Category: Nursing

Nursing Leadership Health Policy Paper

Details:

The IOM Future of Nursing report calls for an increase in leadership from nurses at all levels. One way nurses demonstrate their role as a leader, is through public policy change. A leader does not always carry an official title or position, but demonstrates leadership through the work and the stance the leader takes to make a change for the good of others. Nurses have been noted by the Gallop poll year after year as the most trusted professionals.

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This assignment requires thought about a public policy that is needed or needs to be changed that relates to nursing, health care, or the public. Policy changes can occur by working with members of your legislature, and state or national nurses associations, to introduce a new bill and/or change to a current law in your state or federal government Nursing Leadership Health Policy Paper.

Examples of public policy includes any component of the current legislation governing health care, Medicare Part D, Medicaid, nursing regulation, medication technicians, etc.

In 750-1,000 words, propose a health policy change (that is currently a bill, a law, or may not exist at all) at the state or federal level that you believe needs to change and why.

The policy must not be a clinical care policy for individual care. The policy involved may include public or community health, legislative or regulatory, professional organization (nursing-oriented), advanced nursing practice, health plan, or hospital plan Nursing Leadership Health Policy Paper.

Include a specific section for the exact wording for the bill or change in wording of the law.

Include the plan for the implementation of your policy development, to lobbying for passage, to next steps after passage.

Discuss who would be the champion for the bill/law change from your state advocates (legislators, federal legislators, local or national state nursing organizations). Are these individuals also influential in making changes occur? Did you vote for the individual in office that you want to help you make this change? Nursing Leadership Health Policy Paper.

Resources:

Review different pieces of legislation for ideas on wording.

Visit your state’s legislative governmental affairs website site to understand the process your policy change could take if you wanted to introduce to into legislation.

 

Legislative Change

The policy must not be a clinical care policy for individual care. The policy involved may include public or community health, legislative or regulatory, professional organization (nursing-oriented), advanced nursing practice, health plan, or hospital plan. Include a specific section for the exact wording for the bill or change in wording of the law.

The Medicare Prescription Drug, Improvement, and Modernization Act that was passed in 2003 presents a policy for managing Medicare. The legislation added a new section (Part D) to the Medicare Program that allowed private entities to be reimbursed by Medicare for prescription drugs they provide to Medicare beneficiaries. Although the new legislation offers greater benefits for the beneficiaries, it presents an opportunity for fraud. This is particularly true when claims are made for improper rebates, red-lining, enrollment fraud, overcharging, and duplicate billing (False Claims Act, 2018) Nursing Leadership Health Policy Paper. The implication is that the legislation has a glaring loophole that can easily be exploited through fraud.

The loophole in the legislation should be addressed through institutional changes that include greater oversight, inclusion, and control from a body comprised of representatives from all stakeholders, with stricter checks and double verification systems. In fact, there is a need to revise the legislation by calling for mandatory institutional changes. This conceptualized change is best understood by exploring the causes of fraud in health care. Harris (2015) mentions that greater control, inclusion and oversight should minimize the opportunities for fraud in medical care. This assessment is based on the fact that these measures would improve healthcare efficiency and competitiveness while encouraging good governance, values and norms (Harris, 2015).

Emanuel (2014) mentions that although fraud is considered a vice by most stakeholders, there are those who embrace the practice and would be resistant to any change that eliminates fraud. This is especially true for the health care industry where both personnel and facilities readily participate in fraudulent activities in quid pro quo trade that sees benefits flowing both ways. For instance, some medical facilities earn substantial profits from fraudulent Medicare claims that they then share with the personnel who facilitated the earnings. This makes it clear that there is a need to consider the distinguishing features of both personnel and facilities (along with other stakeholders in the medical industry). The consideration helps in defining how the stakeholders would apply their strategic plans. For example, it would show how a facility that benefits from fraud would react to legislative efforts to curb fraud (Emanuel, 2014).

Political economists confirm that fraud is resultant of resource scarcity and limited competition. In fact, a succinct assessment shows that weak governance enables fraud. Case in point, some facilities are pressured by their environment to enable fraud as a salient industry practice. In such cases, the facilities that do not enable fraud may finds that they position becomes insecure within the industry with some of them being targeted (Teitelbaum & Wilensky, 2013) Nursing Leadership Health Policy Paper. In this respect, the proposed change to the legislation would entail including a clause that calls for mandatory institutional changes (greater oversight, inclusion, and control) with stricter checks and double verification systems to reduce the opportunities for fraud. In essence, the proposed legislative change argues that adequate oversight and regulation through the current legislation’s loopholes will allow for greater accountability, oversight and regulation to reduce the opportunities for fraud Nursing Leadership Health Policy Paper.

Include the plan for the implementation of your policy development, to lobbying for passage, to next steps after passage.

The first step in implementing the policy development is to explore the existing problem. In this case, the shortcomings in the current legislation must be identified and explored with the opportunities for fraud well highlighted. Next, a range of solutions are developed through exploring literature and holding discussion. This is followed by identifying the most viable solution with the best chance of succeeding. The solution is then framed as a legislation and further explored for its value in solving the existing problem. The key stakeholders would then be identified, focusing on the persons with the potential to influence legislative activities. Lobbying for the legislative change would ensure whereby these stakeholders are approached to improve their buy in into the proposed legislative change Nursing Leadership Health Policy Paper. Once their stakeholders support is garnered, the proposed legislative change would then be presented to the appropriate legislative assemblies (such as Congress) to discuss the change and pass it based on its merits. The final step would be to implement the legislative change to include monitoring in action.

Discuss who would be the champion for the bill/law change from your state advocates (legislators, federal legislators, local or national state nursing organizations).

The champion for the legislative change would be legislators. That is because their primary responsibility is to ensure that public resources are allocated to areas that are most in need. By eliminating opportunities for fraudulent Medicare claims, legislators are able to save the funds that would then be allocated towards other healthcare needs. Nursing Leadership Health Policy Paper.

Are these individuals also influential in making changes occur?

It is notable that legislators are influential in making the change occur since their official responsibility is to debate legislation, discarding those without public merit and passing those with public merit.

Did you vote for the individual in office that you want to help you make this change?

Although I did not vote for my legislator, this will not influence whether or not I would receive help. That is because the legislator is a publicly elected official who is accountable to the whole electorate and would evaluate the proposed change based on its merits and demerits Nursing Leadership Health Policy Paper.

References

Emanuel, E. (2014).
Reinventing American Health Care: How the Affordable Care Act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system
. New York, NY: Public Affairs Publications.

False Claims Act (2018).
Health Care Fraud and False Claims
. Retrieved from https://www.falseclaimsact.com/common-types-of-fraud/health-care-fraud

Harris, M. (2015).
Handbook of Home Health Care Administration
(6
th
ed.). Burlington, MA: Jones & Bartlett Learning.

Teitelbaum, J. & Wilensky, S. (2013).
Essentials of Health Policy and Law
(2
nd
ed.). Sunbury, MA: Jones & Bartlett Learning Nursing Leadership Health Policy Paper.

Conflict and Collaboration essay

Purpose

This week’s graded discussion topic relates to the following Course Outcomes (COs).

CO 2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO 3)

CO 3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO 7)

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[MUSIC] Thank you for agreeing to talk to me about the discussion we had the other day about assigning patient load. As I started to say in the meeting but got interrupted, it is that I really don’t like the new plan that we have. I like the old one better and I don’t understand why we need to change Conflict and Collaboration essay.

I think that they expressed one concern about visiting patients in Iron Ridge.And that is the key as they were with high crime rate. We all recognize this issue. I do understand, but the new patient assignment scheme is meant to match you with a patient who will most benefit from your specialty and not where you live geographically.

There are many patients in Iron Ridge who have diabetes that need your expertise. [BLANK_AUDIO] Well, I really do love my patients, and I don’t hold it against them that they live in a bad part of town Conflict and Collaboration essay. But frankly, I’m afraid.Every night when I watch the news, there’s somebody that’s been involved in a shooting or a carjacking.

At times the needs of our families conflict with our work responsibilities. Could this possibly be the underlying issue here?

Explain the conflict resolution skills displayed by the leader in the scenario. On a scale of 1-10, how would you rate those of the leader.

How might earlier collaboration have been beneficial? What other leadership skills should be used? Conflict and Collaboration essay.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

Practice Issue Worksheet Directions

A tutorial with tips for completing this assignment may be viewed at https://atge.webex.com/atge/ldr.php?RCID=4905b26a67572323c11b839e3251c96a (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site.

Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation, from the required List of Approved Systematic Reviews (Links to an external site.)Links to an external site..

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Follow the grading criteria below to formulate your practice issue, which must be based on the topic of the systematic review you have selected.

Download the required Milestone 1 Practice Issue and Evidence Summary Worksheets (Links to an external site.)Links to an external site. (both worksheets appear in ONE file) to document the practice issue presented and approved by your instructor in the Week 2 Discussions.

Your practice issue will be the same for all three Milestone assignments in this course.

Please type your answers directly into the worksheet. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Evidence Summary Worksheet Directions

Develop an evidence summary by following the grading criteria below.

Document this on the evidence summary portion of the worksheet.

You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.

Please type your answers directly into the worksheet.

Guidelines

Purpose

Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star Model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO4)

CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO8)

Due Dates

Milestone 1 consists of the completion of ONE form with two worksheets. Complete both worksheets and submit the form (Attached)

You are required to use the linked article (
under order 201804) and Worksheets or you will earn a “0” for the assignment. In addition, assignments that do not follow the current guidelines or use the required Worksheet or article will be evaluated for evidence of an academic integrity violation.

Practice Issue Worksheet Directions

Choose the 
ONE
systematic review topic that is of most interest to you, or most relevant to your practice situation, from the required List( submitted under order 201804)

Follow the grading criteria below to formulate your practice issue, 
which must be based on the topic of the systematic review you have selected
.

Download the required worksheets (both worksheets appear in ONE file) to document the practice issue presented and approved by your instructor in the Week 2 Discussions. –
Attached

Your practice issue will be the same for all three Milestone assignments in this course.

Please type your answers directly into the worksheet Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Evidence Summary Worksheet Directions

Develop an evidence summary by following the grading criteria below.

Document this on the evidence summary portion of the worksheet.

You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.

Please type your answers directly into the worksheet.

Rubric

NR451_Milestone_1_2

NR451_Milestone_1_2

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomePractice Issue Statement, Scope of Practice, Practice Area

Identifies a practice issue statement that is an independent nursing decision, and is relevant to the systematic review topic chosen from among the approved list provided in the course. Describes the scope of practice issues. Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminate the falls? This is where you begin your initial search into the problem or practice issue identified. Identifies the practice area.

20.0 pts

Practice issue is identified based on the approved systematic review topic chosen. Practice issue is an independent nursing decision. Scope of practice issue is fully described. Practice area identified.

18.0 pts

Practice issue is identified but is not clear, however it is based on the approved systematic review topic chosen. Practice issue is an independent nursing decision. Scope of practice issue is described in simple terms. Practice area identified.

16.0 pts

Practice issue is identified but is not clearly related to a nursing practice issue, however it is based on the approved systematic review topic chosen. Practice issue is not an independent nursing decision. Scope of practice issue is described but is not clear. Practice area identified.

8.0 pts

Practice issue is unclear. Practice issue is not based on the approved systematic review topic. Practice Issue is not an independent nursing decision. Scope of practice issue is not described. Practice area identified.

0.0 pts

Practice issue is not identified; practice issue is not an independent nursing decision; scope of practice issue is not described; practice area is not identified.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

20.0 pts

This criterion is linked to a Learning OutcomePractice Issue-Rationale for Selections

Identifies how rationale behind how the practice issue was selected as a practice issue/problem. Documents the practice issue in a logical manner.

35.0 pts

Identifies and documents what types of evidence is needed for review. Thoroughly describes rationale for all checked types of evidence selected.

31.0 pts

Identifies and documents what types of evidence is needed for review. Briefly describes rationale for all checked types of evidence selected.

28.0 pts

Identifies and documents what types of evidence is needed but includes only a minimum description for rationale for selected evidence.

13.0 pts

Does not document more than one type of evidence that is needed for review and does not include rationale for selected type of evidence.

0.0 pts

Does not document types of evidence or rationale.

35.0 pts

This criterion is linked to a Learning OutcomeTypes of Evidence Gathered-Rationale for Selections

Identifies and documents types of evidence that must be gathered for review of the Practice Issue. Describes rationale for each type of evidence that is selected.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

20.0 pts

Identifies and documents what types of evidence is needed for review. Thoroughly describes rationale for all checked types of evidence selected

18.0 pts

Identifies and documents what types of evidence is needed for review. Briefly describes rationale for all checked types of evidence selected.

16.0 pts

Identifies and documents what types of evidence is needed but includes only a minimum description for rationale for selected evidence.

8.0 pts

Does not document more than one type of evidence that is needed for review and does not include rationale for selected type of evidence.

0.0 pts

Does not document types of evidence or rationale.

20.0 pts

This criterion is linked to a Learning OutcomePractice Problem Description

States practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms. Describes practice setting in measureable terms. Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?

10.0 pts

-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is identified -Magnitude of problem is discussed. -The practice issue is stated in measurable terms.

9.0 pts

-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is discussed. -The practice issue is stated in measurable terms.

8.0 pts

-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is not discussed. -The practice issue is stated in measurable terms.

4.0 pts

-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is not discussed. -The practice issue is stated but not measurable.

0.0 pts

-Practice problem is not in own words -There are no references to the population of interest. -Setting and magnitude of problem is not discussed -The practice issue is not stated in measurable terms.

10.0 pts

This criterion is linked to a Learning OutcomeSource(s) of Evidence

Identifies a source of evidence that is a nursing topic and is the subject of a systematic review article. Provides a complete reference for the systematic review article that was chosen from the list, as well as any optional scholarly source in support of the project topic.

20.0 pts

Full Marks

-Source is a Systematic Review article chosen from the approved list (plus optional scholarly article of support). Complete APA formatted reference(s) is given for with no errors. The source (s) must be relevant to the practice issue identified.

18.0 pts

-Source is a Systematic Review article chosen from the approved list (plus optional scholarly article of support). -A reference is given, but it has APA formatting errors. -The source must be relevant to the practice issue identified.

16.0 pts

-Source is a Systematic Review article chosen from the approved list. (plus optional scholarly article of support). -No reference is provided. -The source must be relevant to the practice issue identified.

8.0 pts

-Source of evidence is a research article or systematic review not on the approved list. -A reference for the article or systematic review is given. -The source is not relevant to the practice issue identified.

0.0 pts

-Source of evidence is not provided, or is not a research article or systematic review. -Reference is missing.

20.0 pts

This criterion is linked to a Learning OutcomeArticle Objectives/Statement of Questions

Identifies the objectives of the article. Identifies questions being addressed by author/s. Explains relationship to the chosen practice issue

20.0 pts

-Objectives of article are identified. -Questions addressed by author/s are thorough. -Relationship to your practice issue is explained.

18.0 pts

-Objectives of article are identified. -Questions addressed by author/s are explained but not thorough. -Relationship to your practice issue is explained.

16.0 pts

-Objectives of article are identified. -Questions addressed by author/s are not thorough. -Relationship to your practice issue is vague.

8.0 pts

-Objectives of article are identified. -Questions addressed by author/s is missing. -Relationship to your practice issue is not explained.

0.0 pts

-Objectives of article are not identified. -Questions addressed in article and relationship to own practice is not identified.

20.0 pts

This criterion is linked to a Learning OutcomeInterventions/Main Findings Summary

Summarizes, in own words, suggested interventions by the author/s to improve patient outcomes. Summarizes main findings of the author/s including strength of evidence for each main outcome. Describes the relevance to the Milestone 2 paper.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

30.0 pts

-Thoroughly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Thoroughly summarized main findings of the author/s. -Included strength of evidence for each main outcome.

26.0 pts

-Briefly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Briefly summarized main findings of the author/s. -Included strength of evidence for each main outcome.

24.0 pts

-Vaguely summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Vaguely summarized main findings of the author/s. -Included strength of evidence for most of main outcomes.

11.0 pts

-Summary of interventions is not in own words. -Summarized main findings of the author/s is not apparent. -Did not include strength of evidence for any of the main outcomes.

0.0 pts

-Summary of the interventions the author(s) suggest to improve patient outcomes is missing. -Summary of the main findings of the author is missing. -The strength of the evidence for outcomes are missing.

30.0 pts

This criterion is linked to a Learning OutcomeEvidence-based Solutions and Limitations

Outlines evidence-based solutions to consider for the capstone project. Discusses any limitations to the studies included in the systematic review that he/she believes may impact use of the evidence provided in their project

20.0 pts

-Outline of evidence-based solutions considered for project is documented and clear. Discussed any limitations to the studies performed. Documents limitations believed may impact use in project.

18.0 pts

-Outline of evidence-based solutions being considered for project is documented but not clear. Discussed any limitations to the studies performed. Documents limitations believed may impact use in project.

16.0 pts

-Outline of evidence-based solutions considered for project is documented but not clear. Discussed most limitations to the studies performed. Documents limitations believed may impact use in project.

8.0 pts

-Outline of evidence-based solutions being considered for project is not documented. -Discussed most limitations to the studies performed. Documents limitations believed may impact use in project.

0.0 pts

-Outline of evidence-based solutions, limitations of studies and potential impact to project is missing.

20.0 pts

Total Points: 175.0

NR451_W3_Milestone1_Worksheets

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

 

Student Name:
                                                        
Date:

Directions

Refer to the guidelines for specific details on how to complete this assignment.

Type your answers directly into the worksheets below.

Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.

Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.

 

Practice Issue Worksheet

 

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

Health-Associated Infection

Cooper, F., Alexander, C., Sinha, S. & Omar, M. (2016). Policies for replacing long-term indwelling urinary catheters in adults.
Cochrane Database of Systematic Reviews
, 2016(7), Art. No.: CD011115. doi:10.1002/14651858.CD011115.pub2

What is the nursing practice issue you have identified related to the topic you have chosen?

The nursing practice issue to be addressed is whether or not incorporating antibiotic prophylaxis when using long-term indwelling urinary catheters reduces the incidence of symptomatic bacteruria for adults’ patients with lower urinary tract problems. As a result, it intends to answer the question: In adults with lower urinary tract problems, does the use of long-term indwelling urinary catheters in combination with antibiotic prophylaxis, versus indwelling urinary catheters used in isolation, affect the incidence of symptomatic bacteruria over a period of three months?

Fully describe the scope of the practice issue:

Nurses are typically advised to use antibiotics with caution, particularly when facing the possibility of resistance development. Still, for adult patients suffering from lower urinary tract problems and using long-term indwelling urinary catheters, the catheters present an additional risk of infection. That is because they act as avenues for infection, especially from repeated handling. Despite the warning linked with antibiotics use, analysis shows that reducing the risk of infection is the best outcome for the patient. Antibiotic prophylaxis improves the capacity for preventing infection, thus presenting a good possibility for application by nursing personnel Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

What is the practice area?

_X_
Clinical

___ Education

___ Administration

___ Other (List):

How was the practice issue identified?
(check all that apply)

___ Safety/risk management concerns

_X_
Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

 

 

___ Difference between hospital and community practice

_X_
Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

Using catheters increases the risk of the patients’ acquiring opportunistic infections. As such, the research intends to show that using antibiotic prophylaxis can reduce the risk of acquiring opportunistic infection.

What evidence must be gathered?
(check all that apply)

_X_
Literature search

___ Guidelines

_X_
Expert Opinion

___ Patient Preferences

_X_
Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

 

Describe the rationale for your checked selections:

A literature search will be conducted to understand how past publications view the current topic.

Expert opinion and clinical expertise will be collected to understand how nursing personnel understand the problem. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

 

Evidence Summary Worksheet

Directions
: Please type your answers directly into the worksheet.

 

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

Even when used in clear environments, catheters still present a route for opportunistic infection. This occurs through regular handling by the nursing personnel. The risk for infection is higher among adult patients suffering from lower urinary tract problems since their immune system appears compromised and they can easily be infected. As such, it is prudent to adopt a proactive approach by using antibiotic prophylaxis that effectively prevents the possibility of opportunistic infection.

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional
optional
supplemental scholarly source related to the review you wish to use.

Cooper, F., Alexander, C., Sinha, S. & Omar, M. (2016). Policies for replacing long-term indwelling urinary catheters in adults.
Cochrane Database of Systematic Reviews
, 2016(7), Art. No.: CD011115. doi:10.1002/14651858.CD011115.pub2

Identify the objectives of the article:

The article intended to determine the effectiveness different policies for replacing long-term indwelling urinary catheters in adults.

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

The article answer the question of whether there are any differences in the outcomes from the different policies applied in replacing long-term indwelling urinary catheters in adults. This is an acknowledgement that each policy presents a risk of infection although at different levels. This shows that even with the best policy, there is still some risk of infection Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal. By including antibiotic prophylaxis, the risk of infection is greatly reduced.

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

The article concludes that the best policy for replacing urinary catheters must take into account certain factors that include the patients’ satisfaction, quality of life, type of trauma on the urinary tract, economics, replacement method used, environment-specific performance difference at home and hospital, catheter replacement strategy, and lubrication used.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper
.
(If an
optional
supplemental source is also used, include a statement of relevance to it as well.)

The article makes it clear that additional evidence is required before a conclusion can be reached. More information must be collected on the different policies for a complete evaluation.

 

Outline evidence-based solutions that you will consider for your project
.

The project considers the position that antibiotic prophylaxis can play in reducing the possibility of infection so that the differences in policies for handling catheters become of less significance.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

The major study limitation will be how to decide from among the many types of antibiotics that are available in the market. In essence, there are many pathogens that can cause infection. Using the many types of antibiotics on a single patient is unrealistic, while using one type means that the prophylaxis does not offer protection against the other types of antibiotics Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

 

Capstone Project Milestone 2: Design for Change Proposal

Purpose

You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program.

Course Outcomes

This assignment enables the student to meet the following course outcomes.

CO1: Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO1)

CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO2)

Rubric

Click to view and download the 
NR451 Milestone 2: Design for Change Proposal Rubric (Links to an external site.)Links to an external site.
.

Points

Milestone 2 is worth 
225 points
.

You are required to use one of the required articles from the Week 3 Milestone 1 assignment or you will earn a “0” for the assignment. In addition, assignments that do not follow the current guidelines or use the required article will be evaluated for evidence of an academic integrity violation.

After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. It is your responsibility to submit the correct assignment to the correct submission area.

Directions

A tutorial with tips for completing this assignment may be viewed at 
https://atge.webex.com/atge/ldr.php?RCID=b0c912eaf53b4aabb1347a026466c60e(Links to an external site.)Links to an external site.

Review the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.

Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific 
Milestone 2 Design Proposal Template(Links to an external site.)Links to an external site.
. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.

The format for this proposal will be a paper following the 
Publication manual of APA
6 
th

The paper is to be four- to six-pages excluding the Title page and Reference page.

As you organize your information and evidence, include the following topics.

Introduction:
Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the 
Publication manual of the American Psychological Association 
(2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Change Model Overview: 
Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.

Evidence: 
Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.

Translation: 
develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.

Conclusion: 
Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.

Citations and References
must be included
 to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.

Tables and Figures may be added
as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Title

Your Name

Chamberlain College of Nursing

NR451 RN Capstone Course

Term and Year

 

Your title here

This paragraph(s) is to introduce the paper. State the problem and potential solutions backed by evidence. Briefly, introduce the nursing focused plan. Remember this is a scholarly APA assignment so
you cannot use first person
. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper.

Change Model Overview

In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process. Feel free to state why nurses should use this model as a guide to facilitate change. Under each of the second level headers listed below, you now link your identified topic to the ACE Star model EBP Process.

Define the Scope of the EBP

Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale?

Stakeholders

You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.).

Determine Responsibility of Team Members

Why are the members chosen important to your project? What are their roles?

Evidence

Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines?  Briefly discuss the strength of this research. This is
not
where you describe the results of your studies. This is done in the following steps.

Summarize the Evidence

In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.

Develop Recommendations for Change Based on Evidence

What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Translation

Action Plan

You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study?  What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results.

Process, Outcomes Evaluation and Reporting

What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?

Identify Next Steps

How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?

Disseminate Findings

How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)? Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Conclusion

Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

 

References

 

NR451 Milestone2 Rubric

 

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome Introduction

Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.)

25.0 pts

Introduction to the plan is nursing focused, and evidence-based. Potential interventions clearly identified.

22.0 pts

Introduction to the plan is missing one of the elements listed in the first column.

20.0 pts

Introduction to the plan is missing two elements listed in the first column.

10.0 pts

Introduction lacks evidence to support need for change and/or potential solution is not evidenced-based.

0.0 pts

Introduction is missing.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

25 pts

This criterion is linked to a Learning Outcome Change Model Overview

An overview of the ACE Star model as a guide for change is given. Scope of the problem is identified. Stakeholders are identified. Team members and their roles and practice area are identified and discussed. State how nurses should use this model as a guide to facilitate change.

50.0 pts

Overview of the ACE Star model is given. Scope of problem is identified. Rationale for change is present. Stakeholders are identified. Practice area, team members and role are discussed.

44.0 pts

All elements in the first column are included but discussion of one or more items lacks details.

40.0 pts

Overview is missing one of the elements from the first column.

19.0 pts

Overview of the ACE Star model is given. Scope of problem is not identified. Rationale for change is not present. Stakeholders are not identified. Practice area, team members and role are not discussed.

0.0 pts

Change Model Overview is missing all elements of the first column.

50 pts

This criterion is linked to a Learning Outcome Evidence

Evidence is provided thru basic information that indicates a change is needed. For example, there have been 6 urinary tract infections over the last two months and there were none present the last two years at the same time period. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use?

50.0 pts

Evidence summary is thoroughly provided with information of the current problem in the work setting indicating a change is needed. Interventions discovered in Evidence Summary are used in planning for change.

44.0 pts

Evidence summary contains all elements in the first column, however, one or more items lacks detail.

40.0 pts

Evidence is vaguely provided through information of the current problem in the work setting indicating a change is needed. Some of the interventions discovered in Evidence Summary are used in planning for change.

19.0 pts

Evidence is provided through information of the current problem but is not convincing. Interventions discovered in Evidence Summary are not used in planning for change.

0.0 pts

Evidence summary is not provided.

50 pts

This criterion is linked to a Learning Outcome Translation

Activities to achieve the final steps of change are fully described. What is needed to achieve? How do you translate what information you have gathered into practice? Include measurable outcomes. How do you inform staff? What is your plan of action to pilot the plan? What is the timeline?

50.0 pts

Activities to achieve final steps of change are fully described. Ways to translate evidence into practice are discussed (outcomes). Methods to inform staff, activities planned for plan of action and timeline are discussed.

44.0 pts

Activities to achieve final steps of change are adequately described.

40.0 pts

Activities to achieve final steps of change are briefly described.

19.0 pts

Minimal description of the activities to achieve final steps of change.

0.0 pts

Activities for final change plan are missing. Translation of evidence into practice is missing.

50 pts

This criterion is linked to a Learning Outcome Conclusion

Clear, solid summary of the key points, ACE Star model and steps of the change plan are included; ways to sustain the change plan are described.

25.0 pts

Detailed summary of main points using ACE Star model. Ways to sustain plan are thoroughly described.

22.0 pts

Summary of main points/model is brief. Ways to sustain plan are briefly described.

20.0 pts

Summary of main points/model is vague. Ways to sustain plan are vaguely described.

10.0 pts

Summary of main points/model OR ways to sustain plan are not described.

0.0 pts

Summary is missing. There is no plan to sustain change.

25 pts

This criterion is linked to a Learning Outcome Mechanics

APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors

25.0 pts

APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors

22.0 pts

Two to three errors in elements from the first column.

20.0 pts

Four to five errors in elements from the first column.

10.0 pts

Six to seven errors in elements from the first column.

0.0 pts

More than seven errors.

25 pts

Total Points: 225 Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

 

Design for Change Proposal

Your Name

Chamberlain College of Nursing

NR451 RN Capstone Course

Term and Year

Design for Change Proposal

Urinary Tract Infect (UTI) is a common medical condition in which the urinary tract is considered infected, to include either the kidneys, bladder or urethra with the result is a persistent pain in the urinary tract. UTI classification occurs based on the specific organ that is infected with infection of the kidneys called pyelonephritis, infection of the bladder called cystitis, and infection of the urethra called urethritis. Medical studies indicate that 50% of women and 5% of men will report a UTI during their lifetime Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal. The condition is typically caused by microorganisms (such as
Escherichia coli
) colonizing the tract, in which case antibiotics will be prescribed to combat them and subsequently clear the microorganisms as well as their associated symptoms. Although UTI is a common medical concern, the concern is heightened by the use of a catheter in the bladder and urethra. That is because the catheter is a foreign that presents an opportunity for microorganisms to gain entry when it is being handled (Brooks, 2012). In this respect, a UTI is construed as an infection of the urinary tract and caused by colonization by microorganisms that gain entry through catheters.

Change Model Overview

The most appropriate model for guiding both the evidence-based practice process and change as a strategy for motivating stakeholders is the Stetler Model of Evidence-Based Practice. The selection of this model is directed by the understanding that change is best achieved through use of a conceptual framework that acts as a guide for the different aspects of evidence-based practice to interact. The most important aspect of the model is that it acknowledges sources of information beyond primary research as being capable of influencing evidence-based practice. At its core is the understanding that every assertion or change recommendation must be substantiated with clear, replicable, observable, credible, verifiable and supportable evidence from both internal and external sources (Ellis, 2016) Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal. In the present case, the problem (identified as the position that antibiotic prophylaxis can play in reducing the incidence of symptomatic bacteruria for persons using urinary catheters) is recognized as one that requires a solution to improve medical care outcomes. For a solution to garner support, it must be based on acceptable evidence.

Define the Scope of the EBP

The project intends to determine whether or not incorporating antibiotic prophylaxis when using long-term indwelling urinary catheters reduces the incidence of symptomatic bacteruria for adults’ patients with lower urinary tract problems. In fact, it intends to answer the question: In adults with lower urinary tract problems, does the use of long-term indwelling urinary catheters in combination with antibiotic prophylaxis, versus indwelling urinary catheters used in isolation, affect the incidence of symptomatic bacteruria over a period of three months?

Stakeholders

A six-person team that includes the research as team manager, four nurses concerned with catheter management, and a hospital administrator.

Determine Responsibility of Team Members

The team manager is responsible for presenting the project details, assigning responsibilities to the other team members, collecting the outcomes, and presenting the results. The four nurses are responsible for applying the policy of incorporating antibiotic prophylaxis when using long-term indwelling urinary catheters Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal. The hospital administrator is responsible for communicating the hospital management’s outlook and support for the project.

Evidence

Available literature was evaluative through a systematic review that identified one journal that presented supporting evidence to highlight the existing problem and need for a solution.

Summarize the Evidence

Cooper et al. (2016) evaluates the impact of policy changes on outcomes when using long-term indwelling urinary catheters. It notes that each of the available policies for handling catheters presents some element of risk. As such, it recommends that the best policy for handling catheters must at least take into account patients’ satisfaction, quality of life, type of trauma on the urinary tract, economics, replacement method used, environment-specific performance difference at home and hospital, catheter replacement strategy, and lubrication used.

Develop Recommendations for Change Based on Evidence

Based on the results from Cooper et al. (2016) that identify the best features for handling catheters that reduces the risk of infection, there is a possibility that using antibiotic prophylaxis in combination with the catheters would reduce the risk of infection even as it meets the set features.

Translation

Action Plan

The project will first be implemented by the team. Following which results will be collected at the end of the project to note the differences in infection levels between the group that used antibiotics and those that used other policies. The results of the project will then be presented to stakeholders with recommendations for practice change made based on the results. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Process, Outcomes Evaluation and Reporting

The anticipated result is that including antibiotic prophylaxis will reduce the risk of infection. That is because the antibiotics target the pathogens that have gained entry and eliminates them. This results will be verified by comparing the infection incidence for those who use the antibiotic prophylaxis against those who do not use the prophylaxis. Once the results are collected and evaluated, they will be presented to stakeholders who would use them as evidence to implement policy and practice changes.

Identify Next Steps

Should the results show that antibiotic prophylaxis is effective in reducing the risk of infection for catheter users, that support will be sought to conduct a larger scale study that verifies the results. The larger scale study would improve the results generalizability by targeting a larger demographic of subjects. If the results are verified as true, then a recommendation will be made for policy changes to be applied on a larger scale to improve care outcomes. The recommendation would be made to the government and medical organizations that are capable of effecting change at the national level Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Disseminate Findings

The project results will be published in peer-reviewed journals to facilitate access by other stakeholders who are interested in the same subject.

Conclusion

One must accept that the high risk of infection associated with catheter use is worrying for medical practitioners. That is because the infection has the capacity to reverse medical care gains. The issue is best addressed by introducing a catheter management practice element that eliminates the pathogens that cause infection. Given this awareness, the present project suggests that antibiotics be used in combination with catheters to eliminate the pathogens so that the risk of infection is reduced. Should the project verify that using antibiotic prophylaxis reduces the risk of infection for catheter users, then the results will be availed to health stakeholders with the recommendation that antibiotic prophylaxis be routinely used to reduce the incidence of symptomatic bacteruria for persons using urinary catheters.

References

Brooks, D. (2012).
Urinary Tract Infection
. New York, NY: Springer.

Cooper, F., Alexander, C., Sinha, S. & Omar, M. (2016). Policies for replacing long-term indwelling urinary catheters in adults.
Cochrane Database of Systematic Reviews
, 2016(7), Art. No.: CD011115. doi:10.1002/14651858.CD011115.pub2

Ellis, P. (2016).
Evidence-based Practice in Nursing
(3
rd
ed.). London: Learning Matter/SAGE Publications Ltd. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

In

Week 1, complete the following human research protection program essay tasks:

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Think about different areas in the field of nursing and identify the importance of research to nursing practice.

Learn about the fundamentals of research and the research process.

Gain insight into the planning of research

Use APA style and citations/references

human research protection program essay

Computed Tomography (CT) essay

Articles in the scientific literature  over the past several years have implied that computed tomography (CT) may cause cancer and that physicians and patients must exercise caution in its use. What is your opinion regarding this subject. Please research and give your input abut the topic.

Minimal 4 paragraphs. ( No introduction is needed )

at least 3 scholarly sources are requested (No older that 5years) .

Examples of scholarly sourses:

-Published journal articles, books and other works (encyclopedias & newspapers)

-Official websites ending in .gov, .org, .edu (CDC,NIH,ADA,WHO, HARVARD, FIU,FNU)

Do not use Sites such Wikipedia, WebMD, Nursingworld, Allnurses they are
NOT
scholarly sources. Computed Tomography (CT) essay.

Describe and draw symatric cipher model and decrypt it also using play fair technic.

Cryptographic algorithms provide the under lying tools to most security protocols used in today’s infrastructures. The choice of which type of algorithm depends on the goal that you are trying to accomplish, such as encryption or data integrity. These algorithms fall into two main categories: symmetric key and asymmetric key cryptography. In this essay, please discuss the strengths and weaknesses of symmetric key cryptography and give an example of where this type of cryptography is used Symatric Cipher Model. Then discuss the strengths and weaknesses of asymmetric key cryptography and give an example of where this type of cryptography is used.

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Symmetric key encryption is a type of encryption that makes use of a single key for both the encryption and decryption process. Some of the
encryption algorithms
that use symmetric keys include: AES (Advanced Encryption Standard), Blowfish, DES (Data Encryption Standard), Triple DES, Serpent, and Twofish. If you want to apply symmetric key encryption to a file transfer environment, both the sender and receiver should have a copy of the same key. The sender will use his copy of the key for encrypting the file, while the receiver will use his copy for decrypting it. If you manage a
secure file transfer server
that only supports symmetric encryption and one of your users wants to encrypt a file first before uploading it, one of you (either the user or you, the server admin) should first generate a key and then send the other person a copy of that key. Symmetric key encryption doesn’t require as many CPU cycles as asymmetric key encryption, so you can say it’s generally faster. Thus, when it comes to speed, symmetric trumps asymmetric (Villanueva, 2015) Symatric Cipher Model.

Asymmetric key encryption, on the other hand, makes use of two keys. A private key and a public key. The public key is used for encrypting, while the private key is used for decrypting. Two of the most widely used asymmetric key algorithms are:
RSA and DSA
. If you’re going to use asymmetric key encryption in a file transfer environment, the sender would need to hold the public key, while the receiver would need to hold the corresponding private key. If you manage a file transfer server and one of your users wants to encrypt a file first before uploading it, it would typically be your duty to generate the key pair. You should then send the public key to your user and leave the private key on the server. Asymmetric keys simplify the key distribution process (Villanueva, 2015).

Cryptography has been used in one form or another for over 4000 years and attacks on cryptography have been occurring since its inception. The type of people attempting to break the code could be malicious in their intent or could just be trying to identify weaknesses in the security so that improvements can be made Symatric Cipher Model. In your essay response, define cryptanalysis and describe some of the common cryptanalytic techniques used in attacks.

Cryptanalysis is the science of cracking codes and decoding secrets. It is used to violate authentication schemes, to break cryptographic protocols, and, more benignly, to find and correct weaknesses in encryption algorithms. Forging an encrypted signal to be accepted as authentic. People who have been able to discover the key will now want to use it to their advantage. There are many different attacks that may happen to obtain this information.  Ciphertext only attack is a case in which only the encrypted message is available for attack, but because the language is known a frequency analysis could be attempted. Symatric Cipher Model. In this situation the attacker does not know anything about the contents of the message, and must work from ciphertext only. Know Plaintext attack both the plaintext and matching ciphertext are available for use in discovering the key. The attacker knows or can guess the plaintext for some parts of the ciphertext. For example, maybe all secure login sessions begin with the characters LOGIN, and the next transmission may be PASSWORD. The task is to decrypt the rest of the ciphertext blocks using this information. This may be done by determining the key used to encrypt the data, or via some shortcut. A chosen plaintext attack occurs when the attacker gains access to the target encryption device – if, for example, it is left unattended. The attacker then runs various pieces of plaintext though the device for encryption. This is compared to the plaintext to attempt to derive the key. In an adaptive chosen plaintext attack, the attacker not only has access to the plaintext and its encryption, but can adapt or modify the chosen plaintext as needed based on results of the previous encryptions. In a chosen ciphertext attack, the cryptanalyst can choose different ciphertexts to be decrypted and has access to the decrypted plaintext. This type of attack is generally applicable to attacks against public key cryptosystems. An adaptive chosen ciphertext attack involves the attacker selecting certain ciphertexts to be decrypted, then using the results of these decryptions to select subsequent ciphertexts. The modifications in the ciphertext help in deciphering the key from the decryptions. Cryptographic communications and key exchange protocols are susceptible to an attack in which the attacker is able to place himself on the communication line between two parties. In the “man-in-the-middle attack” the attacker is able to position himself to intercept the key exchange between two parties. He performs his own key exchange with each Symatric Cipher Model. Then, with both parties thinking they have set up a secure channel, the attacker decrypts any communications with the proper key, and encrypts them with the other key for sending to the other party. The parties think that they are communicating securely, but in fact the adversary is reading everything. Preventing a man-in-the-middle attacks is possible if both sides compute a cryptographic hash function of the key exchange, sign it using a digital signature algorithm, and send the signature to the other side. The recipient then verifies that the hash matches the locally computed hash and the signature came from the desired other party. Side channel attacks are a type of attacks based on implementation details such as timing, power, and radiation emissions. By carefully measuring the amount of time required to perform private key operations, attackers may be able to find fixed Diffie-Hellman exponents, factor RSA keys, and break other cryptosystems. Against a vulnerable system, the attack is computationally inexpensive and often requires only known ciphertext. Actual systems are potentially at risk, including cryptographic tokens, network-based cryptosystems, and other applications where attackers can make reasonably accurate timing measurements. A brute force attack involves trying all possible keys until hitting on the one that results in plaintext. This can involve significant costs related to the amount of processing required to try quadrillions (in the case of DES) of keys. The time required is a factor of how many keys can be tried per unit of time, which is a factor of how many computers can be assigned to the task in parallel. Because computers are getting faster all the time. The unit of measure for comparison purposes is million-instructions-per-second per year. It is the number of instructions a million-instructions-per-second computer can execute in one year. Moore’s Law states that processing speed doubles every 18 months. As a result, advances in technology and computing performance will always make brute force an increasingly practical attack on keys of a fixed length (Heward, 2014) Symatric Cipher Model.

Many people overlook the importance of physical security when addressing security concerns of the organization. Complex cryptography methods, stringent access control lists, and vigilant intrusion detection/prevention software will be rendered useless if an attacker gains physical access to your data center. Site and facility security planning is equally important to the technical controls that you implement when minimizing the access, a criminal will have to your assets. In your essay response, define CPTED and describe how following the CPTED discipline can provide a more aesthetic alternative to classic target hardening approaches. Make sure that the three CPTED strategies are covered in your response Symatric Cipher Model.

CPTED is the proper design and effective use of the built environment that can lead to a reduction in the fear and incidence of crime, and an improvement in the quality of life. Three different concepts that are used to define CPTED are natural access control, natural surveillance, and territorial reinforcement. Natural access control design features that clearly indicate public routes and discourage access to private structural elements. The elements decrease an opportunity for crime by creating in an offender a perception of unacceptable risk when attempting access to private areas Symatric Cipher Model. Natural surveillance design features that increase the visibility of a property. These features maximize the ability of persons in the area to see persons in the vicinity and avoid trouble and allow external activates to be seen from adjacent building structures by persons who could call for help. Lastly territorial reinforcement design features that clearly indicate public and private structural elements of a property. An individual will develop a sense of territoriality for a space with frequent activities in an area, a sense of ownership. The sense of territory and ownership by an individual is reinforced through regularly scheduled activities, inspections, and maintenance. Target hardening is the use of mechanical devices such as locks and alarms, organized crime prevention strategies make an area harder to access buy may have a tendency to make the inhabitants feel unsafe. This technique is the opposite of natural which reflects crime prevention as a byproduct from normal and routine use of an environment. Target hardening often happens after crime has been committed Symatric Cipher Model. The integration of similar, but customer service oriented CPTED strategies in the initial environment design may be as effective, but less threatening (Krehnke,2009).

References

Heward, G. (2014, January 26). Cryptanalysis and Attacks. Retrieved January 24, 2017, from    https://www.experts-exchange.com/articles/12460/Cryptanalysis-and-Attacks.html

Krehnke, M. (2009). Crime Prevention through Environmental Design. Retrieved January 25, 2017, from http://www.infosectoday.com/Articles/CPTED.htm

Villanueva, J. C. (2015, March 15). Managed File Transfer and Network Solutions. Retrieved January 24, 2017, from http://www.jscape.com/blog/bid/84422/Symmetric-vs-Asymmetric-Encryption Symatric Cipher Model.

Health economics and Gini index

Required Resources

Read/review the following resources for this activity:

Textbook: Chapters 5, 6, 7, 8

Lesson: Week 3, 4

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Instructions

Choose one question from each of the question sets below (2 sets total). In other words, you will be answering two questions total (1 from each set).

Question Set 1

Explain the difference between income inequality and wealth inequality in the United States. Explain the racial wealth gap.

What is social stratification? Examine four common ways or systems in which groups have become stratified. How does race or ethnicity play a role in the stratification?

Briefly compare and contrast a Weberian approach and a Marxian approach to characterize the social classes in the United States. In a Weberian approach, what are social classes based on or how are they understood? In a Marxian approach, how is class understood? In a Weberian approach, how is the racial wealth gap understood? In a Marxian approach, how is the racial wealth gap understood? Health economics and Gini index.

 

Question Set 2

Explain some characteristics of the U.S. poor based on age, gender, and race or ethnicity. Predicts people’s relative chances of being poor based on age, gender, or race, for example.

Explain the Gini index and its relationship to global inequality. Compare the Gini coefficient for the United States with that of other nations. Health economics and Gini index.

What is global stratification? Examine global stratification’s relationship to economic inequality.

 

Writing Requirements (APA format)

Length: 1-2 pages (not including References page)

1-inch margins

Double spaced

12-point Times New Roman font

Running header in the upper left of all pages

Page number in the upper right of all pages Health economics and Gini index.

Parenthetical in-text citations included and formatted in APA style

References page (at the very least the textbook and/or online lessons should be cited)

 

Grading

This activity will be graded based on the Essay Grading Rubric.

 

Course Outcomes (CO): 3, 4, 5, 6

 

Week 4 Assignment Rubric

Week 4 Assignment Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeEssay 1 Central Idea

20.0 pts

Essay is clear and cohesive. Main questions are answered thoroughly.

17.0 pts

Essay is basically cohesive and stays on topic. Central Idea is apparent and major questions are answered.

15.0 pts

Central idea is present, but is not maintained as central throughout. Main questions need more attention.

12.0 pts

Central idea is difficult to identify. No seeming organization or cohesion in structure of paper.

0.0 pts

No effort

20.0 pts

This criterion is linked to a Learning OutcomeEssay 1 Writing

Health economics and Gini index

5.0 pts

Throughout the whole work, the writing is free of major errors in grammar, spelling, and punctuation. Essay utilizes paraphrases and/or quotes effectively and includes in-text citations and a references page.

4.25 pts

Throughout most of the work, the writing is free of major errors in grammar, spelling, and punctuation. Essay utilizes paraphrases and/or quotes mostly effectively and includes in-text citations and a references page.

3.75 pts

Throughout some of the work, the writing is free of major errors in grammar, spelling, and punctuation. Essay utilizes paraphrases and/or quotes somewhat effectively and includes in-text citations and a references page.

3.0 pts

Throughout little of the work, the writing is free of major errors in grammar, spelling, and punctuation. Does not paraphrase or quote and cite the textbook or online lessons.

0.0 pts

No effort

5.0 pts

This criterion is linked to a Learning OutcomeEssay 2 Central Idea

20.0 pts

Essay is clear and cohesive. Main questions are answered thoroughly.

17.0 pts

Essay is basically cohesive and stays on topic. Central Idea is apparent and major questions are answered.

15.0 pts

Central idea is present, but is not maintained as central throughout. Main questions need more attention.

12.0 pts

Central idea is difficult to identify. No seeming organization or cohesion in structure of paper.

0.0 pts

No effort

20.0 pts

This criterion is linked to a Learning OutcomeEssay 2 Writing

5.0 pts

Throughout the whole work, the writing is free of major errors in grammar, spelling, and punctuation. Essay utilizes paraphrases and/or quotes effectively and includes in-text citations and a references page.

4.25 pts

Throughout most of the work, the writing is free of major errors in grammar, spelling, and punctuation. Essay utilizes paraphrases and/or quotes mostly effectively and includes in-text citations and a references page.

3.75 pts

Throughout some of the work, the writing is free of major errors in grammar, spelling, and punctuation. Essay utilizes paraphrases and/or quotes somewhat effectively and includes in-text citations and a references page.

3.0 pts

Throughout little of the work, the writing is free of major errors in grammar, spelling, and punctuation. Does not paraphrase or quote and cite the textbook or online lessons.

0.0 pts

No effort

5.0 pts

Total Points: 50.0 Health economics and Gini index

State Policies On Access To Contraception And Abortion

Investigate the FL state policies on access to contraception and abortion for women with insurance and those without. What are the state’s infant and maternal mortality rates? Discuss the possible relationship between these factors.

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Minimum 250 words, references must be cited in APA format, and must include minimum of 2 scholarly resources published within the past 5-7 years.

The term growth and development refers to a dynamic process. Growth being the term for physical changes and development being the term that refers to the increase in complexity of the skills a person is able to perform. There are many factors that influence growth and development these can be divided into biological, environmental, and social factors.

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Theories are used to organize growth and development that humans experience. It is important that as a health care provider you have an understanding of the appropriate expectations of physical, psychosocial, cognitive, moral and spiritual development.

Choose one of the following theorists and describe the stages of development and the nursing implications: Erickson, Piaget, Kohlberg, or Fowler Effects of aging essay.

Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation. Effects of aging essay.

MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay)

As part of your internship with South Padre Medical Center, you are working under the supervision of the coding supervisor, Marla Kauffman. The clinic’s CDI Director, George Bowman, wants to better educate the physicians on the importance of accurate and complete medical records.  Therefore, George is planning on beginning a series of education sessions every month. He has asked Marla to prepare a presentation on proper documentation.

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Marla thinks that helping with this presentation would be a wonderful opportunity for you during your internship so that you can learn how to improve clinical documentation by identifying some key elements that are missing or unclear inpatient documentation. Marla’s plan for the presentation is to present some cases and examples where the coders did not have the information they needed to code. MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay). Marla has asked you to assist in preparing for this presentation by identifying any missing or unclear information from four patient records and drafting a PowerPoint presentation on your findings.

Because you are a new coder, Marla also thinks it would be helpful for you to research the importance of proper documentation and ways to ensure documentation is complete and accurate and then include information from your research findings into your PowerPoint presentation.

MCCG262 Professional Coder Practicum

Documentation Presentation

 

Course, Program, and Institutional Outcome(s) Assessed:

This assignment measures your ability to meet the follows outcome(s):

Course outcome:
Demonstrate competency and proficiency required for billing and coding operations in outpatient services.

Course outcome:
Evaluate patient records for accuracy and completeness, as defined by policy, regulations, and standards, and summarize finding to share with different stakeholders in the coding process. MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

Program outcome:
Evaluate the accuracy and completeness of the patient record as defined by policy, external regulations, and standards.

Institutional outcome – Information Literacy and Communication
:
Utilize appropriate current technology and resources to locate and evaluate information needed to accomplish a goal, and then communicate findings in visual, written, and/or oral formats.

Relevant Background Information:

Evaluating documentation for accuracy and completeness is part of a coding professional’s daily duties.  It is essential that coders understand what components make up a complete and accurate medical record.  As coders are reading through patients’ medical records to code them, they determine if the documentation is not complete or needs more clarity.  In those instances, the coder will obtain the missing documentation or query the physician for further clarification. MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

Assignment Purpose:

This assignment asks you to review documentation in real patient medical records and specify if there is any missing or unclear documentation that the coder would need in order to assign the correct codes.

 

Assignment Directions:

As part of your internship with South Padre Medical Center, you are working under the supervision of the coding supervisor, Marla Kauffman.  The clinic’s CDI Director, George Bowman, wants to better educate the physicians on the importance of accurate and complete medical records.  Therefore, George is planning on beginning a series of education sessions every month.  He has asked Marla to prepare a presentation on proper documentation.

Marla thinks that helping with this presentation would be a wonderful opportunity for you during your internship so that you can learn how to improve clinical documentation by identifying some key elements that are missing or unclear inpatient documentation.  Marla’s plan for the presentation is to present some cases and examples where the coders did not have the information they needed to code.  Marla has asked you to assist in preparing for this presentation by identifying any missing or unclear information from four patient records and drafting a PowerPoint presentation on your findings. MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

Because you are a new coder, Marla also thinks it would be helpful for you to research the importance of proper documentation and ways to ensure documentation is complete and accurate and then include information from your research findings into your PowerPoint presentation.

Once you have reviewed the four patients’ medical records and completed your research, you will present your PowerPoint to Marla so she can determine how she wants to incorporate it into her presentation at the education session for the physicians MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

Follow the steps below to complete this assignment:

 

Part 1: Research

 
Conduct research to find information on the importance of proper documentation and ways to ensure documentation is complete and accurate.

Make sure you find enough information to effectively explain proper documentation in your PowerPoint presentation.

Make sure your sources are authoritative and recent.

Part 2: Patient Record Review

 

Locate the following patient records in the AHIMA vLab Outpatient Clinic Cases:

410057

410092

410198

410296

 

Your coding supervisor has also provided you with a coding summary for each patient record. You may find these in the coding summary at the end of this document.

 

Review the patient records. For each patient record, identify if there is any missing or unclear information the coder would need. MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

 

Part 3: The PowerPoint Presentation

 

Gather the information from your sources and from your review of the four identified patient records. Create a PowerPoint presentation that achieves the following:

Provides examples from all four patient records of pieces of the medical records that are properly documented.

Provides examples from all four patient records of pieces of the medical records that do not have accurate or complete information.

Explains the importance of proper medical documentation.

Provides suggestions to ensure physician documentation is complete and accurate.

Is the right length to thoroughly cover all necessary information MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

MCCG262 Professional Coder Practicum

Documentation Presentation

Rubric

 

Level 3

Level 2

Level 1

Level 0

50-42.5

42.4-35

34.9-32.5

34.2-0

Content

Student includes 
accurate, thorough, and detailed
explanations of
all
presentation requirements.

Student includes 
accurate, somewhat thorough, and somewhat detailed
explanations of 
most (75%)

of the presentation requirements.

Student includes
accurate
explanations 
with little to no details
 of 
half
of the presentation requirements.

Student includes
inaccurate 
explanations

without details
 of 
less than half
of the presentation requirements.

35-29.75

29.74-24.5

24.4-22.75

22.74-0

Presentation

Presentation length is
adequate
for the material being presented.

 

Audio commentary matches slides presented.

Presentation length is
mostly adequate
for the material being presented, but the presentation would have better if the length was
slightly adjusted.

 

Audio commentary matches slides presented.

Presentation length is
partially adequate
for the material being presented, but the presentation would have better if the length was
significantly adjusted.

 

Audio commentary does 
not 
match slides presented.

Presentation length is
inadequate
for the material being presented.

 

Audio commentary does 
not 
match slides presented.

10-8.5

8.4-7

6.9-6.5

6.4-0

Sources

Student refers to 
authentic and recent
sources that provide
abundant
information for the material being presented.

 

Student includes the sources for 
all 
information in the PowerPoint.

 

Student refers to 
authentic and recent
sources that provide
adequate
information for the material being presented.

 

Student includes the sources for 
most 
(at least 75% of the) information in the PowerPoint.

Student refers to 
authentic and recent
sources that provide
inadequate
information for the material being presented.

 

Or the sources are
not authentic or recent.

 

Student includes the sources for 
half
 of the
 
information in the PowerPoint.

Student fails to refer 
any 
sources.

 

Student fails to include the sources or only includes sources for 
less than half
 of the information in the PowerPoint.

5-4.25

4.24-3.50

3.49-3.25

3.24-0

Institutional Outcome

Information Literacy and Communication:

Work indicates that the student has 
exceeded expectations 
for this institutional outcome.

 

Information Literacy and Communication:

Work indicates that the student has 
successfully met expectations 
for this institutional outcome.

 

Information Literacy and Communication:

Work indicates that the student has 
partially met expectations 
for this institutional outcome.

 

Information Literacy and Communication:

Work indicates that the student has 
not or scarcely met expectations 
for this institutional outcome.

 

Final ScorMCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay)e:

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MCCG262 Professional Coder Practicum

Documentation Presentation

Coding Summary

 

The coding supervisor has provided you with the coding summary of each coded case and these are as follows:

 

410057

Diagnosis Codes:

Dx Reason for Visit: C50.411 Malignant neoplasm of upper outer quadrant of right female breast

Primary Diagnosis: C50.411 Malignant neoplasm of upper outer quadrant of right female breast

Secondary Diagnosis: Z17.1 Estrogen receptor negative status [ER-] MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay)

 

Detailed CPT Procedures:

19301-RT Partial Mastectomy; (RT Right side of body)

14301 Adjnt tis trnsfr/reargmt any area 30.160 sq cm

19285-RT Placement of breast localization device(s), percutaneous; first lesion, including ultrasound guidance; (RT – Right side of the body) MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay)

 

410092

Diagnosis Codes:

Primary Diagnosis: D12.2 Benign neoplasm of ascending colon

Secondary Diagnoses:

I10 Essential (primary) hypertension

9 Type 2 diabetes mellitus without complications

909 Unspecified asthma, uncomplicated

9 Hypothyroidism, unspecified

9 Gastro-esophageal reflux disease without esophagitis

0 Pure hypercholesterolemia

 

Coder’s note: There are numerous laboratory procedures on this record relating to gene analysis.  Per clinic policies, we are not assigning codes to these as they would most probably be captured by the chargemaster system in place at the facility. Procedure code could not be assigned.

410198:

Diagnosis Codes:

Dx Reason for Visit: L72.0 Epidermal cyst

Primary Diagnosis: L72.0 Epidermal cyst

Secondary Diagnoses: E03.9 Hypothyroidism, unspecified

 

Detailed CPT Procedures:

11441 Excision, other benign lesion including margins, except skin tag, face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm

12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay).

 

410296
:

Diagnosis Codes:

Dx Reason for Visit: Z01.21 Encounter for dental examination and cleaning with abnormal findings

Primary Diagnosis: Z01.21 Encounter for dental examination and cleaning with abnormal findings

Secondary Diagnoses:

F79 Unspecified intellectual disabilities

0 Autistic disorder

409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus

5 Hyperlipidemia, unspecified

7 Periapical abscess without sinus

 

Detailed HCPCS Codes:

D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal)

D2332 Resin based composite three surfaces, anterior

D2393 Resin based composite three surfaces, posterior

D2140 Amalgam one surface, primary or permanent

D0180 Comprehensive periodontal evaluation new or established patient

MCCG262 Professional Coder Practicum Documentation Presentation (Medical Billing And Coding Essay)