NURS 3005 – Nursing in Complex Settings

NURS 3005 – Nursing in Complex Settings

NURS 3005 – Nursing in Complex Settings

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

(Prerequisite(s): NURS 3000.)

NURSING 3005 – Nursing in Complex Settings Essay Papers – Note

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

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

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

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

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

 

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

NURS 3005

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NURSING 3005 – Nursing in Complex Settings Essay Papers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Integrated data repository

Example IDR schema

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Current state and policy initiatives

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

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

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

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

Provincial and territorial programmes include the following:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In China

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Case Studies

ETC

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

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

Annex 1. Scope and Purpose

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

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

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

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

Editor: Sari Helena Räisänen, Helsingin Yliopisto, FINLAND

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Fig 1. Flow diagram of the study selection process.

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

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

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

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

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

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

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

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

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

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

*Only for diabetic patients.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Table 1.
Clinical domains in the interRAI Acute Care.

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

Table 2.
Applications derived from the interRAI Acute Care.

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

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

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

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

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

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

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

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

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

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

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

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

DESIGN:
Integrative review.

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

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

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

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

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

This unit of study is not available in 2019

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

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

This unit of study is not available in 2019

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

This unit of study is not available in 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tertiary care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health information technology components:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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