2. Submit Part One Portfolio due 02/02/193 .Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.Practice 1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.  Education 1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.  Research 1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.  Administration 1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 4. Support the development and integration of palliative care services for all in- and outpatients and their families.   Discussion Board Question 2: End of Life Care.Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.

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This week you will reflect upon accountability in healthcare to answer the following questions:

• How can you play your part in accountability?  
• Briefly define the Accountability Care Organization
• What challenges do we face?
• How do you see the role of the healthcare worker changing as a result of these challenges?

Assignment Expectations: How will students be successful?

• Length:
  • 1000-1250 words (4-5  pages); answers must thoroughly address the questions in a clear, concise manner
• Structure:
  • Include a title page and reference page in APA style
• References:
  • Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions

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Bioethics Case Study: This assignment asks you to examine a current ethical controversy case study. The paper is informal, but should be in APA style, and does not need an abstract or cover page. With a minimum of two pages and a maximum of four pages A reference page is needed. In-text citations should be in APA format. 

Papers will be graded on a 0 to 25-point scale.Case Study in Primary care:One hypothetical case study involves Jim a 54, year old patient who has recently diagnose with hypertension and his Creatinine and BUN laboratory results are elevated, if left untreated, will result in kidney failure. The patient refuses to take the medication because he said it will affect his sex life The NP must work with the patient to respect the fact that he doesn’t want the medication (autonomy), and needs to find a solution that would prevent him from going into kidney failure and other complications, which is in his best interest (beneficence). Although medications are the best choice, forcing the patient to accept the medication will result in probably patient leaving the care (non-maleficence). Finally, the NP needs to consider the impact that the patient’s choices might have on others if he starts to go into preventable kidney failure, he’ll need dialysis, which affects other people who need the same treatment (justice). So before making the final decision the NP must consider all four principles of health care ethics, which will help the NP make the choice that will have the best possible benefits for both the patient and society.

Questions?What are the skills necessary for the provider to identify, address, and assess this clinical ethical issue?What are the provider’s obligations when a patient discloses does he not intent to follow the treatment?What are the ethical considerations in evaluating a patient’s failure to adhere to a prescribed therapy?Will you terminate care for this patient? What are the implications?Case Study RubricCriterionOutstanding  (25)Very Good  (22)   Average (18)Unacceptable (15)ScoreCompletenessComplete in all respects; reflects all requirementsComplete in most respects; reflects most requirementsIncomplete many respects; reflects few requirementsIncomplete in most respects; does not reflect requirements 

UnderstandingDemonstrates excellent understanding of the topic(s) and issue(s) Demonstrates an accomplished understanding of the topic(s) and issue(s)Demonstrates an acceptable understanding of the topic(s) and issue(s)Demonstrates an inadequate understanding of the topic(s) and issue(s)

 AnalysisPresents an insightful and through analysis  of the issue (s) identifiedPresents a thorough analysis of most of the issue(s) identifiedPresents a superficial analysis of some of the issue(s) identifiedPresents an incomplete analysis of the issue(s) identified. 

EvaluationMakes appropriate and powerful connections between the issue(s) identified and the concept(s) studiedMakes appropriate connections between the issue(s) identified and the concept(s) studiedMakes appropriate but somewhat vague connections between the issue(s) identified and the concept(s) studiedMakes little or no connection between the issue(s) identified and the concept(s) studied.

 OpinionSupports opinion with strong arguments and evidence; presents a balanced and critical view; interpretation is both reasonable and objectiveSupports opinion with reasons and evidence; presents a fairly balanced view; interpretation is both reasonable and objectiveSupports opinion with limited reasons and evidence; presents a somewhat one-sided argumentSupports opinion with few reasons and little evidence; argument is one-sided and not objective. 

RecommendationsPresents detailed, realistic, and appropriate recommendations clearly supported by the information presented and concepts studiedPresents specific, realistic and appropriate recommendation supported by the information presented and the concepts studiedPresents realistic or appropriate recommendation supported by the information presented and the concepts studiedPresents realistic or appropriate recommendation with little, if any, support from the information and the concepts studied.

 Grammar and SpellingMinimal spelling and grammar errorsSome spelling and grammar errorsNoticeable spelling and grammar errorsUnacceptable number of spelling and grammar errors APA guidelinesUses APA guidelines accurately and consistently to cite sourcesUses APA guidelines with minor violations to cite sourcesReflects incomplete knowledge of APA guidelinesDoes not use APA guidelines                  

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Chapter 4-Hospitals:  Origin, Organization and Performance

Due at 5PM CST, Monday, September 11, 2017

Assigned Readings:  Chapter 4

Answer the following questions:

1. For a hospital to operate efficiently and effectively, the three important influences in its governance, medical staff, board of trustees, and administration, must work together in reasonable harmony. What factors might contribute to tensions among these groups?
2. As the nursing profession has expanded through advanced degrees, specialization, and clinical practice, nurses’ salaries and responsibilities have also increased. Now, hospitals substitute non-nurses for nurses to perform all but the most technical tasks. What are the implications for the nursing profession? Have nurses lost their traditional role of hands-on patient care and, if so, is that to their advantage or disadvantage?
3. The traditional management style of hospitals has been hierarchical and internally focused.  What are three important challenges that face hospitals to accommodate new payer and consumer expectations?
4. The availability of hospital insurance removed an important cost constraint from hospital services and charges. What were some positive and negative consequences of that development?
5. The organization and practices of modern hospitals reflect the promotion of specialization and sub-specialization by academic health centers. What were the advantages and disadvantages to patients of increasing the number of physicians who limit their activities to narrower fields of practice?
6. With significant oversupply of hospital beds in the U.S. what is the rationale for taxpayer support of the separate and costly hospital system of the Department of Veterans Affairs?

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Due at 12PM CST, Monday, November 6, 2017

HCA 340 500

Discussion Board Assignment #10

Chapters12—Research:  How Health Care Advances and 13–Future of Health Care

Answer the following questions on Research: How Health Care Advances:

1.            Definitions of the quality of medical care are no longer left to clinicians who decide for themselves what technical performance constitutes “good care.”  Name one (1) other dimension of quality care and why is it important? 
2.            What is the primary method of continuous quality improvement (CQI) in health care, and what is its underlying premise?
3.            Since an ever-increasing amount of research is funded by commercial companies, what is your opinion on a requirement for authors of scientific studies who receive income from these companies to disclose funding sources in their scientific publications?

Future of Health Care Questions:

1.            Today’s not-for-profit hospitals and health systems are commonly multi-billion dollar tax-exempt organizations. What is your position on the new federal scrutiny upon, and reporting requirements for justifying the charitable missions of not-for-profit hospitals and health systems?
2.            In 1999, the Institute of medicine report, To Err is Human,generated a brief flurry of concerns about avoidable hospital deaths.  While progress has been made in addressing system errors and deficiencies, it remains inconsistent across the nation’s hospitals.  Fourteen years after this report, is it time for the professions, payers and the public to demand corrections of system problems in an accountable, transparent and publicly disclosed manner?  What form can or should these demands take?

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