DQ3 Cultural Competence in the Health History and Physical Examination

Read chapter 3 of the class textbook and review the attached PowerPoint presentation.  Once done answer the following questions;

1.  Mention and discuss the process and content needed for a comprehensive cultural assessment of clients from diverse cultures.

2.  Mention and discuss biocultural variations in common laboratory tests.

3.  Identify and discuss biocultural variations in health and illness for individuals from diverse cultures.

Please present your assignment Word document, 12 Arial font attached to the forum in 

A minimum of 2 references (excluding the class textbook) no older than 5 years must be used.  If you use the textbook as a reference will not be counted.  Every reference that you present in your assignment must be quoted in the assignment.

A minimum of 700 words are required (not counting first and reference page) 

 

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                             Discussion: Financing of Health Care

With coinciding concerns about health care costs and the imperative to improve quality of care, health care providers and others face difficult decisions in the effort to achieve an appropriate balance. Such decisions often are addressed in the policy arena. How do policymakers evaluate which health care services should be financed through government programs? How do ethics-related questions and other considerations play into this evaluation process? Is it possible to contain costs and provide accessible, high-quality care to all, or is the tension between cost and care inherent in the U.S. health care delivery system? These questions are central to health care financing decisions in the United States.

For this Discussion, you will focus on the policy decision-making process that determines what types of care are covered by public and private insurers and the ethical aspects of such financial decisions.

                                                     To prepare:

Read the case study “Economic Impact of States Declining Medicaid Expansion”  page 190 of the Milstead text( BOOK :HEALTH POLICY AND POLITIC ATTACHED BELLOW) .

Review the information in the Washington Post article “Review of Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate” in the Learning Resources. ( DOCUMENT ATTACHED BELLOW)

Consider how policy decisions currently are made about what will and will not be paid for and what changes, if any, could improve the process.

Reflect on how the Washington Post example illustrates the tension between cost and care.

Post your analysis and assessment of the ethical and economic challenges related to policy decisions such as those presented in the Washington Post article. 

How does this type of situation contribute to the tension between cost and care? Substantiate your response with at least two outside resources. 

CHECK THE MEDIA PRESENTATION ATTACHED BELLOW

 

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Violence Prevention Research articles pertaining to the reporting of workplace violence:     Arnetz, J. E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M. J., Russell, J., & Essenmacher, L. (2015). Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents. Workplace health & safety, 63(5), 200–210. doi:10.1177/2165079915574684  This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.  Strength- Approval for study was granted by the Internal Review Board at the University, and the Research Review Council of the hospital system. Article was peer reviewed. Analysis was completed by Chi-Square. The study was aimed at comparing self-report of WPV with actual documentation of violent incidents, it also intended to highlight which care areas had the highest incident of WPV,due to poor responsiveness of participants it highlights underreporting as a critical barrier to developing WPV prevention strategies.  Weakness- questionaires are limited by design, and it is hard to quantify underreporting of workplace violence among healthcare workers. Data collection was completed by a questionaire mailed to the homes of employees. Only 22% of employees responded to the questionaire. The questionaire asked respondents to retrospectively recall incidents from the past year, creating recall bias. Another limiting factor to the study, while hospital policy mandates violent episode reporting there may be underreporting as the study did not examine what types of violent expericences therefor some individuals may not deem certain behaviors as violent, such non-physical incidents,      Campbell, C. L., Burg, M. A., & Gammonley, D. (2015). Measures for incident reporting of patient violence and aggression towards healthcare providers: A systematic review. Aggression & Violent Behavior, 25, 314–322. https://doi-org.lopes.idm.oclc.org/10.1016/j.avb.2015.09.014  Patient violence and aggression towards healthcare providers is a significant health and public affairs problem receiving international attention. Such violence is found to occur regardless of healthcare setting or provider discipline. However, most of the evidence of a high frequency of incidents perpetrated against providers is anecdotal and solid data on the prevalence of these incidents is not yet available. Studies have shown that accurate incident reporting remains one of the primary impediments to creating organizational policies and procedures to ensure the safety of the clinical direct care healthcare provider. Yet there is no clear evidence base currently existing to suggest what measures are of most utility in remedying this underreporting. This article contributes to the literature by conducting a systematic review of existing instruments designed to measure and report incidents of patient violence against health care workers. It is hoped that this review of existing measures will stimulate health care agencies to employ routine provider reporting mechanisms in order to increase provider reporting, improve the data on patient violence and consequentially work towards combatting this public affairs problem.  Strength: This article is a systematic review of literature over the last 20 years. Both conceptual and systematic research articles were utilized for this review. Articles were excluded that were not published in peer review journals. The study included all articles written in English as part of its inclusion criteria. This meta-analysis found that violence in nursing is an international problem. The research did include three large scale studies, two national level studies from Australia and one international study. The conclusion highlights a lack of standardized measures for reporting and no standardized systematic approaches to handle WPV. But findings did suggest that violence is prevalent and underreported.  Weakness: the study was limited to only English written articles.  It is important to note that the research excluded articles of violence perpetuated by patient visitor.   Copeland, D., & Henry, M. (n.d.). Workplace Violence and Perceptions of Safety Among Emergency Department Staff Members: Experiences, Expectations, Tolerance, Reporting, and Recommendations. JOURNAL OF TRAUMA NURSING, 24(2), 65–77. https://doi-org.lopes.idm.oclc.org/10.1097/JTN.0000000000000269  Workplace violence (WPV) is a widely recognized problem in emergency departments (EDs). The majority of WPV studies do not include nonclinical staff and do not address expectations of violence, tolerance to violence, or perceptions of safety. Among a multidisciplinary sample of ED staff members, specific study aims were to (a) describe exposure to WPV; (b) describe perceptions of safety, tolerance to violence, and expectation of violence; (c) describe reporting behaviors and perceived barriers to reporting violence; (d) examine relationships between demographic variables, experiences of violence, tolerance to violence, perceptions of safety, and reporting behaviors; and (e) identify perceptions of viable interventions to improve workplace safety. A cross-sectional design was used to survey ED staff members in a Level 1 Shock Trauma center. Eleven disciplines were represented in 147 completed surveys; 88% of respondents reported exposure to WPV in the previous 6 months. Members of every discipline reported exposure to WPV; 98% of the sample felt safe at work and 64% felt violence was an expected part of the job. Most violence was not reported, primarily because “nobody was hurt.” Emergency department staff members expected and experienced violence; nevertheless, there was a widespread perception of safety. Perceptions of safety and reasons for not reporting did not mirror previous findings. The WPV exposure is not isolated to clinical staff members and occurs even when prevention strategies are in place. The definition of WPV and the individual’s interpretation of the event might preclude reporting.  Strength- this is a cross sectional study making the quality of evidence highly reliable. The study was multifactorial allowing for a broad examination of the perceptions of safety, toleration of violence, reporting behaviors and barriers, as well as demographic variables. It also identified potential interventions to improve workplace safety. One interesting note about the study is that while exposure to WPV was slightly higher than previous studies, respondents also noted a perception of safety greater than the exposure. This bears the question of whether actual versus perceived safety are congruent?  Weakness- small sample size, and only included one facility. Because most of the respondents were at least BSN prepared and were certified in their specialties with more than 11 years of experience, the perceptions and experiences of respondents may be different than nurses with less experience in handling challenging behaviors. Less experienced nurses may not recognize escalating behaviors or know how to de-escalate a situation prior to violence. This may ultimately change perceptions of safety comparable to peers. Because the study was multifactorial it is worth mentioning that there were docuemtned inconsistencies in “formal” reporting.   Hogarth, K. M., Beattie, J., & Morphet, J. (2016). Nurses’ attitudes towards the reporting of violence in the emergency department. Australasian Emergency Nursing Journal, 19(2), 75. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edo&AN=115741170&site=eds-live&scope=site  The incidence of workplace violence against nurses in emergency departments is underreported. Thus, the true nature and frequency of violent incidents remains unknown. It is therefore difficult to address the problem. Aim To identify the attitudes, barriers and enablers of emergency nurses to the reporting of workplace violence. Method Using a phenomenological approach, two focus groups were conducted at a tertiary emergency department. The data were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results Violent incidents in this emergency department were underreported. Nurses accepted violence as part of their normal working day, and therefore were less likely to report it. Violent incidents were not defined as ‘violence’ if no physical injury was sustained, therefore it was not reported. Nurses were also motivated to report formally in order to protect themselves from any possible future complaints made by perpetrators. The current formal reporting system was a major barrier to reporting because it was difficult and time consuming to use. Nurses reported violence using methods other than the designated reporting system. Conclusion While emergency nurses do report violence, they do not use the formal reporting system. When they did use the formal reporting system they were motivated to do so in order to protect themselves. As a consequence of underreporting, the nature and extent of workplace violence remains unknown.  Strength: The method utilized for this study was a phenomenological approach, in this context the intention was to have participants describe and attach meaning to their experiences in relation to the underreporting of WPV. Ethics approval was obtained by the Monash University Human Research Ethics Committee and the relevant hospital ethics committee, the study was peer reviewed. Nurses did make reports informally, when nurses did complete formal reports they were able to track the progress and learn the outcomes which they perceived as beneficial  Weakness: Nurses did not formally report because the reporting system was too cumbersome and was not user friendly. Because the study was voluntary, participants may hold a strong degree of bias about the subject. Because the study was conducted in a public forum, some may feel reluctant to speak freely   Findorff MJ, McGovern PM, Wall MM, & Gerberich SG. (2005). Reporting violence to a health care employer: a cross-sectional study. AAOHN Journal, 53(9), 399–406. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=106545936&site=eds-live&scope=site  The purpose of this cross-sectional study was to identify individual and employment characteristics associated with reporting workplace violence to an employer and to assess the relationship between reporting and characteristics of the violent event. Current and former employees of a Midwest health care organization responded to a specially designed mailed questionnaire. The researchers also used secondary data from the employer. Of those who experienced physical and non-physical violence at work, 57% and 40%, respectively, reported the events to their employer. Most reports were oral (86%). Women experienced more adverse symptoms, and reported violence more often than men did. Multivariate analyses by type of reporting (to supervisors or human resources personnel) were conducted for non-physical violence. Reporting work-related violence among health care workers was low and most reports were oral. Reporting varied by gender of the victim, the perpetrator, and the level of violence experienced.  Strength: this was a cross sectional design, using a random sample of 100 employees from over 21,000 individuals who work for the healthcare organization. Review boards for the university and the healthcare organization approved the survey instrument. Peer reviewed. This study was specific to who was likely to report and how frequently participants had experienced violence.  This study was interesting to discern demographically who was more likely to report and what criteria prompted persons to report.   Weakness: The study size was small with only 100 potential participants out of 21,000 organizational employees. Limitations to the study were modest response and recall bias. Participants may only remember the more serious incidents, and or report the more serious events. Another resulting bias may have been that those who participated in the study may or may not have been more motivated to respond based on their experiences with violence. Interestng, that the researchers attempted to assure confidentiality of the study participants, some staffers expressed concern about how results would be reported to their employer, which does speak to other studies that express fear of retaliation from victims.      Stene, J., Larson, E., Levy, M., & Dohlman, M. (2015). Workplace violence in the emergency department: giving staff the tools and support to report. The Permanente journal, 19(2), e113–e117. doi:10.7812/TPP/14-187  Workplace violence is increasing across the nation’s Emergency Departments (EDs) and nurses often perceive it as part of their job. Through a quality improvement project, reporting processes were found to be inconsistent and nurses often did not know what acts constitute violence. As a result, nurses were under-reporting violence in the ED, and as a direct result resources were not recognized or provided. A staff nurse-led workgroup developed an initial survey to assess the perception and occurrence of violence within the ED in nurses and patient care assistants. This workgroup evaluated the survey responses and identified a need for development of a brief, concise reporting tool and an educational program. A reporting tool was created and education was provided in multiple venues and modalities. A follow up process and support were given from nursing leadership. A post-education survey was completed by nurses and patient care assistants to assess their comprehension of acts of workplace violence, and found their perception that workplace violence was part of their job was reduced by half, along with increased knowledge about what acts constitute workplace violence and what is reportable to law enforcement. As a result of the education, the reporting of the violent acts has increased and staff perceive the ED to be a safer environment. With the appropriate education, reporting tool and leadership support, ED nurses can create a culture with a zero-tolerance policy for violence within the department, creating a safer environment for staff and patients.   Strength- The article was peer reviewed and offered several key insights into the benefit of educational programs that help ED staff understand what constitutes workplace violence and by developing a concise and easy to use reporting tool staff members became more consistent reporters of workplace violence. The educational tool utilized several different modalities that help with retention of knowledge.   Weakness- the study have many different limitations, the study was not approved by a review committee to confirm the reliability of the study questions. The study also only followed a small sample of individual in one hospital, so it is difficulty to generalized the results as a sample of the general target population. The questions on the survery were not reviewed by a review board prior to administration of assure validity of key related items, this may mean that vital information is excluded or it does not represent all of the conditions that the target population may encounter. Not all participants in the before and after survey were the same.            Reply  |  Quote & Reply                               Previous |  Next                                                                                                                                                                                                        © 2019 BNED LoudCloud LLC   Terms & Conditions |    Privacy Policy |      Tech Support        [Ver: 7.1]      Bookmarks   E-mail –  Oct 28, 2019 7:56:13 AM Mountain Standard Time                                                                                                                                                                                                                                                                             Chrome   Firefox   IE Explorer   Safari                               Content loaded successfully

 

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Grading Rubric Advice and Sample Table for This Discussion Question

Class after completing all of the assigned readings answer the following question:

For the middle-aged adult, exercise can reduce the risk of various health problems. Choose two at-risk health issues that regular physical exercise and activity can help prevent and manage. Discuss the prevalence of each of these health problems in society today. Describe measures that you would take as a nurse to assist clients with health promotion measures to incorporate exercise and physical activity into their lives. Include the kind of activities you would recommend, the amount of exercise, and the approach you would use to gain cooperation from the client. Support your response with evidence-based literature.

Your post should illustrate that you completed the readings and be well related to the unit’s objectives. Please do not use consumer web sites like Mayo.org as the information is summarized and simplified for the consumer. Your post should illustrate knowledge much deeper than a consumers.

Grading Rubric

States twohealth issues that physical exercise could help prevent and manage in the middle aged adult +1

Provides prevalence of the problems in society today (current statistics) +2

Lists/ discusses health promotion measures for prevention/ management of each problem +2

Includes examples of activities/ exercises +2

Supports response with evidence-based literature. +1

USE SCHOLARLY ARTICLES ONLY!

 

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What are the methods a nurse can use to gather cultural information from patients? How does cultural competence relate to better patient care? Discuss the ways in which a nurse demonstrates cultural competency in nursing practice.

 

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