Change is part of our daily healthcare environment. Clinical nursing judgments based on quality and safety, as well as protocols and standards, reflect our patient-centered care values.

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Purpose

This week’s graded topic relates to the following Course Outcome (CO).

CO4: Integrates clinical nursing judgment using effective communication strategies with patients, colleagues, and other healthcare providers. (PO#4)

Discussion

Change is part of our daily healthcare environment. Clinical nursing judgments based on quality and safety, as well as protocols and standards, reflect our patient-centered care values.

  • What steps could you take to develop more resilience in your practice setting?
  • How might you communicate a change in practice to patients and nursing peers?

Professor’s comment:

Class please discuss clinical nursing judgments based on safety and quality of care.

references: American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

American Nursing Association [ANA]. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: American Nurses Publishing

An outline is a short plan of the paper. It is usually presented in the form of a bullet point list where each bullet represents a separate paragraph. An outline has to help the customer complete the future paper, so it must have a clear structure and logically connected ideas.

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  • Type of paperOther
  • SubjectSport
  • Number of pages25
  • Format of citationAPA
  • Number of cited resources0
  • Type of serviceEditing

Instructions will be uploaded later.

Additional Service

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Essay outline

An outline is a short plan of the paper. It is usually presented in the form of a bullet point list where each bullet represents a separate paragraph. An outline has to help the customer complete the future paper, so it must have a clear structure and logically connected ideas.

Progressive delivery

With progressive delivery, you have an additional deadline by which you have to provide a first half of the paper for the customer. The customer may evaluate this work and add his or her commentary.

Hemoglobin AIC test tells you your average level of blood sugar over the past 2 to 3 months. Diabetic patients need this test to tell if their levels are staying within range. The target A1c for people with diabetes is usually less then 7%. A patient’s AIC level will also let the Doctor know dependent upon the patient’s range if the patient’s Diabetic medication needs to be adjusted. It can also be used to diagnose diabetes.

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For this assignment you will need to revisit previous chapters.

1. Think of a time where you yourself has utilized this process or as witnessed it being implemented.

2. Compose a 2 -3 page paper (APA format) demonstrating the correct usage of the five step problem-solving process.

3. Submit this assignment in the discussion section.

THIS IS CLEARLY FOR AN EXAMPLE NOT TO BE USED FOR MY WORK NOR OTHER OR SHOWN PUBLICLY.

The Problem-Solving Process

In this report I will talk about how we used this process in our Family Medicine Clinic to track our Diabetic that were not coming back to have their Hemoglobin AIC checked every 6 months. And this was causing our clinic to have a failing score on our Hedis Measures.

Hemoglobin AIC test tells you your average level of blood sugar over the past 2 to 3 months. Diabetic patients need this test to tell if their levels are staying within range. The target A1c for people with diabetes is usually less then 7%. A patient’s AIC level will also let the Doctor know dependent upon the patient’s range if the patient’s Diabetic medication needs to be adjusted. It can also be used to diagnose diabetes.

Hedis Measures is a set of comprehensive performance measures used to identify opportunities for improvement. Our patient’s AIC needs to be below 7 and most was ranging form 7 and up. Our clinic average should be about 95% and we were between 78%-85%.

Identifying the problem

We found that most out that patient’s did not want to come into the office just to have that test done. But because the way the system was set up. They could not have the A1c done without seeing the Doctor and then Doctor will then place the order for the patient to have the A1c test done.

Gathering Information

We sent out surveys to all of patients how to improve this process and how we could make it easier for them to come and get their A1c’s done. The majority of the patient’s had the same complaint. They did not feel as it though it was necessary for them to have to come in for a Doctor’s visit just to have that test done. After evaluating all of the patient surveys and noticing the one issue that most had was the same which was most of them did not want to come in for a visit just to have that test done. They wanted to just be able to go straight to the lab and get tested.

Choose and Alternative and take action

After evaluating all of the patient surveys and noticing the one issue that most had was the same which was most of them did not want to come in for a visit just to have that test done. They wanted to just be able to go straight to the lab and get tested. We came up with a program called the Diabetic honor program. This program allowed for patients to report directly to the lab for their A1c testing up to twice a year. As long as they were in range there was no need for them to come in for a visit until it was time for their annual visit. This program also allowed the patients to go the pharmacy and pick up their diabetic supplies minus medication without having to come in and see the Doctor.

Evaluate and revise as needed

After revaluating this program after a month period, we found that it is working. Our clinic Hedis Measure for our Diabetic patients getting their A1c done was on the rise and we were just above our goal of 93% in just a six month period. We then evaluated the program at a year point and we had surpassed our goal of 95% and was at 96.5%. The program implementation of the Diabetes Honor Program has been working and we did not need to do any revision to the program.

PLEASE DO NOT PLAGIARIZE!!!!

Identify, explain, and assess the critical failures of the Articles of Confederation

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  Prior to the start of the American Revolution, the British imposed a series of legislative actions on the colonies to extract profit. The colonists reacted to these legislative actions while attempting to remain British citizens. Identify, explain, and assess three, legislative actions imposed on the colonists and the subsequent colonial reactions. 

2. Identify, explain, and assess the critical failures of the Articles of Confederation

Mary Roach tackles the most pondered and least understood conundrums that have baffled humans for centuries

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Mary Roach tackles the most pondered and least understood conundrums that have baffled humans for centuries. Based on the TED video by Mary Roach. Analyze and explain 10 things you did not know about orgasm. What did you learn? You must provide four paragraphs. Use the APA format. (Do not plagiarize)

Give detailed answers and cite a minimum of 2 references (1 can be textbook) appropriately in-text. Follow APA guidelines.

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Discussion Question #2 :

  1. You are a new administrator at Jonestown Medical Center. You receive a telephone call from the nurse manager of the emergency room. Dr. Smith, an emergency room physician who is an employee of your hospital, has just reported for duty. The nurse manager suspects that Dr. Smith is intoxicated. What do you do?

  2. You are the practice manager of Docs R Us, Ltd., a large multispecialty medical practice employing more than 100 physicians. You are conducting a random review of billing for doctors in the practice and you discover that one of the internists in your group who treats mostly Medicare recipients has been checking off the wrong code for her procedures on the billing form. The procedures on the patient record do not match the billing form codes. You pull up her files for the past 3 months and find a pattern of upcoding. When you meet with her to review this miscoding, she becomes very defensive and angry. What do you do? How could you have prepared better for the meeting with the physician?

  3. You are a new administrator at a hospital, well known for pulmonary medicine. The physicians in the ICU, the ER, and the department of pulmonary medicine have demanded to meet with you about the shortage of respiratory therapists. You stall them for 48 hours so you can gather data. What types of information will you need to collect to have an intelligent conversation with this powerful group of physicians?

  4. Dr. White ordered an unusual dose of a medication. May Patterson, RN, sees the order and believes it to be the wrong dose. She calls Dr. White, who insists that she give the medication—as written. Nurse Patterson calls you, the administrator on call for the weekend, to resolve this crisis. What do you do?

Give detailed answers and cite a minimum of 2 references (1 can be textbook) appropriately in-text. Follow APA guidelines.

S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her individual psychotherapy 3 months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.

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MODULE 07 CASE STUDY

S.is a 48-year-old divorced woman with one adult daughter and three grandchildren. She is currently working as an LPN part-time in a nursing home and also works at a convenience store one or two days per week. She has had many jobs over the last 22 years, usually changing every one or two years. S notes that she has been called less often to work in the convenience store and worries that they don’t like her anymore. She reports being written up several times for arguing with customers. She also reports that her supervisor at the nursing home “is a bitch”; although she really liked her supervisor at first, she says “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get fulltime jobs five times in the last four years, was hired for three, but only lasted one or two weeks at each one.

S. reports that she is currently not talking to her daughter because “she is horribly mean to me and she needs to apologize or I won’t talk to her again”. She is upset that she hasn’t seen her three small grandchildren in about a year. She sends them presents and cards frequently that says “I still love you! Grandma”, but hasn’t called them since she stopped talking to her daughter. She is considering reporting to the county that her daughter is keeping her grandchildren from her.

S. is very unhappy that she isn’t in a relationship. She was abused by her ex-husband and has a pattern of meeting and dating men who eventually abuse her. She states that her last relationship was very good, however; the man was not abusive and “I loved him very much”. The relationship ended for reasons that S. doesn’t understand, although she does report many arguments that ended in “scenes” such as her throwing chairs, stomping out of the house, making crank phone calls to his family, and calling the police with false reports. But S. also reports that she “couldn’t have loved him more and I showed it”. She gives examples of going to her boyfriend’s place of work with flowers, buying him expensive presents, surprising him with tickets to Mexico at the last minute – she was very upset that he wasn’t willing to drop everything and go with her. S. reports asking him why he didn’t love her and what she was doing wrong on a regular basis. When the boyfriend asked to break up, S. reports sitting outside his house for weeks, crying; she called his mother, called his boss, and called and texted him until he filed a restraining order. This occurred about 4 months ago.

S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her individual psychotherapy 3 months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.

Questions:

Read the case study about Borderline Personality Disorder and answer the following questions in your initial posting:

1. How would you use therapeutic communication and the principles of cognitive-behavioral therapy with the client?

2. Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and appropriate nursing intervention.

3. What interdisciplinary referrals might be appropriate?

Your paper must adhere to APA standards in formatting . Additionally, your paper must be 2,500 words or more and use at least 5 scholarly references in support. Be sure that you list your references per APA and cite each reference at least once

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You are on an IT management/leadership team in a medium size IT organization and are responsible for three engineering teams. Your teams are implementing about 15-20 projects per year for the company, and also provide support and maintenance of current systems. While your teams have been successful in project delivery overall, you have to constantly shift people from project to project to meet multiple competing timelines. The engineers are overworked and stressed, and any small delay or problem impacts multiple project deliveries. Your engineers are also reminding you that some of the core technologies your systems are built on are getting old and will need upgrades or completely different technical approaches. Their preliminary analysis also shows that upgrading or replacing core technologies will result in the need to reengineer some of your existing systems, so that teams can better support current and future projects as well as take advantage of the new technologies. A new CIO has recently joined your company and has assembled a committee to determine and prioritize the necessary changes in IT processes, technologies, and approaches to project delivery. You have been invited to participate in this committee to provide your and your teams’ perspectives as input to upcoming operational strategy changes. As you reflect on the day-to-day issues your teams are facing, you note the following trends:

• People – the number of employees you have is relatively small compared to the number of people needed to staff all projects and other IT activities your teams are responsible for. When you have requested additional employee positions, you were told that the company does not want to expand the IT organization at this point. There is a budget associated with each project, so you can use this budget to hire contracting resources. You are asked to keep costs down, so you have to think of creative ways to staff projects quickly and with qualified people, while reducing costs. You are concerned that the system and technology knowledge may be lost when contractors leave. You can also see the strain on your employees, who are tasked with overseeing contractors, facilitating knowledge transfer and ensuring the projects remain high quality and with on-time delivery despite the changing staff members.

• Project delivery – your company has a thorough process of selecting projects for IT implementation based on business priorities. Selected projects go through multiple reviews of technical and architecture approaches and a detailed budgeting process before they are approved for implementation. While you value the diligent governance for IT project delivery, you are also concerned that many of the projects end up with a very short implementation timeline due to the long initial selection/ideation/budgeting/approval process. Your teams are often faced with delivering projects on very compressed schedules, resulting in cuts to time spent testing, stressed team members, and some functionality being delivered in later releases.

• Core technology upgrades – while your teams are busy on project implementation and deliveries, technology frameworks that your systems are built on seem to be aging quickly. You have been setting aside some budget and engineering time every year to upgrade or replace one or two of the many core technologies powering your systems. These technology improvements seem to always take longer than you expect, impact a lot of the systems, require some changes and lots of retesting. In some cases, there is no choice but to upgrade, as vendors announce plans to retire your versions of their products. In other cases, you have some flexibility on the timing of the upgrade, and wonder about the relative costs of upgrading vs. falling behind on the technology curve. Your engineers bring up various opportunities and advantages of switching to new technologies or the latest versions of the vendor products. You are wondering how you can balance the cost and impact of continuous technology changes with the need to deliver new projects and maintain/enhance current systems.

Your Challenge:

What changes in the current operational strategy can you propose to the new CIO, as your input to operational strategy committee? Please address the following topics in your paper:

• Provide a summary of the challenges of the current operational process. Describe the current and expected long-term impact of these challenges if they are not addressed.

• For each challenge, provide three alternative strategies to address the challenge – one that is aggressive, one that is balanced, and one that is moderate.

•An aggressive strategy can be a major change to the current processes and ways of operating. It may also have major impacts on the organization in terms of restructuring, changing people roles/responsibilities, major changes to how work is done, or major cost impacts. A balanced strategy may be an introduction of some changes to the current processes and operating strategy, with less impact and disruption compared to an aggressive strategy. It may also be a phased introduction of the some or all elements of the aggressive strategy. A moderate strategy may have some incremental changes to the current processes and operating strategy, while leaving most of the current way of operating as is. A moderate strategy aims to minimize changes and disruptions, while introducing gradual improvements.

• Provide your recommendation of the preferred strategy for each challenge. Explain why the selected strategy is preferred in each case, and provide the next steps to plan for or introduce the new strategy. Please consider the overall impact of your recommendations for the organization – if you are recommending aggressive strategy changes in all areas, there will be major changes in the work processes, with higher improvement potential. If all recommendations are moderate, the changes will be minimized, but the positive impact may not be sufficient. What is the right combination? How well is your company prepared to deal with recommended changes?

Create your response to this challenge as a proposal you will submit to the operational strategy committee. Your paper must adhere to APA standards in formatting . Additionally, your paper must be 2,500 words or more and use at least 5 scholarly references in support. Be sure that you list your references per APA and cite each reference at least once

Hourly rates vary form the consultant-client combinations and are based on several factors, including project type and consultants” experince. The rates( dollars per hour) for each consultants-client combination are as follows:

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Premier Consulting’s two consultants, Avery and Baker, can be scheduled to work for clients up to a maximum of 160 hours each over the next four  (4) weeks. A third consultant Campbell has some adminstrative assignments already planned and is availble for clieents up to a maximum of 140 hours over the next four (4) weeks. The company has four (4) clients with projects in process. The estimated hourly requirments for each of the clients over the four-week period as follows:

CLIENT                         HOURS

A                                      180

B                                      75

C                                      100

D                                      85

Hourly rates vary form the consultant-client combinations and are based on several factors, including project type and consultants” experince. The rates( dollars per hour) for each consultants-client combination are as follows:

                                                                   CLIENT

CONSULTANTS                            A              B                    C                   D

AVERY                                        100             125               115              100

BAKER                                         120             135             115               120

CAMPBELL                                  155             150            140               130

a) Develop a network representation of the problem.

b) formulate the problem as linear program, with the optimal solution providing the hours each consultant should be scheduled for each client to maximize the consulting firm’s billings. What is the schedule and what is the total billing?

c)New information shows that Avery doesn’t have the experince to be scheduled for client B. If this consultingnassignment is not premitted, what impact does it have on total billings? What is the revised scheduled?

To solve problem using LINGO software. 

Not only is the U.S. experiencing a demographic shift, but the world is also changing, and national borders are becoming blurred.

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Assignment 2: Required Assignment 2—Five-Year Global Workforce Forecast

Not only is the U.S. experiencing a demographic shift, but the world is also changing, and national borders are becoming blurred. This increased connectivity will highlight human differences while putting organizations in a position to benefit from the multiple perspectives gained through a diversified workforce. BANKS Industries continues to look for business acquisitions and plans to continue to expand over the next five years.

Consider forecasted changes in the U.S. and on a global level, and write an 8–10-page executive report addressing the following:

  • Given increased globalization and demographic shifts, what changes in the workplace are likely to occur? Explain in terms of workforce demographics, new challenges, and benefits.
  • How will these changes impact the way organizations function?
  • How will HR practices change staffing, rewarding, employee relations, communication, performance management, training and development, and technology? Within that discussion, point out current best practices that may require modification as well as the most appropriate modifications.
  • What are the legal and ethical implications of change?
  • How should current employees and leaders begin to prepare for this change? Prepare a change management plan that includes strategies to communicate relevant information to employees.

Write an 8–10-page executive report in Word format. Support your predictions and suggestions with scholarly resources and empirical evidence. The executive report should include a cover letter, a title page, a reference page, and sections addressing the topics listed. Apply APA standards to citation of sources. 

By Wednesday, June 7, 2016, deliver your assignment to the M5: Assignment 2 Dropbox.

Assignment 2 Grading CriteriaMaximum Points
Described the likely changes in the workplace given increased globalization and demographic shifts as well as their impact on the way that organizations function.60
Explained possible changes in HR practices with regard to staffing, rewarding, employee relations, communication, performance management, training and development, and technology. Identified current best practices that will require modification and suggested appropriate modifications.76
Described the legal and ethical implications of change.28
Recommended strategies in which current employees and leaders can begin preparing for this change through a change management plan. Included strategies to communicate relevant information to employees.76
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; displayed accurate spelling, grammar, and punctuation.60
Total:300