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 A strategic plan is a document used to structure and communicate organizational goals. It is also used to mitigate risks and alleviate the potential for legal cases. Barbara receives information that there is an additional, more pressing issue at a satellite clinic that is not documented in the original UCCO case. This issue relates to the emergency care clinic, which is used to treat patients with trauma-related injuries. The clinic has been over-utilized for the past year, resulting in stressed staffing, overwhelming costs, and decreasing quality of patient care and customer satisfaction. Staff productivity is affected by use of personal cell phones and clinic equipment is often used for social media.

In one particular case, a 13-year old patient was seen for trauma care by the UCCO Emergency Clinic. The patient’s parents make it clear to the staff that they are not willing to give consent to any procedure involving blood products or transfusion. The risks are explained to the parents. The patient arrived unconscious but shortly regains consciousness. After the parents leave the room, the patient tells the nurse that she is afraid of dying and would like any care, including blood procedures and products, to save her life. The nurse later finds out that the rejection by the parents was due to religious reasons. The nurse quickly discusses the case with fellow employees, one of which posts comments on her social media page using a clinic-owned computer. The nursing director give a verbal warning to all involved nurses and staff.

Visit the Rasmussen online Library and search for a minimum of 3 articles covering the topics of ethics, healthcare professionalism, and federal legislations. Conduct academic research using the library’s databases, like:

• CINAHL
• Discovery
• Business Source Complete via EBSCO
• Business via ProQuest

In the databases use basic search languages (controlled vocabulary/keywords) to determine ethics laws specific to this situation. Some keywords to consider are healthcare professional code of ethics. Then, refine your searches based on your search results. Make sure to include a minimum of 3 credible, academic sources in your paper.

Using your research, address the following points in a minimum of 3-page report:

• Was the nursing manager legally compliant with to protect patient information? Explain the legal risks and support with federal legislations and professional expectations, such as HIPAA and professional codes of ethics.
• What bearing does the age and religious requests have on the patient’s case? Are there medical and ethical laws that supersede the parent’s requests?
• What is the role and importance of communication among UCCO facilities, particularly in reference to compliance and ethical standards?
• What are the ethical and professional factors of using social media?
• Were the reactions to the patient’s case illegal, or just unethical? How does this align with UCCO’s mission, values, and strategic action plans? How does it compare to your own personal beliefs and values?

Healthcare Policy Case Scenario: A 45-year-old female has requested a copy of her 80-year-old father’s health record. She has presented a power-of-Attorney (POA) and has a legal right to access his records. You provide a copy to the woman, but she has many questions regarding documentation of her father’s diagnosis. He has a Living-Will but the daughter does not have the right to make medical decisions. He was admitted to the intensive-care-unit (ICU) last week from the skilled nursing facility. When discharged, he was transferred to a long-term care facility that is part of the same healthcare system.

Instructions:

1. Explain the continuum of healthcare delivery across systems and services. 

2. Use the case scenario to provide examples of a continuum of care in a healthcare system.

3. Evaluate the case and impact of policies on healthcare delivery.

4. Determine one U.S. federal, one state, and one local level healthcare policy that may impact the case.

5. Evaluate the impact of the patient’s age, the relationship of the requestor, and the POA for health record access.

6. Assess the impact of a Living-Will and why the daughter may/may not have the right to make medical decisions.

7. Interpret each policy, in relation to the case.

8. Justify your rationale for applicable policies.

9. Evaluate how the policy affects national and global health delivery systems, both directly and indirectly.

Please answer the attached 

Using Power Point presentation describe the clinical manifestations, physical findings, and clinical management of the Urinary Tract Obstructions. 

Signature Assignment: Medicare and Medicaid

Consider how people qualify to receive Medicare and/or Medicaid and write a paper that addresses the bullets below. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Start your paper with an introduction and include a “Conclusion” section that summarizes all topics. This paper should consist of at least 1750 words and no more than 2000.

This week reflect upon the Medicare and Medicaid programs to address the following:

• Describe      the Quality Improvement Organization (QIO) and explain how the QIO      improves policies and healthcare for Medicare beneficiaries.  
• Briefly      define the qualifications for Medicare and Medicaid benefits. How can      qualifications be modified to serve more people who are considered a      vulnerable population?
• Discuss      the impact (including at least two positive and two negative aspects) that      the ACA has had on benefits and coverage for Medicare and Medicaid      recipients. 
• Describe      your role(s) as a healthcare leader as it applies to the practice of      advocating for cost effective care for vulnerable populations.

Assignment Expectations

Length: 1750-2000 words in length

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

CIS450 Assignment Mod 8:

Signature Assignment Title: Informatics in Healthcare

Signature Assignment Description/Directions:

Beginning in Module 1 of this course you have been researching a healthcare informatics topic of your choice. Now you will present your findings in a 7 to 12 minute recorded presentation complete with PowerPoint slides (no length requirement). 

• Discuss      your topic and its relationship to your current (or future) practice.      Discuss why the topic is important in healthcare informatics. 
• What      research have you have found on the topic? Describe how each scholarly      article relates to the topic and your current (or future) practice.      Describe what conclusions you have drawn based on your research of the      topic.
• What      ethical or legal issues does this topic present?
• Create      a plan for implementing a change (or justify the need for no change). Who      needs to be involved? What training programs are needed? Is there a need      for on-going training? Discuss how you would evaluate the success of the      change (or the continued success of what you are currently doing). What is      the cost to implement or maintain this change? Who will be financially      responsible? How feasible is this change?
• Finally,      identify how changes in public policy and technological advances in the      future could impact this topic. What would those changes mean to the      healthcare industry?  

Assignment Expectations

Length: Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time.

Structure: Include a title slide, objective slide, content slides, reference slide in APA format. 

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Monica Cooper (6052) Week 8 /Module 5 – Initial Posting by Monica M. Cooper: Patient Preferences and Decision Making

I previously managed a weight loss prevention program at a long-term care facility for three years.  Considering that weight loss is one of the most significant risk factors for mortality amongst older adults, patient interventions were implemented, received, and revised to ensure optimum patient outcomes.  The Registered Dietitian would recommend patients who were experiencing weight loss to have all meals served in the formal dining rooms vs. their private rooms.  Incorporating this invention had positive benefits such as close supervision and meal consumption monitoring, but it completely removed all autonomy from the patients.  As stated by Lindberg et al. 2018, it is a moral duty for staff to be more attentive to their personal traits, conditions, and wishes, generating opportunities for patients to be more participatory and with greater potential to influence their care.

The patient preference I suggested to the interdisciplinary team to counter negative consequences was to start an “all hands on deck” approach at mealtimes.  No matter their role or position, every employee was assigned designated units for which rounds were made at each meal.  This approach allowed for increased visibility of patients’ in their living quarters and monitoring meal consumption for all patients and not just for those experiencing weight loss.  The patients were happy, and so were their families.  Some family members even partook in their loved one’s treatment plan by making intentional visits at mealtimes.  For example, there was one patient whose daughter would visit at breakfast.  Her grandson would visit at lunch and another at dinner.  Meal consumption increased, making including the family a bonus!

According to Latenstein et al. 2020, decision aids present comparative information about the advantages and disadvantages of available options and evaluate the patient’s values and preferences.  They are proven to effectively improve knowledge, reduce decisional conflict, and change patients’ preferred treatment (Latenstein et al., 2020).  While decision aids do not assure compliance to treatment, they present a realistic overview of personalized guidelines for condition management. 

I chose the Malnutrition: Options to Limit Weight Loss in Older Adults decision aid (OHRI, 2019).  The aid’s value is relatively practical as it offers general information and specific recommendations based on preference.  I could not apply it to the exact experience I described; however, I completed it for myself as my eating habits are not satisfactory.  My appetite fluctuates depending on high busy I am.  I usually skip breakfast, and other days I only eat one meal.  After exploring my options, I made an informed choice to incorporate oral nutritional supplements into my diet.  They can be taken as a liquid supplement or as fortified food once or twice a day, between meals.

I might use this decision aid inventory further in my personal life by sharing it with friends who also struggle with meal imbalances.  I do understand that it is unhealthy to skip meals as it increases fatigue and other health concerns.  The decision aid helped me have a starting point to rectify my poor eating habits, and I think it would be beneficial to others.

Latenstein, C. S. S., Thunnissen, F. M., Thomeer, B. J. M., Wely, B. J., Meinders, M. J., Elwyn, G., & Reuver, P. R. (2020). The association between patients’ preferred treatment after the use of a patient decision aid and their choice of eventual treatment. Health Expectations, 23(3), 651–658. https://doi-org.ezp.waldenulibrary.org/10.1111/hex.13045

Lindberg, C., Fagerström, C., & Willman, A. (2018). Patient autonomy in a high‐tech care context—A theoretical framework. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 27(21–22), 4128–4140. https://doi-org.ezp.waldenulibrary.org/10.1111/jocn.14562

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

Tiffany Dennis

main post

Being a mental health nurse, I have often found myself being the patient advocate because some healthcare workers believe that patients with mental illnesses do not have the same right as patients being treated in the hospital for any other medical reason. Evidence-based medicine (EBM) and shared decision making (SDM) should co-exist; however, this concept is not appreciated. SDM is the clinician and patient process jointly participating in a health decision after discussing the options, the benefits, and harms, and considering the patient’s values, preferences, and circumstances (Hoffmann et al., 2014). Sadly, this is the first time I have heard of decision aids, and I have been a nurse for 13 years. Position aids are used to increase a patient’s knowledge of options, improve awareness concerning medication and non-medicinal options; it provides a sense of comfort and control for patients (Melnyk & Fineout-Overholt, 2018). Often in an acute psychiatric setting, we receive patients in acute psychosis or mania. When the patient is in a state of mind, it is challenging to discern between reality and delusions.

One time I remember a very physically fit and robust patient arriving at the unit out of control. The drug of choice in this situation was to administer a Thorazine injection stat. The patient kept yelling; I cannot take that; I cannot take that. I am allergic to that medicine. Of course, the nurse assumed the patient was lying and did not want to be sedated; therefore, the medication was given regardless after a glance to make sure that the medicine was not an allergy listed on the transfer paperwork. Within minutes after the injection, the patient had an adverse reaction. Once the nurse had the opportunity to look over the patient’s history, Thorazine was listed as an allergy with a severe reaction. In this particular situation, if the nurse would have just taken a little longer to research or allow the patient to speak and validate the patient concerns and contact the physician for another medication, perhaps the patient would not have required a higher level of care and lapse in the treatment of the acute mental illness. It is vital to include patient preferences and values while providing nursing care.

Especially in mental health because most of the time, patients are admitted on an involuntary basis. Allowing the patient to be a part of the treatment and hearing a doctor’s reasoning behind medication changes could improve medication compliance. I did not find a decision aid for Schizophrenia, but I did see one on Bipolar II. The Bipolar II decision aid is broken down into three main sections, medications, psychological options, and making decisions. It is designed to help patients and their families decide about treatment and prevent relapse (Bipolar II DECISION AID, 2019).  A rule of thumb that has stuck with me since nursing school is that if a patient questions a procedure, medication, or statement, “this is not what I usually take,” is always to pause, re-look, and double-check. I can utilize these positions aids to help educate patients and also as resources during nursing education groups.

References

Bipolar II DECISION AID. (2019). The Ottawa Hospital Research Institute. Retrieved October 20, 2020, from https://www.bipolardecisionaid.com.au/guideline/introduction.html

Hoffmann, T., Montori, V., & Del Mar, C. (2014). The Connection Between Evidence-Based Medicine and Shared Decision Making. Journal of the American Medical Association, 312(13), 1295–1296. https://doi.org/10.1001/jama.2014.10186

Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

3 SOURCES ON EACH DISCUSSION

 What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.  

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

 Scenario 1:    You see another nurse practitioner writing a prescription for her husband, who is not a patient of the nurse practitioner.  The prescription is for a narcotic.  You can’t decide whether or not to report the incident. 

• Review the scenario assigned.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state (Texas) or region, and reflect on these as you review the scenario assigned by your Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

Write a 2- to 3-page paper that addresses the following:

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state (Texas)
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. 
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

As  a nurse leader, you have been assigned a new initiative project. What steps would you take to ensure that you are using all the components of evidence-based practice? Explain why each step is essential.

To prepare

• Review the information that Dr. Hathaway presents in the Week 1 media program, “Theoretical Foundation for Research,” regarding the phases of theory development and the similarities and differences between frameworks and theories.
• Search the literature and identify two frameworks/theories that may be useful for investigating your phenomenon of interest.
• Review the procedure for theory analysis presented in Chapter 12 of Walker and Avant (2019). Apply these steps to each framework/theory you have selected and identify the strengths and weaknesses of each framework/theory. Determine whether additional development or refinement is needed (i.e., for each framework, identify which aspects would require further research in order for it to meet the requirements of a theory).
• Evaluate the value of each framework/theory for addressing your phenomenon. Determine which framework/theory has the most potential for use as part of your theoretical foundation of your research.
• Think about any questions you have related to theory analysis and evaluation.

By Day 3

Post a description of the two frameworks/theories you analyzed and evaluated, and explain why each is considered either a framework or a theory. For framework(s) you have selected, explain which aspects would require further research to meet the requirements of theory. Explain why one has the most potential for use in your theoretical foundation for research, noting its strengths and weaknesses. Also pose any questions that have arisen through your examination of frameworks/theories.