Examines nursing actions to achieve optimal scores to contribute to the hospital’s financial success. Provides a list of recommended nursing actions to improve the selected key area.

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CASE STUDY

Scenario
Your hospital received $4,000,000 in revenue this past year. Medicare withholds 2.6% of this amount ($) until the value-based purchasing scores are in. If the scores are good this year, the hospital will earn back this money. If scores are below the national average, the hospital can lose this money. Twenty five percent (25%) of this score is based upon the Community Engagement patient satisfaction score (HCAHPS). Last year’s patient satisfaction scores (HCAHPS) in the following areas were below the national average, which cost your hospital $398,000 in revenue.

The hospital director of Quality Improvement has asked you to participate in developing a nursing action plan for your facility.

Instructions
Prepare a nursing action plan in poster format for improving one of the following key areas that:

Selects one key area of focus:
Communication with nurses
Communication with physicians
Responsiveness of hospital staff
Communication about medications
Cleanliness and quietness
Discharge information
Care transition
Examines nursing actions to achieve optimal scores to contribute to the hospital’s financial success.
Provides a list of recommended nursing actions to improve the selected key area.
Appraises references/resources for best practices to increase score and enhance reimbursement.
Communicates the rationale for the nursing actions listed in the action plan.
Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the action plan poster.
Academic sources no older than 5 years.

Provide your peers with specific feedback, constructive criticism, suggestions for improvement, and ideas for resources or support. Comment to a minimum of two peers.

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Week 4 Discussion Forum

44 unread replies.44 replies.
Post a draft of your Cultural and Ethical Perspectives inquiry paper for peer review. At a minimum, your post should include:

Your thesis statement.
Cultural Perspective Questions: One level one and one level two research question for the Cultural Perspectives. (Review the Content ‘Activities section for details and examples.)
A minimum of one paragraph addressing each (level one and level two) research question that includes information from a scholarly source, published within the last five years indicated by in-text citations.

Ethical Perspective Questions: One level one and one level two research questions for the Ethical Perspectives. (Review the Content ‘ Activities section for details and examples.)
A minimum of one paragraph addressing each (level one and level two) research question that includes information from a scholarly source, published within the last five years indicated by in-text citations.

Ensure at least one of the sources selected is a qualitative study.
List of references used in APA format.
Below the references, pose any specific questions you would like your peers to address as part of the peer review process.
It is important to post as early in the week as possible to have the best chance of getting a peer to review your work.

In your responses, provide your peers with specific feedback, constructive criticism, suggestions for improvement, and ideas for resources or support. Comment to a minimum of two peers. Remember that your feedback and support are important! Ensure your feedback is substantive and clear.

Does the Increase frequency of rounding on elderly patients 65 or greater by designated nursing staff every hour decrease falls per 1000 patient days over a six-month duration?

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Rough Draft Part II – Quantitative Research Critique

PICOT: P- Elderly patients age 65 or greater that are admitted are at greater risk for falls. This increases their mortality and morbidity rates substantially. Nursing staff rounds on each patient every hour.  C-Evaluate patient outcomes between one hour rounding and four hour rounding.  O-prevention of falls (no falls) per 1000 patient days T- Over six months.

The PICOT question: Does the Increase frequency of rounding on elderly patients 65 or greater by designated nursing staff every hour decrease falls per 1000 patient days over a six-month duration?

Utilize critical thinking skills to apply the nursing process and evidence-based practice in providing accurate and safe care. Practice nursing within the legal, ethical, and regulatory standards of professional nursing practice, advocating for patients/families and participating in ongoing professional development.

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Clinical Nurse Specialist Practice Strategies for Children With Medical Complexity.

One of the most important aspects of Evidence-Based Practice (EBP) is the critical appraisal and application of information. This assignment is designed to promote reflection on clinical experiences related to an analysis of the nursing literature.

Select an article from a professional nursing journal on a topic related to some aspect of pediatric nursing. The best resource for Nursing-specific journals is CINAHL. Information on how to access CINAHL is provided here: Research Tip #3: Searching for Articles in CINAHL Complete. The journal must be a current reference, no older than 3 years. Reference the article with a complete citation and attach the full article to your posting. Give a brief summary of the article and apply the topic to pediatric nursing care or a specific pediatric clinical situation. Describe how the article meets two of the MCN numbered objectives which are listed under one of the five Cs on your clinical evaluations. Present a brief summary of your paper during post-conference debriefing on a day assigned by your clinical instructor.

Use the Grading Rubric (below) to guide your article analysis. The paper must be a minimum of 750 words. You must submit (upload) this paper electronically as a Word document, along with the full article, in Canvas by 1159 two nights before your assigned post-conference debriefing presentation is scheduled. If you are having any issues with uploading your assignment, please email your clinical instructor PRIOR TO the deadline. Presentations may be given on the makeup day if the student is absent on the assigned day. Papers not uploaded by the 1159 deadline will receive a maximum score of 50 for the assignment.

This assignment is tied to the following clinical course objectives:

Integrate the concepts of evidence-based practice into the nursing care of maternity and pediatric clients and their families (Clinical Competence and Decision Making, Collaboration and Management of Care). Objective 2

Apply concepts from learned theory to assist maternity and pediatric clients and their families to attain and maintain a state of health and wellness (Clinical Competence and Decision Making, Collaboration and Management of Care). Objective 3

Demonstrate commitment to professionalism and accountability in the role of the student learner (Commitment to Professionalism) Objective 6

This assignment contributes to the following End-of-Program Student Learning Outcomes:

Clinical Competence and Decision Making: Utilize critical thinking skills to apply the nursing process and evidence-based practice in providing accurate and safe care.

Commitment to Professionalism: Practice nursing within the legal, ethical, and regulatory standards of professional nursing practice, advocating for patients/families and participating in ongoing professional development.

Collaboration and Management of Care: Collaborate with the health care team to prioritize patient care, coordinate access to resources, and delegate tasks.

Describe an example of an electronic health record (EHR) application used in a health care setting. Describe the key elements of design usability for that application by reducing data errors and improving data integrity.

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Human Factors Engineering Paper

Describe an example of an electronic health record (EHR) application used in a health care setting.
Describe the key elements of design usability for that application by reducing data errors and improving data integrity.
Compare human factors and heuristic principles and discuss how they affect the chosen EHR application.
Recommend an improvement to the chosen electronic application.
Provide a rationale for the suggested improvement based on knowledge of design usability.
Support your findings with a minimum of two scholarly resources.

Identify and discuss a minimum of three community or national resources for your illness group preferably in your community. Discuss integration of these resources into a plan of care.

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Locating Resources

Instructions
Study the resources in your community related to the illness group chosen in Week 1. In a Microsoft Word document of 4-5 pages formatted in APA style, describe the resources, including the following information:

-Identify and discuss a minimum of three community or national resources for your illness group preferably in your community.

-Include in your response all the information the patient should know about the services.
*Benefits
*Specific services they offer.
*Fee schedules, if and when appropriate.
*Criteria for eligibility.
*Application process.
*Availability of transportation.

-Discuss integration of these resources into a plan of care.

-Discuss potential advantages and disadvantages for vulnerable populations in seeking these resources.

-Support your responses with examples and information from library resources, textbook and lectures.

Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

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Case study

For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam.

Learn how to access and navigate Aquifer.

This week, complete the Aquifer case titled “Family Medicine 03: 65-year-old woman with insomnia”

Apply information from the Aquifer Case Study to answer the following discussion questions:

-Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
-Describe the physical exam and diagnostic tools to be used for Mrs. Gomez. Are there any additional you would have liked to be included that were not?
-Please list 3 differential diagnoses for Mrs. Gomez and explain why you chose them. What was your final diagnosis and how did you make the determination?
-What plan of care will Mrs. Gomez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Develop a business plan to start or manage a practice (6-10), identify SWOT analysis, marketing plan, key stakeholders, reimbursement, insurance issues, a solid budget plan (expense and revenue sheet).

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Power Point Presentation

Instructions
Generate a professional Power Point presentation that sums the following areas:
Introduction to topic, include introducing yourself, why this is important (1 slide)
Develop a business plan to start or manage a practice (6-10), identify SWOT analysis, marketing plan, key stakeholders, reimbursement, insurance issues, a solid budget plan (expense and revenue sheet).
Construct an employment contract for an advanced practice nurse in your selected care setting. (3-4)) Be specific. What should APRN ask for salary, vacation, Health insurance, dental, vision, long and short term insurance, professional development/education fees, professional journals, any others?
Compare the legal, ethical, and contractual considerations for APRN in the employment setting (2-3 slides)

Parameters
Inclusive of references in presentation, and references then fully presented in final slide of presentation as a reference page (1-2 slides)
Use APA for formatting
Presentation should be minimally 25 slides, enough slides to appropriately cover material being presented
Presentation is to be designed as if you, the ARPN, were seeking funding for starting your own clinic.
Presentation to include:Contract portion is to be designed as if student/APRN was seeking a position. What would an APRN want in the contract? Provide details within the contract about salary, insurances, benefits, duties, etc.
Type of clinic, clientele serving, location
Mission/vision statement
DETAILED budget analysis. Expense and revenue reports

Insurance and reimbursement: Provide information on expected revenue. What would an APRN charge for certain visits (sick versus health check), what is expected pay from insurance types (private, Medicare/Medicaid?)
Contract portion is to be designed as if student/APRN was seeking a position. What would an APRN want in the contract? Provide details within the contract about salary, insurances, benefits, duties, etc.

MUST USE NOTES SECTION. NO AUDIO. Use the notes section to discuss content. Professor will be assessing analysis and synthesis of understanding of the content)
Estimated time to complete: 10 hours

Discuss the diagnostic cues gathered during Mr. Luke’s examination in the emergency department that indicate a possible DVT. Discuss Virchow’s triad and the physiological development of a DVT.

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Nursing Care Plan #2 DVT

Case Study

Mr. Luke is a 58-year-old man who is currently a client on an outpatient rehabilitation unit following a left total knee replacement (TKR) five days ago. This afternoon during physical therapy he complained that his left leg was unusually painful when walking. His left leg was noted to have increased swelling from the prior day. He was sent to the emergency department to be examined. Mr. Luke’s vital signs are temperature 98.1°F (36.7°C), blood pressure 110/50, pulse 65, and respiratory rate of 19. His oxygen saturation is 98% on room air. The result of a serum D-dimer is 7 μg/mL. Physical exam reveals that his left calf circumference measurement is ¾ of an inch larger than his right leg calf circumference. Mr. Luke’s left calf is warmer to the touch than his right. He will have a noninvasive compression/doppler flow study (doppler ultrasound) to rule out a DVT in his left leg.

Questions
1. The health care provider in the emergency department chooses not to assess Mr. Luke for a positive Homan’s sign. What is a Homan’s sign and why did the health care provider defer this assessment?

2. Discuss the diagnostic cues gathered during Mr. Luke’s examination in the emergency department that indicate a possible DVT.

3. Discuss Virchow’s triad and the physiological development of a DVT.

4. The nurse who cared for Mr. Luke immediately following his knee surgery, when writing the postoperative plan of care, included appropriate interventions to help prevent venous thromboembolism. Discuss five nonpharmacological interventions the nurse included in the plan.

5. Discuss the common pharmacologic therapy options for postsurgical clients to help reduce the risk of a DVT.

6. Mr. Luke’s noninvasive compression/doppler flow study (doppler ultrasound) shows a small thrombus located below the popliteal vein of his left leg. While a positive DVT is always of concern, why is the health care provider relieved that the thrombus is located there and not in the popliteal vein?

7. Mr. Luke was admitted to the hospital for observation overnight. He is being discharged back to the rehabilitation unit with the following prescribed discharge instructions:
(a) bed rest with bathroom privileges (BRP) with elevation of left leg for 72 hours;
(b) thromboembolic devices (TEDs);
(c) continue with enoxaparin 75 mg subcutaneously (SQ) every 12 hours;
(d) warfarin sodium 5 mg by mouth (PO) per day starting tomorrow; (e) nicotine transdermal system 21 mg per day for 6 weeks, then 14 mg per day for 2 weeks, and then 7 mg per day for 2 weeks;
(f) acetylsalicylic acid 325 mg PO once daily;
(g) prothrombin time (PT) and international normalized ratio (INR) daily;
(h) occult blood (OB) test of stools;
(i) have vitamin K available; and
(j) vital signs every four hours.

Provide a rationale for each of the prescribed discharge instructions.

9. Prioritize five nursing diagnoses to include in Mr. Luke’s plan of care when he returns to the rehabilitation unit.

10. What is an inferior vena cava (IVC) filter and for which clients is this filter indicated?

11. Discuss the symptoms the nurse at the rehabilitation center should watch for that could indicate that Mr. Luke has developed a pulmonary embolism (PE).

12. Because of the DVT, Mr. Luke is at risk for post- phlebitic syndrome (also called post-thrombotic syndrome or PTS). Discuss the incidence, cause, symptoms, and prevention of this potential long-term complication.

Write a brief 2-3 page report about a healthcare economic issue that you have identified. Address the reasons why you selected the issue you did; identify how this issue impacts the work of you, your colleagues, and your organization; and describe the gap that you see contributing to this issue.

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Identifying a Local Health Care Economic Issue

Write a brief 2-3 page report about a healthcare economic issue that you have identified. Address the reasons why you selected the issue you did; identify how this issue impacts the work of you, your colleagues, and your organization; and describe the gap that you see contributing to this issue.