demand for health care and advanced medical technologies is growing consistently with a concomitant rise in health expenditure. [Zhou 2001] Health expenditure in the U.S. has risen from 7.4% of the GNP in 1970 to 15% of the GNP in 1995.[Zhou, 2001] The Health care sector deals with not only the clinical medical services, but also include methods which finance them, for e.g. insurance, benefit schemes, Medicare and Medicaid. eforms have…...

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References:

1. Kotkin, J, 2002 St. Louis: On the Way to Somewhere? Rebuz Inc.

2. Author not available, 1997, Economic Report of the President. Government Printing Office, Washington, D.C. [accessed on 4/4/03]:  http://www.umsl.edu/services/govdocs/erp/1997/chap3.htm 

3.Author not available, 1996, Focus... Non-Elderly Missourians without Health Insurance, March 1996, Vol. 30, No. 1 [accessed on 4/4/03]: http://www.dhss.state.mo.us/MonthlyVitalStatistics/March96Vol30No1.html

4. Author not available, January 1999, Focus... Managed Care (MC+) in Medicaid Population, January 1999 Vol. 32, No. 11[accessed on 4/4/03] at http://www.dhss.state.mo.us/MonthlyVitalStatistics/Jan99Vol32No11.html

Transitional Care of Older Adults Hospitalized with Heart Failure Experiment
Naylor, M.D., Brooten, D., Campbell, R.L., Maislan, G.,, McCauley, K.M. Schuartz, J. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized Trial.

This article has an interesting approach to summarizing the experiment that was conducted. Instead of a formal abstract, the article instead summarizes the design and outline in several sections. These sections include objectives, design, setting, participants, intervention, measurements, results, and conclusions. The sections that are listed replace the standard format for an abstract that condenses the design and the findings into one formal section. Personally, I prefer the organization of this format better as it more clearly illustrates all of the factors in the research in a clear and easily identifiable format.

Analysis of the Introduction

The authors of this research do state the problem that they are researching in a clear and coherent manner. The specific problem relates…...

I. Introduction
A. Definition of community-based services
B. Importance of registration and inspection in ensuring quality and safety

II. Types of community-based services subject to UK registration and inspection
A. Healthcare services
1. Home care agencies
2. Community nursing services
B. Social care services
1. Day care centers
2. Supported living accommodations
C. Education and training services
1. Adult education centers
2. After-school programs

III. Registration process for community-based services in the UK
A. Requirements for registration
1. Evidence of qualifications and experience
2. Criminal background checks
B. Application process
1. Submission of application form
2. Site visit and assessment by regulatory body

IV. Inspection process for community-based services in the UK
A. Role of regulatory bodies in conducting inspections
1.....

Essay Outline: Explain Community-Based Services Subject to UK Registration and Inspection

I. Introduction
- Hook: Define community-based services and their significance in the UK.
- Thesis statement: Community-based services subject to UK registration and inspection provide essential support to vulnerable populations.

II. Regulated Community-Based Services

- Health and Social Care
- Care homes
- Nursing homes
- Home care services
- Education and Childcare
- Nurseries
- Daycare centers
- Childminders

III. Registration and Inspection Process

- Care Quality Commission (CQC)
- Role and responsibilities
- Registration requirements
- Inspection Framework
- Key Lines of Enquiry (KLOEs)
- Inspection ratings

IV. Importance of Registration and Inspection

- Quality Assurance
- Ensures....

1. Improved coordination of care: By integrating health and social care services, providers can better coordinate the care and support they provide to patients. This can help ensure that patients receive all the services they need in a timely and efficient manner, leading to better health outcomes.

2. Holistic approach to care: Integrating health and social care services allows providers to take a holistic approach to patient care, addressing not just their medical needs but also their social and emotional needs. This can lead to better overall outcomes and improved quality of life for patients.

3. Better communication and collaboration: Integration of....