Please Answer According The Comments Thanks Remember 100 Words For Each Reference Between 2013 2018 Thanks 18986981

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Comment 1

The PPACA was aimed to improve the health care system, offering affordable health insurance to more Americans, expand the Medicaid program to cover all adults that live below the poverty level, and to support innovative medical care delivery methods designed to lower the costs of health care generally (Lampert, 2009). The PPACA mandates that everyone that is legal will have health coverage in the United States or a penalty will have to be paid at the end of the year. With the influx of people now receiving healthcare, they will be seeking medical attention where in the past they would not. The increase in people seeking medical attention will result in a needed increase in nurses to take care of these patients and more training to gain more expertise and skills to be able to manage the emerging needs and diseases.

A key nursing provision is the health care workforce loan repayment program (Section 5203). This section focuses more on children. It has a focus on pediatric medical or surgical and children mental and behavioral health care. The repayment program will offer psychiatric nurses, social workers, and professional/school counselors up $35,000 a year in loan repayments for their participation in an accredited pediatric specialty residency program.  A second key provision is public health workforce recruitment and retention programs (Section 5204).  This provision is aimed at eliminating the shortage of public health agencies. This provision has offered a one third repayment of loans for an exchange of a contract of employment acceptance with a public health agency for three years. This program is offered to eligible public health or health professions.

I know my nursing career will be affected by the provisions that were listed above along with all the other provisions listed in the PPACA. Offering loan repayments will give nurses the incentive to obtain higher degrees. Recruitment and retention would likely decrease the nurse shortage by new nurses coming in and showing loyalty to the season nurses.

Comment 2

The effect of the Patient Protection and Affordable Care Act (PPACA) resonates profoundly in the U.S. healthcare environment and among the public. Two key provisions of the act include: 1) Guaranteed issue prohibits insurers from denying coverage to individuals due to pre-existing conditions; 2) Section 5204 Public health workforce recruitment and retention programs.

           With the first requirement, health care setting experienced a rise in the number of new patients, as expected. Many of these patients were probably afraid or restricted from going to the hospital or seeking medical care due to the lack of healthcare coverage. The impact is that more people are seeking medical care. From my nursing practice, I observe some of these patients have chronic illnesses that have been neglected and thus require more care. Also, more patients come for medical services; emergency rooms fill with more patients. This increases patients’ population. In return, this affects nurse to patient ratios. Nurses have to care for more patients. They have to work extra time due to shortage of staff. The downsides is that nurse morale is low and the risks for medical errors are high.  

                The second nursing provision (Section 5204) retained refers to the established “Public Health Workforce Loan Repayment Program.” This provision gird to assure an adequate supply of public health professionals to eliminate workforce shortages in public health agencies. The positive impact of this provision is that government will repay up to “1/3 of loans incurred by a health professions student in exchange for an agreement to accept employment with a public health agency for at least three years” (CDC). Ultimately, this provision makes it easier to attract young people to the field of nursing. This will have a positive impact on the nursing shortage. It is an attract incentive for many current nurses to pursue their studies and opt for advanced degree in nursing. This is exactly what I am intended to do.

Comment 3

Nice post! Some important aspects of the ACA, include the consumer assistance program, which is a program that helps people enroll in coverage as well as file complaints if a person is denied payment for any type of healthcare service. There are also preventative healthcare services if eligible, paid by insurance. Seniors that are on Medicare who are struggling with prescription costs, can find assistance with discounts and rebates as well. The ACA also offers more options when choosing insurance coverage. There is also a pre-existing condition insurance plan for people who may have a disability or chronic condition, that were previously denied coverage under regular insurance options. In addition, parents are able to cover their children under the age of twenty-six if they are unable to get insurance. The ACA has given people the ability to choose any doctor they wish to see, whether or not they are affiliated with a network or not. Additionally, the Children’s Health Insurance Program (CHIP) will be extended from 2015 through 2019, providing coverage to children in low-income families (KHN, 2018).

 
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Please Answer According The Comments Thanks Remember 100 Words For Each Reference Between 2013 2018 19027049

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Comment 1

I work on a Labor and Delivery/Postpartum unit. I work the night shift for the past 19 years and I have seen the high rate of nurse turnover and struggle with nurse retention. Of the varied reasons for discord is the perception and role that the new nurses are expected to jump into after a harried orientation. I also see the inability to conform or endure the role of a night nurse on a very busy unit. 

Expectations seem to be unrealistic and not well defined when progressing through the orientation process that begins on the “day” shift when a orientee is hired for a night shift position.  According to Mazhindu, D. M., Griffiths, L., Pook, C., Erskine, A., Ellis, R., & Smith, F. (2016), the resilience and devotion to performing the job hired for is not clear or misinterpreted. Also the financial aspect of training or orienting nurses is always increasing. According to Colosi (2018), the 2018 National Health Care Retention & RN Staffing Report shows that the average cost of RN turnover ranges from $38,000 to $61,000 which translates into the hospital cost for turnover  ranging from $4.4M – $7.0M. 

Comment 2

I currently work in a sub-acute unit of a long term care center. The center has two units, the senior nursing facility (SNF) and sub-acute unit. My unit is very different from the SNF side because they all have tracheotomies, require total care, most of them have PEG tubes, and their acuity is higher. It is a 27-bed unit and each nurse is usually responsible for 6-8 patients over an 8 hour shift. The unit is divided into four different carts and some carts are more difficult than others. We are not only responsible for medication pass, but we also need to assist our CNAs with ADLs. A major problem the organization is facing is the high turn-over rate. I have only worked at the facility for a year and it took me about 4 months to finally get used to the unit. It is a very difficult unit to work on and many nurses have quit because they are not adequately trained. The length of training is only 1-2 weeks and at most 8 shifts total. Most of the time it is usually less until the nurse is put on the floor by themselves. Luckily, most of the nurses are very nice and helpful, but everyone is busy so it can be hard to stop what you’re doing to help the new nurse. The major problem is the inadequate training that new nurses receive.

Two implications for nursing involve adequately training nurses to improve retention. Providing adequate training to new nurses is vital because not only increases their chances of staying with the organization, but improves their competency in giving their patients the most appropriate care. Another implication is the cost for turn-over and according to Maryniak, Markantes, & Murphy (2017), the cost of turn-over for a clinical RN ranges from $37,700 to $58,400. Training new nurses is not only very costly, but also time consuming as well. Fixing the problem of inadequate training of nurses is vital because if a nurse feels overwhelmed, they are more likely to leave and find a place that prepares them better.

Comment 3 (Abigail)2 DQ 2

I think that the main issue that my organization is addressing is providing patient safety through quality care. There have been many in-services dedicated to making sure that we keep our patients safe by making sure we follow correct protocols in regards to moving and transferring. The also made sure that the residents that are a fall risk have an armband. Some of them even have mats placed by the bedside as well. According to van Gaal, Schoonhoven, Vloet, Minties, Borm, Koopman, & Achterberg (2010), educating staff and about proper interventions increases patient safety. They also mentioned that passive education (written material and large-scale educational meetings) is less effective than education that is personal and interactive. A great way for an organization to address and resolve patient safety and quality care issues, would be to require the employees to stay-up-to date on evidence-based practices. This can be accomplished by providing the information and requiring them to read the material, answer some questions based on the material, and go through a skills check off list and demonstrate how tasks should be completed. This way, the employee will read the information, be able to write or say the answers based on questions, and implement them in a clinical setting.

 
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Please Answer Base In This Answer In Apa Format Write At Least 250 Words Please Answer The Comments By Number And List Your Answers Please Thank You 18873199

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1-You made some good points Judy, but the U.S is not the only one struggling with the health care . I was reading different articles and realized there are so many countries going through the same things and maybe even worser. The Pakistan’s health profile portrays high maternal and child mortality, increase population growth rate, and the twofold burden of infectious and non-infectious diseases (WHO, 2007).Just 27% of the Pakistani people avail advantage from full coverage of health care that include armed force members, beneficiaries and government employees, whereas, the rest 73% of the population pay out of pocket (Settle, 2010).They are viewed as a country that is not really important and get overlooked and struggle with health care. People are still paying a crazy amount of money just to get the care they need to stay healthy. With everything going on it makes it hard and for people to reach out when they really need it and it progresses to where it can not be reversed and as a nurse it just sucks seeing people go through this and hope it gets better as the years pass. 

  

2-Many American families have a limited access to health and are uninsured. Our healthcare system focuses more on treatment and medical services than preventive care. Health care spending has been increasing over the years, yet there isn’t a significant improvement in health outcomes (Kaiser Family Foundation, 2017). In 2013, $2.9 trillion dollars was spent on the healthcare alone, which is about $9,255 per person (Levitt, Claxton, Cox, Gonzales & Kamal, 2014). For insured families, insurance premiums have risen about 11% and household earnings only 3% increase from 1996-2003. Soon, family premiums will cost more than the family income by 2025 if trends continue. All that money spent, yet there coverage in limited/inadequate. Over recent years, insurance premium cost increases have slowed, but this places more of the financial burden on the family (Devoe, 2008).

In 2016, 27.6 million people are not insured. Many low income families cannot afford to pay for health insurance, so they gamble and delay any medical services in fear of how much it will cost them (Kaiser Family Foundation, 2017). Many fear that it could lead to financial ruin. Among families with health insurance, almost half of all personal bankruptcies were due to high medical costs (Devoe, 2008).

There is also the issue of people uninsured when they’re in between jobs or waiting for approval of Medicare/Medicaid. About 82 million Americans have these coverage gaps during a 2-year period (Devoe, 2008). Life is unpredictable, and something can during these gap periods.

References

Devoe, J. (2008). The Unsustainable US Health Care System: A Blueprint for Change. The Annals of Family Medicine, 6(3), 263-266. doi:10.1370/afm.837

Levitt, L., Claxton, G., Cox, C., Gonzales, S., & Kamal, R. (2014). Assessing the performance of the U.S. health system. Retrieved May 24, 2018, from https://www.healthsystemtracker.org/brief/assessing-the-cost-and-performance-of-the-u-s-health-system/#item-start

Kaiser Family Foundation. (2017, December 07). Key Facts about the Uninsured Population. Retrieved May 23, 2018, from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

  

3-I have found that the health care system in the United States is expensive and not easily obtained. There is much room for improvement. The concern about quality arises more from fear and anecdote than from facts; there is little systematic evidence about quality of care in the United States. We have no mandatory national system and few local systems to track the quality of care delivered to the American people. More information is available on the quality of airlines, restaurants, cars, and VCRs than on the quality of health care (Scuster, 2005).  The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating health care coverage for almost everyone. This can be difficult for someone who is working minimum wage and has a job that does not require to give employees benefits such as health care insurance. One could argue that minimum wage is not meant to be a long term job for an adult. Though the theory of minimum wage jobs might have originally been meant for minors, the reality of our nation is that many adults living in poverty are employed at minimum wage paying jobs. It should be our duty to provide affordable health care for all members of our nation regardless of our own personal beliefs. Obama Care may not be a perfect system because even though it is said to be afforable health care, it has shown to still not be as affordable as one might need based on their income. However, I believe that this was a good start and can be improved to fit our nation and every individual in it as needed. Health care is only getting more and more expensive with the new medications and technology that we are developing as time goes by. Our nation leaders need to think of someway to have health care available for everyone. One option could be to provide health care for everyone like Canada has for their citizens. Though this comes with problems of its own, I believe that it is a system that cares for all and would great individuals that cannot afford health care. Whatever the United States decides to do regarding the issue of so many Americans being uninsured, something needs to be done quick. With so many people being uninsured, many diseases go untreated or even diagnosed due to the financial fear individuals that are uninsured face. People would rather not see a doctor or a clinic because of the fear that they will bring financial burden to their family. As a nurse, this breaks my heart. 

Schuster, M. A., McGlynn, E. A., & Brook, R. H. (2005). How Good Is the Quality of Health Care in the United States? The Milbank Quarterly, 83(4), 843–895. http://doi.org/10.1111/j.1468-0009.2005.00403.x

 
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Please Answer Base In This Answer In Apa Format Write At Least 250 Words Please Answer The Comments By Number And List Your Answers Please Thank You 18867075

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1-I agree with you. Advocating for mental health is important. These groups are also found in this category due to a lot of issues. Some of them started with depression due to one thing or the other and since they don’t have access to healthcare for treatment, they may start overeating which may lead to obesity and other health issues, some will start using drugs which will even make things worse.

  

2-I work night so I do not typically interact with social workers face to face. I do however put in many social worrk consults for patients that I believe may benefit from one. At Baylor Scott and White you can put a social work consult for someone if they simpley over the age of 80 and you feel that they need one. I picked up day shift for a week this past month and saw how much social workers interact with patients on a daily basis. They do a great job at making sure patients are well taken care of out side of the hospital.

  

3-Great points. These minority groups are dying in silence because they have no one to cry to, and they believed even if they cry no one will listen to them. As an African American, and considering where I come from, sometimes I think only the influential and the upper class are getting what they need/want. These groups have little or no access to health care, even if they are sick, they can’t afford the huge bills. Some will rather stay at home to use home remedies which may not work and their lives will be in danger. Therefore, as nurses, advocating for these groups will be great achievements for us. God help us.

  

4-I actually believe that there is very little known about the cause of diabetees and that researchers have barely scratched the surface of studying and understanding the disease. After watching the program “What The Health” I started to question a lot of what I was taught in school. This program was actually trying to prove that the information given on ADA websites and everything is actually very inaccurate. Websites for diabetees give you healthy food options to cook such as bacon wrapped scallops and chicken. MD’s on this program were actually saying that meat is the cause of diabetees because the proteins and fats block the cells from allowing sugar to go in so the sugar then roams free in your blood. So even if you are eating the best fruits or the darkest most nutrient dense fruits it doesn’t matter. As long as you are still consuming meat or any processed foods no matter how good the sugar is for you it will be roaming free in your blood stream because the proteins and fat are blocking it from going into the cell and being of any actual use for your body. Most of the diabetic organizations get their money from dairy farms or meat industries so they continue to advertise that all is a part of a healthy diet. Like they say ..just follow where the companies get their money and you will see the truth.

  

5-Shands at the University of Florida, where I work focuses a lot on Cultural diversity. All health care professionals are required to take a mandatory cultural diversity class. The goal is to increase cultural awareness, knowledge and skills in our delivery of care. Another example of cultural accomadation that comes to mind in my practice is I was taking care of an Indian patient who used Reiki treatments in her past for anxiety and depression. “Reiki is an energy-healing practice that is considered safe with no side effects. Under the notion that the body is more than a physical entity, Reiki focuses on all aspects of being including mentally, emotionally and spiritually”. I was able to get in touch with the therapy department and find a practioner that had training in Reiki. I arranged for him to come atleast twice a week for treatments. This helped the patient relax and promoted healing.

  

6-What a sad story.  You are very correct in that people, including people in health care, may be quick to assume or judge as to why a patient may be refusing treatment.  This is just another case that confirms how messed up our health care system is.  The are so many people out there in the same situation as we have talked about this week with vulnerable and at risk communities.  We see a lot of sad stories in our profession.  Thankfully we have good stories too to balance us out.  

 
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Please Answer According The Comments Thanks Rememberber 100 Words For Each

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Comment 1

I agree with you that over use of NSAIDS is probable for his development of peptic ulcer disease (PUD).  All though Mr. C is essentially taking three medications, the dosing schedule really requires a high level of compliance. It is very important to stress the importance of maintaining a steady regime.  Some of the complications of PUD include “bleeding, perforation, and gastric outlet obstruction with hemorrhage being the most common complication” (Fashner & Gitu, 2015). 

Comment 2

Before Mr. C would undergo surgery, he would need an extensive psychosocial evaluation to determine if he is an appropriate candidate. During the examination, several aspects of Mr. C’s life would be assessed, such as, eating pattern, history of weight loss attempts, family history, substance use history, cognition, social support, coping skills, adherence and motivation/expectation about the surgery (Marek et al., 2016, p. 1143). As someone in the medical field, I would want to know how serious Mr. C was about wanting to lose weight and have him on a trial diet regimen for a few months to see if he can be compliant. I wouldn’t suggest that he undergoes bariatric surgery if he was unwilling to change his lifestyle prior to the procedure.  

Comment 3

 like that you brought up a mental health issue with Mr. C as one of his actual/potential problems. There have been many studies regarding obesity and mental illness and it made me look deeper into research. I read in a recent study that lack of exercise can decrease serotonin synthesis and worsen depression and anxiety (Lu et al., 2018, p. 4). Also, because of the stigmatism of obesity, some people become socially isolated and are less likely to eat healthy (Lu et al., 2018, p. 4). On the other hand, depression and/or anxiety could’ve begun 2 to 3 years ago for Mr. C and therefore has resulted in the increased weight gain.  

 
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Please Answer According The Comments Thanks Rememberber 100 Words For Each 18977199

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Comment 1You correctly stated that Mr. C is a candidate for bariatric surgery based on his poor health history including high cholesterol, an elevated BMI level of 45, OSA, high fasting blood glucose (FBG) of 146 mg/dl, has a high respiratory rate of 26 which can point to pulmonary disease.  Good candidates for weight-loss surgery are obese adults who also have an obesity-related health condition, who are aware of the risks and benefits of surgery, and are willing to make lifestyle changes after surgery, especially in regard to eating habits. Following bariatric surgery many patients show improvement in obesity-related conditions, such as diabetes, high blood pressure, obstructive sleep apnea and arthritis.

Comment 2

Nice post! You bring up very good points when speaking about the functional health patterns and problems the patient has. I particularly liked how you brought up assessing for sleep apnea. People don’t really understand the implications of having sleep apnea and energy levels throughout the day. People can also suffer from headaches/migraines if they have obstructive sleep apnea. It’s so important for our body to recharge while sleeping and part of that recharging has to do with proper oxygenation. Many people who are obese are unaware that they may have this problem and need to have a sleep study. Many of my patients don’t know they have it until I or another nurse notices they are snoring and desaturated while sleeping. This can be a scary finding. 

Comment 3

Hi Diona, one specific thing that caught my attention from reading Mr. C’s case study was that this patient takes multiple medications at different times throughout the day because of multiple diseases that are present. This requires the patient to place a lot of attention and plan accordingly. The patient also has to make sure to manage their medications in order to decrease their chances of overdosing, missing a medication, or drug contraindications. Some strategies that can be used are: fill the prescriptions at one pharmacy, use a pill dispenser, and make a list.

 
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Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 18930033

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4-The mean, median, and mode are all measures of central tendency. “A measure of central tendency is a single value that attempts to describe a set of data by identifying the central position within that set of data” (Laerd Statistics, 2018). The mean is going to be the most popular when used in central tendency. Mean is known as the average of all numbers/data being calculated. Median and mode will then follow. Median is explained as the middle score in the set of data. The data first needs to be but into chronological order and then you can figure out the median from there. Lastly, the mode will be the score seen the most throughout all of the data, but this is normally not as reliable when measuring central tendency. Usually, all of these answers should coorelate with each other, if they don’t the data could be skewed. This is one way for people to evaluate whether data can be credible or not. 

Laerd Statistics (2018). Measures of central tendency. Laerd Statistics. Retrievied from https://statistics.laerd.com/statistical-guides/measures-central-tendency-mean-mode- 

  

5-Mean, median and mode are the three measures of central tendency used to describe study variables. Central tendency is a measure of average.

The mean is the average of the values of the data collected. By adding the values of the data and dividing by the total number of values, one will get the average of the data. Mean is sensitive to unusually low or high scores known as an outlier. If the outlier is included in the math, it will skew the results and may not be the appropriate average to use in these situations (Bluman, 2015).

The median is used to find the center or middle value of a data set. It is necessary to use to find out whether the data values fall into the upper half of lower half of the distribution. The median is used for open-ended distribution and is not as sensitive as the mean by extremely low or high values (Bluman, 2015.

The mode is the only measure of central tendency that can be used in finding the most typical case when the data are nominal or categorical such as religious preference, gender or political affiliation. It is the easiest average to compute and used when the most typical case is desired. The mode is the highest variable or the one that appears the most in a set of data. A data set can one mode or no mode at all (Bluman, 2015).

Reference:
 

Bluman, A.G., (2015). Elementary Statistics: A Step by Step Approach, A Brief Version, 7th edition. McGraw-Hill Education, New York, NY.

6-In nursing research when processing raw data to get conclusions, researchers use statistical analysis through mean, mode and median to categorize the data. The mode though a part of these three measures of computing data, it lacks mathematical significance in analysis. The median is the middle number in the data set when arranged in ascending or descending order. When the data set has four variables, you add the middle two and then divide the number. Mean is the average number when all the numbers are added within the data set, and then divided by the number of variables.

 
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Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 18928085

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1-Inaccuracies or misrepresentation of data can occur both purposely. Sometimes poor sampling methods or other sources of injustice influence the accuracy of the data without the researcher realizing there is a problem, these could be  caused by a lot of factors such as; insufficient or deceiving data, misleading visualization of the result and insufficient  reasoning on the basis of results (Smith, 2015). A simple example, which occurs very frequently, is the presentation and clarification of data where some data items are absent. A much-reported example of this concerned the analysis of the failure of O –rings on the US space shuttle in 1986. NASA staff and their contractors examined the pattern of failures of O-rings during starts against temperature. They concluded that the data showed no apparent relationship between the number of failures and temperature.

  

2-Most of our politician’s abuse numbers exploit them and misinterpret them for their gain. All politicians love to quote numbers and say, look what I have done but are those numbers accurate. When they share what they have done for example creating so many new job but how many jobs were lost. They never reveal the negative side or never include all the variables when presenting their numbers .I hope America has realized that politicians will say and do anything to win.

  

        3-Statistics is a collection of methods for planning experiments, obtaining data, and then organizing, summarizing, analyzing, interpreting, presenting, and drawing conclusions based on the data (Jones, 2016). Using statistics and graphs can be misrepresented in many ways that can be either accidental or intentional.

    Data can be ill judged if the sampling is not done appropriately.  A random selection without background knowledge or without specified criteria leads to misunderstanding of the data. Another reason of misunderstanding is difference in causation and connection. Feature may co-exist though, may not be reliant on one another.  One of the influenced areas in medical world is pharmaceuticals. Pharmaceutical companies use mistaken data in competitive markets. Generic medicines for same purposes are branded out and to advertise a misguiding catalog is used.  The most essential thing to consider while comprehending or predicting a result of a statistical analysis is a well-balanced and well-selected population. Sample partakers should be chosen considering different aspects of the problem so that the result will not be unfair. This demands the proper understanding of the statistical tools and how to select the sample population. Furthermore, the sample size should be sufficiently large enough to get more fixed conclusions.

 
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Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 18905233

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4-I really enjoyed reading your post. I agree that interaction is when one variable relies on the effects of another variable. I really like the example you gave about over weight men having higher cholesterol than overweight woman. This The variable being that if it is a man or woman that is over weight will affect how high the cholesterol is. 

  

5-If I was comparing chantix, nicotine patch, and placebo these three variables would be appropriate for ANOVA versus a t-test that compares less variables.

   

6-An interaction is when one variable is dependent on another variable. This means that if one variable changes it can affect the outcome of another variable. There are many factors that go into my job working as an Occupational therapy assistant at a hand and shoulder rehabilitation center. First the doctor that preforms surgery with efficiency. As therapists we need to do our jobs and follow protocol, to get the body part functioning properly again. The patient needs to do their job and complete their home exercise program as instructed by the therapist. All these variables will assist in allowing the patient to have the best possible outcome.

 
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Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 18905227

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1-I really enjoyed reading your post. I really like the way you were able to describe analysis of variance. It is a way to determine the difference in samples. It also helps determine if the null hypothesis is true or false. Analysis of variance also has two types, the first is one-way and the second is two-way. ”  

2-If any of the assumptions are violated the results could be misleading or produce errors in the analysis. The tests can still be conducted and the findings trusted even if the assumptions of homogeneity or normality are somewhat violated as long as the groups are large and of equal size.

  

3-I really enjoyed reading your post. I really like the way your were able to describe analysis of variance into basic terminology for someone who has never take a statistics class. The example you provided to show how analysis of variance was very help and descriptive. It is important to understand analysis of variance. 

 
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