Middleville Regional Health Care is one (1) of three (3) hospitals serving a community of 350,000 people. Summary statistics on Middleville and its competitors, from the AHA Guide, are shown below in Table 1. All three organizations are not-for-profit.

Table 1: Middleville, Brierfield, and Greystone Health Care Systems

    

Name

Beds

Admissions

Census

OP Visits

Births

Expenses (000)

Personnel

 

Middleville

575

13,000

350

221,000

2,300

$125,000

2,000

 

Brierfield

380

17,000

260

175,000

1,200

$130,000

1,875

 

Greystone

350

10,000

180

40,000

900

$80,000

1,200

The governing board of Middleville hired a consulting company to evaluate its strategic performance, specifically in the areas of Human Resources, Information Technology, Financing, and Marketing. As part of the consultant’s evaluation, several leaders of Middleville’s units were asked their perspective of the organization’s performance. 

You are working for the consultant. Your job is to identify the issues from the response that should be considered further by the consultant team and possibly discussed with the governing board and the CEO. The firm has a rule, “Never offer a criticism or negative finding without suggesting how the client organization can correct it,” so you must indicate what sort of correction you would recommend as part of your list. Because you know there were about two (2) dozen other interviews, you decide you should rank your issues in importance, to make sure the most critical are discussed.

Write a six to eight (6-8) page paper in which you:

1. Explain the governing board’s role in these strategic initiatives, determining its responsibility and involvement.
2. Evidence-based management means that operational and strategic decisions are made based upon the evidence that goals and objectives are actually being met. Quantitative measurements must be identified and measured. This data is then used to evaluate the HCO’s performance. Name three (3) performances Middleville can use to measure its success in providing quality healthcare to the community, and identify quantifiable, measureable indicators that can be used to do so. Explain the importance of each performance measurement.
3. Given the statistics of Middleville and its two (2) competitors provided in Table 1, recommend to the HCO what areas it should focus on to maintain its competitive market share as well as continue to provide healthcare to the community in the 21st century.
4. Some of Middleville’s Board members are very interested in pursuing advanced technology systems over the next five (5) years, while others are concerned about the enormous expense and need assurance that the investment in technology will be worthwhile. In both monetary and process terms, describe the costs and benefits associated with implementing EMR and associated health data systems. Lay out a plan for how various systems can be implemented.
5. Middleville has faced many challenges in recruiting and retaining nurses and other clinical employees. The economy has hit the area very hard and budgetary limitations have reduced the amount of money available for salary increases. The Board knows it needs to provide other benefits to their valued employees. Provide at least two (2) suggestions to Human Resources to promote employee satisfaction and, therefore, retain experienced personnel.
6. Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.
7. Format your assignment according to the following formatting requirements:

a.  Typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides.

b.  Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length.

c.  Include a reference page. Citations and references must follow APA format. The reference page is not included in the required page length.

The specific course learning outcomes associated with this assignment are:

• Examine how healthcare management concepts and theories are applied to critical issues in healthcare organizations.
• Analyze the critical management issues, purpose, functions, and performance measures of different departments within healthcare organizations.
• Explain how public policy has shaped the development of the U.S. healthcare system.
• Use technology and information resources to research issues in health services organization management.
• Write clearly and concisely about health services organization management using proper writing mechanics.

Click here to view the grading rubric for this assignment.

 

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Discuss  and provide 2 specific ways Early Conceptualization About Nursing Theory can be applied to advanced practice nursing. Identify one MSN Essential that most relates to this particular topic.

*Under the Class Resources tab, students will find the MSN Essentials which help to guide and shape graduate nursing education. Select 1 of these essentials that most closely reflect the concepts of this theory.**

 

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Please check all attached files. Ive attached milestone 1 because if you put ur mouse over the boxes you will see the professor comment and the last part on the milestone 1 was recommended for this milestone. Thank you sooo much

 

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Please refer to milestone before completing assignment. 

1. Review the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.
2. Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Template (Links to an external site.)Links to an external site.. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.
3. The format for this proposal will be a paper following the Publication manual of APA 6 th edition.
4. The paper is to be four- to six-pages excluding the Title page and Reference page.
5. As you organize your information and evidence, include the following topics.
   1. Introduction: Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.
   2. Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.
   3. Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
   4. Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.
   5. Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.
6. Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
7. Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.
8. Submit your paper by 11:59 p.m. MT by Sunday of the end of Week 4.

MILESTONE 1 

  

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

For Use May 2018

Student Name: Date: 5/21/18

Directions

1. Refer to the guidelines for specific details on how to complete this assignment.

2. Type your answers directly into the worksheets below.

3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.

4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.

Practice Issue Worksheet

  

List the topic and include the   citation for the systematic review you have selected from our approved list   (optional: an additional scholarly source of support):

Support for   healthy Breastfeeding mothers with healthy term babies. 

McFadden, A., Gavine, A., Renfrew, M. J., Wade, A.,   Buchanan, P., Taylor, J. L., … MacGillivray, S. (2017). Support for healthy   breastfeeding mothers with healthy term babies. Cochrane Database of   Systematic Reviews, Issue 2. Art. No.: CD001141.   doi:10.1002/14651858.CD001141.pub5

 

What is the nursing practice issue   you have identified related to the topic you have chosen?

The nursing   practice issue identified is the unavailability of resources that can   facilitate the teaching of feeding cues to the mothers and expecting mothers in   order to provide the best breastfeeding practices.

 

Fully describe the scope of the practice issue:

The benefits of   breastfeeding for both mother and child is widely accepted across the medical   field. The world health organization has made a recommendation that infants   should be breastfed until six months exclusively, and even continue for up to   two years exclusively as the main part of infant diet. The current level of   breastfeeding in most of the countries does not indicate that recommendation.   Knowing this, instead of offering brief lactation classes on postpartum   units, interactive and in-depth lactation support should be available to all   expecting mothers and new mothers.

 

What is the practice area?

___   Clinical

_x__   Education

___   Administration

___   Other (List): 

 

How was the practice issue   identified? (check all that   apply)

___   Safety/risk management concerns

___   Unsatisfactory patient outcomes

___   Wide variations in practice

__x_   Significant financial concerns

___   Difference between hospital and community practice

___   Clinical practice issue is a concern

___   Procedure or process is a time waster

___   Clinical practice issue has no scientific base

__   Other:

 

Describe the rationale for your   checked selections:

For this practice   issue, I selected significant financial concerns as a reason to why lactation   courses are not as prioritized as they should. Providing the resources needed   in order to facilitate an interactive in depth course may illuminate a   financial concern.

 

What evidence must be gathered? (check all that apply)

 

___   Literature search

___   Guidelines

___   Expert Opinion

___   Patient Preferences

_x__   Clinical Expertise

__x_   Financial Analysis

___   Standards (Regulatory, professional, community)

___   Other

 

Describe the rationale for your   checked selections: 

I selected   financial analysis because in order to supply the resources for these   lactation courses, the facilities/hospital’s financial capacity should be   considered. Hiring additional staff that offer expertise is essential in   offering quality care to the specific population.

      

Evidence Summary Worksheet 

Directions: Please type your answers directly into the worksheet.

  

Describe the practice problem in your   own words with reference to the identified population, setting and magnitude   of the problem in measurable terms:

As previously mentioned, though it has been   medically recommended for mothers of infants to breast feed for at least 6   months, the number of mothers that actually follow through with breastfeeding,   does not reflect its importance. Expecting and new mothers are not offered   enough support in regards to education, to ensure breastfeeding compliance.   As a result, the benefits of breastfeeding are not being reaped by mother and   infants.

 

Type the complete APA reference for   the systematic review article you chose from the list provided. It must be   relevant to the practice issue you described above. Include the APA reference   for any additional optional supplemental scholarly source related to   the review you wish to use.

Renfrew, M. J., McCormick,   F. M., Wade, A., Quinn, B., & Dowswell, T. (2012). Support for healthy   breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev, 5(5).

 

Identify the objectives of the article:

To determine the categories of breastfeeding   support that haven examined in the controlled research, the timing for the   intervention and the setting which the research and interventions are used 

To determine the efficiency of diverse modes   for offering the intervention support for instance, whether the offered   intervention is reactive, proactive and over the phone or face to face, and   if such intervention has the elements of postnatal and antenatal and their   effectiveness. 

To evaluate the effectiveness of various   caregivers and trainings in situations   where there was series of trainings. 

To explore the interactions between the rates   of breastfeeding background and support effectiveness. 

Provide a statement of the questions being addressed in the work and   how these relate to your practice issue:

Offering the support for the breastfeeding to women   both antenatal and postnatal results in the increase of the exclusivity and   duration of breastfeeding, hence better health for mother and child. The   practice issue identified, suggests that the resources and the availability   of staff may be an issue. Financially, many facilities may not deem these   interventions as those that require priority, thus dwarfing the availability   interactive lactation support courses.

 

Summarize (in your own words) the interventions the author(s) suggest   to improve patient outcomes.

In order to gain success, these courses should   be instructed by qualified personnel who are able to provide in depth   expertise. The program should provide progressive arranged visits with women   on the based on the time that they’re available. The program should be   tailored to the setting and need of the group. 

Summarize the main findings by the   authors of your systematic review including the strength of evidence for each   main outcome. Consider the relevance   to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a   statement of relevance to it as well.)

The main findings are that the support offered   by both the professional and lay persons had positive impact on the outcome   of breastfeeding. 

Factors like the face to face breastfeeding   support and personalized trainings encourage the duration and exclusivity of   breastfeeding in new mothers.

 

Outline evidence-based solutions that you will consider for your   project.

Evidence-based solutions that increase the   rate of breastfeeding includes; patient centered care of mothers who are   experiencing issues with breast feeding, giving support in the settings that   have high rate of initiation, and education provided by experts that enables   mothers both antenatal and postnatal to have access to all the information   they need to provide the best care for their infants. Also, the support   strategy should include face to face interactions for higher chances of   success for the breastfeeding women. 

Discuss any limitations to the studies that you believe impacts your   ability to utilize the research in your project.

The studies were limited to 100 studies, and   73 studies were limited to 29 countries which is even less than 50% of the   countries across the globe. Statistics cannot rely on such figure as   representatives. 

 

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Topic 4: Mike was recently diagnosed with type 2 diabetes.  He is feeling good and has not noticed any changes in his health.  Sam, his twin, has not been diagnosed with type 2 diabetes.  They both like the same activities and foods. Mike does not understand why he has diabetes, but his brother does not and why he has not had any noticeable symptoms. How would you explain this to him? Carbohydrate is broken down in our digestive tract to monosaccharides and glucose, a monosaccharide, stimulates the release of insulin.  The release of insulin does not cause insulin resistance and eating more carbohydrate does not cause insulin resistance either.  Insulin acts at the muscle to unlock the cell and let glucose in.  Sometimes that key does is not as efficient at letting glucose in causing insulin resistance.  One thing we know promotes resistance is excess fat which somehow blocks insulin’s efforts to get glucose into the cell.  In our example, Mike has type II diabetes.  He has plenty of insulin, but it is not working right.  What health changes should Mike make to reduce his body fat?

 

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