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SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography HI, I UPLOADED MY INSTRUCTION FILE AND MY 8 SOURCES. YOU WILL NEED 12 SOURCES FOR THIS ASSIGNMENT. I ALREADY RESEARCH 8 SOURCES FOR YOU. YOU WILL NEED TO RESEARCH 4 SOURCES BY YOURSELF AND Sources can include books, article, monographs, websites and other documents. All sources should be substantial in length and content. All articles should come from appropriate professional journals. PLEASE LOOK AT ALL FILES WHICH I UPLOADED. I don’t know how many pages will have for this assignment. I think It will have more than 4 pages. PLEASE LET ME KNOW IF YOU HAVE ANY QUESTION. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography annotated_bibliography.docx sources.docx SOURCE #1 How patients’ use of social media impacts their interactions with healthcare professionals Author links open overlay panel A.Benetoli ab T.F.Chen a P.Aslani a Show more https://doi.org/10.1016/j.pec.2017.08.015 Get rights and content Highlights Patients were empowered by using social media for health-related purposes. Patients could participate more actively in the treatment decision-making processes. The use of social media by patients improved their relationship with their healthcare professionals. However overt or tacit opposition from healthcare professionals was reported. Abstract Introduction Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients’ use of SM impacted their interactions with healthcare professionals (HCPs). Methods Focus groups (n = 5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 60–90 min, were audio-recorded, transcribed verbatim, and thematically analysed. Results Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patient-HCP relationship due to increased knowledge, better communication, and empowerment . Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography Conclusion Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making. Practice implications HCPs should be aware of patients’ activities and expectations, and support them in their online activities. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography Previous article in issue Next article in issue Keywords Social media Patients Chronic conditions Decision-making Empowerment Healthcare professionals Introduction The Internet has increased access to a range of health-related information, and its evolution to Web 2.0 has provided a more participatory environment where users develop and disseminate online content. Web 2.0 has provided the technological foundation for the appearance of social media platforms [1] . Web 2.0 has allowed the development of easy-to-use and interactive platforms where individuals and communities share, co-create, discuss, and modify user-generated content (e.g. texts, images, audios, videos, games) employing mobile and web-based technologies [2] . Social media (SM), dubbed the “participative Internet” [3] , has therefore been enabled through the evolution of Web 2.0. Putting it simply, SM consists of a wide range of websites and applications whose content is created by Internet users [1] . It has provided a new venue for public communication, including health communication [4] . As a result, SM has turned out to be not only an emerging trend for patients seeking health information [5] , but also a venue for them to interact with one another. Online communities of patients with a shared health problem have become common [6] . Popular topics discussed include disease symptoms, prognosis, examinations and procedures, and treatments [7] . Besides getting additional useful information directly from peers [8] , online patients have also obtained social support for self-management of their chronic conditions [9] . It has been argued that patients’ access to online health information can impact their relationship with healthcare professionals (HCPs) [10] . As Web 2.0 and SM are dynamic communication technologies with increasing penetration in people’s daily lives, it is vital to keep abreast of changes in its use by patients. Additionally, it is important to fully comprehend how patients are accessing health services and interacting with their HCPs after engaging with peers on social media. Findings from the literature have revealed that patient participation in health-related discussions on SM and other online forums could have an impact on the patient-HCP relationship. Patients have felt empowered and confident with the knowledge and support obtained online [11] , [12] and consequently have asked more relevant questions and communicated better with HCPs [11] , [13] , [14] , [15] , [16] . However, on the flip side, it has been claimed that patients’ active participation in online health activities with peers could threaten HCP expertise in some cases [17] leading them to negatively react to patients’ online autonomous health activities. This in turn could have a disempowering effect on patients [18] . Patients have ended up looking for other health providers in response to a physician’s negative attitude or due to the recommendation of “good doctors” from peers [15] . SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography Chiu and Hsieh [13] investigated how cancer patients wrote (and read) blogs about their condition and the impact of such activity on their illness experience. Cancer patients reconstructed their life story in the blog, articulated their expected end of life and how they wished to be remembered after death [13] . Using in-person and virtual focus groups, Rupert et al. [18] found that patients used online health communities or support groups to obtain information not provided by HCPs and discussed information obtained online with their clinicians, positively impacting the patient-HCP relationship [11] , [18] . An Australian study [17] employing interviews explored the use of online support groups by men with prostate cancer . It showed that the online environment allowed patients to share private information without the constraints imposed by face-to-face social interactions . However, medical specialists perceived this behaviour as a threat to their expert status and control over decision-making processes [17] . SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography A recent review by Smailhodzic et al. [19] about the use of SM in healthcare incorporated studies dealing with patients’ use of SM and its influence on their relationship with HCPs. While recognizing the limited number of studies on this topic, the authors proposed that SM use by patients increased their empowerment leading to a more equalized power balance between patients and HCPs. Considering the relative novelty and relevance of the topic, further research is deemed necessary. A comprehensive understanding of patients’ use, perceptions, and opinions about the use of SM for health-related purposes is important in order to design services that meet their needs and expectations. Moreover, further research is necessary in order to better understand SM’s potential for supporting patient-HCP relationships [20] . Therefore, the aim of this research was to explore patients’ experiences, opinions and perceptions about their use of SM for health-related purposes. Specifically, the study objectives, reported here, were to determine the impact of these online activities on patients’ in-person healthcare services use and health decision-making behaviour; and its effect on patient-HCP relationships. Methods 2.1. Focus groups A qualitative approach was used to allow participants to articulate their experiences, and help elicit in-depth information from them [21] . Focus groups were chosen because they are an efficient way of gathering the views of several individuals simultaneously [22] , uncovering important constructs that may not be tapped through individual interviews [23] . A focus group guide (Appendix 1 in Supplementary materials) was developed to address the broad research aims. Findings pertaining to the questions on impact of SM on healthcare services use and healthcare professional interactions have been reported here.SUNY HLPM300 Impact Social Media on Healthcare Annotated BibliographySUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography 2.2. Participants and recruitment 2.2.1. Inclusion criteria Participant inclusion criteria were: 1) adults with a chronic disease, 2) taking a medication for that disease, 3) had used SM for health-related purposes in the last 12 months, and 4) able to participate in the study without the assistance of a translator. 2.2.2. Recruitment All participants were recruited from the Sydney metropolitan area by a market research company. They received detailed verbal and written information about the study. Forty participants were recruited and thirty-six participated in the discussions. Each participant was reimbursed AUD$80 for their time and travel expenses. 2.3. Data collection Five focus groups were conducted in three separate dedicated venues in Sydney, Australia. All participants provided written consent and completed a demographics questionnaire. Discussions lasted 60–90 min and were facilitated by PA, a female pharmacist and academic experienced in conducting focus groups. The discussions were guided by the focus group questions (Appendix 1 in Supplementary materials) and audio-recorded. Focus groups were conducted until data saturation [24] , which was at the conclusion of the fourth focus group. One additional focus group was conducted for validation purposes. 2.4. Data analysis Note taking during discussions and debriefing immediately after ensured that important information was not ignored and constituted a preliminary analysis [23] . Therefore the data analysis started during and in parallel with data collection [25] . All audio-recordings were transcribed verbatim and thematically analysed [26] . Thematic analysis was chosen as it is not aligned with a particular epistemological, philosophical, or theoretical approach and is a flexible tool to generate themes in qualitative research [26] . Repeated reading of notes and transcriptions afforded familiarity with the data. Transcriptions were then coded line-by-line, by AB, with the assistance of NVivo 11 ® (QSR International), and discussed with PA. Coding was open, not restricted by theoretical assumptions and was dynamic and iteratively developed throughout the analysis. An inductive approach [27] assured a data-driven analysis. Codes with a repeated pattern across the data were collated together and grouped into sub-themes and later assembled into overarching themes. Results A total of 36 participants ( Table 1 ) took part in the focus groups (n = 5). A wide range of chronic disease states (e.g. hypertension, depression, anxiety, cancer, arthritis , Crohn’s disease) was represented among the participants. Table 1. Participants’ demographics. Characteristic Participants (n = 36) Sex Female 17 (47%) Male 19 (53%) Age Range 27–71 Mean ± SD 47.3 ± 10.2 Country of birth Australia 26 (72%) England 2 (5.5%) New Zealand 2 (5.5%) Other 6 (17%) Education Less than High School 3 (8%) High School 11 (30%) College or Technical Education (TAFE) a 6 (17%) Undergraduate 12 (33%) Postgraduate 2 (6%) Data missing 2 (6%) Employment status Full-time 18 (50%) Part-time 9 (25%) Home duties 3 (8%) Retired 2 (6%) Unemployed 4 (11%) Self-reported health status Excellent/very good 14 (39%) Fair 17 (47%) Poor/very poor 5 (14%) Three overarching themes related to the impact of SM in patients’ interactions with HCPs and health care services emerged from the analysis. Table 2 provides a sample of quotations illustrating such themes. Table 2. Overarching themes and respective quotation sample. Themes Illustrative quotations SM use and its impact on interactions with HCPs “I think, if you know the language and you’re familiar with concepts and closer to a level that a doctor understands or operates in, it’s a little bit easier, the interaction” [Focus group (FG)2, female participant (f)10] “I think if you prepare yourself for a session with the doctor, you know what exactly you want to ask; they can answer” [FG5, f31] “I think they [HCPs] probably take you a bit more seriously when you know your stuff, because they can’t fool you around, because they know that you have the answers” [FG2, f12] “I have questions mentally prepared, questions which I think are going to be pragmatic for me and kind of get the information directly from a professional” [FG5, m35] Decision-making process “I’ve gone to my doctor with the information. So, I don’t just take it literally until I get further into it and then I’ll decide or speak to the doctor about it” [FG4, f27] “I was like pretty helpless … other times just gets really confusing if I tell them my stuff and then they tell me other stuff” [FG3, m19] “I was on a discussion group on polycystic ovaries. And there was this talk about metformin. Well, that’s for diabetes. Where’s the connection? But some doctors had discovered that metformin worked really well for polycystic ovaries because are insulin resistant. So I went to my doctor with that and he gave me puzzled look. He said ‘give me a week and I’ll read up’. And within that week I went back and he immediately put me on it” [FG1, f8] “I was having a problem with a high blood pressure tablet. I was getting dizzy, sick. And I said to the doctor ‘there’s something wrong with me’. He said ‘just give it some time’. So I went on to the forum and people had the same problem. They said ‘tell your doctor he’s wrong and get off that, and tell him you want to try Drug XX or something else’ … then I went back to the doctor and I told him and he changed the medication. Perfect. But if I stayed with the doctor’s advice and never checked it myself, I’d feel sick all the time” [FG2, m13] SM use and its impact on healthcare services usage “I go to my doctor once a fortnight. I skipped the last two meetings. I was getting more online than I was in the office” [FG3, m20] “I have one [GP], but then … I would do research and come to idea that I have some problem … I would ask and insist on certain tests and then if she refused … I found few other doctors that are completely okay with that” [FG3, f16] “Maybe it saves you the trip to the doctor… because you’re informed and can go to the pharmacist” [FG5, m35] “I used SM to figure out who are the good doctors and who are the bad doctors” [FG5, m35] 3.1. SM use and its impact on interactions with HCPs No participant reported interacting with HCPs via SM. Only digital communication technology predating SM (e.g. chatroom) was used for communicating with HCPs. For example, non-government organisations like BeyondBlue (beyondblue.org.au) and Black Dog Institute (blackdoginstitute.org.au) were cited as useful online resources where psychologists and psychiatrists could be accessed for live chats. Participants received private counseling and referral to other services if needed. A private service named “Ask the Doctor” (askthedoctor.com), where patients could ask health-related questions, was also mentioned. No other online interactions with HCPs were reported. Most participants did not expect to interact with HCPs on any SM platforms they were using. In fact, they thought it would be strange if a HCP participated in online communities: “I probably would be quite dubious if somebody sort of popped up and messaged saying ‘hi, I’m a professor or I’m a brain surgeon’ … I would be wary” [FG1, f3]. However, some did expect that “undercover” HCP researchers could be among virtual community users. Interestingly, it was mentioned that not only HCPs’ credentials, but also the advice provided in these circumstances would be questionable since this service would be dissociated from a HCP’s regular workload and employment. Even though not interacting with HCPs on SM, participants reported that being active online improved their face-to-face relationship with HCPs. This effect was perceived to be due to their empowerment , manifested as improved health literacy and better communication. Participants stated that interactions with online peers helped them to better prepare and to articulate questions during consultations: “I think it helps also to ask your doctor the right questions because you understand your conditions better” [FG2, f12]. Some participants even hypothesised that HCPs would have a higher regard for well-informed patients; consequently providing better services for them. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography This improved interaction was perceived to facilitate participants to obtain more useful information from their doctors: “to make use of your time with your specialist, to ask the right questions … you’re going in armed with information so you can engage and get as much information” [FG2, f10]. They believed that improved communication and being better prepared for consultations meant more efficient consultations, especially as they are often short. Moreover, participants believed that HCPs, particularly specialists, did not have to spend time explaining basic information about the disease, prognosis, and treatment options because they were better informed. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography 3.1.1. Sharing information obtained online with HCPs Most participants tended to discuss the information obtained online with their HCPs, especially with their doctors. It was pointed out that verifying the validity of the information found online was an important activity performed by HCPs: “I read, take note, compare … then when I go see the doctor, I ask to get more clarity” [FG1, m1]. Similarly, pharmacists were mentioned as HCPs who could be accessed for double-checking online health information: “I tend to ask the professionals … I was with the pharmacist at the hospital, and I asked him about something. I talk to my chemist too” [FG1, f5]. However talking to pharmacists was problematic due to lack of privacy in the community pharmacy setting: “I tend to prefer my doctor because my pharmacist has a thousand people around with no privacy” [FG1, f3]. 3.1.2. Participants’ experiences and perceptions of HCPs reactions to their use of SM Some participants reported on their HCPs’ reactions when they visited them with health-related information found online or discussed in SM groups. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography The majority felt that HCPs did not appreciate that their patients were accessing online health information. In fact, some participants reported that some HCPs overtly expressed opposition: “I went to a sports injury physio, and when she talked about something she knows I want to check online, watch YouTube, then she tells me ‘don’t go to websites … don’t trust websites”’ [FG3, f17]. They believed that this opposition may be because HCPs were concerned about patients being more inquisitive: “maybe they feel that because we know what they’re going to talk about, we may ask more questions. I find doctor doesn’t really like you to ask questions” [FG3, f17]. In some cases, participants experienced hostility : “he rolls his eyes and goes ‘another one’s been to the Internet again”’ [FG2, m9]. Indifferent reactions were also reported. In general, several participants had the impression that HCPs do not support patients’ autonomous search for health information and participation in online forums and SM: “doctors don’t even like SM. I know one that hates it” [FG5, m36], “I think the [healthcare] professional people are very against it [SM]” [FG3, f17]. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography On the other hand, there were some participants who reported that HCPs were receptive to their online health-related activities. Patients’ increased knowledge about their condition and treatment options not only led them to be more assertive when interacting with HCPs but also sometimes changed the way HCPs approached them, i.e. HCPs were more interested in their comments and opinions. A few participants reported strong support from physicians for their online activities: “my doctor tells me to get whatever information I can and if I’m not sure about it, just give him a call” [FG3, m21]. With a few even reporting that doctors would recommend patients to go online to find ways of helping themselves, particularly when no actual treatment or procedure was indicated. This helped to establish a respectful and collaborative patient-HCP relationship. 3.2. Decision-making process SM had a significant role in fostering decision-making: “listen to another people’s thoughts if they’ve had the same experience … help me to make a decision” [FG3, f17]. Online engagement increased participants’ willingness to be actively engaged in therapeutic decision-making: “if you’ve got knowledge, then you can negotiate, suggest, and talk about it more successfully rather than just being told ‘this is what you’re going to take”’ [FG1, f5]. Several participants highlighted that decision-making was an agreement between the HCP and themselves and for most, discussing the information obtained online with HCPs before acting on it was the rule. However, a few expressed a firm resolve to follow what they themselves believed was right, regardless of HCPs’ opinions. Participants bringing and discussing online treatment information during consultations, influenced medication selection and initiation. A few participants reported that their doctors could be persuaded to change their treatment even though acknowledgment of the patient’s contribution was not always explicit: “they might change it [treatment] but they won’t tell you they’re changing it for that reason [information brought by patient]” [FG4, m23]. Suggestions to discontinue or change medications due to side-effects were also common after participants had discussed these matters with online peers. Participants felt they could better discuss treatment options with their doctors and treatments could be modified as they would suggest new treatments according to what they had learnt on SM. Being knowledgeable about health, however, did not change participants’ reliance on HCPs. Most articulated that HCPs were the most trusted and well-trained people: “I want to be able to read and look, research, have all this knowledge. But you still got to go take it to people who do all that training” [FG1, f8]. Despite most participants acknowledging that their online activities empowered them for the decision making process, some participants felt frustrated in the decision-making process when doctors did not acknowledge their contribution by disregarding the information they were presenting. Moreover, the negative impact on patients’ ability to participate in the decision-making process was strongly felt when HCPs expressed hostility towards their online activities: “disempowers you pretty quickly” [FG1, m9]. 3.3. SM use and its impact on healthcare services usage The use of SM for health-related purposes seemed to influence the frequency with which healthcare services were accessed by the participants, though a clear trend was not established in this study. On the one hand, a few participants accessed fewer healthcare services since some of their health needs were met by the virtual peer interactions and the information obtained. But on the other hand, there were participants who increased their healthcare services use due to improved health knowledge . One participant even identified HCPs inclined to accept suggestions obtained from online sources. Accessing other health services was also mentioned. For example, a few participants reported that with the information obtained on SM they could get their health needs addressed by their community pharmacist rather than their doctor. It is important to note that the selection of health services, in particular HCPs, was influenced by online peer interactions as patients were seeking recommendations. While some participants preferred to obtain a HCP recommendation from strangers within large online forums or SM groups, others believed that recommendations from close friends on social networking sites were more appropriate and trustworthy: “sometimes I put out a message on my page saying, ‘I’m looking for a practitioner, has anyone got some good referrals?”’ [FG2, m11]. SM was used as a platform to post complaints about health services and the health system: “I use it for venting quite a lot about frustrations to do with access to services, stigma when it comes to using those services” [FG3, m21]. Discussion and conclusions This study has demonstrated an overall positive impact on the patient-HCP relationship due to patients’ use of SM as clearly articulated by the participants, and has provided new insights into the specific aspects of patient-HCP relationship. This study also corroborated previous research indicating that patients’ use of SM for health-related purposes positively influenced their relationship with HCPs [11] , [14] , [18] , [28] . Whilst previous research found that patients did not disclose their Internet activity during clinical visits [29] , this current study demonstrated that they did. Participants stated being open about their online sources when interacting with HCPs. Therefore it can be hypothesised that SM use by patients can increase their openness about online activity compared to other types of Internet sources. Furthermore, it is also possible that the increased use of the Internet for information, in general, and for health, specifically, has shifted the “societal norm” to patients being more likely to report seeking and finding health-related information on-line (Internet and SM). The findings presented here are in line with previous research that has shown that patients’ access to online health information tended to diminish the paternalistic approach to care experienced since patients were more prepared and able to participate and take more responsibility for their health outcomes [10] . The interactive environment provided by SM can help not only to consolidate knowledge that could have been acquired from traditional sources and websites, but also provides a more informal and user-friendly mechanism for information transmission, expanding the chances of obtaining further knowledge. Such improvements in patients’ knowledge and empowerment are therefore reflected in a new patient-HCP relationship. Therefore, it is possible that SM is providing more opportunities for patients to learn, especially to gain first-hand experiences and opinions from peers, which can also support better engagement with HCPs. Additionally, the study has shown that patients were not only resorting to online peer interactions to supplement information from HCPs as shown in the literature [18] , but also they were preparing themselves prior to clinical consultations. For this reason, the findings substantiate a prediction made in 2003 that one of the key features of the future patient would be to bring a list of questions to consultations [30] . Irrespective of how and when patients were seeking health-related information on SM platforms, the availability of SM and their online activities have transformed their health-related behaviour as demonstrated in this study. Online peer interactions increase patients’ health-related knowledge [15] because patients share both relevant health information and their own experiential stories [31] . Such increased knowledge has been conducive to patient empowerment [11] , [12] , [32] , which is then reflected in patients’ ability to better articulate doubts and concerns [33] and to actively participate in the decision-making process, particularly treatment choices. The findings corroborate previous studies that have reported improved patient-HCP communication when patients actively participate in online discussions [11] , [32] , [33] . This study also revealed that patients believed the improvements in patient-HCP relationship were due to patient empowerment and the higher regard from HCPs towards informed patients. This study, however, did not investigate if patients with a relatively good relationship with their HCPs would be the ones to perceive the most improvement. Therefore future studies should address this point. This study highlighted that despite the health information accessed online and the increasing online discussions among patients about health-related matters, HCPs remained a trusted source to validate information. This is in line with studies reporting that most patients or carers relay the information found online with their doctors [34] . Such approach seems to be an important component of the improved communication previously discussed and a vital element for patients’ participation in decision-making. It has been found that peer-to-peer online discussions provide patients with useful quality information [35] and by discussing this information with their clinicians patients were asserting themselves during consultations and influencing treatment decisions. Although this active role in imparting their own information can be interpreted as a sign of patients’ concern that HCPs may not be aware of the latest treatment breakthroughs [33] , it is most probable that patients are increasingly taking responsibility for their own health. Interestingly, participants’ perceptions of improved relationships with HCPs contrasted with most of them reporting overt or tacit HCP opposition to their online health-related activities. HCPs negatively reacting to patients presenting online information during consultations have been reported previously [29] . There may be several reasons explaining this behaviour. For example, it is known that HCPs struggle between paternalism and patient autonomy as they see their expertise and judgment undermined by online informed patients [36] . HCPs who may feel threatened in their expertise may react negatively during consultations with patients who bring online content [17] , [18] . Other reasons that may lead HCPs to express opposition include concern about misleading health information, improper use of health services (e.g. delayed visits), incorrect disease self-management [37] , and limited time [38] . Regardless of the underlying reasons, HCPs’ resistance to patients’ use of SM for health-related purposes was found to disempower patients, as also reported by other researchers [18] . Additionally, HCPs should be mindful that their opposition can lead to patients not only getting a second opinion, but even to change their healthcare provider [15] , [18] . As SM use might represent an important element in the evolving nature of the patient-HCP relationship [39] , it is thus suggested that HCPs should move to information exchange (dialogue) rather than transfer [40] , favouring a patient-centred interaction involving collaboration in obtaining and analysing the information [41] . As a result, patients’ contribution would be acknowledged strengthening their relationship with their HCP. SUNY HLPM300 Impact Social Media on Healthcare Annotated Bibliography Lastly, patients’ use of SM may impact healthcare services usage. This finding contrasts with a previous research reporting that Internet use by patients had no impact on healthcare services usage [42] . One explanation for this

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Nursing

Discussion: Nursing theory concept analysis ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Nursing theory concept analysis Please see rubric attached, APA format is required, 6 scholarly references must be used as well. Discussion: Nursing theory concept analysis nr501_w4_assignments NR501 Concept Analysis Guidelines and RubricPurposeThis assignment provides the opportunity for the student to complete a concept analysis of a concept found in a nursing theory using an identified process. The assignment fosters analytical thinking related to the selected concept as well as application within the profession.Course OutcomesThrough this assignment, the student will demonstrate the ability to: (CO#1) Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO1) (CO#3) Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO3, 7, 10) (CO#4) Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO4. 7) Due Date Sunday 11:59 PM MT at the end of Week 4 Total Points Possible : 250 PointsRequirements Description of the Assignment This assignment presents a modified method for conducting a concept analysis of ONE concept found in a nursing theory. The source of the concept for this assignment must be a published nursing theory. The selected concept is identified and then the elements of the analysis process are applied in order to synthesize knowledge for application within the model and alternative cases. Non-nursing theories may NOT be used. The paper concludes with a synthesis of the student’s new knowledge about the concept. The scholarly literature is incorporated throughout the analysis. Only the elements identified in this assignment should be used for this concept analysis. Criteria for Content Introduction The introduction substantively presents all following 4 (four) elements: Identifies the role of concept analysis within theory development, Identifies the selected nursing concept, Identifies the nursing theory from which the selected concept was obtained, and Names the sections of the paper. Definition/Explanation of the selected nursing concept This section includes: Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and Information about the concept as discussed by the theorist from the selected nursing theory is substantively presented. Discussion: Nursing theory concept analysis A substantive discussion of this section with support from nursing literature is required. Literature review This section requires: A substantive discussion of at least 6 (six) scholarly nursing literature sources on the selected concept. Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Support from nursing literature is required. Please Note: Primary research articles about the selected nursing concept are the most useful resource for the literature review. Defining attributes For this section: A minimum of THREE (3) attributes are required. A substantive discussion of this section with support from nursing literature is required. Explanation : An attribute identifies characteristics of a concept. For this situation, the characteristics of the selected nursing concept are identified and discussed. Antecedent and Consequence This section requires the identification of: 1 antecedent of the selected nursing concept, and 1 consequence of the selected nursing concept. A substantive discussion of the element with support from nursing literature is required. Explanation: An antecedent is an identifiable occurrence that precedes an event. In this situation, an antecedent precedes a selected nursing concept.A consequence follows or is the result of an event. In this situation a consequence follows or is the result of the selected nursing concept. Empirical Referents This section requires the identification of: 2 (two) empirical referents of the selected nursing concept. A substantive discussion of the element with support from nursing literature is required. Explanation: An empirical referent is an objective ways to measure or determine the presence of the selected nursing concept. Model Cases 1 model case is created by the student and discussed substantively by demonstrating within the case each of the following areas: Definition, All identified attributes, Antecedent, Consequence, and Empirical referent or Measurement Information from selected nursing theory is applied to the created model case. A substantive discussion of the element with support from nursing literature is required. Explanation: A model case is an example of the hypothetical individual who demonstrates all of the attributes, antecedents, consequences, and referents noted previously in this assignment. Alternative Cases This section requires: The identification of 2 (two) alternative cases correctly created and presented. The two required alternative cases are: Borderline (absence of one or two of previously identified attributes of the selected nursing concept. Contrary (demonstrates the complete opposite of selected nursing concept) Applies information from selected nursing theory. Explanation: Alternative cases represent the opposite of the model case. For this assignment, two alternative cases are required. These are: Borderline case which is a created case where one or two of the previously identified attributes are missing. Contrary case which is a created case that demonstrate the complete opposite of the selected nursing concept. Discussion: Nursing theory concept analysis Conclusion This section requires: Summarization of key information regarding: Selected nursing concept, Selected nursing theory, and Application of concept analysis findings to advanced nursing practice. The concluding statements include self-reflection on the new knowledge gained from conducting a concept analysis. Preparing the Assignment Criteria for Format and Special Instructions The paper (excluding the title page and reference page) should be at least 8, but no more than 10 pages. Points will be lost for not meeting these length requirements. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6 th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used. The source of the concept for this assignment must be a published nursing theory. Non-nursing theories may NOT be used. A minimum of 6 (six) scholarly references must be used. Required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. A dictionary maybe used as a reference for the section titled “Definition/Explanation of the selected nursing concept”, but it is NOT counted as one of the 6 required scholarly nursing references. For additional assistance regarding scholarly nursing references, please see “What is a scholarly source” located in the Course Resources tab. Be aware that information from .com websites may be incorrect and should be avoided. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them. Ideas and information from scholarly, peer reviewed, nursing sources must be cited and referenced correctly. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing. PLEASE note: Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases. Possible Concepts: The following concepts are not required; students may select one of these concepts or find another concept. Each selected concept must be associated with a nursing theory; the use of non-nursing theories is NOT allowed. If you have any questions regarding your concept or the nursing theory, please consult with your faculty member for assistance. Please note: the concepts of incivility and civility are not allowed for this assignment. · Behavioral system· Boundary lines· Caring· Empowerment· Homeostasis· Noise· Open system· Palliative care· Resources· Self-care · Adaptation· Comfort· Compassion· Engagement· Leadership· Meaningfulness· Modeling· Pain· Pattern· TransactionDiscussion: Nursing theory concept analysis Directions and Assignment Criteria Assignment Criteria Points % Description Introduction 10 4 The introduction substantively presents all following 4 (four) elements: · Identifies the role of concept analysis within theory development,· Identifies the selected nursing concept,· Identifies the nursing theory from which the selected concept was obtained, and· Identifies the sections of the paper References from nursing literature are required. Definition/Explanation of Selected Concept 25 10 This section includes:· Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and· Information about the concept as discussed by the theorist from the selected nursing theory is substantively presented. References from nursing literature are required. Literature Review 30 12 This section requires:· A substantive discussion of at least 6 (six) scholarly nursing literature sources on the selected concept.· Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Defining Attributes 25 10 For this section:· A minimum of THREE (3) attributes are required.References from nursing literature are required. Antecedents & Consequences 25 10 This section requires the identification of:· 1 antecedent of the selected nursing concept, and· 1 consequence of the selected nursing concept.References from nursing literature are required. Empirical Referents 25 10 This section requires the identification of:· 2 (two) empirical referents of the selected nursing concept. References from nursing literature are required. Model Case 30 12 This section requires: 1 model case is created by the student and discussed substantively by demonstrating within the case each of the following areas:· Definition,· All identified attributes,· Antecedent,· Consequence, and· Empirical referent or MeasurementInformation from selected nursing theory is applied to the created model case. Alternative Cases (one borderline; one contrary) 30 12 This section requires:· The identification of 2 (two) alternative cases correctly created and presented. The two required alternative cases are:o Borderline (absence of one or two of previously identified attributes of the selected nursing concept.o Contrary (demonstrates the complete opposite of selected nursing concept Applies information from selected nursing theory. Conclusion 10 4 This section requires:· Summarization of key information regarding:· Selected nursing concept,· Selected nursing theory, and· Application of concept analysis findings to advanced nursing practice. Paper Specifications 20 8 A nursing theory was used. The source of the concept for this assignment was a published nursing theory. Non-nursing theories may NOT be used. Paper meets length requirements of 8 to 10 pages Minimum of 6 scholarly nursing referencesA dictionary (except for Definition section), required textbooks for this course and Chamberlain College of Nursing lesson information, may NOT be used as scholarly references for this assignment. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them. Discussion: Nursing theory concept analysis APA Format (6 th edition) 10 4 Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6 th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.One deduction for each type of APA style error Citations in Text 5 2 Ideas and information that come from readings must be cited and referenced correctly. Writing Mechanics 5 2 Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal written work as found in the 6 th edition of the APA manual. Total 250 100 % A quality assignment will meet or exceed all of the above requirements. Grading Rubric Assignment Criteria Exceptional(100%)Outstanding or highest level of performance Exceeds(88%)Very good or high level of performance Meets(80%)Competent or satisfactory level of performance Needs Improvement(38%)Poor or failing level of performance Developing(0)Unsatisfactory level of performance Content Possible Points = 230 Points Introduction 10 Points 9 Points 8 Points 4 Points 0 Points Presentation of information was exceptional and included all of the following elements: Identifies the role of concept analysis within theory development. Identifies the selected nursing concept. Identifies the nursing theory from which the selected concept was obtained. A nursing theory was used. Identifies the sections of the paper. References from nursing literature are required. Presentation of information was good, but was superficial in places and included all of the following elements: Identifies the role of concept analysis within theory development. Identifies the selected nursing concept. Identifies the nursing theory from which the selected concept was obtained. A nursing theory was used. Identifies the sections of the paper. References from nursing literature are required. Presentation of information was minimally demonstrated in the all of the following elements: Identifies the role of concept analysis within theory development. Identifies the selected nursing concept. Identifies the nursing theory from which the selected concept was obtained. A nursing theory was used. Identifies the sections of the paper. Limited references from nursing literature were provided. Presentation ofinformation in one or two of the following elements fails to meet expectations: Identifies the role of concept analysis within theory development. Identifies the selected nursing concept. Identifies the nursing theory from which the selected concept was obtained. A nursing theory was used. Identifies the sections of the paper. Limited or no references from nursing literature were provided. Discussion: Nursing theory concept analysis Presentation of information is unsatisfactory in three or more of the following elements: Identifies the role of concept analysis within theory development. Identifies the selected nursing concept. Identifies the nursing theory from which the selected concept was obtained. A nursing theory was used. Identifies the sections of the paper. Limited or no references from nursing literature were provided. Definition/Explanation of Selected Concept 25 Points 22 Points 20 Points 10 Points 0 Points Presentation of information was exceptional and included all of the following elements: Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required). Information about the concept as discussed by the theorist from the selected nursing theory. References from nursing literature are required. Presentation of information was good, but was superficial in places and included all of the following elements: Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required). Information about the concept as discussed by the theorist from the selected nursing theory. References from nursing literature are required. Presentation of information was minimally demonstrated in the all of the following elements: Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and Information about the concept as discussed by the theorist from the selected nursing theory. Limited references from nursing literature were provided. Presentation ofinformation in one of the following elements fails to meet expectations: Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and Information about the concept as discussed by the theorist from the selected nursing theory. Limited or no references from nursing literature were provided. Discussion: Nursing theory concept analysis Presentation of information is unsatisfactory in two or more of the following elements: Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and Information about the concept as discussed by the theorist from the selected nursing theory. Limited or no references from nursing literature were provided. Literature Review 30 Points 26 Points 24 Points 11 Points 0 Points Presentation of information was exceptional and included all of the following elements: A substantive discussion of at least 6 (six) nursing literature sources on the selected concept. Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Presentation of information was good, but was superficial in places and included all of the following elements: A substantive discussion of at least 6 (six) nursing literature sources on the selected concept. Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Presentation of information was minimally demonstrated in the all of the following elements: A substantive discussion of at least 6 (six) nursing literature sources on the selected concept. Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Presentation ofinformation in one of the following elements fails to meet expectations: A substantive discussion of at least 6 (six) nursing literature sources on the selected concept. Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Presentation of information is unsatisfactory in the following elements: A substantive discussion of at least 6 (six) nursing literature sources on the selected concept. Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in a disorganized fashion. Defining Attributes 25 Points 22 Points 20 Points 10 Points 0 Points Presentation of information was exceptional and included all of the following elements: A minimum of 3 (three) attributes References from nursing literature are required. Presentation of information was good, but was superficial in places and included all of the following elements: A minimum of 3 (three) attributes are required. References from nursing literature are required. Presentation of information was minimally demonstrated in the all of the following elements: A minimum of 3 (three) attributes are required. Limited references from nursing literature were provided. Presentation ofinformation from following elements fails to meet expectations: One or two attributes of the selected nursing concepts were presented. Limited or no references from nursing literature were provided. Presentation of information is unsatisfactory in the following elements: No attributes of the selected nursing concept were presented. Limited or no references from nursing literature were provided. Antecedents & Consequences 25 Points 22 Points 20 Points 10 Points 0 Points Presentation of information was exceptional and included all of the following elements: 1 antecedent of the selected nursing concept. 1 consequence of the selected nursing concept. References from nursing literature are required. Presentation of information was good, but was superficial in places and included all of the following elements: 1 antecedent of the selected nursing concept. 1 consequence of the selected nursing concept. References from nursing literature are required. Presentation of information was minimally demonstrated in the all of the following elements: 1 antecedent of the selected nursing concept. 1 consequence of the selected nursing concept. Limited references from nursing literature were provided. Presentation ofinformation in one of the following elements fails to meet expectations: 1 antecedent of the selected nursing concept. 1 consequence of the selected nursing concept. Limited or no references from nursing literature were provided. Presentation of information is unsatisfactory in two or more of the following elements: 1 antecedent of the selected nursing concept.· 1 consequence of selected nursing concept. Limited or no references from nursing literature were provided. Discussion: Nursing theory concept analysis Empirical Referents 25 Points 22 Points 20 Points 10 Points 0 Points Presentation of information was exceptional and included all of the following elements: 2 (two) empirical referents of the selected nursing concept. References from nursing literature are required. Presentation of information was good, but was superficial in places and included all of the following elements: 2 (two) empirical referents of the selected nursing concept. References from nursing literature are required. Presentation of information was minimally demonstrated in the all of the following elements: 2 (two) empirical referents of the selected nursing concept. Limited references from nursing literature were provided. Presentation ofinformation in one of the following elements fails to meet expectations: 2(two) empirical referents of the selected nursing concept. Limited or no references from nursing literature were provided. Presentation of information is unsatisfactory in two of the following elements: 2(two) empirical referents of the selected nursing concept. Limited or no references from nursing literature were provided. Model Case 30 Points 26 Points 24 Points 11 Points 0 Points Presentation of information was exceptional and included all of the following elements: 1 model case was created by the student and discussed substantively by demonstrating within the case each of the following areas:· Definition,· All identified attributes,· Antecedent,· Consequence, and· Empirical referent Information from selected nursing theory is applied to the created model case. Presentation of information was good, but was superficial in places and included all of the following elements: 1 model case is created by the student and discussed substantively by demonstrating within the case each of the following areas:· Definition,· All identified attributes,· Antecedent,· Consequence, and· Empirical referent Information from selected nursing theory is applied to the created model case. Presentation of information was minimally demonstrated in the all of the following elements: 1 model case was created by the student and 1 or 2 of the following are missing: · Definition,· All identified attributes,· Antecedent,· Consequence, and· Empirical referent Information from selected nursing theory is applied to the created model case. Discussion: Nursing theory concept analysis Presentation ofinformation in the following elements fails to meet expectations: 1 model case was created by the student and 3 of the following are missing:· Definition,· All identified attributes,· Antecedent,· Consequence, and· Empirical referent Information from selected nursing theory is applied to the created model case. Presentation of information is unsatisfactory in the following elements: 1 model case was created by the student and 4 or more of the following are missing:· Definition,· All identified attributes,· Antecedent,· Consequence, and· Empirical referent Information from selected nursing theory is applied to the created model case. Alternative Cases (one borderline; one contrary) 30 Points 26 Points 24 Points 11 Points 0 Points Presentation of information was exceptional and included all of the following elements: The identification of 2 (two) alternative cases correctly created and presented. · Borderline (absence of one or two of previously identified attributes of the selected nursing concept. · Contrary (demonstrates the complete opposite of selected nursing concept) Applied information from selected nursing theory. Presentation of information was good, but was superficial in places and included all of the following elements: The identification of 2 (two) alternative cases correctly created and presented. · Borderline (absence of one or two of previously identified attributes of the selected nursing concept.· Contrary (demonstrates the complete opposite of selected nursing concept) Applied information from selected nursing theory. Presentation of information was minimally demonstrated in the all of the following elements: The identification of only ONE alternative cases correctly created and presented. · Borderline (absence of one or two of previously identified attributes of the selected nursing concept.· Contrary (demonstrates the complete opposite of selected nursing concept) Applied information from selected nursing theory Presentation of information in the following elements fails to meet expectations: The identification of only ONE alternative cases correctly created and presented. · Borderline (absence of one or two of previously identified attributes of the selected nursing concept.· Contrary (demonstrates the complete opposite of selected nursing concept) Applied information from selected nursing theory Presentation of information is unsatisfactory in the following elements:The identification of only ONE alternative cases correctly created and presented. · Borderline (absence of one or two of previously identified attributes of the selected nursing concept.· Contrary (demonstrates the complete opposite of selected nursing concept) Applied information from selected nursing theory Conclusion 10 Points 9 Points 8 Points 4 Points 0 Points Presentation of information was exceptional and included all of the following elements: · Summarizing information on selected nursing concept,· Summarizing information on selected nursing theory, and· Summarizing the application of concept analysis findings to advanced nursing practice. Self-reflection on the new knowledge gained regarding concept analysis Presentation of information was good, but was superficial in places and included all of the following elements: · Summarizing information on selected nursing concept,· Summarizing information on selected nursing theory, and· Summarizing the application of concept analysis findings to advanced nursing practice. Self-reflection on the new knowledge gained regarding concept analysis Presentation of information was minimally demonstrated in the all of the following elements: · Summarizing information on selected nursing concept,· Summarizing information on selected nursing theory, and· Summarizing the application of concept analysis findings to advanced nursing practice. Self-reflection on the new knowledge gained regarding concept analysis Presentation ofinformation in one or two of the following elements fails to meet expectations: · Summarizing information on selected nursing concept,· Summarizing information on selected nursing theory, and· Summarizing the application of concept analysis findings to advanced nursing practice. Self-reflection on the new knowledge gained regarding concept analysis Presentation of information is unsatisfactory in two or more of the following elements: · Summarizing information on selected nursing concept,· Summarizing information on selected nursing theory, and· Summarizing the application of concept analysis findings to advanced nursing practice. Self-reflection on the new knowledge gained regarding concept analysis Paper Specifications 20 Points 18 Points 16 Points 8 Points 0 Points This section included all of the following: A nursing theory was used. The source of the concept for this assignment was a published nursing theory. Paper meet length requirements of 8 to 10 page. Minimum of 6 scholarly nursing references A dictionary (except for Definition section), required textbooks for this course and Chamberlain College of Nursing lesson information, were NOT used as scholarly references. References are current – within a 5-year time frame unless a valid rationale was provided and the instructor approved them. This section included three of the following: A nursing theory was used. The source of the concept for this assignment was a published nursing theory. Paper meet length requirements of 8 to 10 pages Minimum of 6 scholarly nursing referencesA dictionary (except for Definition section), required textbooks for this course and Chamberlain College of Nursing lesson information, were NOT used as scholarly references. References are current – within a 5-year time frame unless a valid rationale was provided and the instructor approved them. This section included only two of the following: A nursing theory was used. The source of the concept for this assignment was a published nursing theory. Paper meet length requirements of 8 to 10 pages Minimum of 6 scholarly nursing referencesA dictionary (except for Definition section), required textbooks for this course and Chamberlain College of Nursing lesson information, were NOT used as scholarly references. References are current – within a 5-year time frame unless a valid rationale was provided and the instructor approved them. This section included only one of the following: A nursing theory was used. The source of the concept for this assignment was a published nursing theory. Paper meet length requirements of 8 to 10 pages Minimum of 6 scholarly nursing referencesA dictionary (except for Definition section), required textbooks for this course and Chamberlain College of Nursing lesson information, were NOT used as scholarly references. References are current – within a 5-year time frame unless a valid rationale was provided and the instructor approved them. This section included none of the following: A nursing theory was used. The source of the concept for this assignment was a published nursing theory. Paper meet length requirements of 8 to 10 pages Minimum of 6 scholarly nursing referencesA dictionary (except for Definition section), required textbooks for this course and Chamberlain College of Nursing lesson information, were NOT used as scholarly references. References are current – within a 5-year time frame unless a valid rationale was provided and the instructor approved them. Content Subtotal _____of 230 points Format Possible Points = 20 Points APA Style 10 Points 9 Points 8 Points 4 Points 0 Points APA guidelines, as per the 6 th edition of the manual, are demonstrated for the· title page,· running head,· body of paper (including citations and headings), and· reference pageOne deduction for each type of APA format error 0 to 1 APA error was present APA guidelines, as per the 6 th edition of the manual, are demonstrated for the· title page,· running head,· body of paper (including citations and headings), and· reference page One deduction for each type of APA format error 2 – 3 APA errors were present APA guidelines, as per the 6 th edition of the manual, are demonstrated for the· title p

Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Help me study for my Nursing class. I’m stuck and don’t understand. Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Create a 5 pages Journal draft for publication following the Guidelines for Manuscript Preparation provided midwifery_proposal.docx __author_guidelines_for_man Midwifery Led Continuity Care in Different Birthplaces Scenarios Table of Contents Introduction ………………………………………………………………… Significance of the Practice Problem ………………………………………. Research Questions ………………………………………………………… PICOT Question …………………………………………………………….. Theoretical Framework …………………………………………………. Synthesis of Literature …………………………………………………… Practice Recommendations ……………………………………………………. Project Description ………………………………………………………….. Project Evaluation Results ………………………………………………… Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Discussion and Implications for Nursing and Healthcare ………………. Plans for Dissemination ………………………………………………….. Summary and evaluation …………………………………………………… Abstract This research encompassed an exploration into Maternity Led Continuous Care. It took the form of a synthesis of literature after forming a PICOT question. Significance of the practice problem entailed Midwifery-Led Continuity Care in Different Birth Places Scenario being a relatively new care model. Importantly, the model requires mothers and their infants to be monitored by the same midwife or obstetric team throughout the pregnancy, childbirth, and postal natal period. Consequently, the theoretical framework was one of a Caring model incorporating the former approach. The comprehensive synthesis of literature provided confirmation showing some unique challenges encountered in executing the model. A major challenge related to evidence -based data impacting the science globally. Hence, more documentation of outcomes and events within a research context is required. Ultimately, from an overall perspective there is evidence showing where at the Nursing Science level, Midwives function as primary care givers to pregnant women, internationally. As such, it is hoped that this research will encourage addition to the body of knowledge now existing moving forwards strategic interventions that facilitate application of the model worldwide. Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Introduction Midwifery Led Continuity Care in Different Birthplaces Scenarios Research shows that at the Nursing Science level, Midwives function as primary care providers to women of childbearing age, internationally. While this is true as well as commendable, synthesized data regarding whether differences exist in morbidity and mortality outcomes are not available. This is when compared to other models. Psychosocial consequences between midwife-led continuity models seem obscure. It is either that no specific efficient care models can be identified or the distinction between models overlap. So, measurement of care outcomes become impossible. Further, in comparing midwife- led continuity care model with alternative maternal care types, numerous difficulties are encountered when differentiating between women and the interventions undertaken for them and their infants. Measurement consistency was one of the greatest challenges. This related to women satisfaction with their care when a number of other models were applied. The outcomes were narrated (Sandall & Soltani, 2016). While satisfaction rates showed marked improvement in studies conducted using midwifery-led continuity care model, no clarity emerged. Actually, cost reduction trends surfaced with difficulties understanding the model. Providers comparing the financial implications of using this model in relation to alternatives, found marked irregularities with cost effectiveness, too. These concerns specifically were focused towards identifying the continuity aspect of this care model. Generally, it is perceived that the care continuity framework is complex as a nursing process, while being critical. Despite strategies to keep healthcare costs down always there is the issue of quality being compromised in almost every case. Therefore, when the Different Birth Places Scenario is conceived costs must be adjusted (Dreiher & Comaneshter, 2016). For example, in a community setting, midwifery poses such a challenge. Postnatal care usually embraces a number of home visits. Essentially, mothers’ access pre as well as postnatal care from the same midwife. As such, the limited staff-handovers facilitates enhancement of relationships between mothers and midwives, as well as providers. It allows for more definitive opportunities to identify predisposing conditions before they occur. The face to face interactive home visit sets up the scenario for this to happen. Studies reveal, further, that efficient allocation and routing of midwives in the community setting, could alleviate many challenges encountered in this scenario (Bowers & Cheyne, 2019). One study examined the use of multiple variant travelling salesmen problem integrating logarithmic measurements in to determine cost effectiveness. They were able to estimate the basics of staff preferences in relation to trade-offs between travel time and continuity of care. They combined the algorithm with a simulation method in assessing staff effects availability and consequent outcomes (de Jonge, & Stuijt, 2016). The specifics of this strategic intervention allowed additionally for evaluating shift patterns implicating part-time schedules. It was discovered that care continuity can be reached with small travel time increases without undue costs. Nonetheless, shift patterns remain unresolved again putting care continuity in jeopardy. The conclusion in this scenario is that perfection in care continuity under these circumstances seem obscure. Perfection can only be achieved if there is flexibility in midwives’ visit schedules during community setting interactions (Sandall & Soltani, 2016). Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces This research proposal addresses the issue of Midwifery-Led Continuity Care in Different Birth Places Scenario. Definitively, midwife-led continuity care models are ones providing women with care from the same midwife or team of midwives. This occurs during the pregnancy, birth and early parenting period. Referral to specialist obstetric care is required for interventions to begin (Sandall, Hatem & Daven, 2019). The modality embraces co-ordination care protocols with interactive relationships for an agreed period on time. Different Birthplace scenarios according to this research proposal relates to hospitals, birthing centers, community centers and home deliveries. This research structure would encompass an outline of the Significance of the Practice Problem; Research Question; Theoretical Framework; Synthesis of the Literature; Practice Recommendations; finally, Discussion and Implications for Nursing and Healthcare. The purpose of this study is to reinforce about Midwifery Led Continuity Care in different birthplace scenarios. As results, I hope to deliver a useful material from the point of view of the practicing nurse, where we can also find an interesting field. Significance of the Practice Problem Midwifery-Led Continuity Care in Different Birth Places Scenario has its unique challenges because this is a relatively new care model. The apparent difficulty encountered by healthcare teams relate to it not being an everyday availability to clients. Importantly, it is a model requiring that mothers and their infants be monitored by the same midwife or obstetric team throughout the pregnancy, childbirth and postal natal period. Infant follow up assessments occur immediately after delivery being another care critical requirement. This characterizes the modality being continuity-led midwife care. From studies conducted on the method, continuity is not always upheld in the way intended (Fernandez & Roe, 2019). As such, it is crucial for this study that an investigation be launched into what are the challenges. Particularly, it is finding out reasons for them not functioning as planned and the scenarios where they are best applied. Besides, with the midwifery-led continuity care model, women do not fully understand how it functions to benefit them and their unborn child. While the National Maternity review in 2016 indicated that the model does produce safer care ultimately, by establishing a vison for Maternity care in England, understanding how the model works in different birth place scenarios still cannot be measured (Fernandez & Bick , 2019). Therefore, this study is expected to provide clarify adding to the body of knowledge in this field of science Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Research Questions How is Midwifery-led continuity care model more efficient than other maternity care models? What are the challenges facing providers when executing this model? How can this model be utilized in different birth scenarios? What birthplace scenarios are more adaptable to this model? What care birthplace scenarios are less adaptable to this model? What can be done to enhance adaptability of maternity – led care model in more birthplace scenarios? PICOT Question Do (P) pregnant women in different birthplace scenarios receive (O) safer outcomes when the (I) maternity-led continuity care model is applied versus other (models during their pregnancy (T). P – People: Pregnant women I – Intervention: Maternity -led continuity care model C – Contrast: Other models O – Outcome: Safer Outcomes T – Time: Duration of Pregnancy Theoretical Framework This theoretical framework pertains to models in Nursing Science. Models facilitate focusing on care intervention applications, rather than medical practice. Since nursing moved away from philosophical underpinnings towards scientific deliberations, bringing theory into play, supporting evidence -based protocols models have emerged as the real deal in the care protocols. They allow for combining levels and types of nursing theories into methodologies explaining how nursing process could be improved as well as understood from a logical premise. For example, in this research the Midwifery-led continuity care model is an explanation of how pregnant mothers could access maternal and infant care through a systemic approach of the same midwife or obstetric team for the entire pregnancy. This model limits multiple providers interference within the patient’s care plan. The advantage of this, nursing process and patient safety are enhanced. These are proven valid evidenced – based practices (Homer & Brodie, 2019) Further, it is argued that utilizing antenatal care models efficiently is a current mandatory global policy goal. While this is true, actual implementation could become problematic due to its multifaceted nature. Importantly, opportunities are created for extensive implementation. Sadly, seldom prior evaluations are conducted before the actual implementation. Most times the models applied are rarely understood. This is true of the one being used in the present research investigation. Experts have, however, revealed that very little is known about how processes function and why features do not work. Reasons for providers encountering challenges they do are in explicable. This scenario occurs due to lack of analysis of these models, meaning they may lack the evidence-based practice properties for adequate implementation. There is current evidence informing efficient application of maternal and newborn care (QMNC) framework (McFadden & McNeill, 2016). Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces With this foundation of how care models function being both enhancement and hindrances to care quality, the Middle Range theory espoused by Swanson Caring Theory, guided this Theoretical Framework. It is most appropriate due to the caring assumptions enclosed therein. Specifically, it offers five caring processes: knowing, being with, doing for, enabling, and maintaining belief (Nurse-Clark, 2019). `These can be utilized in nursing education as well as the nursing process. Midwifery-led continuity care model in itself endeavors to provide a caring atmosphere from conception unto early postnatal period for the pregnant woman, fetus and neonate. While not being a distinct midwife caring model combining it with compatible models as in this research investigation, would greatly highlight the caring aspects of Midwife-led continuity care. The truth is that this theory cannot be taken in isolation in this research study whereby, it is sought to review Midwifery Led Continuity Care Different Birth Places Scenario. Precisely, the question is asked Do (P) pregnant women in different birthplace scenarios receive (O) safer outcome when the (I) maternity-led continuity care model is applied versus other models (T) during their pregnancy. Clearly, while the desired outcome is Safer Care , the model adopted plays a significant role in this case. Therefore, combining the two theoretical perspectives is rather valuable to this research study. The caring processes are rather relevant (Nurse-Clark, 2019). Knowing: This means acquiring accurate knowledge of the event through scientific evidence. Nursing science functions from the logical premise of evidence-base practice, developed into models of care, especially, in obstetric nursing. This is the knowing being referenced in this assumption (Côté-Arsenault, 2019). Being with: This means being emotionally present during interactions with the mother, infant and relatives. There is nothing more satisfying than when a mother and relative are being supported, emotionally, by a healthcare provider (Nurse-Clark, 2019). Doing for: This means that the provider willingly makes him/herself available to the client/patient doing first that which he/she cannot do for themselves as well as completing tasks for which they are licensed to carry out, when assigned (Hutti, 2019). Enabling : The provider functions as a facilitator in cases when patients/clients are undertaking transitions during the illness or event. As nursing leaders, it a requirement mandating professional development among staff (Nurse-Clark, 2019). Maintaining belief: This aspect of the care process articulates application of cultural competence when interacting with clients, patients and their loved ones. It could stretch across to other health care providers who may have cultural differences. These differences would force them to have alternative values and belief paradigms. Maintaining beliefs, is allowing everyone to be safe practicing their beliefs be it religious or beyond, while in the same environment (Nurse-Clark, 2019). Synthesis of Literature A minimum of twenty (20) pieces of literature reporting on primary studies will be explored in answering the PICOT question as well as those posed as research questions. However, the PICOT question will be the focus of these deliberations. One study conducting a primary review of randomized controlled trials (RCTs) revealed that a number of criteria were used to measure the outcomes of midwifery-led care models against alternative ones. They were collectively called ‘models of care.” In some cases, an obstetrician or another doctor heads the professional team. In other scenarios it is the midwife. On occasions responsibilities were shared between obstetrician and midwife. A popularly applied model is the midwife-led continuity care. In this type, the midwife assumes the lead professional role. It begins from initial booking appointment extending towards early parenting periods. Researchers were eager finding out whether mothers and their infants received enhanced care with the midwife-led continuity model in relation to alternative models (Sandall, et.al, 2019). Further, researchers found 15 primary studies with a total of 17,674 mothers and babies. They were searched for and found January 25 th , 2016. The sample involved low risk of complications women, higher risk, but not at the time facing any serious obstetrical problems. All trials recruited professionally qualified midwives. None of them utilized care models neither were any delivery or services rendered at home. However, valid delivery methods were applied in evaluating care quality evidence. Seven key outcomes were measured. They included, the amount of preterm births preterm birth (birth before 37 weeks of pregnancy); the risk of fetal death during pregnancy or f during the first month post-natal; spontaneous non-induced vaginal birth labour as well as non-forceps assisted; caesarean birth; instrumental vaginal birth such as forceps or ventouse; ripped perineum , and utilization of regional analgesia like epidural (McFadden & McNeill, 2016). It was discovered that tremendous benefits were derived from women who accessed midwife-led continuity of care. Importantly, they were at least risk for epidural. Additionally, less women episiotomies or instrumental births were reported. Chances of a spontaneous vaginal birth were far more highly probable also increased. Caesarean births incidences remained the same. Remarkably, preterm birth incidences were reduced significantly as well as still birth or infant deaths. In addition, women were more likely to be cared for in labor by midwives they already knew. Care continuity was fully established in each circumstance, since mothers were provided care by the same midwife throughout their pregnancy, childbirth experience even on to early parent procedures (Sandall, et.al, 2019). An independent primary study evaluating continuity of care in a community setting as an exploration into the impacts of different birth scenarios on outcomes. Perceptions regarding maternal and infant health interventions were sought too. The focus of this study was acquiring primary knowledge that inform a postnatal care design based on community care interactions. It was imperative that a model be utilized, which could both explore as well as expose many polices in the care analysis. From this exploration, it was hoped that policies would emerge determining key design parameters. These were expected to enhance understanding towards continuity care implications. In this care the Midwife-led continuity care model was not considered the care protocol (Bowers & Cheyne, 2019). The major concern for this study was whether continuity of care was feasible in a community setting. A number of variables emerged in the study when certain logarithms were applied testing processes and events. This study was conducted in the United Kingdom from a perception that continuity of maternity care entailed specific problems anticipating non-feasibility in this birthplace scenario. Researchers declared that the study itself encompassed a Home Health Care Problem (HHCP) embodying a Multiple Travelling Salesman Problem (MTSP). It was agreed that ultimately when these studies are conducted the goal is reducing travel hours as well as complication in establishing continuity of care feasibility (Bowers & Cheyne, 2019). Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Simulation experiments that were conducted in this study revealed that care continuity at the community level is possible under the given circumstances. It was, however, identified that shift patterns along with part-time work greatly disrupts care continuity. During the postnatal period upon which emphasis is placed in this study, care continuity can be realized. The key to its success, nonetheless, lies in flexible home visits schedules. To think that one hundred percent of care continuity is possible is an ambitious presumption. A seventy percent is a feasible expectation based on the simulation experiment evaluations. Care targets must be compatible with prevailing conditions (Bowers & Cheyne, 2019). In summarizing the evidence gained from this simulation experiment, researchers claimed that the study is greatly relevant within and without health care boundaries. This study also offers suggestions to environments where time and travel implicates quality care continuity. Significantly, activity flows within the simulation modelling experiment embraces measures such as utilization of waiting time along with processes. It must be noted too that ultimately, continuity of service quantitative measures offers simulation strategies applicable to other care quality criterion, relative to the interactions between staff and their patients or clients (Bowers & Cheyne, 2019). The two foregoing citations are entirely different investigations. The first sought to completely review key features of Midwife-led continuity care models versus alternative ones. Fifteen (15) primary studies were assessed for relevance. Obviously, the aims were dis-similar, ultimately the outcomes showed the adjustments, there are distinct differences between randomized controlled trails and simulation experiments. No one is better than the other. There are just not the same. However, the goal in both cases was evaluating how continuity care strategies were applied in unique settings, improved patient outcomes. In both study scenarios researchers utilized measurements peculiar to their desired results. So far, it can be recorded that data was retrieved from sixteen (16) studies, fifteen clusters and one simulation experiment. While these are not at all enough, they represent a whole lot for an investigation of this nature. Another study reviewed relates to an ethnographic study of women living in Brazil entitled Birth Care Providers’ Experiences and Practices in a Brazilian Alongside Midwifery Unit: An Ethnographic Study. The purpose was exploring beliefs, values, experiences, and practices associated with birthing as well as neonatal care. This was a preliminary study in preparation for opening a new birth care facility structure. It was called alongside midwifery units in Brazil. Components of the study as well as desired structure embraced an ethnographic ideology. This meant that the design went beyond obstetric best-practices into the cultural competence of serving this community of women. In my point of view this study is relevant to the PICOT question being that, it implicates both providers’ as well as clients/patients’ predisposition to Maternity Care Involvement (MTI) (Nunes, 2016). The theme of this study while entertaining a purpose was “between the proposed and the possible.” The research process was interesting. Researchers obtained permission from hospital authorities. Research procedure allowed for observation, interpreting, as well as writing the ethnographical text. Culture was defined from inferences due to words and actions of participants. They were studied as groups of individuals. The manner of commination between and among professionals was observed and recorded. They were expected to provide data relating birth and neonatal care. Additionally, how professional interacted with clients/patients during antenatal care, delivery as well as the postnatal era. Even support of companions were observed. These could be spouses and other relatives of pregnant women. The facility, AMU’s natural environment along with their daily practices were considered influential to the study outcomes. For example, the organization would have their paradigm of expectations which were interpreted too. Participant Observation (PO) was conscious of these variables (Longworth & Kingdon, 2019). Researchers arrived at some startling conclusions from their participant observations. Strengths and barriers influencing implementing of an AMU’s midwifery birth care model were identified. Remarkable possibilities were also discovered. Many desired outcomes became evident. For example, synchronizing of values, belief paradigms along with maternal neonatal care were interpreted. Applications were most beneficial when professionals and clients demonstrated common knowledge of these artifacts. Interactions became pronounced when support among professionals, clients/patients and relatives was necessary to enhance the level of care. Notable areas concern related to inclusivity of interdisciplinary team functioning on maternity units. It is believed that they should play a more meaningful role in the overall care interventions as well as continuity (Nunes, 2016). Additionally, they ought to systematically participate in designing AMU’s birth philosophy, which should include care guidelines. Currently, this is not an integrated process within unit functioning. These interventions are important towards enhancing obstetrician’s confidence in achieving birth safety through midwives’ care provisions. They delivery care autonomous provider while being part of a professional. When birth places are shifted various adjustments are required, especially, when care moves outside of the hospital setting. These adjustments implicate a number of factors inclusive of organizational culture, midwife’s participation audits as well as institutional structural adjustment (Douglas & Rosenkoetter, 2015). The foregoing study is different from the previous sixteen reviewed in this literary appraisal. An ethnographic design was adopted. This is somewhat unusual to healthcare practice since the focus of this investigation implicates Maternity -let continuity care in different birthplace scenarios. No distinct healthcare model application was observed as part of the maternity care interventions. Importantly, while care did spread across pre, intra and post-natal segments, no mention of the term midwife led- continuity care was made, even though midwifes took the lead role in obstetric care in this scenario. Attempts at making inferences to both hospital and out of hospital birth places were undertaken with limited specificity than the previous studies. The value of the ethnographic study to this investigation is observing how midwifery-led care was administered to women in this hospital setting (Davis- Floyd, 2019). The eighteenth (18 th ) study to be reviewed in this literature appraisal consists of 17 independent primary Randomized Controlled Trials (RCTs). The researcher conducted a systemic review of these studies. They focused on Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care. The study encompassed A systematic review of RCTs of midwifery-led antenatal care models. These models were Mapped and evaluated comparatively to QMNC framework. Data was data extracted from each model. Forms were utilized to score the information retrieved. Five framework components were found. Researchers teamed up to conduct the data collection process. A quality evaluation applying QMNC framework measurements was conducted based upon an established standardized Randomized Controlled Trial (RCT) criteria (Symon & Pringle, 2016). Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces Thirteen thousand and fifty (13,050) documents citing 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each) were identified. The QMNC framework scores went from 9 to 25 with an anticipated range of 0–32). Incidentally, many models reported less than 50% characteristics linked to quality maternity care. Care model characteristics were limited. However, actual interventions were strong. The way in which care was organized received the best description component. There were some discrepancies regarding foundations of care philosophy in the studies individually as well as collectedly. Thesis aspect was considered under reported (Allen, Gamble, & Stapleton, 2015). A study of interest, which could add value to this literature synthesis thesis as it relates to the selected theoretical framework adopting Swanson’s five care process into understanding the midwife- led Care model in different Birthplace scenarios is Application of Caring Theory to Nursing Care of Women Experiencing Stillbirth. The researchers conducted a primary investigation. The reason for this investigation was to find out the extent Midwives accurately utilized the caring process espoused by Swanson’s middle-range theory as an intervention for comfort as well as emotional support for women grieving the loss of their fetus during labor and childbirth. It was a secondary analysis of primary qualitative interview. Twenty (20) 20 labor and delivery nurses were recruited during grounded theory intervention. A content analysis of how they applied using interactions with women who were grieving loss of their fetus was conducted. The five caring process assumptions of Swanson theory was used to ode behavior as well as interactions over the evaluation. Research concluded that application of the five caring processed were effectively utilized by labor and delivery nurses. Women were therapeutically comforted. while the pain did not go to alleviate the pain of the loss offering comfort. While these were the conclusions, it is clear that this is merely one birthplace scenario (Nunes, 2016). It was communicated that nursing care at this level did not focus on a specific model such as Midwife -let continuity. This seemed not to have existed. The focus was on bringing emotional support to mother and relatives. As such, providers gave attention to protecting and preserving dignity; understanding what the woman was feeling, offering information and explanation on coping with the disappointment. It was important too that she refrain from feeling guilty as well as blaming anyone. Researchers finally declared that the theory was very useful as a support in this particular situation but might not be tart efficient for when someone is going through labor itself (Gordon, 2019). Practice Recommendations Maternity led continuity care model is one among many applied in obstetric nursing across the world. It is more utilized in some countries than others. In attempting to answer the research and PICOT question, many recommendations could be made for future. In reflecting it was asked: 1 How is Midwifery-led continuity care model more efficient than other maternity care models? While at this point of the investigation the answer to this question is inconclusive the recommendation is for more research in the practice of the model since there is limited data on its effectiveness 2 What are the challenges facing providers when executing this model? The obvious challenge relates to solid evidence -based data of its impact within the science globally. Hence, more documentation of outcomes and events within a research context. 3 How can this model be utilized in different birth scenarios? From this research, it was discovered that middle range theories were being used for comforting mothers and relatives during and after stillbirths. It is recommended that the Midwife-led continuity care model be combined with caring interventions. The model can be applied in different birthplace scenarios s 4 What birthplace scenarios are more adaptable to this model? Based on research findings the most appropriate application of this model is within the clinic-hospital setting. Therefore, maternity centers or hospitals should make deliberate attempts to use this model throughout the system.Discussion: Effectiveness of Midwifery Led Continuity Care in Birthplaces 5 What birthplace scenarios are less adaptable to this model? The community settings seemed most difficult to translate this model due to schedules in meetings clients as well as costs. 6 What can be done to enhance adaptability of maternity – led care model in more birthplace scenarios? Training and in some cases adequate funding. In shortage of professionals there is not guarantee that care continuity is possible. PICOT Question Do (P) pregnant women in different birthplace scenarios receive (O) safer outcome when the (I) maternity-led continuity care model is applied versus (C) other models during their pregnancy (T). P – People: Pregnant women I – Intervention: Maternity -led continuity care model C – Contrast: Other models O

Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times Module 4 Assignment Clarification Posted on Jan 28, 2020 8:00:00 AM Hello All! For module 4, you are asked to complete 4 things in a 3-4 page paper. Please see the following assignment clarifications: Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times Number 2 should be interpreted as the quality measures or data you would gather to get information about the wait times. Number 4 should be interpreted as the tools or models you would use to collect this information such as those found in under the module 4 lesson content link – “Models for Collecting and Analyzing Data”. The latest quality report showed that the average (median) time from emergency department (ED) arrival to transfer to the inpatient unit at your facility was above the national average of 275 minutes (4.5 hours, based on current Hospital Compare data). Your quality improvement team will review some emergency department data to help determine where there may be issues affecting wait times ( Download the ED data spreadsheet here ). The length of time patients wait to be admitted to the unit or discharged from the Emergency Department (ED) exceeds the quality goal set by your hospital of 275 minutes (which is the same as the national average benchmark). Write a 3-4 page paper (in APA format) that: Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times Calculate the wait times for each patient and determine if they are consistently above or below the 275 minute average. Identifies the tools that could be used to gather information about the wait times (such as number of patients being registered, patient volume by time of day or staffing). Determines the departments and units that could be involved in improving this issue. Selects the tools that would be needed to collect data. Chapter 4: CHAPTER FOUR What to Measure—and Why I n many organizations quality is a vague concept, and one that is thought to be completely subjective and therefore unscientific. However, quality can be objectified by developing clearly defined measures, collecting data about those measures, analyzing the data, and communicating the resulting information to appropriate individuals. Quality measures, which are required by regulatory agencies, can offer health care leaders information to assess and improve patient care and to ensure that they have timely, efficient, and effective care, with expected outcomes. Included in the definition of quality care is compliance with the CMS (Centers for Medicare and Medicaid Services) evidence-based indicators (such as aspirin for acute myocardial infarction, antibiotics for pneumonia, and smoking cessation counseling at discharge). When measures are used quality can be defined objectively and scientifically. In this chapter I will outline how measures can be developed and used to offer health care professionals, both clinicians and nonclinicians, information to improve the quality of care delivered in their institutions. I will also describe how the use of quality methodologies, such as the PDCA for performance improvement, can provide a framework for developing appropriate measures and for monitoring and improving various aspects of the delivery of care. LEADERSHIP DETERMINES WHAT TO MEASURELeaders lead according to a value system, defining the kind of organization the institution should be. It is up to the senior leadership of the hospital to define the level of quality that is acceptable and the level that is not. Leadership defines priorities by answering such questions as these: • What aspects of the organization are critical to its success? • What expenses are most and least profitable? • How can excellent patient outcomes be achieved efficiently and economically? Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times • What variables influence patient satisfaction? These and many other factors need to be understood and balanced—through measures. With objective criteria in hand, administrators have access to quality variables and can use factual information to make decisions. Becoming familiar with and using quality measures to deliver quality care helps the health care leader to do the right thing for the patient and to increase financial efficiency for the organization. The better the care, the fewer the complaints, complications, and incidents. When administrators understand how measures of quality reflect operational processes, clinical care, and patient services, as well as underlie good financial management, they become more comfortable about monitoring the delivery of care they are responsible for. Leadership and a strong quality management department should collaborate on using measures to understand the processes, procedures, and operations that have positive and negative impacts on patient care and organizational processes. MEASURES DEFINE QUALITY CAREPrevention is good medicine and helps the organization maintain its financial stability. Measures should be used to establish benchmarks for preventive processes—processes such as monitoring sterilization to prevent infection, providing fall prevention, preventing skin injuries, or reducing length of stay (LOS) through appropriate and timely antibiotic administration. For example, to decrease expenses, increase efficiency, and produce good to excellent outcomes, leadership needs to control nosocomial (hospital-acquired) infection. Specifying the numerator and denominator of the measure ensures that it accurately reflects the information you want to collect. For instance, the general infection rate can be computed as the relationship between the number of patients who contract any infection within a month (the numerator, or N ) divided by the number of patients admitted to the hospital per month (the denominator, or D ). However, if the information you want is more specific, you define the measurement accordingly. If you are concerned about the incidence of sternal wound infections postsurgery, N becomes the number of postsurgical patients with wound infections over a specific period of time divided by the total number of surgical patients over that same time period ( D ). Once the measure is defined and the rate can be calculated, the information can be tracked over time. Collecting such measures allows an administrator to monitor trends, such as whether infection is rising, decreasing, spiking, or comparable to the national benchmark. Figure 4.1 illustrates the rate of surgical site infection in one hospital over a twenty-two-month period and shows that its rate is, by and large, lower than the national benchmark. Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times By carefully defining a measure, with the specific numerator for the objective of the study and the denominator delimiting the population of which the numerator is a subset, leaders can objectively and productively study performance, success, and opportunities for improvements. The data in Figure 4.1 , for example, show that spikes in infection occur in the same months each year (January–February and September). With that information leadership can drill down in their data and attempt to analyze what might be contributing to the rise of infection during those months. MEASURES INFORM FINANCIAL DECISIONSData regarding the specifics of care help administrators make efficient financial decisions. For example, the nursing shortage in this country has resulted in staff vacancies that have had an impact on patient care. CEOs and senior administrative staff are expected to make hiring decisions, but how? Using what information? In other words, what are the criteria for evaluating long-term versus short-term investment decisions? Hiring decisions obviously have an impact on the budget, but unless administrative leadership uses objective measures to look at the specifics of operations, evaluates the effectiveness of services, and gauges the effect of staff-patient ratios, how can they understand staffing requirements and the relationship between staffing and patient outcomes? Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times Figure 4.1. Surgical Site Infection Rate over Time. Many health care institutions are in financial difficulty because important decisions are being made without adequate understanding and information. Think of open-heart surgery and its huge requirements in terms of the operating room (OR), intensive care unit (ICU), specialized staff, and ancillary services and then compare those requirements to, for example, the treatment of patients with pneumonia, a far less resource-intensive hospitalization, assuming, that is, that the patient does not develop complications. Variables for both these conditions can be measured. Information (that is, data) about these variables gives administrators insights into the relationships among services, outcomes, and resource needs. Tracking several potentially related variables can offer leadership important information. Figure 4.2 combines two variables, LOS and readmission within thirty days, across eight hospitals. If a patient requires readmittance within thirty days of discharge, it is possible that that patient was discharged prematurely or that the care was in some way deficient or inadequate. If administrators examine only LOS, they might believe that the shorter the LOS, the more efficient the hospital. However, if the hospital with a short LOS has a high rate of readmittance, as Hospital B does, then leaders may want to investigate and target improvements. Hospital D has both a long LOS and a high rate of admittance, suggesting inefficiencies of care that have financial consequences. Hospital G is providing the most efficient and effective care. Because the government reimburses institutions according to the complexity of each case (using the case mix index, or CMI) and the procedures required to treat specific diseases, financial resources are dependent on clinical considerations and operational processes. For open-heart surgery cases, a measurable variable, such as turnaround time in the operating room, can have a financial impact for the institution. If the first procedure of the day is postponed due to operational issues, then for the rest of the day procedures are late. Late procedures have implications. It may become necessary to hire extra staff to work into an evening or night shift. Any complication during a procedure tends to cause expensive delays. Therefore good clinical supervision with clinical support can reduce such expenses. Ideally, a finance officer and a senior administrator learn enough about the delivery of care to ask intelligent questions and establish appropriate measures for data collection and analysis. Figure 4.2. Length of Stay and Readmissions Within Thirty Days. Tools and technology and even staff cannot be evaluated as a unidimensional financial expense. An administrator or financial officer can collect data in order to understand the complexity of services. For example, in the ICU there is usually a one-to-one patient-staff ratio. However, administrators may want to know if that ratio is crucial to the welfare of the patient, if the expense results in improved outcomes, or if it is simply a high degree of (perhaps unnecessary) monitoring. Analyzing measures helps an administrator discover the clinical as well as the financial value of a service. When leadership understands clinical care, financial decisions are not made in a void. MEASURES AND PURCHASING DECISIONSThe financial implications of purchasing decisions are entwined with various aspects of patient care, and intelligent decisions cannot be made without an understanding of other expenditures and the impact on patient outcomes. Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times Administrators should consider using their quality management departments to mediate information between finance and the medical requirements of care. Quality indicators can help administrators determine the value of specific services, such as whether an elaborate (and expensive) CAT scan will result in better patient outcomes. Without data there is no way to assess whether more sophisticated technology should be purchased. With data, leadership can expect answers to such reasonable questions as what are the financial and clinical implications of a 64-slice CAT scan, and how will it be better for patient care than a 34-slice scan? The medical staff may request new equipment, but it is up to leadership to understand that equipment’s relative value to the organization. Measures improve administrative understanding by providing detailed information. Some decisions regarding expenses may have far-reaching implications, others may be of less consequence. Purchasing improved cardiac stents, for example, may reduce bleeding and complications from the stent procedure, so although this purchase is expensive it may result in fewer complications, a shorter LOS, and therefore a better financial situation than the hospital would have if the purchase were not made. Data collected over time would reveal the value, and leadership would be able to intelligently monitor costs and benefits. Likewise, robotics technology is very costly. Without objective data it would be difficult to determine if such an expense is of worth to the patients and to the hospital. Information can be collected about the volume of patients who might be attracted to the institution if robotic surgical procedures were in place and the outcomes were excellent. A financial assessment could be projected based on those numbers. Obviously, numbers provide a great deal of crucial information for decision making. An example of a quality variable that reveals a great deal about operational and financial efficiency is mortality. Administrators should collect these measures monthly in order to monitor the delivery of care and the services being offered. If there are problems, for example, if there were three unexpected mortalities in the OR, there may be a problem that requires addressing. Mortalities cost money. Reports have to be filed with appropriate agencies; malpractice suits can occur; peer reviews have to be conducted. If the source of the mortality is infection, then corrective actions have to be put in place. If the source of the mortality is clinical incompetence, intervention or reeducation can be conducted. But it is most important to know that the mistakes occurred and then to ascertain the causes in order to develop appropriate improvements. Administrators look at mortality reports and often go looking for someone to blame, rather than considering the situation as an opportunity to improve the delivery of care. If the hospital reports a high mortality rate for a specific procedure, such as cardiac bypass surgery, or for a particular patient population, such as heart failure patients, there might be a financial impact associated with that report because patients with these conditions or who need these procedures may be less attracted to the hospital. The public understands mortality data. (Physicians may say the data are flawed or not risk adjusted, but if the data are out there and the public is afraid, people won’t come to the hospital for treatment.) Operationally, it may be important to understand why the rate is high so that specific processes can be targeted for improvement. Quality issues and operational issues are interdependent. If data reveal that patients with certain conditions, such as elderly patients with AMI, have a higher incidence of mortality than others, then the care of that patient population has to be carefully reviewed. If patients from certain nursing homes die at a higher rate than others because those patients have comorbidities that are having an impact on mortality, then improving risk assessment might increase safety for those patients. These questions can be empirically tested through developing measures, collecting data, and analyzing trends. MEASURES AND PATIENT SAFETYQuality management data are required by agencies for accreditation and for compliance with regulations, but data are also collected as part of various national programs to assess and improve the quality of care, such as the CMS core measures, the Institute for Healthcare Improvement (IHI) 100,000 Lives Campaign, and the National Patient Safety Goals initiative of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (see Figure 4.3 ). JCAHO mandates that each of its goals be implemented; the individual organization determines how to implement each goal. For example, to improve accuracy of patient identification, an organization is required to check two patient identifiers before administering medication, blood products, or performing clinical testing, treatments, or procedures. The hospital determines which two identifiers it will use. Improving communication involves ensuring that phone and verbal orders are properly understood; JCAHO recommends that hospitals require a read-back by the person receiving the order. Medication safety involves several improvements: limit drug concentrations, review look-alike and sound-alike drugs to prevent interchanges, and label all medications. For infections, comply with CDC guidelines for hand hygiene. These goals and their implementation recommendations can be found at the JCAHO Web site ( jcaho.org ). Figure 4.3. JCAHO’s 2006 Hospital National Patient Safety Goals. Note: Because JCAHO has retired some goals over the years as it has added new ones, the numbering of current goal sets is no longer consecutive. The data about safety are collected, and administrators should use the information to understand their operations; furthermore, because quality management data are benchmarked against national standards, administrative and other leaders can evaluate how their operations compare to other institutions. Through measures and benchmarks the data provide relevant information about daily performance and about areas where improvements should be instituted. The IHI 100,000 Lives Campaign is the first national initiative to prevent avoidable deaths in hospitals and to implement change to improve patient care. The goal is to save 100,000 lives as of June 14, 2006. Highlights of the prevention program include the creation of rapid responses teams, using evidence-based care for AMI, preventing ventilator-acquired pneumonia, preventing indwelling venous catheter infections, preventing surgical site infections, and preventing severe drug events. QUALITY METHODOLOGY FOR PERFORMANCE IMPROVEMENTCollecting data on an operational variable, such as blood administration, waiting time in the ED, turnaround time in the OR, or time to receive consultations or laboratory reports, reveals information about efficiency; efficiency has an impact on the financial success of the institution. In addition to using the quality management department to establish databases and benchmarks for best practices, the organization can use quality methodologies, such as PDCA and Six Sigma, that help analysts to inform administrators about services and to improve the delivery of care. Using quality methodologies may enhance the assumption that excellent care is equal to a sound business plan and economic success. However, a simple economic model might even be in opposition to the mission of a hospital, which may be to serve the poor and the underserved. Such patients may not have the luxury of focusing on health prevention in the way that individuals with economic means and health insurance do. This lack of prevention might result in more sickness, which might in turn burden the hospital because it will be providing expensive care without reimbursement. Such expense can be anticipated, however. Therefore those expenses within the organization’s control should be maximally efficient. Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times As long as the CEO is using a methodology that is based on data and statistical analysis, measures help employees and managers and administrators and members of the governance committees to share clearly defined goals that stem from a specific philosophical position and to share a commitment to excellence and improvement. Using any deliberate methodology creates a focus for addressing the process of care or product or service. With numbers, administrators can suggest, for example, improving the volume (that is, raising the numbers), eliminating wasteful services (as measured through volume and finance), improving productive services, and targeting specific goals. Six Sigma is a methodological tool designed to reduce the negative economic impact of inefficient services. Based on the concept of the normal curve, Six Sigma was initially used as a measurement standard in product variation. In the 1920s, Walter Shewhart showed that three sigma from the mean is the point where a process requires correction. As a quality management tool for health care, Six Sigma is useful for analyzing and improving operational processes through measuring how far specific data vary from the mean. For example, to understand turnaround time in the OR, data can be gathered about timeliness of patient preparation, OR readiness, equipment reliability, surgeon start time, readiness of appropriate ancillary staff, availability of required documentation, causes of delays, if any, and analysis of morbidity that might require extra OR time or an unanticipated return for repair. All of these variables can and should be measured, and each has a financial analogue. Once the inefficient process is identified, improvements can be developed. The Plan Do Check Act (PDCA) cycle is a robust performance improvement methodology, and one that works particularly well in a health care setting. This model was also developed for monitoring quality improvement in industrial settings and is designed to standardize processes and minimize variation, that is, eliminate mistakes and rework. The PDCA cycle, by breaking function and role into variables that can be measured, helps leadership understand the clinical and medical environment and the method of providing care. Using the PDCA cycle to continuously improve quality allows current performance to be measured, processes to be analyzed, and improvement actions to be identified (Plan). Improvement actions are then implemented (Do), and the benefits of the actions are measured (Check). Once measured, improvements can be standardized and communicated and reassessed (Act). The PDCA cycle provides for the systematic acquisition of knowledge through focused data collection and, through measurements, validates that improvements are effective (see Figure 4.4 ).Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times There are many advantages to using an industrial performance improvement model, such as PDCA, to continuously evaluate improvement and determine variation from the standard. The PDCA cycle provides a continuous loop of quality monitoring, based on data from measures. By defining the numerator and denominator of a measure, leadership can objectively understand the product being delivered, and by holding staff accountable to these measures, leadership clearly anticipates a uniform standard of excellence. As with most complex activities, doing something according to a plan is more productive than simply reacting to some stimulus on the spur of the moment. In health care, planning involves collecting information and analyzing current processes, identifying gaps in care, establishing improvements, and monitoring their effectiveness. Making improvements or changing processes is often met with resistance and confusion over accountability (who is in charge) and details of the process changes (who is doing what). Figure 4.4. A Quality Improvement Methodology: PDCA. My experience shows that to improve a process, adopt new information, and actually change the delivery of care, the unit manager and the clinicians benefit by working within a methodology, such as the PDCA, that continuously and objectively reviews and evaluates their actions. The PDCA method allows the professionals to pause and consider the workload with a critical eye. Working with many patients, with multiple diagnoses and treatment plans, caregivers require a method that directs and prioritizes activity. Daily planning must be continuously communicated, from the beginning to end of shift, through the changes in shift, and to the end of the shift to maximize efficiency and reduce potential for errors. DEVELOPING A PERFORMANCE IMPROVEMENT PLANEvery aspect of the PDCA cycle depends on measurements, not of an individual’s experience but of a population of patients. The first stage, Plan, requires that stakeholders, who have similar goals, formulate an assumption about care, in other words, develop a hypothesis. The hypothesis may be derived from external or internal sources. For example, because the CMS requires smoking cessation counseling for pneumonia patients, administrators may assume that most of the patients are receiving the recommended counseling. Their assumption may be that clinicians are incorporating patient education about smoking into their practice. Data can be collected to confirm that assumption. Quality management can develop a methodology for chart review and determine the percentages of patients who have had the counseling and of those who haven’t. With this information in hand, further analysis can drill down in the data and examine the records of those patients who did not receive counseling to see if they have any areas in common, such as physician, unit, secondary diagnoses, and so forth. However, without quantifying the process, it is hard to convince anyone that there is a problem, let alone that it should be fixed. The assumption or hypothesis should reflect areas of concern to the investigating team. Another assumption might be that patients who are given antibiotics before surgery have fewer infections than patients who are not given this medication. This is a testable assumption. Other testable assumptions are that patients who develop pneumonia on ventilators were not properly weaned off the ventilators, and that patients who fall do so because of a desire to be mobile when there are insufficient staff to assist them. Administrators and staff should meet together to determine which assumption to measure and which care process to improve. In the planning stage organizational culture should be evaluated to determine whether there are possibilities for change and whether a structure exists to implement changed practices. Leadership chooses which battles deserve to be fought; not every process needs to be changed, and different stakeholders may be interested in different issues. Physicians may be concerned with high mortality, surgeons with infections, nurses with falls, and respiratory therapists with ventilator-associated pneumonias. It is up to the administrative leadership to determine priorities, perhaps based on the goals, mission, and vision of the institution or derived from external pressures from the public and the media or revealed on some scalar dimension by such questions as which problem poses the highest risk, where can the impact of improvement efforts be greatest, or where can financial gains be seen? The senior staff of the organization decides priorities for improvement, what outcomes to look at, what processes to change, which measures to use, and what process to develop to monitor, assess, analyze, and communicate the results of the data collection activities. Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times Before you determine your measures it is essential to define your clinical or operational goals, establish priorities, and understand the patients (the organization’s customers) and their concerns and priorities. The quality management department at our health system developed a prioritization matrix to help decision makers evaluate competing issues for performance improvement (see Table 4.1 ). Competing issues for improvement are listed across the top of the matrix. Each issue is evaluated by the criteria listed along the side of the matrix—such as alignment with leadership goals and vision, impact on the delivery of care, or outcomes showing a negative trend. Different organizations will define their criteria differently, but it is useful to think about prioritization in terms of structure, process, and outcome. For each issue a value is entered in each cell of the matrix, from 0 to 3 (no application to maximum concern) and these values are totaled. A comparison of the totals defines the most pressing priorities. By objectifying and quantifying priority options, stakeholders have an opportunity to evaluate and consider how to allocate resources. Table 4.1. Prioritization Matrix. In the Plan stage the stakeholders should be able to realize that change is possible and that change would be good for the institution, the patients, and themselves. Even this initial point may be difficult because often caregivers see no need for improvement, an attitude that there is no reason to fix what isn’t broken. Tradition—doing things the way they have always been done—makes people comfortable. However, acquiring data usually reveals that improvements should be made. When the senior staff agree on priorities, develop assumptions about performance improvement, and assign responsibilities for roles and functions within the organization, the Do phase of the cycle begins. The stakeholders of a process or procedure determine the improvement. For example, surgeons may want a better assessment for administering antibiotics in a timely way. When weaning protocols are being reviewed, the pulmonary physicians and the respiratory therapists are the stakeholders, as well as the nursing staff. If falls are being investigated, perhaps a multidisciplinary committee can develop an improved risk assessment screen for patients who are at high risk for falls. The Do phase is where a change is designed and relevant measures (numerators and denominators) are defined to monitor the process of change and the improvements. Also in this phase, procedural details are developed, such as which staff members will be collecting data for the measure, how the data will be collected (in what form) and reported (to whom), who will analyze the data, over what period of time, and how the results of the analysis will be reported out and to whom. Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times As always, the measure is defined by what the stakeholders want to know. If mortality rates are at issue, then the group may want to look at various procedures and have analysts analyze mortality according to various clinical services, patient populations, treatment, and diagnoses, whatever is of interest to leadership and staff. It is a good idea to review the literature for existing methods of data collection and analyses. Established studies can become benchmarks for the standard of care. Once the design of the measure and the data collection efforts have been accomplished, improvements and changed practices are designed and implemented. The Check phase of the PDCA cycle is used to monitor the new procedures and to see if they are successful. New measures may need to be developed, such as the timing of antibiotic administration. During the Check phase it is important to keep monitoring the improvements to ensure that they are maintained. This phase is the evaluation phase, in which the program under study is assessed. It is useful to ask the stakeholders and the medical board for input, in order to increase confidence in the improvement efforts. In the Act phase, changes are implemented, a procedure that requires administrative commitment. During this phase a table of measures can be developed that will provide a snapshot of improvements (or the lack thereof) over time. In this stage it is also important to effectively communicate information about changed processes throughout the organization, from the bedside workers to the members of the highest governance committees. Assignment – Identify Tools for Developing a Plan to Reduce ED Wait Times CASE EXAMPLE: PLAN DO CHECK ACT

Case Study on Moral Status Essay Case Study on Moral Status Essay Permalink: https://nursingpaperessays.com/ case-study-on-moral-status-essay Case Study on Moral Status Based on “Case Study: Fetal Abnormality” and the required topic study materials, write a 750-1,000-word reflection that answers the following questions: What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity? Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected? How does the theory determine or influence each of their recommendations for action? What theory do you agree with? Why? How would that theory determine or influence the recommendation for action? Remember to support your responses with the topic study materials. ORDER NOW FOR ORIGINAL, PLAGIARISM FREE PAPERS While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Case Study on Moral Status Essay This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Attachments PHI-413V-RS-T2CaseStudyFetalAbnormality.docx RUBRIC Attempt Start Date: 01-Mar-2021 at 12:00:00 AM Due Date: 07-Mar-2021 at 11:59:59 PM Maximum Points: 200.0 Topic 2 Study Materials Practicing Dignity: An Introduction to Christian Values and Decision-Making in Health Care ***PASTED BELOW*** Read Chapters 2 from Practicing Dignity . URL: https://www.gcumedia.com/digital-resources/grand-canyon-university/2020/practicing-dignity_an-introduction-to-christian-values-and-decision-making-in-health-care_1e.php God, Humanity, and Human DignityBy Nathan H. White “Great are you, O Lord, and exceedingly worthy of praise; your power is immense, and your wisdom beyond reckoning. And so we humans, who are a due part of your creation, long to praise you—we who carry our mortality about with us, carry the evidence of our sin and with it the proof that you thwart the proud. Yet these humans, due part of your creation as they are, still do long to praise you. You stir us so that praising you may bring us joy, because you have made us and drawn us to yourself, and our heart is unquiet until it rests in you.” (St. Augustine, trans. 2001) Case Study on Moral Status Essay Essential Questions What does it mean to be a human being? Why does a human being have value? What is meant by the concept of personhood? What are the practical implications for the value of human beings within a health care context? Introduction Humankind’s restless heart is an invitation to be involved with the human endeavor and particularly with those who are sick and dying. In caring for other human beings while loving God, human hearts may feel flooded with the fulfilling praises of God. Those called as nurses can praise God through their hands, bodies, minds, hearts, and spirit, and will make decisions that may decide life and death. They may even help others find salvation. St. Augustine writes, “My heart is listening, Lord; open the ears of my heart and say to my soul, I am your salvation” (St. Augustine, trans 2001). This chapter will address why nurses carry this care to others based upon the Christian belief that every human being is made in the image of God. One of the main hallmarks of the medical profession is its interpersonal nature. Medicine is, if nothing else, a very human profession. A nurse gives medicine, offers comfort to a dying patient, educates patients about their diseases, and walks with patients through their medical treatment. Interpersonal caring defines the experience of the profession. Throughout history, health care professionals have acknowledged and celebrated the compassionate nature of nursing as its motivation and foundation. Although the vocation of nursing centers around caring for other human beings, medical professionals often do not stop to ask why they are doing what they are doing or what it is about another human being that warrants the kind of involved, and often difficult, care that nurses provide day in and day out. In seeking answers to these questions, the inherent value of human beings becomes apparent. Nurses frequently empathize with others and want to do the best for them, and this is to be applauded. Yet primarily, the Christian belief that human beings are created in the image of God , or imago Dei , undergirds the value and dignity of every human being simply because of his or her existence. This belief suggests certain practical implications in a range of contemporary health care issues, such as abortion, in vitro fertilization, the definition of death, and euthanasia. This chapter will begin to address many of these topics by looking at ways that science, philosophy, and theology have attempted to answer them. What Does It Mean to Be a Person? While the question “What does it mean to be a person?” may at first seem to be a straightforward question, scientists, philosophers, and theologians still debate the answer. Some perceive a person to be only a physical body with a brain dependent on the body. This is called physicalism . Others suggest that each person has a body and a soul . This is termed dualism . Some have more complicated understandings of the human person that identify the significance of characteristics, such as reason and the search for meaning, that separate human persons from other living organisms. Each of these descriptions of a person understands a human being in a different way. In the field of health care, how health care professionals approach what it means to be a person uniquely informs treatment options. Case Study on Moral Status Essay For example, if a physician perceives a human as having an eternal soul, practitioners will craft treatment that involves this spiritual reality. If a person is understood as having only a physical body, treatment will focus entirely on these options. Every nurse already approaches a patient with an idea of what a person is, and the goal of this chapter is to raise awareness of the reality of the personhood that lies within every patient. At its most basic level, being a person means that an individual has inherent worth. The person possesses moral, ethical, and legal rights that a nonperson does not have. Generally, in the Christian tradition, personhood has been understood as a substantive nature that all human beings possess. A person may also possess certain traits, such as faith, reason, moral capacity, and consciousness, that enable deep mutual relationality with other persons, including God. In the Christian understanding, personhood is inherent to human beings and is not merely based upon recognition of certain capacities, such as reason, moral capacity, and consciousness. Worldview and the Question of Personhood Worldview significantly impacts the understanding of what it is to be human and to be an individual person. Some believe that God or a transcendent source gives human beings value. Alternatively, another may understand humankind as simply being at the top of the food chain, within the closed system of natural selection. Yet an individual who believes in the existence of God would find God’s nature to be of primary importance for understanding what it means to be human. On the other hand, an individual who subscribes to the worldview described as scientism would assume that science can completely answer the question of what it means to be human. In each of these cases, the question of personhood is not primarily a scientific one, but rather a philosophical one. Additionally, an individual’s worldview about personhood directly influences decisions regarding the care and treatment of patients. Nurses and other health care professionals may think that beliefs and actions separate easily into different boxes without mutual interaction. In reality, beliefs and assumptions about the world significantly shape interactions with the world. This is easily seen in health care situations. If belief in God shapes understanding of personhood, a nurse may display his or her faith determining the care that is needed based on personal and professional perception as well as listening attentively to the patient. If a practitioner perceives a person as being only a physical body, personal interaction with patients and health care considerations may remain at the level of basic physical care. For example, in the context of palliative care, what constitutes a human person may help decide when to withhold or withdraw treatment from a patient. If quality of life is assumed to be the only consideration for care, treatment could be withdrawn too early before other methods of comfort care are considered. Alternatively, the Christian worldview makes it clear that every human being is approached as being made in the image of God and worthy not only of quality care for physical ailments, but also of complete care for both body and soul. The Metaphysical Question: What Kind of Thing Is a Human Person? The Bible describes the need to reverently consider the mystery of the human person. Some 3,000 years ago, the writer of the Psalms, prayerfully reflecting on the finitude of humanity and the mystery of God’s relation to human beings, wrote, “what is man that you are mindful of him, and the son of man that you care for him?” (Psalm 8:4 English Standard Version). Yet the psalmist does not specifically relate what is so special about human beings or what about human nature separates them from other creatures. Case Study on Moral Status Essay In the postmodern health care situation, nurses will find many understandings of the human person suggested by other professionals and patients. For example, some philosophers, such as Hume, have hypothesized that human beings are only a collection of perceptions. Some, such as Searle, say humans are the creators of their own reality, while others, such as Wittgenstein, say that human beings might not exist at all. All these viewpoints may exist in the health care setting. Yet within the Christian religious tradition, human beings themselves are inherently deserving of dignity and respect. Because, in creation, God made human beings in his image, personhood has a transcendent origin; therefore, human dignity should be recognized and valued in all human beings. Practically, the truth of human dignity calls forth respectful treatment from others. For instance, people who consider themselves as having dignity would not let others treat them in a demeaning or degrading manner, but rather would consider themselves as being worth more than such treatment would suggest. Thus, individuals would look at themselves as being inherently valuable and deserving of proper treatment. Dignity logically relates to the concept of human rights. People rightly view abuses against human rights, such as genocide, as being among the worst kind of offenses. But the exact nature of these human rights is not clear. The U.S. Declaration of Independence suggests that human rights refer to the right to “Life, Liberty, and the pursuit of Happiness,” but others may consider human rights as being more or less than this. For instance, some consider the right to life as the most primary of human rights, while others recently have included access to high-speed Internet as a human right (Human Rights Council, 2016). The range of viewpoints is quite staggering. Unless practitioners can determine the source of these rights, whether from God or elsewhere, then there is little reason to ascribe rights to human beings any more than to any other entity. A medical professional’s beliefs about what constitutes a human being significantly impact actions when caring for a sick or dying patient. The person of Christian faith sees the human being as a creation of God. In the Bible, the psalmist wrote as a prayer to God, “I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well” (Psalm 139:14a). Clearly, in the psalmist’s view, human beings have a special relationship to their Creator who made them in such an extraordinary way. The relationship of human beings to God and to other creatures is, then, of utmost importance. Scientific Classification: Human Persons in Relation to Other Species The scientific classification system, based on the ancient Greek philosopher Aristotle’s thought, divides up entities into various categories based upon observed traits. The basic differentiation is between the nonliving or the living, with further differentiation into categories such as animal or plant, vertebrate or invertebrate. In regard to human beings, the species labelled Homo sapiens , such classification labels describe shared characteristics between human beings and other animals. This is helpful to describe what a human being is like, but this does not, in the end, provide an answer regarding what kind of thing a human being is. For instance, it cannot not explain why human beings have particular characteristics, such as reason, emotion, or spirituality. In his The Origin of Species , Charles Darwin, the originator of the naturalistic theory of evolution, attempted to explain human existence without reference to a divine being. Naturalistic evolution has roots in this system of taxonomy and views the law of survival as the driving force behind the onward movement of life itself. Naturalistic evolution, though, fails to answer some questions fully, such as why human beings exist or how nonphysical phenomena, such as consciousness, arose from purely physical origins. Case Study on Moral Status Essay Darwin’s Thesis Published in 1859, the full title of Darwin’s book is quite telling as to its thesis: On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. Human beings, in this understanding, are the most advanced form of life on earth, but are not the ultimate end to evolutionary progress. One implication of this viewpoint is that continued human enhancement is not only acceptable but is almost mandated in the onward march of progress. Another implication follows from this: Human beings are merely one stop in nature’s continuing development in the evolution of living things. Yet if human beings are not different kinds of things than a beetle, then there is little ethical reason that they should not both be treated in a similar manner. If it is ethically justified to kill a beetle, naturalistic evolution provides little justification for not treating other organisms, including human beings, likewise. In their assessment of justified ethical treatment for animals, some secular ethicists, such as Peter Singer (1975), argue animals should receive just as much consideration as humans. Theistic Evolution Some individuals ascribe to belief in theistic evolution, wherein God is understood to have created all that exists but chose to use the process of evolution to develop the world to what it is today. This approach resolves some fundamental difficulties with a naturalistic account of evolution, but it also may raise other difficulties. In naturalistic evolution, the existence of phenomena such as the soul, ideas, conscience, and love are either created by physical factors, such as brain chemistry, that assist to aid survival or do not exist at all. For example, philosopher Richard Rorty (1982) wrote, “There is nothing deep down inside us except what we have put there ourselves, no criterion that we have not created in the course of creating a practice, no standard of rationality that is not an appeal to such a criterion, no rigorous argumentation that is not obedience to our own conventions” (p. xlii). Thinking, emotions, faith, and self-awareness, then, come merely as a means of aiding physical survival. This is a form of reductionism called physicalism in which human persons are treated as nothing but physical material. This reductionism is an implication of scientism, and it has negative effects in health care because it reduces human beings to merely a system of physical phenomena rather than multifaceted beings who should be cared for holistically. In contrast to reductionism, dualism is a viewpoint that sees human beings as complex entities consisting of multiple levels; therefore, dualism offers a foundation for understanding human thinking, emotional awareness, and spiritual reality. Case Study on Moral Status Essay Dualism The characteristics that differentiate human beings from other living species are nonphysical realities, such as mind, soul, or spirit . Dualism views the human person as being made of both the physical body and nonphysical realities, such as the soul. The soul is intricately connected with the body but is not identical to the body and continues after the physical death of the body. In the history of Christian thought, some thinkers also regard the human person as being comprised of body, soul, and spirit. Theologians and philosophers debate exactly what constitutes the nonphysical reality of human beings, with much debate even about the existence of the human mind. The contents of belief regarding nonphysical phenomena may differ, but that such a reality exists is affirmed by many. In recent years, empirical research has supported the reality of human transcendent phenomena. Modern research has shown the efficacy of nonphysical, even spiritual, elements in creating beneficial medical outcomes (Koenig, King, & Carson, 2012). Many medical studies have demonstrated that spiritual and religious activities, such as prayer, religious service attendance, and meditation, have positive health outcomes. Alternatively, spiritual maladies, such as unforgiveness and anger, have corresponding negative physical health outcomes. Additionally, other nonphysical phenomena that are not specifically related to spirituality, such as expectation, reappraisal, and worldview, have been shown to have significant effects upon physical outcomes, including the experience of pain (Tracey, 2010; Wiech, Farias, Kahane, Shackel, Tiede, & Tracey, 2008). Many Christians and other religions believe that a spiritual reality exists beyond the physical; this spiritual reality interfaces with the physical realm, but it is also separate from it. In this understanding, the human being is more than a body, and some part of the human being can survive physical death. As an example, in this view, the human mind is separate from the human brain, though the mind interfaces with and is in some way dependent on the brain; therefore, damage to the human brain can influence expression of the human mind, but it does not eradicate or permanently damage the mind, the soul, or the human being. Case Study on Moral Status Essay The Question of Value? Many medical professionals perceive human beings as being inherently valuable and see belief in God as being foundational to their work. They want to ensure the care of other human beings because each person would want to receive such care. This attitude has been summed up in the Golden Rule: “The second is this: ‘You shall love your neighbor as yourself.’ There is no other commandment greater than these” (Mark 12:31). Human beings seem to implicitly recognize some aspects of right and wrong, including the inherent value and worth of human beings. For instance, C. S. Lewis in The Abolition of Man (Lewis, 1944/2001) identifies the reality of consistent moral standards across diverse cultures around the world. Murder, rape, and kidnapping are almost universally regarded as wrong. Mauthausen survivors cheer the soldiers of the 11th Armored Division of the U.S. Army one day after their actual liberation. The banner reads: “The Spanish Anti-Fascists Salute the Liberating Forces.” Photo courtesy of National Archives and Records Administration, College Park. Value and ethical judgments such as these seem to indicate that human beings have a different status from other creatures. This suggests that human beings should not be treated in degrading ways. A significant 20th-century example lies in the war crimes the Nazis perpetrated against millions of Jews, Gypsies, and others they deemed undesirable. In the Nuremberg Doctor’s Trial following World War II, Nazi doctors were charged with crimes against humanity for the genocide and medical experiments they conducted on innocent victims. Significantly, the Nuremberg Code that came out of this tribunal set the basic standards for ethical treatment of human beings in medical and research practice. Standard medical concepts, such as informed consent, have their origin in this document. Additionally, in the aftermath of World War II, the United Nations (1948) made a landmark declaration in the history of humanity regarding “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family” (para. 1). Case Study on Moral Status Essay Holocaust Viktor Frankl (1973), a Jewish psychiatrist who survived the Holocaust, later wrote: The gas chambers of Auschwitz were the ultimate consequence of the theory that man is nothing but the product of heredity and environment—or, as the Nazis liked to say, “of blood and soil.” I am absolutely convinced that the gas chambers of Auschwitz, Treblinka, and Maidanek were ultimately prepared not in some ministry or other in Berlin, but rather at the desks and in lecture halls of nihilistic scientists and philosophers. (p. xii) If human beings are worthy of any dignity and respect, then reasons for arriving at this conclusion must exist. In general, there are two ways of reasoning why human beings have value: a functional view of value and an essentialist view of value. Functional View of Value According to the functional view of human value , a person’s abilities determine the value of that person. For example, a person who has highly developed rational thinking abilities may be seen as valuable and important to society. Or a nurse’s ability to educate patients about diabetes or to comfort dying patients will be understood rightly as making a beneficial contribution. The problem with functionalism lies in the very logic it uses. By making human worth contingent upon function, it becomes arbitrary. A person with deficits in rational thinking abilities may be thought of as less valuable than the person with these abilities; a person without emotional and social awareness may be perceived as less than other people. Philosophers call this understanding of a person an extrinsic or instrumental perspective because it relies on external criteria for determining a person’s worth. For instance, society could decide the value of a person depending on his or her actions, abilities, and contributions, though the assessment of these valuations may change. Alternatively, an intrinsic view of value views human beings as inherently having worth regardless of abilities. Case Study on Moral Status Essay In Nazi Germany, for instance, a functional view of the value of persons led to the extermination of the disabled and handicapped. Yet even insulting and degrading those with whom one disagrees can also be a subtle form of dehumanization. Others may be seen as impersonal adversaries rather than human beings with feelings, families, and inherent worth. Even considering a patient as a number or a symptom rather than holistically as a human being is itself a type of dehumanization. Sadly, this extrinsic perspective can be applied to patients without their awareness of this judgment. For example, if a patient goes through an unsuccessful medical procedure that leads to extensive brain damage, his or her family must decide about whether to continue treatment or let their loved one die without intervention. According to the functional understanding, because the patient’s brain functioning is now diminished, it would follow that the patient’s value is also diminished. In another example, when a fetus appears to have few functional abilities, the value of this fetus may be diminished in the view of the family. This process of perceiving people at any stage of life as valuable based on their level of functionality can lead to dehumanization, in which others see the nonfunctioning person as a thing to be manipulated and even destroyed. Essentialist View of Value An essentialist view of human value regards humans as themselves being intrinsically worthy of value. In contrast to an extrinsic view, an intrinsic viewpoint regards human beings as having inherent value apart from any external benefits or valuations. The essentialist viewpoint is compatible with Christian belief and undergirds most approaches to Christian ethics. This is why many Christians believe that abortion, euthanasia, and genocide are morally wrong because they all are instances of killing a human being who has inherent value simply by virtue of being human. The kind of care consistent with the essentialist view of persons is seen in medical professionals providing hospice care for the dying. In this view, patients’ dignity and worth are recognized throughout as they near the end of their earthly lives. Case Study on Moral Status Essay Another example of the practical implications of an essentialist view of human value is the care given to individuals with mental handicaps. Christians believe that people with severe mental deficits still deserve moral and ethical treatment as fellow human beings. Yet in a functionalist view of human value, the affording of equal value to disabled persons makes little sense because these individuals do not have the same level of functioning as other human beings. The essentialist view of human value, by regarding human beings as of worth beyond simply the functions that they are able to perform, has significant practical implications in medical practice. Respect for Persons This brief survey of thought about human beings has argued that persons have special worth that is bestowed by God. This value is part of the substance of what it means to be a human being. This is how, in essence, a person is very different from a thing. A thing can be used and manipulated; however, personhood suggests that people ought to relate mutually with one another in an ethical, moral, and respectful manner. To be a person, then, in part, is to have the ability to be in relationship with God and others. Human beings have the grace-filled gift of relating to God and to others, which is a part of personhood. Those who are deemed to be a person are afforded certain rights and privileges in accordance with this status. Significantly, many of the standards of care within modern nursing came about because of human rights abuses in the past. For example, the actions of Nazi doctors in unethical research led to the drafting of the Nuremberg Code in which current ideas about autonomy and informed consent were formed. Later the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978) wrote the Belmont Report that adopted principles of respect for persons , beneficence, and justice. This report was, in part, a response to another human rights violation in the Tuskegee syphilis study, during which the test subjects were not informed of the negative impact participation in the study would have upon their health. In each case, external oversight boards felt it necessary to define and delimit the proper treatment of human subjects within the realm of medicine. Case Study on Moral Status Essay The effects of these guidelines are still evident today when institutional review boards apply these criteria for the proper treatment of human beings as subjects of research and medical care. In each case, respect for persons is at the heart of these considerations. This means, at a minimum, that practitioners must respect the autonomy of patients, provide them with informed consent, be truthful, and afford them courtesy and respect. Practitioners should see these actions as being fundamental to medical care, not just because these documents say so, but because it is an inherent duty given the nature of human beings as persons. In other words, these documents identify what is already objectively true of human persons—that they have inherent worth and ought to be treated in an ethical manner. If persons ought to be respected, then practitioners must have a way to determine who qualifies as the proper recipient of such respect. Ethicists have utilized the term moral status to identify those to whom respect and ethical treatment is due. The next section, then, will deal with various ways that practitioners may make determinations regarding moral status. Moral Status Within the medical community, moral status commonly refers to a judgment given about an individual’s value and rights to be treated according to moral and ethical standards. For some ethicists, moral status may apply to human beings as well as to animals and objects in the natural world. If practitioners deem an individual to have moral status, then there is a moral imperative to treat that person in accordance with ethical standards. But the most important consideration is how to determine whether an individual has moral status. This has very practical implications in health care settings. For instance, when a nurse gives quality and attentive care to a patient, the nurse is implicitly bestowing moral status upon that patient by recognizing something in her deserving of such treatment. Case Study on Moral Status Essay The distinction between functional and essentialist views of human value is a helpful starting point for determining moral status, but further clarity is needed. Particular theories of moral status more specifically identify the reasoning behind why a practitioner believes an individual has moral status. Each of these theories is a different way of reasoning that an individual possesses moral status and, therefore, deserves moral and ethical treatment. There are five primary theories of moral status: the theory based on human properties , the theory based on cognitive properties , the theory based on moral agency , the theory based on sentience , and the theory based on relationships . In the field of nursing, the care that patients receive may change with the moral status theory subscribed to by the health care professional. For instance, a nurse may consider whether a brain-damaged patient has the same moral status as a patient who is not brain damaged. In this case, the medical care that a severely brain-damaged patient receives could be dependent on how and why the health care professionals caring for him or her determine whether he or she has moral status. The Theory Based on Human Properties The moral status theory based on human properties has many similarities to an essentialist view of human value. Both consider human beings as having value because of fundamental realities that pertain only to human beings. Using the theory based on human properties, a practitioner would deem an individual as having moral status simply if that individual is human. In this way of reasoning, a practitioner would consider unborn children, the elderly, and all human beings as having moral status because each is human; therefore, a practitioner who uses this theory would oppose abortion, euthanasia, and destructive medical testing, for instance. Case Study on Moral Status Essay The Theory Based on Cognitive Properties Alternatively, the theory based on cognitive properties views an individual as possessing moral status if he or she has certain basic cognitive functions that are foundational to high-level functioning. An individual may regard the ability to reason and to communicate as basic cognitive functions that are necessary prerequisites for moral status. Thus, a person using this theory of moral status may suggest that a tree does not have moral status because it does not have any cognitive properties, but neither would a fetus or a brain-dead human being because cognitive functionality is severely impaired or nonexi

Discussion: Impact of Telehealth on Women ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Impact of Telehealth on Women Chapter 1: Introduction to the Study Introduction Drug and alcohol addiction as a major health problem throughout the world (Miller, 2013). The World Health Organization (WHO; 2014) indicated that worldwide, 5.5% of the world’s population suffer from drug or alcohol addictions. The National Survey on Drug Use and Health (NSDUH) showed that slightly less than 11% of Americans with substance use disorder (SUD, which can include drugs or alcohol) were able to receive treatment at a facility (Center for Behavioral Health Statistics and Quality, 2016). Some of those suffering from addictions are not able to or choose not to get help with their substance use disorders (Cook, et al., 2013). Discussion: Impact of Telehealth on Women Different definitions exist for the term recovery. One definition is generalized as a journey a person takes over time, including multiple stages throughout the process (Substance Abuse and Mental Health Service Administration, 2012). These stages can be seen as early recovery, sustained recovery, and stable recovery (Betty Ford, 2007). Neale (2014) discussed recovery as abstinence, or reduction in use of substances, that results in better living situations, better health, employment, or some positive outcome. Recovery from dependence on a substance is seen as a voluntary act, maintained by change in lifestyle to include sobriety (abstinence) health, and community involvement (Betty Ford, 2007). In 1991, The U.S. Department of Health and Human Services developed an office to focus on the health and wellness of women (National Institute Drug Addiction, 2018). The National Institute of Drug Addiction (NIDA) focused on studies in women as the biological differences between men and women became more prominent in addictions to drugs and alcohol (NIDA, 2018). An entire department titled the Office of Research on Women’s Health is dedicated to determining the differences between the genders on health-related topics (NIDA, 2018). Women face unique challenges surrounding substance and alcohol abuse that are also impacted by culture and geography (Wilsnack, 2013). A few of these challenges facing women entering recovery include problems with domestic violence, victimization, sexual assault and trauma (Evans, Padwa, Li, Lin & Hser, 2015). These instances can lead to co-occurring disorders in women to include depression, anxiety, and low self-esteem (Evans et al., 2015). Background The following articles form the background to this research. Benavides-Vaello, Strode and Sheeran (2013) discussed the use of technology for treating persons with substance abuse to reduce disparities. Discussion: Impact of Telehealth on Women. Dixon and Chartier (2016) presented that alcohol is the most abused drug in the rural areas within the United States. Edmond, Aletraris and Roman (2015) showed the fundamental and quality difference that exists between the rural and the urban treatment centers. Ghia, C. J., Patil, A. S., Ved, J. K., & Jha, R. K. (2013) acknowledged that telemedicine is increasingly becoming a widely recognized concept globally. Hickson, Talbert, Thornbury, Perin, and Goodin (2015) discussed online technologies, and how there is a more efficient and better care system. Melemis (2015) acknowledged that four primary ideas exist for relapse prevention. Pullen and Oser (2014) highlighted substance abuse as a major concern in both urban and rural areas, with more focus on the rural areas. Sigmon (2014) focused on the access to treatment for those who are in rural America. The specific target treatment for the study is on opioid dependence. Wang, Becker and Fiellin (2013) is premised on the fact that rural areas in the United States have shown an increase in overdose deaths due to the nonmedical use of prescription opioids. Zanaboni, Knarvik and Wootton (2014) explored the state of application of routine telemedicine with specific reference to Norway Problem Statement Substance abuse is a steadily growing concern (Pullen & Oser, 2014) in rural America (Sigmon, 2014). According to the U.S. Census Bureau (2016), a rural area is defined as areas of population not classified as urban. Areas of urban populations are denser, with more developed territories, leaving areas farther away from city centers to be classified as rural (U.S. Census Bureau, 2016). In general, rural areas lack easy access to quality healthcare (Pullen & Oser, 2014). Throughout the United States, rural areas report physician shortages, travel difficulties, and lack of specialized treatment options (Warren & Smalley, 2014). Alcohol and substance abuse in Georgia is a social problem that has caused a significant level of social and economic problems (SAMHSA, 2016). In a paper, “Gender Impact Assessment of Georgia’s Drug Reform”, the Gender Equality Council of the Parliament of Georgia (GECPG) indicates that there are over 45,000 substance abuse cases in Georgia. Out of this number, 10% are women (Gender Equality Council of the Parliament of Georgia, 2017). Even though lack of rehabilitation is a threat to individual health and well-being, there remain significant hindrances to the treatment of abusers of substances (Pullen & Oser, 2014). One of the primary challenges to the treatment of substance abuse is the availability of resources in communities (Edmond, Aletraris & Roman, 2015), while marginalization and stigmatization are other devastating challenges. One proposed way to overcome the obstacles in addiction recovery in rural areas is the use of online systems. One such option for rehabilitation from substance use disorder is that of telerehabilitation, a sub-discipline of telemedicine. Telemedicine is one of the most recent improvements in the provision of medical services (Mid-Atlantic Telehealth Resource Center, 2016). It allows medical practitioners to provide medical services to patients without ever meeting them. It refers to the use of various forms of technologies and communication systems to offer rehabilitation services and assist the affected persons to start living independently (Mid-Atlantic Telehealth Resource Center, 2016). A study of online substance abuse recovery was completed in the United Kingdom in 2015, comprising of smart phone apps, online groups, and websites (Graham, Irving, Cano, & Edwards, 2018). This study revealed a strong correlation between those in established and stable recovery and the usage of some type of virtual recovery tool. Established or stable recovery is a period of sobriety of more than 5 years (Betty Ford, 2007). The study did not reveal if online services for those beginning recovery, or those in early recovery, which is a period of time less than 1 year, were used, which suggests further research is needed to understand recovery change via online sources with a focus on gender (Graham et al., 2018). Best et al. (2016) describes the amount of judgment from outsiders women receive in comparison to men when dealing with substance use disorders. According to the Federal Center for Substance Abuse Prevention (2017), about 2.7 million women in the United States abuse drugs or alcohol. Some women may know that they are struggling and will take pills or alcohol while hiding whereas other women will view it as a social activity and will not agree to see it as a problem (Bepko, 2014). Women face pressure to have everything together, meaning a perfect balance between work, raising kids and other social activities. It is for this reason that once a woman gets addicted, accepting that they are addicted is quite hard and seeking treatment is even harder (Bepko, 2014). Discussion: Impact of Telehealth on Women Although the aforementioned research regarding deliveries of rehabilitation services for women suffering from substance abuse and alcohol addiction illuminates important findings, I have found no research that has examined how women located in rural areas who suffer from addiction use telerehabilitation as a primary recovery option. Discussion: Impact of Telehealth on Women Purpose of the Study. The purpose of this general qualitative study is to gain deeper understanding of the experiences of recovery from substance abuse disorders among women in rural North Georgia who are limited in access to in-person treatment options and rely on online rehabilitation services. The research will explore the experience of recovery stabilization from substance abuse and related diseases. Focus will be limited to women clients of recovery treatments living in North Georgia. The online treatment platform provides a private and convenient option for drug and alcohol addiction recovery (Griffiths, 2015). Health related outcomes have been studied from the social media platform of recovery, showing positive benefits, with little negative impacts (Merolli, Gray, & Martin-Sanchez, 2013). Highly trained medical experts can provide therapeutic intervention via the internet. This platform offers numerous benefits in addition to the traditional recovery approach. Differing interactions via online such as counseling, peer groups, and other tools for successful recovery are available. More engagement online will positively influence the results of addiction treatment for women clients in rural areas. Utilizing the online tools, the women of North Georgia will benefit from full flexible schedules 24/7, therapeutic support, and continual progression in counseling. Connection is a strong part of recovery, and through online applications, women can stay connected to counselors and set up appointments as needed. Length of online meetings and sessions will vary, but the nature of interaction will depend entirely on the woman and her desire for support (Griffiths, 2015). Research Question What are the experiences of recovery from substance abuse disorders among women in rural north Georgia who are limited in access to in-person treatment and who rely on online rehabilitation services? Theoretical Foundation Framework The self-regulation theory will serve as the theoretical framework for this study. The self-regulation theory developed by Baumeister and Bandura (1989) is a self-directed management system that involves guiding one’s thoughts, feelings and behaviors towards the attainment of certain goals (Baumeister & Vonascha, 2015). It involves what we feel, think, say or do that helps in controlling our urges, emotions and behaviors (Baumeister, 1994). This theory is effectively used for impulse control, illusion control, goal attainment and management of sickness behavior making it eligible for this study (Baumeister & Vonascha, 2015). Bandura claimed that humans control behaviors through self-regulation and the behaviors associated with the social cognitive theory and social learning theory (Baumeister, Bratslavsky & Muraven, 2018). Schunk and Zimmerman reviewed the theory and came up with particular strategies that contribute to an individual’s learning process that leads to self-regulation (as cited in Panadero, 2017). Baumeister designed four components of self-regulation to be the standard of behaviors that are desired, the motivation to meet the standards, analyzing and evaluating situations and ideas and the willpower to control urges (Baumeister, Bratslavsky & Muraven, 2018). Individuals engage in their own learning in three stages: planning, monitoring and reflection (Panadero, 2017). The individual lays out strategies to tackle the tasks, monitors their performance and reflects on the outcome (Panadero, 2017). In monitoring of health-related issues, the self-regulatory model may be used. It describes the stimulus, cognitive and emotional responses, the coping responses and evaluation of the coping responses and health outcomes (Baumeister & Vonascha, 2015). Patients are guided in identifying their health problems, the risks and issues involved and an action plan to handle the problem (Panadero, 2017). The self-regulation theory is applied by an individual who takes control and evaluates his/her behaviors to attain satisfaction trough life experience. Definitions Recovery – Recovery, for the purposes of this paper, will describe the process of change that an individual achieves through abstinence and improved health, wellness, and overall quality of life. (Center for Substance Abuse Treatment, 2007). Telehealth – The usage of electronic information and telecommunication strategies to support and promote long-distance clinical health care, patient and professional healthcare education, and health and public safety administrations. (Department of Health and Human Services, 2019). Telemedicine – Similar to telehealth , telemedicine is the practice of the medical field using technology to deliver care at a distance. Physicians in one location can utilize telecommunications infrastructure to provide adequate care to a patient who, for one reason or another, is separated from them. (AAFP, 2017). Tele-Rehabilitation – Rehabilitation through traditional techniques, but utilized through telecommunication devices like computers, web-cams, and telephones. (Peretti, 2017). Relapse – The return of a disease or the signs and symptoms of a disease after a general improvement period. Moreover, the returned use of addictive substances or behaviors. (NIH, 2018). Substance Abuse – The usage of illegal drugs, prescriptions, over-the-counter drugs, or alcohol for purposes other than what they were initially intended for. Typically, these substances are abused or utilized in excessive amounts that do not have clinical reasoning. (NIH, 2018). Opioid Dependence – The dependency on opioids, a substance used to treat moderate to severe pain. A dependence on drugs like morphine and codeine are detrimental to the receptor in the central nervous system. (NIH, 2018). Rural Areas – Areas in the continental United States that are open country and settlements with fewer than 2,500 inhabitants. (USDA, 2019). Urban Areas – Unlike rural areas, urban areas refer to larger places where the space around them is high in population density. Urban areas do not follow clear municipal boundaries and are often classified with inhabitants of roughly 50,000 people. (USDA, 2019). Treatment – The desired course of action between a doctor and patient in rehabilitating an ailment of disease. Plans are structured around or deliberately designed to curtail the disease or ailment through medication, procedures, and medical devices. (Hart, 2020). Rehabilitation – The process to restore mental or physical health incurred from an injury or disease. The programs are used in order to allow someone to function in normal or near-normal life. (NIH, 2018). Medical Practitioners – A practitioner is an individual who is qualified and experienced to work in a specific medical profession. A doctor or nurse are considered healthcare practitioners. (NIH, 2018). Assumptions The nature of this study will be qualitative inquiry with a general approach that will focus on the lived experiences of women living in rural north Georgia who utilize online treatment for recovery from substance use disorder. According to van Manen (2014), the heart of human experiences presented to the researcher has meaning to the participants through their surroundings, and how their meaning influences behaviors. Purposeful sampling will align with the purpose of this qualitative study. Sampling will allow for selection of participants to meet the requirements needed to further the study (Suri, 2011). Individual interviews will be conducted, utilizing semi-structured questions. A total sampling of between 12 to 15 women will be selected on a voluntary basis, ensuring anonymity through only voice recording. Women will be a minimum of eighteen years old, with no age limit. Some will have entered into recovery on their own decision and some may have been assigned to it through court ordered processes. The location of the participants will be in Northern Cherokee County in the state of Georgia. Selection will be from more rural areas, with a minimum of 20 mile drive to the closest treatment option for addiction recovery. Participant pool will lead to a better understanding of the experiences of women entering into recovery from substance use disorders. Discussion: Impact of Telehealth on Women Scope and Delimitations In this study, the focus is on the analysis of the experiences in stable recovery for women living in rural north Georgia who treat substance use disorders through online rehabilitation services. The deeper understanding under investigation may accrue a qualitative attachment to the research methodology investigated. Hence, it is imperative to focus not on outside events, but on the experiences being presented. Following a thorough analysis of women seeking online treatment on drug abuse online, there has existed a limited scope and need to research the particular field to find out the motivation behind the action (Matua & Van Der Wal, 2015). The motivation behind the whole concept points to the fact that there are gaps within community centers charged with engaging the society in containing substance abuse amongst women in the Georgian community. From a sample of women, it was agreed that drug and substance abuse problems had online choices and should be expanded to other territories for better service (Van Manen, 2014). Of specific interest is: The experiences in stable recovery for women living in rural north Georgia; and The treatment of disorders through online rehabilitation services. Data will be analyzed through thematic content analysis. Through this technique, the common patterns across a data set will be established. During the analysis of collected data, individuals will read and re-read data, then label and code for broad patterns of meaning. The themes will be reviewed to ensure that the data will correlate (Braun & Clarke, 2014). Themes will be named and then defined appropriately. Write up will include quotes from the interviews. Limitations The method to be used, semi-structured interviews has its shortcomings. First, the method can be time-consuming and utilizes many resources. Additionally, the technique requires confidentiality which has to be assured and if not, the participants may feel hesitant to share information. The skills to analyze the data can be a problem as there are chances of construing so much (Van Teijlingen, 2014). A main limitation may be achieving the correct sample size. According to Babione (2015), saturation is the point in a qualitative research where new data and analysis only confirm previous conclusions. Consequently, it determines when to stop data collection and analysis. At the saturation point, the theory appears clear and is easy to construct since there are no gaps of unexplained phenomena. Sirakaya-Turk et al. (2017) considers saturation to be reached when no new concepts can emerge and the data cannot contribute any further to theoretical development. Data repetition and redundancy begins to appear and further collection is unproductive since it yields no new information. According to Phillips (2014), any additional information after saturation becomes redundant because the purpose of qualitative research is to discover the context and diversity rather than a large number of participants with the same experience. The failure to achieve saturation has a negative impact on the research quality and the validity of the results (Fusch & Ness, 2015). Further, there is no universal data collection method for attaining data saturation. According to Fusch & Ness 2015, some methods have a high probability of reaching saturation than others. Data collection approaches depend on the study design and hence researchers should select a study design that is explicit about reaching data saturation (Fusch & Ness, 2015). Saturation should be operationalized in a method consistent with the theoretical position, study questions, and the adopted analytical context (Saunders et al., 2018). Discussion: Impact of Telehealth on Women Ethical Procedures One of the things that will be ensured in the study is research confidentiality. The consent of the interviewees will also be sought before carrying out the study. The research aim and objectives will be made known to the researchers as well. A steady focus to keep and remove any bias of the researcher will be maintained, after using any experiences necessary to gain complete confidence from participants. Significance Overdose deaths increased at a more rapid rate in the state of Georgia than the national average last year (CDC, 2018). In 2016, 928 Georgia residents died in the circumstances related to substance use disorder (Cupit, 2018). During 2017, the number of overdose deaths reached 1,035 people living in Georgia (Cupit, 2018). The mortality rate in Georgia is now considered an epidemic crisis. Deaths relating to drug abuse in Georgia for 2018 reached 2000 people. This study will provide useful information benefitting women living in rural North Georgia battling substance abuse issues. The results from this study will provide a contribution to the literature on understanding addictions in women with less access to treatment (King et al., 2018). Significance will be seen through a reduction of barriers to treatment and recovery by improving the online ability to treat substance use disorders. The results gathered from this research will contribute to literature by revealing depths of substance abuse in women. Knowledge obtained from this study could promote social change through recommendations from collected information towards policy makers in rural areas (King et al., 2018) to increase availability of services for those suffering substance use disorders. The ripple effect of this information will reduce deaths in the community from addiction because more availability to recovery help will be available. Policy makers within the state of Georgia will be involved in positive changes for availability of treatment for women suffering from substance use disorder. This study will be fundamental in importance by reducing the number of deaths in the area thru online recovery options. Discussion: Impact of Telehealth on Women Summary *** IS THIS WHERE THE SUMMARY OF CHAPTER 2 GOES??*** Chapter 2: Literature Review History of drug abuse/addiction/dependency In the History of substance abuse research in the United States, VanGeest et al. (2016) ascertained that substance abuse is one of the most widely studied aspects of human health in the United States. Drug or substance abuse is the use of a drug in amounts that are harmful to individuals’ health or others. There are many reasons why people engage in the use of drugs irrespective of their background or age. According to Robinson (2019), people do experiment with recreational drugs out of curiosity to have some enjoyable time or because some other people like friends are doing it, reducing stress or other problems, or maybe as a result of depression. Substance abuse and addiction results not only from the use of illegal drugs like cocaine or heroin but also from prescribed medications, which include painkillers or sleeping pills. In the U.S, most people are addicted to prescribed drugs such as painkillers (Segal, 2019). In most parts of the United States, Opioid painkillers abuse has become so powerful and has paved the way for the use of more dangerous drugs (VanGeest et al., 2016). Substance abuse has been going on in the United States for a long time, but it was not until the last parts of the 19 th century that many scholars started taking an interest in the matter (Sarvet & Hasin, 2016). Development of Drug Addiction According to Melinda Smith (2019), drug use can easily lead to addiction based on various factors. Any person can develop problems of drug use, but vulnerability differs from one person to another. Some of the things that play a role in this include the individual’s family, mental health, and the environment he/ she socialize from. Other factors include the history of addiction within the family, Abuse, traumatic experiences, depression and anxiety, and the method of administering the drug, which includes injection or smoking. *******NEED MORE**** Drug Use and Addiction in Georgia Alcohol use In Georgia, drug and substance abuse is one of the most felt health crisis, and this is a severe challenge that the population faces and which take distinct forms. According to Lakeview Health publication in 2019, Alcohol is probably the most abused drug in Georgia. Although it is widely accepted as a regular social activity, many people have become addicts in a way that is affecting them negatively. The rate of use of this substance varies with the geographic location of the residents, primarily rural and urban areas. There has been a lot of concern about Alcohol Use Disorder among these populations and there is a need for humanitarian help in addressing this problem. (WHO GHO, 2016). Alcohol use disorder is mainly a big concern among conflict-affected civilians (Ga Dept of health, 2019). This is because they are often exposed to traumatic and occurrences that bring about complications such as depression and anxiety. This exposure to traumatic events and violence result in alcohol use as a form of self-medication. Armed conflicts and related displacements of people arise to poor living conditions and poverty, and loss of properties. This makes alcohol a solution strategy to these stressors. Alcohol use and addiction is the leading cause of non-communicable diseases such as cirrhosis, heart conditions and diabetes to these populations (Almli & Lori, 2018). It also results in behavioral and other social impacts such as violence which is based on gender. This is a big problem in many areas affected by conflicts. Georgia has been marked by conflicts that involved secessionist movements in the 1990s and in 2008 which led to displacements and setting up internally displaced people’s camps (WHO, 2016). These displaced communities are faced with poverty, unemployment, poor living conditions, and limited access to other local communities. This is one of the reasons why they use alcohol in a big way. Limited access to good healthcare and health facilities results in continuous addictions. Alcohol use is more on the rural parts of the country as compared to the urban area as a result of the above-highlighted factors. Although women in rural regions who engage in alcohol are less than men, about 16% of them engage in drinking (WHO, 2016). Discussion: Impact of Telehealth on Women Opioid Use These are mostly used as medicines, and mainly they are prescribed as painkillers for chronic pain. With their prolonged use, their ability to relieve pain can reduce, and the pain increase and this can make the body develop dependence. Their continued use develops withdrawal symptoms, and this makes it difficult to stop using them. According to the Georgia Department of Public Health (2020), the deaths caused by Opioid overdose have been on the rise in Georgia since 2010. This has been attributed to the increased use and misuse of prescription opioids, such as oxycodone and hydrocodone. From 2013, illicit opioids such as heroin and fentanyl led to a sharp increase in the deaths associated with opioid overdose (Abraham, Adams, Bradford, & Bradford, 2019). According to the National Institute of drug abuse in March 2019, there were 1014 deaths associated with opioid use. More cases involved synthetic opioids (mainly fentanyl). There was a massive increase in the number of related deaths by 358 between 2012 and 2017 (Ga dept of health, 2019). There was also a significant rise in the number of women who use opioid especially in the rural parts of the country, and this is attributed to the pain-relieving prescriptions (Ga dept of health, 2019). Adverse effects of drugs on women in North Georgia Addiction in Women According to Hardy, Fani, Jovanovic & Michopoulos (2018) there was an increase in the number of deaths for women, which resulted from addictions and overdoses as compared to men. The use of alcohol is on the rise, as well as other drugs such as opioids. The fact that opioid is given as a prescription drug, even increases more chances of women involvement, as they frequently feel chronic pain. Continued use is the one that brings about the addiction to a point where they cannot survive without using the substance (Hardy, Fani, Jovanovic & Michopoulos, 2018). This becomes serious because unlike men, women can transfer the effects to children in case they use them when pregnant or develop more severe problems in their health. This review focus on women’s drug use in rural north Georgia and telerehabilitation (Salas-Wright, Vaughn, & González, 2016). It’s better to understand that there are many negative impacts that women experience after opioid use and addiction (Salas-Wright, Vaughn, & González, 2016). One of them is Neo-natal Abstinence Syndrome. This occurs when a woman uses drugs such as opioids when she is pregnant (Darlington & Hutson, 2017). This may result in babies being born with such symptoms of drug effects. There is also a prevalence of cases such as HIV which has been attributed to Injection Drug Use (IDU) (Darlington & Hutson, 2017). Although most of the affected are male, about 2.3% of women cases were attributed to IDU. Other infections that arise include Hepatitis C (HCV) prevalence, which was attributed to injections (Mazure & Fiellin, 2018). According to Zibbell, Asher, Patel, Kupronis, Iqbal, Ward, and Holtzman (2018), the annual acute HCV infection incidence increased by more than two times from 0.3 to 0.7 cases per 100,000 from 2004 to 2014. This varied among different selected groups with the main cause being the injection of a drug such as heroin. Discussion: Impact of Telehealth on Women North Georgia drug problems In an article titled Time for Georgia to Admit It Has a Drug Problem, Soderstrom (2016) makes it clear that “Drug abuse is rampant in the state, fueled primarily by the use of opioids such as prescription painkillers and heroin.” There is no doubt that Georgia, as a whole, is facing a crisis. The level of substance use is high, and having adverse effects on the state. In the article, the writer makes it clear that North Georgia is one of the areas of Georgia that are adversely affected by this problem of drug use. The paper proceeds to indicate that “In North Georgia, addiction to prescribed opioids such as OxyContin and Vicodin has crippled families and destroyed lives. Ten of the state’s 67 opioid addiction clinics are located in the region, despite only six percent of the population living there.” (Soderstrom, 2016). From this data, there is no doubt that substance use is a major problem in North Georgia. The National Institute on Drug Abuse indicates that “In Georgia, over 60% of drug overdose deaths involved opioids with 866 fatalities (a rate of 8.3) reported in 2018” (The National Institute on Drug Abuse, 2020). The data suggest that the rates of fatalities associated with substance abuse in Georgia are greater than the national fatality rates. Concerning the very high rates of substance use and related fatalities in North Georgia, one of the hypotheses that have been developed to help understand the cause of the trends in the region is that “People in that area are very competitive and hard-working. There is a lot of pressure to keep up appearances and a lot of pressure on school kids to get good grades, so they qualify for certain scholarships” (LakeView Health, 2020). Thus, this story suggests that social and economic pressures have contributed significantly to substance abuse challenges in North Georgia. Addiction in women In North Georgia, a significant number of women abuse a wide range of drugs. It is recorded that more than 41 percent of women (Rehab Center, 2015) were in treatment for substance abuse in Georgia during 2013, (SAMHSA, 2013). The data provided in the text suggests that the majority of these cases are in the northern region of Georgia (Rehab Center, 2015). It is unfortunate to find a situation where four out of ten women in a state are battling substance addiction (Rehab Center, 2015). Beginning of telemedicine/telerehab Technology has played an important role in the advancement of medical practices. The use of technology has enhanced the quality and s

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