Category: Nursing

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 These charts, although still used in many practices today, have slowly been replaced by a more advanced method called electronic health record or EHR.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

Asset-Based Approach in Nursing and Healthcare

Asset-Based Approach

Objectives

• Describe the asset-based approach

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Assignment Overview

In this writing assignment, you will use the asset-based approach to understanding the strengths of a population.

Deliverables

1. A one-page (250-word) paper that summarizes the asset-based approach

a. Write a paper.

In your paper, address the following prompts:

i. Describe the asset-based approach in relation to a health care issue of your choice.

ii. Explain when the asset-based approach is used in relation to a health care issue of your choice.

iii. Explain three strengths of the asset-based approach in relation to a health care issue of your choice.

iv. Explain three weaknesses of the asset-based approach in relation to a health care issue of your choice. Asset Based Approach in Nursing and Healthcare

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.

Article Analysis – Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations

Article Analysis 2

Search the GCU Library and find two new health care articles that use quantitative research. Do not use articles from a previous assignment, or articles that appear in the Topic Materials or textbook.

Complete an article analysis for each using the “Article Analysis: Part 2” template.

Refer to the “Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial,” in conjunction with the “Article Analysis Example 2,” for an example of an article analysis.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting 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. Article Analysis – Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations.

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You are required to submit this assignment to LopesWrite. Refer to the

LopesWrite Technical Support articles

for assistance.

RUBRIC

Attempt Start Date:

27-May-2019 at 12:00:00 AM

Due Date:

02-Jun-2019 at 11:59:59 PM

Maximum Points:

130.0

Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial

Review “Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial,” by Utens et al., from

International Journal of Nursing Students Article Analysis – Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations

(2013).

Review this article in conjunction with the “Article Analysis Example 2” document to help prepare for the article analysis assignment due in this topic.

URL:

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0020748913000941

Article Analysis 2

No of Criteria: 10 Achievement Levels: 5

CriteriaAchievement LevelsDescriptionPercentage1: Unsatisfactory0.00 %2: Less Than Satisfactory65.00 %3: Satisfactory75.00 %4: Good85.00 %5: Excellent100.00 %Content100.0

Two Quantitative Articles10.0Fewer than two articles are presented. None of the articles presented use quantitative research.N/ATwo articles are presented. Of the articles presented, only one article is based on quantitative research/two articles are presented. Both articles are based on quantitative research. Article Citation and Permalink10.0Article citation and permalink are omitted. Article citation and permalink are presented. There are significant errors. Page numbers are not indicated to cite information, or the page numbers are incorrect. Article citation and permalink are presented. The article citation is presented in APA format, but there are errors. Page numbers to cite information are missing, or incorrect, in some areas. Article citation and permalink are presented. Article citation is presented in APA format. Page numbers are used to cite information. There are minor errors. Article citation and permalink are presented. Article citation is accurately presented in APA format. Page numbers are accurate and used in all areas when citing information.Broad Topic Area/Title10.0Broad topic area and title are omitted. Broad topic areas and title are referenced but are incomplete. Broad topic area and title are summarized. There are some minor inaccuracies. Broad topic areas and title are presented. There are some minor errors, but the content overall is accurate. Broad topic area and title are fully presented and accurate.Hypothesis10.0Definition of hypothesis is omitted. The definition of the hypothesis is incorrect.The hypothesis is summarized. There are major inaccuracies or omissions.Hypothesis is generally defined. There are some minor inaccuracies. The hypothesis is defined. Hypothesis is generally defined. There are some minor inaccuracies.Hypothesis is accurate and clearly defined. Independent and Dependent Variable Type and Data for Variable10.0Variable types and data for variables are omitted.Variable types and data for variables are presented. There are major inaccuracies or omissions.Variable types and data for variables are presented. There are inaccuracies.Variable types and data for variables are presented. Minor detail is needed for accuracy.Variable types and data for variables are presented and accurate.Population of Interest for the Study10.0Population of interest for the study is omitted.Population of interest for the study is presented. There are major inaccuracies or omissions.Population of interest for the study is presented. There are inaccuracies.Population of interest for the study is presented. Minor detail is needed for accuracy.Population of interest for the study is presented and accurate.Sample10.0Sample is omitted.Sample is presented. There are major inaccuracies or omissions.Sample is presented. There are inaccuracies.Sample is presented. Minor detail is needed for accuracy. Page citation for sample information is provided.Sample is presented and accurate. Page citation for sample information is provided.Sampling Method10.0Sampling method is omitted.Sampling is presented. There are major inaccuracies or omissions.Sampling is presented. There are inaccuracies. Page citation for sample information is omitted.Sampling is presented. Minor detail is needed for accuracy.Sampling method is presented and accurate.How Was Data Collected10.0The means of data collection are omitted.The means of data collection are presented. There are major inaccuracies or omissions.The means of data collection are presented. There are inaccuracies. Page citation for sample information is omitted.The means of data collection are presented. Minor detail is needed for accuracy. Page citation for sample information is provided.The means of data collection are presented and accurate. Page citation for sample information is provided.Mechanics of Writing (includes spelling, punctuation, grammar, and language use)10.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.The writer is clearly in command of standard, written, academic English.

Total Percentage  100

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

Case Study: Mr. M.

Clinical presentation of Mr. M

Mr. M. is a 70-year-old male patient. Mr. M denies any allergies. Mar M has an unsteady gain and experiences challenges in ambulating. Mr. M experiences memory lapses since he finds it difficult to remember the names of family members, the number of his room or repeating the words he has uttered. Mr. M shows fear and shows aggressiveness. Mr. M cannot bathe dress or feed without being assisted. Mr. M looks pale and tired due to lack of adequate rest and relies on Zolpidem to manage his sleep disorder. From the objective data collected from the lab tests, Mr. M has a normal body temperature hence no signs of fever. Mr. M has blood pressure of C BP 123/78 HR 93 RR 22 Pox 99%, which signifies prehypertension, which is usually asymptomatic. Mr. M shows no sign of being in any pain and denies feeling any pain. Mr. M is overweight after calculating his Body Mass Index Height: 69.5 inches; Weight 87 kg, which translates to a BMI of 28.4. Mr. M has a WBC count of 19.2 (1,000/uL) and lymphocyte count of 6700 (cells/uL).  The results from a CT scan of the head shows no alteration since the preceding scan. Mr. M Urinalysis read positive for a substantial amount of leukocytes and appeared cloudy. Mr. M protein analysis stood at 7.1 g/dL; AST: 32 U/L; ALT 29 U/L.

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Primary and Secondary diagnosis

Primary diagnosis of Mr. M would include stroke, or a heart attack since has a C BP 123/78 HR 93 RR 22 Pox 99% which signifies prehypertension. Any reading above 120 systolic pressure means prehypertension even when the diastolic pressure ranges from 60 to 79 (Mymedicalscore, 2019). The worse reading is used in the event diastolic, and systolic pressure fall into different ranges. Furthermore, people with prehypertension have increased chances of experiencing heart attacks compared to individuals with lower blood pressure (Mymedicalscore, 2019). The second primary diagnosis would be to test for urinary tract infections in Mr. M due to the presence of leukocytes in urine. An unusual elevated number of leukocytes in urine signifies swelling or infection in the urinary tract, most commonly in the bladder or kidney (Pol et al., 2017). The diagnosis is essential to Mr. M, who is undertaking medications such as Lipitor and Lisinopril, which has known side effects to the kidneys. Hence, the diagnosis of urinary tract infection is necessary.

A secondary diagnosis that needs to be carried out include liver damage due to the daily intake of Lisinopril and Lipitor, which have damaging effects on the liver (Emedicinehealth, 2019). The second diagnosis is that of the mental health condition of Mr. M. The reason is that Mr. M. experiences mental loss and cannot remember his rooms or the words he has spoken despite CT scan showing no changes (Pol et al., 2017). The other secondary diagnosis that would be necessary is to check for kidney stones since the elevated amount of leukocytes can at times, indicate the presence of kidney stones.

Expected abnormalities would you expect to find

The expected abnormalities a nurse would expect to see include changes in the vital signs of the patient. These include body temperature changes, changes in blood pressure, decreased increased respiratory rate, which may vary from time to time depending on the presence or absence of infection. Besides, Mr. M denies may pain; a nursing assessment on him would prove otherwise (Registered Nursing, 2018). The baselines of vital signs are recorded because they are vitally crucial for comparison during and after treatment. Vital signs are highly responsive to abnormalities and changes of a patient

Physical, psychological and Emotional aspects to the patient and family

Mr. M’s health condition has significantly impacted on him physically. Mr. M. experiences challenges in ambulating and does not have a steady gait. Also, Mr. M. has a tibial fracture status postsurgical repair. The condition has also lead to memory loss, and Mr. M finds it difficult even to remember his room number, names of family members, or words he had uttered.  Mr. M has also been affected psychologically and emotionally in that when he is aggressive and agitated easily. Mr. M’s unsteady mental state sees him wander at night and often get lost. The condition has also affected his family since Mr. M. has become dependent with many ADLs. Initially, Mr. M could bathe, dress, and feed on his own; however, right now, he depends on his family members to assist him doing ADLs. Besides, Mr. M becomes in approachable, especially when he is aggressive as he becomes fearful and afraid.

Interventions that can be put in place

Interventions to be implemented include mental assessment of Mr. M., and Mr. M. needs to be assigned to a therapist to help in the recovery process to minimize his aggressive behaviour. In addition, the family needs to hire a private practitioner or assistant to assist Mr. M. in his ADLs, thereby reducing the burden on the family members. Mr. M from the case study seems lonely, and that’s why he wonders alone and get lost, putting him up in a facility with other people of the same age or health conditions would undoubtedly help in his recuperation. Furthermore, he forgets the names of family members, occasional visits by family members would be helpful for bonding or otherwise arrange visits to the homes of family members away from the assisted living facility.

Potential problems faced by Mr. M. due to his condition.

Due to hypertension and hypercholesterolemia, Mr. M has a potential of developing stroke. A stroke occurs when a blood vessel transporting oxygen and nutrients in the brain is blocked or bursts. A stroke occurs when blood supply to the brain is reduced (Mayo Clinic Staff, 2019). The second potential problem Mr. M can face is the risk of cardiovascular failure. Hypertension can strain the heart leading to weakening of the heart muscles making the heart to work less efficiently, and with time, the heart gets overwhelmed and fails (Mayo Clinic Staff, 2019). Hypercholesterolemia can also increase the likelihood of Type 2 diabetes because diabetes can impact different cholesterol levels and increases the chances of developing atherosclerosis (Mayo Clinic Staff, 2019). Mr. M. is also at the verge of developing dementia. Dementia is a disease of the brain that leads to challenges of thinking, speaking vision, movement, and reasoning (Mayo Clinic Staff, 2019). There are several causes of dementia one being vascular dementia, that is caused by narrowing and blockage of arteries that supply blood to the brain.

 

References

Mayo Clinic Staff. (2019, January 09). How high blood pressure can affect your body. Retrieved from
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868

 

Pol, J. G., Levesque, S., Workenhe, S. T., Gujar, S., Le Boeuf, F., Clements, D. R., … & Fucikova, J. (2018). Trial Watch: Oncolytic viro-immunotherapy of hematologic and solid tumors.
Oncoimmunology
,
7
(12), e1503032.

 

Mymedicalscore. (2019). 123/78 Blood Pressure – Good or Bad? – MyMedicalScore. Retrieved from
https://mymedicalscore.com/blood-pressure/123-78/

 

Emedicnehealth. (2019). Lipitor (atorvastatin) Side Effects, Interactions, Uses & Drug Imprint. Retrieved from
https://www.emedicinehealth.com/drug-atorvastatin/article_em.htm

 

RegisteredNursing.org. (2018, May 29). Changes and Abnormalities in Vital Signs: NCLEX-RN. Retrieved from
https://www.registerednursing.org/nclex/changes-abnormalities-vital-signs/
 Case Study: Mr. M

Tulsa Memorial Hospital Case Study

Assignment for Unit 2 – Tulsa Memorial Hospital (SoonerCare)

You are a member of the consulting firm advising Dr Wilson.  The following case study contains the instructions and requirements for the deliverable. 

Tulsa Memorial Hospital is a community hospital in Tulsa, Oklahoma.  Recently, the hospital and its affiliated physicians formed Tulsa Memorial Healthcare (TMH), a physician-hospital organization (PHO).   TMH is close to signing its first contract to provide exclusive local healthcare services to enrollees in SoonerCare (the Plan), the local Blue Cross Blue Shield of Oklahoma HMO      TMH as an alternative.  In the proposed contract, TMH will
assume full risk
for patient utilization.  In fact, the proposal calls for TMH to receive a fixed premium of $200 per member per month from the Plan, which it then can allocate to each provider component in any way it deems best using any reimbursement method it chooses.  TMH’s executive director, Dr. Randy Wilson, a cardiologist and recent graduate of the University of Oklahoma Nonresident Program in Administrative Medicine, is evaluating the Plan’s proposal.  To help do this, Dr. Wilson hired a consulting firm that specializes in PHO contracting.  The first task of the consulting firm was to review TMH’s current medical panel and estimate the number of physicians, by specialty, required to support the Plan’s patient population of 50,000, assuming aggressive utilization management.  The results in exhibit 3.1 show that TMH’s medical panel currently consists of 249 physicians, whereas the number of physicians required to support the Plan’s patient population is only 61.  Note, however, that TMH physicians serve patients other than those in the Plan.  Thus, the total number of physicians required to treat all of TMH’s patients far exceeds the 61 shown in the right column of exhibit 3.1. Tulsa Memorial Hospital Case Study

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The second task of the consulting firm was to analyze TMH’s physicians’ current practice patterns.  Clearly, utilization, and hence, cost is driven by·TMH’s physicians and that variation in practice patterns.   Results of the analysis show significant variation in practice patterns, both in the physicians’ offices and in the hospital.  For example, exhibit 3.2 contains summary data on hospital costs by physician for three common diagnosis related groups (DRGs).  Consider DRG 470 (major joint replacement).  The physician with the lowest hospital costs averaged $12,872 in costs per patient, the highest-cost physician averaged $24,638, and the average cost for all physicians was $14,999. 
The consulting firm commented that reducing this variation is important because TMH is at full risk for patient utilization. 

The third task of the consulting firm was to recommend an appropriate allocation of the premium dollars to each category of provider.  Specifically, the contract calls for TMH to receive $200 per member per month, for a total annual revenue of$200 x 50,000 members x 12 months = 120 million.  To reduce potential conflicts about how to divide the 120 million among providers, the consulting firm proposed a “status quo” allocation that would maintain the current revenue distribution percentages shown in exhibit 3.3.

The final task of the consulting firm was to recommend provider reimbursement methodologies that create appropriate incentives.  In the contract, TMH assumes full risk for patient utilization, so the consulting firm recommended that all component providers be capitated to align cost minimization incentives throughout TMH.  Furthermore, capitation of all providers would eliminate the need for risk pools, a risk-sharing arrangement that TMH has never used.  In addition to the consulting firm’s report, Dr. Wilson decided to ask TMH’s new operations committee for a short report on th;e current line of thinking among TMH’s major providers.  The committee provided the following information.

Tulsa Memorial Hospital

Historically, the profitability of Tulsa Memorial Hospital has been roughly in line with the industry.  Last year, when the hospital received about 75 percent of charges, on average, the hospital achieved an operating margin of about 3 percent.  However, hospital managers are concerned about its profitability if the Plan’s proposal is accepted.  The managers believe that controlling costs under the full-risk contract would require extraordinary efforts and that the most effective way to control costs is to create a subpanel of physicians to participate in the capitation contract.  When asked how the subpanel should be chosen, the operations committee  recommended choosing the physicians who would do the best job of containing hospital costs.

Primary Care Physicians

Many of the primary care physicians are dissatisfied.  On average, primary care physicians receive only about 60 percent of charges and are concerned about being penalized by accepting utilization risk for the Plan’s enrollees.  Primary care physicians know that they are paid less and believe that they have to work much harder than do the specialists.  Furthermore, primary care physicians believe that the specialists supplement their own incomes by overusing in-office tests and procedures.  Some primary care physicians are even talking about dropping out of TMH to form their own contracting group, taking away the entire capitation payment from the Plan and contracting themselves for specialist and hospital services.

Specialist Care Physicians

The specialists believe that the primary care physicians refer too many patients to them.  The specialists do not mind the referrals as long as their reimbursement is based on charges because, on average, they receive 90 percent of charges.  However, if they are capitated, the specialists want the primary care physicians to handle more of the minor patient problems themselves.  Also, whenever the subject of subpanels is raised, many of the specialists become incensed.  ”After all,” they say, “the whole idea behind the PHO is to protect the specialists.” Both sets of physicians-primary care and specialist-agree that the hospital is hopelessly inefficient.  Said one specialist, “No matter how much revenue the hospital receives, it still seems to barely make a profit.”

 

 

Question 1

What reimbursement method would you recommend for each of the following providers? Be sure to justify your answers.

Primary Care Physicians

Primary care physicians should be paid by capitation, which, however, encourages these physicians to shift patients to other service providers, but the sharing of risk will generate incentives to lower utilization levels of hospitals as well as specialists aligned to patient traffic. Aleternatively these physicians can also be paid service fee on discounted basis which will work as an incentive offer comprehensive preventive care thereby restricting cost escalation in the long run.

Specialists

Specialists can also be paid by capitation, but then there exist peculiar issue with respect to this mode of payment. Based on estimated patient population of 50,000, the number of physicians required for certain specialities will be relativley smaller. Given as per exhibit 3.1, the number of cardiology, neurosurgery, thoraic, and urology surgeons required is just 1.0 in each case. Around 25 specialists would be optimal, however with lower utilization levels resulting in accretion of lower capitation payments from PHO. As a result of this a small increase in high-cost patients will put physician on the losing side with lower capitation fees. Thus it is wise to pay specialists on a discounted-fee basis, however may be lower than their current reimbursement percentage of 90%.

Hospital

It is a common practice with managed care plans to pay hospitals on a per day basis and hence make it attractive for physicians to limit admissions and length of stay. This is because hospital utilization can be controlled more effectively by managed care plans than the hospital itself. As a result, payment on per day basis will keep a check on the costs over the long run for the PHO.

Other Services

The utilization levels are lower and unpredictable in this case and such services are often managed by out-of-area providers. Thus they should be reimbursed on fee-for-service basis. Services given by frequent providers can be engaged at discounted contract rates and rest should be paid at actuals.

Question 2

What allocation of premium dollars do you recommend for each provider? Be sure to justify your recommendations.

Though the case provide allocation as guided by the consultant, we have made certain changes to include consideration for risk pool, which was ignored by the consultant. According to us, PHO administration overhead and in-system physicians should be given the greater allocation than what was advised by the consultant. This is because if fixed payments needs to be made to PHO and are made accountable for healthcare needs of the covered population, it needs to be equipped with talent pool of managerial staff and adequate information system which will enable them to exercise control over its components. Further, PHO should be in a position to create reserves (surplus overheads) to cover any such payments to providers on non-capitated basis over and above those allocated.

Primary care should be given higher allocation and specialists and in-system hospital should be given lower allocation than recommended by the consultants in order to set up a risk sharing arrangements within the PHO so as to reduce the amount of specialty and inpatient services provided going ahead. While the primary care physicians’ charges can be increased above traditional rates, the total compensation of specialists and hospital must be reduced in order to run successful PHO. Under the new contract, if utilization levels of these services are reduced, the profitability of specialists and hospital can be increased but with increased pressure on the hospital and specialists under the new proposed revenue distribution. Professional and in-patient services risk pools should be encouraged to get established which will provide financial incentives for promoting more cost effective and efficient practice patterns. Given that rest of categories falls outside the purview of PHO, the recommendations given by consultant seem reasonable.

The new allocation should be phased over next two to three years, instead of pushing from year 1, in order to make hospital and specialists familiar with reduced allocation of reimbursements and understand and respond to newly introduced incentives of risk pools so as to become more productive and efficient. Tulsa Memorial Hospital Case Study

Question 3

What proportion of the premium dollar would you allocate to the professional services risk pool?

Generally, risk-sharing arrangements allocate 10% to 20% of each reimbursement amount to one or more risk pools. Since PHO has never used risk pools in the past, it is prudent to start with 10% with gradual increase in later periods one they become familiar with the risk sharing experience. Since typical allocation of premium dollar for specialists is given as 16%, the allocation to professional services risk is given as 10% x 16% = 1.6% of premium amount and rest 14.4% is allocated to specialists.

How would you split the professional services risk pool between primary care physicians and specialists?

We have taken 50% for each category in order to maintain simplicity.

What proportion of the premium dollar would you allocate to the inpatient services risk pool?

Typical allocation of premium amount for hospital is 33%. Similar to professional services risk pool, 10% x 33% or 3.3% of premium amount is allocated to inpatient services risk pool and balance 29.7% or premium amount is allocated to hospitals.

How would you split the inpatient services risk pool among primary care physicians, specialists, and the hospital?

For simplicity purpose, we have divided this equally among the three parties. Tulsa Memorial Hospital Case Study

Question 4

Conduct a sensitivity analysis. More specifically, using your allocation of the premium dollars, how does the total budgeted reimbursement compare with the total actual reimbursement to primary care physicians, specialists, and the within-system hospital.

If actual payments equal the premium allocation?

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If both specialist and hospital payments are 10 percent greater than the premium allocation?

If both specialist and hospital payments are 10 percent lower than the premium allocation?

Do the risk pools provide appropriate incentives to the primary care physicians and the specialists?

If actual payments of hospital and specialists are above 10% over the budgetary allocation, the primary care physicians failed to exercise proper control over referrals to specialists, and specialists failed to exercise proper control over hospital utilization. As a result, the actual reimbursement of both groups is less than the budget.

In case of primary care physicians, the actual payment equals the budgetary allocation given that we chose to capitate them. However, their poor specialist referral program reduces the amount they receive from professional services risk pool from $960,000 to $96,000 and hence indicates that they have incentive to reduce specialist referrals.

In case of specialists, the actual premium payment at $19,008,000 is more than the budgetary allocation given that the physicians are paid on discounted-fee service basis. However, such increase in premium payment is offset by decline in professional service risk pool (reduced from $960,000 to $96,000) amount influenced by poor specialist referral performance of primary care physicians. The amount further gets reduced by inpatient service risk pool (reduced from$1,320,000 to $132,000) due to poor performance of specialists with respect to utilization of hospital. This shows that specialists have clear incentive to reduce hospital utilization. This has also reduced primary care of physicians share of inpatient risk services pool from $1,320,000 to $132,000. v

Above analysis reveal that, the risk pools provide clear incentive for control of specialist referral and hospital utilization.

Question 5

What are some reasons in favor of forming subpanels of the PHO’s primary care physicians to handle only Plan patients?

It makes financial sense to create subpanels to handle only Plan patients.

Primary Care Physicians will have only capitated payments and thus will not have to worry about varying incentive structure based on different reimbursement methodologies.

Overheads would be reduced in absence of need to maintain staff for billing third party vendors.

Risk of each provider on the panel would be reduced given that they would have large number of capitated patients from the Plan.

Of the total 57 primary care physicians, 25 can work on Plan patients and rest on non-Plan patients.

What are some reasons against forming subpanels of the PHO’s primary care physicians to handle only Plan patients?

In reality subpanel may be difficult to create given that only those primary care physicians may be willing to join who do not have full workload of patients and hence may not give requisite numbers.

While some physicians may have lower number patients because of low traffic, others may have because of poor quality of physicians or poor bedside manners.

Voluntary formation of subpanel may create pool of less efficient and effective Team.

Because of full workload by these members, Plan patients, currently seeing other primary care physicians, may be forced to change physicians as would non-Plan patients who are seeing the physicians for the Plan. It will create problems both for the physicians, by losing patients, and for the patients, who would have to change physicians. Tulsa Memorial Hospital Case Study

As a result, keeping competitive forces in mind, restricting Plan patients to lower number of primary care physicians will impact PHO’s revenues.

Should subpanels of the PHO’s specialists be created to handle only Plan patients?

It is easy to create subpanels for specialists. Given that future reimbursements might be less than the current reimbursements, specialists could be polled to find out their interest to join subpanel to serve Plan patients. So long as sufficient numbers are recruited, subpanel may be created for each category. Since they would continue to reimbursed based on discounted-fee for service basis, billing and efforts would remain unaffected.

 

 

Question 6

Consider some other actions that the PHO could take to ensure that its contract with the Plan is successful. Specifically, comment on the advisability and feasibility of taking actions in the following areas:

Utilization Review

PHO must be in possession of adequate information system in order to ascertain individual physician referral costs and the costs and effectiveness of alternative treatment methods. Further PHO should convince providers that lower-cost treatment is equally effective compared to higher cost treatment and hence encourage providers to use lower cost methods. Further such review can be used to limit referrals and inpatients utilization to those that are clinically warranted. Tulsa Memorial Hospital Case Study

Quality Management

Better the quality lower will the costs in the long run. Hence use of correct procedure and use it in the first attempt will be crucial. Stressing on quality throughout PHO will lead to higher patient satisfaction thereby ensuring contract renewal with the Plan and a potential driver to negotiate higher payments.

Information Systems

All above actions and performance will become possible only with availability of accurate, timely and structured clinical and financial information. Lack of availability of information will lead to collapse of entire PHO. Hence creation of proper information system infrastructure will be critical for the success of PHO which will help to manage patient population and financial drivers under check. Tulsa Memorial Hospital Case Study

 

Question 7

What are three key learning points from this case

It helps to build an understanding on premium payment allocation and risk-sharing with an integrated set up – PHO.

It helps to build an understanding on impact of referrals and hospital utilization on premium payments.

It improves analytical skillset with respect to using the case information into a financial model and interpret results basis change in assumptions. Tulsa Memorial Hospital Case Study

Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children

This week’s discussion board was about a case study on an underweight twelve-year-old girl whose parents were also underweight and what health issues and risks should the provider lookout for pertaining to this child. This assignment will also discuss and additional information that may be needed to further assess this case and questions that should be asked to parents to gather information on the child’s development and sensitivity issues she may have. Lastly, the discussion board will mention two strategies to encourage the patient and family to get to a healthy weight and ensure her health is improving.

Health Issues

When individuals are underweight there are some health concerns and issues that can…

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Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children

CASE STUDY: Severely underweight 12-year-old Hispanic girl with underweight parents who has been bullied in school just recently

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process. Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.

By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or 
Child Health
 Case (Option 2). 
Note:
 Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.

Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather? Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.

If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.

Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment

Assignment
 (3–4 pages, not including title and reference pages)
:

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

A description of how the assessment tool or 
diagnostic test
 you were assigned is used in healthcare.

What is its purpose?

How is it conducted?

What information does it gather?

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting. Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children. Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

Assignment Option 2: Child Health Case:

Include the following:

An explanation of the health issues and risks that are relevant to the child you were assigned.

Describe additional information you would need in order to further assess his or her weight-related health.

Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion. Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.

Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight. Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

 

Assessment Tools and Diagnostic Test in Adults and Children

This week’s discussion board was about a case study on an underweight twelve year old girl whose parents were also underweight and what health issues and risk should the provider look out for pertaining to this child. This assignment will also discuss and additional information that maybe needed to further assess this case and questions that should be asked to parents to gather information on the child’s development and sensitivity issues she may have. Lastly, the discussion board will mention two strategies to encourage the patient and family to get to a healthy weight and ensure her health is improving.

Health Issues

When individuals are underweight there are some health concern and issues that can impact their overall health and life span. This patient is underweight which causes concern for poor nutrition which will impact her growth and development, inability to fight off infections and illnesses as well as high risk for heart attacks and impaired thinking such as deceased concentration (Semba & Bloem, 2017). Another concern is that her parents are underweight as well which could suggest that their socioeconomic status is poor where they are not able to buy food or some form of genetic and diseases that affect the endocrine and digestive systems (Russo, 2017). Another factor that could contribute to her being underweight could be her mental health. She may have had a traumatic event take place to where she is ashamed of her body and controls her life through her weight, and eating disorder or she may be bullied at school and is depressed (Martin, et al., 2014).

Additional Information Needed

       
When realizing the health concerns and issues the information that is going to be needed is the nutritional factors for the family. What they eat, how often do they buy food and if they believe this is a healthy weight. The provider will need to gather the body mass index (BMI) for the patient as well as her family to gauge if they are healthy or underweight (Ball, et al., 2015). The formula for calculating BMI is to take the patients weight and divide it by her height. If the number is under 19.5 the patient is consider to have poor nutrition (Ball et al., 2015). Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

Three Targeted Questions

         
 Looking at the case study and the information that is going to be needed to further investigate into the patient’s health history certain question will need to be asked. The three targeted questions the provider should ask the patient and parents are:

How would you describe your weight? (CDC, 2017). This question will allow the provider to asses her mental health status on how she sees herself.

Are your family member very slim as well? (Russo, 2017). This question will gather information on genetics being the possible factor to the provider (Russo, 2017).

What do you typically eat within a 24 hour period?

Two Strategies to Encourage Proactivity

In order to promote an individual’s health, the first strategy is to educate the patient on their health and management. If the patient is not aware of the risk factors associated with their health history, family history and habits they will not succeed in positive outcomes regarding their health Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children. In this scenario nutrition education is needed (Gibbs & Chapman-Novakofski, 2012). This can include a nutrition consult, information about my plate which tells you the amount of servings needed for fruit, veggies and meat as well as what can happen when the body is not meeting the nutritional requirements. In order to promote education, the provider needs to know the health literacy of the patient. Most people read at a third grade level so understanding how your patient learns is essential in preparing a treatment or plan of care that the patient will follow and understand (Gibbs & Chapman-Novakofski, 2012).

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            The second strategy to promote healthy eating is to advocate for the patient and supply her with resources that can help her acquire food if she is having a hard time meeting the need due to finances. Many government offices have WIC programs that can give the family vouchers to buy food that is needed to keep the body healthy and meet the plate guidelines for what percentage of carbs, protein and fats for healthy growth (Ball, et al., 2015) Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children.

Summary

In order to help your patient have a healthy lifestyle and know how to prevent health problems from occurring, the provider needs a detailed history and physical of the patient. Asking the right questions and understanding the patient’s background can also help the provider choose the correct treatment and medications. Establishing a good rapport with patients and their families are important so that they are open, honest and not fear judgement.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
Seidel’s guide to physical examination (8th ed.).
St. Louis, MO: Elsevier Mosby. Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children

CDC. (2017).
Youth Risk Behaviors Surveillance System (YRBSS) Overview.
Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/overview.htm

Gibbs, H., & Chapman-Novakofski, K. (2012).
Exploring nutritin literacy: Attention to assessment and the skills clients need.
Retrieved from Health, 4(3), 120-124: http://dx.doi.org/10.4236/health.2012.43019

Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R. (2014).
Weight Status Misperception as Related to Selected Health Risk Behaviors Among Middle School Students.
Retrieved from Journal of School Health, 84(2), 116-123: doi:10.1111/josh.12128

Russo, J. (2017).
What are the Causes of Underweight Children?
Retrieved from http://www.livestrong.com/article/198981-what-are-the-causes-of-underweight-children/

Semba, R. D., & Bloem, M. W. (2017).
Nutrition and Health in a Developing World (2nd ed.).
Retrieved from https://www.researchgate.net/profile/Barry_Popkin/publication/225833386_The_Nutrition_Transition_and_Its_Relationship_to_Demographic_Change/links/54c7b36a0cf289f0cecd96c8/The-Nutrition-Transition-and-Its-Relationship-to-Demographic-Change.pdf#page=137 Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children

Stages Of Life Essay and Interview

Write a 500‐750‐word essay on the Stages‐of‐Life and the influence of age in health care from a patient’s perspective. Interview a friend or family member about that person’s experiences with the health care system. You may develop your own list of questions.

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Suggested questions:

Do you feel that your stage‐of‐life had any effect on your interaction with health care professionals?

Which areas of the hospital or clinic were most concerned with your well‐being and feelings?

Was your family with you during this hospital stay or outpatient visit?

Was your family included in your treatment, such as post‐procedure instructions? Stages Of Life Essay and Interview

Asthma And Stepwise Management Essay Assignment Paper

Asthma is a chronic inflammatory respiratory disease of the airways characterized by airway obstruction, inflammation and hyperresponsiveness (Arcangelo and Peterson, 2013).  The principal objective to treating asthma is to control the disease.  Asthma control focuses on preventing problematic symptoms such as shortness of breath, wheezing, extreme coughing and/or frequent respiratory infections.  In order to treat and control asthma, the advance practice nurses must be able to recognize and distinguish life-threatening symptoms and understand the stepwise management approach for treatment.  There are two treatment choices that are utilized to treat asthma, long-term control and quick relief treatment.  Asthma And Stepwise Management Essay Assignment Paper. The purpose of this paper is to describe the long-term control and quick relief treatment and explain the stepwise approach to asthma treatment and management.  Finally, the paper will also explain how stepwise management assist health care providers and patients in gaining and maintaining control of the disease.

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Long-Term Control and Quick Relief Treatment

Long-Term Control

The goal of long-term control asthma pharmacotherapy is to prevent symptom flair ups and control asthma.  According to Arcangelo and Peterson (2013), long-term control medications must be taken every day to achieve and maintain control in persistent cases.  Long-term asthma medication is the most effective medication when preventing asthma attacks and controlling chronic symptoms.  According to Drugs.com (2012), long-term medication includes inhaled corticosteroids, long-acting beta-agonists (LABAs), leukotriene modifiers, theophylline, and combination inhalers containing both LABAs and corticosteroids.  One of the most important and effective long-term control medication is inhaled corticosteroid.  This long-term medication is considered to be the most effective anti-inflammatory medication because it prevents the passage and stimulation of inflammatory cells.  In return it prevents airway hyperresponsiveness, improves symptoms, and the function of the respiratory system.  According to Arcangelo and Peterson (2013), the impact of inhaled corticosteroids includes oral fungus known as “thrush”, coughing, hoarseness, osteoporosis and easy bruising.  In children one of the most crucial side effect is delayed or suppressed growth.  It is important for advance practice nurses and physicians to monitor the effects of the medication and educate patients on the possible side effects Asthma And Stepwise Management Essay Assignment Paper.

Quick-Relief Treatment

Quick relief medications also known as “rescue medications” are used to…

 

To Prepare

Reflect on drugs used to treat asthmatic patients, including  long-term control and quick relief treatment options for patients. Think  about the impact these drugs might have on patients, including adults  and children.

Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.

Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease

Create a  5- to 6-slide PowerPoint presentation that can be used in a staff  development meeting on presenting different approaches for implementing  the stepwise approach for asthma treatment. Be sure to address the  following:

Describe  long-term control and quick-relief treatment options for the asthma  patient from your practice as well as the impact these drugs might have  on your patient.

Explain the 
Stepwise Approach
 to asthma treatment and management for your patient.

Explain  how stepwise management assists health care providers and patients in  gaining and maintaining control of the disease. Be specific.

Please review the rubric for this assignment..

 

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Excellent   Good   Fair   Poor       Describe the long-term control and quick relief treatment options for  the asthma patient from your practice, as well as the impact these drugs might have on your patient.          Points Range:     27 (27%) – 30 (30%)   The presentation clearly and  accurately describes in detail the long-term control and quick relief  treatment options for the asthma patient from their practice.

The presentation clearly and accurately describes in detail the impact these drugs might have on their patient.        Points Range:     24 (24%) – 26 (26%)   The presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice.

The presentation accurately describes the impact these drugs might have on their patient.        Points Range:     21 (21%) – 23 (23%)   The presentation inaccurately or  vaguely describes the long-term control and quick relief options for the  asthma patient from their practice.

The presentation inaccurately or vaguely describes the impact these drugs might have on their patient.        Points Range:     0 (0%) – 20 (20%)   The presentation inaccurately and  vaguely describes the long-term and quick relief options for the asthma  patient from their practice, or is missing.

The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing.     Explain the stepwise approach to asthma treatment and management for your patient.          Points Range:     27 (27%) – 30 (30%)   The presentation clearly and  accurately explains in detail the stepwise approach to asthma treatment  and management for their patient.        Points Range:     24 (24%) – 26 (26%)   The presentation accurately explains the stepwise approach to asthma treatment and management for their patient.        Points Range:     21 (21%) – 23 (23%)   The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.        Points Range:     0 (0%) – 20 (20%)   The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.     Explain how stepwise management assists health care providers and  patients in gaining and maintaining control of the disease. Be specific.          Points Range:     27 (27%) – 30 (30%)   The presentation clearly and  accurately explains in detail how stepwise management assists health  care providers and patients in gaining and maintaining control of the  disease.

The presentation provides accurate and detailed examples to support the explanation provided.        Points Range:     24 (24%) – 26 (26%)   The presentation accurately  explains how stepwise management assists health care providers and  patients in gaining and maintaining control of the disease.

The presentation provides accurate examples to support the explanation provided.        Points Range:     21 (21%) – 23 (23%)   The presentation inaccurately or  vaguely explains how stepwise management assists health care providers  and patients in gaining and maintaining control of the disease.

The presentation provides inaccurate or vague examples to support the explanation provided.        Points Range:     0 (0%) – 20 (20%)   The presentation inaccurately and  vaguely explains how stepwise management assists health care providers  and patients in gaining and maintaining control of the disease, or is  missing. Asthma And Stepwise Management Essay Assignment Paper.

The presentation provides inaccurate and vague examples to support the explanation provided, or is missing.     Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs  make clear points that support well developed ideas, flow logically,  and demonstrate continuity of ideas. Sentences are carefully  focused–neither long and rambling nor short and lacking substance.          Points Range:     5 (5%) – 5 (5%)   Paragraphs and sentences follow writing standards for flow, continuity, and clarity.        Points Range:     4 (4%) – 4 (4%)   Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.        Points Range:     3.5 (3.5%) – 3.5 (3.5%)   Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.        Points Range:     0 (0%) – 3 (3%)   Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.     Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation          Points Range:     5 (5%) – 5 (5%)   Uses correct grammar, spelling, and punctuation with no errors        Points Range:     4 (4%) – 4 (4%)   Contains a few (1–2) grammar, spelling, and punctuation errors        Points Range:     3.5 (3.5%) – 3.5 (3.5%)   Contains several (3–4) grammar, spelling, and punctuation errors        Points Range:     0 (0%) – 3 (3%)   Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding          Total Points: 100 Asthma And Stepwise Management Essay Assignment Paper

 

Asthma and Stepwise Management

Asthma is a chronic inflammatory respiratory disease of the airways characterized by airway obstruction, inflammation and hyperresponsiveness (Arcangelo and Peterson, 2013).  The principal objective to treating asthma is to control the disease.  Asthma control focuses on preventing problematic symptoms such as shortness of breath, wheezing, extreme coughing and/or frequent respiratory infections.  In order to treat and control asthma, the advance practice nurses must be able to recognize and distinguish life-threatening symptoms and understand the stepwise management approach for treatment.  There are two treatment choices that are utilized to treat asthma, long-term control and quick relief treatment.  The purpose of this paper is to describe the long-term control and quick relief treatment and explain the stepwise approach to asthma treatment and management. Asthma And Stepwise Management Essay Assignment Paper.  Finally, the paper will also explain how stepwise management assist health care providers and patients in gaining and maintaining control of the disease.

Long-Term Control and Quick Relief Treatment

Long-Term Control

The goal of long-term control asthma pharmacotherapy is to prevent symptom flair ups and control asthma.  According to Arcangelo and Peterson (2013), long-term control medications must be taken every day to achieve and maintain control in persistent cases.  Long-term asthma medication is the most effective medication when preventing asthma attacks and controlling chronic symptoms.  According to Drugs.com (2012), long-term medication includes inhaled corticosteroids, long-acting beta-agonists (LABAs), leukotriene modifiers, theophylline, and combination inhalers containing both LABAs and corticosteroids.  One of the most important and effective long-term control medication is inhaled corticosteroid.  This long-term medication is considered to be the most effective anti-inflammatory medication because it prevents the passage and stimulation of inflammatory cells.  In return it prevents airway hyperresponsiveness, improves symptoms, and the function of the respiratory system.  According to Arcangelo and Peterson (2013), the impact of inhaled corticosteroids includes oral fungus known as “thrush”, coughing, hoarseness, osteoporosis and easy bruising.  In children one of the most crucial side effect is delayed or suppressed growth.  It is important for advance practice nurses and physicians to monitor the effects of the medication and educate patients on the possible side effects.

Quick-Relief Treatment

Quick relief medications also known as “rescue medications” are used to control flair ups such as wheezing, shortness of breath, and extreme or severe coughing during an asthma attach.  These medications are known as bronchodilators because they relax the airway muscles by eliminating the symptom.  It is crucial that the asthmatic patient knows and understands the importance of keeping a rescue inhaler with them at all times.  These medications have a faster onset to improve breathing and treat attacks versus the long-term control medications.  These medications are Metaproterenol, Pirbuterol, Bitolterol, Terbutaline, Levalbterol, and Albuterol (Drugs.com, 2012).  The advance practice nurse or physicians must establish an asthma action plan in regards to when the drug must be used and the amount to use during an attack with the patient (Bousquet, 2000).  Although these medications eliminate symptoms during an attack, it is important to know the impact of the medication could cause tremors, headaches, anxiety, restlessness, and fast and uneven heartbeats in both adults and children (Arcangelo & Peterson, 2013) Asthma And Stepwise Management Essay Assignment Paper.

Stepwise Approach to Treatment and Management

When asthma is diagnoses and the severity of disease is assessed, the advance practice nurse or physician will then utilize the stepwise approach to decide which step of therapy should be considered to coincide the proper level of asthma severity.  The Expert Panel Report 3 from the National Asthma Education and Prevention Program (NAEPP EPR-3) (2007) recommends a stepwise approach to the implementation and adjustment of pharmacotherapy in asthma management.  The purpose of the stepwise approach is to initiate a more intensive therapy to attain rapid control, and then step down to the least possible therapy.  There are six steps outlined in the stepwise approach.  Step one involves using a short acting beta-agonist to treat intermittent asthma.  Steps two through six includes treating individuals with persistent asthma utilizing daily medication.  According to the  National Asthma Education and Prevention Program (NAEPP EPR-3) (2007), the following doses are recommended for each step; step two low-dose inhaled corticosteroids (ICS), step three a medium-dose ICS or low-dose LABA plus ICS, step four LABA and medium-dose ICS, step five a LABA and high-dose ICS, and step six an oral corticosteroid plus a LABA plus a high-dose ICS.

Stepwise Management Assist Health Care Providers and Patients

The stepwise approach is a tool that both the health care provider and patient can benefit from utilizing.  When the approach is used the health care provider can utilize questionnaires to help determine if the level of control has been achieved (Osman et al., 1993).  This provides an opportunity to determine if the current treatments are beneficial to the patient and the impact of the medication.  The stepwise approach is critical in the management and prescribing of medication based on the stage of the disease and provides alternative medications.  Comorbidities management, environmental control, and patient education accompany each stage of the stepwise approach, which is important in managing and treating asthma Asthma And Stepwise Management Essay Assignment Paper.

Conclusion

The main objective of asthma care is the accomplishment and maintenance of asthma control.  This is achieved by decreasing the impairment and risk by utilizing pharmacotherapy and the stepwise approach.  It is critical that health care providers and patients collaborate closely to identify the needs of the patients early.  A thorough health history should be established to identify individual triggers for easier management and identifying the proper medications.  Although there is no cure for asthma it can be controlled properly by the health care provider and patient.

 

Reference

Arcanglo, V.P., & Peterson, A.M., (Eds). (2013).
Pharmacotherapuetics for advanced

            practice: A practical approach
(3
rd
). Ambler, PA: Lippincott Williams & Wilkins

Bousquet, J. (2000). Global initiative for asthma (GINA) and its objectives. Clinical and Experimental Allergy, 30(6; SUPP/1), 2-5.

Drugs.com., (2012). Asthma. Retrieved from
https://www.drugs.com/asthma.html

Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services. Published August 28, 2007. Retrieved from
www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/full-report

Osman, L. M., Russell, I. T., Friend, J. A., Legge, J. S., & Douglas, J. G. (1993). Predicting patient attitudes to asthma medication. Thorax, 48(8), 827-830. Asthma And Stepwise Management Essay Assignment Paper