Compare and contrast an Australian example of food democracy with a large supermarket in Australia. In your essay you need to examine both the nature of �food� and �democracy� in your chosen environments. Address the following questions in your essay;
– What do you notice about the fundamentals of �democracy� in your chosen example of food democracy?– Compare and contrast each example; What do you notice in each site?– What stands out in terms of �food� and �democracy� and its� principles in each example.– Use food democracy as a lens to examine how consumers are given choice or invited to participate, or not as the case may be, in each example.
Assessment criteriaYour assignment will be assessed according to the following criteria, the extent to which it:
1. Demonstrates an understanding of the key principles and types of democracy and how these may be applied to food10
2. Describes the ways in which democratic principles may be applied to food/ food systems in the context of public health
3. Demonstrates an understanding of the concepts of food citizenship and civic agriculture
4. Meets the general assessment criteria, such as:
� Provides a lucid introduction that relates your paper to public health issues generally
� Shows a sophisticated understanding of the key issues
� Shows the ability to interpret relevant information and literature in relation to the topic
� Shows evidence of reading beyond the core and recommended reading
� Justifies any conclusions reached with well-formed arguments not merely assertion complies with normal academic standards of legibility, referencing and bibliographical details
� Is written clearly with accurate spelling, grammar and sentence and paragraph construction.

 

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.
Scenario:
It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, �My hip area and leg hurt really bad. I have never had anything like this before.� Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B�s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B�s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B�s current medications are atorvastatin and oxycodone for chronic back pain. After the nurse completes Mr. B�s assessment, Nurse J informs the ED physician of admission findings and the ED physician proceeds to examine Mr. B.
Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B�s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at four out of ten on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by the ED physician and are awaiting further treatment or orders.
After evaluation of Mr. B, Dr. T, the ED physician, writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication (hydromorphone) is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician�s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B�s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient�s medical history, Dr. T notes that the patient�s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.
Finally at 4:25, the patient appears to be sedated and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m. and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are en route with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time Nurse J leaves his room. The nurse allows Mr. B�s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35, Mr. B�s B/P is 110/62 and his O2 sat is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.
Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B�s O2 saturation alarm is heard and shows �low O2 saturation� (currently showing a sat of 85%). The LPN enters Mr. B�s room briefly and resets the alarm and repeats the B/P reading.
Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering respiratory treatments, CXR, labs, etc.
At 4:43, Mr. B�s son comes out of the room and informs the nurse that the �monitor is alarming.� When Nurse J enters the room, the blood pressure machine shows Mr. B�s B/P reading is 58/30 and the O2 sat is 79%. The patient is not breathing and no palpable pulse can be detected.
A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient�s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called and, upon the family�s wishes, the patient is transferred to a tertiary facility for advanced care.
Seven days later, the receiving hospital informed the rural hospital that EEG�s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.
Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (�conscious sedation�) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital�s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J�s prior annual clinical evaluations by the manager demonstrated that the nurse was �meeting requirements.� Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.
Task:
A. Complete a root cause analysis (RCA) that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient�s outcome).
B. Discuss a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario.1. Discuss a change theory that could be used to implement the process improvement plan developed in B.
C. Use a failure mode and effects analysis (FMEA) to project the likelihood that the process improvement plan you suggest would not fail.1. Identify the members of the interdisciplinary team who will be included in the FMEA.2. Discuss steps for preparing for the FMEA.3. Apply the three steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B.4. Explain how you would test the interventions from the process improvement plan from part B to improve care in a similar situation.
Note:You are not expected to carry out the full FMEA, but you should explain each step, and how you would apply it to your process improvement plan.
D. Discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities.

 

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.
Scenario:
It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, �My hip area and leg hurt really bad. I have never had anything like this before.� Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B�s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B�s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B�s current medications are atorvastatin and oxycodone for chronic back pain. After the nurse completes Mr. B�s assessment, Nurse J informs the ED physician of admission findings and the ED physician proceeds to examine Mr. B.
Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B�s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at four out of ten on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by the ED physician and are awaiting further treatment or orders.
After evaluation of Mr. B, Dr. T, the ED physician, writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication (hydromorphone) is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician�s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B�s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient�s medical history, Dr. T notes that the patient�s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.
Finally at 4:25, the patient appears to be sedated and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m. and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are en route with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time Nurse J leaves his room. The nurse allows Mr. B�s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35, Mr. B�s B/P is 110/62 and his O2 sat is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.
Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B�s O2 saturation alarm is heard and shows �low O2 saturation� (currently showing a sat of 85%). The LPN enters Mr. B�s room briefly and resets the alarm and repeats the B/P reading.
Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering respiratory treatments, CXR, labs, etc.
At 4:43, Mr. B�s son comes out of the room and informs the nurse that the �monitor is alarming.� When Nurse J enters the room, the blood pressure machine shows Mr. B�s B/P reading is 58/30 and the O2 sat is 79%. The patient is not breathing and no palpable pulse can be detected.
A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient�s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called and, upon the family�s wishes, the patient is transferred to a tertiary facility for advanced care.
Seven days later, the receiving hospital informed the rural hospital that EEG�s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.
Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (�conscious sedation�) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital�s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J�s prior annual clinical evaluations by the manager demonstrated that the nurse was �meeting requirements.� Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.
Task:
A. Complete a root cause analysis (RCA) that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient�s outcome).
B. Discuss a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario.1. Discuss a change theory that could be used to implement the process improvement plan developed in B.
C. Use a failure mode and effects analysis (FMEA) to project the likelihood that the process improvement plan you suggest would not fail.1. Identify the members of the interdisciplinary team who will be included in the FMEA.2. Discuss steps for preparing for the FMEA.3. Apply the three steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B.4. Explain how you would test the interventions from the process improvement plan from part B to improve care in a similar situation.
Note:You are not expected to carry out the full FMEA, but you should explain each step, and how you would apply it to your process improvement plan.
D. Discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities.

 

Weekly tasks or assignments (Individual or Group Projects) will be due by Monday, and late submissions will be assigned a late penalty in accordance with the late penalty policy found in the syllabus. NOTE: All submission posting times are based on midnight Central Time.
Research and discuss 1 public health issue in the United States today. Write a paper that addresses the following:
• Explain why it is a public health issue and what is currently being done to address it at the local, state, and federal levels.
• Discuss any applicable health policies and regulations that may be in place to address the issue.
• APA formatted with 2 scholarly references
Assignment Objectives
Evaluate the effect that public health has on the delivery of healthcareCompare and contrast the effects that various health policies and regulations have made on healthcare systemsAnalyze the correlation between the performance of health systems and population health status

 

Read through the following case study. In this case study you are the primary care nurse on a busy medical-surgical floor. Answer the questions utilizing the section�s PowerPoint presentation and readings. Submit your assignment in a Word document using proper APA formatting. Please refer to the Grading Rubric for Discussions.
Mrs. Paul is a 48-year old woman dying of end-stage liver disease and chronic renal failure. She is fatigued and has experienced significant weight loss, despite significant edema. She was diagnosed with colon cancer three years ago.
Mrs. Paul�s family is very upset and wants aggressive interventions done to help improve her appetite, curb her weight loss (she has lost 18 pounds in the last 4 weeks) and prevent nausea/vomiting. Her physician believes that one of the contributing factors to her fatigue is that her hemoglobin and hematocrit are low. She has receive 4 units of packed red blood cells over the past 2 weeks. The patient stats that the fatigue continues, despite the blood transfusions. She has intractable nausea and vomiting and, as a result, she is frequently admitted to the hospital. As the nurse on the medicine unit you are admitting and assessing Mrs. Paul during her most recent admission. The medical unit staff is very upset with Mrs. Paul�s family. The patient�s primary doctor and oncologist have not taken an active role in discussing palliative care with the patient or the family. One of your peers that has been caring for Mrs. Paul during frequent her frequent admissions states: �this family and patient deserve better-someone needs to be truthful with them so they know that their loved one is dying.�Questions to answer:
Discuss your evaluation process in this case regarding: fatigue, weight loss, nausea, and vomiting.Based on you assessments identify what management strategies you would use. What issues would you want to discuss with the interdisciplinary team?Considering Mrs. Paul�s and her family�s needs and concerns, what strategies and interventions might you consider in her nursing plan of care?How would you approach the physician about entertaining the possibility of palliative care for the patient and her family?Case Continued
Ms. Paul has four children (ages 15, 17, 21, 25). You happen to have a conversation with the two youngest children, as they have come to the hospital after school to visit their mother. Their mother has gone to radiology for a CT-scan and you (the bedside nurse) decide that this would be a good time to talk with her children. The youngest confides in you that she knows her mother is dying. �I saw her vomit blood before we brought her to the hospital.� �We used to put puzzles together, but she is too tired anymore.� �Is my mother going to die?�Questions to answer:
How would you respond to the 15-year old daughter?What other members of the interdisciplinary team would you want to contact to assist with the family?