Healthcare

Continuous Quality Improvement (CQI)”  Please respond to the following: Identify a contact person for the quality improvement program at a long-term care facility in your geographic area. Conduct a brief in-person, telephone, or email interview with this contact person, concentrating on the following areas: Structures Processes Outcomes Regulatory minimum standards Next, describe the current quality improvement program in place at this facility, focusing on the areas listed above, and specify the main roles involved in this program. Finally, determine whether or not this quality improvement program is aligned with Deming’s Process Improvement Cycle. Provide a rationale for your determination.

Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare & Medicaid Services to help facilitate this cooperation.   Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).   Write a 700- to 1,050-word executive summary that discusses the purpose of joining an ACO and the funding available through one. Ensure your summary does the following: Describe the organization you selected and the general services that would be offered to Medicare patients. Describe the types of ACOs recognized by the Centers for Medicare & Medicaid Services. Evaluate industry dynamics that would influence your organization’s decision to participate in an ACO. Identify the steps needed to participate in an ACO. Justify participation in an ACO for your organization.   Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

List and describe the differences between mechanical ventilation in the home and mechanical ventilation in an acute care setting Background Mechanical ventilation provided in the home is drastically different from that delivered in an acute care setting. In an acute care setting such as the hospital, the patient is surrounded by an array of medical equipment and supplies. Specialized health care providers are available at all times to provide diagnostic and therapeutic procedures. In addition, the patient in an acute care setting gets little rest because of frequent vital sign assessments and routine lab tests. An alternative to the acute care setting is to provide mechanical ventilation in a non-acute environment such as the patient’s home. Extension of life is the primary goal of medical and health care procedures. Quality of life is an important issue, for this reason, the patient must be involved in the decision-making process before changing the ventilator care plan from an acute care setting to the patient’s home. When patients require long-term mechanical ventilation beyond the acute care setting, there are many factors that must be considered such as: Indications of need Patient unable to be weaned for invasive support Progression of the disease Contraindications Unstable condition without resources in the home setting Unsafe physical environment Patient non-compliant Non-financial resources  Precautions and possible complications Medical problems that return patient to acute status Equipment malfunctions of failure of the ventilator operation   Assessment of outcome Determine is indications are present and contraindications are absent Determine if therapy will sustain patient’s life and reduce mortality Monitoring Patient’s physical condition Ventilator settings Equipment function   The plan of care Most patients who require ventilator support outside the acute care hospital fall into one of the three broad categories. The patient is unable to maintain adequate ventilation (elevated PaCo2) The patient requires ventilation for survival The patient is terminally ill with a short life expectancy Home Mechanical Ventilation (HMV) HMV requires a detailed discharge plan because it involves many different agencies, departments and caretakers. Before a decision is made to provide HMV for a patient, four needs-assessment questions should be evaluated. The four questions are: Does the patient have a disease state, high cervical spine injury, severe respiratory muscle paralysis, which may result in persistent respiratory failure and an inability to be completely weaned from invasive ventilator support? Does the patient exhibit clinical characteristics (impending respiratory failure, cerebral hypoxia) that require mechanical ventilation? Is the patient clinically stable enough to be managed outside an acute care setting? Are there other noninvasive alternatives besides artificial airway and mechanical ventilation for the patient? Diseases That May Benefit from HMV Chronic obstructive pulmonary disease (COPD) Restrictive lung disease Respiratory muscle dysfunction Central hypoventilation syndromes Invasive versus Noninvasive Ventilation Support Noninvasive ventilation (NIV) is the first choice if the following conditions are met: The patient must be mentally competent, cooperative, and are using limited sedation or narcotics The patient needs minimal amount of oxygen (less than 40%) The patient is able to maintain an oxygen saturation greater than 90% The patient has normal swallowing and airway protection The patient does not have a history of seizures or substance abuse The patient does not have facial trauma     Patients who benefit from usually fall into two categories: Conditions that could lead to imminent death Patients with asthma Acute exacerbation of COPD or pulmonary edema Quadriplegia or patients with certain neuromuscular disorders Conditions that do not lead to imminent death  Chronic Neuromuscular and chest wall diseases Invasive ventilation is especially used for patients who require long-term pressure ventilation by tracheostomy. This method is associated with potential problems including secretion retention, infection, aspiration, and ventilator-associated pneumonia. The preferred location for long-term mechanical ventilation is in the home, because costs are reduced, quality of life is enhanced, and integration into the community is maximized. The indications for both invasive and noninvasive mechanical ventilation support in the home are increasing as technology and infrastructure support improves; however, reimbursement constraints make it challenging to provide home ventilator patients with the optimal equipment and services required. A central registry would allow for the development and monitoring of national home mechanical ventilator patient outcomes.  Equipment The choice of a ventilator is determined by the patient’s clinical need and available support resources. Watch this video on ventilator management. You will gain a better understanding of how patients live daily by means of home mechanical ventilation. Adult home ventilation (total time 5:43 minutes) Home Mechanical Ventilation CH 07-Ashley's Story  (Links to an external site.) Child Home Ventilation (total time 5:21 minutes) Watch this video on home continuous positive airway pressure (CPAP). You will gain a better understanding of the pros and cons of its use in the home care setting. Home Mechanical Ventilation CH 02-HMV Considerations  (Links to an external site.)  CPAP Therapy (pros and cons of CPAP; total time 5:04 minutes) The Pros and Cons of Using CPAP  (Links to an external site.) Negative Pressure Ventilation Iron Lung (total time 3:13 minutes) Watch this video on the Iron lung and its function. You will gain a better understanding of how mechanical ventilation was performed in the 1950’s.   The Iron Lung  (Links to an external site.) Prompt In your assignment this week, you will describe types of respiratory care delivered in alternative sites. Your responsibility as a home RT is to educate the patient and family about the care they will receive. For each of the therapies provide the following information. Fully define the therapy and include the a. Indication for use b. Hazards and c. procedure for set-up. 1. Bland Aerosol Therapy 2. Aerosol Drug Therapy 3. Continuous Positive Airway Pressure Therapy (CPAP) 4. Apnea Monitoring     Submit your answers in at least 500 words on a Word document. You must cite at least three references in IWG format to defend and support your position.

Identify changes in ventilator graphics based on the patient’s lung condition Identify changes in ventilator graphics caused by inappropriate ventilator settings or equipment or device malfunctions  Background Ventilator graphics provides the clinician with a valuable monitoring and diagnostic tool to help them achieve the best possible patient outcomes.  Though mechanical ventilators measure various lung pressures, volumes and mechanics these values within themselves are not enough to give us a complete understanding of the various changes that can occur within a patient’s lungs. The values measured and provided by ventilators are invaluable; however, these values are enhanced when we also consider ventilator graphics. Let’s look at an example of how graphics work. We take a patient’s blood pressure which gives us a digital numerical display of the pressures within the blood vessels and the rate of their heartbeat. Assessing a patient’s blood pressure and heart rate helps us to evaluate the rate and strength of their heartbeat. However, what if we were to perform an EKG or place a patient on a heart monitor? Not only will we assess their heart rate and the strength of their heartbeat but it will also provide us with valuable insight into the heart’s rhythm. The heart is electrically conducted so being able to view the heart’s function during each heartbeat provides us with more information. It also gives us an opportunity to identify many more abnormalities that we would otherwise overlook. Instead of only looking at numerical values to help us understand patient-ventilator interaction, ventilators incorporate graphical displays (waveforms) which give us greater insight into the changes that occur in a patient’s lung mechanics over a period of time. Ventilator waveforms are a useful tool in detecting abnormalities such as Abnormal ventilatory parameters/lung mechanics Alveolar overdistention Auto-PEEP (air trapping) Patient-ventilator Interaction Patient-ventilator dyssynchrony Flow starvation Auto-triggering Ventilatory circuit related problems Auto-cycling Secretion buildup in the ventilator circuit Interpreting ventilator waveforms takes practice so don’t become discouraged if you don’t become an expert by the end of this course (I don’t expect you to). As we previously discussed there are two types of ventilator waveforms: scalars and loops. Scalars are waveform representations of pressure, flow or volume on the y- axis vs. time on the x- axis. Loops are representations of pressure vs. volume or flow vs. volume. Let’s take a closer look at recognizing lung overdistention. There are many waveforms we can look at to recognize lung overdistention but let’s take a look specifically at a pressure-volume loop. Since lung overdistention can be caused by the delivery of too much pressure or volume during inspiration then the pressure-volume loop is ideal. A normal pressure-volume loop is shown below.   Now notice below what can happen when we deliver high tidal volumes during volume ventilation or too much pressure during pressure- controlled ventilation. Correcting lung overdistention is done by first recognizing that it is occurring and secondly by decreasing either tidal volume (if in volume control ventilation) or peak inspiratory pressure (if in pressure control ventilation). Prompt For this assignment, you will provide detailed responses to the following questions: Pressure-volume loops assess compliance, which is measured by the change in volume for a given change in pressure. Another benefit of pressure-volume loops is the assessment of PEEP during mechanical ventilation. Application of PEEP may increase compliance. How does the addition of PEEP increase compliance and affect the pressure-volume loop? How are pressure-volume loops useful in determining optimal PEEP levels? Use a flow volume image in your responses that illustrate your response. Be sure to cite your source. Flow volume loops are used to obtain information about airway resistance. List and describe at least two conditions that are easily recognized with flow volume loops. Use an image for each condition in your response. Be sure to cite your source. Submit your answers in at least 500 words on a Word document. You must cite at least three references in IWG format to defend and support your position.

Module 1-B Paper: Phenomenon of Interest Module 1-B Paper: Phenomenon of Interest Criteria Ratings Pts This criterion is linked to a Learning OutcomeIntroduction and Thesis Statement 1. Introduce the problem/Phenomenon of Interest (POI) you plan to explore in one (1) paragraph. 2. Conclude the introductory paragraph with a direct thesis statement that informs the reader of the purpose, or the primary objective of the paper. 1.0 to >0.8 pts Met The information fully addresses the required content and demonstrates an understanding of the POI. Thesis statement was well developed. 0.8 to >0.0 pts Not Met Minimal or partial information that does not full address the required element; either an introduction or thesis statement may not be included 0.0 pts Missing Student did not address. 1.0 pts This criterion is linked to a Learning OutcomePhenomenon of Interest Identity Phenomenon of Interest (POI) 1. Describe your approved POI, including the setting and population. 2. Describe the significance of your POI to your advanced specialty focus (Nurse Practitioner, Executive Nursing Administration, Nursing Informatics, etc), and population 3.. Discuss the impact of the POI on the overall healthcare system and support your discussion with relevant statistical data.  4. Include at least three (3) current peer-reviewed references in addition to any textbooks. 6.0 to >4.0 pts Met or Exceeds The information fully addresses the required elements and demonstrates an understanding of the significance of chosen POI to the area of practice. Content is supported with peer-reviewed literature. 4.0 to >2.0 pts Met Minimum Criteria The information was basic and addressed the required content in some manner. Content may not be well supported with peer-reviewed literature. 2.0 to >0.0 pts Did not Meet Criteria The information did not address each of the required elements. Content may not be supported with current peer-reviewed literature 0.0 pts Missing Student did not address. 6.0 pts This criterion is linked to a Learning OutcomePhilosophic Viewpoints 1. Weigh the differences between the Analytical and Continential philosophic viewpoints and identify your preferred philosophic view. 2. Discuss how your preferred philosophic view influences the type of information (data) you evaluate regarding your chosen POI and the impact of your view on the way you provide care. 5. Describe the value of information (data) represented by your alternative or opposing philosophic viewpoint in evaluating your chosen POI 4. Describe how you would incorporate both the Analytical and Continental philosophic views in your advanced nursing practice. 5. Include at least four (4) peer-reviewed references in addition to any textbooks. Classic references based on theory may be older than 5 years. 6.0 to >4.0 pts Met or Exceeds Criteria The information fully addresses the required elements and demonstrates an understanding of the POI through the lens of the primary philosophic view. Content is well supported with peer-reviewed references, of which classic literature based on theory may be older than 5 years. 4.0 to >2.0 pts Met Minimum Criteria The information was basic and addressed the required content in some manner. Content may not be well supported with peer-reviewed references. 2.0 to >0.0 pts Did not Meet Criteria The information did not address the required content. Content may not be supported with peer-reviewed literature. 0.0 pts Missing Student did not address. 6.0 pts This criterion is linked to a Learning OutcomeWays of Knowing 1. Summarize the four patterns of knowing described by Carper (1978). 2. Discuss how each of the four patterns of knowing will influence your future advanced practice role. 3. Describe how you will use the patterns of knowing to seek information needed to care for your patient or a population. 4. Support your discussion with at least two (2) peer-reviewed references, citing primary sources. Classic literature may be older than 5 years. 4.0 to >2.5 pts Met or Exceeds Criteria The information fully addresses the required elements and demonstrates an understanding of the four ways of knowing. Content is well supported with peer-reviewed reference, of which classic literature may be older than 5 years. 2.5 to >1.5 pts Met Minimum Criteria The information was basic and addressed the majority of the required content in some manner. Content may not be well supported by peer-reviewed literature. 1.5 to >0.0 pts Did not Meet Criteria The information did not address the required content. Content may not be supported with peer-reviewed literature. 0.0 pts Missing Student did not address. 4.0 pts This criterion is linked to a Learning OutcomeConclusion 1. Summarize the major points of the paper in one (1) paragraph. 2. No new information or references should be included in this section. 1.0 to >0.8 pts Met The information fully summarizes the major points in the paper, without including any new information or references 0.8 to >0.0 pts Not Met The information did not adequately summarize the major points in the paper. New information or references may have been introduced. 0.0 pts Missing Student did not address. 1.0 pts This criterion is linked to a Learning OutcomeGraduate Level Scholarship Demonstrate Graduate Level Scholarship 1. Formal, scholarly writing style with no first-person language. 2. Writing should be clear and concise, and free of grammatical and spelling errors 3. Organize work by headings 4. Writing should be free of APA 7th errors, including citations and references. 5. Full paper (except reference page, appendices, and attachments) submitted to Turnitin, with minimal similarity. 6. College of Nursing approved format for the title page. 7. A minimum of nine (9) peer-reviewed references (excluding textbooks). 8. Paper not to exceed six (6) pages (excluding title page, reference page, and any appendices). 9. Follow all assignment instructions. 10. Additional deductions may apply for late submissions, plagiarism, or lack of scholarship and professionalism. 2.0 to >1.6 pts Met or Exceeds Criteria Demonstrates graduate-level scholarship with no more than one (1) to two (2) types of error. Faculty discretion will apply. 1.6 to >1.4 pts Met Minimum Criteria Demonstrates minimal graduate-level scholarship with three (3) types of errors (the error type may have been repeated multiple times). Faculty discretion will apply. 1.4 to >0.0 pts Did not Meet Criteria Does not demonstrate graduate-level scholarship with four (4) types of error (the error type may have been repeated multiple times). Faculty discretion will apply. 0.0 pts Missing Graduate-level scholarship missing, with five (5) or more types of errors (the error type may have been repeated multiple times). Faculty discretion will apply. 2.0 pts

imagine you are a manager at a lifespan management facility and you are giving a training on compliance.   Create a 750-1050 word document in which you: Analyze employment, licensure, and operational requirements for lifespan management services and facilities. Describe the use of compliance reporting in lifespan management services and facilities. Analyze the relationship between technology and compliance in lifespan management services and facilities. Provide an article, or current event on a compliance issue in lifespan management. Highlight the compliance issues and what should have been done instead. Provide an overview of consequences related to non-compliance.   Include 2 references to support your information

This discussion will allow you to create content for your Final Project regarding the use of an appropriate marketing strategy. Marketing strategies provide direction for marketing efforts that support the goals of the strategic plan. As described in Chapter 7, there are three basic marketing strategies: Undifferentiated Strategy Focus Market Strategy Segmented Strategy For this discussion, you will select an appropriate marketing strategy for each of the following long-term care organizations: Happy Valley Health Care is an 80-bed, rural long-term care organization with little to no competition. Over the years, the organization has been able to meet the needs of its marginalized customer base and provide long-term care, skilled care, and physical therapy to its patients. Sunny Valley Health Care is a 150-bed, urban long-term care organization that specializes in renal care, cardiac patients, and skilled care for orthopedic patients undergoing knee and hip replacement surgery. Green Acres Health Care is a 300-bed, inner city long-term care organization that specializes in caring for elderly patients with dementia often associated with Alzheimer’s disease and traumatic brain injuries.   For your initial post, Select one specific marketing strategy for each of the long-term care organizations noted above. In your post, explain the following: Why you chose the strategy for that long-term care organization Which of the three marketing strategies would best fit the goals of your chosen HCO How the strategy would be applied to your marketing plan

Read the M.H. Case Study: M.H. is an 80-year-old Caucasian female who is married and lives with her spouse. She presents to your office today with her spouse, feeling “coocoo, I just don’t feel right.” Currently she is taking rosuvastatin prescribed by her cardiologist for hyperlipidemia and a daily 325 mg aspirin. She drinks 3-6 hard liquor drinks a day, 3-4 times a week in the evening, and has a 65-year smoking habit, currently smoking two packs per day (ppd). She has no known allergies. Past surgical history includes hysterectomy for a benign fibroid. Family history of breast cancer in three sisters, Type 2 diabetes and CVA in one sister, cancer of unknown origin in one brother. All siblings and parents are deceased. Her husband reports that she is hard of hearing. He feels that it is due to cerumen build-up in her ears, which she refuses to have him removed. Her husband is also worried about her memory—states that she “just does not remember things like she used to. She keeps asking me the same questions over and over.” She does not eat very well; this is the way that she has been for years, but it does seem to be getting worse. You notice on her chart that she was given lisinopril-hydrochlorothiazide 40/25 mg daily at her last office visit but she is not currently taking it. She states that she did take the medicine but she ran out. She reports that she does not have high blood pressure. She has fallen a few times in the past year but her husband states that he has fallen more, so he is not concerned. Last mammogram was two months ago and was normal. She gets her influenza vaccine yearly. Last pneumonia vaccine was two years ago. She had a colonoscopy several years ago and it was normal. Vitals signs: BP 172/96 right arm, 179/92 left arm; pulse regular 92; respirations 18; temp 97.4 F Weight 72 lbs. Height 4’11” No chest pain, shortness of breath, edema, headache, change in vision, abdominal pain, vomiting, black tarry stools, blood in the stools, dysuria, urgency, frequency, nocturia, enuresis, sore throat, or recent fever. Positive cough, rhinorrhea, nausea, and slight dizziness. Answer the following questions: List three concerns about this patient and why you are concerned. Do you want more information? If so, what? Will you order tests? If so, what testing? List at least four differential diagnoses. What counseling and recommendations would you give to M.H.?

Answer each question with minimum 200 words and 1 reference: Question 1: Measuring Community Benefit.  Is Community Benefit important?  What is the best way (in your opinion) to measure community benefit? **1st reference goes with this question** Question 2: Select two examples of intangible value. Propose one or more approaches that an organization might use to measure each of those values. **2nd reference goes with this question**

“Start-Up of Blissful Gardens”  Please respond to the following: Review the Case Study: Start-Up of Blissful Gardens, located on page 510 of your text. Next, suggest two (2) marketing goals for the facility that Ms. Remedios could implement. Take a position on which of the three (3) types of market targeting strategies (single-offer, mass-market coverage, single-segment concentration, or selective specialization) would work best for this start-up. Provide a rationale for your position.