Nursing care of a patient with altered urinary and renal function
Order Description
Sonya, a 45year old female, is being admitted to your ward from the emergency department during your afternoon shift for observations, treatment and further investigations of her urinary and renal symptoms. Sonya was referred to the local hospital by her GP after returning 5 days ago from her honeymoon overseas with a urinary tract infection (UTI). Her primary concern was dysuria and frequent scant urination. Sonya was prescribed an oral antibiotic for 5 days and rest. On assessment Sonya stated 3-4 days of fevers with rigors, lower back and flank pain which is not responding to regular paracetamol, nausea with intermittent vomiting and lethargy. She has been unable to tolerate oral intake for over 24 hours and her urine remains dark and offensive. In the emergency department the preliminary diagnosis of pyelonephritis was made by the medical team but confirmation is pending pathology results and renal ultrasound. Sonya has a past medical history of hypertension, hyperlipidaemia and renal calculi but has been unable to tolerate her regular medications. She has a documented allergy to penicillin. Prior to transfer her observations have been charted and remain stable:
Topic: Nursing care of a patient with altered urinary and renal function Length: 2000 words Assessment purpose: Are developing appropriate critical thinking, clinical reasoning and sound clinical decision making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings
? Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in medical surgical settings
? Are able to explain and justify or defend their nursing care decisions
? Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context
? Are progressing towards the level of professional written communication required for nursing practice in Australia
Presentation
Assessment is to be submitted and presented:
? As a computer generated document in Word format.
? 1.5 spaced using Arial or Calibri font in size 11 or 12
? In clear, coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia
? Using appropriate professional terminology
? Contents page, title page, introduction and conclusion are NOT required
? With no acronyms, abbreviations and/or nursing jargon
? Unless otherwise indicated, grammatically correct sentences and topic paragraphs are required
? No more than 20% over or under the stated word count o Note: Headings, any task information copied in and in-text citations are included in the word count
? Use of trade names is not acceptable. Only generic terms or names are to be used when referring to specific medications or other prescribed treatments or resources that may be used in nursing practice
Referencing Students are reminded of their academic responsibilities and professional nursing practice requirements when using the work of others in assignments. Reminder marks are allocated for academic integrity.
? All information is to be interpreted and restated in your own original words demonstrating your ability to interpret, understand and paraphrase material from your sources
? APA 6th referencing style is to be used for both in-text citations and end of assessment references. ? Use current, reliable evidence for practice
? All resources for this assignment should be from quality, reliable and reputable journals relevant to nursing practice and the Australian healthcare industry or reputable, reliable, professional websites. ? All resources must be dated between 2008 and 2016
? There must be at least 12 peer-reviewed journal articles cited in your assignment.
Assessment: Case scenario
Sonya, a 45year old female, is being admitted to your ward from the emergency department during your afternoon shift for observations, treatment and further investigations of her urinary and renal symptoms. Sonya was referred to the local hospital by her GP after returning 5 days ago from her honeymoon overseas with a urinary tract infection (UTI). Her primary concern was dysuria and frequent scant urination. Sonya was prescribed an oral antibiotic for 5 days and rest. On assessment Sonya stated 3-4 days of fevers with rigors, lower back and flank pain which is not responding to regular paracetamol, nausea with intermittent vomiting and lethargy. She has been unable to tolerate oral intake for over 24 hours and her urine remains dark and offensive. In the emergency department the preliminary diagnosis of pyelonephritis was made by the medical team but confirmation is pending pathology results and renal ultrasound. Sonya has a past medical history of hypertension, hyperlipidaemia and renal calculi but has been unable to tolerate her regular medications. She has a documented allergy to penicillin. Prior to transfer her observations have been charted and remain stable:
Vital signs Urinalysis
Glasgow Coma Scale 15 alert & orientated
Blood Pressure 110/60mmHg
Heart Rate 117bpm regular
Oxygen saturation 99% on nasal [email protected]
Respiratory rate 18bpm
Pain score 5/10
Temperature 38.6oC
Output 30mL/hr cloudy & dark
LEU Positive
NIT Positive
URO Negative
PRO Positive
pH 6.0
BLO Positive
SG 1.005
KET Negative
BIL Negative
GLU Negative
Medical orders
? Regular observations
? Monitor fluid input and output
? Nil by mouth until ultrasound completed
? Urine to be strained for renal calculi
Medications orders
? Hartmann?s 1000mls over 12 hours
? intramuscular Ondansetron 4mg prn 12 hourly
? oral Paracetamol 1g 4hourly, oral ibuprofen 400mg 8hourly and S/C morphine 5mg prn
? Intravenous Vancomycin 1g 12hourly
Assessment Tasks: Using the template provided and, based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, aIDress the following tasks. Do not make up or assume information in relation to or about Sonya. Only use what you know from the information you received today.
Task 1:
Based on the handover information and in grammatically correct sentences identify
? The charts and documentation that will accompany her from the emergency department or that you need to commence for Sonya?s care on admission. AND For each chart/document you have identified explain:
? Why it is necessary for Sonya?s diagnosis and nursing care?
? What consequences can occur if this documentation is not in place or completed accurately?
(200 words, 5 marks)
Task 2:
Based solely on the handover you have received and using the template provided, develop a full nursing care plan for Sonya. Your plan must aIDress the physical, functional and psychosocial aspects of care.
Note: Students are expected to demonstrate they have read beyond the set texts to prepare their nursing care plan. Reliance on text books alone is no guarantee that your information is current and reliable evidence for practice. However, set texts are a good place to start to identify key points and to develop search strategies to locate appropriate journal articles.
For each nursing problem on your plan you need to identify what it is in relation to and your:
? Goal of care
? Interventions
? Rationales for interventions
? Evaluation
Notes for Task 2 only
? The nursing problem of pain has been provided for you as an example. This will not be included in marking allocation.
? Dot points may be used in the care plan template
? Appropriate professional language must be used, no abbreviations or nursing jargon
? Rationales must be appropriately referenced. It is strongly recommended only current, reliable journal articles be used as references when providing rationales
(750-1000 words, 30 marks)
Task 3:
Two important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications, how to monitor the patient to ensure they are responding to the prescribed medications as they should and identify any contraindications with medication type or administration choice.
? In grammatically correct sentences briefly explain why Sonya has been prescribed;
? Analgesics orally
? Vancomycin intravenously
? Hartman?s 1000mls over 12 hours AND
? Identify and explain
? The nursing responsibilities associated with administering the three (3) medications/fluid above
? How you will assess or monitor Sonya to ensure she is responding appropriately to these three (3) medications/fluid you are administering today?
(350 words, 10 marks)
Information needed for Tasks 4 and 5
You will need to use the following information to complete tasks 4 and 5 (this information is for these tasks only). During your shift the following occurs:
Vital Signs
Glasgow Coma Scale 14 confused and disorientated
Blood Pressure 95/50mmHg
Heart Rate 135bpm thready & irregular
Oxygen saturation 96% on Hudson [email protected]
Respiratory rate 26bpm
Pain score Unable to assess score? verbal groans only
Temperature 39.9oC
Output <25mL/hr dark, cloudy, purulent, offensive
Capillary refill >3sec, pale, poor skin turgor
? Indwelling catheter in place with hourly collection bag
? MC&S collect and sent to pathology
? Blood cultures taken by attending doctor and sent to pathology
? Ultrasound completed still waiting for the report
? No arterial blood gas done
? Cannula in right arm has signs of inflammation yet still flushing well
? Offensive vaginal discharge noted during personal cares
? Fluid challenge of 300mls given with no change
? Medical team have reviewed Sonja and requested urgent transfer to ICU
Task 4:
Based on what has occurred during your shift (see previous page) aIDress the following:
? What conclusion would you make from the signs and symptoms
AND
? Explain why you have come to this conclusion about Sonya?s current condition
(200 words, 2.5marks)
Task 5: Clinical communication handover ward transfer
Using ISBAR and incorporating the aIDitional information from the previous page prepare a written handover for the nurse taking over Sonya?s care in ICU. Handover must aIDress the physical, functional and psychosocial aspects of care and reflect any changes required to your nursing care plan above. You must use appropriate professional language with no jargon or abbreviations.
(250 words, 5 marks)
Task 6:
An important part of the clinical reasoning process is to reflect on what you have done and learnt as well as to help you understand the concepts of holistic nursing practice.
? Reflecting on the care plan you have prepared for Sonya, tell me about your experience developing the care plan. Things you might consider to include: what was easy for you and what was challenging?
? Reflect on how applying the nursing care plan framework you used in Task 2 will help you to provide holistic nursing care for people in the clinical setting.
(200 words, 2.5 marks)
Notes for Task 6 only
Reflective writing is the opportunity for you to document your thoughts and feelings. This requires a different writing style to the rest of the assignment.
As you are expressing your thoughts and feelings, you write in the first person. It is expected to see words like ?I? and ?my? and phrases like ?I have learnt??, ?I now understand or realise that??
It is not appropriate to reference your own personal thoughts and feeling. However, if you refer to professional nursing standards and codes, information from specific sources (eg a text book or journal) or draw on your understanding of the role and scope of practice of the registered nurse, you must provide a reference to support your statements.
MARKING CRITERIA
? Task 2: Nursing care plan: Ability to interpret & aIDress task Demonstrated ability to develop an individualised evidence based nursing care plan for case scenario aIDressing physical, functional and psychosocial needs. Identifies appropriate nursing problems, what each is related to, goals of care, interventions, and rationales for planned care and evaluates outcomes for each stated nursing problem. At least 9 nursing problems identified. All are appropriately stated and relevant to case. All rationales demonstrate high level ability to explain or justify identified nursing actions. High level ability to evaluate appropriate expected outcomes for planned care.
? Ability to interpret & aIDress other tasks Demonstrated ability to (1) identify nursing priorities & actions, to provide rationales for nursing care & to reflect on assignment learning. (2) Develop a succinct, comprehensive handover that incorporates physical, functional and psychosocial aspects of care [Task 1, Task 3, Task 4, Task 5, and Task 6] Excellent interpretation of the items. Demonstrates high level ability to (1) identify nursing priorities & actions, discuss medication management responsibilities, to provide rationales for nursing care and to reflect on assignment learning (2) develop a succinct, comprehensive handover that incorporates physical, functional and psychosocial aspects of care
? Critical thinking & clinical reasoning Demonstrates the ability to critically interpret, integrate and apply evidence to practice and to make sound clinical decisions. Clear paraphrasing which demonstrates level of understanding. Demonstrates a high level ability to interpret, integrate and apply evidence to practice and to make sound clinical decisions. Demonstrates high level of understanding and ability to paraphrase information.
? Academic Integrity 1: Evidence for practice Demonstrated engagement with current, reliable evidence for practice. Has 12 or more relevant journal articles that meet stated criteria. One nursing and one medication textbook only used as a reference. Demonstrates high level engagement with current, reliable evidence for practice. At least twelve (12) highly relevant journal articles that meet stated criteria. Only one (1) nursing and one (1) medication textbook cited as a reference.
? Referencing Demonstrated ability to adhere to academic and professional policies and standards when using the work of others. Thoughts and ideas well supported by correct and accurate in-text citations and complete and accurate reference list in APA format. Direct quotes appropriately acknowledged but minimal.
? Academic Literacy Demonstrates appropriate level of written communication for nursing practice. Content flows logically and demonstrates appropriate professional language with no spelling or grammatical errors and no acronyms, abbreviations, nursing jargon, lists, or diagrams. Uses grammatically correct sentences and paragraphs. Dot points and table format only used where directed.
? Presentation/submission Assignment is submitted on required template and is no more than 20% over and 10% under stated word count including in-text citations, identified headings, any task information copied in. Identifying information and reference list excluded from word count.
The Five R?s approach to ethical nursing practice
Order Description
Discussion
Apply the framework of The Five R?s approach to ethical nursing practice from this weeks reading (chapter 2) to answer the questions about values and choices.
? References: Textbook: Nursing Ethics, 4th edition, Janie B. Butts
What are values?
Q. What are your personal values?
Q. Why do you value them?
Q. What are the values in your society?
Q. How do you make choices?
Q. Are your choices based on your values?
Q. What values are useful in society?
What are the limits to personal choice?
Q. Who limits your choices?
Q. Are limits to choices good?
Q. Do you limit other peoples choices?
Q. Should the health care organization or the government limit peoples choices? If so, how, and under what circumstances?
Finally, consider this: A common idea in health care is that if you are drawn to health care as a profession, you are inherently guided by an inner compass that is composed of a strong moral framework. Why is this a dangerous assumption?
importance of cultural competency in nurse care. Cited sourse60
importance of cultural competency in nurse care. Cited sourse
The pathophysiology of the presenting complaint in the scenario./ Evaluation of the nurses role in relation to nursing care of the child and family in the chosen
The pathophysiology of the presenting complaint in the scenario./ Evaluation of the nurses role in relation to nursing care of the child and family in the chosen
scenario;
Assessment task 1 Assistance
The following is a guide to assist you in writing your essay.
Using the research, you have undertaken for your chosen scenario, discuss how the information will
guide evidenced based Australian Nursing practice. This should a reference to:
1. The pathophysiology of the presenting complaint in the scenario.
This section is science based and the expectation is that you have a pathophysiology text book and
scientific journal articles to discuss the science related to the presenting problem in your chosen
scenario. You should aim at 300-500 words for this section. The aim of this is that you attain
knowledge of what is happening at a cellular, organ and system level so that you understand the
presenting clinical manifestations
2. Evaluation of the nurses role in relation to nursing care of the child and family in the chosen
scenario; which should include a reference to:
i. growth and developmental theories,
This part of the assessment task is concerned with ensuring the essay has a child and adolescent
focus. Throughout the essay discussion, it is expected that you make reference to the childs
expected developmental milestones at that age, depending on which scenario you have chosen. It is
expected that growth and development research is undertaken for your chosen scenario and you
make reference to growth and developmental theories that you think are relevant in enhancing your
essay argument. Some ideas include things like, at what age do you include a child in medical related
conversation, how does a child/adolescent make decisions based on their developmental level, and
even through your pathophysiology, you can make mention of underdeveloped organ systems that
might influence your nursing care.
ii. developmentally appropriate care;
This part is a follow on from discussing the growth and developmental expected milestones of the
child and really focuses on how it influences your care. How does a nurse provide developmentally
appropriate care to the specific age presented in your scenario inclusive of the presenting complaint?
iii. family centred care and,
Neonatal/paediatric and adolescent nurses provide a family centred care model. It is important that
this is reflected in your essay and may bring forward issues of consent, compliance and child
presentation into care. How are siblings affecting, the role of the extended family, cultural influences
and whatever may be specific to the scenario.
iv. Reference to the hospitalised child and family.
This part follows on from the family centred care component where it is important to understand the
effects of a childs presentation to services particularly in a hospital setting on not only the child but
the whole family.
All of the above points should be in reference to how your nursing care will be guided in a paediatric
setting.
As a guide only I have provided the following general essay information.
The assessment task is 1600 words.
Paragraph and Essay Structure
An essay includes an introduction, body and conclusion.
1. The introduction should provide the reader with a framework for the essay and
what will be discussed. Sometimes its easier to write the introduction last or after you have
completed outlining what you will be discussing. (Approximately 100 words)
2. The pathophysiology as discussed above. (Approximately 300-500 words)
3. The body of the essay is the crux of your discussion and will consume the bulk of your words.
Your paragraph structure is important to note as follows:
? Each paragraph should have an introductory and concluding statement.
? Each paragraph should have a direct connection with the one prior and one after it.
This allows the essay to flow.
4. The conclusion should provide a summary of the key points presented in the essay.
(Approximately 100 words)
5. The definitions used in your essay should only use academic references (not online
dictionaries)
6. It is important to note that this is an academic essay and should be written in the third person.
7. There are no minimum requirements for the number of sources you use however as a general
guideline an academic paper can have 1 source per hundred words.
8. In regards to the currency of the references, it is generally expected that sources are within 5
years published age. However, if you have sourced a reference that is older than this you must
demonstrate how it is relevant in your writing.
Finally defining what we mean by the following:
ANALYSIS What do the experts state regarding the topic? Here you present the research you
have undertaken and looking at different perspectives.
SYNTHESIS What connections can I make regarding the research into expert discussions
EVALUATION What conclusion do I come to after presenting the arguments based on my analysis
and synthesis?
Please refer to the rubric for more detailed information on the expectations for each criterion.
Nursing Care of a Person with Angina
Nursing Care of a Person with Angina
Mrs Brown (54 years) is brought to the emergency department by her husband following two episodes of chest pain, lasting approximately 15 minutes each, at work. She
reports she has had increasing frequency of angina in the last few weeks. She does however admit to not taking her medication as required as she believed she had
recovered from angina. Mrs Brown is admitted to hospital, to the medical ward, six hours later for further investigation. Her husband and family accompany her. She has
a history of hypertension, her weight is 120kg, and she currently has an executive management job. Observations on admission are temperature 37.2oC, pulse 110b/min,
respirations 24 respirations/min, and BP 146/89mmHg. You are working as a new graduate registered nurse on this ward. When you introduce yourself to Mrs Brown she
tells you how stressed she is in her current job with numerous projects to develop and manage and tells you I have no time to exercise anymore and I?m so busy and so
tired my husband and I just end up eating take away a few times a week as I can?t be bothered cooking. Later that evening you answer Mrs Brown?s nurse call bell and
she tells you she has chest pain now. She states she just went for a walk around the ward and started to feel a bit short of breath. She rubs her sternum and left
upper arm. She states her pain score is 9 out of 10. When you ask her to describe her pain she states It feels like someone?s squeezing or pressing down on my chest,
it feels really tight. She has an anxious look on her face, is pale and you can see her face is a little sweaty.
.State an overview of the patients condition and identify TWO priority nursing problems. Give a brief plan for the essay topics.
For the first problem (800 words): Briefly explain how it relates to the patients assessment data. Identify TWO priority nursing interventions to aIDress the
problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant
positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature. Outline the
evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
For the second problem (800 words): Briefly explain how it relates to the patients assessment data. Identify TWO priority nursing interventions to aIDress the
problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant
positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature. Outline the
evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
Conclusion (100 words): Briefly restate the patients condition and problems and how the nursing interventions can benefit the patients health.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET AN AMAZING DISCOUNT ??
nursing case study 2
nursing case study 2
1- use at least one referrance of the follewing
a- book relateed to education
b- research based article
c- literature based article
2- 2-3 pages without referrance & cover page
3- double sapce
4- line size is 12
CASE STUDY:
Mr. X, a new (neophyte) nurse educator who is struggling with his own anxiety about: (1) performing as a faculty and (2) establishing his own professional identity as
a teacher. He opened his class with a short video that ended at a crucial decision point. He invited the class to discuss the best nursing response to the situation
and then to break into small groups and role play various reactions. After the role3-playing situation, he brought the class back together to discuss what worked, what
did not, and why; what concepts they identified; and how they planned to use what they learned in the clinical area?
QUESTION:
What evidence is there that Mr. X managed the class?
Curriculum Design & Evaluation in Nursing Ed
Curriculum Design & Evaluation in Nursing Ed
Learning Outcomes and Evaluation Strategies;
In Part 2 of the scenario from Week 1, you are the new Dean of Nursing in the fictitious University of the Seven Seas, College of Nursing (USS CON) and you are tasked to design a BSN curriculum for the new nursing program. This week you will write your learning outcomes (similar to your goals but more narrow in focus), and evaluation strategies. Remember that program outcomes flow from and are reflective of your nursing department philosophy and goals.
For Part 2 of the Scenario you will develop your learning outcomes and evaluation strategies. You will create a 68-page paper(excluding title page, references, and Appendices) aIDressing these items. Be sure to include:
Learning outcomes that represent a vision of what students would achieve.
Evaluation strategies that will illustrate how you will measure that your learners met the learning outcomes, through standardized tests and other means.
Program, Course, and Student Evaluations. Use the following questions to develop these evaluation strategies:
Program evaluation:
What are the accrediting bodies requirements for program evaluation?
Who will be responsible for preparing the report?
How often does a report have to be written?
Course evaluation:
Does the university have a standard course evaluation form?
What information would be included in a course evaluation form?
Who would be responsible for administering the course evaluations?
How will you ensure student confidentiality and privacy?
Student evaluation:
How often will you do formative evaluations of the students?
How often will you do summative evaluations of the students?
How will you measure that your learners have met the learning outcomes (through standardized tests and other means)?
What will be the grading scale for the program?
How will the program deal with students who grieve their grades?
Your learning outcomes and evaluation strategies should be completed in a Word document and submitted to the W2: Assignment 2 Dropbox by Tuesday, August 18, 2015. Be sure to follow proper APA guidelines in your paper.
Assignment 2 Grading Criteria Maximum Points
Learning outcomes are a vision of what students would achieve upon program completion. 20
Learning outcomes are aligned to the program philosophy and goals. 20
Evaluation strategies are appropriate to the desired level of knowledge, skill, and experience of the learners. 20
Evaluation strategies are appropriate and include standardized tests and other means. 20
Provides a thorough discussion of program evaluation strategies, including all criteria. 35
Provides a thorough discussion of course evaluation strategies, including all criteria. 35
Provides a thorough discussion of student evaluation strategies, including all criteria. 35
Followed APA guidelines for writing style, spelling and grammar, and citation of sources. 20
Total: 205
What are the common symptoms associated with an exacerbation of COPD? What assessment techniques will you use to assess Mary? Identify smoking strategies that would be appropriate for each of the encounters that Mary had with the nurse throughout the video that could have been used to assist Mary in quitting smoking.
Category : Bold Essays Writing
nursing hwAssessment of Respiratory Status (graded)
Please review the video on the assignments page under the discussion section as it will provide you with an opportunity to immerse yourself in the role of a nurse aIDressing tobacco use during routine patient care. In doing so, reflect on what you have learned about tobacco use and the role that nurses and other interdisciplinary team members play in helping to assist tobacco users with quitting. While viewing, it is also important to keep in mind that tobacco users move through stages of change in the process of quitting. They move from pre-contemplation to contemplation, contemplation to preparation; preparation to abstinence; abstinence to maintenance. Every stage requires a different strategy by a nurse.
After watching the video, and reflecting on the information presented, aIDress each of the following questions.
What are the common symptoms associated with an exacerbation of COPD?
What assessment techniques will you use to assess Mary?
Identify smoking strategies that would be appropriate for each of the encounters that Mary had with the nurse throughout the video that could have been used to assist Mary in quitting smoking.
Find a resource in your community that could assist Mary. Start by searching the Internet for your local health departments website. What services are available to Mary? Briefly describe the services that the state quit line provides. Does it meet the 4 As? Is it accessible, acceptable, affordable, or available for Mary?
What will you do to follow-up on Marys smoking cessation process?
Respond
Masters Prepared Nurse Interview
Category : Bold Essays Writing
Masters Prepared Nurse Interview
Refer to the Masters Prepared Nurse Interview Guide_student as you prepare this assignment.
Interview a nurse who is masters-prepared in nursing and is using this education in a present position. Preferably, select someone who is in a position similar to your chosen specialty track. The purpose of the interview is for you to gain insight into the interplay among education, career path, and opportunities. Be certain to identify specific competencies that the MSN-prepared nurse gained, and is presently using, that reflect advanced education. Organize your interview around the topics below:
Overview of the masters-prepared nurses career
Reason for seeking graduate education
Description of present position and role
Usefulness of graduate education for present role
Pearls of wisdom he/she is willing to share
In 750-1,000 words, write the interview in a narrative format. Use the following guidelines:
Within the papers introduction, explain your interview selection.
Do not identify the individual by name.
Use centered headings to separate parts of the interview.
In the conclusion, identify one or more competencies from the interview that are consistent with GCU program competencies and/or AACN education essentials. In aIDition, provide a statement that reflects what you gained from the interview.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center.
NUR502.Rubric.MastersPreparedNurseInterviewGuide_1-9-14.docx
[SOLVED] nursing9TT1234
nursing9TT1234
nursing9TT1234
Order Description
Half of page per response to my peers, with references, use first person, thank you. Discussion attached.
Respond in one or more of the following ways:
1)Ask a probing question, substantiated with aIDitional background information, evidence, or research using an in-text citation in APA format.
2)Share an insight from having read your colleagues postings, synthesizing the information to provide new perspectives.
3)Validate an idea with your own experience and aIDitional research.
4)Expand on your colleagues postings by providing aIDitional insights or contrasting perspectives based on readings and evidence.
(Darinka)
HITECH Legislation
The federal Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted in 2009 as part of the American Recovery and Reinvestment Act (ARRA) (Gialanella, 2012). The purpose of the ARRA was to stimulate the economy and improve health care (Gialanella, 2012). As a result, health information technology policies and standards, privacy and security, and meaningful use were developed to meet the requirements to protect patient health information and receive financial incentives tied to reimbursement initiatives (Gialanella, 2012).
HITECH Impact on my Organization
My facility recently implemented computerized physician order entry (CPOE) as a result of the new legislation. The for-profit facility is part of the Hospital Corporation of America (HCA), the largest provider of health services in America. The implementation of a large computer system, or any business or clinically associated improvement, is enacted throughout all organizations and most hospitals are not given a choice regarding which technology to implement. As a result, all facilities utilize the same computer systems. Although this is considered a wise business strategy, due to cost benefits and improved patient care coordination, most organizations would rather have input regarding decisions that affect clinicians and workflow processes.
The implementation of CPOE had a positive impact on the organization because it helped to meet compliance regulations associated with reimbursement, but it was not met with enthusiasm by clinicians. I am not sure that my facility would have chosen to implement the technology if it were not related to long-term financial incentives and reimbursement. The act essentially forced one of the largest providers of health care to implement the computer system and comply with meaningful use criteria. As a for-profit organization, HCA values the profit margins it generates and although it strives to ensure high-quality care, meeting financial goals across hospital divisions is equally as important to stakeholders. My facility is an excellent example of how the legislation forced facilities to start to comply with the requirements and mandated the necessary infrastructure to support the proper use to obtain meaningful data.
AIDress how its related incentives influence the adoption of health information technology in health care and impact the quality of patient care
How Incentives Influence Adoption of Health Information Technology
The HITECH provision was created to provide financial incentives for hospitals to implement necessary tools to provide meaningful information and care coordination across providers (Murphy, 2010). Five initiatives meet meaningful use criteria:
1. Improve quality, safety, and efficiency, and reduce health disparities.
2. Engage patients and families.
3. Improve care coordination.
4. Improve population and public health.
5. Ensure adequate privacy and security protections for personal health information (Murphy, 2010).
The federal government allocated $19 billion to incentivize providers to implement electronic health records (EHR) (Murphy, 2012). According to Brown (2010) the final ruling surrounding meaningful use has three stages and criteria associated core requirements. There are 14 eligibility core requirements for hospitals to meet and 15 core requirements for healthcare providers (Brown, 2010). Ten aIDitional objectives are required, and both hospitals and providers must chose five. As long as hospitals/providers meet and submit the measures within the specified year, then they will receive the incentive payments (Murphy, 2010).
Technology and reporting requirements will have a large impact on patient care are projected to be extensive. Clinical research is perhaps one of the biggest benefits of HIT implementation (Gialanella, 2012). Specified quality measures are reported to Medicare and Medicaid and will impact the delivery of care affecting cost, and improve quality through tracking data that lead to evidence-based care. The measures will also enhance coordination of patient care among providers to reduce repeat testing and decrease medical errors (Gialanella, 2012). Health care reform is focusing on promoting prevention, early detection, and improved management of chronic diseases through health information technology. Promoting wellness will be enhanced through the use of HIT for early detection of disease states, rapid responses to pandemics, and identify at risk-patient populations (Gialanella, 2012).
Provide a summary of the article you identified and explain how it demonstrates the ability of health information technology to meet the requirements of meaningful use.
Summary of Article and Demonstration of Technology to Meet Meaningful Use
Authors Jones, Heaton, Friedberg, and Schneider (2011) investigated meaningful use as it relates to decreasing hospital mortality in three areas heart attack, heart failure, and pneumonia by using electronic medication order entry systems. There is uncertainty whether meaningful use standards will improve care, reduce errors, and improve patient safety. Evaluating the benefit of electronic order entry is sought to provide data to support the assertion (Jones et al., 2011). Stage one meaningful use requires facilities to use computer order entry systems for approximately 30% of patients to be eligible for reimbursement. The percentage of use requirements would increase with subsequent stages eventually requiring 80% use of computer order entry for eligible patients by stage three (Jones et al., 2011). The authors obtained data from the Association Annual Survey database. The database provided data on 4,156 acute care facilities included in the Hospital Compare Database of which 2,543 had responded to the 2007 American Hospital Association Information Technology Supplement. 2,543 represented the cohort size (Jones et al., 2011).
The authors reported 61% of the hospitals studied did not use electronic medication order entry, 13% of the hospitals reported ordering from one to 25%, four percent of hospitals reported ordering 26 to 50%, and six percent of hospitals reported using electronic ordering from 51 to 90% of patients (Jones et al., 2011). Despite the small number of facilities utilizing computer order entry in any capacity the benefit of its use was appreciated with improved mortality rates in heart attack and heart failure categories (Jones et al., 2011). Significantly improved mortality was seen with higher use of computer order entry systems and a much better statistics.
Overall, the authors reported that hospitals meeting stage one requirements could appreciate 1.2% reduction in mortality rates, but this is not statistically significantly because estimated thresholds were not met (Jones et al., 2011). With stage 2 requirements, reduced mortality could be as high as 2.1% (Jones et al., 2011). The study was beneficial in proving that greater use of computer order entry has the potential in reducing mortality rates.
References
Brown, B. (2010). The final rules for meaningful use of EHRs. Journal of Health Care Compliance,12(5), 4950. Retrieved from http://sfxhosted.exlibrisgroup.com/waldenu?url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&ctx_enc=info:ofi/enc:UTF-8&ctx_ver=Z39.88-2004&rfr_id=info:sid/sfxit.com:azlist&sfx.ignore_date_threshold=1&rft.object_id=111030132863024&rft.object_portfolio_id=&svc.fulltext=yes
Gianlanella, K. M. (2012). Legislative aspects of nursing informatics: HITECH and HIPPA. In McGonigle, D., & Mastrian, K. G. (Eds.). Nursing informatics and the foundation of knowledge. (pp. 161-184). (Laureate Education, Inc., custom ed.). Burlington, MA: Jones & Bartlett Learning
Jones, S. S., Heaton, P., Friedberg, M. W., & Schneider, E. C. (2011). Todays Meaningful Use Standard For Medication Orders By Hospitals May Save Few Lives; Later Stages May Do More. Health Affairs, 30(10), 2005-2012. doi:10.1377/hlthaff.2011.0245
Murphy, J. (2010b). Nursing informatics. The journey to meaningful use of electronic health records.Nursing Economic$, 28(4), 283286.
Retrieved from http://search.proquest.com/openview/a5ca4c04a06bbb25597728fa8424c252/1?pq-origsite=gscholar
(Linsey)
HIT , HIPPA, and HITECH
The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 was in acted to improve the quality of healthcare, reduce cost, and improve communication across the healthcare community (McGonigle, & Mastrian, 2012). The HITECH has had both positive and negative impact on my current organization. The positive has been strengthening Health Insurance Portability and Accountabilty Act (HIPPA), The HITECH Act has improved privacy and security of patient health information by applying the requirements of HIPPA directly to the business associates of covered entities (McGonigle, & Mastrian, 2012, p. 179). It also helps with decreasing disparities between health facilities and quality of care. All patients, regardless of race, ethnicity, or socioeconomic status should receive care that is effective, safe, and timely. With the national health information technology (HIT) infrastructure contemplated by the HITECH Act, such disparities are bound to decrease (McGonigle, & Mastrian, 2012, p.167). The implementation of electronic health records and HIT the HIPPA compliance has strengthened and also verification of patients information is easier. The negatives of the HITECH is the expense, the size, complexity, and capabilities of the covered entity or business associate; the technical infrastructure, hardware, and software security capabilities of the covered entity or business associate; the financial costs of implementing security measures; and the probability and criticality of potential risks to electronic protected health information( ePHI) security breaches (Kempfert & Reed, 2011, p.261).
Incentives and Meaningful Use
Incentives from the HITECH have been overall favorable in the adopting of electronic health records (EHR); however, due to the cost of buying equipment, software, and training, the benefits of the incentives are not seen until later. The HITECH act also provides significant monetary incentives for providers who engage in meaningful use of HIT. Meaningful use (MU) is the new standard that has entered healthcare. This week in my practice there is a meaningful use meeting. We are going through all the things we must aIDress in every patients note to get incentives for meaningful use. The physicians are tracked on if they are meeting the criteria and us, as their nurses honestly must do most of the work to comply.
Summary of Article
MU means that youre digital records in a way that provides improved patient care-not just that youve moved from paper files to computer files. The best way to improve patient care is to make sure that medical staff always has the right information at the right time. Automated document and reports management are key components to achieving MU (Colpas, 2013, p. 11). The article Contemplating Meaningful Use overviews that steps of MU and the steps that facilities must take to achieve compliance and incentives. Steps such as patient portal implementation, security measures, information collection, and HIPPA compliance are discussed and several information specialists (IT) explain why meaningful use is important in patient safety and quality care improvement. This article was interesting as is gave a guideline to the many ways for facilities to implement their meaningful use programs for success.
References
Colpas, P. (2013). Contemplating meaningful use. Health Management Technology, 34(8), 8-11.
Kempfert, A. E., & Reed, B. D. (2011). Health Care Reform In the United States: HITECH Act and HIPAA Privacy, Security, and Enforcement Issues. FDCC Quarterly, 61(3), 240-273.
McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
(Starr)
HITECH Act
The Health Information Technology for Economic and Clinical Health Act (HITECH) enacted February 17, 2009, is part of the American Recovery and Reinvestment Act (ARRA) (McGonigle, & Mastrian, 2012). The ARRA was enacted to stimulate various sectors of the US economy during the most severe recession this country has experienced since the Great depression of the late 1920s and early 1930s (McGonigle, & Mastrian, 2012, p.161). The HITECH act aIDresses the development, adoption and implementation of Health Information Technology (HIT) policies, standers, and provides enhanced privacy and security for patients information (McGonigle, & Mastrian, 2012, p.162).
Currently in my facility computerized physician order entry (CPOE) is implemented; a few years ago this was a positive impact on my facility due to meeting compliance regulation associated with reimbursement with the government. However, with this positive impact was negative impact related to staff moral in learning the new computerized program.
Effects of HITECH Act
HITECH Act has had many positive and negative effects, like any new legislation implemented. One of the positive contributions noted from the HITECH ACT is increased strength and enforcement of Health Information Privacy act (HIPA) (McGonigle, & Mastrian, 2012). HITECH Act also contributes to patients explanation of care and billing; existing accounting rules are enhanced under this act, giving patient the right to access electronic health record (EHR) and receive an accounting of all disclosures (McGonigle, & Mastrian, 2012, p.179). Most would agree that the expense of HITECH has been a negative. The complexity and time spent of the HITECH act has been a burden for many businesses, and lack of nurse implementation can also cause some negativity.
Meaningful definition
According to Healthit.gov meaningful use is using certified electronic health record (EHR) technology to:
Improve quality, safety, efficiency, and reduce health disparities
Engage patients and family
Improve care coordination, and population and public health
Maintain privacy and security of patient health information (Healthit.gov, 2015).
The Healthit.gov also states to receive an EHR incentive payment, providers have to show that they are meaningfully using their certified EHR technology by meeting certain measurement thresholds that range from recording patient information as structured data to exchanging summary care records (Healthit.gov, 2015).
Summary of article
Kruse, Bolton, & Freriks conducted a systemic review study attempting to answer whether the use of patient portals increase patient outcomes. The conclusion of this study stated the ability of the patients to be able to view their health information electronically meets the intent of Meaningful use (Kruse, Bolton, & Feriks, 2015). Patient portals use is intertwined with many of the meaningful use bullets, such as engaging patients and families, and improve care coordination. Patient portals are very helpful with encouraging patient to be apart of their own care.
Reference
HealthIT.gov. (2015, February 1). Meaningful Use Regulation. Retrieved July 27, 2015,
from http://www.healthit.gov/policy-researchers-implementers/meaningful-use-
regulations
Kruse, C. S., Bolton, K., & Freriks, G. (2015). The effect of patient portals on quality
outcomes and its implications to meaningful use: a systematic review. Journal Of
Medical Internet Research, 17(2), e44. doi:10.2196/jmir.3171
McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
(Lowell)
HITECH Legislation and Hospital-Acquired Infections
One of the main purposes of the federal Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 is to improve healthcare quality by enhancing coordination of services between and among the various healthcare providers a patient may have, fostering more appropriate healthcare decisions at the time and place of delivery of services, and preventing medical errors and advancing the delivery of patient-centered care (McGonigle & Mastrian, p.163). The goals of this Act are to insure that each patient has the safest, and most appropriate medical care possible. My hospital has been influenced greatly by the HITECH Act when it comes to reimbursement from Medicare and Medicaid services. The tracking and documentation of hospital-acquired infections is a main topic of observation at my organization.
At my hospital, when a patient obtains a hospital-acquired infection, or a hospital-acquired pressure ulcer, it is documented with our Risk Management department. The data is continuously reported to Medicare and Medicaid. After evaluation of the documentation, reimbursements are either deducted, or held entirely, depending on the severity of the situation. Reporting hospital-acquired infections is extremely important in meeting criteria for meaningful use. According to Judy Murphy (2010), one of the criteria for meeting meaningful use is the initiative to improve quality, safety, and efficiency, and reduce health disparities. The main focus of reporting these incidents is not to get hospitals in trouble, but rather to determine actions that need to be put in place in order to improve patient care. Working to provide a safer environment for patients ensures that hospitals will continue to grow.
Article Review
In the article Mandatory Reporting of Hospital-Acquired Infections: Steps for Success, authors Cardo, Brennan, and Peaden (2005) examine the benefits of reporting infections to a national database. They state that the overall goal is to examine the cause for the infections, and implement a system to prevent them. The state of Pennsylvania mandates that all hospital-acquired infection information be public record. This is to reinforce the strategy by giving information to health care providers so that they can identify opportunities to contain costs and improve the quality of care they deliver (Cardo, et al. 2005). This article reflects the use of health information technology by acquiring data, and using it to improve patient safety, and reduce the risks of complications with hospitalizations.
References
Cardo, D., Brennan, P., & Peaden, D. J. (2005). Mandatory reporting of hospital-acquired infections: steps for success.Journal of Law, Medicine & Ethics, 33(4), 86-88.
McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
Murphy, J. (2010b). Nursing informatics. The journey to meaningful use of electronic health records. Nursing Economic$, 28(4), 283286.
Retrieved from the Walden Library databases.