Financing U.S. healthcare
THESIS STATEMENT: Financing U.S. healthcare in the 21st century is impacted by a continued provider shortage, increasing healthcare costs, and attempts at healthcare reform.
PLEASE PROVIDE RELEVANT BACKGROUND MATERIAL TO THE THESIS STATEMENT.
Financing U.S. healthcare – public and private insurances
Provide background information on public and private insurances and their effect on overall financing.
Cardiovascular, neurologic, respiratory, or gastrointestinal disorder
Reflect on a patient who presented with a cardiovascular, neurologic, respiratory, or gastrointestinal disorder during your Practicum Experience. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain how the patient’s gender might have impacted or influenced her care. If you did not have an opportunity to evaluate a patient with this background during the last 10 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.Assignment 2: Practicum – Journal Entry
Reflect on a patient who presented with a cardiovascular, neurologic, respiratory, or gastrointestinal disorder during your Practicum Experience. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain how the patient’s gender might have impacted or influenced her care. If you did not have an opportunity to evaluate a patient with this background during the last 10 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.
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The chronicity of COPD takes into account self-administration by sufferers. (Cafarella et al 2012.). The self-administration objective is lessened doctor’s facility affirmations and enhanced life quality (Puhan et al 2011). Sufferers ought to have admittance to an extensive variety of abilities accessible from the multidisciplinary group. Those incorporate worsening restriction, respiratory disappointment, constant beneficial hack and nervousness, and discouragement.
Sign Recognition
Patients released from doctor’s facility are defenseless to the process of doing admission again (Coventry, Gemmell & Todd, 2011). Getting to have the situations and knowing or being aware of their happening is a fuel for basic self-administration or management, in that given conditions there is what should be done, and in the sense that there is a need for pharmaceutical to yield, or acknowledge they require clinic dealing.
Treatment
In this point the fundamental type of medicines originates from breathed in treatments and clarified underneath should be the point at that they should direct in their way of understanding are the main consideration in self-administration. In a shortness of breath and practice confinements: A small action of the beta 2 agonists (as required) or small action on a muscarinicfoe (as required).
In the intensifications or industrious windedness: A long-acting beta2 agonist, long-acting muscarinic foe, to long-acting beta2 agonist took in corticosteroid (Combination Inhaler) OR a long-acting muscarinic enemy (must hold back acting adversary once this is begun). (Keep in mind if using Corticosteroids, this has no proof of long terms assistances).
In the event that encountering determined intensifications or shortness of breath. Long stand-in Muscarinic opponent long stand-in beta2 competitor and breathed in corticosteroid (joined nebulizer). Coffman & Levenson (2011) depict how oxygen treatment can likewise be utilized, yet attention to improper oxygen treatment with COPD patients is basic as it brings about respiratory sorrow.
Self-evaluation
There are a recognized five high effect activities which enhance results for individuals being released after an intense worsening. The shape is a snappy method for distinguishing patients’ requirement for those medications, guaranteeing their necessities are considered. In this point, it is reducedin the healing center in the rates of doing readmission with self-observing patients. The activities are;
• A survey in the pharmaceutical and exhibit that the nebulizers use.
• Give a kept in touch with anEmergency and Self-Management plan for the tranquilizing pack.
• Investigate and give a recommendation for the smoking impression.
• A survey in reasonableness for aspiratory recovery.
• Orchestrate a subsequent call within 72 hours of release.
Educational Interventions
Rijken et al, (2014) clarify aspiratory restoration as projects that get to work in by the patients to assist in dealing with their illness, muscle quality, capacity in adapting to their ailment, it helps with social prerequisites in that individuals can turn out to be very detached.
Test incorporates incremental transport to walk for a 10 meter race course, sequential runs, in every time that gets quicker, weighed on how much it can get to be in providing thoughts of what to persevere for the activity program that gives the story part in – The all planning in enhancing wellness and personal satisfaction, in the process of having to break the cycle of not having one any activity at the residential place because of dread of getting to be noticeably winded, which will simply be adding to exacerbating of side effects. The point is making the patient short of breath, so as to show them the way to adapt when experiencing issues breathing in your place of stay. It additionally diminishes dangers of heart attack, stroke, and diabetes.
Modification of life
Those who are the victims should know that customary exercise at home is critical. They have to take a gander at their way of life, and remain as sound and positively disapproves as it can provide assistance in keeping the sickness under control. Smoking is a factor that contributes as an element in the illness that ought to be ceased. The nicotine substitution ought to be given in the data on gatherings, for example, the sensation of smoking.
LOC2:
The crumbling in a patient’s ailment is a to a great degree stressing and upsetting the period that is included: In the Patent, families and nursing staff with similar intentions. Have it right now when families can to a great degree stressed, furious and worried with the circumstance and they will take a gander at the staff, expecting superlative administer to their friends and family, they will watch and tuning into everything the Nurse says and does.
Action planning must be set up previously, with the perspectives and conclusions of the patient at the bleeding edge of any choices that will be made. How they need to be breastfed, where they need to be breastfed, and creatively where they need to kick the bucket ought to all be chosen heretofore.
Different institutions have rules set up and named in Medical adherence: including ailing persons in choices on recommended drugs and basing the support to the adherences given. (NICE, 2009). It ought to be taken after the choices are decided on about the medicines to be used on ailing persons and furthermore when treatment will be done and when death is drawing nearer.
The point at which Concordance is identified with the kind of situation experienced.It is not to go along or hold fast to something, it is a method for cooperating with individuals and ought to be viewed as the moral objective of everybody included. It is basic that mutual
basic leadership is utilized inside the NHS and ought to be attempted without question under all circumstances. (Joseph-Williams, Elwyn & Edwards, 2014).
Picking up a comprehension of somebody’s wellbeing convictions is not generally a need for the medical caretaker. Simon (2013) clarifies that occasionally, the chain of however can point toward another path and maybe to genuine thought is given to the patient’s convictions.
According to Nevertheless, Jasper (2011) he illuminate that paying little mind to the amount of data the ailing person or family require, with regards to choices made on medications, expert judgment for the attendant is favored by the dominant part, yet in the way in which the attendant have clarified the different medicines accessible with a comprehension of them, provides the ailing persons and family a sentiment consideration in the fulfillment that they understanding being the best in care .
.
In spite of the fact that there are Nursing staff who are not qualified as councilors, in their part they have to make in light of death care is to board the family, they requires and anticipate that they will talk about their despondency, to clarify in depth the happenings in any way and be at there at their help whatever methods that are fundamental at this time taking after the death of the patient. According to Garbutt (2014) portray the occasion that life as what you know has changed significantly, and will never remain the same again. It may be known that death was coming, yet until the minute it decides to happen that is the point at which it hits them and they are abruptly stood up to with the truth.
LOC3:
The new telehealth system was propelled as a method for watching over the expanding quantities of sick people using the NHS. Directed clients were to be a semblance of the old patients and those with long-term conditions unessential of their age. Rustic In the health sector the Department of Health (2012) demands that on the off chance that it is utilized legitimately the reserve funds on the NHS spending plan is endless. Mischance and Reserve confirmations are much cheaper, as the elective affirmations. They additionally express the vast drop in death rates in territories in which the framework has been executed and is being used productively.
According to Steventon et al, (2012) they characterize the system as an intercession that will permit distant trade of information’ and extra data among the patientand the medicinal service proficient aiding the funding and administration of a person’s wellbeing condition. Sick people in remote ranges of the UK and those with restricted administrations adjacent, and in addition patients who experience issues getting to their neighborhood administrations are as of now profiting by the administration.
McLean et al (2013) embraced a review keeping in mind the end goal to ascertain the viability of the framework. Results were greatly positive all through, and it was turned out to be exceptionally savvy, easy to use and patient criticism was useful and empowering for the administration.
A moment thinks about, by Venter, et al (2012) took a look at the sick with different long term conditions: which are included in the COPD, Pulmonary Disease, Asthma, Diabetes, Hypertension and Heart Failure. This review is explored in the quantities of patients with each condition, the kind of Telehealth medications utilized – alongside intercession time and patient results. End figures found that about 90 % of the results which were taken from the endorsement of the administration, all encountering enhanced outcomes from past eras when the administration had no accessible. Results for review were founded on declining, proportional or change before execution of the administration in their residential places.
More typically for the advantage of the NHS 24, joining the Scottish Center for Telehealth system and Telecare (SCTT), which is the national giver and issuer of the telehealth organizations in Scotland. Another advantage shapes the toll number (999), which is the contact point for people from individuals all in all who want to acquire remedial help or just restorative direction. The Contact to the organization can be made by a cell phone, on the web and even by modernized TV openings. (Natsiavas et al, 2014).
The operational type of the organization gives a quality ensured prosperity data, it has a similar website especially for the request of caring for the old people. The essential organization is the cell phone based system that has specialists opportunities and plans to acknowledge your call and guide you through your request – that helps to save you from an inconsequential excursion to the authority or despite calling a crisis vehicle in free for all of not perceiving what isn’t right or what to do. Staff toward the complete of the phone joins sustain authorities, prosperity information providers, tranquilize masters, dental nursing staff, promoters and self-change coaches.
Staff give a total phone triage and counsel audit and attempt abnormal state, on the spot decision making.
LOC4:
• A:
As a nation the legislature perceives the need to enhance the strength of the populace and spare cash, the National Health Service (NHS) is attempting to adapt to the numbers that are as of now utilizing it, individuals are living longer, sicknesses that run with maturity are ending up plainly more typical, there are lacking assets to provide for the NHS and it is as of now turned out to be working at inadmissible levels. Wellbeing changes need to made, change exercises set up, essential and auxiliary tertiary avoidance, conveyed in social insurance – with the expectation that a man or individuals will receive and keep up a more beneficial way of life or even know and have a comprehension of their well-being all in all.
The difficulties encompassing the deliverance of dependable and receptive superb social insurance and recovering the wellbeing of the populace are connected with the exclusive requirements anticipated from individuals, with most requiring execution of way of life changes, statistic change, the maturing populace and the monetary atmosphere which runs as one with budgetary limitations for most of the objective clients of the administration.
The Marmot Review (2010) battles that disproportionate attributes in thriving are related with contrasts in the all-inclusive community eye; subsequently the degree flourishing difference is typical for ‘how far society has come.’ Inequalities in our general populace are numerically incredible, and this without any other person is ended up being a deterrent inside excited watch out for those included. The WHO activity, Improving Access to Psychosocial Therapies (IAPD) (2010) follows how such procedures, went for reducing success disproportionate qualities can be finished.
While the soundness of the masses general is fundamental and saw, Specific spaces in the nation are viewed as ‘focus on zones’ for activities, regions that are found in individuals by and large eye as poorer or denied as for the most part genuinely higher in wiped out success, both rationally and physically. Developed passing rates are in like way connected with such ranges. Layard et al (2006).
The attestation for thriving use is worldwide and not particular to the UK, and the WHO delineates relative execution issues which are related to psychosocial issues. Joins with material conditions, for example, home owning, remuneration ordinary particularly zones, human hereditary qualities and family history wrapping points of view to success and undertaking way of life changes. Through making a move they might want to see quantifiable redesigns in the key markers of therapeutic organizations quality.
A meander by the NHS Scotland called ‘Show some liberality Paisley’ tried individuals screening for ascertainment, success bearing and surveys with proposals to particular endeavors. Adhering to a tolerable eating regimen, sharpen classes and smoking sensation get-togethers were all around required in enlisting.
This was produced using cheerful care approach that had been drawn up by the Health Service to attempt and overhaul the flourishing of the general open of Paisley – and shield them from twisting up clearly some piece of the estimations concerning sufferers of entire planning conditions. (Gittelsohn, 2012).
Katherine Renpenning & Taylor (2011) depict the reasoning of cheerful care as running in conjunction with stretched out assertion and hypothesis with regards to the success state of the general population – government test to join the qualities of fundamental helpful care and the chance of thriving, flourishing get ready when all is said in done. Energetic care proceeded and keeps advancing in the nation. The flourishing needs of the country make in standard with the masses numbers.
• B:
The broadly comprehensive examination of a patient does not simply take the patient and the given affliction into the record. Researching the comprehensive technique incorporating the patient is in like way considered – this breaker their given conditions, evaluation, examination, and joining as much about them into the blueprint as is conceivable. This would make it less asking for to see any adjustments in a patient’s condition at any given time later on.
O’Brien, 2012 from the LRT model with respect to the five standard contemplations, future, well-ordered living, reliance/self-administration, influencing components on well-ordered living exercises. The portions which influence our endeavor of well-ordered living exercises (mental, sociocultural, ordinary, normal and politico cash related) are intertwined as everyone has particular impacting components on how we try our well-ordered living aptitudes. (Lynch 2015). This model sponsorships exhaustive examination and care sorting out in cheerful care.
Tolson, Booth & Schofield (2011) Explain that future is viewed as a continuum. Regardless, in light of current conditions in opposition to the reliance to reliance continuum the jar is looking in as of late bearing which given the criticalness of continuing just – until we achieve the end of life and kick the can.
Williams (2017) clear up that inside a clinical condition, the LRT model is taken after when exploring research request in regards to particular down to business needs found in patients that are requiring skilled nursing care. Encounters about the model being utilized hence are in like way given by Douglas, Nicol & Robertson (2013) and strengthen the relationship between the LTR appear and broad evaluation and care plan in nursing. Precisely when the given expert degrees are explored and tended to completely, enhanced patient results are met. This is not simply in the extraordinary setting but rather those at home living with LTC, for example, COPD besides advantage from taking after the model. (McGilton et al, 2014).
In the scholastic setting, the model sponsorships therapeutic watchmen make and test a theory about outcomes of care with a nursing structure (Janakiraman, Parish & Berry, 2011). The joining of a setup and think nursing centered sensible model amplified the measure of targets, prescribes that a broadly comprehensive way deal with oversee understanding focused care arranging moves more noticeable thought in patient care. (Barnes et al, 2012).
Anemia Case Study
Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”
Laboratory values are as follows:
Hemoglobin = 8 g/dl
Hematocrit = 32%
Erythrocyte count = 3.1 x 10/mm
RBC smear showed microcytic and hypochromic cells
Reticulocyte count = 1.5%
Other laboratory values were within normal limits.
Question
Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.
Functional Health Pattern Assessment (FHP)
Pattern of Health Perception and Health Management:
• How does the person describe current health?
• What does the person do to maintain health?
• What does person know about links between lifestyle and health?
• How big a problem is financing health care for this person?
• Can this person report his/her medications and the reason for taking them?
• If this person has allergies, what does he/she do to prevent/manage them?
• What does the person know about medical problems in his/her family?
• Have there been any important illnesses/injuries in this person’s life?
Nutritional-Metabolic Pattern:
• Is this person well-nourished?
• How does this person’s food intake compare with recommended food intake?
• Does this person have any disease that affects nutritional/metabolic function?
Pattern of Elimination:
• Are the person’s excretory functions within normal range?
• Does the person have any disease of the digestive system, urinary system, or skin?
Pattern of Activity and Exercise:
• How does this person describe his/her weekly pattern of:
Activity/Leisure?–Exercise/Recreation?
• Does this person have any disease that affects his/her:
Cardio/Respiratory System?–Musculoskeletal System?
Cognitive/Perceptual Pattern:
• Does this person have any sensory deficits?If yes, are they corrected?
• Can this person express himself/herself clearly and logically?
• What is this person’s level of education?
• Does this person have any disease that affects mental or sensory functions?
• If this person has pain, describe it and its causes.
Pattern of Sleep and Rest:
• Describe this person’s sleep/wake cycle.
• Does this person appear physically rested and relaxed?
Pattern of Self-Perception and Self-Concept:
• Is there anything unusual about this person’s appearance?
• Does this person seem comfortable with his/her appearance?
• Describe this person’s feeling state.
Role-Relationship Pattern:
• How does this person describe his/her various roles in life?
• Has, or does this person presently have positive role models for these roles?
• Which relationships are most important to this person at this time?
• Is this person presently going through any changes in role or relationships?If yes, describe changes.
Sexuality – Reproductive Pattern:
• Is this person satisfied with his/her situation related to sexuality?
• Does this person have any disease/dysfunction of the reproductive system?
• Is this person satisfied with his/her plans regarding children?
Pattern of Coping and Stress Tolerance:
• How does this person cope with difficult situations/problems?
• Do these coping mechanism/actions help or make things worse?
• Has this person had any treatment for emotional distress?
Functional Health Pattern Assessment (FHP)- Pattern of Value and Beliefs:
• What principles did this person learn as a child that are still important to him/her?
• Does this person identify with any social, religious, ethnic, regional, cultural, or other groups?
• What support systems does this person currently have?
Nurse Shortage in US Health Care
Background information
There is a projection that the United States health care system is going to experience a great shortage of the registered nurses as the health care needs continue to intensify (Yang, Hung, & Chen, 2015). Quality and outcome measurement are valuable methods of determining the influence of nurse staffing and achieving the desired patient outcome goals. A number of effort have been made to improve the capacity of the nursing schools across the US so as to have more students enrolling so as to assist in meeting the increased demand of the elevating demand for health care system. The American Association of Colleges of Nursing has made various cooperation with institutions and policy makers have tried to make this health concern as a global problem. Following a report by the bureau of labor statistics, registered nurse employment was projected to be among the top occupations in terms of growth form 2014-2024(Robert,2017). This growth in the health workforce is expected to elevate form 2.6 million in 2014 to 3.1 million by 2024 which will be translated as a 16% increase (Robert, 2017).
Further research by the American journal of medical quality explains that nurse shortage is projected to rise around the United States between 2013 -2030 (Nantsupawat, Nantsupawat, Kulnaviktikul, & McHugh, 2014). A report by the institute of medicine on the focus on future of nursing highlighted that there was a need to significantly increase the number of baccalaureate nurses in the health work force to 80% as well as increasing the number of nurse by two (Yang, Hung, & Chen, 2015). There is only 55% of the baccalaureate registered nurses and thus creating a big deficit. In a systematic review performed in the hospital setting, it was identified that increased patient load to a single nurse due to shortage was highly associated with elevated rates of patient readmission. Inaddition, American journal of nursing highlights that increased patient to nurse ration was greatly linked with rising incidences of nurse burnouts and profound health acquired infections such as urinary tract infection.
Significance of the problem
With a well proportion number of health care providers within the health care system, there will be reduced number of nurse burn out, reduced job dissatisfaction and finally enhances the health well-being of both the patients and the nurses. As a result of the escalating global nurse shortage, cases of medical errors are regularly being reported. This problem has been contributed by many factors among them being the ageing of the baby boomer generation. Yang, Hung, and Chen (2015)indicated that majority of the health care providers in the United States are aged above 65yeasr and thus approaching retirement age hence creating the shortage. Despite nursing being explained as the fastest growing profession in the US, about 1.2 job vacancies of registered nurses are likely toemerge between 2014 -2022 (Robert, 2017). It is very significant to address this issue and acquire a lifelong intervention to the problem.Measure of addressing this health issue must however focus on preparing more baccalaureate-prepared nurses in order to ensure access to high quality, safe patient care. Increasing the capacity of nursing schools is also very essential as this would at long last increase the number of physicians joining the job marketand hence reduce the remedying the shortage. With increased and appropriate number of nurses within the health care systems, patient’s health outcomes will be improved as well as ensuring a positive well-being of the care providers. With nursing care being a primary factor in patient satisfaction and little relief from shortages, nursing leaders are compelled to establish methods of measuring staffing effectiveness.
Problem Statement
The United States has the highest number of registered nurses of over 3 million nurse though there still exist a great deficit (Yang, Hung, and Chen, 2015). The most significant cause of the is nurse shortage in this great nation is the elevating aging population that has led to more incidences of chronic diseases, there is also a large number of old nurse work force as well as the nursing institutions lack the capacity to satisfy the entire health care center with care providers. With the increased nurse shortage, there have been raise cases of job dissatisfaction which results from stressful working condition brought about by workload. Moreover, the nurses are pressured to leaving the job and find alternative career. Patient safety is another issue of concern that come about by reduced nurse number. In a research conducted by the health service research, it was indicated that a reduced patient to nurse ratio on both medical and surgical units consequently led to low numbers of death (Robert, 2017).
According to a study carried out in Canada, it was explained that there were 4.9 fewer deaths per 1,000 patients on intensive care units staffed with a higher percentage of nurses with bachelor’s degrees (Van et al., 2013). In a meta-analysis performed by the agency for health research and quality, it was found that registered nurse reduction plus increased nurses workload posed a significant threat to patient’s quality and safety during acquisition of health services. The main purpose of this research proposal is to examine the association between registered nurse shortage to the patients’ health outcome and wellbeing to the nurses.
Research questions
What are the main causes of increasing nurse shortage in the United States?
Is there a relationship between nurse shortage and patients health outcome and nurse well-being?
Hypothesis
H
0
: increased incidences of nurse shortage in the United States health care system is directly associated with poor patient outcome, job dissatisfactionand burnout among health career providers.
H
1
: There is no direct association in deteriorating the patient’s health outcome and job dissatisfaction, nurse burn out with the increasing nurse shortage in the United States health care system.
Variables
The independent variables will include the patient’s health outcomes, nurse job dissatisfactionand burnout. These variables will be determined by getting the total number of nurses in a hospital and the resultant rate of patient readmission and incidences of medical errors and this will signify the level of patient outcome. For the well-being of the nurses, intentions of the nurses to leave the career coupled with cases of burn out will highlight the level of satisfaction and dissatisfaction for the nurses and thus this will directly be related to patient outcome.
The dependent variables that will be examined in the research paper will be the level of nurse shortage. This variable will be examined by determining the total number of nurses that are in a health care center compared to the appropriate number that should be present. This will however give out the nurse deficit.
References
Nantsupawat, A., Nantsupawat, R., Kulnaviktikul, W., & McHugh, M. D. (2014). Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand.
International Journal of Nursing Practice
17
(1), 112-118. doi:10.1111/nhs.12140
Robert, R. (2017). American Association of Colleges of Nursing | Nursing Shortage. Retrieved from
http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
Van, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E., &Sermeus, W. (2013). Effective strategies for nurse retention in acute hospitals: A mixed method study.
International Journal of Nursing Studies
,
50
(2), 185-194. doi:10.1016/j.ijnurstu.2011.12.001
Yang, P., Hung, C., & Chen, Y. (2015). The impact of three nursing staffing models on nursing outcomes. Journal of Advanced Nursing, 71(8), 1847-1856. doi:10.1111/jan.12643
Health History and Examination
Health Assessment of the Head, Neck, Eyes, Ears, Nose, Mouth, Throat, Neurological System, and the 12 Cranial Nerves Skin, Hair, Nails, Breasts, Peripheral Vascular System, Lymphatics, Thorax, Heart, Lungs, Musculoskeletal, Gastrointestinal, and Genitourinary Systems
Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include relevant data for your client.
Student Name: Date:
Client/Patient Initials: Sex: Age:
Occupation of Client/Patient:
Health History/Review of Systems
(Complete and systematic review of systems)
Neurological System (headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, difficulty swallowing, etc., medications):
Head and Neck (pain, headaches, head/neck injury, neck pain, lumps/swelling, surgeries on head/neck, medications):
Eyes (eye pain, blurred vision, history of crossed eyes, redness/swelling in eyes, watering, tearing, injury/surgery to eye, glaucoma testing, vision test, glasses or contacts, medications):
Ears (earache or other ear pain, history of ear infections, discharge from ears, history of surgery, difficulty hearing, environmental noise exposure, vertigo, medications):
Nose, Mouth, and Throat (discharge, sores or lesions, pain, nosebleeds, bleeding gums, sore throat, allergies, surgeries, usual dental care, medications):
Skin, Hair and Nails (skin disease, changes in color, changes in a mole, excessive dryness or moisture, itching, bruising, rash or lesions, recent hair loss, changing nails, environmental hazards/exposures, medications):
Breasts and Axilla (pain or tenderness, lumps, nipple discharge, rash, swelling, trauma or injury to breast, mammography, breast self-exam, medications):
Peripheral Vascular and Lymphatic System (leg pain, cramps, skin changes in arms or legs, swelling in legs or ankles, swollen glands, medications):
Cardiovascular System (chest pain or tightness, SOB, cough, swelling of feet or hands, family history of cardiac disease, tire easily, self-history of heart disease, medications):
Thorax and Lungs (cough, SOB, pain on inspiration or expiration, chest pain with breathing, history of lung disease, smoking history, living/working conditions that affect breathing, last TB skin test, flu shot, pneumococcal vaccine, chest x-ray, medications):
Musculoskeletal System (joint pain; stiffness; swelling, heat, redness in joints; limitation of movement; muscle pain or cramping; deformity of bone or joint; accidents or trauma to bones; back pain; difficulty with activity of daily living, medications):
Gastrointestinal System (change in appetite – increase or loss; difficulty swallowing; foods not tolerated; abdominal pain; nausea or vomiting; frequency of BM; history of GI disease, ulcers, medications):
Genitourinary System (recent change, frequency, urgency, nocturia, dysuria, polyuria, oliguria, hesitancy or straining, urine color, narrowed stream, incontinence, history of urinary disease, pain in flank, groin, suprapubic region or low back):
Physical Examination
(Comprehensive examination of each system. Record findings.)
Neurological System (exam of all 12 cranial nerves, motor and sensory assessments):
Head and Neck (palpate the skull, inspect the neck, inspect the face, palpate the lymph nodes, palpate the trachea, palpate and auscultate the thyroid gland):
Eyes (test visual acuity, visual fields, extraocular muscle function, inspect external eye structures, inspect anterior eyeball structures, inspect ocular fundus):
Ears (inspect external structure, otoscopic examination, inspect tympanic membrane, test hearing acuity):
Nose, Mouth, and Throat (Inspect and palpate the nose, palpate the sinus area, inspect the mouth, inspect the throat):
Skin, Hair and Nails (inspect and palpate skin, temperature, moisture, lesions, inspect and palpate hair, distribution, texture, inspect and palpate nails, contour, color, teach self-examination techniques):
Breasts and Axilla (deferred for purpose of class assignment)
Peripheral Vascular and Lymphatic System (inspect arms, symmetry, pulses; inspect legs, venous pattern, varicosities, pulses, color, swelling, lumps):
Cardiovascular System (inspect and palpate carotid arteries, jugular venous system, precordium heave or lift, apical impulse; auscultate rate and rhythm; identify S1 and S2, any extra heart sounds, murmur):
Thorax and Lungs (inspect thoracic cage, symmetry, tactile fremitus, trachea; palpate symmetrical expansion;, percussion of anterior, lateral and posterior, abnormal breathing sounds):
Musculoskeletal System (inspect cervical spine for size, contour, swelling, mass, deformity, pain, range of motion; inspect shoulders for size, color, contour, swelling, mass, deformity, pain, range of motion; inspect elbows for size, color, contour, swelling, mass, deformity, pain, range of motion; inspect wrist and hands for size, color, contour, swelling, mass, deformity, pain, range of motion; inspect hips for size, color, contour, swelling, mass, deformity, pain, range of motion; inspect knees for size, color, contour, swelling, mass, deformity, pain, range of motion; inspect ankles and feet for size, color, contour, swelling, mass, deformity, pain and range of motion):
Gastrointestinal System (contour of abdomen, general symmetry, skin color and condition, pulsation and movement, umbilicus, hair distribution; auscultate bowel sound;, percuss all four quadrants; percuss border of liver; light palpation in all four quadrants– muscle wall, tenderness, enlarged organs, masses, rebound tenderness, CVA tenderness):
Genitourinary System (deferred for purpose of this class)
FHP Assessment
Cognitive-Perceptual Pattern:
Nutritional-Metabolic Pattern:
Sexuality-Reproductive Pattern:
Pattern of Elimination
Pattern of Activity and Exercise:
Pattern of Sleep and Rest:
Pattern of Self-Perception and Self-Concept:
Summarize Your Findings
(Use format that provides logical progression of assessment.)
Situation (reason for seeking care, patient statements):
Background (health and family history, recent observations):
Assessment (assessment of health state or problems, nursing diagnosis):
Recommendation (diagnostic evaluation, follow-up care, patient education teaching including health promotion education):
Nurse Shortage in Health Care
Problem Statement
The United States health care system is experiencing a great demand for health care services beyond the capacity in which they can hold. According to the bureau of labor statistic, there united states have the largest number of health care providers adding to a total of 3million (Darkwa, Newman, Kawkab, & Chowdhury, 2015). Despite this enormous number, there exist a great nurse shortage which has been represented by the increased patient to nurses ration of ten nurses to responsible for providing care for 1000 patients (Van et al,. 2013). With this high nurse patient dependency ratio, research highlights that there is a growing demand for health care professionals where there has been a projection of about 16% growth in the nursing occupation by 2024 (Yang, Hung, & Chen, 2015). Due to this issue patient are experiencing reduced quality health outcomes since the present health care providers are not able to satisfy the needs of the population. As a result, there is an elevating workload for these hospital workforce that lead to reduced patient safety and thus increased incidences of medical errors.
In addition, the problem have also increased nurse burn outs and intention to leave the nursing career among the care providers have also escalated. This has consequently led to the increasing challenge. The increased aging population of care providers have significantly contributed to the growing shortage as more nurses are retiring form the job and thus not meeting the demand (Darkwa et al., 2015). However, the increasing number of aging population is experiencing major chronic medical conditions that are consequently demanding for more attention. This therefore have led to the elevation of this problem in the United States. The purpose of the research proposal is to examine the association between nurse shortage and patient health outcomes as well as developing an appropriate intervention to solve this critical issue in the health care system.
Research Questions
1. What are the major causes of nurse shortage in the United States health care problem?
2. Is there an association between nurse shortage and patient
health outcomes?
3. Which is the most appropriate intervention to reduce nurse shortage in the US health care system?
Picot Question
For hospital having current number of nurses {P} , how does increasing nursing schoolcapacity to have more qualified nurses in the market {I}, compared to the existing nurse shortage {C} influence the patient outcome [O] over the years {T}.
Purpose of the Research
There is a nurse shortage in the health care system of the United States. In addressing this issue the researchers will be focused in determining the age, gender and the level of satisfaction of the nurses as the main characteristics.
Condition
TheUnited States nursing is among the leading job creators in the US economy contributing to over 2.7 million health care nurses. It is projected that form 2014-2024, there will be an increased job vacancy of over 1.3 nursing vacancies (Van et al., 2013)There is reduced number of nursing students enrolling for nursing course and this has created more shortage. In a research by the American journal of nursing about 56 % of all the 756 nursing schools reported to have a great deficit in the holding capacities of the school amounting to 1236 vacancies(Dawson et al., 2014). A significant nurse shortage issue thus exist.
Intervention
Following this problem in this critical health system an appropriate and long life intervention is desired so as to solve the issue. The government need to increase funding for nursing education which can significantly increase the nursing student enrollment. With increased qualified and skilled nurses within the health care centers patient outcome would greatly be reduced as a result of reduced workload and job satisfaction among nurses.
Alternative to the intervention
An alternative approach that would also enhance increased patient outcome as well as reduced nurse shortage due because of increased job retention is providing high wages and improving the hospital working environment.
Outcome
With the development of appropriate intervention to reduce nurse shortages within the nursing environment, patient health outcomes would also be enhanced. This would as well improve provision of quality services since nurses would no longer experience workload leading to burnout. Additionally, it’s expected that nurses would also have job satisfaction and thus serving the health care for a longer period. It is expected that patient safety would also be enhanced due to reduction in incidences of medical errors.
References
Darkwa, E. K., Newman, M. S., Kawkab, M., & Chowdhury, M. E. (2015). A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC Health Services Research, 15(1). doi:10.1186/s12913-015-1012-z
Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S., & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies. BMC Nursing, 13(1). doi:10.1186/1472-6955-13-11
Van, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E., &Sermeus, W. (2013). Effective strategies for nurse retention in acute hospitals: A mixed method study. International Journal of Nursing Studies, 50(2), 185-194. doi:10.1016/j.ijnurstu.2011.12.001
Yang, P., Hung, C., & Chen, Y. (2015). The impact of three nursing staffing models on nursing outcomes. Journal of Advanced Nursing, 71(8), 1847-1856. doi:10.1111/jan.12643
SMART Goals and Project Objectives
Module 2: Capstone Project – SMART Goals and Project Objectives
Name: Date:
Overview: Capstone Project – Smart Goals and Project Objectives
In this assignment, you will locate and summarize content of 2 articles on the use of SMART goals/objectives: what they are, how they are used, and why they are effective. Assignment must contain citations and references in correct APA format.
You will also select 3 peer reviewed articles that address your chosen focus area for your Capstone Project and create 3-5 goals/objectives for your Capstone Project using the SMART Goals/Objective format.
Objectives
• Summarize 2 articles discussing what SMART goals are, how they are used, and/or why they can be an effective tool.
• Select 3 peer reviewed articles addressing chosen focus area to include in the provided grid.
• Create 3-5 objectives for Capstone Project using SMART format.
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Rubric
Use this rubric to guide your work on the Module 2 assignment.
NOTE: All assignments and discussion posts are expected to be completed on time.
Tasks Target Acceptable Unacceptable
1. SMART Goals Article Summary
(40 pts) Clear and strong summary of 2 articles on use of and purpose of SMART goals. Writes 2 summaries – one summary for each article. Each summary is 1 paragraph of 3-4 well-written, original sentences.
(40 pts)
General statements reflecting article summary and/or missing one article summary, missing SMART goal format.
(20 pts) No synthesis of articles on use of and formulating SMART goals.
(0 pts)
2. Creates 3-5 SMART goals/objectives.
(20 points) Creates 3-5 goals/objectives using SMART format including Bloom Taxonomy terms.
(20 points) 2 or less goals/objectives utilizing SMART goal format using Bloom Taxonomy terms.
(10 points) Goals/Objectives not written in SMART goal format and/or no use of Bloom Taxonomy terms.
(0 points)
3. Cites 3 peer reviewed articles related to the chosen focus area of Capstone project (management, education, or clinical specialty)
(30 pts) Correctly cites 3 peer reviewed articles for chosen focus area of Capstone project
(30 pts) Cites 2 or less peer reviewed articles. SMART Goals and Project Objectives
(15 pts) No peer reviewed articles cited to support SMART goals/objectives.
(0 points)
APA format
(10 pts) Articles and lists the APA references correctly – no errors. (10 pts) Articles and lists the APA references correctly. 1-3 errors. (6 pt.) Articles and lists the APA references correctly. 4 or more errors. (0 pts)
1. Summarize Articles on SMART Objectives Format (Type in the box below)
Summarize content of 2 articles found on SMART goals/objectives. Write your summary in proper APA format. Must include in-text citations and references for both articles. Write one paragraph for each article summary. Should have paragraphs.
TYPE IN THE BOX BELOW (Box will expand as you type in it)
2. Create 3-5 Project Objectives (Type in the grid provided below).
3. Cite 3 Peer Reviewed Articles on Chosen Focus Area for Capstone Project
Create a minimum of 3 and maximum of 5 objectives based upon Bloom’s Taxonomy (See http://mysite.cherokee.k12.ga.us/personal/drew_lawson/site/Subject%203%20Notes/1/Blooms%20Taxonomy.pdf and/or https://tips.uark.edu/using-blooms-taxonomy/ and you can always “google” Bloom Taxonomy for more information). These objectives reflect the changes you want to see in the behavior of the participants/audience as a result of acquiring the information that you present. Remember: Objectives must be specific, measurable, attainable, realistic, and timed (S.M.A.R.T.) and each must include a Bloom term. At a minimum, at least one objective should be “immediate” and one “long term.” Use the table below to record the Objectives and Content for your Capstone Project. (You must create at least three objectives. If you have more, insert rows in the table). Remember that your final project will need at least three references (less than five years old). See the example for how to format this grid. SMART Goals and Project Objectives
Example Objectives
(3-5 Objectives) Example Content and Citing of Peer Reviewed Articles
(Total of 3)
1. By the end of the presentation, 98% of the audience will be able to identify three ways to prevent falls in the LTC until.
(Note: this is an immediate outcome, there is a time frame, there is a % of the audience, identify is the Bloom term. This goal is measurable). • Fall prevention
Doe, J. (2014). How to prevent falls in a long term care unit. Journal of Fall Prevention, 8(26), 23-32. Retrieved from EBSCOhost.
2. Within three months of the presentation, 95% of the audience will be able to recite three reasons to use a fall assessment form with any change in condition for residents. SMART Goals and Project Objectives.
(Note: this is a long-term goal, there is a time frame, there is a % of the audience, and “recite” is the Bloom term. This goal is measurable). • Fall assessment forms
Smith, J. (2013). Why are fall assessment forms important? Journal of Fall Assessments, 7(4), 12-15. Retrieved from EBSCOhost.
3. (Write your third outcome here – it can be either immediate or long-term. Remember it must be SMART and include a Bloom term). • Content Topic
Must have at least one reference here as three are required for this assignment – one for each outcome. Please note that for your final project, you will need three references for each outcome that you have for a minimum of nine references. If you have four outcomes, you will need a minimum of twelve references. SMART Goals and Project Objectives
Grid provided below for assignment completion.
Complete this grid with your information. Must have a minimum of 3 and maximum of 5.
Project Objectives
(3-5 Objectives) Content and Citing of Peer Reviewed Articles
(Cite 3 Articles)
1. •
2. •
3. •
4. •
5. •
Uploading Completed Assignment Template:
• Save this completed assignment template with your individual assignment content to your computer in a file you can easily retrieve.
• Upload the completed assignment template into Module 2: Assignment 2 of 2 area in Module 2 of the course. SMART Goals and Project Objectives.