Posts in category: Nursing Papers

Common Models In Health Informatics Evaluation

Common Models in Health Informatics Evaluation
Have you ever watched a movie in which the same scene was shown several times but as viewed by different individuals? Or, have you watched a detective show in which the witnesses all had differing accounts? The same can hold true for conducting an evaluation of a health information technology project. How you plan and conduct the evaluation is largely dependent on the viewpoint you assume and the perspective with which you approach the evaluation.
Consider a new patient discharge protocol at a small hospital. Do you want to know how the patient feels about the process? Do you want to gather the opinions of nurses who are using this process? Perhaps you want to determine if it is saving the hospital money by freeing up bed space in a more timely fashion. Obtaining each of these viewpoints would require a different approach. Depending on the goal of your evaluation, the model and viewpoint you opt to use will likely vary.
In this Discussion, determine which evaluation model would be most effective for evaluating the health information technology described in one of the scenarios below. Your Instructor will assign a specific scenario by Day 1 of this week.

• Scenario 1: You have recently provided a training program to help nurses and physicians become proficient in the use of a new bedside medication verification (BMV) system.

• Scenario 2: The Chief Medical Officer at your hospital is interested in finding out the impact of a new decision support system on the number of adverse events occurring in the past year.

• Scenario 3: You are helping with the design of a new outpatient surgery center to be built adjacent to the hospital. You are tasked with evaluating the opinions of physicians, nurses, and the general public toward this facility.

To prepare:

• Review the information on the types of evaluation models covered in this week’s Learning Resources.
• Determine which model would be most appropriate to use for evaluation in the scenario to which you were assigned.
• Consider why the viewpoint of the scenario or situation would impact the model used.
• View the scenario from a different viewpoint, and consider how a different model might be used.
• Reflect on the importance of basing an evaluation on a model.

By tomorrow 12/13/2016 at 9pm, post a minimum of 550 words in APA format with a minimum of 3 references from the list below, which include the level one headings as numbered below:
1)      Post which scenario (1, 2, or 3) you were assigned and two different models that could be utilized to approach the evaluation.
2)      Explain why you selected those models and how you would use them.
3)       Explain why it is important to consider the intended goal of the evaluation and the viewpoint that is selected.
4)      Finally, assess the importance of basing an evaluation on a model. Justify your response.
 
 
 
 
Required Readings
 
Technology Acceptance Model
 
Kowitlawakul, Y. (2011). The Technology Acceptance Model: Predicting nurses’ intention to use telemedicine technology (eICU). Computers, Informatics, Nursing, 29(7), 411–418.
Retrieved from the Walden Library databases.
Nurses encounter a variety of technological tools that are used in their field. This article explores the technology acceptance model and how it applies to nurses’ intention to use telemedicine technology.
 
    Pai, F.-Y., & Huang, K. (2011). Applying the Technology Acceptance Model to the introduction of healthcare information systems. Technological Forecasting and Social Change, 78(4), 650–660.
Retrieved from the Walden Library databases.
This article focuses on the attempt to develop a model that will assist nurses in mastering the use of health information technology (HIT), thus enabling them to spend more time on patient care and less on clerical-type duties. The authors also studied how the use of HIT could increase patient safety.
 
    Rippen, H. E., Pan, E. C., Russell, C., Byrne, C. M., & Swift, E. K. (2013). Organizational framework for health information technology. International Journal of Medical Informatics, 82(4), e1–e13.
Retrieved from the Walden Library databases.
In this article, the authors highlight results of a literature review on the implementation of health information technology and the related theories and models. Based on their research, the authors developed a framework of key areas that provides a structure to organize and capture information on the use of health IT.
 
    Mohamed, A. H., Tawfik, H. M., Al-Jumeily, D., & Norton, L. (2011). MoHTAM: A Technology Acceptance Model for mobile health applications. Developments in E-systems Engineering (DeSE) Conference, 13–18.
Retrieved from the Walden Library databases.
In this article, the authors highlight a model they developed to determine how the decision to use a mobile health application is influenced by the design of the technology, the perceived ease of using it, and the perceived usefulness of the technology.
 
Diffusion of Innovations
 
Barnett, J., Vasileiou, K., Djemil, F., Brooks, L., & Young, T. (2011). Understanding innovators’ experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study. BMC Health Services Research, 11, 342.
Retrieved from the Walden Library databases
In this article, the authors describe the experiences of innovators in the medical field and the barriers that they have experienced in the implementation and diffusion of health care service innovations.
 
    Kaissi, A. (2012). “Learning” from other industries: Lessons and challenges for health care organizations. Health Care Manager, 31(1), 65–74.
Retrieved from the Walden Library databases.
 
 
 
In this paper, the author explores how diffusion of innovations occurs in a variety of different industries and how these lessons can be adapted for use in the health care industries.
 
Thakur, R., Hsu, S. H. Y., & Fontenot, G. (2012). Innovation in healthcare: Issues and future trends. Journal of Business Research, 65(4), 562–569.
Retrieved from the Walden Library databases.
The medical field is a constantly evolving and improving. This article explores important innovations in the health care industry while highlighting certain issues and trends that may affect the future of the field.
 
    Dickinson, A. D., & Scott, M. (2012). Diffusion of innovations in the National Health Service: A case study investigating the implementation of an electronic patient record system in a UK secondary care trust. In UK Academy for Information Systems (UKAIS) 17th Annual Conference, 27–28 March 2012, New College, Oxford. Retrieved from http://nrl.northumbria.ac.uk/6223/2/UKAIS_2012_paperDD_MS.pdf
This article examines a case study that focuses on the implementation of an electronic patient record system in a UK secondary care trust. In particular, the study highlights how new users adopt the system.
 
Valente, T. W., & Rogers, E. M. (1995). The origins and development of the diffusion of innovations paradigm as an example of scientific growth. Science Communication, 16(3), 242–273.
Copyright 1995 by Sage Publications Inc. Reprinted by permission of RISage Publications Inc. via the Copyright Clearance Center.
In this article, Valente and Rogers explore the origins and development of the diffusion of innovations paradigm. Through examining the different stages, it is possible to better understand how innovations are spread, accepted, and adopted within a health care organization.
 
Disruptive Innovation
 
Christensen, C. M., Bohmer, R., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102–112.
 
Retrieved from the Walden Library databases
The health care field is constantly in need of new technologies to fill specific needs and niches. In this article, the authors discuss the role disruptive innovations could play in the development of the needed technologies.
 
Dhar, M., Griffin, M., Hollin, I., & Kachnowski, S. (2012). Innovation spaces: Six strategies to inform health care. Health Care Manager, 31(2), 166–177.
Retrieved from the Walden Library databases.
In this article, the authors use the disruptive innovation model as the framework to examine how innovation occurs in health care organizations. They determined six strategies to encourage innovation: dedicated times, formal teams, outside ideas, idea-sharing platforms, company/job goals, and incentives.
 
    Poll, W. (2011). Derision is the sweet spot of adoption: Unleashing disruptive growth.  Hospital Topics, 89(1), 23–25.
Retrieved from the Walden Library databases.
It is common that many people look at change and new technologies with a hint of disdain or distrust. The author of this article discusses how new ideas and disruptive innovations can be effectively presented to a somewhat hesitant organizations.
 
Sociotechnical Theory Models
 
    Ancker, J. S., Kern, L. M., Abramson, E., & Kaushal, R. (2012). The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety. Journal of American Medical Informatics Associations, 19(1), 61–65.
Retrieved from the Walden Library databases.
The authors of this article explain the Triangle Model for designing studies on the safety and quality outcomes of health information technology projects. The article focuses on the predictors of the model, including attributes of the technology in question, the technology provider, the organizational setting, and the population involved.
 
    Currie, L., Sheehan, B., Graham, P., Stetson, P., Cato, K., & Wilcox, A. (2009). Sociotechnical analysis of a neonatal ICU. Studies In Health Technology and Informatics, (146), 258–262.
Retrieved from the Walden Library databases.
In this article, the authors provide a brief overview of sociotechnical theory. The authors also describe the results of a sociotechnical analysis of a neonatal intensive care unit.
 
    Molleman, E., & Broekhuis, M. (2001). Sociotechnical systems: Towards an organizational learning approach. Journal of Engineering and Technology Management, 18(3), 271–294.
Retrieved from the Walden Library databases.
The authors of this article explore the application of sociotechnical systems (STS) theory for designing work processes to improve organizational performance. The authors examine the application of STS with four organizational performance indicators: price, quality, flexibility, and innovation.
 
    Scott‐Findlay, S., & Estabrooks, C. A. (2006). Mapping the organizational culture research in nursing: A literature review. Journal of Advanced Nursing, 56(5), 498–513.
Retrieved from the Walden Library databases.
This article provides an empirical review of the nursing literature on organizational culture and its influence on practitioners.

Literature Review: The Use Of Clinical Systems To Improve Outcomes And Efficiencies

Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
 
To Prepare:
1. Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, per example “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
The research should describe the use of information systems to improve health outcomes and efficiencies.  Please select ONE Topic to investigate.  Some examples of topics include (you can select another topic of your choice, these are just ideas of appropriate topics for the assignment):
 
· An article that describes the use of personal health records to support adherence to medication regimen or appointment.
· Research describing the use of Computerized Physician Order Entry (CPOE) to reduce the risk of adverse drug events
· Evidence summarizing the role of clinical decision support systems (CDSS) and evidence-based practice
· Literature investigating the effect of mobile applications and chronic disease management
· Research that provides details regarding the effect of simulation and knowledge retention / learning among health care students
· An article identifying an association among electronic communication and efficiencies in care
· Literature describing the role of telehealth and healthcare access
· Genomics and genetic testing
 
2. Identify and select 4 peer-reviewed research articles from your research.
 
 
 
INSTRUCTIONS
 
The Assignment: 5 pages not including the title and reference page.
In a 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:
· Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
· Include an introduction explaining the purpose of the paper.
· Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
· In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
· Use APA 7 format and include a title page.
· For information about annotated bibliographies, visit  /orders/academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies (See attached document)
 
 
 
NOTES FROM PROFESSOR:
1. The assignment requires one to search the literature addressing the impact of clinical systems on outcomes and efficiencies in healthcare delivery, including nursing practice.
2. You are required to located four (4) peer-reviewed articles published within the previous five (5) years.  Points will be deducted for including articles not within this specific time frame or less than four articles.
3. Just a reminder to use the required format for an Annotated Bibliography (see attached example) and please adhere to the template format as this is in accordance with APA 7th edition.
4. Five-page limit are among the required elements of the assignment.  Points will be deducted for exceeding page length or not following the established, provided format. Do not exceed five pages (excluding title page and references
5. You are required to summarize four, recent articles and identify the improvement to outcomes, efficiencies, and lessons learned.
6. Please do not provide a summary that includes mostly direct quotes from the article. Summarize the content in your own words, cite accordingly, include references.
 

Need Response For Below Discussion

APA format for SOAP NOTE 3 peer review articles 1 and half pages long please follow below instructions
Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning
 
case Study #3   Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked
S
Cc: “Earache right ear”
HPI: Patient is an 11-year-old Caucasian boy who was brought in by his grandmother after complaining about having a mild earache for the past two days.  Patient states that the pain is worse when he falls asleep and that it has become harder for him to hear, grandmother believes that he feels warm but has not taken his temperature
Medications: Patient does not take any medications
PMH: No significant illnesses, shots are up to date
FH: No history of previous ear concerns no family history of ear disease. During the school year, patient lives at home with his mother, father and he does not have pets. Patient is staying with grandmother and grandfather most of summer
SH: Student in public school and is currently on summer break, has been spending a lot of time this summer in the pool per his grandmother that he is spending the summer with.
ROS: general: negative for chills fever currently
EENT: complains of mild right ear pain and mild hearing loss, denies tinnitus, denies pain in throat, or eye pain
O
VS: T 100.8, P 94, R 18, BP 98/64
General: Patient appears to be in mild pain, holding head to right side slightly
HEENT: right tympanic membrane obscured, ear canal is read and has a musty odor from ear canal with small amount of watery drainage, head is normocephalic without signs of trauma, no nasal drainage, PEARL, no complaints of sore throat, no redness in throat
SKIN: Warm and dry, good skin turgor, prominent tan
NECK: No lymph node edema or signs of pain on palpation
NEUROLOGICAL: No complaints of headache or dizziness
Diagnostic results. WBC slightly elevated, low grade temp
A
Differential Diagnoses:
1) Acute Otitis Externa
2) Acute Otitis Media
3) Pharyngitis
Primary diagnoses/presumptive diagnoses: Acute otitis media
P – not indicated per template
Assessing for a possible ear infection would require additional information from the patient in addition to a physical assessment of the ear and the patient.  Obtaining background information including recent travel, activities, family history, trauma, history of previous illnesses and treatments that have been used for treatment that were successful or not successful.
Diagnostic studies used to diagnose the specific pathogen would include obtaining a culture of purulent drainage, simple otoscopy was mostly used for diagnosing AOM (D’silva, 2013) or a more invasive way of evaluating white blood cell elevation is by completing a CBC which is not used as often as visual inspection of the ear canal. White blood cell count (WBC), a classical inflammation marker, is also used in many scoring systems during routine daily clinical practice (Kutlucan et al., n.d.). Using data from a CBC can also provide information about the patient’s overall health.
Otitis externa
Acute otitis externa is the most common infection of the external auditory canal (Demirel et al., 2018). Ball describes (2015) symptoms of otitis externa as having watery to purulent and thick drainage mixed with pus with a musty odor and usually occurs after swimming.
Acute otitis media
Acute otitis media is one of the most frequent bacterial infections in children, and one of the primary reasons for the prescription of antibiotics by pediatricians (Intakorn, n.d.). Otitis media can have an abrupt onset with fever, feeling of a blockage, and interferes with sleep.  The middle ear fills with pus causing conductive hearing loss (Ball).
Acute pharyngitis:
Acute respiratory infections are one of the most common diseases, accounting for one of the main causes of patient visits to community health centers and hospitals (Yuniar, 2017). Ball (2015) describes a patient with acute pharyngitis as having a sore throat with deferred pain in ears and dysphagia with fever, malaise, fetid breath, abdominal pain and headache.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S.,   Stewart, R. W. (2015). Seidel’s guide to
physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Demirel, H., Arlı, C., Özgür, T., İnci, M., & Dokuyucu, R. (2018). The Role of Topical
Thymoquinone in the Treatment of Acute Otitis Externa; an Experimental Study in
Rats. Journal of International Advanced Otology, 14(2), 285–289. /orders/doi-
org.ezp.waldenulibrary.org/10.5152/iao.2017.4213
D’silva, L., Parikh, R., Nanivadekar, A., & Joglekar, S. (2013). A Questionnaire-Based Survey
of Indian ENT Surgeons to Estimate Clinic Prevalence of Acute Otitis Media, Diagnostic
Practices, and Management Strategies. Indian Journal of Otolaryngology & Head & Neck
Surgery, 65, 575–581. /orders/doi-org.ezp.waldenulibrary.org/10.1007/s12070-012-0545-2
Intakorn, P., Sonsuwan, N., Noknu, S., Moungthong, G., Pircon, J.-Y., Liu, Y., … Hausdorff, W.
P. (n.d.). Haemophilus influenzae type b as an important cause of culture-positive acute
otitis media in young children in Thailand: a tympanocentesis-based, multi-center, cross-
sectional study. BMC PEDIATRICS, 14. /orders/doi-org.ezp.waldenulibrary.org
/10.1186/1471-2431-2431-14-157
Kutlucan, L., Kutlucan, A., Basaran, B., Dagli, M., Basturk, A., Kozanhan, B., … Kos, M. (n.d.).
The predictive effect of initial complete blood count of intensive care unit patients on
mortality, length of hospitalization, and nosocomial infections. EUROPEAN REVIEW
FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 20(8), 1467–1473.
Retrieved from
/orders/ezp.waldenulibrary.org/login?url=/orders/search.ebscohost.com/login.aspx?direct=t
rue&db=edswsc&AN=000380260000006&site=eds-live&scope=site
Yuniar, C. T., Anggadiredja, K., & Islamiyah, A. N. (2017). Evaluation of Rational Drug Use for
Acute Pharyngitis Associated with the Incidence and Prevalence of the Disease at Two
Community Health Centers in Indonesia. Scientia Pharmaceutica, 85(2), 1–10.
/orders/doi-org.ezp.waldenulibrary.org/10.3390/scipharm85020022

Transforming Nursing And Healthcare Through Technology

Discussions
1. Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization./building-on-your-drawings-from-last-week-and-feedback-from-your-instructor/
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provides insights on change management, the reasons people resist change, and the ways to establish a culture that is more open to change initiatives.
Gruber, N., Darragh, J., Puccia, P. H., Kadric, D. S., & Bruce, S. (2010). Embracing change to improve performance. Long-Term Living: For the Continuing Care Professional, 59(1), 28–31.
This text describes the implementation of a new electronic health record system at a 105-bed hospital related-facility. The authors highlight five key elements that were deemed necessary for a successful EHR implementation.
Hyrkäs, K., & Harvey, K. (2010). Leading innovation and change. Journal of Nursing Management, 18(1), 1–3.
According to the authors, the health care field is in need of more effective leaders who understand innovation, who appreciate diversity and change, and who can foster and implement innovation and creativity. The authors describe how nurse leaders can be instrumental in embracing and disseminating innovation throughout the health care system and provide scaffolding for subsequent articles in this issue of the journal.
Mooney, B. L., & Boyle, A. M. (2011). 10 steps to successful EHR implementation. Medical Economics, 88(9), S4–6, S8–S11.
The authors of this article describe the incentives and requirements for electronic health records (EHRs) outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act. The authors then provide 10 steps for health care leaders and organizations to follow when implementing EHRs.
Murphy, J. (2011). Leading from the future: Leadership makes a difference during electronic health record implementation. Frontiers of Health Services Management, 28(1), 25–30.
In this article, the author examines the causes behind the increasing complication of EHR implementations. In addition, the author explores the role of leadership in guiding successful EHR implementations.
Required Media
Laureate Education (Producer). (2012b). Electronic health records. Baltimore, MD: Author.
In this video, Katie Skelton, Richard Rodriguez, Carina Perez, Shannon Mori, and Carmen Ferrell describe how their hospital implemented an electronic health record. They also outline the general considerations, benefits, and support measures related to electronic health records.
2. Successful Implementation of Electronic Health Information Technology
Since the inception of the HITECH Act, health organizations have faced increased pressure to update their health information technology (HIT) resources. As discussed last week, many believe that the increased use of electronic health records and the quick and efficient communication afforded by HIT can lead to improved quality of patient care. Yet there are significant costs associated with implementing such systems. What can organizations do to ensure that the correct system is selected and that the system will be appropriate for those required to use it? Who should be involved in those decisions?
This week introduces the systems development life cycle and discusses how it can guide an organization through the complexities of adopting a new HIT system.
In this Discussion, you are asked to consider the role of nurses in the SDLC process.
To prepare:
Review the steps of the systems development life cycle.
Think about your own organization, or one with which you are familiar, and the steps the organization goes through when purchasing and implementing a new HIT system.
Consider what a nurse could contribute to decisions made at each stage when planning for new health information technology. What might be the consequences of not involving nurses?
Reflect on your own experiences with your organization selecting and implementing new technology. As an end user, do you feel you had any input in the selection or and planning of the new HIT system?
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 10, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making”
This chapter explains the systems development life cycle and explores various methods of applying it. The chapter also examines the importance of interoperability in implementing HITECH.
Chapter 11, “Administrative Information Systems”
This chapter provides an overview of agency-based health information systems. The text also details how administrators can use core business systems in their practice.
Boswell, R. A. (2011). A physician group’s movement toward electronic health records: A case study using the transtheoretical model for organizational change. Consulting Psychology Journal: Practice and Research, 63(2), 138–148.
The authors of this article present a case study on an EHR implementation in a multispecialty physician group. The case study attempts to determine actions that promote successful EHR implementation and the pros and cons of implementation.
Hsiao, J., Chang, H., & Chen, R. (2011).A study of factors affecting acceptance of hospital information systems: A nursing perspective. Journal of Nursing Research, 19(2), 150–160.
The focus of this article is to determine what factors are most important in predicting the acceptance of new health information technology. The results of the study indicated that self-efficacy, top management support, and the quality of information retrieved are the most important determinants of the willingness of nurses to adopt and use a new technology.
Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011). Electronic nursing documentation as a strategy to improve quality of patient care. Journal of Nursing Scholarship, 43(2), 154–162.
This article summarizes a literature review of the relationship between electronic health records (EHRs) and quality of patient care. The article identifies deficiencies in existing research regarding the daily interactions of nurses, patients, and electronic documentation, and it provides a comparison between electronic and paper-based documentation and its effect on quality of care.
Nurse leaders discuss the nurse’s role in driving technology decisions. (2010). Virginia Nurses Today, 18(1), 8–9.
This article summarizes a roundtable held with a number of nursing executives to discuss the role nurses should take in the selection and adoption of new technologies for health care. The executives concluded that the nurses’ goals should be to select technology that will further their ability to provide safe, quality care to their patients.
Page, D. (2011). Turning nurses into health IT superusers. Hospitals & Health Networks, 85(4), 27–28.
This article highlights the importance of involving nurses with all phases of the decision and implementation process surrounding new health information technology. The author stresses the importance of communication in the process as well as defining success.
Swab, J., & Ciotti, V. (2010). What to consider when purchasing an EHR system. hfm(Healthcare Financial Management), 64(5), 38–41.
In this article, recommendations are given for purchasing health information technology. These include selecting the appropriate vendor, carefully considering the cost of both new equipment and personnel, and involving clinicians in decisions.
Required Media
Laureate Education (Producer). (2012g). Systems development life cycle. Baltimore, MD: Author.
The systems development life cycle (SLDC) provides a framework for all of the steps necessary to implementing a new technology or process within an organization. This video explains the SDLC and how it is used in the health care field.
Optional Resources
Agency for Healthcare Research and Quality. (2005). A toolkit for redesign in health care. Retrieved from http://www.ahrq.gov/legacy/qual/toolkit/index.html
This website supplies strategies for reconfiguring and transforming a hospital’s care processes. The text breaks down the redesign process into a series of steps.
3. Understanding Workflow Design
As you explored last week, the implementation of a new technology can dramatically affect the workflow of an organization. Newly implemented technologies can initially limit the productivity of users as they adjust to their new tools. Such implementations tend to be so significant that they often require workflows to be redesigned in order to achieve improvements in safety and patient outcomes. However, before workflows can be redesigned, they must first be analyzed. This analysis includes each step in completing a certain process. Some systems duplicate efforts or contain unnecessary steps that waste time and money and could even jeopardize patient health care. By reviewing and modifying the workflow, you enable greater productivity. This drive to implement new technologies has elevated the demand for nurses who can perform workflow analysis.
In this Discussion, you explore resources that have been designed to help guide you through the process of workflow assessment.
To prepare:
· Take a few minutes and peruse the information found in the article “Workflow Assessment for Health IT Toolkit”.
o As you check out the information located on the different tabs, identify key concepts that you could use to improve a workflow in your own organization and consider how you could use them.
o Go the Research tab and identify and read one article that is of interest to you and relates to your specialty area.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

• Chapter 14, “Nursing Informatics: Improving      Workflow and Meaningful Use”
  This chapter reviews the reasons for conducting workflow analysis and      design. The author explains specific workflow analysis and redesign      techniques.

Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43–61.
Retrieved from the Walden Library databases.
In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.
Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.
Retrieved from the Walden Library databases.
This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.
U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865
This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.
Document: Sample Workflow of Answering a Telephone in an Office (Word document)
Required Media
Laureate Education (Producer). (2012f). System design and workflow. Baltimore, MD: Author.
This video provides an overview of how workflow modeling can be used in a health care setting to target areas for revising current practices and procedures. The video also shows how technology and informatics can be used to improve workflow efficiency and increase the quality of care.
4. Using Health Information Technology as a Source of Evidence-Based Practice
Before the digital revolution, health information technology supplied very limited support for evidence-based practice. If nurses wanted to be informed about cutting-edge research, their best bet was to either subscribe to leading journals or make periodic trips to the library. With the establishment of research databases, however, nurses became empowered to learn about and facilitate interdisciplinary and translational research. Databases are just one example of how health information technology supports evidence-based practice.
To prepare:
· Read the following scenario from the text (McGonigle & Mastrian, 2015, p. 445):
Twelve-hour shifts are problematic for patient and nurse safety, and yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (Board on Health Care Services & Institute of Medicine, 2004) published a report that referred to studies as early as 1988 that discussed the negative effects of rotating shifts on intervention accuracy. Workers with 12-hour shifts realized more fatigue than workers on 8-hour shifts. In another study done in Turkey by Ilhan, Durukan, Aras, Turkcuoglu, and Aygun (2006), factors relating to increased risk for injury were age of 24 or less, less than 4 years of nursing experience, working in the surgical intensive care units, and working for more than 8 hours.
· Consider how the resources identified in the scenario above could influence an organization’s practice.
· Select an issue in your practice that is of concern to you. Using health information technology, locate at least three evidence-based practice resources that address your concern and that could possibly inform further action.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

• Chapter 23, “Research: Data      Collection, Processing, and Analytics”

The authors of this chapter relate nursing research to the foundation of knowledge model. The chapter assesses informatics tools for collecting data, storing information, and processing and analyzing data.

• Chapter 25, “Translational      Research: Generating Evidence for Practice”

In this chapter, the authors differentiate evidence-based practice and translation research. They also describe models used to introduce research findings intro practice.
Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D., & Francis, J. (2010). Use of health information technology to advance evidence-based care: Lessons from the VA QUERI program. Journal of General Internal Medicine, 25(Suppl. 1), S44–S49.
This article presents a study that evaluated the role of health information technology (HIT) in the Department of Veteran Affairs’ Quality Enhancement Research Initiative. The authors convey their findings on how HIT provided data and information to aid implementation research, and how implementation research helped further HIT development. Additionally, the text details methods of overcoming common HIT barriers to implementation research.
Jamal, A., McKenzie, K., & Clark, M. (2009). The impact of health information technology on the quality of medical and health care: A systematic review. Health Information Management Journal, 38(3), 26–37.
This text details a study that reviews the published evidence concerning the impact of health information technology (HIT) on the quality of health care. The study investigated the use of HIT in medical care and allied health and preventive services. The authors primarily focus on the impact of electronic health records, computerized provider order-entry, and decision support systems.
Umscheid, C. A., Williams, K., & Brennan, P. (2010). Hospital-based comparative effectiveness centers: Translating research into practice to improve the quality, safety and value of patient care. JGIM: Journal of General Internal Medicine, 25(12), 1,352–1,355.
This article revolves around the usage of the hospital-based comparative effectiveness (CE) center model. The authors highlight the model’s benefits and the increasing usage of CE evidence. The article also reviews solutions to overcoming many of the challenges to operating hospital-based CE centers.
Optional Resources
Chlan, L., Tracy, M. F., & Grossbach, I. (2011). Pulmonary care. Achieving quality patient-ventilator management: Advancing evidence-based nursing care. Critical Care Nurse, 31(6), 46–50.
5. HITECH Legislation
In order for organizations to receive the incentives offered through the HITECH legislation, they must be able to demonstrate that they are using the technology in meaningful ways. The following criteria for meaningful use must be evident to qualify for EHR incentives (U.S. Department of Health & Human Services, 2012). The technology must:
· Improve quality, safety, and efficiency, and reduce health disparities
· Engage patients and families
· Improve care coordination
· Improve population and public health
· Ensure adequate privacy and security protections for personal health information
For this Discussion, you consider the impact of the meaningful use criteria of the HITECH legislation on the adoption of health information technology.
To prepare:
· Review the Learning Resources on the HITECH legislation and its primary goals.
· Reflect on the positive and negative impact this legislation has had on your organization or one with which you are familiar.
· Consider the incentives to encourage the use of EHRs. Focus on the definition of meaningful use and how it is measured.
· Reflect on how the incentives and meaningful use impact the quality of patient care.
· Find an article dealing with one of the criteria to qualify for meaningful use and how it has been successfully met.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

• Chapter 9, “Legislative Aspects of Nursing      Informatics: HITECH and HIPAA”
  This chapter explores two pieces of legislation that dramatically impact      nursing informatics: the Health Information Technology for Economic and      Clinical Health Act of 2009 and the Health Insurance Portability and      Accountability Act of 1996.

Arlotto, P. (2010). 7 strategies for improving HITECH readiness. hfm(Healthcare Financial Management), 64(11), 90–96.
This article reviews seven strategies to help prepare for the implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). The central point of the article focuses on demonstrating meaningful use of electronic health records.
Begum, R., Smith Ryan, M., Winther, C. H., Wang, J. J., Bardach, N. S., Parsons, A. H., & … Adams Dudley, R. (2013). Small Practices’ Experience With EHR, Quality Measurement, and Incentives. American Journal Of Managed Care, 19eSP12–8.
This article presents a study of clinician’s attitudes toward the use of financial incentives for the implementation of electronic health records in small practices.
Brown, B. (2010). The final rules for meaningful use of EHRs. Journal of Health Care Compliance, 12(5), 49–50.
In this article, the author poses four questions pertaining to the EHR system in the United States. In particular, the article examines Medicare and Medicaid incentive payments and the ways the meaningful use of certified EHRs will be verified.
Classen, D. C., & Bates, D. W. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365(9), 855–858.
This article details the challenges of meeting the meaningful use standards in order to receive the benefits legislated under the HITECH Act. The authors specify the requisites for achieving benefits with EHRs, the relationship between meaningful use and commercial EHRs, and the tools needed to evaluate EHRs after implementation.
Kempfert, A. E., & Reed, B. D. (2011). Health care reform in the United States: HITECH Act and HIPAA privacy, security, and enforcement Issues. FDCC Quarterly, 61(3), 240–273.
The authors of this article examine HITECH, in addition to the impact of the privacy rules under the Health Insurance Portability and Accountability Act (HIPAA). The article details the potential negative repercussions of failing to comply with HIPAA and HITECH.
Murphy, J. (2010b). Nursing informatics. The journey to meaningful use of electronic health records. Nursing Economic$, 28(4), 283–286.
This article reviews HITECH and the background leading up to its passage. The author also details the financial incentives intended to assist health care providers in purchasing and implementing HIT and EHR systems.
Optional Resources
U.S. Department of Health & Human Services. (2011). Health IT home. Retrieved from http://www.healthit.gov/ 
U.S. Department of Health & Human Services. (2012). Regulations and guidance. Retrieved from http://www.healthit.gov/policy-researchers-implementers/health-it-rules-regulations

Descriptive Statistics

Week 4 Descriptive Statistics
To prepare:
Review the Statistics and Data Analysis for Nursing Research chapters assigned in this week’s Learning Resources. Pay close attention to the examples presented, as they provide information that will be useful when you complete the software exercise this week. You may also wish to review the Research Methods for Evidence-Based Practice video resources to familiarize yourself with the software.
Refer to the Week 4 Descriptive Statistics Assignment page and follow the directions to calculate descriptive statistics for the data provided using SPSS software. Download and save the Polit2SetA.sav data set. You will open the data file in SPSS.
Compare your data output against the tables presented in the Week 4 Descriptive Statistics SPSS Output document. This will enable you to become comfortable with defining variables, entering data, and creating tables and graphs.
Formulate an initial interpretation of the meaning or implication of your calculations.
To complete:
Complete the Part I, Part II, and Part III steps and Assignment as outlined in the Week 4 Descriptive Statistics Assignment page.
Part I
Using the Polit2SetA data set, run descriptive statistics on the following variables: respondent’s age (age) and highest school grade completed (higrade). Create a frequency distribution for the variables: race and ethnicity (racethn) and currently employed (worknow). Create a table (in APA format) summarizing the results, using the below table shell as a model. Write a paragraph summarizing the information in the table.
Table 1. Demographic Data (N = 30)
n % M (SD)
Age (in years)     30  15(2.4)
Highest School Grade Completed  29  11(1.2)
Race and Ethnicity
Black, Not Hispanic    14 (46.67)
Hispanic       8 (26.67)
White, Not Hispanic      6 (20.0)
Other        2 (6.66)
Currently Employed
Yes      27 (90)
No        3 (10)
Note. Differences in sample size are due to missing data.
Follow these steps when using SPSS:
1. Open Polit2SetA data set.
2. Click on Analyze, then click on Descriptives Statistics, then Descriptives.
3. Click on the first continuous variable you wish to obtain descriptives for (respondent’s age), and then click on the arrow button and move it into the Variables box. Then click on highest school grade completed and then click on the arrow button and move it into the Variables box.
4. Click on the Options button in the upper-right corner. Click on mean, standard deviation, minimum, maximum, and skewness.
5. Click on Continue and then click on OK.
To run the frequency distribution in SPSS, do the following:
1. Click on Analyze, then click on Descriptive Statistics, then Frequencies.
2. Click on the first categorical variable you wish to obtain a frequency for (race and ethnicity), and then click on the arrow button and move it into the Variables box. Then click on currently employed, and then click on the arrow button and move it into the Variables box. Click on the Statistics button in the upper-right corner, then in the Dispersion box click on Minimum and Maximum.
3. Click on Continue and then click on OK.
Assignment: Create a table (in APA format) summarizing the results, using the below table shell as a model. Write a paragraph summarizing the information in the table.
Part II
For the variables respondent’s age (age) and highest school grade completed (higrade) create a histogram with a normal curve displayed over the histogram.
To create a histogram for respondent’s age in SPSS, do the following:
1. Click on Graphs, then on Legacy Dialogs, then Histogram.
2. Click on the variable respondent’s age and then click on the arrow button and move it into the Variables box. Click on the Display Normal Curve button, which is right below the Variables box.
3. Click on OK.
To create a histogram for highest school grade completed in SPSS, do the following:
1. Click on Graphs, then on Legacy Dialogs, then Histogram.
2. Click on respondent’s age in the Variable box and click the arrow to move it back to the box on the left that contains all the variables.
3. Click on the variable highest school grade completed and then click the arrow button and move it into the Variables box. The Display Normal Curve button should alredy be on.
4. Click on OK.
Assignment: Using the data obtained when you ran the descriptives and the histograms, determine whether the data skewed. If so, is it a positive or negative skew?
Part III
Using the Polit2SetA data set, run descriptive statistics on the variable “Family Income Prior Month, all sources” (Income).
Follow these steps when using SPSS:
1. Click on Analyze, then click on Descriptives Statistics, then Descriptives.
2. Click on Family Income Prior Month, all sources, and then click on the arrow button and move it into the Variables box.
3. Click on the Options button in the upper-right corner. Click on mean, standard deviation, minimum, maximum, S.E. Mean (standard error of the mean), and skewness.
4. Click on Continue and then click on OK.
Assignment: Using the descriptive statistics for Family Income Prior Month, all sources (Income), answer the following questions:
1. What is the mean income in this sample?
2. What is the standard deviation?
3. What is the standard error of the mean?
4. Compute a 95% confidence interval around the mean. (Use 1.96 for the 95% CI and get the standard error from the descriptive statistics table). The formula is as follows:
95% CI = [mean ± (1.96 ´ SE)] 5. Compute a 99% confidence interval around the mean. (Use 2.58 for the 99% CI and get the standard error from the descriptive statistics table). The formula is as follows:
99% CI = [mean ± (2.58 ´ SE)] 6. Which interval is wider? Explain.
Review the corresponding Week 4 Descriptive Statistics Exercises SPSS Output document that has the SPSS output for the above problems. Compare your output with the output in the file.
REFERENCES
aureate Education, Inc. (Executive Producer). (2011). Research methods for evidence-based practice: Quantitative research: Data analysis. Baltimore, MD: Author.
Polit, D. (2010). Statistics and data analysis for nursing research (2nd ed.). Upper Saddle River, NJ: Pearson Education Inc.
· Chapter 1, “Introduction to Data Analysis in an Evidence-Based Practice Environment”
Running head: DESCRIPTIVE STATISTICS
 
 
2
DESCRIPTIVE STATISTICS
 

 
 
 
 
 
 
 
 
 
 
 
 
 
Descriptive Statistics
Gloria Okoye
Walden University
 

 
 
 
 
 
DESCRIPTIVES VARIABLES=age higrade
/STATISTICS=MEAN STDDEV MIN MAX SKEWNESS.
 
Descriptives
 
 
 
 
 

 
 
 
 
Frequency Table
 
 
 

 
 
 
The study in this data set was conducted using women in low economic status communities (Polit, 2010). The data in each table represents an occurrence or a trait shared by the women in the group. The results show that women’s ages ranged from 19 to 49 years of age and had completed anywhere from 1 year of school to 16 years. The majority of women were black, followed by Hispanics, whites and other. Out of these women only one had refused to give information on her race or ethnicity. The majority of the women were not employed.
 
PART II

 
 

 
 
In the first histogram, the information is negatively skewed. The long tail is pointed to the left. This histogram shows the respondents ages. In the next histogram is symmetric and can be split down the middle to mirror each half.
 
Part III
Family Income
 

 
 
Questions
 
1. What is the mean of this sample?
2. What is the standard deviation?
3. What is the standard error of the mean?
4. 95% CI =Mean(1,172.59$ +(-)(1.96x.$26.346)=
5. 99%CI=(1,172.59$+(-)(2.58 x $26.346)=
6. What interval is wider ? Explain
Answers
1. $1,172.59
2. $788.153
3. $26.345
4. 1,224.2262,1120.95184=103
5. 1,240.56268, 1,104.61732=135
6. The 99% interval is wider because it covers more possibilities and the likelihood of being correct is greater.
 
Resources
Polit, D. (2010). Statistics and data analysis for nursing research (2nd ed.). Upper Saddle
River, NJ: Pearson Education Inc.

Assignment: Dashboard Analysis And Nursing Plan DUE

Week 5 Assignment: Dashboard Analysis and Nursing Plan
 
Alexis Nicole Runge
 
Walden University
 
NURS 4005/NURS 4006: Topics in Clinical Nursing
 
May 12, 2017
 
 
 
 
 
 
 
 
 
 
 
Dashboard Analysis and Nursing Plan
 
In order for health care facilities to enhance and improve the care they deliver to their patients, they rely on data collected within their facility and from surveys sent out to patients. The information collected is formatted into a quarterly dashboard where goals are set for each quality indicator and then interpreted if the facility met those goals. Through the use of dashboards and quality indicators proactive decisions can be made based on actual events occurring, rather than changing the plan of care based on assumptions. The dashboard is effective in determining particular areas in which improvements would be beneficial to not only the care of the patient but the overall morale of the health care facility. The dashboard is also helpful in strategic planning, where the assessment of performance can be undertaken (Tomlinson, Hewitt, & Blackshaw, 2013). The overall objective of this paper is to analyze areas where the facility excels, and determining a plan of action to improve negative performance by utilizing evidenced based practice.
After carefully analyzing the data presented in this week’s dashboard, communication between the nurses and the patients excels. Nurses develop a good rapport with the majority of their patients and give thorough explanations of the care provided. However, their promptness and attention to detail needs to be an area addressed to improve patient outcomes. Thus, could also be the result of negative data reflected on the dashboard that represents patient safety measures such as falls, pressure ulcers, mislabeled specimens and uncontrolled pain. Patient safety is crucial in the plan of care and if not carefully addressed could lead to adverse events and outcomes.
Paying attention to details is important for avoiding errors, maintaining efficiency, preventing injuries, making a good impression and analyzing information. Attention to detail improves accuracy in performing tasks. Preventing errors is valuable when providing care to all patients. Careful management of details contributes to overall efficiency and success in the healthcare facility. Reducing errors also contributes to patient satisfaction. By developing a nurse-patient relationship you are able to address needs and concerns of the patient, as well as pick up on detail-oriented cues that will need implemented for each individual patient in order to maintain a balance of trust and communication during the patients stay.
Attention of detail leads to patient safety. Patient safety throughout the hospital should be developed by the leadership. Leadership assumes a role in establishing a culture of safety that minimizes hazards and patient harm by focusing on processes of care. The leaders of the organization are responsible for fostering an environment through their personal example; emphasizing patient safety as an organizational priority; providing education to medical and hospital staff regarding the commitment to reduction of medical errors; supporting proactive reduction in medical/health care errors; and integrating patient safety priorities into the new design and redesign of all relevant organization processes, functions and services (IHI, 2017).
There are many quality indicators that fall into the category of patient safety such as: medication errors or adverse events, pressure ulcers, falls, restraint use, nosocomial infections, VTE, etc. Various tools can be set in place to ensure adequate monitoring of these areas to protect the patients and the facility. Conducting a thorough head-to-toe physical examination on admission is a high priority. Patients come into the hospital and we treat their presenting symptoms, however many times there may be an underlining problem that needs addressed to ensure an optimal outcome and patient experience. A full physical assessment gives you a thorough picture of the patient’s condition.
Best practice would be to conduct a fall risk assessment and a skin risk assessment on each patient every shift or as needed if there has been a change in the patient’s condition. With a fall risk assessment, it can determine what interventions need put in place to ensure patients are free from physical injury while in our care. The fall risk assessment we use at our facility is similar to the one presented by John Hopkins, called the JHFRAT (Hopkins Medicine, 2017). The fall risk assessment tool addresses various patient safety indicators such as: age, history of falls within 6 months, elimination of bowel and bladder (incontinence, urgency or frequency), medications (PCA/opiates, anticonvulsants, antihypertensive, diuretics, hypnotics, laxatives, sedatives, psychotropic, etc.), use of patient care equipment (IV infusion, chest tube, indwelling catheter, SCDs, etc.), mobility (unsteady gait or needs assistance), sensations (decrease in hearing, vision, etc.), and cognition (impulsive behavior, sedation, or altered mental status). If the patient scores greater than 6 then they are required to wear fall risk socks, fall risk bracelet, and bed/chair alarms are put in place. This is a great tool as we can reassess it multiple times throughout the day to ensure the safety of the patient and decrease the rate of falls on our dashboard to improve quality indicators. It also shows the patients that we are concerned for their safety and are putting all measures of safety in place to ensure a positive outcome.
Another best practice tool we can utilize would be the skin risk assessment to prevent and manage pressure ulcers. The Braden Scale for predicting pressure sore risk is a clinically validated tool that allows nurses and other health care providers to reliably score a patient/client’s level of risk for developing pressure ulcers. It measures functional capabilities of the patient that contribute to either higher intensity and duration of pressure or lower tissue tolerance for pressure. Lower levels of functioning indicate higher levels of risk for pressure ulcer development (NLM, 2013). The Braden Scale uses various categories to determine the patient’s skin risk such as: sensory perception (ability to respond meaningfully to pressure-related discomfort), moisture (degree to which skin is exposed to moisture), physical activity (degree of physical activity), mobility (ability to change and control body positions), nutrition (usual food intake pattern), and friction and shear risk. A score of 18 or below alerts the nurse that the patient may be at risk for pressure areas, a score 9 or less determines that the patient is high risk. Interventions should be put in place to prevent pressure ulcers for at risk patients. The nurses should be required to inspect patients skin each shift, manage moisture on the skin, conduct a skin risk assessment each shift or as needed if there is a change in the patient’s condition, minimize pressure to bony prominence by reposition patient every 1-2 hours, increasing nutrition intake and hydration (if the patient is unable to consume these orally then intravenous methods need to be implemented). By completing each of these steps for all patients it will prevent secondary diagnosis and prolonging of patient stay. Maintaining skin integrity will increase the patient’s outcome and satisfaction.
Through the use of quality indicators and data collection we have the ability to improve our patient satisfaction and the care we deliver on a daily basis. By utilizing best practices to maintain patient safety and recognizing the needs and concerns of our patients we can achieve high standards. We must realize though that perfect scores across the dashboard is unrealistic. Health care and evidenced-based practices are always changes and the care we are providing is becoming more acute. By continuing our education and having our patient’s safety as our number one priority we will continue to excel in the health care continuum.
 
 
 
 
 
Reference
Tomlinson, P., Hewitt, S., & Blackshaw, N. (2013). Joining up health and planning: How Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning. Perspectives In Public Health, 133(5), 254-262. Retrieved from: http://dx.doi.org/10.1177/1757913913488331
Institute for Healthcare Improvement. (2017). Patient Safety Plan. St. Francis Health System: St. Joseph Medical Center. Bloomington, Illinois. Retrieved from: http://www.ihi.org/resources/Pages/Tools/PatientSafetyPlan.aspx
Hopkins Medicine. (2017). Fall Risk Assessment: JHFRAT. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieved from: http://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html
National Library of Medication. (2013). Braden Scale. National Institutes of Health, Health & Human Services. Retrieved from: /orders/www.nlm.nih.gov/research/umls/sourcereleasedocs/current/LNC_BRADEN/

Discussion: Diversity And Health Assessments

Discussion: Diversity and Health Assessments
May 2012, Alice Randall wrote an article for The New York Times on  the cultural factors that encouraged black women to maintain a weight  above what is considered healthy. Randall explained�from her  observations and her personal experience as a black woman�that many  African-American communities and cultures consider women who are  overweight to be more beautiful and desirable than women at a healthier  weight. As she put it, �Many black women are fat because we want to be�  (Randall, 2012).
Randall�s statements sparked a great deal of controversy and debate;  however, they emphasize an underlying reality in the healthcare field:  different populations, cultures, and groups have diverse beliefs and  practices that impact their health. Nurses and healthcare professionals  should be aware of this reality and adapt their health assessment  techniques and recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic,  spiritual, lifestyle, and other cultural factors that should be taken  into considerations when building a health history for patients with  diverse backgrounds. Your Instructor will assign a case study to you for  this Discussion.
CASE STUDY:
EB is a 68-year-old black female who comes in for  follow-up of hypertension. She has glaucoma and her vision has been  worsening during the past few years. She lives alone and is prescribed  four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL  200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily ). She  brings in her medication bottles and she has some medication bottles  from the previous year full of medications. She is missing one  medication she had been prescribed and says she may have forgotten it at  home. Her BP in clinic today is 182/99 with HR of 84.
To prepare:
� Reflect on your experiences as a nurse and on the information  provided in this week�s Learning Resources on diversity issues in health  assessments.
� By Day 1 of this week, you will be assigned a case study by your  Instructor. Note: Please see the �Course Announcements� section of the  classroom for your case study assignment.
� Reflect on the specific socioeconomic, spiritual, lifestyle, and  other cultural factors related to the health of the patient assigned to  you.
� Consider how you would build a health history for the patient.  What questions would you ask, and how would you frame them to be  sensitive to the patient�s background, lifestyle, and culture? Develop  five targeted questions you would ask the patient to build his or her  health history and to assess his or her health risks.
� Think about the challenges associated with communicating with  patients from a variety of specific populations. What strategies can you  as a nurse employ to be sensitive to different cultural factors while  gathering the pertinent information?
Post an explanation of the specific socioeconomic, spiritual,  lifestyle, and other cultural factors associated with the patient you  were assigned.
Explain the issues that you would need to be sensitive to  when interacting with the patient, and why.
Provide at least five  targeted questions you would ask the patient to build his or her health  history and to assess his or her health risks.
NOTE: THIS IS THE LINK TO DOWNLOAD THE BOOK
/orders/www.sendspace.com/file/wd7quh
Required Readings
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
 
· Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)
This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.
 
· Chapter 2, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
 
· Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605
Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.
 
The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.
Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from /orders/npin.cdc.gov/pages/cultural-competence
 
This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from /orders/cccm.thinkculturalhealth.hhs.gov/
 
From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311. /orders/doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2013.301798
Note: You will access this article from the Walden Library databases.
 
The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.
Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120.
Note: You will access this article from the Walden Library databases.
 
The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.
 

Developmental Red Flags

Developmental Red Flags
 
Case Study 1:/nurs-6501-week-1-module-1-adv-pathophysiology-assignment-case-study-analysis/
 
A mother brings in her 16-month-old, Brittany, for treatment of an acute illness. During the history, the mother reports that her mother-in-law is concerned about the toddler’s development. Further questioning reveals the following:
 
•Brittany was a term infant born vaginally with no intrapartum complications. Birth weight was 8 pounds 1 ounce and current weight is 26 pounds 9 ounces.
 
•She was breastfed until 12 months of age and now drinks 24 ounces of whole milk and eats table foods daily.
 
•Physical milestones are as follows: Rolled front to back at 6 months, developed pincer grasp at 11 months, crawled at 8 months, and began cruising at 10 months. She does not walk independently.
 
•Social development includes mimicking adult behavior, four-word vocabulary (mama, dada, baba, and no), follows one-step commands, and quiets easily when comforted.
 
 
 
To prepare:
 
•Review this week’s media presentations, as well as “Developmental Management of Infants” and “Developmental Management of Toddlers and Preschoolers” in the Burns et al. text.
 
•Think about how physical, social, and cognitive development vary during infancy, toddlerhood, and the preschool years. Reflect on normal versus abnormal growth and development and consider the decision-making process of identifying and managing red flags of abnormal development.
 
•Select one of the three case studies provided. Reflect on the patient information included in the case study and consider any developmental red flags.
 
•Reflect on standardized screening tools, clinical guidelines, and management strategies that would be used to assess and manage the patient in your selected case study.
 
 
 
Post    2 discussion page paper on :An explanation of any developmental red flags that presented in the case study you selected based on the stages of normal physical, social, and cognitive development for infants, toddlers, and preschoolers. Explain how you differentiated between normal and abnormal growth and development for this patient and identify which standardized screening tools, clinical guidelines, and management strategies you might use to assess and manage this patient and why
 
REFERENCES
 
Readings
 
• Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
 
◦ Chapter 5, “Developmental Management of Infants” (pp. 59–75).
 
◦ Chapter 6, “Developmental Management of Toddlers and Preschoolers” (pp. 76–91
 
◦ Chapter 11, “Breastfeeding” (pp. 186-201)
 
Chapter 17, “Role Relationships” (pp. 334–344)
 
Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics
 
Infancy” (pp. 253–380)
 
◦“Early Childhood” (pp. 381–461)
 
 
 
Media
 
•Laureate Education (Producer). (2013c). Strategies for determining red flags. Retrieved from /orders/class.waldenu.edu

Wk 9 10 Inform Assign

Portfolio Assignment: The Role of the Nurse Informaticist in Systems Development and Implementation
Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team.
To Prepare:
· Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented.
· Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology.
The Assignment: (2-3 pages)
In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps:
· Planning and requirements definition
· Analysis
· Design of the new system
· Implementation
· Post-implementation support
· Let your citations match your references
Submit your completed Role Description.
Submission and Grading Information
· RUBRIC

Name: NURS_5051_Module05_Week10_Assignment_Rubric

Walden Module 6 Pathophysiology Knowledge Check

QUESTION 1 – 4 
A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling.
Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.
Question 1 of 4:
Describe the positive symptoms of schizophrenia and relate those symptoms to the case study patient.
Question 2 of 4:
Explain the genetics of schizophrenia.
Question 3 of 4:
The APRN reviews recent literature and reads that neurotransmitters are involved in the development of schizophrenia. What roles do neurotransmitters play in the development of schizophrenia?
Question 4 of 4
The APRN reviews recent literature and reads that structural problems in the brain may be involved in the development of schizophrenia. Explain what structural abnormalities are seen in people with schizophrenia.
QUESTION 1 – 6
A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.
Question 1 of 6:
Discuss the role genetics plays in the development of bipolar 2 disorders.
Question 2 of 6:
Explain how the hypothalamic-pituitary-adrenal (HPA) system may be associated with bipolar type 2 disease.
Question 3 of 6:
Discuss the role inflammatory cytokines play in the development and exacerbation of bipolar type 2 symptoms
Question 4 of 6:
Discuss the role of the amygdala in bipolar disorder.
Question 5 of 6:
How does neurochemical dysregulation contribute to bipolar disorders?
Question 6 of 6:
What is the current status of the use of nutraceuticals in management of depression?
QUESTION 1 – 2 
A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something “terrible is going to happen”. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack.
Question 1 of 2:
What are panicogens and how do they contribute to the development of panic attack symptoms?
Question 2 of 2:
How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders?
QUESTION 1 – 2 
A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semester’s end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD).
Question 1 of 2:
Describe the areas of the brain that are associated with social anxiety disorder.
Question 2 of 2:
How is oxytocin associated with SAD?
QUESTION 1 – 2 
A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD).
Question 1 of 2:
Discuss the role of neurotransmitters in the expression of GAD.
Question 2 of 2:
Explain the structural brain changes that occur in people with GAD.
QUESTION 1 – 2 
A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq. He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD).
Question 1 of 2:
Describe the changes seen in the brain structure in patients with PTSD.
Question 2 of 2:
Briefly discuss the role glucocorticoids may have on the development of PTSD.
QUESTION 1 – 2 
A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).
Question 1 of 2:
What is primary pathophysiology of OCD?
Question 2 of 2:
Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors