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NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper

NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper

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Nurses play an important role in promoting public health. Traditionally, the focus of health promotion by nurses has been on disease prevention and changing the behaviour of individuals with respect to their health. However, their role as promoters of health is more complex, since they have multi-disciplinary knowledge and experience of health promotion in their nursing practice. This paper presents an integrative review aimed at examining the findings of existing research studies (1998-2011) of health promotion practice by nurses. Systematic computer searches were conducted of the Cochrane databases, Cinahl, PubMed, Web of Science, PsycINFO and Scopus databases, covering the period January 1998 to December 2011. Data were analysed and the results are presented using the concept map method of Novak and Gowin. The review found information on the theoretical basis of health promotion practice by nurses, the range of their expertise, health promotion competencies and the organizational culture associated with health promotion practice. Nurses consider health promotion important but a number of obstacles associated with organizational culture prevent effective delivery.

What does it mean, really? How does someone promote health? I’m going to address the concept of health promotion from my perspective as a Registered Nurse in Ontario. Nurses play a huge role in illness prevention and health promotion. We, as nurses assume the role of ambassadors of wellness. Yes, I do believe that nurses play just as an important role in caring for the well as they do in caring for the sick. Perhaps caring for the well is the more important role. In this day and age of budget cuts, cost reduction and staffing shortages, health promotion makes sense. If we can preserve wellness, we reduce the number of times a person needs to enter the health-care system, thus reducing costs.

As life expectancy in the United States is declining and the number of people struggling with chronic conditions continues to rise, nurses are everywhere: in our hospitals, schools, businesses, homes, and communities. There are many social, political, and economic influences shaping healthcare delivery today that are expanding the scope of responsibility for the executive nurse leader. The focal point of change is the passing of the Patient Protection and Affordability Care Act (ACA), where there is a clear strategic shift to provide patient care in the right setting with the formation of Accountable Care Organizations (ACOs). Financial reimbursement strategies are being aligned to facilitate these changes. Executive nurse leaders are trying to navigate through these healthcare changes by developing cost-effective care delivery models, supporting the role of the professional and advanced practice nurse, and advocating for the patient. In healthcare reform, this translates to healthcare being delivered in community venues and the executive nurse leader being the advocate for the healthcare needs of the population in the community.

Consistently named as the most trusted health profession, nurses are trained to see each person they care for in the context of his or her life. Regardless of their specific backgrounds or assignments, nurses have a responsibility and obligation to promote public and population health no matter where or how they practice. To truly achieve the best possible health and well-being for everyone in our nation, it is increasingly essential for nurses to play an expanded role.

Stemming from a range of Robert Wood Johnson Foundation (RWJF) programs focused on the nursing profession, this collection includes analysis and perspectives how to more fully leverage nurses in addressing critical public health issues across our nation, and incorporate a stronger population health focus into nursing education and practice.

Public health nursing (PHN) involves working with communities and populations as equal partners, and focusing on primary prevention and health promotion (ANA, 2007). These and other distinguishing characteristics of PHN evolved in the context of historical and philosophical perspectives on health, preventive health care, and the professionalization of nursing. Specifically, these are roles that involve collaboration and partnerships with communities and populations to address health and social conditions and problems.

The focus of this course is on application of theories and concepts from nursing and public health sciences in assessing health status, preventing and controlling disease, and promoting a healthier population by working with families, aggregates, communities, and healthcare systems. Students apply system thinking by using epidemiological and community assessment techniques to examine  at-risk populations, health promotion, and levels of prevention with special emphasis on ethnically diverse and vulnerable populations. Major local, state, and national health issues are considered including, communicable disease, chronic illness, environmental and occupational health, bioterrorism, emergency and disaster preparedness and response. Practice experiences provide learning experiences in population-based health promotion by collaborating with interdisciplinary public health partners in a local community.

Public health nursing developed as a distinct nursing specialty during a time when expanding scientific knowledge and public objection to squalid urban living conditions gave rise to population-oriented, preventive health care. Public health nurses were seen as having a vital role to achieve improvements in the health and social conditions of the most vulnerable populations. Early leaders of PHN also saw themselves as advocates for these groups.

In the 21st century, public health nurses practice in diverse settings including, but not limited to, community nursing centers; home health agencies; housing developments; local and state health departments; neighborhood centers; parishes; school health programs; and worksites and occupational health programs. High-risk, vulnerable populations are often the focus of care and may include the frail elderly, homeless individuals, sedentary individuals, smokers, teen mothers, and those at risk for a specific disease.

Contemporary PHN practice, like the practice of early PHN leaders, is often provided in collaboration with several agencies and focused on population characteristics that cross institutional boundaries (Association of Community Health Nursing Education [ACHNE], 2003). PHN practice and roles are defined from, …the perspective, knowledge base, and the focus of care, rather than by the site in which these nurses practice. Even though they are frequently employed by agencies in which direct care is provided to individuals and families, these nurses view individual and family care from the perspective of the community and/or the population as a whole (ACHNE, 2003, p. 10).

…PHN knowledge and competencies prepare nurses to take a leadership role to assess assets and needs of communities and populations… At an advanced level, PHN knowledge and competencies prepare nurses to take a leadership role to assess assets and needs of communities and populations and to propose solutions in partnership. Community- or population-focused solutions can have widespread influence on health and illness patterns of multiple levels of clients including individuals, families, groups, neighborhoods, communities, and the broader population (ACHNE, 2003).

The purpose of this article is to describe evolving roles in the specialty of public health nursing. A brief history of PHN provides a historical and philosophical background for current practice. A model for community participation with ethnographic orientation, and an exemplar of its use in a rural youth substance use prevention project, illustrates current advanced PHN practice. The article concludes with a discussion of essential PHN competencies, evidence that supports evolving PHN roles, and implications for contemporary public health nursing roles.

Brief Background and History of PHN Role: NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper

Prevention and curative care have been distinct concepts since ancient times. In Greek mythology, Hygeia was the goddess of preventive health, and her sister Panacea was the goddess of healing (Lundy & Bender, 2001). The notion of health care as healing, or treating those already sick, maintained dominance over preventive care for many centuries. During the mid-19th century however, new scientific understanding of transmission of disease enabled successful sanitation interventions that prevented disease on a large scale.

To carry preventive care forward, district nursing evolved as the first role for public health nurses, and Florence Nightingale concurrently professionalized nursing as an occupation (Brainard, 1922, 1985). Evolving PHN practice required an understanding of how culture, economics, politics, psychosocial problems, and sanitation influenced health and illness and the lives of patients and families (Fitzpatrick, 1975). Public health nursing in the United States (U.S.), England, and other countries quickly grew to include working with vulnerable populations in diverse settings including communities, homes, schools, neighborhoods, and worksites.

The new public health nursing role struggled, and continues to struggle, with appropriate interventions that would achieve quick results, but also leave lasting improvements in the population. With the advent of preventive health care, a moral tension arose between giving resources to the needy, and teaching them how to meet their own needs. Nursing of the acutely ill fits more easily into a model of one-way flow of resources from nurse to patient (Buhler-Wilkerson, 1989). The new public health nursing role struggled, and continues to struggle, with appropriate interventions that would achieve quick results, but also leave lasting improvements in the population. The Christian principle of helping those who help themselves guided this tension, but could not easily resolve it (Brainard, 1922, 1985). Public health nurses were urged to balance “wisdom and kindness” (Buhler-Wilkerson, 1989, p.32). Giving free services or free supplies to the poor was seen as creating dependency and upsetting the natural social fabric of communities. Public health nurses have addressed this moral tension over many years with innovative solutions that seek positive health outcomes, as well as advocate for vulnerable populations.

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By the early 1900s, public health nursing roles extended beyond the care of the sick to encompass advocacy, community organizing, health education, and political reform (American Nurses Association [ANA], 2007). Several examples of exceptional PHN initiatives show how these roles improved the health of communities and populations. The visionary work of Lillian Wald’s Henry Street Settlement, started in New York City in 1906, evolved from finding and caring for the sick poor, to advocating and educating about the poor to other organizations. Wald expanded this mission to advocating for new federal agencies and a host of local improvements (Stanhope & Lancaster, 2011).

In the 1920s in Mississippi, Mary Osborne formed a collaborative between public health nurses and African-American (AA) lay midwives to improve perinatal mortality of AA women and babies (Lundy & Bender, 2001). In the 1960s in Detroit, Nancy Milio integrated community organizing, community decision-making, and PHN to develop a maternal-child health center that was highly accepted and even protected by the AA neighborhood during the “Detroit riots” (Milio, 1970). Public health nurses and other community professionals have continued to recognize the advantages of community participatory methods, including the potential for more effective intervention outcomes and capacity-building for long term benefit to the community (Savage et al., 2006).

Community Participatory Health Promotion Model: NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper

The community participation and ethnographic model (see Figure 1) is an innovative framework that demonstrates evolving public health nursing practice. It was developed, based on the work of Aronson, Wallis, O’Campo, Whitehead, and Schafer (2007a), by an inter-professional research team from the University of Virginia (UVA), Virginia Polytechnic Institute and State University (Virginia Tech [VT]), and Carilion Clinic (CC) (Kulbok, Meszaros, Bond, Botchwey, & Hinton, 2009) to address youth substance use prevention in a rural tobacco-growing county of Virginia. The community participation and ethnographic model builds on assumptions underlying community-based participatory research (CBPR) and encourages engagement of community members and trusted community leaders in processes from problem identification to project evaluation and dissemination. The CBPR approach is philosophically based in critical and social action theory; it builds partnerships with community members across social-economic status and focuses on community assets and resources rather than on deficits (Israel, Eng, Schulz, & Parker, 2005; Kretzmann & McKnight, 1997: NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper). CBPR seeks balance between community members and practitioners or researchers through shared leadership, co-teaching, and co-learning opportunities; it benefits from the expertise of both community members and practitioners or researchers (Anderson, Calvillo, & Fongwa, 2007; Isreal et al., 2005: NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper).

Hospitals are taking a stance on patients’ lifestyles since non-medical factors such as social, behavioral and environmental issues have a substantial impact on patient health.Public health nursing (PHN) practice is population-focused and requires unique knowledge, competencies, and skills. Early public health nursing roles extended beyond sick care to encompass advocacy, community organizing, health education, and political and social reform. Likewise, contemporary public health nurses practice in collaboration with agencies and community members. The purpose of this article is to examine evolving PHN roles that address complex, multi-causal, community problems. A brief background and history of this role introduces an explanation of the community participation health promotion model. A community-based participatory research project, Youth Substance Use Prevention in a Rural County provides an exemplar for description of evolving PHN roles focused on community health promotion and prevention. Also included is discussion about specific competencies for PHNs in community participatory health promoting rolesand the contemporary PHN role.

A standard definition of population health emerged from a 2003 report published in the American Journal of Public Health entitled, What is Population Health? In the report, authors David Kindig and Greg Stoddart defined population health as: “Health outcomes of a group of individuals, including the distribution of such outcomes within the group.”Nurses are trained to think holistically, to consider the context of a patient’s life and how that impacts his or her health,” says Paul Kuehnert, DNP, RN, FAAN, assistant vice president for RWJF Program staff,  who commissioned the study. Whole care also means assessments of the patient’s healthcare environment, which can include acute, ambulatory, home, behavioral health and community interventions. “Because of the nature of their roles, nurses often spend more face-to-face time with patients, which allows them to gain insight into the community and societal factors that impact patients’ lives and health. Armed with this insight, nurses can work with primary care physicians to help connect patients to resources within the community that can improve their overall well-being.”

This was the definition used by the NACNEP in its 2016 report, “Preparing Nurses for New Roles in Population Health Management.” While it has become the accepted definition of the term, the concept continues to evolve as the role of healthcare professionals is refined.

In 2015, the online publication Healthcare IT Newssought clarity by asking 37 healthcare leaders to offer their personal definitions of population health. The definitions varied, but a consensus emerged around opportunities for health systems, agencies and organizations to work together for better health outcomes in their respective communities.

And that is where the idea of population health begins to be revealed as a practical concept for understanding and meeting the needs of patient communities throughout the nation.

Tech companies have also been stepping into the population health ring. In March 2018, Uber announced Uber Health: a way to partner with healthcare organizations to provide reliable, comfortable transportation for patients. The announcement mentioned that over 100 U.S. healthcare organizations, are already using Uber Health to encourage patients to be more proactive in their care.

As more organizations focus on population health initiatives, healthcare workers adjust their practice to fit those needs. The role of the bedside nurse continues to shift beyond acute care.

Promoting wellness and disease prevention is not new to nurses at the bedside. However, since the Affordable Care Act in 2010, more reimbursement programs are encouraging hospitals to be catalysts in community health engagement. Many U.S. facilities require nurses to be patient health advocates in helping people stay healthy and avoid chronic diseases.

In 2016, the National Advisory Council on Nurse Education and Practice (NACNEP) called for changes in nursing education to better align with a new emphasis away from acute care and toward population health management.

Population health management programs are geared toward closing the gap of health disparities across demographics because of social determinants of health. Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks, according to Healthy People 2020.

Nurses who desire to succeed in health promotion take an active role in educating families and communities to improve their health status. Ordinarily, health promotion activities involve the assessment of individuals, or families and whole communities to plan, implement and evaluate intervention programs.

The best form of health promotion goes beyond education on healthy living to include disease prevention. Nurses use a robust advocacy approach to promoting health by identifying health risk factors in every person’s life. These are the factors that prevent underserved groups of the population from engaging in the health promoting activities. Some of the risk factors are:

Health promotion thrives when people access professional advice from someone who enables them to have more control of their health and improve their wellness. Nurses facilitate the process by providing appropriate information. Many patients get help promotion from nurses as they are the health personnel that they interact with frequently. Nurses are also easy to reach. They trust nurses because they are well educated, experienced and accessible in many settings.

For example, some people rely on telehealth service to call in with questions, concerns or discuss a health issue. Nurses use their experience to offer advice on their phone. For acute cases that require immediate attention, nurses providing telehealth help direct callers to local resources or facilities that can solve their health issues.

When nurses work in the traditional health promotion model, they interact with all sorts of individuals.

Those who want to promote health can do it at every interaction. For instance, a nurse who is changing the dressing on a wound can use the opportunity to inform the patient about the importance of taking a blood sugar test or determine the last tetanus booster from the chart. A home visit to a new mother is a chance to pass information about childhood vaccines, best vitamin supplements and healthy feeding methods for older siblings. Nurses consistently provide health promotion strategies hence are significant promoters.

Nurses play a dynamic and crucial role in healthcare. A nurse is usually the first person a patient interacts with. Nurses are responsible for assessing patients’ needs and diagnosing illnesses. As such, nurses are an integral part of the comprehensive standards of care and health promotion. The World Health Organization (WHO) defines health promotion as “the process of enabling people to increase control over the determinants of health and thereby improving their health.” Before we can examine the role of nurses in health promotion, we must first assess the guiding principles of health promotion.

The three main tenets of health promotion are advocate, enable and mediate. Nurses advocate on behalf of their patients and the community at large by supporting causes that help optimize health, such as nonprofit organizations and educational campaigns. Nurses enable or empower their patients by striving for equal access to healthcare services. Race, gender and ethnicity are important factors to consider. Finally, to promote health for all citizens, nurses play the role of mediator between healthcare providers, governments, businesses and the media. A collaboration between various institutions is the only way to ensure the health of a population.

A comprehensive health education — the use of different learning approaches to help improve health through knowledge and experience — is essential to effective health promotion. Thus, health promotion underpins a nurse’s role within a healthcare setting. Nurses are able to improve their capacity for promoting health in an online RN to BSN program that incorporates health promotion strategies into the curriculum and learning environment.

In 2016, the Centers for Medicare and Medicaid Services announced a 5-year, $157 million test of a payment model called Accountable Health Communities to accelerate the development of a scalable delivery model for addressing upstream determinants of health. Hospitals in lower-income areas have more pressure from Medicaid to enact population health management initiatives. The impact of population health programs is much greater in lower-income urban communities than in suburban counterparts.

Through the practice of health promotion, nurses provide patients the information they need to manage and ultimately improve their health. A nurse’s work environment makes it easy to take advantage of a routine interaction with a patient and use it as an opportunity to educate.

For example, a nurse can educate new parents at their baby’s wellness visit on their child’s upcoming vaccines. Or a nurse can use the time treating a patient’s diabetes-related foot ulcer to review tips and tricks regarding how to best control blood sugar levels. Equipping patients with accurate information, while also advocating for a healthy lifestyle, can help them gain better control of their health.

It can also have a big effect on healthcare costs. With an industry-wide focus on cost reduction and staffing shortages in healthcare facilities, effective health promotion can reduce the frequency with which an individual must seek out treatment.

The Journal of Professional Nursing acknowledged health promotion has become a popular buzzword, and concluded health promotion is aimed at mitigating the determinants of health through community action, action by health professionals and group action.

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Health promotion focuses on holistically addressing health issues, as opposed to lecturing individuals concerning habits that are negatively affecting their health. Often, individuals may be aware of health practices they should make habits (exercise) or stop (smoking). However, health promotion is more about ensuring access to the resources needed to improve healthy behavior. On a much higher level, nurses might also be able to advocate for societal changes to reduce resource scarcity that may impede health promotion.

There are a number of conceptual models that attempt to organize the main elements that affect health. Some models list five elements, some six. In general, though, there are six main dimensions of health that comprise most models:

• Biophysical: Physical risk factors for disease, including age, genetics and any anatomical abnormalities
• Psychological and emotional: Coping mechanisms, ability to adapt, level of cognition, and inclination and drive to adapt healthy behaviors
• Behavioral: Lifestyle choices that impact health, whether beneficial, like an exercise regimen or detrimental, like a smoking habit
• Social-cultural: Individual-level attributes like socioeconomic status and support systems, as well as broader social influences including beliefs, practices and values influenced by culture
• Physical environment: Anything in a patient’s environment that may impact health, including water and air quality
• Health systems: A patient’s ability to access healthcare systems, both because of the individual’s willingness to do so and his or her ability to pay for and access appropriate care

As technology continues to develop, educating patients through the practice of health promotion will become easier. Nurses no longer must be face-to-face with their patients in to share information.

Medical technology improvements such as telehealth have expanded patient access to nurses, which allows patients to contact a healthcare professional via phone or a video chat.

When one thinks of health care, notions of treatment and management for existing medical conditions come to mind. A major component of health care, however, also involves the prevention of illness. Known as preventative health care, a number of strategies fall under this banner. A United Healthcare fact sheet details that procedures performed in a doctor’s office, such as physical examinations, drawing blood for testing, immunizations and screenings for certain illnesses can be considered preventative health care measures. This classification is used because the procedures are performed in order to uncover illness in its early stages or to look for signs that may indicate elevated risk for certain conditions. NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper

A health care professional will screen for certain kinds of cancers — colon and breast cancer — as these diseases are typically far easier to treat if they are discovered in their earliest stages, before the onset of symptoms. A primary care provider also may test a patient’s blood sample for evidence of problems that could lead to disease further down the road: High cholesterol and high blood pressure can foreshadow the development of heart disease, for example.

As noted in the United Healthcare article, preventative measures such as screenings, physical examinations and immunizations often are implemented in accordance with demographic factors like age, gender and family history. A fact sheet from the U.S. Centers for Disease Control and Prevention (CDC) detailed one such example, being colorectal cancer, which is widely screened for but only in adults over the age of 50. The CDC suggests the age threshold of 50 because adults younger than this are statistically at a much lower risk for exhibiting with disease.

Texture Health combines deep healthcare and technical expertise to create integrated, advanced and highly-configurable, cloud-based and mobile technology solutions that help providers, health plans, patients and the people who care for them connect, communicate, and collaborate like never before.

We help ACOs, Integrated Delivery Networks, Behavioral Health Collaboratives, Hospitals and Health Systems, Health Plans and MCOs improve patient health and achieve their value-based initiatives, by caring for more patients, in less time, with less resources.

• The Interprofessional Student Hotspotting Learning Collaborative is an annual program that trains interdisciplinary teams of professional students from schools around the country to learn to work with complex medical and social needs using a patient-centered approach. Student Hotspotting is part of the Camden Coalition of Healthcare Providers’ effort to educate and provide mentorship for the next generation of health care professionals and is run through the National Center for Complex Health and Social Needs.

• Available WIPs: Foundations of Population Health Science and Practice – Mini Course for Public Health Professionals

  Health departments and community-based organizations that operate with public health central to their mission have unique needs, modalities, approaches, regulatory, and public policy contexts to inform their population health improvement efforts. Population health trainings/mini courses that specifically address the unique needs and goals of public health are not universally accessible. There is a need for training that provides high yield information that equips the public health workforce with foundational knowledge in population health science and best practices in population health. The proposed WIP will contribute to the ongoing professional development of the public health workforce by increasing their foundational knowledge of population health science and the effective design, implementation, and evaluation of population health practice activities.

According to the 2015 study Moving From Patient Care to Population Health: A New Competency for the Executive Nurse Leader, the goal in population health management is to keep the patient population as healthy as possible and minimize the need for acute care interventions such as emergency room visits and hospitalizations. If population health initiatives are measured successfully in terms of a reduction in the total cost to the organization, hospitals are rewarded with increased reimbursements.Our task force put together a list of education programs that can help nurses gain the knowledge they need to be visionary thinkers in this new model of care,” Zangerle said. “There are everything from graduate to certificate programs available, and nurses will need to self-determine which class or program would best help them to acquire the knowledge they need to assist in leading PHM efforts.

… NURS 4211 Assignment – Role of the Nurse Leader in Population Health Essay Paper

DNP 805 Health Care Informatics Essay Assignment Papers

DNP 805 Health Care Informatics Essay Assignment Papers

DNP 805 Health Care Informatics Essay Assignment Papers – Full Course Discussions

DNP 805 Topic 1 Discussion 1

Select a specific health care technology-related regulation, law, statute, or ethical standard that applies to informatics. Provide a summary of your example and a statement describing your reasoning either in support of the example you select, or in opposition to it.

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DNP 805 Topic 1 Discussion 2

Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors. Discuss how the application of the theory you select can guide the use of technology in advanced practice. What strengths does the theory possess that would make it useful to the DNP-prepared nurse? What weaknesses does the theory present that might prevent its use?

DNP 805 Topic 2 Discussion 1

Discuss the usefulness of the electronic health record (EHR) and its impact on patient safety and quality outcomes. Describe strengths and limitations that might apply to its usage.

DNP 805 Topic 2 Discussion 2

You are now a DNP-prepared nurse in a new leadership position in clinical practice. Analyze your new practice workflow to incorporate seeing patients and in regards to communication with the health care team and the infusion of the EHR into your practice. What elements do you need to consider if this position is in a magnet acute-care hospital in a busy metropolitan area? How might your practice change if the setting was a rural regional clinic system?

DNP 805 Topic 3 Discussion 1

Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice. Identify one element of either the CPOE or CDSS you would improve that could enhance the effectiveness of the system for that patient population.

DNP 805 Topic 3 Discussion 2

Select a particular medication or clinical problem. Describe how the CPOE and/or CDSS technologies support care decisions in this area.

DNP 805 Topic 4 Discussion 1

Select a defined patient population and list elements that you think will be valuable in a database. What elements are required and why? What elements are optional and why?

DNP 805 Topic 4 Discussion 2

In the prior discussion question in this topic, you selected a defined patient population and listed elements that you think will be valuable in a database. Of those elements you identified to be valuable in a database, which are structured and unstructured? Explain.

DNP 805 Topic 5 Discussion 1

Select a specific clinical problem and post a clinical question that could potentially be answered using data mining. Identify data mining techniques you would apply to this challenge, and provide your rationale. Are there any specific data mining techniques you would not use? Support your decision.

DNP 805 Topic 5 Discussion 2

Using the clinical question you identified from above, determine the individual components to that question and pinpoint the location in the hypothetical database where the information you require will be extracted.

DNP 805 Topic 6 Discussion 1

A patient of your choice is being discharged to home and will use telehealth technology. Post the technology your patient will use at home and how will you connect with the patient using this technology.

DNP 805 Topic 6 Discussion 2

Consider current telehealth strategies and alternatives. Evaluate current implementation strategies for telehealth systems and provide an assessment of the pros and cons. Identify a particular practice area (e.g., clinic, hospital, primary care site) and discuss how you as a health care leader might you implement a similar strategy in that area?

DNP 805 Topic 7 Discussion 1

Describe one technology that you use on a daily basis that you thoroughly like or appreciate. What features or elements does that technology provide to you that make it easy, enjoyable, or necessary to use? Name one element of the technology you would change to improve its functionality for your needs?

DNP 805 Topic 7 Discussion 2

Describe one technology that you use on a daily basis that you dislike or that is dissatisfying in some manner. What features or elements of that technology make it difficult, frustrating, or not enjoyable to use? Name one element of the technology you would change to improve its functionality for your needs?

DNP 805 Topic 8 Discussion 1

For a specific patient population, select one application or a technology that could effectively increase patient engagement and patient outcomes for your future practice area or work focus. What elements of this application or technology are the most valuable to you? How could you improve this technology?

DNP 805 Topic 8 Discussion 2

Describe how you can apply the spectrum of health care technology options to develop a plan to manage your patient from acute care to home care and then into the community. What organizational, societal, cultural, or other factors might impact your plan, and how could you address these?

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DNP 805 Health Care Informatics Essay Assignment Papers – Full Course Assignments

DNP 805 Health Care Informatics Essay Assignment Papers – Topic 1 Individual Success Plan (ISP)

DNP 805 Health Care Informatics Essay Assignment Papers – Topic 6 Assignment Telehealth

Details:

Telehealth encompasses a wide range of basic to complex health care delivery options, with an equally expansive array of technologies that may be employed. For this assignment, you will locate a scholarly article published within the last 3 years in a peer-reviewed journal on telehealth. This assignment consists of two parts; Part One requires you to develop and present a two-paragraph assessment comprising a précis and critical evaluation of a scholarly article focusing on a telehealth technology, and the second part requires you to construct a Mind Map to generate ideas about how the telehealth technology you identified can be used in your current practice.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

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

Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center.

Directions:

PART I: Précis and Critical Evaluation.

Donald Davidson, in his book, American Composition and Rhetoric, discusses the précis as follows:

“A précis is not an outline, but a summary or digest. It is useful as an exercise in grasping the essential ideas of an already completed composition and in stating these ideas in concentrated form. The précis shears away all elaborations of the thought and gives only what is left, in such a way as to make the summary a complete composition. It does not, therefore, skeletonize the original composition so much as it reduces its scale. Many of the articles in The Reader’s Digest are only précis, so skillfully done that the average reader does not know that he is reading a summary. Since the précis says a great deal within a brief space, it is of great service in taking notes on library assignments and general reading.”

The précis should be an organization of ideas, include logical sequencing of points, contain clear and meaningful expression, and use language suitable to the situation. When finished, the précis should clearly state:

A statement of what was studied (i.e., argued, discussed, deliberated).

A statement of focus of the scholarly article you selected, (i.e., how it was organized and completed).

A statement of what information was identified or learned from the scholarly article.

A statement of why the information in the article is important to your field of study.

PART II: Mind Map.

Brainstorm to generate ideas about how the telehealth technology you identified can be used in your current practice using a mind map. Submit the final map along with the précis to the Topic drop box.

How to do it:

Take a sheet(s) of paper and write an identifiable main idea in the center of the page, using a one-three words. (You may also achieve this via an electronic sheet of “paper”).

Draw a branch off your main idea; on the branch write or draw a main topic related to your main idea.

Continue to branch off from your main idea with main topics as needed.

From your main topics, branch off with subtopics.

From your subtopics, branch off with supporting details (write and/or draw). Continue to add more details. You are free to add more topics, subtopics, or any other items.

When you stand back and survey your work, you should see a map: hence the name for this activity. At this point you can start to form conclusions about how to approach a potential area of practice change. At the end of the day, what you do with the particular “map” or “cluster set” or “web” that you produce depends on what you need.

Submit both the précis and the final mind map in fulfillment of this assignment.

DNP 805 Health Care Informatics Essay Assignment Papers – Week 7 Assignment Case Report Health Care Informatics

Details:

In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in the current course and potentially solving an identified practice problem.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

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

Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Directions:

For a specific focus of patient practice (e.g., acute care hospital, clinic, primary care, long-term care, home health), select a particular disease process. Identify and fully describe the required technology elements that will be involved in providing care and define how these technologies will integrate treatment and/or monitoring from the identified care setting to the home and then to ongoing care.

Your case report must include the following:

Introduction with a problem statement

Brief literature review

Description of the case/situation/conditions

Discussion that includes a detailed explanation of the synthesized literature findings

Summary of the case

Proposed solutions

Conclusion

Portfolio Practice Hours:

It may be possible to earn Portfolio Practice hours for this case report. Enter the following after the references section of your paper:

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DNP 805 Health Care Informatics Essay Assignment Papers – Week 8 Assignment Evaluation of Health Care Technology

Details

For this assignment, you will utilize content from the course materials as well as additional qualified resources to synthesize new information which you can apply towards your DPI Project, your future work area or your clinical practice as a DNP-prepared nurse.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
• You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center.

Directions:

For this assignment, write a 1,000-1,250 word paper in which you:

1. Select a technology that has been explored in the course.
2. Perform an assessment using elements of user-technology interface or human factors methods to determine functionality.
3. Using the content in the readings and textbook, list three elements that will be used to evaluate the user-technology interface.
4. Select a technology and list the elements that will be evaluated. Include their definition and describe how the element would be measured or evaluated.
5. For each element, propose practicable suggestions for improvement using support from the literature.

Portfolio Practice Hours

It may be possible to earn Portfolio Practice hours for this case report. Enter the following after the references section of your paper:

DNP 805 Health Care Informatics Essay Assignment Papers – Week 8 Assignment Reflective Journal

Details:

Learners are required to maintain a reflective journal integrating leadership and inquiry into current practice.

In your journal, reflect on the personal knowledge and skills gained in the this course and address a variable combination of the following: new practice approaches, intraprofessional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy, leadership and economic models, and/or health disparities. Outline what you have discovered about your professional practice, personal strengths and weaknesses that surfaced, what additional resources and abilities could be introduced to a given situation to influence optimal outcomes, and finally how you met the competencies aligned to this course.

You are not required to submit this assignment to Turnitin.

Submit your reflective journal both to the instructor and in the Typhon Tracking System under the corresponding course section. Failure to submit your journal in both the course room and Typhon systems may result in a grade of Incomplete for the course.

DNP 810 Assignments Essays

DNP 810 Assignments Essays

GCU DNP 810 Week 1 Individual Success Plan (ISP)

Details:

The Individual Success Plan (ISP) assignment in this course requires your collaboration with the course faculty early on to establish a plan for successful completion of mutually identified and agreed upon specific deliverables for your programmatic requirements. Programmatic requirements are: (1) completion of required practice immersion hours, (2) completion of work associated with program competencies, (3) work associated toward completion of your Direct Practice Improvement Project.

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General Requirements:

Use the following information to ensure successful completion of the assignment as it pertains to deliverables due in this course:

• Locate and download the Individual Success Plan (ISP) document in the DNP Program Documents folder in the DNP Program Materials section of the DC Network.
• Review the DNP Program Milestones document in the DC Network and identify which milestones apply to this course. Note: Not all courses have milestones.
• Determine what practice experiences you plan to seek in order to address each competency. Include how many hours you plan to set aside to meet your goals. Learners will apply concepts from each of their core courses to reflect upon, critically examine, and improve current practice, and are required to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.
• Use the ISP to develop a personal plan for completing your practice hours and how competencies will be met. Show all of the major milestones and deliverables.

Within the ISP, ensure you identify specific deliverables which can include the following: Individualized DNP practice immersion contracts; comprehensive clinical log of hours applied to doctoral level learning outcomes; learner evaluations; mentor evaluations; current and updated CV; scholarly activities; GCU DNP competency self-assessment; reflective journal; course goals and plan for how competencies and practice immersion hours will be met; faculty and mentor approvals of course goals and documented practice immersion hours; and DPI project milestones.

• Identify the specific deliverables you will complete throughout this course from those defined above or others negotiated with your faculty. You must turn in a new ISP in each course.
• Identify the remaining deliverables you will complete in the upcoming courses.
• List the challenges you expect to encounter as you continue the practice hour and competency requirements throughout this course? How might you overcome these challenges?
• You can renegotiate these deliverables with your faculty throughout this course and update your ISP accordingly.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• You not are required to submit this assignment to LopesWrite.

Directions:

Complete the Contact Information table at the beginning of the ISP document and type in your signature and the date on which you completed the table.

Read the information in the ISP document including the following:

1. Learner Expectations
2. Derivation of the ISP
3. Instructions for completing the ISP

Follow the instructions and complete the ISP.

DNP 810 Assignments Essays – Week 1 Reading Check for Understanding

Details:

Complete the questions listed in the “Problems” section of the textbook on pages 23, 39, and 58. Check your answers in the back of the textbook in the “Answers to Problems” appendix.

DNP 810 Assignments Essays – Week 2 Case Report Part 1

Details:

You will be creating a case report in stages over four course topics. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization in which you practice may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Include the following:

• Guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy).
• The role that money and grants play in scientific advances; the economics of health care (capitalism).
• The role and involvement family plays into the health care decision.

Directions:

For this assignment (Part 1 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1 and 2. Include the following:

1. Describe the disease, its prevalence, and its incidence.
2. Discuss the laboratory testing that is possible.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Case Report: Part 1  

DNP 810 Assignments Essays – Week 2 Reading Check for Understanding

Details:

Complete the questions listed in the “Problems” section of the textbook on pages 84, 113, 147-149, 174, and 205. Check your answers in the back of the textbook in the “Answers to Problems” appendix.

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DNP 810 Assignments Essays – Week 3 Case Report Part 2

Details:

You will be creating a case report in stages over four course topics. This assignment will add to your previous work in Topic 2. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

For this assignment (Part 2 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1-3. Include the following:

1. Describe if chromosomal analysis is/was indicated.
2. Detail the causes of the disorder.
3. Describe the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education.
4. Analyze the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Case Report: Part 2  

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DNP 810 Assignments Essays – Week 3 Family History

Details:

Taking a family history is an important step in determining current and future health needs and education. There are many tools available to complete a comprehensive health history. The Surgeon General’s Family Health History tool is part of the larger Family Health History Initiative that encourages people to talk about and write down health issues that seem to run in the family, bringing a larger focus on this important issue. This assignment allows the learner to use the tool and become familiar with this initiative.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
• Use the Surgeon General’s Family History Tool at
• (http://www.hhs.gov/familyhistory/portrait/index.html) to complete this assignment.

Directions:

Use the Surgeon General’s Family History Tool (http://www.hhs.gov/familyhistory/portrait/index.html) to document your own family history.

Designate a proband for the pedigree with a disease or condition of interest.

Write a 750-1,000 word summary of your findings. Include the following information:

1. Discussion of the heredity patterns discovered.
2. Evaluate the risk of transmission to other/new family members.
3. Propose the feasibility of using this tool in your own practice.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Family History

DNP 810 Assignments Essays – Topic Week 4 Genetic Counseling

Details:

With the increase in knowledge around genetic issues, it is important that all health care providers are prepared to have thorough genetic-based discussions now with their patients. In this assignment, you will synthesize your knowledge into a client case with a real or potential genetic health-related illness.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
• Use the Surgeon General’s Family History Tool at
• (http://www.hhs.gov/familyhistory/portrait/index.html) to complete this assignment.

Directions:

Write a 1,000-1,250 word paper addressing a client case that might benefit from the process of genetic counseling.

Describe the reason for the genetic counseling based on the findings from your completion of the history tool.

Discuss the possible reactions the patient may have to your counseling and how to avoid negative reactions.

Imagine this assignment as if you are giving this counseling to a patient. Discuss the following:

1. Health.
2. Prevention
3. Screening
4. Diagnostics
5. Prognostics
6. Selection of treatment
7. Monitoring of treatment effectiveness

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

Genetic Counseling

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DNP 810 Assignments Essays – Topic Week 5 Case Report Part 3

Details:

You will be creating a case report in stages over four course topics. This assignment will add to your previous work in Topic 3. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

For this assignment (Part 3 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1-5. Include the following:

1. Examine how genetics can influence policy issues.
2. Discuss any nutritional influences for the cause of this disease.
3. Discuss the process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.
4. Discuss the prevalence rates, testing, treatment, and prognosis as they relate to human nutrition.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP 810 Assignments Essays – Topic Week 6 Health Issues for the Aging

Details:

As of 2014 health care expenditures in the United States are near 17% of our gross domestic product (GDP), with a major portion of Medicare funding goes towards chronic illness and care at the last 6 months of life. The Patient Protection and Affordable Care Act has made some initial legislative changes in our health system, but not sufficient to address our growing expenditures and caring for our large aging population. In this assignment, learners will synthesize issues in aging with health policy solutions by writing a paper on one health issue for older individuals addressed in the topic and offering a policy solution. Example of issue: In 2014, over 50% of the costs of institutional long-term care for older persons are paid for with public funds from Medicaid.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Write a 1,000-1,250 word paper that addresses a health issue for older individuals. Include the following:

1. Evaluate what the literature suggests as a resolution to your chosen issue.
2. Discuss any attempts to incorporate the solution into public policy.
3. Determine the barriers to implementation of the solution.
4. Analyze the options being discussed for public and/or private funding.
5. Propose your own recommendation.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

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Health Issues for the Aging

DNP 810 Assignments Essays – Topic Week 8 Case Report Cumulative

Details:

You will be creating a case report in stages over four course topics. This assignment will add to your previous work in Topic 5. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Include the following:

• Guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy).
• The role that money and grants play in scientific advances/the economics of health care (capitalism).
• The role and involvement family plays into the health care decision.

Directions:

For this assignment (Conclusion of the Case Report), include previous Parts 1, 2, and 3 of the Case Report in one document, combined with additional genetics information learned from the assigned readings from all course topics. This final Case Report document should include the following:

1. Describe the disease, its prevalence, its incidence and general knowledge of the disease.
2. Discuss the laboratory testing that can be done.
3. Describe if chromosomal analysis is/was indicated, and detail the chromosomal change that caused the disease if it is a chromosomal disorder.
4. Describe the disorder in terms of its origin as either a single gene inheritance, or as a complex inheritance and considerations for practice and patient education.
5. Describe the gene mutation of the disease, as well as whether it is acquired or inherited, and how the mutation occurs.
6. Examine how genetics can influence policy issues.
7. Discuss any nutritional influences for this disease.
8. Process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.

Continue your paper with 1,000-1,250 words which include the following:

1. Discuss any ethical considerations for this disease.
2. Compare how genetics can improve care and health outcomes while reducing cost to usual practices.
3. Discuss the changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events.
4. Create a plan for how you might educate colleagues and/or patients on this genetic disorder.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

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Case Report: Cumulative

DNP 810 Assignments Essays – Topic Week 8 Final Evaluation by Mentor

Details:

The mentor will perform a final clinical evaluation via the Typhon system. The mentor will receive an e-mail link at the beginning of Topic 6 to access the evaluation through Typhon.

Students will access the completed mentor evaluations in Typhon under the tab for “EASI: Evaluation and Survey Instrument” and print out the completed evaluation, sign it, and upload the signed evaluation into LoudCloud.

The course faculty will review the evaluation in LoudCloud and confirm in Typhon.

It is the student’s responsibility to ensure that the mentor has completed evaluation. If the mentor does not receive the evaluation via the e-mail address on file with GCU, the student should contact the course faculty immediately.

DNP 810 Assignments Essays – Topic Week 8 Reflective Journal

Details:

Learners are required to maintain a Reflective Journal integrating leadership and inquiry into current practice.

In your journal, you will reflect on the personal knowledge and skills gained in the current course addressing a variable combination of the following: new practice approaches, intraprofessional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy, leadership and economic models, and/or health disparities. Outline what you discovered about your professional practice, personal strengths and weaknesses that surfaced, what additional resources and abilities could be introduced to a given situation to influence optimal outcomes, and finally how you met the competencies aligned to this course.

Submit your Reflective Journal to both the instructor and the Typhon Tracking System under the corresponding course section. Learners must submit this deliverable in Typhon and LoudCloud. Failure to submit in both locations can result in an Incomplete for the course.

DNP 810 Topic Week 8 Scholarly Activities

Details:

Throughout the DNP Program, learners are required to provide a report documenting participation in a minimum of four scholarly activities outside of clinical or professional practice. These reports will be due in specific courses throughout the program (listed below) and must be documented in your Practice Portfolio by the end of each course in which an activity report is due.

Examples of scholarly activities include attending conferences, seminars, grand rounds, participating in policy and quality improvement committees, writing scholarly publications, participating in community planning, serving as a guest lecturer, etc. Involvement and contribution to interdisciplinary initiatives are also acceptable scholarly activities.

Documentation of these activities is required in DNP-810, DNP-820, DNP-830, and DNP-840.

A summary report of the scholarly activity including who, what, where, when, and take home points will be submitted as the assignment. Include the appropriate program competencies associated with the scholarly activity and the future professional goals related to this activity. You may use the attached template to help guide this assignment.

Scholarly_ Activity_Summary_Template.doc

DNP 810 Assignments Essays – Topic Week 8 Practice Hours Portfolio

Details:

The Typhon Tracking System will be used to document and follow the status of your practice immersion hours throughout this and every subsequent course. Learners must be able to document a minimum of 50 concurrently or previously logged practice hours in association with this course, which will contribute to fulfillment of the total required 1,000 post-baccalaureate practice hours by the conclusion of the program. Please review the Practice Hours Portfolio Required Elements below, then review the Guidelines for Graduate Field Experience Manual document in the DC Network for details on what may/may not qualify as practice hours.

Practice Hours Portfolio Required Elements

The Practice Hours Portfolio (using the Typhon Student Tracking System) will include all of the following elements:

1. Individual Success Plan signed off by mentor.
2. Comprehensive clinical log of hours applied to doctoral level learning outcomes.
3. Learner evaluations (final).
4. Practice mentor evaluations (final).
5. Current and updated CV (update each course as necessary).
6. Faculty approvals of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)
7. Practice mentor’s approval of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)

Practice Hours Completion Statement

Learners will track their practice hours within the Typhon Tracking System throughout each course and via the Practice Hours Completion Statement assignment provided in this assignment.

Complete the following statement in a Word documen, submit to the instructor, and complete the Typhon Tracking System entries appropriate for this course.

Create a Word document with the following text:

Practice Hours Completion Statement DNP-810

I, (INSERT NAME), verify that I have completed (NUMBER OF) practice hours in association with the goals and objectives for this course. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

NURS 3005 – Nursing in Complex Settings

NURS 3005 – Nursing in Complex Settings

Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts. In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery. They examine legislative, regulatory, and financial processes relevant to the organization and provision of healthcare services. Students also assess and consider the impact of these processes on quality and safety in the practice environment and disparities in the healthcare system.

(Prerequisite(s): NURS 3000.)

NURSING 3005 – Nursing in Complex Settings Essay Papers – Note

♦ Students may take this as a non-degree course, which means they do not have to be enrolled in a program. Contact an Enrollment Advisor [1-866-492-5336 (U.S.);1-443-627-7222 (toll)] for more information.

Courses listed below are open only to students formally admitted into one of the nursing programs (BSN, MS, or DNP) as required of their specific program option or concentration. Exceptions include NURS 1101, 2240, and 3250, which are open to any student.

USP Codes are listed in brackets by the 2003 USP code followed by the 2015 USP code (i.e. [QB<>Q]).

1101. First-Year Seminar. 3. [{none}<>FYS]

2240. Medical Terminology. 3. Introduces medical terminology. Includes word structure of medical-surgical terms, body parts and organs, body systems and commonly used medical abbreviations.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

2340. Developmental Influences on Health. 3. Explores interaction between development and health. Discusses human development of physiological, psychological, cognitive, sociocultural, and spiritual systems across the lifespan. Identifies selected theories associated development over the lifespan and implications for health care. Provides foundation for more in-depth consideration of developmental factors related to health maintenance and human potential. Prerequisites: Progression or admission into clinical component of the program and completion or concurrent enrollment with NURS 3435, 3490, and PHCY 3450 or PHCY 4450.

NURS 3005

3005. ReNEW Distance Foundations. 1. Prepares learners for ReNEW BSN Completion in a distance delivery format. The course includes concept-based delivery in the UW learning system, APA formatting, writing scholarly papers, and library resources and skills. Prerequisite: Enrolled in or graduate of ReNEW Nursing Program.

3015. Introduction to Baccalaureate Nursing. 3. Introduces the role of a professional nurse with a baccalaureate degree. Conceptual foundations including nursing theories, healthcare systems, application or evidence-based practice, informatics and the components of safety, quality and leadership in nursing practice are presented. Students are prepared to move on to additional nursing coursework. Prerequisites: Current RN license or concurrent enrollment in WY ADN education program or graduate of WY ADN education program; NURS 3005 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

3020. Cultural Diversity in Family Health Care. 3. [D<>{none}] Concepts of cultural heritage, history, diversity, health, illness, and family theories are applied to nursing assessment and care of the family as client. Contemporary issues of immigration and poverty, the effect of culture, social class, religion/spirituality, family form, family development stage and situational factors on family as client are studied. Prerequisites: admission into the nursing major component of the program; RN/BSN: NURS 3015 or concurrent enrollment. (Normally offered spring semester)

3045. Health Assessment in Nursing Practice. 3. Assessment of the physiological, psychosocial and sociocultural variables of the individual across the lifespan. History taking, advanced physical exam techniques and appropriate documentation of findings assist the student in identifying normal variations, potential problems of human health experiences and health promotion opportunities. Prerequisite: admission to nursing major component of the program; NURS 3015 or concurrent enrollment.

3125. Professional Nursing. 3. Introduction of core concepts, theory and processes essential to professional nursing. Roles and scope of practice of the professional nurse, principles of therapeutic communication, patient safety, nursing theory and process, and evidence based practice will be emphasized. Prerequisite: admission to the nursing major component of the program.

3140. Health Assessment. 3. Students learn to assess the physiological, psychological, sociocultural and developmental variables of individual client systems across the lifespan. Normal variations and potential problems of human health experiences are identified. Documentation skills are developed. Prerequisite: admission to the nursing major component of the program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

3250. Health Psychology. 3. Provides overview of growing partnership between psychology and health care, including history of psychology in health care; theoretical foundations of health and illness; intervention and research techniques; stress and high risk behaviors (e.g., substance abuse, eating behaviors, AIDS); psychology’s contribution to improving outcomes and quality of life in chronic and life-threatening behaviors. Cross listed with PSYC 3250. Prerequisite: PSYC 1000 or consent of instructor.

3425. Bridging Nursing Paradigms. 3. This course prepares incoming ADN- or Diploma-educated Registered Nurses for completion of the Fay W. Whitney School of Nursing (FWWSON) BSN degree. Nursing knowledge, skills, and abilities in selected content areas will be evaluated and augmented in preparation for BSN Completion coursework. Prerequisite: Current RN license.

3435. Fundamentals of Professional Nursing Practice. 1. This course introduces the concepts and skills of basic nursing care and nurse/patient safety. The course allows students to gain confidence and competency in the performance of basic clinical skills. Prerequisites: Progression or admission to the clinical component of the program and completion or concurrent enrollment with NURS 2340, NURS 3490, and PHCY 3450 or PHCY 4450.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

3440. Adult Health I. 3. Develop clinical judgment skills by using a consistent process in identifying relevant client data, responding to that data appropriately, planning care and evaluating that care. This process will be accompanied by exploring a wide range of nursing concepts essential in caring for the adult client, through the use of case studies, interactive and/or group active learning. Prerequisites: admission into the nursing major component of the program; NURS 3140, 3125, PHCY 4470 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

3475. Nursing Practicum: Adult Health I. 4. Students provide basic nursing care using the nursing process in a clinical setting with adult clients experiencing alterations in health status. The focus is on the physiological, psychological, spiritual, developmental and sociocultural dimensions of the client. The students will identify the roles of the professional nurse. Satisfactory/Unsatisfactory only. Prerequisite: NURS 3440 or concurrent enrollment.

3490. Health Promotion in Professional Nursing Practice. 5. Students will learn and apply concepts of health promotion across the lifespan. Emphasis is on cultural diversity, health risks, behavior change and healthy practices for individuals, families, and populations. Students will incorporate evidence in designing interventions to promote health and prevent illness for self and clients. Prerequisites: Progression or admission to the clinical component of the program and completion or concurrent enrollment with NURS 2340, NURS 3435, and PHCY 3450 or PHCY 4450.

3630. Health Promotion. 4. [P<>{none}] Learn health promotion concepts and theories, identify at risk behaviors, and design nursing interventions to promote health and prevent illness. The teaching role of the nurse is emphasized for individual and group clients across the lifespan. Students strive to effect positive changes to their own personal health and fitness. Prerequisites: admission into the nursing major component of the program; NURS 3015, 3020, and 3045 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

3635. Health Assessment and Clinical Judgement. 3. Students learn to assess the physiological, psychological, sociocultural, spiritual, and developmental dimensions of individuals across the lifespan. Normal variations and potential alterations of health are identified. Clinical judgment and documentation skills are developed. Prerequisites: NURS 3490 and completion or concurrent enrollment with NURS 3665, 3690, 3695, and PHCY 4470.

3665. Foundations of Professional Nursing Roles. 3. This course introduces the student to professionalism, leadership, safety, and patient-centeredness. The concepts emphasized provide the foundation for professional nursing practice. Prerequisites: NURS 3490 and completion or concurrent enrollment with NURS 3635, 3690, 3695, and PHCY 4470.

3690. Professional Nursing Acute/Chronic Illness. 3. Students will examine concepts of nursing practice in the care of adults with acute and chronic illness. Emphasis is on utilizing the nursing process to develop clinical judgement. Prerequisites: NURS 3490 and completion or concurrent enrollment with NURS 3635, NURS 3665, NURS 3695, NURS 4470.

3695. Professional Nursing Acute/Chronic Illness Practicum. 4. Students provide nursing care using the nursing process in a clinical setting with adult clients experiencing acute and chronic illness. Emphasis is on demonstration of clinical judgement. Prerequisites: NURS 3490 and completion or concurrent enrollment with NURS 3635, NURS 3665, NURS 3690, PHCY 4470.

3710. Nursing Fundamentals and Laboratory. 2. Includes concepts of basic care/comfort, technical skills, medical equipment, asepsis, medication administration, nurse/client safety, and client rights. Increased confidence and competency in critical thinking, communication skills, and the performance of motor skills. Prerequisites: previous bachelor’s degree; admission to the BRAND track; concurrent enrollment in NURS 3750 and NURS 3730.

3715. Foundational Laboratory. 2. Using system analysis, students assess all dimensions of individual clients across life span. Concepts and demonstration of basic care/comfort; technical skills; use of equipment; asepsis/infection control; medication administration; nurse/client safety; client rights and dignity. Allows the student to gain confidence and competency in performing motor skills; critical thinking; communication; self-development. Prerequisites: previous Bachelor’s degree; admission to BRAND; concurrent enrollment in NURS 3710; NURS 3750.

NURSING 3005 – Nursing in Complex Settings Essay Papers

3730. Introduction to Professional Nursing. 2. Introduces students to the core concepts of professional nursing practice. Nursing process, domains of nursing practice, health policy, evidence-based practice, legal and professional standards will be assimilated into nursing practice from discussion, role playing and case studies. Contemporary nursing issues and situational factors will be examined. Prerequisites: previous Bachelor’s degree; admitted to the BRAND nursing track.

3750. Health Assessment and Promotion. 4. Using system analysis, students assess the physiological, psychological, spiritual, socio-cultural, developmental variables of individual clients across the life span. Nursing process and evidence-based nursing practice are used to promote/protect health of clients through health promotion, risk reduction, disease prevention of the client/client systems. Process skills and professional roles are integrated. Prerequisites: previous bachelor’s degree; admitted to BRAND program; concurrent enrollment in NURS 3710.

3770. Nursing Care in Acute and Chronic Illness. 9. Discern critical elements of professional nursing medical-surgical concepts for adults experiencing acute/chronic health alterations progressing to complex health alterations. Focuses on patient safety principles; quality initiatives; evidence-based nursing; information technology; interprofessional collaboration, communication; health promotion strategies; and critical thinking in the planning of client centered nursing care for the adult. Prerequisites: NURS 3710, NURS 3750, NURS 3730, NURS 3780.

3780. Evidence-Based Practice in Nursing. 4. Prepares nursing students to engage in evidence-based practice in nursing, specifically how to search the literature and databases, ask meaningful clinical questions, find relevant evidence, critically appraise evidence, integrate best evidence with clinical expertise and patient/community values. Prerequisites: admission to the BRAND program, concurrent enrollment in NURS 3770.

3771. Nursing Care in Acute and Chronic Illness Practicum. 7. Application of critical elements of professional nursing practice with adults experiencing acute and chronic health alterations. Focus is on incorporation of patient safety principles; quality initiatives; evidence-based nursing practice; information technology; interprofessional collaboration and communication; health promotion strategies; and critical thinking and clinical reasoning in the provision of nursing care. Prerequisites: NURS 3710, NURS 3750, NURS 3730, NURS 3780.

3840. Adult Health II. 3. Progress from novice to beginner in developing critical judgment skills by applying nursing concepts and evaluating concepts on the adult client with illness. Analyze and synthesize data, develop plans of care, implement care and re-evaluate that care when necessary, through the use of case studies, interactive and/or group active learning. Prerequisites: NURS 3440 and 3475; NURS 3020 or concurrent enrollment.

3842. Care of the Older Adult. 3. Explores the physiological, psychological, spiritual, developmental and socio-cultural dimensions of the older adult and addresses the 30 AACN/Hartford Foundations’ Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care. Prerequisites: NURS 3440 and 3475; NURS 3020 or concurrent enrollment.

3844. Mental Health and Illness. 3. Explores psychiatric illnesses and mental health concepts consistent with the roles of the professional nurse. Emphasis is on the nursing process, DSM-IV criteria, therapeutic communication, treatment modalities, legal and ethical concerns, community resources, and inter-related client needs in a variety of health care settings. Prerequisites: NURS 3440 and 3475; NURS 3020 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

3875. Nursing Practicum: Adult Health II. 4. Junior nursing students are placed in clinical settings to provide patient-centered nursing care using the nursing process. The focus is on adult clients experiencing acute, chronic and/or psychiatric alterations in health. The physiological, psychological, spiritual, developmental and socio-cultural client dimensions are studied and professional nursing roles are integrated into practice. Satisfactory/Unsatisfactory only. Prerequisites: NURS 3840, 3842, 3844 or concurrent enrollment.

3890. Professional Nursing Care in Complex Illness. 3. Students will examine concepts of nursing practice in the care of adults with complex illness. Emphasis is on utilizing the nursing process to develop clinical judgment. Prerequisites: NURS 3695 and completion or concurrent enrollment with NURS 3891, 3892, 3895, 4125.

3891. Professional Nursing Care of Older Adults. 3. Students will examine concepts of nursing practice in the care of older adults. Emphasis is on utilizing the nursing process to develop clinical judgment. Prerequisites: NURS 3695 and completion or concurrent enrollment with NURS 3890, 3892, 3895, 4125.

3892. Professional Nursing Care in Mental Health and Illness. 3. This course explores mental health and illness concepts. Emphasis is on the role of the professional nurse in caring for clients with alterations in mental health. Prerequisites: NURS 3695 and completion or concurrent enrollment with NURS 3890, 3891, 3895, 4125.

3895. Professional Nursing Care in Complex Illness Practicum. 4. Students provide patient-centered care using the nursing process in clinical setting wth adult and older adult clients experiencing complex illness and alterations in mental health. Emphasis is on demonstration of clinical judgment. Prerequisites: NURS 3695 and completion or concurrent enrollment with NURS 3890, 3892, 3891, 3892, 4125.

3970. Nursing Externship. 3. Allows students to obtain college credit for nursing experience gained in an approved setting. Increases application of nursing theory, knowledge of a health care agency, interpersonal working relationships, technical skills and organization of time in providing nursing care. Offered S/U only. Prerequisites: NURS 3840, 3842, 3844, and 3875. (Offered once a year in summer)

4055. Application of Evidence in Nursing Practice. 3. [L<>COM3] Prepares RN students to engage in evidence-based nursing, specifically how to ask meaningful clinical questions, find relevant evidence, critically appraise evidence, and integrate best evidence with clinical expertise and patient/community values. Prerequisites: ReNEW ADN Benchmark or Formal RN-BSN Admission; STAT 2050 or 2070 or equivalent; COM1 and COM2.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4125. Evidence-Based Nursing. 3. [L,WC<>COM3] Prepares students to engage in evidence-based nursing, specifically how to ask meaningful clinical questions, find relevant evidence, critically appraise evidence, and integrate best evidence with clinical expertise and patient/community values. Prerequisites: WA and WB or COM1 and COM2; STAT 2050 or 2070 or equivalent; admission into the nursing major component of the program.

4145. Public/Community Health Nursing. 3. Students are introduced to public health nursing, the core functions and essential services of public health, and community health nursing competencies. Includes population-focused nursing, epidemiology, community assessment, and the application of the nursing process to the community as client. Students assess their communities and research health problems. Prerequisites: admission into the nursing major component of the program; NURS 3630 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4250. Leadership in Nursing. 3. The role of leader in nursing practice is developed through the integration of leadership, management, and organizational theories. Emphasis is placed on the nurse as health care provider and manager of care facilitating planned change in clients and/or environments. Prerequisites: NURS 4475; concurrent enrollment with NURS 4875.

4255. Nursing Leadership. 3. [WC<>{none}] Students study the concepts and theories of leadership, management, and organizations. Emphasis is placed on the nurse as health care provider and the development of leading, managing, decision-making, problem-solving, and writing in nursing skills. Course content includes controlling the profession, legal and ethical aspects, informatics, and professional development. Prerequisites: WA and WB or COM1 and COM2; admission into the nursing major component of the program; NURS 3630 or concurrent enrollment.

4440. Public Health Nursing. 4. Introduces the student to population-focused nursing and applies the nursing process to the community as client. Addresses core functions and essential services of public health. Focuses on epidemiology, community assessment, community planning and implementation, analysis of the health care system, emergency preparedness, and legal aspects of public health. Prerequisites: NURS 3875; NURS 4125 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4442. Nursing Care of Children and Families. 4. Theory course which encompasses the care of children and childbearing families including the physiological, psychological, spiritual, developmental and socio-cultural dimensions. The focus of this class is on obstetrical and pediatric nursing care. Integrates wellness and illness issues in all aspects of family care. Prerequisites: NURS 3875; NURS 4125 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4475. Nursing Practicum: Family and Public Health. 4. In this senior clinical practicum, students apply the nursing process to childbearing families, children and communities. The focus is on the physiological, psychological, spiritual, developmental and socio-cultural dimensions of individuals, families and populations. Students will incorporate professional nursing roles into population centered care. Satisfactory/Unsatisfactory only. Prerequisites: NURS 4440, 4442 or concurrent enrollment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4630. Public/Community Health. 2. Students examin public/community health nursing roles and apply the nursing process to community as client. Focuses on improving community health, levels of prevention, and addresses multiple determinants of health. Core functions, essential services, community assessment and planning, emergency preparedness, and analysis of the public healthcare system will be studied. Prerequisites: ReNEW Progression or Formal RN-BSN Admission; NURS 3005 or NURS 3425.

4635. Community as Client. 2. Learners will understand relationships among health, disease, and the environment, with emphasis on the role of community health agencies and programs for communities in need of health care support, regionally, nationally, and globally. In this course, an assessment and planning framework guides students in assessing the health of a community. Prerequisites: ReNEW ADN Benchmark or Formal RN-BSN Admission; NURS 3005 or NURS 3425.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4640. Health Disparities. 2. Learners will examin population-focused concepts to assess vulnerable and opressed populations. The magnitude of health disparities both in the United States and globally will be discussed. Focuses on a multi-level and multi-cultural view of population health challenges, alleviating health disparities, and a commitment to health equity. Prerequisites: ReNEW Progression or Formal RN-BSN Admission; NURS 3005 or NURS 3425.

4645. Population Health. 2. Focuses on analysis of local, regional, national, and international data that are indicators of population health. Disease outbreaks are analyzed. Learners study development of innovative, collaborative, multi-disciplinary interventions and policies to improve public health. This course provides opportunities for learners to improve population health through application of theory and evidence. Prerequisites: ReNEW ADN Benchmark or Formal RN-BSN Admission; NURS 3005 or NURS 3425.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4660. Healthcare Informatics. 3. Students will develop knowledge and skills to utilize and evaluate information technologies to improve patient outcomes across diverse populations. Includes the use of Clinical Information Systems to plan and document the nursing process. Ethical and legal considerations of data management. Prerequisite: ReNEW Progression of Current RN license.

4665. Heathcare Informatics in Professional Nursing Practice. 3. Utilizing a conceptual framework, students will examine nursing informatics within healthcare systems. Emphasis is placed on examining the role of clinical information systems in improving patient outcomes across practice, education, adminstrative, research, and interdisciplinary applications. Ethical and legal considerations of data management are examined. Prerequisites: NURS 3895 and completion or concurrent enrollment with NURS 4690, 4691, 4695.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4690. Professional Nursing Care of Populations. 4. Introduces the student to population-focused nursing and applies the nursing process to the community as client. Addresses core functions and essential services of public health. Focuses on vulnerable populations; epidemiology; community assessment, planning, and implementation; analysis of the healthcare system; emergency preparedness; and ethical/legal aspects of public health. Prerequisites: NURS 3895 and completion or concurrent enrollment with NURS 4665, 4691, 4695.

4691. Professional Nursing Care of Children and Families. 3. This course encompasses the care of women, children, and their families across physiological, psychological, spiritual, developmental, and socio-cultural dimensions. The focus of this class is on women’s health, obstetrical, and pediatric nursing care including health promotion and wellness specific to maternal and pediatric health. Prerequisites: NURS 3895 and completion or concurrent enrollment with NURS 4665, 4690, 4690.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4695. Professional Nursing Care of Populations Practicum. 4. Students will apply the nursing process to childbearing families, children, and communities. The focus is on physiological, psychological, spiritual, developmental, and socio-cultural dimensions of individuals, families, and populations. Students will incorporate professional nursing roles into population-based care. Prerequisites: NURS 3895 and completion or concurrent enrollment with NURS 4665, 4690, 4691.

4710. Nursing Care of the Aging Family. 3. Utilizes nursing process to assess, promote, and protect health of aging families. Focus is on physiological, psychological, spiritual, developmental, socio-cultural dimensions of the geriatric adult, including family dynamics. Evidence-based practice guides illness and disease management; disease prevention. Expected, unexpected responses to therapies; grief, loss, end of life concepts will be incorporated. Prerequisites: senior standing; consent of instructor.

4735. Vulnerable Populations and Mental Health. 3. This course introduces students to nursing principles and concepts of mental health psychopathology, physiology, psychology, and spirituality, along with developmental and socio-cultural considerations while incorporating treament modalities related to the nursing of the middle-aged and aging adult. Prerequisites: NURS 3770, NURS 3771, concurrent enrollment in NURS 4710 and NURS 4736.

4736. Nursing Care of Vulnerable Populations Practicum. 3. Applies past learning and cultivates evidence-based nursing practice for vulnerable populations in acute/ community settings. Focuses on the vulnerability associated with mental health, psychiatric illnesses. Core public health functions of community assessment, essential health services, disaster preparedness, health policy development/global health care are also emphasized to implement population-based nursing interventions. Prerequisites: NURS 3770; concurrent enrollment in NURS 4735.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4740. Nursing Care of the Young Family. 6. Utilizes nursing process to assess, promote, and protect the health of young families as client. Focus is human sexuality and reproduction, family planning, pregnancy stages, neonatal, pediatrics. Growth and development, health promotion, disease prevention, family dynamics are included. Evidence-based nursing guides practice to promote a healthy family and family system. Prerequisites: NURS 3770; 3771, and concurrent enrollment in NURS 4741.

4741. Nursing Care of the Young Family Practicum. 3. Applies and synthesizes nursing process to assess, promote, and protect the health of young families as clients. Focus is human sexuality and reproduction, family planning, pregnancy stages, neonatal, pediatrics. Growth and development, health promotion, disease prevention, family dynamics are included. Evidence-based nursing guides practice to promote a health family/family system. Offered S/U only. Prerequisites: NURS 3770 and 3780; concurrent enrollment in NURS 4740.

4750. Independent Study in Nursing. 1‑4 (Max. 6). Provides students with opportunity to investigate a problem in nursing care not considered in required nursing courses or to explore in more depth an area considered in one of required nursing courses. Area of study and requirements for earning credit are determined in consultation with nursing faculty member. Prerequisite: senior standing in nursing or consent of instructor. Offered S/U only. (Normally offered fall, spring and summer)

4775. Nursing Senior Capstone. 10. Provides opportunities to utilize and synthesize core concepts of professional nursing. Intensive clinical experience allowing students to become socialized into health care delivery system; gain in autonomy/confidence in performing skills; practice critical thinking and clinical reasoning in making ethical clinical decisions; develop leadership in providing and coordinating evidence-based nursing care. Offered S/U only. Prerequisites: NURS 4710; NURS 4735; NURS 4736; and concurrent enrollment in NURS 4785.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4785. Nursing Integration. 2. Focuses on the continuing integration of previously learned concepts. The student further develops the role of consumer of research and incorporates leadership and management skills as a member of the profession. Prerequisites: NURS 4735; NURS 4736; NURS 4710; and concurrent enrollment in NURS 4775.

4790. Special Topics in Nursing. 1-3 (Max. 8). Provides offerings in selected nursing topics on concepts, theories or practices as related to specified areas in nursing. Prerequisites: junior standing in nursing and consent of instructor.

4792. Cultural and International Health Care Immersion. 3. An in-depth examination of cultural influences on health care systems, which will include both classroom and in-field immersion experiences. Prerequisites: senior or graduate standing in student’s major and instructor permission.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4830. Leadership in Heathcare Today. 2. Focuses on the role of nurse leader and manager through integration of leadership, management, and organizational concepts, models, and theories. Emphasis in on leadership, followership, management, advocacy, professional development and activism, and managing resources. Prerequisites: ReNEW Progression or Formal RN-BSN Admission; NURS 3005 or NURS 3425.

4835. Leading Nursing Practice. 2. Focuses on nurser leaders making a difference using evidence-based nursing practice. Learners utilize and synthesize basic concepts of professional nursing practice. This course creates the opportunity for learners to lead nuring practice in a variety of settings. Prerequisites: ReNEW ADN Benchmark or Formal RN-BSN Admission; NURS 3005 or NURS 3425.

4840. Healthcare Systems and Policy. 2. Learners examine healthcare quality and the regulation of professional nursing practice in various settings. The focus is on ethical and legal issues and policy development for healthcare delivery. Prerequisites: ReNEW Progression or Formal RN-BSN Admission; NURS 3005 or NURS 3425.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4845. Innovation in Nursing Practice. 2. Focus in on use and synthesis of concepts in professional nursing practice. This course provides an opportunity to employ critical thinking, to apply ethical decision-making, to use evidence, and to demonstrate the ability to lead planned change. Prerequisites: ReNEW ADN Benchmark or Formal RN-BSN Admission; NURS 3005 or NURS 3425.

4855. Contemporary Nursing Practice. 2. Focus in on practice as critically effective members and leaders of the healthcare team. Learners analyze a variety of societal, economic, political, and professional issues that influence contemporary nursing. This course provides an opportunity to be creative in examining trends in nursing and healthcare. Prerequisites: ReNEW ADN Benchmark or Formal RN-BSN Admission; NURS 3005 or NURS 3425.

4865. Professional Nursing Leadership. 3. The role of the nurse leader in nursing practice is developed through integration of leadership, management, and organizational theories. Emphasis in on interprofessional care management, planned change, advocacy, activism, and professional development. Prerequisites: NURS 4695 and completion or concurrent enrollment with NURS 4895.

4875. Capstone Practicum. 12. A precepted capstone clinical course that assists students in synthesizing basic concepts of professional nursing. Learning experiences allow students to gain confidence, practice clinical reasoning and leadership skills, communicate effectively with the interprofessional team, apply ethical decision making skills and develop evidence-based practice. Satisfactory/Unsatisfactory only. Prerequisite: all required courses in the nursing major. (Normally offered spring semester)

4895. Professional Nursing Capstone Practicum. 12. Students utilize and synthesize basic concepts of professional nursing practice. The course socializes students into a healthcare system. Learning experiences allow students to gain confidence in managing patient care, practicing critical thinking, developing leadership and advocacy skills, and exploring ethical decision-making in clinical situations. Prerequisites: NURS 4695 and completion or concurrent enrollment with NURS 4865.

4985. RN/BSN Capstone Project. 3. Synthesizes program concepts through analysis of a documented public health issue. Students will use evidence based resources, address public health competencies and analyze how the identified issue and interventions impact the health of the affected population. Prerequisites: Admission into the nursing major component of the program; all required courses in the nursing major; NURS 4255 or concurrent enrollment, current RN license.

5140. Pharmacotherapy for Primary Care Practitioners. 4. Prepares primary care practitioners in drug therapy management for a variety of client populations with an emphasis on rural practice. Cross listed with PHCY 5140. Prerequisite: admission into NP program; NURS 5165; or consent of NP program coordinator.

5165. Advanced Pathophysiology for Primary Care Practitioners I. 2. A system-based approach is used to explore selected pathophysiological states encountered across the lifespan in primary care. The developmental physiology, etiology, pathogenesis, clinical manifestations, and physiological responses to illness and treatment regimens are examined, providing a basis for the foundation of clinical decisions. Prerequisite: Admission in the Doctor of Nursing Practice program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5166. Advanced Pathophysiology for Primary Care Practitioners II. 3. A system-based approach is used to explore elected pathophysiological states encountered across the lifespan in primary care. The developmental physiology, etiology, pathogenesis, clinical manifestations, and physiological responses to illness and treatment regimens are examined, providing a basis for the foundation of clinical decisions. Prerequisites: Admission in Doctor of Nursing Practice (DNP) program and successful progression in the DNP program of study.

5405. Theoretical Foundations in Nursing: Exploring Learning and Leadership. 3. Emphasizes the learning and leadership potential of constructivist and developmental approaches, including transformative learning and complementing theories as a foundations for education and leadership practice. Prerequisite: Admitted to UW’s MS Nursing Program; Co-requisite: NURS 5410.

5410. Becoming a Leader. 3. Emphasis on strategic use of self as a foundation for professional leadership development. Prerequisite: Admitted to UW’s MS Nursing Program; Co-requisite: NURS 5405.

5415. Evidence-Informed Decision-Making. 3. Emphasis on use of a guiding framework to conduct a methodical process for evidence-informed decision making. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410.

5420. Leadership Within Health Care Systems. 3. Emphasis on strategic use of systems and outcomes as a foundation for professional leadership development. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410.

5424. Rural and Global Population Health and Policy. 3. Emphasis on population health, epidemiology, and health policy related to rural and global health. Prerequisites: Admission to the nursing MS program; NURS 5405; NURS 5410.

5440. Science of Quality Improvement and Safety. 3. Emphasis on theoretical and scientific foundations for quality improvements and safety in healthcare. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410.

5451. Advanced Leadership Strategies. 3. Emphasis on optimization of leadership. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410; NURS 5420.

5452. Curriculum Development. 3. Emphasis on the process of developing curricula in nursing educational or healthcare setting to include evaluation of program outcomes. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410; Co-requisite of NURS 5462.

5461. Business of Healthcare. 3. Emphasis on leading and managing entrepreneurial healthcare opportunities. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410.

5462. Teaching Methodologies and Evaluation. 3. Emphasis on evidence-based teaching methodologies, development of course materials, and evaluation of students learning outcomes. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410.

5472. Integrated Advanced Pathophysiology, Pharmacology, and Assessment. 3. Emphasis on integration of advanced pathophysiology, and assessment in relation to chronic conditions. Prerequisites: Admission to UW’s MS Nursing Program; NURS 5405; NURS 5410.

5750. Independent Advanced Study. 1-4 (Max. 8). Provides students the opportunity to analyze a problem in nursing; apply theory to clients in a clinical setting; or pursue an area of interest under the guidance of a faculty member. Requirements and evaluation are mutually established between the student and faculty member. Offered as satisfactory/unsatisfactory only.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5790. Advanced Issues in Health. 1-3 (Max. 12). Designed to provide graduate students the opportunity of pursuing advanced issues in health. Prerequisite: graduate status.

5800. Foundations of Integrative Advanced Practice Nursing. 3. An introduction to the core concepts and roles of advanced practice nursing, particularly the doctoral-prepared nurse practitioner. Special emphasis is given to 1) the integration of nursing and other health-related theories and models in rural nurse practitioner-delivered care and 2) professional writing in advanced practice nursing. Prerequisite: admission to the DNP program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5805. Evidence-based Practice for Advanced Practice Nursing I. 3. Overview of the evidence-based practice model, including the contributions of research, patient preferences, and clinician expertise, and the theoretical frameworks that inform this expertise. Evaluating typical research designs for advanced practice nursing. Prerequisite: admission to the DNP program.

5810. Health Behavior Change I: Foundations. 3. This course will cover foundations of health behavior change including theories/models, techniques, as well as the application to advanced nursing practice. Topics include exmaination of individual, contextual, and cultural factors. Topics function as skill building for advanced Health Behavior Change (HBC) courses. Prerequisite: admission to the DNP program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5815. Evidence-based Practice for Advanced Practice Nursing II. 3. Students learn to develop an evaluation of clinical practice based upon critical appraisal of the existing research evidence, clinician expertise, and patient preferences. Special emphasis is placed on methods that an advanced practice nurse might use to generate and disseminate evidence from clinical practice. Prerequisite: NURS 5805.

5820. Health Behavior Change II: Primary Prevention and Wellness. 3. This course will cover the application of theories and techniques of health behavior change and principles of epidemiology to health issues from the individual to the community level. Topics include population health and health disparities in the context of health practice, including needs assessment, intervention development, and evaluation. Topics also include understanding lifestyle and behavior change interventions. Prerequisites: NURS 5805 and 5810.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5824. Advanced Health Assessment and Clinical Decision-Making for Nurse Practitioners. 2. Builds upon basic nursing assessment skills; includes a human cadaver lab experience to enhance learners’ understanding of anatomy, physiology, and pathophysiology, progressing to didactic, hands-on practice, and check-offs of student ability to perform client interviewing and advanced physical assessment techniques. Prepares learners for the clinical decision-making required of nurse practitioners. Prerequisite: Admission in the Doctor of Nursing Practice (DNP) program and successful progression in the DNP program of study.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5825. Advanced Health Assessment and Clinical Decision-Making for Family Nurse Practitioners. 4. Advanced health assessment and diagnostic decision-making for family nurse practitioners. Builds on previous assessment skills and covers specialty exams used in primary care. Emphasizes a systematic diagnostic reasoning approach that leads to accurate clinical decision-making. Additionally, course focuses on sociocultural influences, growth and development, and gender concepts. Prerequisite: Admission in the Doctor of Nursing Practice Family Nurse Practitioner (FNP) program and successful progression in the FNP program of study.

5830. Health Behavior Change III: Secondary and Tertiary Prevention. 3. This course will cover the application of health behavior change skills in advanced nursing practice with a focus on chronic illness. Topics include the development of skills for understanding adherence and self-management, supporting client/patient self-management goals, and creating education/treatment plans. Topics also include the use of general and specific health behavior change techniques for integration into advanced nursing practice. Students will participate in on-campus intensive practice of behavior change skills with standardized patient actors. Prerequisites: NURS 5805 and 5810.

5840. Leadership in Advanced Practice Nursing. 3. Organizational and systems leadership for improvement of health. Focuses on interrelationship among systems, ethics, policy, and change. Identifies qualities and behaviors associated with exemplary nursing leadership. Special emphasis is given to rural health care systems. Prerequisite: passing DNP Program Preliminary Exam.

5845. Health Communication/Informatics. 3. Emphasizes understanding, managing and using of information systems/technology to provide healthcare in rural health settings. Discussion includes the evaluation and project management of the human/technology interface with specific attention to business, ethical and legal issues encountered in interdisciplinary, collaborative settings. Prerequisite: passing DNP Program Preliminary Exam.

5850. Innovative Practice Models. 4. Examination of innovative health care models and their incorporation into primary care. Emphasizes the evaluation models in care delivery, quality management, and business improvement strategies. Prerequisite: Admission to DNP program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5861. Practicum: Therapeutic Interventions Across the Lifespan. 3. Clinical practicum focused on beginning level therapeutic competencies in the advanced practice role of the PMHNP. Prerequisites: Admission to the Doctor of Nursing Practice (DNP) Psychiatric Mental Health Nurse Practitioner (PMHNP) program and successful progression in the PMHNP program of study.

5862. Practicum: Diagnosis and Management of the Psychiatric Client for the PMHNP I. 5. Clinical practicum focused on beginning level diagnostic and clinical management competencies for the PMHNP. Prerequisite: Admission to the Doctor of Nursing Practice (DNP) Psychiatric Mental Health Nurse Practitioner (PMHNP) program and successful progression in the PMHNP program of study.

5863. Practicum: Diagnosis and Management of the Psychiatric Client for the PMHNP II. 5. Clinical practicum that allows students to continue to practice and refine competencies in the PMHNP role with multiple and complex psychiatric populations. Prerequisite: Admission to the Doctor of Nursing Practice (DNP) Psychiatric Mental Health Nurse Practitioner (PMHNP) program and successful progression in the PMHNP program of study.

5865. Doctor of Nursing Practice Seminar. 1 (Max. 6). Instructor and student-led discussions designed to facilitate role transition of the doctorally-prepared nurse practitioner. Seminars include topics related to integration and application of nursing and other health-related theories and models in rural nurse practitioner-delivered care. Topics will vary by year and semester as students’ progress through the DNP program. Prerequisites: admission to the DNP program and progression through DNP plan of study.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5871. Wellness for Adults in Primary Care. 3. Provision of wellness primary care for adults across the lifespan, including primary and secondary prevention. Prerequisite: Admission to DNP program.

5872. Practicum for Wellness in Primary Care. 3. Clinical practicum for NURS 5871, Wellness for Adults in Primary Care. Prerequisite: Admission to DNP program.

5873. Primary Care for Children, Adolescents, and Families. 3. Provision of primary care for children, adolescents, and families across the lifespan, including primary and secondary prevention. Prerequisite: Admission to DNP program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5874. Practicum for Primary Care for Children, Adolescents, and Families. 3. Clinical practicum for NURS 5873, Primary Care for Children, Adolescents, and Families. Prerequisite: Admission to DNP program.

5875. Primary Care for Acute & Chronically Ill Adults. 3. Diagnosis and management of select acute and chronic illnesses experienced by adults across the lifespan. Primary focus is on those physical and behavioral illnesses with high prevalence in rural primary care. Prerequisite: Admission to DNP program.

5876. Practicum for Primary Care for Acute & Chronically Ill Adults. 3. Clinical practicum for NURS 5875, Primary Care for Acute & Chronically Ill Adults I. Prerequisite: Admission to DNP program.

5877. Primary Care for Acute & Chronically Ill Adults II. 3. Continuation of NURS 5875. Diagnosis and management of select acute and chronic illnesses experienced by adults across the lifespan. Primary focus is on those physical and behavioral illnesses with high prevalence in rural primary care. Prerequisite: Admission to DNP program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5878. Practicum for Primary Care for Acute & Chronically Ill Adults II. 3. Clinical practicum for NURS 5877, Primary Care for Acute & Chronically Ill Adults II. Prerequisite: Admission to DNP program.

5880. Neurobiology, Assessment, and Psychopharmacology for Advanced Practice Mental Health Nursing. 3. The advanced study of neurobiology, assessment, and psychopharmacology in the treatment of psychiatric disorders across the lifespan. In depth exploration of how the advanced practice psychiatric nurse can utilize pharmacodynamics and pharmacogenetics to inform the clinical decision making in the treatment complex mental illnesses and addiction. Prerequisites: Admission to the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner (PMHNP) concentration and successful progression in the PMHNP program of study.

5881. Psychotherapy Models and Theories for Advanced Practice Mental Health Nursing. 3. Utilization of psychotherapy frameworks in the care of individuals, families, and groups. Emphasizing the couseling role and skill development of the advanced practice mental health nurs in the assessment, intervention and evaluation of diverse populations across the lifespan. Issues of ethics, rural practice, and diversity are addressed throughout the course. Prerequisites: Admission to the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner (PMHNP) concentration and successful progression in the PMHNP program of study.

5882. Advanced Psychiatric Mental Health Nursing Diagnosis and Management for the Adult, Older Adult, and Vulnerable Populations. 4. Advanced knowledge of evidence based assessment, diagnosis, treatment, management, and health promotion of adults and aging adults with mental illness. Explore culturally sensitive care among vulnerable populations. Examine the professional, ethical, policy, and practice issues influencing the role of the advanced practice psychiatric nurse. Prerequisites: Admission to the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner (PMHNP) concentration and successful progression in the PMHNP program of study.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5883. Advanced Psychiatric Mental Health Nursing Diagnosis and Management for the Child and Adolescent. 4. Evidenced based assessment, diagnosis, treatment and management of mental health disorders in children and adolescence at the individual, family and community level. Theories of family development including behavioral patterns will be assessed using a culturally sensitive lens. Review of psychotherapy, psychopharmacology, psychoeducation, and health promotion as is developmentally appropriate. Prerequisites: Admission to the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner (PMHNP) concentration and successful progression in the PMHNP program of study.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5891. DNP Project I. 3. In collaboration with a facility, learners will examine clinically relevant data to target a practice and/or patient outcome for improvement. Learners will collect and critically appraise related evidence and develop an intervention, including an outcome evaluation plan. Prerequisite: Admission to DNP program.

5892. DNP Project II. 3. Continuation of NURS 5891, DNP Research Project I. In collaboration with a facility, learners will implement the proposed clinical intervention, evaluate the outcome, and professionally disseminate the results. Prerequisite: Admission to DNP program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

5895. Final DNP Practicum. 5-6 (Max. 6). This final clinical experience provides learners with the opportunity to integrate previous learning from the DNP program in the provision of evidence-based health care. Prerequisite: Admission to DNP program.

5900. Practicum in College Teaching. 1-3 (Max. 3). Work in classroom with a major professor. Expected to give some lectures and gain classroom experience. Prerequisite: graduate status.

5920. Continuing Registration: On Campus. 1-2. (Max 16). Prerequisite: advanced degree candidacy.

5940. Continuing Registration: Off Campus. 1-2 (Max. 16). Prerequisite: advanced degree candidacy.

5960. Thesis Research. 1-12 (Max. 24). Graduate level course designed for students who are involved in research for their thesis project. Also used for students whose coursework is complete and are writing their thesis. Prerequisite: enrolled in a graduate degree program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Health informatics (also called health care informatics, healthcare informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics) is information engineering applied to the field of health care, essentially the management and use of patient healthcare information. It is a multidisciplinary field[1] that uses health information technology (HIT) to improve health care via any combination of higher quality, higher efficiency (spurring lower cost and thus greater availability), and new opportunities. The disciplines involved include information science, computer science, social science, behavioral science, management science, and others. The NLM defines health informatics as “the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning”.[2] It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and bio-medicine. Health informatics tools include computers, clinical guidelines, formal medical terminologies, and information and communication systems, among others.[3][4] It is applied to the areas of nursing, clinical medicine, dentistry, pharmacy, public health, occupational therapy, physical therapy, biomedical research, and alternative medicine,[5][unreliable medical source?] all of which are designed to improve the overall of effectiveness of patient care delivery by ensuring that the data generated is of a high quality.[6]

The international standards on the subject are covered by ICS 35.240.80[7] in which ISO 27799:2008 is one of the core components.[8]Subspecialities
Healthcare informatics includes sub-fields of clinical informatics, such as pathology informatics, clinical research informatics (see section below), imaging informatics, public health informatics, community health informatics, home health informatics, nursing informatics, medical informatics, consumer health informatics, clinical bioinformatics, and informatics for education and research in health and medicine, pharmacy informatics.[9][10][11][12][13][14][excessive citations]

Healthcare informatics
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Clinical informatics
Clinical informatics is concerned with the use of information in health care by and for clinicians.[15][16]

Clinical informaticians, also known as clinical informaticists, transform health care by analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve [patient] care, and strengthen the clinician-patient relationship. Clinical informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and health informatics tools to:

assess information and knowledge needs of health care professionals, patients and their families.
characterize, evaluate, and refine clinical processes,
develop, implement, and refine clinical decision support systems, and
lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.
Clinicians collaborate with other health care and information technology professionals to develop health informatics tools which promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable. Many clinical informaticists are also computer scientists.

In October 2011 American Board of Medical Specialties (ABMS), the organization overseeing the certification of specialist MDs in the United States, announced the creation of MD-only physician certification in clinical informatics. The first examination for board certification in the subspecialty of clinical informatics was offered in October 2013 by American Board of Preventive Medicine (ABPM) with 432 passing to become the 2014 inaugural class of Diplomates in clinical informatics.[17]

Fellowship programs exist for physicians who wish to become board-certified in clinical informatics. Physicians must have graduated from a medical school in the United States or Canada, or a school located elsewhere that is approved by the ABPM. In addition, they must complete a primary residency program such as Internal Medicine (or any of the 24 subspecialties recognized by the ABMS) and be eligible to become licensed to practice medicine in the state where their fellowship program is located.[18] The fellowship program is 24 months in length, with fellows dividing their time between Informatics rotations, didactic method, research, and clinical work in their primary specialty.

Integrated data repository

Example IDR schema

Achilles tool for data characterization of a healthcare dataset
One of the fundamental elements of biomedical and translation research is the use of integrated data repositories. A survey conducted in 2010 defined “integrated data repository” (IDR) as a data warehouse incorporating various sources of clinical data to support queries for a range of research-like functions.[19] Integrated data repositories are complex systems developed to solve a variety of problems ranging from identity management, protection of confidentiality, semantic and syntactic comparability of data from different sources, and most importantly convenient and flexible query.[20] Development of the field of clinical informatics led to the creation of large data sets with electronic health record data integrated with other data (such as genomic data). Types of data repositories include operational data stores (ODSs), clinical data warehouses (CDWs), clinical data marts, and clinical registries.[21] Operational data stores established for extracting, transferring and loading before creating warehouse or data marts.[21] Clinical registries repositories have long been in existence, but their contents are disease specific and sometimes considered archaic.[21] Clinical data stores and clinical data warehouses are considered fast and reliable. Though these large integrated repositories have impacted clinical research significantly, it still faces challenges and barriers. One big problem is the requirement for ethical approval by the institutional review board (IRB) for each research analysis meant for publication.[22] Some research resources do not require IRB approval. For example, CDWs with data of deceased patients have been de-identified and IRB approval is not required for their usage.[22][19][21][20] Another challenge is data quality. Methods that adjust for bias (such as using propensity score matching methods) assume that a complete health record is captured. Tools that examine data quality (e.g., point to missing data) help in discovering data quality problems.[23]

Clinical research informatics
Clinical research informatics (CRI) is a sub-field of health informatics that tries to improve the efficiency of clinical research by using informatics methods. Some of the problems tackled by CRI are: creation of data warehouses of healthcare data that can be used for research, support of data collection in clinical trials by the use of electronic data capture systems, streamlining ethical approvals and renewals (in US the responsible entity is the local institutional review board), maintenance of repositories of past clinical trial data (de-identified).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

CRI is a fairly new branch of informatics and has met growing pains as any up and coming field does. Some issue CRI faces is the ability for the statisticians and the computer system architects to work with the clinical research staff in designing a system and lack of funding to support the development of a new system. Researchers and the informatics team have a difficult time coordinating plans and ideas in order to design a system that is easy to use for the research team yet fits in the system requirements of the computer team. The lack of funding can be a hindrance to the development of the CRI. Many organizations who are performing research are struggling to get financial support to conduct the research, much less invest that money in an informatics system that will not provide them any more income or improve the outcome of the research (Embi, 2009).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Common data elements (CDEs) in clinical research
Ability to integrate data from multiple clinical trials is an important part of clinical research informatics. Initiatives, such as PhenX and Patient-Reported Outcomes Measurement Information System triggered a general effort to improve secondary use of data collected in past human clinical trials. CDE initiatives, for example, try to allow clinical trial designers to adopt standardized research instruments (electronic case report forms).[24]

Data sharing platforms for clinical study data
A parallel effort to standardizing how data is collected are initiatives that offer de-identified patient level clinical study data to be downloaded by researchers who wish to re-use this data. Examples of such platforms are Project Data Sphere,[25] dbGaP, ImmPort [26] or Clinical Study Data Request.[27] Informatics issues in data formats for sharing results (plain CSV files, FDA endorsed formats, such as CDISC Study Data Tabulation Model) are important challenges within the field of clinical research informatics.

Human bioinformatics
Translational bioinformatics
With the completion of the human genome and the recent advent of high throughput sequencing and genome-wide association studies of single nucleotide polymorphic organisms, the fields of molecular bioinformatics, bio-statistics, statistical genetics and clinical informatics are converging into the emerging field of translational bioinformatics.[28][29][30] The relationship between bioinformatics and health informatics, while conceptually related under the umbrella of biomedical informatics,[31] has not always been very clear. The TBI community is specifically motivated with the development of approaches to identify linkages between fundamental biological and clinical information.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Along with complementary areas of emphasis, such as those focused on developing systems and approaches within clinical research contexts,[32] insights from TBI may enable a new paradigm for the study and treatment of disease.

Translational Bioinformatics (TBI) is a relatively new field that surfaced in the year of 2000 when human genome sequence was released.[33] The commonly used definition of TBI is lengthy and could be found on the AMIA website.[34] In simpler terms, TBI could be defined as a collection of colossal amounts of health related data (biomedical and genomic) and translation of the data into individually tailored clinical entities.[33] Today, TBI field is categorized into four major themes that are briefly described below:

Clinical big data
Clinical big data is a collection of electronic health records that are used for innovations. The evidence-based approach that is currently practiced in medicine is suggested to be merged with the practice-based medicine to achieve better outcomes for patients. As CEO of California-based cognitive computing firm Apixio, Darren Schutle, explains that the care can be better fitted to the patient if the data could be collected from various medical records, merged, and analyzed. Further, the combination of similar profiles can serve as a basis for personalized medicine pointing to what works and what does not for certain condition (Marr, 2016).
Genomics in clinical care
Genomic data are used to identify the genes involvement in unknown or rare conditions/syndromes. Currently, the most vigorous area of using genomics is oncology. The identification of genomic sequencing of cancer may define reasons of drug(s) sensitivity and resistance during oncological treatment processes.[33] Omics for drugs discovery and repurposing
Repurposing of the drug is an appealing idea that allows the pharmaceutical companies to sell an already approved drug to treat a different condition/disease that the drug was not initially approved for by the FDA. The observation of “molecular signatures in disease and compare those to signatures observed in cells” points to the possibility of a drug ability to cure and/or relieve symptoms of a disease.[33] Personalized genomic testing
In the USA, several companies offer direct-to-consumer (DTC) genetic testing. The company that performs the majority of testing is called 23andMe. Utilizing genetic testing in health care raises many ethical, legal and social concerns; one of the main questions is whether the healthcare providers are ready to include patient-supplied genomic information while providing care that is unbiased (despite the intimate genomic knowledge) and a high quality. The documented examples of incorporating such information into a healthcare delivery showed both positive and negative impacts on the overall healthcare related outcomes.[33] Computational health informatics
Computational health informatics is a branch of computer science that deals specifically with computational techniques that are relevant in healthcare. Computational health informatics is also a branch of health informatics, but is orthogonal to much of the work going on in health informatics because computer scientists’ interest is mainly in understanding fundamental properties of computation. Health informatics, on the other hand, is primarily concerned with understanding fundamental properties of medicine that allow for the intervention of computers. The health domain provides an extremely wide variety of problems that can be tackled using computational techniques, and computer scientists are attempting to make a difference in medicine by studying the underlying principles of computer science that will allow for meaningful (to medicine) algorithms and systems to be developed. Thus, computer scientists working in computational health informatics and health scientists working in medical health informatics combine to develop the next generation of healthcare technologies.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Using computers to analyze health data has been around since the 1950s, but it wasn’t until the 1990s that the first sturdy models appeared. The development of the Internet has helped develop computational health informatics over the past decade. Computer models are used to examine various topics such as how exercise affects obesity, healthcare costs, and many more.[35]

Examples of projects in computational health informatics include the COACH project.[36][37]

Informatics for education and research in health and medicine
Clinical research informatics
Clinical research informatics (CRI) is an amalgamation of clinical and research informatics. Featuring both clinical and research informatics, CRI has a vital role in clinical research, patient care, and the building of healthcare system (Katzan & Rudick, 2012). CRI is one of the rapidly growing subdivisions of biomedical informatics which plays an important role in developing new informatics theories, tools, and solutions to accelerate the full transitional continuum (Kahn & Weng, 2012). Evolution of CRI was extremely important in Informatics as there was an extraordinary increase in the scope and pace of clinical and translational science advancements (Katzan & Rudick, 2012). Clinical research informatics takes the core foundations, principles, and technologies related to Health Informatics, and applies these to clinical research contexts.[38] As such, CRI is a sub-discipline of health informatics, and interest and activities in CRI have increased greatly in recent years given the overwhelming problems associated with the explosive growth of clinical research data and information.[39] There are a number of activities within clinical research that CRI supports, including:

more efficient and effective data collection and acquisition
improved recruitment into clinical trials
optimal protocol design and efficient management
patient recruitment and management
adverse event reporting
regulatory compliance
data storage, transfer,[40] processing and analysis
repositories of data from completed clinical trials (for secondary analyses)
History
Worldwide use of computer technology in medicine began in the early 1950s with the rise of the computers.[41] In 1949, Gustav Wagner established the first professional organization for informatics in Germany.[42] The prehistory, history, and future of medical information and health information technology are discussed in reference.[43] Specialized university departments and Informatics training programs began during the 1960s in France, Germany, Belgium and The Netherlands. Medical informatics research units began to appear during the 1970s in Poland and in the U.S.[42] Since then the development of high-quality health informatics research, education and infrastructure has been a goal of the U.S. and the European Union.[42]NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Early names for health informatics included medical computing, biomedical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering, and medical computer technology.[citation needed]

The health informatics community is still growing, it is by no means a mature profession, but work in the UK by the voluntary registration body, the UK Council of Health Informatics Professions has suggested eight key constituencies within the domain—information management, knowledge management, portfolio/program/project management, ICT, education and research, clinical informatics, health records(service and business-related), health informatics service management. These constituencies accommodate professionals in and for the NHS, in academia and commercial service and solution providers.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Since the 1970s the most prominent international coordinating body has been the International Medical Informatics Association (IMIA).[44]

In the United States
Even though the idea of using computers in medicine emerged as technology advanced in the early 20th century, it was not until the 1950s that informatics began to have an effect in the United States.[41]

The earliest use of electronic digital computers for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.[45] During the mid-1950s, the United States Air Force (USAF) carried out several medical projects on its computers while also encouraging civilian agencies such as the National Academy of Sciences – National Research Council (NAS-NRC) and the National Institutes of Health (NIH) to sponsor such work.[46] In 1959, Ledley and Lee B. Lusted published “Reasoning Foundations of Medical Diagnosis,” a widely read article in Science, which introduced computing (especially operations research) techniques to medical workers. Ledley and Lusted’s article has remained influential for decades, especially within the field of medical decision making.[47]

Guided by Ledley’s late 1950s survey of computer use in biology and medicine (carried out for the NAS-NRC), and by his and Lusted’s articles, the NIH undertook the first major effort to introduce computers to biology and medicine. This effort, carried out initially by the NIH’s Advisory Committee on Computers in Research (ACCR), chaired by Lusted, spent over $40 million between 1960 and 1964 in order to establish dozens of large and small biomedical research centers in the US.[46]

One early (1960, non-ACCR) use of computers was to help quantify normal human movement, as a precursor to scientifically measuring deviations from normal, and design of prostheses.[48] The use of computers (IBM 650, 1620, and 7040) allowed analysis of a large sample size, and of more measurements and subgroups than had been previously practical with mechanical calculators, thus allowing an objective understanding of how human locomotion varies by age and body characteristics. A study co-author was Dean of the Marquette University College of Engineering; this work led to discrete Biomedical Engineering departments there and elsewhere.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The next steps, in the mid-1960s, were the development (sponsored largely by the NIH) of expert systems such as MYCIN and Internist-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. Around this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett’s Laboratory of Computer Science[49] at Massachusetts General Hospital in Boston, another center of biomedical computing that received significant support from the NIH.[50] In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendent of this system is being used in the United States Veterans Affairs hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA’s over 1,000 health care facilities.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

During the 1960s, Morris Collen, a physician working for Kaiser Permanente’s Division of Research, developed computerized systems to automate many aspects of multi-phased health checkups. These systems became the basis the larger medical databases Kaiser Permanente developed during the 1970s and 1980s.[51] The American College of Medical Informatics (ACMI) has since 1993 annually bestowed the Morris F. Collen, MD Medal for Outstanding Contributions to the Field of Medical Informatics.[52] Kaiser permanente

In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems. In 1970, Warner V. Slack, MD, and Howard L. Bleich, MD, co-founded the academic division of clinical informatics[53] at Beth Israel Deaconess Medical Center and Harvard Medical School. Warner Slack is a pioneer of the development of the electronic patient medical history,[54] and in 1977 Dr. Bleich created the first user-friendly search engine for the worlds biomedical literature.[55] In 2002, Dr. Slack and Dr. Bleich were awarded the Morris F. Collen Award for their pioneering contributions to medical informatics.[56]

Computerized systems involved in patient care have led to a number of changes. Such changes have led to improvements in electronic health records which are now capable of sharing medical information among multiple healthcare stakeholders(Zahabi, Kaber, & Swangnetr, 2015); thereby, supporting the flow of patient information through various modalities of care.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Computer use today involves a broad ability which includes but isn’t limited to physician diagnosis and documentation, patient appointment scheduling, and billing. Many researchers in the field have identified an increase in the quality of healthcare systems, decreased errors by healthcare workers, and lastly savings in time and money (Zahabi, Kaber, & Swangnetr, 2015). The system, however, is not perfect and will continue to require improvement. Frequently cited factors of concern involve usability, safety, accessibility, and user-friendliness (Zahabi, Kaber, & Swangnetr, 2015). As leaders in the field of medical informatics improve upon the aforementioned factors of concern, the overall provision of health care will continue to improve.[57][58]

Homer R. Warner, one of the fathers of medical informatics,[59] founded the Department of Medical Informatics at the University of Utah in 1968. The American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.

Informatics certifications
Like other IT training specialties, there are Informatics certifications available to help informatics professionals stand out and be recognized. The American Nurses Credentialing Center (ANCC) offers a board certification in Nursing Informatics.[60] For Radiology Informatics, the CIIP (Certified Imaging Informatics Professional) certification was created by ABII (The American Board of Imaging Informatics) which was founded by SIIM (the Society for Imaging Informatics in Medicine) and ARRT (the American Registry of Radiologic Technologists) in 2005. The CIIP certification requires documented experience working in Imaging Informatics, formal testing and is a limited time credential requiring renewal every five years. The exam tests for a combination of IT technical knowledge, clinical understanding, and project management experience thought to represent the typical workload of a PACS administrator or other radiology IT clinical support role.[61] Certifications from PARCA (PACS Administrators Registry and Certifications Association) are also recognized. The five PARCA certifications are tiered from entry-level to architect level. The American Health Information Management Association offers credentials in medical coding, analytics, and data administration, such as Registered Health Information Administrator and Certified Coding Associate.[62]

Certifications are widely requested by employers in health informatics, and overall the demand for certified informatics workers in the United States is outstripping supply.[63] The American Health Information Management Association reports that only 68% of applicants pass certification exams on the first try.[64]

In 2017, a consortium of health informatics trainers (composed of MEASURE Evaluation, Public Health Foundation India, University of Pretoria, Kenyatta University, and the University of Ghana) identified the following areas of knowledge as a curriculum for the digital health workforce, especially in low- and middle-income countries: clinical decision support; telehealth; privacy, security, and confidentiality; workflow process improvement; technology, people, and processes; process engineering; quality process improvement and health information technology; computer hardware; software; databases; data warehousing; information networks; information systems; information exchange; data analytics; and usability methods.[65]NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In the UK
The broad history of health informatics has been captured in the book UK Health Computing: Recollections and reflections, Hayes G, Barnett D (Eds.), BCS (May 2008) by those active in the field, predominantly members of BCS Health and its constituent groups. The book describes the path taken as ‘early development of health informatics was unorganized and idiosyncratic’. In the early 1950s, it was prompted by those involved in NHS finance and only in the early 1960s did solutions including those in pathology (1960), radiotherapy (1962), immunization (1963), and primary care (1968) emerge. Many of these solutions, even in the early 1970s were developed in-house by pioneers in the field to meet their own requirements. In part, this was due to some areas of health services (for example the immunization and vaccination of children) still being provided by Local Authorities. Interesting, this is a situation which the coalition government proposes broadly to return to in the 2010 strategy Equity and Excellence: Liberating the NHS (July 2010); stating:NURSING 3005 – Nursing in Complex Settings Assignment Papers.

“We will put patients at the heart of the NHS, through an information revolution and greater choice and control’ with shared decision-making becoming the norm: ‘no decision about me without me’ and patients having access to the information they want, to make choices about their care. They will have increased control over their own care records.”

These types of statements present a significant opportunity for health informaticians to come out of the back-office and take up a front-line role in supporting clinical practice, and the business of care delivery. The UK health informatics community has long played a key role in the international activity, joining TC4 of the International Federation of Information Processing (1969) which became IMIA (1979). Under the aegis of BCS Health, Cambridge was the host for the first EFMI Medical Informatics Europe (1974) conference and London was the location for IMIA’s tenth global congress (MEDINFO2001).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Current state and policy initiatives

This article reads like a review rather than an encyclopedic description of the subject. Please help improve this article to make it neutral in tone and meet Wikipedia’s quality standards. (August 2009)
Argentina
Since 1997, the Buenos Aires Biomedical Informatics Group, a nonprofit group, represents the interests of a broad range of clinical and non-clinical professionals working within the Health Informatics sphere. Its purposes are:

Promote the implementation of the computer tool in the healthcare activity, scientific research, health administration and in all areas related to health sciences and biomedical research.
Support, promote and disseminate content related activities with the management of health information and tools they used to do under the name of Biomedical informatics.
Promote cooperation and exchange of actions generated in the field of biomedical informatics, both in the public and private, national and international level.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Interact with all scientists, recognized academic stimulating the creation of new instances that have the same goal and be inspired by the same purpose.
To promote, organize, sponsor and participate in events and activities for training in computer and information and disseminating developments in this area that might be useful for team members and health related activities.
The Argentinian health system is heterogeneous in its function, and because of that the informatics developments show a heterogeneous stage. Many private Health Care center have developed systems, such as the Hospital Aleman of Buenos Aires, or the Hospital Italiano de Buenos Aires that also has a residence program for health informatics.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Brazil
Main article: Brazilian Society of Health Informatics
The first applications of computers to medicine and healthcare in Brazil started around 1968, with the installation of the first mainframes in public university hospitals, and the use of programmable calculators in scientific research applications. Minicomputers, such as the IBM 1130 were installed in several universities, and the first applications were developed for them, such as the hospital census in the School of Medicine of Ribeirão Preto and patient master files, in the Hospital das Clínicas da Universidade de São Paulo, respectively at the cities of Ribeirão Preto and São Paulo campuses of the University of São Paulo. In the 1970s, several Digital Corporation and Hewlett Packard minicomputers were acquired for public and Armed Forces hospitals, and more intensively used for intensive-care unit, cardiology diagnostics, patient monitoring and other applications. In the early 1980s, with the arrival of cheaper microcomputers, a great upsurge of computer applications in health ensued, and in 1986 the Brazilian Society of Health Informatics was founded, the first Brazilian Congress of Health Informatics was held, and the first Brazilian Journal of Health Informatics was published. In Brazil, two universities are pioneers in teaching and research in Medical Informatics, both the University of Sao Paulo and the Federal University of Sao Paulo offer undergraduate programs highly qualified in the area as well as extensive graduate programs (MSc and PhD). In 2015 the Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, also started to offer undergraduate program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Canada
Health Informatics projects in Canada are implemented provincially, with different provinces creating different systems. A national, federally funded, not-for-profit organization called Canada Health Infoway was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008 there were 276 EHR projects under way in Canadian hospitals, other health-care facilities, pharmacies and laboratories, with an investment value of $1.5-billion from Canada Health Infoway.[66]

Provincial and territorial programmes include the following:

eHealth Ontario was created as an Ontario provincial government agency in September 2008. It has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009.[67] Alberta Netcare was created in 2003 by the Government of Alberta. Today the netCARE portal is used daily by thousands of clinicians. It provides access to demographic data, prescribed/dispensed drugs, known allergies/intolerances, immunizations, laboratory test results, diagnostic imaging reports, the diabetes registry and other medical reports. netCARE interface capabilities are being included in electronic medical record products which are being funded by the provincial government.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
United States
In 2004, President George W. Bush signed Executive Order 13335,[68] creating the Office of the National Coordinator for Health Information Technology (ONCHIT) as a division of the U.S. Department of Health and Human Services (HHS). The mission of this office is widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. See quality improvement organizations for more information on federal initiatives in this area.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In 2014 The Department of Education approved an advanced Health Informatics Undergraduate program that was submitted by The University of South Alabama. The program is designed to provide specific Health Informatics education, and is the only program in the country with a Health Informatics Lab. The program is housed in The School of Computing in Shelby Hall, a recently completed $50 million state of the art teaching facility. The University of South Alabama awarded David L. Loeser on May 10, 2014 with the first Health Informatics degree. The program currently is scheduled to have 100+ students awarded by 2016.

The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July 2006, CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.[69]

Harvard Medical School added a department of biomedical informatics in 2015.[70] The University of Cincinnati in partnership with Cincinnati Children’s Hospital Medical Center created a biomedical informatics (BMI) Graduate certificate program and in 2015 began a BMI PhD program.[71][72][73] The joint program allows for researchers and students to observe the impact their work has on patient care directly as discoveries are translated from bench to bedside.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Europe
Further information: European Federation for Medical Informatics
The European Union’s Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality health care at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union’s strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.[74][75] The European Institute for Health Records is involved in the promotion of high quality electronic health record systems in the European Union.[76]

UK
There are different models of health informatics delivery in each of the home countries (England, Scotland, Northern Ireland and Wales) but some bodies like UKCHIP[77] (see below) operate for those ‘in and for’ all the home countries and beyond.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

England
NHS informatics in England was contracted out to several vendors for national health informatics solutions under the National Programme for Information Technology (NPfIT) label in the early to mid-2000s, under the auspices of NHS Connecting for Health (part of the Health and Social Care Information Centre as of 1 April 2013). NPfIT originally divided the country into five regions, with strategic ‘systems integration’ contracts awarded to one of several Local Service Providers (LSP). NURSING 3005 – Nursing in Complex Settings Assignment Papers. The various specific technical solutions were required to connect securely with the NHS ‘Spine’, a system designed to broker data between different systems and care settings. NPfIT fell significantly behind schedule and its scope and design were being revised in real time, exacerbated by media and political lambasting of the Programme’s spend (past and projected) against the proposed budget. In 2010 a consultation was launched as part of the new Conservative/Liberal Democrat Coalition Government’s White Paper ‘Liberating the NHS’. This initiative provided little in the way of innovative thinking, primarily re-stating existing strategies within the proposed new context of the Coalition’s vision for the NHS. The degree of computerization in NHS secondary care was quite high before NPfIT, and the programme stagnated further development of the install base – the original NPfIT regional approach provided neither a single, nationwide solution nor local health community agility or autonomy to purchase systems, but instead tried to deal with a hinterland in the middle.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Almost all general practices in England and Wales are computerized under the GP Systems of Choice (GPSoC)[78] programme, and patients have relatively extensive computerized primary care clinical records. System choice is the responsibility of individual general practices and while there is no single, standardized GP system, GPSoC sets relatively rigid minimum standards of performance and functionality for vendors to adhere to. Interoperation between primary and secondary care systems is rather primitive. It is hoped that a focus on interworking (for interfacing and integration) standards will stimulate synergy between primary and secondary care in sharing necessary information to support the care of individuals. Notable successes to date are in the electronic requesting and viewing of test results, and in some areas, GPs have access to digital x-ray images from secondary care systems.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Scotland
Scotland has an approach to the central connection underway which is more advanced than the English one in some ways. Scotland has the GPASS system whose source code is owned by the State, and controlled and developed by NHS Scotland. GPASS was accepted in 1984. It has been provided free to all GPs in Scotland but has developed poorly.[citation needed] Discussion of open sourcing it as a remedy is occurring.

Wales
Wales has a dedicated Health Informatics function that supports NHS Wales in leading on the new integrated digital information services and promoting Health Informatics as a career.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Netherlands
In the Netherlands, health informatics is currently a priority for research and implementation. The Netherlands Federation of University medical centers (NFU)[79] has created the Citrienfonds, which includes the programs eHealth and Registration at the Source.[80] The Netherlands also has the national organizations Society for Healthcare Informatics (VMBI)[81] and Nictiz, the national center for standardization and eHealth.[82]

Emerging Directions (European R&D)
The European Commission’s preference, as exemplified in the 5th Framework[83] as well as currently pursued pilot projects,[84] is for Free/Libre and Open Source Software (FLOSS) for healthcare. Another stream of research currently focuses on aspects of “big data” in health information systems. For background information on data-related aspects in health informatics see, e.g., the book “Biomedical Informatics”[85] by Andreas Holzinger.

Asia and Oceania
In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI)[86] was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Australia
The Australasian College of Health Informatics (ACHI) is the professional association for health informatics in the Asia-Pacific region. It represents the interests of a broad range of clinical and non-clinical professionals working within the health informatics sphere through a commitment to quality, standards and ethical practice.[87] ACHI is an academic institutional member of the International Medical Informatics Association (IMIA)[88] and a full member of the Australian Council of Professions.[89] ACHI is a sponsor of the “e-Journal for Health Informatics”,[90] an indexed and peer-reviewed professional journal. ACHI has also supported the “Australian Health Informatics Education Council” (AHIEC) since its founding in 2009.[91]

Although there are a number of health informatics organizations in Australia, the Health Informatics Society of Australia[92] (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA). Nursing informaticians were the driving force behind the formation of HISA, which is now a company limited by guarantee of the members. The membership comes from across the informatics spectrum that is from students to corporate affiliates. HISA has a number of branches (Queensland, New South Wales, Victoria and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

China
After 20 years, China performed a successful transition from its planned economy to a socialist market economy. Along this change, China’s healthcare system also experienced a significant reform to follow and adapt to this historical revolution. In 2003, the data (released from Ministry of Health of the People’s Republic of China (MoH)), indicated that the national healthcare-involved expenditure was up to RMB 662.33 billion totally, which accounted for about 5.56% of nationwide gross domestic products. Before the 1980s, the entire healthcare costs were covered in central government annual budget. Since that, the construct of healthcare-expended supporters started to change gradually. Most of the expenditure was contributed by health insurance schemes and private spending, which corresponded to 40% and 45% of total expenditure, respectively. Meanwhile, the financially governmental contribution was decreased to 10% only. On the other hand, by 2004, up to 296,492 healthcare facilities were recorded in statistic summary of MoH, and an average of 2.4 clinical beds per 1000 people were mentioned as well.[93]NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In China

Proportion of nationwide hospitals with HIS in China by 2004
Along with the development of information technology since the 1990s, healthcare providers realized that the information could generate significant benefits to improve their services by computerized cases and data, for instance of gaining the information for directing patient care and assessing the best patient care for specific clinical conditions. Therefore, substantial resources were collected to build China’s own health informatics system. Most of these resources were arranged to construct hospital information system (HIS), which was aimed to minimize unnecessary waste and repetition, subsequently to promote the efficiency and quality-control of healthcare.[94] By 2004, China had successfully spread HIS through approximately 35–40% of nationwide hospitals.[95] However, the dispersion of hospital-owned HIS varies critically. In the east part of China, over 80% of hospitals constructed HIS, in northwest of China the equivalent was no more than 20%. Moreover, all of the Centers for Disease Control and Prevention (CDC) above rural level, approximately 80% of healthcare organisations above the rural level and 27% of hospitals over town level have the ability to perform the transmission of reports about real-time epidemic situation through public health information system and to analysis infectious diseases by dynamic statistics.[96]

China has four tiers in its healthcare system. The first tier is street health and workplace clinics and these are cheaper than hospitals in terms of medical billing and act as prevention centers. The second tier is district and enterprise hospitals along with specialist clinics and these provide the second level of care. The third tier is provisional and municipal general hospitals and teaching hospitals which provided the third level of care.NURSING 3005 – Nursing in Complex Settings Assignment Papers.  In a tier of its own is the national hospitals which are governed by the Ministry of Health. China has been greatly improving its health informatics since it finally opened its doors to the outside world and joined the World Trade Organization (WTO). In 2001, it was reported that China had 324,380 medical institutions and the majority of those were clinics. The reason for that is that clinics are prevention centers and Chinese people like using traditional Chinese medicine as opposed to Western medicine and it usually works for the minor cases. China has also been improving its higher education in regards to health informatics. At the end of 2002, there were 77 medical universities and medical colleges. There were 48 university medical colleges which offered bachelor, master, and doctorate degrees in medicine. There were 21 higher medical specialty institutions that offered diploma degrees so in total, there were 147 higher medical and educational institutions. Since joining the WTO, China has been working hard to improve its education system and bring it up to international standards.[97] SARS played a large role in China quickly improving its healthcare system. Back in 2003, there was an outbreak of SARS and that made China hurry to spread HIS or Hospital Information System and more than 80% of hospitals had HIS. China had been comparing itself to Korea’s healthcare system and figuring out how it can better its own system. There was a study done that surveyed six hospitals in China that had HIS. The results were that doctors didn’t use computers as much so it was concluded that it wasn’t used as much for clinical practice than it was for administrative purposes. The survey asked if the hospitals created any websites and it was concluded that only four of them had created websites and that three had a third-party company create it for them and one was created by the hospital staff. In conclusion, all of them agreed or strongly agreed that providing health information on the Internet should be utilized.[98]

Standards in China
Collected information at different times, by different participants or systems could frequently lead to issues of misunderstanding, dis-comparing or dis-exchanging. NURSING 3005 – Nursing in Complex Settings Assignment Papers. To design an issues-minor system, healthcare providers realized that certain standards were the basis for sharing information and interoperability, however a system lacking standards would be a large impediment to interfere the improvement of corresponding information systems. Given that the standardization for health informatics depends on the authorities, standardization events must be involved with government and the subsequently relevant funding and supports were critical. In 2003, the Ministry of Health released the Development Lay-out of National Health Informatics (2003–2010)[99] indicating the identification of standardization for health informatics which is ‘combining adoption of international standards and development of national standards’.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In China, the establishment of standardization was initially facilitated with the development of vocabulary, classification and coding, which is conducive to reserve and transmit information for premium management at national level. By 2006, 55 international/ domestic standards of vocabulary, classification and coding have served in hospital information system. In 2003, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the ICD-10 Clinical Modification (ICD-10-CM) were adopted as standards for diagnostic classification and acute care procedure classification. Simultaneously, the International Classification of Primary Care (ICPC) were translated and tested in China ‘s local applied environment.[100] Another coding standard, named Logical Observation Identifiers Names and Codes (LOINC), was applied to serve as general identifiers for clinical observation in hospitals.NURSING 3005 – Nursing in Complex Settings Assignment Papers.  Personal identifier codes were widely employed in different information systems, involving name, sex, nationality, family relationship, educational level and job occupation. However, these codes within different systems are inconsistent, when sharing between different regions. Considering this large quantity of vocabulary, classification and coding standards between different jurisdictions, the healthcare provider realized that using multiple systems could generate issues of resource wasting and a non-conflicting national level standard was beneficial and necessary. Therefore, in late 2003, the health informatics group in Ministry of Health released three projects to deal with issues of lacking national health information standards, which were the Chinese National Health Information Framework and Standardization, the Basic Data Set Standards of Hospital Information System and the Basic Data Set Standards of Public Health Information System.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Objectives of Chinese National Health Information Framework and Standardisation
1. Establish national health information framework and identify in what areas standards and guidelines are required
2. Identify the classes, relationships and attributes of national health information framework. Produce a conceptual health data model to cover the scope of the health information framework
3. Create logical data model for specific domains, depicting the logical data entities, the data attributes, and the relationships between the entities according to the conceptual health data model
4. Establish uniform represent standard for data elements according to the data entities and their attributes in conceptual data model and logical data model
5. Circulate the completed health information framework and health data model to the partnership members for review and acceptance
6. Develop a process to maintain and refine the China model and to align with and influence international health data models
[93]

Comparison between China’s EHR Standard and Segments of the ASTM E 1384 Standard
Recently, researchers from local universities evaluated the performance of China’s Electronic Health Record (EHR) Standard compared with the American Society for Testing and Materials Standard Practice for Content and Structure of Electronic Health Records in the United States (ASTM E 1384 Standard).[101]

China’sEHR standard ASTM E 1384 standard
●　 H.01 Document identifier, H.02 Service object identifier, H.03 Demographics, H.04 Contact person, H.05 Address, H.06 Contacts ●　 Seg1 Demographic/Administrative, Seg14A Administrative/Diagnostic
Summary

●　 H.07 Medical insurance
●　 H.08 Healthcare institution, H.09 Healthcare practitioner ●　 Seg4 Provider/Practitioners
●　 H.10 Event summary ●　 Seg5 Problem List, Seg14A Administrative/Diagnostic Summary
●　 S.01 Chief complaints ●　 Seg14B Chief Complaint Present Illness/Trauma Care
●　 S.02 Physical exam ●　 Seg9 Assessments/Exams
●　 S.03 Present illness history ●　 Seg14B Chief Complaint Present Illness/Trauma Care
●　 S.04 Past medical history ●　 Seg5 Problem List, Seg6 Immunizations, Seg7 Exposure to Hazardous Substances, Seg8 Family/Prenatal/Cumulative Health/Medical/Dental Nursing History
●　 S.05 Specific Exam, S.06 Lab data ●　 Seg11 Diagnostic Tests
●　 S.07 Diagnoses ●　 Seg5 Problem List, Seg14A Administrative/Diagnostic Summary
●　 S.08 Procedures ●　 Seg14E Procedures
●　 S.09 Medications ●　 Seg12 Medications
●　 S.10 Care/treatment plans ●　 Seg2 Legal Agreements, Seg10 Care/Treatment Plans and Orders, Seg13 Scheduled Appointments/Events
●　 S.11 Assessments ●　 Seg9 Assessments/Exams
●　 S.12 Encounters/episodes notes ●　 Seg14C Progress Notes/Clinical Course, Seg14D Therapies, Seg14F Disposition
●　 S.13 Financial information ●　 Seg3 Financial
●　 S.14 Nursing service ●　 Seg8 Family/Prenatal/Cumulative Health/Medical/Dental Nursing History, Seg14D Therapies
●　 S.15 Health guidance ●　 Seg10 Care/Treatment Plans and Orders
●　 S.16 Four diagnostic methods in Traditional Chinese medicine ●　 Seg11 Diagnostic Tests
The table above demonstrates details of this comparison which indicates certain domains of improvement for future revisions of EHR Standard in China. Meticulously, these deficiencies are listed in the following.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The lack of supporting on privacy and security. The ISO/TS 18308 specifies “The EHR must support the ethical and legal use of personal information, in accordance with established privacy principles and frameworks, which may be culturally or jurisdictionally specific” (ISO 18308: Health Informatics-Requirements for an Electronic Health Record Architecture, 2004). However this China’s EHR Standard did not achieve any of the fifteen requirements in the subclass of privacy and security.
The shortage of supporting on different types of data and reference. Considering only ICD-9 is referenced as China’s external international coding systems, other similar systems, such as SNOMED CT in clinical terminology presentation, cannot be considered as familiar for Chinese specialists, which could lead to internationally information-sharing deficiency.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The lack of more generic and extensible lower level data structures. China’s large and complex EHR Standard was constructed for all medical domains. However, the specific and time-frequent attributes of clinical data elements, value sets and templates identified that this once-for-all purpose cannot lead to practical consequence.[102] Hong Kong
In Hong Kong a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. This system has been deployed at all the sites of the authority (40 hospitals and 120 clinics). It is used for up to 2 million transactions daily by 30,000 clinical staff. The comprehensive records of 7 million patients are available on-line in the electronic patient record (ePR), with data integrated from all sites. Since 2004 radiology image viewing has been added to the ePR, with radiography images from any HA site being available as part of the ePR.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development, with input from hundreds of clinicians being incorporated through a structured process. The health informatics section in the Hospital Authority[103] has a close relationship with the information technology department and clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare. The eHealth Consortium has been formed to bring together clinicians from both the private and public sectors, medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong.[104]

India
Main article: Indian Association for Medical Informatics
eHCF School of Medical Informatics[105] eHealth-Care Foundation[106] Malaysia
Since 2010, the Ministry of Health (MoH) has been working on the Malaysian Health Data Warehouse (MyHDW) project. MyHDW aims to meet the diverse needs of timely health information provision and management, and acts as a platform for the standardization and integration of health data from a variety of sources (Health Informatics Centre, 2013). The Ministry has embarked on introducing the electronic Hospital Information Systems (HIS) in several public hospitals including Serdang Hospital, Selayang Hospital and University Kebangsaan Malaysia Medical Centre (UKMMC) under the Ministry of Higher Education (MOHE).

A hospital information system (HIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. As an area of medical informatics, the aim of hospital information system is to achieve the best possible support of patient care and administration by electronic data processing. HIS plays a vital role in planning, initiating, organizing and controlling the operations of the subsystems of the hospital and thus provides a synergistic organization in the process.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

New Zealand
Health informatics is taught at five New Zealand universities. The most mature and established programme has been offered for over a decade at Otago.[107] Health Informatics New Zealand (HINZ), is the national organisation that advocates for health informatics. HINZ organises a conference every year and also publishes a journal- Healthcare Informatics Review Online.

Saudi Arabia
The Saudi Association for Health Information (SAHI) was established in 2006[108] to work under direct supervision of King Saud bin Abdulaziz University for Health Sciences to practice public activities, develop theoretical and applicable knowledge, and provide scientific and applicable studies.[109]

Post-Soviet countries
The Russian Federation
The Russian healthcare system is based on the principles of the Soviet healthcare system, which was oriented on mass prophylaxis, prevention of infection and epidemic diseases, vaccination and immunization of the population on a socially protected basis. The current government healthcare system consists of several directions:

Preventive health care
Primary health care
Specialized medical care
Obstetrical and gynecologic medical care
Pediatric medical care
Surgery
Rehabilitation/ Health resort treatment
One of the main issues of the post-Soviet medical health care system was the absence of the united system providing optimization of work for medical institutes with one, single database and structured appointment schedule and hence hours-long lines. Efficiency of medical workers might have been also doubtful because of the paperwork administrating or lost book records.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Along with the development of the information systems IT and healthcare departments in Moscow agreed on design of a system that would improve public services of health care institutes. Tackling the issues appearing in the existing system, the Moscow Government ordered that the design of a system would provide simplified electronic booking to public clinics and automate the work of medical workers on the first level.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The system designed for that purposes was called EMIAS (United Medical Information and Analysis System) and presents an electronic health record (EHR) with the majority of other services set in the system that manages the flow of patients, contains outpatient card integrated in the system, and provides an opportunity to manage consolidated managerial accounting and personalized list of medical help. Besides that, the system contains information about availability of the medical institutions and various doctors.

The implementation of the system started in 2013 with the organization of one computerized database for all patients in the city, including a front-end for the users. EMIAS was implemented in Moscow and the region and it is planned that the project should extend to most parts of the country.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Law
Further information: Health law
Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. It addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. Health Informatics Law also applies to all matters that involve information technology, health care and the interaction of information. It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care.

As many healthcare systems are making an effort to have patient records more readily available to them via the internet, it is important that providers implement security standards in order to ensure that the patients’ information is safe. They have to be able to assure confidentiality, integrity, and security of the people, process, and technology. Since there is also the possibility of payments being made through this system, it is vital that this aspect of their private information will also be protected through cryptography.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The use of technology in health care settings has become popular and this trend is expected to continue. Various healthcare facilities had instigated different kinds of health information technology systems in the provision of patient care, such as electronic health records (EHRs), computerized charting, etc.[110] The growing popularity of health information technology systems and the escalation in the amount of health information that can be exchanged and transferred electronically increased the risk of potential infringement in patients’ privacy and confidentiality.[111] This concern triggered the establishment of strict measures by both policymakers and individual facility to ensure patient privacy and confidentiality.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

One of the federal laws enacted to safeguard patient’s health information (medical record, billing information, treatment plan, etc.) and to guarantee patient’s privacy is the Health Insurance Portability and Accountability Act of 1996 or HIPAA.[112] HIPAA gives patients the autonomy and control over their own health records.[112] Furthermore, according to the U.S. Department of Health & Human Services (n.d.), this law enables patients to do the following:[112]

Allows patients to view their own health records
Permits patients to request for a copy of their own medical records
Modify any incorrect health information
Provides patients with the right to know who has access to their health record
Grants patients the right to request who can and cannot view/access their health information
Health and medical informatics journals
See also: List of medical and health informatics journals

Impact factors of scholarly journals publishing digital health (ehealth, mhealth) work
Computers in Biomedical and Research, published in 1967, was one of the first dedicated journals to health informatics. Other early journals included Computers and Medicine, published by the American Medical Association; Journal of Clinical Computing, published by Gallagher Printing, Journal of Medical Systems, published by Plenum Press, and MD Computing, published by Springer-Veriag. In 1984, Lippincott published the first nursing-specific journal, titled Journal Computers in Nursing, which is now known as Computers Informatics Nursing (CIN) Journal.[113]

Today, there are many health and medical informatics journals. As of September 7, 2016, there are roughly 235 informatics journals listed in the National Library of Medicine (NLM) catalog of journals.[114]

High performing health systems are critical to address key health challenges faced by Member
States in the European region, such as changes in disease burden and population dynamics, in
governance and funding mechanisms, and in technology and clinical management practice.
Against this background many countries have significantly invested in strengthening the primary
care level including the development of home-based care programmes. At the same time,
hospitals remain essential for the delivery of complex acute specialised care. Hospitals form an
important part of health spending and play an important role in shaping public perception of the
performance of countries’ health systems, and, thus, their political visibility.

The World Health Organization (WHO) acknowledges that due attention must be given to all levels of care as well as the integration and coordination of functions and care mechanisms to meet the challenges of an ageing population, with increasing expectations of service quality and safety and with the ability to access these services nationally and through cross border care.

Work in this field in the European context is closely linked to the global initiative started by WHO headquarters in identifying key questions to be addressed by the global hospital agenda within the wider context of coordinated care. Experiences from various countries and regions of the world can be used to initiate a review of the place, role and function of hospitals within changing health systems, to support all Member States in the challenging process to remodel their hospitals appropriately and to build capacity to support health care delivery reform. The workshop ‘Modern health care delivery systems and the role of hospitals’ aimed to contribute to moving a step further on the road to better integration and coordination of health care service delivery, through:

• Reviewing the current situation in relation to hospital and health system reforms across
the region, including the patient choice perspective
• Creating a shared understanding of current state of healthcare delivery systems and their
capacity and willingness to address change
• Sharing stakeholders experiences and best practice models, both theoretical and applied,
in search of optimised solutions to increase health care delivery performance
• Identifying unanswered questions, gaps in our knowledge and areas where further
research is needed
• Agreeing on priority areas for future work
• Developing a roadmap for action led by WHO Europe with stakeholders to support
Member States in these areas for the coming two years
The workshop began with an opening session that set the context for workshop panel
discussions. It included presentations of the WHO global approach to strengthening health
systems and the WHO Europe strategy for health care delivery systems and public health, the
Belgian vision of and experience in improving health care delivery and EU presidencies’
priorities in promoting European health and the Health 2020 agenda. The opening session was
followed by a series of panel discussions which focused on (1) Public health, primary and
integrated/ coordinated care; (2) Planning for hospitals/ the future role of hospitals; (3)
Governance of hospitals and integrated care; (4) Payment systems and capital investment in
Modern health care delivery systems, care coordination and the role of hospitals
page 2
health care delivery; and (5) Workforce issues. The final session of the workshop, on the
development of a ‘road map’ of future options for the health system, priority areas and next
steps, was continued with an internal expert meeting, at the beginning of 2012.
The following presents a summary of presentations and discussions at the workshop, and
includes the merged preliminary discussion notes (both meetings mentioned above) on planned
developments in the ‘road map’ section.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Setting the context
The opening session identified a set of key challenges facing health systems in the European
region. These are:
• Ageing and the rising burden of (multiple) chronic conditions
• Unequal distribution of health across the region
• Financial crisis raises concerns of affordability and sustainability
• Access to technological advances and medicines
• Fragmentation, commercialisation and hospital-centric systems
The long-term nature of many chronic diseases, and in particular multiple conditions, calls for a
comprehensive health system response that brings together a trained workforce with appropriate
skills, affordable technologies, reliable supply of medicines, referral systems, and active
engagement of people with chronic health problems to manage their own care, all acting over a
sustained period of time. Many systems are not well equipped for providing this comprehensive
response, coming from a tradition of an acute, episodic model of care.
It is against this background that the re-launch of discussions on the role of hospitals in health
systems has been initiated1
. Pressure for change emerges from changing demographics and the
burden of disease, supply issues linked to technology and workforce against financial pressures,
as well as broad social changes because of globalization, government and sectoral reforms.
These pressures need to be balanced against enabling people to live longer and healthier lives
and participate in society, ensuring fair and equitable access to treatment and technologies,
involvement in health care decision-making, being treated with respect and dignity, and enjoying
the benefits of effective and efficient services.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
There has been increasing convergence of equity and health systems agendas as demonstrated by
the reports of the Commission on Social Determinants of Health2 and the WHO reports on health
financing and on health systems3
, among others. These underline the need for the development
of a health systems regulated framework bringing together the basic elements of organising care
towards a people-centred primary care system, which acts as a hub for coordination and is

1 Presentation by Denis Porignon
2 World Health Organisation, 2008. Commission on Social Determinants of Health – final report. Available at
http://www.who.int/social_determinants/thecommission/finalreport/en/index.html 3 World Health Organisation, 2010. The world health report – Health systems financing: the path to universal
coverage. Available at http://www.who.int/whr/2010/en/index.html. World Health Organisation, 2000. The world
health report 2000 – Health systems: improving performance. Available at http://www.who.int/whr/2000/en/
Modern health care delivery systems, care coordination and the role of hospitals
page 3
supported by hospitals (Figure 1). This approach sees hospitals as an important part of the wider
health system, providing a highly valued ‘rescue’ function for life-threatening conditions, and
that can improve treatment outcomes by focusing technology/expertise where necessary. At the
core of this framework are primary care providers who hold the responsibility for the health of a
defined population and act as the primary entry point to the health system while hospitals form
part of health care networks to fill the availability
Modern health care delivery systems, care coordination and the role of hospitals
page 4
and management of primary care7
, as well as ongoing work on the role of hospitals in the context
of integrated health care delivery8
. While not a new framework as such, it provides a renewed
focus on key health outcomes to better link health gain and health system strengthening through
the removal of health system bottlenecks and aiming towards the development of a vision and
strategy by WHO Europe on service delivery.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The need to refocus health system strengthening on health gain is illustrated by the challenge
posed by the rising burden of multiple chronic health problems, requiring a paradigm shift from
‘problem oriented’ care to ‘goal oriented’ care9
. A disease- or problem oriented focus may lead
to a new form of inequity that is determined by the nature of the condition, so potentially
creating “inequity by disease”. Instead, goal orientation emphasizes patient functioning and
social participation, in addition to clinical measures as the core outcomes of effective care. Such
reorientation however requires better integration within and between sectors, with potential
future models of care illustrated in Figure 2. Such a move will face challenges, in particular
regarding the required shift of resources from hospital to ambulatory secondary and primary
health care, implying a need to involve all stakeholders, with a central role for patients in this
process.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Figure 2. New models of care
Source: Degeling and Erskine, 200910
The need for such a shift is also highlighted by the European Union’s draft ‘Health for Growth
Programme, the third multi-annual programme of EU action in the field of health for the period

7 World Health Organisation Regional Office for Europe. Primary Care Evaluation Tool (PCET). Available at
http://www.euro.who.int/en/what-we-do/health-topics/Health-systems/primary-healthcare/publications/2010/primary-care-evaluation-tool-pcet 8 European Observatory on Health Systems and Policies. Investing in hospitals of the future, Observatory Studies
Series, No.16. Available at http://www.euro.who.int/__data/assets/pdf_file/0009/98406/E92354.pdf 9 Presentation by Jan de Maeseneer
10 Degeling P, Erskine J. New models of long-term care and implications for service redesign. In Rechel B, Wright
S, Edwards N, Dowdeswell B, eds. Investing in hospitals of the future. Copenhagen: World Health Organization on
behalf of the European Observatory on Health Systems and Policies, 2009: 27-44.
Modern health care delivery systems, care coordination and the role of hospitals
page 5
2014-2020’11, which focuses on the links between economic growth and a healthy population. In
line with Europe 2020 objectives and policy priorities12, it is aimed at supporting Member
States’ efforts to improve the efficiency and financial sustainability of their health systems
through the identification and implementation of innovative solutions for improving the quality,
efficiency and sustainability of health systems. Specifically, the programme aims to encourage a
shift of resources in the health care sector towards “the most innovative and valuable products
and services” while also seeking to support a greater shift towards community care and
integrated care.
The 2011 ‘Council conclusions; towards modern, responsive and sustainable health systems’
under the Hungarian Presidency further emphasise innovative approaches and models of health
care focusing on effective investment with the overall aim of “moving away from hospitalcentred systems towards integrated care systems”13. Taken forward under the Polish Presidency,
ongoing activities include further work on analyzing countries’ experiences in the
implementation of integrated and/or coordinated care to identify best practices and factors
critical for implementation as well as exploration of options to further the hospital sector,
through improving hospital management and the effective integration between the hospital and
primary care sectors.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The emphasis of ongoing efforts at national, EU and pan-European, and international levels to
reorient health care delivery ‘away from hospital-centric models’ creates a series of pressures for
hospitals and systems14. These include:
• Pressures to centralize because of perceived market advantages, economies of scope and
scale and challenges resulting from workforce shortages against the desire to decentralize to
strengthen hospital autonomy and enable pushing budget responsibility down to lower levels
of management, alongside increased interest in competition, market mechanisms and changes
in ownership
• Need to improve quality, efficiency and value for money through increasing emphasis on
activity-based payment systems, move towards day cases and reduced length of stay,
redesign of clinical processes and the introduction of guidelines and pathways, and the use of
health technology assessment and investment control
• Emphasis on accountability though the development of accreditation and performance
management and the increasing use of indicators, public disclosure and transparency of
information about performance
• Ongoing concerns about existing patterns of provision in particular in the eastern part of the
region, including overcapacity, quality of infrastructure, and parallel hospital systems
alongside the overall challenge of maldistribution especially with regard to rural areas and
single-specialty/mono-profile facilities
Hospitals are not well equipped to meet these challenges because of high fixed costs, inflexible
capital and staffing, and business models that are often based on growing income. In the eastern
part of the European region poor infrastructure and a shortage of funds pose main barriers to

11 European Commission. Proposal for a Regulation of the European Parliament and of the Council on establishing a
Health for Growth Programme, the third multi-annual programme of EU action in the field of health for the period
2014-2020. Available at http://ec.europa.eu/health/programme/docs/prop_prog2014_en.pdf 12 Presentation by Tomasz Pawlega 13 Council of the European Union. Council conclusions: Towards modern, responsive and sustainable health
systems. 6 June 2011. Available at
http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/122395.pdf 14 Presentation by Nigel Edwards
Modern health care delivery systems, care coordination and the role of hospitals
page 6
effectively change the model although access to capital is difficult everywhere and becoming
increasingly more challenging against the backdrop of financial pressures in the public sector.
Challenges for management and governance are in particular in areas around management skills,
capacity and resources alongside underdeveloped financial and information systems; politicised
decision making and ownership structures; and a lack of oversight and accountability for quality.
These challenges are set against more general, system-level barriers to moving to more
innovative models of care, such as fragmentation between the various sectors within health and
between health and social care, often reinforced by existing payment systems that frequently
relate to parts of the patient pathway only and discourage integrated approaches and/or are
poorly adapted to deliver strategic change; lack of skills or expertise both in primary and acute
care towards organizing care that is better suited to the management of chronic health problems;
and the relative isolation of mental health services from other health services.
Where reform efforts gave been initiated these tend to remain within existing structures and
typically relate to the macro- or system-level rather than proposing measures that affect clinical
practice at the meso- or micro-levels. However, even where promising models are available, for
example in the area of e-health or around community-based models of care, it is often not clear
whether these will enable the shift of care that is desired. Furthermore, where (additional)
investment is required, it may be difficult to make the business case for this and to access
necessary funds.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Against this background, there is a need to
• Redefine the role of hospitals in a better balanced health system (balance between
specialization and generalism)
• Define the functions of hospitals (specialized services)
• Identify successes on hospital reforms elsewhere
• Describe the role of national/sub-national authorities and the international community,
including that of WHO in supporting this
PANEL 1. Public health, primary and integrated/ coordinated care
Panel 1 discussions focused on describing the principle requirements for an
integrated/coordinated care system from a systems and the patient perspective, with examples
from a range of European countries drawing on a pan-European survey, and a case study from
Hungary.
At the outset, it was noted that to effectively address the multiple challenges arising from a
change in the disease burden vis-a-vis resource constraints requires short-term action as it relates
to resource use (‘crisis management’) and long-term, transformative change to reform the
delivery system. Achieving the long-term, transformative change requires an overall vision, or
systems perspective on population health management along the continuum of care, balancing
public health and health service interventions (Figure 3).

Modern health care delivery systems, care coordination and the role of hospitals
page 7
Figure 3. Population health management pathway
Source: Bengoa (2011)15
While most countries are engaging in, and improving on, the various elements of the care
continuum, what is lacking is the integrated approach bringing these together by means of
organisations operationalising this approach as a system at the local level. One example for such
a local system is the Hungarian Care Coordination Organisation (CCO). Launched in 1999 and
conceptualized as a pilot project, the CCO assumes responsibility for virtually the entire
spectrum of services (from primary to tertiary care) for a population signed up with primary care
(family doctors) in a given geographical area and against an adjusted capitation payment16.
CCOs can involve groups of GPs, policlinics or hospitals (who will have to contract with local
GPs); they are primarily responsible for managing the patient pathway along the delivery chain
although CCOs do not purchase services. The pilot was terminated in 2009 however, without
formal evaluation, under the previous government; however there is a renewed interest under the
current government.
While approaches such as the CCO in Hungary and other models of care that seek to better
integrate services across the care pathway for a defined population are being implemented in a
number of countries in Europe, typically, these are limited to experiments and/or are being
established in selected geographic areas and so accessible to parts of the population only17.
Where countries have implemented care models that are available nation- or region-wide, these
tend to be disease-specific, typically targeting diabetes, selected respiratory conditions
(asthma/COPD) or cardiovascular disease. Such approaches are however most commonly
implemented within existing care structures, as a means to better coordinate different providers
but without necessarily reducing barriers between sectors.
This further illustrates the need for developing a common vision, the identification of a
“common denominator”18 across primary and secondary care and social services. Coordination is
a reflection of patient-centred care, thus requiring the identification of a common point of access
to care, for example a care coordinator, that (or who) acts as the key point of contact, from health
promotion and disease prevention to targeted referral to specialist care. Patient-centred care also
implies active involvement of service users who have tended to be overlooked as important
partners in the design and implementation of innovative models of care19. Active patient

15 Presentation by Rafael Bengoa 16 Presentation by Peter Gaal 17 Presentation by Ellen Nolte 18 Presentation by Wienke Boerma 19 Presentation by Nicola Bedlington
Modern health care delivery systems, care coordination and the role of hospitals
page 8
engagement in their own care has been identified as a core component of effective chronic care,
yet this engagement is frequently not supported by existing structures. There is a need to move
towards a systems perspective that sees patients and service users as part of the solution and who
can play an important role in improvement strategies. This also means investing in workforce
training to enable health professionals at all levels to engage in the types of conversations suited
to facilitate and encourage patient participation from decision making in their own care to
contribution to healthcare decision making at meso and macro levels.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Overall there is recognition of the importance of cultural context in achieving sustainable
change. It was noted that there is a need to develop cultures that can ‘break silos’ and to
understand system levers of how to implement change. There may be considerable benefit to
analyse how (successful) organizations developed to get to where they are now; the balance of
top-down versus bottom-up engagement in achieving sustainable change; and assessment of the
range of disincentives for providers and services users to engage in change. Therefore, there is
still some way to go in better understanding of what works well in what circumstances
highlighting the need to emphasise ongoing monitoring and evaluation of new ways of
organizing care.
PANEL 2. Planning for hospitals/ the future role of hospitals
Panel 2 discussions aimed at exploring emerging trends with regard to the future role of
hospitals, with examples from a European- and country perspective to identify gaps and/or new
ideas that should be considered.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The panel discussion was introduced by the notion that the traditional vision of a hospital no
longer holds. Instead many contemporary hospitals can be seen to represent a “collection of
things that no longer fit together”20, with elements of high specialization not suited for general
work alongside lack of specialism for high specialist requirements, and the lack of integration
with primary care and social services as highlighted in the opening session. There is therefore a
need to rethink the role and function of the ‘modern’ hospital, which may involve re-orienting
services away from doctor’s specialism to a system which centres on procedures and/or
particular types of patient problems. In this view, hospitals might be conceived as ‘focused
factories’ for high throughput elective surgery; drawing on multidisciplinary teams for messy
and complex problems; and building close links to social care to allow for rapid discharge and
reduce admissions. Hospitals would not be used for rehabilitation services, end of life care or any
treatment or service that is possible outside, for example in a patient’s home.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
In practice, change has taken place with emerging trends involving the creation of chains and
networks in countries such as Sweden, Slovenia and the Netherlands, the formation of integrated
providers as in the UK and Hungary, the development of regional systems as for example in
Denmark and France. Other trends include a rising trend towards mergers, with examples
including the UK and Norway. Indeed, in Norway, mergers have presented the main approach to
more than halving the number of hospitals from around 50 since 200221. This was accompanied
by a number of configurational changes including for example the introduction of observational
units next to A&E departments as a means to reduce admissions, as well as changes to

20 Presentation by Nigel Edwards 21 Presentation by Jon Magnussen
Modern health care delivery systems, care coordination and the role of hospitals
page 9
management structures such as the involvement of physicians and nurses at the various levels of
governance alongside investment in training of hospital managers.
These examples illustrate that change is possible although difficult questions remain such as
trade-offs between centralization and decentralization, for example maternity wards; or the role
of small hospitals in rural areas. It was recognized that hospitals form part of integrated
population health management, and the hospital should be a full part of the pathway. However,
especially in relation to the issue of geographical location discussants expressed concerns of
whether the answer to multimorbidity indeed involved a shift from hospital to primary care, in
particular in sparsely populated areas, or whether it might be more appropriate for training to
accommodate generalist skills in the hospital setting. More broadly, this raises the general
question about the appropriate ‘delivery system’ to respond to the challenge posed by chronic
diseases.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
In this context, considerable discussion also evolved around the definition of a planning unit or,
more broadly, capacity in relation to hospitals, with any such definition or typology needing to
recognize that a hospital is part of a network while at the same time comprising of networks
itself. It may therefore be more appropriate to use the notion of ‘capacity of the network’ rather
than of a given hospital. At the same time discussants noted that in many countries, politicians
and the population view hospitals as a ‘symbol’ of health care, raising questions about the
identity of health care in the absence of hospitals. Moreover, hospitals frequently act as
economic drivers for local areas. At the same time it should be emphasized that in the public eye
‘the hospital’ tends to reflect a rather general concept or construct, given the existing diversity of
hospitals.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Overall, discussants identified a set of ‘action points’ at macro-, meso- and micro-levels as a
means to move forward. These included:
At the macro-level, the need
• for the development of a clear vision for system design regarding how future health care
should look like
• the development of new incentives for hospitals
• to engage with the EU level (subsidiarity)
At the meso-level, the need
• to identify and implement new ways of organising primary care
• to describe the level of population health coordination
• to better understand how hospital change in terms of the delivery model has been
achieved
At the micro-level, the need
• to invest in the workforce involving the development of new skills as well as redesigning
the work of specialists to be better suited to chronic care
• to develop and strengthen the ability to describe and measure what is being produced
• to identify better ways of working between organizations
Modern health care delivery systems, care coordination and the role of hospitals
page 10
PANEL 3. Governance of hospitals and integrated care
Panel 3 discussions aimed at exploring emerging trends with regard to the governance of
hospitals, examining issues around self-governance, quality assurance and performance
assessment and benchmarking, with a case study from Moldova for further illustration.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The panel was introduced by providing principal definitions or descriptions of the topics to be
covered. Thus, ‘good governance’ was described as involving a vision and direction, influence,
transparency, accountability mechanisms and forms of participation of service users and
professionals22. Governance of hospitals in particular was described further according to two
dimensions, with the first axis stretching along a continuum of decentralization, from ‘command
and control’ to ‘fully independent private’ vis-à-vis considerations around tools and mechanisms
such as status and recognition; financing; accountability; and decision capacity on the second.
Quality assurance involves a complex constellation of stakeholders and a wide range of tools and
instruments, such as professional certification and re-certification; quality standards; institutional
accreditation and re-accreditation; and clinical (practice) guidelines, to name but a few.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Self-governance
Recent years have seen a number of trends in the governance of hospitals. These include for
example a move away from centralised approaches to autonomous entities which has provided
managers with tools that are typically not available in the public sector and so enable operation
in a more business-like manner, such as the use of financial incentives and more managerial
discretion internally23.
The evidence of the effects of these changes has remained mixed however. Thus, there is some
evidence that hospital boards are beneficial and necessary for improving accountability, but not
sufficient. Evidence further points to the notion that boards are more effective when related to
fiduciary responsibility rather than when related to ‘community well being’. Also, where
decentralisation occurs without involving providers or the public it is less likely that there will be
noticeable change in the ‘way the system works’. Similar to discussions in Panel 3, the
organizational level needs to carefully balance top-down and bottom-up in order achieve
sustainable change.
In terms of moving forward the following points were identified:
• Regulate hospital governance with particular emphasis on issues around composition of
boards, independence
• Involve providers in governance
• Realize the opportunity to involve patients and citizens in governance
• Creatively regulate autonomous hospitals without killing their autonomy or creating
perverse incentives
• Encourage and learn from the positive deviants

22 Presentation by Josep Figueras 23 Presentation by David Chinitz
Modern health care delivery systems, care coordination and the role of hospitals
page 11
Quality assurance
The session on quality assurance focused on safety in hospitals, highlighting a number of
concerns of relevance for further discussions. A main consideration centred around the use (and
usefulness) of accreditation programmes, guidelines and indicators. Thus, there remains
considerable uncertainty about the boundaries between licensing, certification and accreditation,
and the responsibilities for who should be defining these24. Likewise, the evidence of whether or
not standards indeed improve patient care remains mixed. Indeed, it may be assumed that up to
50 percent of accreditation programmes fail. This may be because of lack of funding to ensure
implementation, systems are not regulated, or the programme is not mandatory. This also raises
the question as to whether accreditation does form the appropriate means to ensure patient safety
(‘safety should not be an option’) and whether other means should be employed instead, based
on the wide range of sources on safety available in Europe, including those issued by the Council
of Europe, the WHO, the European Commission, alongside NGOs an national agencies.
In terms of moving forward the following points were identified:
At the ‘hyper-macro’ level
• Share information, learning
• Adopt common requirements across borders
• Make aid more effective
At the macro-level
• Define national policy on safety; evaluation, planning
• Evaluate impact, scope of regulation
• Require doctor participation
• Define minimum public info on hospitals
At the meso-level
• Test internal systems
• Use external peer review
Performance assessment
There have been numerous activities at national and international level to enable the more
systematic comparison of hospitals. A range of indicators is available with for example at the
international level the OECD Health Care Quality Indicator project providing data on a range of
indicators including mortality, complication rates, readmission rates, and, more recently work on
patient experience.
However, several challenges remain. These relate for example to the selection of indicators, and
the need to identify and describe who and what the information is for. For example, is the
information used to inform quality improvement or for accountability purposes and if so, what
are the mechanisms for inputting these into the quality governance cycle. There is also a need to
ensure an adequate information infrastructure involving administrative databases, registries,
electronic health records, etc. in order to enable meaningful assessment of performance.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

24 Presentation by Charles Shaw
Modern health care delivery systems, care coordination and the role of hospitals
page 12
Establishment of such system may require political willingness and needs to be balanced against
privacy issues.
It will further be important to not view performance assessment in isolation but to link it in with
other quality policies such as accreditation and guideline development. Finally, the measurement
agenda needs be linked in with the integrated care agenda to enable operationalising the
performance assessment of the ‘transition of care’ outside hospital.
In summary, the following key points for further action were identified:
In the area of management/governance the need to
• support the creation of effective Boards & Governance structures, and to develop
effective ways of regulating governance
• balance top down and bottom up initiatives at organizational level
• better understand and identify those elements of the governance structure that are less or
not effective
• develop Governance between organisations & networks
• understand and conceptualise leadership as well as management development
• be accommodate the trade-off between health care, financial responsibilty and
community orientation
In the area of quality assurance the need to
• involve managers in the design of accreditation mechanisms in order to enhance their
effectiveness
• develop learning tool kits around safety
• define the information needs and requirements for reporting on hospitals
• develop and implement peer review systems
• support effective governance
In the area of performance assessment the need to
• select the right indicators fit for different purposes
• advance databases and coding, including data linkage to enable meaningful reporting
• balance privacy and the public good
• create integrated approaches between performance assessment, guidelines, licensing and
accreditation
• develop measurement systems that suppo
Modern health care delivery systems, care coordination and the role of hospitals
page 13
payment in Europe25. However, systems vary across countries, with different patient
classification systems, different approaches in how payment is operationalised (eg budget
allocation vs. case-payment) and differences in the regional/local adjustment of cost
weights/conversion rates. In most settings, DRG-based payments is operated in conjunction with
other payment mechanisms.
The ability of DRG-based payment systems to explain variation in resource use remains mixed.
For example, in the case of appendectomy, for England, Sweden and Estonia DRGs explain costs
‘better’ than patient characteristics, this is not the case for a number of other countries such as
Austria, Finland, Germany and Ireland. There is some evidence that DRG-based payment
systems can enhance hospital efficiency with trends in Europe pointing to a fall in average length
of hospital stay following the move to the DRG-based payment, and a rise in discharge rates to
post-acute institutions. At the same time, in most European countries, the introduction of DRG
payment increased total hospital costs, partly due to higher activity levels. With regard to the
impact of DRGs on quality, the available evidence does not suggest for changes in the payment
system to having negatively influenced health outcomes such as mortality and readmission rates
(Italy, Norway, Sweden, England). However, there have been changes in coding practices and
overall quality may be an issue in DRG based payment. Against this, in the future it will be
important to ensure the availability of a strong information system to enable monitoring of
quality and efficiency, alongside the establishment of a flexible and transparent governance
structure suitable to support continuous fine-tuning of the incentive structure.
These issues need to be placed in the wider context of the global recession and continued
financial imbalances and inadequate regulation of financial markets which creates challenges for
accessing capital26. Public private partnerships (PPP) have been suggested as a means to
overcome these challenges, and there are examples of a range of hospital PPP models across
European countries. A perceived (or real) risk associated with an increasing role of the private
sector in health care may be to reduce the degree of transparency and public control over the
health sector. Approaches to address some of these risks and challenges may include to
• develop contracts which more explicitly allow for later service configuration flexibility
• re-orient the contractual culture so that “partnership” is real rather than rhetorical, and
incentivises flexibility
• reposition the envelope broader than accommodation to foster whole-system healthcare
evolution involving ‘bundling’ of services as well as infrastructure, and of primary care
as well as secondary care.
PANEL 5. Workforce issues
Panel 5 discussions aimed at exploring emerging trends with regard to the healthcare workforce,
with a case study from Kazakhstan for further illustration.
The panel was introduced by setting out a series of questions to be discussed during the session.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
These were:
• Where should the health workforce work?
• What are the right numbers?
• What are right skills and skill mixes?

25 Presentation by Pascal Garel 26 Presentation by Stephen Wright
Modern health care delivery systems, care coordination and the role of hospitals
page 14
• How can we improve the validity of workforce data?
• How can we successfully retain health workers
Some of the immediate answers include that, on average, about 70 percent of nurses in the EU
currently work in hospital but with wider variability across countries and hospitals27. It is
however difficult to estimate a precise figure for the ‘right’ number; this is a question of dose.
There is some evidence suggesting a link between nurse staffing and patient outcomes but this
will vary, depending on case load. What is certain however is that there is likely to be shortage
of health care workers, with estimates that about 15 percent of health care needs might not be
covered by 2020, taking account of ageing of the workforce28. The figure of a shortage of one
million health care workers by 2020 across the EU is likely to be twice as high if long-term care
and ancillary health professions are taken into account.
The question on skill mix concerns the professions, patients and their carers in relation to
preventive, diagnostic, therapeutic, psychological, psycho-social, administrative, communicative,
managerial skills etc29. There has been increasing focus on advanced nursing roles across OECD
countries, in roles as diverse as routine preoperative assessment, management of minor illness in
general practice, nurse practitioners in primary care, nurse prescribing, and others.
Human resources represent 60 percent of expenditure in the health sector. There is a need to
invest in people and the environment to enable them to ‘do their job’. The EC Joint Action under
the Health Programme on forecasting health workforce needs and workforce planning (2012-
2015) aims to address the impending shortage of health workforce in the EU by providing a
common platform for Member States to work on:
• Data for health workforce planning,
• Exchange of good practice with planning methodologies,
• Horizon scanning (forecasting future health workforce needs)
• Sustainability of the results of the Joint Action and framework of impacting on policy
Discussants highlighted the need for bringing together the evidence presented at the European
level to enable cross-country learning, in particular information on activities at country level that
is not easily accessible otherwise. On a broader level and against the workshop discussions
around care integration and coordination and the role of hospitals it was noted that a focus on
quantity of health care workers will have to be complemented by a simultaneous focus on
quality. Thus, there is a need to rethink the type of professional needed for the future whose
skills would be more suited to meeting the needs for this with multiple chronic health problems.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
These issues tend to be neglected at the educational level. Here, an important issue arises around
the location of training, that is in hospitals or practices and the organizational arrangements for
delivering an education and training system that will produce these required skills and
competencies.

Developing a roadmap
The need for innovative design of a modern coordinated health service delivery framework,
connecting various levels of disease prevention, as well as health and social care was discussed,

27 Presentation by Walter Sermeus 28 Presentation by Daniel Reynders 29 Presentation by Matthias Wismar
Modern health care delivery systems, care coordination and the role of hospitals
page 15
having at core the Health2020 values and key definitions. It has been agreed that such approach
has to reflect relevance to health needs, equity and quality, cost effectiveness and innovation.
Cost effective health care services of acceptable quality, making the best use of resources
available, supporting and promoting population health improvement are the main goal of health
systems. Therefore, conceptualizing integrated care needs to start from health and disease
outcomes, services and pillars, and requires a wide network of entities close to the primary care
team.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
In this context it was recognized that hospitals are institutions valued by the public, with a
growing contribution to health improvement and health equity (territoriality). Rethinking the
health service delivery framework in the current context of increasing health needs (ageing
populations, co-morbidities, chronic diseases) and primary care repositioning, has to consider
difficult issues like the regulations applying to both public and private sectors, territoriality,
competition and collaboration, capital investment and purchasing power parity initiatives,
control of technological investment, as well as care coordination, patient empowerment and
participation. There seems to be no shortage of conceptual information for improving health
system delivery. However, a shortage of practical evidence is a current challenge. Policy debate
also circles this issue in balancing both evidence base needs and the human rights dimension.
The following key issues where flagged by the last session working groups for drafting road map
pace and direction:NURSING 3005 – Nursing in Complex Settings Assignment Papers.
– Aging population and workforce, with chronic diseases and multiple morbidity, requires
structural integration (based on defining needs of population groups in integrated ways)
– A bigger change in terms of increasing efficiency and reshaping public and provider
expectations is needed, and case studies (e.g. chronic condition management, emergency
response etc) evaluating consistency and efficiency of interventions should be used to
develop recipes for success (common denominator solutions)
– The new approach to generalism appears to be the real challenge, and requires a transforming
scenario leading to a new pattern of services provided and accessed by educated patients,
populations and providers
WHO role in this process was seen as benchmarker for best practices, knowledge broker
improving the information flow between systems, providing implementation advice/ and/ or
transformation assistance, in full coordination and cooperation with national and international
partners and stakeholders.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The diagram below30 summarizes the structural framework proposed, and the starting point for
the follow up internal expert meeting (01/12, Copenhagen) on developing a road map for health
service delivery summarized below.

30 Presentation by Nigel Edwards
Modern health care delivery systems, care coordination and the role of hospitals
page 16
Clear vision Clinical
strategy
Tools & indicators
Policy frameworks that promote change
Creating & disseminating evidence
Country support
Work on strengthening and developing systems of health care delivery is work on sustainability,
and discussions during the internal expert meeting aimed to define the ‘what’ and the ‘how’ of
road map development.
Two approaches were considered for population centred health service delivery (HSD):
upstream population management and downstream health/clinical management. At system level,
expectations would link clinical behaviour with financial consequences and provide incentives
for better care for individuals and improved population health and reduce inefficiencies. This top
down and bottom up approach would require clinical strategy re-thinking and (no) disease
specific approaches. At patient level the focus remained on scaling up information, capacity of
self-management and coordinated care.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The economic crisis of the decade was viewed as an opportunity to further stimulate change and
organizational development to pull up efficiencies and re-stratification starting from local level.
Consideration was given to disease oriented models versus disease broader care, and the Wagner
model, Kaiser Permanente and IHI Triple Aim were given as examples of functionality design.
Due to its health and economic growing impact, NCD management requires amplified
operational integration and population coverage, supported by models of risk assessment to
estimate and control trends. Packaging world best practices in the field and increasing levels of
patient activation are already part of the chronic care – patient empowerment interface. Due to
high local dynamics, defining the basic benefit package would require a preliminary design of
existing coordinated patient centred flow of delivery.
Within the context of cross border mobility of patients and provider and the increasing mandate
in health, it is expected that mechanisms to make available comparable data on coordinated
services will be soon regulated at EU level. These are expected to expose and assist in addressing
existing variation in care, which causes significant problems, including financial loss.
In WHO AMRO region, work on coordination of care is being done since 2007. This led to the
development of a position paper drawing on latest evidence and promoting three concepts:
comprehensiveness, autonomy-coordination-integration and life long continuity of care
Modern health care delivery systems, care coordination and the role of hospitals
page 17
(continuum of life course). As a result of the regional underlying consultation process, 14
attributes that make the system integrate were identified, as well as typologies of integration.
While considering inter-regional differences in terms of taxonomies and organizational specifics,
this already existing important amount of work could provide valuable inspiration.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
There is space for WHO to conceptualise HSD, including actual service delivery of professionals
to patients and patient perspectives. Work around chronic conditions has validated financial
viability and is further applicable to acute conditions, emphasizing integration of personal care,
public health care and social care.
Health21 – health for all policy, remains a clear and valid statement in the development of HSD,
and provides a structured approach. The move to integration can be done through national
governments and regulatory capacity with evaluation of subsequent market response. Integrated
system logic, supported by the expenditure scenario, is expected to provide options of work.
The proposed entry points would build around:
System design – patients/ population: The patient seen within the context of the wider
population and community is empowered and can participate in decision making about own care,
supports self-management and delivery of care as close to home as is safe and cost effective. It
requires design around the needs of the patient incorporating the aspects of care that they value
including continuity, co-ordination and longitudinal continuity. Particular attention need to be
given to the excluded and disadvantaged, vulnerable populations.
System design – systematic care: In a primary care centred system, high levels of co-ordination
need to be ensured, including home care, social care, ambulances, NGOs and specialist care with
pathways, shared record systems and other systems to support. Evidence based and systematic
care could reduce variation in service delivery provision. The growing burden of illness and the
increasing connection between mental ill health and physical illness requires increased attention.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Institutional providers: There is a clear benefit in reconsidering the pattern of hospital care, and
the development of new models to provide treatment for emergency care. Investment in
infrastructure which is flexible enough to keep pace with changes in medicine and patterns of
demand should be part of the deployment of methods to ensure that safety is a key design
element, to reduce waste and continuously improve quality. Ensuring co-operation within and
between organizations is required to create co-ordination of care
Workforce – health & support: Increasing demand and expectations generated by growing
epidemiology challenges require a more flexible multi-skilled workforce, able to manage
complex care and support patient empowerment. A culture of continuous learning and
improvement, supported by measurement, feedback and appropriate incentives will support team
based approaches to service delivery.
Payers: The development of smarter payers able to create contracts for value and payment
systems that support integrated/coordinated care and population health management, are
expected to incentivise quality improvement and patient self-management.
Governance: Regulatory systems should ensure application of minimum standards for delivery
and promote improvement including clear objectives and well developed mechanisms for
accountability, high levels of transparency of information for patients, public and policy makers
about quality, safety and patient experience. NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Modern health care delivery systems, care coordination and the role of hospitals
page 18
Change management: Implementing change has complex ramifications in both quality and
deployment of performance, including (inter) institutional operations. Innovative cross sector
learning on supporting change management, to be successful, will require a drive for change,
supported by evidence, regulation and vision.
The following diagram presents a generic roadmap for supporting modern health service
delivery, with the visionary statement at its core, to be considered work in progress.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Next steps in this direction include:
– A workshop on applied models of coordinated health services tackling chronic diseases (case
studies across the region, to identify shared challenges and lessons learned)
– Development of a position paper drawing
Modern health care delivery systems, care coordination and the role of hospitals
page 19

Case Studies

ETC

Define steps to take
Visionary statement
Testing with different stakeholders
Mobilise resources
Supportive research
Develop case studies
OBS
Tools + guidance
Measurement + indicators
Care coordination
Social care

Change management
Financing policy
Enabling follow up
Define supporting policy
Futures + horizontal scanning
Vision on clinical issues
Building networks
Point of care
NCDs
Academic references
In country opinion leaders
Literature review
Integrate existing activities
Map current relevant work
Clinical delivery
Outcomes ROADMAP HSD
Modern health care delivery systems, care coordination and the role of hospitals
page 20

Annex 1. Scope and Purpose

High performing health systems are critical to address key health challenges faced by Member
States in the European region, such as changes in disease burden and population dynamics, in
governance and funding mechanisms, and in technology and clinical management practice
Over the last decades, many countries have significantly invested in strengthening the delivery of
services at the primary care level giving lesser attention to the role of referral facilities. While
primary care and home-based care programmes are being developed, hospitals remain essential
for providing complex acute specialized care and continue to represent an important part of
health spending. In addition, hospitals play an important role in shaping population perception
on how health systems function in countries, which gives them political visibility.
Fragmentation and insufficient coherence in health care services are often considered as one of
the main causes limiting the efficiency and quality of care, as well as the health system’s
responsiveness to the needs of the population. The existing models of health care provision do
not seem to have changed sufficiently to face the challenges of an ageing population, with
increasing expectations of service quality and safety and with the ability to access these services
on national grounds and through cross border care.
The World Health Organization (WHO) acknowledges that due attention must be given to all
levels of care as well as the integration of functions and coordination of care mechanisms. This
requires evidence about where and how coordination between all levels of care can be
significantly improved – a review of service delivery models proved most effective and
consideration of barriers to process.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Work in this field in the European context is closely linked to the global initiative started by
WHO headquarters in identifying key questions to be addressed by the global hospital agenda
within the wider context of coordinated care. Experiences from the various countries and regions
of the world can be used to initiate a review of the place, role and function of hospitals within
changing health systems, to support all Member States in the challenging process to remodel
their hospitals appropriately and to build capacity to support health care delivery reform.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
The present workshop aims to move a step further on the road to better integration and
coordination of health care service delivery, by providing the scene for
1. Reviewing the current situation in relation to hospital and health systems reform across the
region, including patient choice perspective
2. Creating a shared understanding of the current state of health care delivery systems and their
capacity and willingness to address change
3. Sharing stakeholders experiences and best practice models, both theoretical and applied, in
the search of optimized solutions to increase health care delivery performance
4. Exploring criteria for determining which areas should be prioritized and the potential
methods for addressing challenges identified
Modern health care delivery systems, care coordination and the role of hospitals
page 21
a) At the operational level – improving effectiveness, quality, safety, patient experience
and efficiency
b) At the organizational level – governance, budgeting, health workforce development
and distribution etc
c) At the financial level – payers and policy makers
d) In integrating systems and levels of care to support and strengthen improvement at all
of the levels mentioned above
5. Identifying unanswered questions, gaps in our knowledge and areas where further research is
needed
6. Seeking expert guidance in how best WHO can continue supporting Member States in these
areas.
Modern health care delivery systems, care coordination and the role of hospitals
page 22
Annex 2. Programme
Monday 21 November
09.30 – 10.00 Registration + Coffee
10.00 – 10.30 Official opening
10.30 -10.45 WHO global approach to strengthening health systems, towards universal
access to quality and safe heath care services
10.45 -11.00 WHO Europe strategy for health care delivery systems and public health
11.00 -11.20 Belgian vision and experience in improving health care delivery
11.20 -11.35 EU presidencies priorities in promoting European health and the Health
2020 agenda
11.35 -12.00 Discussion
12.00 -12.30 Key issues, stakeholders and expectations
12.30 – 13.30 Lunch
13.30 -15.30 Panel block 1: Public health, primary and integrated/ coordinated care
– Public health, health promotion, disease prevention
– Primary care and its interfaces
– Mechanisms and routes of patient referral
– Care coordination
– Role of e-technologies in delivering integrated care
15.30 – 16.00 Coffee break
Modern health care delivery systems, care coordination and the role of hospitals
page 23
15.30 – 16.00 Panel block 2: Planning for hospitals/ the future role of hospitals
– Emerging trends
– What is the evidence/ what works/ what does not work
– Country examples
– What gaps/ new ideas should be explored
19.00 Welcome dinner
Tuesday 22 November
09.00 – 10.30 Panel block 3: Governance of hospitals and integrated care
– Emerging trends
– What is the evidence/ what works/ what does not work
– Country examples
– What gaps/ new ideas should be explored
10.30 – 11.00 Coffee break
11.00 – 11.30 Payment systems and capital investment in health care delivery
11.30 -12.45 Panel block 4: Workforce issues
– Emerging trends
– What is the evidence/ what works/ what does not work
– Country examples
– What gaps/ new ideas should be explored
12.45 – 14.00 Lunch
14.00 -16.00 Developing a ‘Road Map’ (round table discussion on priority actions)
– Where do we agree about the future options for the system
– What are the priority areas where more needs to be done to
understand issues7probelms/ solutions
– What should be done next by each of the levels indicated in the
scope and purpose of event
16.00 Conclusions and close of meeting

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context.NURSING 3005 – Nursing in Complex Settings Assignment Papers.  The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies—3,881 patients) and HbA1c reduction (7 studies—2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01—-1.06), DBP -1.42 (95% CI -1.42—-0.49) and HbA1c -0.15 (95% CI -0.32–0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Figures
Table 5Table 1Fig 1Table 2Table 3Fig 2Table 4Table 5Table 1Fig 1Table 2

Citation: Massimi A, De Vito C, Brufola I, Corsaro A, Marzuillo C, Migliara G, et al. (2017) Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis. PLoS ONE 12(3): e0173617. https://doi.org/10.1371/journal.pone.0173617

Editor: Sari Helena Räisänen, Helsingin Yliopisto, FINLAND

Received: November 27, 2016; Accepted: February 23, 2017; Published: March 10, 2017

Copyright: © 2017 Massimi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: The authors have declared that no competing interests exist.

Introduction
The global burden of non-communicable diseases (NCDs) is increasing rapidly and is expected to reach a prevalence of 57% in 2020, when such chronic conditions will outnumber acute conditions [1] and are likely to kill 38 million people each year [2]. In addition, over the next 20 years, NCDs are projected to cost more than US$ 30 trillion to the health systems, with a dramatic impact on productivity and quality of life [3]. The growing prevalence of NCDs, the aging population, rising patient expectations and the pressing need to contain costs lead to an increasing demand for primary care services, long term care services and reforms that move care from hospitals to the community, providing both first contact care and continuing care of individuals [4,5]. According to the Medical Home Model, the Institute for Healthcare Improvement (IHI) Model and the Chronic Care Model, only a productive interaction between an informed, activated patient and a prepared, proactive practice team can lead to improved outcomes [6]. The caregiver team must be patient-centered, coordinated, multidisciplinary, multi-professional and skilled in self-management support [7,8].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In this health care context, the transfer of tasks from medical doctors to appropriately trained nurses (so-called ‘task shifting’) can reduce both the workload of physicians and the direct cost of care, while achieving the same high quality of care, good health outcomes and, eventually, higher levels of patient satisfaction [4, 9, 10]. The effectiveness of task shifting in primary care, together with changing the skill mix, has been well reported in the literature [11–13] and is gaining growing acceptance among policy-makers [14]. Thus, the WHO has recommended that “continuous monitoring and evaluation must therefore be established as an integral component of the implementation process for task shifting […] and operational research should be developed alongside this implementation process” [15]. Moreover, nurses are already recognized as playing increasingly important roles in primary health care, especially in long-term care programs and in discharge planning programs for in-patients with chronic diseases [16–18].

Primary care must regain its central role in the frontline management of chronic diseases, because poor control at this level leads inexorably to hospital overcrowding due to the need to treat complications [19, 20]. To achieve this, great emphasis has been placed on the role of patient self-management, underlining its importance in primary care [8] and in the complex process of the care of patients with long-term conditions [21, 22]. Nurses, because of their traditional holistic perspective, are well versed in self-care support and must play a leading role in the administration of these systematic educational interventions focused on preserving or enhancing health and self-management goal achievement of a patient previously clinically assessed with a chronic disease. Self-monitoring (of symptoms or of physiologic processes) and decision making (managing the disease treatment or exacerbation or its impact through self-monitoring) are the aims of the interventions [23]. There are several primary studies that compare the impact of nurse-led interventions to support patient self-management with the more usual care-in-the-community programs for chronic patients [24–26]. However, to our knowledge, no systematic reviews on this specific topic are available in the literature; we therefore aim to provide such a systematic review in this study, and we also try to identify specific characteristics that might make interventions more effective.

Materials and methods
Selection criteria and search strategy
We carried out a systematic review of randomized control trials (RCTs) of nurse-led self-management support interventions performed with any method of communication exchange or education in a community setting on patients >18 years old with a diagnosis of chronic disease or multiple morbidity (see Table 1 for definitions). For this purpose, we drafted a protocol based on the population, intervention, comparison and outcome (PICO) approach [27] and the recommended guidelines for the reporting of systematic reviews and meta-analyses [28].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Table 1. Definitions of setting and interventions.
https://doi.org/10.1371/journal.pone.0173617.t001

Studies aimed to evaluate the efficacy of a nurse-led self-management support intervention, compared to the usual care, to improve observer-reported outcomes (OROs) [29, 30]–particularly clinical outcomes–and patient-reported outcomes (PROs) [30, 31]as primary outcomes. We excluded studies that evaluated interventions in which nurses were only involved in medical assessment or therapy optimization and studies that enrolled patients with mental disorders. To ensure maximum retrieval, two reviewers with different skills in bibliographic search methodology and in nursing chronic disease management, searched together for RCTs in MEDLINE (to July 2016) using the strategy reported in S1 File. Additional searches in CINAHL, Scopus and Web of Science were carried out using similar syntax; experts were consulted and bibliographies of relevant articles were reviewed. Bibliographic search was restricted to studies reported in English. Each citation found in the databases was reviewed independently by two authors via a titles-first approach to obtain records for the abstract screening.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Study selection and quality assessment
Two reviewers independently reviewed the abstracts obtained in the search and retrieved the full text article of those that met the inclusion criteria. In cases of disagreement, full text article for review was retrieved. The methodological quality of the RCTs was assessed independently by two reviewers using the risk of bias approach described in the Cochrane Handbook [32]. Random sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting and other potential sources of bias were described and assessed. Any disagreements about methodological quality were resolved by discussion and, if necessary, a third reviewer was involved.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Data extraction
Two reviewers performed data extraction and data entry independently, in duplicate. Differences in data extraction were discussed and if necessary resolved by a third reviewer. A standardized form was used to abstract the following data: bibliographic details; population demographics; interventions; patient condition (diabetes, cardiovascular diseases (CVD), multichronic conditions); type of nurses employed in the study (RN: registered nurse; APN: advanced practice nurse); availability of specific training for the nurses that provide the intervention; type of intervention (face-to-face; telephone/telemedicine; mixed); duration of the intervention; study sample size; outcome data (continuous or binary).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Data synthesis
A rating system, based on the methodological quality of the studies and on the consistency of the findings [33, 34], was used to assess the strength of the evidence for OROs and PROs. The results were synthesized and assigned one of the following three levels of scientific evidence:

strong evidence: provided by generally consistent findings, supporting the hypotheses, in multiple high-quality studies;
moderate evidence: provided by generally consistent findings, supporting the hypotheses, in one high quality study and one or more moderate quality studies, or in multiple moderate quality studies;
insufficient evidence: only one study available or inconsistent findings in multiple studies.
To summarize continuous data, the pooled mean difference (MD) and 95% confidence interval (CI) were calculated [35]. A random effect approach was chosen for all analyses to account for between-study variance [36]. The fixed-effects model [37] was also used to check the level of agreement with random effects conclusions. The I2 metric, which describes the percentage of total variation across studies that was due to heterogeneity rather than sample error (chance) [38], was used to test for heterogeneity. If I2 was ≥60%, a sensitivity analysis was performed by removing the studies contributing to the heterogeneity. Results of studies reported in multiple articles were included once in each meta-analysis. Presence of publication bias was assessed through funnel plot graph.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Given the highly diverse nature of the studies analysed, several stratified meta-analyses were carried out to explore the efficacy in subgroups; meta-analyses were also carried out in the absence of statistical heterogeneity. In particular, we analyzed the effect of the following stratification factors: patient condition (diabetes, cardiovascular diseases (CVD), multichronic conditions); type of nurses employed in the study (RN: registered nurse; APN: advanced practice nurse); availability of specific training for the nurses that provide the intervention; type of intervention (face-to-face; telephone/telemedicine; mixed); duration of the intervention (≤6 months; >6 months); study sample size (≤200; >200); attrition rate (<20%; ≥20%); allocation concealment (clearly stated; undefined/absent).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

All meta-analyses were performed using RevMan software, version 5.2 (Cochrane Collaboration, Oxford, UK, 2012). Reporting was made following the PRISMA Statement guidelines (see S2 File for the Checklist).

Results
Main characteristics of the included studies
Of the 7,279 papers initially retrieved (Fig 1) 29, that describe the results of 23 studies, met our inclusion criteria (see S1 Table for a summary of the main characteristics and an overall quality score of the studies included in the review). A summary of the type of intervention and primary outcomes measured in each study is reported in Table 2.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Fig 1. Flow diagram of the study selection process.

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: 10.1371/journal.pmed1000097.

https://doi.org/10.1371/journal.pone.0173617.g001

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Table 2. Summary characteristics of the intervention of included studies.
https://doi.org/10.1371/journal.pone.0173617.t002

The studies were published from 2000 to 2013, mainly in the USA (15), the UK (5) and the Netherlands (4). Overall, 10,162 patients were enrolled in the 23 studies (range: 51–1665), seven of which enrolled fewer than 200 patients. Six papers [39–44] reported analyses of previous studies [45–49], which extended the follow-up and/or took into account different outcomes; these were included in the meta-analyses as appropriate. Patients’ mean age was reported in all studies, ranging from 55.5 [25] to 77.2 [26] for the experimental group and from 54.8 [25] to 78.1 [26] for the control group.NURSING 3005 – Nursing in Complex Settings Assignment Papers.  The majority of the papers assessed the efficacy of the interventions among patients affected by cardiovascular diseases (11), diabetes (9) or multichronic conditions (7). Only two papers took into account patients with COPD. Interventions were mainly carried out at patients’ homes (10 studies) and in general practices (five studies) by APNs (13 studies) and RNs (10 studies); the nurses were specially trained in 15 studies. It is interesting to note that self-management skills were appropriately assessed in patients by validated tools in only five studies.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The methodological quality was high in nine studies and moderate in another nine (S2 Table). Only one paper fulfilled all the criteria for reducing risk of bias. Eight studies failed to report only one of the criteria. Nine papers out of 29 did not report on the methods used to randomly allocate patients to groups and in 20 and 11 cases the allocation concealment and the blinding, respectively, were not sufficiently detailed or were clearly absent. Five studies were at high risk of bias for attrition.

Observer-reported outcomes
Blood pressure levels.
Overall, 12 studies [24, 25, 39, 43, 44, 48, 50, 51–55] evaluated the levels of systolic blood pressure (SBP) as a primary outcome–on a total of 5,671 patients–showing strong evidence. Seven studies [24, 43, 48, 50, 52, 53, 55] out of 12 found that SBP levels were significantly lower in the experimental groups than in the control groups (Table 3); in particular, all studies with shorter interventions [24, 50, 52, 53] showed significant results.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Table 3. Findings of the impact of nurse led-self management interventions on Observer Related Outcomes (OROs) and Patient Related Outcomes (PROs).
https://doi.org/10.1371/journal.pone.0173617.t003

The majority of effective interventions were carried out by advanced nurses/case managers [43, 48, 52, 53, 55]. A variety of intervention techniques were used: four out of the seven effective studies used face-to-face studies [24, 50, 55] or face-to-face/telephone [53] nurse visits; these were delivered at the patient’s home [50, 53], in nurse-led clinics [24], at local community activity centres [53] or in primary care clinics [55].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

A meta-analysis on SBP reduction was carried out on 10 studies [24, 39, 44, 48, 50–55], involving a total of 3,881 patients. The pooled MD was -3.04 (95% CI -5.01 to -1.06) in favour of the interventions, with significant heterogeneity between studies (I2 = 55%, p = 0.02) (Fig 2).

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Fig 2. Comparison of the effect of nurse-led support interventions and usual care on the reduction of some Observer Related Outcomes (OROs): Systolic Blood Pressure, Diastolic Blood Pressure and Hb1Ac*.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

*Only for diabetic patients.

https://doi.org/10.1371/journal.pone.0173617.g002

Meta-analyses of subgroups showed a statistically significant effect if the interventions were delivered to diabetic patients (MD -2.56, 95% CI -4.82 to -0.31), if an APN was employed (MD -3.57, 95% CI -6.36 to -0.78), if the nurses were specially trained (MD -2.81, 95% CI -4.30 to -1.32), if the studies had a sample size greater than 200 patients (MD -0.13, 95% CI -0.25 to -0.01) and if the allocation concealment was not clearly defined (MD -2.54, 95% CI -5.04 to -0.56). Stratification by type of intervention failed to show a significant effect of any specific intervention. Neither length of intervention nor attrition rate influenced the results, which remained significant in favour of intervention (Table 4).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Table 4. Meta-analysis of the reduction of blood pressure levels stratified by level and training of employed nurses; type and duration of the intervention; study size; attrition rate; allocation concealment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
https://doi.org/10.1371/journal.pone.0173617.t004

The same 12 studies [24, 25, 39, 43, 44, 48, 50–55] explored the effect on diastolic blood pressure (DBP) levels in a total of 5,671 patients with strong evidence (Table 3). Ten studies with 3,881 patients in total were included in the meta-analysis on the reduction in DBP [24, 39, 44, 48, 50–55]. A statistically significant reduction in DBP was found for the whole group (MD -1.42, 95% CI -1.42 to -0.49) with no statistically significant heterogeneity between studies (I2 = 34%, p = 0.14) (Fig 2). The analysis of the funnel plot showed a lack of studies with large sample size and high effect measures.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

An attempt was made to identify possible influencing factors using stratified meta-analyses. A statistically significant effect was shown for interventions on patients with CVD (MD -2.09, 95% CI -4.11 to -0.07), specific training of nurses (MD -1.56, 95% CI 2.63–0.48), face-to-face interventions (MD -2.41, 95% -3.54 to -1.28), attrition rate lower than 20% (MD -1.68, 95% CI -2.93 to -0.43) and unclear presence of allocation concealment (-1.71, 95% CI -2.86 to -0.56). Stratification by type of nurse employed, by sample size and by duration of intervention did not influence the results, which remained significant in all subgroups (Table 4).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

HbA1c.
Of the 29 included studies, 11 [25, 39, 43, 48, 51, 54–59] investigated HbA1c levels as a primary outcome in diabetic patients, resulting in strong evidence of the efficacy of intervention. Overall, these studies included 4,207 patients. The levels of HbA1c were significantly lower in the experimental groups than in the control groups in four studies [25, 43, 48, 58] (Table 3). The two studies with statistically significant results and high methodological quality were based on one-to-one sessions with patients led by a skilled diabetes RN [58] and on telemedicine and videoconferencing carried out by specially trained nurses [48].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The results of seven studies [48, 51, 54–56, 58, 59], involving 2,669 patients, were useful for pooling data. The MD showed a reduction in HbA1c of 0.15 in favour of the experimental group (95% CI -0.32 to 0.01) with a heterogeneity of I2 = 28, p = 0.21 (Fig 2). The funnel plot showed that the results were based mainly on small studies with low-effect measures.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

After stratification, statistical significance was shown for specific training of nurses (MD -0.13, 95% CI -0.25 to -0.01), intervention by telephone/telemedicine (MD -0.14, 95% CI -0.27 to -0.01), intervention length >6 months (MD -0.13, 95% CI -0.25 to -0.01) and a sample size of >200 people (MD -0.13, 95% CI -0.25 to -0.01). Stratification by type of nurse employed, attrition rate and presence of allocation concealment failed to show significant differences between intervention and control (Table 5). Moderate or insufficient evidence was obtained for the reduction of total cholesterol, LDL cholesterol, triglycerides and fasting serum glucose (Table 3).

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Table 5. Meta-analysis of the reduction of HbA1c levels in diabetic patients stratified by level and training of employed nurses; type and duration of the intervention; study size; attrition rate; allocation concealment.
https://doi.org/10.1371/journal.pone.0173617.t005

Total mortality.
Three studies [45, 60, 61], with an overall sample size of 2,564 patients, evaluated total mortality. The study of Delaney et al. [41] used the same population and intervention as Murchie et al. [45] but considered the results from 10 years of follow-up. For all four studies the total number of deaths in the experimental groups was lower than in the control groups, reaching statistical significance in two studies [45, 60] (Table 3); these studies were based on interventions lasting 12 months [45] or longer [60] on patients with coronary heart disease or chronic heart failure led by RNs [45] or APNs [60, 61]. Educational interventions were based on face-to-face visits carried out at nurse-run clinics [45] or hospital [61] with telephone follow-up [60, 61].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Multiple clinical outcomes.
Only one study [62] evaluated as a primary outcome the simultaneous reaching of a threshold in BP levels, LDL serum levels and percentage of HbA1c, taking into account 556 patients. A significantly higher percentage of patients in the intervention group reached the goals compared to the control group. The intervention consisted of an initial personal meeting with a nurse case manager, followed by follow-up telephone calls.

Patient reported outcomes
Quality of life.
Three studies [40, 63, 64] included changes in quality of life–evaluated with SF-36 [40, 64] or other questionnaires related to the specific disease aim of the study [63, 64]–as a primary outcome, but there was insufficient evidence of a significant effect. The overall scores of the questionnaires were analyzed. For two studies [40, 64] the overall scores in the experimental groups were higher rather than the control groups, but this result was only significant for the study of Murchie et al. [40] (Table 3). Educational interventions were based on face-to-face visits [40, 63] or telephone health mentoring [64] led by RNs [40, 64] or APNs [63].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Discussion and conclusions
Primary care systems across the world are facing the challenge of an ageing population and an associated increase in the number of chronic patients [65, 66], leading to a growing demand for a kind of care [67] that meets emerging needs, reduces the costs of hospital-based ambulatory care and prevents avoidable hospital use by the provision of more appropriate care systems. In this context, the rational redistribution of tasks among health workforce teams–namely task shifting [15]–as a means of addressing this public health issue represents a potentially winning strategy.NURSING 3005 – Nursing in Complex Settings Assignment Papers.  More particularly, serious attention has been payed to the support of patient self-management, since it can improve patient self-efficacy [8, 68], disease-related behaviors and, finally, enhance patients’ functional and health status [8, 69, 70]. Among health professionals, nurses can play a pivotal role in the delivery of self-management support interventions, particularly in areas of medical workforce shortage. This policy development clearly brings with it the need to continually seek updated evidence about the roles that nurses can undertake, their clinical effectiveness and cost-effectiveness in these roles, as well as patient satisfaction.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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According to our systematic review and meta-analysis, nurse-led self-management support interventions in chronic care community programs have a positive impact on some OROs, such as a reduction in the levels of HbA1c, DBP/SBP and, to a lesser extent, LDL, particularly in patients with diabetes and CVD. Effects on other outcomes such as serum levels of total cholesterol, fasting serum glucose levels and triglycerides, as well as quality of life and all-causes mortality, remain inconclusive.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Diabetes and CVD are among the diseases that can most benefit from patient self-management. Empowering patients to manage their own diseases and fostering patient-centered activities can effectively reduce complications or reactivation of diseases that can shorten length of life and reduce autonomy. Self-management training in type 2 diabetes has evolved since the didactic primarily interventions of the 1970s into the empowerment models of the 1990s [69, 71]. Such a transformation has led to better glycemic control [69]. Our results confirm this and suggest also that trained nurses can effectively administer self-management support interventions to type 2 diabetes patients [25, 43, 48, 58]. A study published in 2004 showed that a nurse-led education intervention led to the improvement of glycemic control and a delay in the requirement for insulin therapy in patients treated with oral hypoglycemic therapy [58]. Moreover, our results show that nurse-led telemedicine interventions can also have a positive effect by reducing HbA1C levels [43, 48]. The remote monitoring and transmission of physiological data facilitate contact with a health care professional via telephone or video, while disease-specific education guarantees the reinforcement of self-management behaviors [72]. More difficulties were encountered in reducing serum levels of LDL [25, 39, 43, 48, 55] and triglycerides [25] in patients with diabetes. This is of particular interest since LDL oxidation does not decrease after improvement in metabolic control in type 2 diabetes [73]. Together with hypertriglyceridemia, LDL oxidation is involved in the pathogenesis of the so-called metabolic syndrome, which is associated with increased risk of CVD and for which lifestyle modification is an important therapeutic strategy [74]. Therefore, developers of educational interventions should focus on general knowledge of diabetes, adherence to medication, lifestyle changes and, if possible, self-monitoring of blood glucose [75].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

With respect to CVD, the results of our meta-analysis also show that nurses can be more effective than the usual care-in-the-community systems in improving blood pressure control, eventually leading to reduced blood pressure levels. This positive effect is clearer when nurses are specially trained and is more significant among diabetes patients for SBP levels and among CVD patients for DBP levels. Face-to-face interventions seem to be more effective, at least for the reduction of DBP levels, even though nurses also significantly improve self-management behavior by telephone interventions [47].

Nurse-led intervention is less effective at improving clinical outcomes in multi-chronic patients [24–26, 39, 44, 46, 49] probably because of the subjective and objective barriers to good self-management associated with this condition. Indeed, comorbidity has been mentioned in previous studies as a limit to self-care [76, 77]. A semi-structured interview study concluded that major barriers to self-care for people with more than one chronic disease are mainly linked to the combined effects of multiple conditions or to a single dominant disease making the management of the other conditions difficult. Other barriers were identified as a lack of patient knowledge about their conditions, financial constraints, low self-efficacy, inadequate communication with providers, the need for or use of social support and finally various logistical issues [78]. Another qualitative study, which used patient focus groups, placed much more emphasis on the role of physician communication and family support as barriers to the self-management of their chronic conditions [79]. NURSING 3005 – Nursing in Complex Settings Assignment Papers. Clearly, self-care interventions for people with multiple chronic diseases must be tailored to patients’ real needs, since they are likely to be more effective if targeted at particular risk factors or specific functional difficulties [80].

The finding that the benefits of nurse-led intervention to support patient self-management disappear when nurses are not specially trained is one of the most important results of this meta-analysis. Ad hoc training seems to be more important than the role and general experience of the nurse. In fact, the results of the meta-analyses show that APNs are more effective than RNs only in reducing SBP levels. Provider training is recognized to be a key factor in the entire self-management support intervention process. Studies that evaluated the effectiveness of in-person training have reported generally positive results [81–83]. However, promising results also derive from web-based self-management training for health professionals: webinar-based training sessions can benefit participants’ self-beliefs and confidence [84].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Several studies have determined that, among health professionals, nurses are best placed to promote health and to deliver preventive programs within the primary care context [85, 86]. Their employment as providers of self-management support programs in primary care can further improve the health status of chronic patients, even if the task shifting from physicians to nurses in this particular area requires specific education and training. Further research on the efficacy of nurse-led self-management support programs must focus on long-term outcomes. Evidence on the effect of these programs on mortality and hospitalization rates is still insufficient or lacking. Moreover, the evaluation of patient self-efficacy in experimental studies that use reliable and valid instruments is urgently required.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Finally, the methodological quality of RCTs must be improved. In many cases, in the particular context of trials that evaluate the efficacy of nurse-led interventions vs. physician-led interventions, blind participation in the intervention is not always possible. This was often acknowledged in the included studies, but it was not always counterbalanced by appropriate allocation concealment that, in such cases, is universally recognized to reduce bias [87].NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Our systematic review and meta-analysis have several weaknesses that must be taken into account. First of all, we included only publications in English and we did not search for grey literature. However, we made the literature search as widespread and inclusive as possible; primarily, we used electronic databases, but also screened the bibliographies of the retrieved articles for relevant publications. Second, one may argue that some clinical and physiological characteristics of the patients other than the educational interventions could influence the outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers.  To reduce this possibility to a minimum, we included only RCTs because of their lower risk of bias and we used restrictive inclusion and exclusion criteria to minimize heterogeneity among patient populations in terms of severity of disease, learning abilities and capacity to realize autonomously the activities of daily living. However, future research that includes non-randomised trials and/or observational studies are strongly recommended. Finally, we included different types of intervention. We decided to use this strategy because even though self-management support interventions differ in terms of target population, mode, format and content, it is clear that this variability in approach does not markedly affect outcomes [88]. Moreover, we made stratified analyses to account for some characteristics of the interventions that might affect the results.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In conclusion, self-management is a key focus of health policies for chronic disease control in many countries. Nurse-led self-management support interventions can be included in routine primary care activities, since specially trained nurses appear to be more effective than physicians in educating patients with diabetes and CVD in self-management of blood pressure and Hb1Ac in community settings. Future research should evaluate the efficiency of task shifting from physicians to nurses in community settings. Furthermore, trials with higher methodological quality and larger patient populations are urgently needed to assess the efficacy of self-management programs, since current evidence is based on very few large studies of mixed methodological quality.

Underpinning standards for developing comprehensive care in hospital is the need to identify, early in the admission process, functional and psychosocial issues which affect patient outcomes. Despite the value of comprehensive assessment of patients on admission, the process is often sub-optimal due to a lack of standardized assessment practices. This project aimed to develop a concise, integrated assessment for patients admitted to acute care and test its psychometric properties.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Methods:
Two international expert panels of clinicians and health scientists collaborated to establish design parameters. Using clinical observations and a variety of derivative applications sourced from the interRAI research collaborative repository, the panels constructed a draft instrument to examine feasibility, resource requirements, and inter-rater reliability. Field testing was conducted in Australia and Canada. Next, the system was revised to its final form, the interRAI Acute Care, after feedback and review from international interRAI members.

Results:
Constructed using 56 items, the interRAI Acute Care required a median of 15 minutes to complete. Inter-rater reliability tested on 130 paired assessments was substantial to almost perfect for 78% of the clinical items and moderate for the remaining 22% of items. A subset of 30 items from the admission assessment comprised the discharge assessment.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Discussion:
The interRAI Acute Care has been shown to be an efficient nursing assessment instrument with good psychometric properties. Implementation in a digital environment will enable documentation and care planning to comply with standards for quality of care in the general adult hospital population.

Keywords: Nursing assessment, acute care, risk assessment, quality of care, instrument development
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Introduction
Timely, expedient, and high-quality assessment of patients is critical to the optimal planning and management of patients during their stay in the acute care hospital setting.1 In addition to the presenting illness or injury, evidence suggests that, particularly for vulnerable patients, functional and psychosocial problems such as inability to self-care, mobility, and cognitive impairments are a common cause of hospital complications.2,3 In many cases, these problems pre-date the acute illness or are aggravated by it4,5; for some, these issues are new, developing during the course of the hospital stay and further complicate recovery.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Functional and psychosocial impairments often result from an accumulation of deficiencies in multiple domains.6 If undetected or left untreated, many of these problems can lead to undesirable outcomes including delirium, falls, pressure injury, functional decline, low morale and depression, institutionalization, prolonged hospital stay, and death.3 Not only does this severely affect the quality of life of the patient, the costs associated with this also become a significant economic burden on a health care system.7 Evidence indicates that early detection of ‘at-risk’ patients on the acute care unit decreases adverse events.8 In addition, conducting a comprehensive assessment of functional and psychosocial problems on admission and at intervals during the hospital stay has been shown to improve patient outcomes.9 Although the high prevalence of such problems in older people in acute care is well recognized,4,5 they can occur in all age groups,10 hence the need for an inclusive assessment system that applies to all inpatients.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Background
The nursing assessment process provides an ideal opportunity to assess and record patient needs, problems, and risks.1,11 As a core component of nursing practice, assessment is designed to guide clinical decisions in the delivery of safe patient care.12 At admission to an acute care hospital, all patients undergo some form of routine nursing assessment. This generally includes the collection of important administrative data, physiological measures, and functional and psychological evaluation and risk appraisal to inform the nursing care plan.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The effective, timely collection and documentation of this information is essential for the development of a targeted and useful care plan. This plan assists important communication between the patient, family, and all members of the health care team, as well as providing an opportunity for the evaluation of the nursing care being offered.13 It is this documentation that sets the standard for patient care; therefore, the use of a comprehensive and validated assessment instrument with established quality guidelines to support this task is recommended to promote best practice.14,15 High-quality clinical information also has benefits beyond immediate clinical care. It can inform service planning, workload assessment, and appraisal of quality. To fully secure these benefits, information should be dynamic across an episode of care including at the point of discharge.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Despite the value of a comprehensive assessment of the patient on admission to an acute care setting, completion of documentation of patient assessments is often sub-optimal.16 Nursing time constraints, a lack of standardized assessment practices, and an abundance of unstructured and incoherent assessment and documentation forms have been suggested as reasons for poor compliance or delay in completing this essential nursing task.13,16–18 Over time, such practices result in important patient issues being missed or attended to in a fragmented manner, incomplete care, poor health outcomes, and preventable and reversible patient challenges.19,20 Duplication of collected information across forms is common.16 In addition, routine documentation appears to have increased significantly over the years, without the review and removal of pre-existing forms that may no longer have relevance21 and also contributing to nurse perception of high workload burden allowing less time to care for patients.16 The phenomena of missed nursing care appear to exist worldwide and are clearly limiting efficient use of resources and quality care planning.22–24

Standardized and integrated data gathering approaches, processes, and documentation have enormous potential to improve the effectiveness and efficiency of any type of assessment, to reduce administration burden and the risk of adverse events, and to enable quality interdisciplinary care and discharge planning.2 In addition, many health care systems are operating in, or planning to migrate to, a digital documentation structure. This movement in itself ought to reduce the documentation burden and consequent potential for missed care but requires a structured assessment protocol. This generally implies that all clinical observations and assessments must have robust psychometric properties, can be scored unambiguously, and that information can be entered into a well-organized and protected computer system that is accessible to all involved in the patient’s care. Ideally, the time taken to complete this process should be broadly commensurate with, or be less, than the current time allocation for the nursing assessment procedures.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The interRAI research collaborative
As a not-for-profit international research organization, interRAI (www.interrai.org) is a collaborative of researchers and practitioners in more than 35 countries seeking to improve the quality of care of vulnerable persons within and across health settings, through the assembly of accurate clinical information in a standardized format. The principles behind the development of instruments in the interRAI suite are that each instrument is designed for a particular population or health care setting, but with sharing of common measures across settings to form an integrated health information system.25 In response to the above issues and the need to address standards to support clinicians (particularly nurses) to deliver comprehensive care,14,15 members of the Acute Care Network within the interRAI research collaborative set out to develop a concise, robust electronic nurse-administered system to support assessment of adult patients within the acute care setting.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

This study reports on the development and psychometric testing of a standardized assessment administered by nurses for patients admitted to acute care – the interRAI Acute Care.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Design
The process to develop the assessment used a modified nominal group technique directed at generation of ideas and setting priories to achieve consensus of opinion in expert panels.26

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Method
Establishment of expert panels
Two expert panels of clinicians and health scientists were established. The development of the concept and design parameters was undertaken by a working group comprising representatives of the Acute Care Network within the interRAI research collaborative at the Centre for Health Services Research (CHSR) at the University of Queensland in Brisbane, Australia, in partnership with senior staff of the Canterbury District Health Board (CDHB) in Christchurch, New Zealand. In parallel, an international working sub-group of the interRAI Acute Care Network provided technical advice and reviewed the system as it evolved.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The 2 groups met in person on 10 occasions, with monthly teleconferences throughout the development period from 2013 to 2016. Through consensus, the groups set broad design parameters for the assessment, including the target population, desired content, system outputs, resource allocation, and potential integration with other interRAI hospital assessments (emergency department, acute care comprehensive geriatric assessment, and post-acute care and rehabilitation).

Key design parameters
Together, the 2 working groups identified the key clinical domains that are related to functional and psychosocial problems. Medical diagnoses, medications, physiological measures, and administrative information were not included, as these are expected to be collected in other components of an admission assessment. An important design requirement was that embedded applications, such as screeners for delirium, or risk assessments for falls and pressure injury should be at least as valid as current ‘stand-alone’ tools. The following were identified as the key design drivers for the assessment system:NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Determine the immediate patient issues that require a nursing care plan response (eg, the patient is incontinent);

Indicate risk of potential future adverse events or outcomes where nursing care has an important preventive function (eg, the patient is at high risk of pressure injury);

Reduce time taken to complete the admission assessment by having sufficiently few observations to enable completion within 20 minutes for most patients;

Identify clinical problems that require further assessment by the nurse or through referral to specialist clinicians or services;

Suggest the need to engage other care providers in the care delivery process as part of discharge planning if it is likely that the patient will require continuing care (eg, the person is at risk of requiring long term care at discharge);

Provide data to enable construction of a discharge profile for presentation to providers who offer continuing care after discharge and to enable assessment of outcomes of care;

Be suitable for application to all adult inpatients aged 18 years and above, including those admitted to general and specialist medical and surgical units and both elective and emergency admissions;

Enable assessment to be completed in a computerized environment with software to support applications for screening, scaling, and quality measures.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Selection of items
Clinical items considered relevant to the specification were selected from the interRAI inventory, comprising highly reliable clinical observation items and questions developed over 20 years across multiple clinical settings. These items have been subjected to extensive multi-national field-testing of their psychometric properties.27–30 Where a suitable item was not available, an existing item was modified or a new one was created. Some items were selected as they contributed to risk screeners (eg, falls risk), scales (eg, pain scale), or quality indicators that had previously been developed by interRAI for application in the acute hospital setting.31 As a result of this process, a 60-item nursing admission assessment, suitable for use with all adult patients in acute care, was created.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Instrument testing
Psychometric properties of the instrument which were tested included feasibility, resource requirements (time taken), and inter-rater reliability.

Feasibility was tested in a small pilot study involving 8 nurses from 3 Australian hospitals. Each nurse performed assessments on 2 patients and then completed a semi-structured questionnaire (with Likert responses) for feedback on item content, degree of difficulty completing the assessment, adequacy of the summary output reports for planning patient care and comparison with usual assessment.

For inter-rater reliability, trained nurse assessors who were not directly involved in the care of patients were recruited at each of 4 hospitals (3 in Australia and 1 in Canada). Patients aged 70 and older (expected to be the most complex patients) were identified from admission lists. Those who gave informed consent to participate were assessed by 2 of the trained nurses within a 2-hour time frame and within 12 hours of admission to the ward. The function as either first or second assessor was determined at random each time a new patient was included. Assessors were blinded to the other’s results and not permitted to discuss the case with each other nor to exchange information.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

It was planned to collect a minimum of 25 paired assessments at each of the 4 hospitals (total 100 paired assessments). Assessments were completed using the draft interRAI Acute Care, according to standard interRAI convention, based on semi-structured clinical interview, clinical observation, and chart review. If present during the assessment, informal caregivers were interviewed to obtain collateral information. Time to complete the assessment was automatically recorded by the data entry software.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Individual items were compared between the 2 assessors using observed agreement in tandem with kappa coefficients. Unweighted Cohen kappa was used for nominal items, with weighted Cohen kappa used for ordinal items. The strength of agreement for the kappa coefficient is considered as poor for kappa values below 0.40, moderate from 0.41 to 0.60, substantial from 0.61 to 0.80, and above 0.81 almost perfect.32

As a last step, the interRAI Acute Care assessment tool was reviewed by the Instrument and Systems Development Committee of the interRAI research collaborative. This committee, which comprises multi-disciplinary clinicians and scientists, reviews systems to ensure clinical appropriateness, high scientific integrity, and consistency with interRAI standards.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Ethical considerations
Ethics approval was obtained for the studies from the participating institutional review committees (The University of Queensland Institutional Human Research Ethics 2015000995; Metro South Human Research Ethics Committee HREC/15/QPAH/313 for Queensland hospital sites; Northern Health HREC/15/NH/27 for the Victorian hospital site; Conestoga College Research Ethics Board for the Canadian hospital site). Informed written consent was given by all participants.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Results
Face validity, feasibility, and acceptability
Qualitative feedback from the semi-structured questionnaire indicated that the information collected using the interRAI Acute Care was sufficient to plan patient care and that the summary report of the patient profile was easy to understand. Most of the nurses (7 of 8 nurses) reported a low level of difficulty completing the assessment and rated it an improvement on their usual practice.

Inter-rater reliability
In total, 130 paired assessments were completed. Patients had a mean (SD) age of 78.2 (7.6) years and 70 (53.8%) were women. Of the 41 clinical items evaluated, 16 were dichotomous (usually yes/no) and the remainder had ordinal responses. In all, 6 items (14.6%) had almost perfect agreement (kappa > 0.8), 26 (63.4%) had substantial agreement (kappa 0.61-0.80), and 9 (22.0%) had moderate agreement (kappa 0.41-0.60). Supplementary Table S1 lists the clinical items, levels of agreement, and kappa values with 95% confidence intervals.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Resource requirements
The 260 assessments completed as part of the inter-rater reliability assessments showed that the median time for completion of the admission assessment, including data entry, was 15 minutes (inter-quartile range 11-20 minutes).

interRAI Acute Care
Following item testing, the expert panels refined the instrument, resulting in an interRAI Acute Care admission assessment of 56 items (4 redundant items were discarded) and a discharge assessment of 30 items. The admission clinical observations were assessed across a wide array of domains (Table 1), and a further 9 items were triggered for completion in certain cases. For example, if a patient reports pain, then pain intensity and frequency are recorded. Pre-morbid functional status is only scored if the person is not independent in hospital. The pre-morbid assessment period is defined as the 3 days prior to the onset of the acute illness that resulted in the admission. A subset of 30 items from the admission assessment comprises the discharge assessment completed on the day of discharge. This permits construction of a patient profile to support transition to ongoing care (eg, in a community programme, step-down programme or, long-term care) and record outcomes, enabling quality indicators to be scored.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Table 1.
Clinical domains in the interRAI Acute Care.

Cognition
Communication, hearing, and vision
Mood
Behaviour
Functional status, activities of daily living
Continence
Health conditions
Health behaviours
Nutrition
Skin conditions
Applications derived from the interRAI Acute Care include a variety of diagnostic and risk screeners, scales to measure and monitor severity, and quality indicators (Table 2). To establish baseline functional performance, the assessment is ‘locked’ at 24 hours after arrival. However, there is provision to update the assessment with changes in condition progressively, or at intervals, across the hospital stay.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Table 2.
Applications derived from the interRAI Acute Care.

Applications Description
Scales (severity)
Cognitive performance scale This scale describes the cognitive status of a person. Validated against the Mini-Mental State Examination (MMSE)33-36
Activities of daily living (ADL) hierarchy scale This scale reflects the disablement process by grouping ADL performance levels into discrete stages of loss (early loss: personal hygiene; middle loss: toileting and locomotion; late loss: eating)37
Activities of daily living (ADL) short form This scale provides a measure of the person’s ability to perform basic ADLs37-39
Communication scale This scale provides a summary of communication measures (making self-understood and ability to understand others)40
Pressure ulcer risk scale This scale identifies persons at various levels of risk for developing a pressure injury, validated against the Braden Scale41,42
Pain scale This scale summarizes the presence and intensity of pain and validates well against the visual analogue scale43
Body mass index (BMI) Calculated as weight (kg)/height (m)2 the BMI is used as a measure of nutritional status44-46
Diagnostic screening
Delirium The delirium screener assists in identifying the presence of delirium at the time of assessment47
Dementia The dementia screener assists in identifying the presence of cognitive impairment/dementia at the time of assessment35
Depression The depression screener assists in identifying the presence of depression at the time of assessment48
Undernutrition The undernutrition screener assists in identifying the presence of undernutrition at the time of assessment44,49
Risk screening
Delirium The delirium risk screener seeks to identify those at risk of developing delirium50
Falls The falls risk screener seeks to identify those at risk of falling51
Pressure injury The pressure injury risk screener seeks to identify those at risk of developing a pressure injury42
Frailty Index A Frailty Index can be derived based on the accumulation of deficits across domains52
Quality indicatorsa Description
Mobility The proportion of patients discharged with worse levels of locomotion/walking compared with pre-morbid levels
Falls The proportion of patients who fall (at least once) during the hospital episode
Pain The proportion of patients with no pre-morbid pain who reported both pain at admission and unimproved pain at discharge
Bladder catheter The proportion of female patients with a new urinary catheter at admission
Self-care The proportion of patients with pre-hospital decline who failed to return to pre-admission function (or better) by discharge
Skin integrity/pressure injury The proportion of patients with a new or worsening pressure injury at discharge compared with admission
Cognitive health The proportion of patients with delirium indicating behaviours at discharge
Institutional placement The proportion of community-dwelling patients discharged to long-term care
Prolonged stay The proportion of patients with prolonged length of stay (greater than the 90th percentile)
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aOnly validated for use in people aged more than 70 years.
The assessment is designed to be completed in a computerized environment with software support to generate outputs in the forms of problem lists, diagnostic and risk screeners, scales, and quality indicators.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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Discussion
The interRAI Acute Care was developed with a process of extensive consultation and psychometric testing. The instrument achieved all the desired objectives delineated in the ‘key design parameters’ listed above and is capable of integration into a digital environment.

It supports a set of applications that matches, and mostly exceeds, that found in most of the nursing assessment systems that have been examined, and further, it achieves this with vastly fewer clinical observations.16 For example, an analysis of 52 assessment forms collected from hospitals in Victoria, Australia, showed that 150 to 586 data items (median 345) were collected per patient.16 Using standardized items for multiple applications and limiting the scope of assessment to that which is able to be completed by nurses in a busy acute care setting, achieves the aims of ease and speed of completion with high acceptability by staff.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Implementation recommendations
Designed to be used when the patient is admitted to an inpatient unit in an acute care setting, the assessment ensures that critical clinical care is promptly administered. Some information about function and psychosocial problems may not be readily available on admission. In this case, a ’best’ estimate of scoring is made, but with provision for adjustment as new information comes to hand. As clinical observations are updated, all applications may be rescored and the care plan adjusted. The applications generate outputs in the form of problem lists, diagnostic and risk screeners, scales, and quality indicators. To best use these outputs, software developers need to work with clinicians and administrators to configure reports that match workflows and administrative requirements. This may include automated or semi-automated triggers for a care plan (eg, high-pressure injury risk generates a relevant care planning action such as the use of pressure redistribution devices) and referrals (eg, a new mobility problem generates a referral to a physiotherapist).

Although the assessment is intended to be performed by nurses, supporting nursing practice and informing patient care planning, it is anticipated that the data will be of considerable value to other members of the clinical team. The assessment contains information that should alert other staff or members of the interdisciplinary team such as doctors, physiotherapists, and dieticians to those patients who are likely to experience problems and the plan of care to address those risks. The information has the potential to inform resource allocation. If patient information is recorded in a robust manner on a large scale, it may complement traditional systems based on medical diagnoses and procedures to enhance case mix and work assignment systems. Similarly, if discharge assessments are conducted appropriately, it will likely inform appraisal of service quality (eg, through quality indicators).NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Related clinical assessments developed by interRAI
The interRAI Acute Care forms part of the interRAI Hospital Systems designed to support care across the hospital continuum, allowing for seamless transition from admission, through the hospital stay to discharge. The Hospital Systems include assessments in the emergency department (the interRAI Emergency Department Contact Assessment), for comprehensive geriatric assessment in acute care (the interRAI Acute Care for Comprehensive Geriatric Assessment) and for rehabilitation or other form of post-acute care (the interRAI Post-Acute Care and Rehabilitation). It is also compatible with other interRAI assessment systems including community and palliative care, and long-term residential care, sharing many clinical observations, screeners, and scales.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Limitations
Although implementation trials of the interRAI Acute Care are planned in Australia and New Zealand, this system is yet to be applied in usual day-to-day clinical practice. This will require careful appraisal of, and alignment with, care delivery systems and with well-designed software that facilitates the execution of these processes.

Development of the instrument remains incomplete. Our group is presently exploring the possibilities of developing further scales and measures to enhance interpretation of the assessment. Examples of work in progress are screeners to support targeting of patients suitable for rehabilitation or post-acute care or to identify those patients who are at risk of requiring long term residential care at discharge. The quality indicators were developed specifically for older patients31 and have yet to be tested in cohorts of younger patients. Their use is thus recommended only for patients aged more than 70 years at this time.

Although the development of this system engaged clinicians from almost 20 nations, until international field testing is conducted on representative samples of acute care patients, particularly in cohorts younger than 70 years, we cannot fully guarantee applicability. In nations or hospitals with current minimal (and in our view inadequate) assessment protocols, this system will represent an increased workload.

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Conclusions
The interRAI Acute Care has been designed as a comprehensive and efficient system to assess functional and psychosocial needs of adult inpatients in acute care, thus addressing standards for quality inpatient care. This approach meets a set of challenging design criteria. The clinical observations and derivative applications have excellent psychometric properties. It is compatible with other interRAI systems designed for use across the hospital continuum of care and into the community. To our knowledge, there are no similar published systems designed for systematic planning and documentation of care in the general adult hospital population.

AIMS AND OBJECTIVES:
To evaluate structured patient assessment frameworks’ impact on patient care.

BACKGROUND:
Accurate patient assessment is imperative to determine the status and needs of the patient and the delivery of appropriate patient care. Nurses must be highly skilled in conducting timely and accurate patient assessments to overcome environmental obstacles and deliver quality and safe patient care. A structured approach to patient assessment is widely accepted in everyday clinical practice, yet little is known about the impact structured patient assessment frameworks have on patient care.

DESIGN:
Integrative review.

METHODS:
An electronic database search was conducted using Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System, PubMed and ProQuest Dissertations and Theses. The reference sections of textbooks and journal articles on patient assessment were manually searched for further studies. A comprehensive peer review screening process was undertaken. Research studies were selected that evaluated the impact structured patient assessment frameworks have on patient care. Studies were included if frameworks were designed for use by paramedics, nurses or medical practitioners working in prehospital or acute in-hospital settings.

RESULTS:
Twelve studies met the inclusion criteria. There were no studies that evaluate the impact of a generic nursing assessment framework on patient care. The use of a structured patient assessment framework improved clinician performance of patient assessment. Limited evidence was found to support other aspects of patient care including documentation, communication, care implementation, patient and clinician satisfaction, and patient outcomes.

CONCLUSION:
Structured patient assessment frameworks enhance clinician performance of patient assessment and hold the potential to improve patient care and outcomes; however, further research is required to address these evidence gaps, particularly in nursing.

RELEVANCE TO CLINICAL PRACTICE:
Acute care clinicians should consider using structured patient assessment frameworks in clinical practice to enhance their performance of patient assessment.

Credit points: 6 Teacher/Coordinator: Dr Osu Lilje Session: Semester 1,Summer Main Classes: Two 1-hour lectures per week (three lectures in some weeks), one 3-hour practical class per fortnight, one 2-hour workshop per fortnight, 6-9 hours of online activities per fortnight. Prohibitions: BIOL1500 or BIOL1903 or BIOL1993 or EDUH1016 Assumed knowledge: HSC Biology. Students who have not completed HSC Biology (or equivalent) are strongly advised to take the Biology Bridging Course (offered in February). Assessment: One 2-hour exam, assignment, group project presentation and quizzes (100%). Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Note: Students who have not completed HSC Biology (or equivalent) are strongly advised to take the Biology Bridging Course (in February)
This unit of study provides an introduction to human anatomy and physiology. It includes an overview of cell and tissue structures, the skeletal system, nutrition, digestion and excretion. Human Biology looks at how our bodies respond to environmental stimuli with respect to the endocrine, nervous and immune systems. After discussion of reproduction and development, it concludes with an overview of modern studies in human genetics. This unit has four main components: lectures, practicals, workshops and HB Online activities.
Textbooks
Van Putte, C., Regan, J. and Russo, A. (2016) Essentials of Anatomy and Physiology, McGraw Hill.The edition comes with a custom publication of:Mader, S.S. (2006) Human Biology, 11th edition, McGraw Hill. (Chapters 19, 24, 26)
HSBH1006 Foundations of Health Science

This unit of study is not available in 2019

Credit points: 6 Teacher/Coordinator: Dr Andrew Campbell Session: Semester 1 Classes: 2×1-hr lecture/week, 1-hr tutorial/week and eLearning online learning support. Assessment: Tutorial attendance and presentation (30%), essay (30%) and 1.5-hr final exam (40%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Note: Department permission required for enrolment
This is an introductory unit for students entering the health sciences. The unit will provide students with knowledge and understanding of key approaches to health and illness, patterns of health and disease at a national and international level, and how we measure health status in an individual, a community and a nation. Students will gain an understanding of who provides health care at the professional, community and family level, and the roles taken up by non-professionals in advocating for change through health-focused consumer and community-based support groups. Students will develop a range of core skills and competencies needed in the study and practice of health sciences and as a basis for working in health-related areas or for postgraduate study.
PSYC1001 Psychology 1001

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Credit points: 6 Session: Semester 1,Summer Main Classes: Three 1 hour lectures and one 1 hour tutorial per week, plus 1 hour per week of additional web-based (self-paced) material related to the tutorial. Assessment: One 2.5hr exam, one 1150 word research report, multiple tutorial tests, experimental participation (100%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Note: This unit is also offered in the Sydney Summer School. For more information consult the web site: http://sydney.edu.au/summer/
Psychology 1001 is a general introduction to the main topics and methods of psychology, and is the basis for advanced work as well as being of use to those not proceeding with the subject. Psychology 1001 covers the following areas: science and statistics in psychology; applied psychology; themes in the history of psychology; social psychology; personality theory; human development. This unit is also offered in the Sydney Summer School. For more information consult the web site: http://sydney.edu.au/summer_school/
Textbooks
Available on-line once semester commences
HSBH1008 Health Determinants and Interventions

This unit of study is not available in 2019

Credit points: 6 Teacher/Coordinator: Dr Nikki Wedgwood Session: Semester 1 Classes: 1×2-hr lecture/week, 1×1-hr tutorial/week Assessment: Tutorial presentations (20%), essay outline (25%), peer review exercise (10%), final essay (45%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit will introduce students to the main social and economic factors associated with patterns of health in Australia and a global context and will explore the social, cultural and environmental processes involved in determining the similarities and disparities in the health of populations and peoples, drawing primarily on sociological approaches. Students will be introduced to a repertoire of key concepts for understanding these processes including class, gender, occupation, ethnicity, indigeneity, disability, inequality, globalisation, and the role of governments.
Year 1, semester 2
HSBH1009 Health Care Resources and Systems

This unit of study is not available in 2019

Credit points: 6 Teacher/Coordinator: Prof Stephanie Short Session: Semester 2 Classes: 2×1-hr lectures/week, 1-hr tutorial/week Assessment: online quizzes (3 X 10%), team project (30%) and final exam (40%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Note: Department permission required for enrolment
The unit of study comprises three modules: health care systems – provides foundational knowledge about the Australian health care system in an international context; approaches to health policy – introduces students to the key approaches and concepts in health policy analysis and applies them to contemporary challenges in Australian health policy; key challenges in health care resources and systems – outlines key challenges for analysis.
Textbooks
Palmer, G. R., and Short, S. D. (2014). Health care and public policy: An Australian analysis (5th ed.). Melbourne: Palgrave Macmillan.
18 credit points of BHS electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
Note – from 2018, students should seek academic advice from the Course Director should they still need to complete HSBH1006 or HSBH1009
Year 2, semester 1
NURS5042 The Body, Its Function and Pharmacology

Credit points: 6 Session: Semester 1 Classes: 10×2-hr lectures online, and 8×2-hr tutorials Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study will examine various biological processes to assist students in developing their understanding of human cellular structure and function and the contribution this makes to healthy body function. The role of pharmacotherapy and specific pharmacological interventions aimed at restoring or replacing the function of specific cells, tissues or organs affected by these pathological changes will be considered.
NURS5081 Introduction to Nursing Practice

Credit points: 6 Session: Semester 1 Classes: 10×2-hr lectures, 8×2-hr tutorial, 10×2-hr labs, clinical placements (80-hrs) Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
‘This unit of study provides an opportunity for students to develop an understanding of professional nursing; ‘what it is and what it is not’ (Nightingale, 1859) and to observe and explore the roles and relationships among nurses, patients and other health professionals in a practice setting. The unit will introduce physical assessment, work health and safety and will equip nursing students to develop a ‘toolkit’ of fundamental nursing practice strategies and ‘craft’ skills. This will include a focus on working with patients across the lifespan and within different cultural groups. Students will be introduced to the cycle of practice thinking and patterns of knowing that underpin nursing practice.
HSBH2007 Research Methods in Health

Credit points: 6 Teacher/Coordinator: Dr Rowena Forsyth Session: Semester 1 Classes: 1×2-hr lecture/week, 1×1-hr tutorial/week Prerequisites: ((HSBH1006 AND HSBH1009) OR HSBH1012) AND (HSBH1008 OR HSBH1013) Prohibitions: BACH2140 or HSBH1007 Assessment: Written group assignment (20%), written individual assignment (30%), 1×1.5-hr exam (50%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The unit of study introduces students to the design and evaluation of research questions relating to health. Drawing on both qualitative and quantitative research methods, students will be introduced to key concepts relating to methodology; research design and research method.
6 credit points of BHS senior electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
Year 2, semester 2
NURS5006 Illness, Experience and Nursing Care

Credit points: 6 Session: Semester 2 Classes: 12×2-hr lectures, 3×2-hr tutorials online, labs 2×2-hr, and clinical placements (80-hrs) Prerequisites: NURS5081 and NURS5042 or NURS5083 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The ways in which individual people subjectively experience illness and care, particularly nursing care, is the focus of this unit of study. The unit encourages students to think critically about their own attitudes, beliefs, and ideas about health, illness, and care, and to examine how these might have a bearing on the experiences of those in their care. Theories that inform understanding of what it is to be human are examined. Attention is drawn to such factors as embodiment, illness and the body, emotions arising in illness, issues of self-identity and social attitudes to illness and disability. The unit also introduces students to qualitative research methodologies that are used to explore illness experiences. A variety of illness experiences are then examined. With this knowledge, the nurse-patient relationship is then critically examined. From within a communication-based framework, students focus on ideas about therapeutic listening and use of self as well as the concept of knowledge transfer as it is relevant to nurse-patient interactions. Students also engage with contemporary debates about the nature of nurse-patient interactions and relationships today and explore the ways in which these might vary in different health care settings, and with people from different cultural backgrounds, including Aboriginal and Torres Strait Islander peoples.
NURS5043 Understand Health and Managing Disease

Credit points: 6 Session: Semester 2 Classes: 12×2-hr lectures, and 8×2-hr tutorials Prerequisites: NURS5042 or NURS5083 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The knowledge acquired in The Body, Its Function and Pharmacology will be used as a foundation for this unit of study. Basic cellular changes associated with normal function and disease of the gastrointestinal, cardiovascular, renal, respiratory, musculoskeletal and immunological systems will be explored. Pharmacological interventions aimed at restoring or replacing the function of specific cells, tissues or organs affected by these pathological changes will be considered.
6 credit points of BHS senior electives (see list of electives in Bachelor of Health Sciences Chapter of the Faculty of Health Sciences Handbook).
6 credit points of BHS electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
Year 3, semester 1
NURS5002 Social Contexts of Health

Credit points: 6 Session: Semester 1 Classes: 10×2-hr lectures, and 8×2-hr tutorials Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The main focus of this unit is on the social determinants of health through a critical analysis of the relationships between social factors (e. g, ethnicity, gender, socio-economic status, employment) and patterns of health and illness across the lifespan in contemporary Australia. The unit includes a module that introduces students to epidemiology, the study of causes and patterns of disease within defined populations. This unit is underpinned by the understanding that ideas and beliefs about health, illness and care are intrinsically connected to particular social and historical contexts. Some of these ideas and beliefs relevant to Australia today will be explored. The unit also introduces students to the study of cultural competence as it relates to health care in contemporary Australia.
NURS5082 Developing Nursing Practice

Credit points: 6 Session: Semester 1 Classes: 10×2-hr lectures, 9×2-hr laboratory, 8×2-hr tutorials, and clinical placements (80-hrs) Corequisites: NURS5081 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study complements Introduction to Nursing Practice and further develops the understanding of clinical judgement in practice and the role of nursing in assisting those experiencing hospitalisation. Such assistance includes but is not limited to: maintenance of appropriate fluid status, infection control, oral medications, effective levels of oxygenation and pain relief. This knowledge will be extended to incorporate the experience of caring for patients when the body fails to function as expected, and particularly where surgery is required. This unit of study will further develop skills in physical assessment, communication, and documentation and introduce students to medication administration.
6 credit points of BHS senior electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
6 credit points of BHS electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
Year 3, semester 2
NURS5084 Nursing the Acutely Ill Person

Credit points: 6 Session: Semester 2 Classes: 12×2-hr lectures, 11×2-hr labs, 8×2-hr tutorials, and clinical placements (80-hrs) Prerequisites: NURS5082 and NURS5081 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study complements Illness Experience and Nursing Care, focusing on the responses of individuals and others to disruption to health. This unit of study aims to address issues surrounding acute nursing practices for various patients with common health care needs. Nursing practices associated with: the restoration and maintenance of oxygenation, ventilation and circulation; metabolism and elimination; consciousness and regulation; and movement and protection, are expanded upon using the framework for practice thinking. A life span approach will be used throughout with a focus on how diseases manifest and are treated differently as they occur at different life stages. In this unit of study students will further develop comprehensive health assessment skills and their understandings of accurate medication administration.
NURS5085 Mental Health Nursing Practice

Credit points: 6 Session: Semester 2 Classes: 12×2-hr lectures, 8×2-hr tutorials, and clinical placements (120-hrs) Corequisites: NURS5084 Assessment: online quiz (15%) and essay (35%) and written examination (50%) and satisfactory off-campus clinical performance Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study is based on the principle that knowledge of mental health and illness and skills related to working with people with compromised mental health, are essential for all nurses. The unit of study is underpinned by a biopsychosocial or whole-person approach that privileges the individual experience of those with mental health problems. Students are introduced to the constructs of mental health and wellbeing and mental illness and how these apply across the life span alongside cultural and gender influences. Using the context of a whole-person approach, students will explore the role of the nurse in promoting mental health, preventing mental health problems and minimising negative effects of mental illness for individuals and their family/carers. Mental health and illness are explored in relation to determinants of health/risk and protective factors; the stress-vulnerability model, prevalent and low-prevalent mental health problems (for example depression and schizophrenia) and the varied manifestations of symptoms, including mood, anxiety, and psychotic symptoms. Current evidence for nursing care, psychotherapeutic interventions and physical treatment approaches are addressed in relation to symptom management and promotion of mental health and wellbeing. Consumer and carer perspectives will inform and further strengthen students’ understandings. Comorbid physical health conditions and/or poor physical health are common for people experiencing mental health problems regardless of age or diagnosis. In addition, high co-occurrence of substance use is an area of significant concern for this population. These issues increase the complexity and burden of illness. Comorbid conditions and their implications are broadly addressed and the nursing management of comorbid conditions is considered. The nurse’s effective use of self and the therapeutic nurse/client relationship are core aspects of nursing practice with mental health consumers that are addressed from both a theoretical and practical perspective. Students will consider how to develop and demonstrate requisite interpersonal communication skills and will develop foundational assessment and interviewing skills. The care continuum in mental health and the scope of nursing practice in a range of mental health and ethico-legal contexts are addressed with the overall aim of promoting nursing practice that supports effective outcomes for mental health consumers and their family/carers across community, primary and acute care settings.
6 credit points of BHS senior electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
6 credit points of BHS electives (see list of electives in Bachelor of Health Sciences chapter of the Faculty of Health Sciences handbook).
Year 4, semester 1
NURS6018 Care and Chronic Conditions

Credit points: 6 Session: Semester 1 Classes: 6×2-hr lectures, and 4×3-hr labs, and 1×2-hr and 3×3-hr tutorial, and clinical placements (100-hrs) Prerequisites: NURS5084 and NURS5085 and NURS5082 and (NURS5043 or NURS5086) Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study addresses nursing practices designed to meet the needs of individuals and families who are either living with long-term health conditions or terminal illness. A lifespan approach, childhood to old age, will provide an overview. An emphasis is placed on an holistic approach to nursing care, irrespective of setting. Continuity of care provision between hospital and community is emphasised using a case management model of care. The dynamics of self management for persons living with chronic conditions will be highlighted. Common chronic conditions in the Australian population will be identified together with their lifestyle and biomedical risk factors. Mental health issues will be addressed where appropriate, and chronic pain, its impact and management will be discussed as many chronic conditions have pain as a component. Co-morbidities, particularly within the care of elderly persons, will be explored. The importance of community engagement in addressing issues associated with chronic conditions in Aboriginal and Torres Strait Islander communities will be studied. Palliative nursing skills will be a focus, including symptom management and psychosocial care which facilitate a peaceful and dignified death.
NURS6019 High Acuity Nursing

Credit points: 6 Session: Semester 1 Classes: 6×2-hr lectures, 4×3-hr labs, 11×2-hr tutorial, and clinical placements (80-hrs) Prerequisites: NURS5082 and NURS5084 and (NURS5042 or NURS5083) and (NURS5043 or NURS5086) Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study extends the students understanding of acute illness and introduces them to the complex challenges of caring for critically ill and physiologically unstable patients in high acuity settings. An important component of this unit of study is the understanding of the nursing assessment and management required when caring for patients with rapidly changing clinical conditions. Using a systematic approach to patient assessment students will develop nursing practices and interventions designed to meet the needs of these patients. In this context, specific clinical situations will be identified which include caring for patients with altered circulation, trauma, and severe sepsis. This unit also explores the high acuity environment and the technological monitoring devices that can be used to assist in the management of these acutely ill patients. It builds on knowledge and capabilities developed in NURS 5084 Nursing the Acutely Ill Person
NURS6031 Leadership and Collaborative Practice

Credit points: 6 Session: Semester 1 Classes: 6×2-hr lectures, and 3×3-hr tutorials Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Nursing practice involves complex and demanding work, influenced by large bureaucracies and challenging healthcare environments in a constant state of flux. Nurses can empower their practice and thrive in the workplace as health professionals and leaders, by developing the key strategy of resilience. This unit of study is framed by the construct of ‘health professional resilience’, characterised by the capacity to withstand the negative effects and significant change enhanced by individual and environmental protective factors and research-informed decision making.
The unit is designed to: 1) assist students to prepare for transition into the nursing workforce and therefore inform their management of future transitions and changes throughout their nursing career, and 2) to understand and respond to internal and external influences on current practice and professional issues, particularly those relevant to leadership development. Following an introduction to resources to inform leadership decisions, the unit examines key elements of the regulation of health care professionals, using nursing as the example. These elements include registration components, professional-ethical standards, professional competence and practice evaluation.
The unit also addresses key characteristics of resilience in the healthcare workplace, with a focus on emotional intelligence required by nurses to take a leadership role in coordination of nursing and health care, and to develop effective clinical nurse-patient, intra-professional and interdisciplinary relationships.
NURS6033 Health of Indigenous Populations (MN)

Credit points: 6 Session: Semester 1 Classes: 6×2-hr lectures, 1×2-hr and 3×3-hr tutorials Prerequisites: NURS5002 Assessment: Assessment (45%) and presentation (10%) and written examination (45%) Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The fundamental rights and freedoms we enjoy as Australians are universal. Australia has affirmed, within our support for fundamental rights and freedoms, ‘that Indigenous peoples are equal to all other peoples, while recognising the right of all peoples to be different, to consider themselves different, and to be respected as such’ (UN Declaration on the Rights of Indigenous Peoples). Nurses play a pivotal role in ensuring that the rights of Aboriginal and Torres Strait Islander peoples are maintained throughout the health sector. The challenge for nursing is how, in a diverse society, do we navigate the translation of rights to reality? Culturally valid understandings must shape the provision of services and must guide assessment, care and management of Aboriginal and Torres Strait Islander people’s health (Purdie, Dudgeon and Walker, 2009). Subject content explores the practice of cultural competence for Aboriginal and Torres Strait Islander peoples. The subject covers topics such as contemporary Indigenous health and the ways in which historical circumstances have had, and continue to have, an impact on the health of Indigenous peoples. The unit will focus primarily on the health of Australian Aboriginal and Torres Strait Island peoples, but will also briefly explore the health of Indigenous populations in other comparable western nations. Students will explore in some depth the most significant social determinants of health as these relate to the health of Australian Aboriginal and Torres Strait Island populations. The unit will also focus on the relationship between access to health care services and health outcomes for Australian Aboriginal and Torres Strait Island peoples, and the concept of cultural diversity in relation to the provision of health care services to people from Australian Aboriginal and Torres Strait Island backgrounds.
Year 4, semester 2
NURS6022 Community Health Nursing

Credit points: 6 Session: Semester 2 Classes: 8×2-hr lecture, 6×2-hr tutorials, and clinical placements (80-hrs) Prerequisites: NURS6018 and NURS6019 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Increasingly complex and chronic health conditions are being managed in the community. This unit of study examines the major concepts and principles of community health nursing including self-care, continuity of care, primary health care, health promotion/illness prevention, community assessment, family assessment, and home care. Approaches to the provision of nursing care for people of all ages with acute, chronic, or life threatening illness in settings where they live will be examined. Particular attention will be given to case management and the home visit process: its therapeutic nature, communication skills and safety issues. Areas of specialisation within community health will also be discussed, and the nurse’s role in health promotion and disease prevention will be explored with special consideration given to aboriginal, and child and adolescent health. Epidemiological concepts and methodologies integral to community health nursing are explored. Students will undertake a community assessment of a chosen local government area using a ‘community profile’ approach. They also examine a public health problem in relation to the local government area, with the role of the community nurse in addressing the public health problem. Community clinical placements will provide students with the opportunity to consolidate and integrate theoretical knowledge and community nursing practice.
NURS6029 Australian Health Care – Global Context

Credit points: 6 Session: Semester 2 Classes: 8×2-hr lectures, and 6×2-hr tutorials Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study critically analyses the Australian health-care system, with an emphasis on its structure, funding arrangements, and the ways in which it is influenced by contemporary ideologies and economic and political factors. The unit focuses on current political issues and debates (including those concerning nursing and other health professionals) and the ways in which these affect health policy and the delivery of care in Australia and globally. The unit has a particular focus on issues of access and equity, resource allocation, and multidisciplinary teamwork. The Australian health care system is compared with other OECD country systems to help students to think critically about the effectiveness of the Australian system in global terms. The unit explores the role of nurses as global citizens and the role of the profession in its global context.
NURS6030 Research and Evidence

Credit points: 6 Session: Semester 2 Classes: 10×2-hr lectures, and 8×2-hr tutorial Prerequisites: NURS5002 and NURS5006 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study builds on foundational research and inquiry methods introduced within the context of the pre-requisite units to prepare students to recognise the quality and appropriateness of research for translation into nursing knowledge and practice. The process of inquiry is reviewed in relation to clinical questioning, selection of appropriate study designs and literature, consideration of patient and family values and the organisational, ethical and policy environment. Research methods are examined within the context of judging the quality and appropriateness of published research findings for application to practice. Students will be introduced to evidence implementation frameworks that are inclusive of evaluation research techniques.
NURS6032 Professional Practice (MN)

Credit points: 6 Session: Semester 2 Classes: 8×2-hr lectures, 4×2-hr tutorials, 4×2-hr clinical labs, and clinical placements (160-hrs) Prerequisites: NURS5085 and (NURS5043 or NURS5086) and NURS6018 and NURS6019 Corequisites: NURS6022 Assessment: Student assessment (100%) conducted throughout the semester, as advised within the relevant unit of study outline Campus: Mallett Street, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study extends students’ knowledge and skills in a clinical nursing environment of their choice in preparation for practice as a registered nurse. It provides students the opportunity to consolidate prior learning and expands their knowledge base across a variety of health care settings for example: aged care, palliative care, mental health, perioperative, high acuity, paediatrics or primary health care. The framework of the nursing practice thinking cycle will guide the teaching learning strategies and focus on clinical decision making in a range of settings.
Bachelor of Health Sciences senior units of study*
Students must select three of the following Bachelor of Health Science senior units of study:
Semester 1
HSBH3001 Health and Indigenous Populations

Credit points: 6 Teacher/Coordinator: Dr Vanessa Lee Session: Semester 1,Semester 2 Classes: 1×2-hr lecture/week, 1×1-hr tutorial/week. Prerequisites: HSBH1007 or HSBH2007 or BACH1161 or HSBH1003 Assessment: On line quizzes (20%), Case study report 1500wd (40%), Critique diary 1500wd (40%). Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The increasing need to address the health of Indigenous populations is not a new phenomenon. This Unit of Study teaches students, from an Indigenous Australian lens, about delivering services to Indigenous populations to address health and wellness. The semester journey takes into account the strength of Indigenous ways of doing, knowing and being that have enabled Indigenous people to address the social, political and cultural determinants of health. Students will be engaged in understanding the complexities surrounding the collection and recording of accurate Indigenous population health data that has led to Indigenous disadvantage and the gap in life expectancy that Australia still struggles to close. Students will be engaged in strategies for effective cultural communication with Aboriginal and Torres Strait Islander health professionals and patients/ clients. Ethical approaches required for researching Indigenous peoples and communities will also be explored.
HSBH3004 Health, Ethics and the Law

Credit points: 6 Teacher/Coordinator: A/Prof Jennifer Smith-Merry Session: Semester 1 Classes: 1×2-hr lectures/week, 1-hr tutorial/week Prerequisites: 48 credit points of units Assessment: Mid-semester exam (20%), research report (40%) and final exam (40%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study engages students in interdisciplinary experiences that focus on ethics and law in relation to the Australian health system. Fundamental ethical principles applied to ethical issues in health and health research are covered. Medico-legal aspects of health and health services will be explored. Particular areas of focus include mental health, health complaints, reproductive technologies, the start and end of life, disability, public health and genetic technology. Students will develop their own ethical thinking and an understanding of professionally acceptable behaviours appropriate to practice in a wide range of disciplines and health professions. Learning is interactive and scenarios are used to develop ethical thinking. Students will write a research report on an ethical and legal issue of their choosing.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Textbooks
Kerridge, I., Lowe, M., and Stewart, C. (2013). Ethics and law for the health professions. Leichardt: The Federation Press.
HSBH3011 Rural Health

Credit points: 6 Teacher/Coordinator: Dr Krestina Amon Session: Semester 1 Classes: Distance education/intensive on-campus mode. Web-based learning, Week 1 lecture (2hrs) on campus with mandatory attendance. All other materials will be delivered asynchronously online. Prerequisites: HSBH1007 or HSBH2007 Assessment: Attendance at timetabled lecture and online participation (25%), individual report (30%), group project (45%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Distance education/intensive on campus
This unit introduces students to a range of practice and research issues in rural health care. Topics covered include: the nature and variety of rural settings; special populations and cultural safety; rural health needs and access to health services; relevant models of health service delivery; and the rural health workforce and inter-professional practice.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
HSBH3012 FHS Abroad

Credit points: 6 Teacher/Coordinator: Dr Elizabeth Dylke Session: Intensive December,Intensive July,Semester 1,Semester 2 Classes: Full-day briefing session, half-day debriefing session. Prerequisites: Successful completion of all 1st year units in an undergraduate FHS degree Assessment: Pre-departure research (30%), field diary (20%), report (40%) and presentation (10%). Practical field work: 4-6 weeks working with a community-based organisation in a developing country. Campus: Cumberland, Sydney Mode of delivery: Field experience
Note: Students interested in participating must obtain permission from their course director before enrolling in FHS Abroad. Some degrees require participants have a minimum credit average.
Cultural practices, disease patterns and healthcare systems are vastly different in different countries around the globe. This unit provides students with the opportunity to gain international experience in a health services setting in a developing country. Students will participate in a 4-6 week health or care placement with a community-based organisation in South or Southeast Asia. Countries where students can be placed include Vietnam, Cambodia, India and the Philippines. As part of the unit, you will be expected to participate in local development programs, live within the community that you are visiting, and document and reflect on key health and development issues facing local populations. The unit will require you to demonstrate cultural sensitivity and an ability to adapt to new environments, a capacity for critical reflection and awareness of complex global health and development issues.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
HSBH3015 Mental Health Rehabilitation

Credit points: 6 Teacher/Coordinator: A/Prof Lynda Matthews Session: Semester 1 Classes: Online Prerequisites: 48 credit points Assessment: 2x online assessments (20%) ,1x2000wd essay (50%) and participation (30%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Online
Poor mental health poses a major challenge to our society, and health care professionals, among others, are charged with ‘making a difference’. To do so, they need to be equipped with the most up-to-date knowledge of effective mental health approaches and interventions.NURSING 3005 – Nursing in Complex Settings Assignment Papers. This unit will overview major mental health conditions and significant social, philosophical, and historical influences on health care service delivery and reform to provide a context for contemporary rehabilitation practice. Students will be introduced to the goals, values and guiding principles of psychiatric rehabilitation and to practices that aim to address the culture of stigma and low expectations by society of people with mental health conditions. Rehabilitation interventions that have demonstrated efficacy in promoting recovery by reducing obstacles to participation for people with mental health conditions will be examined. Local and international research underpinning best practice in rehabilitation management and service delivery will be reviewed and consumer perspectives and experiences explored.
HSBH3022 Health Promotion: Principles and Practice

Credit points: 6 Teacher/Coordinator: Dr Justin McNab Session: Semester 1 Classes: 1×2-hr workshop/week Prerequisites: HSBH1007 or HSBH2007 Assessment: 1x1500wd essay (40%), 1x 15-min group oral presentation (10%) and 1x 2000wd project plan (50%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study introduces students to the key theories, principles and frameworks underpinning health promotion in the context of a disciplinary group project. Across the unit of study, students engage with their peers in the development and application of critical insight into individual and socio-ecological approaches, models of community participation, and settings approaches. Students will develop an appreciation that effective health promotion involves actions that are aimed, not only at increasing the knowledge and skills of individuals, but also at strengthening community action and to create living and working environments that support health. NURSING 3005 – Nursing in Complex Settings Assignment Papers. Students will develop knowledge in the application of health promotion programs through their disciplinary group project taking account of diverse populations and settings, including Indigenous, culturally and linguistically diverse groups and rural groups. Through their project work, students will consider how health promotion fits within the broader health context, and the ways in which health promotion practitioners work collaboratively with communities, work places, schools, government and other health professionals to improve the health of populations. The theoretical and applied skills that students develop will prepare students for careers in health promotion practice and research.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Semester 2
HSBH3001 Health and Indigenous Populations

Credit points: 6 Teacher/Coordinator: Dr Vanessa Lee Session: Semester 1,Semester 2 Classes: 1×2-hr lecture/week, 1×1-hr tutorial/week. Prerequisites: HSBH1007 or HSBH2007 or BACH1161 or HSBH1003 Assessment: On line quizzes (20%), Case study report 1500wd (40%), Critique diary 1500wd (40%). Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
The increasing need to address the health of Indigenous populations is not a new phenomenon. This Unit of Study teaches students, from an Indigenous Australian lens, about delivering services to Indigenous populations to address health and wellness. The semester journey takes into account the strength of Indigenous ways of doing, knowing and being that have enabled Indigenous people to address the social, political and cultural determinants of health. Students will be engaged in understanding the complexities surrounding the collection and recording of accurate Indigenous population health data that has led to Indigenous disadvantage and the gap in life expectancy that Australia still struggles to close. Students will be engaged in strategies for effective cultural communication with Aboriginal and Torres Strait Islander health professionals and patients/ clients. Ethical approaches required for researching Indigenous peoples and communities will also be explored.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
HSBH3003 Health Service Strategy and Policy

Credit points: 6 Teacher/Coordinator: A/Prof Kate O’Loughlin Session: Semester 2 Classes: 1×2-hr lectures/week, 1-hr tutorial/week Prerequisites: HSBH1007 or HSBH2007 Assessment: Tutorial/workshop activities (10%), online activities (15%), 1×15-min group project plan presentation (15%), 1x2500wd group project report (60%) Practical field work: 1×2-hr workshop Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study offers students an insight into the larger picture of how a nation sets priorities for health services. The importance of evidence-based health policy development in planning health services and strategies for increasing the cost-effectiveness of delivering health services will be covered. Students will gain skills in health service needs assessment, measuring cost-effectiveness, macroeconomic evaluation of health services and systems, and health equity assessment. It is envisaged that students will develop a capacity to understand the concept of health policy and its relevance to the delivery of health care services and to take a problem-oriented approach to analysing and evaluating current policy provisions and strategies in the Australian context.
HSBH3009 International Health

Credit points: 6 Teacher/Coordinator: Dr Zakia Hossain Session: Semester 2 Classes: 1×2-hour lecture/week, 1×1-hr face-to-face/on-line tutorial/week Prerequisites: 48 credit points of units Prohibitions: BACH3128 Assessment: Online activities (20%); tutorial attendance and presentation (20%); and briefing paper 2500wd (60%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit examines theoretical and practical issues confronting global health professionals and practitioners, especially in low-resource settings. It provides students with opportunities to apply their disciplinary expertise in the interdisciplinary, international health setting. NURSING 3005 – Nursing in Complex Settings Assignment Papers. The unit introduces students to: a) historical, political and economic forces that influence the health of populations around the world and contribute to international health inequities; b) global health crises (emerging infectious disease, chronic disease and disability) facing both developed and developing countries and their impact; and, c) international health practices, including key actors and initiatives, as well as challenges and strategies for working in cross-cultural contexts. The unit provides students with an understanding of health determinants and interventions in international contexts, with a particular emphasis on low-resource settings. Examples of topics covered include health, poverty and inequality, foreign aid and development assistance, globalisation, technology and health. The unit also provides an introductory overview of contemporary international health challenges such as food security, humanitarian crises and climate change. Students will undertake an in-depth study of a global health issue, exploring the context in which it emerged and the forces that propel it, and advocate for actions to improve the issue in a specific local context and population group.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
HSBH3010 Health and Lifelong Disability

Credit points: 6 Teacher/Coordinator: Dr Zakia Hossain Session: Semester 2 Classes: 1×2-hr lecture/week, 1×1-hr tutorial/week. Prerequisites: HSBH1007 or HSBH2007 Assessment: On-line activities (20%), essay 2000wd (35%) and case study (45%) . Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study explores the roles and responsibilities of health professionals who work with children, adolescents and adults with lifelong disabilities, and their families.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Using an inter-professional case-based curriculum, students will examine the nature of lifelong disability; factors which affect the participation of persons with lifelong disability in everyday life activities including education, leisure, and employment; and strategies for increasing their participation in these activities. Students will be supported to critique research literature, to examine the roles and responsibilities of allied health professionals in the context of working with persons with lifelong disability, and to develop practical strategies for interacting and working collaboratively and successfully with children, adolescents, and adults with lifelong disabilities, their families and fellow professionals. It is expected that through a combination of face-to-face teaching and online learning activities, this unit will assist students in preparing to work with individuals with lifelong disabilities in a range of workplace settings.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
HSBH3012 FHS Abroad

Credit points: 6 Teacher/Coordinator: Dr Elizabeth Dylke Session: Intensive December,Intensive July,Semester 1,Semester 2 Classes: Full-day briefing session, half-day debriefing session. Prerequisites: Successful completion of all 1st year units in an undergraduate FHS degree Assessment: Pre-departure research (30%), field diary (20%), report (40%) and presentation (10%). Practical field work: 4-6 weeks working with a community-based organisation in a developing country. Campus: Cumberland, Sydney Mode of delivery: Field experience
Note: Students interested in participating must obtain permission from their course director before enrolling in FHS Abroad. Some degrees require participants have a minimum credit average.
Cultural practices, disease patterns and healthcare systems are vastly different in different countries around the globe. This unit provides students with the opportunity to gain international experience in a health services setting in a developing country. Students will participate in a 4-6 week health or care placement with a community-based organisation in South or Southeast Asia. Countries where students can be placed include Vietnam, Cambodia, India and the Philippines. As part of the unit, you will be expected to participate in local development programs, live within the community that you are visiting, and document and reflect on key health and development issues facing local populations. The unit will require you to demonstrate cultural sensitivity and an ability to adapt to new environments, a capacity for critical reflection and awareness of complex global health and development issues.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
REHB3064 Alcohol and Drug Misuse Rehabilitation

Credit points: 6 Teacher/Coordinator: Dr Rodd Rothwell Session: Semester 1 Classes: Online Prerequisites: (HSBH1006, (HSBH1007 or HSBH2007), HSBH1008, HSBH1009) or 48 credit points of previous study. Prohibitions: REHB3061 Assessment: Short answer test (20%), Essay 2500 words (40%), 2 x online MCQ tests (40%) Campus: Cumberland, Sydney Mode of delivery: Distance education
Note: Students must have completed 48 credit points to enrol in this unit
This unit introduces students to issues relating to a major public health problem: the misuse of alcohol and other addictive drugs. The unit introduces students to two major aspects of this area: issues relating to the development of health prevention/health promotion policy, covering the philosophies of harm minimisation and zero tolerance; approaches to rehabilitation and treatment of those overusing both alcohol and other drugs. The unit commences with an analysis of public health policy approaches to the rehabilitation and treatment of people overusing alcohol and other harmful drugs.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Students will be required to undertake an exercise involving an analysis of the effectiveness of the two major policy approaches to the problem of drug overuse and abuse: harm reduction and zero tolerance. They will be required to examine the evidence supporting these two approaches to public health policy. In the second part of the unit students will study the major therapeutic approaches to treatment and rehabilitation. This will include familiarisation with Alcoholics Anonymous, clinically based approaches including transactional analysis and other group therapy oriented approaches, the various behavioural therapies, therapeutic communities, methadone maintenance, needle exchange and recent trails in safe injection facilities. They will become familiar with the nature of services offered, the role of the various health professionals in these services and the nature of effective treatment and rehabilitation outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Students must select one of the following Bachelor of Health Science research units of study:
HSBH3005 Evidence Based Health Care

Credit points: 6 Teacher/Coordinator: Dr Leigh Wilson Session: Semester 2 Classes: 1×2-hr lecture/week, 1×1-hr tutorial/week Prerequisites: HSBH1007 or HSBH2007 Assessment: PICO framework (40%), critical apprisal essay (40%) and impact statement (20%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individuals or the delivery of health services. This unit will introduce students to evidence-based health care by developing an understanding of knowledge and evidence, and critical appraisal skills to inform decision-making in health care policy and practice.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Textbooks
Hoffman, T., Bennett, S. and Del Mar, C. (2013). Evidence-based practice across the health professions (2nd ed.). Chatswood: Elsevier.
HSBH3018 Quantitative Research Methods in Health

Credit points: 6 Teacher/Coordinator: Dr Tatjana Seizova-Cajic Session: Semester 1 Classes: 1×2-hr lecture/week, 1×1-hr laboratory session/week, 1×1-hr tutorial session/fortnight Prerequisites: HSBH1007 or HSBH2007 Prohibitions: PSYC2012 or SCLG3603 Assessment: Group presentation (7%), Quizzes (18%), 1000wd report (25%) and end semester exam 50% Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit teaches about design of observational and experimental studies in health and statistical procedures for data analysis. We will discuss published studies and analyse our own data using relatively simple statistical techniques (correlation, linear regression, t-test, ANOVA, odds ratio, etc.), with understanding of fundamentals of statistical theory. You will develop the ability to draw a sound conclusion about the research question taking into account both statistical result and key aspects of study design. We will also discuss current topics in health research in Australia, and/or globally. You will learn to use Statistical Package for Social Sciences (SPSS), and how to write concise research reports. The unit will prepare you to be a critical reader of health research relevant to your profession and to engage in further research training should you wish to do so.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
Textbooks
There is no single textbook. Recommended textbooks are:
HSBH3019 Qualitative Research Methods in Health

Credit points: 6 Teacher/Coordinator: Prof Stephanie Short Session: Semester 2 Classes: 1×2-hr Workshop/week, 1×1-hr tutorial/week Prerequisites: HSBH1007 or HSBH2007 Prohibitions: SCLG2602 or BACH4056 Assessment: 750wd research report (20%),2000wd research report (50%) and end semester take-home exam (30%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
This unit of study has three aims: to build on core units of study offered in First Year and Second Year to provide critical appraisal skills in reading and utilising qualitative research related to health behaviour and health care; to understand the theoretical orientation of contemporary qualitative health research methods; and to develop skills in undertaking qualitative research methods. With a focus on applying critical and theoretical knowledge, the unit has a practical orientation and students will gain experience in techniques of observation, document analysis, in-depth interviewing and focus group interviews.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
HSBH3024 Designing a Research Project

Credit points: 6 Teacher/Coordinator: Dr Vanessa Lee Session: Semester 2 Classes: 1 x 2-hr workshop, and 1×1-hr online and practical activities/week Prerequisites: (HSBH1007 or HSBH2007) or (BACH1161 or HSBH1003 and HSBH1007) Assessment: ethics assignment 1500 wds (30%), oral presentation (20%), research proposal 2000 wds (50%) Campus: Camperdown/Darlington, Sydney Mode of delivery: Normal (lecture/lab/tutorial) day
Doing research is an exciting exploration of investigating problems and answering questions. By walking through the research design, this unit of study teaches students the foundation principles of writing a research proposal. Students will develop and plan their own research topic from ethics through to the actual proposal, an important process in the methodology of research. Students will be taught the importance of why we need research and how to do research with integrity. Knowledge translation from research to application will also be explored

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals (providers or practitioners) in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Access to health care may vary across countries, communities, and individuals, largely influenced by social and economic conditions as well as health policies. Health care systems are organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), a well-functioning health care system requires a financing mechanism, a well-trained and adequately paid workforce, reliable information on which to base decisions and policies, and well maintained health facilities to deliver quality medicines and technologies.[1]

An efficient health care system can contribute to a significant part of a country’s economy, development and industrialization. Health care is conventionally regarded as an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.[2]

Contents
1 Delivery
1.1 Primary care
1.2 Secondary care
1.3 Tertiary care
1.4 Quaternary care
1.5 Home and community care
1.6 Ratings
2 Related sectors
2.1 Health system
2.2 Health care industry
2.3 Health care research
2.4 Health care financing
2.5 Administration and regulation
2.6 Health information technology
3 See also
4 References
Delivery
See also: Health professionals

Primary care may be provided in community health centers.
The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.[3] This includes professionals in medicine, psychology, physiotherapy, nursing, dentistry, midwifery and allied health, along with many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive, curative and rehabilitative care services.

While the definitions of the various types of health care vary depending on the different cultural, political, organizational and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process and may also include the provision of secondary and tertiary levels of care.[4] Health care can be defined as either public or private.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The emergency room is often a frontline venue for the delivery of primary medical care.
Primary care
Main article: Primary care
See also: Primary health care, Ambulatory care, and Urgent care

Medical train “Therapist Matvei Mudrov” in Khabarovsk, Russia[5] Primary care refers to the work of health professionals who act as a first point of consultation for all patients within the health care system.[4][6] Such a professional would usually be a primary care physician, such as a general practitioner or family physician. Another professional would be a licensed independent practitioner such as a physiotherapist, or a non-physician primary care provider such as a physician assistant or nurse practitioner. Depending on the locality, health system organization the patient may see another health care professional first, such as a pharmacist or nurse. Depending on the nature of the health condition, patients may be referred for secondary or tertiary care.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Primary care is often used as the term for the health care services that play a role in the local community. It can be provided in different settings, such as Urgent care centers which provide same day appointments or services on a walk-in basis.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all types of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care based on the reason for the patient’s visit.[7]

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician.[8]

In the United States, primary care physicians have begun to deliver primary care outside of the managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine. Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington.

In context of global population aging, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected in both developed and developing countries.[9][10] The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.[4]

Secondary care
Secondary care includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury, or other health condition. This care is often found in a hospital emergency department. Secondary care also includes skilled attendance during childbirth, intensive care, and medical imaging services.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

The term “secondary care” is sometimes used synonymously with “hospital care”. However, many secondary care providers, such as psychiatrists, clinical psychologists, occupational therapists, most dental specialties or physiotherapists, do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

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In countries which operate under a mixed market health care system, some physicians limit their practice to secondary care by requiring patients to see a primary care provider first. This restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.

Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Tertiary care

The National Hospital for Neurology and Neurosurgery in London, United Kingdom is a specialist neurological hospital.
See also: Medicine
Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.[11]

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.[12]

Quaternary care
The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers.[12][13] Quaternary care is more prevalent in the United Kingdom.[citation needed]

Home and community care
See also: Public health
Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programs for the prevention of transmissible diseases.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders among other types of health and social care services.

Community rehabilitation services can assist with mobility and independence after loss of limbs or loss of function. This can include prosthesis, orthotics or wheelchairs.

Many countries, especially in the west, are dealing with aging populations, so one of the priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home such as transportation to and from doctor’s appointments along with many other activities that are essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents a challenge for the design of ICT (information and communication technology) for home care.[14]

Because statistics show that over 80 million Americans have taken time off of their primary employment to care for a loved one,[15] many countries have begun offering programs such as Consumer Directed Personal Assistant Program to allow family members to take care of their loved ones without giving up their entire income.[citation needed]

With obesity in children rapidly becoming a major concern, health services often set up programs in schools aimed at educating children about nutritional eating habits, making physical education a requirement and teaching young adolescents to have positive self-image.[citation needed]

Ratings
Main article: Health care ratings
Health care ratings are ratings or evaluations of health care used to evaluate the process of care and health care structures and/or outcomes of health care services. This information is translated into report cards that are generated by quality organizations, nonprofit, consumer groups and media. This evaluation of quality is based on measures of:

hospital quality
health plan quality
physician quality
quality for other health professionals
of patient experience
Related sectors
Health care extends beyond the delivery of services to patients, encompassing many related sectors, and is set within a bigger picture of financing and governance structures.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Health system
Main articles: Health system and Health systems by country
A health system, also sometimes referred to as health care system or healthcare system is the organization of people, institutions, and resources that deliver health care services to populations in need.

Health care industry
See also: Health care industry and Health economics

A group of Chilean ‘Damas de Rojo’ volunteering at their local hospital
The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations’ International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and “other human health activities.” The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates[16] or other allied health professions.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services including biotechnology, diagnostic laboratories and substances, drug manufacturing and delivery.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.[17][18] The United States dominates the biopharmaceutical field, accounting for three-quarters of the world’s biotechnology revenues.[17][19]

Health care research
Main articles: Medical research and Nursing research
For a topical guide to this subject, see Healthcare science.
The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and evidence-based practice in health care delivery.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make populations healthier.[20] Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of artificial intelligence for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, built into standard procedures, and involve the patient.[21]

Health care financing
See also: Health care system, Health policy, and Universal health care
There are generally five primary methods of funding health care systems:[22]

general taxation to the state, county or municipality
social health insurance
voluntary or private health insurance
out-of-pocket payments
donations to health charities
In most countries there is a mix of all five models, but this varies across countries and over time within countries. Aside from financing mechanisms, an important question should always be how much to spend on healthcare. For the purposes of comparison, this is often expressed as the percentage of GDP spent on healthcare. In OECD countries for every extra $1000 spent on healthcare, life expectancy falls by 0.4 years.[citation needed] A similar correlation is seen from analysis carried out each year by Bloomberg. [23]Clearly this kind of analysis is flawed in that life expectancy is only one measure of a health system’s performance, but equally, the notion that more funding is better is not supported.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 3,322 (PPP-adjusted) per capita across the 34 members of OECD countries. The US (17.7%, or US$ PPP 8,508), the Netherlands (11.9%, 5,099), France (11.6%, 4,118), Germany (11.3%, 4,495), Canada (11.2%, 5669), and Switzerland (11%, 5,634) were the top spenders, however life expectancy in total population at birth was highest in Switzerland (82.8 years), Japan and Italy (82.7), Spain and Iceland (82.4), France (82.2) and Australia (82.0), while OECD’s average exceeds 80 years for the first time ever in 2011: 80.1 years, a gain of 10 years since 1970. The US (78.7 years) ranges only on place 26 among the 34 OECD member countries, but has the highest costs by far. All OECD countries have achieved universal (or almost universal) health coverage, except the US and Mexico.[24][25] (see also international comparisons.)

In the United States, where around 18% of GDP is spent on health care,[23] the Commonwealth Fund analysis of spend and quality shows a clear correlation between worse quality and higher spending.[26]

Administration and regulation
See also: Health professional requisites
The management and administration of health care is vital to the delivery of health care services. In particular, the practice of health professionals and operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance.[27] Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.[28]

Health information technology
Further information: Health information technology, Health information management, Health informatics, and eHealth
Health information technology (HIT) is “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.”[29]

Health information technology components:

Electronic Health Record (EHR) – An EHR contains a patient’s comprehensive medical history, and may include records from multiple providers.[30] Electronic Medical Record (EMR) – An EMR contains the standard medical and clinical data gathered in one’s provider’s office.[30] Personal Health Record (PHR) – A PHR is a patient’s medical history that is maintained privately, for personal use.[31] Medical Practice Management software (MPM) – is designed to streamline the day-to-day tasks of operating a medical facility. Also known as practice management software or practice management system (PMS).
Health Information Exchange (HIE) – Health Information Exchange allows health care professionals and patients to appropriately access and securely share a patient’s vital medical information electronically.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

A First Year Experience course designed to help entering freshmen and transfer students with 0-24 credits majoring in nursing adapt to college life and become integrated into Dixie State University. Students will refine academic skills, create and foster social networks, learn about college resources, and explore the field of nursing. Multiple listed with all other sections of First Year Experience. Students may only take one FYE course for credit. FA.
NURS 1005. Certified Nursing Assistant (ALCS). 4 Hours.

Prepares students in the knowledge, skills, and responsibilities required for certification as a nursing assistant by the state of Utah. This course is designated as an Active Learning Community Service (ALCS) course. Students provide service in areas of public concern in a way that is mutually beneficial for both the student and community. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Adapt and apply theoretical and laboratory concepts in a clinical setting. 2. Demonstrate in the laboratory setting acquired knowledge of basic nursing skills and the ability to perform them. 3. Identify the basic needs of patients and describe how a nursing assistant can provide for those needs.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Identify and discuss components of restorative and rehabilitative nursing care 5. Identify and discuss the role of the nursing assistant. 6. Identify and describe specialized job skills and abilities that may be required in the sub-acute care setting, the long-term care setting, the individual’s home setting, and the hospital setting. 7. Identify the principles of safety as they relate to patient care and facilitate safe practices in the clinical setting. 8. Identify and discuss legal and ethical concerns as they relate to health care, in general, and to the elderly population, in particular. Course fee required. Corequisite: NURS 1007. FA, SP, SU.
NURS 1007. Nursing Assistant Clinical. 0 Hours.

Clinical portion of NURS 1005. Provides hands on clinical training in the long term care setting to reinforce nurse assistant skills learned in classroom and laboratory. A minimum of 24 clinical hours required. Corequisite: NURS 1005. FA, SP, SU.
NURS 2000. Intro to Health Concepts. 4 Hours.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

First semester course. Introduces health concepts within the three domains of the client, healthcare, and nursing. Emphasis is placed on an introduction to the concepts of fluid and electrolytes, elimination, thermoregulation, oxygenation, inflammation, tissue integrity, infection, sensory and perception, mobility, comfort, safety, stress and coping, grief and loss, cognition, self, family, diversity, culture, spirituality, critical thinking, and nursing process. Includes classroom and clinical experiences. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Explain applicable concepts within the domains of the healthy client, healthcare, and nursing within the context of concept-based learning. (cognitive) 2. Express an awareness of the values, attitudes, behaviors, and beliefs important to therapeutic nursing care through reflective journal entries.(affective, kinesthetic) 3. Demonstrate understanding of concepts within the domain of nursing by safely providing therapeutic nursing care to individuals in the clinical setting as evidenced by completion of concept map activities.(kinesthetic) 4. Perform nursing assessments, nursing interventions, and clinical decision making related to each applicable concept in the clinical setting.(cognitive, kinesthetic) 5. Demonstrate understanding of concepts within the domain of nursing by safely providing therapeutic nursing care to individuals in the clinical setting as evidenced by completion of concept map activities.(cognitive, affective, kinesthetic) 6. Practice safely and ethically within the healthcare system by adhering to standards of nurse practice act, healthcare policy, and National Patient Safety Goals. (kinesthetic) Course fee required. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2001. Intro to Health Concepts Clinical. 0 Hours.

First semester course. Provides opportunity for student to learn, practice, and achieve clinical competency using concept based clinical skills. Students have the opportunity to complete these clinical skills in long-term based facilities, hospital based affiliates, and with simulation in the laboratory setting. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Exhibit personal traits necessary to establish vision and goals; the ability to plan, organize, motivate, manage, execute, delegate, evaluate, use conflict resolution strategies, and collaborate with other members of the interdisciplinary health care team. 2. Utilize a process of insightful thinking that utilizes multiple dimensions of one’s own cognition and collaborates with the interdisciplinary health care team to develop conclusions, solutions, and alternatives to ensure safe nursing practice and quality care. 3. Apply concepts of communication and therapeutic interaction in building and maintaining relationships with clients, families, groups, communities and other members of the health care team. 4. Demonstrate caring as an altruistic philosophy of moral and ethical commitment toward the protection, promotion and preservation of human dignity and diversity including the recognition and acknowledgment of the value of individuals, families, groups, communities, and other members of the health care team. Caring is the essence of nursing. 5. Exhibit professional behavior by demonstrating adherence to standards of nursing practice, commitment to the profession of nursing, accountability for actions, behaviors and nursing practice within legal, ethical, and regulatory frameworks. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program.
NURS 2005. Nursing Skills Laboratory. 2 Hours.

First semester course. Provides opportunity for students to learn, practice, and achieve competency in basic nursing skills including but not limited to physical assessment, sterile technique, peripheral intravenous insertion, medication administration, blood administration, and wound care. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Perform specific interventions within the scope of nursing practice at a basic level in the nursing lab and with supervision in the clinical setting. 2. Plan execute and evaluate the effectiveness of specified nursing interventions while caring for simulated patients in the nursing lab. 3. Safely perform nursing care interventions recognizing those elements of each skill that if performed incorrectly or omitted pose a significant risk to the patient nurse or nursing student. 4. Demonstrate therapeutic communication techniques while performing interventions and caring for simulated patients in the nursing lab. 5. Plan execute and evaluate the effectiveness of specified nursing interventions while caring for simulated patients in the nursing lab. 6. Safely perform nursing care interventions recognizing those elements of each skill that if performed incorrectly or omitted pose a significant risk to the patient nurse or nursing student. 7. Recognizing the importance of collaborating with members of the interdisciplinary health care team while caring for simulated patients in the nursing skills laboratory. 8. Demonstrate consideration of cultural ethnic social diversity as applicable when performing nursing interventions and providing care for simulated patients in the nursing lab. Course fee required. Corequisite: NURS 2000. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program.
NURS 2400. Health & Illness Concepts I. 5 Hours.

First semester course. Further develops health and illness concepts within the three domains of the client, healthcare, and nursing. Emphasis is placed on the concepts of acid-base, metabolism, cellular regulation, oxygenation, infection, stress and coping, health-wellness-illness, therapeutic communication, caring, technical skills, time management/organization, critical thinking, nursing process, safety, quality improvement, and informatics. Includes classroom, lab, and clinical learning experiences. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Incorporate course concepts and exemplars, with the domain of nursing, to the safe provision of therapeutic nursing care to individuals across the lifespan. (kinesthetic, cognitive) 2. Provide and direct nursing care of the client that incorporates the knowledge of expected growth and development principles, prevention and/or early detection of health problems and strategies to achieve optimal health. (kinesthetic) 3. Express an awareness of the values, attitudes, behaviors and beliefs important to the provision of therapeutic nursing care. (affective) 4. Perform caring nursing assessments, nursing interventions and clinical decision making at a beginning level. (affective, kinesthetic) 5. Explain course concepts and exemplars within the framework of client needs and therapeutic nursing care. (cognitive) 6. Recognize measures needed to reduce the likelihood that clients will develop complications of health problems related to existing conditions, treatments or procedures as related to applicable course concepts and exemplars. (cognitive, affective, kinesthetic) 7. Begin to apply principles of evidence-based practice in the planning and provision of therapeutic nursing care. (kinesthetic) 8. Identify the elements required to provide nursing care that enhances the care delivery setting and protects clients and health care personnel. (affective, cognitive) 9. Manage and provide care for clients with acute, chronic or life-threatening physical health conditions, as related to course concepts and exemplars, at the beginning level. (kinesthetic, affective, cognitive) Course fee required. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2401. Health & Illness Concepts I Clinical. 0 Hours.

First semester course. Clinical opportunities are offered at an increased level of instruction for student to learn, practice, and achieve clinical competency using concept based clinical skills. Students have the opportunity to complete these clinical skills in long-term based facilities, hospital based affiliates, and with simulation in the laboratory setting. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Exhibit personal traits necessary to establish vision and goals; the ability to plan, organize, motivate, manage, execute, delegate, evaluate, use conflict resolution strategies, and collaborate with other members of the interdisciplinary health care team. 2. Utilize a process of insightful thinking that utilizes multiple dimensions of one’s own cognition and collaborates with the interdisciplinary health care team to develop conclusions, solutions, and alternatives to ensure safe nursing practice and quality care. 3. Apply concepts of communication and therapeutic interaction in building and maintaining relationships with clients, families, groups, communities and other members of the health care team. 4. Demonstrate caring as an altruistic philosophy of moral and ethical commitment toward the protection, promotion and preservation of human dignity and diversity including the recognition and acknowledgment of the value of individuals, families, groups, communities, and other members of the health care team. Caring is the essence of nursing. 5. Exhibit professional behavior by demonstrating adherence to standards of nursing practice, commitment to the profession of nursing, accountability for actions, behaviors and nursing practice within legal, ethical, and regulatory frameworks. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2450. Nursing Pharmacology Concepts I. 2 Hours.

First semester course. Provides an introduction to concepts of pharmacology for nurses within the three domains of the client, healthcare, and nursing. Emphasis is placed on the concepts of assessment, therapeutic communication, critical thinking, nursing process, caring, safety, and accountability and their application in various healthcare settings. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Discuss the major concepts associated with pharmacology including pharmacodynamics, pharmacokinetics, therapeutic effects, adverse effects, and factors affecting drug therapy. 2. Explain the legal regulation for drug development, approval and testing. 3. Discuss the challenges associated with drug therapy in current times. 4. Calculate accurate drug dosages for adults and children. 5. Describe the major drug groups and their indications for use. 6. Correlate the actions of the major drug groups with the body system(s) affected. 7. Discuss the important lifespan considerations associated with the major drug groups. 8. Explain the mechanism of action, indications, contraindications and cautions, common adverse effects, and clinically important drug-drug interactions for each of the major drug groups. 9. Relate the importance of renal and hepatic function with drug therapy. 10. Describe the nursing considerations related to drug therapy, including important teaching points, for each of the major drug groups. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2500. Health & Illness Concepts II. 8 Hours.

Second semester course. Further develops health and illness concepts within the three domains of the client, healthcare, and nursing. Emphasis is placed on the concepts of elimination, metabolism, intracranial regulation, cellular regulation, perfusion, infection, immunity, mobility, comfort, behavior, health-wellness-illness, critical thinking, nursing process, caring, time management/organization, leadership/management, and safety. Includes application of pharmacological health and illness concepts in acute care settings. Includes classroom and clinical learning experiences. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Exhibit personal traits necessary to establish vision & goals; the ability to plan, organize, motivate, manage, execute, delegate, evaluate, use conflict resolution strategies, & collaborate with other members of the interdisciplinary health care team. (Leadership) 2. Utilize a process of insightful thinking that utilizes multiple dimensions of one’s own cognition & collaborates with the interdisciplinary health care team to develop conclusions, solutions, & alternatives to ensure safe nursing practice & quality care. (Critical Thinking). 3. Apply concepts of communication & therapeutic interaction in building & maintaining relationships with clients, families, groups, communities & other members of the health care team. (Communication) 5. Demonstrating adherence to standards of nursing practice, commitment to the profession of nursing, accountability for actions, behaviors & nursing practice within legal, ethical, & regulatory frameworks. (Professional Behavior) Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2501. Health & Illness Concepts II Clinical. 0 Hours.

This course is offered in the second semester in the ADN program. It further develops health and illness concepts within the three domains of the client, healthcare, and nursing. Emphasis is placed on the concepts of metabolism, intracranial regulation, cellular regulation, perfusion, infection, immunity, mobility, comfort, behavior, health-wellness-illness, critical thinking, nursing process, caring, time management/organization, leadership/management, and safety. The course includes application of pharmacological health and illness concepts in acute care settings. It includes clinical learning experiences. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Establish vision & goals; to plan, organize, motivate, manage, execute, delegate, evaluate, use conflict resolution strategies, & collaborate with other members of the interdisciplinary health care team. (Leadership) 2. Utilize a process of insightful thinking that utilizes multiple dimensions of one’s own cognition & collaborates with the interdisciplinary health care team to develop conclusions, solutions, & alternatives to ensure safe nursing practice & quality care. (Critical Thinking) 3. Apply concepts of communication & therapeutic interaction in building & maintaining relationships with clients, families, groups, communities & other members of the health care team. (Communication) 4. Demonstrate caring as an altruistic philosophy of moral & ethical commitment toward the protection, promotion & preservation of human dignity & diversity including the recognition & acknowledgment of the value of individuals, families, groups, communities, & other members of the health care team as the essence of nursing. 5. Exhibit professional behavior by demonstrating adherence to standards of nursing practice, commitment to the profession of nursing, accountability for actions, behaviors & nursing practice within legal, ethical, & regulatory frameworks. (Professional Behavior) Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2530. Family Health Concepts. 5 Hours.

Second semester course. Further develops health and illness concepts within the three domains of the client, healthcare, and nursing. Emphasis is placed on the concepts of oxygenation, thermoregulation, sexuality, reproduction, infection, grief and loss, mood and affect, behavior, development, family, critical thinking, and nursing process. Includes classroom and clinical learning experiences. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Apply previous conceptual learning to understanding concepts and exemplars as they relate to the care of women, newborns, children, and the family. 2. Differentiate the family-centered nursing care of women, newborns, and children in the following: pediatric gastroenteritis, pediatric acute renal failure, seizures, SIDS, cystic fibrosis, bronchiolitis, otitis media, pharyngitis, cerebral palsy, ADHD, autism, failure to thrive, Down’s syndrome, pediatric pain assessment, antepartum care, newborn care, postpartum care, gestational diabetes, newborn thermoregulation, prematurity, perinatal loss, postpartum depression, perinatal substance use, breast cancer, family planning, infertility counseling, menstrual dysfunction, menopause, and STIs. 3. Differentiate the family-centered nursing care of men in the following: prostate cancer, erectile dysfunction. 4. Demonstrate the ability to make reasonable clinical judgments through the use of the nursing process and evidence-based practice in providing family-centered care of women, newborns, and children. 5. Value effective communication techniques that are used with individuals, families, and members of the health care team in providing family-centered nursing care of women, newborns, and children. 6. Recognize the importance of collaboration within the interdisciplinary team in the care of women, newborns, and children. 7. Apply caring behaviors that incorporate patient and family advocacy; respect for persons and cultural diversity; and ethical principles in the care of women, newborns, and children. 8. Begin to assume responsibility and accountability in the practice of registered nursing as defined by the Utah Nurse Practice Act and professional standards of registered nursing in the care of women, newborns, and children. Course fee required. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing Program. FA, SP.
NURS 2531. Family Health Concepts Clinical. 0 Hours.

Second semester course. Provides the opportunity for students to learn, practice, and achieve clinical competency in the clinical skills developed in the laboratory setting. Students have the opportunity to implement clinical skills in specialty areas learned in Family Health Concepts. The student attends these clinicals in hospital based affiliates as well as in community settings which provides skill development in all areas of nursing, including care of the perinatal patient and child. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Apply previous conceptual learning to understanding concepts and exemplars as they relate to the care of women, newborns, children, and the family. 2. Differentiate the family-centered nursing care of women, men, newborns, and children. 3. Demonstrate the ability to make reasonable clinical judgments through the use of the nursing process and evidence-based practice in providing family-centered care of women, men, newborns, and children. 4. Use effective communication techniques that are used with individuals, families, and members of the health care team in providing family-centered nursing care of women, men, newborns, and children. 5. Recognize the importance of collaboration within the interdisciplinary team in the care of women, men, newborns, and children. 6. Apply caring behaviors that incorporate patient and family advocacy; respect for persons and cultural diversity; and ethical principles in the care of women, men, newborns, and children. 7. Begin to assume responsibility and accountability in the practice of registered nursing as defined by the Utah Nurse Practice Act and professional standards of registered nursing in the care of women, newborns, and children. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2600. Health Care Systems. 2 Hours.

Third semester course. Further develops student learning outcomes/competencies. An emphasis is placed on Leadership, Critical Thinking, Communication, Caring and Professional Behavior of the graduate nurse. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Explain and explore what personal traits are necessary to establish vision & goals; the ability to plan, organize, motivate, manage, execute, delegate, evaluate, use conflict resolution strategies, & collaborate with other members of the interdisciplinary health care team. 2. Demonstrate of insightful thinking that utilizes multiple dimensions of one’s own cognition & collaborates with the interdisciplinary health care team to develop conclusions, solutions, & alternatives to ensure safe nursing practice & quality care.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 3. The students will explore concepts of communication & therapeutic interaction needed to build & maintain relationships with clients, families, groups, communities & other members of the health care team. 4. The student will explore the concept of caring as an altruistic philosophy of moral & ethical commitment toward the protection, promotion & preservation of human dignity & diversity including the recognition & acknowledgment of the value of individuals, families, groups, communities, & other members of the health care team. 5. The student will explore professional behavior by acquiring knowledge of how to adhere to the standards of nursing practice, commit to the profession of nursing, and accept accountability for their own actions, behaviors & nursing practice within legal, ethical, & regulatory frameworks.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 2700. Complex Health&Illness Concept. 9 Hours.

Third semester course. Assimilates concepts within the three domains of the client, healthcare, and nursing. Emphasis is placed on the concepts of fluid and electrolytes, metabolism, thermoregulation, oxygenation, perfusion, tissue integrity, infection, mobility, stress and coping, family, violence, critical thinking, and the nursing process. Addresses application of complex health and illness concepts in nursing pharmacology. Includes classroom and clinical learning experiences. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Utilize critical thinking skills and the nursing process to prioritize and manage complex medical surgical client situations. 2. Prioritize the technical skills and nursing interventions, as well as propose the effective outcomes necessary to provide care to the client with a complex medical surgical problem. NURSING 3005 – Nursing in Complex Settings Assignment Papers. 3. Demonstrate effective use of therapeutic communication as human needs are taken into consideration. 4. Take into consideration the client’s needs and demonstrate caring behaviors. 5. Work as an effective member of a group, evaluate self and each member of the group, design and implement interventions for improvement. 6. Demonstrate professional behaviors. Course fee required. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. SP, FA.
NURS 2701. Complex Health Concepts Clinical. 0 Hours.

Third semester course. Provides student the opportunity to work with preceptors to further develop the clinical skill needed for a graduate nurse.NURSING 3005 – Nursing in Complex Settings Assignment Papers. The student has the opportunity to learn, practice and master skills previously learned. Students are assigned to a hospital based affiliate, community setting experiences, and the simulation laboratory setting. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Exhibit personal traits necessary to establish vision and goals, the ability to plan, organize, motivate, manage, execute, delegate, evaluate, use conflict resolution strategies and collaborate with other members of the interdisciplinary health care team. 2. Utilize a process of insightful thinking that utilizes multiple dimensions of one’s own cognition and collaborates with the interdisciplinary health care team to develop conclusions, solutions and alternatives to ensure safe nursing practice and quality care. 3. Apply concepts of communication and therapeutic interaction in building and maintaining relationships with clients, families, groups, communities and other members of the health care team.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Demonstrate caring as an altruistic philosophy of moral and ethical commitment toward the protection, promotion and preservation of human dignity and diversity including the recognition and acknowledgement of the value of individuals, families, groups, communities and other members of the health care team as the essence of nursing. 5. Exhibit professional behavior by demonstrating adherence to standards of nursing practice, commitment to the profession of nursing accountability for actions, behaviors and nursing practice within legal, ethical and regulatory frameworks. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
NURS 2750. NCLEX Success Course. 2 Hours.

Third semester course. Builds on previously learned nursing pharmacology concepts in preparation for entry into nursing practice. Emphasis is placed on the concepts of safety, critical thinking, technical skills, nursing process, and evidence-based practice in providing nursing care related to the administration of pharmacological and parenteral therapies in patients across the lifespan. The course also includes a review of nursing licensure by examination requirements. NURSING 3005 – Nursing in Complex Settings Assignment Papers. The eight test plan categories of the NCLEX-RN examination including management of care, safety and infection control, health promotion and maintenance, psychosocial integrity, basic care and comfort, reduction of risk potential, pharmacological and parenteral therapies, and physiological adaptation will be reviewed in detail. Offered in cohort rotation. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Safely administer pharmacological and parenteral therapies to patients across the lifespan. 2. Demonstrate the ability to make sound clinical judgments in the administration of pharmacological and parenteral therapies. 3. Collaborate with appropriate interdisciplinary team members in the administration of pharmacological and parenteral therapies. 4. Develop effective communication techniques to use with patients across the lifespan and their families in the administration of pharmacological and parenteral therapies. 5. Demonstrate caring behaviors the incorporate patient and family advocacy; respect for persons and cultural diversity; and ethical principles in the administration of pharmacological and parenteral therapies. 6. Assume responsibility and accountability in the administration of pharmacological and parenteral therapies as defined by the Utah Nurse Practice Act and professional standards of registered nursing. 7. Discuss the eight NCLEX-RN test plan categories and describe examples of content tested within each. 8. Identify individual strengths as well as weaknesses in each of the eight NCLEX-RN test plan categories. 9. Prepare a personalized study plan using available resources to utilize in preparation to successfully pass NCLEX-RN the first time. 10. Actively participate in class and homework assignments in answering NCLEX-RN type questions to demonstrate knowledge, critical thinking, and ability to use test taking strategies effectively. Prerequisite: Admission to the Dixie State University Associate Degree in Nursing program. FA, SP.
NURS 3005. Foundations of Clinical Nursing Care I. 1 Hour.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Provides opportunity for students to learn, practice, and achieve competency in basic nursing skills including but not limited to sterile technique, medication administration, and wound care. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Demonstrate how to develop a therapeutic relationship supporting patient’s rights, dignity, autonomy, and cultural preferences using the nurse’s knowledge, skills, attitudes, and experiences to facilitate dynamic, goal-oriented care individually designed to meet the needs of patients and families when performing basic nursing skills. 2. Begin to utilize their own cognition skills and ability to work with others when performing basic nursing skills.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 3. Demonstrate the skills necessary to maintain therapeutic communication with patients and families as well as other members of the health care team by utilizing informatics, verbal, and non-verbal means when performing basic nursing skills. 4. Identify how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values and how to provide basic nursing care skills which respects those differences. 5. Exhibit the ethical and legal parameters to ensure adherence to standards of nursing practice, health policy and quality improvement measures while performing basic nursing skills. Prerequisite: Admission to the DSU Bachelor of Science Nursing program. FA, SP.
NURS 3050. Pharmacology. 4 Hours.

Introduces concepts of pharmacology with emphasis on the concepts of assessment, therapeutic communication, critical thinking, nursing process, caring, safety, and accountability and their application in various healthcare settings. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge of medication administration in order to organize and coordinate nursing care for patients receiving medications and their families. 2. Utilize university databases and other resources to obtain valid, reliable pharmacological data to inform clinical practice. 3. Develop therapeutic communication skills and adapt their own style of communicating to provide patient teaching on pharmacology to achieve or improve patient outcomes. 4. Acquire knowledge of how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values related to pharmacotherapy.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 5. Describe accountability and value their own role in preventing medication errors and promoting a culture of safety through the use of factors (quiet zone in medication preparation work area) and processes (the Rights of Medication Administration). Prerequisite: Admission to the DSU Bachelor of Science in Nursing program. FA, SP.
NURS 3100. Professional Nursing Roles. 3 Hours.

Focuses on the transition to professional nursing role and responsibilities and explores the differences in ADN and BSN education and practice levels by exploring the roles of the BSN nurse in the health care environment, including nurse educator, nurse leader, case manager, and community health nurse. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge regarding the standards and principles of delegating, organizing, and prioritizing patient care within the professional nursing role. 2. Identify valid resources for locating evidence reports and evidence summaries as well as using online databases and other resources to acquire knowledge of professional roles, ethics, legal issues, and standards of professional nursing practice. 3. Adapt their own style of communication to the needs of others and the situation as delineated by nursing role and responsibilities. 4. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values and the effect on nursing role and responsibilities within the healthcare environment. 5. Describe professional roles, ethics, standards of nursing practice, and their personal philosophy of nursing. Prerequisite: Admission to the Dixie State University Bachelor of Science in Nursing program. FA, SP, SU.
NURS 3200. Health Assessment. 3 Hours.

Focuses on the development of interviewing and physical assessment skills throughout the lifespan utilizing a holistic approach and critical thinking skills to evaluate assessment findings, differentiate between normal and abnormal variations. Purchase of electronic access is required to navigate this online course. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Discuss the role of the nurse in assessing the patient’s health from the holistic perspective. Collaborate with the patient to identify strengths and problem areas from the health assessment. 2. Differentiate between normal and abnormal findings in a health assessment.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Demonstrate appropriate physical examination skills of an adult patient. Apply special considerations in the assessment of functional status in the older adult. 3. Document a holistic health history and physical examination findings. Demonstrate effective interviewing skills in obtaining a holistic health history. The student will identify therapeutic communication skills when building relationships with patients, families, and other members of the health care team during assessment activities. 4. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values. 5. Function within the scope of a Registered Nurse using skills and knowledge obtained through clinical experiences during assessment activities to care adult patients across the lifespan. Prerequisites: NURS 3900 or BIOL 4400; and NURS 3100 (can be concurrently enrolled). FA, SP, SU.
NURS 3210. Health Assessment. 2 Hours.

Introduces the assessment of and the health promotion for the health care participant as an individual, family or community. Focuses on the development of interviewing and physical assessment skills throughout the lifespan utilizing a holistic approach and critical thinking skills to evaluate assessment findings, differentiate between normal and abnormal variations. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge of assessment to plan and organize care for patients and families in patient care settings with predictable outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 2. Examine the role of the nurse in assessment and health promotion and apply the nursing process to effectively deliver safe patient-centered care. 3. Identify therapeutic communication skills when building relationships with patients, families, and other members of the health care team during assessment activities. 4. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values. 5. Function within the scope of a Registered Nurse using skills and knowledge obtained through clinical, laboratory, and didactic experiences during assessment activities. Prerequisite: Admission to the DSU Bachelor of Science in Nursing Program. Corequisite: NURS 3215. FA, SP.
NURS 3215. Health Assessment Lab. 1 Hour.

This course provides the students with the knowledge and skill necessary to perform a comprehensive health assessment utilizing the skills of history taking, inspection, palpation, percussion, and auscultation.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Normal assessment findings, frequently seen variations from normal and cultural differences are discussed. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Complete a health history and conduct comprehensive and focused assessments (physical, psychosocial, spiritual, developmental, socioeconomic, and environmental) of patients across the life span, to identify current and potential health problems and promote health across the lifespan. (Patient Centered Care) 2. Perform a complete review of systems and physical assessment, discriminating between normal and abnormal findings, using developmentally, spiritual, and culturally appropriate approaches. (Clinical Judgment) 3. Utilize beginning therapeutic communication skills in interactions with patients, peers and health care team members. (Communication) 4. Assess health/illness belies, values, attitudes, and practices of diverse individuals. (Caring) 5. Compare and contrast the roles and responsibilities of the nurse in the process of health assessment and health promotion. (Professional Behavior) Prerequisite: Admission to the DSU Bachelor of Science in Nursing Program. Corequisite: NURS 3210. FA, SP.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
NURS 3300. Transcultural Nursing. 3 Hours.

Prepares professional nursing students to provide culturally sensitive and culturally competent care to individuals, families, and communities, emphasizing the importance of understanding cultural diversity in order to promote appropriate health prevention, disease intervention activities, and teaching strategies. Includes self-evaluation, including biases and prejudices about other cultures and ethnic groups. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Evaluate the concepts of health, wellness, and health care within nursing from a cultural context. Utilize a theoretical framework to perform a cultural assessment of individuals, families, and communities specific to their culture, ethnicity, and social diversity. 2. Analyze theoretical frameworks of transcultural nursing models. Determine the influence of culture on an individual’s belief system and practices especially those surrounding concepts of health, illness, and self-care deficits. 3. Compare the similarities between diverse cultures and the dominant health care model for conflict resolution to improve healthcare outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Identify strategies used to provide culturally competent care to all patients with regard to their culture, ethnicity, and social diversity. Value client rights in decision-making based on cultural factors. 5. Understand their own and others’ cultural biases, gender biases, ethnocentrism, racism, and acceptance of cultural diversity. Prerequisite: NURS 3100 (can be concurrently enrolled). FA, SP, SU.
NURS 3320. Care of Patients Across the Lifespan I. 5 Hours.

Begins to integrate basic concepts of the health-illness continuum across the lifespan with a focus on pathophysiology, pharmacology, health promotion and genetics, using the nursing process as the basis for clinical reasoning and judgment for care of patients with common health problems.NURSING 3005 – Nursing in Complex Settings Assignment Papers. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge to plan and organize care of patients across the lifespan based on patient values, clinical expertise, and evidence. 2. Examine the role of the nurse in applying the nursing process to effectively deliver care to patients across the lifespan. 3. Describe scopes of practice and roles of health care team members in helping patients across the lifespan to achieve and improve healthcare outcomes. 4. Acquire knowledge of how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 5. Describe scope of practice, ethical and legal standards of nursing practice associated with the care of patients across the lifespan. Prerequisite: Admission to the DSU Bachelor in Science Nursing program. FA, SP.
NURS 3321. Care of Patients Across the Lifespan I Clinical (ALCS). 2 Hours.

Incorporates concepts associated with health promotion and illness prevention across the lifespan. Provides clinical experience in supervised settings in hospital and other community settings. This course is designated as an Active Learning Community Service (ALCS) course.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Students provide service in areas of public concern in a way that is mutually beneficial for both the student and community. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Develop individualized care plans for patients across the lifespan based on patient values, clinical expertise, and evidence. 2. Apply the nursing process to effectively deliver care to patients across the lifespan. 3. Demonstrate communication skills reflecting perspectives of all team members in helping patients across the lifespan to achieve and improve healthcare outcomes. 4. Incorporate respect for diverse cultural, ethnic, and social backgrounds as sources of patient and family values. 5. Function within the scope of a Registered Nurse using skills and knowledge obtained through clinical, laboratory, and didactic experiences to care for patients across the lifespan. Prerequisite: Admission to the DSU Bachelor in Science Nursing program. FA, SP.
NURS 3400. Nursing Informatics. 3 Hours.

Introduces informatics in nursing practice, education, research, and administration, exploring how informatics systems can be utilized to assist in providing more efficient and effective client care, including hardware, software, databases, new developments, and associated legal and ethical issues. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Utilize knowledge of informatics and communication methods in all areas of nursing practice, including hardware, software, databases, new developments, and associated legal and ethical issues. NURSING 3005 – Nursing in Complex Settings Assignment Papers. Apply guidelines in the evaluation of health related websites. 2. Understand the basic components of nursing informatics to assist in providing evidence-based nursing care. 3. Use information technology to retrieve hierarchical levels of evidence and evaluate the credibility of sources of information, including but not limited to databases and internet resources to address clinical questions. Evaluate the various types of information systems and electronic health records. 4. Utilize nursing informatics to ensure the best patient outcomes. 5. Comply with state and federal laws including regulations governing the privacy and confidentiality of patient’s health care records. Prerequisite: Admission to the DSU Bachelor of Science in Nursing program and NURS 3100 (can be concurrently enrolled). FA, SP, SU.
NURS 3505. Foundations of Clinical Nursing Care II. 1 Hour.

Provides further opportunities for students to learn, practice, and achieve competency in more invasive nursing skills including but not limited to peripheral intravenous insertion and blood transfusion. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Demonstrate how to develop a therapeutic relationship supporting the patient’s rights, dignity, autonomy, and cultural preferences using the nurse’s knowledge, skills, attitudes, and experiences to facilitate dynamic, goal-oriented care individually designed to meet the needs of the patient when performing nursing skills. NURSING 3005 – Nursing in Complex Settings Assignment Papers. 2. Begin to utilize their own cognition skills and ability to work with others when performing nursing skills. 3. Demonstrate the skills necessary to maintain therapeutic communication with patients and families as well as other members of the health care team by utilizing informatics, verbal, and non-verbal means when performing nursing skills. 4. Identify how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values and how to provide nursing care skills which respects those differences. 5. Exhibit the ethical and legal parameters to ensure adherence to standards of nursing practice, health policy, and quality improvement measures while performing nursing skills. Prerequisites: NURS 3005, NURS 3050, NURS 3210, NURS 3320, and NURS 3321 (All Grade C or higher). FA, SP.
NURS 3600. Nursing Research. 3 Hours.

Introduces quantitative and qualitative research concepts, methodology, and techniques, addressing the scientific approach; preliminary steps in research design, measurement, and data collection; analysis of data; and critiquing. Emphasizes the relationship between research and the practice of professional nursing. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Integrate evidence, clinical judgment, inter-professional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Utilize the process of retrieval, appraisal, and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes. 2. Utilize information technology to retrieve hierarchical levels of evidence and evaluate the credibility of sources of information, including but not limited to databases and internet resources to address clinical questions. 3. Discuss the role of evidence-based practice in organizational and systems leadership to support quality patient care and apply principles of evidence-based practice with diverse populations across the lifespan.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Demonstrate an understanding of the basic elements of the research process, differentiate questions and methods suitable for quantitative and qualitative nursing research, and apply strategies and resources to promote evidence-based practice, especially in areas of quality and safety. 5. Identify practice discrepancies between identified standards and practice that may adversely impact patient outcomes. Prerequisites: Admission to the DSU RN-BSN program and MATH 1040, or STAT 2040, AND NURS 3100 (can be concurrently enrolled). FA, SP, SU.
NURS 3650. Evidence Based Practice and Research Methods. 3 Hours.

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Introduces quantitative and qualitative research concepts, methods, and techniques, addressing the scientific approach; preliminary steps in research design, measurement, and data collection; analysis of data; and critiquing. NURSING 3005 – Nursing in Complex Settings Assignment Papers. Emphasize the relationship between research, evidence-based practice, and the practice of professional nursing. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Demonstrate an understanding of the basic elements of the research process, differentiate questions and methods suitable for quantitative and qualitative nursing research, and apply strategies and resources to promote evidence-based practice, especially in areas of quality and safety. 2. Make clinical decisions based on appraisal of the evidence, patient preferences, and clinical expertise.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 3. Use information technology to retrieve hierarchical levels of evidence and evaluate the credibility of sources of information, including but not limited to databases and internet resources to address clinical questions. 4. Discuss the role of evidence-based practice in organizational and systems leadership to support quality patient care and apply principles of evidence-based practice with diverse populations across the lifespan.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 5. Identify practice discrepancies between identified standards and practice that may adversely impact patient outcomes and utilize the process of retrieval, appraisal, and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes. Prerequisites: Admission to the DSU Bachelor of Science in Nursing program, and NURS 3005, NURS 3050, NURS 3210, NURS 3320, NURS 3321 (All Grade C or higher). FA, SP.
NURS 3700. Gerontological Nursing. 3 Hours.

Focuses on nursing care of the older adult by exposure to best practices for care of the older adult; issues such as quality of life, elder abuse, cultural considerations, and restraint alternatives; normal physiologic changes of aging; pathological disease processes; cognitive and psychological changes; end-of-life care; and environments of care for the older adult. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Conduct a comprehensive assessment of the needs of older adults using valid and reliable tools.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 2. Use clinical judgment to individualize care for older adults based on knowledge of own values, expectations and attitudes towards aging, professional standards of care, and knowledge of complex syndromes of illness in older adults. 3. Use therapeutic communication skills to communicate respectfully and compassionately with older adults and their families taking into consideration the sensory changes of aging that will impact elder’s ability to communicate.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Apply evidence-based standards of care to promote health, prevent disease and reduce risks for elders and adapt technical in consideration of elder’s endurance and capabilities. 5. Apply ethical and legal principles to the complex issues that arise in care of older adults as you advocate for elders in our society. Prerequisite: NURS 3100 (can be concurrently enrolled). FA, SP, SU.
NURS 3710. Foundations of Professional Nursing. 3 Hours.

Introduces health concepts involved in the organization and delivery of healthcare. Professional roles, ethics, and standards of professional nursing practice, as well as the social context of health and healthcare are emphasized. Explores the roles of the BSN nurse in the health care environment, including nurse educator, nurse leader, case manager, and community health nurse. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge regarding the standards and principles of delegating, organizing, prioritizing patient care within the professional nursing role. 2. Identify valid resources for locating evidence reports and evidence summaries as well as using university databases and other resources to acquire knowledge of professional roles, ethics, and standards of professional nursing practice. 3. Adapt their own style of communication to the needs of others and the situation as delineated by nursing role and responsibilities. 4. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values and the effect on nursing role and responsibilities within the healthcare environment. 5. Describe professional roles, ethics, and standards of nursing practice. Prerequisite: NURS 3005, NURS 3050, NURS 3210, NURS 3320, NURS 3321 (Grade C or higher). FA, SP.
NURS 3820. Care of Patients Across the Lifespan II. 5 Hours.

Integrates concepts of the health-illness continuum across the lifespan with a greater focus on pathophysiology, pharmacology, and clinical judgment in care of patients with more complex health problems.NURSING 3005 – Nursing in Complex Settings Assignment Papers. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Gain an understanding of how to develop a therapeutic relationship supporting the patient’s rights, dignity, autonomy, and cultural preferences using the nurse’s knowledge, skills, attitudes, and experiences to facilitate dynamic, goal-oriented care individually designed to meet the needs of the patient. 2. Begin to develop cognitive skills and ability to work with others. Each will further identify evidence based practice which may promote healthy lifestyle, prevent disease, and deliver safe patient-centered care. 3. Acquire the skills necessary to maintain therapeutic interactions with patients, families, and other members of the health care team by utilizing informatics, verbal, and non-verbal means. 4. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values and how to provide nursing care which respects those differences.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 5. Learn the ethical and legal parameters to ensure adherence to standards of nursing practice, health policy, and quality improvement measures. Prerequisites: NURS 3005, NURS 3050, NURS 3210, NURS 3320, NURS 3321 (Grade C or higher). FA, SP.
NURS 3821. Care of Patients Across the Lifespan II Clinical (ALCS). 3 Hours.

Applies concepts related to the complex illness experience of patients across the lifespan and their families. There is an emphasis on communication, assessment, clinical interventions and evaluation of outcomes. NURSING 3005 – Nursing in Complex Settings Assignment Papers. This course is designated as an Active Learning Community Service (ALCS) course. Students provide service in areas of public concern in a way that is mutually beneficial for both the student and community. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Demonstrate how to develop a therapeutic relationship supporting the patient’s rights, dignity, autonomy, and cultural preferences using the nurse’s knowledge, skills, attitudes, and experiences to facilitate dynamic, goal-oriented care individually designed to meet the needs of the patient. 2. Begin to utilize their own cognition skills and ability to work with others.NURSING 3005 – Nursing in Complex Settings Assignment Papers. They will further utilize evidence based practice to promote healthy lifestyle, prevent disease, and deliver safe patient-centered care. 3. Demonstrate the skills necessary to maintain therapeutic interactions with patients, families, and other members of the health care team by utilizing informatics, verbal, and non-verbal means. 4. Identify how diverse cultural, ethnic, and social backgrounds function as sources of patient and family values and how to provide nursing care which respects those differences. 5. Exhibit the ethical and legal parameters to ensure adherence to standards of nursing practice, health policy, and quality improvement measures. Prerequisites: NURS 3005, NURS 3050, NURS 3210, NURS 3320 (Grade C or higher). FA, SP.
NURS 3900. Pathophysiology. 3 Hours.

Applies anatomy and physiology concepts to examine alterations of human function. Explores major pathophysiological concepts using a body systems approach. Relates etiology, pathogenesis, and clinical manifestations in the study of common health problems. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Describe abnormal physiologic processes associated with common disease processes using a body system approach.NURSING 3005 – Nursing in Complex Settings Assignment Papers. (Patient Centered Care) 2. Differentiate normal and abnormal physiological findings and manifestations. (Clinical Judgment) 3. Describe common physiologic stressors, human adaptive and maladaptive responses, and its impact on individuals, families, groups, communities, and populations. (Communication) 4. Explain age-related and cultural differences in physiologic and pathophysiologic processes and their clinical manifestations. (Caring) 5. Describe ethical considerations for diagnosis and treatment of altered pathophysiological processes. (Professional Behavior) Prerequisites: BIOL 2320 (grade C or higher); AND BIOL 2325 (grade C or higher); AND BIOL 2420 (Grade C or higher); AND BIOL 2425 (grade C or higher). FA, SP, SU.
NURS 4010. Care of Patients Across the Lifespan III. 6 Hours.

Integrates concepts of the health-illness continuum across the lifespan in care of patients with multisystem health problems using clinical judgment. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge of how to incorporate concepts of the health illness continuum across the lifespan to manage care for individuals and groups in a variety of patient care settings with both predictable and unpredictable outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 2. Describe strategies to empower patients or families in all aspects of the health care process. 3. Use therapeutic communication skills with adults across the health-illness continuum and across the lifespan to improve patient health outcomes. 4. Acquire knowledge of how to integrate professional standards of moral, ethical, and legal conduct when providing therapeutic nursing interventions for diverse populations across the lifespan in a multicultural environment.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 5. Discuss effective strategies for overcoming barriers, facilitating teamwork, and participating in quality improvement measures to promote health for patients across the lifespan. Prerequisites: NURS 3505, NURS 3650, NURS 3710, NURS 3820, (Grade C or higher). FA, SP.
NURS 4011. Care of Patients Across the Lifespan III Clinical (ALCS). 3 Hours.

Provides students the opportunity to practice and master skills previously learned for patients with multisystem health problems across the lifespan. Students are assigned to a hospital based affiliate and the simulation laboratory setting. This course is designated as an Active Learning Community Service (ALCS) course.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Students provide service in areas of public concern in a way that is mutually beneficial for both the student and community. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to:

1. Incorporate concepts of the health illness continuum across the lifespan to manage care for individuals and groups in a variety of patient care settings with both predictable and unpredictable outcomes.

2. Use strategies to empower patients or families with complex conditions in all aspects of the health care process.

3. Use therapeutic communication skills with patients across the health-illness continuum and across the lifespan to improve patient health outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

4. Integrate professional standards of moral, ethical, and legal conduct when providing therapeutic nursing interventions for diverse populations across the lifespan in a multicultural environment.

5. Utilize effective strategies for overcoming barriers, facilitating teamwork, and participating in quality improvement measures to promote health for patients across the lifespan. Prerequisites: NURS 3505, NURS 3650, NURS 3710, NURS 3820 (Grade C or higher). FA, SP.
NURS 4020. Community Health Nursing. 5 Hours.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Prepares the baccalaureate student to function within the scope of professional nursing practice in the care of individuals, families, and groups in the community with emphasis placed on family assessment, community assessment, health promotion, health maintenance, and disease prevention. Past, present, and future community service trends are explored and analyzed. Includes classroom and clinical learning experiences. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge to incorporate concepts of disease prevention, risk reduction, health promotion, and health restoration to the management and delivery of population-focused nursing care.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Utilize Healthy People 2020 Health Objectives to assess, diagnose, plan, and implement an intervention for a community. 2. Describe research findings and how to apply these findings to the nursing care of community populations. 3. Understand how to apply an interdisciplinary approach in performing a community assessment, decision-making, planning, implementation, and evaluation of population-focused care. 4. Acquire knowledge of how to integrate professional standards of moral, ethical, and legal conduct when providing therapeutic nursing interventions for diverse populations across the lifespan in a multicultural environment. 5. Describe professional roles, ethics, and standards of nursing practice. Also, the student will identify policies, political, and economic influences at the local, national, and state levels related to care of community populations. Prerequisites: NURS 3100 (can be concurrently enrolled). FA, SP, SU.NURSING 3005 – Nursing in Complex Settings Assignment Papers.
NURS 4030. Nursing Policy & Ethics. 3 Hours.

Addresses policy development, political influences and power, and nursing’s involvement in the policy-making process. Legislation past and present, as well as ethical theories, frameworks, and the process of ethical inquiry are examined, explored, and analyzed as a basis for professional nursing practice, education, research, and decision-making. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Demonstrate basic knowledge of healthcare policy, including local, state, national, and global healthcare trends. 2. Integrate concepts from ethical theories, frameworks, codes for nurses, and the process of ethical inquiry into practice, education, research, and decision-making.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 3. Discuss the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery. 4. Advocate for consumers and the nursing profession. Also, prevent unsafe, illegal, and unethical care practices. 5. Describe professional roles, ethics, and standards of nursing practice. Also, participate in political processes and grassroots legislative efforts to influence healthcare policy. Prerequisite: Acceptance into the RN-BSN program. FA, SP.
NURS 4040. Nursing Leadership Management. 5 Hours.

Explores the role of the professional nurse as a leader and manager of patient care by exploring strategies, processes, and techniques of the nurse leader and manager as well as theories, principles, and application of leadership and management within the professional nursing role. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Analyze the principles surrounding therapeutic interactions in providing direct and indirect care for patients, families, groups, communities, and other members of the health care team. 2. Demonstrate insightful thinking through utilization of personal cognition, interdisciplinary collaboration, and evidence based practice. 3. Examine the principles of therapeutic communication need to build and maintain relationships with clients, families, groups, communities, and other members of the health care team and how to utilize informatics in order to improve patient health outcome. 4. Demonstrate a knowledge moral and ethical commitment toward the protection and promotion of human dignity and diversity of individuals, families, groups, communities, and members of the healthcare team.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 5. Examine the principles needed to collaborate with the interdisciplinary healthcare team in order to plan, organize, delegate, and evaluate the implementation of quality care and patient safety. In addition, the student will explore the ethical and legal standards of nursing practice, health care policy, and quality improvement. Prerequisite: NURS 3100 (can be concurrently enrolled). FA, SP.
NURS 4300. Community/Global Health Nursing. 4 Hours.

Prepares the baccalaureate student to function within the scope of professional nursing practice in the care of individuals, families, and groups in the community with emphasis placed on global health perspectives, population-based assessment, health promotion, health maintenance, and disease prevention. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge to incorporate concepts of disease prevention, risk reduction, health promotion, and health restoration to the management and delivery of population-focused nursing care. Utilizes Healthy People 2020 Health Objectives to assess, diagnose, plan, and implement an intervention for a community. 2. Describe research findings and how to apply these findings to the nursing care of community populations. 3. Understand how to apply an interdisciplinary approach in performing a community assessment, decision-making, planning, implementation, and evaluation of population-focused care. NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Acquire knowledge of how to integrate professional standards of moral, ethical, and legal conduct when providing therapeutic nursing interventions for diverse populations across the lifespan in a multicultural environment. 5. Identify policies, political, and economic influences at the local, state, national, and global levels related to care of community populations. Prerequisites: NURS 3505, NURS 3650, NURS 3710, NURS 3820 (Grade C or higher). FA, SP.
NURS 4301. Community/Global Health Nursing Clinical (ALCS). 2 Hours.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Clinical experiences incorporate best practices for population-based assessment, disease prevention and management, risk reduction and health promotion in a variety of multicultural, community based settings. This course is designated as an Active Learning Community Service (ALCS) course. Students provide service in areas of public concern in a way that is mutually beneficial for both the student and community. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Utilize knowledge of how to incorporate concepts of disease prevention, risk reduction, health promotion, and health restoration to the management and delivery of population-focused nursing care by using “Healthy People 2020” health objectives to assess, diagnose, plan, and implement an intervention for a community. 2. Use research findings in the nursing care of community populations. 3. Apply an interdisciplinary approach in performing a community assessment, decision-making, planning, implementation, and evaluation of population-focused care. 4. Integrate professional standards of moral, ethical, and legal conduct while providing therapeutic nursing interventions for diverse populations across the lifespan in a multicultural environment. 5. Apply policies and respect political and economic influences at the local, state, national, and global levels when providing care to a community. Prerequisites: NURS 3505, NURS 3650, NURS 3710, NURS 3820 (Grade C or higher). FA, SP.
NURS 4500. Contemporary Nursing. 4 Hours.

Explores how informatics systems can be utilized to assist in providing more efficient and effective patient care, including hardware, software, databases, new developments, and associated legal and ethical issues. Addresses policy development, political influences and power, and nursing’s involvement in the policy-making process. Legislation past and present, as well as ethical theories, frameworks, and the process of ethical inquiry are examined, explored, and analyzed as a basis for professional nursing practice, education, research, and decision-making. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge to incorporate principles and processes of evidence-based practice including the application of best available evidence, clinical judgement and patient centered care for patients, families, groups, communities, and populations. 2. Acquire knowledge to be able to evaluate and apply the nursing process to assist in providing more efficient and effective patient care in order to promote healthy lifestyle, prevent disease, and deliver safe patient centered care. NURSING 3005 – Nursing in Complex Settings Assignment Papers. 3. Acquire knowledge of informatics and communication methods in all areas of nursing practice, including hardware, software, databases, new developments, and associated legal and ethical issues. 4. Examine how the quality, safety, and cost effectiveness of care may be improved through the principles and processes of evidence-based practice, providing more efficient and effective patient care, and the active involvement of patients, families, groups, communities, populations and members of the healthcare team. 5. Acquire and discuss effective strategies for overcoming barriers, facilitating teamwork, resolving conflict, developing health policy, and participating in quality improvement measures to provide more efficient and effective patient care. Prerequisites: NURS 4010, NURS 4300 (Grade C or higher). FA, SP.
NURS 4600. Senior Capstone. 6 Hours.

Allows the student to select an area of interest and have an intensive experience focused on nursing leadership, research, and/or clinical practice. Student portfolios are used to design an individual learning experience in which students will integrate the role of the professional nurse with previous knowledge and experience. Students will meet the college requirement of 45 work hours per credit. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Develop a professional nursing project that is related to the student’s professional interests and goals then present information to class members.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 2. Demonstrate learning in the analysis, synthesis, and application of the RN-BSN program student learning outcomes in the completion of all course assessments. 3. Engage in collaborative and interactive activities with peers including peer feedback and critique with use of the technology available in the Canvas Learning Management System. 4. Exhibit professional standards of moral, ethical, and legal conduct while fostering collegial relationships when interacting with peers, health care workers, and diverse populations across the lifespan in multicultural environments. 5. Using several perspectives determine current professional development and practice goals. Engage in self-reflection of professional nursing activities and all course assignments for completion of RN-BSN program courses. Integrate professional nursing concepts and principles learned in the RN-BSN program into their current and future professional nursing practice through development of a professional portfolio. Prerequisites: Admission to the Bachelor of Science in Nursing program and NURS 3100; and NURS 3200, NURS 3300, NURS 3400, NURS 3600, NURS 3700, NURS 4020, NURS 4030, and NURS 4040 can be taken concurrently. FA, SP, SU.
NURS 4700. Leadership and Management Capstone. 5 Hours.

Explores the role of the professional nurse as a leader and manager of patient care by exploring strategies, processes, and techniques of the nurse leader and manager as well as theories, principles, and application of leadership and management within the professional nursing role.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Emphasis is placed on management of health information, leadership applied at the point of care and effecting change at the organizational and systems level. Student portfolios are used to demonstrate achievement of end-of-program student learning outcomes. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Acquire knowledge to organize and manage care for patients, families, groups, communities, and populations in a variety of patient care settings with both predictable and unpredictable outcomes. 2. Acquire knowledge to be able to evaluate and apply the nursing process to individuals to promote health lifestyle, prevent disease, and deliver safe patient-centered care. 3. Acquire knowledge of informatics, and communication methods to improve patient health outcomes.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Examine how the quality, safety, and cost-effectiveness of health care may be improved through the active involvement of patients, families, groups, communities, populations and members of the healthcare team. 5. Acquire and discuss effective strategies for overcoming barriers, facilitating teamwork, resolving conflict, developing health policy, and participating in quality improvement measures. Prerequisites: NURS 4010 (Grade C or higher) and NURS 4300 (Grade C or higher). FA, SP.
NURS 4701. Leadership and Management Capstone Clinical (ALCS). 3 Hours.

Provides students the opportunity to work with preceptors to further develop clinical judgment and skills needed for a graduate nurse. The student can learn, practice and master skills previously learned as well as apply principles of leadership and management. This course is designated as an Active Learning Community Service (ALCS) course.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Students provide service in areas of public concern in a way that is mutually beneficial for both the student and community. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Organize and manage care for patients, families, groups, communities, and populations in a variety of patient care settings with both predictable and unpredictable outcomes. 2. Evaluate and apply the nursing process to patients to promote healthy lifestyle, prevent disease, and deliver safe patient-centered care. 3. Utilize informatics and communication methods to improve patient health outcomes. 4. Identify how the quality, safety, and cost-effectiveness of health care may be improved through the active involvement of patients, families, groups, communities, populations and members of the healthcare team. 5. Utilize effective strategies for overcoming barriers, facilitating teamwork, resolving conflict, developing health policy, and participating in quality improvement measures. Prerequisites:NURS 4010, NURS 4300 (Grade C or higher). FA, SP.
NURS 4750. Concept Synthesis. 3 Hours.

Assists students in synthesizing curricular concepts in preparation for professional nursing practice. Emphasis is placed on the concepts of safety, clinical judgment, skills, and evidence-based practice in providing nursing care for patients across the lifespan. This course requires a Differential Tuition Rate which is an additional fee of $75 charged per credit hour. **COURSE LEARNING OUTCOMES (CLOs) At the successful conclusion of this course, students will be able to: 1. Demonstrate knowledge of evidence-based practice in administering pharmacological and parenteral therapies to patients across the lifespan. 2. Demonstrate the role of the nurse in empowering patients, families, groups, communities, and populations in all aspects of the health care process by exhibiting knowledge, comprehension, application, and prioritization within the eight test plan categories of the NCLEX-RN. 3. Participate in group activities as an effective team member and/or leader, constructively voicing their own perspective or position.NURSING 3005 – Nursing in Complex Settings Assignment Papers. 4. Demonstrate through practice tests the understanding of providing nursing care with a moral and ethical commitment toward the promotion of human dignity, diversity of individuals, communities, and members of the healthcare team. 5. Demonstrate an appreciation for vigilance and monitoring of self and others to promote safety and prevent errors. Prerequisites: NURS 4010, NURS 4300 (Grade C or higher).

Nursing is a profession that provides opportunities for specialization, team work, leadership and personal growth. Nursing promotes partnerships with other health care professionals in caring for clients and families across the lifespan through a variety of health care settings. Northern College is one of the partners in the Laurentian University BScN Collaborative Program and, as part of this partnership with Laurentian University, our nursing students are able to complete all four years of the BScN program at Northern.NURSING 3005 – Nursing in Complex Settings Assignment Papers. Northern’s Nursing program provides opportunities for students to practice nursing skills in state of the art nursing practice labs equipped with integrative simulation equipment.NURSING 3005 – Nursing in Complex Settings Assignment Papers. This latest technology will assist in preparing students for actual client care through simulated medical scenarios. Our nursing program also incorporates new technologies, such as specialized software packages and web-based tools, many of which are used in health-care settings. Learning experiences will be enhanced through cooperation and consultation with faculty and peers through shared activities. Northern also utilizes its on site Family Health Team clinic, to provide an excellent opportunity for nursing students to experience community-based nursing first hand while working within an interdisciplinary health care team.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Although we make every effort to accommodate your preference of clinical placement location, you should be aware that you may be placed in a community outside of the district or county where you currently reside. In any event, you are responsible for transportation to and from clinical agencies as well as any and all costs associated with the clinical placement. Also note that clinical days may include weekends and start/end times often occur outside of normal business hours.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

NOTE: Students who are unsuccessful in a course may be required to travel to a different campus to retake course(s) as deemed necessary for program completion.

Career Opportunities
Graduates may find employment in acute and long-term care agencies, public health, community agencies, doctors’ offices, clinics, mental health services, traveling health agencies and with individuals and/or families.

Despite improved hygiene standards, no significant reduction in the number of infections and deaths from MRSA (methicillin-resistant Staphylococcus aureus) in hospitals has been recorded so far. At the same time, the aging population increases the need for nursing homes. Hygiene measures are particularly important in this context, as the immune systems of the elderly and older patients is already weakened, requiring greater protection.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

Furthermore, there is talk of a lack of qualified personnel, not just in Germany, Austria and Switzerland. These personnel shortages and chronically tight budgets are significant challenges for the management of seniors’ homes and nursing facilities, not only with regard to hygiene management.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

To provide more protection and improved hygiene means breaking the infection chain. But how does the number of germs develop between the cycles of cleaning and disinfection? Hand hygiene plays an important role, as many germs are transmitted via surfaces coming in contact with skin. Missing, or inadequate, systematic hygiene processes permit the nearly uncontrolled growth of sometimes multi-resistant germs on plastics, textiles and skin. Disinfection can prevent this to a degree, but is nowhere near enough by itself. Given this, the choice of antimicrobial surfaces may offer a useful addition to the overall hygiene management concept: in hospitals, doctors’ offices, care facilities and nursing homes.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

6310_SAN_Grafik_germs_EU_bearb

Antimicrobial surfaces provide permanent protection from bacterial growth between cleaning and disinfection cycles.NURSING 3005 – Nursing in Complex Settings Assignment Papers.

NURS 6670 Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults Papers

NURS 6670 Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults Papers

NURS 4005 – Topics in Clinical Nursing Case Study Paper

NURS 4005 – Topics in Clinical Nursing Case Study Paper

Clinical Practice – Areas and Topics

• Cutting-edge medical or surgical therapies
• Developments/Advancements on nursing care
• Developments/Advancements on Treatments/Procedures
• Evidence-Based practice
• Practices for Acute and Critical Care Conditions
• Advanced Diagnostic Tests
• Point-of-Care testing
• Clinical Pharmacology
• Management of Acute and Chronic Heart Failure
• Obstetrics and Gynecology

NURS 4005 – Topics in Clinical Nursing Case Study Paper

Nursing’s top 10 pressing issues

Like many other healthcare professions, nursing is at a crossroads. Rapidly evolving regulatory, political, demographic, social and technological forces are challenging nurses in ways that have a huge impact on their ability to advance nursing’s critical role in our nation’s healthcare.NURS 4005 – Topics in Clinical Nursing Case Study Paper

A newly released book, “The Power of Ten—2011-2013: Nurse Leaders Address the Profession’s 10 Most Pressing Issues,” takes on hot button topics, with input from more than 30 international nurse leaders. The thought-provoking, timely publication is intended to get a discussion going, according to its publisher, the Honor Society of Nursing, Sigma Theta Tau International.

The top 10 issues addressed include:

• Evidence-based practice: Harmful or helpful?
• What impact does technology have on nursing?
• Should a bachelor’s degree be the minimum level of education?NURS 4005 – Topics in Clinical Nursing Case Study Paper
• DNP vs. PhD
• Attaining a seat at the policy table
• Coping with growing ethical demands
• Improving workplace culture
• How do nurse leaders affect the profession?
• Closing the workforce age gap
• How to make the profession as diverse as the population

The book aims to be provocative, challenging readers to engage their critical thinking and formulate possible responses to help position nursing leadership to undertake thoughtful and informed action—in other words, to advocate. For example, in the chapter on attaining a seat at the policy table, a discussion point is presented: “Every aspect of a nurse’s practices is regulated by policy. What are the three policy rules or regulations from your organization or state that you’d lobby to change for nursing?” And, in the chapter on evidenced-based practice, this discussion point is posed: “Does evidence-based practice decrease a nurse’s ability to determine care based on how she sees a patient respond?”

Nurses featured in the book don’t hold back in their viewpoints on the state of their profession. “[We need to avoid] glorifying credentials over contributions,” posits one nurse while another says “[It is a challenge that nursing professionals are unable] to act and work together cohesively. [We have become a] fractional profession that has limited professional power.”NURS 4005 – Topics in Clinical Nursing Case Study Paper

Nursing Research Paper Topics

Selecting an essay topic is like laying a foundation for a skyscraper. You need to make the right choice, or the whole essay will collapse before you finish writing. Still, choosing among nursing essay topics can be difficult. There are too many issues to study and discuss. To make your job easier, we have accumulated a list of the best nursing research paper topics. Select one of the major subjects, then browse individual nursing research topics until you find the right one for your paper. And if you are having trouble with the next step of writing an essay, reach out to our professional writers. They will happily assist you with any of these topics.

Mental Health

When choosing among the mental health essay topics, consider different sides of the issue. You can research mental illnesses, care regimes, and first aid techniques. Choose the problem that interests you most or the one with which you are familiar to save time on research and writing.NURS 4005 – Topics in Clinical Nursing Case Study Paper

• The best treatment options for early-stage dementia patients
• The most effective care procedures for suicidal patients
• Does aromatherapy help patients deal with stress and depression?
• When is it necessary to involve psychiatrist in the patient’s treatment?
• How to deal with self-harm patients in emergency rooms?
• Paranoid schizophrenia emergency assistance
• Slowing the cognitive degeneration of patients with Alzheimer’s disease
• The causes and treatments for generalized anxiety disorder
• How does aging influence the patient’s psychological health?
• Can nurses help patients get through depression?

Child Nursing

Choosing a topic of the child nursing essay is difficult as there are so many pediatric issues to discover. Research neonatal care or conventional treatments. Preventative techniques are also among the most crucial aspects of podiatry, so you can outline them in your paper.

• Neo-natal ward improvements to help young mothers and newborns
• How to deal with low survival rate among pediatric cancer patients
• How to treat poor nutrition among pediatric patients
• Measures for child injuries prevention
• The healthy nutrition impact on a child’s well being
• The primary causes of child mortality in your country
• Preventative steps to eliminate the intestinal parasites risk
• The development of chronic disorders in children
• The care regime for children with constipation
• The treatment plan for the pediatric victims of near-drowning

Taking Care of Adult Patients

Unlike children, adult patients face more psychological effects during and after treatment so you might concentrate on them. If you are short on time, select an easier topic to study, like treating heartburn or promoting healthy habits among recent stroke survivors.NURS 4005 – Topics in Clinical Nursing Case Study Paper

• Treating chronic heartburn in middle-aged men
• Helping stroke survivors regain essential motor functions
• Treatment plan and advice for psoriasis patients
• The different possible causes of chest pain
• Helping patients deal with limited mobility after appendage fractures
• Blood pressure improvement tactics for middle-aged men
• Helping intimate partner violence victims
• Emergency medical assistance for road traffic accidents
• Protecting the dignity of adult patients with learning disabilities
• The most effective sepsis treatment procedures

Older Patients Care Regime

There are multiple exciting geriatric research topics. You can choose straightforward issues like hearing loss prevention and treatment if you need the complete the paper quickly. However, if you are into research, concentrate on trickier subjects, like suicide prevention or workout regimes for the elderly patients.NURS 4005 – Topics in Clinical Nursing Case Study Paper

• The basics of osteoarthritis treatment for elderly patients
• Elderly patients malnutrition causes and treatments
• The first signs and interventions for age-related hearing loss
• Light exercise regime to prevent falls and bone fractures
• The advantages of individualized geriatric care for patients
• The critical aspects of caring for elderly patients with diabetes
• How to predict and thwart suicide attempts among the elderly patients
• How to plan and organize a safe discharge for a geriatric patient
• Making dying patients comfortable during their last days
• Technological solutions for geriatric care facilities

Women’s Health Issues

Women’s health issues topics offer a range of research subjects. You can choose something as trivial as an acne treatment or focus on the psychological side of things for domestic abuse or rape victims. Whether you write about recommended treatments or experimental procedures, concentrate on gender-specific details.

• Chlamydia treatment plan and overall sexual health improvement
• Post-pregnancy care after the death of the fetus
• The causes of growing infertility rates
• Which factors increase the risk of osteoporosis among women?NURS 4005 – Topics in Clinical Nursing Case Study Paper
• The importance of breast cancer screening procedures
• Preventative measures for sexually transmitted infections
• Reproductive health assessment barriers nurses have to overcome
• How to help female victims of domestic violence?
• Curbing emotional and physical symptoms of premenstrual syndrome
• Acne treatment and prevention in female patients

Obstetrics

Obstetrics research is ripe with opportunities to let your writing talent shine. Choose the topic you are passionate about, draw from personal experience or your friends’ first-hand accounts to make the papers stand out. If you collect enough data, you can later turn your essay into a full-fledged case study.

• The risks associated with adolescent pregnancy
• Why is midwife’s support for parents and doctors under-appreciated?
• Organizing educational workshops for new mothers
• The importance of blood glucose awareness during pregnancy
• The most effective treatment for pregnancy-induced hypertension
• Is epidural safe for mothers and newborns?
• The difficulties overweight women face during pregnancy and childbirth NURS 4005 – Topics in Clinical Nursing Case Study Paper
• The advantages and disadvantages of delivery with the partner
• The potential risks of multiple pregnancies for women
• Unhealthy habits pregnant women should forget for nine months

Standard Treatments

Choose one of these topics if you are not a fan of experimental techniques and prefer to rely on tried-and-true treatments. You can select any disorder or illness and research the conventional protocols either recommended by your country’s Ministry of Healthcare or the World Health Organization.

• How does post-surgery care increase the patient recovery rate?
• Should nurses get the right to prescribe antibiotics without a doctor’s signature?
• The support system for the family members of ICU patients
• Health care plan for patients with diabetes
• The oxygen therapy benefits for cardiac disorders
• The primary causes of cerebrovascular accidents leading to brain cells’ damage
• Asthma primary health care plan
• Quick thinking required for dealing with the anaphylactic shock
• Phlebotomy skills every nurse should possess
• Preventing and managing ventilator-associated pneumonia

Pain Management

Pain management research is a crucial part of nursing education as most serious cases require careful administration of prescription drugs. Your essay can describe the best techniques, alternative pain management treatments or special considerations for recovering addicts.NURS 4005 – Topics in Clinical Nursing Case Study Paper

• Pain management options for fibrillation patients
• Chronic pain disorders caused by incorrect acute pain treatment
• How can pain assessment techniques be improved?
• Benson’s relaxation therapy for pain reduction among post-cesarean mothers
• Post-discharge pain-relief treatments
• Can pediatric opioid drugs cause addiction problems in teenagers?
• Non-pharmacological pain-relief methods
• The increased risk of opioid poisoning among pediatric patients
• Alternative long-term pain treatments
• Postoperative pain management regime

Health Care Promotion

If you don’t want to dig deep into medical treatments for your essay, a health care topic on healthy lifestyle promotion might be right up your alley. Discuss the right everyday choices for high-risk groups for diabetes, stroke, obesity, teenage pregnancy, etc. You don’t have to follow the guidelines you describe though adding personal touches might win you a few extra points.

• How to curtail the spread of infectious diseases
• Preventing teenage pregnancies among ethnic minorities
• Should overweight nurses be fired for promoting an unhealthy lifestyle?NURS 4005 – Topics in Clinical Nursing Case Study Paper
• The effects of drug use on children and teenagers
• Diabetes-preventing lifestyle: meal plan and sports
• Promoting skin cancer awareness and prevention methods
• How to discourage teenage smoking and drinking?
• Spreading the knowledge of occupational hazards
• The ways to prevent child obesity
• The benefits of influenza vaccination for teachers, law enforcement, and social workers

Professional Nursing Issues

Nurses lead exhausting and stressful lives. As a future nursing professional, learn about the psychological, legal, and financial troubles you might face. Writing about one of these topics, you will get a realistic glimpse into the hardships of your chosen career path and get ready for them in advance.

• How to deal with nervousness and anxiety as a nurse
• Increasing nursing productivity through bench marking data
• The advantages of collaborative nursing
• How to counter the shortage of qualified nurses
• Increasing cultural sensitivity among nursing staff
• The adaptation of internationally trained nurses
• The legal issues nurses can face
• Male nurses providing intimate care for female patients
• The difficulties along the way to becoming a certified nurse
• Should doctors and nurses get to decide when to end the unresponsive patient’s life?

Here you will find research, educational, and evidence-based practice materials carried out by nurses with extensive knowledge in the clinical setting and intended to address issues of interest in Adult Medical/Surgical Care. This collection will disseminate materials of specific importance to practicing nurses who are responsible for patients in a broad range of settings with diagnoses across all medical specialties.

Topics that can be found within this collection may include, but are not limited to:

Advanced Practice; Best Practices; Care Coordination Standards & Policies; Cutting-edge Medical or Surgical Therapies; Developments, Advancements, or Updates on Nursing Care, Treatments or Procedures; Evidenced-based Practice; Infection Control; Medical Error Reduction; Medical/Surgical Care in non-hospital sites: clinics, outpatient surgery centers, MD offices, long-term care facilities, and other practice sites; Multidisciplinary Collaboration in Managing Patient Care; Nursing Care of Patients in Specific Medical/Surgical Areas: Neurology, Neurosurgery, Orthopedics, Organ Transplant, Trauma; Nursing Shortage (How it affects Adult Medical/Surgical Care; Nursing Roles in Adult Medical/Surgical; Orthopedics; Pain Management; Patient/Family Support & Education; Patient Monitoring (Advances in or Changes to); Patient Outcomes, Improvement; Post Anesthesia Care Unit/Recover Room, Policies, Procedures and Standards of Care; Standards of Care

Prior to an item’s inclusion in this collection it has been through a peer-review process conducted by experienced nursing researchers. The collection contains full-text submissions, some of which may be embargoed for a period of time to allow the author to pursue traditional publishing options.

NURS 4005 – Topics in Clinical Nursing Case Study Paper

Research Paper Topics For Nursing Students

If you are tasked with writing a research paper on a nursing topic there are many options available for you. But if you are having a difficult time creating the perfect idea consider the examples below:

1. You can craft a research paper that focuses on how nurses can help people who are suffering from an age related illness
2. You can explore ethics and how this relates directly to patient safety for different nurses
3. You can explore what nurses need to know when handling chronic illnesses NURS 4005 – Topics in Clinical Nursing Case Study Paper
4. You can research why there is a shortage of nurses and how those with in the nursing field can climb the career ladder and achieve higher positions within the industry
5. You can explore the challenges that nurses face in improving women’s health
6. You can research how nurses can renew and transfer their nursing license when they move to a new location
7. You can explore different strategies nurses can use for a quick response to emergency and critical care situations
8. You can explore the role that nurses play in emotional rehabilitation
9. You can research how nurses can help patients to deal with phobias and fears
10. You can explore what nurses can do to promote healthy lifestyles which are designed to prevent illnesses
11. You can explore the difference between primary care providers and nursing staff
12. You can research different nursing careers and what steps have to be taken to attend accredited schools
13. You can explore the role that nursing education has within social media
14. You can review the manner in which the role of nurses has changed over the last few decades
15. You can explore alternative therapies and whether they should be counted as nursing
16. You can explore the different risks associated with nurses and what measures can be taken by medical institutions to insure that all nurses are safe when working NURS 4005 – Topics in Clinical Nursing Case Study Paper

Topics in Clinical Nursing: 2018 Update, including Healthcare Communications and The Team Approach to Patient Care is organized by Continuing Education, Inc and will be held from Jul 06 – 13, 2018 at 7-Night Alaska Cruise Conference Round-trip Seattle, Seattle, Washington, United States of America.

The target audience for this medical event is Nurses, Nurse Practitioners. This CME Conference has been approved for a maximum of 14 Contact Hours.

Topics:

Resolving an Unexpected Medical Outcome using a team approach • Apply two models for disclosing an unexpected medical outcome: when care is reasonable or when care is unreasonable.

Diabetes self-management‐ the key to a successful outcome • Define the key skills needed to support a clinician as a change agent in coaching patients to self-manage their condition.

Transitioning from Cure to Care in chronic disease management • Identify and use a model for documenting the continuum of care for patients being following by a retired nurse volunteer.NURS 4005 – Topics in Clinical Nursing Case Study Paper

The Electronic Health Record ‐ a challenge and an opportunity • Define the challenges that occur when using an electronic health record and 3 skills to overcome these challenges.

Patient Safety: Strategies and tools to promote patient safety and improve clinical performance • Reasons to improve safety in the medical practice, including the role of leadership.

Motivational Interviewing • Demonstrate communication techniques used in motivational interviewing

• Working in Highly Functioning Teams • Diabetes 2018 Update

Update on Communication Skills • Describe new communication tools used when interviewing patients NURS 4005 – Topics in Clinical Nursing Case Study Paper

Burnout • Define Burnout • Relate techniques to manage burnout in oneself and others

The Neuroscience of Anger and the Angry Encounter • Describe new concepts in the neuroscience of anger • Demonstrate use of a communication tool to mitigate anger in oneself and others

Navigating Difficult Conversations • Manage conversations when they become difficult

Advanced Care Planning & End of Life • Describe the differences in ACP & EOL • Explain ACP & EOL to patients and families

Topics around nurse retention

That was the question at the heart of “Better Nursing Outcomes Using Data and Predictive Analytics,” a panel discussion at last month’s Becker’s Hospital Review Health IT + Clinical Leadership conference. The panel, which was attended mostly by nurse leaders, was moderated by Arena president Myra Norton. The other panelists were:NURS 4005 – Topics in Clinical Nursing Case Study Paper

● Mike Rosenberg, Arena Chairman and CEO ● Lisa Cox Schrieffer, Executive Vice President and COO/CNO at Regional One Health ● Michaela Simmons, Research Lead with Advisory Board’s HR Advancement Center

Here are a few highlights from the wide-ranging discussion:

1. “Hiring has changed.”

Hiring has always been a mix of art and science. But Lisa, who has worked in nursing management and leadership roles for over 30 years, says that the hiring process was far more weighted toward the “art” side when she first began her career. Hiring decisions were primarily based on gut feel. Reviewing a person’s resume was as far into the “scientific” realm as most hiring managers got.

But with the advent of data and analytics, the scientific aspect of hiring has come to the forefront. More and more hospital systems are applying data-driven tools like Arena to the process.

2. “Retention is a huge issue.”

Part of this shift is due to a growing need for high-quality nurses who are likely to stay in their roles. Nurse retention is a huge issue in the market today, according to Michaela, who is currently leading research on workforce analytics exploring how Human Resources (HR) leaders can invest in building their analytic capabilities. Retention has significant consequences for healthcare organizations. Churn impacts quality of care and overall nurse morale.NURS 4005 – Topics in Clinical Nursing Case Study Paper

3. “Nurse leadership and HR need to have a strong partnership.”

Myra shared that nurse leadership needs the support of a strong human resources team, and vice versa, to move the needle on retention and other operational challenges.

The skill sets needed for success in both HR and nurse leadership are changing. A fluency with data is an increasingly important skill as more data-driven tools are used throughout the hiring process as well as on the job. Otherwise, it can be difficult to get broad adoption of these tools, despite their proven efficacy.

4. “Predictive analytics can expand your hiring pool.”

Many healthcare organizations struggle with a dearth of applicants for nursing positions. Some have tried to use assessments to evaluate their applicant pool in the past, but struggled because it only further limited the number of eligible candidates.

But as Mike noted, predictive tools like Arena aren’t the same as assessments with cut scores. In fact, Arena can expand your hiring pool. The traditional way of hiring is to look at individuals only for the role to which they’ve applied. But Arena can look at candidates who have applied to other positions as well, and identify those people who might be successful in currently open roles.NURS 4005 – Topics in Clinical Nursing Case Study Paper

5. “Data can help hiring managers make better long-term decisions.”

As a nurse leader desperate to hire nurses, it can be difficult to take retention into account. You’re likely much more focused on just filling an open position to make your life (and your nurses’ lives) easier right now. But data-driven tools can serve as a useful reminder by helping to quantify the risk of hiring a candidate with a low likelihood of retention. Often, it’s better to wait a few weeks to find another candidate rather than put someone in the role who is likely to leave in a couple months.

Selecting a Clinical Nursing Problem for Research

Clinical nursing problems selected for inquiry are generally those encountered in nursing practice and those that deal with modalities of patient care such as support, comfort, prevention of trauma, promotion of recovery, health screening, appraisal and/or assessment, health education, and coordination of health care. The psycho social dimensions of health care are an essential aspect of clinical nursing research. Factors considered in selecting a clinical nursing problem for research fall into three general categories: personal, social, and scientific. The personal factors include interest in the problem, competence to conduct the study, time, energy, and money to conduct the study as well as the essential instruments, space, personnel, and equipment to carry out the study. Social factors are concerned with the advancement of science and the ethical value of the study as well as its practicability and applicability. The scientific factors are those that relate to the logic, empirical, explicable, reductive, and transmittable aspects of selection of the problem for study. NURS 4005 – Topics in Clinical Nursing Case Study Paper

Nursing Paper Topics

Nursing paper topics are often determined by the instructor. For the most part, there is little leeway to express creativity. Fortunately, even if creativity is not an option, personal interest is. Nursing students can focus on the kind of work that inspires them.NURS 4005 – Topics in Clinical Nursing Case Study Paper

Nursing Paper Topics

Nursing students are often working while studying, and at times find that they can only think of what they already do and how they do it. That is a normal problem to have when considering nursing paper topics, but happily we can help.

Whether you want to blow the doors wide open or explore a familiar topic from a new perspective, we can help. We can also help the rote and administrative type assignments that are common for nursing students.

Just like in any field, there are people who find the researching and writing of a professional field more interesting that the practice of that field. Fortunately, those people can become writers and they work with us at Power Papers.com.

Research Papers Topics

Below is a list of research and other nursing paper topics that you can use for inspiration. We can write on these and any other topic that might interest you or be needed.NURS 4005 – Topics in Clinical Nursing Case Study Paper

1. Acquisition of clinical skills: Oncology
2. Basic nursing procedures: Managing stress and fear
3. Breaking the communicable disease chain: Nurses’ roles
4. Clinical nursing skills: Watch the video
5. Communicable diseases: Known reservoirs of contagion
6. Community health nurses in American Indian communities
7. Community nursing in rural areas
8. Community nursing in urban areas
9. Continuing education for nurses: What’s working and what isn’t
10. Critical care nursing in pediatrics
11. Cultural accommodation and nursing in America
12. Cultural competency in nursing
13. Dental nurses: Underutilized
14. Determining the best nurse-patient ratios for obstetric units
15. Emergency room nursing in the US: From trauma to common colds
16. For-profit medical care and the place of nurses
17. Global health issues and nursing
18. Healthy choices make up less than 25% of health determinants, social metrics more than 50%: Why do you talk about the first more than the latter?NURS 4005 – Topics in Clinical Nursing Case Study Paper
19. How would you describe a healthy community?
20. How YouTube can help you support your own learning in nursing school
21. Labor and delivery nurses
22. Learning not to use “weight” as a substitute for health: One nurses journey
23. Long term care nursing in rural environments
24. Med surge nursing: Is it right for you?
25. Medication errors and under staffing
26. Mental health nursing: Career options for graduating nurses
27. Modes of transmission: Communicable diseases
28. Nurse sensitive errors and nurse-patient ratios
29. Nurses and virtual learning environments: Understanding limits in nursing education
30. Nursing education: Know your learning style so you can help yourself
31. Nursing education: We’re all administrator assistants now
32. Nursing informatics and new protocols
33. Nursing jobs for those with cultural brokering expertise
34. Nursing with Dummies: Issues in education: Medical simulation for nurses
35. Other words for compassion: cultural competence and nursing
36. Pain management: What nurses need to know
37. Patient acuity tools and proper scheduling
38. Patient engagement and job satisfaction for nurses
39. Perinatal nursing in communities with high maternal and infant mortality
40. Philosophies of nursing leadership
41. Postpartum education and the reduction of postpartum depression: The role of nurses
42. Profit based health care delivery systems and nursing
43. Range of motion exercises: ROM and rehabilitation nursing
44. Recruiting and retaining nurses
45. Relationship theory in nursing
46. Social determinants of health and the roles of nurses
47. Summary and analysis: Why nurses should be full partners with physicians
48. The BMI lie: How profits and bias got the CDC to ignore its own findings
49. The practice of emotional intelligence: Nursing
50. Traveling nurses: Increasing demand and expanding opportunities

Examples of broad clinical research questions include:

1. Does the administration of pain medication at time of surgical incision reduce the need for pain medication twenty-four hours after surgery?NURS 4005 – Topics in Clinical Nursing Case Study Paper
2. What maternal factors are associated with obesity in toddlers?
3. What elements of a peer support intervention prevent suicide in high school females?
4. What is the most accurate and comprehensive way to determine men’s experience of physical assault?
5. Is yoga as effective as traditional physical therapy in reducing lymph edema in patients who have had head and neck cancer treatment?
6. In the third stage of labor, what is the effect of cord cutting within the first three minutes on placenta separation?
7. Do teenagers with Type 1 diabetes who receive phone tweet reminders maintain lower blood sugars than those who do not?
8. Do the elderly diagnosed with dementia experience pain?
9.  How can siblings’ risk of depression be predicted after the death of a child?
10.  How can cachet be prevented in cancer patients receiving aggressive protocols involving radiation and chemotherapy? NURS 4005 – Topics in Clinical Nursing Case Study Paper

Examples of some general health services research questions are:

1. Does the organization of renal transplant nurse coordinators’ responsibilities influence live donor rates?
2. What activities of nurse managers are associated with nurse turnover?  30 day readmission rates?
3. What effect does the Nurse Faculty Loan program have on the nurse researcher workforce?  What effect would a 20% decrease in funds have?
4. How do psychiatric hospital unit designs influence the incidence of patients’ aggression?
5. What are Native American patient preferences regarding the timing, location and costs for weight management counseling and how will meeting these preferences influence participation?NURS 4005 – Topics in Clinical Nursing Case Study Paper
6.  What predicts registered nurse retention in the US Army?
7. How, if at all, are the timing and location of suicide prevention appointments linked to veterans‘ suicide rates?
8. What predicts the sustainability of quality improvement programs in operating rooms?
9. Do integrated computerized nursing records across points of care improve patient outcomes?
10. How many nurse practitioners will the US need in 2020?

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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NURS 3010 Assignments – Information Management in Nursing and Healthcare

NURS 3010 Assignments – Information Management in Nursing and Healthcare

Healthcare providers at our core, Xelpha’s founders met at the junction of medicine and technology. Through their work with patients in numerous resource-limited environments from South Sudan to Western Kenya all the way to the USA, they identified an underlying thread impacting the quality of healthcare being provided: information. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

The quality of decisions made in healthcare – whether by providers or by patients – is limited by the quality of information factored into those decisions. In resource-limited places, there is a healthcare informatics gap, stemming from a lack of access, accuracy, completeness, efficacy, organization, and liquidity of information, resulting is poor quality healthcare. With the belief that healthcare should be accessible to all people globally irrespective of geography or economy, our founders developed a solution to facilitate engagement with the metrics of a healthy life. Through the interlacing of technology, business models, and value-based healthcare, Xelpha is addressing the unique challenges of health in resource-limited environments, improving healthcare and improving lives. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Professionals often use information technology to support clinical and managerial decision making in the field of healthcare. Students in this course explore these information technology applications through a variety of written and practical assignments. They focus on information technology that supports the delivery of services, including the collection, storage, retrieval, and communication of data; information systems safeguards; ethical and legal issues; and information management to promote patient safety and quality of care. Students also share examples of information literacy and discuss why it is important to the practice of nursing. Additionally, students identify basic hardware and software components and explore fundamental software applications, including spreadsheets and healthcare databases.

NURS 3010 Assignments – Information Management in Nursing and Healthcare.

NURS 1000 Professional Nursing Orientation

[1 credit hour (1, 0, 0)]

Course provides opportunity for development of academic, personal, and interpersonal skills required to become a successful, independent learner, introduces student to professional nursing as a career.

Term Offered: Spring, Fall

NURS 3040 Nursing to Promote Wellness Across the Lifespan

[5 credit hours (3, 0, 2)]

Focus on wellness and primary prevention across the lifespan. Introduction to nursing as a discipline. Emphasis on concepts of wellness, communication, lifespan, clinical judgment and physiologic processes. Recognize individuals in context of family and community. Student experiences in community-based settings.

Corequisites: NURS 3080, NURS 3150, NURS 3190

Term Offered: Spring, Summer, Fall

NURS 3080 Fundamentals of Nursing and Assessment Across the Lifespan

[5 credit hours (2, 0, 3)]

Focus on holistic assessment of individuals across the lifespan. Emphasis on assessment, skills, technology and professional nursing role. Experiential learning with peers in a simulated environment. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Corequisites: NURS 3040, NURS 3150, NURS 3190

Term Offered: Spring, Summer, Fall

NURS 3110 Nursing Agency II: Assessment

[3 credit hours (1, 6, 0)]

Provides for acquisition of knowledge and development of skill in comprehensive nursing assessment.

Term Offered: Spring, Summer, Fall

NURS 3120 Adult Health Nursing I

[7 credit hours (4, 0, 9)]

Care of adults with common nursing problems using Orem’s Self-Care Deficit Theory of Nursing.

Prerequisites: (NURS 3010 (may be taken concurrently) with a minimum grade of C and NURS 3110 (may be taken concurrently) with a minimum grade of C and NURS 3170 (may be taken concurrently) with a minimum grade of C and NURS 3210 (may be taken concurrently) with a minimum grade of C and NURS 4950 (may be taken concurrently) with a minimum grade of C)

Term Offered: Spring, Summer, Fall

NURS 3130 Gerontological Nursing

[3 credit hours (3, 0, 0)]

Focus on theories and concepts of aging and health, based on Universal Self-Care Requisites from Orem’s Self-Care Deficit Theory of Nursing. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 4030 (may be taken concurrently) with a minimum grade of C and NURS 4020 (may be taken concurrently) with a minimum grade of C and NURS 3620 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Summer, Fall

NURS 3150 Pathopharmacology 1

[3 credit hours (3, 0, 0)]

Focus on fundamental concepts in pathophysiology and pharmacology across the life span. Foundation for understanding disease processes and drugs [i.e. therapeutic outcomes and potential drug interactions. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Corequisites: NURS 3040, NURS 3080, NURS 3190

Term Offered: Spring, Summer, Fall

NURS 3170 Concepts Of Pathophysiology

[3 credit hours (2, 1, 0)]

Basic science of pathophysiology of disease across the life span. Prepares for critical thinking in application of concepts to nursing practice.

Term Offered: Spring, Summer, Fall

NURS 3180 Concepts Of Nursing Pharmacology

[3 credit hours (2, 1, 0)]

Fundamental pharmacologic principles of physiological response to drugs, therapeutic outcomes and potential drug interactions. Prepares for critical thinking in application of pharmacotherapy principles to nursing. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3010 (may be taken concurrently) with a minimum grade of C and NURS 3110 (may be taken concurrently) with a minimum grade of C and NURS 3210 (may be taken concurrently) with a minimum grade of C and NURS 3170 (may be taken concurrently) with a minimum grade of C and NURS 4950 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Summer, Fall

NURS 3190 Nursing Research 1

[2 credit hours (2, 0, 0)]

Focus on introduction of concepts, issues, and processes in nursing research.

Corequisites: NURS 3040, NURS 3080, NURS 3150

Term Offered: Spring, Summer, Fall

NURS 3280 Advanced Fundamentals

[3 credit hours (1, 0, 2)]

Focus on application of assessment skills and demonstrating safe procedures for high risk interventions in simulated experiences. Emphasis on the concepts of clinical judgment, professional behaviors, and collaboration. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3040 with a minimum grade of C and NURS 3190 with a minimum grade of C and NURS 3150 with a minimum grade of C and NURS 3080 with a minimum grade of C

Corequisites: NURS 3290, NURS 3300, NURS 3400, NURS 3540

Term Offered: Spring, Summer, Fall

NURS 3290 Nursing Research 2

[1 credit hour (1, 0, 0)]

Introduction to evidence based practice. Emphasis is on learning how to evaluate research for evidence based practice in nursing as a baccalaureate nurse. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3040 with a minimum grade of C and NURS 3190 with a minimum grade of C and NURS 3150 with a minimum grade of C and NURS 3080 with a minimum grade of C

Corequisites: NURS 3300, NURS 3400, NURS 3540

Term Offered: Spring, Summer, Fall

NURS 3300 Nursing Care of Persons with Health Challenges

[4 credit hours (2, 0, 2)]

Focus on holistic care of adults and older adults in acute care settings experiencing health problems. Emphasis on the concepts of leadership, collaboration, and communication. Recognizes individuals in context of family and community. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3040 with a minimum grade of C and NURS 3190 with a minimum grade of C and NURS 3080 with a minimum grade of C and NURS 3150 with a minimum grade of C

Corequisites: NURS 3280, NURS 3400, NURS 3540

Term Offered: Spring, Summer, Fall

NURS 3400 Family Health

[4 credit hours (2, 0, 2)]

Focus on health, wellness and illness of child – bearing families and children across various settings. Emphasis on concepts of gas exchange, sexuality, reproduction, grief, mood and affect, family, safety, advocacy and family communication. Recognizes individuals in context of family and community. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3040 with a minimum grade of C and NURS 3190 with a minimum grade of C and NURS 3150 with a minimum grade of C and NURS 3080 with a minimum grade of C

Corequisites: NURS 3280, NURS 3300, NURS 3540

Term Offered: Spring, Summer, Fall

NURS 3540 Pathopharmacology 2

[3 credit hours (3, 0, 0)]

Focuses on selected alterations and related pharmacology across the life span. Foundation for understanding disease processes and drugs [i.e. therapeutic outcomes and potential drug interactions]. Basis for critical thinking in nursing to help clients cope with effects of illness and return to health. Emphasis on concepts of: clotting, elimination, gas exchange, intracranial regulation, mood & affect, nutrition, patient education, perfusion, reproduction, sensory perception, tissue integrity. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3040 with a minimum grade of C and NURS 3190 with a minimum grade of C and NURS 3150 with a minimum grade of C and NURS 3080 with a minimum grade of C

Corequisites: NURS 3280, NURS 3300, NURS 3400

Term Offered: Spring, Summer, Fall

NURS 3620 Women’s Health Nursing

[5 credit hours (3, 0, 6)]

Provides didactic and clinical opportunities relevant to care of women across lifespan. Various clinical settings used in application of nursing system with a self-care framework.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Prerequisites: (NURS 3120 (may be taken concurrently) with a minimum grade of C and NURS 3180 (may be taken concurrently) with a minimum grade of C and NURS 3630 (may be taken concurrently) with a minimum grade of C)

Corequisites: NURS 4020, NURS 4030

Term Offered: Spring, Summer, Fall

NURS 3630 Mental Health Nursing

[5 credit hours (2, 0, 9)]

Psychosocial influences on self-care agency are presented within the context of culturally competent nursing care. Concepts are interpreted within self-care deficit theory and applied in clinical experiences.

Prerequisites: (NURS 3010 (may be taken concurrently) with a minimum grade of C and NURS 3110 (may be taken concurrently) with a minimum grade of C and NURS 3210 (may be taken concurrently) with a minimum grade of C and NURS 3170 (may be taken concurrently) with a minimum grade of C and NURS 4950 (may be taken concurrently) with a minimum grade of C)

Term Offered: Spring, Summer, Fall

NURS 3640 Parent-Child Nursing

[5 credit hours (2, 0, 9)]

Nursing care of infants, children, and adolescents within families and groups using Orem’s Self Care Deficit Theory of Nursing. Clinical experiences in wellness, acute, and chronic care settings.

Prerequisites: (NURS 3620 (may be taken concurrently) with a minimum grade of C and NURS 4020 (may be taken concurrently) with a minimum grade of C and NURS 4030 (may be taken concurrently) with a minimum grade of C)

Corequisites: NURS 3130, NURS 4010, NURS 4250

Term Offered: Spring, Summer, Fall

NURS 4010 Community Health Nursing

[5 credit hours (2, 0, 9)]

Focuses on design and implementation of nursing care for aggregates and communities. Individual and family care is provided within the context of population health. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: (NURS 3620 (may be taken concurrently) with a minimum grade of C and NURS 4030 (may be taken concurrently) with a minimum grade of C) and NURS 4020 with a minimum grade of C

Term Offered: Spring, Summer, Fall

NURS 4020 Leadership And Management In Nursing

[3 credit hours (3, 0, 0)]

Focus on principles and theories of management/leadership as a basis for provision of nursing care.

Prerequisites: (NURS 3120 (may be taken concurrently) with a minimum grade of C and NURS 3180 (may be taken concurrently) with a minimum grade of C and NURS 3630 (may be taken concurrently) with a minimum grade of C)

Corequisites: NURS 4030

Term Offered: Spring, Summer, Fall

NURS 4030 Adult Health Nursing II

[7 credit hours (3, 0, 12)]

Design and implementation of nursing systems for the adult population with complex health states. Includes application of nursing leadership principles in clinical settings.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Prerequisites: (NURS 3120 (may be taken concurrently) with a minimum grade of C and NURS 3180 (may be taken concurrently) with a minimum grade of C and NURS 3630 (may be taken concurrently) with a minimum grade of C)

Term Offered: Spring, Summer, Fall

NURS 4120 Nursing Leadership And Management

[5 credit hours (3, 0, 6)]

Focus on principles of management and leadership for the baccalaureate prepared nurse. Provision of professional care in a variety of settings. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: (NURS 4230 (may be taken concurrently) with a minimum grade of C and NURS 4180 (may be taken concurrently) with a minimum grade of C and NURS 4190 (may be taken concurrently) with a minimum grade of C)

Term Offered: Spring, Fall

NURS 4130 Nursing Care of Persons in Crisis 1

[4 credit hours (2, 2, 0)]

Focus on nursing care of persons across the lifespan in the acute care setting with mental health issues. Emphasis on concepts related to coping and stress tolerance; emotion; cognitive function; and maladaptive behavior. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3280 with a minimum grade of C and NURS 3300 with a minimum grade of C and NURS 3540 with a minimum grade of C and NURS 3290 with a minimum grade of C and NURS 3400 with a minimum grade of C

Corequisites: NURS 4240, NURS 4260

Term Offered: Spring, Summer, Fall

NURS 4180 Theoretical And Professional Foundations In Nursing

[4 credit hours (4, 0, 0)]

Focus on RN student’s transition to professional higher education and theory-based practice. Current professional issues are explored. Political, socioeconomic, ethical and legal issues are critically examined and discussed.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Term Offered: Spring, Fall

NURS 4190 Interpersonal Strategies In Nursing Of Older Individuals

[6 credit hours (4, 0, 6)]

Focus on application of Self-Care Deficit Theory of Nursing and health maintenance for older individuals within the family and environment; emphasis on development of interpersonal skills for RNs.

Prerequisites: NURS 4180 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4200 Population Focused Care

[5 credit hours (1, 0, 7)]

Focuses on the design and implementation of nursing care for aggregates and communities. Individual and family care is provided within the context of population focused care. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: (NURS 4190 (may be taken concurrently) with a minimum grade of C and NURS 4230 (may be taken concurrently) with a minimum grade of C)

Term Offered: Spring, Fall

NURS 4210 Applied Nursing Research

[3 credit hours (2, 0, 1)]

Emphasizes all phases of the research process. Analysis and application of research strategies for the professional nurse.

Term Offered: Spring, Fall

NURS 4220 Applied Pathophysiology And Pharmacology

[4 credit hours (4, 0, 0)]

Concepts of pathophysiology and pharmacology. Prepares for critical thinking in application of concepts to nursing practice.

Term Offered: Spring, Fall

NURS 4230 Applied Health Assessment

[3 credit hours (2, 3, 0)]

Nursing application of health history, physical and psychosocial assessment skills across the lifespan.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Term Offered: Spring, Fall

NURS 4240 Nursing Care of Persons in Crisis 2

[8 credit hours (5, 0, 3)]

Focus on changes in health in acute care settings across the lifespan. Emphasis on concepts related to oxygenation and hemostasis; homeostasis and regulation; protection and movement, and coping and stress tolerance.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Prerequisites: NURS 3280 with a minimum grade of C and NURS 3300 with a minimum grade of C and NURS 3400 with a minimum grade of C and NURS 3290 with a minimum grade of C and NURS 3540 with a minimum grade of C

Corequisites: NURS 4130, NURS 4260

Term Offered: Spring, Summer, Fall

NURS 4250 Professional Nursing Competency

[2 credit hours (0, 0, 2)]

This course provides an overview of NCLEX and practice in the application of knowledge required for the professional nursing examination. Required for passing of exam. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: (NURS 3620 (may be taken concurrently) with a minimum grade of C and NURS 4020 (may be taken concurrently) with a minimum grade of C and NURS 4030 (may be taken concurrently) with a minimum grade of C)

Term Offered: Spring, Summer, Fall

NURS 4260 Professional Development

[3 credit hours (0, 0, 3)]

This course facilitates the development and implantation of strategies to enable the synthesis of professional development for the baccalaureate nurse. The course enables the student to recognize and understand the critical role that nurses play in health care delivery. Students will analyze principles of professional practice and will explore strategies to model the professional practice role in current clinical situations. This course also assists the student in the online classroom environment. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 3280 with a minimum grade of C and NURS 3300 with a minimum grade of C and NURS 3540 with a minimum grade of C and NURS 3290 with a minimum grade of C and NURS 3400 with a minimum grade of C

Corequisites: NURS 4130, NURS 4240

Term Offered: Spring, Summer, Fall

NURS 4270 Applied Health Assessment Across the Lifespan

[3 credit hours (0, 0, 3)]

This course emphasizes the concepts and skills essential to the assessment parameter of the nursing process. The purpose of this course is to broaden the learners’ knowledge base, to increase their assessment skills, and to facilitate their ability to apply these skills in a clinical setting. The knowledge from this course is immediately applicable to everyday patient care. This is an online course. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4290 Nursing Care of Older Adults

[4 credit hours (0, 0, 4)]

Focus on the analysis and application of health and illness concepts with older adults. Concepts include healthcare delivery, attributes & roles of the nurse, and patient profile concepts. This is an online course.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4310 Research Methods and Evidence Based Practice

[3 credit hours (0, 0, 3)]

Introduction to concepts, issues and processes in nursing research and evidence-based practice. Emphasis is on the use of research as a baccalaureate-prepared nurse, including critical analysis and evaluation of published research for use in evidence-based practice.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Summer, Fall

NURS 4320 Pathopharmacology Across the Lifespan

[4 credit hours (0, 0, 4)]

Covers basic concepts of pathophysiology and pharmacology. Prepares the nurse for critical thinking in application of concepts to nursing practice.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4330 Nursing Leadership and Management

[5 credit hours (0, 0, 5)]

Students focus on the professional nurse’s role in applying the principles and theories of leadership and management as a basis for provision of nursing care across healthcare delivery systems. Emphasis will be on leadership concepts to achieve safe, high quality patient-centered nursing care. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4340 Population Focused Care

[5 credit hours (0, 0, 5)]

This course facilitates the development and implementation of strategies to enable the synthesis of professional development for the baccalaureate nurse within the community. The course enables the student to recognize and understand the critical role that nurses play in community and public health care delivery. Students will analyze principles of public health and will explore strategies to model the professional practice role in current community clinical situations. This course also assists the student in the online classroom environment. This is an online course.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4350 Transition to BSN Practice

[2 credit hours (0, 0, 2)]

This course facilitates the development and implementation of strategies to enable the synthesis of professional development for the baccalaureate nurse. The course enables the student to recognize and understand the critical role that nurses play in health care delivery. Students will analyze principles of professional practice and will explore strategies to model the professional practice role in current clinical situations. This course also assists the student in the online classroom environment. This course is online.

Term Offered: Spring, Fall

NURS 4360 Theory and Collaborative Practice

[3 credit hours (0, 0, 3)]

This course facilitates the development and implementation of strategies to enable the synthesis of nursing theory and collaborative practice for the baccalaureate nurse. The course enables the student to recognize and understand the critical role that nurses play in health care delivery collaboration. Students will analyze theories of nursing and will explore strategies to apply nursing theory in current clinical situations. This course also assists the student in the online classroom environment. This is an online course.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Summer, Fall

NURS 4390 Health Promotion and Wellness Across the Lifespan

[3 credit hours (0, 0, 3)]

Focus on wellness and primary prevention across the lifespan. Emphasis on concepts of wellness, communication, lifespan, and physiologic processes. Additional concepts include the role of the nurse in healthcare delivery as related to health promotion. This is an online course. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Prerequisites: NURS 4350 (may be taken concurrently) with a minimum grade of C

Term Offered: Spring, Fall

NURS 4510 Population Health

[4 credit hours (2, 0, 2)]

Focuses on the design and implementation of nursing care for aggregates and communities across the lifespan. Emphasis on professional nursing and health care concepts.

Prerequisites: NURS 4130 with a minimum grade of C and NURS 4240 with a minimum grade of C and NURS 4260 with a minimum grade of C

Corequisites: NURS 4620, NURS 4700, NURS 4760

Term Offered: Spring, Summer, Fall

NURS 4620 Precepted Clinical Practicum

[5 credit hours (1, 0, 4)]

Focus on partnering with clients (individuals. families, groups and/or communities) who are dealing with complex health problems of any age group and setting. Emphasis on concepts of health-care delivery, attributes and roles of nurse, and care competencies. Includes weekly seminars relevant to clinical issues.

Prerequisites: NURS 4130 with a minimum grade of C and NURS 4240 with a minimum grade of C and NURS 4260 with a minimum grade of C

Corequisites: NURS 4510, NURS 4700, NURS 4760

Term Offered: Spring, Summer, Fall

NURS 4700 Nursing Care of Persons and Families with Complex Care Needs

[3 credit hours (3, 0, 0)]

Focus on nursing care of people with complex health issues across the lifespan. Emphasis on care coordination and Interprofessional collaborative teamwork.

Prerequisites: NURS 4130 with a minimum grade of C and NURS 4240 with a minimum grade of C and NURS 4260 with a minimum grade of C

Corequisites: NURS 4510, NURS 4620, NURS 4760

Term Offered: Spring, Summer, Fall

NURS 4760 Professional Nursing Competency

[3 credit hours (3, 0, 0)]

Focus on preparation for the National Council Licensure Examination for Registered Nurses (NCLEX – RN). All concepts in the curriculum are included in comprehensive review.

Prerequisites: NURS 4130 with a minimum grade of C and NURS 4240 with a minimum grade of C and NURS 4260 with a minimum grade of C

Corequisites: NURS 4510, NURS 4620, NURS 4700

Term Offered: Spring, Summer, Fall

NURS 4990 Independent Study

[1-3 credit hours (0, 0, 0-3)]

Independent study in nursing.

Term Offered: Spring, Summer, Fall

NURS 3010 Assignments – Information Management in Nursing and Healthcare.

BACKGROUND: Communication is central to safe medication management. Handover is a routine communication forum where nurses provide details about how patients’ medications are managed. Previous studies have investigated handover processes as general communication forums without specific focus on medication information exchange. The effects of social, environmental and organisational contexts on handover communication and medication safety have not been explored.

OBJECTIVES: To examine dominant and submissive forms of communication and power relations surrounding medication communication among nurses, and between nurses and patients during handover.

DESIGN: A critical ethnographic approach was utilised to unpack the social and power struggles embedded in handover practices.

SETTINGS: The study was conducted in two medical wards of a metropolitan teaching hospital in Melbourne, Australia from January to November 2010.

PARTICIPANTS: All registered nurses employed in the medical wards during the study time were eligible for participation. Patients were eligible if they were able to communicate with nurses about how their medications were managed. In total, 76 nurses and 27 patients were recruited for the study after giving written consent for participation.

METHODS: Participant observations, field interviews, video-recordings and video reflexive focus groups were conducted. Fairclough’s critical discourse analytic framework guided data analysis. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

RESULTS: Nurse coordinators’ group handovers in private spaces prioritised organisational and biomedical discourses, with little emphasis on evaluating the effectiveness of medication treatment. The ward spatial structure provided an added complexity to how staff allocation occurred. Handovers involving patients in the public spaces at the bedside facilitated a partnership model in medication communication. Nurses exercised discretion during bedside handovers by discussing sensitive information away from the bedside. Handovers across different wards during patient transfers caused communication breakdowns because information was not exchanged between bedside nurses.

CONCLUSIONS: Nurse coordinators need to relinquish organisational control of the handover practice and appreciate the contribution of bedside nurses to patient information exchange. Bedside nurses need to be provided with opportunities to raise questions during the group handover. Designated meeting spaces need to be provided to reduce interruptions to the group handover process.

The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses’ perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Citation: Lavin, M., Harper, E., Barr, N., (April 14, 2015) “Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings” OJIN: The Online Journal of Issues in Nursing Vol. 20 No. 2.

DOI: 10.3912/OJIN.Vol20No02PPT04

Keywords: Experiential-reflective reasoning, electronic health record, informatics, informaticists, nursing practice, health information technology, standards, documentation, quality, safety, patient responses, patient outcomes

The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs (Beck et al., 2013; Harper, 2012a; Towsley, 2013). Although nurses indicate dissatisfaction with the EHR design and cumbersome electronic processes (Sockolow, Liao, Chittams, & Bowles, 2012; Stevenson, Nilsson, Petersson, & Johansson, 2010), they view the EHR and the data generated as an opportunity to improve care, safety, quality, and coordination (Cipriano et al., 2013), as well as a tool to study appropriate nurse staffing and to gauge or predict staffing needs (Beck et al., 2013; Harper, 2012b).

…the EHR [is] seen by nurses as both a benefit and a source of considerable frustration. The work of the Nursing Practice Committee (NPC) of the Missouri Nurses Association (MONA) included identifying areas of interest to direct care nurses. One identified interest area was the EHR, which was seen by nurses as both a benefit and a source of considerable frustration. Furthermore, nurses were challenged to articulate their concerns due, in part, to the fact that there was no available taxonomy to describe EHR-related difficulties. This article begins to articulate EHR concerns of Missouri nurses. Realizing that these concerns transcend state boundaries, the MONA NPC decided to share their recommendations with a broader nursing audience with the hope that they would increase participation of all direct care nurses in EHR, vendor, and Health Information Technology (HIT) department decisions and problem solving. In this article, we share the reflections and recommendations of MONA nurses with direct care nurses and HIT communities across the nation and around the world. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

…nurses were challenged to articulate their concerns due, in part, to the fact that there was no available taxonomy to describe EHR-related difficulties. The goals of this article are to add to the EHR literature by categorizing views of nurses as expressed by members of the MONA NPC and to enhance the computer vocabulary of all nurses, empowering them to voice their EHR concerns to IT staff and vendors and to take their places at the table when health and nursing-related IT decisions are being made. In this article, we will describe the experiential-reflective reasoning and action model used to accomplish these objectives; share committee reflections and recommendations for improving both documentation and documentation technology; and conclude by encouraging nurses to consider how they can develop their documentation and informatics skills.

The Model

We used an experiential-reflective reasoning model, one that leads to action, to accomplish our purpose. This model includes consideration of participants’ context, experience, reflection, action and evaluation. This experiential-reflective reasoning model has been incorporated into Jesuit pedagogy for more than 450 years. Within nursing, the Jesuit model has been used as a basis for transformative change (Pennington, Crewell, Snedden, Mulhall, & Ellison, 2013). It is analogous to the learning theory and the change/action research methods identified by Kurt Lewin (Atherton, 2013; Smith, 2001). We used this model to categorize the experiences of the members of the MONA Nursing Practice Committee related to their use of the EHR, to reflect upon these experiences, and to draw up a set of recommended actions. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Direct care nurses, at their core, are risk managers. They attach meaning to what is and anticipate ‘what might be.’ We reflected and articulated direct care nurses’ concerns regarding the EHR. We involved direct care nurses in this initiative because they plan care used to address the clinical judgments/diagnoses flowing from a nursing assessment and provide care to individuals and/or families. The care itself is designed, through this planning process, to achieve the desired outcomes (American Nurses Association [ANA], 2010; Shake, n.d.).

Direct care nurses are bedside nurses; they include generalists, advanced practice registered nurses, care coordinators, visiting nurses, public health nurses, camp nurses, and school nurses. In brief, they are found in any and every setting where nurses practice. Direct care nurses, at their core, are risk managers. They attach meaning to what is and anticipate ‘what might be’ (Meyer & Lavin, 2005). When they anticipate risk, they conduct surveillance, intervene when necessary, and document not only their risk prevention findings/observations, but their reasoning and clinical judgments, interventions, patient responses and outcomes. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

HIT and the electronic documentation of nursing care directly influence patient safety. HIT and the electronic documentation of nursing care directly influence patient safety. This is because nursing documentation facilitates real-time communication among all healthcare providers and because electronic documentation allows for its study in proportions never before attempted. If patient safety is to be optimized through EHR use, effective collaboration between nurses and HIT staff is needed, along with greater clarity of the patient safety perspective that direct care nurses offer.

Committee Reflections and Recommendations for Improving Documentation The reflections and recommendations described in this section are not research findings, but rather reports of the experiential/reflective thinking of the committee, categorized under the headings of both medication safety, and direct care nursing documentation and standards of practice. It is from these reflections that recommendations flow. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Medication Safety

The investigation of EHR-associated medication administration errors is a ripe area for nursing research and/or nurse-led quality improvement studies. NPC members focused primarily on medication safety, with special attention to the prevention of errors and adverse events. They approached the discussion by following the four categories used to organize medication error prevention strategies in the Agency for Healthcare Research and Quality (2012) report. The Nursing Practice Committee felt that the system, as implemented within the EHR, is weighted toward maximizing the safety of the prescribing, transcribing, and dispensing categories (see Table 1). The table indicates that, of the citations retrieved, only 35 were devoted to medication administration. Of these, only two included the word nurse or nursing in the title (Debono et al., 2013; Yuan, Finley, Long, Mills, & Johnson, 2013). There were no nurses as first authors among the 35 citations dealing with medication administration, nor were there any citations from nursing journals. The investigation of EHR-associated medication administration errors is a ripe area for nursing research and/or nurse-led quality improvement studies. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Table 1. Distribution of Citations Retrieved from PubMed Central Database on September 28, 2014

Search string: EHR AND prevention AND medication error AND…

Number of citations retrieved

More recent and last citation publication date

Prescribing

201

2004 – 2014

Transcribing

9

2010 – 2014

Dispensing

69

2005 – 2014

Administering

35

2005 – 2014

Total number of citations and overall range

314

2005 – 2014

The NPC further recommended that all four categories of prescribing, transcribing, dispensing, and administering (thus including the nursing-sensitive medication administration category) be digitalized and synchronized in the EHR. Such an action would combine bar code medication administration technology at the point of care with real-time medication surveillance of therapeutic goal attainment, enhanced adverse drug-event alerts, and adverse event-surveillance information. In other words, if bar code data could be used to do more than identify the patient and report medication administration doses, the additional synchronization of information would broaden the scope of the medication-administration patient safety zone. NURS 3010 Assignments – Information Management in Nursing and Healthcare. This would give nurses more efficient access to information which the nurse actually uses when administering medications. Additional information, triggered by the bar code, might help the nurse to:

Identify and evaluate the appropriateness of the drug dose and route, given the drug’s specific therapeutic goal Respond to an enhanced, real-time medication contraindication/drug interaction check with the EHR, by linking the drug on the same screen with the most recent, clinically relevant laboratory values For example, if a low serum potassium value were to appear, it would prompt the nurse to request a supplement for the patient receiving a thiazide. It is important to note that the nurse currently takes these steps manually in a time-consuming process, searching for the potassium values while preparing the drug for administration. The electronic process being recommended is both more efficient and safer.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Electronic medication records (eMARs) should also include trending of medications along with clinically relevant laboratory values. Insulin administration in the eMAR should be trended with the most recent plasma glucose and serum potassium levels in a single view, so as to keep busy nurses from having to retrieve the labs from another flow sheet in the EHR.

In each of these examples, the data were already contained within the EHR; they simply needed to be connected in a nurse-and-patient-safety-sensitive manner. In each of these examples, the data were already contained within the EHR; they simply needed to be connected in a nurse-and-patient-safety-sensitive manner. Programming of drug administration processes at the point of patient contact, with strategically placed tips and alerts, might lessen medication errors significantly. We authors support informatics research that moves in this direction. We also offer the following additional medication safety recommendations:

Improve user friendliness (screen size, font size, adequate LED lighting for use in darkened rooms) of handheld devices used to bar code scan medications Build in efficient and timely access to laboratory results for all medication providers (physicians, advanced practice registered nurses [APRN], pharmacists, and other direct care nurses). Finally, we encourage careful consideration of policies governing the use of pharmacy technicians in dispensing medications without direct pharmacist supervision. Boards of Nursing and Pharmacy may want to take up this consideration from a regulatory or statutory viewpoint. EHRs need to reflect the credentials of the person dispensing and administrating the medications to compare medication error rates between and among licensed and unlicensed personnel. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Direct Care Nursing Documentation and Standards of Practice

Appropriate quality care comparisons among and between providers and practices can only be made when standardized processes and products are used. This section will explore three aspects of the patient safety implications of direct care nursing documentation and its unique characteristics from three aspects, including standardization of evidence-based care processes, transparency of the nursing process, and development of an electronic workflow tool to standardize and improve communication.

Use of non-standard materials will cause documentation to appear as if nurses are not meeting patient education/health promotion standards. Standardization of evidence-based care processes. The NPC recommended standardization of evidence-based care processes, including patient educational materials and actions plans, within and eventually across the care setting. Appropriate quality care comparisons can only be made when such standardized processes and products are used. The operational phrase is ‘when standardized processes and products are used.’ If nurses or nurse practitioners use their own materials and do not use, for example, the EHR-generated patient education materials, then they are at a disadvantage when electronic comparisons within and between institutions are made. Use of non-standard materials will cause documentation to appear as if nurses are not meeting patient education/health promotion standards. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

…it is imperative that specialty-specific nurses become involved in the selection and updating of computer-generated, patient-education materials to ensure the evidence base and the appropriateness of all materials. Registered nurses, including APRNs, may defend themselves by saying that their own personal materials are the most current and most evidence-based. If this is so, then it is imperative that specialty-specific nurses become involved in the selection and updating of computer-generated, patient-education materials to ensure the evidence base and the appropriateness of all materials. In addition, documents generated by the EHR must be written clearly and simply, in keeping with sound health-literacy and evidence-based patient education strategies and tools Harvard School of Public Health (n.d.). Nurses may also voice concerns about newer electronic documentation methods interrupting workflow, in which case they need to become personally involved in workflow design with vendors or with IT department personnel. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Some may object to the notion of ‘standardized’ care processes, incorrectly thinking it eliminates individualized care. In contrast to this misperception, it is important to recognize that evidence-based practices and standardization of care processes help to assure that the quality of care is optimized for each individual patient. The premises underlying evidence-based practice and standardized care do not negate, but rather heighten, individualization of care, including consideration of personal beliefs, values, and individual preferences. In brief, evidence-based practice and the standardization of care processes enhance the trust patients have in nurses to consistently function on behalf of their best interest.

Prioritization of diagnoses and transparency of the nursing process. The Nursing Practice Committee recommended that nurses make the nursing process more transparent in the EHR for each patient problem requiring nursing care. The Committee also recommended that nurses properly prioritize patient problems in their documentation.

…the electronic health record should allow providers to manually order or sort the problem list. Proper prioritization of diagnoses and a more transparent process are two methods of evaluating nursing documentation. The American Health Information Management Association indicates the electronic health record should allow providers to manually order or sort the problem list (AHIMA Workgroup, 2011). Analogously, nurses need to have the ability to manually order or sort by priority the diagnoses that drive their interventions.

Transparency refers to the clarity of the record for its users. Transparency, in more recent times, has come to mean the open sharing of information. For purposes here, we define electronic health record transparency as clear and open sharing of information among providers and with patients. While providers using the EHR have access to information inserted by interdisciplinary team members, access to this information is not always intuitive, nor is its presentation always clear. Systems today do provide patients with electronic access to limited information in their EHRs. However, it is possible that even greater information sharing in the future will further improve the quality of care (Delbanco et al., 2010; Delbanco, et al., 2012).

Development of an electronic workflow to standardize and improve communication. Additionally, the Nursing Practice Committee recommended that the nursing process steps be researched and developed into an abbreviated communication tool, one that would describe and prioritize each individual patient problem for use during handoff at change of shift and also when documenting planning of care during admission, transfers, and discharges. The NPC suggested that nurses apply ANA nursing practice and documentation standards within the EHR using the nursing process model illustrated in the Figure. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Figure. Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation Model

A simple, electronic workflow helps standardize and improve communication of direct care in keeping with the ANA documentation standards (2010), as in the following focused-care example.

Assessment: Data provide information for nurses to arrive at specific clinical judgments (diagnoses/problems). Diagnoses/Problems/Clinical Judgments: Appropriate outcome identification, planning, and implementation of interventions are not random actions, but are actions that are assessment-and-diagnostic-specific. Outcome Identification and Planning: In these two standards, nurses specify the intervention(s) to be used to achieve the desired outcomes, both process outcomes and clinical outcomes. Implementation: Engage the individual/family/community/population in care planning and on the implementation of interventions. Conduct on-going vigilance and act to prevent or to reverse movement toward outcomes that are undesired. Initiate rescue, as needed.

Evaluation: Document patient outcomes and make summative statement/analysis, e.g., condition stabilizing/worsening. Continue to modify plan to achieve desired process and clinical outcomes. The purpose of nursing documentation is to record nursing care provided and patient responses. The old adage, ‘If it wasn’t charted, it wasn’t done,’ still holds today. Because the current standard of care is the nursing process, the steps in the nursing process need to be evident in nursing documentation. If the process is documented, then the practice standard will be judged as ‘met.’ If the process is not documented, then the practice standard will be considered ‘not met.’ This standard holds true for registered nurses at all levels, whether nurses are documenting in EHR or on paper health records.

When documentation is poor it is likely that both human and technologic improvements are needed. We authors find human-machine interaction to be interesting. When there is an issue with documentation, those closest to the world of informatics are quick to exculpate the EHR by saying it was never intended to fill a gap in practice. On the other hand, those closest to the clinical world are quick to exculpate themselves by blaming one or more technical features of the EHR. Reality most likely lies somewhere in the middle. When documentation is poor it is likely that both human and technologic improvements are needed. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

It may be that standardization of care processes, including clinical decision-support processes, becomes more fully appreciated as the number of Doctor of Nursing Practice (DNP) graduates increase. These graduates are prepared to use new quality improvement technologies; organize and analyze the evidence that flows from their own practice; and compare their practice parameters against those of others. The following paragraph provides an overview of DNP clinical projects designed to improve patient outcomes or reduce patient risk by improving care processes.

Examples of DNP projects that incorporated clinical decision-support processes include: a) establishing criteria for evaluating provider compliance with amiodarone guidelines in primary care (Dixon, Thanavaro, Thais, & Lavin, 2013); b) addressing therapeutic or clinical inertia in the management of patients with diabetes (Apsey et al., 2013; Mackey et al., 2014); and (c) decreasing HbA1C by building confidence in patient ability to select correct portion sizes and complete weekly exercise plans (Beckerle & Lavin, 2013). APRNs, and especially DNP graduates, know that the ability to take advantage of EHR data to improve patient care first requires the proper entry of process and outcome data in the record.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers.

Appropriate timing of nursing documentation, both real time/synchronous and late charting/asynchronous documentation, requires that nurses have access to and use the EHR at the point of care. Nurses use both synchronous and asynchronous methods to document care . Perhaps when voice activated, natural language processing methods are further developed and better integrated into the EHR, all nursing documentation will be synchronous.

Clinical decision support (CDS) information depends on real time data. Clinical decision support (CDS) information depends on real time data. Triggering an alert for sepsis is only beneficial if the alert comes as soon as the system inflammatory response system (SIRS) criteria are met. If the vital signs are written on paper and entered later, the alert is delayed and patient safety is impaired.

Continued research is needed in basic nursing care of the ill patient and its documentation (Englebright, Aldrich, & Taylor, 2014; Van Achterberg, 2014). Documentation studies indicate that factors to promote diagnostic reasoning and accuracy have been identified. These factors include use of problem, etiology, and signs/symptoms (PES) structure; computerized aids (e.g. diagnostic specific scales); and standardized care plans (Müller-Staub & Paans, 2011; Paans, Nieweg, van der Schans, & Sermeus, 2011; Paans, Sermeus, Nieweg, Krijnen, & Schans, 2012). NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Other methods to improve documentation include nursing documentation audits, use of safety checklists in surgery, and nursing diagnostic-specific checklists (Mykkänen, Saranto, & Miettinen, 2012; Treadwell, Lucas, & Tsou, 2014). Researchers should work closely with EHR vendors and terminology developers to be assured that tools with known validity and reliability are correctly incorporated into the clinical workflow. These scales not only meet nursing and hospital system standards but are increasingly being incorporated into big data and population-health management.

Committee Reflections and Recommendations for Improving Documentation Technology …structured, electronic documentation is more closely associated with quality patient outcomes in primary care than free text or dictated documentation. Comparisons of physician documentation suggest that structured, electronic documentation is more closely associated with quality patient outcomes in primary care than free text or dictated documentation (Linder, Schnipper, & Middleton, 2012). On the other hand, unintended consequences may flow from what a clinical ethicist calls EHR quality and documentation pitfalls. Examples include “copying and pasting data from day to day without proper evidence of verification, authorship ambiguities, inadvertent inclusion of un-obtained data in templated notes, ambiguous history and physical examination findings, failure to review prepopulated data, inadequate discharge summaries” (Bernat, 2013, p.1057).

Each of these issues may be prevented or addressed by discussion and exchange of information between the provider, whether physician or nurse, and the vendor and/or IT department. Most vendors provide software with a variety of options for each assessment parameter (e.g., yes, no [not present], no [NA], or deferred). Yet, well-intended but clinically inappropriate IT decisions may be made. For example, in an attempt to save electronic memory/space, a system may be designed to include ‘only’ a single yes/no option for each assessment parameter. In such cases, the EHR nurse/physician on the next shift — or much later when a case is presented in court — does not know if a recorded ‘no’ means that the parameter was assessed and found to be negative, or was not assessed because it was not applicable, or was deferred. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

When clinicians identify problems, such as ambiguous yes or no options, they are encouraged to correct them by explaining clinical and legal consequences of such decision-making to IT department staff or to healthcare system executives. Other technology issues may also need to be voiced to vendors.

In the paragraphs below, we will first consider efficiency and EHR technology concerns. Then we will offer HIT and nursing practice recommendation.

Efficiency Concerns Related to the Use of EHR Technology

Efficiency in the delivery of healthcare is defined as “avoiding waste, including waste of equipment, supplies, and ideas” (Institute of Medicine, 2001, pg 6). Several studies have documented the lack of efficiency in current EHR documentation practice.

A time-and-motion study of resident physicians’ note-writing practices using an EHR revealed high fragmentation in clinical work (Mamykina, Vawdrey, Stetson, Zheng, & Hripcsak, 2013). Activities that interrupted documentation included: phone calls, patient requests, and frequent transitions between various types of documentation modalities. Researchers suggested that physicians rely on synthesis rather than composition to write progress notes. Newer technologies that support synthesis are exemplified by highlighting and thus capturing single words or phrases from the chart to construct a new note descriptive of the patient at the current point in time. Another technology would be use of the ‘ready selection of clinically relevant trend lines’ to indicate the patient’s current clinical status. Research is needed to compare the quality of such charting and to determine if it is less vulnerable to fragmentation than current charting methods. This research needs to include study of the documentation by both direct care nurses and physicians.

A time and motion study addressing nurses’ work in the acute care setting found that collecting, entering, and accessing data used a large portion of nurses’ time. A time and motion study addressing nurses’ work in the acute care setting found that collecting, entering, and accessing data used a large portion of nurses’ time. This resulted in in considerably less nursing time available for patient care (Hendrich, Chow, Skierczynski, & Lu, 2008). NURS 3010 Assignments – Information Management in Nursing and Healthcare.

A recent hospital-based study by Englebright et al. (2014) developed a definition of basic nursing care documentation for the adult patient and integrated it into an EHR. The researchers concluded that this newer method minimized or eliminated documentation that did not directly support patient care. These investigators recommended use of alternative options for recording non-patient-care-related information and use of EHR technology to help nurses document and communicate basic care elements.

The Nursing Practice Committee of the Missouri Nurses Association is committed to efficiency in the provision of care. These nurses recognize that efficiency, including efficient capture of meaningful data, helps to translate information and to communicate nursing-based knowledge to other members of the healthcare team, thus improving patient safety and care quality. The MONA Nursing Practice Committee has recommended:

Ease of access and availability to computer devices in patient rooms. Emphasis should be on positioning of the computer to augment the engagement of the nurse and the patient as partners in care. Because no single device will work in all care areas, nurses should consider multiple types of computer device options. The number of devices available should be contingent upon the number needed to cover high volume times of day.

High reliability/consistency when accessing/using computers on wheels. Variables to consider include quality of the wireless connection, battery life limitations, and available bedside space. Improvements in the ‘time-to’ issue. Examples include time-to-sign into the record, time-to-save nursing documentation, and time-to-switch between screens to review all aspects of the patient’s chart. Efficiency-related issues, if unaddressed, minimize electronic documentation. Given a choice between providing high quality care and quality documentation within an inefficient EHR system, it is safer to provide the care required and minimize documentation time than to compromise on care to be sure that documentation is complete. Understanding and correcting the etiology of such documentation work-arounds, and all other work-arounds, is essential to improving the healthcare system (Debono et al., 2013). Members of the Nursing Practice Committee have recommended that, if current systems are inefficient or suboptimal, the goal for nurses, IT staff, and institutional administrators should be to improve the system not work around it.

…a well-constructed EHR also reflects accurately how nurses think (assess), arrive at clinical judgments (diagnose), identify outcomes, plan, intervene and evaluate care. Direct care nurses report that EHR issues also affect the quality of their charting. These include, when using some products, rigidity in the number of available options for entering nursing data; a lack of pertinent patient information presented in a readily accessible and comprehensible manner to support critical decision making; drawbacks associated with over-dependence on the checklist quality of nursing documentation; and the relatively little attention given to diagnostic-specific interventions and their evaluation. Such issues lead to poor visibility, presentation, and possible incorrect use of clinical information that may compromise patient outcomes. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Issues related to electronic charting, however, may not always be the fault of the EHR. Documentation, electronic or otherwise, reflects the critical thinking of the nurse and the quality of the nursing care itself. In other words, correct or solid human reasoning is needed to interpret data collected correctly, make appropriate clinical judgements, act upon them competently, and document clearly. When such is lacking, the lack is evident in the documentation. In addition to it being a vehicle that facilitates big data research, the EHR may be used to facilitate the regular review of randomly selected records for documentation case reviews and quality improvement purposes. For example, a random review may reveal findings like those indicated in Table 2, which illustrate that the EHR is not a substitute for incorrect thinking. In fact a well-constructed EHR reflects, as Table 2 shows, lapses in adhering to nursing standards. Conversely, a well-constructed EHR also reflects accurately how nurses think (assess), arrive at clinical judgments (diagnose), identify outcomes, plan, intervene and evaluate care (Lang, 2008).

Table 2. Case Scenario

An EHR documents practice and reflects the quality of underlying direct care nurse thinking; it does not replace thinking or serve as its substitute but reflects adherence to or lapses in adherence to nursing standards.

User case scenario: 68 year old female admitted to nursing unit with diagnosis of pneumonia and history of heart disease. Temperature at 101° F; blood pressure 148/92; heart rate 96/min (regular rate and rhythm); respiratory rate 28/min; and pulse oximetry 93%. Patient denies pain but complains of increasing fatigue, cough and shortness of breath. The admitting RN documents the initiation of intake and output; daily weights; and vital signs; including pulse oximetry, four times daily. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Standard 1. Assessment

Documentation

RN collects comprehensive data pertinent to the healthcare consumer’s health or the situation.

Over the course of the next few days, the RN staff collects pertinent data. Intake and output records reveal an alarming fluid volume overload. Vital signs reveal a decrease in fever but a steady increase in systolic and diastolic pressures, increasing heart rate, and slowly declining oxygen saturation.

Standard 2. Diagnosis

Documentation

RN analyzes the assessment data to determine the diagnoses or issues.

There is apparently no attempt to analyze the data or report it to the attending physician. Fluid volume overload is not mentioned in the patient record, although the patient’s fall risk and skin integrity are noted. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Standard 3. Outcome Identification

Documentation

RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.

No expected outcomes are identified. There is also no mention of the increasing risk of pulmonary edema/congestive heart failure due to increasing fluid volume overload. On the fourth day, the patient develops acute pulmonary edema and is transferred to Intensive Care Unit (ICU).

Standard 4. Planning

Documentation

RN develops a plan of care that prescribes strategies and interventions to attain expected outcomes.

While the prior plan of care included appropriate surveillance activities (e.g. intake and output, daily weights, pulse oximetry and appropriate vital sign monitoring), nothing was done to conduct surveillance at regular intervals or to adapt the plan of care appropriately – i.e., report and control fluid volume overload and report signs of impending heart failure to the physician. In other words, electronic nursing documentation of surveillance activity was haphazard and findings did not lead to appropriate implementation. NURS 3010 Assignments – Information Management in Nursing and Healthcare..

Standard 5. Implementation

Documentation

RN implements interventions identified in plan.

This case scenario begins and ends with the collection of data. There was no documented professional analysis of the data or diagnosis, nor was a plan of care appropriate to the patient’s needs documented.

Standard 5A. Coordination of Care

There was no documented coordination of patient care.

Standard 5B. Health Teaching and Health Promotion

There was no documented health teaching or health promotion.

Standard 5C. Consultation (Graduate Prepared Specialty or APRN)

Not applicable

Standard 5D. Prescriptive Authority and Treatment (APRN)

Not applicable

Standard 6. Evaluation.

RN evaluates progress toward attainment of outcomes.

Patient outcomes (pulmonary edema) could have been prevented had assessment data been correctly analyzed and the diagnosis of fluid volume overload recognized. As it was, the patient was admitted to ICU, appropriate treatment was initiated, and patient was discharged home, but length of hospital stay had been extended and the patient now has a history of congestive heart failure, recent onset.

Lapses in reasoning, documentation, and actions were also present during the paper-chart era. The difference is that the extent of these lapses could not be readily evaluated with paper charts. On the other hand, the use of the EHR enhances the ability to conduct retrospective reviews of databases and identify the extent of lapses in professional documentation/care. Consequently, electronic audit technology creates opportunity to systematically improve, on a large scale, care quality and/or its documentation (Baus, Hendryx, & Pollard, 2012; Golberg, Mick, Kuzel, Feng & Love., 2013).

NURS 3010 Assignments – Information Management in Nursing and Healthcare.

HIT and Nursing Practice Recommendations

The reasoning model we used also facilitated the expansion of our thinking and enabled us to arrive at a number of broad recommendations. In the following paragraphs, we discuss HIT practice recommendations, Health IT department concerns, and nursing practice recommendations.

HIT practice recommendations. This section presents HIT issues raised by participants. We offer recommendations to address interoperability, vendor concerns, IT department concerns and the need to innovate. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

A foundational aspect of interoperability is the use of a core set of taxonomies to communicate between all disciplines interacting with the patient. EHR interoperability concerns raised by participants included the lack of interoperability of computer systems between provider offices, hospitals, extended care facilities, home health agencies, community health centers, and schools (McMurray et al., 2013). Lack of interoperability leads to poor coordination of care and less than efficient care transitions between and among agencies, thus increasing the potential for error. A foundational aspect of interoperability is the use of a core set of taxonomies to communicate between all disciplines interacting with the patient. The ANA (2006) currently recognizes 13 taxonomies. Of these taxonomies, only the Standardized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) represents a standardized terminology that supports nursing practice as well as the practice of other health disciplines. Nurse informaticists provide leadership in the development and application of these terminologies. Also needed is continued and even more input into the architecture of clinical patient care within HL7, the organization that addresses the standards for interoperability of health information globally (Health Level Seven® International, 2014).

The Nursing Practice Committee recommends that more Missouri nurses become both certified in informatics and members of informatics/health information technology organizations. They will then be positioned to advocate for the adherence to both HIT and to nursing standards within the EHR. They will be the experts who know that nurses are expected to document in accord with ANA nursing standards. They will have the background to contribute directly to the EHR display so that it represents practice in accord with ANA nursing standards as well as the HIT standards.

Nurses need to be at the table when vendor-selection decisions are made. The Nursing Practice Committee also addressed vendor concerns. The Committee noted that when practice concerns were voiced to informaticists, a frequent response was: “Have you expressed these concerns to the EHR vendors?” The general consensus was that there are both non-responsive and responsive vendors. Non-responsive vendors pay little heed to clinical nurses other than to ‘teach’ them how to use the system. These vendors spend minimal time listening to the needs of clinicians not employed by the vendor’s company. On the other hand, responsive vendors employ nurses who are both experienced in the clinical workflows and possess advanced education in the sciences of nursing, informatics, and computers. They work with clinicians with the end result being significant improvements in workflow and user (nurse) friendliness of the system. Nurses need to be at the table when vendor-selection decisions are made.

Health IT department concerns. Sometimes vendors may be blamed for non-responsiveness when IT department personnel do not communicate nurse concerns to vendors. Nurses identified such communication issues within two large and separate Missouri healthcare systems. IT departments blocked the flow of information from nurses to vendors. Instead of transmitting concerns, IT staff proffered such reasons as: the software did not allow such a change, the system was not designed to function in that way, and software updates permitting access to newer versions were not possible at this time. This may be reflective of the IT department’s limited time and resources due to competing IT projects, or the lack of nurses at the table when IT project priorities are set. It is essential for clinicians to be engaged in all clinical IT projects. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

In terms of needed innovation, the Nursing Practice Committee believes there are multiple opportunities to improve clinical practice and, equally important, to embrace evidence-based practice through innovative HIT initiatives. Suggested initiatives include:

Use clinical decision support technology to create nursing care alerts, not unlike medical, laboratory and medication risk alerts (Sidebottom, Collins, Winden, Knutson, & Britt, 2012). Build into the EHR patient-centric, real-time quality and operational dashboards, audits, and comprehensive retrospective reviews of the quality of nursing documentation (Patterson et al., 2013; Tan, Hii, Chan, Sardual, & Mah, 2013). This helps assure the inclusion of nursing data in big data warehouses. This facilitates the study of large datasets to generate new knowledge to find, for example an optimal balance between patient outcomes and staffing ratios and optimal patient levels of care or patient throughput (Checkley et al., 2014; Harper, 2012b). NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Continue to develop standardized, nursing sensitive eMeasures, facilitating automatic summaries and comparisons within and between nursing units and healthcare systems. The use of these measures provides the basis for the development of quality improvement programs and new research initiatives. Just as the Nursing Practice Committee recommended general health information technology recommendations, they also recommended actions to strengthen nursing’s informatics knowledge base and to remind nurses that nursing knowledge is power.

Nursing practice recommendations. Each of the following directives enhances the power base of nurses within the field of informatics. Areas discussed include voicing nursing’s concerns; improving basic informatics education; reviewing and advancing nursing sensitive EHR technology; increasing collaboration between health IT and nursing standards; and making nursing practice visible.

…the nursing profession cannot wait for attention until more power is granted to nurses within an institution nor until cost-benefit analyses justify their value to the institution. A nursing voice may be lacking because nurses are not perceived as healthcare system decision makers or revenue generators. Hence, their input may be dismissed without due consideration. This major concern needs to be addressed in nursing. Physicians are vocal and evoke attention that motivates vendors to listen. However, the nursing profession cannot wait for attention until more power is granted to nurses within an institution nor until cost-benefit analyses justify their value to the institution. Rather, resolution lies in nurses simply assuming that they have the power to articulate their value and to expect solutions that measurably improve electronic documentation and communication, patient safety and quality care. We need to share stories about the Missouri nurses, and all nurses, who have exercised health IT power in meaningful ways and who have been responsible for improvements in practice. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Although the American Association of Colleges of Nursing considers informatics essential nursing knowledge within baccalaureate, masters, and doctoral degree programs, the current lack of basic informatics education within nursing programs, coupled with the failure to expect graduates to exhibit informatics competencies, remains an issue. This deficit extends beyond learning how to document and communicate within an EHR, and leads to a reciprocal problem: lack of capacity to prepare clinical nurse informaticists in sufficient numbers to process needed requests in a scientifically sound and evidence-based manner. This article is, therefore, a call to all nurses to become informed regarding nursing informatics and pursue additional informatics educational opportunities. The Nursing Practice Committee has recommended that the number of Missouri nurse informaticists be tracked and that methods of incentivizing nurses to become informaticists be considered. This is important for all states within the United States and for nurses around the world.

It is also important for nurses to review, study, and advance nursing sensitive EHR technology. Nurses need to join informatics or informatics-related organizations (e.g., Healthcare Information and Management Systems Society, American Nursing Informatics Association, American Medicine Informatics Association as well as patient safety organizations. Advanced practice nurses are encouraged to join standards-setting organizations (e.g., Health Level Seven® (HL7) or the Healthcare Informatics Technical Committee of the International Standards Organization [ISO]). NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Deepening collaboration between health IT standards technology and nursing standards practice at point-of-care is also important. Standards-based health IT has been shown to facilitate communication and information flow among interprofessional team members caring for children receiving palliative care (Madhavan et al., 2011). Standards-based nursing practice is the norm and is written into each State Nurse Practice Act. Increased collaboration and closer coordination between HIT standards-based technology and standards-based nursing practice is indicated. Join your agency/institution IT committee!

Finally, we must make nursing practice more visible by closing the gap between nursing practice standards and EHR documentation of care. As authors, we realize that there is a direct patient care and physiological outcomes bias in this article. It reflects the nursing background of the authors and Maslow’s priorities, as well as Florence Nightingale’s interests in the Crimean War (e.g., decreasing infection rates and mortality rates). However, the principles discussed to make nursing practice more visible are applicable to all aspects of care. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

… all nurses from all backgrounds have a vested interest in increasing the visibility of nursing practice through use of the electronic health record. Our main point is that all nurses from all backgrounds have a vested interest in increasing the visibility of nursing practice through use of the electronic health record. Communicating effectively with informaticists and helping them develop documentation measures that reflect the full spectrum of evidenced-based and standards-based nursing practice advances this objective. Simultaneously, we need to position nurses to exert greater influence in the transformation of healthcare for the benefit of all. Nurses are good strategists, problem solvers and decision-makers; they are committed to the National Quality Strategy having the ‘triple aim’ of improving care, improving health and lowering costs (Agency for Healthcare Research and Quality, 2014).

Summary and Conclusion

This article categorized the concerns of nurses expressed to or by the members of the Missouri Nurses Association Nursing Practice Committee on the subject of electronic health record documentation. It is hoped that this information will enhance the informatics vocabulary of direct care nurses and build confidence in their ability to sit at the HIT table to address issues that directly affect patient safety, care quality and the documentation of care. Broader informatics concerns were addressed as well, both from an HIT and a nursing perspective. From an HIT perspective, interoperability remains a significant HIT concern. Vendors and IT departments need to be rewarded for their responsiveness to this nursing concern. Conversely, those who remain unresponsive need to be held accountable. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Innovation, including increasing use of big data and eMeasures, will continue to improve patient safety and care quality. From a nursing perspective, we hope this article will help empower direct care nurses and the nursing profession to better articulate nursing informatics concerns and also to value and improve the role the EHR plays in making visible the practice of nursing.

The Nursing Practice Committee recognizes that the EHR cannot address documentation deficiencies. Therefore, we encourage you as a direct care nurse to identify where you are in this process. Plan how you want to best develop your own documentation and informatics skills. We conclude with three possible development scenarios.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers. If you know how to document the nursing process appropriately, work with vendors and IT staff to communicate your knowledge, observations and suggestions to them. If you know how to document the nursing process appropriately, but do not do so regularly, reflect on why and develop a plan to correct your own inaction or to identify and correct barriers within the system that hinder appropriate documentation. If you lack the ability to document the nursing process in the care you provide, develop a continuing education plan that helps you build this skill. Regardless of the scenario in which you best fit, act smartly upon your reflections, with the objective of improving practice and education institutionally, locally, nationally, and globally.

NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Acknowledgement

Mary Ann Lavin, Ellen Harper, and Nancy Barr are members of the Missouri Nurses Association (MONA) Nursing Practice Committee. Their health information technology recommendations in this article are an outgrowth of the issues and problems that they have heard members express. They are grateful to the Nursing Practice Committee for the wealth of information presented, as this has allowed for the categorization of the data. It is their hope that such a categorization will help nurses name and communicate their concerns more clearly, and contribute directly to the design decisions made. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Authors Mary Ann Lavin, ScD, APRN, ANP-BC, FNI, FAAN Email: lavinma@slu.edu

Dr. Lavin is a graduate of St. John’s Hospital School of Nursing in St. Louis, MO; Saint Louis University (BSN, MSN); and Harvard School of Public Health (MS, DSc), Boston, MA. She is an advanced practice nurse, board certified as an adult nurse practitioner, and a charter fellow in both NANDA International and the American Academy of Nursing. Dr. Lavin was an early leader in nursing diagnosis classification, co-coordinating the First National Conference on the Classification of Nursing Diagnosis in St. Louis, Missouri in 1973. She is a member of NANDA-International, serving on the Board and later as President. In 2011, she was inducted into the Missouri Nurses Hall of Fame. Dr. Lavin is a member of the American Nurses Association (ANA) Working Group on the Scope and Standards of Practice, a member of Missouri Nurses Association Nursing Practice Committee, founder of the Network for Language in Nursing Knowledge Systems (nlinks.org), and an independent nursing and healthcare consultant. Until her retirement from Saint Louis University in June 2014, she chaired Doctor of Nursing Practice capstone projects, taught advanced pharmacology and interprofessional patient risk reduction collaboration methods, and served as the nurse lead in the Southern Illinois University Edwardsville-Saint Louis University Center of Excellence in Pain Education. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Ellen Harper, DNP, RN-BC, MBA, FAAN Email: eharper@cerner.com

Dr. Harper received an associate degree from Iowa Central Community College in Fort Dodge, Iowa, a bachelor’s degree in healthcare management from Ottawa University in Kansas City, MO, a master’s degree in business from the University of Phoenix, Kansas City, MO, and a Doctor of Nursing Practice degree from American Sentinel University in Denver, Colorado. Dr. Harper, a board certified nurse informaticist, is Vice President and Chief Nursing Officer at Cerner Corporation in Kansas City, MO. She has more than 30 years of experience in healthcare, of which more than 20 years have been focused on using technology and informatics to automate evidence based, interdisciplinary, patient-centered workflows.NURS 3010 – Information Management in Nursing and Healthcare Assignment Papers. She is a fellow of the American Academy of Nursing. Her research interests include: the development and testing of eMeasures to advance the science of nursing practice; evidence-based staffing; big data and the economic value of healthcare data and its implications for practice and research; and the evolution and growth of evidence-based science; and demonstration of the value of interprofessional inclusivity in maximizing patient-centric care.

Nancy Barr, MSN, RN Email: nbarr@kumc.edu

Ms. Barr is a graduate of St. Mary’s Hospital School of Nursing, Kansas City, MO, Avila University (BSN) in South Kansas City, MO, and the University of Kansas School of Nursing, Kansas City, KS. She is a clinical assistant professor at the University of Kansas School of Nursing, Her clinical involvement with the University of Kansas undergraduate nursing students requires a working relationship with several vendors of acute care electronic health records (EHRs). Additionally, she uses an office-based EHR, which requires meaningful use as it was implemented via the federal guidelines for primary care providers in an office setting, one of the largest privately owned medical groups in the Midwest. Barr is active as the Chairperson of the Missouri Nurses Association Committee on Nursing Practice and co-chair of the Missouri Emergency Nurses Association Nursing Practice Committee. She is also active with the Missouri Action Coalition, and is responsible for some aspects of the implementation of the Affordable Care Act (computer-driven enrollment). NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Do you want a career where you can truly make a difference? The Lake County Health Department and Community Health Center is one of the largest human service providers in Lake County. We live our mission each day, promoting the health and well-being of all who live, work, and play in Lake County. If you are passionate about giving back and ready to be a part of an innovative team, we are looking for you!

About the Role:

Independent application of the nursing process, comprehensive case management services to clients (individuals and/or families) in the home and a variety of community settings. Participates in orientation, program development, community assessment, and quality assurance/improvement. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Location: 3010 Grand Avenue, Waukegan IL

Hours: Monday – Friday (8:30am – 4:30pm) *Occasional some Saturdays*

Skills and Experience

Participates in on-going assessment of health needs of population and individuals, and develops plans with clients and other health professionals to meet identified needs. Implements outcome oriented nursing process (assessment of community, family, client health needs, formulates goals with client, develops, implements, and evaluates care plan and client’s progress) for clients in assigned geographic area or clinics.

Confers with other members of multidisciplinary health care team, community services and organizations to develop and modify care plans for clients.

Effectively manages assigned caseload, including timely and appropriate contact with clients and provision of needed interventions.

Maintains complete timely, accurate, and concise documentation of nursing interventions and outcomes. Compiles interagency/intra-agency reports as required. Maintains current knowledge in maternal, child and adolescent health trends, issues and applies it to practice.

Participates in clinical case conferences, staff meetings, in-services, committees, and orientation of staff and students, as appropriate. Provides health education in clinic settings or community groups and interprets Health Department services as appropriate.  NURS 3010 Assignments – Information Management in Nursing and Healthcare.

Serves as a resource to other staff, health care providers and the community in the management of multidisciplinary situations related to public health issues.

Directs and monitors ancillary staff activities and assigned duties. Interprets for staff and client families if bilingual. Program Specific Functions

To perform community assessment and to participate in developing or improving programs to meet identified needs. To independently perform physical and psychosocial assessment of individuals and/or families. To independently implement nursing process and evaluate outcome of interventions. To independently adapt nursing care to unique and differing environments with consideration to individual’s and family’s spiritual and cultural perspectives.

To organize day-to-day activities and responsibilities in a cost effective manner. To problem solve and act independently in a crisis and/or a complex and unfamiliar situation. To communicate effectively orally and in writing.

Education, Qualifications, and Certification:

Requires a Bachelor’s of Science degree in nursing or an Associate Degree in Nursing with recent OB or pediatric nursing experience Experience: One year of recent experience as a registered nurse in an acute care setting or a public health agency Licensure: Current Illinois licensure as a registered professional nurse or Illinois license by reciprocity within six months of the initial date of employment; valid driver’s license Requires access to privately owned and insured vehicle during working hours Maintain CPR certification

About the Perks:

Lake County offers a competitive salary and benefit package with performance-based incentive plans. We also offer flexible working hours, and a comprehensive wellness and training program. Visit the Health Department page to get additional information on why you should work for us.

To learn more about the department you will be working for, please visit the Public Health Nursing/Family Case Management information page. If you would like to learn more about our community impact and to see some of our employees in action, please review this short video.

Any offer of employment is conditioned on the successful completion of a background screening, drug and alcohol testing and may include a pre-employment medical exam. NURS 3010 Assignments – Information Management in Nursing and Healthcare.

The Lake County Health Department and Community Health Center is an Equal Opportunity Employer.

Nurses are the health care professionals most people rely on today, whether it’s the nurse practitioner who treats their everyday ills at a walk-in clinic or the emergency-room or critical-care nurse who soothes fears while helping save lives. Students who care—about people, about technology, about science, about their colleagues and the community—can join the MTSU School of Nursing’s competitive and robust academic programs to develop their commitment to the art and science of nursing.

What we’re doing

Easing the path to a B.S.N. MTSU and Columbia State Community College have made it easier for nursing students with associate’s degrees to upgrade to a Bachelor of Science in Nursing degree. A partnership announcement in late 2012 offers special advising options and transfer-student coordination to help increase the number of graduates in nursing jobs critical to Tennessee. The agreement even includes special help from Maury Regional Medical Center in Columbia, Tenn., to assist with clinical placement and career advancement.

Making connections with campus patients

The members of the MTSU Student Nurses Association aren’t afraid to roll up their sleeves — or to ask others to do the same. Each spring, the students in the School of Nursing sponsor the MTSU Health Fair, a half-day event that features free health screenings, health-related giveaways, and advice for the campus community. The free screenings provide test results for patients’ hearing, speech, vision, blood pressure, body-mass index, blood glucose, bone marrow, and HIV status. Student nurses, who help administer the tests, also help special resource providers offer information about good mental and sexual health, avoiding and treating eating disorders, and ensuring personal safety.

DNP 820 Weekly Discussions & Assignment

DNP 820 Weekly Discussions

DNP 820 Full Course Discussions GCU

DNP 820 Topic 1 DQ 1

Describe a situation in which a new clinical practice was put into place. Was there a DNP-prepared nurse leading the translation of the practice from research to practice? If so, describe the process that individual took for translation and why it made a difference in the translation. If there was not a DNP-prepared nurse, describe the process and what would have been different about the process had there been a DNP-prepared nurse leading the practice translation?

DNP 820 Topic 1 DQ 2

Compare the PhD and DNP degrees. Define the differences in roles and education associated with the two degrees. Describe future opportunities for DNP-prepared nurses. DNP 820 Weekly Discussions & Assignment Essays.

DNP 820 Topic 2 DQ 1

Which research methodology would be the most appropriate for your project and how does it align with your clinical question, data collection, and data analysis? Demonstrate an example of when you might use the opposite methodology in your EBP projects and why.

DNP 820 Topic 2 DQ 2

Within nursing, the patient’s perception is recognized as the patient’s reality. How does this way of knowing in nursing fit within an objective or subjective paradigm of the world? Explain your reasoning.

DNP 820 Topic 3 DQ 1

Which method do you prefer in determining levels of evidence? Describe two advantages to the method and one disadvantage to the method. Explain how you have used this method in your current practice or education. Why are levels of evidence important in selecting empirical articles for your ROL (Chapter 2 of your DPI project)?

DNP 820 Topic 3 DQ 2

Research can take between 10-20 years to be translated into practice. Discuss your thoughts on the reasons why this may occur and describe the barriers within your own practice that prevent you from practicing from a 100% evidence base.

DNP 820 Topic 4 DQ 1

Reliability and validity are often misunderstood and not given much notice in research articles. Using any example, demonstrate how you would correctly describe these two terms to a nurse prepared at a bachelor’s degree level or below. Then describe why the reliability and validity of a study is important for translation. DNP 820 Weekly Discussions & Assignment Essays.

DNP 820 Topic 4 DQ 2

What are the criteria for selecting qualitative versus quantitative resources in relation to your literature review? Which method(s) of research are you selecting? Why?

DNP 820 Topic 5 DQ 1

What effect does a meta-synthesis or meta-analysis have on research translation? Describe a clinical practice in place that is supported by this level of evidence.

DNP 820 Topic 5 DQ 2

Comparative effective research is important in translating research. Describe one study that used comparative effective research. What were the findings and were they translated into practice?

DNP 820 Topic 6 DQ 1

There is a heavy focus on achieving statistical significance when evaluating outcomes. Often in research or EBP projects, there is no statistical significance, only possible clinical significance. When is it appropriate to deem a project’s outcomes successful only using clinical significance as the only measure of success?

DNP 820 Topic 6 DQ 2

The three components of EBP include clinical expertise, best evidence, and patient preference. Often, patient preference and clinical expertise are at odds with each other. Describe a scenario where you might need to mediate this issue and what is the solution when this occurs. It can be a real-life example as well. DNP 820 Weekly Discussions & Assignment Essays

DNP 820 Topic 7 DQ 1

Choose one model for EBP implementation. Describe its components and why you believe this model is most appropriate for assisting in translational activities. Contrast this model with another.

DNP 820 Topic 7 DQ 2

Discuss the role of the DNP-prepared nurse in sustaining an EBP culture. What are two effective methods the DNP can use in sustaining an EBP culture?

DNP 820 Topic 8 DQ 1

Describe and discuss the differences between research, research utilization, and evidence-based practice. Provide examples.

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DNP 820 Topic 8 DQ 2

Describe how you will assist others to generate their own evidence-based practice questions. Discuss what your professional obligation as a DNP-prepared nurse is related to evidence-based practice, patients, and other nurses?

DNP 820 Full Course GCU

DNP 820 Full Course Assignments GCU

DNP 820 Week 1 Individual Success Plan (ISP)

Details:

The Individual Success Plan (ISP) assignment in this course requires your collaboration with the course faculty early on to establish a plan for successful completion of mutually identified and agreed upon specific deliverables for your programmatic requirements. Programmatic requirements are: (1) completion of required practice immersion hours, (2) completion of work associated with program competencies, and (3) work associated toward completion of your Direct Practice Improvement Project.

General Requirements:

Use the following information to ensure successful completion of the assignment as it pertains to deliverables due in this course:

• Locate and download Individual Success Plan (ISP) document in the DC Network.
• Review the DNP Program Milestones document in the DC Network and identify which milestones apply to this course. Note: Not all courses have milestones. Determine what practice experiences you plan to seek in order to address each competency. Include how many hours you plan to set aside to meet your goals. Learners will apply concepts from each of their core courses to reflect upon, critically examine, and improve current practice and are required to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.
• Use the Individual Success Plan to develop a personal plan for completing your practice hours and how competencies will be met. Show all of the major milestones and deliverables.
• Within the Individual Success Plan, ensure you identify specific deliverables which can include the following: individualized DNP practice immersion contracts; comprehensive clinical log of hours applied to doctoral level learning outcomes; learner evaluations; mentor evaluations; current and updated CV; scholarly activities; GCU DNP competency self-assessment; reflective journal; course goals and plan for how competencies and practice immersion hours will be met; faculty and mentor approvals of course goals and documented practice immersion hours; and DPI project milestones.
• Identify the specific deliverables you will complete throughout this course from those defined above or others negotiated with your faculty. And you need to turn in a new Individual Success Plan for all courses.
• Identify the remaining deliverables you will complete in the upcoming courses.
• List the challenges you expect to encounter as you continue the practice hour and competency requirements throughout this course? How might you overcome these challenges?
• You can renegotiate these deliverables with your faculty throughout this course and update your Individual Success Plan accordingly.
• This assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the expectations for successful completion.
• You are not required to submit this assignment to LopesWrite.

Directions:

Complete the Contact Information table at the beginning of the ISP resource, and type in your signature and the date on which you completed the table.

Read the information in the ISP document including the following:

1. Learner expectations
2. Derivation of the ISP
3. Instructions for completing the ISP

Follow the instructions and complete the ISP.

Individual Success Plan (ISP)  

DNP 820 Weekly Discussions & Assignment Essays

DNP 820 Week 2 DPI Project Milestone

DPI Project Milestone: 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Details:

In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Locate the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” that you completed in DNP-815.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required.
• This assignment uses a rubric. Please Review the rubric prior to the beginning 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.

Directions:

Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP-820-RS-10StrategicPointsfortheProspectusProposalandDPI.docx

DPI Project Milestone: 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project  

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DNP 820 Week 3 Critical Appraisal of Practice Guidelines

Details:

While there are several tools to critically appraise practice guidelines, the most comprehensively validated appraisal tool is the AGREE II Instrument. The AGREE II Instrument can be used by individual practitioners to critically appraise health guidelines and by decision makers to inform policy decisions. The purpose of the AGREE II Instrument is to provide a framework to:

1. Assess the quality of guidelines.
2. Provide a methodological strategy for the development of guidelines.
3. Inform what information and how the information ought to be reported in guidelines.

Overall assessment includes rating the overall quality of the guideline and whether the guideline would be recommended for use in practice.

Items are rated on a 7-point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). A score of 1 is given when there is no information on that item or if it is poorly reported. A score of 7 is given if the quality of reporting is excellent and when full criteria have been met (Score explanations found in the AGREE II-GRS Instrument).

A quality score is calculated for each of the six domains, which are independently scored. Domain scores are calculated by summing up all the scores of the items in the domain and by scaling the total as a percentage of the maximum possible score for that specific domain.

For this assignment, you will choose a guideline and assess the overall quality and whether the guideline would be recommended for use in practice.

General Requirements:

Use the following information to ensure successful completion of this assignment:

• Download the AGREE II instrument.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required.
• This assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the expectations for successful completion.
• You are not required to submit this assignment to LopesWrite.

Directions:

Perform the following tasks to complete this assignment:

1. Using the AGREE II instrument as your guide, create a table that discusses a practice guideline in which you might have questioned the recommendations. (Note: You may be able to copy and paste the instrument into a new Word document and complete the information.)
2. Each domain must have its own cell (similar to the one shown in the manual) and add domain scores and an overall guideline assessment. Be sure to include comments and additional considerations that influenced your rating decision and cite any sources used.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor. DNP 820 Weekly Discussions & Assignment Essays

Critical Appraisal of Practice Guidelines  

DNP 820 Week 4 Introduction to the Literature Review

Details:

Empirical research is the foundation of scholarly research and scholarly writing. An empirical article is defined as one that reports actual results of a research study. An empirical article includes a description of the study, an introduction, a research question, an explanation of the study’s methodology, a presentation of the results of the study, and a conclusion that discusses the results and suggests topics for further study.

As you search the library for scholarly research, you should limit your search to identify empirical articles. (You can use the “Empirical Research Checklist” from DNP-801 to assist in this determination.) After finding an empirical study, begin to assess the validity of the conclusion by determining if the conclusion answers the proposed research question and if the methodology is appropriate.

As you move forward in your doctoral journey, you will read research papers that will require you to assess the validity of the studies in question. To accomplish this, qualitative assessments about the research must be made by comparing, contrasting, and synthesizing what the research says.

In this assignment, you will continue to develop the skill of writing, by reviewing 15 research articles associated with your chosen topic and using the content to identify at least five major concepts and subthemes related to your topic. DNP 820 Weekly Discussions & Assignment Essays

General Requirements:

Use the following information to ensure successful completion of this assignment:

• Use the “Empirical Research Checklist” to assist in the determination of empirical articles.
• Use the “Research Article Chart” to provide a summary review of each component of your assignment.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is 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.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Part 1: Selection of 15 Articles  

Select 15 empirical articles related to your PICOT question. Use the “Empirical Research Checklist” worksheet to ensure that each article you select meets all of the established criteria. At least one article must demonstrate a quantitative methodology. DNP 820 Weekly Discussions & Assignment Essays

Part 2: Research Article Chart 

Using the articles acquired in Part 1, provide a summary review of each component using the “Research Article Chart” template.

Part 3: Synthesis of Research Studies 

Based upon your review of the 15 research articles, identify at least five major concepts that relate to your project topic, and three subthemes related to each concept.

Using the information from the completed “Research Article Chart,” and the major concepts and subthemes you have identified, write a 2,000-3,000 word paper that synthesizes the content of the 15 research studies.

Summarize each major concept and focus on providing a detailed synthesis of the three identified subthemes that support that concept by addressing the following.

1. Introduction of the identified subtheme
2. Summary of the research questions posed by the studies
3. Summary of the sample populations used
4. Summary of the limitations of the studies
5. Summary of the conclusion and recommendations for further research

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network. DNP 820 Weekly Discussions & Assignment Essays

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP 820 Full Course GCU

DNP-820-RS-EmpiricalResearchChecklist-Student.docx DNP-820-RS-ResearchArticleChart.docx

Introduction to the Literature Review  

KINDLY ORDER NOW FOR A CUSTOM-WRITTEN AND PLAGIARISM-FREE PAPER

DNP 820 Week 5 Implementation Into Practice

Details:

The Institute of Medicine set a goal that 90% of health care decisions should be evidence-based by 2020. At best guess, less than 10% of decisions use best evidence. Bridging the gap between research, findings, and practice implementation is one strategy to meet this important goal. This assignment will help you to find gaps that may be used for your project.

DNP 820 Weekly Discussions & Assignment Essays

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Review the Agency for Healthcare Research and Quality (AHRQ) website to complete the assignment.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required.
• This assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the expectations for successful completion.
• Use at least two additional scholarly research sources published within the last 5 years. Provide citations and references for all sources used.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Select a practice from the AHRQ comparative effectiveness research site and write a 1,000-1,250 word paper that looks at a gap that exists between research findings and the implementation of those findings in practice. Include the following:

1. Discuss the practice.
2. Assess to what extent the practice is being implemented.
3. Evaluate the barriers to implementation into practice.
4. Propose ways to overcome the barriers.
5. Discuss the resources available on the selected site to inform translation.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP 820 Full Course GCU

Implementation Into Practice  

DNP 820 Week 6 Benchmark Drafting a Literature Review

Details:

In this assignment, you will draft the body of a literature review. You will continue to add and revise this draft literature review (Chapter 2 of your DPI Project) as you progress through the program. You may be able to use the feedback and suggestions from your instructor (on the Introduction to the Literature Review assignment in Topic 4) to expand the literature review for this assignment. DNP 820 Weekly Discussions & Assignment Essays

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Use the “Empirical Research Checklist” worksheet to ensure that each article you select meets all of the established criteria.
• Use the “Research Article Chart” to provide a summary review of each component of your assignment.
• Submit the completed Research Article Chart to your instructor.
• Refer to the most recent prospectus template found in the DC Network (dc.gcu.edu) for details and criteria for the Literature Review (Chapter 2).
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required.
• This assignment uses a rubric. Please Review the rubric prior to the beginning 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.

Directions:

Part 1: Selection of 15 Articles  

Select 15 empirical articles related to your PICOT question. Use the “Empirical Research Checklist” worksheet to ensure that each article you select meets all of the established criteria. At least one article must demonstrate a quantitative methodology.

Part 2: Research Article Chart 

Using the articles acquired in Part 1, provide a summary review of each component using the “Research Article Chart” template.

Part 3: Literature Review 

Prepare a Literature Review (Chapter 2) of 2,000-3,000 words for your scholarly project.

Utilizing the major concepts identified in the Topic 4 assignment, further develop each major concept and subtheme by locating 15 more empirical articles related to your project topic (30 articles total: 15 from Topic 4 assignment and 15 from Topic 6 assignment).

Use the “Research Article Chart” as a guide to analyze and synthesize (summarize) the literature into the paper you began in the Topic 4 assignment. DNP 820 Weekly Discussions & Assignment Essays

Based upon your review of the 15 additional research articles, expand on your summary of each major concept and your synthesis of the three identified subthemes that support each concept. At the end of each major concept, include a summary statement.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor. 

DNP 820 Weekly Discussions & Assignment Essays

DNP-820-RS-ResearchArticleChart.docx DNP-820-RS-EmpiricalResearchChecklist-Student.docx

Benchmark – Drafting a Literature Review  

DNP 820 Weekly Discussions & Assignment Essays

DNP 820 Week 7 Case Report Translational Research and Evidence Based Practice

Details:

In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in the current course and potentially solving an identified practice problem.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Use at least two additional scholarly research sources published within the last 5 years. Provide citations and references for all sources used.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment uses a rubric. Please Review the rubric prior to the beginning 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. DNP 820 Weekly Discussions & Assignment Essays

Directions:

For a specific focus of patient practice (e.g., acute care hospital, clinic, primary care, long-term care, home health), select a particular disease process. Chose a topic of concern such as providing elements of care for a specific disease process or an administrative problem. This topic must be in need of progression or process improvement. Once identified, summarize the literature supporting proposed change. Identify an action plan to introduce change and potential barriers to implementing change. Finally, describe how you would propose evaluating the change.

Your case report must include the following:

1. Introduction with a problem statement.
2. Brief synthesized review.
3. Description of the case/situation/conditions.
4. Proposed solutions describing the validity and reliability of the research you have read.
5. Conclusion.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP 820 Weekly Discussions & Assignment Essays

Case Report – Translational Research and Evidence-Based Practice  

DNP 820 Weekly Discussions & Assignment Essays

DNP 820 Week 8 Final Evaluation by Mentor

Details:

The mentor will perform a final clinical evaluation via the Typhon system. The mentor will receive an e-mail link at the beginning of Topic 6 to access the evaluation through Typhon.

Learners will access the completed mentor evaluations in Typhon under the tab for “EASI: Evaluation and Survey Instrument” and print out the completed evaluation, sign it, and upload the signed evaluation into LoudCloud.

The course faculty will review the evaluation in LoudCloud and confirm in Typhon.

It is the learner’s responsibility to ensure that the mentor has completed evaluation. If the mentor does not receive the evaluation via the e-mail address on file with GCU, the learner should contact the course faculty immediately.

DNP 820 Full Course GCU

DNP 820 Week 8 Practice Hours Portfolio

Details:

The Typhon Tracking System will be used to document and follow the status of your practice immersion hours throughout this and every subsequent course. Learners must be able to document a minimum of 50 concurrently or previously logged practice hours in association with this course, which will contribute to fulfillment of the total required 1,000 post-baccalaureate practice hours by the conclusion of the program. Review the Practice Hours Portfolio Required Elements below, then review the Guidelines for Graduate Field Experiences located in the GCU Student Success Center for details on what may/may not qualify as practice hours. DNP 820 Weekly Discussions & Assignment Essays.

Practice Hours Portfolio Required Elements

The Practice Hours Portfolio (using the Typhon Student Tracking System) will include all of the following elements:

1. Individual Success Plan signed off by mentor.
2. Comprehensive clinical log of hours applied to doctoral level learning outcomes.
3. Learner evaluations (final).
4. Practice mentor evaluations (final).
5. Current and updated CV (update each course as necessary).
6. Faculty approvals of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)
7. Practice mentor’s approval of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)

Practice Hours Completion Statement

Learners will track their practice hours within the Typhon Tracking System throughout each course and via the Practice Hours Completion Statement provided in this assignment.

Complete the following statement in a Word document, submit it to the instructor, and complete the Typhon Tracking System entries appropriate for this course.

Practice Hours Completion Statement DNP-820

I, (INSERT NAME), verify that I have completed (NUMBER OF) practice hours in association with the goals and objectives for this course. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP 820 Week 8 Reflective Journal

Details:

Learners are required to maintain a reflective journal integrating leadership and inquiry into current practice.

In your journal, reflect on the personal knowledge and skills gained in the this course and address a variable combination of the following: new practice approaches, intraprofessional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy, leadership and economic models, and/or health disparities. Outline what you have discovered about your professional practice, personal strengths and weaknesses that have surfaced, what additional resources and abilities could be introduced to a given situation to influence optimal outcomes, and finally how you met the competencies aligned to this course.

Additional information regarding your reflective journal is found in the DC Network.

Submit your reflective journal both to the instructor and in the Typhon Tracking System under the corresponding course section. Failure to submit your journal in both the course room and Typhon systems may result in a grade of Incomplete for the course. DNP 820 Weekly Discussions & Assignment Essays.

You are not required to submit this assignment to LopesWrite.

DNP 820 Week 8 Scholarly Activities

Details:

Throughout the DNP program, learners are required to provide a report documenting participation in a minimum of four scholarly activities outside of clinical or professional practice. These reports will be due in specific courses throughout the program, as described below, and must be documented in your Practice Portfolio by the end of each course in which an activity report is due.

Examples of scholarly activities include attending conferences, seminars, grand rounds, participating in policy and quality improvement committees, writing scholarly publications, participating in community planning, serving as a guest lecturer, etc. Involvement in and contribution to interdisciplinary initiatives are also acceptable scholarly activities.

Documentation of these activities is required in DNP-810, DNP-820, DNP-830, and DNP-840.

A summary report of the scholarly activity, including who, what, where, when and take home points, will be submitted as the assignment. Include the appropriate program competencies associated with the scholarly activity and future professional goals related to this activity. You may use the “Scholarly Activity Summary” template to help guide this assignment.

Scholarly_ Activity_Summary_Template.doc

NURS 8410 Week 7 Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice

NURS 8410 Week 7 Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice

NURS 8410 Week 7 Discussion: Advocating for New Practice Approaches Through Policy

Advocating for New Practice Approaches Through Policy

“I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.” —Florence Nightingale

Through the policy process, nurses can put their feelings—as well as their experiences and expertise—into actions that create results. In this course, you have been honing your skills for critically assessing evidence with the purpose of improving practice and developing new practice approaches. As a DNP-prepared nurse, you can influence health care outcomes at the population or aggregate level. Leading policy development to address health care concerns is a vital way to achieve this.

For the past several weeks, you have been focusing on a health care issue of interest to you for your EBP Assignement. For this Discussion, consider how you could lead policy development in support of a proposed evidence-based practice approach that addresses that issue and is designed to promote quality.

Reference: Nursing Schools. (2012). 100 entertaining and inspiring quotes for nurses. Retrieved from http://www.nursingschools.net/blog/2010/06/100-entertaining-inspiring-quotes-for-nurses/

To prepare of Discussion: Advocating for New Practice Approaches Through Policy:

• Select one of the new practice approaches you developed for the Week 6 Discussion.

Review the Trautman (2009) article listed in the Learning Resources. Assess the strategies for engaging in the policy process.

NURS 8410 Week 7 Discussion: Advocating for New Practice Approaches Through Policy

By Day 3 of Discussion: Advocating for New Practice Approaches Through Policy

Post a cohesive response that addresses the following:

• Identify your proposed practice approach in the first line of your posting.
• How would you lead policy development for your selected issue?
• What strategies could you use to overcome barriers you may encounter while engaging policy makers? (Select two or more strategies to focus on in your posting.)

Read a selection of your colleagues’ responses.

By Day 6 of Discussion: Advocating for New Practice Approaches Through Policy

Respond to two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• 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 and/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.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues. NURS 8410 Week 7 Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Submission and Grading Information

Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice

This week you begin working on Application 3. As a nurse engaged in advanced practice, you have the exciting opportunity to be a leader in translating evidence into practice.

For this first section of Application 3, consider the economic and financial implications of addressing your EBP Assignment issue. In addition, reflect on your leadership skills. As a DNP-prepared nurse, you are expected to employ the principles of business, finance, and health policy in the development of initiatives that will improve the quality of care delivered.

Prepare for this week’s section of Application 3 as follows:

• Continue (from this week’s Discussion) to evaluate the new strategies you developed to address your selected issue and the potential economic impact.
• Review Chapter 6 in the course text, Translation of Evidence Into Nursing and Health Care Practice, and ask yourself the following: How are these activities enhancing my leadership skills? How does translating evidence enable me, as a leader, to affect or strengthen health care delivery and my nursing practice?

You will build on this Application next week as you look at advancing new approaches to practice through the policy process.

By Day 7 of Week 7 OF Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice

Application 3 is due. You do not need to submit anything this week.

Practicum FOR  Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice

Continue to keep a time log and journal of your practicum experiences. See the Practicum Guidelines located in the Practicum area of the Course Overview page for a complete description of the practicum.

By Day 7 of Week 7 OF Assignment: Application 3: Becoming a Leader in the Translation of Evidence to Practice

Reminder: You will submit your time log and a journal entry in Week 7.

Week in Review

This week, you evaluated economic impacts of new practice strategies and integrated theoretical foundations in developing evidence-based practice strategies. You also appraised your personal growth in leadership skills.

Next week, you will explore how to utilize the concepts presented in earlier weeks to advocate for health care policy to improve health-related outcomes.

NURS 8410 Week 5 Assignment: Application 2 Part I and II

NURS 8410 Week 5 Assignment: Application 2 Part I and II

Application 2: Laying the Foundation for New Approaches to Practice

NURS 8410 Week 5 Discussion: New Models for Evidence-Based Practice

New Models for Evidence-Based Practice

A professional goal for DNP-prepared nurses is to produce new evidence-based models of care and develop evidence-based guidelines. As you continue to develop and engage in your EBP Assignment, keep this aim in mind. What could help to facilitate the acceptance of new practices?

As noted in earlier weeks, every specialty area should base practice on research and evidence. For example, in informatics, an informatician who plans to implement a new health information system would be wise to follow a model that research shows has been effective. Similarly, those involved in leadership or management can review change models and theories, exploring current evidence on best practices that produce positive results. For this Discussion, you evaluate evidence-based practice models, change theories, and frameworks that assist with the adoption of new evidence-based practice approaches. NURS 8410 Week 5 Assignment: Application 2 Part I and II.

To prepare for New Models for Evidence-Based Practice:

• Reflect on your practicum setting and the use of evidence-based practice models. How are these models used? If they are not used, how might the integration of an evidence-based practice model change practice?
• Review the Rosswurm and Larrabee article presented in the Learning Resources focusing on the model they present for integrating new evidence-based practices.
• Research and locate an evidence-based practice model from nursing or another discipline that could be used in your specialty area to lead a systematic change to evidence-based practice approaches. You may also use a model or framework discussed in your course text, Translation of Evidence Into Nursing and Health Care Practice.
• Consider how using a model for evidence-based practice can facilitate adoption of new approaches to practice.

By Day 3 of New Models for Evidence-Based Practice

Post a cohesive response that addresses the following:

• Discuss the use of evidence-based models in your practicum setting.
• Describe a model for evidence-based practice or change theories and frameworks that you could utilize to facilitate the adoption of new approaches to practice. Substantiate your selection with evidence from the literature.

Read a selection of your colleagues’ postings.

By Day 6 of New Models for Evidence-Based Practice

Respond to two of your colleagues in one or more of the following ways:

• Provide specific feedback on your colleague’s chosen research method and selected evidence-based practice model.
• Suggest another model if appropriate.
• Ask a probing question, substantiated with additional background information, evidence, or research. NURS 8410 Week 5 Assignment: Application 2 Part I and II.
• Offer and support an alternative perspective using readings from the classroom and/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.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.