4-I agree with you that Sampling theory was developed to determine the most effective way of acquiring a sample that accurately reflects the population under study. A sample is the selected group of people or elements in a study. The sample selected should represent an identified population or a particular group of individuals or elements that is the focus of the research. And  to add that Sampling theory is also  the study of the relationship that exist between a target population and the samples that are drawn from the population and this only applies to samples that are drawn randomly.  The main concepts of the sampling theory are the target population, representative samples and sampling plans or methods.

Target population is also known as research universe.  The subject of investigation is the whole statistical data.  A sampling plan normally states methods that are to be used to collect random samples from the population in such a way that there is very minimal to zero biasness.  The methods can use random probability sampling techniques.

The following steps are normally involved when developing a sampling plan, they are as follows,

Identification of parameters to be measured.

Designing intervals of measurement.

Selection of sample sizes

Establishment of data storage formats

Assigning roles and responsible to the research teams.

Generalizability is the process of extrapolating the research findings of a sample population to the general population.  The reason behind it, that the sample population that was selected represented the entire population. As such the research could extrapolate the findings and make a conclusion that represents the entire population.

   References:

Chambers, R, Chambers R, L & Skinner, C(2003), Analysis of Survey Data. Retrieved from https://www.powells.com/books/analysis.

Korn, E & Graubard, B. (1999) Analysis of Health Surveys. Retrieved from online library .wiley.com.

  

5-‘In theoretical sampling the sample is ‘not selected from the population based on certain variables prior to the study, rather the initial sample is determined to examine the phenomena where it is found to exist. Then, data collection is guided by a sampling strategy called theoretical sampling. This implies that the researcher starts the study with a sample where the phenomenon occurs and then the next stage of data collection is when theoretical sampling begins. Theoretical sampling is the process of data collection whereby the researcher simultaneously collects, codes and analyses the data to decide what data to collect next. Deciding where to sample next according to emerging codes and categories is theoretical sampling” (Coyne, 1997)

An example might include a group of Caucasian men, ages 60-70, diagnosis of heart failure. The study could include the effects of following a sodium and fluid restriction diet and the impact on the men’s health.

“Generalizability is a measure of how useful the results of a study are for a broader group of people or situations. If the results of a study are broadly applicable to many different types of people or situations, the study is said to have good generalizability. If the results can only be applied to a very narrow population or in a very specific situation, the results have poor generalizability” (Hydrocephalus, n.d)

Coyne, I. (1997). Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear

             boundaries? Journal of Advanced Nursing, 26(3), 623-630. Retrieved 9 13, 2018, from

             http://corcom300-

             s12-lay.wikispaces.umb.edu/file/view/article_sampling_qualitative.pdf

Hydrocephalus Association, n.d. Research 101:  Generalizability. Retrieved 9 13, 2018, from

  

6-I agree with you that Sampling is choosing a determinate variable within a research study.  There are many steps in the process of choosing a sample.” Sampling theory was developed to determine the most effective way of acquiring a sample that accurately reflects the population under study. And  to add that Sampling also entails studying a chosen group of people who represents a larger population.  Sampling theory describes two sampling domains: probability sampling and non-probability sampling.   In probability sampling findings can be generalized to the given population while in non-probability sampling, findings can only be generalized to the place the study was done. (Summers, 1991)

Probability sampling methods are systemic sampling, random sampling and cluster sampling while non-probability sampling methods involves theoretical sampling, purposeful sampling, network sampling and convenience sampling. (Thompson,1999)

The textbook defines generalizability as the extendibility “of the implication of the findings from the samples or situation that was studied to a larger population or situation.” (Grove et al. 2015).  In my opinion, findings from a health-related research study should only be generated if it is performed among many people and is proven to be accurate multiple times.

        References:

Grove, S, Gray, J & Burns, N.( 2015) Understanding Nursing Research, 6th edition.

Summers, S(1991) Selecting a sample from a research study. Post Anesthesia Nurse. Retrieved from http://ebn.bmj.com.

Thompson, C(1999) .If you could just provide me with a sample: examining sampling in qualitative and quantitative research papers. Retrieved from http://ebn.bmj.com.

 

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4-  The article by the author “The Role of Spirituality in Health Care “informative in its analysis and attention to the spiritual needs of the patient which is often overlooked (Puchalski ,2001). Spirituality in terms of disease and healing is important and can help with coping and recovery when facing a chronic illness, suffering, or a loss. These belief values can vary from person to person however they tend to have an overarching core principle of a spiritual faith-based core belief set. As part of a physical work-up and collection of history and physical data is collected a spiritual history is also taken and incorporated into the healthcare treatment model in this way the healthcare professionals are providing a holistic all-encompassing care of the patient also addressing the spiritual needs of the patient (Puchalski ,2001).

                                                                                 Reference:

Puchalski, C. M. (2001, October). The role of spirituality in health care. Retrieved December 18, 2018. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305900/

 
 

5- I found the published article by Puchalski (2001), to be very interesting as it demonstrated numerous examples of research based on the use of spirituality in the healthcare setting. In an example developed by Dr. Puchalski and a group of physicians with the intent of helping healthcare professionals better encounter and address spirituality with their patients and how it can positively can impact the patients’ health and the overall success of the treatment being rendered by the healthcare team.  As part of a physical work-up and collection of history and physical data is collected a spiritual history is also taken and incorporated into the healthcare treatment model in this way the healthcare professionals are providing a holistic all-encompassing care of the patient also addressing the spiritual needs of the patient (Puchalski ,2001).

                                                                             Reference:

Puchalski, C. M. (2001, October). The role of spirituality in health care. Retrieved December 18, 2018. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305900/

 

6-The aspects of the topic readings that I found most interesting were the  “polarity between the older and newer nursing theories.” The older nursing process theories are associated with taxonomies and quantitative measures, whereas the new holistic theories use more qualitative measures and softer phenomena. The revolution in the approach of how we think about nursing and nursing interventions in association to ethical decision making. With the belief that nursing is both a science and an art, the new theories expand upon this concept. The other aspect that is interesting to me is using world views to challenge contemporary ethos by using philosophical clarity and religious sensitivity.

After reading about the analysis of disease and healing I would agree that the involvement of spirituality helps enhance recovery and facilitate healing in our patients. I found the required article to read, “The Role of Spirituality in Health Care” very interesting and informative. Patients who are ill and suffering can use their spirituality to recover and heal. It was so interesting to read that patients who were spiritual and had certain beliefs lived longer and recovered faster than non spiritual patients. I think that spirituality lets us and our patients worry less and let go or live in the present moment.

-Michelle Childress

References: 

Puchalski C. M. (2001). The role of spirituality in health care. Proceedings (Baylor University. Medical Center), 14(4), 352-7.

 

 

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4-The subjective data provided by Ms. G included complaints of “…pain and heaviness in her (left) leg” and the inability to bear weigh on her leg and that she has been in bed for 3 days. Ms. G also states that she has been applying heat to the left leg for the last 48 hours, but her leg is more painful and she is” chilling”. In addition, Ms. G stated that she is a Diabetic and does not have anyone to help her with her meals and that she lives alone.

The objective data obtained from the assessment revealed that Ms. G is a 23-year-old diabetic who is 5’3 and 184 lbs. Ms. G’s left lower leg is red from the ankle to the knee and the left calf measurement is 3 inches larger than her right calf. Ms. G also has a round open wound with a moderate amount of thick yellow drainage that is 2cm in diameter and 1 cm deep located above the medial malleolus. From the description provided in this scenario, the patient has cellulitis (Mayo Clinic, 2019). The lab results are: WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands. The wound culture report indicated: Staphylococcus aureus was present in the wound. According to the Mayo clinic (2019), “The incidence of a more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) is increasing” (Para, 6). Perhaps the patient also needs to be evaluated for this, as well.

My recommendations are as follows: After checking for allergies, the patient will require a course of antibiotic treatment, NSAIDS for pain, APAP to reduce fever and education concerning wound care. The patient should be educated concerning cellulitis, diabetes, blood sugar monitoring, medications, wound care, diabetic foot hygiene and inspection, proper heat application, diet and professional home health care. Increased protein, foot and ankle hygiene and wound care will facilitate wound healing. Education provided by this writer and reinforced by home healthcare staff concerning disease processes will help the patient to better understand how to manage her diabetes and cellulitis (Mayo Clinic, 2019).  

According to the ARC: Anatomy Resource Center (n.d.) the bony prominence, the medial malleolus is located on the inner aspect of the ankle.  The potential groups of muscles that could be affected include, but are not limited to, the left Abductor Hallucis muscle, the Gastrocnemius, Soleus, Tibialis Anterior and the Extensor Digitorum Longus.

The significance of the subjective and objective data provided about follow-up diagnostic/laboratory testing, education, and future preventative care involves education concerning proper care and follow up with wound care. The patient should be taught to report any increasing signs and symptoms of infection to her physician. The patient should be taught the importance of diagnostic/ lab testing and preventative care. Furthermore, the patient should be taught how to apply heat safely and the importance of implementing suggested care from her physicians and home care staff. Moreover, the patient should be educated concerning monitoring her blood sugar, taking her medications, foot care hygiene, wearing proper foot wear and the inspection of her feet daily.

The factors that are present that could delay wound healing, and the precautions that are required to prevent delayed wound healing involve a diabetic patient with cellulitis who is living alone and stayed in bed for 3 days due to pain. Her wound culture indicated that Staphylococcus Aureus was present in the wound. There are a multitude of issues that all point to further education for this patient. The precautions needed are appropriate handling of the wound, elevation of the left leg, hygiene, blood sugar monitoring, medications and the importance of taking all antibiotics prescribed to her, diet, increased protein essential for wound healing and daily foot inspection (Grand canyon University, 2013). If the patient understood more about all aspects of her care she would be enabled to participate more fully in her care.

References

ARC: Anatomy Resource Center. (n.d.). Muscular System in Grand Canyon University ARC: Anatomy Resource Center.  Retrieved from https://lc.gcumedia.com/bio155l/anatomy-resource-center/v2.1/#/main

Grand Canyon University. (2013). NRS410 Lecture 1.Introduction to pathophysiology and nursing management of disease. Cell Structure , Infalamation and innmune system. Retrieved fromhttps://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=home&token=7iDqO7mKYHjzXbS%2bWFIznME7xLNavXJeUIkiTPCqFkm%2bTLQVeqi4QCwAxfNHd01vWR5On60EMHEnAScw%2fgtDjQ%3d%3d&classId=1695951#/learningPlatform/loudBooks/loudbooks.html?viewPage=past&operation=innerPage&topicMaterialId=145e45e2-0efc-4ff9-85ca-7fab0aa81183&contentId=64be1e20-3e70-4fd0-929f-d70532cdd950&

Mayo Clinic. (2019) Cellulitis.  Retrieved from https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762

 

5-Great post! That is amazing to hear how the medical fields has advanced so much to the point that they are now able to test the organism to test and see which antibiotic would work best for it. I am sure her diabetic history would need to be considered as well for her treatment and would need to be taken into consideration. Post care would need to be considered and patient education would be ideal for prevention for her as well. 

 

6-Great post and recommendations. You are right, a DVT came to my mind first thing due to the swelling, so a doppler would be necessary. Although I do like wounds, I am not a wound care nurse and would need a consult. Her diabetes would need to be addressed. Hopefully after this incident she would be educated more about the health of her diabetes and how important it is to keep it under control. 

 

 

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4-The Collaborative Patient Care Management Model, which is a multi-disciplinary and a population-based case management model, was first introduced in the year 2006. The prime objective of the model was to target such patients, which could be classified as high-cost and high-risk. The nurses not only manage these patients but also play a vital in the development of inter-disciplinary care plan (Kimball, Joynt, Cherner, & O’Neil, 2007). The model allows to develop a highly potent care plan, which has 1) greater potential to produce the desired results, and 2) the ability to reduce the overall cost of the care to be provided without compromising on its quality.

Reference

Kimball, B., Joynt, J., Cherner, D., & O’Neil, E. (2007). The Quest for New Innovative. Journal of Nursing Administration, 37(9), 392-398.

 

 

 
 

5-Thank you for sharing your post.  I agree that the ACO’s are beneficial in helping to streamline healthcare.  I have enjoyed the creation of the EMR as it allows other doctors within the same health organization access to my record so they know what it going on with me and I do not have to remember all the details.  This can be important especially in the older population as many forget to write things down.  Providing coordinated care helps to ensure that patients are receiving the right care.  Continuity of care is important to patients as well because they do not want to repeat everything that is going on with them when it has already been asked.  I find that many patients want the same nurse back if they are going to be there for several shifts in a row as they can build a short term relationship with them.

 

 

6-Accountable Care Organizations (ACO) is a network of doctors, hospitals, care providers home care and long-term care agencies, physician group practices, and other health care entities, such as medical homes, that come together to form a network to coordinate Medicare patient care. They share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. ACO are beneficial to both providers and patients. Providers become eligible for bonuses if they keep their patient’s healthy, while also meeting quality targets keep a portion of the savings. Patient’s benefit from having their care coordinated instead of getting each part of their health care separately. This reduces hospital stays, emergency room visits and expensive specialist and testing services that may be repeated by multiple healthcare providers. To protect patients ACOs must meet a long list of quality measures to ensure they are not saving money by stinting on necessary care. And if a patient is unsatisfied with there ACO they can see doctors of their choice outside the network without paying more and decline to have their information shared with the ACO (KaiserHealthnews.2015).

Reference

Kaiser Health News.(2015). Accountable Care Organizations, Explained. Retrieved from https://khn.org/news/aco-accountable-care-organization-faq/

 

 

 

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4-CMS no longer reimburses health care providers for services that are required to treat certain complications of care. The complications of care have been nick-named “never events” because according to CMS, these events should never happen and are “reasonably preventable by following evidence-based guidelines.” Examples of these never-events include, stage III and IV pressure ulcers, PE or DVTs after certain surgeries, injuries resulting from falls while in-patient, retention of foreign object after surgery, surgery on the wrong body part, surgical site infections after certain surgeries, transfusion of the wrong blood type, and UTI resulting from a catheter.

Some of these events are reasonable. There is simply no excuse to operate on the wrong body part and if a physician makes the mistake of leaving a foreign object in someone after surgery, it is reasonable to not pay them for another surgery to remove it. However, some of these events are going to happen even if every precaution has been taken to prevent these events. DVTs and PEs are still possible even when someone is on heparin or lovenox. Regardless of exactly “how” preventable these conditions are, this change by CMS will certainly cause providers in in patient facilities to be more attentive in their care and prevention of these conditions. Because CMS specifically mentions that these events are preventable by evidence-based guidelines, in patient care models are focusing even more on these guidelines and basing their care off of them. For example, most hospitals now have protocols to prevents CAUTIs, such as requirements to perform and document catheter care, and algorithms for early removal of catheters, and prevention of unnecessary insertion of catheters in the first place.

Reference:

O’Rourke, P. T., & Hershey, K. M. (2018, September 14). Never-Event Implications. Retrieved from https://www.the-hospitalist.org/hospitalist/article/124081/never-event-implications

 

 

 
 

5-The Centers for Medicare & Medicaid Services or CMS is investigating ways that they can help to reduce or eliminate the occurrence of “never events” (ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS – NEVER EVENTS, 2006). These events are defined as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. “Never events,” like surgery on the wrong body parts or mismatched blood transfusions can cause serious injury or death to patients. There is not an exact number of “never events” but they are the cause in many deaths and additional health care costs that the CMs is trying to minimize. The rules for reimbursement are changing. The Deficit Reduction Act allows CMS to begin adjusting payments for hospital-acquired infections and reduce the payments when they occur. This has caused for a shift in how hospitals require nurses to care for their patients. At my hospital, they implemented 4eyes on upon admission. This means that two registered nurses must assess every square inch of a patient’s body upon admission to insure that the hospital is not responsible for previously acquired injuries. This helps to prevent unnecessary cost on our part treating wounds that were acquired at home. We still treat them but we are not shown as responsible for their development.

ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS – NEVER EVENTS. (2006, May 18). Retrieved April 2, 2019, from CMS.gov: https://www.cms.gov/newsroom/fact-sheets/eliminating-serious-preventable-and-costly-medical-errors-never-events

 

 

 
 

6-The CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities as this caused facilities to provide more quality based care to prevent the possibility of not getting paid for services that would be considered acquired through the facility. Many of the patients that come into the hospitals should be coming for their reasons for treatment not acquiring any other conditions due to their stay. Hospitals would be denied any additional payment for case in which one of the selected conditions was not present on admission. This caused many hospitals to panic and they attained means in order for this to be avoided. Due to this, facilities have developed distinct protocols and measures to make sure that this doesn’t occur. These conditions are known as never events, which include:

1. Air embolism
2. Blood incompatibility
3. Catheter-associated urinary tract infection
4. Certain manifestations of poor control of blood sugar levels
5. Deep-vein thrombosis or pulmonary embolism after total knee and hip replacements

2. Falls/trauma
7. Objects left in during surgery
8. Pressure ulcers
9. Surgical-site infections after certain orthopedic and bariatric surgeries
10. Surgical-site infections after coronary artery bypass graft
11. Vascular catheter-associated infection

Reference:

ESBCO Host. (n.d.). Preventing Never Events. Retrieved April 2, 2019, from https://www.ebscohost.com/shared/never-events.pdf.

 

 

 

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