Evidence-Based Practice
Write a 2-3 page (not including title and reference) paper in 6th edition APA format. Give an example of how nursing can be involved in evidence-based practice. What are the barriers to implementing EBP in your own organization and how cost and quality impact the utilization of EBP within your own organization?
SAMPLE ANSWER
Evidence-Based Practice
Evidence based practice (EBP) is a type of practice in healthcare that focuses on findings from researches and different types of data such as data that is used in quality improvement and quality improvement. EBP is usually used with the aim of improving healthcare services and over the recent years, nursing has been involved in EBP through numerous ways.
One of the most notable and common way through which nursing has been involved in EBP is in nursing management. Over the years, there have always been issues in a number of healthcare facilities concerning how the nursing management process is undertaken. With the introduction of evidence based practice, wide management science evidence has been drawn for the purposes of enhancing the nursing practice. This management science practice has enabled nursing executives to acquire new skills and competencies which have enabled them to shift and develop into a corporate focus. This shift in focus has undeniably played a big role in improving nursing as it has been seen in the manner in which healthcare facilities have grown for example through expanding outpatient services, cost containment and increased demand for quality outcomes. A report by the American Nurses Association indicates that with the incorporation of EBP in nursing management, the total health expenditure is expected to hit 13% of GDP by the 2032. (Holland & Rees, 2010, pg 216)
Implementing EBP in a number of organizations has at times been difficult due to the numerous barriers that have presented themselves. Implementing EBP requires literature review of bulk literature articles, for example it is estimated that approximately 8,000 literature articles which are relevant to family medicine practice and a practitioner in such a practice would require over 20 hours of literature review everyday so as to stay abreast of new evidence. This is practically impossible and is one of the main factors lowering the pace of implementing EBP. The perception by most of the healthcare practitioners has also been a major barrier in implementing EBP. In my organization, for example, most nurses and management officials have the perception that EBP is difficult to implement since it requires a lot of input in terms of time and this has provided reluctance in the adoption of this practice. Implementation of EBP requires one to have skills such as IT and information searching skills. Most nurses lack these skills and are therefore unable to implement the practice in an efficient manner as it is required. (Houser & Oman, 2011, pg 11)
Utilization of EBP requires enormous funds set aside for the purposes of conducting the relevant researches. Most organizations such as my own organization usually have insufficient funds to enable them effectively conduct the practice efficiently. The quality of healthcare services that most organizations aim to produce has played an enormous role in promoting the use of EBP as it has been shown by the numerous studies and researches conducted. Over the years, EBP has shown to produce quality healthcare services in terms of the now easier task of nurses in care giving and reduced timeline that patients now take to recover compared to the timeline they used to take with the use of the traditional method. My organization, just like many other organizations, has encouraged the use of EBP so at to accomplish the providing of quality healthcare services. (Goldstein & Morrison, 2013, Pg 410).
In conclusion, EBP is a very effective means of improving the nursing practice but it has a number of challenges that must be overcome in order to accomplish this.
Holland, K., & Rees, C. (2010). Nursing: Evidence-based practice skills. Oxford: Oxford University Press.
Houser, J., & Oman, K. S. (2011). Evidence-based practice: An implementation guide for healthcare organizations. Sudbury, MA: Jones and Bartlett Learning.
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Provide an overview of the inpatient setting you have chosen.
Conduct an interview with a member of the leadership team responsible for the department/unit.
In your interview be sure to address, at a minimum, the following:
Provide background information on the interviewee (title/position, summary of academic and professional background, etc.).
Identify trends (e.g., supply and demand, political climate, regulatory, demographic changes, or patient care) that are impacting this particular inpatient
setting and how these are being leveraged or mitigated by the leadership.
Identify the challenges (micro or macro level) this department is experiencing. How are they addressing these challenges?
Based on your interview and the research you have conducted for both the Case and SLP assignments, create a table that illustrates the similarities and
differences in trends between the research conducted for the Case Assignment and the feedback in the interview. Analyze and discuss the findings shown in the table. This analysis should include both quantitative and qualitative approaches to analyzing the data.
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The research is a systematic review and I want to evaluate the pattern of health education activities in Saudi Arabia and see if its met with WHO
the sample is other research from 2014 to 2018
Variables could be Types of patterns
People are the target community
Sources of health information in the community.
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Prevention of foot ulcers in patients with diabetes in home nursing: a qualitative interview study
Qualitative research article
Gershater, M. A., Pilhammar, E., & Roijer, C. A. (2016) Prevention of foot ulcers in patients
with diabetes in home nursing: a qualitative interview study. European Diabetes Nursing, 10,
52-57. doi: http://onlinelibrary.wiley.com/doi/10.1002/edn.227/pdf
The articles cited above can be accessed via Bb.
These articles have been chosen from different areas to expose you to different research
content that may have reflection on your practice as a member of the healthcare team. In other
words, the article that you choose for your assignment does not have to be specific to the
degree (nursing or midwifery) that you are doing. Therefore, it is required that you read both
articles to determine which one you understand better and critique the following aspects of the
article:
Abstract
Literature review and/or background to the problem
Research Design
Findings
Discussion
Reliability & Validity/ Trustworthiness
You will need to critique these selected aspects in the context of the entire research report and
will therefore need a thorough understanding of the entire report. You will provide your critique
in short paragraph answer format, ensuring that you provide rationale for your critique,
substantiated with appropriate literature. More detailed instructions for this assessment can be
accessed through Bb.
You will need to use the information and skills that you developed during Modules 7-12 to
assist you to critique the article. In addition, you should review the chapter on ?�Reading and
critiquing research articles’ in your prescribed text and use the marking guide provided so that
you cover all the necessary aspects.
This assignment is required to be typed using Times New Roman, font size 12 and double
spaced. The required word limit for this assessment is 1000 words (±100) with minimum of 4
references. This word count does not include the references and other information related to
This assignment is required to be typed using Times New Roman, font size 12 and double
spaced.
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Clear Introduction
• Provide a clear statement of intent and signpost the essay.
• Tell the reader what will be included in this essay and in what order.
• State why the topic is important to your field of nursing.
• Outline the importance of research in nursing, critiquing research and link to evidence based practice.
• Define key terms which are relevant to your essay – ensure the definitions are relevant to your essay content (e.g. if using quantitative research, ensure your definition relates to the type of studies and methodology you are discussing).
Body
• Critique the research paper using the framework issued by the module leader (see below) identifying strengths and limitations of the study. Make sure that you address the literature review and methodological issues:
– study design
– sampling
– data collection
– study tools if relevant including validity and reliability
– any bias that is evident in the study
– ethics (including consent)
-how the data was analysed and presented
In doing this you will be showing an understanding of the research process. Make sure that you support your discussion with relevant references, identifying any implications of the issues identified.
• Demonstrate that you have conducted an appropriate inspection of the literature related to this topic
• Summarise the significant findings, showing where this study fits in to the wider evidence base on the topic. This will help you to demonstrate wider reading and should show that you have undertaken an inspection of the relevant literature.
Conclusion
• Conclude your essay by summarising what you have discussed throughout this essay in a logical order. Do not just repeat your introduction. Start this by giving an overall summary – what have you done – what have you shown, how is this relevant to current practice, where does this need to go from here?
Throughout, you need to demonstrate
• Evidence of original thought
• within the word limit (3000 words)
• Demonstrate correct referencing –this should follow university guidelines: Harvard referencing style.
• the assignment should be well presented (see guidance below) with correct grammar and spelling
Critiquing framework
The use of one of the critiquing frameworks below is compulsory:
For quantitative research: Template version: 8 10
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The scenario based on the topic is: Houston Methodist St. John Hospital patient satisfaction scores have decreased over the past year.
A general description of the training topic.
Why this training is needed.
Who is to be trained.
How many are being trained.
Develop a training needs analysis for your topic (3–4 pages). For the purposes of this project, you are not expected to actually conduct the training needs analysis (TNA). Instead, create the following information as if it is based on a TNA.
Identify what the trainees should know or be able to do after they have completed the training program. Research your topic to determine what you want your trainees to learn. Your sources might be anything from an Internet search for data, to a meeting with subject matter experts (SMEs) who are good at the task involved. For example, if you training topic is how to tile a wall, you might search the Internet for do-it-yourself instructions, or you might consult with a specialist at a home improvement store.
Summarize the results of your research or provide a set of the questions you would ask SMEs if you were to meet with them.
Identify what the trainees know or what they can do before the training.
Create a sample survey, a questionnaire, a set of interview questions, or an observation checklist. Include this in your assignment submission as a separate attachment.
Develop training objectives for your training program (1–2 pages). Create 3–5 specific training objectives for your topic.
Create your objectives based on what you have determined the trainees should know (or be able to do) after attending the training program.
Design a training program for your topic (3–4 pages). Define each of the following aspects and explain why you made the choices you did.
How long will the training program be?
Will there be one or more training sessions?
Will those who facilitate the training be internal or external instructors?
Where will the training program be held?
How will learners be motivated to learn?
Who is the intended audience for the training?
SAMPLE ANSWER
Introduction
Patient satisfaction remains a significant and commonly used indicator that many medical facilities incorporate in measuring the quality of health care services they offer to patients. It is imperative to realize that patient satisfaction has the capacity to affect the retention of patients, medical malpractice complaints, and clinical outcomes (Hall, Shirey, & Waggoner, 2013). It also impacts the efficiency, timely, and patient-centered delivery of quality health care plan.
The Houston Methodist St. John Hospital in its delivery of services to the community has realized a decrease in patient satisfaction scores over the past years, a factor that has reduced the retention levels of patients in the medical facility (Hall, et.al). In order to address the issue, the management of the hospital embarks on a mission to develop a training program aimed at targeting the analytical needs that are designed to identify the background, motivations and expertise that can be employed by the learners to improve the condition of the hospital.
General description of the training topic
Houston Methodist St. John Hospital has realized the need to improve the quality of health delivery. The hospital in solving this issue is striving to define and measure the quality of healthcare provision in order to improve patient satisfaction scores. This comprehensive training program is therefore aimed at educating the medical practitioners within the institution in sound methodologies that can be employed in improving patient satisfaction (Hall, et.al).
The training program is therefore based on the concepts of practical improvements that require sound local evidence that determines the nature of the existing problem and risks and also considering the possible solutions. Inclusive of the training program is the systematic analysis of the specific interventions that can be employed and that fit within the medical facilities context.
The need for Training
It is essential to note that this training program is a vital element for Houston Methodist St. John Hospital. The essence of the program is on improving patient-physician communication. It has been discovered that patient-physician communication is a primary contributor to reduced patient satisfaction. Patient-physician communication has been a challenge, and if improved, a tremendous opportunity for improvement is likely to be noticed (Hall, et.al).
Studies have determined that when in patients are asked to identify the physicians who are in charge of their care during their times of discharge, close to 90% of the patients are unable to identify and correctly name the doctors responsible (Hall, et.al). When it turns to orthopedic patients, challenges are even more intense since these patients are mostly admitted to the emergency departments and are identified as unable to identify their treating physicians.
It is important to notice that the acuity of some orthopedic injuries may not allow some patients and their surgeons to establish a concise and strong patient-physician relationship prior to surgeries (Otani, Herrmann, & Kurz, 2011). In such a setting, it may be difficult to address patient concerns and priorities as a result of the differences that exist between surgeons and patients, a factor that results in low patient satisfaction. However, when there is an active inbound relationship between a physician and a patient, the patients are more likely to be satisfied, a factor that results in better outcomes.
The other need for this training is on finding better approaches geared towards improving the satisfaction of patients in the medical facility. The Houston Methodist St. John Hospital is therefore working out on the sound modules that can be employed in training to enhance patient satisfaction among their patient population by ensuring that medical practitioners are trained on effectuating their communication approaches on patients (Otani, et.al). It is anticipated that after training, there will be improved physician recognition and enhanced communication between the patients and their physicians, a factor that will increase the patient satisfaction scores.
The management of patient expectations and psychosocial factors such as depression and pain that have the capacity to drive patient satisfaction may prove to be challenging. However, through an individualized patient preoperative counseling approach and a shared decision-making, medical practitioners are likely to identify the specific factors that affect patients such as chronic pains that may negatively impact their satisfaction scores (Otani, et.al). Through the management of depression and pain including setting up an appropriate preoperative expectation, physicians are able to attain good outcomes. This training is therefore developed for all the medical employees and the RN within the Houston Methodist St. John Medical facility including support staff members in the facility. The number of patients and employees to be trained amounts to one hundred
Training Needs Analysis
The training and development of the medical practitioners and other support staff members within this medical facility is pivotal to the overall vision of the medical fraternities aimed at improving patient satisfaction through an improved quality of the care of patients. In order to achieve this, it is essential that the learning and development resources are appropriately aimed at ensuring the efficiency of training programs (Otani, et.al). The management fraternity of the Houston Methodist St. John Hospital is committed to ensuring that it’s skilled workforce is motivated by providing quality services aimed at improving the satisfaction of patients.
The hospital is therefore articulating approaches of training all the relevant staff members on the provision of better care. Through the training needs analysis (TNA), an outline is provided that ensures appropriate, and relevant training needs to the staff groups are comprehensively covered. The TNA, therefore, focuses on the specific training requirements that are mandatory in meeting the institution’s needs.
Houston Methodist St. John Hospital is a comprehensive surgical and medical hospital with 121 beds. The hospital according to sources records visits that amount to 24,940 patients in the emergency room. The total admissions of the hospital also amount to 6, 628 with its physicians performing 2,062 inpatients, and 2995 outpatient surgeries. The hospital specializes in the treatment of Cancer, heart and vascular diseases, gastroenterology, and GI surgeries, neurological and neurosurgeries, orthopedic and sports medicine, transplants among other services.
With these facts, it is significant to notice that the hospital attends to a broad range of individuals who have varied health needs and require special care that satisfies their needs. The staff members in this facility, therefore, have the responsibility to maintain professional standards through a fulfilled training initiative (Otani, et.al). The training needs analysis TNA will, therefore, ensure that compliance is monitored carefully, and the results of the training are noticeable in practice. Find the training needs analysis attached on the appendix.
Summary of the Research Results
After carrying out a research on the need for training in order to address the low levels of patient satisfaction; it has been determined that there are certain factors such as noise levels and the doctors’ bedside manner. In addition, whether patients are in position to recommend the hospital to friends or family is also part of the areas that need to be observed in order to improve patient satisfaction.
These factors, therefore, hold a key in the future of the hospital (Otani, Chumbler, Judy, Herrmann, & Kurz, 2015). The research determined that patient satisfaction remains the main key to a new marketing tool for many hospitals, considering the fact that many patients are now involved in choosing hospitals. It is, therefore, significant to note that the findings of the study determined the fact that patients liking of the doctors has much to do with their getting better.
A patient’s expectation when they visit a medical facility is in receiving good services. It has come to realization that these expectations are determined by the gender, age, nature of illness, and the attitudes towards the circumstances of a patient. Patients also expect doctors to keep time, communicate in a simple language that is understandable, and behave cordially (Otani, et. al). They also expect care, courtesy, concern and in addition to this, professionalism. In summary, the study revealed that patient satisfaction is the key driver of patient outcomes and plays an important aspect of the pay-for –performance metrics. This therefore translates to the fact that an improved patient-physician communication has the capacity to improve patient satisfaction.
Before the training program commenced, it was discovered that the trainees had an idea from past experiences on how to improve patient satisfaction. However, their knowledge was not applicable in the context of Houston Methodist St. John Hospital since the approaches they had in mind were used in different medical organizations. This, therefore, called for the need to derive a contextualized approach that is particularly formulated to meet the needs of this medical facility (Otani, et. al). The trainees were therefore expected to prepare for the training through availing themselves and making sure that they complete the process. The trainees are also expected to incorporate the learned ideas in their practice in order to promote patient satisfaction in the health facility.
Training Objectives for the Training Program
Table 1.1
OBJECTIVE
OUTCOME
Patient Satisfaction/Quality Outcomes
1. Reduction of medical errors.
2. Eliminated instances of bad communication.
3. Increased relationship with patients.
4. Elimination of wrong surgeries.
5. Patients are well cared for in the facility.
Team Work and Communication
1. An Improved employee satisfaction score.
2. An Improved patient satisfaction score.
3. An Improved physician satisfaction score.
4. Deceased staff turnovers.
5. Increased patient turnover.
Efficiency
1. Improved provision of quality health services.
2. Improved response time to patients.
3. Increased attendance to patients with pain and depression.
Reliability
1. Decreased levels of medical errors.
2. Compliance with the Medical regulations in caring for patients
3. Increased staff-patient relationship.
Specific Training Objectives
The specific training objectives include;
Improving the patient-physician communication
Developing personal relationships with patients through showing care and compassion.
Improving the quality of services.
Training Program
In order to develop the competencies among the trainees, it is significant that time is clearly factored in order to allow the exploration of the subject in depth and detail. Through this, the trainees are able to acquire more details and get opportunities to demonstrate their newly acquired skills through practice (Otani, et. al). The training program will, therefore, take a period of 4 days spread over a period of one year in order instill the developed learning needs.
The training will be organized on an annual basis as a result of the costs associated in developing such programs. The facilitators of the training will be external instructors who have the knowledge on the subject. The trainings will be carried out within the organizations facilities and the learners will be motivated to learn through an approach aimed at waiving the training costs and fees.
The learners who show absolute commitment to the training will also be awarded (Otani, et. al). The intended audiences for the training include medical personnel’s from other health organization. The registered nurses and other medical employees within Houston Methodist St. John Hospital will be among the audience attending the training.
Table 1.2
DAY
TIME
TOPIC
TRAINING METHOD
COMPETENCY
Day 1
0800-0900 am
Introduction to the Training Program.
08.00-09.00 09.00-
11.00 11.00-12.00
12.00-13.00 13.00-
14.00 14.00-15.00
15.00-16.00 16.00-
17.00
What is Patient Satisfaction
The Results of Unsatisfied Patients.
Causes of Unsatisfaction in a health facility
LUNCH
Global priorities in reduced patient satisfaction research
Understanding the need for improving patient satisfaction.
Lecture
Lecture
Small Group discussion
Lecture
Hands on practice
1.1
1.2
1.3
1.3
2.1
Day 2
0800-0900 am
Understanding the causes of decreased patient satisfaction
Lecture
1.6
08.00-09.00 09.00-
11.00 11.00-12.00
12.00-13.00
13.00-
13;00-14;00
14.00 14.00-15.00
15.00-16.00 16.00-
Understanding the things that affect patients; The system approach
Understanding the things that affect patients; Human factors
Understanding the things that affect patients; Organizational Level
LUNCH
Research Findings on the things that affect patients and impact their satisfaction
Review of the Discussions of the Day
Discussions among Groups
Lecture
Lecture
Lecture & Discussion
Lecture and Small Group Discussion
Group Discussion
1.6
1.6
1,6
1,6
1.7
Day 3
0800-0900 am
Case analysis of a Hospital
Hands on Practice
1.6
08.00-09.00 09.00-
11.00 11.00-12.00
12.00-13.00 13.00-
13;00-14;00
14.00 14.00-15.00
15.00-16.00 16.00-
Research methods on measuring the success levels of a health institution.
Research findings on measuring the success levels of a health institution. Qualitative approach, Interviews.
Approaches of improving patient satisfaction in Medical Organization
LUNCH
Improving patient satisfaction in Medical facilities
Patient roles in ensuring they are satisfied with the provision of health services
Lecture
Lecture
Lecture
Lecture
Lecture
1.6
1.6
1.6
1.6
1.6
Day 4
0800-0900 am
Group Presentations of Research plan
Group Presentation
08.00-09.00 09.00-
11.00 11.00-12.00
12.00-13.00 13.00-
13;00-14;00
14.00 14.00-15.00
Organizational Changes that can be employed to solve the problem
Implementing Change in an institutional level
LUNCH
Using evidences to demonstrate patient
Implementing Change on a individual level
Group work
Lecture
Lecture
Lecture
3.5
3.5
3.5
3.4
Conclusion
Patient satisfaction remains a significant and commonly used indicator that many medical facilities incorporate in measuring the quality of health care services they offer to patients. A patient’s expectation when they visit a medical facility is in receiving good services. It has come to realization that these expectations are determined by the gender, age, nature of illness, and the attitudes towards the circumstances of a patient.
Patients also expect doctors to keep time, communicate in a simple language that is understandable and behave cordially. It is imperative to realize that patient satisfaction has the capacity to affect the retention of patients, medical malpractice complaints, and clinical outcomes (Otani, et. al). It is essential to note that this training program is a vital element for Houston Methodist St. John Hospital. Patient-physician communication has been a challenge, and if improved, a tremendous opportunity for improvement is likely to be noticed.
The essence of the program is on improving patient-physician communication. The essence of the training program is on improving patient-physician communication. It has been discovered that patient-physician communication is a primary contributor to reduced patient satisfaction. After training, it is anticipated that the levels of patient satisfaction will increase, a factor that will impact an organizations delivery of services in the community. Through the training, the trainees learned variable approaches of improving communication and also increasing the delivery of services to patients aimed at improving the satisfaction levels of patients.
References
Hall, D., Shirey, M. A., & Waggoner, D. C. (2013). Improving Access and Satisfaction with Spiritual Care in the Hospice Setting. Omega: Journal Of Death & Dying, 67(1/2), 97-107.
Otani, K., Herrmann, P. A., & Kurz, R. S. (2011). Improving patient satisfaction in hospital care settings. Health Services Management Research, 24(4), 163-169. https://www.doi:10.1258/hsmr.2011.011008
Otani, K., Ye, S., Chumbler, N. R., Judy, Z., Herrmann, P. A., & Kurz, R. S. (2015). The Impact of Self-Rated Health Status on Patient Satisfaction Integration Process. Journal Of Healthcare Management, 60(3), 205-218.
Appendix
TRAINING NEEDS ANALYSIS (TNA) FOR HOUSTON METHODIST ST. JOHN HOSPITAL.
EMPLOYEE NAME:
POSITION
TNA DONE BY:
Major tasks of position
Training/skills development required?
If yes, identify what training needs exist
How will this be achieved?
(eg on the job, external training)
When?
Who to organise?
Training provider?
Y
N
<insert major tasks of position>
ü
<insert training needs, if any>
<insert how this will be achieved>
<insert when>
<insert who is going to deliver the training>
eg on the job, external training
What do we want to achieve in the period ahead?
<insert comments>
How will the trainees attitudes change towards the new information provided during training?
<insert comments>
How are we going to make this happen?
<insert comments>
What will you need from the Medical Institution to help you to reach your career goals?
<insert comments>
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As pediatric patients grow from infancy to adolescence, there are many common body system disorders that may potentially present. As an advanced practice nurse caring for these patients, you must understand the pathophysiology and epidemiology of these disorders as this will help you to recognize symptoms and select appropriate assessment and treatment options. In this Assignment, you prepare for your role in clinical settings as you design a protocol for the diagnosis, management, and follow-up care for a common body system disorder.
To prepare:
•Reflect on “Lyme disease”.
•Think about the pathophysiology and epidemiology of the disorder.
•Consider a protocol for the diagnosis, management, and follow-up care of the disorder you selected.
•Think about how culture might impact the care of patients who present with this disorder.
To complete:
Write a 2- to 3-page paper that addresses the following:
•Explain the disorder Lyme disease, include its pathophysiology and epidemiology.
•Explain a protocol for the diagnosis, management, and follow-up care of this disorder.
•Explain how culture might impact the care of patients who present with the disorder you selected.
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
SAMPLE ANSWER
Lyme Disease
Introduction
Many different kinds of body infections exist hence, is prudent for advanced practice nurses to understand (APN) them to provide better diagnosis, management, and even follow up. Lyme disease is one of such body system disorders that APN need to know to manage the same well. The author therefore, deliberates on Lyme disease, its epidemiology and pathophysiology, explains protocol from diagnosis, management, and follow-up, and explains how culture might affect the care of patients suffering from this disease.
Lyme disease
Despite the fact that the prevalence of Lyme disease is becoming prevalent in communities, many APN as well as physicians are still unfamiliar with it. Lyme disease known by another name as Lyme borreliosis is among the common vector borne diseases (Pearson, 2014). The disease is infectious as a bacterium known as Borrelia burgdorferi belonging to the spirochaetes causes it. The disease is usually transmitted through the bite of an infected tick.
Pathophysiology
The moment an infected tick bites a human being, B. burgdorferi is left in the skin and henceforth begins to spread. Signs and symptoms of the disease manifest due to the immune response to the spirochete in the tissues of the body (Beard, Nelson, Mead, Petersen, & Raoult, 2012). During the bite, the saliva of the tick is released together with spirochete as the tick feeds and this disrupts the immune response at the site where the bite occurred (Glatz, Resinger, Semmelweis, Ambros-rudolph, & Müllegger, 2015). Therefore, such a point is conducive to spirochete to establish an infection which grows and multiplies on the surface of the skin (dermis). The inflammatory response of the host leads to the formation of a circular EM lesion (Halperin, 2014). Because Neutrophils fails to appear to destroy spirochetes, the EM lesion develops and spread on the entire body. Few days after the bite, the spirochetes spread through blood stream to other parts of the body such as heart, joint, distant skin sites and nervous systems. In case, the bacteria is not treated immediately, it may persist in the body for months or even years, regardless of the production of B. burgdorferi.
Epidemiology
The disease is prevalence in the northern hemisphere and more incidences have been on increase across the world. Reasons for this are changes in biodiversity, climate change, land management, human interactions with nature and increasing awareness about the disease. Laboratory findings in UK found that Lyme cases have increased nearing to 1200 in a year even though true incidence is not known because of many cases that go unreported (Pearson, 2014). Incidences of Lyme disease are higher in Southern England, including, Scottish highland, and London. Level of public and health care professionals’ awareness about the disease in UK is still lacking. The disease has as well been reported in various countries across Africa, Europe, north and South America and Asia. Highest cases are among people aged between 45-65 years followed by those in age bracket 24-44 years (Pearson, 2014).
Diagnosis, management, and follow-up care
Lyme disease has treatment, and the journey begins from diagnosis. Those eligible for diagnosis are those with the history of tick bite, other signs, and symptoms of Lyme disease and erythema migrans (Pearson, 2014). Diagnosis should be clinically based and should be based on careful history taking, examination and getting information from carers, and ensuring careful interpretation of results. Other tests can as well be undertaken as part of the diagnosis to ascertain the infections. Treatment should then start immediately after diagnosis. Even though a range of antibiotics is available, the choice of the best is under debate as some have side effects. Some of the antibiotics recommended include amoxicillin, and doxycycline administered in different dosages depending on the age of the patient (Pearson, 2014). Patients require close monitoring to ensure they take the right medication, dosage until they recover.
Culture Aspect in Care of Patients
The culture of people differs and may have adverse effects on patients with Lyme (Aenishaenslin, Ravel, Michel, Gern, Milord, Waaub & Bélanger, 2014). Some people believe that this disease is for animals and therefore, health care providers may be adamant to take care of such patients. Therefore, the attitudes and beliefs of people, especially the carers can have a negative implication on the health care that is provided to patients. It becomes important for all public health professional and public to be sensitized about the disease for them to accord respect and assistance to Lyme patients.
Conclusion
Lyme disease like any other body disease needs proper management and treatment. The disease is spreading across the world because of increased sensitization. Cultural factors can halt efforts to manage the disease and is appropriate for all relevant authorities to step up their awareness campaigns to sensitive more health providers and public for better management of this disease.
References
Aenishaenslin, C., Ravel, A., Michel, P., Gern, L., Milord, F., Waaub, J., & Bélanger, D. (2014). From Lyme disease emergence to endemicity: a cross sectional comparative study of risk perceptions in different populations. BMC Public Health, 14(1), 1070-1091. doi:10.1186/1471-2458-14-1298
Beard, C. B., Nelson, C. A., Mead, P. S., Petersen, L. R., & Raoult, D. (2012). Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Emerging Infectious Diseases, (11), 1918.
Glatz, M., Resinger, A., Semmelweis, K., Ambros-rudolph, C. M., & Müllegger, R. R. (2015). Clinical Spectrum of Skin Manifestations of Lyme Borreliosis in 204 Children in Austria. Acta Dermato-Venereologica, 95(5), 565-571. doi:10.2340/00015555-2000
Halperin, J. J. (2014). Lyme Disease: Neurology, Neurobiology, and Behavior. Clinical Infectious Diseases, 58(9), 1267-1272.
Pearson, S. (2014). Recognising and understanding Lyme disease. Nursing Standard, 29(1), 37- 43.
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Providing cost effective care without limiting access
Providing cost effective care without limiting access
Order Instructions:
Providing cost effective care without limiting access
Providing cost effective care is a professional aspect of the Advance Nurse Practitioner’s role when caring for clients. Diagnostic testing can aid in therapeutic decision making, but contributes substantially to the cost of medical care. Testing is necessary in most cases, and if used improperly can cause significant cost and not lend much to diagnostic accuracy.
Write a 4 page APA formatted paper on the need to provide cost effective care without limiting access to care.
Discuss:
• Why this is an important aspect of providing care to patients
• How care can be made more affordable without limiting access to necessary care
• How to maintain cost effectiveness and still get the needed information for a diagnosis without ordering unnecessary diagnostic exams
Assignment Requirements
The finished Assignment should be a 4-page descriptive and critical/evaluative essay, excluding the title page and references. The viewpoint and purpose of this Assignment should be clearly established and sustained.
Before finalizing your work, you should:
• utilize spelling and grammar check to minimize errors; and
• review APA formatting and citation information found online, or on APA manual
Your Assignment should:
• follow the conventions of Standard American English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 6th edition format for organization, style, and crediting sources including:
• properly formatted header
• 12-point, double-spaced, Times New Roman font
• use of in-text citations
• title page and reference page
• use of headings (if applicable)
Resources
Choosing Wisely: Knowing the Costs of Health Care (Dana Frank, MD)
Choosing Wisely: The Impact of Rising Costs on Health Care (Joe Marine, MD)
Choosing Wisely: The Need to Simplify Health Care (Ann Morrill, MD)
Providing Cost Effective Care without Limiting Access
Introduction
Providing affordable care is a professional characteristic of (APN) Advanced Nurse Practitioner’s responsibility when taking care of clients. Diagnostic procedures in most of the time assist in making therapeutic decision-making. However, these procedures can contribute substantially to the expenditure of medical attention. Testing is crucial in medication, but if used improperly, it can bring considerable expenditure and not lend much for diagnostic accuracy. Therefore, the following discussion will indulge in discussing the importance of enhancing care that is cost-effective without restraining access. In addition, paper will discuss how care can be made more affordable. The paper concludes by suggesting ways on how to maintain cost effectiveness in the provision of cost-effective care without ordering unnecessary diagnostic exams.
Discussion
Providing care that is cost-effective without restraining access has a number of considerable benefits. Considering that the cost of health care services in the U.S. is increasing every year, government and other health stakeholders are looking for ways on how to health care affordable. One importance noticed by Greene (2015) is that cost-effective care will automatically relieve the heavy burden carried by health providers. For instance, health organizations can fight turnover costs of their nurses. This is because saved costs are usually used in motivating and retaining nurses. Persad (2015) argues that this will save the health organization the costs of advertising, and the overall costs employed to market nursing positions in the effort to recruit and employ nurses to take the turnover vacancies. This importance leads to another importance of increased productivity, which is one of the main agendas for the existence of a health organization as a business. Another importance regarding providing cost-effective care without limiting access is an improvement in providing quality healthcare. This is because cost effective care ensures that there is enough money saved to revolutionize medication administration, communication improvement, facilitate intensified and extensive follow-up, as well as client engagement (Greene, 2015). Considerably, affordable care without limited access facilitates coordination of patient care to decrease unneeded assessment and processes. Besides, a health facility can work effectively with other health providers such as case managers to ensure that there is safe and well-timed hospital discharge. Finally, transparency is witnessed when there is cost effective care (Persad, 2015). When cost effective care is put on the ground, nurses and medical practitioners do not find it necessary to direct a client to unnecessary diagnosis or procedures. Rather, the practitioners inform the patients all matters in black and white and involve other professionals in it.
Health care expenditures remain a key challenge to most Americans in accessing quality health care in the U.S. Greene (2015) argues that although such Act as the Affordable Care Act strives to make every American get affordable care, there has been limitation in accessing the health care services. One method to get affordable health care, Greene (2015), for instance, is by patients avoiding scheduling non-medically illustrated labor instructions before thirty-nine weeks. This is meant to reduce the use of unnecessary imaging assessments, for example, early utilization of MRI or CT for mild complaints that will automatically disappear on their own. Dana (2011) continued to assert that most unnecessary tests and procedures expose a patient to radiation and unwanted surgery.
Ann (2011) who added that the inaccessibility to affordable care is because of the complexity of health care echoes Dana’s argument. Ann (2011), an endocrinologist at Maryland Medical Center, argues that the only affordable care that can be made available to Americans is patient-centered care. In other words, Ann (2011) calls for an absolute simplification of the processes involved in mediation in the interest of the patients. Ann (2011) continued to assert that many patients give up in the quest for affordable health due to inconveniences of bureaucratic procedures in accessing health care. However, Joe (2011), a cardiologist at John Hopkins Bayview, appears on the realm of this discussion about affordable health care by attesting that the reason behind inaccessibility to affordable health care is the continued rising costs of health care. Greene (2015) echoes this statement by arguing that patients have to be assisted financially to access health care.
Another alternative to making care affordable is by empowering non-physician providers. This empowerment will ensure that non-physicians such as advanced-practice nurses practice entirety of their training (Persad, 2015). Progressively, these providers will expand the workforce, which will necessarily lower prices to make health care affordable. Making medical insurance cover cheaper will also aim at making health care affordable. Health insurance exchange plans are reasons behind unaffordable health care (Greene, 2015). These costs make makes it hard to make health care affordable.
By fostering efficient communication between health care providers and patients, cost effectiveness can be maintained, and make doctors acquire the required data for a diagnosis without ordering pointless diagnostic assessments. Contributing in the Choosing Wisely, Ann (2011) argued that poor communication between the two parties hinders accessibility for affordable health care. When there is coherent communication between providers and patient, Greene (2015), there is a better discussion about tests and procedures, and the patient will be able to make the decision about his or her condition. For instance, when a man is suffering from prostate cancer is fed with information regarding the treatment of the disease he might not seek medication. Persad (2015) argues that this is because the condition is unlikely to affect him before he dies due to other causes. Therefore, the patient will not go for testing and scanning, as they become unnecessary. Although health care resources are abundant, they are however utilized improperly. Dana (2011) who argued that nurse practitioners do not know the costs of health are procedures gave this statement. He also added that many billions of money is wasted each year through unnecessary services such as fraud and excessive administrative expenditures. Therefore, Persad (2015), the physician ends up recommending unnecessary diagnostic procedures. Thus, there is need to educate the physician about the cost of the health care procedure, which they will be using to reevaluate their decisions before prescribing unwanted medical procedures and tests. In addition, nurse practitioners need to be supplied with comprehensive copies of the cost of each test. According to Dana (2011), this will assist them in getting back to the list and evaluate whether it is effective to carry out a diagnostic test.
Summary
In conclusion, it can be deducted from the above discussion that nurse practitioners can unintentionally result in unnecessary medical testing and procedure. This leads to misuse of resources leading to cost-ineffectiveness. However, this can be averted if there is established good communication between providers and patients to reduce the numbers of unnecessary procedures and tests. Altogether, affordable care will be made available to the patients if medical insurance premiums are made affordable and the workforce of nurse practitioners expanded.
References
Ann, M. (18 Aug, 2011). Choosing Wisely. The Need to Simplify Health Care. [You Tube]. Retrieved on 10 July, 2015 from:
Greene, S. (2015). A survey of emergency medicine residents’ perceptive of the choosing wisely campaign. American journal of Emergency Medicine, (6), 853.doi:10.1016/j.ajem.2015.03.067
Joe, M. (18 Aug, 2011). Choosing Wisely: The Impact of Rising Costs on Health Care. [You Tube]. Retrieved on 10 July, 2015 from:
Persad G. (2015). The Medical Cost Pandemic: Why Limiting Access to Cost-Effective Treatment Hurts the Global Poor. Chicago Journal of International Law, 15559.
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Community Needs Assessment: Prince George’s County
Order Instructions:
W2 Clinical Assignment: Assess the Needs of the Community
Community & Public Health Nursing
Assess the Needs of the Community
Data Gathering: Data can come from a variety of sources and can include the following:
• Demographics of the community
• Vital statistics
• Previously conducted surveys
• Information from state and local health departments
The paper will use prince Georges County in Maryland as its community in question.
SAMPLE ANSWER
Community Needs Assessment: Prince George’s County
Needs assessment is a vital practice in communities as it allows stakeholders to identify gaps and work toward their closure. It is through needs assessment that parties identify problems and seek measures of addressing them. The utilization of the results that need assessment studies reveal could facilitate developments in communities. The process is usually systematic, and it is the desire to improve living conditions and other aspects of life that motivates the personnel that conducts the assessments. In most communities, needs could be relative, perceived, or expressed.
Prince George’s County has people of varied origin, and Hispanics and African-Americans constitute the majority. 98% of the county’s population was residing in the urban in the year 2012, and only 2% of the total population dwelled in rural areas (Onboard Informatics, 2015). Males constitute 44% of the population while females make up the remaining 56%. According to studies, the mean weight of men in the county is 198 pounds while that of females is 172 pounds (Onboard Informatics, 2015). The population recorded a score of 3.6 on general health, and, therefore, the county hits the average mark. The studies indicated that more than 70% of the residents engage in frequent physical activities (Onboard Informatics, 2015). The studies also showed that less than half of the population smoked cigarettes, and almost a three-quarter of the adults took alcohol (Onboard Informatics, 2015).
There are varied forms of needs in Prince Georges. Public health is among the areas where the residents of Prince George’s express needs. For instance, the community requires an enhancement of health care accessibility. Raised cost of services hinders a significant population from accessing medical care. Measures such as making prescription medications cheaper could promote the accessibility of health care. There is also a considerably uninsured population in the county, and extending cover to such persons could promote care accessibility. Focusing on the needs of the elderly could also offer an efficient measure toward the enhancement of care accessibility. The county has a considerably large population that is beyond sixty-five years, and supporting them could have a substantial impact on the community’s public health sector.
There is also a need for stakeholders to offer intensive education to the residents of the region. For instance, stakeholders could make the population aware of health hazards that could present in their area. There is a need to inform the residents of the appropriate livelihood to adopt so as to avoid diseases. From the demographics, an appreciable percentage undertakes physical activities, and educators could encourage more residents to pursue the approach (Onboard Informatics, 2015). The population also needs education on chronic ailments. It could be necessary to warn the residents of Prince Georges against practices that could predispose them to terminal illnesses.
There is a need to reduce alcohol consumption among residents of Prince Georges. About 80% of the adult population is alcoholic, yet the practice comes with adverse effects on the health of the alcohol users (Onboard Informatics, 2015). The community should understand the conditions associated with alcohol use.
The community also constitutes of people of varied origins, and there could be a possibility of discrimination in care access on the basis of people’s origin. Therefore, there is a need for leaders and health care practitioners to ensure that they offer services beyond racial considerations. Stakeholders should ensure that community members access standard care without racial barriers.
