Nursing

Assignment: Practicum Journal Entry
Assignment: Practicum Journal Entry
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Practicum – Week 5 Journal Entry
Practicum Experience Time Log and Journal Template
Student Name:
E-mail Address:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
(Continued next page)
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
Time Log
Week
Dates
Times
Total Hours for This Time Frame
Activities/Comments
Learning Objective(s) Addressed
1
“not on site”
2
6/5/17
8am-5pm
8
Admissions, evaluations, follow-ups, med management, psychotherapy
Mini-mental state examination, CAGE and Beck depression inventory was used
6/6/17
8am-5pm
8
Admissions, evaluations, follow-ups, med management, psychotherapy
Intake and initial assessments were performed. Mini-mental state examination was administered.
Total Hours Completed: 16
Journal Entries
The Client
24-year-old white male self-admitted as an inpatient due to fear of hurting others. Patient is from out of town, currently attending military drills. Patient found out that his significant other he was planning on proposing to has be actively having relations with his step-brother. Patient has a history of fits of rage at a young age that caused hospitalizations of others so he felt it was best he received help before doing harm to others. Patient has no other psychiatric history, no suicidal ideations, not hearing voices or seeing things that are not present, he does not believe others are out to do harm to him. Patient states that no one in his immediate family has history of psychiatric conditions. Patient does report physical and verbal abuse from step-father as a young child. During his teenage years patient was addicted to illicit drugs and alcohol.
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5), the patient presents with characteristics of PTSD. The patient exhibits “irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression, reckless or self-destructive behavior, exaggerated startle response, problems with concentration and sleep disturbance lasting since his early teen years” (American Psychiatric Association, 2013).
Patient states he has difficulty trusting others, assures his back is always to a wall, is easily agitated and tends to frequently relay his anger verbally, was once addicted to illicit drugs to cope with the stress in is life, has difficulty concentrating on simple tasks and must keep himself busy at all time, also states he sleeps very little.
Legal and Ethical Implications
Special concerns with this patient were voiced because of his current non-active role in the military. The patient came from training drills to seek help for his anger. The military has certain requirements for the patient to be able to safely return to drills. Ethically it is important to ensure the patient’s safety first and assess his intent to do harm to others. In the case of this patient, he was kept for observation for three days before being allowed discharge although the patient was addiment that he just needed a safe place for one night and that he did not feel the need to do harm to himself or others. The case can be made that individuals with military training, combat exposure, and ensuing PTSD may find it even more difficult to engage in an accurate appraisal of danger. Training for combat increases reliance on muscle memory or automatic actions in times of perceived threat, training that was provided initially by the military to help soldiers stay alive. But the physiological sensitivity that results from a chronically disordered pattern of arousal as is found in PTSD can set the stage for a quicksilver reactivity that leads to actions in a civilian setting that have criminal justice implications (Tramontin, 2010).
Practicum – Week 5 Journal Entry References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Tramontin, M. (2010). Exit Wounds: Current Issues Pertaining to Combat-Related PTSD
of Relevance to the Legal System. Developments In Mental Health Law, 29(1), 23-47.
© 2012 Laureate Education Inc. 2
© 2014 Laureate Education, Inc. Page 5 of 5
Learning Objectives
Students will:
· Develop diagnoses for clients receiving psychotherapy*
· Evaluate the efficacy of therapeutic approaches for clients*
· Analyze legal and ethical implications of counseling clients with psychiatric
disorders*
The Assignment
Select a client whom you observed or counseled that suffers from a disorder related to trauma. Then, address the following in your Practicum Journal:
· Describe the client (without violating HIPAA regulations) and identify any
pertinent history or medical information, including prescribed medications.
· Using the DSM-5, explain and justify your diagnosis for this client.
· Explain whether any of the therapeutic approaches in this week’s Learning
Resources would be effective with this client. Include expected outcomes based
on these therapeutic approaches. Support your approach with evidence-based
literature.
· Explain any legal and/or ethical implications related to counseling this client.
Learning Resources
Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 13, “Stabilization for Trauma and Dissociation” (pp. 469–508)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Required Media
Ochberg, F. (2012). Psychotherapy for chronic PTSD [Video file]. Mill Valley, CA: Psychotherapy.net.
· NOTE: PLEASE SEE AND PAY ATTENTION TO THE ATTACHED Practicum Journal
Template AND JOURNAL SAMPLE (TIME LOG & JOURNAL ENTRIES) FOR WRITING
THIS ASSIGNMENT…..ALSO FOR THE TIME LOG AND JOURNAL ENTRIES, JUST
MAKE UP A REASONABLE INFORMATION AND CLIENT INFORMATION IN MENTAL
HEALTH NURSING.
Practicum Experience Time Log and Journal Template
Student Name:
E-mail Address:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
(Continued next page) Assignment: Practicum Journal Entry
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
Time Log
Week Dates Times Total Hours for This Time Frame Activities/Comments Learning Objective(s) Addressed
Total Hours Completed:
Journal Entries
· Include references immediately following the content.
· Use APA style for your journal entry and references.
© 2012 Laureate Education Inc. 2
© 2014 Laureate Education, Inc. Page 3 of 3

Assignment: Attachment Styles & Potential
Assignment: Attachment Styles & Potential Outcomes
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We have learned that attachment occurs due to safety needs, but what if these needs were not met? In this discussion, you will consider attachment styles and potential outcomes when conditions are not ideal for attachment, as well as the interaction between attachment styles and temperament.
Kandi is an 11-year-old girl who has lived in Centervale with a foster family, the Jacksons, for one month. She has been in foster care most of her life, having been removed from her biological parents’ care at the age of 10 months. Kandi’s parents were addicted to drugs and alcohol and Kandi spent most of her infancy in her crib or playpen, alone in her room. It is likely that Kandi was exposed to drugs and alcohol in utero. It is unknown whether, in addition to neglect, she was abused sexually or physically. These are possibilities given her parents’ addictions and presence of multiple adults in her house at any given time.
Since Kandi’s arrival, her foster parents have noted several behaviors that seem odd. Despite her sweet personality, Kandi loses her temper easily. She hugs people indiscriminately, while at the same time pushing others away. At times, Kandi avoids her foster mother or seems unconcerned with her not being in the room. At other times, she becomes very distraught and cries frantically when her foster mother goes to the laundry room. She has a difficult time interacting socially with the other children at Centervale Elementary and has only a few friends. At the same time, she clings to her teacher, constantly hugging her, and even trying to kiss her. Although she has been provided with toys, books, and games, Kandi collects odd things such as used staples or the rubber pieces left over from pencils.
Based on your analysis of the scenario, respond to the following:
How would you explain the various attachment styles proposed by John Bowlby?
Why is it important to understand attachment styles?
What disruptions in attachment might be inferred from Kandi’s behavior?
Given her early isolation and multiple caregivers, what are some important social development stages or aspects that Kandi may have missed? Discuss concepts such as imitation, social reciprocity, and exploration.
How might Kandi’s temperament affect her development?
What protective factors might help her?

Application Of Epidemiology
Application Of Epidemiology
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Please respond to thoroughly. You should use textual evidence to support your argument
t
Consider the focus on hospitality, reputation, and kinship ties in Beowulf. What might this suggest about Anglo Saxon culture? Use examples from the text to support your discussion.
The Norton Anthology of English Literature – Norton Topics Online: Linguistic and Literary Contexts of Beowulf “Caedmon’s Hymn” “The Dream of the Rood” Beowulf
Application of Epidemiology
Describe an application of epidemiology and give a current, real world example of it.
Initial responses should be no less than 200 words in length not including your reference(s) and supported by at least two references (aside from the textbook).
Management Information Systems
Discussion
Read Does IBM’s Watson Have a Future in Business? in Chapter 11. You can also research IBM’s Watson online. Explain Watson’s capabilities for knowledge management and decision making. Initial responses should be no less than 200 words in length not including your reference(s) and supported by at least two references (aside from the textbook).
Management Information Systems
Assignment
Columbiana is a small, independent island in the Caribbean that wants to develop its tourist industry and attract more visitors. The island has historical buildings, rain forests, mountains, beaches, first-class hotels, tropical agricultural products, etc. When writing your paper, it should be at least three pages and include the business model, domain name, and web hosting options.
Answer the following questions:
1.What Internet business model would be appropriate, and what functions should the website perform? (How will the website be used?)
2.What domain name would you want for this site? It should be unique and not owned. You can search domain names to see if your choice is available. Explain the value of using this domain.
3.What is the pricing for the site through a web hosting site?

Healthcare: Innovating For Emerging Markets
Healthcare: Innovating For Emerging Markets
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Due Week 5 and worth 300 points
Read the case study titled “GE Healthcare (A): Innovating for Emerging Markets” I have attached study see below
Write a three to four (3-4) page paper in which you:
Determine two (2) emerging trends in the external environment that prompted General Electric (GE) Healthcare to develop a new strategy for the production and marketing of a low cost Electroencephalography (EEG) machine in bottom of the pyramid markets (BOP).
Examine two (2) internal barriers GE Healthcare faced when developing its BOP market in India and determine the manner in which they hindered GE Healthcare’s growth in this market segment.
Analyze two (2) of the significant external barriers that GE Healthcare faced when trying to meet its marketing goals in the Indian market. Propose two (2) ways to address these barriers.
Analyze the specific steps GE took in developing its strategy to grow its BOP market. Determine the manner in which those actions apply to the principles of strategic thinking and strategic planning.
Determine the manner in which GE Healthcare’s strategy to improve its position in BOP markets contributed to the organization’s value chain in both emerging and developed markets.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
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 and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
Differentiate between strategic management, strategic thinking, strategic planning, and managing strategic momentum.
Analyze the significance of the external environment’s impact on health care organizations.
Examine the role of internal environmental analysis in identifying the basis for sustained competitive advantage.
Examine the organizational value chain, including the components of the service delivery and support activities.
Examine barriers to new product development that comply with initiatives in the health care industry.
Use technology and information resources to research issues in the strategic management of health care organizations.
Write clearly and concisely about strategic management of health care organizations using proper writing mechanics.

Assignment: Case Research misconduct.
Assignment: Case Research misconduct.
Assignment: Case Research misconduct.
Module V Discussion Conduct a literature search and provide an example of an ethical violation or research misconduct. Describe the event, supply the reference, and discuss what should have been done to prevent the problem from occurring. Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
Research misconduct means fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results.
(a) Fabrication is making up data or results and recording or reporting them.
(b) Falsification is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record.
(c) Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit.
(d) Research misconduct does not include honest error or differences of opinion.
Questionable Research Misconduct
Some aspects of conduct are too new or poorly defined to allow for a simple answer about what is appropriate. Other behaviors may stem simply from bad manners, honest error, or differences of opinion, which may be questionable without being research misconduct.
Impressions should be validated before making serious charges, and many apparent problems can be resolved by other means.
Dispute resolutionMany concerns are best addressed by means other than alleging research misconduct. Some institutions have formal mechanisms in place for conflict resolution, mediation, or arbitration; absent such mechanisms, finding a solution to a dispute may require some creativity.
Conflict resolution: Often, good conflict resolution skills may be helpful or even sufficient. Deal with the problem as early as possible. Begin by defining points of agreement and then work on areas of disagreement. Emphasize the problem rather than the person. Give and ask for clear communication about what is most important to each of the interested parties.
Mediation: A respected third party can sometimes help with mediating a dispute. The goal is to clarify issues in a way that permits the best possible agreement or compromise.
Arbitration: When other avenues of communication have failed, then parties to a dispute might be convinced to put their cases before a mutually agreeable arbitrator for review and a binding decision.
Public Allegations
The pace of the process for dealing with alleged misconduct can be frustrating. In such circumstances, it can be tempting to discuss the case publicly. However, placing a complex, unresolved issue into the public arena can be harmful to those directly involved and the scientific community as a whole.
Publicity may also compromise the integrity of an ongoing inquiry and the privacy of parties to the investigation. Moreover, an attempt to circumvent the institutional process may prejudice those charged with reviewing the allegation.

Measurable Learning Objectives
Measurable Learning Objectives
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In this Discussion, you gain experience in crafting learning objectives that are both meaningful to the learning activity and also measure the learning that is taking place. To begin, consider the following scenarios:
Scenario 1: In-service for nursing staff
Orange City is a mid-sized town comprised mostly of elderly and retired Caucasian adults. Since the addition of a new highway, shopping mall, and various other small businesses, Orange City has seen a recent explosion of families moving into the area. Many of these families come from diverse backgrounds adding a new layer of cultural diversity to the city. Because the nurses at Orange City hospital have traditionally worked with the same type of clientele, many have been taken off guard when individuals deny certain health care measures due to religious or cultural beliefs. One day the nursing manager approaches you, the nurse educator, and asks if you could create an in-service that highlights the ways culture and religion can impact patient responses to medicine, preventative care, and treatment options.
Scenario 2: Patient training session
As a patient educator at an endocrinologist’s office, you have the important responsibility to educate patients on health management. The lead physician at your office explains that she would like to see all Type 1 and Type 2 insulin-dependent diabetes patients use the insulin pump instead of insulin injections. You know that many patients tend to shy away from the pump system because of initial discomforts and worries. However, you agree that the insulin pump helps patients to receive a steady basal rate into their system. The advantages of using the pump as a replication of the pancreas definitely outweigh the act of giving injections after food consumption. Now you must figure out how to communicate and motivate patients towards this way of thinking.
Scenario 3: Educational leadership course
As an experienced registered nurse and full-time faculty at Bay Area University, you know how important it is for nursing students to develop effective leadership skills. You also know that becoming a leader in the nursing profession involves the ability to effectively manage colleagues who initiate conflict in the workplace. In reading students’ reflections, you see that many note a level of discomfort in working with conflict-prone colleagues. You realize that you need to engage students in a learning activity that will increase their acumen in managing conflict situations in the workplace.
To prepare:
· Reflect on this week’s Learning Resources, paying specific attention to the alignment between learning activities and learning objectives.
· Review this week’s media, Crafting Learning Objectives, to examine an effective approach to crafting meaningful, measurable learning objectives.
· Using your answers to the questions above, create learning objectives and a learning activity applicable to your scenario.
Posting Directions: When creating your post, use the title: “Learning activity for Scenario _____.”
Questions to be addressed in my paper:
1. Select one of the scenarios above for your posting. Then, consider the following questions:
What are the learning needs illustrated in the scenario?
What meaningful learning objectives could you craft to address these learning needs?
How could you use the learning objectives to create an educational, learner-centered activity?
What type of activity might you create to help your learners achieve the learning objectives?
How can you use the learning objectives to measure if learning has taken place?
2. A list of the meaningful, measureable learning objectives you constructed and a thorough description of your learning activity.
3. Explain how this activity aligns to the learning objectives and justify how each of those objectives can be used to measure student, staff, or patient learning.
4. Conclusion/Summary of The Art of Crafting Meaningful,
Measurable Learning Objectives
Reminders:
1. Put APA citations and references 2011 – 2016….
2. Put headings on each addressed question.
Required Readings
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
Chapter 6, “An Introduction to Curriculum Development”
Chapter 6 consists of many examples educators can use to better understand the process of writing outcomes and competencies. [Review]
Candela, L. (2011). Taxonomies and critical thinking in curriculum design. In S. B. Keating (Ed.),Curriculum development and evaluation in nursing (2nd ed., pp. 71–86). New York, NY: Springer.
The connection between educational taxonomies and critical thinking to curriculum design is explored in Chapter 4. Taxonomies are identified as a way to develop and evaluate learning objectives. Critical thinking is then necessary to determine the degree to which the student engages with the content.
McKimm, J., & Swanwick, T. (2009). Setting learning objectives

Potential Ethical Issues Assignment
Potential Ethical Issues Assignment
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Potential ethical issues in social science often influence design decisions. Most of these ethical issues involves the methodologies employed (Babbie, 2017). Relative to quantitative research, it is not unusual to select participants—human subjects—for a particular study. The Belmont Report asserts three key principles—Resect for persons, beneficence, and justice—that must be considered (Babbie, 2017). Regardless, there will always be some risks to someone, when conducting research. Nevertheless, some designs are more feasible in mitigating risks than others (Babbie, 2017). Thus, researchers should consider a design that will best safeguard against these risks. One approach, regarding design decisions is to structure the research in a manner that guarantees anonymity.
References:
Babbie, E. (2017). The basics of social research (7th. Ed). Boston, MA: Cengage.
Burkholder, G.J., Cox, K.A., & Crawford, L.M. (2016). The Scholar-Practitioner’s Guide to Research Design, 1st Edition.
[MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9781624580314/
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal
inference. Boston, MA: Houghton-Mifflin.
Potential ethical issues in social science often influence design decisions. Most of these ethical issues involves the methodologies employed (Babbie, 2017). Relative to quantitative research, it is not unusual to select participants—human subjects—for a particular study. The Belmont Report asserts three key principles—Resect for persons, beneficence, and justice—that must be considered (Babbie, 2017). Regardless, there will always be some risks to someone, when conducting research. Nevertheless, some designs are more feasible in mitigating risks than others (Babbie, 2017). Thus, researchers should consider a design that will best safeguard against these risks. One approach, regarding design decisions is to structure the research in a manner that guarantees anonymity.
References:
Babbie, E. (2017). The basics of social research (7th. Ed). Boston, MA: Cengage.
Burkholder, G.J., Cox, K.A., & Crawford, L.M. (2016). The Scholar-Practitioner’s Guide to Research Design, 1st Edition.
[MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9781624580314/
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal
inference. Boston, MA: Houghton-Mifflin.

Assignment: Noninfectious Disease Presentation
Assignment: Noninfectious Disease Presentation
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You are a staff epidemiologist for a research and consulting firm. Your research and consulting firm has been hired by a local hospital to assess effects of disease occurrences on health care planning. The study period will cover the past five years, during which the region served by the local hospital has seen an increase in medical conditions, similar to other parts of the United States.
Your role is to review relevant information related to the hospital’s readiness to anticipate health care needs related to noninfectious diseases and resources to address those needs. In this part of the project, identify and evaluate epidemiologic studies that have direct applicability to noninfectious diseases, which may result in an increased utilization of health care resources. Your evaluation will be presented to the hospital board.
Select a medical condition that exists as a direct consequence of lifestyle choices.
Prepare a 20- to 25-slide Microsoft® PowerPoint® presentation, including detailed speaker’s notes, summarizing the analysis results. Include the following elements:
Brief description of the condition.
Review of at least two experimental and observational studies of this condition.
Critique of the studies in terms of study design’s strengths and weaknesses, and the relevance and usefulness of the data.
Critique of the epidemiologic implications of the studies, including morbidity and mortality repercussions, and potential treatment implications.
Suggestions for two additional studies, including a description of the preferred design, which is value-added in understanding the medical condition from an epidemiologic standpoint and how that goal could be achieved through those studies.
Format citations and references according to APA guidelines.
Click the Assignment Files tab to submit your Population Health, Part I – Noninfectious Disease Presentation assignment.
DHA 731 WEEK 7 Population Health, Part II – Financial and Economic Implications Analysis Paper
In the second part of the project, provide information to supplement the initial analysis.
Use the information from Population Health, Part I as background information.
Write a 1,050- to 1,400-word analysis that addresses the following:
Select at least two different pharmacoeconomic, financial, or economic analyses of the disease you addressed.
Summarize the analysis results. What are the disease’s financial and economic implications?
Critique the analyses’ strengths and weaknesses. Are there additional financial and economic analyses you would recommend?
Discuss the potential effect of the results in terms of strategic planning, quality of care, treatment paradigm modification, and treatment of patients with the disease from a strategic planning standpoint.
Format your paper according to APA guidelines.
Click the Assignment Files tab to submit your assignment.

Assignment: Health And Safety
Assignment: Health And Safety
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Assignment 2: Occupational Health and Safety
Consider the information presented in this unit regarding occupational health and safety. Prepare an article for a newspaper (approximately 3 pages) that discusses the top 10 causes of accidents in the work place and the steps that can be taken to reduce the number of those accidents. Support your claims with examples and research.
Submit the training plan to the M4: Assignment 2 Dropbox by Wednesday, June 26, 2013.
Assignment 2 Grading Criteria
Maximum Points
Prepared newspaper article (approximately 3 pages) which discusses the top 10 causes of accidents in the work place.
50
Included steps that can be taken to reduce the number of work place accidents.
30
Claims were well supported with examples and research.
10
Used correct grammar, spelling, and word choice and cited all sources as per the APA style.
10
Total:
100
M1 – Promoting Health and safety in the workplace This assignment is about how legislation, roles and responsibilities affect people in the workplace, it is the people who are working in the environment to ensure that risks are kept to a minimum; it’s everyone’s responsibility to promote health and safety in the workplace. There are various pieces of legislation that outline what the responsibilities of professionals is, this helps professionals, volunteers and charity workers know how they could be working and what they can to do to promote and support theses pieces of legislation. Employee responsibilities Employees play an important part in health and safety, they need to look at legislation and fulfil the role they play in promoting procedures it the employees responsibility to make sure they are working to the right legislation, this is done though going on health and safety courses, this needs to be done a few weeks into employment, this is for employees to under stand the Health and safety at work act, and it is the employees responsibility to ensure they under go this course.
Middle
Senior staffs are also responsible for putting new employees on training days when they are first employed this is to ensure that adequate training is given where needed so that new members of staff know what to if when certain situations occur and what paper work needs to be written. Senior staffs are also responsible for making sure new employees have CRB checks and that these are up to date before working with venerable people, this is so that anyone who is risk to people and has a criminal conviction is kept from working with people that may not be able to protect themselves. Safeguarding Safeguarding is used by all professionals working with children, young people and vulnerable people, this is important in the fact that it’s there to minimise any risks that may affect the welfare of a person, the legislation outlines that all agencies need to work together for the protection of people and that there should be efficient training and courses attended to protect the welfare of people and look at signs of abuse and anything that maybe risking the welfare to a person.

Health Care Advertising Assignment
Health Care Advertising Assignment
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Health Care Advertising Assignment: Open your browser and search for recent health care advertisements from similar health care services, facilities, or other health sector-related occupations (e.g., labor supply, productivity improvement, technology, or personnel benefit design).
Select three advertisements and deconstruct each one to evaluate the marketing strategies employed.
Write a 525- to 700-word paper evaluating the advertisements you selected and how they are effective or ineffective in their design.
Consider the following when writing your Health Care Advertising Assignment paper:
Trade-offs
Personal cost
Incentives
Open trade
Marketing strategy(s) employed
Targeted demographics
Value exchange
“Five Cs” framework
Cite at least 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).
Format your assignment according to APA guidelines.
Click the Assignment Files tab to submit your Health Care Advertising Assignment.
MHA 506 WEEK 6 Marketing Plan: Final Draft
Write a 1-page executive summary to add to the beginning of you Marketing Plan.
Finalize your Marketing Plan with the components in the following order:
Executive Summary
Situation Overview
Goal/Objectives
Marketing Strategy
Tactics
Implementation
Control
Exhibits
Reference page
Create a 9- to 12-slide presentation using either Microsoft® PowerPoint® or websites such as Google Slides™, Adobe® Slate, or Prezi. Be sure to present each element of your Marketing Plan.
Format your assignment according to APA guidelines.
Click the Assignment Files tab to submit your assignment.
MHA 506 WEEK 5 Control and Exhibits
Write a minimum of 2 pages for the Control and Exhibits portions for your Marketing Plan to address the situation in the case study.
Cite at least 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).
Format your assignment according to APA guidelines.
Click the Assignment Files tab to submit your assignment.
Mha/506: ethical marketing: the new health care economics team
Case Study: East Chestnut Regional Health System
MHA/506 Version 2 10
CASE STUDY:
History
Within the last 10 years, East Chestnut Regional Health System (ECRH) was formed from the merger of three organizations: the East River Medical Center, the Northern Mountain Hospital Consortium, and the Archway Hospital.
East River Medical Center (ERMC)
ERMC is the anchor hospital for the system. The medical center resides along the east side of the Chestnut River. Historically, ERMC was recognized as the location of choice for medical care. However, this reputation has deteriorated over the last 3 to 5 years. As the city of Chestnut has grown, ERMC has found itself on the edge of an urban blight. Safety has been a concern for patients, visitors, and physicians who use and serve the medical center. The technology offered at the medical center has been maintained at an excellent level of proficiency. At the same time, the medical staff is aging with the average age of the physicians being 57. There are younger primary care physicians who serve the specialists, but the specialists are aging as well. ERMC boasts a Level 1 Trauma Center with an air service. The total number of licensed beds for ERMC is 550. On any given day, the occupancy rate is 300 heads on the beds.
Northern Mountain Hospital Consortium (NMHC)
NMHC was originally formed in response to the migration of patients to Chestnut. Due to the rather aggressive strategies carried out by the hospitals in Chestnut, these rural hospitals decided to create a consortium of rural hospitals so that they could gain economies of scale in a number of areas, which include group purchasing, benefit administration, and physician and staff recruitment. Additionally, they worked together to stem any further deterioration of their market share. Patients were selecting to go to the larger community for services and leaving the smaller communities that collared the Chestnut metropolitan area. NMHC represented individual hospitals in four counties that circled Chestnut County: Walnut, Butternut, Oak, and Maple. Walnut and Butternut Counties had good employment with Oak and Maple Counties being mostly rural. In each county, the inpatient facilities averaged about 20 years of age. The upkeep of these facilities has been sketchy. No facility needs any major upgrades, but modernization is needed. The state does not have a Certificate of Need (CON) process. The medical staff makeup varies each location. The hospitals in Oak and Maple Counties are critical access hospitals. Further details will be provided regarding these organizations later in the case study.
Archway Hospital (AH)
AH is located directly in the community of Chestnut. It fully resides in the urban area of the community. The hospital has 200 registered beds, but on any given day there are only 50 to 75 patients in this facility. This hospital was a Doctor of Osteopathy (DO) hospital; therefore, most of the physicians that worked out of this facility were DOs. The payer mix for this hospital was heavily burdened with Medicare and Medicaid. This payer mix composed nearly 85% of the reimbursement. The facility is aging and needs considerable repairs. It is questionable if it will be worth the investment in this facility.
Leadership and Organizational Culture
The original merger that created the East Chestnut Regional Health System (ECRH) occurred 10 years ago. This merger was between ERMC and AH. AH had a rather dynamic leader who was about 57 years old at the time of the merger. The AH CEO became the new President and Chief Executive Officer of ECRH after the merger. Since this CEO had only worked in a smaller organization, he had not experienced the cultural changes and demands that occur after the merging of a large organization. Additionally, he began to change the culture of the organization such that decisions were made on a decentralized basis. He trusted the management team at AH to do the right things and make the right decisions with low supervision. However, the Chief Operating Officer (COO) who was put in charge was originally from AH but left 2 years after the merger with a new COO being put in place. This COO developed a rather poor reputation and was known to want to build his own empire at AH and to be dishonest at times. This reputation created a culture within the traditional AH that lacked a cohesive team effort to create a system. This positioning of the COO was left unattended by the President and CEO of ECRH since he was actively pursuing the acquisition of NMHC. The hospitals of NMHC were doing okay, but those in the consortium realized that their ability to stand alone was becoming difficult in today’s market. When the leadership of the consortium assessed the market as to a partnership, they decided that ECRH would be the best choice. The other option was to develop a for-profit hospital that also resided in Chestnut. The leadership was attracted to what they saw happen with AH. They liked that the central leadership of the system allowed AH to continue on as their own entity without a lot of centralized control.
By the time all of this was put together, the President and CEO of ECRH was near retirement. He retired about three years after all of the merger activity was complete. During those three years, he became lax in his leadership role. ECRH deteriorated in market share and profitability during this time. Upon his retirement, the Board of ECRH performed a national search for a replacement. They employed Hunter Brown as the new President and CEO. Mr. Brown was the CEO of a smaller health system and had been in that position for nearly 10 years. Therefore, he had limited experience from other markets in the art of strategic implementation. However, he was also well trained, bright, and articulate in expressing his knowledge. He has now been the President/CEO of ECRH for nine months.
As for the remainder of the leadership team for ECRH, there is a newly hired corporate counsel. She has 15 years of experience and is extremely competent in the work that she does.
The CEO also hired a new Chief Financial Officer. He has taken good strides in managing the accounts receivable throughout the system as well as extracting exceptional dollars from high quality supply chain management.
The Chief Operating Officer (COO) is new and has three years of previous experience from the same organization where the CEO departed.
The Chief Medical Officer (CMO) has been retained from the old leadership team. His reputation is excellent, and he works well with other physicians, including the medical staff and the employed physicians.
The Chief Nursing Officer (CNO) is three years away from retirement. She is known for not getting along with the medical staff and will always defend nursing when at times this is not appropriate.
The Senior Vice President for Human Resources is competent and respected by management and staff throughout the organization.
The remainder of the leadership team was retained from the old regime. This included information technology, employed physician group leadership, marketing, human resources, and other vice presidents or directors responsible for varying service lines. It should be noted that the IT leadership is just completing the implementation of the EPIC system. The future for this team depends on how well the overall implementation of the system goes. Likewise those in the marketing department will need to be stellar in senior leadership advisement regarding the marketing of complex issues that will be encountered ahead. They have been told if marketing misses the target, then replacements will occur within this department.
The new CEO inherited the management team of AH and NMHC. For NMHC the organizational structure was left intact with the COOs for each of the individual hospitals being retained. It was agreed that this traditional structure would be left intact for at least five years. This agreement was near its end and the new CEO had plans to change the existing structure as well as management. This change was being considered for this year’s strategic plan development. Even if the structure of NMHC was going to be changed to a more direct relationship with corporate leadership, all of the existing COO’s would be retained as they have performed well since the merger. As for the COO of AH, he had been recently terminated. An interim COO is now in place pending the board approved closure of this hospital.
Competitive Assessment
ECRH was not the only provider of care in the community. There was a for-profit hospital, Banford Medical Center (BMC), that had been purchased by a large publicly traded for-profit health system about 10 years ago. The for-profit health system was the largest in the country. The CEO of this hospital was good at optimizing performance as a result of the weaknesses of ECRH and its leadership. He was an effective opportunist.
BMC has 400 registered beds with a current occupancy rate of 85%. They have been effective at taking market share away from ECRH. For each loss of service line market share by ECRH, BMC has shown proportional gains. After the acquisition of BMC, the for-profit immediately moved to build a new facility. This new facility is located on the growing wealthy edge of the community. Additionally, at the time that this new facility was developed, the for-profit syndicated ownership to the physicians. The highest level of syndication occurred with the obstetrics and gynecology physicians in the community. Therefore, women’s services deteriorated at ECRH. It should be noted that this physician syndication occurred before the Affordable Care Act was passed, which precluded hospital ownership by physicians.
It is important that additional information is provided regarding ECRH. ECRH recently purchased 100 acres of land across the interstate from BMC. This land is located northwest of Chester. The intention is to eventually build a new medical center on this location. The initial planning of this land has occurred and it has been approved to build a regional oncology center on this site. The construction of the project is already underway with an anticipated completion in 6 months.
In addition, ECRH has an orthopedic hospital attached to the current ERMC site and a behavioral health hospital at this same location. ECRH also has two ambulatory surgical centers that are conveniently located on the growing northwest and southwest side in the community. The one surgical center is located on the 100 acre development site. The orthopedic hospital has done well and has been listed in the top 100 orthopedic hospitals. However, the behavioral health hospital is losing significant dollars, so the Board of Directors for ECRH has decided to close down this hospital. ECRH has also developed a joint venture imaging center with the radiologists. This center resides across from a major shopping area in the community. It is conveniently located near heavily populated neighborhoods and shopping. The only downside is the location is not close to physician offices that would refer to this center. However, if a new facility is built on the 100 acres, which would include physician offices, the imaging center will be in an ideal location. Leadership is developing a free standing emergency center on the 100 acre site, which is on the northwest side of Chestnut.
The last competitive issue is the location of a medical school and hospital in the city of Chestnut. The facility resides in a downtown location. This medical school had been established by the state nearly 45 years ago and is associated with Greenbranch University. It mostly serves the indigent community in Chestnut and the surrounding area. This academic center has a rather negative reputation in the surrounding area. There are four other medical academic centers in the state as well as a medical center with a world renowned reputation. There have been ongoing rumors that this world renowned organization was planning on assuming the responsibility of the Chestnut academic center. This change would substantially alter the complexion of the local medical community if it were to occur. Speed in ECRH dealing with some of its market issues is an imperative.
Additional Market Information: Population Demographics
Chestnut County
With 433,689 people, Chestnut County is the 6th most populated county in the state.
The largest Chestnut County racial/ethnic groups are Caucasian (70.1%), African American (18.5%), and Hispanic (6.5%).
In 2015, the median household income of Chestnut County residents was $41,777. However, 21.1% of Chestnut County residents live in poverty.
The median age for Chestnut County residents is 37.7 years old.
Employment is strong in Chestnut County. Unemployment resides at 4.5%. Employer diversity is strong since the community is not dependent on singular large employers. Employment includes some high-tech jobs, general manufacturing to support the automobile industry, and there is a large university, Greenbranch University, located in the community. The university has 25,000 students and offers most majors, which includes engineering and nursing.
Walnut County
With 42,537 people, Walnut County is the 57th most populated county in the state.
The largest Walnut County racial/ethnic groups are Caucasian (89.8%), followed by Hispanic (7.2%) and African American (3%).
In 2015, the median household income of Walnut County residents was $55,120. However, 10.8% of Walnut County residents live in poverty.
The median age for Walnut County residents is 39.8 years old.
Butternut County
With 38,352 people, Butternut County is the 65th most populated county in the state.
The largest Butternut County racial/ethnic groups are White (87.0%), Hispanic (9.5%), and African American (1.7%).
In 2015, the median household income of Butternut County residents was $50,663. However, 13.4% of Butternut County residents live in poverty.
The median age for Butternut County residents is 39.7 years old.
Oak County
With 37,120 people, Oak County is the 66th most populated county in the state.
The largest Oak County racial/ethnic groups are Caucasian (93.3%), Hispanic (4.0%), and African American (1.1%).
In 2015, the median household income of Oak County residents was $42,492. However, 14.9% of Oak County residents live in poverty.
The median age for Oak County residents is 46.6 years old.
Maple County
With 27,816 people, Maple County is the 79th most populated county in the state.
The largest Maple County racial/ethnic groups are Caucasian (90.8%), Hispanic (7.1%), and African American (1.0%).
In 2015, the median household income of Maple County residents was $39,353. However, 15.4% of Maple County residents live in poverty.
The median age for Maple County residents is 48.2 years old.
Both Oak and Maple Counties are rural with an older population. Many patients have Medicare and Medicaid that come from these two counties. Likewise the hospitals located in each of these counties have been designated as critical access. Like many rural counties, Oak and Maple have been blighted with younger people using drugs, including methamphetamine.
Employed Physicians
ECRH employs 400 physicians throughout its system. The breakdown for each location is as follows:
Chestnut County
135 primary care
100 specialists
Walnut County
40 primary care
10 specialists
Butternut County
30 primary care
12 specialists
Oak County
27 primary care
10 specialists
Maple County
25 primary care
11 specialists
There have been ongoing complaints from the newly recruited physicians that their practices have not been marketed well; thus, their patient volumes have been slow to grow.
Service Line Performance Information
The following is a list of bullet points regarding service line performance by ECRH and issues of operational concern.
Women’s health services deteriorated significantly since the syndication by Banford Medical Center. Obstetrical deliveries are down 20% across the system. BMC has done an excellent job of creating attractive facility and services for women. This includes nurse navigation, women’s breast center, and a series of other amenities. BMC has also started a neonatal intensive care unit, which rivals the services of ECRH.
The cardiologists at ECRH are aging. This has been a traditionally strong service for ECRH, but 50% of the cardiologists will be retiring within the next 3 to 5 years. All cardiologists who serve ERCH are employed by the health system. Cardiology is a service that is gaining strength within the Greenbranch Medical Center, particularly since they brought in a renowned cardiologist to rebuild their program.
The orthopedic volumes are down 7%. ECRH does jointly operate an orthopedic hospital with an independent orthopedic group located in the community. There have been some internal problems within the orthopedic group where the old guard of orthopedic surgeons has forced a low retention with younger, and to some degree better trained, surgeons. Retention is becoming a growing concern regarding the status of this group with consideration of ECRH hiring their own surgeons. The joint venture hospital does not exclude other surgeons from working in this hospital.
Emergency department (ED) volumes are down 5%. The hospital uses an emergency physician group to supply physicians to cover all of the EDs within ERCH. These physicians are known for poor customer service and making rude comments to patients who are self-pay or Medicaid.
The ambulatory visits and services are up 3%. This volume increase is from the younger primary care physicians who have been employed by ECRH. This young group of physicians has become great support for ECRH and refer patients loyally to the organization.
General surgery cases are down 4%. The aging surgeons are starting to retire and it is difficult to recruit new surgeons to replace past demand. Some of this work is going to Greenbranch since they have good general surgeons.
The oncology services for ECRH have increased in volume and revenue by 4%. ECRH’s development of the new oncology center has created a magnet for referrals to the oncologists. The oncologists are very enthusiastic about the development of this new center and have begun to shift work to ECRH.
ECRH has the regional burn center. ECRH works with Greenbranch Medical Center for training residence in the burn setting. This includes the plastic and general surgeons. The downside of this service is that it is losing money. A decision has been made to close down this service with Greenbranch starting their burn center.
ECRH is a Level 1 Trauma Center, and this designation has been a historical positive for the system. The helicopter service is well recognized by the community as well as first responder professionals found in the region. They historically have been top of mind for major trauma cases. The usage of this service is down 5% since the for-profit has established a similar service. BMC however only has a Level 2 Trauma Center. They have worked diligently to acquire ambulance services in some of the outlying communities. This has helped feed patients to BMC.
The ECRH Board of Directors decided to close down the behavioral health hospital. It is uncertain where patients will be able to receive inpatient care. An active out-patient service will still be provided by ECRH.
Payer Mix
The payer mix for ECRH has deteriorated. The current inpatient payer mix for the entire system is as follows:
55% Medicare
15% Medicaid
30% Commercial
There has been a long standing joint venture relationship with a national insurance company for commercial insurance. Administratively this venture has not developed as anticipated; however, in some of the regional markets, the Chestnut Care insurance has a strong presence. Of the 30% commercial pay, 20% is Chestnut Care based. The national insurance company in the venture is Aetna. The next strongest product is Anthem. It is the expectation of the CEO that Chestnut Care be leveraged and positioned for growth.
The 15% Medicaid has helped the hospital gain additional disproportionate share dollars, which does help the bottom line of the hospital.
Historical Strategic Initiatives
Accountable Care Organization
When the Affordable Care Act was passed in 2010, ECRH decided to get into the one-sided model of an accountable care organization (ACO). This venture has not gone well, and ECRH has decided to leave the ACO business. However, they are concerned about the public image of this decision. The details of the termination are under discussion with a need to determine how to minimize the public perception of termination, particularly since there was so much marketing of their getting in this venture. The regulatory requirements of the government regarding the timing of terminating an ACO venture further complicate this decision.
Primary Care Medical Home
The employed primary care group has been active in establishing accredited primary care medical homes within all of the primary care offices throughout the ECRH system. This initiative is a positive emerging strategy for ECRH. It has also been an attractive draw for the family practitioners from Greenbranch Medical Center residency program since Greenbranch has established an accredited medical home for their family practice residency program.
American Nursing Credential Center Status (ANCC)
ECRH has been working on becoming a magnet status for ERMC. This work has stalled out as an initiative. Some of this is due to the nursing leadership within ERMC. The CEO intends to move this priority up in the organization’s goals.
Information Technology
ECRH has invested heavily in their information technology infrastructure. This investment became a requirement just to be able to gather the data needed for the ACO development. This cost has become significantly greater than anticipated. ECRH fully implemented EPIC as their core information technology system. There have been implementation problems since the ECRH was operating off of multiple systems before the decision to consolidate to one platform. The implementation of EPIC required considerable retraining for the staff and physicians. Data conversions have gone well. The difficulties have been more human-related relative to the effective use of the system. One of the major issues has been the lack of ECRH not meeting meaningful use requirements which has cost ECRH significant lost revenue from not meeting these goals.
Legal Actions Pending for ECRH
Federal Trade Commission Investigation
With the merger and acquisition of NMHC, questions of antitrust have been raised. In the service lines of cardiology and oncology it has been found that ECRH controls 60% of the cardiology market and 52% of the oncology market. Chestnut Care in some markets has been strong in steering patient volumes to ERMC. Union leaders for the varying trades were instrumental in precipitating this investigation. At the time that this issue was raised, the President and Executive Branch of the federal government were very pro-labor, thus, their interest in pursuing this matter.
As to the projected disposition of this case, it is anticipated that a negative determination will be made due to the market share control in oncology and cardiology. This could force ECRH to divest their ownership in the Chestnut Care insurance venture. Another option might be that certain hospitals of NMHC be divested. It is not anticipated that both determinations would occur. This case has cost ECRH considerable money to stave off investigation of this allegation.
Predatory Collections and the Loss of Not-for-profit Tax Status for NMHC
NMHC negotiated that they would continue to act independently. The consortium leadership set policies that included predatory collections for the patients that would be served in the NMHC hospitals. In a recent evening news report, an investigative reporter interviewed an elderly patient that had her home taken from her to pay for her medical bills. This home had been in her family for over 100 years. This story prompted the state’s Attorney General’s Office to investigate the predatory collection policies of ECRH and NMHC.
The state has already taken an aggressive stance to investigate the status of not-for-profits not fulfilling requirements (e.g., charity care, research, and education). The state is in economic trouble and is seeking revenue from wherever they can find it. The outlook is dim regarding the anticipated final decision of the Attorney General’s Office. If NMHC is required to pay taxes, this would wipe out the bottom line for these hospitals and many of the needed services supplied to the indigent population by ECRH would be reduced or eliminated.
Faith & Main Consultants Report
Within the last year, ECRH contracted with Faith & Main to study the market perception of their women’s services. The following is a summation of the findings of Faith & Main.
Interest in a Women’s Center Crosses County Lines
36% of women in the service area would travel across county lines to receive excellent women’s health services
72% of women in Chestnut County would consider using the women’s services of East Chestnut Regional Medical Center
Women in all counties were most interested in these services:
Breast care
General gynecology services
Female doctors
Services in one area
Physicals for women
Interest in a Heart Care and a Health Information Line
A physician approved source of information
A nurse help line that could be a resource for women’s care in heart health as well be a source for health navigation.
Clear Expectations Regarding Getting Appointments with Their Primary Care Physician
Women expect same-day appointments
In the collar counties to Chestnut County, women ranked this in the top 28.7%
Chestnut County women ranked this in the top 37.7%
Expectation of same-day appointments ranked highest for women of childbearing age
Percent expecting same-day appointments
42.9 % of Chestnut County women of childbearing age
31.3% of collar county women of childbearing age
Willingness to be Seen by a Nurse Practitioner Overwhelmingly “Yes”
75.7% of Chestnut County women of childbearing age
76.1% of collar county women of childbearing age
Respondents Expressed How Health Care Could Be Improved
24% of all Chestnut County women, and 26% of all collar county women named adding more primary care doctors and more children’s care with urgent care outranking any other single topic.
Respondents of Childbearing Age Widely Represented in Study:
86% of women respondents of childbearing age in Chestnut County had children under the age of 18
76% of women respondents of childbearing age in the collar counties had children under the age of 18
Willingness to be seen by nurse practitioner was viewed as favorable by those in this study.
This data from Faith & Main will be used to ramp up improvements in the women’s services for ECRH.
Strategic Plan Goals for the Upcoming Year
Women’s service line improvement
Increase obstetrical deliveries by 20% over 3 years
Establish nurse navigation system for the entire system
Facility improvement and development for women’s services
Improve access standards for women’s care
Assist in the marketing of the implementation of the consultant’s report regarding women’s services
Oncology Center grand opening
Mature the retail strategy with the primary care employed physician group
Assess the market impact of the lawsuits and develop marketing strategy to counteract the negative impact if decisions are made against ECRH
Aggressively recruit new physicians to reduce the average age of the medical staff and strategically enhance service line development
Use lean management processes to correct service issues found in the ED. Improve ED visits by 6%.
Review physician contracts to enhance physician service performance
Investigate the fast track ED concept
Implement the free standing ED strategy
Abandon the Accountable Care Organization (ACO)
Re-establish relationships with regional emergency medical services to raise the utilization of the medical air service. Growth goal is to get back to the previous level of utilization within 18 months
Decision to close the regional burn unit and let those cases go to the academic medical center
Implement the decision to close the behavioral health services of ECRH
Implement the decision to close AH
CEO Instruction to Marketing Team
The marketing department for East Chestnut Regional Health System will be asked to step up their game to develop a marketing plan for the regional health system. The CEO has had some concerns regarding the ability of the marketing department to keep up with the rapidly moving strategic environment that he has created. So he established a time line for the department to develop a system wide marketing plan over the next six weeks. The VP of marketing has been in all of the senior leadership cabinet meetings so she is aware of all of the details. Therefore, the learning curve regarding the institutional strategic goals is of no concern.
The following are elements that the CEO wants in the marketing plan. Health Care Advertising Assignment
A consultant, Faith & Main, was used to test the impression of the women in the key service markets for East Chestnut Health System. The summary of the consultant’s report can be seen above. The survey covered all aspects of women’s care. The marketing department will need to develop a marketing campaign to match the recommendations of the consultant’s report. Health Care Advertising Assignment
It is recognized that the age span for communicating with women consumers will be quite variable. On one end of the spectrum you have the younger child bearing age women, next are the women that are middle aged followed by women that are pre-elederly then those that are elderly. Therefore, a communication plan using social media to conventional marketing techniques will be required. Health Care Advertising Assignment
A communication plan will need to be developed for the closure of the regional burn center as well the exiting the accountable care organization and the closure of the behavioral health hospital. Health Care Advertising Assignment
A communication plan will be needed to deal with the closure of AH. Health Care Advertising Assignment
A branding strategy will need to be developed to overcome the current weak brand identity that is i