Discuss how you can implement change in your department to bring your quality scores up.

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Discuss how you can implement change in your department to bring your quality scores up.

Question 1
Below are the hyperlinks to the websites where our information
(quality/HCAHPS) can be accessed by the public:
The Joint Commission Quality Check:
http://www.qualitycheck.org/consumer/searchQCR.aspx
US News:
http://health.usnews.com/best-hospitals/area
US Department of HHS (Hospital Compare):
http://hospitalcompare.hhs.gov/
National Patient Safety Goals
jointcommission.org
These topics are hot topics for healthcare and CMS will be deducting reimbursements on quality scores starting 2013. They are monitoring these scores now to see what percentage they will be deducting. We are finding in the hospitals across the country that nurses do not have any clue or understanding about these and they have been around for years.

2012 Care Measures (AMI, CHF, PNU, and SCIP).
2012 Patient Safety Goals
Fall Preventions
HCAHPS-(Hospital Consumer Assessment of Health Plans) Patient satisfaction scores
Go to these links and compare your facility to another hospital in your area. As a change agent pick one of the topics and discuss how you can implement change in your department to bring your quality scores up. Post your hospital scores in your presentation.

Post. Reply to at least one peer’s post with reflective and respectful questions or argumument.
2. Who controls nursing? (Consider nursing practice on all levels in your discussion.

 

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How many more visits will the company generate if it accepts Medicare patients?The president of Gentiva Health Services is considering increasing her number of Medicare patients served next year.

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How many more visits will the company generate if it accepts Medicare patients?The president of Gentiva Health Services is considering increasing her number of Medicare patients served next year.
The first task is: Source of Revenue: An Increase in the Medicare Patient Population

The president of Gentiva Health Services is considering increasing her number of Medicare patients served next year. However, to do so she must begin to use RNs for client visits, which Medicare reimburses at $45 per visit. An RN costs $35 per hour versus the current cost of $15 for an LPN or nurse’s aide. The president believes she can increase her patient visits by 15% by accepting Medicare patients. She is also aware that if she increases her Medicare patients, the company’s administrative costs will increase by approximately $10,000 per year because of the claims file complexity.

Use the following websites to gather data:

10K Annual Report
10Q Quarterly Report
Use the following volumes for your calculations:

Volume for the year:

Flexible budget: 6,000 visits
Static budget: 5,945 visits
Actual budget: 5,889 visits
Prepare a two-page report that addresses the following:

How many more visits will the company generate if it accepts Medicare patients?
What would be the estimated profit or loss associated with the Medicare service line?
Would you recommend that Gentiva Health Services increase its number of Medicare patients served? Why or why not?
The second task is: Business Plan

Review the quarterly report and develop a business plan for the organization for its upcoming financial year. Be sure to include the following in your organized business plan:

Organization segment
Marketing segment
Financial segment
Projected cash flow statement
Projected income statement
Projected balance sheet

 

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What technology is used? Is it low-technology (basic assessment tools, screening tests) or high-technology (i.e, patient diagnostic, monitoring, and/or data processing systems) or a combination of both?

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What technology is used? Is it low-technology (basic assessment tools, screening tests) or high-technology (i.e, patient diagnostic, monitoring, and/or data processing systems) or a combination of both?

WRITE a paper (at least 750 words) on a Innovative Nursing Care Delivery Model. Read the two (2) articles below:
? Norlander, L. (Ed.). (2011). Transformational models of nursing across different care settings. Report: The future of nursing: Leading change, advancing health (Appendix G). Washington, DC: National Academy of Sciences, Institute of Medicine.
(CLICK on PDF file: TRANSFORMATIONAL NURSING MODELS)
NOTE: For this assignment, ignore curriculi/nurse education models
? Hughes, F. (2006). Nurses at the forefront of innovation. International Nursing Review, 53, 94-101.
(CLICK on PDF file: NURSING PRACTICE INNOVATIONS)
Baccalaureate-prepared nurses are expected to function as managers, educators, collaborators, advocates, and leaders within a variety of settings. These articles describe a variety of innovative or “transformational” models in nurse-managed care across various care settings. Another source of ideas are the vignettes and case studies found in your textbook chapters.
For this paper, you will develop an innovative nursing care delivery model for a vulnerable population, care specialty, and setting in the United States OR a low income global country that reflects nurse managed care, collaboration, care across settings, and technology.
For your paper, it is easiest to focus on one (1) population, one (1) health issue/disease, and one (1) type of setting within a country. Be specific. If you use a low income country, name your low income country (see list in module 1) and adjust your model to the disease(s) and conditions found within that country. Consider that low income countries will not have access to the same level of facilities, technology related to diagnostics and communication, medications, and the health care professionals found in the U.S.
? A vulnerable population can include low income children and/or adults; elderly; homeless; migrants; immigrants; racial & ethnic minorities, people with chronic health or terminal conditions/diseases (or any group at risk for obtaining appropriate health care).
? A care specialty can include preventative care; primary care; acute care; chronic care; palliative or end-of-life care (including the targeting of any disease or condition that results in a health risk).

? A setting can include rural or urban community housing and/or clinic; school; specialty unit in a hospital; emergency room; health provider office; armed services facility; rehabilitation facility; hospice facility; ambulatory health care center; client home; nursing home; prison or detention center; short term stay housing (or any setting where a vulnerable client/patient population is available for care).
a) Content of paper:
Title of Paper (top of page 2, centered) Innovative Nursing Care Delivery: [Name of Your Model]
PAPER HEADING: Introduction [Level 1] What is your model’s population, setting, care specialty, and your model’s goal(s) and/or purpose(s)? For example, are you targeting a particular group or disease/condition? Choose a name for your model and include it in your paper title.
PAPER HEADING: Description of the [Name of Your Model] [Level 2] You are welcome to use your creativity in the model–develop your own or base it on an existing model. For ideas, start with the articles found with the assignment, textbook (Global Health 101) scenarios, or do literature searches on the internet. However, be sure that the model is nurse-led or nurse-managed. Registered nurses have authority to make decisions regarding nursing diagnoses, interventions, and referrals. Registered nurse practitioners have additional authority related to medical diagnoses and interventions (prescriptions).
Be sure to include the themes crucial to meeting the challenges of the future: nurse- managed care, collaboration, continuity of care and technology in describing your model. Be aware of cost-effectiveness; you could develop the “Cadillac” of models, but no one would consider implementing it because the cost would be too high.
Nurse led and nurse managed health care. [Level 3] Were nurses instrumental in the development and implementation of your model? How is your model nurse managed? Are nurses consulted and/or make decisions re: budget, personnel, and the communication, referral, and evaluation processes?

 

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He states he ran a traditional Vietnamese family, unlike his children, who are married and have now moved away.

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Healthy People Initiative (graded)
As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic woman who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After doing her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She is in class a total of 15 hours per week, plus 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children.She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1hour from campus and commutes each day.Using .healthypeople.gov/”>Healthy People 2020as a guide:
1. What additional information would you like to gather from Maria?
2. What are Maria’s real and potential health risks?
3. Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?

Cultural Bias (graded)
Understanding cultural phenomena is essential to the completion of an accurate health assessment. Please choose a cultural group from Table 4.1 from your text and describe the cultural differences pertinent to that group. Remember, the table may not include all cultural groups. Let’s try to include all the groups listed in the discussion, so please do not choose a group that has already been done. To expedite this, please use the group name in the title of your post.

week 2

Pain Assessment (graded)
John, a 46-year-old African-American male presents for admission to your hospital for hemi-colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work related injury. History of two (2) previous back surgeries with relief of numbness in RLE but pain has not been relieved. His current medications include Methadone, Neurontin and Norco. John states he takes Benadryl PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain.
• What risk factors does John have for risk of opioid withdrawal during this hospitalization?
• Is there a stigma connected to being disabled and or methadone?
• Does the nurse need to be concerned about acetaminophen use?
• What are the differences in acute and chronic pain?
•

Nutritional Assessment (graded)
Yulang Lei, an 82-year-old Vietnamese man, was admitted to your floor with dehydration and a urinary tract infection following a fall at home. He is alert and oriented, but weak. He appears frail. His admission history includes the following.
• He lives alone; his wife died 6 months ago.
• He states he ran a traditional Vietnamese family, unlike his children, who are married and have now moved away.
• His wife did all the cooking and he hasn’t had much of an appetite since she died. He eats rice and some vegetables, but rarely “bothers to cook meat for just one person.”
• Usual daily activity is reading the Vietnamese community newspaper with his morning tea for breakfast. He says he usually eats lunch, but can’t remember what he usually eats. He has rice and a few vegetables for dinner.
• You notice that his clothes fit very loosely. He states he weighed 140 pounds at his doctor’s office 5 months ago. When you weigh him, he weighs 123 pounds and is 5’8″ tall.
Look at the list of nursing diagnoses in Appendix A of your text. What nursing diagnoses would you choose for Mr. Lei?
• What additional questions would you ask to confirm your diagnosis?
• What physical examination and laboratory findings would you expect Mr. Lei to have?
• What psychosocial and cultural factors should you consider when assessing Mr. Lei?

General Survey and Health History (graded)
Casey is a 17-year-old high school student admitted to the ER with a compound fracture of the left leg obtained falling at the local skateboard park while practicing for a national competition. He has never been hospitalized before. His mother has been notified and is on her way. The EMTs gave him morphine and he reports his pain level as “okay.”
• What part of the interview and examination can be done prior to his mother’s arrival?
• As you enter the room for the first time, what should you observe as part of the general survey?
• As you complete his history, what areas are especially important?
• What are the important developmental considerations for Casey?

 

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Explain the types of watermelons (girls) there are… righting an essay about a woman’s body, will need some help.

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Explain the types of watermelons (girls) there are… righting an essay about a woman’s body, will need some help.

Explain the types of watermelons (girls) there are… righting an essay about a woman’s body, will need some help

 

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DISCUSS YOUR ROLE AS AN ADVOCATE AND HEALTHCARE LEADER IN PROMOTING POSITIVE SOCIAL CHANGE.

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DISCUSS YOUR ROLE AS AN ADVOCATE AND HEALTHCARE LEADER IN PROMOTING POSITIVE SOCIAL CHANGE.

DISCUSS YOUR ROLE AS AN ADVOCATE AND HEALTHCARE LEADER IN PROMOTING POSITIVE SOCIAL CHANGE
Discuss your role as an advocate and healthcare leader in promoting positive social change as a scholar-practitioner to improve the health of vulnerable populations in your community.
•In your current practice and as a health leader in your community how will you collaborate with other healthcare providers to promote the health of your community (especially in childhood obesity)?

 

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How human behaviors can prevent the spread of nosocomial infections in the healthcare environment?

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How human behaviors can prevent the spread of nosocomial infections in the healthcare environment?

How human behaviors can prevent the spread of nosocomial infections in the healthcare environment? Discussion question: Share a Research Design for Your Significant Nursing Clinical Issue (graded) 1.) Describe which research design will work best for your research question. Why? Explain your answer.

 

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According to the ECG findings what is the differential diagnosis? At the time of admission a blood sample is taken to determine whether PJ has suffered an MI. Which laboratory findings would indicate MI? Describe the pathophysiological responses occurring in the body during an MI.

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According to the ECG findings what is the differential diagnosis? At the time of admission a blood sample is taken to determine whether PJ has suffered an MI. Which laboratory findings would indicate MI? Describe the pathophysiological responses occurring in the body during an MI.

PJ is a sixty-seven-year-old man with a long history of stable angina. He is treated with nitroglycerin tablets as needed for chest pain. He has mild hypertension which is well controlled by diet and an angiotensin-converting enzyme (ACE) inhibitor. PJ has noticed that his chest pain is occurring with increasing frequency and less activity is required to initiate the symptoms; however the pain subsides quickly with rest and one or two nitroglycerin tablets.
PJs symptoms are consistent with what diagnosis? What education would you provide to PJ?
One morning at about 4:00 a.m. PJ is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and the left arm. He is diaphoretic and pale. His wife calls for emergency assistance and PJ is transported to the local emergency department. Upon admission the electrocardiogram (ECG) shows significant ST-segment elevation.
According to the ECG findings what is the differential diagnosis? At the time of admission a blood sample is taken to determine whether PJ has suffered an MI. Which laboratory findings would indicate MI? Describe the pathophysiological responses occurring in the body during an MI.
>>>Note: Use up-to-date bibliography from pathophysiology books no later than 5 years<<<

 

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Does the current structure empower nurses to provide the best patient care possible?

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Does the current structure empower nurses to provide the best patient care possible?

CASE STUDY

Moreno Medical Center (MMC) is a 600-bed, full-service acute care facility located in the Northwest Kelsey community. The hospital is a physician-owned, for-profit hospital that takes pride in the provider-patient relationship. With recent changes in managed care, every dollar, process, and interest of the patient serves as a common ground for making an organization more efficient.

To remain competitive in the marketplace, the management team at MMC decided to take a look at various processes within the hospital and noted that the overall patient experience in the outpatient surgical clinic was less than satisfactory. The main problem seems to focus on long delays throughout the entire admission to discharge process. If the hospital wants to maintain its competitive position, the administration will have to redesign the current process to improve patient satisfaction.

The hospital administration appointed an internal quality consultant to facilitate the planning process. The quality consultant for this new organizational role is an experienced intensive care RN with a business degree. She understands that health care is a personal encounter and that patients and families expect to have their priority needs met when experiencing a health care issue.

The quality consultant decided to work closely with the surgical department RN administrator who would be a powerful change agent in leading the improvement process. During the review of the surgical department processes, the administrator and consultant identified several major issues:

· Surgeons delaying surgery times causing backlog of surgery schedule

· Other hospital departments (e.g., admitting, finance, lab) conducting separate encounters with surgical patients without regard to the surgery schedule

· Long wait times for patient transportation from surgical area to recovery room

· Ancillary staff providing patient discharge instructions when nurses are busy

· Nursing staff displaying a culture that the procedure, not the patient, is the priority

The surgical department RN administrator acknowledges that changes need to occur and the new process must be guided by what is in the best interest of the patient. He developed a new vision statement for the department with its first priority to provide a patient and family focused quality care culture.

Review the introduction videos and organizational charts.

Read the case study detailing key issues that have been identified at MMC.

Write a 1,050- to 1,400-word paper in which you:

Analyze MMC’s characteristics and organizational structure to determine how they could be affecting patient satisfaction in both positive and negative ways.
Could reorganization help drive better patient outcomes?
Does the current structure empower nurses to provide the best patient care possible?
Analyze social and cultural aspects of MMC that could be exacerbating or helping resolve admission and discharge issues.
Are the right individuals involved in the admission and discharge process or do roles and team dynamics contribute to the issue?
Assess the responsibilities of MMC leaders and managers to act as change agents in mitigating the patient satisfaction issues.
What actions have already been taken and what other actions would you suggest to make a greater impact?
Analyze how delegation is contributing to or improving MMC’s issues.
Analyze how MMC’s staffing and performance evaluations could help improve overall patient satisfaction.

 

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Examine the negative results on stakeholders and the financial statements of an IRS audit which generates additional tax and penalties or subsequent audits.

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Examine the negative results on stakeholders and the financial statements of an IRS audit which generates additional tax and penalties or subsequent audits.

Assume you are the partner in an accounting firm hired to perform the audit on a fortune 1000 company. Assume also that the initial public offering (IPO) of the company was approximately five (5) years ago and the company is concerned that, in less than five (5) years after the IPO, a restatement may be necessary. During your initial evaluation of the client, you discover the following information:

The client is currently undergoing a three (3) year income tax examination by the Internal Revenue Service (IRS). A significant issue involved in the IRS audit encompasses inventory write-downs on the tax returns that are not included in the financial statements. Because of the concealment of the transaction, the IRS is labeling the treatment of the write-down as fraud.
The company has a share-based compensation plan for top-level executives consisting of stock options. The value of the options exercised during the year was not expensed or disclosed in the financial statements.
The company has several operating and capital leases in place, and the CFO is considering leasing a substantial portion of the assets for future use. The current leases in place are arranged using special purpose entities (SPEs) and operating leases.
The company seeks to acquire a global partner, which will require IFRS reporting.
The company received correspondence from the Securities and Exchange Commission (SEC) requesting additional supplemental information regarding the financial statements submitted with the IPO.

 

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