COST SAVING/COST INCREASING IN HEALTHCARE

Describe the difference between cost-saving and cost-increasing technology-based innovations. Provide an example of each and analyze why a cost-increasing innovation would continue to be used. PROVIDE IN TEXT CITIATION

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NURS-6050 Assignment Week 8

Please see complete instructions and resources – Attached documents

Instructions

The Assignment: (2–4 pages) 

In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:

• Tell us about a      healthcare program, within your practice – Psychiatry. What are the costs      and projected outcomes of this program?
• Who is your      target population?
• What is the role      of the nurse in providing input for the design of this healthcare program?      Can you provide examples?
• What is your      role as an advocate for your target population for this healthcare      program? Do you have input into design decisions? How else do you impact      design?
• What is the role      of the nurse in healthcare program implementation? How does this role vary      between design and implementation of healthcare programs? Can you provide      examples?
• Who are the      members of a healthcare team that you believe are most needed to implement      a program? Can you explain why?

**at least 2 outside resources and 2-3 course specific resources that fully supports the summary provided. **

 

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Research Critiques And PICOT Statement Final Draft

—-APA ONLY ASSIGNMENT

Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

Case Study:

Mrs. Adams, a 68-year-old widow who was referred to case management upon discharge from the hospital based on her physician’s recommendation that she is not able to care for herself independently. Her diagnosis is diabetes, hypertension, and breast cancer. She is 5 days’ post-op from a right sided mastectomy.   Mrs. Adams apartment is located in a low income area of the city where crime is prevalent.  Upon assessment by the Community Health Nurse, Mrs. Adams apartment was in disorder with minimal airflow or light. Her cloths appeared unchanged and she had no food in the apartment.  The small apartment also housed 3 cats and a small dog who Mrs. Adams considers family since the death of her husband 1 year ago. Mrs. Adams complains of pain and draining from her surgical site and a broken air conditioner.

• Using Nightingales Environmental Theory, what actions would the nurse take upon the first assessment?
• What are the five essential components of Nightingales Theory?
• Prioritize an appropriate care plan for Mrs. Adams?
• Apply Nightingale’s Environmental Theory to an area of your nursing practice, what patient population would benefit from this approach?  Support this practice change with at least one evidenced-based article (this means current EBP of 5 years of less for the article.)

The assignment should be completed in APA format, as an essay of between 1000 and 1500 words. The paper should include at least 2 outside references and the textbook. The paper should be in APA format with a title page, level headings, and reference page, please see the Shell that I have included in this module. 1st person is not acceptable in APA papers, make sure to keep this is 3rd person. 

The Development Of An Interprofessional Team To Address A Problem In Delivering Safe, High-Quality Health Care.

· Competency 1: Explain the concepts, principles, and characteristics of effective health care leadership.

o Analyze the factors contributing to a problematic health care issue.

· Competency 2: Explain the role of health care leaders in facilitating interprofessional collaboration.

o Explain the need for interprofessional collaboration to improve the quality and safety of health care in specific instances.

o Assess the effectiveness of a particular leadership approach in building and maintaining interprofessional collaborative relationships.

o Develop a collaborative plan for improving the quality and safety of health care in specific instances.

o Determine the leader’s role in implementing collaborative health care improvement projects.

· Competency 4: Determine the influence of the practitioner-scholar role on professional practice and leadership development.

o Determine how the practitioner-scholar model might be applied in resolving a particular health care issue.

· Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.

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Environmental Factor And Health Promotion

Environmental Factors and Health Promotion: Accident Prevention and Safety Promotion for Parents and Caregivers of Infants

The growth, development, and learned behaviors that occur during the first year of infancy have a direct effect on the individual throughout a lifetime. For this assignment, research an environmental factor that poses a threat to the health or safety of infants and develop a health promotion that can be presented to caregivers.

Create a 10-12 slide PowerPoint health promotion, with speaker notes, that outlines a teaching plan. For the presentation of your PowerPoint, use Loom to create a voice over or a video. Include an additional slide for the Loom link at the beginning, and an additional slide for references at the end.

Include the following in your presentation:

1. Describe the selected environmental factor. Explain how the environmental factor you selected can potentially affect the health or safety of infants.
2. Create a health promotion plan that can be presented to caregivers to address the environmental factor and improve the overall health and well-being of infants.
3. Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.
4. Offer examples, interventions, and suggestions from evidence-based research. At least three scholarly resources are required. Two of the three resources must be peer-reviewed and no more than 6 years old.
5. Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource.
6. In developing your PowerPoint, take into consideration the health care literacy level of your target audience, as well as the demographic of the caregiver/patient (socioeconomic level, language, culture, and any other relevant characteristic of the caregiver) for which the presentation is tailored

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

Refer to the resource, “Loom,” located in the Student Success Center, for additional guidance on recording your presentation.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

RUBRIC

Evidence-Based Strategies To Create High-Performance Interprofessional Teams

ABA JOURNAL

Chemerinsky: How the Roberts Court could alter the administrative state

BY ERWIN CHEMERINSKY

SEPTEMBER 4, 2019, 6:00 AM CDT

It has been widely predicted that the Roberts Court will impose significant new limits on the administrative state, especially by increasing judicial review of agency decisions.

Both Justices Neil M. Gorsuch and Brett M. Kavanaugh, as federal court of appeals judges, urged less judicial deference to the decisions of federal administrative agencies. The court certainly had the opportunity to do this in the October 2018 term, but it didn’t happen.

Of course, that doesn’t mean that it won’t happen in the terms ahead. In fact, some of the cases suggest that such limits might be on the horizon. There were three important administrative law decisions last term, and each could have important future implications.

GUNDY V. UNITED STATES

There long has been a principle that Congress cannot delegate its legislative power, including to administrative agencies. But the Supreme Court last struck down federal laws as unconstitutional on this basis in 1935 when it invalidated provisions of the National Industrial Recovery Act as impermissible delegations in Panama Refining Co. v. Ryan and Schechter Poultry Corp. v. United States.

In the 80-plus years since Panama Oil and Schechter, not a single federal law has been declared an impermissible delegation of legislative power. Although these decisions have not been expressly overruled, they never have been followed either. All delegations, no matter how broad, have been upheld. Although the court says that when Congress delegates its legislative power it must provide criteria—“intelligible principles”—to guide the agency’s exercise of discretion, all delegations, even without any criteria, have been upheld.

Undoubtedly, this reflects a judicial judgment that broad delegations are necessary in the complex modern world and that the judiciary is ill-equipped to draw meaningful lines.

Reviving the nondelegation doctrine would be a powerful way to impose significant limits on the administrative state. The court had the chance to do so in Gundy v. United States.

The Sex Offender Registration and Notification Act makes it a federal crime for a person to cross state lines if he or she is a convicted sex offender who did not register as required by law. The Act leaves open many questions, including the application of the law to those convicted before the law was enacted. These matters were left to the attorney general to resolve.

Herman Gundy, who was convicted under SORNA pursuant to the attorney general’s application of the statute, argued that this was an impermissible delegation of power to the executive branch of government. In a 5-3 decision (it was argued before Kavanaugh was confirmed), the court rejected Gundy’s argument and again refused to revive the nondelegation doctrine.

Justice Elena Kagan wrote the plurality opinion, joined by Justices Ruth Bader Ginsburg, Stephen G. Breyer and Sonia Sotomayor. She declared this an “easy” case and explained that the statute gives an intelligible principle to the attorney general. She wrote that under the statute, “the attorney general must apply SORNA’s registration requirements as soon as feasible to offenders convicted before the statute’s enactment. That delegation easily passes constitutional muster.” She said that “(i)ndeed, if SORNA’s delegation is unconstitutional, then most of government is unconstitutional.”

Justice Samuel A. Alito, was the fifth vote for the majority, concurring in the judgment. He wrote a brief enigmatic opinion stating: “If a majority of this court were willing to reconsider the approach we have taken for the past 84 years, I would support that effort. But because a majority is not willing to do that, it would be freakish to single out the provision at issue here for special treatment.”

Justice Gorsuch wrote a strong dissent, joined by Chief Justice John G. Roberts Jr. and Justice Clarence Thomas. He said that he “would not wait” to revive the nondelegation doctrine and that SORNA should be declared unconstitutional as violating that principle.

With Kavanaugh on the bench, it is easy to see five justices who will be willing to revive the nondelegation doctrine and bring about a dramatic change in administrative law. It is puzzling, though, as to why Alito did not vote with the other conservatives to create a 4-4 tie and have the case reargued with Kavanaugh on the bench. That is exactly what happened last term in Knick v. Township of Scott, Pennsylvania, which was reargued and then decided 5-4 with the conservative justices in the majority.

KISOR V. WILKIE

In Auer v. Robbins and Bowles v. Seminole Rock & Sand Co., the Supreme Court articulated the principle that courts should defer to agencies’ reasonable readings of ambiguous regulations. The court granted review in Kisor v. Wilkie on the question of whether these cases should be overruled. Kagan, writing for the court said, “We answer that question no. Auer deference retains an important role in construing agency regulations. But even as we uphold it, we reinforce its limits.”

James Kisor, a Vietnam veteran who suffers post-traumatic stress disorder, applied for benefits. The Veteran’s Administration interpreted its own regulations to deny them. The court used this case as the vehicle for considering whether to overrule Auer deference.

Kagan’s opinion detailed the reasons for Auer deference. But she also stressed that such deference is appropriate only if a regulation is genuinely ambiguous, if the agency’s interpretation of the rule is reasonable, and “if the character and context of the agency interpretation entitles it to controlling weight.” To meet the latter, the regulation must be the “authoritative position” of the agency, within the scope of the agency’s substantive expertise, and reflect the “fair and considered judgment” of the agency.

Roberts was the fifth vote for the majority and wrote separately to say he agrees that “overruling those precedents is not warranted.” But he stressed that Auer deference is limited by the requirements set forth in Kagan’s opinion.

Gorsuch wrote an opinion concurring in the judgment (because he agreed with the result in this case), but that was clearly a dissent as to overruling Auer deference. He declared: “It should have been easy for the Court to say goodbye to Auer v. Robbins. … A legion of academics, lower court judges, and Members of this Court—even Auer’s author—has called on us to abandon Auer. Yet today a bare majority flinches, and Auer lives on. Still, today’s decision is more a stay of execution than a pardon.”

Lurking in the background is how the court will deal with a related doctrine—Chevron deference—which says that courts should defer to agency interpretation of the statutes that they enforce. (Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc.,1984). Indeed, in a footnote, Gorsuch said, “there are serious questions, too, about whether that doctrine comports with the APA and the Constitution.”

Indeed, there may be five votes in a future case to overrule, or greatly limit, Chevron deference.

DEPARTMENT OF COMMERCE V. NEW YORK

For much of American history, through the 1950 census, there was a question on the census forms about citizenship. From 1960 to 2000, the census form that went to everyone did not include such a question, but a longer form that went to some people asked about citizenship. The question was discontinued out of concern that it would discourage noncitizens from completing the form. An accurate enumeration of the population is essential; much depends on it, ranging from apportionment of the House of Representatives to the allotment of federal money.

Secretary of Commerce Wilbur Ross decided to include a question about citizenship on the 2020 census. Federal district courts enjoined this, both as violating the Administrative Procedures Act and the Constitution’s requirement for an accurate enumeration of the population. The Supreme Court granted the government’s request for expedited review based on the need for resolving the issue by June 30 to have census forms printed.

In a 5-4 decision, the Supreme Court held that the United States failed to offer a sufficient justification for its decision to meet the requirements of the Administrative Procedures Act. Roberts wrote for the court, joined by Justices Ginsburg, Breyer, Sotomayor and Kagan. The court held that it did not violate the Constitution or the Census Act to ask a question about citizenship.

But the court concluded that “viewing the evidence as a whole, we share the District Court’s conviction that the decision to reinstate a citizenship question cannot be adequately explained in terms of DOJ’s request for improved citizenship data to better enforce the [Voting Rights Act].” As the court explained, there was no evidence in the administrative record that asking this question would enhance enforcing of the Voting Rights Act. The court remanded the case to the agency to give it a chance to justify the question. Subsequently, the Trump administration decided not to proceed because of the need to get the census forms printed.

The dissenters stressed the need for great deference to the agency. Thomas, for example, said: “Our only role in this case is to decide whether the Secretary complied with the law and gave a reasoned explanation for his decision. The court correctly answers these questions in the affirmative. That ought to end our inquiry.”

It was interesting to see the conservative justices, who generally want more judicial oversight of federal agencies, here argue for much greater deference.

IN CONCLUSION

This, of course, was just the first term with Gorsuch and Kavanaugh on the bench. There were no major changes in administrative law. But perhaps they are to come.

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 Review Of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.
Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

references

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

Chapter 2, “Understanding Contexts for Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 37–62)
Chapter 3, “Current Challenges in Complex Health Care Organizations: The Triple Aim” (pp. 63–86)
45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

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Discussion: Assessing Musculoskeletal Pain

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

                                           To prepare:

· By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

· Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

                                      Case : Ankle Pain

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy,

· what foot structures are likely involved?

· What other symptoms need to be explored? What are your differential diagnoses for ankle pain?

· What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

With regard to the case study you were assigned:

· Review this week’s Learning Resources, and consider the insights they provide about the case study.

· Consider what history would be necessary to collect from the patient in the case study you were assigned.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources.

Provide evidence from the literature to support diagnostic tests that would be appropriate for each case.

List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

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Case Study: Mrs. J.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

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

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

You are required to sub

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