discusion 1
As I mentioned in my introduction, I manage two OBGYN practices at the University of Kentucky. One of those practices is located in Rowan County, in a small town called Morehead, KY. In the community, our clinic is one of only two OBGYN practices. In addition, many of the surrounding rural counties are without OBGYN physicians. Therefore, many of our patients make a lengthy commute to see one of our providers. Fortunately, Morehead does have a hospital that is equipped with labor and deliver services. The next closest hospital or OBGYN high risk specialist is over an hour’s drive away on the main UK campus in Lexington, KY. Recognizing the lack of services, and the difficulty of travel for our patients, we started offering telehealth in 2013 to expand access of care and improve the quality of care for our high risk OB patients with the Blue Angels program.
All patients who are considered as having a high risk pregnancy are offered a telehealth consult with a high risk OBGYN specialist from Lexington via telehealth with the Blue Angels program. This consultation occurs during the patient’s routine ultrasound. The exam room is equipped with a large 55 inch monitor that allows the physician to see both the patient and the ultrasound that is being performed by the sonographer, in real time. This allows the provider and the patient to communicate as if they were face to face in an office visit. From 2015-2016, 1,863 patients participated in the Blue Angels program – a 62% growth in patient volume from the previous year. Deliveries and NICU referrals from the area to Lexington grew almost 40% from 2013-2016.
The set up cost for telehealth was minimal in comparison to the progress and benefits being made in our high risk patients. According to the document “The Role of Telehealth in an Evolving Health Care Environment”, telehealth allows rural areas to increase quality of care and patient volumes, reduce emergency department visits and hospital readmissions, and offer specialty care at a lower cost, not to mention saving the patients time, money, and traveling to Lexington. Other methods of web-based communication tools have also proven to help manage complex health care needs by providing virtual access to multiple specialty providers. In a pilot study, researchers developed the “Loop”, a secure online communication tool that allowed patients to communicate with multiple members of a health care team. The study proved the “Loop” to be successful in providing effective medical team collaboration with patients. Similar in design and access, patient portals allow for patients to get medical information, appointments, and prescriptions all in the click of a computer. In the article “Patient Web Portals, Disease Management, and Primary Prevention”, the authors state that web portals have been shown to increase patient adherence to medical regimens, and have improved the overall efficiency and quality of health care.
Patient-centered care was our approach in the planning, delivery and implementation of the Blue Angels Program. Poor access to medical specialty care in rural Kentucky is a key factor resulting in high infant mortality rates. It is critical to diagnose high risk mothers early in their pregnancies, and avail them to appropriate care. Since 2013, eleven additional sites have been established. Our goal is to eventually break the barriers created by geographic circumstance, workforce shortages, and even socioeconomic factors for women in all rural areas of Kentucky.
discusion 2
The health industry is a very dynamic environment. Healthcare organizations are faced with many challenges. The leadership in an organization coupled with teamwork will make all the difference in meeting those challenges. A constant evaluation process is needed to identify all factors affecting the working success of an organization. Various influences may affect the success of an organization. These generally fall within one of two categories. The first being internal and the second being external (Ginter, P. M et.al 2013).
Within health care organizations of all sizes—from large academic medical centers to independent solo practices—many people are experiencing distress. Some of this is appropriately attributed to such external factors as payment reductions, regulation, and the business practices of insurers. Less well recognized is the contribution of factors internal to the organizations: styles of leadership and management, administrative policies and procedures, and organizational culture. As compared with external factors, these internal characteristics have more direct, immediate, and powerful effects and are far more amenable to change at a local level. Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organization, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers (Kotler, P., Shalowitz, J., & Stevens, R. J. 2008).
The health organization I know is known as Green view hospital. It provides health care services to all people and it’s known for high quality delivery. The main way the hospital market its services is by providing high quality services and products to its customers. Also, Green view hospital has been able to create a conducive environment for their patients thus making them feel at home even when they are in pain. Finally, the hospital has a well-established nurse/doctor- patients’ relationship thus making it easier for the patient to express their needs to the nurses and doctors. The major changes that I have noticed in Green View hospital is that it has helped improve the quality of Healthcare services as the providers can take care of customers as well as their employees since the Medicare is classified as per the group it cares for.
Respond to at least two posts from two different classmates. Each response to your peers must be at least 100 words with a minimum of one (1) reference is required per peer reply. (8 points)

Understanding Environmental Health in Totality
Now that you have understood the impact of environmental factors on human health, create a 7- to 10- page Microsoft Word document addressing the following questions:
Describe three waterborne diseases and suggest methods for their prevention.Provide one example of a toxic chemical that may enter the public water supply? Describe some of the health effects that are attributed to toxic chemicals present in drinking water.What health hazards are associated with uncontrolled and older waste sites in the United States? Describe the processes through which hazardous solid wastes can affect human beings.Compare and contrast the current methods for treating sewage from those that were used in the Middle Ages? Historically speaking, what factors spurred the development of today’s sanitary sewage systems?Describe the stages for processing sewage. At what stage of processing is it permissible in the United States to dispose of wastewater from sewage into waterways?What health-related considerations relate to the use of recycled water? What level of processing is required for wastewater to be recycled? Describe some of the uses of recycled water.Even though workers in professional occupations usually are not exposed directly to hazardous agents, they are prone to occupationally associated illnesses. What types of hazards and associated illnesses predominate in professional occupations? What interventions would you propose to mitigate these hazards?Support your responses with reasoning and examples.
Cite any sources in APA format.
Submission Details
Name your document SU_HSC3002_W5_A2_LastName_FirstInitial.doc.
Submit your document to the W5 Assignment 2 Dropbox by Tuesday, August 29, 2017.
Assignment 2 Grading CriteriaMaximum PointsDescribed three waterborne diseases and suggested methods for their prevention.20Provided one example of a toxic chemical that may enter the public water supply. Described some of the health effects that are attributed to toxic chemicals present in drinking water.30Explained the health hazards associated with uncontrolled and older waste sites in the United States. Described the processes through which hazardous solid wastes affect human beings.20Compared and contrasted the current methods for treating sewage from those that were used in the Middle Ages. Explained the historical factors that spurred the development of today’s sanitary sewage systems.30Described the stages for processing sewage. Discussed the stage of processing in which it is permissible to dispose of wastewater from sewage into waterways.20Discussed the health-related considerations in the use of recycled water. Discussed the level of processing required in order for wastewater to be recycled. Described some of the uses of recycled water.40Discussed the types of hazards and associated illnesses that predominate in professional occupations. Explained the interventions that were proposed to mitigate these hazards.40Written components.

NURS-6052N-37, Essent of Evidence-Based Pract.2017
Discussion:-1
Nursing Research and Evidence-Based Practice
In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.
Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).
To prepare:
Consider a recent clinical experience in which you were providing care for a patient.
Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
What questions have you thought about in a particular area of care such as a procedure or policy?
Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.
Learning Resources
Required Readings
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 1, “Introduction to Nursing Research in an Evidence-Based Practice Environment”
This chapter provides an introduction to nursing research, its history, and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.
Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice”
The focus of this chapter includes an overview of the key aspects of evidence-based practice, a review of how to identify credible research and appraise its value, and, finally, a discussion on how to take the identified evidence and convert it into a practice.
Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research”
In this chapter, quantitative and qualitative research models are compared and the major steps in each approach are described. Information is also presented on the different sections of a research journal article and how you can identify the research model that was utilized.
Adams, J. S. (2010). Utilizing evidence-based research and practice to support the infusion alliance. Journal of Infusion Nursing, 33(5), 273–277.
This article examines how evidence-based research and practice supports infusion alliances. The text also specifies the increasing challenges that infusion nurses face.
Mallory, G. A. (2010). Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm. Nursing Outlook, 58(6), 279–286.
This article describes strategies for reducing the gap between research knowledge and practice. The article also details how nursing societies could use these strategies to improve the quality of care.
Newhouse, R. P., & Spring, B. (2010). Interdisciplinary evidence-based practice: Moving from silos to synergy. Nursing Outlook, 58(6), 309–317.
In this article, the authors examine the state of interdisciplinary evidence-based practice (EBP). The authors detail efforts to promote interdisciplinary EBP, academic and clinical training regarding interdisciplinary EBP, and strategies that may facilitate EBP translation across disciplines.
Shaheen, M., Foo, S., Luyt, B., Zhang, X., Theng, Y-L., Chang, Y-K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236.
This article reviews a study that sought to determine nurses’ awareness of, knowledge of, and attitude toward EBP. The article also describes factors likely to promote barriers to EBP adoption.
Shivnan, J. C. (2011). How do you support your staff? Promote EBP. Nursing Management, 42(2), 12–14.
This article explores the role of the nurse manager in supporting evidence-based practice. The article also explains barriers and strategies to promote EBP for a nurse manager.
Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9, 2014, from http://academicguides.waldenu.edu/content.php?pid=183871&sid=2950360
Media
Laureate Education (Producer). (2012). Timeline of nursing research. Baltimore, MD: Author.
This multimedia piece features a timeline of major events in nursing research. The timeline highlights how historical events and seminal research have contributed to nursing practice.

It is important to understand how middle-range theory can help you in your everyday environment as a nurse. In the previous assignment, you identified a practical problem that emerged from the evidence in the extant literature or professional practice. In this assignment, you will explore and apply middle-range theory to solve the specific problem that you identified in the previous assignment.
DIRECTIONS:
Consider the problem that you described in the previous assignment and the instructor feedback about that assignment.
Write a paper (1,000 to 1,500 words) that describes how middle-range theory can be applied to the identified problem. The paper should include the following:
A brief summary of the problem.A description of a middle-range theory that could be applied to the problem. Is this middle-range theory appropriate to your identified problem?A brief discussion of the middle-range theory’s origins.A discussion of how the middle-range theory has been previously applied.A discussion of the application of the middle-range theory to the identified problem. How would your practice change by incorporating this theory?

Understanding Environmental Health in Totality
Now that you have understood the impact of environmental factors on human health, create a 7- to 10- page Microsoft Word document addressing the following questions:
Describe three waterborne diseases and suggest methods for their prevention.Provide one example of a toxic chemical that may enter the public water supply? Describe some of the health effects that are attributed to toxic chemicals present in drinking water.What health hazards are associated with uncontrolled and older waste sites in the United States? Describe the processes through which hazardous solid wastes can affect human beings.Compare and contrast the current methods for treating sewage from those that were used in the Middle Ages? Historically speaking, what factors spurred the development of today’s sanitary sewage systems?Describe the stages for processing sewage. At what stage of processing is it permissible in the United States to dispose of wastewater from sewage into waterways?What health-related considerations relate to the use of recycled water? What level of processing is required for wastewater to be recycled? Describe some of the uses of recycled water.Even though workers in professional occupations usually are not exposed directly to hazardous agents, they are prone to occupationally associated illnesses. What types of hazards and associated illnesses predominate in professional occupations? What interventions would you propose to mitigate these hazards?Support your responses with reasoning and examples.
Cite any sources in APA format.
Submission Details
Name your document SU_HSC3002_W5_A2_LastName_FirstInitial.doc.
Submit your document to the W5 Assignment 2 Dropbox by Tuesday, August 29, 2017.
Assignment 2 Grading CriteriaMaximum PointsDescribed three waterborne diseases and suggested methods for their prevention.20Provided one example of a toxic chemical that may enter the public water supply. Described some of the health effects that are attributed to toxic chemicals present in drinking water.30Explained the health hazards associated with uncontrolled and older waste sites in the United States. Described the processes through which hazardous solid wastes affect human beings.20Compared and contrasted the current methods for treating sewage from those that were used in the Middle Ages. Explained the historical factors that spurred the development of today’s sanitary sewage systems.30Described the stages for processing sewage. Discussed the stage of processing in which it is permissible to dispose of wastewater from sewage into waterways.20Discussed the health-related considerations in the use of recycled water. Discussed the level of processing required in order for wastewater to be recycled. Described some of the uses of recycled water.40Discussed the types of hazards and associated illnesses that predominate in professional occupations. Explained the interventions that were proposed to mitigate these hazards.40Written components.