Defenses to Malpractice and Risk Management Techniques
Defenses to Malpractice and Risk Management Techniques
Order Instructions:
Look at this case and respond to the 3 main points raise in the question, it is critical that the writer detail out the respond to the question clearly using credible sources and past case laws to support your stand on the case.
Take the malpractice case below and discuss the defenses that may be raised in that case. Discuss how the incident could have been prevented. What risk management techniques could have been used?
Case Study : Malpractice Action Brought by Yolanda Pinnelas
People Involved in Case:
Yolanda Pinnelas-patient
Betty DePalma, RN, MS-nursing supervisor
Elizabeth Adelman, RN, recovery room nurse
William Brady, M.D., plastic surgeon
Mary Jones, RN-IV insertion
Carol Price, LPN
Jeffery Chambers, RN-staff nurse
Patricia Peters, PharmD-pharmacy
Diana Smith, RN
Susan Post, JD-Risk Manager
Amy Green-Quality Assurance
Michael Parks, RN, MS, CNS-Education coordinator
SAFE-INFUSE-pump
Brand X infusion pump
Caring Memorial Hospital
Facts:
The patient, Yolanda Pinellas is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy. Caring Memorial is a hospital in Upstate New York. Yolanda was a student at Ithaca College and studying to be a music conductor.
Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN inserted the IV on the day shift around 1300, and the patient, Yolanda, was to have Mitomycin administered through the IV. An infusion machine was used for the delivery. The Mitomycin was hung by Jeffrey Chambers, RN and he was assigned to Yolanda. The unit had several very sick patients and was short staffed. Jeffery had worked a double shift the day before and had to double back to cover the evening shift. He was able to go home between shift and had about 6 hours of sleep before returning. The pharmacy was late in delivering the drug so it was not hung until the evening shift. Patricia Peters, PharmD brought the chemotherapy to the unit.
On the evening shift, Carol Price, LPN heard the infusion pump beep several times. She had ignored it as she thought someone else was caring for the patient. Diana Smith, RN was also working the shift and had heard the pump beep several times. She mentioned it to Jeffery. She did not go into the room until about forty-five minutes later. The patient testified that a nurse Updated: June 2014 MN506- Unit 9 Page 3 of 5
came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done.
Diana Smith responded to the patient’s call bell and found the IV had dislodged for the patient’s vein. There was no evidence that the Mitomycin had gone into the patient’s tissue. Diana immediately stopped the IV, notified the physician, and provided care to the hand. The documentation in the medical record indicates that there was an infiltration to the IV.
The hospital was testing a new IV Infusion pump called SAFE-INFUSE. The supervisory nurse was Betty DePalma, RN. Betty took the pump off the unit. No one made note of the pump’s serial number as there were 6 in the hospital being used. There was also another brand of pumps being used in the hospital. It was called Brand X infusion pump. Betty did not note the name of the pump or serial number. The pump was not isolated or sent to maintenance and eventually the hospital decided not to use SAFE-INFUSE so the loaners were sent back to the company.
Betty and Dr. William Brady are the only ones that carry malpractice insurance. The hospital also has malpractice insurance.
Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The Claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying.
During the procedure for the skin grafting, the plastic surgeon, Dr. William Brady, used a dermatome that resulted in uneven harvesting of tissue and further scarring in the patient’s thigh area where the skin was harvested.
The Risk Manger is Susan Post, J.D. who works in collaboration with the Quality Assurance director Amy Green. Amy had noted when doing chart reviews over the last three months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings and nights then coming back and working the evening shift. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several units. Prior to this incident the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on this unit and what types of resources and training was needed.
Resources
Anselmi, K. K. (2012). Nurses’ personal liability vs. employers’ vicarious liability. MEDSURG Nursing, 21(1), 45–48.
Essentials of Nursing Law and Ethics
Chapter 5: “Defenses to Negligence or Malpractice”
Chapter 6: “Prevention of Malpractice”
Chapter 7: “Nurses as Witnesses”
Chapter 8: “Professional Liability Insurance”
Chapter 9: “Accepting or Refusing an Assignment/Patient Abandonment”
Chapter 10: “Delegation to Unlicensed Assisted Personnel”
SAMPLE ANSWER
Defenses to Malpractice and Risk Management Techniques
Introduction
It is the mandate of every medical practitioner to take care of the clients entrusted under his care. The doctor should not harm the patients, and neither should they make the existing illness worse. This case involves Yolanda Pinellas a 21 year old cancer patient entrusted under the care of Jeffrey Chambers. The client was admitted at Caring Memorial Hospital for chemotherapy but suffered massive injuries after being left unattended for over forty minutes. Despite the fact that she rung the bell, the medical staff in charge did not hurry to assuage her pain. Medical malpractice occurs when the treatment administered by the physician leads to further injury to the client (Infusion Nurses Society, 2010). Notably, there was an infiltration to the IV and as a result Yolanda suffered necrosis of the hand requiring her to go through multiple surgical procedures, skin grafting, and reconstruction. During the skin grafting process, the surgeon, Dr. William Brady, used a dermatome resulting to uneven harvesting of tissue, further scarring the patient’s thigh area where the skin was harvested.
The Defenses In This Case
While medical practitioners together with the other health care providers are not required to be perfect they have the duty to act responsibly and use reasonable care in their medical profession (Wickham, 2006). In the case of Yolanda VS Caring Memorial Hospital, Diana Smith, working during the shift heard the pump beep several times. She immediately alerted Jeffrey who was entrusted to take care of the client. Jeffrey did not take swift action as required, Diana went to the room after 40 minutes and discovered that IV had dislodged for the patient’s vein. She cross-checked and found that there was no evidence that the Mitomycin had gone into the patient’s tissue. Later it was discovered that indeed Mitomycin had gone to her tissue leading to massive injuries.
In Diana’s case, the practitioners were not apathetic, Diana responded to the patient’s bell. She took the right precautions by immediately stopping the IV, notifying the physician, and providing the necessary care to the hand. The major cause of the harm caused to Yolanda was not as a result of negligence. The Risk Manager Susan Post had noted over the last three months prior to the incidence that there were challenges of short staffing. Moreover, the nurses were working double shifts like Jeffery and this could compromise on their performance. Often the hospital assigned float nurses to several units (Sauerland, 2007). The hospital was in the process of implementing a training program to bolster the staff performance. In this case the damages that Yolanda occurred can be blamed on multiple acts of negligence, the burden of proof lies with the plaintiff to proof that more likely than not, the injuries she incurred were as a result of a particular negligent act.
How The Incident Could Have Been Avoided
This incident could be avoided by foremost ensuring that the ward in which Yolanda was admitted was sufficiently staffed because there were critically ill patients admitted in that ward. Infiltration which caused the leaking of the IV fluid could have been avoided if only one practitioner was assigned to conduct the operation. The staff who inserted the IV was not the one who administered the drug through the infusion machine. The practitioner should have applied a splint for stability and to prevent dislodging the IV infusion machine (Infusion Nurses Society, 2010).The hospital should have ensured that only qualified, chemotherapy-certified nurses trained in venipuncture are allowed to allowed administer vesicants. When Diana Smith heard the first bell from the client she should have respondent aptly knowing that the ward comprised of critically ill patients.
Management techniques That Could Have Been Used
During the administration of IV fluid the practitioner should have chosen a large vein with good blood flow for the placement of infusion machine. This would have minimized chances of infiltration (Ener, 2004). The venipuncture site must have been monitored closely to make sure that there was no infiltration, pain or discomfort.
References
Ener R., A. (2004). Extravasation of systemic hemato-oncological therapies. Ann Oncol. June;15(6):55-62.
Infusion Nurses Society (2010). Infusion Nursing. [3rd edition] 2010
Sauerland C,. A.(2007). Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Oncol Nurs Forum. 2007 Nov 27;33(6):114-41.
Schrijvers DL. Extravasation: a dreaded complication of chemotherapy. Ann Oncol. 2003;14 Suppl 3:iii26-30.
Wickham, R.(2006). Vesicant extravasation part II: Evidence-based management and continuing controversies. Oncol Nursing Forum. November 27;33(6):1143-50.
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Take note that this paper comes in two sections and each section is suppose to have its reference list at the end of that section. For section A, you will have to paste the link to the article used for the critique, and also any references used in the paper. and for section you will provide 4 minimum references from credible pear review sources. remember to follow proper rules on how to critique an article.
SECTION A (1 page)
Health Reform Shaped by Nursing Research
Critique a reliable internet source that describes a health reform-related public policy that was shaped or influenced by the application of nursing research in the U.S and should not be more than 5 years old. Also post the link to the internet source at the end of your paper.
Paste the link at the end of this section, which will directly link the reader to the article use for the critique.
SECTION B (1 page) ( 4 references minimum)
For this section, refer to 111521 and 111489 to better understand this section as those sections will have some reasonable information to the writer a better understanding of the amendment we are working on.
Compare two ethical principles and three measurable goals that would support passage by Congress of your amendment hear below.
The public policy problem is that section 2713 requires organizations to provide their workers with birth control as part of their insurance coverage. The public policy question is: should the federal government mandate that organizations can choose whether or not to provide contraceptive services to employees as part of their insurance coverage? The public policy resolution is an amendment to section 2713(a) (4) of PL 111-148 that would say: organizations – both for-profit and non-profit organizations – have the option of either offering their employees birth control as part of their insurance coverage or not to offer contraceptive services (Cauchi, 2014).
The reforms in the health sector have been researched by various researchers in the nursing field. One of the highly recognized researchers that came up with a series of reforms in the health sector is the IOM report as by the committee of Robert Wood Foundation. Their research methodology was very efficient given the breadth of the area of study. Survey was used in observing the practitioners in the field and the use of questionnaires in collecting the data was very recommendable in their study.
The findings came were analyzed and the researchers recommended the changes that were to be effected in the field so that the field could be running effectively and smoothly. The first finding according to the researchers is that nurses in the U.S do not practice their nursing fully due to a variety of historical, regulatory and policy barriers which have limited the ability and scope of practice of the nurses (IOM, 2011, chapter 3). In regard to this barrier the researchers recommended that there is need for standardization of policies of practice by the nurses in all over the states of America. Once the rules have been standardized then the staff turnover will be reduced and any nurse can work at any hospital within the United States (Montgomery & Keegan, 2013, p. 59). All nurses should be allowed fully to the degree of their knowledge without limitations. Secondly the researchers found out that the education levels of the nurses were never advanced and therefore recommended that nurses should achieve higher education training through an improved education system that promotes seamless academic progression (IOM, 2011, chapter 4). Thirdly they found out that the nurses were not cooperating fully with the physicians. They recommended that nurses should be full partners with physicians and other health professionals in redesigning the healthcare system in United States (IOM, 2011, chapter 5). Laureate &Grey (2010, p.4) refer to this as the change in the practice model for the better achievement of results and effective flow of work in the working environment. Fourthly, the researchers’ findings revealed a lapse in the patient management of information. The researchers recommended effective workforce planning and policy making require better data collection and an improved information structure (IOM, 2011, chapter 6).
Reference
IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health.
Washington, DC: The National Academies Press. Retrieved from
One of the ethical principles is the principle of autonomy. This principle stands for independence and the ability to be self directed. According to this principle everyone has a right to self-determination and arte entitled to decide what happens to the life. Adults have the ability to think and capacity to consent to or refuse the treatment. This amendment will provide that everyone’s wishes are respected even if they do not agree to them. Mandating that the insurance companies cover the contraceptives, sterilizations and drugs or devices that are meant to induce the expulsion of human embryo would violate the consciences of many Americans which shall be against the promises made by president Obama (Centre for Medicare and Medical Services, 2011).
The other ethical principle is justice to all. This requires that all clients be treated equally irrespective of the origin, race or occupation. This principle stands to equalize those who are in the job market and those who are not. The bill is unfair because it concentrates on providing the contraceptives to those people who are in working in organizations or companies. Those who work in the private sector or who do not work will have not been affected by this bill. According to the National Catholic Bioethics Center (2010) pregnancy is not a disease and therefore contraceptives, sterilizations and abortifications should not be included as mandated preventive services. Therefore amending t he bill will ensure that both the workers and those who are not working are all treated equally.
One of the measurable goals is public education in regard to the use of the contraceptives their side effects and other better birth control methods. Another measurable goal is workers engagement in understanding the need for the amendment. The amendment should be expressed fully to the workers explaining to them why we need the amendments. Once they have understood then the need for the amendment then they can be the first ones to campaign for the amendment. The third measurable goal is engage organizations and groups that stand against the bill. for instance the religious group[s such as the Catholics are on record for opposing this bill, therefore engaging them in the amendment process will give more support to the amendment. The amendment should have the support of as many people as possible and one of the ways is to use such organizations.
Is it possible for a health policy to fail due to cultural factors? How important is it for the community to get involved with the decision-making process during policy development?
You will recognize the significance in cultural awareness and health policy development. For this writing, consider community engagement in policy development.
Consider the importance of beliefs and behaviors when developing health policies. This is a 3 pages):
Answer the following Questions:
1. Explain the importance of culturally appropriate health policies.
2. Explain how one can develop a policy so that it gets the support of the community.
3. Explain how you might engage the community to be part of the voice when developing a policy.
Articles:
Campbell, D. (2011). Anthropology?s contribution to public health policy development. McGill Journal of Medicine, 13(1), 76.
Anthropology?s contribution to public health policy development by Campbell, D., in the McGill Journal of Medicing (MJM), 13(1). Copyright 2011 by McGill
University/Faculty of Medicine. Reprinted by permission of McGill University/Faculty of Medicine via the Copyright Clearance Center.
Lee, K., Buse, K. & Fustukian, S. (Eds.). (2002). Health policy in a globalising world. Cambridge, United Kingdom: Cambridge University Press.
Health policy in a globalizing world by Lee, K., Buse, K. & Fustukian, S. Copyright 2002 by Cambridge University Press. Reprinted by permission of Cambridge University Press via the Copyright Clearance Center.
Allen, T. & Heald, S. (2004). HIV/AIDS policy in Africa: What has worked in Uganda and what has failed in Botswana? Journal of International Development, 16(8), 1141?1154.
Retrieved from the Walden Library databases.
Porter, J. D. H. (2006). Epidemiological reflections of the contribution of anthropology to public health policy and practice. Journal of Biosocial Science, 38(1), 133?144.
Retrieved from the Walden Library databases.
Laureate Education (Producer). (2011). Global health and issues in disease prevention [Multimedia file]. Retrieved from https://class.waldenu.edu
Medical Care?s Role in Promoting Health,? featuring Stephen Bezruchka, MD
Fortier, J. (Director & Producer). (2008). Importance of culturally appropriate care for Native Americans [Video excerpt]. In L. Adelman (Executive producer),
Unnatural causes: Episode 4?Bad sugar. United States: Public Broadcasting Service. Retrieved from http://www.unnaturalcauses.org/video_clips_detail.php?res_id=77(c) California Newsreel, 2008. www.unnaturalcauses.org? Fortier, J. (Director & Producer). (2008).
Tohono Odham Community Action (TOCA)?Cultural renewal to improve health [Video excerpt]. In L. Adelman (Executive producer), Unnatural causes: Episode 4?Bad sugar. United States: Public Broadcasting Service. Retrieved from http://www.unnaturalcauses.org/video_clips_detail.php?res_id=46
Please apply the Application Assignment Rubric when writing the Paper.
I. Paper should demonstrate an excellent understanding of all of the concepts and key points presented in the texts.
II. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.
III. Paper should be well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with doctoral level writing style.
IV. Paper should be mostly consistent with doctoral level writing style.
SAMPLE ANSWER
The increasing diversity of the healthcare spectrum comes with challenges and opportunities for healthcare providers, policy makers, and healthcare systems to develop and deliver culturally competent healthcare services. In the healthcare setting, cultural competence is defined as the ability of healthcare organizations and providers to deliver effectively healthcare services that satisfy the cultural, social, and linguistic patient needs, (Johnson et al, 2008). Culture is defined as incorporated models of human behavior. These include thoughts, language, actions, communications, beliefs, customs, values as well as institutions of religious, racial, ethnic and social groups. In essence culture is generally the way of life of a particular community (Galea, 2007). Benefits of culture include the ability of people to provide adequate preparation response as well as recovery from disaster based on their culture, it provides for a protective system that can provide comfort and reassurance, it also defines suitable behavior and provide a support system that identifies a shared dream for recovery. However despite the strength of culture, some cultures can render one group vulnerable compared to others (Galea, 2007).
The importance of culturally appropriate health policies cannot be adequately stressed. A healthcare system governed by culturally appropriate cultural policies has improved health outcomes and enhanced quality of care, and contributes greatly to ethnic and racial discrepancy elimination. The healthcare systems that are culturally competent easily implement strategies that provide relevant enlightenment on cultural capability, competence as well as cross-cultural concerns to health personnel besides initiating policies that decrease linguistic and administrative setbacks to patient care. Cultural competence is also important for it can help reduce long standing differences in mental and physical health conditions of people who belong to different ethnic, cultural and racial backgrounds.
According to Johnson et al (2008), culturally appropriate health policies are crucial in improving healthcare through: effectively eliminating ethnic and racial disparities, improving healthcare quality, and increasing the access to healthcare. In the present day healthcare climate, there is a high potential for appropriate and competent healthcare policies to increase healthcare quality , which is a significantly motivating factor for healthcare providers to undertake training to improve their practice of cultural competence and appropriateness, (Johnson et al, 2008).
If someone wants to develop a policy so that it gets the support of the community, they can establish a policy that supports culturally competent care. Five themes govern such a policy that has a community support namely: a patient-centered emphasis; effective physician-patient communication; achieves balance of skill/attitude-centered and fact-centered approaches to achieving cultural competence as a process of development; and incorporates the understanding of the alternative care sources, as illustrated by Donini-Lenhoff & Hedrick (2010). The policy should be based on a conceptual framework that emphasizes on the cultural competence that focuses much of the attention on the patient and the kin, as opposed to the characteristics of cultural group of the patient or the disease.
Effective communication must be underlined in the policy because such communication facilitates the success of the patient-physician relationship. Important concepts that should be incorporated into the model to facilitate communication include: proper interviewing techniques, negotiation of treatment, and implementing the explanatory model, as mentioned by Donini-Lenhoff & Hedrick (2010). Methodologies to acquire cultural competence are either skill/attitude-centered or fact-centered. The fact-centered approach focuses on education on specific ethnic group information. The model must ensure community acceptance by incorporating the skilled/attitude-centered approach so that patient cannot appear to be represented as racial stereotypes, according to Chin (2011). As well the policy must acquire cultural competence as a developmental process and underline the alternative healthcare sources so that it can fit into the community. Gaskin & Hoffman (2010) argues that the best way of ensuring that a healthcare policy is acceptable to the community is by engaging the community to be part of the voice when developing the policy, as argued by Chin (2011).
Many of the conceptual frameworks that address cultural appropriateness and competence in healthcare emphasize the significance of healthcare policies to recognize the voice of the patients because community compliance to healthcare policies is improved by culture compliance. The voice of the community can be part of developing a healthcare policy if the policy is focused towards provision of linguistically and culturally competent care, (Geron, 2012). To achieve this, before implementing the policy, data can be collected from the community regarding ethnicity, race and language preferences, which will be a basis of designing the policy. After identifying any disparities in the reported in the data collected, the policy can be designed to reflect the voice of the community by focusing on the provision of linguistically and culturally competent care, (Geron, 2012). The policy should also underline that the entire spectrum of the healthcare profession should receive training in diversity issues. It should also emphasize development of a patient language resource, written patient communication and addresses ethnic and racial diversity. Such a policy will inhibit the voice of the community, as illustrated by Gaskin & Hoffman (2010).
References
Chin, J. L. (2011, January/February). Culturally competent health care. Public
Health Reports, 115(1), 25-33 Crimmins, E.M., Hayward, M.D., & Seeman, T.E. (2004). Race/ethnicity, socioeconomic status and health. In N.B. Anderson, R.A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in later life (pp. 310-352). Washington, DC: National Academies Press
Donini-Lenhoff, F. & Hedrick, H. (2010). Increasing awareness and implementation of cultural competence principles in health professions education. Journal of Allied Health, 29:241-245.
Johnson, M., Noble, C., Matthews, C., & Aguilar, N. (2008). Towards culturally competent health care: language use of bilingual staff. Australian Health Review, 21(3), 49-66
Gaskin, D.J., & Hoffman, C. (2010). Racial and ethnic differences in preventable hospitalizations across 10 states. Medical Care Research Review, 57(Suppl.1), 85-107.
Geron, S.M. (2012). Cultural competency: How is it measured? Does it make a difference? Generations, 26, 39-45.
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HPI
A 40-year-old Asian American male, who works as a roofer, complains that three days ago he was lifting a heavy object at work, following which he got low back pain. The pain is in the middle of the back near his waist. The pain increases when he bends forward and he is experiencing numbness and tingling in the toes of his right foot. He has had similar symptoms before, but it has not been so bad in the past. This is the worst he has had because in the earlier instances, he has never had the tingling sensation in his right foot before.
In the past, he got better with rest and some Ibuprofen. He is worried that he will not be able to continue his work and make money. He is out of work as a result of the pain. He has a lot of difficulty getting sleep at night. He has started taking some of his friend’s medication and it seems to help.
He has pain in the mid lumbar area, which radiates to the right buttock. He also has numbness and tingling down the back of his right thigh to his toes. The pain and numbness has been increasing since the problem started three days ago. He has tried over-the-counter Ibuprofen and some stretching exercises, but it does not seem to help. He has not sought any medical care yet. In the past, the pain had just gone away, but this time the pain is persistent. There is a gradual worsening of his symptoms and he is concerned about the pain that has been increasing steadily over the past three days. He is wondering whether he has a herniated disc. His major concern is that he has no health insurance and will be missing work.
ROS
Pain in the mid lumbar area radiating to the right buttock. There is a tingling sensation that goes down the back of his right thigh to the toes. He does not have urinary or bowel incontinence. No nausea, vomiting, or fever. He denies abdominal pain and pain with urination. There is no gross hematuria.
MEDICATIONS
Patient does not take any prescription medications, only over-the-counter Ibuprofen. He is using 800mg of Ibuprofen every four hours. Patient is compliant with the prescribed regimen; in fact, he could be using too much. Patient is seeking care because of the increasing pain. He has tried chiropractic manipulations in the past for low back pain.
Common low back pain affects more than two thirds of people aging over 40 years. It a rampant problem in the society on the basis of its direct cost associated with health care as well as its socio-economic ramifications. Ten percent of the people with low back pains fear that the pain may evolve to become a chronic case. With reference to the case study of the 40 year old Asian American man, the cause of his musculoskeletal condition is thought to be caused by physical straining especially lifting heavy loads (Leg Numbness, Tingling Feet and Toes. (Dawson, n.d.).
From the signs and symptoms of the subject in the case study, it can be suspected that he is suffering from DDD. The herniating of the disc may occur suddenly or gradually, especially after lifting a heavy load from the ground. The disorder is the most prevalent cause of disability among the middle aged persons.
Pathophysiology
His suspicion that he has a herniated disc in the lumbar spine which is probably pressing the sciatic nerve is likely to be true. Herniation of the nucleus pulposus (HNP) come about when this nucleus breaks dissociates from the annulus fibrosus of an intervertebral disc which is the spinal shock absorber. This leads to degenerative disc disease (DDD).
Signs/symptoms
Pain is the most common disabling symptom in musculoskeletal disorders. The man in the case study has been forced to seek medical attention quite often as a result of the pain. The symptoms characterizing DDD have been manifested by the patient. These include pain, tingling in the lower back, calf or foot, thigh, typically affecting one side. The symptoms worsen when the patient is standing, sitting, lying down and some certain movements such as bending or, as in the case of the subject in the case study, lifting objects from the ground (Degenerative Disc Disease Progression over Time. (n.d.).
Progression trajectory,
The progress of lumbar degenerative disease is slow since it also starts as a benign, manifesting its symptoms in a slow rate. According to the case study, the pain tends to increase with time especially during some movements. It is predicted that if one starts experiencing several low back pains at the age of thirties, chances of being in a wheel chair when they reach sixties are high. Although there will be progression in the disc generation, it is not common for low back pain and related symptoms to progress (Disc Disease Progression over Time, n.d.).
Diagnostic testing
The diagnostic of DDD is done by achieved through carrying out various diagnostic studies. Some of the tests carried out include computed tomography, discography, radiographs and magnetic resonance. The discography is able to tell the source of pain experienced by the patient. These studies are, for instance, provocative discography, lumbar radiographs and magnetic resonance imaging. The patient history, physical examination together with these studies is useful in the diagnostic process although they are not in and of themselves ultimate procedures in the diagnosis of pain. The overall diagnosis is therefore determined by the clinical status of the patient and his response to the prescribed treatment (Hasz, 2012).
A reliable explanation on the cause of back pain experienced by patients is obtained through a diagnosis of degenerative disc disease. This is a usual practice during clinical practice.In Diagnosis of these patients is carried out to find evidence associated with degenerative changes. This is done by healthcare providers by use X-ray, Computed Tomography (CT) or MRI scans. The result obtained from the diagnostic tests provides an explanation for the cause of pain. The health care team use the diagnosis as the basis of decisions made on treatment models chosen. In some cases, procedures such as epidural steroid injections and spine surgeries are focused on modifying degenerative changes occurring in the spine. A common belief by most of the healthcare providers and patients is that these diagnostic tests involving MRI or CT scan make out the cause of pain or degenerative disc changes experienced in the spine (Degenerative Disc Disease., n.d.).
Treatment options
Treatment of degenerative disc disease is treated effectively by conservative care which also comprises of medication to manage pain and inflammation. This medication may be administered orally or intravenously through epidural injections. There are many surgery forms available today as a common form of treatment for DDD. The surgeries use different technologies which have to pass a test of time. Different cultures also have their own remedy on how to conservatively intervene against this disorder. However, exercise and physical therapy is cuts across all cultures and interventions. It is worth noting that there is no sure way of treating DDD hence this remains highly difficult and controversial (Alexandre, 2011).
Differentiate the Disorder from Normal Development
The normal intervertebral discs occur between the vertebral bodies which is important in linking the discs together. They form make up to one third of the spinal column in which they also form consist of its main joints. Normal discs play an important role in providing mechanical support through constantly transmitting loads arising from body activity as well as body weight through the spinal column. The spinal column is flexible due to these discs which allow torsion, bending and flexion. There thickness is approximately 7–10 mm thick and have a diameter of 4 cm. The thick outer ring making up the complex intervertebral discs structures are made of fibrous cartilage known as the annulus fibrosus, which also lines a more gelatinous core referred to as the nucleus pulposus. The cartilage end-plates sandwich the nucleus pulposus. With an increase in age and as one grows and there is skeletal maturation, the distinction between the annulus and nucleus decreases and the nucleus becomes less gel like and more fibrotic. The morphology of the disc changes becoming more disorganized
Physical and Psychological Demands on the Patient and Family
The man in the case study is said to be divorced hence he depends on himself through a job he gained through his high school certificate. Having been overwhelmed by challenges of marriage indicates that the patient must have contributed to many problems in the family probably mainly caused by his illnesses.
Key Concepts to Achieve Optimal Management and Outcomes
Optimal disorder management and outcomes with regards to care for the man suffering degenerative disc disease refers to concepts which will improve his wellness and control of problems and psychological factors closely associated with the specific physical conditions and disease. It is important to manage the patient’s cognitive and psychological factors in competence to enable him to manage his own affairs. Also, there is need to manage factors which will ensure motivation, productivity, leadership and healthy workplaces.
With patient-centered care, the family and their patient should be provided with relevant and adequate information which will enable them to manage the disorder ethically. Since it typically arises from the aging process hence it has a tendency to care become a chronic problem. This means that the patient should lead an active life, according to evidence based care, so as to manage their incapacity, whether short term or long term disability.
The Role of Interdisciplinary Team
There is no one person, due to his skills and knowledge can claim responsibility over the success of the team or provision of all care needed by the patient against a disorder such as DDD.Each of the individuals in a team handling the disorder shares a common although each contributes his common goal. The physicians, health care givers and family or friends join the collaborative care teams which align themselves around values and requirements of the patient. The collaborative team should agree on which regenerative therapies would be suitable to repair the degenerated disc or discs.
Facilitators and Strategies to Overcome Barriers
Some of the strategies acceptable by the American Nurses Association are aimed at overcoming self destructive tendencies and promoting patient centered care. In order to restore the patient to back to active life, identification of a proper form of treatment is necessary. The medical practitioners need to use the most appropriate diagnostic procedures before choosing the most preferred therapy for the patient. The patient in the case study has not sought for adequate medical intervention due to economic and social inadequacy.
Alternative ways are available to intervene in the patient’s case. Since he is divorced at the age of 40 years and already takes the blame, this may be a hindrance for his quick recovery. The team is encouraged to provide a lasting solution which is helpful in enabling the man to move on in life. For instance, exploring ways of carefully evaluating the patient’s psychosocial issues with an aim of providing professional counselling will improve the man’s better view of life. Identification of these psychosocial problems would make it easier to counter the factors which quicken the rate at which the disorder becomes chronic. The musculoskeletal disorder related pains will be controlled hence setting the patient toward healing process.
Section II
Plan of Care
According to basic science the disc is not entirely to blame for the pain the pain the patient may be experiencing. This gives the first hint on where the care plan should be directed since it indicates that annulus is not obviously compromised. The care plan considers both indications and diagnostics for either disc replacement or fusion in patients with DDD. However, research hold that the benefits of this process still do not outweigh risks.
How does patient’s socio-cultural background potentially impact the optimal management and outcomes of this plan of care?
From the patient history given, therapy needs to be coupled with a structured rehabilitation program that takes account of cognitive-behavioural therapy and exercise. Research should provide a guide or a framework on this can be done owing to the fact that the man is lonely.
Subjective Data and Objective Data
The patient’s subjective data entails the history taken from his background with regards to his sickness from degenerative disc disease. On the other hand, the objective data will include all other factors related to the effects of the patient’s sickness. These include his divorce, lack of health insurance and poor attention to medical therapy in relation to continuing with work. The issue of family dysfunction, social isolation and poor attention to proper health measures would comprise of objective data.
Assessment
From the history given the patient has not sought for proper medical attention since he only prefers over the counter Ibuprofen. Although he has tried chiropractic manipulation in the past, his problems could not end since this was not the best remedy for this.
Goals of care
·To change the patient’s attitude toward medical attention
·To ensure the patient commences appropriate medication immediately; involving diagnosis and prescription of the right drugs.
·To counsel the patient approach marriage on a better dimension so as to win his wife back.
·To give enable the patients adopt a better lifestyle of nutrition, exercise and work.
How does patient’s socio-cultural background potentially impact the optimal management and outcomes of this plan of care?
The social cultural background of the patient, which is engraved in his attitude to all the issues surrounding him, would make it difficult to implement this plan. However, with an enforced rehabilitation, the plan will work wonders. The negative perception of the patient toward the use of social amenities and services provided would make it a challenge for a successful disease management.
Plan of care
The plan of care for the patient and others like him is to be based on evidence based care. This involves paying serious attention to many aspects other aspects besides responding to patient symptoms and patient history alone. The identification of the right therapy should be ideal to comprehensively solve the problems the man’s seeking. This includes working in collaboration with close family members, employer and other medical experts (Belfer, 2013).
1.Diagnostic test:List, Include IC9 codes.
I.Physical examination
II.Computed Tomography (CT)
III.Provocative discography,
IV.Lumbar radiographs
V.Magnetic resonance imaging
2.Medications: Listnew or changes to dose and time. Make sure you write medication, dose, route and length of time to take if relevant.
vAcetaminophen (such as Tylenol)
vNSAIDs, or non-steroidal anti-inflammatorydrugs. These are:
1.Ibuprofen
2.Naproxen
3.COX-2 inhibitors
(Pain Medications for Degenerative Disc Disease Treatment. (n.d.).
3.Conservative treatments:This would be treatments such as ice, raise head of bed, weigh every day, etc.
Conservative treatment for degenerative disc disorder is based on the patient’s culture. The Asian American people treat DDD by tying a restrainer around the lower back to exert pressure on the part expected to have a lumbar curvature.
4.Education: The education plan for the patients such as the patient in the case study is the introduction social training on how to balance work, family, social life, nutrition and exercise.
5.Collaboration and/or referrals: To ensure the plan is implemented, the county health officer would be mandated to supervise the process. With this position, the officer is capable of influencing all departments and institutions in the country where the individual comes from.
6.Follow-up: The follow-up will comprise of the implementation tools. These include a copy of care plan, sample regimen for the disease and charts for illustration.
References
Alexandre, A., Masini, M., & Menchetti, P. M. (2011). Advances in minimally invasive surgery and therapy for spine and nerves. Wien: Springer.
Belfer, I. (2013). Nature and Nurture of Human Pain. Hindawi, 2013(-), -.
Application of Standards of Care and the Nurse Practice Act to Advance Practice Nurses Involved in a Legal Action
Before completing this paper , it is important that the write understand very well the Nurse Practice Act that’s is use in the U.S because it will be discuss base on the fact that it happened hear in the U.S . It is critical to discuss every details that’s mentioned in this case hear and also use case laws and pear review articles to supports the facts.
Describe the case below and discuss the standard of care that the parties will be held to in this case. How will the standards of care and the Nurse Practice Act be applied in a court of law if the case is sued?
Hear below is the case to be use for this paper . let the writer take time to look at it and respond to the above questions according using case laws to support his augments.
People Involved in Case:
Yolanda Pinnelas-patient
Betty DePalma, RN, MS-nursing supervisor
Elizabeth Adelman, RN, recovery room nurse
William Brady, M.D., plastic surgeon
Mary Jones, RN-IV insertion
Carol Price, LPN
Jeffery Chambers, RN-staff nurse
Patricia Peters, PharmD-pharmacy
Diana Smith, RN
Susan Post, JD-Risk Manager
Amy Green-Quality Assurance
Michael Parks, RN, MS, CNS-Education coordinator
SAFE-INFUSE-pump
Brand X infusion pump
Caring Memorial Hospital
Facts:
The patient, Yolanda Pinellas is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy. Caring Memorial is a hospital in Upstate New York. Yolanda was a student at Ithaca College and studying to be a music conductor.
Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN inserted the IV on the day shift around 1300, and the patient, Yolanda, was to have Mitomycin administered through the IV. An infusion machine was used for the delivery. The Mitomycin was hung by Jeffrey Chambers, RN and he was assigned to Yolanda. The unit had several very sick patients and was short staffed. Jeffery had worked a double shift the day before and had to double back to cover the evening shift. He was able to go home between shift and had about 6 hours of sleep before returning. The pharmacy was late in delivering the drug so it was not hung until the evening shift. Patricia Peters, PharmD brought the chemotherapy to the unit.
On the evening shift, Carol Price, LPN heard the infusion pump beep several times. She had ignored it as she thought someone else was caring for the patient. Diana Smith, RN was also working the shift and had heard the pump beep several times. She mentioned it to Jeffery. She did not go into the room until about forty-five minutes later. The patient testified that a nurse Updated: June 2014 MN506- Unit 9 Page 3 of 5
came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done.
Diana Smith responded to the patient’s call bell and found the IV had dislodged for the patient’s vein. There was no evidence that the Mitomycin had gone into the patient’s tissue. Diana immediately stopped the IV, notified the physician, and provided care to the hand. The documentation in the medical record indicates that there was an infiltration to the IV.
The hospital was testing a new IV Infusion pump called SAFE-INFUSE. The supervisory nurse was Betty DePalma, RN. Betty took the pump off the unit. No one made note of the pump’s serial number as there were 6 in the hospital being used. There was also another brand of pumps being used in the hospital. It was called Brand X infusion pump. Betty did not note the name of the pump or serial number. The pump was not isolated or sent to maintenance and eventually the hospital decided not to use SAFE-INFUSE so the loaners were sent back to the company.
Betty and Dr. William Brady are the only ones that carry malpractice insurance. The hospital also has malpractice insurance.
Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The Claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying.
During the procedure for the skin grafting, the plastic surgeon, Dr. William Brady, used a dermatome that resulted in uneven harvesting of tissue and further scarring in the patient’s thigh area where the skin was harvested.
The Risk Manger is Susan Post, J.D. who works in collaboration with the Quality Assurance director Amy Green. Amy had noted when doing chart reviews over the last three months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings and nights then coming back and working the evening shift. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several units. Prior to this incident the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on this unit and what types of resources and training was needed.
Resources
Hunt, J. A., & Hutchings, M. (2014). Innovative group-facilitated peer and educator assessment of nursing students’ group presentations. Health Science Journal, 8(1), 22–31.
Essentials of Nursing Law and Ethics
Chapter 2: “Regulation of Nursing Practice”
Chapter 4: “Standards of Care”
Chapter 33: “Contracts”
Chapter 48: “Social Media and Online Professionalism”
Chapter 50: “Maternal and Fetal Rights”
SAMPLE ANSWER
Legal Malpractice or Negligence Case Fact Pattern
Introduction
Medical practitioners in their line of duty engage in legal malpractices or even neglect their role in provision of quality services to their patients. Upon performing these malpractices and acts of negligence, a patient can sue the nurse in a court of law (Yonda- Wise, 2014). The nurse can be charged for violating the Nurse Practice Act and negligence of the Standards of Care. The following discussion describes a certain case and how standards of care will be held in this case. The paper also indulges to argue how Standard of Care and Nurse Practice Act can be applied in a court of law if the case is sued.
Description of the Case
The case involves a 21-year-old female, Yolanda Pinnelas, who is admitted for chemotherapy at Caring Memorial Hospital. Mary Jones inserted the recommended Mitomycin using IV and it was hanged on using an infusion machine. The situation at the hospital was that there were limited staff, and the pharmacy delayed in delivering the drug on time so that it was not hung until evening by Jeffrey. In the evening, Carol Price heard the infusion pump beeping severally and ignored. Diana Smith, still on the shift, heard of the beeping and informed the RN in charge, but did not go into the patient’s room until about forty-five minutes later. The patient was not informed of what had happened. It was reported of Infiltration on the IV after it was stopped. During this time, the hospital was trying a new ‘safe infuse’ device. When putting it into practice, the supervisor, Betty DePalma, did not take note of the name and serial number of the pump. The pump was neither isolated nor maintained and eventually led to its dismissal. After all this malpractices and negligence, Yolanda, develops necrosis of the hand. During harvesting of the skin to remedy the problem, Dr. William Brady caused further scarring of Yolanda’s skin.
Standard of care violated in the case above
The main element of violating standard of care in this case is negligence. In the case above, Patricia Peters neglected his role in providing drug on time (Lilley, Collins, Snyder & Savoca, 2014). Jeffrey in charged did not hang the infusion at the appropriate time (Carol, 2011). Mary Jones was first to hear the beeping of the infusion machine, but did not bother about. Although Diana smith heard the beeping and informed the RN in charge, he did not go into the room immediately (Masters, 2014). In addition, the RNs did not take the initiative to inform the patient about her treatment process. Betty DePalma depicts some elements of negligence when he could not take note of the name of the devise and its serial number when testing it.
Legal implications of the malpractices and negligence
This scenario will be judged in rhyme with case law of ‘Monk vs. Doctor’s hospital’ where the facility and the physician were found negligent when an application of a surgery resulted in a patient burn (Wojcieszak & Houk, 2006). Another case law that can be applied to the case above is ‘Llyod Noland Hospital vs. Durham’. In this case law, the court ruled that the staff failed to administer a standing order of preoperative antibiotics to a patient (Wojcieszak & Houk, 2006). All the cases relate to Yolanda’s case where negligence of the hospital staff led to her developing necrosis of hand. The implication will be that Yolanda will be compensated while the medical practitioners involved in the negligence will either be suspended, fired, or their licenses revoked.
Conclusion
In summary, malpractices and negligence in provision of services in hospital can lead to legal implications. RNs stand chances of being sued for the failure to observe and perfect standard of care. This is because the society expects services from them to be ideal. Susan Post is likely to be fired on sleeping on her job. William, Army, and Michael can be sued for complicating the health of Yolanda.
References
.Carol B. Liebman, (2011). Medical Malpractice Mediation: Benefits Gained, Opportunities. Journal for legal and contemporary problems in nursing
Lilley, L. L., Collins, S. R., Snyder, J. S., & Savoca, D. (2014). Pharmacology and the nursing process. St. Louis, Mo: Elsevier/Mosby.
Masters, K. (2014). Role development in professional nursing practice. Burlington, MA: Jones & Bartlett Learning.
Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2009). Essentials of Nursing Leadership and Management. Philadelphia: F.A. Davis Co.
Wojcieszak, D & Houk, C. (2006). The sorry works! Coalition; making the case for full disclosure. Journal on Quality and patient Safety.
Yonda- Wise, P. (2014). Leading and managing nursing. St. Louis, Mo: Elsevier Mosby.
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Read the Real World Case (at the end of Chapter 16) in course text book Health Information Management Technology: An Applied Approach (Fourth Edition) and answer the following questions using the knowledge you gained from the chapter. Your responses should be written in paragraph format:
1. What are the physicians trying to accomplish through buying the same EHR product at their hospital? What are the pros and cons? 2. Why cannot the physicians send a medication order to the hospital from their e- prescribing device? 3. What is the difference between scanning, COLD feeding, and point-of-care (POC) data entry? 4. How could the hospital improve upon its data quality? 5. Use the information that you gathered so far for your previous PowerPoint assignments and consider the real world case study and what the physicians are trying to accomplish by purchasing these products. When you think about the system development life cycle, use what you learned to determine how this could help in accomplishing the goals associated with this case study.
Requirements
The Assignment should be four to five pages in length, prepared in a Microsoft Word
document, and APA-formatted.
This Assignment should follow the conventions of Standard American English (correct
grammar, punctuation, etc.). Your writing should be well ordered, logical, and unified, as well
as original and insightful. The resources used (including your text) should be properly cited.
Your work should display superior content, organization, style, and mechanics.
This Assignment must have a title page and a reference page.
SAMPLE ANSWER
Electronic Health Record Communication Technologies
Physicians have adopted a new move of trying to improve and support users through making available complete and accurate data, practitioner reminders and alerts, links to bodies of medical knowledge, clinical decision support systems, and other aids when buying the same EHR product at hospital (Merida, 2012). Therefore, the physicians were propelled to improve quality and continuity of health care at the hospital. The advantage of buying the same EHR is that back-up of information is integrated into the hospital system (Merida, 2012). Another advantage is that no interfaces are required or a few of them are to be employed to perfect the process. The disadvantage of purchasing the same EHR at the hospital is that the hospital had a greater need meeting regulatory and financial requirements. Billing and accounting packages are costly to acquire and install (Merida, 2012). The reason why the physicians cannot send a medication order to the hospital from their e-prescribing device is that they feared of patient not accepting electronic prescription and ought for mediation to be written on paper form.
The difference between scanning, COLD feeding, and Point-of Care (POC) data entry is that POC is used to input information to mobile phones, PDA, and tablets. Scanning is the method used to get information from papers through use of lens. COLD feeding is the process of storing large mass of data on a laser disk (Merida, 2012). Meanwhile, the hospital could have improved on its quality data by successful implementation of HER, which calls for strong leadership, mandatory staff training, strict adherence to time and budget and overall involvement of clinical staff in the design of EHR (Merida, 2012). When the physicians address the cons from EHR and improve on its quality data, it will effect faster retrieval of hospital data, and this will consequently enhance realization of its goal to improve health care.Reference
Merida, J. (2012).Health Information Management Technology. An Applied Approach (Fourth Edition). Chicago; AHIMA.
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Critique of health contemporary health program evaluation
Critique of health contemporary health program evaluation
Order Instructions:
Course: Health Promotion
Subject Name: Planning and evaluation 2
Level: Undergraduate year 2
Reference: Harvard (10 references)
Assignment Topic: critically analyse a contemporary health program evaluation, considering a range of social, economic and cultural contexts.
Format: Critical Appraisal
Length: 1000 WORDS
(3 PARTS: INTRODUCTION AND BACKGROUND, THE EVALUATION, CONCLUSIONS AND RECOMMENDATIONS)
This task requires you to REVIEW AND CRITIQUE THE FOLLOWING PUBLISHED EVALUATION: (PROVIDED)
DAVIS, B, McGrath, N, Knight, S, Davis, S, Norval, M, Freelander, G & Hudson, L 2004. Aminina Nud Mulumuluna (‘You gotta look after yourself’): Evaluation of the use of traditional art in health
promotion for aboriginal people in the Kimberley region of Western Australia, Australian Psychologist, 39(2), pp. 107-113. http://www.tandfonline.com/doi/abs/10.1080/00050060410001701816#.VA0lSfmSySo
This task is designed to encourage you to explore an evaluation that has been completed and has been published in an academic journal. In the CRITIQUE of THIS EVALUATION, you WILL IDENTIFY AND BRIEFLY DISCUSS THE FOLLOWING:
1) PROVIDE AN INTRODUCTION AND SOME BACKGROUND TO THE PROGRAM THAT WAS EVALUATED
What are the aims and/or objectives of the program?
Are they clear?
How could they have been made clearer? eg. Are they SMART?
Within this discussion, you need to make some judgement (with supporting EVIDENCE) as to whether these are appropriate.
What is the rationale for conducting the program?
You might also choose to mention something about the target group, the methods that were used or other relevant aspects. (NEED EVIDENCES)
2. WHY DO WE NEED TO EVALUATE THE PROGRAM??
Why is it important to know whether this program is effective or not?
In this section, you will talk about the evaluation of the program.?
Consider this: why do we need to evaluate programs in general?
Why does this program need to be evaluated?
Are there gaps in the literature?
Run in a different region or country?
Has it been modified?
Is it brand new?
Perhaps the program has been run before with, for example, a different population group, or is this the first time?
If it, or something similar, has been run previously, was it evaluated?
(TO GET HIGH SCORES):
1) Clear and comprehensive introduction to the program is presented (including aims).
2) Clearly stated RATIONALE or justification for the program is presented, the health issue is identified and the need for the program is supported by evidence.
3) A clear understanding of the program of study is demonstrated.
THE EVALUATION
What is the evaluation trying to do?
What are the aims of the evaluation – are they clear?
How could they have been made clearer?
What type of evaluation is this study? eg. process or impact? OR is it both? – ensure that you PROVIDE ADEQUATE DEFINITIONS TO BACK UP your response here…
Rigorous, quantitative measurement of an intervention requires accurate measurement of any change and a high degree of confidence that the change was due to the program and not other
factors (hint: (PROVIDED) Windsor et al (2004) article would be beneficial here).
What is the study design for the evaluation of this program?
Once you have identified the design and methods used in the evaluation, you should make some comment on the strength of the?evaluation. (NEED EVIDENCES)
In doing so, you will provide answers to the following:
Is there a more rigorous study design that could have been used?
Why wasn’t it used for this specific study?
What are the advantages and disadvantages of such a study design. (NEED EVIDENCES)
You should briefly discuss any possible sources of measurement error or bias in the study, as well as any possible threats to internal and external validity. (NEED EVIDENCES)
Were the methods used for data collection in the evaluation appropriate? (NEED EVIDENCES)
(TO GET HIGH SCORES):
1) AIM(S) of the EVALUATION are clearly presented.
2) The TYPE of EVALUATION is clearly presented
3) An understanding of the STRENGTHS AND LIMITATIONS of this EVALUATION is clearly demonstrated and evidenced.
4) The EVALUATION METHODS are clearly described; the CRITIQUE is comprehensive and strongly supported by evidence.
5) The FINDINGS of the EVALUATION are clearly described and are related, with support from THE LITERATURE, TO THE BROADER CONTEXT OF THE HEALTH ISSUE
CONCLUSIONS & RECOMMENDATIONS
What were the findings of the evaluation?
Did the evaluation show that the intervention was a success? (NEED EVIDENCES)
Have the authors acknowledged the limitations of the evaluation?
Are threats to validity of concern in this evaluation? (NEED EVIDENCES)
Can you make any recommendations to strengthen the evaluation? (NEED EVIDENCES)
(TO GET HIGH SCORES):
1) Clear identification and succinct evidence-based discussion of all LIMITATIONS of the EVALUATION.
2) Comprehensive discussion of how THE FINDINGS OF THE EVALUATION might be used to improve the PROGRAM.
3) Appropriate & evidence-based RECOMMENDATIONS for improvement to EVOLUTION design are included.
SAMPLE ANSWER
Critique of health contemporary health program evaluation
Introduction
Background of the program
The following discussion engages in critical analysis of the evaluation of the use of traditional art in health promotion for aboriginal’s people in the Kimberly region of Western Australia. The aim of the project was on evaluation of preventive health resource developed for aboriginal people in the west Kimberly region. The project was been undertaken by the Jean Hailes foundation For the Women and Aboriginals and non-Aboriginal health workers, educators and artistes from Looma, Pandunus Park, Mowanjum and derby (Allegrante & Sleet 2004, p 157-171).
The aim of the project was to determine whether traditional art and language in health promotion can provide for cultural identity and imparting modern health knowledge, that is, to determine whether integration of modern health knowledge and traditional one can contribute to contemporary view of the Aboriginal health ( Raingruber 2014, p 156-167).The aims of the project was not clear. This is because initiatives and hypothesis from the project were not widely disseminated and used in other regions and communities. They mainly encompassed on Aboriginals only rather than having incorporated other regions to have effective data. The objectives could have been made SMART if they could have not engaged other regions to act as control group to their project (Fallon, Begun & Riley 2013, p 143-178). For the program to be Specific, it is to be formulated to one community so that it can yield a good sample size to study with. For the program to be realistic, it has to produce diverse findings that can be deductively hypothesis to test its predictions. The issue of the time was not addressed in the program, as there was wastage of time in getting sample from Kimberly and South West Victoria. The other regions for example, could have some background of scenarios where incorporation of traditional art in health promotion was effective. These places could have been referenced from United States or other parts of Australia. The target group for the program was Aboriginal women. The program surveyed Aboriginal women using a comprehensive women’s health questionnaire in order to fully understand their reproductive and general health needs. The surveys were conducted to women from both the Kimberly and South West Victoria. The rationale behind this program was to identify reproductive health status and general; lifestyle factors associated with diabetes and cardiovascular.
Evaluation
`The program needs to be evaluated to detect areas that were not addressed. Another reason for evaluating the program is to provide alternative methods that could have been used by the program to produce effective results. The program needs to be evaluated to determine whether initiatives to the indigenous languages have a positive impact on the health promotion of the Aboriginal people of the Western Kimberly. Therefore, the program is a type of impact-oriented project (Raingruber 2014, p 156-167). The evaluation has to be undertaken to bridge the gap between the literatures. The gap between the literatures is the missing data on how far has the impacts from the program entrenched to the Aboriginals’ society. The program used questionnaires only to conduct its study. The study could have brought reasonable results if it had included such methods such as RCTs and Case studies.
The positive thing about RCTS is that the population studied is likely to give more personal data unlikely to questionnaires where most of the people lie. Case studies on the other hand are objective in the research eliminating the elements of emotions and feeling in the study. The antagonistic of case study is that, although people will corporate, samples will be in constant fear and anxiety in the study. For the evaluation to be effective, observation should be devised to be used (Tsey & Every2000, p 140-148). This comprises of observing the impacts of combination of modern and traditional methods in health promotion for Aboriginal people in Western Kimberly. Observation may take the form of overt and overt where the participants in health settings are studied. This type of evaluation had recently been employed in South Western Kimberly to determine the impact of improving communication between health workers and Aboriginal patients in health care setting in Australia.
Strength and weaknesses of this evaluation
There were varied strengths emanating from the evaluation of the strength was that Aboriginal women above 18 years corroborated in the study to provide reliable results. Many Aboriginals were able to change their diet and lifestyle to reinforce the need for preventive health strategies among these women. Another positive about the evaluation is that, the findings from the questionnaires suggested a high prevalence of PCOS in this population (Hoghugi & Long2004, p 120-123).The weakness of the evaluation was that, due to small sample size, the data lacked the elements of quantification. Another limitation from the evaluation was that the program was highly electrified with Western paradigms (Cara & Macrae 2005, p 134-137). This denied the evaluation to borrow from Aboriginals system of health. Another limitation from the evaluation is that the program kept jumping from one method to another that lead to inconsistent data (Cara & Macrae 2005, p 134-137).
Findings of the evaluation
The finding from the evaluation is that fifty percent of the women participated in the study. A half of the remaining women were from the Western Kimberly and the other half from South Victoria region. Most of Aboriginal women from the rural area cooperated as compared to their counterparts from urban centers. The overall findings are that women were highly characterized by high risk of cardiovascular disease (Tsey, Whiteside, Haswell-Elkins, Bainbridge, Cadet-James & Wilson 2010, p 169-179). Patients with diabetes and Cardiovascular disease need holistic and comprehensive involvement in the research to ensure that their plights are encompassed under one roof (Tsey, Whiteside, Haswell-Elkins, Bainbridge, Cadet-James & Wilson 2010, p 169-179). .
Conclusion
The analysis concludes that there exists literature gap between the evaluations of contemporary health program. It has been concluded that, the results could have been amplified if the study concentrated on the Aboriginal people of the Western Kimberly Only than encompassing on the other from South west Victoria. Not all participants cooperated in the study and therefore, led to small size of data (Raingruber 2014, p 156-167). Therefore, intervention with observations and RCTs will improve the evaluation of the program, as people with the disease will act in their capacity to perfect he preventive intervention to improve their contemporary life.
Recommendations
It is recommended that any attempt to evaluate contemporary health program evaluation should range from economic, social and cultural perceptive. It also recommended that the attempt should include not only questionnaires in its evaluation, but it should employ observations, RCTS and cohort studies (Turner, Richards& Sanders 2007, p 430-455). The evaluation has devised that case/cohort studies are important in addressing challenges experienced by the Aboriginals of South western Kimberly in Australia ( Raingruber 2014, p156-167)..
Reference
CARA, E., & MACRAE, A. (2005). Psychosocial occupational therapy: a clinical practice. Clifton Park, NY, Thomson Delmar Learning. pp134-137.
FALLON, L. F., BEGUN, J. W., & RILEY, W. J. (2013). Managing health organizations for quality and performance. Burlington, Mass, Jones & Bartlett Learning.pp143-178.
HOGHUGHI, M.& LONG, N. (2004). Handbook of parenting: theory and research for practice, London: SAGE Publications Ltd.pp120-123.
RAINGRUBER, B. (2014). Contemporary health promotion in nursing practice. Burlington, Mass, Jones & Bartlett Learning.pp156-167.
STEWART-BROWN, S.& MCMILLAN, AS.(2001). Home and community based parenting support programmers and interventions: report of Work-package 2 of the Data Prev project. Coventry: Warwick Medical School, University of Warwick. Retrieved from:<http://wrap.warwick.ac.uk/3239/>.
TSEY, K.& EVERY, A.(2000). Evaluating Aboriginal empowerment programs: the case of Family Wellbeing, Australian and New Zealand,Journal of Public Health.pp140-148.
TSEY, K., WHITESIDE, M., HASWELL-ELKINS, M., BAINBRIDGE, R., CADET-JAMES, Y.& WILSON, A.(2010). Empowerment and Indigenous Australian health: a synthesis of findings from Family Wellbeing formative research. Health and Social Care in the Community 18(2):169–79.
TURNER, K., RICHARDS, M.& SANDERS MR 2007. Randomized clinical trial of a group parent education programmer for Australian Indigenous families. Journal of Pediatrics and Child Health. pp430-455.
ALLEGRANTE, J. P., & SLEET, D. (2004). Derry-berry’s Educating for Health a Foundation for Contemporary Health Education Practice. Hoboken, John Wiley & Sons. pp157-171.
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In 2000, the crude mortality rate from all causes for Haiti (a very impoverished country) was 6.0 deaths per 1,000 persons. In contrast, the crude mortality rate from all causes for the United States was 10.4 deaths per 1,000 persons.
Then respond to the following:
What are some of the factors you would want to consider in assessing such a difference in mortality?
Discuss possible explanations as to why the crude mortality rate is lower in Haiti than in the United States.
SAMPLE ANSWER
Measuring Disease Frequency
Different countries experience different rates of mortality brought about by varied reasons. Crude mortality rate helps to estimate the number of deaths of people in mid-year. Comparing the crude mortality rate of various countries can help stakeholders to enhance the quality of health services to promote better care. This paper explores the factors contributing to differences in crude mortality rate of Haiti and USA as well on reasons why the crude mortality rate is lower in latter.
Statistics indicates that in 2000, crude mortality rate from all causes for Haiti was 6.0 deaths per 1000 persons compared to the U.S. that recorded 10.4 deaths per 1000 persons. Various factors may be considered in assessing these differences in crude mortality rate., one of which is gender. Women are believed to live longer, 5-10 years longer than men do. Therefore, if the number of women is more than men in a country, then the rate or mortality is expected to be low. Another factor is the age of the population. A country with old population will record higher death rates compared to that with lower age population (Guang-zhen, 2010). The economic level of a country also determines the rate of crude mortality. In countries that have stable economies, the rate of mortality is low compared to those with unstable economies (Guang-zhen, 2010). This is because, established economies provides incentives and have easy accessibility to infrastructure to support better heath. Cultural beliefs also play a critical role in enhancing the quality of care and more so when it comes to the morbidity rates of a country. Some cultural practices and beliefs are outdated and impact negatively on the healthcare leading to more deaths.
In this context, therefore, one of the reasons that explain why the crude mortality rate is lower in Haiti than in the United States is the number of aging population. U.S. has a high number of aging population compared to Haiti, and this contributes to greater level in this discrepancy. Most of older people are vulnerable because of their age compared to young people that make a larger percentage of Haiti.
Exposing the Gaps—How Does the United States Compare in Key Determinants of Health?
When the health of a population is measured by various mortality indicators such as life expectancy, infant or child mortality, or the chances of surviving to retirement, surprising trends emerge. Health, as measured by longevity, appears to be declining in substantial segments of the U.S. population, especially for women (United Health Foundation, 2013). These findings receive little attention in most public health efforts or in the mainstream media, at least in the United States.
For this Assignment, you select health indicators used to measure the health of the U.S. population and contrast them to other countries around the world. You compare various determinants of health within different states in the United States as well as across continents.
To prepare for this Assignment, complete the readings and view the media in your Learning Resources. Install the free Gapminder Desktop tool and experiment plotting different health outcomes against various determinants already loaded along the two axes. Using the various health ranking resources provided, select two key health indicators for which the United States ranks lower than other nations.
Note: In grading every required Application Assignment, your Instructor uses an Application Assignment Rubric, located in the Course Information area. Review this rubric prior to completing your assignment.
The Assignment (3–4 pages):
Provide a brief description of the two health indicators you selected, citing specific sources.
Explain how the U.S. ranks on these indicators compared to other nations.
Explain two factors that might influence those rankings and the relative standing of the U.S. compared to the other nations.
Determine which two states rank the best and which two states rank the worst for those indicators.
Describe factors you believe might contribute to those relative rankings among the states.
Share any insights you gained or conclusions you drew as a result of making these comparisons.
Expand on your insights utilizing the Learning Resource
SAMPLE ANSWER
How U.S. Compares in Key Determinants of Health
The two health indicators selected are life expectancy and infant mortality rates. Life expectancy is understood as the expected number of years of life that is remaining at a particular age. Life expectancy is extensively utilized in measuring health even though it only takes into consideration the length of life of people in the country and not their quality of life (Kliff, 2013). Infant mortality rate (IMR) is basically the rate of deaths amongst children who are below the age of 1 year, for each 1,000 live births averaged over 3 years (Castillo, 2013).
IMR = (Number of child deaths in a year / No. of live births in the same year) x 1000.
Relative to other nations, America is ranked 26th in life expectancy. This is illustrated in the table below:
Table 1: Life expectancy in the U.S. compared to other countries (Kliff, 2013)
Rank
Country
Life Expectancy
1
Switzerland
82.8
2
Japan
82.7
3
Italy
82.7
4
Spain
82.4
5
Iceland
82.4
6
France
82.2
10
Norway
81.4
11
Netherlands
81.3
12
New Zealand
81.2
15
United Kingdom
81.1
17
Canada
81.0
18
Germany
80.8
23
Belgium
80.5
24
Slovenia
80.1
25
Denmark
79.9
26
United States
78.7
27
Chile
78.3
28
Czech Republic
78.0
The life expectancy for women in America is 80.7 and 75.6 for men (Castillo, 2013). Although the life expectancy in the United States is increasing, it is doing so a lot more slowly compared to other developed countries. Two factors that may influence the life expectancy rankings are violence and disease. In essence, life expectancy in the U.S is lowest amongst industrialized countries because of violence and disease. The violence is partly because of the widespread possession of guns as well as the practice of storing firearms in unlocked places at home (Castillo, 2013). Besides the impact of gun violence, people in the United States get involved in more accidents involving alcohol and consume the most calories among high-income nations. Moreover, heart disease, diabetes in addition to lung disease are more prevalent in the U.S. than in other developed countries (Castillo, 2013).
Figure 1: Infant Mortality Rates of U.S. compared to other high-income nations (Kliff, 2013)
In America, the infant mortality rate is more than 2 times that of peer nations such as Sweden and Japan (Kliff, 2013). Two factors that may influence those infant mortality rate rankings include poor nutrition of American babies compared to babies from other high-income countries, and inadequate nutrition/under nutrition of American babies compared to babies in other developed nations (Castillo, 2013).
Table 2: the two best and two worst states in the U.S. by infant mortality rates (Statistica, 2013)
Ranking
State
Deaths per 1,000 live births
States that rank the best
1
New Hampshire
4.42
2
Minnesota
4.55
States that rank the worst
49
Alabama
8.49
50
Mississippi
9.86
The above statistic indicates the infant mortality rates of the 2 best and 2 worst states in the United States as of the year 2012. The State of New Hampshire had the best rate which was 4.42 for every 1,000 live births prior to the age of 1 year, followed by Minnesota with 4.55. Alabama and Mississippi had the worst with 8.49 and 9.86 respectively (Statistica, 2013). Factors that may contribute to those relative rankings among the states include poor nutrition as well as under nutrition considering that in terms of child food insecurity rates, the state of Mississippi ranks at the bottom and neighboring Alabama is ranked 44th out of 50 states. Conversely, the top 2 states in terms of child food insecurity rates are New Hampshire and Minnesota (Ochs, 2014).
Table 3: U.S. states by life expectancy (Greenwood, 2014)
Ranking
State
Life Expectancy
The Best States
1
Hawaii
81.3
2
Minnesota
81.1
Worst States
50
West Virginia
75.4
51
Mississippi
75.0
At 81.3 years, the state of Hawaii has the longest life expectancy exceeding the national average by more than 2 years. It is followed by Minnesota with a life expectancy at birth of 81.1. Out of all the U.S. territories, Mississippi ranks with the shortest life expectancy having 75.0 (Greenwood, 2014). The two main factors which essentially contribute to those ranking include diseases such as diabetes, as well as the quality of health care in the state, bearing that the state of Minnesota has more doctors per capita compared to West Virginia or Mississippi. Having more doctors per capita ensures the provision of adequate, and better quality health care for citizens of that state (Ochs, 2014).
In sum, America ranks poorly in terms of infant mortality rates as well as life expectancy compared to other developed countries. Two factors that may influence those infant mortality rate rankings include poor nutrition and inadequate nutrition. The factors that contribute to the life expectancy rankings are violence – gun violence in particular –, and disease particularly heart disease and lung disease. The southern states of West Virginia, Mississippi, and Alabama rank at the bottom in terms of life expectancy while Minnesota and Hawaii are at the top. In infant mortality, New Hampshire and Minnesota are at the top while Alabama and Mississippi are at the bottom.
References
Castillo, M. (2013). Report: U.S. Life Expectancy Lowest among Wealthy Nations due to Disease, Violence. CBSNews.
Greenwood, K. (2014). The 15 U.S. States with the Longest Life Expectancies. Boston, MA: CRC Press.
Evolving Practice of Nursing and Patient Care Delivery Models
Order Instructions:
The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by CCNE and AACN using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, their specific care discipline and their local communities.
As the country focuses on the restructure of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and less will be available in acute care hospitals.
Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and changes. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics and medical homes.
In 800-1,000 words summarize the responses shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
A minimum of three scholarly references are required for this assignment.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.
SAMPLE ANSWER
Evolving Practice of Nursing and Patient Care Delivery Models
Registered Nurses and BSN play a critical role in the delivery of healthcare to patients. Regardless of the role they play, they are as well faced with a myriad of challenges that require immediate address. The field of nursing is growing and changing every day and, therefore, nurses must be abreast with the new developments and changes to remain effective in their duty. The paper exemplifies on the shared impressions about anticipated changes to healthcare delivery and the new roles of nurses in communities, hospital, clinical, and medical homes settings. The paper further discuses whether these views are consistent with the findings pertaining to health reform.
The colleagues noted that the medical care in US has been marred with extremely high costs and poor quality as well as fragmented delivery. The high cost of accessing quality medication has hindered many people from receiving quality healthcare, and this has compromised healthcare. However, with the new reforms in the healthcare, nurses are optimistic of new changes. They have already begun experiencing positive outcomes in terms of delivery of services. The new concepts of integrated healthcare delivery have been developed including, Accountable Care Organizations (ACOS) and patient centered medical homes that will to greater extent impact positively on the field of nursing. Accountable care organizations are partnerships between the healthcare providers and aim to coordinate and manage patient care. The aim of this program is to ensure that quality care is delivered at reduced cost to help control huge amount of Medicare spending.
The Accountable Care Organizations groups include hospitals, nursing homes, physical groups, and home health cares services. The alliances are created through contracts that create a circle of service agreements aimed at bringing patient care under one umbrella. This concept ensures that health care costs are low as services are provided at one single corporate structure hence, eliminates duplication of services.
The nurses also postulated that the new changes will ensure provision of better care to all the individuals. The six dimensions of quality including effectiveness, safety, patient centeredness, timeliness, efficiency, and equity are guaranteed (Longworth, 2013). With home based care, nurses are in a better position to provide quick and effective care to patients. Healthcare is no longer going to be provided at the acute care centers, but the changes will see more people get better and quick healthcare in their homes. Citizens are also going to receive better services through education on the major causes of illnesses, health, poor nutrition, substance abuse, physical activity, and poverty among many others. This means that preventive measures are going to be embraced such as physical examination and vaccinations, including influenza and polio among others, thereby helping to improve the quality of life.
The nurses as well agreed that integrated delivery system models are very effective in cost savings and at the same time improving quality of care. Through these changes and reforms, hosipital admissions will reduce and visits to emergency departments will as well come to a minimum, hence, saving costs. The group health cooperative of Puget was able to reduce the total costs of health by $10 per member in every month and recorded 16% reduction in new hospital admissions as well as 29% reduction in emergency visits (Longworth, 2013). This statistics is a clear indication that indeed with the emergence of these new concepts in nursing, quality is guaranteed at a lower cost.
Indeed, the impression elicited by the nurse colleagues is consistent with the studies on health reforms. Government and other stakeholders in the health sector have instituted various changes in health to help enhance the quality of services. The government through such policies such as Affordable Care Act aims at ensuring that all the members of the U.S can access quality health care at an affordable cost (Daemmrich, 2013). Through partnerships with insurance companies such as Medicare and Medicare, many citizens will get the opportunity to access to quality healthcare.
According to Longworth (2013), the concept of ACOs, which was spawned by Elliott Fisher in 2006 aimed at improving coordination of care within the Accountable Care Organizations (Longworth, 2013). It was also intended to reduce fragmented care, control the costs of accessibility to care, and improve the outcome. This resonates with the colleagues’ impression of the new reforms of ensuring that quality care is provided at an affordable cost. Nurses have the responsibility to ensure that they improve the quality of care of their patients. In doing so, they must at all times ensure that they adhere to the professional codes of ethics and legislations. Even as these reforms in healthcare are implemented, it will require that nurses undergo further training to equip themselves with more skills to help in management of different diseases. ACO’s will require increase in the number of nurses to render their services to the members of the communities (Kelly, 2011). They will as well be required to embrace technology and innovation to handle health problems in the society.
In conclusion, nurses must be always be updated on the new developments in health profession. They have a greater role to play in healthcare and must be able to address the new changes and challenges they face. They must adhere to ethical standards in their execution of duties and must at all times ensure that they promote positive healthcare. The new reforms in the healthcare such as integrated patient centered care and ACOs have become important and are revolutionizing this sector. Nurses must be ready to adapt to these changes in order to help transform and impact positively on the quality of healthcare among the members of the community.
Kelly, E. (2014). Patient care delivery and integration: Stimulating advancement of ambulatory care pharmacy practice in an era of healthcare reform Am J Health Syst Pharm, 71(16):1357-1365
Longworth, D. (2013). Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Retrieved from: http://www.ccjm.org/content/78/9/571.long
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