I Complete Journaling Activity 6-1 on pg. 188. Answer all 3 questions using the assessment tools found in the chapter and document your findings to be handed in to the instructor at the end of the Community class.

1. In your clinical Journal, discuss a situation you observed or in which you were the care taker for some one who had several teaching needs. Outline the process used to assess, plan, and teach client and family member ‘

2. Using theory form this chapter, Identify what was not successful related to teaching and learning for this client and family

3. What would you do differently from what was done when you are in a similar situation in the future? from the experience, what did you learn about yourself and teaching clients and families.

Details:

In this assignment, you will be writing a 1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

1. Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation.
2. Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
3. Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.
4. Identify a possible funding source that addresses your issue. Consider looking at federal, state, and local organizations. For example: There are many grants available through the CDC, HRSA, etc.
5. Use at least two references other than your text and those provided in the course.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

RUBRIC:

 

1
Unsatisfactory
0.00%2
Less than Satisfactory
71.00%3
Satisfactory
79.00%4
Good
89.00%5
Excellent
100.00%80.0 %Content 35.0 %Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is not provided.The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided; however, relevant information is missing, such as not providing support for your rationale by using the theories, principles, skills and roles of the leader versus manager described in your readings, or not providing at least two references beyond your text.The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided and meets the basic criteria for the assignment as indicated by the assignment instructions.The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, and is provided in detail.The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.35.0 %Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.The identification of the approach that best fits your personal and professional philosophy of nursing is not provided.The identification of the approach that best fits your personal and professional philosophy of nursing is provided; however, relevant information is missing, such as an explanation to why the approach is suited to your personal leadership style.The identification of the approach that best fits your personal and professional philosophy of nursing is provided and meets the basic criteria for the assignment.The identification of the approach that best fits your personal and professional philosophy of nursing, along with an explanation to why the approach is suited to your personal leadership style, is provided in detail.The identification of the approach that best fits your personal and professional philosophy of nursing meets all criteria for the assignment, and is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.10.0 %Identify a possible funding source that addresses your issue.A source of funding is not identified.A source of funding is referenced, but does not meet the assignment criteria.A source of funding is discussed. Some assignment criteria are met. More information is needed.A source of funding is discussed. The overall assignment criteria are met. Some detail is needed for clarity.A strong source of funding is established. The assignment criteria are clearly met. How the source of funding will address the proposed issue is thoroughly discussed.15.0 %Organization and Effectiveness 5.0 %Thesis Development and PurposePaper lacks any discernible overall purpose or organizing claim.Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.Thesis and/or main claim are apparent and appropriate to purpose.Thesis and/or main claim are clear and forecast the development of the pap. It is descriptive and reflective of the arguments and appropriate to the purpose.Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.15.0 %Organization and Effectiveness 5.0 %Paragraph Development and TransitionsParagraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.15.0 %Organization and Effectiveness 5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present.Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.Writer is clearly in command of standard, written, academic English.5.0 %Format 2.0 %Paper Format (use of appropriate style for the major and assignment)Template is not used appropriately or documentation format is rarely followed correctly.Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.Template is used, and formatting is correct, although some minor errors may be present.Template is fully used; There are virtually no errors in formatting style.All format elements are correct.3.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)No reference page is included. No citations are used.Reference page is present. Citations are inconsistently used.Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present.Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.In-text citations and a reference page are complete. The documentation of cited sources is free of error.100 %Total Weightage

Research the range of contemporary issues teenagers face today. In a 1000word paper, choose one issue (besides teen pregnancy)and discuss its effect on adolescent behavior and overall well-being. Include the following in your submission:

1.  Describe the contemporary issue and explain what external stressors are associated with this issue.

2.  Outline assessment strategies to screen for this issue and external stressors during an assessment for an adolescent patient.

3.  Describe what additional assessment questions you would need to ask and define the ethical parameters regarding what you can and cannot share with the parent or guardian.

4.  Discuss support options for adolescents encountering external stressors. Include specific support options for the contemporary issue you presented. 

Prepare this assignment according to the guidelines found in the APA Style, NO PLAGIARISM, 5 APA REFRENCES WITHIN THE LAST 5 YEARS.

Improving Quality

Improving the quality of health care delivery and patient safety continues to be a political concern and has been at the heart of reform issues for many years. The American Nurses Association (ANA) and the Institute of Medicine (IOM) have increased awareness of health care quality and safety issues, as well as advocated for health care reform. The documents featured at the ANA and IOM websites listed in this week’s Learning Resources focus on many of the current issues surrounding quality and safety in the health care industry.

To prepare:

• Review this week’s Learning Resources, focusing on the Six Aims for Improvement presented in the landmark report “Crossing the Quality Chasm: The IOM Health Care Quality Initiative.”
• Consider these six aims with regard to your current organization, or one with which you are familiar. In what areas have you seen improvement? What areas still present challenges? As a nurse leader, how can you contribute to improving the organization’s achievement of these aims?
• Select one specific quality or safety issue that is presenting a challenge in the organization. Consider at least one quality improvement strategy that could be used to address the issue, as well as which of the six aims for improvement would then be addressed.
• Reflect on your professional practice and your experiences with inter-professional collaboration to improve quality and safety. How has inter-professional collaboration contributed to your organization’s efforts to realize the IOM’s six aims for improving health care? Where has inter-professional collaboration been lacking?

 

Post a description of the quality or safety issue you selected and a brief summary of the impact that this issue has on health care delivery. Describe at least one quality improvement strategy used to address this issue. Then explain which of the six “aims for improvement” are addressed by the strategy. Finally, explain how inter-professional collaboration helps improve quality in this area.

Read a selection of your colleagues’ responses.

 

Respond  in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research using an in-text citation in APA format.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

 

Discussion 1

Improving Quality: Patient Center Care

Patient-centered care (PCC) is increasingly being highlighted as an important model to improve quality of health care having been linked to improved patient satisfaction, better health outcomes, and cost-effective care (Bauchat, Seropian & Jeffries, 2016).  Lack of communication with patients and providers can affect patient compliance, hospital stays, and overall patient outcomes. Poor communication has been well documented as one of the top three contributors to sentinel events by the Joint Commission (Bauchat, Seropian & Jeffries, 2016).  The Institute of Medicine (2012), states that if a health care system can achieve major gains in the six areas of safe, effective, patient-centered, timely, efficient, and equitable care, it would be far better at meeting patient needs. The challenge is to find an effective means of training non-technical skills, such as empathy, to promote a patient-centric model of care; empathy is arguably an important cornerstone to effective PCC (Bauchat, Seropian & Jeffries, 2016).

Impact on Healthcare Delivery

According to Reuben and Tinetti (2012), major efforts have been launched to make care more patient-centered, defined as respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Attention to patient-centered measures and outcomes will be particularly important as the Centers for Medicare and Medicaid Services (CMS) moves increasingly to link health care providers’ reimbursement to their performance on selected measures (Reuben & Tinetti, 2012). Assessments of quality of care and health outcomes have not incorporated patient-centeredness. Measurement of quality has addressed preventive care while outcomes focuses on condition-specific processes. An alternative approach to providing better care would be to focus on a patient’s individual health goals within or across a variety of dimensions (Reuben & Tinetti, 2012).

Quality Improvement Strategy

The VA looked at developing a better relationship between patients, families and health care teams. Beginning in 2010, the VA adopted the Patient Aligned Care Team (PACT) model of care, which is adapted from the patient-centered medical home (Burkhart & et al., 2016). At the same time, the VA also established the Office of Patient-Centered Care and Cultural Transformation to guide transformation toward patient-centered care (PCC) (Burkhart & et al., 2016). This transformation to care for patients involved health coaching, decision-making initiatives, alternative medicine and pet therapy. Access to care improvements included same-day appointments, after hours availability, expanded visitor policy for inpatients, and valet parking (Burkhart & et al., 2016). The aim for improvement was focused directly on patient-centered care.

Aim for Improvement: Patient-Centered Care

Providing patient-centered care means giving patients the information they need to participate actively in decision making about their care with goals of obtaining the most desirable outcome (Knickman & Kovner, 2015). The individual’s culture, social context and specific needs should be addressed and the patient should have input in their own care. The achievement of a truly patient-centered health system will require the participation of patients, family members, physicians, nurses, and other health care providers involved in the provision of care (Knickman & Kovner, 2015). It is this team collaboration that makes the process more effective in patient care. Families should be more involved in the care process and goals should be discussed with the patient to obtain a more realistic approach.

Inter-professional Collaboration

Collaboration in health care has been shown to improve patient outcomes such as reducing preventable adverse drug reactions, decreasing morbidity and mortality rates and optimizing medication dosages (Bosch, Mansell, 2015). Trust must be established to build health care team. One way is consistency in care. Developing trust takes time and a lot of personal contact (Bosch, Mansell, 2015). This may be a challenge in some health care settings due to things such as rotating staff schedules, which contributes to constantly changing teams. Developing a personal relationship with a patient take time and adds to the patient centered approach to individual care.

Conclusion

In conclusion, the Institute of Medicine of the National Academies (2012) defines patient-centered as providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Patient care should reflect individual and safe care as part of achieving quality health care.

 

References

Bauchat, J. R., Seropian, M., & Jeffries, P. R. (2016). Communication and Empathy in the Patient-Centered Care Model—Why Simulation-Based Training Is Not Optional. Clinical Simulation in Nursing, 12(8), 356-359. doi:10.1016/j.ecns.2016.04.003

Bosch, B., & Mansell, H. (2015). Interprofessional collaboration in health care. Canadian Pharmacists Journal (Sage Publications Inc.),148(4), 176-179. doi:10.1177/1715163515588106

Burkhart, L., Min-Woong, S., Jordan, N., Tarlov, E., Gampetro, P., & LaVela, S. L. (2016). Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration. Quality Management in Health Care, 25(2), 102-110. doi:10.1097/QMH.0000000000000093

Institute of Medicine of the National Academies. (2012). Crossing the quality chasm: The IOM Health Care Quality Initiative. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

Reuben, D. B., & Tinetti, M. E. (2012). Goal-oriented patient care—an alternative health outcomes paradigm. New England Journal of Medicine, 366(9), 777-779.

 

 

 

Discussion 2

Quality of care issue: Electronic Health Records.

Today Electronic Health Records (EHRs) are at the center of health care uniting health care professionals, working as one team to improve the quality of care to all patients (Center for Medicare & Medicaid Services, 2012). However, quality of health care throughout the US varies among states, individual providers and even inter-departmental within hospitals (Knickman & Kovner, 2016). Additionally, even with advances in science and technology, 40% of the population is made up of chronic diseases; we need to bridge this gap between acute and chronic care, to ensure patients are receiving what they deserve in a more consistent way (Institute of Medicine, 2001). Providing safe and quality health care is paramount, and the Institute of Medicine (IOM) identified six issues, improving the overall health of the nation: Health care should be safe, effective, patient-centered, timely, efficient, and equitable (2001).

Impact of Delivery

EHRs are a digital version of the patient’s medical records and are an important part of today’s health care. EHRs are real-time, providing up to date information about both medical history and treatment of the individual patients. As nurses, we spend a lot of our time with our patients, so the EHRs provides an up to date record of the nurse-patient interaction.  EHRs are an invaluable tool for the day to day events of the patient. By using EHRs, communication improves which allows information to be readily and instantly available to authorized personnel (HealthIT.gov, 2013). Also they have a significant impact on patient-centered care, providing one particular place for all the pertinent information about the patient such as medical history, treatment plans, and laboratory results. Another benefit of EHRs is the instant access to evidence-based practice, allowing incorporation into the treatment of the patient, making treatment more efficient and effective (HealthIT.gov, 2013). Lastly, by having all this information stored digitally and in one place, information can flow across all providers; data can flow from primary care to specialist physician to pharmacy, radiology, emergency room, etc. (HealthIT.gov, 2013).

Strategy for improvement.

When I first started nursing, if someone would have told me I would be charting at computers at the bedside, I would have been very skeptical. In fact, when I was introduced to the idea of EHRs, I thought this was going to take me away from the bedside and put me in front of a computer screen. However, now having used EHRs for many years in different countries, I can see the benefits. It gave me more time with the patient rather than less. Now I find it an integral part of everyday life and communication with all members of the health care team. One strategy for improvement is by working with student nurses, incorporating EHRs into their curriculum. By combining this within their program, it provides a greater knowledge and understanding of the benefits for both the user, the patient and their family (Kowitlawakul, Chan, Pulcini & Wang, 2015).  By encouraging acceptance of EHRs, we promote a united front and a positive attitude towards our patient’s overall care.  Also we can aim to bridge the gap between the care that the patient is receiving and what they desire for the best outcome for their health (IOM, 2001).

When looking at combining EHRs into nurse education, this allows for the improvement of patient care from many different angles. Mostly I feel this looks at the patient as a whole, promoting a patient-centered approach to care. By looking at the patients holistically, it allows for the patient to be at the forefront of treatment, taking into consideration, their preferences and needs, benefiting and involving them in their medical decision (IOM, 2011).

Inter-professional collaboration

EHRs ensure a safer practice, uniting all medical personnel, so preventing medical errors and benefiting the patient. This effective teamwork and pooling of computerized evidence-based information promotes new and more efficient ways of treatment for patient care but always having the patient in the center of their medical plan.

Conclusion

In conclusion, EHRs are invaluable in the care and treatment of our patients and their families. EHRs are patient-centered, providing a unique way to tell the individual’s story, utilizing teamwork, excellence and evidence-based practice into an individualized package.

References

Center for Medicare and Medicaid Services. (2012) Electronic Health Records. Retrieved from https://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html

HealthIT.gov. (2013). What is an electronic health record (EHR)? Retrieved from https://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr

Institute of Medicine of the National Academics. (2001). Crossing the quality chasm: a new health system for the 21st century. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Knickman, J. R., & Kovner, A. R. (2015). Health care delivery in the United States (11th ed.). New York, NY: Springer Publishing.

 

Kowitlawakul, Y., Chan, S. W. C., Pulcini, J., Wang, W. R. (2015). Factors influencing nursing students’ acceptance of electronic health records for nursing education (EHRNE) software program Nurse Education Today. Retrieved from http://www.sciencedirect.com.ezp.waldenulibrary.org/science/article/pii/S0260691714001944

 

Discussion 3

 

Improving Quality: Patient -Centered Care.

According to the Institute of Medicine (2012), in order to improve health care, the goal should be to provide safe, effective, patient-centered, timely, efficient and equitable care. Health care needs to be patient-centered and all though most places claim to base their practice around patient’s, it does not always happen that way. As providers feel pressured to see more patients in less time, care has shifted to the needs of the system rather than the patient. According to Knickman and Kovner (2015), even though many tools, techniques, and measure have been implemented to evaluate and improve quality in the U.S, patient-centered treatment is still an ongoing problem in the US.

Quality Improvement Strategy

According to The Institute for Health Care Improvement, 2016 “care that is truly patient-centered considers patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient an integral part of the care team who collaborates with care providers in making clinical decisions. Patient-centered care puts responsibility for important aspects of self-care and monitoring in patients’ hands long with the tools and support they need to carry out that responsibility”.

Aims for Improvement

Knickman

 

Improving Quality with Interpersonal Communication

“Communication is an integral part of life; without it, we would not survive. Verbal and non-verbal communication begins at birth and ends at death. We need communication not only to transmit information and knowledge to one another, but more importantly, to relate to one another as human beings around the world in the context of relationships, families, organizations, and nations” (American Nurses Association,2012). Bedside reporting is a great example of implementing interpersonal communication, it allows the patient to meet the on coming nurse and it allows the patient to be part of their care. Also the doctor setting up a follow up appointment for the patient before they discharge is a way to keep an open line of communication between patient and doctor and it provides patient center care. I see both of these examples done at my place of employment.

 

Summary

 

Although there has been much improvement to patient-centered health care, there is still much more work to be done. I have heard the expression, we are guests in our patients lives, instead of hosts in our health care organization. This is a great motto to live by  and to use as we grow to be the kind of health care organization that patients do not mind revisiting as their health needs permit.

 

 

 

Reference:

American Nurses Association. (2012). Improving health care in your state. Retrieved from

http://nursingworld.org/MainMenuCategories/ Policy- Advocacy/Advocacy Resources Tools/ Looking-for-Solutions.pdf

Institute of Medicine of the National Academies.  (2012). Crossing the quality chasm:  The IOM Health Care Quality Initiative.  Retrieved from http://www.nationalacademies.org/hmdl/~/media media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Institute for Health Care Improvement. (2016). Across the Chasm Aim #3: Health Care must be Patient centered. Retrieved from:  http://www.ihi.org/resources/Pages/ImprovementStories/AcrosstheChasmAim3HealthCareMustBePatientCentered.aspx

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.