Manager of a Primary Care Clinic
A new primary care facility has been established approximately 25 miles outside of a small city that has a population of 50,000 people. This facility currently has five family physicians, two nurse practitioners, twenty clinical support staff, and two physician assistants. The main objective of this new primary care facility is to provide primary care services to an increasingly diverse community of people within and outside the city. Despites the tremendous growth opportunities in the city, most of the residents still struggle to make end meet. Since the central city comprises two huge acute care facilities and one tertiary care facility, the residents are forced to use the facilities' emergency departments for routine conditions and illnesses in cases where their private physicians are unavailable. Therefore, this new primary care facility will play a crucial role in enhancing the health and well-being of this population through…...

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References

Alvarez & Marsal Holdings. (2015, May 18). Retail Healthcare: Growing Trend for Healthcare Service Delivery. Retrieved November 3, 2015, from  http://www.alvarezandmarsal.com/retail-healthcare-growing-trend-healthcare-service-delivery 

Health Resources and Services Administration. (2011, April). Performance Management and Measurement. Retrieved from U.S. Department of Health and Human Services website: http://www.hrsa.gov/quality/toolbox/508pdfs/performancemanagementandmeasurement.pdf

Heidenreich, J. & Peterson, L. (2013, August 14). 4 Tips for Your Primary Care Strategy. Retrieved November 3, 2015, from  http://www.beckershospitalreview.com/hospital-physician-relationships/4-tips-for-your-primary-care-strategy.html

Halcomb, Peters, and Mclennes (2015) aims at examining pre-registration nurses' experiences in community clinic assignments as well as the effect such assignment has on their education. The authors have determined that clinical assignments to community facilities may offer nursing undergraduates important opportunities for learning. The research was conducted using a qualitative study design.
The research work attempts at examining pre-registration nurses' experiences in community clinic assignments as well as the effect such assignment has on their education.

Statement of Purpose

For promoting the profession of primary healthcare, comprehending pre-registration pupils' experiences within primary care contexts at the time of clinical assignment is vital.

In spite of the observable advantages such assignment have for pupils, poor supervisor-student relationships, work climates that do not foster a sense of belonging, and the absence of adequate guidance and monitoring are proven to have strong links to exacerbated anxiety and stress levels, greater pupil attrition and an inferior…...

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Reduced treatment mistakes and patient falls, together with patient perceptions of being better informed during shift change, was witnessed by researchers. The intervention incorporated a 3-hour nursing pupil handoff practicum, 2-hour clinical staff training, and a formative student assessment and feedback in the course of clinical experiences all through the 3rd semester. The pupil practicum was integrated into clinical orientation and clinical lab experience. Best practices in bedside hand-offs were addressed as well. All through the course of the practicum, emphasis was placed on the handoff receiver's active participation in safety communication (Avallone & Weideman, 2015). Numerous favorable results were recorded with regard to combined bedside nurse shift reporting practice, with a small number of downsides. Nursing outlook towards reporting during final data acquisition proved to be more favorable as compared to their outlook at the start of program implementation. If put into proper practice, bedside nurse reporting may improve patient safety results and nurse and patient satisfaction. But it is imperative to ensure nurse involvement in practice implementation and to continually check both report format uniformity and process support on nurses' and patients' part (Jecklin-Sand & Sherman, 2014).

Avallone, M., & Weideman, Y. (2015). Evaluation of a nursing handoff educational bundle to improve nursing student handoff communications: A Pilot Study. Journal of Nursing Education and Practice, 65 - 75.

Jecklin-Sand, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal of Clinical Nursing, 2854 - 63.

Leaders in Healthcare Facilities
THE CAUSE AND ITS REMEDIES

Lack of Leadership in Healthcare Facilities

When clinicians provide care, they necessarily assume leadership responsibilities (lumenthal et al., 2012). Existing evidence demonstrates that effective leadership produces the desired clinical outcomes. Yet only scattered residency programs teach and train residents on leadership. Many clinicians are thus poorly prepared to meet the leadership requirement of their daily tasks (lumenthal et al.).

Canada's national health care system urgently recommended drastic changes, which to this day, have hardly been implemented (Goldberg & Page, 2006). illions have been consistently spent yet patients continue to form long lines in waiting rooms to obtain treatment. Emergency rooms remained full and many still do not have primary physicians to turn to. The cause of the problem is not the lack of money but leadership. This report said that 70% of all the strategic initiatives and approved changes have not been worked on…...

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BIBLIOGRAPHY

Blumenthal, D.M. et al. (2012). Addressing the leadership gap in medicine" residents'

need for systematic leadership development training. Vol. 87 Issue 4, Academic

Medicine Journal: Association of American Medical Colleges. Retrieved on February

7, 2014 from  http://www.ncbi.nlm.nih.gov/pubmed/22361800

Provide sustained technical assistance (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)

Evaluation of the process in rural and small communities includes: (1) scope of the project; (2) goals; (3) critical success factors; and (4) technical assistance." (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Community grants have been focused on the provision of 'personal digital assistant (PDA) systems in assisting with the decision support role. The initiative is stated to include: (1) development of toolkits; (2) leveraging known tools; (3) developing capacity; and (4) disseminating best practices. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)

Ormond, Wallin, and Goldenson report in the work entitled: "Supporting the Rural Health Care Safety Net" (2000) state: "The policy - and market-driven changes in the health care sector taking place across country are not confined to metropolitan areas. Rural communities are experiencing changes impelled by many of the same forces that are…...

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Bibliography

Healthcare and Healthcare Insurance Country Report: India (2004) Tata Consultancy Services and Microsoft. WebHealthCentre.com. 2004 August. Online available at http://download.microsoft.com/documents/customerevidence/7144_WebHealth_CS.doc

Expert Panel Meeting: Health Information Technology (2003) Agency for Healthcare Research and Quality (AHRQ) 23-24 July 2003. Online available at  http://www.ahrq.gov/data/hitmeet.htm 

Silberman, P. And Slifkin, R. (nd) Innovative Primary Case Management Programs Operating in Rural Communities: Case Studies of Three States. Working Paper No. 76 North Carolina Rural Health Research and Policy Analysis Program.

Ormond, Barbara a.; Wallin, Susan Wall; and Goldenson, Susan M. (2000) Supporting the Rural Health Care Net. 15 May 2000 Urban Institute

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,…...

6% of the respondents stated that this was what they did. This number however is not reflected in lower numbers for life style disease and so it must be given greater scrutiny at another time (See table below).
Fruit and vegetable consumption by ethnicity

Lifestyle diseases

There are a number of diseases and health conditions that have been linked to life style behaviors and belief systems. The prevalence of these diseases demonstate that while persons may report a certain behavior emperical evidence suggests that another behavior may be taking place. This may occur principally because respondents may over estimate what they do on a daily basis since they are not taking active records of their behaviors.

On several indicators African-Americans have higher rates of the disease and death as a consequency than White populations. The data for diabetes shows that African-Americans are twice as likely to report having diabetes than white Americans. African-Americans also…...

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References

A religious portrait of African-Americans (2009) Retrieved from  http://pewforum.org/A-Religious-Portrait-of-African-Americans.aspx 

Department of health and senior services New Jersey. (2011).

 http://www.state.nj.us/health/chs/dataindex.htm 

Dowd, K. (1996). Dietary patterns and physical activity among New Jersey adults. Center for health Statistics 1(3):1-4.

Also, as care is prioritized, those individuals deemed to be in a less urgent need of care are given a lower priority, which results in a wait list. Finally, as physicians are compensated on the same level of salary, fewer people may be attracted to the profession for its financial rewards. In a public system, patients shop around less for providers because most providers charge the same fees. ithin a public system there is less 'siphoning' of middle-income people to higher-cost physicians with short waiting lists.
Visit: http://www.csc-surgery.com/contact.php.hatexactly is this hospital? hat would your policy response be?

According to its website, the Cambie Surgery Centre is a private healthcare clinic. The site notes that the "BC provincial government looks to private health care facilities like the Cambie Surgery Centre to help ease the long public wait lists." The hospital is a paying hospital that uses sophisticated technology to perform its services.…...

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Works Cited

Cambie Surgery Centre." Official website. 7 Apr 2008. http://www.csc-surgery.com/contact.php

Economies of scale." Investopedia. 7 Apr 2008.  http://www.investopedia.com/terms/e/economiesofscale.asp 

Economies of scope." Investopedia. 7 Apr 2008.  http://www.investopedia.com/terms/e/economiesofscope.asp 

Green, David G., Ben Irvine & Ben Cackett. "Health care in Germany." 2005.

Healthcare System -- Linkages and Alliances
The healthcare system is a complex but integrated system that allows patients, providers, pharmacists, insurance agencies, hospitals, and regulators to all come together so that the needs of each are met. This paper will select one healthcare delivery organization in the U.S. that provides care to patients and discuss the relationship between this organization and the other stakeholders in healthcare -- in particularly how it links and aligns with these stakeholders.

As the Institute of Medicine (2009) points out, "healthcare delivery organizations play a critical role because of their ability to drive practice trends, set standards, and influence smaller practices by sharing information, resources, and guidelines." This is something that Humana Care Delivery Organization is able to help achieve through its extensive network within the overall Humana family. By employing a balanced team, innovative pioneers, and using great locations to reach the population it targets, Humana…...

Health Care System
Healthcare Professionals

Health care providers must be properly integrated at every system level and must be allowed to lead the processes of designing, implementing and operating ideal health systems. esearch works identify a number of challenges with regard to healthcare personnel integration. Apparent loss of control, status, returns or practice style modifications may lead to healthcare providers becoming discontented. This discontentment can give way to bitterness and, ultimately, practitioners may end up resisting change (Suter et al., 2009).

Capitalizing on current networks, an intense emphasis on patients and informal inter-provider bonds are anticipated to ease healthcare practitioners' functioning within ideal healthcare systems. Economic integration of healthcare providers, utilization of compensation structures for recruiting and retaining the best candidates, measures for improving workplace climate quality and financial incentives are identified as crucial to system success.

Facilities and Supplies

Amodel healthcare system would include a standard formulated list of standardized healthcare supplies and…...

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References

Nelson, A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666.

Suter, E., Oelke, N. D., Adair, C. E., &Armitage, G. D. (2009).Ten Key Principles for Successful Health Systems Integration. Healthcare Quarterly (Toronto, Ont.), 13(Spec No), 16 -- 23.

alph Peterson, CMH:
There are a number of solutions to the current problem of City indigents frequenting the ED that CMH is now experiencing because of City Hospital's diversion. City cannot afford to treat all of the indigents and neither can we. However, there are a number of steps that we could take to solve this problem. In this memo, I will list and describe these steps. Below is a brief bullet point outline of what I propose.

People who come to the ED regularly go there because they believe it is the only place they can receive primary care. In some cases, it is. This does not mean, however, that CMH must bear the burden of this cost. Even though the problem is that the indigents are unable to pay for their care, there are several options available for relieving this burden and helping these indigents at the same time.…...

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References

CNNMoney. (2013). Who loses out under Obamacare? CNNMoney. Retrieved from  http://money.cnn.com/2013/07/25/news/economy/obamacare-medicaid/ 

DeLia, D., Cantor, J. (2009). Emergency department utilization and capacity. The Synthesis Project Research Synthesis Report, 17: 1-32.

Goodell, S., DeLia, D., Cantor, J. (2009). Emergency department utilization and capacity. The Synthesis Project Policy Brief, 17: 1-6.

The ACA and the U.S. Health Care System · The Affordable Care Act (ACA) was meant to promote greater quality care through increased implementation of preventive care; but as Lichtenfeld (2011) and Moynihan (2015) have shown, the health care industry remains committed to a course of treatments and tests because both are generally subsidized by the federal government—and, frankly, preventive care does not ensure that customers will keep coming through the door to make the industry money.
· The problem with the ACA has been that it has done little to reduce the putting of profits before people mentality that plagues the health care industry.
· It idealistically identified the right objectives—increasing access to care, increasing quality of care, lowering the cost of care, and increasing preventive care (Obama, 2016).
· However, in practice it failed to ensure that a mechanism was in place to actually enable the achievement of these objectives.
· Premiums began…...

As well as expanding patient's abilities to obtain primary care, virtually, telemedicine can enable patients in isolated locations to see specialists. When rural patients are connected to a hospital network such as the Grinnell egional Medical Center, they are able to access high-quality physicians through some of the more advanced healthcare technology available, although this is not always possible in a local healthcare system with fewer physicians and less access to high-level technology. Technology can still enable patients in a variety of settings to keep track of vital signs such as heart rate, blood pressure, and blood sugar, and to alert their physician immediately if their readings are abnormal.
While some surgeons have even performed procedures through virtual consults, certain aspects of medicine remain challenging to provide rural patients, such as physical rehabilitative services, which may require the patient to travel to receive the full benefit of the services. Patients…...

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References

Campbell, James D. (2001, May). Introducing telemedicine technology to rural physicians and settings. Journal of Family Practice. Retrieved January 27, 2011 at  http://findarticles.com/p/articles/mi_m0689/is_5_50/ai_75244766/ 

Spath, Patrice. (2011). Community Continuum of Care planning.

Brown-Spath & Associates. Retrieved January 27, 2011 at  http://www.brownspath.com/original_articles/cccplan.htm

Secondary Assessment
Tracy Folsom is a 28-year-old female who was brought to the Emergency Department by her neighbor. The neighbor stated that Miss Folsom was found lying semi-conscious in the shower. The patient was received in the ED by the on call nurse. The nurse's performance with Miss Folsom's management is reviewed in this article.

Emergency evaluation of a patient is supposed be in a systematic manner. A systemic approach prevents the examiner from missing out important clues that may point to a patient's diagnosis. This approach is divided into primary and secondary.

As part of the Primary Assessment, the patient's Airway, Breathing, Circulation and degree of Disability was evaluated, as per protocol. Miss. Folsom's airway was patent, breathing was shallow, and her skin color was pink, indicating good perfusion. She was obeying commands and pupils were equal in size and reactive to light. It is also helpful to state the capillary…...

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REFERENCES

Canadian Medical Association. (2007, July). Putting patients first ®: patient-centred collaborative care a discussion paper. Retrieved from http://fhs.mcmaster.ca/surgery/documents/CollaborativeCareBackgrounderRevised.pdf

Dean, R & Mulligan, J, 2009, 'Initial management of patients in an emergency situation', Nursing Standard, vol. 24, no. 5, pp. 35-41, (Academic Search Complete).

Gilbert, G., Souza, P., & Pletz, B. (2009). Patient assessment routine medical care primary and secondary survey. San Mateo County EMS Agency, 1-5. Retrieved from  http://smchealth.org/sites/default/files/docs/243322118Patient_Assessment.pdf 

Institute of Medicine. (2001) Crossing the quality chasm. Washington, DC: National Academy Press.

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

Cares for Nurses" by Cecil Deans (2004)
hen people become healthcare practitioners today, perhaps one of the furthest things from their minds is the increasingly violent nature of their potential workplaces. In his article, "ho Cares for Nurses" (2004), though, Cecil Deans makes the point that North American healthcare settings are very violent places to work and many institutions are not providing their practitioners with sufficient protections, and some are simply looking the other way -- all at the expense of the mental and physical well-being of their nursing staff. In their essay, "Challenges Facing Nurses' Associations and Unions: A Global Perspective" (2003), Clark and Clark note that, "Nurses, as the most highly trained caregivers with regular patient contact, are at the heart of any health care system. idespread anecdotal evidence suggests that the problems in health care have had a particularly negative effect on the workplace experience of nurses"…...

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Works Cited

Antai-Otong, Deborah. (2001). Critical Incident Stress Debriefing: A Health Promotion Model

for Workplace Violence. Perspectives in Psychiatric Care, 37(4):125.

Boyd, Neil. (1995). Violence in the Workplace in British Columbia: A Preliminary

Investigation. Canadian Journal of Criminology, 37(4):491-519.