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  • Management action plan in healthcare essay

    Management action plan in healthcare essay

    discussion
     

    Recall what you have learned in this unit about incrementalism. In your opinion, when is it beneficial to use this strategy in healthcare policy reform? What are the possible risks?

    Unit VI Project

    Instructions

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    Management Action Plan (MAP): Part 5

    Incrementalism relies on an advanced knowledge of a need to add to a project using many small, accurate, and incremental changes instead of undertaking a few, well-planned, large jumps.

    First, you will need to decide on the sequencing of your key action steps. Start by reviewing your key action steps in Part 4. For each key action step, ask yourself what other steps must be completed before that specific action can be taken. Management action plan in healthcare essay.

    Next, explain the merits of incrementalism in your MAP and possible consequences if incrementalism is not utilized.

    Finally, rearrange your key action steps into a sequence of ordered activity. Then, look at your plan once again. Are there any ways to simplify the plan further before presenting it?

    Address accountability. For each key action step, assign a responsible party or group within your hypothetical or actual organization (by position, department, or team name—not by individual name), and assign a suspense date by which the key action steps must be completed. Then, based on all of your key action steps and the suspense dates, provide a realistic completion date for the entire MAP. Management action plan in healthcare essay.

    Develop measurement and monitoring. Explain in detail how you will measure the success of your MAP following implementation and how you will monitor ongoing performance to prevent regression and loss of the positive change that has taken place.

    This part of the course project will be a minimum of three pages in length, not including the title and reference pages or material from previous project submissions. It should be organized well and contain an introduction. At a minimum, your textbook should be used as reference material for this part of your project. Management action plan in healthcare essay.

  • Discussion: Treating Childhood Abuse Essay

    Discussion: Treating Childhood Abuse Essay

    In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Discussion: Treating Childhood Abuse Essay. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.

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    In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

    Learning Objectives

    Students will:

    · Recommend strategies for assessing for abuse

    · Analyze influences of media and social media on mental health

    · Evaluate the need for mandatory reporting of abuse Discussion: Treating Childhood Abuse Essay

    To Prepare
     
    for this Discussion:

    · Read the Learning Resources concerning treating childhood abuse.

    Read the Child Abuse Case Study in the Learning Resources. Visit ( 
    https://class.content.laureate.net/c2d25a50e4f76a67640daef9661a07f1.pdf

    · Use subheadings please when writing, please.

    Post:

    · What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.

    · How might exposure to the media and/or social media affect the patient?

    · What type of mandatory reporting (if any) is required in this case? Why?

     

    Treating Childhood Abuse

    Introduction

    The statistics on physical child abuse are alarming. Children are physically abused each year by a parent or close relative; majority die as a result of the abuse. For those who survive, the emotional trauma remains long after the external bruises have healed. According to the National Child Welfare Information Gateway(2017), 49 States reported a total of 1,585 fatalities.2 Based on these data, nationally estimated 1,670 children died from abuse or neglect in 2015. Children who experience and or witness stressors in life have a high likelihood of physical and mental health problems (Westbrook & Berenbaum, 2016). Preventing the occurrence of such events in life, early detection, and interventions when they occur and rehabilitation in complications is significant in limiting the future adverse complications. This week’s discussion will focus on the strategies for assessing child abuse, ways in which exposure to media impacts the patient and mandatory reporting required in child abuse case. Discussion: Treating Childhood Abuse Essay

    Strategies for Assessing Child Abuse

    Trauma assessment is an in-depth exploration of the nature and severity of the traumatic events, the consequences of those events, and current trauma-related symptoms. The case study of Morgan’s case presents one of the many situations where children are finding themselves in the hands of hostile caregivers who take advantage of their predicaments to sexually or physically abuse them. In this case,  Morgan would require a trauma-informed mental health assessment, intensive counseling and gain trust to reveal his predicaments. Studies have shown that childhood abuse is consistently associated with personality disorders including Borderline Personality Disorder.  People who have difficulties in controlling or regulating their emotions have been linked to physical/sexual abuse (Crowell, 2016). Having strategies in place for the assessment of child abuse is an essential step in detecting child abuse more so in those cases where the children may be threatened with fear of disclosure. Effective strategies require the proper and the consistent use of screening tools for the assessment process when there is suspicion of child abuse. Bailhache, M., Leroy, V., Pillet, P., & Salmi, L.(2013). Give an outline of the possible benefits of using assessment tools for early detection of child abuse. Healthcare providers should consider assessing for more than one type of child maltreatment if there is suspicion of child abuse. The routine physical examination is vital for early detection of child abuse. The trauma-informed mental health assessment is a structured framework for gathering information across several essential domains of functioning. It is also used to identify and address the needs of children and families exposed to traumatic events; it also entails the coding which summarizes the information and communicated to with families and other providers (Kisiel, Conradi, Fehrenbach, Torgerson, & Briggs; 2014). Currently, the Center I work uses the Child and Adolescent Needs and Strengths (CANS). Trauma Comprehensive Version “CANS-Trauma”  a flexible, multi-purpose tool used in different capacities depending on the needs of a particular child-serving system (Kisiel, Conradi, Fehrenbach, Torgerson, & Briggs; 2014). The CANS is used to gather information on a range of domains relevant to the functioning of the child and caregiving system, and the information is directly incorporated into individualized plans of care (Kisiel, Conradi, Fehrenbach, Torgerson, & Briggs, 2014). When assessing an abused child /adolescent, the best thing to do is to provide a calm reassurance and unconditional support. Show empathy and reassure the client of their safety.

    In the case of Morgan, the trauma-informed approach and the CANS was chosen because of the childhood abuse he experienced, and how he continues to relieve the consequence of the abuse, not been able to keep a job, having nightmares because the cousins who abused him is released from prison. Selecting the trauma-informed strategy allows the survivor’s need to be respected, informed, connected, and hopeful regarding his recovery.

    Influences of media and social media

    Social media play an integral role in shaping the personality of some teenagers worldwide. One cannot, therefore, ignore the impact of social media on the mental health. The portrayal of violence, sex, and drugs/alcohol in the media has been known to affect the behavior of children and adolescents adversely. There is a strong association between perceptions of media messages and observed behavior, especially with children. Contrasting literature has explored the role of media in mental health, citing relieve of anxiety and depression, enhancing social interaction, and hence creating a wide support network. Discussion: Treating Childhood Abuse Essay. Other scholars, however, argue based on the adverse effects of sedentary online life that may paradoxically lead to depression and suicidal ideations in youth. Increased access to social media platforms has been associated with the high cases of mental problems currently among the young population. The fact that Morgan has a diagnosis of anxiety depression, social media is likely to exacerbate this condition. A good number of studies have associated increased incidences of anxiety, depression, loneliness, narcissism and compulsive behavior among the young population (Berryman, Ferguson, & Negy, 2017). However, if Morgan can use social media to learn more about social support networks, then he is likely to benefit by joining a social network of people who have been through the same road, hence will benefit from the psychosocial support. Discussion: Treating Childhood Abuse Essay.

    Mandatory reporting

    Mandatory reporting requires that people or organizations working with children should report any form of physical, sexual or emotional abuse of children (Douglas & Walsh, 2015). As practitioners it is mandatory we report any child abuse, disciplinary actions are considered against those who do not report such cases. In Morgan’s case, he had been molested by this close relative, who is now out of jail. It is mandatory to report this issue to the children’s’ protection department and ensure that Morgan is protected from chronic abuse from the relative. Discussion: Treating Childhood Abuse Essay.

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    References

     

    Bailhache, M., Leroy, V., Pillet, P., & Salmi, L. (2013). Is early detection of abused children possible?: A systematic review of the diagnostic accuracy of the identification of abused children. BMC Pediatrics, 13(1). Retrieved
    https://doi.org/10.1186/1471-2431-13-202

     

    Kisiel, C., Conradi, L., Fehrenbach, T., Torgersen, E., & Briggs, E. C. (2014).Psychiatry and Behavioral Sciences(2014)Assessing the Effects of Trauma in Children and Adolescents in Practice Settings, Retrieved https://www.scholars.northwestern.edu/en/publications/assessing…

     

    Berryman, C., Ferguson, C. J., & Negy, C. (2017). Social Media Use and Mental Health among Young Adults. Psychiatric Quarterly. Retrieved https://doi.org/10.1007/s11126-017-9535-6 Discussion: Treating Childhood Abuse Essay

     

    Crowell, S. (2016). Faculty of 1000 evaluation for An examination of the relationship between childhood emotional abuse and borderline personality disorder features the role of difficulties with emotion regulation. F1000 – Post-publication peer review of the biomedical literature. Retrieved https://doi.org/10.3410/f.727015348.793525739

     

    Douglas, H., & Walsh, T. (2015). Mandatory Reporting of Child Abuse and Marginalized Families. Mandatory Reporting Laws and the Identification of Severe Child Abuse and Neglect, 491-509. Retrieved https://doi.org/10.1007/978-94-017-9685-9_23

     

    Westbrook, J., & Berenbaum, H. (2016). Emotional Awareness Moderates the Relationship Between Childhood Abuse and Borderline Personality Disorder Symptom Factors. Journal of Clinical Psychology, 73(7), 910-921. Retrieved https://doi.org/10.1002/jclp.22389

     

    Child Welfare Information Gateway. (2017). Child abuse and neglect fatalities Statistics and interventions. Department of Health and Human Services, Children’s Bureau, https://www.childwelfare.gov Discussion: Treating Childhood Abuse Essay

  • NRS-451 Organizational Culture and Values Nursing PowerPoint presentation

    Organizational Culture and Values

    NRS-451 Organizational Culture and Values Nursing PowerPoint presentation

    Prepare a 10-15 slide PowerPoint presentation, with speaker notes, that examines the significance of an organization’s culture and values. For the presentation of your PowerPoint, use Loom to create a voice-over or a video. Refer to the Topic Materials for additional guidance on recording your presentation with Loom. Include an additional slide for the Loom link at the beginning, and an additional slide for References at the end.

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    Outline the purpose of an organization’s mission, vision, and values.

    Explain why an organization’s mission, vision, and values are significant to nurse engagement and patient outcomes.

    Explain what factors lead to conflict in a professional practice. Describe how organizational values and culture can influence the way conflict is addressed.

    Discuss effective strategies for resolving workplace conflict and encouraging interprofessional collaboration.

    Discuss how organizational needs and the culture of health care influence organizational outcomes. Describe how these relate to health promotion and disease prevention from a community health perspective. NRS-451 Organizational Culture and Values Nursing PowerPoint presentation.

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

    This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. NRS-451 Organizational Culture and Values Nursing PowerPoint presentation

  • Nurs 6051 Transforming Nursing and Healthcare Week 1 Discussion Essay

    Nurs 6051 Transforming Nursing and Healthcare Week 1 Discussion Essay

    Health information technology can improve patient safety and patient health tremendously. Information processes must be streamlined with the idea of preventing error. Although it is okay to make mistakes, errors in healthcare should not be the norm. As nursing professionals, we are held to very high standards. Nursing educators must ensure that nursing and the lives of others is not taken without extreme caution and attentiveness to detail. Training on technology processes should be continually provided as well as monitored. With the rise in technological innovations in health care, the need for health information nurse specialists is in high demand. I agree we should encourage the free flow of information and error reporting. Nurs 6051 Transforming Nursing and Healthcare Week 1 Discussion Essay. I disagree that we should put all the responsibility of a mistake on a machine and its processes. With more technological systems in place, more professionals feel they have the ability to rely on the intelligence of machines simply. Nurs 6051 Transforming Nursing and Healthcare Week 1 Discussion Essay.

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    Creation of Health Information Technology Safety Centers is on the rise. The Office of the National Coordinator for Health Information Technology (HIT) was created to supervise the safety of technological processes and its functions. Patient safety should be monitored by HIT safety centers and work cogently with stakeholders, organizations, vendors and administrators to improve care. Four ways to achieve this are through 1.) post-marketing surveillance of security events; 2.) investigation of significant HIT-related safety occurrences; 3.) create random assessments of infrastructures; 4.) coordinate and advocate HIT safety with governmental and private healthcare credentialing bodies. It is interesting to note the importance of federally supported HIT safety centers in revolutionizing the delivery of health care. Nurs 6051 Transforming Nursing and Healthcare Week 1 Discussion Essay.

    Care is based primarily on visits rather than on continuous healing relationships is practiced in many facilities. Unfortunately, inadequate staffing/supplies diminish the opportunity to provide best evidence-based care. Whether intentional or not, administrators are dictating the type of care provided based on visits. In this scenario, professionals instead of patients control the care.

     

    References

    Patient safety goals for the proposed Federal Health (n.d.). Retrieved from https://psnet.ahrq.gov/resources/resource/28477 Patient safety goals for the proposed Federal Health  (n.d.). Retrieved from https://psnet.ahrq.gov/resources/resource/28477

    Sittig, D. F., Classen, D. C., & Singh, H. (2015).
    Patient safety goals for the proposed Federal Health Information Technology Safety Center.

    Journal Of The American Medical Informatics Association: JAMIA
    ,
    22
    (2), 472-478. doi:10.1136/amiajnl-2014-002988 Nurs 6051 Transforming Nursing and Healthcare Week 1 Discussion Essay

  • NURS 6051 Week 1 Discussion – To err is human essay

    NURS 6051 Week 1 Discussion – To err is human essay

    Even the best of us can make mistakes. We are all human.  Although in health care, mistakes can prove to be devastating, costly and in many cases deadly.  In 1999, the Institute of Medicine (IOM) published 
    To Err Is Human: Building a Safer Health System
    which called for a change in the practice of health care in the prevention of medical errors.  The study stunned the nation with its grim statistic estimating that up to 98,000 patients died per year from preventable medical errors in hospitals (Plawecki and Amrhein, 2009).  Medical errors as defined by IOM 1999 report, “is the use of a wrong plan of care to achieve an outcome or the failure of a planned action to be completed as intended” (Plawecki and Amrhein, p. 27, 2009). NURS 6051 Week 1 Discussion – To err is human essay. The landmark study also exposed that a major barrier to patient safety is the lack of awareness of how extensive medical errors are in the health care setting and how often they occur (Wakefield, 2008).  As Plawecki and Amrhein acknowledged, it doesn’t matter how many times a procedure has been performed or a medication given, there is always the potential of a preventable error (2009).  Faulty systems and processes have been shown to be the cause of most mistakes versus an individual’s behavior (IOM, 1999).  As health care providers, one of our biggest fear is that we can be fallible.  The IOM’s report although distressing, brought awareness and understanding about the weakness in our country’s health care system.  In response to this pivotal publication, the IOM proposed methods to transform the health care setting.  A call for action among all responsible parties in the health care system is needed to prevent the continual rise in medical errors.  The series known as
    Crossing the Quality Chasm
     was developed to redesign how health care settings operate (Wakefield, 2008).  Wakefield discussed in the 
    Quality Chasm Series
    the simple rules with the 21st Century (2008) NURS 6051 Week 1 Discussion – To err is human essay.  It challenged the system to implement the major actions for achieving a safer, more effective, and efficient health care (Wakefield, 2008).

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    To achieve the recommended goals, there are enormous potential for transforming health care using Health Information Technology (Cipriano & Murphy, 2011).  Additionally, web-based information has considerable potential to enhance patient knowledge and stimulate healthy behavior (Cipriano & Murphy, 2011).  According to new rule four from the
    Quality Chasm Series,
     the sharing of knowledge and access to information, increased communication and encourage shared ideas with all participant of health care. The Magnet hospital that I work for utilizes electronic medical record (EMR) known as Cerner in all outpatient and inpatient units.  Through access of clinical information and data collection, communication improved among providers, and other health care members thus reducing errors.  Not only are the health care team members employing EMR but patients are also encouraged to sign up to access their own clinical records through the patient portal from the Internet or an application through their cell phones.  NURS 6051 Week 1 Discussion – To err is human essay. They can also communicate to their health care team, keep track of their appointments, or request appointments and medication refills.  Thus, allowing patients to be proactive in their own care.  The EMR also allowed providers to enter their own orders through the computerized physician order entry (CPOE) systems, therefore alleviating nurses from having to decipher handwritten orders or taking verbal ones which could lead to errors and misunderstanding.  Health information technology is constantly growing and improving, whether it’s in the design interface or increasing user friendliness or management of data.  One area of growth that is needed is through the management of chronic conditions remotely to patients who have difficulty traveling such as nursing home or homebound patients.  Implementation of virtual care and remote monitoring tools are still not widely utilized in critical populations.  Telehealth is limited to a select few.  In my hospital, it is available only to prisoners in a set location. NURS 6051 Week 1 Discussion – To err is human essay.  This is mainly due to issues with how to charge for services and the financial burden it poses to increase access to outside rural areas.

    Overall information technology (IT) is a wonderful tool.  It has made advances in health care, improved the safety of patients, and the efficiency for effective care for better health outcomes for patients.  IT has enormous potential and growth.  It has the ability to provide critical information with ease of access and reduce miscommunication and delay in care if properly implemented, maintained, and updated.  The future of health informatics is exponential. NURS 6051 Week 1 Discussion – To err is human essay.

    References:

    Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. 
    Nursing Economic$,  29
    (5), 282, 286–289.

    Institute of Medicine. (1999). To err is human:  Building a safer health system.  Retrieved from the National Academies Press website:  http://www.nap.edu/catalog.php?record_id=9728

     

    Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. 
    Journal of Gerontological Nursing, 35
    (11), 26–29. Retrieved from the Walden Library database.

    Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), 
    Patient safety and quality: An evidence-based handbook for nurses
    (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services. NURS 6051 Week 1 Discussion – To err is human essay.

  • Electronic Health Records (EHR) Essay Examples

    Electronic Health Records (EHR) Essay Examples

    Week 5: Electronic Health Record

    Main Post

    Introduction

    Electronic Health Records (EHR) are the cause of a major force that is creating change in the health care industry. Dramatic changes, apprehension, excitement, along with fear and concern are the focus of a new era from paper charting to a new electronic health record system. This research paper will examine benefits and challenges electronic health records face, along with resistance to change and fear many have toward this new system. Electronic Health Records (EHR) Essay Examples.

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    Electronic Health Record Initiation

    The transition from paper based charting to electronic base charting has shown to be very complex and difficult. Not many years ago, there was only one method of keeping medical records and this was utilizing paper charts. These charts, although still used in many practices today, have slowly been replaced by a more advanced method called electronic health record or EHR. The Centers of Medicare and Medical Services (CMS), defines “electronic health records as an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include demographics, progress notes, problems, medication, vital signs, past medical history, immunizations, laboratory data, and radiology reports” (CMS.gov, 2012).   Resistance to change is always a crucial challenge for the success of any innovation. Research has found that physician resistance is a challenge in the implementation of a new EHR system when switching from a paper-based practice.

    In my organization where I work, I was concerned about incomplete documentation and double entry during EHR transition. For instance, “medication wasn’t documented in the computer because somebody didn’t have time, or somebody didn’t know how.” Also, I m worried about diminishing eye contact between doctor and patients and computer crashes. For some nurses, changes tend to be less resistance who are more tech savvy, those who grew up with a computer, can type quickly and are comfortable clicking around a screen. Some doctors have difficulty adjusting to the use of new electronic charting. Most problems are about their typing skills. Some staff stated, “comfort level with the program and allocating an appropriate amount of time for training will have an impact on the patient volume and overall budget.” Similarly, another staff stated, “medical assistants and nurses will be expected to use the new EHR; there may be lots of variation in technology comfort level among support staff. Training these peoples adequately and making sure they are comfortable with the EHR are significant.”

    Challenges

    Regardless of the many benefits, EMRs have some challenges. The first significant challenge of EMRs is the high costs. Deltev (2007) reports that electronic record management systems are extremely costly to acquire, and is this is the significant barrier for implementing EMRs on clinical practices. For instance, ongoing training is a big concern and a hidden cost.

    Another challenge in implementation of EHR is the potential privacy threat. The high levels of accessibility and portability of EMRs also tend to increase the risk of unauthorized access or data theft. Paper records may be tedious and inefficient, but they don’t face threats from cyber-attacks. Such security breaches could cause substantial harm to patients, as well as result in legal issues to providers. According to the previous study, the common privacy concerns with EHRs are unauthorized access to records, tampering with records and the risk of losing information due to a natural disaster. Since EHRs allow for easier access to sensitive information, there is an increased risk of privacy violations Electronic Health Records (EHR) Essay Examples. These may include intentional “prying” or may be accidental by using improper security measures.

    The last major essential challenge is the use of copy and paste. Because documentation is more involved with EHRs, physicians may rely on the copy and paste function as a shortcut, particularly for routine or follow-up visits. While this may save time for the physician, this puts the patient’s safety at risk and impairs quality of care as updates or changes between visits can be overlooked or not documented properly.

    Strategies

    COST – EHR systems can be expensive. Finding the capital to invest in the infrastructure, personnel, training and support required to install and maintain an EHR system can be a barrier, especially for small to mid-sized practices. Uncertainty over the long-term return on investment can exacerbate this concern. Associated costs, such as increased physician time requirements and decreased patient visits during EHR implementation, can affect providers’ bottom lines (USFHealth, n.d.) Electronic Health Records (EHR) Essay Examples.

    Privacy concerns – There are ways in which electronic health record entities can provide superior security and privacy solutions once the EHR is implemented such as; Guide employees through the stringent privacy and security training process, provide identification and verification requirements to all system users, Issue specified punishments to employees not following compliance guidelines, and disguise all data inside medical files through cryptography. Reliable electronic health records companies apply these enhanced security and privacy protocols. Perhaps the most important security protocol is data encryption, which causes data to become unreadable to outside sources. Electronic health records specialists also provide remote storage and data backup systems. While this may not necessarily present as strong of a defense against hackers and data breaches as data encryption, it provides security for healthcare organizations against the potential of software failures or natural disasters that could destroy or damage files.

    Copy and Paste Issue – according to The Joint Commission, the American Health Information Management Association recommended the strategies to prevent copy and paste errors in EHR. These includes: development of a policies and procedures addressing the proper use of the copy and paste function (CPF) to assure compliance with governmental, regulatory and industrial standards; addressing the use of features such as copy-and-paste in the organization’s information governance processes; providing comprehensive training and education on proper use of cop-and-paste, to all EHR users; and monitoring compliance and enforce policies and procedures regarding use of of copy-and-paste, and institute corrective action as needed (The joint commission, 2014).     The advantages of EHRs to the clinicians and patient alike are considerable. To avoid these issues, hospitals and healthcare systems must perform a thorough evaluation of the EHR system before purchase and implementation. To truly achieve the type of change that health care staff seek, tighter clinical integration across practice settings is a must. I believe these challenges could be addressed with proper education and training. Electronic Health Records (EHR) Essay Examples

    References

    CMS.gov (2012). Electronic health records. Retrieved from:
    https://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html?redirect=/EhealthRecords/

    Deltev, S. B. (2007). The executive’s guide to electronic health records
    .

    New York: Health            Administration Press.

    The Joint commission (2014. Preventing copy and paste in EHR. Retrieved from:             
    https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_10.pdf

    USFHealth (n.d.). Overcoming Hurdles Faced During HER Implementation. Retrieved from:            

    EHR Implementation Plan: Your Guide to Conquering EHR Hurdles

     

    Week 7 Assignment

     

    Information technology (IT) has quickly assimilated into healthcare improving patient care and reducing costs by tracking patient care. The nursing population as a whole resists change, set in their ways nurses have specific routines that propel them through the shift efficiently. As a nurse facilitator, one may encounter an individual resistance when everyday routines are threatened. The purpose of this paper is to use Rogers’s diffusion of innovation (relative advantage, compatibility, complexity, trialability, and observability) as a tool to facilitate a smooth transition into the world of electronic health records (EHR) for nurses in a working hospital setting.

    Efficacious execution of new IT involves overcoming the fears and resistance to change most people display, especially if change means learning a new process for a skill you have already mastered. In the world of nursing time, management is crucial in patient care. The American Recovery and Reinvestment Act (ARRA), mandated that U.S. hospitals are to become meaningful users of EHR (Kelley, Brandon, & Docherty, 2011). The U.S. government apportioned an estimated $19 billion for hospitals and ambulatory settings to carry out the necessary application of EHR (Murphy, 2011). The challenge is demonstrating the positive outcomes EHR’s will provide, ease of use when accessing patient information and clear, concise physician orders. Electronic Health Records (EHR) Essay Examples.

    Relative Advantage

    Rogers (2003) defined relative advantage as “the degree to which an innovation is perceived as being better than the idea it supersedes” While presenting an innovative way of patient care providing evidence to the potential user that the EHR will be an improvement to the outmoded systems. Illustrating the how and why the innovation will benefit all who are concerned with the project. Providing the nursing staff as well as physicians, with efficient, time-saving ways to review patient charts, diagnostic results, and reduced charting time. The CORE Measures and Patient Safety Goals set by the Joint Commission mandates the timeliness and effectiveness of care for specific conditions. By employing the use of EHR, tracking compliance will save healthcare institutions millions of dollars every year Electronic Health Records (EHR) Essay Examples.

    Compatibility

    Electronic health records must fit the knowledge base of every healthcare organization. Rogers (2003) stated that “compatibility is the degree to which an innovation is perceived as consistent with the existing values, past experiences, and needs of potential adopters” User-friendly programs geared to fit the individual requirements of every unit and department in the hospital or any other healthcare setting. A straight forward, restructured data flow that is repurposed over and over again simply by adding the information into the EHR system allowing access to anyone that logs into the patient record (Friedman, Parrish, & Ross, 2013). Molding the program to correspond to the individual needs of the users is a prerequisite of any new concept. Demonstrating the ease of use and time-saving convenience by charting electronically can alleviate the trepidation of the staff.

    Complexity

    Rogers (2003) defined complexity as “the degree to which an innovation is perceived as relatively difficult to understand and use”. An individual or individuals can determine whether or not the modernization of patient information will benefit the nurses as well as the patient. A decision stage is a “full use of innovation as the best course of action available” (Rogers, 2003). Determining the level of expertise employees have with computers can establish the degree of training that is required and determine the intensity and success of the training it entails. Specifically targeting older adults that may not have experienced technology in a way the newer generations have. What seems simple to a computer user may be difficult to comprehend for a person with no exposure to technology. Another issue that sways nurse’s decisions is the possibility that technology will pull nurses away from having a personal patient-focused care experience. Nurses are concerned that the advent of modern technology will overstep the abilities of the RN to care for the patient (Gregory & Buckner, 2014). Overcoming the preconceived ideas about EHR, allowing the nurses to have hands on experience before the rollout navigating the program to get a feel for the process. Also encouraging input on how the program can be streamlined to fit the needs of the individual departments. All of these processes can assist the staff in making a sound decision. Electronic Health Records (EHR) Essay Examples.

    Trialability

    According to Rogers (2003), “Trialability is the degree to which an innovation may be experimented with on a limited basis”. This is the stage where the trialability of the product comes into play. This is where all of the “bugs” are worked out. With most new startups there will be hiccups in the process of actually managing the workload. Some in trepidation and negative opposition will arise in this stage. “The innovation loses its distinctive quality as the separate identity of the new idea disappears” (Rogers, 2003). As a unit facilitator, the encouragement of the process will have a large impact on the negative feelings that begin to appear. Identifying the problematic areas and creating solutions by ironing out the glitches as a unit.

    Observability

    Rogers (2003) defined observability as “the degree to which the results of an innovation are visible to others”. The use of technology is an observable process, and although problems may arise, there is often a solution. At this point, the level of enthusiasm may wane, and an attitude of detachment may occur (Hayrinen, Saranto, & Nykanen, 2008).  At this point of the innovation, some employees may choose not to stay with the facility, even though the inevitability of working with EHR in the near future in another setting is definitive. Peer observation is elementally a motivating factor in the adaptation of the diffusion of technology (Frattini, 2010). Relating knowledge to peers on the unit will encourage the nurses to overcome the obstacles. Employing members of the nursing staff to create a “super user” team to troubleshoot any problems with operating the programs so the workflow of the units will not be interrupted. Electronic Health Records (EHR) Essay Examples.

    Summary

    By using Rogers’ five determinants of success, innovations complications, difficulties, and setbacks are identified before their occurrence. The feasibility of implementing a once thought too complicated system was made possible through the identification of factors before the execution of the electronic health record program. Successful acceptance brought on by the realization of benefits to nurses, physicians, general nursing staff and most of all the patients. Improving patient care is what nursing is all about; the electronic age is upon us and will always be a part of our modern civilization. The key to introducing and successful transitioning of innovations is total involvement in the process. Nurses worldwide will use technology to develop new skill sets that will impact the future of the medical profession. Acquiring the skills to work with programs that deliver a safer environment for patients will be an invaluable asset to the nursing world (Furst et al.,2013).

    References

    Best, M. F., & Thurston, N. E. (2004). Measuring Nurse Job Satisfaction. 
    JONA: The Journal of Nursing Administration
    , 
    34
    (6), 283-290. doi:10.1097/00005110-200406000-00007

    Frattini, F. (2010). Achieving Adoption Network and Early Adopters Acceptance for Technological Innovations. 
    Gaining Momentum
    , 81-120. doi:10.1142/9781848163553_0003

    Friedman, D. J., Parrish, R. G., & Ross, D. A. (2013). Electronic Health Records and US Public Health: Current Realities and Future Promise. 
    Am J Public Health
    , 
    103
    (9), 1560-1567. doi:10.2105/ajph.2013.301220

    Furst, C. M., Finto, D., Malouf-Todaro, N., Moore, C., Orr, D. A., Santos, J., … & Tipton, P. H. (2013). Changing times: enhancing clinical practice through evolving technology. 
    Medsurg Nursing
    , 
    22
    (2), 131.

    Gregory, D., & Buckner, M. (2014). Point-of-Care Technology. 
    Critical Care Nursing Quarterly
    , 
    37
    (3), 268-272. doi:10.1097/cnq.0000000000000030

    Harrison, J. (2004). Addressing increasing patient acuity and nursing workload. 
    Nursing Management
    , 
    11
    (4), 20-25. doi:10.7748/nm2004.07.11.4.20.c1984

    Hayrinen, K., Saranto, K., & Nykanen, P. (2008). Definition, structure, content, use and impacts of electronic health records: A review of the research literature.
    International Journal of Medical Informatics
    , 
    77
    (5), 291-304. doi:10.1016/j.ijmedinf.2007.09.001

    Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. Nurses for Evidence-Based Practice. 
    AJN, American Journal of Nursing
    , 
    105
    (9), 40-51. doi:10.1097/00000446-200509000-00025 Electronic Health Records (EHR) Essay Examples.

     

    References

    Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011). Electronic Nursing Documentation as a Strategy to Improve Quality of Patient Care. 
    Journal of Nursing Scholarship
    , 
    43
    (2), 154-162. doi:10.1111/j.1547-5069.2011.01397.x

    Murphy, J. (2011). HITECH Programs Supporting the Journey to Meaningful Use Of EHRs.
    CIN: Computers, Informatics, Nursing
    , 
    29
    (2), 130-131. doi:10.1097/ncn.0b013e318210f0fc

    Rogers, E. M. (2003). 
    Diffusion of innovations
     (5th ed.). New York, NY: New York Free Press.

    Stokowsk, L. (2013, September 12). Electronic Nursing Documentation: Charting New Territory. Retrieved from http://www.medscape.com/viewarticle/810573_3 Electronic Health Records (EHR) Essay Examples

  • Data-information-knowledge-wisdom (DIKW) continuum essay

    Data-information-knowledge-wisdom (DIKW) continuum essay

    NURS-6051C-8, Transforming Nursing and Healthcare through Technology

    Reducing Blood Culture Contamination Using the Data-Information-Knowledge-Wisdom Continuum

    The data-information-knowledge-wisdom (DIKW) continuum is a concept introduced by Blum in 1986 as a structure to better understand clinical informatics and how it affects health care (American Nurses Association, 2015). The DIKW framework in nursing helps nurses improve understanding on how wisdom can be applied in their clinical practice from all available data which are organized into information, then synthesized to form relationships known as knowledge. By discussing the interrelationships within the DIKW continuum, the framework has become a vehicle in transporting and educating the health care industry towards making nursing interventions visible (Charlene, Currie, & Rodney, 2016). Data-information-knowledge-wisdom (DIKW) continuum essay.

    ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

    Nursing has undergone changes in the recent years and now, there are high expectations from nurses to keep their practice up to date to improve nursing processes. Questions are developed in the clinical areas seeking for answers to help enhance the quality of patient care. The use of the DIKW paradigm in solving clinical questions assists nurses to practice with wisdom and apply wisdom to practice. The purpose of this paper is to identify a clinical question relevant to the emergency department and discuss the answer through the progression of the methods of the DIKW framework Data-information-knowledge-wisdom (DIKW) continuum essay. Applying the knowledge obtained from this method in the clinical setting will demonstrate how informatics is instrumental to gain wisdom.

    Clinical Question

    Blood cultures are laboratory tests to discern the presence of microorganisms in the blood and identify the disease-causing agents for the infection (Reed, 2017). Contaminated blood cultures have negative impact to patients and hospitals in terms of unnecessary antibiotic therapy, superfluous hospitalization, and an extended hospital length of stay. In my area of practice, the blood culture contamination rate for November is more than three percent. Current national average of contamination rates is between two to three percent (Bentley, Thakore, Muir, Baird, & Lee, 2016). The clinical question to explore in this paper is:
    What are the best ways to reduce blood culture contamination rates in the emergency department?
    It is necessary to find out the factors that affect the elevated contamination rate so that interventions could be implemented to reduce or eliminate the problem. Data-information-knowledge-wisdom (DIKW) continuum essay.

    Using the DIKW Continuum to Address the Clinical Question

    The DIKW continuum first utilizes data, which is defined as facts obtained through observation with no interpreted meaning (McGonigle & Mastrian, 2018). The November data of the blood culture contamination rate in the emergency department and the national average are two distinct data that are available at this stage of the paradigm.

    Using the Walden Library, I conducted a search using
    Cinahl Plus with Full Text
    from the six recommended nursing databases. I chose this database because it contains peer-reviewed literatures and evidence-based articles that have full texts as described in the database description. The key words that were used were blood culture contamination that yielded 103 articles. The search was further narrowed down to 52 after limiting the time period from 2013-2018. To obtain articles that are relevant to my specialty field, emergency department were used as additional key words that produced 14 articles. From the last selection, I researched the titles that would help obtain information to answer the clinical question.

     

     

    Data to Information

    Information are gathered by integrating data points to give structure to the group of data that are available (McGonigle & Mastrian, 2018). Data for blood culture contamination from the infection control department of the hospital showed that emergency department has the following contamination rates: September- 3.24%, October- 3.76%, and November- 3.89%. The information showed an upward trend. The national average rate is between two to three percent, thus, compared to the national standards, the department’s rate is high in the past three months. Additional information learned from the infection control department said poor site preparation is the main cause of the problem. Lack of education on proper blood culture collection was also identified as another cause. Data-information-knowledge-wisdom (DIKW) continuum essay The data reveals the information that there are two main factors that caused the increased contamination rates in the department.

    Information to Knowledge

    Knowledge is derived from the synthesis of cluster of information where patterns and relationships are established (McGonigle & Mastrian, 2018). The information gathered leads to the conclusion that improper insertion site preparation in obtaining blood culture and lack of education in proper blood culture collection caused the upward trend of the department’s contamination rate. From the articles reviewed in the nursing database, best practices were identified regarding blood culture collection. It is necessary to look for strategies that are evidence-based to overcome the issues identified in the department. Some of the recommendations in the research study by Constance, Coleman, and Cunningham (2015) said that staff education with return demonstration, use of sand timers to provide accurate time for cleaning blood culture collection site, and utilization of a blood culture kit are effective strategies in reducing contamination rates. Another article recommended the use of optimum skin antisepsis, sterile glove protocol, and training a set of dedicated staff members who will draw blood culture specimens (Denno & Gannon, 2013). The use of knowledge in answering the clinical question is done through analyzing which best practice is relevant to the department based on the main factors that were causing the problem.

    Knowledge to Wisdom

    Wisdom is the use of knowledge to implement solutions to the problem (McGonigle & Mastrian, 2018). This step is the application of the knowledge obtained from the interpreted and organized data and information. There were two identified causes of the problem. To apply knowledge into wisdom, the best practices that were identified which should be implemented in the emergency department based on practicality and cost-effectiveness are the use of blood culture kits and implementation of staff education on proper blood culture collection followed by a return demonstration to verify competencies of the nurses and emergency department technicians. There is no single cause for blood culture contamination, thus, facilities need to identify the unique contributors to contamination and develop a tailored strategy based on the available resources. Data-information-knowledge-wisdom (DIKW) continuum essay.

    Summary

    The American Nurses Association (2015) recognizes the significance of data, information, knowledge, and wisdom to nurses in all specialty areas. Utilizing the DIKW continuum, decision-making process is facilitated to arrive at a sound nursing judgment when faced with a clinical problem. Nursing informatics, as a nursing specialty, helps gain wisdom in nursing practice. Answering the clinical question on the best method of reducing blood culture contamination was made intelligently through the progression of the DIKW paradigm. In my future practice as an acute care nurse practitioner, the DIKW model will be used to guide me in my clinical practice and decision-making. Data-information-knowledge-wisdom (DIKW) continuum essay.

    References

    American Nurses Association. (2015).
    Nursing informatics: Scope and standards of practice
    (2nd ed.). Silver Spring, MD: Author.

    Bentley, J., Thakore, S., Muir, L., Baird, A., & Lee, J. (2016). A change of culture: Reducing blood culture contamination rates in an emergency department.
    BMJ Quality Improvement Reports
    ,
    5
    (1). doi: 10.1136/bmjquality.u206760.w2754

    Bowen, C. M., Coleman, T., & Cunningham, D. (2015). Reducing blood culture contaminations in the emergency department: It takes a team.
    Journal of Emergency Nursing
    ,
    42
    (4), 306-311. doi:10.1016/j.jen.2015.10.021

    Denno, J., & Gannon, M. (2013). Practical steps to lower blood culture contamination rates in the emergency department.
    Journal of Emergency Nursing
    ,
    39
    (5), 459-464.  
    https://doi.org/10.1016/j.jen.2012.03.006

    McGonigle, D., & Mastrian, K. G. (2018).
    Nursing informatics and the foundation of knowledge
    (4th ed.). Burlington, MA: Jones and Bartlett Learning.

    Ronquillo, C., Currie, L. M., & Rodney, P. (2016). The evolution of data-information-knowledge-wisdom in nursing informatics.
    Advances in Nursing Science
    ,
    39
    (1), e1-e18. doi: 10.1097/ANS.0000000000000107 Data-information-knowledge-wisdom (DIKW) continuum essay

    Steed, L. L. (2017). Reducing blood culture contamination.
    Clinical Lab Product
    . Retrieved from

    Reducing Blood Culture Contamination

  • HITECH Act Essay and EHR

    HITECH Act Essay and EHR

    To prepare:

    Review the Learning Resources on the HITECH legislation and its primary goals.

    Reflect on the positive and negative impact this legislation has had on your organization or one with which you are familiar.

    Consider the incentives to encourage the use of EHRs. Focus on the definition of meaningful use and how it is measured.

    Reflect on how the incentives and meaningful use impact the quality of patient care. HITECH Act Essay and EHR.

    Find an article in the Walden Library dealing with one of the criteria to qualify for meaningful use and how it has been successfully met.

    ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

    By Day 3

    Post
     a description of how HITECH legislation has positively or negatively impacted your organization. Address how its related incentives influence the adoption of health information technology in health care and impact the quality of patient care. Provide a summary of the article you identified and explain how it demonstrates the ability of health information technology to meet the requirements of meaningful use.

     

    Response# 3

    HITECH

    The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. (Bates, & Gawande, 2003) Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice. Also HITECH’s goal is not adoption alone but “meaningful use” of EHRs — that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in health care processes and outcomes. HITECH Act Essay and EHR.

    HITECH calls on the secretary of health and human services to develop specific “meaningful use” objectives. With the Centers for Medicare and Medicaid Services (CMS) in the lead, the Department of Health and Human Services (DHHS) has used an inclusive and open process to develop these criteria, providing an extensive opportunity for public and professional input

    Meaningful Use of HITECH

    Core objectives comprise basic functions that enable EHRs to support improved health care. As a start, these include the tasks essential to creating any medical record, including the entry of basic data: patients’ vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses, and smoking status. (Blumenthal, & Tavenner. 2010)

    Core objectives include using several software applications that begin to realize the true potential of EHRs to improve the safety, quality, and efficiency of care. These features help clinicians to make better clinical decisions — and avoid preventable errors. To qualify for incentive payments, clinicians must start employing such clinical decision support tools. They must also start using the capability that undergirds much of the value of EHRs: using records to enter clinical orders and, in particular, medication prescriptions. Only when providers enter orders electronically can the computer help improve decisions by applying clinical logic to those choices in light of all the recorded patient data. And to begin extending the benefits of EHRs to patients themselves, the meaningful use requirements will include providing patients with electronic versions of their health information.

    Conclusion

    The meaningful use rule strikes a balance between acknowledging the urgency of adopting EHRs to improve our health care system and recognizing the challenges that adoption will pose to health care providers. The regulation must be both ambitious and achievable. Like an escalator, HITECH attempts to move the health system upward toward improved quality and effectiveness in health care. But the speed of ascent must be calibrated to reflect both the capacities of providers who face a multitude of real-world challenges and the maturity of the technology itself. HITECH Act Essay and EHR.

    References

    Bates, D. W. Gawande, A. A. (2003). Improving safety with information technology. The New England Journal of Medicine, 348(25), 2526–2534

    Blumenthal, D.Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. The New England Journal of Medicine, 363(6), 501–504.

    Murphy, J. (2010). Nursing Informatics: The Journey of Meaningful Use of Electronic Health

    Records. Nursing Informatic$. 28(4). 283-286.

     

    Tags:
      None

     

    Response # 2

     

    I enjoyed reading your post

                                         
     Privacy and Security of Electronic Health Information

    The HITECH Act study technical and policy approaches to improving the security and privacy of electronic health information. Developing such solutions will probably require a multifaceted strategy that involves technical, educational, legal, and policy interventions by many public and private stakeholders. (HITECH Act of 2009) Most healthcare breaches of security in health information systems result from simple human error or carelessness, not from technical failings or outside hacking. The causes include providers sharing passwords or not using them at all, failing to encrypt health data in EHRs or other storage sites, and losing laptops or flash drives containing identifiable health information. Addressing these problems will require extensive education of providers and the enforcement of meaningful penalties for failing to observe basic security precautions. HITECH Act Essay and EHR.

    Also, the health care system is composed of many different structures that it is imperative for health care organizations to ensure privacy and protection of patient information and medical records at all times. There are so many different programs and technology driven sources within the health care organization that is utilized to ensure patient safety and privacy, there has to be standard levels of accessing patient information without jeopardizing their information. In the event that there is a security breech occurs, then the health care facility will be held liable and that would cause the organization to lose a lot of credibility and credentials. All organizations have a process that is used to guarantee that a patient information remain safe and secure.

    As with any online digital format, concerns of breach exist. Internet hackers possess a digital power that frightens individuals looking to conceal sensitive data. There have been cases in which medical information has been accessed by unauthorized users. While this does not occur all too frequently, the occurrences are enough to plant some cynicism in the minds of physicians and patients. These are valid concerns. If private records end up in the possession of an individual not aware of the information, the penalties can be devastating. Theft of medical records can result into identity theft, which can abolish a person’s assets, credit and status. Victims could pursue lawsuit against the healthcare organization. If the incident affected numerous patients, the facility could foresee a long road of lawful misfortunes. This is why reliable records administration companies works hard to offer quality safety within their software in order to try to remove the risk of any possible security issues. There are ways to reduce the likelihood of exposing safety risks, which can include thorough background checks on employees, extensive training, and making sure that the policies and procedures remain updated at all times (Electronic Health Records Security and Privacy Concerns. 2016). The most successful methods is assigning PIN numbers and access codes to all staff, and make sure that these individuals have to log into all systems at all times. This process can monitor all authorized users and where they were and what systems they are using at all times.

    .                                  
    Security and Privacy of HITECH

    In addition ,during the transition phase, the EHR vendor must work closely with the healthcare provider for a smooth and secure transition. The company should provide some type of comprehensive user guide for the users in the provider’s practice.

    Enhance Administrative Controls
    -Through Updating policies and procedures, Guide employees through the stringent privacy and security training process, Run background checks on all employees HITECH Act Essay and EHR.

    Monitor Physical and System Access
    -Create physically inaccessible systems to unauthorized individuals, Have exigencies in place for data recovery or restoration, Provide identification and verification requirements to all system users, Access the list of authorized users, Supply passwords and personal identification numbers (PINs),Provide automatic software shutdown routines, Leave data backup and recovery to the professionals, Businesses should leave data backup and recovery to the professionals

    Identify Workstation Usage
     -Set privacy filters at each workstation, Distinguish the different capabilities of different workstations

    Audit and Monitor System Users
    -Identify any weakness in the system, detect any security breach or attempt at a breach, regularly audit all authorized users, Issue specified punishments to employees not following compliance guidelines

    Employ Device and Media Controls
    -Construct a security plan for data disposal, remove data from reusable hardware, Track all reprocessed hardware, Back up all data from all hardware

    Apply Data Encryption
    -Disguise all data inside medical files through cryptography

    Summary

    Reliable electronic health records companies apply these enhanced security and privacy protocols. Perhaps the most important security protocol is data encryption, which causes data to become unreadable to outside sources.

     

    References

    Greene AH. HHS steps up HIPAA audits. J AHIMA. 2011; 82:58–9.

    HITECH Act of 2009, 42 USC sec 139w-4(0)(2) (February 2009), part 2, subtitle C, sec 13301, subtitle B, sec 3014: Competitive grants to States and Indian tribes for the development of loan programs to facilitate the widespread adoption of certified EHR technology.

    Electronic Health Records Security and Privacy Concerns. (2016). Retrieved from 
    http://www.ironmountain.com/Knowledge-Center/Reference-Library/View-by-Document-Type/General-Articles/E/Electronic-Health-Records-Security-and-Privacy-Concerns.aspx

     

     

     

    Great post ,to add to your points here  are some great  points

     

                                        Advantages and Disadvantages of HITECH 

    There are several advantages and disadvantages associated with an HITECH adoption.

    Advantages of EHRs include clinical outcomes improved quality, reduced medical errors, increase organizational outcomes financial and operational benefits, and societal outcomes improved ability to conduct research, improved population health, reduced costs. Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system

    Potential drawback of EHRs is the risk of patient privacy violations, which is an increasing concern for patients due to the increasing amount of health information exchanged electronically (Zurita & Nohr, 2004) to relieve some of these concerns, policymakers have taken measures to ensure safety and privacy of patient data. For example, recent legislation has imposed regulations specifically relating to the electronic exchange of health information that strengthen existing Health Insurance Portability and Accountability Act privacy and security policies. (Westin, 2005) Although few electronic data are 100% secure, the rigorous requirements set forth by the new legislation make it much more difficult for electronic data to be accessed inappropriately. Many hospitals and physicians are implementing strict, no tolerance penalties for employees who access files inappropriately. Although privacy will likely continue to be a concern for patients, many steps are being taken by policymakers and individual organizations to ensure that EHRs comply with the strict laws and regulations intended to ensure the privacy of clinical information HITECH Act Essay and EHR.

    .                                                     
    Conclusion

    However, nationwide implementation of HITECH is necessary, although not sufficient, part in transforming the US health care system for the better. EHR adoption must be considered one of many approaches that diversify our focus on quality improvement and cost reduction.In the long run, providers and researchers will be eager to quantify the returns that are expected from these investments into HITECH implementation.

     
                                                               
    References

    Zurita L, Nohr C. (2004) Patient opinion: EHR assessment from the user’s perspective. Student Health Technology Information. 107(2):1333–1336

    Westin A. F (2005). Public attitudes toward electronic health records. Privacy and American Business. ; 12(2):1–6.

    Parver C. (2009) How the American Recovery and Reinvestment Act of 2009 Changed HIPAA’s privacy requirements. CCH Health Care Compliance Letter.4–7. HITECH Act Essay and EHR.

     

     

    Thanks for reading my Post ,

                                                         HITECH    Implementation

    HITECH  functionalities, including  support clinical decision support systems, computerized order entry systems,  health information exchange., improved quality of care, reduced medical errors,  promotes organizational outcomes (e.g., financial and operational benefits), and societal outcomes (e.g., improved ability to conduct research, improved population health, reduced costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system.(IOM, 2010) Moreover, EHRs are associated with potential perceived privacy concerns among patient

    There are several advantages and disadvantages associated with an HITECH adoption. Many of the benefits accrue to patients and society overall. For these benefits to be realized, the US Government has embarked on an ambitious journey to transition a maximum number of providers toward HITECH adoption and “meaningful use”. (Blumenthal $ Tavenner 2010) Without ubiquitous use of EHR technologies, experts believe that many efficiencies in the US health care system cannot be realized. The financial incentives built into the HITECH Act are designed to defray some of the costs associated with EHR adoption, especially for smaller organizations where these expenses serve as a major barrier. (Menachemi, et al 2007.)The financial incentives in HITECH, which are made available through the Medicare and Medicaid programs, are also an attempt to correct some of the misalignment of incentives associated with HITECH, especially because the US Government, through the Medicare and Medicaid programs, is the largest insurer in the country that is further addressed legislatively in the HITECH Act. HITECH Act Essay and EHR.

                                                                 Conclusion

    Most of the times, the authors evaluate the cost, money and outcomes of using HITECH. However, nationwide implementation of HITECH is a necessary, although not sufficient, part in transforming the US health care system for the better. EHR adoption must be considered one of many approaches that diversify our focus on quality improvement and cost reduction. The current major legislative and political support for EHRs represents the greatest investment in health information technologies in US history. In the long run, providers and researchers will be eager to quantify the returns that are expected from these investments into HITECH implementation.

                                                                                                                References

    IOM (2010). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: Institute of Medicine

    Dexter P.R, Perkins S, Overhage JM, et al. (2001) A computerized reminder system to increase the use of preventive care for hospitalized patients. 
    New England Journal Medicine. ;
     345(13):965–970.

    Blumenthal D, Tavenner M. (2010) The “meaningful use” regulation for electronic health records. 
    New England Journal Medicin
    e. 2010; 363(6):501–504.

    Menachemi N, Ford EW, Beitsch LM, Brooks RG. (2007)Incomplete EHR adoption: late uptake of patient safety and cost control functions. 
    American Journal of Medicine Quality
    . 2007; 22(5):319–326 HITECH Act Essay and EHR.

     

     

    INITIAL DISCUSSION

     

    HITECH Legislation

    The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted by President George Bush announced in 2004 during a State of the Union Address that all health care professionals need to participate in the health information technology (HIT). (Murphy, 2010). The passing of this Act and subsequent definition of meaningful use encourages physicians and hospitals to use EHR to gain incentives from the government. Those incentives are paid out yearly as long as the hospital or physician follows guidelines exactly passing of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 was implemented to promote the adoption and meaningful use of health information technology (US Department of Health and Human Services, 2017. Since part of the HITECH Act focuses on healthcare financial strategies, just like MEDICARE and MEDICAID, it expects providers to show meaningful use of EHRs in order to get paid (Arlotto, 2010. p. 90).

    For this requirement to be easy for healthcare professionals to adopt, the HITECH provided $19.2 billion for healthcare providers who took Medicaid and Medicare patients and also funded Medicare with $44,000 to give each provider over 5 years for implementing “meaningfully use” certified EHRs (Shin and Sharac, 2013 The purpose of this discussion post is to describe how HITECH legislation has positively impacted my organization .It will also address how the incentives of HITECH influence the adoption of health information technology (HIT) in health care and impact the quality of patient care. Finally, an article that explains how the ability of health information technology meets the requirements of meaningful use, will be summarized HITECH Act Essay and EHR.

    Influence Healthcare Incentives on HITECH Adoption

    The introduction of a HIT as a tool in the workplace has been challenging for most, and some have been skeptical about its usage have seen the benefits of using HIT to improve the quality of care and reduce medication errors in my practice. The future of using HIT will continue to reduce these errors and improve the quality of care that is provided to patients in the healthcare setting. The opportunity was to create a system that will arouse the economy while healthcare delivery is being improved (McGonigle and Mastrian. 2015). Meaningful use requires both hospitals and providers to have certain percentages of the following, computerized medication, laboratory and radiology orders, computerized vital sign entries, patients who have online access to their health information and actually access it, smoking status and demographic data recorded (CMS Releases Stage 2 Meaningful Use Requirements. 2012. p. 11). “The intent of meaningful use was to provide incentives to providers not only to adopt EHRs but also to use them in ways that would improve quality, safety, and efficiency” (Classen and Bates, 2011, p. 855). In my institutions, they implemented EPIC to fulfill one of the meaningful use criteria of “improving quality, safety, efficiency, and reduce health disparities” (Health IT, 2017). The physicians were able to access medical information from EPIC-using hospitals to make better clinical decisions and efficiently treat each patient.

    HITECH Healthcare Impact on Patient Care

    One of the purposes of HITECH focuses on how chronic diseases can be prevented, detected early and managed which in turn promotes the improvement of human health (McGonigle and Mastrian. 2015). On the medical-surgical floor, where I work pre-op doses of antibiotic is ordered for each patient who is going to surgery. Another dose starts running in the operating room before the surgery starts and documented on the anesthesiologist’s sheet. The third dose is given after surgery, within 24 hours. All this is done to prevent post-op infection which is common with complications of surgery and some end up with amputation. The benefit of qualifying for financial incentives such as Medicare and Medicaid payments for six years is positive when healthcare providers reach certain achievements and can prove the use of an EHR. To be certified to receive this incentive health care provider must show compliance with having greater than 50% of their patient records are involved and part of the EHR (Brown, 2010). The problem of EHR is the ease of access, which is still an issue with slow systems, but the benefits of medication safety and much more are obvious. The benefits of using the HITECH require healthcare providers and organizations to stay up-to-date on the technology and system improvements to optimize the advantages and outcomes to patients and the healthcare corporation. (Classen & Bates, 2011).

    Research Article and Meaningful Use of HITECH

    The article titled Readiness for Meaningful Use of Health Information Technology and Patient-Centered Medical Home Recognition was a survey conducted by Shin and Sharac, (2013) from the University Of George Washington University in conjunction with the National Association of Community Health Centers. The survey was done to check the readiness of community health centers based on factors that impact the use of HIT and meaning use (Shin and Sharac, 2013). The survey showed there was a progression towards fully implementing electronic health records. After three years of using EHRs, 98% patient demographics were recorded, they maintained 97% of their medication list and recorded 98% of their vital signs. (Shin and Sharac, 2013). They met other meaningful-use requirements with high percentages.This shows that the Clinicians included in this study were using the EHR meaningfully and had results to prove it. In order to obtain reimbursement from the government, physicians need to provide attestation statements in accordance with the Centers for Medicare and Medicaid Services (Brown, 2010) HITECH Act Essay and EHR

                                                           Summary       

    In my present the organization, I have seen the benefits of meaningful use of HITECH. Among which is the use of electronic transfer of vital signs to our patient’s EHR, our physician electronically enter medications into MAR, lab and radiology orders, we have individuals who come to patients to assist them in registering in order for them to access their health records online. HIT provides safe, fast and easy, care to patients if used appropriately The HITECH act provided an incentive program to cover some of the costs of implementing HIT. Incentives for being certified to receive Medicare and Medicaid reimbursement also encourage compliance with using an EHR for greater than 50% of patient records. Maintenance and information system updates are essential for the HIT to be beneficial to healthcare providers, and used to improve patient outcomes. Having a system to prevent medication errors, reduce costs, improve health care safety and patient outcomes will be the greatest benefit of all.

    References

    Brown, B. (2010). The final rules for meaningful use of EHRs. 
    Journal of Health Care Compliance,
     12(5), 49-50, 79-80.

    Classen, D.C. & Bates, D.W. (2011). Finding the meaning in meaningful use. 
    New England Journal of Medicine,
     36(9), 855-858.

    Murphy, J. (2010). Nursing Informatics. The journey to the meaningful use of electronic health records. Nursing Economics$, 28(4), 283-286.

    Arlotto, P. (2010). 7 strategies for improving HITECH readiness. Hfm (Healthcare Financial Management), 64(11), 90-96.

    CMS Releases Stage 2 Meaningful Use Requirements. (2012). hfm (Healthcare Financial Management), 66(4), 11.

    McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learn

    Shin, P., & Sharac, J. (2013). Readiness for Meaningful Use of Health Information Technology and Patient-Centered Medical Home Recognition Survey Results.Medicare & Medicaid Research Review, 3(4), E1-E9. doi:10.56 HITECH Act Essay and EHR

     

     

    INITIAL DISCUSSION

     

    HITECH Legislation

    The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted by President George Bush announced in 2004 during a State of the Union Address that all health care professionals need to participate in the health information technology (HIT). (Murphy, 2010). The passing of this Act and subsequent definition of meaningful use encourages physicians and hospitals to use EHR to gain incentives from the government. Those incentives are paid out yearly as long as the hospital or physician follows guidelines exactly passing of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 was implemented to promote the adoption and meaningful use of health information technology (US Department of Health and Human Services, 2017. Since part of the HITECH Act focuses on healthcare financial strategies, just like MEDICARE and MEDICAID, it expects providers to show meaningful use of EHRs in order to get paid (Arlotto, 2010. p. 90). For this requirement to be easy for healthcare professionals to adopt, the HITECH provided $19.2 billion for healthcare providers who took Medicaid and Medicare patients and also funded Medicare with $44,000 to give each provider over 5 years for implementing “meaningfully use” certified EHRs (Shin and Sharac, 2013 The purpose of this discussion post is to describe how HITECH legislation has positively impacted my organization .It will also address how the incentives of HITECH influence the adoption of health information technology (HIT) in health care and impact the quality of patient care. Finally, an article that explains how the ability of health information technology meets the requirements of meaningful use, will be summarized

    Influence Healthcare Incentives on HITECH Adoption

    The introduction of a HIT as a tool in the workplace has been challenging for most, and some have been skeptical about its usage have seen the benefits of using HIT to improve the quality of care and reduce medication errors in my practice. The future of using HIT will continue to reduce these errors and improve the quality of care that is provided to patients in the healthcare setting. The opportunity was to create a system that will arouse the economy while healthcare delivery is being improved (McGonigle and Mastrian. 2015). Meaningful use requires both hospitals and providers to have certain percentages of the following, computerized medication, laboratory and radiology orders, computerized vital sign entries, patients who have online access to their health information and actually access it, smoking status and demographic data recorded (CMS Releases Stage 2 Meaningful Use Requirements. 2012. p. 11). HITECH Act Essay and EHR. “The intent of meaningful use was to provide incentives to providers not only to adopt EHRs but also to use them in ways that would improve quality, safety, and efficiency” (Classen and Bates, 2011, p. 855). In my institutions, they implemented EPIC to fulfill one of the meaningful use criteria of “improving quality, safety, efficiency, and reduce health disparities” (Health IT, 2017). The physicians were able to access medical information from EPIC-using hospitals to make better clinical decisions and efficiently treat each patient.

    HITECH Healthcare Impact on Patient Care

    One of the purposes of HITECH focuses on how chronic diseases can be prevented, detected early and managed which in turn promotes the improvement of human health (McGonigle and Mastrian. 2015). On the medical-surgical floor, where I work pre-op doses of antibiotic is ordered for each patient who is going to surgery. Another dose starts running in the operating room before the surgery starts and documented on the anesthesiologist’s sheet. The third dose is given after surgery, within 24 hours. All this is done to prevent post-op infection which is common with complications of surgery and some end up with amputation. The benefit of qualifying for financial incentives such as Medicare and Medicaid payments for six years is positive when healthcare providers reach certain achievements and can prove the use of an EHR. To be certified to receive this incentive health care provider must show compliance with having greater than 50% of their patient records are involved and part of the EHR (Brown, 2010). The problem of EHR is the ease of access, which is still an issue with slow systems, but the benefits of medication safety and much more are obvious. The benefits of using the HITECH require healthcare providers and organizations to stay up-to-date on the technology and system improvements to optimize the advantages and outcomes to patients and the healthcare corporation. (Classen & Bates, 2011).

    Research Article and Meaningful Use of HITECH

    The article titled Readiness for Meaningful Use of Health Information Technology and Patient-Centered Medical Home Recognition was a survey conducted by Shin and Sharac, (2013) from the University Of George Washington University in conjunction with the National Association of Community Health Centers. The survey was done to check the readiness of community health centers based on factors that impact the use of HIT and meaning use (Shin and Sharac, 2013). The survey showed there was a progression towards fully implementing electronic health records HITECH Act Essay and EHR. After three years of using EHRs, 98% patient demographics were recorded, they maintained 97% of their medication list and recorded 98% of their vital signs. (Shin and Sharac, 2013). They met other meaningful-use requirements with high percentages.This shows that the Clinicians included in this study were using the EHR meaningfully and had results to prove it. In order to obtain reimbursement from the government, physicians need to provide attestation statements in accordance with the Centers for Medicare and Medicaid Services (Brown, 2010)

                                                           Summary       

    In my present the organization, I have seen the benefits of meaningful use of HITECH. Among which is the use of electronic transfer of vital signs to our patient’s EHR, our physician electronically enter medications into MAR, lab and radiology orders, we have individuals who come to patients to assist them in registering in order for them to access their health records online. HIT provides safe, fast and easy, care to patients if used appropriately The HITECH act provided an incentive program to cover some of the costs of implementing HIT. Incentives for being certified to receive Medicare and Medicaid reimbursement also encourage compliance with using an EHR for greater than 50% of patient records. Maintenance and information system updates are essential for the HIT to be beneficial to healthcare providers, and used to improve patient outcomes. Having a system to prevent medication errors, reduce costs, improve health care safety and patient outcomes will be the greatest benefit of all.

    References

    Brown, B. (2010). The final rules for meaningful use of EHRs. 
    Journal of Health Care Compliance,
     12(5), 49-50, 79-80.

    Classen, D.C. & Bates, D.W. (2011). Finding the meaning in meaningful use. 
    New England Journal of Medicine,
     36(9), 855-858.

    Murphy, J. (2010). Nursing Informatics. The journey to the meaningful use of electronic health records. Nursing Economics$, 28(4), 283-286.

    Arlotto, P. (2010). 7 strategies for improving HITECH readiness. Hfm (Healthcare Financial Management), 64(11), 90-96.

    CMS Releases Stage 2 Meaningful Use Requirements. (2012). hfm (Healthcare Financial Management), 66(4), 11.

    McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learn

    Shin, P., & Sharac, J. (2013). Readiness for Meaningful Use of Health Information Technology and Patient-Centered Medical Home Recognition Survey Results.Medicare & Medicaid Research Review, 3(4), E1-E9. doi:10.56 HITECH Act Essay and EHR.

  • Assignment: Adaptive Response

    Assignment: Adaptive Response

    Introduction

    All humans are designed with two types of immunity; innate and adaptive. The innate immune system can distinguish between different classes of pathogens and recruit the most effective form of adaptive immune response to eliminate them. Adaptive responses are a response that the body adapts to certain injuries or insults. Innate responses are non-specific to the insult. Unlike innate immune responses, the adaptive responses are highly specific to the particular pathogen that induced them (Alberts et al, 2004). Injured tissue cells release chemicals that cause inflammation called “chemical mediators of inflammation.”  These chemicals primarily produce their effects in the localized areas where they are released (Alberts et al, 2004).  It is extremely important that health care professionals are familiar with innate and adaptive responses to correctly treat the condition and symptoms a presenting patient may be experiencing. Assignment: Adaptive Response.

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    Pathophysiology and Alteration in Case Study #1

    In case study number one the child’s body is reacting to a bacterial infection in the throat. When bacteria is introduced to the body it can stimulate an immune response (Huether & McCance, 2012).  Normally there is normal flora that prevents the bacteria from attacking the host. However, for many reasons the protective mechanism may be ineffective and then the body reacts to the virus or bacteria antigen. The virus or bacteria is the antigen that activates the complement system. The activation of the complement system causes the release of cytokines. The cytokines are the mediators responsible for the symptoms the child is experiencing. The cytokines that are specifically responsible for the symptoms are prostaglandins. The release of prostaglandins causes pain, fever and inflammation of the tonsillar tissue.  When released prostaglandins are able to reset the temperature control center in the brain thus, resulting in a fever.

    Pathophysiology and Alteration in Case Study #2

    In this case study the body activates the innate immune system. The skin which is the first line of defense senses a insult from the abrasive chemicals. After the injury from the chemicals the body activates its second line of defense (Huether & McCance, 2012). The result of the exposure to the chemicals results in a hypersensitivity. It is considered a type IV tissue specific type of hypersensitivity. These types of reactions are mediated by T lymphocytes. When the skin on the hands became exposed over a period of time a delayed cell mediated response was triggered.

    Pathophysiology and Alteration in Case Study #3

    In the third case study the patient is experiencing a reaction to the influence of stress over time. The stress response is complex and involves mechanisms of both protection and injury (Huether & McCance, 2012).    In this case, the patient is experiencing two types of stress: physiological and perceived stress. Assignment: Adaptive Response. Her history of hypertension is environmental stress. This is a type of chronic stress. The emotional stress of her mother’s broken hip triggers the stress response by the body. Assignment: Adaptive Response.When the alarm reaction occurs it results in an increased secretion by the adrenal medulla of glucocorticoids, epinephrine, and norepinephrine (Huether & McCance, 2012).  The release of those substances stimulates the “fight or flight” response. The secretion of those substances are the cause of her “racing heart rate’, decreased appetite and inability to sleep.

    Conclusion

    The pathophysiology of the bodies’ actual or perceived threat is a complex mechanism. It may serve as a mechanism for defense, adaptation or autoimmunity when its protective mechanisms become detrimental to the bodies maintenance of homeostasis. Activation of these systems and their adaptations may manifest in many ways. It is important to understand the physiology of the immune response to adequately and accurately treat the host. Assignment: Adaptive Response.

    Mind Map

    References

    Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Chapter 24, The Adaptive Immune System. Available from: http://www.ncbi.nlm.nih.gov/books/NBK21070/

    Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

     

     

    Assignment: Adaptive Response

    As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

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    Consider the following scenarios:

    Scenario 1:

    Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. Assignment: Adaptive Response. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

    Scenario 2:

    Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished. Assignment: Adaptive Response.

    Scenario 3:

    Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

    To Prepare

    • Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

    • Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

    • Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Assignment: Adaptive Response.

    • Review the Application Assignment Rubric found under Course Information

    To Complete

    Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

    • For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.

    • Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Assignment: Adaptive Response.

     

    Introduction

    With the pathogen invasion, injury or any disease process our body defense mechanism gets activated by producing antibody, phagocytes and other complimentary response (Huether, & McCance, 2017). Understanding the process of adaptive response is important for advanced practice nurse to treat patient disease and alleviate the symptoms by recognizing the right pathophysiology behind it. The purpose of this paper is to discuss the pathophysiology and the compensatory mechanism (adaptive responses) and alterations of the disease processes and other factors that need consider for Scenario 1 diagnosis.

                                                              Scenario and Possible diagnosis

    Jennifer is two year old girl presented with a temperature of 102.8, Heart rate of 128 beats per minutes and respiratory rate  of 24/minutes. On assessment cervical nodes are palpable and tender to touch on the left side further assessment revealed +4 tonsils with diffuse exudates. Clinical manifestation: Jennifer clinically presented with typical symptoms of acute bacterial tonsillitis include the following:

    Sore throat

    Swollen and very red tonsils with a yellowish coating

    Difficulty swallowing

    Fever over 38°C (100.4°F)

    Headache

    Fatigue and tiredness

    Loss of appetite

    Bad breath

    Swollen and painful lymph nodes in the neck

    Tonsillitis can be caused by viral infection, typical cold symptoms such as a cough or a stuffy nose are likely too but there will be a low graded fever. On the other hand patient presented with pharyngitis have all this symptoms including inflammation of throats. So in above scenario Tonsilitis and dehydration secondary to poor appetite can be the most appropriate diagnosis based on the sign and symptoms.

    Pathophysiology of Tonsillitis

    Tonsillitis is an infection of tonsil gland caused by certain bacteria and virus. Mostly the bacteria and viruses spread through tiny droplets – in other words, when someone who is infected talks or sneezes, droplets containing the germs are released into the air (Huether& McCance, 2017). They can then come into contact with other people‘s mucous membranes, where they start multiplying.

    The most common bacterial tonsillitis is caused by a specific type of streptococcus bacteria known as group A beta-hemolytic streptococcus (GABHS) (Huether& McCance, 2017).
    S pyogenes
    adheres to adhesion receptors that are located on the tonsillar epithelium (Shah, 2017). Immunoglobulin coating of pathogens may be important in the initial induction of bacterial tonsillitis. Sometimes tonsillitis occurs as a result of scarlet fever, which is also caused by bacteria. Viral infections like mononucleosis (also called “mono” or glandular fever) can lead to tonsillitis too. Assignment: Adaptive Response.

    Epidemiology

    Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than 2 years. In the above case scenario Jennifer is 2 years and at this age there are rare population are seen with bacterial tonsillitis.

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    Differential Diagnosis:

    As Jennifer in given scenario is just 2 years old it is good to rule out the infectious agent that cause tonsillitis. Consider infectious mononucleosis (MN) due to Epstein-Barr virus (EBV) in an adolescent or younger child with acute tonsillitis, particularly when it is accompanied by tender cervical, axillary, and inguinal nodes; splenomegaly; severe lethargy and malaise; and low-grade fever (Shah, 2017).A monospot serum test and rapid antigen test can be done to rule out and able to identify the causative agent (Shah, 2017).Throat culture help to choose provider the right sensitive antibiotic if indicated. In addition Complete blood Count and Basal metabolic panel may be necessary (Shah, 2017) Assignment: Adaptive Response.

    Treatment

    The main goal of treatment is to alleviate symptoms and prevent further complications. Antipyretic and analgesic drugs like ibuprofen or acetaminophen can help to alleviate pain and fever(PubMedHealth,2016).Antibiotic is standard treatment for treating  bacterial tonsillitis Throat lozenges, or using home remedies such as a neck wrap or gargling with salt water or tea can also help to alleviate the symptoms(PubMedHealth,2016).

     

    Some people relieve their symptoms by sucking on Recurrent tonsillitis can also be treated with painkillers or antibiotics. The surgical removal of tonsils is a treatment option for people who frequently get tonsillitis(Shah, 2017) Assignment: Adaptive Response.

    Summary

    Clinical manifestations of disease processes can lead an advance practice nurse to begin to create the differential diagnosis of different pathologies of immune reactions their adaptive responses and associated alterations caused by a disease processes.  Studying immune responses allows for the advanced practitioner to think, accurately diagnosis and treat individuals critically.

    Mind Map

    References

    Huether, S. E., & McCance, K. L. (2017). 
    Understanding pathophysiology 
    (6th ed.). St. Louis, MO: Mosby.

    Tonsillitis: Overview. (2016, December 01). Retrieved March 07, 2018, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0090038/

    Shah, U. (2017, December 15). Tonsillitis and Peritonsillar Abscess Workup. Retrieved March 07, 2018, from https://emedicine.medscape.com/article/871977-workup#c7 Assignment: Adaptive Response.

  • NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

    NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

    Introduction

    Hypoglycemia protocol; and treatment algorithm is developed to provide safe and effective management for the hypoglycemic episode throughout the hospital to achieve blood glucose control under the standards care from the American Diabetic Association,2015. Hypoglycemia occurs when blood glucose (BG ) level drop below 70mg/dl. Most of the patient start developing the symptoms below the blood glucose serum 70, the symptoms include tachycardia, diaphoresis, palpitation, nausea, hunger, irritability, confusion, blurred vision, tiredness, difficulty speaking, and headaches(Service,1995).BG level less than 40 can cause severe, life-threatening complication like seizure and coma. Hypoglycemia is one of the associated cause of death in the critically ill patient.

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    Hospital-acquired hypoglycemic coma, hyperglycemic coma, or diabetic ketoacidosis
    has financial consequence because Medicare plan does not cover expenses related to this. So, most of the hospital have a nurse-driven protocol for treating hypoglycemia. The purpose of initiating nurse-driven hypoglycemia is to manage the hypoglycemia without delay for patient’s experiencing hypoglycemia, with or without symptoms and this protocol is based on evidence-based treatment. NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart.

     Policies and rules

    My facility(Unity Point Health) the hypoglycemia protocol we use is an IQ4 Type 2 protocol. IQ4 Type 2 protocols may be initiated by authorized personnel not meeting the definition of a licensed independent practitioner (i.e., an RN) by an order mode that does not require prior licensed independent practitioner (i.e., an MD) authorization.IQ4 protocols will be reviewed annually at the Medical Staff meeting to comply with CMS (Centers for Medicare and Medicaid Services) regulations and guidelines. This protocol is strictly for all non-pregnant Adults.

    How, when, why, or where the step is executed for the initation of hypoglycemia protocol

    As a nurse we have to keep the following patient populations in mind to evaluate the risk for hypoglycemia.

    Any patient taking glucose lowering agents including:

    Injectable:
    Subcutaneous or IV insulin, or an insulin pump,Non-insulin diabetes injection medications including exenatide or pramlintide

    Non-Injectable
    : Orals: A. Insulin Secretagogues: Sulfonylureas such as glimiperide, glyburide, glipizide or Glinides such as Repaglinide or Nateglinide

    Alpha-Glucosidase Inhibitors such as carobs or miglitol, Inhaled insulin: Afrezza

    patient with or without diabetes who has:

    an insulinoma

    history of gastric bypass surgery

    changes in nutritional status: emesis, NPO, reduced PO intake, changes in enteral or parenteral nutrition.

    system (organ) failure and fluctuation in function

    tapering of corticosteroids

    changes in other medications that alter blood glucose

    infection, stress, pain, sepsis

     
    Information for the execution Hypoglycemia protocol

     
    Nurses  can initiate adult hypoglycemia treatment protocol if blood glucose is below 70 mg/dL in the following condition:

    If not already ordered in EPIC, the nurse initiates by: a. Placing a single order for “Initiate Adult Hypoglycemia Treatment Protocol” with order mode of “Hospital policy – Cosign required.”

    Placing the Order Set for Adult Hypoglycemia Treatment Protocol using the ordering mode “Protocol Orders.” NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

    Documentation

    The documentation is an integral part of hypoglycemia event as I mentioned earlier all the hypoglycemia is reviewed by the medical staff meeting to comply with Centre of Medicare and Medicaid Services(CMS). RN will document the entire hypoglycemic episode in EPIC in Flowsheets called as Hypoglycemia flowsheet.

    1 Once: Initial assessment, treatment

    Each: 15-minute post-treatment reassessment, treatment (if applicable)

    Each: provider notification and

    Once: Hypoglycemia resolution assessment at 1 hr recheck

    Include probable causes of the hypoglycemic episode

    Additional relevant details can be charted as needed in a Significant Event Note. If a rapid response (emergency process) is called, pertinent document details of the Rapid Response Navigator is significant. Not only this we do document hypoglycemia event in the hospital’s incident reporting system

    Effectiveness of the Nurse Driven Hypoglycemia protocol

    The Nurse-driven protocol is very feasible  It helps in controlling and preventing both mild and severe hypoglycemic episodes. Moreover, nurses particularly appreciated the gain in autonomy and involvement in the management of diabetic patients.

    Shortcomes

    A common error I personally felt when treating the patient with hypoglycemia is to overtreat hypoglycemia with an excess of carbohydrate. This, in combination with the counterregulatory hormone response to hypoglycemia, facilitates subsequent hyperglycemia. After treatment of any hypoglycemic episode, frequent bedside glucose monitoring should be continued until a stable glucose level is achieved. Depending on the time of day and insulin peak times, a balanced snack with carbohydrate, protein, and fat (i.e., peanut butter and crackers, or milk) can prolong treatment effectiveness (Tomky,2015) NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

    Conclusion

    There is an evidence-based research shows that simple nurse-managed hypoglycemia protocol measures significantly reduced hypoglycemia in diabetic hospitalized patients. NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart. We cannot deny the fact that hypoglycemic events are frequent in the hospital setting and have adverse prognostic implications.Close attention and monitoring are needed to ensure patients have intravenous glucose infused during prolonged fasting; Patient dietary intake also should be monitored This should become an in-hospital routine preventive strategy with insulin treatment(Tomky,2015).

    References

    American Diabetes Association Workgroup on Hypoglycemia 2005. Diabetes Care.2005;28(5):1245-1249.

    American Diabetes Association. 2015 Standards of Medical Care in Diabetes. DiabetesCare. 2015;38(Suppl. 1):S38-40, S80-85.

    (2015, April 16). Effectiveness of a Nurse-Managed Protocol to Prevent Hypoglycemia in Hospitalized Patients with Diabetes. Retrieved October 23, 2017, from https://www.hindawi.com/journals/jdr/2015/173956/cta/ NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

    http://care.diabetesjournals.org/content/38/Supplement

    Service, F. J. (1995). Hypoglycemic Disorders. 
    Handbook of Diagnostic Endocrinology,
     193-212. doi:10.1385/1-59259-293-7:193

    Tomky, D. (2005, January 01). Detection, Prevention, and Treatment of Hypoglycemia in the Hospital. Retrieved October 23, 2017, from http://spectrum.diabetesjournals.org/content/18/1/39

    UnityPoint Health Trinity’s Hypoglycemia Protocol NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart