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Bullies And Incivility In Nursing Essay Paper Bullies And Incivility In Nursing Essay Paper Undergraduate nursing programs include a combination of classroom work, simulation activities and professional experience (clinical) placements. Clinical placements are integral components of programs where students can immerse themselves in “real world” nursing practice. They experience firsthand the clinical work and culture of nursing in health care services. Nursing students completing their clinical placements are vulnerable to workplace stressors as a result of their position in the healthcare hierarchy, particularly given that they are not permanent employees of the organisations in which they are placed.Bullies And Incivility In Nursing Essay Paper Permalink: https://nursingpaperessays.com/ bullies-and-inci…sing-essay-paper / The American Nurses Association Code of Ethics implores nurses to maintain caring and professional relationships with colleagues as well as with patients and their families. Provision 1.5 of this code specifically states that the nurse must “create a culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect” (American Nurses Association, 2015, p. 4). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the primary authority in healthcare regulation. The Joint Commission has issued a mandate for institutions to address uncivil behaviors in healthcare as they create a threat to patient safety. Despite these directives, nurse-to-nurse hostility is a known problem according to the past 25 years of professional literature (Embree & White, 2010). Inter-collegial hostility, or incivility, is particularly prevalent in the nursing profession versus non-nursing vocations. This is an enigma, as the nursing profession is based upon interpersonal relationships and the care of others.Bullies And Incivility In Nursing Essay Paper Civility is defined as the display of polite and courteous acts and expressions that show regard for others (Clark & Carnosso, 2008). Clark & Carnosso, in a concept analysis of civility, find that civil behavior includes tolerance, listening, accepting other viewpoints without negativity, respecting differences, treating one another with dignity and honor, and engaging in social discourse (2008). Civility not only denotes particular behaviors but also describes an attitude of respect for other persons. The word civility has Latin roots in the word ‘civilitas’ meaning community or city. Civility is more than just polite behavior; it is a prerequisite for humans to live together and function as a community. Thus, civility has been described as active engagement in creating and participating in a group or community (Clark & Carnosso, 2008). Conversely, incivility can then be understood to delineate impolite, discourteous, rude conduct that shows a disregard or disrespect for others. Common forms of incivility in nursing are non-verbal innuendos, verbal affronts, condescending language, impatience, reluctance or refusal to answer questions, disrespect, and undermining (Embree & White, 2010; Weinand, 2011). Unlike civility, uncivil behavior purposely keeps others out of the in-group, e.g. the community.Bullies And Incivility In Nursing Essay Paper Nursing has been considered the primary occupation at risk for horizontal violence and workplace bullying. Studies estimate that approximately 85 percent of nurses are victims of incivility and up to 93 percent of nurses’ report witnessing incivility in the workplace (Christie & Jones, 2014; Lachman, 2014). Studies comparing nursing versus non-nursing work environments find a rate of incivility at 85 percent in nursing work environments, compared to 75 percent in non-nursing occupations (Hunt & Marini, 2012). Additionally, non-nursing occupations generally report managers as the perpetrators of bullying in a top-down relationship of power (Hoel et al., 2010). Unique to nursing is the prevalence of incivility between workers with equivocal levels of power. Patient care environments may be particularly susceptible to incivility due to high-emotions, stressful conditions, challenging and difficult work, and diverse roles and interactions. Nonetheless, nurses as a distinct sector of the healthcare team have a particular propensity toward uncivil treatment of each other. Workplace incivility (WPI) is a significant problem in healthcare centres, disturbing not only the clinicians enduring the negative behaviors but also the care that is delivered under the shadow of incivility.[1] Hutton and Gates stated that “incivility is characteristically rude and disrespectful, revealing a lack of respect for others.[2]Bullies And Incivility In Nursing Essay Paper Individuals who experience incivility, either as targets or witnesses, may suffer numerous negative behavioral, psychological, and somatic effects.[3,4,5,6,7,8,9,10,11,12,13,14,15] In addition, threatening and disruptive actions can also lead to medical errors, reduce patient satisfaction, and increase the cost of care; meanwhile, with the recent modifications in the health care system, such concerns have become even more crucial to address.[16] The incidence rate of incivility, in terms of experiencing incivility or witnessing WPI was reported to be 11 to 99%.[17,18,19,20] High prevalence of incivility and even violence is reported in Iran,[21,22,23] and some studies even see it as inevitable.[24] Therefore, in this case, further investigation and clarification of the perspectives regarding prevention methods is warranted. However, a limited number of surveys, to our knowledge, have focused on the attitudes which nurses, as the major staff in the health care system, have regarding incivility prevention. Many studies have been published about WPI but most have focused on the frequency, types, and significance of uncivil behavior in healthcare organizations. Meanwhile, describing the experience of incivility prevention from nurses’ perspective is valuable to a better understanding of its risk factors, outcomes, and ways of prevention. Exploring these perspectives is important because they could affect the way nurses are challenged to prevent and manage incivility.[25,26]Bullies And Incivility In Nursing Essay Paper This qualitative study is aimed at determining how to prevent WPI from nurses’ perspective. The findings of the study may provide a valuable understanding into the perspective of nurses toward the prevention and management of WPI. While bullying in the healthcare workplace has been recognized internationally, there is still a culture of silence in many institutions in the United States, perpetuating underreporting and insufficient and unproven interventions. The deliberate, repetitive, and aggressive behaviors of bullying can cause psychological and/or physical harm among professionals, disrupt nursing care, and threaten patient safety and quality outcomes. Much of the literature focuses on categories of bullying behaviors and nurse responses. This qualitative study reports on the experiences of nurses confronting workplace bullying. We collected data from the narratives of 99 nurses who completed an open-ended question embedded in an online survey in 2007. A constructivist grounded theory approach was used to analyze the data and shape a theory of how nurses make things right when confronted with bullying. In a four-step process, nurses place bullying in context, assess the situation, take action, and judge the outcomes of their actions. While many nurses do engage in a number of effective yet untested strategies, two additional concerns remain: inadequate support among nursing colleagues and silence and inaction by nurse administrators. Qualitative inquiry has the potential to guide researchers to a greater understanding of the complexities of bullying in the workplace.Bullies And Incivility In Nursing Essay Paper The situations are subtle and can range from sarcastic comments to being set up with the wrong patient chart… these sorts of things undermine your work day… erode your sense of comfort and security that you need to do your job in a professional manner (Nurse 41, 2007). Given the stressful healthcare workplace, it’s no wonder nurses and other healthcare professionals sometimes fall short of communicating in respectful, considerate ways. Nonetheless, safe patient care hinges on our ability to cope with stress effectively, manage our emotions, and communicate respectfully. Interactions among employees can affect their ability to do their jobs, their loyalty to the organization, and most important, the delivery of safe, high-quality patient care.Bullies And Incivility In Nursing Essay Paper The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements clearly articulates the nurse’s obligation to foster safe, ethical, civil workplaces. It requires nurses “to create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect” and states that “any form of bullying, harassment, intimidation, manipulation, threats, or violence will not be tolerated.” However, while nurses need to learn and practice skills to address uncivil encounters, organization leaders and managers must create an environment where nurses feel free and empowered to speak up, especially regarding patient safety issues. All of us must strive to create and sustain civil, healthy work environments where we communicate clearly and effectively and manage conflict in a respectful, responsible way. The alternative—incivility—can have serious and lasting repercussions. An organization’s culture is linked closely with employee recruitment, retention, and job satisfaction. Engaging in clear, courteous communication fosters a civil work environment, improves teamwork, and ultimately enhances patient care.Bullies And Incivility In Nursing Essay Paper In many cases, addressing incivility by speaking up when it happens can be the most effective way to stop it. Of course, meaningful dialogue and effective communication require practice. Like bowel sound auscultation and nasogastric tube insertion, communication skills can’t be mastered overnight. Gaining competence in civil communication takes time, training, experience, practice, and feedback. The consequences of workplace bullying are as evident today as they were one hundred years ago. In 1909 Leon Harris condemned the treatment of nurses by their managers in an article published in The New York Times . Dr. Harris, citing multiple examples of workplace mistreatment, emphasized how “head nurses abuse their position of power” [1]. A century later the workplace has changed for the better in many parts of the world [2]. Yet, in spite of such advances, nurses still experience bullying in the workplace.Bullies And Incivility In Nursing Essay Paper A problem in many healthcare institutions, workplace incivility is often referred to as bullying, lateral/horizontal violence, or harassment. 1-3 It can be defined as “repeated offensive, abusive, intimidating, or insulting behavior, abuse of power, or unfair sanctions that make recipients upset and feel humiliated, vulnerable, or threatened, creating stress and undermining their self-confidence.” 4 Uncivil behaviors can range from lack of support to rude or humiliating comments, and may even include verbal threats. 5 Determining the actual incidence and prevalence of workplace incivility is difficult because it’s often unrecognized and underreported. 6 However, studies examining workplace incivility assert that the percentage of nurses experiencing some form of incivility ranges from 27% to 85% Bullies And Incivility In Nursing Essay Paper Acts of incivility are devastating to nurses, affecting their performance, mental health, and intention to remain with an organization or even within the profession of nursing. 5,6,8 Hospitals and healthcare organizations experience additional consequences from an uncivil work environment through increased costs related to nursing turnover, absenteeism, and decreased work performance. 6 According to one report, the average hospital will spend an estimated $379,500 for every percentage point increase in turnover rates. 9 In addition, healthcare organizations spend an estimated $30,000 to $100,000 per year for each employee experiencing workplace incivility due to costs related to absenteeism, decreased work performance, staff treatment for depression and/or anxiety, and increased nursing turnover. 6 Although the effects on nurses and healthcare organizations are clearly detrimental, a more dangerous consequence of incivility comes from its threat to patient safety. One study demonstrated a connection between incivility toward nurses and behaviors that may lead to compromised patient safety. 10 The study included 130 nurses and delineated specific unsafe nurse practices that were directly related to instances of incivility. These unsafe practices included interpreting an unreadable order rather than asking for clarification, lifting or ambulating heavy patients without asking for help, and carrying out orders not considered to be in the best interest of the patient without challenging them.Bullies And Incivility In Nursing Essay Paper In 2009, realizing that intimidating behavior affects morale, staff turnover, and patient care, The Joint Commission put standards in place that require leaders to maintain a culture of safety. 11 According to The Joint Commission, organizations that fail to address unprofessional behavior are indirectly promoting such behavior. Uncivil behavior undermines the healthcare team’s effectiveness and can lead to medical errors and preventable adverse patient outcomes. 12 Interventions aimed at reducing incivility in the workplace are beneficial to nurses, healthcare organizations, and patient Bullies And Incivility In Nursing Essay Paper Workplace stress can influence healthcare professionals’ physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers’ mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%). Our research protocol was first approved by the hospital’s review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events , evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach’s ?=0.862). Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals’ emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life – BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001) and quitting (t=?2.564, P=0.011) are predisposing factors. For the ‘mental health and spirituality’ regression model, positive re-assessment (t=5.528, P=0.000) and seeking social support (t=?1.991, P=0.048) are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0.000) is a predisposing factor. According to our findings, there was a notable lack of workplace stress management strategies, which the participants usually perceive as a lack of interest on behalf of the management regarding their emotional state. Some significant factors for lowering workplace stress were found to be the need to encourage and morally reward the staff and also to provide them with opportunities for further or continuous education.Bullies And Incivility In Nursing Essay Paper As the toll of workplace bullying has become more widely known in all work settings, research has dramatically increased. Many North American studies focus on behavioral categories, causes, and typologies of individual responses [3]. There is limited information on how nurses experience and resolve workplace bullying. While bullying in the healthcare setting has been internationally recognized and researched [4, 5], many institutions minimize its impact or deny its existence, creating a culture of silence that impedes solutions to this problem [6–8]. While most individuals consider bullying to be a highly overt behavior, it is usually an insidious form of workplace aggression causing professionals to distance from each other fearing social exclusion or becoming the target of abuse. The consequences of bullying include compromised performance, job dissatisfaction, increased absenteeism, and staff turnover [4, 5, 9]. Newly graduated nurses are at significant risk as evidenced by higher resignation rates during the first year of practice [10–12].Bullies And Incivility In Nursing Essay Paper Workplace bullying has also been acknowledged as a threat to patient outcomes and the delivery of quality of patient care, as well as the erosion of personal health and professional wellbeing [9, 13, 14]. Excellence in patient care flourishes in an environment built on open communication and respectful professional relationships. An environment that condones bullying perpetrates destruction of professional communication. Bullying goes by many names: workplace aggression, indirection aggression, social or relational aggression, horizontal (lateral) violence, and workplace violence. It has become so popularized in the press; bullying is often, mistakenly, used as an overarching concept. There is a tendency to use many of these terms interchangeably [8]. Bullying is different from horizontal violence in that a real or perceived power differential between the instigator and recipient must be present [15]. Some of the most recent literature suggests that all of these behaviors exist on a conceptual continuum of workplace victimization [3].Bullies And Incivility In Nursing Essay Paper Authors from different disciplines have contributed to the proliferation of constructs that label hostile workplace behaviors [16, 17]. Bullying is a contested concept. Instead of agreement on a universal concept and definition, authors have added to the challenges of building a relevant literature base and conceptual framework. Europeans have led research and policy advances in the field for over three decades. Swedish psychologist Heinz Leymann was the first to study workplace bullying in a systematic way, finding that these negative actions occurred frequently and over time, causing physical, emotional, and social consequences [18]. Others define bullying as repeated, offensive, abusive, intimidating, or insulting behaviors, abuse of power, or unfair sanctions [12, 19]. These negative social acts, not only occur repeatedly and regularly over time but also escalate and occur between individuals who have different positions of power [15]. Saunders et al. [20] suggest that the characteristics of negative actions and harm are the essential elements of bullying.Bullies And Incivility In Nursing Essay Paper Scholars have underscored the importance of the durational characteristics of bullying [15, 21]. The dual dimensions of frequency and duration of bullying actions distinguish it from day-to-day social stresses or poor management styles in the workplace. Keashly and Jagatic propose that repetition is a principal characteristic of bullying; yet few studies have explored the repetitive experience of bullying, either by frequency, duration, patterns, or escalation [17]. The relationship between negative psychological consequences and workplace bullying is well established [3]. In addition to the emotional and cognitive effects, there are physiological consequences [13]. Recipients of bullying feel humiliated, vulnerable, or threatened, thus creating stress and undermining their self-confidence [12, 19].Bullies And Incivility In Nursing Essay Paper Prior to the last ten years, the nursing literature leaned towards anecdotal reports or articles suggesting practical solutions for dealing with workplace bullying [22]. Outside of nursing, research has been conducted using quantitative studies, primarily prevalence surveys. This complex phenomenon may require qualitative approaches for a fuller explication [23]. Such methods will allow us to unearth the interaction of individual, organizational, and cultural factors that enable, trigger, and reward bullying [6]. To this end, workplace bullying must be seen as a social process, “in which the impact on the person experiencing it is of primary importance” [24]. This qualitative study was part of a larger survey whose purpose was to validate the occurrence and patterns of bullying among nurses in the US [8]. The second-level qualitative analysis of the nurses’ narratives describing their bullying experiences in health care settings is presented in this paper. We specifically sought to understand how nurses encounter bullying in the workplace and the strategies they use to protect themselves and their patients.Bullies And Incivility In Nursing Essay Paper The approach adopted for this qualitative study was based on constructivist grounded theory methods [25, 26]. Charmaz contends that theory emerges not solely from the data but in concert with the individual experiences of the participants as well as values and experiences of the researcher [25, 26]. In a constructivist approach, the central question addresses how social reality is constructed. In addition, the researcher seeks to identify the elements of that reality [27]. To that end we were guided by both questions. First, we wanted to know how the social reality of bullying in the workplace came together for nurses and second what are the elements and organization of their reality. Working back and forth between these two questions throughout the analysis allowed us to make visible important aspects of the nurses’ world and understand their experience of bullying. In a constructivist approach, Charmaz [25, 26] suggests that data and its analysis are social constructions leading us to ask what is the purpose of the narratives and how does the setting influence the phenomenon?Bullies And Incivility In Nursing Essay Paper Whether you’re an ICU nurse dealing with life-or-death situations, a social worker counseling clients through traumatic events, a pharmacist faced with prescription quotas or another type of healthcare worker coping with your own pressures, learning to handle stress is critical to managing your healthcare career. Ongoing stress can manifest itself in a host of physical and psychological symptoms, including headaches, sleep disturbances, poor concentration and depression. Research suggests that high stress levels may impair the immune system and increase the risk of cardiovascular disease and cancer.Bullies And Incivility In Nursing Essay Paper Complete objectivity is not possible by the researcher, “constructivist grounded theory assumes relativity, acknowledges standpoints and advocates reflexivity” [28]. Researchers bring their own values, experiences, and biases to the research process. Examining the relativity of perspectives, positions, practices, interactions, and the research situation is crucial to the process. With Charmaz’s premise in mind, we acknowledge that the members of our research team come from different viewpoints to understand bullying in the nursing workplace. The diversity of our perspectives and experience are convergent, not biasing our approach. Our values and experiences complement one and other, allowing us to see the perspectives of the participants through different lenses. Our reaction to workplace bullying particularly in the health care setting and specifically among nurses was consistent. It was precisely our own workplace experiences and listening to the stories of nurses that brought us to formally investigate this problem.Bullies And Incivility In Nursing Essay Paper Markham states, “an ethical researcher is a reflexive researcher who works from the heart” [29]. Being reflexive throughout the research process focused us on understanding how we contributed to the construction of meaning. Repeatedly, we stopped at critical junctures and explored why and how we came to an interpretation or a particular decision. This required a constant vigilance in rediscovering and sharing our own values, interests, politics, and even the influence we had on each other. Because we conducted the study in a virtual setting, we thought a great deal about our respondents, who they are, and where they worked. Our participants existed both online and offline, and we reflected on their location within those worlds, a connected space of sorts [30]. We also understood the possibility that what happens in the online world is interwoven with the offline real world; there can be mutual shaping of the two [31]. Within the communication context, there is an interaction of the encounter and the virtual space [31].Bullies And Incivility In Nursing Essay Paper Unprofessional behavior among clinicians adversely affects patient safety and the quality of care. This literature review sought to apply a systems approach to studies of workplace civility in nursing. The included studies demonstrated that rude behavior is perceived to diminish care quality, increase risk of adverse events, and worsen patient satisfaction. Researchers identified triggers for workplace incivility, such as negative organizational climate and power imbalances, as well as consequences including low self-esteem and decreased productivity. The authors note that high stress environments can foster incivility and lead to burnout. They recommend practice-based competency in civility in order to improve patient safety. A previous PSNet perspective discussed how to identify and manage problem behaviors.Bullies And Incivility In Nursing Essay Paper Permission to conduct the study was obtained from the institutional review board (IRB) at a large university in the state of Massachusetts. An Internet web link to a 30-item anonymous e-survey was created [32] and appended to an article about workplace bullying in Nursing Spectrum a hard-copy and web-based, free, biweekly nursing magazine [33] . Consent to participate was affirmed by respondents completing the online survey and posting the optional narrative. The respondents were anonymous and not matched to the data of the larger quantitative study [8]. The optional question in the online survey was offered to participants as follows, “If you would like, in the space below please describe the bullying situation as you remember it. Please refrain from using any identifiable data (e.g., names, specific hospital, etc.).” The Internet web link was open for participant responses for a three-month period.Bullies And Incivility In Nursing Essay Paper A total of 99 narratives were submitted through the online survey and downloaded into Microsoft Word. Eleven responses were removed from analysis because the respondent offered commentary, broad generalizations, or opinions. Another six narratives were removed from analysis because they met the US Equal Employment Opportunity Commission definitions of harassment (sexual, disability, racial, or national origin) [34]. One narrative was removed because a nurse did not write it. A total of 81 narratives, ranging from five words to 780 words, were analyzed. Some narratives were very brief, “it is too painful to talk about,” while others wrote several hundred words describing who, what, when, where, how, and the consequences of working in a hostile environment. Prior to open coding, we performed preliminary readings to capture the tone of each narrative and become attuned to the text, allowing us to gain a holistic understanding of the respondents’ experiences before further analysis.Bullies And Incivility In Nursing Essay Paper Charmaz’s [26] approach to coding is multilayered. To optimize our sensitivity and carefully attend to the nurse’s perspectives, we first coded narratives as a team and later, the first author led continued coding. We used the constant comparative method [35] to make comparisons at each level of our analysis looking for similarities and differences. We began with open coding (line by line) allowing us to look closely at the responses and reflect on the substance of the narratives. In some cases the nurses’ words provided initial code names (in vivo codes). During the second phase we began focused coding by taking the most significant and frequently occurring earlier codes to sort through the data. The next step allowed us to identify linkages and connections. We developed categories by clustering similar codes, and from those categories we generated hypotheses about how the categories were related. We then moved to the discovery of a core social process [36]. We used theoretical coding to integrate the emerging theory. Theoretical coding allowed us to go beyond description and specify properties of and relationships between categories. We used Charmaz’s analytic categories of agency, action, power, networks, and narrative and biography to further investigate the data at the stage of theoretical coding [26]. Throughout each phase of this process, we wrote memos, conferred with each other, and reached agreement on codes, categories, and concepts. We revisited the text of the nurses’ responses throughout the analysis.Bullies And Incivility In Nursing Essay Paper Causes of Incivility in Nursing A perceived power imbalance is most often a requisite to bullying. Bullying appears to be particularly prevalent in institutions where hierarchy and power imbalances are strongly emphasized (Salin, 2003). Nursing was founded as a predominantly female profession in a patriarchal society with a cultural standard of gender oppression (Bartholomew, 2006). Additionally, in Western healthcare, nursing is practiced in a medically-dominant environment, where work structures are traditionally hierarchal in nature. Patients are admitted under the treating physician’s name and nameless nurses will execute physician’s orders. Furthermore, the organizational model of nursing is derived from historical roots in the military. This hierarchal system is thought to place nurses in a position of inferiority of rank and subordination. Literature supports the subordinate role of nurses, finding that nurses lack autonomy, control, and self-esteem (Freshwater, 2000). As a result, nursing has been described as a culture characterized by obedience, servitude, dedication, and adherence to hierarchy (Hutchinson, Vickers, Jackson, and Wilkes, 2010).Bullies And Incivility In Nursing Essay Paper Uncivil behavior among nurses is posited to result from this culture of oppression and subordination. Horizontal violence and incivility was originally described as an internal manifestation of conflict that resulted from oppression of one group by a more powerful entity (Freire, 2000). An oppressed group is one in which members lack power or control except within the group itself (Peters, in press). Internalized beliefs about their own inferiority prevents the oppressed group from controlling their own destiny, maintaining the status quo and allowing power structures to remain unchallenged. Frustration with these feelings results in aggression toward colleagues within the oppressed group (Hutchinson, Vickers, Jackson, & Wilkes, 2005). Members of the oppressed group direct their frustrations toward each other as they cannot act out directly to those who create the oppression (Freshwater, 2000). From this perspective, incivility in nursing is the reaction to the oppression and subordination experienced by nurses as a collective profession.Bullies And Incivility In Nursing Essay Paper Besides a culture of oppression, the socialization of nurses into the profession is said to propagate a culture of incivili

NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Different Kinds of Research Human beings like to categorize things. We don’t like amorphous groupings of ideas floating around. It just makes things difficult to comprehend. I’m not going to shock anyone when I say that one thing that is divided into categories is research . One way to make research topics more manageable is dividing the topics by asking the question, ‘What will this be used for?’NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Permalink: https://nursingpaperessays.com/ nurs-5501-introd…s-research-paper / ? Applied research is one type of research that is used to answer a specific question that has direct applications to the world. This is the type of research that solves a problem. We will look at an example later. Basic research is another type of research, and it is driven purely by curiosity and a desire to expand our knowledge. This type of research tends not to be directly applicable to the real world in a direct way, but enhances our understanding of the world around us. So, the real difference between the two types of research is what they will be used for. Will the research be used to help us understand a real world problem and solve it, or will the research further our general information?NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Applied Research As mentioned before, applied research is something that we can use. Here is a simple question: ‘How should a student study?’ There are many ways to go about answering this question, and the ones we will look at have a direct and applicable finding. For example, what can research tell us about how a student studies? Applied Research Applied research “aims at finding a solution for an immediate problem facing a society, or an industrial/business organization, whereas fundamental research is mainly concerned with generalizations and with the formulation of a theory”[1]. Applied research is considered to be non-systematic inquiry and it is usually launched by a company, agency or an individual in order to address a specific problem.[2]NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Difference s between Applied Research and Fundamental (Basic) Research The difference between applied and fundamental or basic research is straightforward – findings of applied research can be applied to resolve issues, whereas fundamental studies are used simply to explore certain issues and elements. Moreover, differences between applied and basic research can be summarized into three points: 1. Differences in purpose . Purpose of applied studies is closely associated with the solution of specific problems, while the purpose of fundamental studies relate to creation of new knowledge or expansion of the current knowledge without any concerns to applicability. 2. Differences in context . In applied studies, research objectives are set by clients or sponsors as a solution to specific problems they are facing. Fundamental studies, on the other hand, are usually self-initiated in order to expand the levels of knowledge in certain areas NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper . 3. Differences in methods . Research validity represents an important point to be addressed in all types of studies. Nevertheless, applied studies are usually more concerned with external validity, whereas internal validity can be specified as the main point of concern for fundamental researchers.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Examples of Applied Research The following are examples for applied research. You can notice that each of these studies aim to resolve a specific and an immediate problem. A study into the ways of improving the levels of customer retention for Wall-Mart in China An investigation into the ways of improving employee motivation in Marriot Hotel, Hyde Park Development of strategies to introduce change in Starbucks global supply-chain management with the view on cost reduction NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper A study into the ways of fostering creative deviance among st employees without compromising respect for authority. Advantages and Disadvantages of Applied Research The advantages and disadvantages of applied and fundamental research mirror and contrast each other. On the positive side, applied research can be helpful in solving specific problems in business and other settings. On the negative side, findings of applied research cannot be usually generalized. In other words, applicability of the new knowledge generated as a result of applied research is limited to the research problem. Moreover, applied studies usually have tight deadlines which are not flexible.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper You need to specify the type of your research in the earlier part of the research methodology chapter in about one short paragraph. Also, in this paragraph you will have to justify your choice of research type. The Research Methodology and Statistical Reasoning Course includes topics ranging from what is a variable to, where can one use a two-way ANOVA. Statistics are widely used in social sciences, business, and daily life. Given the pervasive use of statistics, this course aims to train participants in the rationale underlying the use of statistics. This course aims to explain when to apply which statistical procedure, the concepts that govern these procedures, common errors when using statistics, and how to get the best analysis out of your data.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Research methodology is used a base to explain statistical reasoning. The course also familiarizes you with commonly used software for statistical analysis. The course will take 11 hours to complete, including one contact hour with the course instructor after completion of the workshop. The course is divided into 11 broad sections, which include 59 lectures and 21 quizzes. Participants would benefit from the course because understanding basic research methodology and statistics is essential prior to taking up any research-related endeavor. It is also an important part of the college curriculum from undergraduate to PhD levels. Designing research methods requires knowledge about various methods and understanding data. The comprehensive nature of the course ensures that students and professionals are not only able to understand, but also apply the course content. The course not only includes course content, but instructors that are approachable after completing it, who will provide feedback and address your specific needs.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper This paper presents a basic methodology for an effective and efficient retrieval and recording of written materials in a subject area. The purpose of the literature review is examined and the criteria for selection of materials for inclusion are outlined. The methodology then describes the role of the librarian, various types of information resources, how to choose appropriate indexing and abstracting services, and a simple efficient method of recording the items found.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper The importance and use of Medical Subject Headings for research in physiotherapy is emphasized. A survey of types of book materials and how to locate them is followed by a detailed description of the most useful indexing and abstracting services available, in particular, the publications of the National Library of Medicine, notably Index Medicus, as well as Excerpt Media and the Science Citation Index. A discussion of on-line search services, their coverage and availability in Canada, concludes the review of information sources. Finally, guidelines for selecting and summarizing the materials located and comments on the literary style for a review are supplied. The mission of the Research, Measurement, and Evaluation (RME) doctoral program is to provide students with the requisite training in the application of statistical and measurement methodologies to conduct original research in the fields of research and measurement methodology, and to serve as an expert in the areas of research design, data analysis, and measurement.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Purpose and Goals The objective of the RME program is to train individuals to become experts in the research methodology, measurement, and applied statistics used in conducting applied research, evaluations, and assessments related to educational, psychological, and health outcomes. Graduates of the program have obtained skills concerning: how to design research studies and evaluations, what statistical and measurement analyses must be conducted to answer the desired research questions, how to analyze the collected data using appropriate statistical software. An emphasis of the program is on gaining experience in the application of the relevant methodologies using real-world data examples.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper The Ph.D. in RME provides individuals with an in-depth knowledge of intermediate and advanced statistical and measurement methodologies, as well as preparing individuals to make original contributions to the fields of measurement and statistics. Completion of the Ph.D. requires a minimum of 63 graduate semester credit hours, divided between a core set of required courses, a set of elective courses, and dissertation hours. Although students in the Ph.D. program are trained in a broad range of measurement and statistical methodologies, they will conduct focused research in one of two areas of specialization under the tutelage of RME faculty: (a) research methodology and statistics, and (b) measurement. Research methodology and statistics concern how to collect and analyze data to answer desired research questions. Statistical analyses can range from very simple descriptive analyses, to cutting-edge methods using sophisticated statistical models. The field of measurement concerns how we obtain measures of mental, psychological, and cognitive traits (e.g., ability, intelligence, depression). Because many of the traits investigated in education, psychology, and the health sciences are not directly observable the field of measurement makes use of a variety of statistical models to obtain the best possible estimates of an individual’s level on the desired trait based on the responses given to a set of items (i.e., a test, rating scale, or psychological inventory). These techniques are of particular importance to testing agencies that are assessing the ability of examines taking high-stakes tests.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Clemson’s Department of Public Health Sciences Doctor of Philosophy (PhD) and Master of Science (MS) degrees in Applied Health Research and Evaluation rigorously prepare future scholars to conduct research in population health and healthcare. Students learn to design and employ cutting-edge research methodologies with community, private sector, and public partners to provide effective solutions to challenging health problems. The curriculum emphasizes a full spectrum of methodological skills that enable students to design and implement research focused on health outcomes, effective and efficient health services delivery, comparative effectiveness of clinical and cost outcomes, and to conduct program evaluation. Students devote substantial attention to implementation science: that bridge between health research and health practice.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Our interdisciplinary faculty hold terminal degrees in health promotion and behavior, community psychology, epidemiology, health communication, medical sociology, medicine, health services research, health economics, and health policy. The doctoral program in Applied Health Research and Evaluation is designed to produce innovative, independent leaders in methodology and healthcare research skilled at transcending the traditional barriers between clinical, laboratory, and social science to rigorously test and evaluate clinical and population health data and then translate those findings into practice. Because this program fosters trans disciplinary faculty collaboration and involves research partnerships in communities and healthcare settings in the region, graduates are prepared to initiate and conduct applied research and evaluation that improves a wide variety of health delivery systems. Graduates of this program possess a depth and breadth of knowledge in the determinants of health, healthcare systems, research and evaluation design, epidemiology, and quantitative and qualitative methods, making them valuable assets to academia, large corporations, the health insurance industry, government agencies, health care organizations, and consulting firms.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Candidates for the PhD degree must complete 66 hours of approved coursework in five years. These credits include 36 hours of core research courses and seminars, 18 hours of dissertation coursework, and 12 hours of content coursework approved by the student’s adviser. Students who enter the program with a master’s degree, may be allowed to exempt a maximum of 12 credits if appropriate courses were completed in their master’s degree program. The faculty determines course exemptions and approves them at the time of admission The doctoral program in Applied Health Research and Evaluation also awards a master of science degree (en route) for those who complete PhD degree. Students who choose to leave the program before the completion of the PhD must complete 34 credits of core research and seminar coursework, and prepare a publishable paper in order to be awarded the MS in Applied Health Research and Evaluation.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Students applying to the PhD program are expected to have competitive GRE scores, have completed six credits of statistics or research methods, and have previous research experience. Deficits in courses completed or foundation skills in statistics require remediation with approved classes taken in addition to the courses outlined in the PhD curriculum below. This curriculum is representative, but flexibility with regard to content and dissertation coursework is expected. Content courses allow students to develop an appropriate content area to enrich their research agenda. These courses could include those in nutrition, physical activity, the build environment, aging, substance abuse, violence, health communication, health care, advanced statistics, qualitative assessment, survey design, or secondary data analysis. Students should consult their advisor.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper This program provides students with a broad understanding of appropriate applications of statistical and research methodology and with experience in using computers effectively for statistical analysis. The master’s and doctoral programs in Applied Statistics and Research Methods are designed to prepare graduates in statistics and education who make important contributions to educational practice. Through the programs, great emphasis is placed on how research design and statistics can be applied to educational issues and problems. Service courses are offered by the school in support of other university programs at the graduate level. Admission : Applications must be complete and on file in the ASRM office by March 1 for Fall admission and by October 1 for Spring admission.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Applied Statistics and Research Methods M.S. Students planning on concentrating on applied statistics need a working knowledge of calculus and linear algebra. Students must also provide a written statement regarding the relationship of the Master’s program to the student’s professional goals. Completion of this degree will enable the graduate to seek employment in a career field requiring the application of statistical or research methodology, for example: data analysis or experimental design; to teach in a community or junior college; to work as an evaluation/assessment specialist in a public school setting; or to enter a Ph.D. program in statistics, educational research, or a related area.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Statistics are vital to nursing. A statistic is basically a way of viewing and understanding data. More specifically, data describes how one event or situation relates to another event or situation. It is also important in knowing what methods are most effective when administering medications or following protocols. Many times when a veteran nurse knows something specific through experience, it is also a form of informal statistics. Sometimes a nurse may make observations about a patient that may or may not require concern. Statistics allow the nurse to make a judgement on whether or not follow up or further immediate medical attention is required. For example, a triage nurse needs to know what the likelihood of waiting a certain time in an emergency room exacerbating a condition will be in order to make informed decisions about prioritizing treatment. A nurse who has been in practice for many years may know what the priority should be without knowing the formal statistics and percentages involved.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper It is also important in clinical nursing to determine if a commonly used method should be changed or if protocols should be revised. For this example, all of the numbers are random and only used to show the main idea. If the policy in a hospital is to change out an IV line every twenty-four hours, but there is a study that shows that changing the IV line every twenty hours reduced the risk of phlebotomists by 20%, it would be a statistical reason to change procedures.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Statistics is an integral part of the nursing profession. It has a direct affect on patient care in a variety of settings as well as the potential to change policies and procedures on a wider scale. A working understanding of the major fundamentals of statistical analysis is required to incorporate the findings of empirical research into nursing practice. The primary focus of this article is to describe common statistical terms, present some common statistical tests, and explain the interpretation of results from inferential statistics in nursing research. An overview of major concepts in statistics, including the distinction between parametric and non parametric statistics, different types of data, and the interpretation of statistical significance, is reviewed.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Examples of some of the most common statistical techniques used in nursing research, such as the Student independent t test, analysis of variance, and regression, are also discussed. Nursing knowledge based on empirical research plays a fundamental role in the development of evidence-based nursing practice. The ability to interpret and use quantitative findings from nursing research is an essential skill for advanced practice nurses to ensure provision of the best care possible for our patients. Applied Nursing Research presents original, peer-reviewed research findings clearly and directly for clinical applications in all nursing specialties. Regular features include “Ask the Experts,” research briefs, clinical methods, book reviews, news and announcements, and an editorial section. Applied Nursing Research covers such areas as pain management, patient education, discharge planning, nursing diagnosis, job stress in nursing, nursing influence on length of hospital stay, and nurse/physician collaboration. Applied Research Methodology in Nursing Care The master’s degree in Applied Research Methodology in Nursing Care provides the knowledge and skills required to carry out and evaluate quantitative and qualitative research projects on the areas of care, teaching and management in which nurses work.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper The principle objective of the master’s degree is for students to gain essential skills in planning, organizing and evaluating scientific studies on nursing care. The syllabus introduces the scientific method and covers the procedures and techniques used to obtain and analyse data and to communicate and disseminate the results and conclusions of studies. In addition, the course offers a wide range of optional subjects, such as research areas in nursing, information and communication technologies, social and health inequalities, ethics and the gender perspective in research, and evidence-based nursing practice, among others. This master’s degree is intended for holders of nursing degrees and diplomas with some experience of research-related activities.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Nursing Research: Definitions and Directions In order to provide further insight into the need for, philosophy, and scope of nursing research this appendix presents a position statement issued by the Commission on Nursing Research of the American Nurses’ Association. It is quoted here in its entirety: 1 Recent years have seen a growing awareness among the public that valuable resources are finite and their use must be carefully considered. In this context, increasing attention is being given to the relative cost of various strategies for utilizing health care resources to meet the present and emerging needs of the nation. Concurrently, nurses are assuming increased decision-making responsibility for the delivery of health care, and they can be expected to continue to assume greater responsibility in the future. Therefore, the timeliness and desirability of identifying directions for nursing research that should receive priority in funding and effort in the 1980s is apparent.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper The priorities identified below were developed by the Commission on Nursing Research of the American Nurses’ Association, a nine-member group of nurses actively engaged in research whose backgrounds represent considerable diversity in preparation and experience. The priorities represent the consensus of the commissioners, developed through a process of thoughtful discussion and careful deliberation with colleagues. Accountability to the public for the humane use of knowledge in providing effective and high quality services is the hallmark of a profession. Thus, the preeminent goal of scientific inquiry by nurses is the ongoing development of knowledge for use in the practice of nursing; priorities are stated in that context. Other guiding considerations were the present and anticipated health problems of the population; a historic appreciation of the circumstances in which nursing action has been most beneficial; nursing’s philosophical orientation, in which emphasis is on a synthesis of psycho social and biomedical phenomena to the end of promoting health and effective functioning; and projections regarding the types of decisions nurses will be making in the last decades of the twentieth century. NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper New, unanticipated problems will undoubtedly confront the health care resources of the country; yet it is clear that many of the problems of the future are already manifest today. New knowledge is essential to bring about effective solutions. Nursing research directed to clinical needs can contribute in a significant way to development of those solutions. Definition of Nursing Research Nursing research develops knowledge about health and the promotion of health over the full lifespan, care of persons with health problems and disabilities, and nursing actions to enhance the ability of individuals to respond effectively to actual or potential health problems.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper These foci of nursing research complement those of biomedical research, which is primarily concerned with causes and treatments of disease. Advancements in biomedical research have resulted in increased life expediencies, including life expediencies of those with serious injury and those with chronic or terminal disease. These biomedical advances have thus led to growth in the numbers of those who require nursing care to live with health problems, such as the frail elderly, the chronically ill, and the terminally ill. Research conducted by nurses includes various types of studies in order to derive clinical interventions to assist those who require nursing care. The complexity of nursing research and its broad scope often require scientific underpinning from several disciplines. Hence, nursing research cuts across traditional research lines, and draws its methods from several fields.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Directions for Research Priority should be given to nursing research that would generate knowledge to guide practice in: 1.Promoting health, well-being, and competency for personal care among all age groups; 2.Preventing health problems throughout the life span that have the potential to reduce productivity and satisfaction; 3.Decreasing the negative impact of health problems on coping abilities, productivity, and life satisfaction of individuals and families; 4.Ensuring that the care needs of particularly vulnerable groups are met through appropriate strategies; 5.Designing and developing health care systems that are cost-effective in meeting the nursing needs of the population. Nursing research is research that provides evidence used to support nursing practices. Nursing, as an evidence-based area of practice, has been developing since the time of Florence Nightingale to the present day, where many nurses now work as researchers based in universities as well as in the health care setting.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Nurse education places focus upon the use of evidence from research in order to rationalise nursing interventions. In England and Wales, courts may determine if a nurse acted reasonably based upon whether their intervention was supported by research. Nursing research falls largely into two areas: Quantitative research is based in the paradigm of logical positivism and is focused upon outcomes for clients that are measurable, generally using statistics. The dominant research method is the randomized controlled trial. Qualitative research is based in the paradigm of phenomenology, grounded theory, ethnography and others, and examines the experience of those receiving or delivering the nursing care, focusing, in particular, on the meaning that it holds for the individual. The research methods most commonly used are interviews, case studies, focus groups and ethnography NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Clinical Research Methodology 3: Randomized Controlled Trials Randomized assignment of treatment excludes reverse causation and selection bias and, in sufficiently large studies, effectively prevents confounding. Well-implemented blinding prevents measurement bias. Studies that include these protections are called randomized, blinded clinical trials and, when conducted with sufficient numbers of patients, provide the most valid results. Although conceptually straightforward, design of clinical trials requires thoughtful trade-offs among competing approaches—all of which influence the number of patients required, enrollment time, internal and external validity, ability to evaluate interactions among treatments, and cost.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Observational study designs, as explained in our previous 2 reviews, are inherently vulnerable to systematic errors from selection and measurement biases and confounding; retrospective studies may additionally be subject to reverse causation when the timing of exposure and outcome cannot be precisely determined. Fortunately, 2 study design strategies, randomization and blinding, preclude or mitigate these major sources of error. Randomized clinical trials (RCTs) are cohort studies—necessarily prospective—in which treatments are allocated randomly to the subjects who agree to participate. In the most rigorous randomized trials, called blinded or masked, knowledge of which treatment each patient receives is concealed from the patients and, when possible, from investigators who evaluate their progress. Blinded RCTs are particularly robust because randomization essentially eliminates the threats of reverse causation and selection bias to study validity, and, considerably mitigates the threat of confounding. Well-executed blinding/masking simultaneously mitigates measurement bias and placebo effects by equalizing their impacts across treatments. 1 We now discuss these benefits in more detail.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper In reviewing patient records, we would not expect 2 treatments for a medical condition to be randomly distributed among patients because care decisions are influenced by numerous factors, including physician and patient preference. Patients given different treatments may therefore differ systematically and substantially in their risks of outcomes. Randomization eliminates selection bias in treatment comparisons because, by definition, randomized assignments are indifferent to patient characteristics of any sort. For example, investigators reviewing records might find that aggressively treated septic critical care patients do better than those treated conservatively. Improved outcomes might occur because aggressive therapy was more effective. But it might equally well be that patients who appeared stronger were selected for more aggressive therapy because they were thought better able to tolerate it and then did better because they were indeed stronger. Looking back, it is hard to distinguish selection bias from true treatment effect.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper The threat of confounding, which can be latent in a population or result from selection or measurement bias, refers to attribution error because of a third-factor linking treatment and outcome. For example, anesthesiologists may prefer to use neuralgia anesthesia in older patients under the impression that it is safer. Let us say, however, that younger patients in a study cohort actually do better. But did they do better because of they were given general anesthesia (a causal effect of treatment) or simply because they were younger (confounding by age, the third variable)? Looking back in time, as in a retrospective analysis of existing data, in complex medical situations, it is difficult to determine the extent to which even known mechanisms contribute causally to outcome differences. And it is essentially impossible to evaluate the potential contributions of unknown mechanisms.NURS 5501 – Introduction to Statistics and Applied Research Methods Research Paper Confounding can only occur when a third factor, the con founder, differs notably between treatment groups in the study sample. Randomization largely prevents confounding because, in a sufficiently large study, patients assigned to each treatment group will most likely be very similar with respect to non–treatment-related factors that might influence the outcome. The tendency of randomization to equalize allocations across treatment groups im

Examining Nursing Specialties Essay Examining Nursing Specialties Essay You have probably seen one or more of the many inspirational posters about decisions. A visual such as a forked road or a street sign is typically pictured, along with a quote designed to inspire. Examining Nursing Specialties Essay Decisions are often not so easily inspired. Perhaps you discovered this when choosing a specialty within the MSN program. This decision is a critical part of your plan for success, and you no doubt want to get it right. This is yet another area where your network can help, as well as other sources of information that can help you make an informed choice. Examining Nursing Specialties Essay To Prepare: Reflect on your decision to pursue a specialty within the MSN program, including your professional and academic goals as they relate to your program/specialization. By Day 3 of Week 10 Post an explanation of your choice of a nursing specialty within the program. Describe any difficulties you had (or are having) in making your choice, and the factors that drove/are driving your decision. Identify at least one professional organization affiliated with your chosen specialty and provide details on becoming a member. ( Make sure to include at least 4 paragraphs and 3 references) APA 7 format. Examining Nursing Specialties Essay Permalink: https://nursingpaperessays.com/ examining-nursin…pecialties-essay / By Day 6 of Week 10 Respond to at least two of your colleagues’ posts by sharing your thoughts on their specialty, supporting their choice or offering suggestions if they have yet to choose. The two discussions below require at least 3 paragraphs and 2 references.APA 7 format. Discussion one for ELIZABETH I had never planned on advancing my education. I love being a nurse and love the job I am in. I have been afforded many opportunities as a nurse, and hadn’t considered the full value of continuing my education until recently. I have seen a tremendous shift in the way care is delivered, from reactionary to preventative, leaving a void in areas of chronic disease management. I realize that to achieve my full potential, and to best serve the needs of my patients, it is imperative that I pursue my advanced degree with a concentration in family medicine. Examining Nursing Specialties Essay I have always worked in a hospital, but more recently I have spent more time in our outpatient clinic. I have always enjoyed the fast-paced nature of an intensive care unit, but really love more to manage patients less critically ill. My patient population ranges in age from 18 to 78, so there are really a multitude of differing needs that arise. Also, because of the complexity of their disease process, many defer to our clinic for primary treatment of all chronic conditions. Because of this, I determined it would best serve these needs to receive training in all areas across the lifespan to best treat my patients. There is also a great need for primary care providers in family medicine as there is more emphasis placed on preventative care (Nursejournal, 2020). In order to keep myself relevant and marketable, should I choose to change jobs, having family medicine training will certainly be helpful. Examining Nursing Specialties Essay There isn’t a specific professional organization for family nurse practitioners, however, American Association of Nurse Practitioners (AANP) is a very comprehensive organization that covers all specialties. There are sub-groups within the larger organization that allow the opportunity to network in a specific area. There are different membership levels based on what point you are in your training (AANP, n.d.). For instance, if I wanted to apply now, I would be eligible to join as a student member, but if I wait until I finish my degree I would be able to join as an NP. In order to assure that I am providing excellent clinical care to my patients based on evidence based practice, I have joined as a member of a disease specific nursing organization, American Association of Heart Failure Nurses. Although there isn’t a specific requirement for nurse practitioners, this organization will help tremendously to allow for brainstorming and networking within my field of practice. There is also opportunity for mentorship within this organization to help with my transition from RN to NP (AAHFN, n.d.). Examining Nursing Specialties Essay It can be intimidating to think about the road that lies ahead to APN, but it is equally important to realize the opportunities for guidance that exist. We are lucky to have so many resources available to help us on our journey, as well as once we finish. Knowing there is a plan and an end in sight will keep us strong on the road to success. References AAHFN. (n.d.). About AAHFN. Retrieved October 6, 2020, from https://www.aahfn.org/page/about Examining Nursing Specialties Essay AANP. (n.d.). What’s my member type? Retrieved October 6, 2020, from https://www.aanp.org/membership/whats-my-member-type NurseJournal. (2020, June 3). 7 Future job trends for nurse practitioners. Retrieved October 6, 2020, from https://nursejournal.org/nurse-practitioner/7-future-job-trends-for-nurse-practitioners/ Examining Nursing Specialties Essay Discussion two GUERLINE Since I have become a nurse, I knew that I wanted to continue my education as an Advance Practice Registered Nurse (APRN). I was not sure of the specialty that I prefer to focus on. I have worked with many APRNs who have shared the ups and downs of their experiences. It only occurs to me that I want to become a psychiatry mental health nurse practitioner when I have family member that have been diagnosed with metal heath disease. I have felt helpless and hopeless where I cannot help my close family member in anyway. The disease of mental health had become such a myth and so difficult to grasp to a point where I realize I need to know more about this field as a nurse. I need to explore it, understand that population and help those that are suffering. Examining Nursing Specialties Essay Every nurse is a psychiatry nurse, because nurses take care of patient holistically. Center for disease control and prevention (CDC) report that “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices.” (cdc.gov). About 50 %. Of American population has a diagnosis of mental health during their lifetime report CDC. Mental health is important in nursing. A personal definition of mental health is that it is a virtual world where not many can get in but where some get lost and cannot find their way out. Every time I start thinking of that situation it saddens me and makes me want to push forward to get the credential I need to reach out to those in need. Examining Nursing Specialties Essay I have always been involved with organization at a local or national level, but I don’t think I have ever taken full advantage of them. American Society for Quality (ASQ) is one of a national professional organization that I have been involved with, its membership serves of quality professional education advancement which gives access to exclusive quality knowledge (asq.org). At a local level I have been involved with religious group and volunteer at committee board member. For my professional career as a Psychiatry mental health Nurse Practitioner (PMHNP), I have found the American Psychiatry Nurses Association (APNA) that offers very low membership cost for full time students as low as 25 dollars a year (apana.org). I am thrilled to find that information and will join them in the near future once I get all requirements (proof of full time student, name of my school, name of the director of my school, expected graduation date). APNA offers continuing education and professional growth, networking and information access and many discounts (apna.org). My goal is to work toward becoming a member of that professional organization. Examining Nursing Specialties Essay References Data and Publications – Mental Health – CDC. (2018, January 26). Retrieved November 03, 2020, from https://www.cdc.gov/mentalhealth/data_publications/index.htm Mental Health – Home Page – CDC. (2018, January 26). Retrieved November 03, 2020, from https://www.cdc.gov/mentalhealth/ Why Join ASQ or ASQE? Value. (n.d.). Retrieved November 03, 2020, from https://asq.org/membership Why Join? (n.d.). Retrieved November 03, 2020, from https://www.apna.org/i4a/pages/index.cfm?pageid=3680 Examining Nursing Specialties Essay I am a Specialty Trainee (ST6) in general adult psychiatry and I currently work as a clinical teaching fellow in mental health at St. George’s, University of London (SGUL). At SGUL, the main method used for assessing clinical competence of the students is the objective structured clinical examination (OSCE) and I am asked to examine OSCEs at SGUL on a regular basis. SGUL are currently in the process of revising the OSCEs for medical students in their clinical years; this revision is marked by a change to the use of global rating scales to assess OSCE candidates and I have selected this assessment experience as the topic of this assignment in order to consider the evidence for global rating scales. The OSCE has long been recognised as “one of the most reliable and valid measures” of clinical competence available [1] . Since they were first conceptualised in the 1970s [2] , OSCEs have become a very common form of clinical examination in both undergraduate and postgraduate medical education. They were developed in order to help address the unreliability and lack of authenticity of the traditional assessments of clinical competence, namely the ‘long case’ and the ‘short case’. Examining Nursing Specialties Essay During the OSCE, the candidates pass through a number of independently scored stations. The candidate will be set a task in each station, which will often involve an interaction with a standardised patient who portrays a clinical scenario. Tasks can include physical examination, history-taking and explaining diagnoses and treatment options. Examining Nursing Specialties Essay The experience of examining in an OSCE I was recently asked to examine in a summative end of term OSCE for transition year (T-year) students at SGUL. Prior to the day of the examination, I received copies of the candidate instructions, simulated patient script, examiner instructions and examiner mark sheet, all of which I reviewed in advance, familiarising myself with the checklist mark sheet. On the day of the examination, I attended a thirty-minute examiner briefing, which covered how to use the mark sheets. As four identical concurrent OSCE circuits were running that afternoon, immediately prior to the examination start time, I met with the other examiners and simulated patients that would be examining and acting in the same station as me, in order to discuss any uncertainties in the mark sheet and to ensure as much consistency as possible. Examining Nursing Specialties Essay Throughout the course of an afternoon, I examined approximately thirty students. Each student had ten minutes in which to discuss smoking with the simulated patient and to apply motivational interviewing techniques. The simulated patient was an actor with previous training and experience in medical student OSCEs. The candidates had one minute to read their instructions before entering the station. A one-minute warning bell rang at nine minutes. Examining Nursing Specialties Essay The mark sheet consisted of a checklist of twenty-three items, a simulated patient mark and a global rating. Each checklist item was marked either 0 for poorly done or not done, 1 for skill completed adequately or 2 for does well. I completed the checklist marks as the candidate undertook the station. The simulated patient mark was based on how easy the candidate made it for them to talk and they could award 0, 1 or 2, which was added to the overall checklist score. The simulated patient and I devised a silent hand signal system for informing me of their mark after the student had left the station. Finally, I awarded an overall global rating on a 1 to 5 Likert scale, with 1 being a clear fail and 5 being outstanding. During the examiner briefing, it was explicit that the global rating should reflect how the examiner felt the student performed, irrespective of the checklist score. I used the one-minute reading time between candidates to check that I had completed the mark sheet and to award the global rating. Examining Nursing Specialties Essay I awarded the majority of students a global rating of 3 (clear pass) with one candidate receiving a clear fail and one receiving an outstanding. Examining Nursing Specialties Essay Critical reflection on the experience I often feel anxious about examining clinical examinations, especially those that are summative, as I am responsible for ensuring a fair and consistent examination. However, I felt that I was able to prepare well for the examination and familiarise myself with the scenario and mark sheet, as I received this information two days prior to the examination. I also received guidance from the responsible examiner on the level expected from the students, which helped to allay my anxiety about forgetting what stage the students are at and expecting the wrong standard. The station expected the candidates to use motivational interviewing, which is something that I am familiar with as a psychiatrist. Therefore, I had a good level of understanding of the station and what was expected of the students. However, I was surprised when I reviewed the checklist mark sheet, as I felt that, as an “expert” I may not have asked all the questions that the students were required to ask in order to obtain the marks. I suspected that this was because, as an experienced clinician, I would need less information to reach the correct diagnostic conclusion. However, this left me wondering whether checklists are the best method for assessing experienced clinicians or, in the case of this OSCE, the better students. Examining Nursing Specialties Essay As the same station was occurring simultaneously, it was important to make sure that there was inter-rater reliability. Therefore, I was keen to discuss the station and mark sheet with the other examiners that were examining the same station in order to ensure consistency with the more subjective points on the mark sheet. However, there was very little time for this after the examiner briefing, as examiners were rushing to find the correct station and speak to their actor. This left me worried about the risk of subjectivity being introduced by individual examiner’s interpretations of the mark sheet. On a positive note, I did have some time to run through the station with the simulated patient before the examination, to ensure that they were clear how much information to give the candidates and how to indicate their marks. The simulated patient was familiar with the station, as she had already participated in a morning examination session; thus she was able to provide me with information about problems that had arisen with the station, in order to ensure consistency. Examining Nursing Specialties Essay In terms of other aspects of the examination that went well, I remained quiet and non-intrusive during the examination, allowing the candidates to interact with the simulated patient uninterrupted. Even though OSCEs are called objective, I have always wondered how objective they truly are. Even with checklist scoring, there is room for some degree of subjectivity, especially when deciding whether a student did something adequately or well. During this examination, I had difficulty allocating the global rating for each students and I was concerned that I may have been inconsistent with this, introducing further subjectivity into the examination. I was particularly concerned that the first few students were judged differently to later students, as I was still familiarising myself with the general standard of the students. When the Royal College of Psychiatrists (RCPsych) moved to using global ratings instead of checklist scores in their membership examinations, they removed the word “objective” from the title of the examination. I will address this in the key points. Examining Nursing Specialties Essay On the other hand, as a psychiatrist, I am often asked to examine OSCE stations with a strong emphasis on communication skills, as described in this experience, and I do not feel that checklists necessarily reflect these skills. Students tend to fire off a list of rehearsed questions, in order to meet the checklists requirements within the limited time they have. This negatively impacts on rapport with the simulated patient. Like the RCPsych, SGUL is changing the format of the OSCEs for the more senior years of the undergraduate medicine courses to use global rating scales instead of checklist scores and I was interested to investigate the evidence for the advantages of global ratings over checklists. Examining Nursing Specialties Essay Key points Are global rating scales as reliable as checklist scores? Do global rating scales have advantages over checklists for more experienced candidates? Are global ratings a better method of assessing communication skills than checklists? Examining Nursing Specialties Essay Literature review Educational theory In 1990, psychologist George Miller proposed a framework for assessing clinical competence [3] (see Figure 1). At the lowest level of the pyramid is knowledge (knows), followed by competence (knows how), performance (shows how), and action (does). OSCEs were introduced to assess the ‘shows how’ layer of Miller’s triangle. Figure 1: Miller’s pyramid for assessing clinical competence (taken from Norcini, 2003) [4] OSCE marking strategies Historically, marking of the candidate’s performance in the OSCE has been undertaken by an examiner who ticks off items on a checklist as the student achieves them. In some cases, the total checklist score forms the mark awarded to the candidate. Examining Nursing Specialties Essay The use of checklists is proposed to lessen subjectivity, as they make the examiners “recorders of behaviour rather than interpreters of behaviour” [5] . However, in recent years, global ratings have increasingly been used in conjunction with or even instead of checklists. There are a number of reasons for this. Firstly, global ratings have been shown to have psychometric properties including inter-station reliability, concurrent validity and construct validity, that are equal to or higher than those of checklists [6] , [7] . Further, checklists do not reflect how clinicians solve problems in the clinical setting [8] . Finally, binary checklists do not take into account components of clinical competence, such as empathy [9] , rapport and ethics [10] , [11] . Global ratings versus checklists: psychometric properties Van der Vleuten and colleagues conducted two literature reviews of the psychometric properties of different examination scoring systems, including those used in OSCEs [12] . They made a distinction between objectivity and objectification, describing objectivity as the “goal of measurement, marked from subjective influences” [13] . The authors acknowledged that “subjective influence cannot completely be eliminated” [14] . Consequently, they defined objectification as the use of strategies to achieve objectivity and suggested that such strategies might include detailed checklists or yes/no criteria. The studies they reviewed consistently indicated that objectification does not result in “dramatic improvement” in reliability. Examining Nursing Specialties Essay They concluded that methods considered to be more objective, including checklists, “do not inherently provide more reliable scores” and “may even provide unwanted outcomes, such as negative effects on study behaviour and triviality of the content being measured” [15] . This conclusion was supported by the results of another study, which found higher reliabilities for subjective ratings than for objective checklists [16] . Regehr et al directly compared the reliability and validity of task-specific checklists and global rating scales in an OSCE [17] . They discovered that, compared with checklists, global ratings “showed equal or higher inter-station reliability, more accurate prediction of the training level of the … (candidate)”, indicating better construct validity, and “more accurate prediction of the quality of the final product”, indicating better concurrent validity. The results of the study also revealed that the combination of checklists with a global rating scale did not significantly improve the reliability or validity of the global rating alone. Examining Nursing Specialties Essay Cohen et al [18] undertook a study to determine the validity and generalizability of global ratings of the clinical competence made by expert examiners. They administered a thirty-station OSCE to seventy-two foreign-trained doctors who were applying to work in Ontario. For each candidate, the examiners completed a detailed checklist and two five-point global ratings. Their results revealed that “generalizability coefficients for both ratings were satisfactory and stable across cohorts”. There were significant and positive correlations between the global ratings and total test scores, demonstrating construct validity. This further supports the conclusion that global ratings are as reliable, or even more reliable, than checklists. Examining Nursing Specialties Essay Whilst studying the psychometric properties of global rating scales, Hodges et al [19] found that the student’s perception of how they are being evaluated can affect their behaviour during the examination. Students who believed that they were being assessed by checklists tended to use more closed questions in a focused interview style. However, those students that perceived that they were being marked on a global rating scale tended to use more open-ended questions and gave more attention to their interaction with the patient. This finding was supported by another study [20] , which also found that reliability of global ratings is further improved when the students anticipate evaluation by a global rating scale. The authors concluded, “not only student scores but also the psychometrics of the test may be affected by the students’ tendency to adapt their behaviours to the measures being used”. Examining Nursing Specialties Essay Global ratings versus checklists: the effect of the level of expertise of the candidate Dreyfus and Dreyfus [21] suggested that there are five stages of developing expertise: novice, advanced beginner, competence, proficiency and expertise. Each stage is characterised by a different type of problem-solving, for example the novice will collect large amounts of data in no particular order to use for problem-solving. At the other end of the spectrum, experts tend to gather specific data in a hierarchical order. However, experts have great difficulty in breaking down their thinking into the individual components and, therefore, struggle to return to the novice type of problem-solving. Examining Nursing Specialties Essay This theory has been shown to apply to clinical practice through research investigations. For example, Leaper [22] studied the behaviour of clinicians when interviewing patients, in particular what questions they asked and in what order. The study included doctors specialising in surgery, ranging from pre-registration house officer to consultant. Leaper found that the more junior doctors would apply the same set of questions to each patient, irrespective of whether they were relevant to that patient or not. Whereas, the senior doctors were more flexible in their use of questions and were able to yield more information with fewer questions. Examining Nursing Specialties Essay This shows how, as clinicians develop expertise, they tend to move away from applying checklist style questions to each patient and towards complex, hierarchical problem-solving skills. Therefore, whilst the checklist marking used in OSCEs may be appropriate for novices, it penalises the more experienced clinician who “integrate information as they gather it, in a way that they may not be able to articulate” [23] . In order to test this theory, Hodges et al evaluated the effectiveness of OSCE checklists in measuring increasing levels of clinical competence. They asked forty-two doctors of three different grades to undertake an OSCE comprised of two fifteen-minute stations. In each station, an examiner rated the candidate’s performance using a checklist and a global rating scale. Each station was interrupted after two minutes to ask the candidate for a diagnosis. Each candidate was again asked for a diagnosis at the end of the station. The results revealed significantly higher global ratings for experts than junior doctors but a decline in checklist scores with increasing levels of expertise. The consultant grade doctors scored significantly worse than both grades of junior doctors on the checklists. The accuracy of diagnoses increased between two and fifteen minutes for all three groups, with no significant differences between the groups. These results were consistent with a previous study, which found that senior doctors scored significantly better on OSCE global ratings than their junior counterparts, but not on checklists [24] . This study was primarily designed to examine the validity of a psychiatry OSCE for medical students. Thirty-three medical students and seventeen junior doctors completed an eight-station OSCE, during which examiners used both checklists and global ratings to assess the candidates. Although it was not the primary aim of the study, the results suggested that checklists were not effective for evaluating the junior doctors, as they did not capture their higher level of expertise. Examining Nursing Specialties Essay Global ratings versus checklists: assessment of communication skills The OSCE has been shown to be an effective method for assessing communication and interpersonal skills [25] , [26] . More recently, research has focused on whether global rating scales are a preferable method of marking communication skills in an OSCE. Examining Nursing Specialties Essay Scheffer et al [27] explored whether students’ communication skills could be reliably and validly assessed using a global rating scale within the framework of an OSCE. In this study, a Canadian instrument was translated to German and adapted to assess students’ communication skills during an end-of-term OSCE. Subjects were second and third year medical students at the reformed track of the Charite´-Universitaetsmedizin Berlin. Different groups of raters were trained to assess students’communication skills using the global rating scale and the judgements of different groups of raters were compared to expert ratings as a defined gold standard. The examiners found it easier to distinguish between better students by using a combination of a checklist and a global rating scale. With only the checklist, examiners reported that students often earned the same score despite considerable differences in their communication skills. Examining Nursing Specialties Essay Mazor et al [28] assessed the correspondence between OSCE communication checklist scores and patients’ perceptions of communication effectiveness. Trained raters used a checklist to record the presence or absence of specific communication behaviors in one hundred encounters in a communication OSCE. Lay volunteers served as simulated patients and rated communication during each encounter. The results revealed very low correlations between the trained raters’ checklist scores and ratings by simulated patient, averaging about 0.25. The authors suggested that checklists are unable to capture the complex determinants of patient satisfaction with a clinician’s communication. In a discussion paper, Newble concludes that “a balanced approach is probably best” [29] with checklists being more appropriate for assessing practical skills and global ratings more appropriate for process aspects, such as communication skills. Examining Nursing Specialties Essay Analysis of literature and discussion Are global rating scales as reliable as checklist scores? Reliability refers to the consistency of a measure and is a proxy for objectivity. In my reflection I expressed concerns about whether global rating scales are more subjective in comparison to checklist scores and how this affected the reliability of the OSCE. In two thorough literature reviews, Van der Vleuten, Norman and De Graaff discussed and criticised this presumption [30] . They argued that checklists may focus on easily measured and trivial aspects of the clinical encounter, and that more subtle but critical factors in clinical performance may be neglected. They referred to such measurement as “objectified” rather than objective. My presumption was that objective or objectified measurement is superior to subjective measurement, such as global ratings, with respect to psychometric properties such as reliability. However, van der Vleuten et al reviewed the literature and concluded that “objectified methods do not inherently provide more reliable scores” and “may even provide unwanted outcomes, such as negative effects on study behaviour and triviality of content being measured” [31] .Examining Nursing Specialties Essay All the literature that I reviewed supported the finding that global rating scales are at least as reliable as checklist scores [32] , [33] , [34] . In addition, studies show that reliability of global ratings is further improved when candidates are aware that the examination will be marked using global ratings [35] . Further, Regehr et al found that combining a checklist and global rating scale did not significantly improve the reliability of the global rating scale alone [36] . However, the results of this study are not necessarily generalisable for several reasons: the examination was only testing practical surgical skills; the research population was heterogeneous with the researchers recruiting candidates with a wide range of ability levels, whereas OSCEs are most commonly used to examine students at the same level of training; and the study only used “expert” examiners. Research addressing this key question has other weaknesses. A lot of the studies refer to global ratings that are allocated by the simulated patient, rather than the examiner, which is not usually the case in the exams at SGUL. Different schools use slightly different OSCE formats, so study results from one school or course may not be generalisable to all medical schools. At SGUL, examiners come from variety of backgrounds and are not necessarily clinicians. In some schools, the standardised patient also marks the candidate, instead of an examiner. Examining Nursing Specialties Essay There is very little research from the UK and much of the relevant literature is from the 1980s and 1990s with a paucity of recent research. This may reflect the stability of the background theory to the OSCE but it may be useful to repeat some of the previous research in light of changes to undergraduate medical curricula in the last twenty years. Examining Nursing Specialties Essay Conclusion The overwhelming evidence from the literature is that global rating scales are at least as reliable as checklist scores. Indeed, reliability of the examination can be improved through the use of global ratings, especially if the students are aware that this is how they will be assessed. Nonetheless, up-to-date literature regarding OSCEs is very sparse and there is a lack of good quality, large scale randomised controlled trials in the OSCE field in general. There is opportunity for more UK-based studies following the changes to undergraduate medical curricula over the past twenty years. The use of global rating scales should be a key focus of future research, in order to provide more support for the recent move of medical education institutions, including SGUL, to use global rating scales rather than checklists in OSCEs. Examining Nursing Specialties Essay Do global rating scales have advantages over checklists for more experienced candidates? Educational theory suggests that, as clinicians develop expertise, they tend to move away from applying checklist style questions to each patient and towards complex,

Funding Of Healthcare/ Reimbursement Issues Essay Paper Funding Of Healthcare/ Reimbursement Issues Essay Paper Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare. Funding Of Healthcare/ Reimbursement Issues Essay Paper Permalink: https://nursingpaperessays.com/ funding-of-healt…sues-essay-paper / Discussion How Reimbursement Is Affected By Pay-For-Performance Approach Healthcare payers agree with the idea of Evidence-Based Medicine (EBM) to advocate for pay-for-performance in provider reimbursement on quality and efficiency. The fundamental system that most payers use to compensate physicians and provider associations embodies enticements for excellence and efficiency. Reimbursement can be affected by the P4P approach and other factors such as the claims process, out-of-network payments, legislation, audits and denials. While the same P4P approaches are attempts to commence incentives and new strategies into the healthcare, the underlying arrangement of the compensation system produces Funding Of Healthcare/ Reimbursement Issues Essay Paper There are two broad approaches to financing health care: a market-based approach and a government-financed approach. For each approach, answer the following questions: 1. Who is provided access? Most government financed systems are inclined to make available for every person living in the nation with treatment which proposes access to some fundamental level of care. Majority of people pay for coverage through taxes and additional charges. In government financed health care the government may provide care itself such as the United Kingdom or they may contact other providers to do so ex: Germany and Japan or in the United States …show more content… This rewards quantity over quality. Fee for service does nothing to promote low cost, high value services, such as preventive care or patient education even if they could considerably enhance patients’ physical condition and reduce health care costs through the system. 78% of employer sponsored health insurance is was fee for service. Reimbursement is the form of payment for services provided. The most common practice is the insurance company pays to the provider directly. Under the MCO when receiving care the patient is usually required to pay a small amount out of pocket such as 15 or 20 dollars and the rest is picked up by the managed care plan. 4. How does reimbursement apply? Reimbursement is the determination how much to pay for certain services. Reimbursement is costs or repayment for health care benefits. In the United States health benefits are often provided before the payment is made. End result physicians, clinics, hospitals, and other health care contributor establishment request reimbursement for health services provided in addition to expenses incurred. Presently reimbursement of claims for healthcare service depends on the appointment of medical codes to explain the diagnosis.Funding Of Healthcare/ Reimbursement Issues Essay Paper There are two broad approaches to financing health care: a market-based approach and a government-financed approach. For each approach, answer the following questions: 1. Who is provided access? Most government financed systems are inclined to make available for every person living in the nation with treatment which proposes access to some fundamental level of care. Majority of people pay for coverage through taxes and additional charges. In government financed health care the government may provide care itself such as the United Kingdom or they may contact other providers Funding Of Healthcare/ Reimbursement Issues Essay Paper This rewards quantity over quality. Fee for service does nothing to promote low cost, high value services, such as preventive care or patient education even if they could considerably enhance patients’ physical condition and reduce health care costs through the system. 78% of employer sponsored health insurance is was fee for service. Reimbursement is the form of payment for services provided. The most common practice is the insurance company pays to the provider directly. Under the MCO when receiving care the patient is usually required to pay a small amount out of pocket such as 15 or 20 dollars and the rest is picked up by the managed care plan. 4. How does reimbursement apply? Reimbursement is the determination how much to pay for certain services. Reimbursement is costs or repayment for health care benefits. In the United States health benefits are often provided before the payment is made. End result physicians, clinics, hospitals, and other health care contributor establishment request reimbursement for health services provided in addition to expenses incurred. Presently reimbursement of claims for healthcare service depends on the appointment of medical codes to explain the diagnosis. correctly with varied crowds of patients to reduce incentives to keep away from most patients is quite challenging. Finally, the effects pay-for-performance will have on the future of the health care depends on incentives with “teaching to the test” to guarantee that the affirmative objectives are not attained at an enormous price. The Social Security Act of 1965 created Medicare and Medicaid, which provides health care coverage for the elderly, poor, and disabled. Medicare has become the largest single payer health entity spending $57.9 billion in 1980, $271 billion in 2003, and $513 billion in 2010 (Social Security Administration, 2012). Whereas, Medicaid being state funded, its governance is state-specific for spending. There have been very few changes to The United States health care payment system since Medicare’s and Medicaid’s inception, until March 23, 2010 Funding Of Healthcare/ Reimbursement Issues Essay Paper Definition of the problem intended to be solved by legislation/policy The problems (for this paper) with the current reimbursement for patients with Medicare and Medicaid, begins with and depends on how one looks at the problem. Physicians/providers, patients, and payers all have different opinions on what the actual problems are. This graduate nursing student (GNS) identifies these five primary problems. First, the traditional fee-for-service model, that pushes or rewards (financially) quantity of care provided, and deters or punishes quality of care provided seems to be the most pressing issue (Thorpe and Ogden, 2010), as well as, contradicts the premise of the ACA. Second, the reimbursement rates for Medicaid are significantly lower than Medicare and Medicaid dollars spent are matched at the federal level. Depending on the state and service, the difference can be up to 59% lower for Medicaid. (Sommers, Paradise, and Miller, 2011). Third, the looming 24% Medicare cut across the board, that will affect Medicaid too, has been thwarted again by legislation. Fourth, prior to the ACA, physicians were already limiting the number of Medicare and Medicaid patients because of lower reimbursement rates, delayed payments, and non-clinical spent for patient care (not reimbursed) (Sommers, Paradise, and Miller, 2011). Now, only four years after the ACA was passed into law, the number of primary care physicians has decreased by 17% (AHRQ, 2014), creating an even larger dilemma then reimbursements. Fourth, with the above mentioned problems and along with Medicaid expansion (in the states that have chosen to expand) have caused an increase in the number of people eligible. Thus, this creates an even larger bottleneck to prevent access to health care The Department of Veterans Affairs is a prime example of too many patients and not enough resources. Although, the looming 24% Medicare cut required by a law passed in 1997 to reduce Medicare payments to all providers is not addressed by the ACA, this GNS thinks it is vitally important to note that it was just passed by Congress for the 17th time and has become known as doc fix legislation (Peterson, 2014). Funding Of Healthcare/ Reimbursement Issues Essay Paper Finally, the problem with the ACA is not only with what it did address, but with what it did not address in making sure health care is accessible and reimbursed to providers, presumably its stated goal. For example, Medicare will have 140,000 different codes next year for billing that the ACA has not addressed, which is complicating matters. The Economist (May 31-June 6 ) discusses how there are nine codes for injuries related to a turkey encounter (patient struck or pecked, once or multiple times, infection/s as a result, etc…). This GNS mentions this because it is a great example of Medicare’s ridiculousness and an area that the government has ignored and hindered health care’s functionality. Dr. B. Bojewski, D.O. (personal communication, May 23, 2014) reports, providers in all areas of practice,… More and more, the popular press discusses rural hospitals as though they were an “endangered species,” with the implication that the forces leading to their extinction are inexorable. Indeed, the problems facing these institutions do seem at times to be overwhelming. 1 During the 1980s, the declining economy of many rural areas led increasing numbers of young adults to migrate to urban areas. The remaining population served by rural hospitals is becoming poorer, older, and increasingly likely to be covered by public insurance programs. Because of the relatively high proportion of rural hospital patients who are elderly, rural hospitals are particularly vulnerable to Medicare payment policies. Rural advocates argue that current policies are insensitive to the special problems of small hospitals, pointing to reports of widespread financial losses and an increasing number of hospital closures concentrated among facilities with fewer than fifty beds. 2 Some sources predict that as many as 600 rural hospitals could close over the next few years.Funding Of Healthcare/ Reimbursement Issues Essay Paper The problems of rural hospitals have generated a sympathetic response from the media and some members of Congress. 4 Both the 99th and the 100th Congress passed legislation to modify the way in which rural hospitals are paid under Medicare’s prospective payment system (PPS). In the 100th Congress, the National Rural Health Care Act of 1988 was introduced by Rep. Edward Roybal (D-CA) with a wide-ranging agenda for changes in rural health care financing and delivery. Congress also legislated a “transition grants” program, under the sponsorship of Sen. David Durenberger (R-MN). This program, administered through the Health Care Financing Administration (HCFA), provides small grants to rural hospitals to diversify services, convert acute care beds to other uses, and engage in other similar activities. In addition, the Department of Health and Human Services (HHS) has created an Office of Rural Health Policy to coordinate public- and private-sector initiatives on rural health care. Clearly, rural health care delivery, and particularly the viability of rural hospitals, has emerged once again as a high-profile issue for federal health policymakers, although no coherent overall rural health policy has yet been articulated.Funding Of Healthcare/ Reimbursement Issues Essay Paper Stimulated in part by government and private foundation grant programs, rural hospitals have increasingly sought to address their problems through collective action. Many of these facilities have affiliated with a multihospital system. The American Hospital Association (AHA) reports that about one-third of rural community hospitals are owned, leased, or contract-managed by multihospital systems, and that system involvement is heaviest in regions where investor-owned systems are most prevalent (South Atlantic, Mountain, and Pacific). 5 However, this trend appears to have weakened, possibly because of financial losses incurred by these systems coupled with concerns on the part of rural communities that system affiliation can result in a loss of hospital autonomy and reduced hospital sensitivity to local needs. 6 In contrast, rural hospital alliances, or consortia, seem to be gaining in popularity among rural hospitals as a means of obtaining the benefits of collective action, while maintaining a greater degree of local control over hospital decision making. In this essay, we describe rural hospital consortia in the United States and discuss the factors that appear to facilitate or impede their development, using data collected as part of an ongoing evaluation of The Robert Wood Johnson Foundation’s Hospital-Based Rural Health Care (HBRHC) program.Funding Of Healthcare/ Reimbursement Issues Essay Paper While the level of formality of consortium arrangements varies, the primary purpose of all rural hospital consortia is to provide an administrative framework for developing joint activities among member institutions. As the Senate’s Special Committee on Aging (1989) has observed, relatively little is known about the number, structure, and activities of rural hospital consortia or the developmental problems that they face. 7 A 1986 survey conducted by National Health Advisors found nine rural hospital alliances ranging in size from four to twenty-five hospitals. 8 More recently, a staff report to the Senate’s Special Committee on Aging speculated that as many as a quarter of rural hospitals (approximately 650) participate in hospital consortia. Funding Of Healthcare/ Reimbursement Issues Essay Paper In December 1988, we initiated an effort to identify and survey all rural hospital consortia in the United States. We began with a list of 180 consortium applicants to the HBRHC program and added to this number through a phone survey of representatives of each of the fifty state hospital associations. We identified 269 potential rural hospital consortia in this manner. We completed telephone interviews with representatives from 266 of these organizations, resulting in a list of 127 groups of rural hospitals that met our loose definition of a consortium: any group of rural hospitals (or rural and urban hospitals) that meet or work together for specific purposes and have specific membership criteria. The average number of rural hospitals in these consortia was 12.7, with a median participation of nine. If this represented an unduplicated count, it would suggest that 1,600 hospitals nationwide belong to consortia. However, since many rural hospitals participate in more than one consortium, the total number of hospitals participating in consortia is approximately 1,000, or slightly less than half of all U.S. rural hospitals. Clearly, rural hospital consortia have the potential to play a significant role in health care delivery in rural areas.Funding Of Healthcare/ Reimbursement Issues Essay Paper It appears that rural hospital consortia are a relatively recent phenomenon, since 59 percent of the consortia we identified were three years old or younger in December 1988, while only 14 percent had existed for longer than ten years. Twenty-eight percent of the consortia had nonhospital members, and slightly over half listed a hospital located in a metropolitan statistical area as a member. Typically, hospitals in rural consortia retain the option of participating, or not participating, in each consortium activity. The common thread among all such activities is that voluntary cooperation among rural hospitals can yield benefits unavailable to an individual hospital acting alone. For example, while a single rural hospital may not have adequate numbers of patients or resources to purchase specialized equipment, a group of rural hospitals may be able to do so in a cost-effective manner. Thus, a consortium of rural hospitals in the Midwest has purchased magnetic resonance imaging (MRI) equipment jointly. Sharing services of this type can benefit rural hospitals financially by reducing the likelihood that rural residents will travel to urban centers for specialized diagnostic care. It also, of course, improves access to services in rural areas.Funding Of Healthcare/ Reimbursement Issues Essay Paper Joint physician and staff recruitment can be carried out through consortia, since a group of hospitals often can negotiate a more favorable contractual arrangement with a recruiting firm than can a single rural hospital. Consortium members can share advertising costs for allied health personnel and nurses, allowing broader coverage in national journals. In some consortia, shared staff arrangements for allied health and nursing personnel have evolved to address fluctuations in patient census or the need for flexible part-time staff. Consortia can also facilitate the sharing of costs for marketing surveys or community relations campaigns for their members. And, group efforts to improve quality in rural hospitals are now occurring through consortia. Standardized credential review processes and the sharing of a full-time quality assurance coordinator often result from these efforts. Many other kinds of activities are possible under a consortium framework, including management and financial consultation, acute care bed conversions, the development of primary or specialty clinics, lobbying on legislative issues, and regional planning. In our survey, we found that the average consortium was involved in six different types of activities. Four out of five consortia had educational programs for physicians or hospital personnel, and four of five had shared service programs. Two-thirds of rural hospital consortia conducted legislative liaison activities. The least common activities arguably were the ones requiring the highest level of cooperation and trust among participating hospitals: acute care bed conversions and quality assurance. Only one of five consortia reported acute care bed conversion projects, and two of five had joint quality assurance or credentialing efforts.Funding Of Healthcare/ Reimbursement Issues Essay Paper If participation in a hospital consortium proves to be an attractive way for rural hospitals to enhance their financial viability and the quality of the services they offer to their communities, then it will be important for policymakers and hospital administrators to understand the factors that can influence consortium development and implementation. To identify these factors, we conducted structured interviews with consortium directors and hospital administrators at the thirteen HBRHC program sites, approximately four to nine months after they had first received grant funds from The Robert Wood Johnson Foundation. The consortia in the HBRHC program were selected from 180 applications submitted by groups of hospitals and other health care organizations in response to a program solicitation by the foundation. Fourteen consortia were chosen to receive funding of approximately $150,000 per year, with a progress review to occur at the end of two years. The foundation offered a maximum of four years of support, along with access to loan funds not to exceed $500,000 per consortium. One of the selected consortia withdrew from the program early in its first year because it was unable to maintain support among its member hospitals for its only proposed program—a rural health maintenance organization (HMO).Funding Of Healthcare/ Reimbursement Issues Essay Paper. There was considerable variation in regional environments and organizational characteristics among the remaining thirteen consortia. The degree of prior collaboration among hospitals ranged from little or no previous cooperative activities or meetings in some consortia to a highly formalized consortium that had been in existence for ten years. The consortia were administered through state hospital associations, state planning agencies, tertiary care centers, and freestanding consortium organizations. In most cases, the consortium’s governing board was composed of all consortium members, while, in a few cases, the board was composed of a smaller number of appointed members. All consortia had a designated director, although the person designated sometimes had other duties as well. The number of additional consortium staff, beyond the director, ranged from none to over forty.Funding Of Healthcare/ Reimbursement Issues Essay Paper Environmental and demographic characteristics indicate a great deal of diversity among the thirteen consortium sites. The population of their market areas ranged from 44,000 persons in northern Montana to nearly one million persons in South Carolina and in southern Maine. The smallest geographic area included within a consortium boundary was 3,500 square miles (northeastern New York), while the largest was 90,000 square miles (Nevada). Population density was lowest in Nevada, at 1.1 persons per square mile, and highest in western New York, at 119 persons per square mile. The percentage of the population age sixty-five and over ranged from 9.8 percent in South Carolina to 15.4 percent in Missouri, while the percentage of area population living in poverty ranged from 10.6 percent in western New York to 25.3 percent in Alabama. Physician shortages appeared particularly acute in Nevada (sixty-one physicians per 100,000 residents) and Montana (sixty-six per 100,000 residents). Northern Maine, southern Maine, and northeastern New York were the consortium areas with the greatest number of physicians per capita, but they were still below the national average of about 180 patient care physicians per 100,000 population.Funding Of Healthcare/ Reimbursement Issues Essay Paper The HBRHC consortia proposed to pursue a broad range of activities (Exhibit 1 ). Eight consortia intended to develop shared-services programs of some type, while seven planned joint professional recruitment activities. Seven others hoped to develop primary care or specialty clinics through the cooperative efforts of participating hospitals. At the other extreme, only two consortia planned to develop quality assurance programs. The two programs are very different, but they both come under the management of the Centers for Medicare and Medicaid Services. This is a division of the U.S. Department of Health and Human Services. President Lyndon B. Johnson created both Medicaid and Medicare when he signed amendments to the Social Security Act on July 30, 1965.Funding Of Healthcare/ Reimbursement Issues Essay Paper Medicaid is a social welfare, or social protection, program. Data from August 2018 show that it serves about 66.6 million people. Medicare is a social insurance program that served more than 56 millionenrollees in 2016. Medicaid, Medicare, the Children’s Health Insurance Program, and other health insurance subsidies represented 26 percent of the 2016 federal budget, according to the Center on Budget and Policy Priorities. The Centers for Medicare and Medicaid Services (CMS) report that 91.1 percent of the U.S. population had medical insurance in that year. According to the 2017 U.S. census, 67.2 percent of people have private insurance while 37.7 percent have government health coverage.Funding Of Healthcare/ Reimbursement Issues Essay Paper Medicaid makes it possible for many people with a low income to access healthcare. Medicaid is a means-tested health and medical services program for certain individuals and low-income households with few resources. Primary oversight of the program happens at the federal level, but each state is responsible for: establishing its eligibility standards determining the type, amount, duration, and scope of its services setting the rate of payment for services administering its own Medicaid program Each state makes the final decisions regarding what their Medicaid plans provide, but they must meet some federal requirements to receive federal matching funds.Funding Of Healthcare/ Reimbursement Issues Essay Paper Medicaid does not directly provide people with health services. Instead, it reimburses healthcare providers for the care that they deliver to enrolled patients. Not all providers need to accept Medicaid, so it is essential that users check their coverage before receiving care. People who do not have private health insurance can seek help at a federally qualified health center (FQHC). These provide coverage on a sliding scale, depending on the person’s income. Centers must provide specific services, including: inpatient hospital services outpatient hospital services prenatal care vaccines for children physician services nursing facility services for people aged 21 years or older family planning services and supplies rural health clinic services home healthcare for people who are eligible for skilled nursing services laboratory and X-ray services pediatric and family nurse practitioner services nurse-midwife services FQHC services and ambulatory services early and periodic screening, diagnostic, and treatment (EPSDT) services for both children and adults under the age of 21 years Funding Of Healthcare/ Reimbursement Issues Essay Paper States may also choose to provide optional additional services and still receive federal matching funds. The most common of the 34 approved optional Medicaid services are: diagnostic services prescribed drugs and prosthetic devices optometrist services and eyeglasses nursing facility services for children and adults under the age of 21 years transportation services rehabilitation and physical therapy services dental care The program aims to help people in low-income households, but there are other eligibility requirements too. These relate to age, pregnancy status, disability status, other assets, and citizenship. For a state to receive federal matching funds, it must provide Medicaid services to individuals who fall under certain categories of need. For example, the state must provide coverage for some individuals who receive federally assisted income-maintenance payments and similar groups who do not receive cash payments. The federal government also considers some other groups to be “categorically needy.” People in these groups must also be eligible for Medicaid.Funding Of Healthcare/ Reimbursement Issues Essay Paper They include: children under the age of 18 years whose household income is at or below 138 percent of the federal poverty level (FPL) pregnant women with a household income below 138 percent of the FPL people who receive Supplemental Security Income (SSI) parents who earn an income that falls under the state’s eligibility for cash assistance States may also choose to provide Medicaid coverage to other, less well-defined groups who share some characteristics with those above. These may include: pregnant women, children, and parents who earn an income above the mandatory coverage limits some adults and seniors with low income and limited resources people who live in an institution and have low income certain adults who are older, have vision loss or another disability, and have an income below the FPL individuals without children who have a disability and are near the FPL “medically needy” people whose resources are above the eligibility level that their state has set Medicaid does not provide medical assistance to all people with low income and resources. The Affordable Care Act of 2012 gave states the option to expand their Medicaid coverage. In the states that did not expand their programs, several at-risk groups are not eligible for Medicaid.Funding Of Healthcare/ Reimbursement Issues Essay Paper These include: adults over the age of 21 years who do not have children and are pregnant or have a disability working parents with incomes below 44 percent of the FPL legal immigrants during their first 5 years of living in the U.S. Medicaid does not pay money to individuals but sends payments to healthcare providers instead. States make these payments according to a fee-for-service agreement or through prepayment arrangements, such as health maintenance organizations (HMOs). The federal government then reimburses each state for a percentage share of their Medicaid expenditures. This Federal Medical Assistance Percentage (FMAP) changes each year, and it depends on the state’s average per capita income level. The average reimbursement rate varies between 57 and 60 percent. Wealthier states receive a smaller share than poorer states, which can receive up to 73 percent of the money back from the federal government. In the states that chose to expand their coverage once the Affordable Care Act became effective, more adults and families on low incomes became eligible because the new provision allowed enrolment at up to 138 percent of the FPL. In return, the federal government covers all of the expansion costs for the first 3 years and over 90 percent of the costs moving forward.Funding Of Healthcare/ Reimbursement Issues Essay Paper Medicare is a federal health insurance program that pays for hospital and medical care both for people in the U.S. who are older and for some people with disabilities. The program consists of: two main parts for hospital and medical insurance (Part A and Part B) two additional parts that provide flexibility and prescription drugs (Part C and Part D) Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays and other services. Medicare can help people to access facilities such as walkers and wheelchairs. In the hospital, this includes: meals supplies testing a semi-private room It also pays for home healthcare, such as: physical therapy occupational therapy speech therapy However, these therapies must be on a part-time basis, and a doctor must consider them medically necessary. Part A also covers: care in a skilled nursing facility walkers, wheelchairs, and some other medical equipment for older people and those with disabilities Payroll taxes cover the costs of Part A, so a person does not usually have to pay a monthly premium. However, anyone who has not paid Medicare taxes for at least 40 quarters will need to pay it.Funding Of Healthcare/ Reimbursement Issues Essay Paper Medicare Part B, or Supplementary Medical Insurance (SMI), helps pay for specific services. These include: medically necessary physician visits outpatient hospital visits home healthcare costs other services for older people and those with a disability preventive care services For example, Part B covers: durable medical equipment, such as canes, walkers, scooters, and wheelchairs physician and nursing services certain vaccinations blood transfusions some ambulance transportation immunosuppressive drugs after organ transplants chemotherapy certain hormonal treatments prosthetic devices eyeglasses For Part B, people must: pay a monthly premium, which was $134 per month in 2018 meet an annual deductible of $183 a year, before coverage begins Funding Of Healthcare/ Reimbursement Issues Essay Paper Premiums might be higher or lower depending on the person’s income and Social Security benefits. Enrollment in Part B is voluntary. Medicare Part C, also known as Medicare Advantage Plans or Medicare+ Choice, allows users to design a custom plan to suit their medical needs more closely. Part C plans provide everything in Part A and Part B, but may also offer additional services, such as dental, vision, or hearing. These plans enlist private insurance companies to provide some of the coverage. However, the details will depend on the program and the eligibility of the individual. Some Advantage Plans team up with HMOs or preferred provider organizations (PPOs) to deliver preventive healthcare or specialist services. Others focus on people with specific needs, such as individuals livin

The Modern Day View On Society And Culture Assignment Papers. The Modern Day View On Society And Culture Assignment Papers. In today society if you are not above average or what is conceived by others to be ‘normal’, based on dimensions such as culture, politic, social and economic, you are considered ‘less than’ or abnormal, you face exclusion from a society that you were born into. Examples of minority groups are the LGBTQ+ community, Social class, disability, gender and race. Within this assignment we will be assessing the extent to which mainstream psychology has contributed to the exclusion of marginalized groups, then comparing with how features and research within critical psychology is able to make reparations to those excluded, focusing on Social class specifically the working/lower class, then concluding with final observations of research found within to the assignment.The Modern Day View On Society And Culture Assignment Papers. Permalink: https://nursingpaperessays.com/ the-modern-day-v…ssignment-papers / ? The Social class system affects many aspects of the human experience, these categories offer an identity and stereotype to individuals without a choice. Social class is known as a group of individuals who occupy similar characteristic, traits as well as socio-economic indicators and the socio-cultural aspects of the individual’s life (Rothman, 2017). These economic markers that provide part of the decision are based on, job title, education, earning, and where they live (Cole, 2017) Alongside these indicators researcher believe that cultural capital offers insight into how these groups are labelled, this “currency” is the idea that those with understanding of behaviours and knowledge of the upper class or those seen as dominant in their culture hold, are able to move upwards, reflecting in the clothes or style of the individual, intellect, education and rhetoric (Bourdieu, 1986).The Modern Day View On Society And Culture Assignment Papers. The core concept of the social class system is hierarchy, by being closer to the top, the more power and autonomy you have with having greater access to resources such as healthcare and education (Montague, 1951). Within this social class system there are often three to four level that one would be placed into, at the top of the “pecking order” a metaphor used to describe the hierarchy of status, is the Upper class this group will be filled with those wealthiest, a graduate degree within a job such as doctor, lawyer or politician for example, those who hold the most power with our society. Then comes the Middle class those who survive off earned incomes without help, often educators, conventional and seen as the everyday Norm. Finally, the lower/working class this group hold the least status in terms of the ladder with lower income, intelligence, fewer assets, access to resources and stigma which does not encourage motivation for transitioning (Fox Et al., 2009).The Modern Day View On Society And Culture Assignment Papers. “Classism refers to stereotypes and prejudice about class position that contributes to discrimination and domination” (Day et al., 2014). The class system is a socially constructed concept built by those who would be at the top, this power based concept grew Classism, which is the attitude and belief system that encourages difference between the classes ensuring that those in the upper class maintain their dominance with however the expense of the lower/middle class by diminishing access and encouraging negative typecasting (Fox Et al., 2009). We are socialized to want power and to look at those with no power or the ability to gain it as undesirable, this occurs through being nurtured by family or friends and how the classes are portrayed through media such as film, T.V, social networks and books, which are often ran or publicised by the elites of society showing only the desired parts of popular culture and ignoring the less desirable, unless it has an admirable story line of ‘rags to ritches’ (Hall, 1982).The Modern Day View On Society And Culture Assignment Papers. However, in reality meritocracy, meaning that through hard work anyone can transfer into the upper class, is filled with greater obstacles than what media and films may portray, it is particularly difficulty for those in the lower class.The Modern Day View On Society And Culture Assignment Papers. A poll taken by YouGov for the Economist looked at how well the population in Britain are aware of their social class, results showed that 48% of people over 30 hope to reach further up the ‘ladder’ than their parent, however only 28% feel that they would be able to achieve upward mobility, these statistics show the attitudes toward social mobility as being unlikely, in addition to these pieces of data, the poll also showed the 2 thirds of the 1,995 sample believed that they or any children or future children will be able to move upward of the social class they’re born into (Class, 2006). Classism and social opinion, contribute to the marginalization of the lower class, stopping them from living fulfilled social lives, with no control over expectations of their abilities or resources available to them, decreasing their self-esteem and confidence due to public attitudes which are encouraged by media, showing how this class is oppressed and rejected by society (Prilleltensky, 2008).The Modern Day View On Society And Culture Assignment Papers. In addition to being excluded through social representation and public attitudes, Mainstream psychology also contribute as an influencer to the marginalization of the lower class, as the social science contains attributes and ideas that are in line with the ideologies of the social class system. The role of psychologists is seen as respected and influential in society bringing foreword development, understanding and knowledge. Psychology and practitioners are themselves upper class in the social system, due to the education required as mentioned previously a graduate degree, high intellect and income are socioeconomic indicators of Upper class membership (Rothman, 2017). when receiving treatment from practitioner we trust their support, council and diagnosis, by respecting the qualification or title of Dr understanding that they must know better than us because they have certificates on show to prove it, this shows how psychologist are a part of the hierarchy, by using their knowledge as influence to persuade or guide care users, this indicates that a power dynamic is used between the client and practitioners (Saper, 1970).The Modern Day View On Society And Culture Assignment Papers. Psychology is able to identity abnormal behaviours and personalities as it concentrates on people, cultures and societies, as we’ve observed psychology itself is powered by elitist, therefore it often follows similar views of what characteristics define those who are different or ‘abnormal’ with those in the upper class that reject the working class. Within western culture psychology see ‘normal’ as individuals who are have appropriate behaviours, happiness, health, productive work and being able to rely on one’s self however for those of lower socio economic status their accessibility to higher skilled job, efficient healthcare and in some cases the need for financial assistance, does not fit the psychological model of ‘Normal’ (Maisel, 2012).The Modern Day View On Society And Culture Assignment Papers. Ignoring those who are living below the perceived line of normal, is also seen within research as Psychology see the ideal subject that will be used to generalised in clinical research as a white, male, middle class person, this is an example of how mainstream psychology may exclude other minorities such as race, gender and the lower class (Levesque, 2012). Samples often used within psychological research are often gained from college/university students, this pool of participants will often be representatives of the middle or upper class, as students will often have a higher IQ through gaining education and a degree, putting them into middle class section of the ‘ladder’, this leads to the middle class being over represented in research as the ‘norm’ however then ignoring those in the population who are unable to acquire higher education, meaning the research is not representable or generalised and biased, however these factors are overlooked, further supporting the ideals that lower class member of society are excluded from the norm and considered ‘others’ within the field of research (Fox Et al., 2009).The Modern Day View On Society And Culture Assignment Papers. Psychological research in to social class is often over looked and ignore, though it affects every aspect of the human experience, social class does not show to be a core focus within research (Day et al., 2014). However, when there has been a direct focus on this social construction, the research favours the angle that individuals have the notion of ‘choice’, that poverty can be resolved and anyone can attain social mobility with the myth of meritocracy through changing the individual, not the structure that developed and constructed the rules of normality or negative stigmas for those who deviate from the desired model. A study conducted by Catherine Cozzarelli on attitudes and attributions of the poor, sample taken from Midwestern college, the overall opinion was negative to the poor for example their poverty being the result of their personal failure due to lack of abilities and effort. However, a pattern showing that of a contrasting opinion between those of different ethnic backgrounds, the sample that were middle class, white and male, agreed with mainstream psychology that individuals have control over whether they remain in the lower class, whereas those considered minorities immigrants & females disagreed and highlighted that social structures must also play a part (Cozzarelli et al., 2001). This study supports how mainstream psychology is biased toward the social structure not being the issue, as they are practitioners at the top of the ‘pecking order’, in by doing this psychology ignores and forgets the real life implications of encouraging descriptions such as talentless/effortless therefore encouraging class difference and the negative stigma that the lower class offer nothing to society.The Modern Day View On Society And Culture Assignment Papers. Additionally, mainstream psychology also encourages the stigma, that those of low socio economic status have considerably low IQ in comparison with others. By focusing on the differences between classes in their abilities, cognition and motivation for social mobility comparing these alone encourages class differences in highlight weaknesses of the classes leading to possible discrimination, ensuring there are always dominating and lesser than classes (Day et al., 2014).The Modern Day View On Society And Culture Assignment Papers. American Psychologist Linda Gottfredson, researched the possibilities that lower levels of intelligence is able to explain why and where people are placed on the ‘ladder’, by reviewing literature which offered various views, that IQ is able to predict whether or not individuals will live a successful fulfilled life or not, along wither another view that IQ and status is inherited and maintain from parents nurturing their young to follow their path. Results showed a positive correlation between a father social class which is defined through their occupation and their child’s attained social class matching with their parents, Goffredson also reviews result that display test taken at the age of eleven can also predict the possibility of class transitioning (Gottfredson, 2004). Furthermore, she concluded with this data that all young people are exposed to the same quality/ level of education and expectations no matter the social class, therefore indicating it is down to the child or individual if they are unable to attain success (Gottfredson, 2004).The Modern Day View On Society And Culture Assignment Papers. In addition, this incites the removal of ‘blame’ on the social structures and places it again on the individual, this point is further argued and agreed with by Bernice Lott another American psychologist, she argues that those of low socio economic status aren’t able to access the same quality of education that the wealthy or middle class are granted access to, therefore their IQ would be lower due to lower quality education (Lott,2012). As it would also be if a working class child were able to get middle class schooling, a stigma encouraged by mainstream psychology and society, would follow the child and result in lower expectation due to background, therefore as seen in research previous mentions, younger working class children are then ‘othered’ by the education system, however if the young person showed higher intelligence than what expected, they are celebrated in be able to ‘escape’ the ‘horrid’ working class, rejected by society (Lott,2012) Along with disempowering the lower class through education and public attitude, Mainstream psychology also regards them as ‘problematic’ when faced with health issues. By being seen as disadvantaged by society, they are stereotyped to have lower health including both mentally and physical, that due to the supposed ‘risky behaviour’ of the lower class with common habits such as smoking, lack of nutrition, drinking and not active enough increases the likelihood of poor health (Miller & Grigg, 1966). However, though the negative stigma that exist around people of lower class that they all make bad life, career and health choices, along with being seen as lazy and vulnerable to addiction, this grouping is incorrect as not all individual apart of the lower class fit this stereotype (Wardle, 2013). Often poor health issues are due to being unable to access efficient and affective healthcare, in terms of the U.S aside from overrun free clinic, healthcare is costly as is the insurance which requires a job with stable income, as for the U.K even with the NHS healthcare accessibilities is decreasing due to financial cuts by the government, which causes waiting times and overworked staff to increase, resulting in care below the standard (Ham, 2005)The Modern Day View On Society And Culture Assignment Papers. After looking at various factors and research conducted within mainstream psychology, clear themes of disempowerment and oppression come to the surface, showing that psychology and practitioner use similar negative language as public attitudes and the media, such as Lazy, Rejected, talentless, lesser than and ignored. This terminology used by people and heard by the lower/working social class incites them to accept these lower expectation, resulting limited unfulfilled social life, facing society and it obstacles alone without the support of even psychological practitioner who only see a way to ‘fix’ the individual, not the problem that is the social class system. However, we now move on to how another strand of social science is able to benefit and redress the issues the working class are faced with.The Modern Day View On Society And Culture Assignment Papers. In today’s world, the modern person is educated, independent and aggressive. To be a success, you must put forth your most competitive side and win it all. Nothing less will be permitted. This is the mindset of most business tycoons, stockbrokers and the like. However, on the other side of the globe, third world countries follow a more traditional lifestyle where the outlook on life is a little less malicious. In these countries, the society’s idea of success is being part of a large family with prosperous crops and livestock. How is it that our society and theirs have both been successful? And why has the traditional way of life stayed so prevalent in such an industrialized world? First, what exactly …show more content… Females do give birth to the children, but in these societies, a female is more like a piece of property than of heritage. Marriage in these societies is usually based on the best dowry, rather than being based on love like most modern marriages.The Modern Day View On Society And Culture Assignment Papers. Traditional societies believe that family heritage is what holds a family together. These societies have ascriptive values, meaning to follow their family’s ancestry and way of life. In modern culture, an individual has the power to decide for him/herself as to what he/she wants to attain in life – including an education, career and mate. To those of us living in a modern world, traditional societies may seem to have it rough. However, to those living the traditional way, their life is set for them. They need not worry about how powerful they will be or how much money they will make. Their life brings them security. Medical knowledge is less than adequate in these societies, leading to much illness and a very high death rate. The infant mortality rate is overwhelmingly high, which is a reason for the high birth rates. In some ways, traditional culture and modern culture are alike. Any culture is a system of learned and shared meanings. People learn and share things over the course of generations, and so we say they are a culture. Traditional and modern culture function similarly because both are ways of thinking, ways of relating to people and to the universe.The Modern Day View On Society And Culture Assignment Papers. The beginning of culture was language. The first word was culture. Someone looked up from whatever else was going on and said something, and that first word was the building block of all human culture. You could pass it around. You could imitate it or change it. Its meaning could be shared among people. Maybe the word was “food” or “love” or “God.” It doesn’t matter what the word was, what language it began, or when or how. It just was. And the word constituted culture, because the word carried meaning.The Modern Day View On Society And Culture Assignment Papers. REAL LIFE. REAL NEWS. REAL VOICES. Help us tell more of the stories that matter from voices that too often remain unheard. Subscribe Now If there were only one concept to be considered in the discussion of culture, it is this: meaning. How do we know whether the group of letters a-p-p-l-e represents that sweet-tart yellow or red fruit, or a brand name of computer? How do we know whether the group of letters l-e-a-d represents that blue-gray metallic chemical element, or the verb that signifies “to show the way?” How do we know what a person’s intentions are when they wave their hand at us from across the street? It is because we have learned to share the meanings of words.The Modern Day View On Society And Culture Assignment Papers. Of course meanings are not limited to written words but began with thought words and spoken words, signed words, gestured words, pictured words. All these kinds of words carry meaning. And it is in the meanings of things that culture resides, regardless of whether it is traditional or modern culture. So we can commence with the idea that our traditional ancestors, like their modern descendants, learned and shared meanings. Traditional and modern culture are alike in another way. Both developed to accommodate their surroundings. Both traditional and modern culture work for people because they are suited to local environmental conditions. A farming culture would not work as well in Antarctica. Inuit (Eskimo) culture would not survive as well in the Sahara. Bedouin culture would not function as well in Manhattan. Culture of any kind works best (and longest) if it is well adapted to local conditions.The Modern Day View On Society And Culture Assignment Papers. It should perhaps be noted that there is apparently nothing genetic about the presence or absence of traditional culture; traditional culture is not the sole province of any one ethnic group. For example, in ancient Europe the Celts and Teutons lived traditional culture. In ancient North America the Anishinabe and Lakota lived traditional culture. In ancient Africa the Bantu and Yoruba lived traditional culture. At some point back in history all human beings — regardless of what continent they occupied and which ethnic group they constituted — all lived in a traditional tribal culture. Modern culture developed in some areas of the planet as human societies grew larger. Mass organization in some form — first the development of large work forces and armies, and later the development of mechanized means of production — was an important force in changing traditional culture into modern culture. The shift from rural life to urban life is at the core of the development of modern culture.The Modern Day View On Society And Culture Assignment Papers. While traditional and modern culture may be similar in some ways, in some very significant ways they are clearly different from each other. Traditional culture, such as our human ancestors enjoyed, is held together by relationships among people — immediate family, extended family, clan and tribe. Everyone lives nearby. Everyone knows how he or she fits into the mix because relationships, and the behaviors that go along with them, are clearly defined. “Brother” is someone toward whom I must act like a brother. “Uncle” is someone from whom I expect a certain kind of behavior. If I violate what is expected, everyone will know. Perhaps there will be severe consequences.The Modern Day View On Society And Culture Assignment Papers. But this does not rob the humans who live traditional culture of their individuality. Some brothers act differently from other brothers. Some uncles take on different roles depending, for example, on whether they are mother’s brother or father’s brother, or whether they are particularly gregarious or more somber, and so on. But in general, well-defined family and clan relationships, and the kinship terms that signal them, make daily operations in traditional society take a workable course. If you have the proper relationship with someone, you can get just about anything accomplished. If, on the other hand, you don’t have the proper relationship, you find it difficult, if not impossible, to accomplish anything. You learn that kinship terms are key phrases in getting along. In traditional culture, relationships and people seem to be what matters.The Modern Day View On Society And Culture Assignment Papers. In the modern culture of mainstream America, most people live in nuclear families: Mom and Dad and 2.5 kids. Many have only occasional contact with family members outside the immediate household. Young people quickly learn that their importance depends on how many and what kind of things they can control. Eventually they learn that power — personal, economic, social, political, religious, whatever — gets things done. Modern culture has a tendency to spread out, to build empires, to capitalize on as many resources as possible. Modern culture seems to be held together by power and things, not by people and relationships.The Modern Day View On Society And Culture Assignment Papers. In modern culture people learn that business life is separate from personal life, for example that church and state can be kept apart. We learn to compartmentalize our lives. During the week we can be shrewd business-makers in a competitive marketplace where there are happy winners and tragic losers. On the weekend we can go to church or temple and ask forgiveness for our transgressions, and then go back on Monday and start all over again. We learn (in some form) two key phrases: “It’s nothing personal, but…” and “It’s just business.”The Modern Day View On Society And Culture Assignment Papers. But in traditional culture things are not that simple — business life and personal life are often the same thing. Partners in trade and other economic activities are generally the same people as one’s kin relations. Similarly, the principles and values that guide spiritual and ceremonial life are the same principles and values that guide political life. Thus in traditional culture, the compartmentalizing or separating of business and personal life, of religious and political life, would not work. You cannot separate how you treat your trade partners from how you treat your cousins if they are the same people. You cannot separate your spiritual values from your political values if they are the same values.The Modern Day View On Society And Culture Assignment Papers. Another way in which the two differ is that traditional culture tends to stay relatively the same for long periods of time. It is basically a conservative system. Does this mean that new ideas are not incorporated from time to time, that traditional culture is static? Certainly not. The traditional culture of our ancestors changed in response to the same kinds of forces that produce biological change. The invention of new things in traditional culture (for example, new technologies such as ceramics or the bow and arrow) work in the same way as genetic mutations: something unusual happens, and things after that are different.The Modern Day View On Society And Culture Assignment Papers. Preferences for especially useful things and ideas in traditional culture work in the same way as natural selection: something does a better job or is more desirable in some way, so it becomes more common thereafter. Ways of thinking and doing things in traditional cultures flow from one culture to another just like genes flow from one biological population to another: folks come into contact, something gets exchanged. Isolation of a small, unusual sample of people in a traditional culture causes whatever that thing is that makes them unusual to become more common in future generations (for example, if a small group of people sets off to start a new village, and they all just happen to like to wear their hair a certain way, then their offspring would tend to wear their hair that way too) — in just the same way that genetic drift operates. Ancient traditional culture did change. But it was such a conservative system that it tended to resist change whenever it could.The Modern Day View On Society And Culture Assignment Papers. In contrast, modern culture thrives on change. It creates new goods and services, and teaches us to want them. It adds new technologies, things and ideas at an increasingly rapid rate, such that the amount of cultural change experienced in America between 1950 and 2000 is far greater than the amount of change experienced in the entire eighteenth and nineteenth centuries in America. Change in modern culture is propelled by all the same forces that cause change in traditional culture, only in modern culture the changes happen more quickly. Modern culture is a more mutable system that tends to change often.The Modern Day View On Society And Culture Assignment Papers. Another way in which traditional culture and modern culture differ is in their relationship to environment. Traditional cultures lived in close contact with their local environment. This taught that nature must be respected, cooperated with, in certain ritualized ways. One did not make huge changes in the environment, beyond clearing fields for agriculture and villages. Society saw itself as part of nature; its spiritual beliefs and values held humans as the kinsmen of plants and animals.The Modern Day View On Society And Culture Assignment Papers. In contrast, modern culture creates its own environment, exports that cultural environment to colonies in far away places. It builds cities and massive structures. It teaches that nature is meant to be manipulated, to be the source of jobs and wealth for its human masters. It sees itself as being above nature. Its religions commonly cast humans as the pinnacle of nature: at best its paternalistic supervisors, at worst its righteous conquerors.The Modern Day View On Society And Culture Assignment Papers. These differences in the way traditional and modern culture perceive and interact with the environment have various consequences for the humans in those cultures. Not the least of these is the difference in sustainability. A culture that lives in relative harmony with its environment has a greater likelihood of sustaining itself than does a culture that destroys its environment. The culture of our human ancestors existed for thousands of years without doing any substantive damage to the ecosystem. In a very few centuries modern culture has eliminated or endangered numerous plant and animal species, degraded many waterways and negatively impacted the health of many of its citizens: “better” living through chemistry!The Modern Day View On Society And Culture Assignment Papers. A closely related comparison between traditional and modern culture concerns ways of thinking. Modern culture is built upon knowledge. The more bits of knowledge one controls — a larger database, a larger computer memory — the more power one has. Modern culture produces new bits of knowledge so rapidly that sometimes our computers tell us “Memory is Full!” People in modern culture are more likely to feel that things are changing, that bits of knowledge are coming at them, so rapidly that they cannot absorb it all, cannot make sense of it all. Modern culture is long in knowledge.The Modern Day View On Society And Culture Assignment Papers. The traditional culture had a broad base of knowledge, as well. All plants and animals in the local environment were known by name and by their potential usefulness to humans. Weather, geology, astronomy, medicine, politics, history, language and so on were all parts of a complex integrated body of knowledge. But in traditional culture life went on beyond knowledge, to the level of wisdom — seeing the patterns in the bits of knowledge — and to the level of understanding — realizing that there are more profound patterns made by the patterns of wisdom.The Modern Day View On Society And Culture Assignment Papers. Take medicine as an example. Traditional man had a pain in his stomach; he found a plant in his local environment that had a certain medicinal property. These were bits of knowledge. If he prepared the plant’s leaves a certain way, and drank the tea that resulted, it would make the pain in his stomach go away. This is a scientific method, a process that involves seeing the pattern in the bits of knowledge: x (the plant) goes with y (the preparation) to produce z (the treatment). This realizing of patterns is what I call wisdom. Both modern and traditional culture go this far, but here they often tend to diverge.The Modern Day View On Society And Culture Assignment Papers. Eventually this traditional ancestor realized that there were all kinds of plant treatments for all kinds of ills — that for every ailment there was a treatment — and that there was a balancing act that operated on a universal scale of which he was but a small part. There was a harmony that could become disturbed if he destroyed the forest in which the plants grew, or if he overestimated himself by taking for granted the wisdom he had gained about the plants — and this harmony had to be maintained on all levels (physical, social, environmental, spiritual, etc.). This realization that the patterns of wisdom were themselves connected in higher order patterns was the beginning of what I call understanding. The traditional culture of our ancestors was long in understanding, whereas modern culture frequently seems to stop the thought process at the level of wisdom.The Modern Day View On Society And Culture Assignment Papers. In modern culture, the elders tend to think of traditional culture as “primitive,” “backward,” somehow “childlike.” In traditional culture, on the other hand, the elders tend to think of modern culture as “hollow,” “ignorant,” somehow “childlike.” But modern culture tends to take over traditional culture because modern culture is powerful: it is mechanized, it moves mountains, it digs canals and drains swamps, it overwhelms, and it is seductive — it glitters, it tastes sweet, it goes fast. And it advertises.The Modern Day View On Society And Culture Assignment Papers. So why do so many people these days seem to be refugees from modern culture? Why are so many people who were raised in the ways of modern culture now so interested in traditional American Indian or Celtic culture? Why is there a constant stream of people searching for a “new age,” for “medicine men” and powwows and traditional ceremonies and Highland games?The Modern Day

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Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago NURS 6550 FINAl EXAM – Walden University sUMMER 2018 QUESTION 1 1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes: Permalink: https://nursingpaperessays.com/ walden-nurs-6550…itted-2-days-ago / A. Foley lodged in the urethra causing post-renal failure B. Decreased renal perfusion causing prerenal failure C. Age-related decreased eGFR causing prerenal failure D. Post-surgical rhabdomyolysis causing intrarenal failure QUESTION 2 1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of: A. Hashimoto’s thyroiditis B. Cushing’s syndrome C. Grave’s disease D. Addison’s disease QUESTION 3 1. Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE? A. Fever, normal white count, elevated sedimentation rate B. Hyperkalemia, hyponatremia, low blood pressure C. Leukocytosis, hyperglycemia, hypokalemia D. Joint pain, rash, fever QUESTION 4 1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be: A. Meclizine B. Diazepam C. Bed rest D. Epley’s maneuvers QUESTION 5 Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago 1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is: A. Osteoarthritis B. Drug or alcohol toxicity C. Hypotension D. Urosepsis QUESTION 6 1. A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities? A. Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg B. Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg C. Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg D. Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg QUESTION 7 1. Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates: A. Penetration of the cornea with resultant aqueous leak B. A rust ring remnant due to metal foreign body C. An elevated intraocular pressure D. Paradoxical pupil dilation in response to light QUESTION 8 1. Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis? A. An erythrocyte sedimentation rate B. A white blood cell differential C. Two sets of blood cultures D. Echocardiography QUESTION 9 1. Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of: A. Serotonin B. Norepinephrine C. Acetylcholine D. Dopamine QUESTION 10 1. Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated? A. Increased FiO2 B. Increased respiratory rate C. Increased tidal volume D. Increased PEEP QUESTION 11 1. A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control? A. Ibuprofen B. Pseudoephedrine C. Propranolol D. Methimazole QUESTION 12 Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago 1. Jennifer is an 18-year-old homeless female who was found unresponsive. She was admitted to the hospital for management of severe bleeding after a spontaneous abortion escalated to a uterine hemorrhage. An underlying infection and dehydration were corrected and nutritional supplements were started. Her volume status is stable, morning labs were all within normal limits and she is to be discharged today. When the AGACNP enters the room to prepare the patient for discharge, she finds her agitated, pale, and diaphoretic with vital signs to include a pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a temperature is 97.9° F. The most appropriate action would be to: A. Order a CBC to assess for recurrent bleeding B. Request and abdominal CT to assess for bleeding C. Evaluate the patient for anxiety/panic attack D. Prescribe alprazolam 1 mg now CLICK HERE TO ORDER CUSTOM PAPER – Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago QUESTION 13 1. Physical examination findings in a patient with pneumothorax is likely to reveal: A. Increased tactile fremitus B. Low grade temperature C. Hyperresonance to percussion D. Egophany QUESTION 14 1. Mr. Parker brings his 73-year-old wife to a clinic appointment because he is worried about her. She has a long history of hypertension and dyslipidemia, but he says she has taken medication for years and everything has been OK. His concern today is that for a long time she has been very forgetful, and he has tried to help her by keeping a strict routine around the house. Over the past few months, she just seems more and more forgetful, does not seem interested in doing anything, and now seems to be forgetting how to do simple everyday tasks. Yesterday she could not figure out which dollar bills to use at the store to pay the cashier. The AGACNP knows Mrs. Parker should first be screened for: A. Depression B. A brain tumor C. Hypothyroidism D. Adrenal dysfunction QUESTION 15 1. M.R. is a 40-year-old female who has a known history of peptic ulcer disease. She has been admitted through the emergency room with a diagnosis of GI bleeding—she is vomiting dark blood and had a nasogastric tube placed. When attached to low intermittent suction it initially drained 400 cc of dark brown/black drainage, but now it is starting to drain lighter red colored blood. The AGACNP knows that immediate priorities of care include: A. Ensuring hemodynamic stability B. Beginning a parenteral proton pump inhibitor C. Beginning gastric lavage D. Ordering a gastrointestinal consult QUESTION 16 1. A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six precordial leads. The AGACNP expects which physical finding? A. A grade IV/VI systolic murmur with radiation to the axilla B. A split S2 that increases with inspiration C. A pericardial friction rub D. An S4 heart sound QUESTION 17 1. J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with aHgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia? A. Iron deficiency B. Sickle cell anemia C. Pernicious anemia D. Anemia of chronic disease QUESTION 18 1. Megan K. is a 21-year-old female who presents complaining of irritated eyes. She says this happens a couple of times a year and this time it is really a problem. Both eyes are itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive, and accommodate. The AGACNP knows that immediate treatment should include ophthalmic application of: A. Steroids B. Antihistamine C. Antibiotic D. Cycloplegic QUESTION 19 1. Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few days ago. A day or two later it started to hurt, and when she began to pick at it she felt drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm draining abscess in the right post auricular region with posterior cervical lymphadenopathy. Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision and drainage of the abscess, effective management must include: A. Systemic antibiotics B. Tetanus immune globulin C. Tetanus toxoid D. Antipyretics QUESTION 20 Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago 1. A 13-year-old male presents with a chief complaint of ear drainage. The patient and his mother both indicate that the patient has not had any pain or any systemic complaints, but the pus-like discharge from the ear is very persistent. According to Mom they went to a retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam reveals only a large amount of mucopurulent drainage—the tympanic membrane could not be visualized. The AGACNP knows the diagnosis is most likely: A. Acute otitis media B. Acute otitis externa C. Cholesteatoma D. Otitis media with effusion QUESTION 21 1. A 71-year-old male patient with lung cancer is admitted for treatment of sepsis related to his chemotherapy-induced immunosuppression. He seems to be improving from an infectious perspective, but during today’s assessment the AGACNP appreciates coarse rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8 hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP orders a basic metabolic panel anticipating which of the following abnormalities? A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hypochloremia QUESTION 22 1. A crescendo-decrescendo systolic murmur best appreciated at the second intercostal space, right sternal border with radiation to the carotid artery is most likely an indicator of: A. Aortic stenosis B. Aortic regurgitation C. Tricuspid stenosis D. Tricuspid regurgitation QUESTION 23 1. The AGACNP knows that diagnostic findings consistent with rheumatoid arthritis include: A. Soft tissue swelling of the metacarpals B. Radiographic joint space narrowing C. Heberden’s nodes D. Subungal hemorrhages QUESTION 24 1. C.T. is a 39-year-old female who presents for evaluation of what she thinks is her “rosacea acting up.” She has a history of acne rosacea and has medicated on and off for years with tetracycline and topical metronidazole. Today however she presents with a pronounced red/purple area on her left cheek extending to the nasal border. It is very warm to the touch. The borders of the affected area are very well defined and raised. C.T. also has a temperature of 100.7° F and a generalized headache. The AGACNP appreciates tender submandibular and cervical lymphadenopathy. The likely diagnosis is: A. Complex rosacea B. Cellulitis C. Erysipelas D. Allergic reaction QUESTION 25 1. Mr. Lopez is a 51-year-old male patient who is being treated for T2DM. His HgbA1c is 15.6% and initial management will include aggressive attempts for weight reduction as his body mass index (BMI) is 45. He says he is unable to participate in any meaningful exercise because he very often has back pain; he has had it for years and has tried all sort of over the counter medicines with little relief. He describes it as a profound ache that occurs across the lower part of his back bilaterally; it does not travel down either leg. The physical inspection is normal, but he has significant paraspinal tenderness to palpation bilaterally. He cannot identify any injury or accident that preceded the pain. The history and physical exam is noncontributory. The AGACP knows that the likely diagnosis is: A. Lumbar radiculopathy B. Ankylosing spondylitis C. Lumbar sacral strain D. Degenerative disk disease QUESTION 26 1. A patient presents with acute onset of vesicular lesions on her vulva. They are surrounded by areas of redness and they hurt. The patient says that she has even more of them now then she did when she woke up this morning. There is also inguinal lymphadenopathy. The AGACNP is suspicious for: A. Human papilloma virus B. Primary syphilis C. Gonorrhea D. Herpes simplex virus QUESTION 27 1. Classic radiographic features of osteoarthritis include: A. Soft tissue swelling B. Joint deformity C. Bone mineral loss D. Joint space narrowing QUESTION 28 1. Mrs. Sandoval is a 72-year-old female who presents with a chief complaint of transient verbal confusion. She was speaking with her friend on the phone this morning when she suddenly couldn’t get words out. Her friend went over to her home and found Mrs. Sandoval awake, alert, and oriented, responding appropriately with non-verbal gestures, but she could not properly articulate her thoughts. By the time she arrived at the office this had passed, although during the examination she appeared to have infrequent difficulty finding a single word. The patient denies any contributory medical history, but a 12-lead ECG in the office reveals atrial fibrillation with a ventricular response of 91 b.p.m. The blood pressure is 140/94 mm Hg; remaining vital signs are normal. The AGACNP knows that management should include: A. Antiplatelet therapy B. Anticoagulation C. Blood pressure control D. Speech therapy QUESTION 29 1. C.L. is a 48-year-old female who presents complaining of activity intolerance. She is usually very active and fit^. She jogs regularly and typically does 4-5 miles a day. About a week ago she became so tired she had to stop, and lately she has become aware of becoming easily fatigued while going up and down stairs. She admits that she thinks she is beginning menopause—she is having a lot of bleeding with her periods, and her periods seem to be more frequent. A complete blood count (CBC) reveals the following results: Hgb 10.1 g/dL Hct 30% MCV 75 fL RDW 21% The AGACNP orders which of the following laboratory test to confirm the suspected diagnosis? A. Vitamin B12 B. Folate C. Ferritin D. Hemoglobin electrophoresis QUESTION 30 1. Kevin H. is a 61-year-old male who presents for treatment of profound anxiety. He has been treated on and off for years—most recently he was taking escitalopram 20 mg p.o. daily, and although he does admit to some improvement, he still cannot function appropriately thoughout the day. He has been counseled about poor work performance and is concerned about losing his job, but he is just so worried all of the time he cannot concentrate on work. The AGACNP knows that the most appropriate action is to: A. Increase the dose of escitalopram to 40 mg daily B. Refer Kevin for a psychiatric consultation C. Stop escitalopram and begin venlafaxine D. Discuss therapeutic expectations with Kevin QUESTION 31 Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago 1. When examining a patient with a skin presentation suggestive of necrotizing fasciitis, the AGACNP knows that the most important and sensitive diagnostic test is: A. A complete blood count B. Plain film radiographs C. The finger test D. CT scan QUESTION 32 1. While evaluating a patient with abdominal pain, the AGACP knows that when the pain is described as coming in waves or cycles, with periods of relief in between, the cause likely centers around: A. Peristalsis of bowel B. Disorders of pelvic organs C. Organ inflammation D. Hyperacidity QUESTION 33 1. Which of the following findings is not typically associated with testicular torsion? A. Acute pain B. Edema C. High riding testis D. Dysuria QUESTION 34 1. 152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Yes No QUESTION 35 1. While preparing to perform an incision and drainage on a 7 cm fluctuant abscess on a patients posterior thorax, the AGACNP knows that the most important part of the procedure is: A. Immediate coverage with antistaphylococcal antibiotics B. Maintaining sterility with topical betadine and drapes C. Breaking up loculations and aggressive irrigation D. Proper injection of local anesthetic QUESTION 36 1. A patient is being evaluated with significant nausea, fatigue, and a general sense of feeling unwell; mild jaundice is noted on physical examination. Transaminases are markedly elevated and a hepatitis screening is done. Results are as follows: + HbsAb + anti-HAV IgM – anti-HCV The correct interpretation of these findings is: A. The patient has acute hepatitis A B. The patient has acute hepatitis B C. The patient has chronic hepatitis B D. The patient has acute hepatitis C QUESTION 37 1. When treating a patient with an unknown overdose or toxicity, the AGACNP knows that all of the following should be administered except: A. Dextrose 50% B. Thiamine 100 mg C. Nalaxone 0.4 mg D. Ativan 4 mg QUESTION 38 1. The AGACNP is evaluating 29-year-old female who presents by ambulance and is unresponsive. There is no witness and no history available; the patient is not wearing any sort of medic alert bracelet. While assessing for toxicity or overdose, the patient is found to have vital signs as follows: Temp of 96.2° F, pulse of 48 b.p.m., respirations of 10 b.p.m., and blood pressure of 84/50 mm Hg. The patient’s pupils are constricted, but do react briskly to light to 1 mm. The AGACNP suspects which type of substance? A. Cholinesterase inhibiting drugs B. Stimulants such as MDMA C. Anticholinergics D. Ethanol or opiates QUESTION 39 1. The AGACNP knows that the one class of pain medication that is effective to some extent for all forms of pain is: A. NSAIDs B. Antidepressants C. Antiepileptics D. Opiates QUESTION 40 1. K.P. is a 76-year-old male admitted for antibiotic management of urosepsis. His medical history is significant for a CVA with resultant right-sided hemiparesis. He is nonverbal, maintained on enteral nutritional support and has an indwelling Foley catheter. The AGACNP knows that which of the following bacteria is the primary treatment target for this patient’s urosepsis? A. Proteus mirabilis B. Pseudomonas aeruginosa C. Staphylococcus aureus D. Streptococcus pneumoniae QUESTION 41 1. A patient is admitted for a COPD exacerbation and placed on mechanical ventilation. His settings are as follows: FiO2 of 40%, TV of 700mL, SIMV of 12. His morning ABG reveals a pH of 7.37, paCO2 of 51 mm Hg, paO2 of 84 mm Hg and HCO3 of 30 mm Hg. The AGACNP knows that the appropriate response is to: A. Leave the ventilator settings as is B. Increase the SIMV to 16 b.p.m. C. Increase the FiO2 to 50% D. Repeat the ABG in one hour QUESTION 42 1. All of the following are required for a diagnosis of systemic inflammatory response syndrome (SIRS) except: A. White blood cell count < 4000 or > 12,000 cells/uL B. Heart rate > 90 b.p.m. C. Respiratory rate > 20 b.p.m. or paCO2 < 32 mm Hg D. Two sets of positive blood cultures QUESTION 43 1. J.T. is a 41-year-old female patient who presents with a chief complaint of “heartburn.” She says that it doesn’t really seem to be related to meals or food—it occurs at random times. She does note, when asked, that it seems to happen a lot at night and occasionally wakes her up. Her only other symptom complaint is an occasional cough. It does not produce mucus, and she admits to assuming it was a “nervous” cough. The next appropriate action for the AGACNP would be to: A. Order an H. pylori test B. Request a GI consult for endoscopy C. Order a proton pump inhibitor 30 minutes before breakfast D. Request a 72-hour diet history QUESTION 44 1. Your patient has diabetes insipidus (DI). Anticipated physical assessment findings include: A. Dry skin, tachycardia, hypertension B. Weak pulse, dry skin, decreased skin turgor C. Thin hair, thready pulse, dry mucous membranes D. Hypothermia, jugular venous distention, bradycardia QUESTION 45 1. The AGACNP is beginning medical management of a patient newly diagnosed with T2DM. The patient has a BMI of 39 and has been unsuccessful in making significant diet and lifestyle changes over the last six months. Other than her weight, her physical examination is essentially within normal limits. Her HgbA1c is 9.5%. A basic metabolic panel is within normal limits. The medication of choice to begin therapy will be: A. A sulfonyurea B. A meglitinide C. A biguanide D. An incretin mimetic QUESTION 46 1. Felty’s syndrome is a condition of immune neutropenia seen sometimes in patients with: A. Polymyalgia rheumatica B. Giant cell arteritis C. Systemic lupus erythematosus D. Rheumatoid arthritis QUESTION 47 1. When treating a patient for the profound cough of acute bronchitis, the AGACNP knows that the most appropriate pharmacotherapy consists of: A. An opiate based cough suppressant B. Oral prednisone C. A first generation-antihistamine combination D. An inhaled anticholinergic QUESTION 48 1. Mr. Truman is transferred to the emergency department by ambulance. His wife called 911 this morning because he was acting “funny” when he woke up. Both the patient and his wife went to bed last night at approximately 10:30 and everything was normal. This morning he could not communicate orally and seemed confused about how to ambulate. Upon arrival to the emergency department his vital signs are as follows: Temperature 100.9° F, pulse 89 b.p.m., respirations 14 b.p.m. and blood pressure 168/94 mm Hg. A non-contrast CT scan of the head reveals thrombotic CVA. The AGACNP know that immediate management of this patient should include: A. Thrombolytics B. IV vasodilators C. Aspirin D. Antiepileptics QUESTION 49 1. Your patient is complaining of profound nausea and vomiting that started at bedtime last night and kept him awake all night long. Early this morning he started having abdominal cramping and explosive diarrhea. Based upon the character of symptoms you are suspicious of infection with Staphylococcus aureus. To assess risk for exposure to this organism, you ask the patient about which meal? A. Breakfast yesterday B. Lunch yesterday C. Dinner yesterday D. Bedtime snack yesterday QUESTION 50 1. D.R. is a 54-year-old male patient who was admitted for the management of cellulitis and treated with parenteral antibiotics. He has not been responding as well as anticipated. During today’s exam the AGACNP appreciates a couple of changes. All of the following indicate the need for immediate surgical evaluation except: A. Skin anesthesia B. Violaceous bullae C. Gas bubbles in tissue D. Lymphangetic spread QUESTION 51 1. R. O. is a 21-year-old female who comes to the emergency department because of a severe headache. Her vital signs and neurological examination are within normal limits. She complains of a pulse-like pain in her right temple and admits that she has almost vomited. Her mother gets the same type of headache and the last time this happened R.O. took one of her mother’s prescription headache pills. They helped a lot, but this time her mother told her she had to come be evaluated. The AGACNP knows that which of the following is the appropriate action? A. A non-contrast CT scan of the head B. Administration of a 5HT agonist C. Dilaudid 2 mg IM x 1 dose D. Requesting a headache diary QUESTION 52 1. A 39-year-old female presents for evaluation of a rash. She denies any significant medical history, and has no other complaints. The rash appeared suddenly on both forearms approximately one week ago, and she is concerned because it is not going away. It does not itch or hurt—it is just there. Physical examination reveals a diffuse macular hypopigmentation on both forearms that extends to the hands. The patient denies any drug or alcohol use; she is single and has had 4 unprotected sexual partners in the last year. The AGACNP knows that initial laboratory testing must include a(n): A. FTA-Abs B. Fungal skin scraping C. RPR screening D. CBC QUESTION 53 1. J.S. is a African-American female who presents for a wellness examination. Her medical history is significant for beta thalassemia minor. Anticipated red blood cell differential would include which of the following patterns? A. Hgb 10.2 g/dL, Hct 30%, MCV 70 fL, RDW 12.6% B. Hgb 9.9 g/dL, Hct 28%, MCV 83 fL, RDW 13.9% C. Hgb 11.5 g/dL, Hct 35%, MCV 94 fL, RDW 15.8% D. Hgb 12.8 g/dL, Hct 38%, MCV 105 fL, RDW 18.1% QUESTION 54 Walden NURS 6550 FINAl EXAM – Mr Jeffers was admitted 2 days ago 1. M.T. presents complaining of acute pain in his left eye, nausea, and one episode of vomiting. He denies any significant medical problems, and says that the only medication that he takes is an occasional over-the-counter sleeping pill. Physical examination reveals a steamy red cornea and conjunctiva with a pupil that is 5 mm and not reactive to light. The AGACNP knows that diagnostic testing should include: A. A CT scan of the head B. An MRI of the orbit C. A toxicology screen D. A measurement of intraocular pressure QUESTION 55 1. Justin is a 23-year-old male who is being managed for an acute manic episode. Justin was diagnosed with bipolar disorder several years ago, but his home life has been unstable and he has not been very adherent to a medication regimen. Most recently he was started on the SNRI venlafaxine by his primary care provider, which he has been taking as prescribed for about 6 weeks, but he began a manic episode a few days ago which peaked this evening. The AGACNP considers that: A. The manic episode is probably a result of medication instability and he should continue his current regimen with a follow-up in 6-8 weeks B. A mood stabilizing agent should be added to the venlafaxine C. All medication should be held for 6-8 weeks and the then the patient should be reevaluated D. The SNRI should be stopped and a mood stabilizing agent started QUESTION 56 1. Mr. Livingston is a 79-year-old male who presents from a long term care facility with a change in mental status. His medical history is significant for T2DM, CAD, CHF, hypothyroidism, Alzheimer’s dementia and osteoarthritis. He has been stable, but over the last few days the staff say he has been a bit disconnected. This morning he was found in his bed in a stuporous state. His vital signs include a temperture of 98.9° F, pulse of 103 b.p.m., respiratory rate of 20 b.p.m., and a blood pressure of 92/64 mm Hg. His metabolic panel demonstrates a Na+ of 129 mEq/L, K+ of 3.3 mEq/L, Cl- of 100 mEq/L, CO2 of 24 mEq/L, glucose of 644 mg/dL, BUN of 51 mg/dL and creatinine of 1.9 mg/dL. The AGACNP knows that the primary problem is most likely: A. Diabetic ketoacidosis B. Hypertonic hyponatremia C. Myxedema coma D. Hyperosmolar hyperglycemic coma QUESTION 57 1. The AGACNP is evaluating a patient with systemic lupus erythematosis who complains of fatigue. Based upon his knowledge of the most commonly affected visceral organ, which of the following diagnostic studies should be ordered? A. Echocardiogram B. Chest radiography C. Hepatic function enzymes D. Urinalysis with microscopic QUESTION 58 1. All of the following are true statements about post-traumatic stress disorders (PTSD) except: A. It is more common in women than men B. It is unlikely to occur in children especially < 10 years old C. It is differentiated from acute stress reaction by time D. It is not likely in persons with no preexisting psychiatric disease QUESTION 59 1. Ray M., a 49-year-old male, walks into the emergency room complaining of back pain. He has never had this problem before and cannot identify any injury, but he is in such severe pain he is sure something is wrong. He states that his back has been hurting so badly sometimes he has to stop whatever he is doing and bend forward at the waist. The pain also travels along the outer edge of his left thigh to mid-calf, and he reports a small area of numbness on his anterior thigh. His history and physical examination are otherwise negative. He is an insurance attorney and is not especially active at work, but goes to the gym 5 days a week. He is not overweight, and his vital signs are normal. Physical examination reveals no paraspinal tenderness, and his straight leg raise is negative. A few times during the exam he lay back on the table and grabbed his left leg, flexed both hip, and pulled his knee to his chest, because it helped the pain. The AGACNP knows that immediate pain relief measures must include: A. An opiate analgesic B. Systemic steroids C. Physical therapy D. Bedrest for 72 hours QUESTION 60 1. A patient with peptic ulcer disease is admitted to the hospital with significant upper abdominal discomfort. She has guarding and rebound tenderness on examination. Abdominal radiography demonstrates free air in the abdomen. The AGACNP knows that the immediate priority is to: A. Obtain a stat surgical consult B. Begin an IV proton pump inhibitor C. Order an abdominal CT scan D. Obtain a stat gastroenterology consult QUESTION 61 1. Jennifer is a 15-year-old female who attempted suicide by taking a bottle of acetaminophen. She took 30, 500 mg tablets approximately six hours ago, but then became frightened and told her mother what she did. Her mother said that Jennifer seems OK, other than being a lit