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APA Peripheral Vascular Disease Essay Paper APA Peripheral Vascular Disease Essay Paper Arteries deliver oxygen-rich blood from the heart to every part of the body, and the peripheral arteries carry blood away from the heart to the arms and legs. Peripheral Arterial Disease (PAD) develops when these arteries begin to build up plaque, obstructing and narrowing the passageway and preventing blood, oxygen, glucose from flowing to the legs. The buildup of fat, cholesterol and other substances causes of the pain and discomfort patients experience in their legs as the muscles and tissue starve for blood. Just like how the build up of plaque in the heart causes a heart attack, blocked blood flow in the legs causes a “heart attack” of the tissue and muscle in the legs and can lead to the death of the limb and ultimately the need for amputation.APA Peripheral Vascular Disease Essay Pape Permalink: https://nursingpaperessays.com/ apa-peripheral-v…ease-essay-paper / r If lifestyle modifications and medications are not enough to treat PAD, our physicians at Pedes Orange County utilize a combination of Angiogram, Atherectomy, Stenting, and Angioplasty to restore healthy blood flow through the arteries to all parts of your feet and legs. Our physician can also address arterial obstruction that occurs in other arteries such as in the arms or the renal artery that carries blood to the kidneys. Peripheral arterial disease (PAD), also called “peripheral vascular disease” or “claudication,” occurs when blood flow to the legs is reduced or completely blocked by atherosclerosis (hardening of the arteries). When blood flow to one or both legs can’t keep up with demand, the result is leg pain while walking (“intermittent claudication”) and other symptoms. If blood flow to the legs is completely blocked, tissues in the leg and/or foot die, increasing the risk of amputation.APA Peripheral Vascular Disease Essay Paper Although PAD most frequently affects the legs and feet, it can also affect arteries that carry blood from the heart to the head, arms, heart and other internal organs. According to the US National Heart, Lung, and Blood Institute, PAD affects 8 to 12 million people in the United States, especially those over the age of 50. According to The Lancet medical journal, as of 2010, the number of people with PAD is estimated at 202 million world-wide. If peripheral vascular disease (PVD) occurs only in the arteries, it is called peripheral artery disease (PAD). Most cases of PVD affect the arteries as well, so the terms are often interchangeable. In this article, we take a close look at PVD, including causes, symptoms, diagnosis, and treatments. Fast facts on PVD: PVD affects an estimated 1 in 20 Americans over 50 years of age. Common risk factors include being over 50, smoking cigarettes, and having high blood pressure or high cholesterol. Common symptoms include pain and cramps in the legs, hips, and buttocks. According to the Centers for Disease Control and Prevention (CDC), PVD affects men and women equally. Arteriosclerosis and atherosclerosis are among the most common causes of PVD.APA Peripheral Vascular Disease Essay Paper Types of peripheral vascular disease There are two main types of PVD: Organic PVD results from changes in the blood vessels caused by inflammation, plaque buildup, or tissue damage. Functional PVD happens when blood flow decreases in response to something that causes the blood vessels to vary in size, such as brain signals or changes in body temperature. In functional PVD, there is no physical damage to the blood vessels. Symptoms PVD commonly affects the legs. Signs and symptoms of PVD often appear gradually. They occur more commonly in the legs than the in arms because the blood vessels in the legs are further from the heart. Pains, aches, or cramps while walking are typical symptoms of PVD. However, up to 40 percent of people with PVD or PAD do not experience any leg pain. Pains, aches, and cramps related to walking, which is known as claudication, might occur in the following areas: buttock calf hip thigh Symptoms of claudication often develop when someone is walking quickly or for long distances. The symptoms typically go away with rest. However, as PVD progresses, symptoms can get worse and become more frequent. Leg pain and fatigue may persist even while resting.APA Peripheral Vascular Disease Essay Paper Other symptoms of PVD include: leg cramps when lying down pale or reddish-blue legs or arms hair loss on the legs skin that is cool to the touch thin, pale, or shiny skin on the legs and feet slow-healing wounds and ulcers cold, burning, or numb toes thickened toenails slow or absent pulse in the feet heavy or numb sensations in the muscles wasting away of the muscle (atrophy Causes Causes of PVD vary and depend on the type a person has. Causes of organic PVD Arteriosclerosis, which is caused by changes in the structure of the blood vessels, is a common cause of organic PVD. Atherosclerosis, which is a specific type of arteriosclerosis, occurs when plaque (fats and other substances) build up in the blood vessels. Atherosclerosis can restrict blood flow, and if left untreated, can cause clots. Clots block the arteries and cause loss of limbs or organ damage. Common risk factors for atherosclerosis include: high blood pressure (hypertension) high cholesterol or triglycerides inflammation from arthritis, lupus, or other conditions insulin resistance smoking The following conditions may cause structural changes in the blood vessels: Buerger’s disease chronic venous insufficiency deep vein thrombosis (DVT) Raynaud’s syndrome thrombophlebitis varicose veins Injury, inflammation, or infection in the blood vessels may also cause structural changes in the blood vessels. Causes of functional PVD Functional PVD occurs when blood vessels have an increased response to brain signals and environmental factors. Common causes of this include:APA Peripheral Vascular Disease Essay Paper cold temperatures drug use feeling stressed using machines or tools that cause the body to vibrate Smokers and people over the age of 50 are at an increased risk of developing PVD. In general, the risk factors for PVD are similar to those for arteriosclerosis. They include: Age . People aged 50 years and over are more likely to get PVD and PAD. Being overweight or obese increases risk of arteriosclerosis, PVD, and other cardiovascular conditions. Lifestyle choices . People who smoke, use drugs, avoid exercise, or have an unhealthful diet are more likely to get PVD. Medical and family history . PVD risk rises for people who have a history of cerebrovascular disease or stroke. Those with a family history of high cholesterol, hypertension, or PVD are also at higher risk. Other medical conditions . People with high cholesterol, hypertension, heart disease, or diabetes are at an increased risk of developing PVD. Race and ethnicity . African American people tend to develop PVD more frequently. Peripheral artery disease: Symptoms, causes, and more Peripheral vascular disease that affects only the arteries is called peripheral artery disease (PAD). Find out more about the causes, symptoms, and treatment for PAD here. If a person suspects they have PVD, it is essential that they see a doctor. Early diagnosis and treatment can improve the outlook for the disease and prevent severe complications from occurring.APA Peripheral Vascular Disease Essay Paper A doctor will diagnose PVD by: Taking a full medical and family history, which includes details of lifestyle, diet, and medication use. Performing a physical examination, which includes checking the skin temperature, appearance, and the presence of pulses in the legs and feet. They may also order tests to confirm a diagnosis or rule out other conditions. Several other disorders can mimic the symptoms of PVD and PAD. Diagnostic tests used to diagnose PVD include: Angiography . Angiography involves injecting dye into the arteries to identify a clogged or blocked artery. Ankle-brachial index (ABI) . This non-invasive test measures blood pressure in the ankles. The doctor then compares this reading to blood pressure readings in the arms. A doctor will take measurements after rest and physical activity. Lower blood pressure in the legs suggests a blockage. Blood tests . Although blood tests alone cannot diagnose PVD, they can help a doctor check for the presence of conditions that can increase a person’s risk of developing PVD, such as diabetes and high cholesterol. Computerized tomography angiography (CTA) . A CTA imaging test shows the doctor an image of the blood vessels, including areas that have narrowed or become blocked. Magnetic resonance angiography (MRA) . Similar to a CTA, magnetic resonance angiography highlights blood vessel blockages. Ultrasound . Using sound waves, an ultrasound allows the doctor to see blood circulation through the arteries and veins.APA Peripheral Vascular Disease Essay Paper Peripheral vascular disease (PVD) is a nearly pandemic condition that has the potential to cause loss of limb or even loss of life. PVD manifests as insufficient tissue perfusion initiated by existing atherosclerosis acutely compounded by either emboli or thrombi. Many people live daily with significant degrees of PVD; however, in settings such as acute limb ischemia, this latent disease can suddenly become life-threatening and necessitate emergency intervention to minimize morbidity and mortality. [1, 2] Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs. Both PAD and coronary artery disease (CAD) are caused by atherosclerosis. Atherosclerosis narrows and blocks arteries in critical regions of the body.APA Peripheral Vascular Disease Essay Paper Quick facts about PAD The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again. Be aware that: Many people mistake the symptoms of PAD for something else. PAD often goes undiagnosed by healthcare professionals. People with peripheral arterial disease have a higher risk of coronary artery disease, heart attack or stroke. Left untreated, PAD can lead to gangrene and amputation. View our interactive PAD library Added risks for PAD Other factors can increase your chances for peripheral artery disease, including: Your risk for peripheral artery disease increases with age. High blood pressure or high cholesterol puts you at risk for PAD. If you smoke, you have an especially high risk for PAD. If you have diabetes, you have an especially high risk for PAD. If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that: PAD is easily diagnosed in a simple, painless way. You can take control: Follow your doctor’s recommendations and strive to lead a heart-healthy lifestyle. Some cases of PAD can be managed with lifestyle changes and medication. Atherosclerosis and PAD If you have atherosclerosis, that means that plaque has built up inside your artery walls. Plaque is made up of deposits of fats, cholesterol and other substances. Atherosclerosis in the peripheral arteries is the most common cause of PAD. To see how plaque limits blood flow, view our interactive PAD library. What happens is this: First, plaque builds up enough to narrow an artery, which chokes off blood flow. Next, if that plaque becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot can further narrow the artery, or completely block it. If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb. If the blockage occurs in a carotid artery, it can cause a stroke.APA Peripheral Vascular Disease Essay Paper Watch an atherosclerosis and PAD animation It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all. Treatment Effective PVD treatment aims to slow or stop disease progression, manage pain and other symptoms, and reduce the risk of serious complications. PVD treatment plans usually involve lifestyle changes. Some people may also require medication, and severe cases may require surgical treatment. Lifestyle changes include: engaging in regular exercise, including walking eating a balanced diet losing weight if necessary quitting smoking Medication Medications to treat PVD include: cilostazol to reduce claudication pentoxifylline to treat muscle pain clopidogrel or aspirin to stop blood clotting Co-occurring conditions may also require medicines to keep symptoms under control. For example, some people may need: statins (such as atorvastatin and simvastatin) to reduce high cholesterol angiotensin-converting enzyme (ACE) inhibitors for hypertension metformin or other diabetes medications to manage blood sugar APA Peripheral Vascular Disease Essay Paper Surgery People with severe PVD might require surgery to widen arteries or bypass blockages. Surgical options are: Angioplasty . This involves inserting a catheter that is fitted with a balloon into the damaged artery and then inflating the balloon to widen the artery. Sometimes, the doctor will place a small tube (stent) in the artery to keep it open. Vascular bypass surgery . Also known as a vascular graft, this procedure involves reconnecting blood vessels to bypass a narrow or blocked part of a vessel. It allows blood to flow more easily from one area to another. PVD can increase the risk of a heart attack. If PVD is left undiagnosed and untreated, it can cause severe or life-threatening complications such as: gangrene (tissue death), which can require amputation of the affected limb heart attack or stroke impotence severe pain that restricts mobility slow-healing wounds potentially fatal infections of the bones and blood APA Peripheral Vascular Disease Essay Paper Prevention A person can reduce their risk of developing PVD by: quitting smoking, or not starting engaging in at least 150 minutes of cardiovascular activity, such as walking or running, each week eating a balanced diet maintaining a healthy body weight managing blood sugar, cholesterol, and blood pressure levels When diagnosed early, PVD is often easily treated with lifestyle modifications and medications. A doctor can monitor a person’s improvement by measuring the distance they can walk without claudication. If treatments are effective, people should be able to gradually walk longer distances without pain. Early intervention may prevent the condition from progressing and can help to avoid complications. Anyone experiencing any of the symptoms of PVD should see a doctor. The sudden development of pale, cold, and aching limbs with loss of pulses is a medical emergency and requires immediate treatment.APA Peripheral Vascular Disease Essay Paper Atherosclerosis is the pathological process in the coronary arteries, cerebral arteries, iliac and femoral arteries, and aorta that is responsible for coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD). It begins during childhood in the intima of the large elastic and muscular arteries with deposits of lipids, principally cholesterol and its esters, in macrophages and smooth muscle cells (Figure 19-1). The lesions, called fatty streaks, produce only minimal intimal thickening and cause no disturbances in blood flow during early childhood, but they rapidly become more extensive during adolescence. In young adults, more lipid is deposited at some sites, and a core of lipid and necrotic debris becomes covered by a cap of smooth muscle and fibrous tissue. These changes produce elevated lesions called fibrous plaques that project into the lumen and begin to disturb blood flow. The relationship between fatty streaks and fibrous plaques has been one of the most controversial aspects of the pathogenesis of atherosclerosis. The coronary arteries differ from most other arteries by having a prominent intimal layer of longitudinal smooth muscle and fibrous tissue that is apparent even in childhood. By the age of 20, the thickness of this layer is about equal to that of the media, even when it does not contain abnormal lipid (Stary, 1987a,b). This fibromuscular intimal layer occurs in all populations, even in those not predisposed to coronary atherosclerosis in adulthood (Geer et al., 1968) and is considered to be a normal anatomic structure rather than an atherosclerotic lesion.APA Peripheral Vascular Disease Essay Paper Some evidence suggests that fibrous plaques are created by cellular proliferation and subsequent fatty degeneration without prior lipid deposition (Benditt, 1974), and some observations are not consistent with the progression of fatty streaks to fibrous plaques. For example, fatty streaks are more extensive in the thoracic aortas of children, but fibrous plaques are more extensive in the abdominal aortas of adults. Young women have more extensive fatty streaks in their coronary arteries and aortas than do young men, but among adults this pattern is reversed. (McGill, 1968). Peripheral artery disease ( PAD ) is an abnormal narrowing of arteriesother than those that supply the heart or brain. [5] [15] When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular disease. [4] Peripheral artery disease most commonly affects the legs, but other arteries may also be involved. [4] The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication. [2] Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg. [3] Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke. [4] Up to 50% of people with PAD do not have symptoms APA Peripheral Vascular Disease Essay Paper The greatest risk factor for PAD is cigarette smoking. [4] Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol. [7] [16] The most common underlying mechanism of peripheral artery disease is atherosclerosis, especially in individuals over 40 years old. [6] [17] Other mechanisms include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis. [5] [16] PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm. [9] Duplex ultrasonography and angiography may also be used. [8] Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks. [9] It is unclear if screening for peripheral artery disease in people without symptoms is useful as it has not been properly studied. [18] [19] [17] In those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy improve outcomes. [11] [12] Medications, including statins, ACE inhibitors, and cilostazol may also help. [12] [20] Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease due to the increased risk of heart attacks. [17] [21] [22] Anticoagulants such as warfarin are not typically of benefit. [23] Procedures used to treat the disease include bypass grafting, angioplasty, and atherectomy APA Peripheral Vascular Disease Essay Paper In 2015, about 155 million people had PAD worldwide. [13] It becomes more common with age. [24] In the developed world, it affects about 5.3% of 45- to 50-year-olds and 18.6% of 85- to 90-year-olds. [7] In the developing world, it affects 4.6% of people between the ages of 45 and 50 and 15% of people between the ages of 85 and 90. [7] PAD in the developed world is equally common among men and women, though in the developing world, women are more commonly affected. [7] In 2015 PAD resulted in about 52,500 deaths, which is an increase from the 16,000 deaths in 1990 Overall, however, evidence supports the association of fatty streaks with fibrous plaques. Lesions in the arteries of young adults have many histological and chemical characteristics of fatty streaks as well as fibrous plaques—an observation suggesting a continuous progression from one type of lesion to the other (Geer et al., 1968; Katz, 1981; Stary, 1987a,b). Furthermore, in contrast to the differences in location of fatty streaks and fibrous plaques in the aorta, the sites of fatty streaks in the coronary arteries of children are the most common sites of fibrous plaques in adults (Montenegro and Eggen, 1968). The major risk factors, hypercholesterolemia and hypertension, are closely associ-APA Peripheral Vascular Disease Essay Paper ated with the extent of fibrous plaques in adults (Solberg and Strong, 1983). The few relevant data indicate that there is an association between serum cholesterol and low-density lipoprotein (LDL) cholesterol concentrations with fatty streaks in childhood (Freedman et al., 1988; Newman et al., 1986). Furthermore, it seems most likely that fatty streaks in children are labile, i.e., some may regress or remain as fatty streaks whereas others progress and evolve into fibrous plaques. This later process occurs particularly in the coronary arteries and abdominal aorta, where some fatty streaks are gradually converted to fibrous plaques by continued lipid deposition and reactive chronic inflammation and repair. For a review of this subject, see McGill (1988). Regardless of their origin, fibrous plaques undergo a variety of qualitative changes in early middle age in the U.S. population, as illustrated in Figure 19-1. These changes result in fibrous plaques that vary in their content of lipids, smooth muscle cells, connective tissue, calcium, and vessels. The most serious complication is ulceration of the connective tissue and smooth muscle cap of fibrous plaque, a change that exposes blood to the lipid-rich necrotic debris of the core and is likely to precipitate thrombosis. Another serious complication is hemorrhage into the plaque. This causes sudden swelling of the plaque and may precipitate ulceration and thrombosis.APA Peripheral Vascular Disease Essay Paper Thrombosis overlying an advanced atherosclerotic fibrous plaque is the most common event that occludes the lumen of the coronary artery and causes ischemia. At a point, determined by such factors as blood pressure, collateral circulation, and tissue oxygen demand, the blood supply is reduced below a critical level and ischemic necrosis occurs in the tissue supplied by the affected artery. Lesions in the coronary arteries lead to CHD, which is the most common and most serious manifestation of atherosclerotic cardiovascular diseases in middle-aged adults. The atherosclerotic process that occurs in the cerebral and peripheral arteries is similar to that which occurs in the coronary arteries, but the lesions usually develop a decade or two later than those in the coronary arteries.APA Peripheral Vascular Disease Essay Paper Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. The most common symptom of peripheral vascular disease is intermittent claudication. At other times, peripheral vascular disease leads to acute or critical limb ischemia. Intermittent claudication manifests as pain in the muscles of the legs with exercise; it is experienced by 2 percent of persons older than 65 years. Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. Magnetic resonance arteriography, duplex scanning, and hemodynamic localization are noninvasive methods for lesion localization and may be helpful when symptoms or findings do not correlate with the ankle-brachial index. Contrast arteriography is used for definitive localization before intervention. Treatment is divided into lifestyle, medical, and surgical therapies. Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. Medical therapy is directed at reducing platelet aggregation. In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Surgical therapies include stents, arterectomies, angioplasty, and bypass surgery.APA Peripheral Vascular Disease Essay Paper In approximately one-third of all CHD cases, coronary artery occlusion causes a fatal arrhythmia within a few minutes or hours (sudden cardiac death). If the patient survives the first few hours, ischemic necrosis of the myocardium occurs (myocardial infarction). Afterward, the necrotic tissue is removed and replaced by connective tissue. The subsequent clinical outcome is determined, for the most part, by the amount and location of cardiac muscle that is lost. A few days after infarction, and before much connective tissue has formed, the heart may rupture at the site of infarction (cardiac tamponade). The patient surviving this stage may recover cardiac function as the remaining heart hypertrophies to compensate for myocardium lost by infarction. At any stage, the patient may die from failure of the heart to pump sufficient blood (congestive heart failure) or from a disturbance in the conduction system controlling the distribution of the contractile impulse (arrhythmia). Stenosis of the coronary arteries sometimes is sufficient to cause ischemic pain, but not infarction, especially on exertion (angina pectoris). This condition indicates the presence of severe lesions and high risk of myocardial infarction. All these syndromes (angina pectoris, myocardial infarction, sudden cardiac death) are included in the term coronary heart disease.APA Peripheral Vascular Disease Essay Paper If thrombosis forms over an atherosclerotic plaque in a cerebral artery, ischemic necrosis occurs in the brain (cerebral infarct). Cerebral infarction (one type of stroke) typically causes paralysis on the contralateral side due to lack of upper motor neuron function, and disturbances of speech, vision, hearing, and memory, depending on the anatomic location of the infarct. Death may occur due to involvement of the brain centers controlling respiration or to cerebral edema. The necrotic tissue is converted to a liquid-filled cavity. Function is usually recovered to some degree as edema subsides, but neurons do not regenerate. Neural control of muscles and sensory organs may be regained in part as other pathways are developed. If the arterial occlusion is partial or temporary, temporary functional cerebral impairment may occur for a few minutes to a few hours (transient ischemic attacks). These episodes, which are analogous to angina pectoris, indicate that the patient has a high risk of developing cerebral infarction.APA Peripheral Vascular Disease Essay Paper Another type of stroke is cerebral hemorrhage, which includes intracerebral hemorrhage (bleeding into the brain) and subarachnoid hemorrhage (bleeding into the space between the arachnoid membrane and the surface of the brain). In an intracerebral hemorrhage, an artery within the brain ruptures and causes a large area of tissue destruction. Its clinical manifestations are similar to those of cerebral infarction, except that it is more rapid in onset and more likely to be fatal. This type of stroke is almost always associated with severe hypertension. Since hypertension augments cerebral atherosclerosis, it is a major risk factor for both cerebral infarction and intracerebral hemorrhage. The rupture of an artery into the subarachnoid space is usually at the site of a developmental defect in the artery wall. Either the defect, or its rupture, or both may be enhanced by hypertension. The clinical manifestations of a subarachnoid hemorrhage are similar to those of other types of stroke.APA Peripheral Vascular Disease Essay Paper Peripheral arterial disease (PAD) occurs when atherosclerosis and its complications in the abdominal aorta, iliac arteries, and femoral arteries produce temporary arterial insufficiency in the lower extremities upon exertion (intermittent claudication) or ischemic necrosis of the extremities (gangrene). In the abdominal aorta, weakening of the media underlying the atherosclerotic plaque leads to an aneurysm, which may become filled with a thrombus or rupture into the abdominal cavity. The major risk factors associated with clinically manifest atherosclerotic diseases also are associated with the severity of atherosclerosis. In particular, LDL cholesterol levels are positively correlated with fibrous plaques and other advanced lesions, and high-density lipoprotein (HDL) cholesterol levels are inversely associated with advanced lesions (Solberg and Strong, 1983). Hypertension is more closely associated with advanced atherosclerosis in the cerebral arteries than in other arteries, a selective effect consistent with the identification of hypertension as the dominant risk factor for stroke. Cigarette smoking is associated with advanced atherosclerosis of the abdominal aorta and iliac-femoral arteries, and consequently with PAD (DHHS, 1983). Smoking also is associated with advanced coronary atherosclerosis, but the increased coronary atherosclerosis in smokers is not sufficient to account for their much greater risk of CHD; other mechanisms, particularly thrombosis, are probably involved. Diabetes mellitus also is associated with severity of atherosclerosis in all arteries. Men have more severe coronary atherosclerosis than women, just as they have a higher frequency of CHD, but there is no sex difference in the severity of atherosclerosis of the aorta or cerebral arteries.APA Peripheral Vascular Disease Essay Paper In populations with low serum cholesterol levels, atherosclerosis is less severe in those without hypertension and diabetes. However, among the latter, the severity of the disease is less than in populations where hyperlipidemia is prevalent (Robertson and Strong, 1968). Thus, hyperlipidemia, hypertension, and diabetes are additive in their effect on atherosclerosis, just as they are additive in their effect on risk of clinical disease. There is less information about the effects of cigarette smoking among different populations, but the evidence (Keys, 1980; Robertson et al., 1977) suggests that a similar relationship exists. CHD risk factors for which no associations with severity of atherosclerosis have been found include physical activity and obesity (Solberg and Strong, 1983). The relationship of other putative risk factors to the severity of atherosclerosis has not been determined.APA Peripheral Vascular Disease Essay Paper Results of animal experiments are consistent with observations in humans. LDL cholesterol and HDL cholesterol levels, and the ratio of the two lipoprotein cholesterol concentrations to one another are highly predictive of lesions in laboratory animals. High blood pressure combined with hyperlipidemia accelerates experimentally induced atherosclerosis. Despite several attempts, no effect of cigarette smoking on experimentally induced atherosclerosis has been demonstrated (Rogers et al., 1988). Peripheral vascular disease is the most common type of arterial disease, and a major risk factor for cardiac arrest and stroke. Specialized vein treatment can be the most effective way to manage peripheral vascular disease, but you can support these efforts with healthy changes to your lifestyle. These same healthy behaviors can also help prevent you from getting heart disease in the first part.APA Peripheral Vascular Disease Essay Paper Control Your Ca

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Nursing Gerontology Essay Paper Nursing Gerontology Essay Paper Geriatric Nursing Geriatric nursing is a heartfelt profession which allows you to connect with the patients. Gerontology is an nurse who works in the field of geriatrics that focuses on caring for older adults. This career is highly recommended because older people are most likely to require health services. Most hospitals have patients at the age over 65, and only 1% of the nurses are certified in geriatrics. Geriatric nurses are educated to understand and treat physical and mental health needs of older adults. They help and assist with the mental and physical changes occurring in their time. Geriatric nurses help older adults for them to be independent and active as long as possible. Nursing Gerontology Essay Paper Permalink: https://nursingpaperessays.com/ nursing-gerontology-essay-paper / ? Geriatric Nursing Geriatric nursing is a heartfelt profession which allows you to connect with the patients. Gerontology is an nurse who works in the field of geriatrics that focuses on caring for older adults. This career is highly recommended because older people are most likely to require health services. Most hospitals have patients at the age over 65, and only 1% of the nurses are certified in geriatrics. Geriatric nurses are educated to understand and treat physical and mental health needs of older adults. They help and assist with the mental and physical changes occurring in their time. Geriatric nurses help older adults for them to be independent and active as long as possible. Geriatric nurses are to provide disease prevention, health promotion, and positive aging. The American Journal of Nursing, the American Nurses Association, and John A. Hartford Foundation Institute for geriatric nursing contributed to the development of gerontological nursing (Pierre, “Gerontological Nursing”). In 2001, the John A. Hartford Foundation awarded the American Association of Colleges of Nursing (AACN) a $3.99 million grant to launch a new initiative entitled “Enhancing Geriatric Nursing Education in Undergraduate Advanced Practice Nursing Programs 1. End of Life Issues and the Elderly (2) “Identify and discuss the role of the nurse in providing family centred care to an elderly client who is palliative and living at home with his/her spouse or another family member”.Nursing Gerontology Essay Paper Palliative care is an approach to provide a coordinated medical, nursing, and allied health service to address the patient’s physical, social emotional and spiritual needs for people with progressive incurable illness. Palliative care seeks to deliver allied health service within the environment of person’s choice to improve quality of life for both an ill person and the family or friends. In the United States, Europe and other part of the world, number of people reaching the advanced age and having the need of specialities for the management of pain control continues to increase. (Royal College of Nursing, 2004). Meanwhile, a nurse plays vital roles in providing family centred care to an elderly palliative client living at home with his or her spouse or family member. Nurses’ roles to an elderly palliative client are as follows: Relief client from physical symptoms Providing quality of life-care for an elderly patient Family support Assisting the client to achieve good death or dying well Nursing Gerontology Essay Paper -is the accumulation of changes in a person over time. Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand. Research shows that even late in life, potential exists for physical, mental, and social growth and development. Ageing is an important part of all human societies reflecting the biological changes that occur, but also reflecting cultural and societal conventions. Roughly 100,000 people worldwide die each day of age-related causes. Age is measured chronologically, and a person’s birthday is often an important event. However the term “ageing” is somewhat ambiguous. Distinctions may be made between “universal ageing” (age changes that all people share) and “probabilistic ageing” (age changes that may happen to some, but not all people as they grow older including diseases such as type two diabetes). Chronological ageing may also be distinguished from “social ageing” (cultural age-expectations of how people should act as they grow older) and “biological ageing” (an organism’s physical state as it ages). There is also a distinction between “proximal ageing” (age-based effects that come about because of factors in the recent past) and “distal ageing” (age-based differences that can be traced back to a cause early in person’s life, such as childhood poliomyelitis). Nursing Gerontology Essay Paper Nurses who work in the field of geriatrics, also known as gerontology, focus on caring for older adults. This is a high-demand practice area, because older people are more likely to require health services. Half of all hospital admissions are for patients over age 65, but only 1% of nurses are certified in geriatrics (ExploreHealthCareers.org, 2013). Geriatric nurses are educated to understand and treat the often complex physical and mental health needs of older people. Nurses try to help their patients protect their health and cope with changes in their mental and physical abilities, so older people can stay independent and active as long as possible. Many older people have health conditions that do not require hospitalization, but must be treated with medication, changes in diet, use of special equipment, daily exercises or other adaptations. The nurses often function as a case manager, linking families with community resources to help them care for elderly members. (ExploreHealthCareers.org, 2013.) Geriatric nursing is a fast-growing career, because Americans are living longer. The post-WWII “Baby Boomer” generation is just now hitting retirement age. According to the U.S. Census, by 2050 more than 20% of Americans – 88 million people –– will be over age 65. (Cherry, 2011) Nursing Gerontology Essay Paper Have you ever wondered, what will happen to you when you become older? Who is going to take care of you? Who will help you when you get sick? As chronic illnesses, memory loss, hearing loss, and other complications set in with age, you are worried who will take care of you? All of above are worries that elderly people face on a daily bases as they get older in the United States of America, today. Well, with the high increase of elderly visit in the United States, geriatric health care is a booming job and becoming a high demand job. So, no more worrying elderly! The new geriatric health care field is here and geriatric (LTC) nurses can take care of you today. The geriatric health care environment extends from home …show more content… Your college choice should be based off your desired degree, modality, and length of time, cost, and location. Just remember to choose the college that best fits you and meets your selected degree, because without the proper education you will not understand medical terminology such as: LPN, RN, or even BSN; which basically just stands for licensed practical nurse (LPN), registered nurse (RN), and Bachelor of Science Nurse, because a “nurse” is just never a nurse (Geriatric Nurses). (2) Focus on geriatric- related training while in school.Nursing Gerontology Essay Paper Katy Katz research states, prospective college student should “pay special attention to classes with training for care of older adults and take as many as possible and when it comes time to schedule your internships at off-campus clinical sites, try to work in a program where you will get extra time working with geriatric patients.” Focus on the materials from your desired degree, the more experience you have, the better it will look once you graduate and trying to find a job with different facilities (Katz). The health of older citizens will become a critical national policy issue during this century. As a country, we Americans may have to rethink fundamental cultural values about the meaning of providing health care to older adults with chronic conditions. Simply treating disease is no longer sufficient. The growing number of older adults, and the families who care for them, will need emotional, educational, and financial resources that are not currently available. Planning to meet this challenge is important because an elderly population explosion is coming, beginning in 2010.Nursing Gerontology Essay Paper By 2030, 70 million U.S. citizens will be over age 65, and 8.5 million Americans will be over age 85 (National Center for Health Statistics, 1999). The “oldest old” Americans—those aged 85 years or more—are the fastest growing group in the US. This trend is important to those planning health care needs for the future because the oldest old individuals are most likely to be disabled, use multiple medications, or need consistent caregiving. Many older adults will be from ethnically diverse cultures. For example, Hispanic elders, now 5.6% of the elderly population, will increase to 16.4% of the elderly population during the next 50 years. In some states such as California, where 25% of the population is foreign born, the proportion of older Americans from diverse cultures will be even higher (National Center for Health Statistics, 2002).Nursing Gerontology Essay PaperThis growing elderly population will have an increasing need for health care and related services, an effect that will ripple through society as we grapple with the implications of caring for our elders. The increased proportion of older adults in the population need not present major problems if we can provide appropriate resources for adequate quality of life for older adults, such as specialized health care that includes attention to the management of chronic illness, support for family caregivers, and the financial constraints of older adults. Even today, when the number of older adults is smaller, critical health and quality of life issues remain unresolved, issues that may grow worse as the population of older adults increases.Nursing Gerontology Essay Paper The purpose of this article is to provide an overview of major issues that affect whether the growing number of older adults can expect to enjoy a healthy old age. Four critical areas will be discussed: providing resources to individuals to help manage chronic medical conditions, assuring a sufficient number of primary health care providers educated in geriatrics and gerontology, removing financial barriers to accessing health care and medications, and changing the cultural value system that emphasizes disease treatment over providing emotional, educational, and support resources. Reassessing current public policies that influence our ability to provide for the health and well-being of older citizens will influence our success in meeting these health challenges. The policy implications of these four major health issues will be briefly discussed in this article and addressed in more detail in the other articles in this topic of the journal, each of which focuses on a particular challenge related to health care and aging. Because of their fragile health, elderly individuals often need special care, particularly since a minor health related issue can sometimes spin out of control quickly in the elderly.Nursing Gerontology Essay Paper Working as a geriatric nurse is often very gratifying and rewarding personally. However, it takes a special type of person to work in this field, and the work can also be frustrating or disheartening at times as well. If you are looking to become a geriatric nurse, you must keep in mind that the aging process affects everyone differently. While some elderly patients are somewhat content or even happy-go-lucky, others may be sad, scared, or even angry that their health is failing. Before becoming a geriatric nurse, you should evaluate your personality. Geriatric nurses should be generally upbeat and cheerful people. They should also be patient, understanding, empathetic, and compassionate, with a true desire to work with aging patients. If you choose this career, you should also be able to handle and bounce back from depressing events, such as the death of a patient.Nursing Gerontology Essay Paper Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is known regarding how education can motivate students to choose geriatrics. The authors’ aim was to examine geriatrics from the students’ perspective to identify elements that can be useful in education and improving attitudes toward, interest in, and knowledge about geriatrics. The authors analyzed narrative reflection essays of 36 students and clarified the themes from the essays during focus group sessions. Four overarching themes that influenced students’ perspective on geriatrics were identified: professional identity, perception of geriatrics, geriatric-specific problems, and learning environment. Students have an inaccurate image of clinical practice and the medical professional identity, which has a negative impact on their attitude toward, interest in, and knowledge of geriatrics. Furthermore, this study yielded the important role of the hidden curriculum on professional identity, the novelty of geriatric-specific problems to students, and the importance of educational approach and good role models.Nursing Gerontology Essay Paper Given our aging population, most doctors will likely serve the health care needs of patients who are frail and older at some point, and will, therefore, need a basic set of geriatric assessment and care competencies. However, geriatrics has traditionally been an unpopular field, despite the high job satisfaction reported among geriatricians (Haley & Zelinski, 2007 Haley, W. E. , & Zelinski, E. ( 2007 ). Progress and challenges in graduate education in gerontology: The U.S. experience . Gerontology & Geriatrics Education , 27(3), 11 – 26 . doi: 10.1300/J021v27n03_02 [Taylor & Francis Online] , , [Google Scholar] ; Higashi, Tillack, Steinman, Harper, & Johnston, 2012 Higashi, R. T. , Tillack, A. A. , Steinman, M. , Harper, M. , & Johnston, C. B. ( 2012 ). Elder care as “frustrating” and “boring”: Understanding the persistence of negative attitudes toward older patients among physicians-in-training . Journal of Aging Studies , 26(4), 476 – 483 . doi: 10.1016/j.jaging.2012.06.007 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Shah, Aung, Chan, & Wolf-Klein, 2006 Shah, U. , Aung, M. , Chan, S. , & Wolf-Klein, G. P. ( 2006 ). Do geriatricians stay in geriatrics? Gerontology & Geriatrics Education , 27(1), 57 – 65 . doi: 10.1300/J021v27n01_04 [Taylor & Francis Online] , , [Google Scholar] ). Moreover, doctors often feel overwhelmed by the complexity of problems presented by geriatric patients (Nilsson, Lindkvist, Rasmussen, & Edvardsson, 2012 Nilsson, A. , Lindkvist, M. , Rasmussen, B. H. , & Edvardsson, D. ( 2012 ). Staff attitudes towards older patients with cognitive impairment: Need for improvements in acute care . Journal of Nursing Management , 20(5), 640 – 647 . doi: 10.1111/j.1365-2834.2012.01406.x [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ), and many medical students lack a positive attitude toward older patients (Drickamer, Levy, Irwin, & Rohrbaugh, 2006 Drickamer, M. A. , Levy, B. , Irwin, K. S. , & Rohrbaugh, R. M. ( 2006 ). Perceived needs for geriatric education by medical students, internal medicine residents and faculty . Journal of General Internal Medicine , 21(12), 1230 – 1234 . doi: 10.1111/j.1525-1497.2006.00585.x [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Haley & Zelinski, 2007 Haley, W. E. , & Zelinski, E. ( 2007 ). Progress and challenges in graduate education in gerontology: The U.S. experience . Gerontology & Geriatrics Education , 27(3), 11 – 26 . doi: 10.1300/J021v27n03_02 [Taylor & Francis Online] , , [Google Scholar] ; Higashi et al., 2012 Higashi, R. T. , Tillack, A. A. , Steinman, M. , Harper, M. , & Johnston, C. B. ( 2012 ). Elder care as “frustrating” and “boring”: Understanding the persistence of negative attitudes toward older patients among physicians-in-training . Journal of Aging Studies , 26(4), 476 – 483 . doi: 10.1016/j.jaging.2012.06.007 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Lun, 2011 Lun, M. W. A. ( 2011 ). Student knowledge and attitudes toward older people and their impact on pursuing aging careers . Educational Gerontology , 37(1), 1 – 11 . doi: 10.1080/03601270903534770 [Taylor & Francis Online], [Web of Science ®] , , [Google Scholar] ). At the same time and possibly related to this, the number of medical students enrolling in geriatrics is insufficient, especially considering the growing demands of our aging society.Nursing Gerontology Essay Paper Recently, the Association of American Medical Colleges established minimum geriatric competencies for medical students (Leipzig et al., 2009 Leipzig, R. M. , Granville, L. , Simpson, D. , Anderson, M. B. , Sauvigne, K. , & Soriano, R. P. ( 2009 ). Keeping granny safe on July 1: A consensus on minimum geriatrics competencies for graduating medical students . Academic Medicine , 84(5), 604 – 610 . [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ). Every graduating physician must meet these minimum geriatric competencies. However, despite this recent effort to address society’s pressing demand for doctors with basic geriatric assessment competencies and to improve attitudes among doctors toward older patients, only a few medical schools have a mandatory clerkship in geriatrics, or some other geriatric-specific training program (Atkinson et al., 2013 Atkinson, H. H. , Lambros, A. , Davis, B. R. , Lawlor, J. S. , Lovato, J. , Sink, K. M. , & Williamson, J. D. ( 2013 ). Teaching medical student geriatrics competencies in 1 week: An efficient model to teach and document selected competencies using clinical and community resources . Journal of the American Geriatrics Society , 61(7), 1182 – 1187 . doi: 10.1111/jgs.12314 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Tullo, Spencer, & Allan, 2010 Tullo, E. S. , Spencer, J. , & Allan, L. ( 2010 ). Systematic review: Helping the young to understand the old. Teaching interventions in geriatrics to improve the knowledge, skills, and attitudes of undergraduate medical students . Journal of the American Geriatrics Society , 58(10), 1987 – 1993 . doi: 10.1111/j.1532-Nursing Gerontology Essay Paper 5415.2010.03072.x [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ). Currently, little is known about how education can positively influence attitude toward older persons and about how young doctors take more interest in the field of geriatrics and care for older persons (Campbell, Durso, Brandt, Finucane, & Abadir, 2013 Campbell, J. Y. , Durso, S. C. , Brandt, L. E. , Finucane, T. E. , & Abadir, P. M. ( 2013 ). The unknown profession: A geriatrician . Journal of the American Geriatrics Society , 61(3), 447 – 449 . doi: 10.1111/jgs.12115 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Nanda et al., 2013 Nanda, A. , Farrell, T. W. , Shield, R. R. , Tomas, M. , Campbell, S. E. , & Wetle, T. ( 2013 ). Medical students’ recognition and application of geriatrics principles in a new curriculum . Journal of the American Geriatrics Society , 61(3), 434 – 439 . doi: 10.1111/jgs.12139 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ). To achieve such improvements, insight is needed into educational methods that will appeal to students and that will improve their attitudes toward and interest in as well as knowledge about geriatrics and care for older persons. The process of shaping knowledge, values, and behaviours takes place at different levels throughout the course of a student’s education: at the formal education level; course catalogs, class syllabi, lectures, notes and handouts, and at the informal level of the so called hidden curriculum; learning that occurs by means of informal interactions among students, faculty, and others and/or learning that occurs through organizational, structural, and cultural influences intrinsic to training institutions. It is through this hidden curriculum that students are socialized to clinical practice and where their professional identity is shaped (Gaufberg, Batalden, Sands, & Bell, 2010 Gaufberg, E. H. , Batalden, M. , Sands, R. , & Bell, S. K. ( 2010 ). The hidden curriculum: What can we learn from third-year medical student narrative reflections? Academic Medicine: Journal of the Association of American Medical Colleges , 85(11), 1709 – 1716 . Nursing Gerontology Essay Paper doi: 10.1097/ACM.0b013e3181f57899 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Hafferty, 1998 Hafferty, F. W. ( 1998 ). Beyond curriculum reform: Confronting medicine’s hidden curriculum . Academic Medicine: Journal of the Association of American Medical Colleges , 73(4), 403 – 407 . doi: 10.1097/00001888-199804000-00013 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; White, Kumagai, Ross, & Fantone, 2009 White, C. B. , Kumagai, A. K. , Ross, P. T. , & Fantone, J. C. ( 2009 ). A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors . Academic Medicine , 84(5), 597 – 603 . doi: 10.1097/ACM.0b013e31819fba36 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ). Our discussion here examines how medical students’ attitudes toward and interest in geriatrics and care for older persons are shaped by various factors, including the formal and hidden curriculum. Student narrative reflection essays provide a rich source of information about the impact of the formal and hidden curriculum and are a potential substrate for curricular enhancement (Fischer et al., 2008 Fischer, M. A. , Harrell, H. E. , Haley, H. L. , Cifu, A. S. , Alper, E. , Johnson, K. M. , & Hatem, D. ( 2008 ). Between two worlds: A multi-institutional qualitative analysis of students’ reflections on joining the medical profession . Journal of General Internal Medicine , 23(7), 958 – 963 . doi: 10.1007/s11606-008-0508-1 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ; Karnieli-Miller, Vu, Holtman, Clyman, & Inui, 2010 Karnieli-Miller, O. , Vu, T. R. , Holtman, M. C. , Clyman, S. G. , & Inui, T. S. ( 2010 ). Medical students’ professionalism narratives: A window on the informal and hidden curriculum . Academic Medicine: Journal of the Association of American Medical Colleges , 85(1), 124 – 133 . doi: 10.1097/ACM.0b013e3181c42896 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ). We hypothesized that student narrative reflection essays would help identify students’ preconceptions and image of geriatrics and care for older persons and geriatrics education. To this end, we asked 3rd-year medical students, who had taken a 4-week geriatric course, to write a narrative reflection essay about their experiences in the course and their thoughts on geriatrics and care for older persons before and after the course. The course in question was new and combined traditional teaching methods with a recently developed medical educational game called GeriatriX (van De Pol, Lagro, Fluit, Lagro-Janssen, & Olde Rikkert, 2014 van De Pol, M. H. , Lagro, J. , Fluit, L. R. , Lagro-Janssen, T. L. , & Olde Rikkert, M. G. ( 2014 ). Teaching geriatrics using an innovative, individual-centered educational game: Students and educators win. A proof-of-concept study . Journal of the American Geriatrics Society , 62(10), 1943 – 1949 . doi: 10.1111/jgs.13024 [Crossref], [PubMed], [Web of Science ®] , , [Google Scholar] ). After analyzing the essays, we held focus group interviews to elaborate and clarify the elements that emerged from the essays. This study specifically seeks to explore the preconceptions and image of delivering medical care for persons who are frail and older from the students’ perspective to identify elements that can be useful in education in improving attitudes toward, interest in and knowledge about geriatrics. We argue that when it is clear which elements are responsible for improving attitudes toward, interest in, and knowledge about geriatrics, they can be used to adjust medical curricula to deliver geriatric competent young doctors.Nursing Gerontology Essay Paper Negative stereotypes of older age and nursing homes persist in our society. Common misconceptions include the view that older adults are lonely, bored, or dissatisfied with life and that nursing homes are lifeless institutions (Gugliucci & Weiner, 2012). Suffice it to say that the later years of one’s life may be challenging, and if one moves to a nursing home, residing there may not be the “home” of choice. However, as complex as nursing home environments may be, social and developmental opportunities abound, and operations are under constant scrutiny to create culture change. For this review each book (leg) offers components of life lived in nursing homes. The Learning by Living project is but one integration point. In short, Beaulieu’s book provides the staff perspective and the details of what staff needs to be aware of in providing social work care in the nursing home environment; Gaffney’s book represents one person’s experience of nursing home living, in a variety of homes for the remainder of her life; and Doll’s book offers specific insights into sexuality, a real issue that could enhance nursing home residents’ quality of life. My credentials for this essay include being a gerontologist, a member of a nursing home board of trustees, the principal investigator for the Learning by Living project, sharing countless experiences with students, and, maybe most importantly, having cared for a parent in a nursing home. I suggest each leg of this review represents important issues that need to be considered if we are to create a nursing home environment in which we undo the negative stereotypes of both older age and nursing homes.Nursing Gerontology Essay Paper Long-term care (LTC) and nursing home care are two terms that erroneously get used interchangeably. LTC is the umbrella term, describing the provision of care for people who have disabilities or chronic care needs, including dementia, over a long period of time. However, those needing LTC may or may not require 24-hr professional care or need to reside in a nursing home. The services may be provided in a variety of settings, such as the person’s home, in the community, in assisted living facilities, or in nursing homes. Nursing home care is one form of LTC and usually is based on a medical model. It is the provision of 24-hr care with licensed professional nurses in a residential setting. Residents tend to have physical, cognitive, or mental health issues that keep them from performing at least one (usually more) of the activities of daily living (ADLs) (i.e., bathing, dressing, eating, walking, toileting, and grooming). Nursing home professional staff includes medical directors, nurses, geriatric social workers, activities directors, and registered dieticians, and sometimes physical, occupational and speech therapists. Certified nursing assistants assist with frontline resident care. It is important to note that short-term or rehabilitative care, even if provided in a nursing home, is not LTC. Instead the person may need assistance and/or rehabilitation after surgery, an illness, or an injury. This care can be provided in the person’s home, in a rehabilitation hospital, or in a skilled or rehabilitation unit in a nursing home. When a person is admitted to a nursing home for LTC, she/he becomes a resident of the nursing home. It is preferable not to refer to the person in this situation as a patient. However, if a person is admitted into a nursing home for a short-term stay, skilled care, or rehabilitation, then the person is considered a patient.Nursing Gerontology Essay Paper The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living in this review) was piloted in 2006. It was designed and implemented as an experiential medical education learning model by the Director of Geriatrics Education and Research within the Medical School’s Department of Geriatric Medicine. Since its inception, medical and other health professions students have been “admitted” into nursing homes to live the life of an elder nursing home resident for approximately 2 weeks—(24hr a day/7 days a week)—complete with a medical diagnosis and “standard” procedures of care. Thus far, 28 medical students, two social work students, one gerontology student, and one student of architecture have participated in the Learning by Living project in 14 nursing homes in four states.Nursing Gerontology Essay Paper The Learning by Living Project utilizes qualitative ethnographic and autobiographic research designs, whereby a unique environment or “culture” (nursing home) is observed and life experiences of the medical student are reported by him/her while living within the environment. Medical students “admitted” into the nursing home as a resident are asked to answer these questions: What is it like for me to live in a nursing home ; What does it mean to me to be a nursing home resident? The Learning by Living ethnographic immersion has three stages: (a) Pre-fieldwork—getting ready for the experience; (b) Fieldwork—living in the environment with a diagnosis, standard procedures of care including a “medication” regimen, toileting, bathing, transferring with assistance, eating pureed foods, and engaging in activities and relationship building; and (c) Post-fieldwork—reflection on what occurred during fieldwork (Denzin & Lincoln, 1994, 2005).Nursing Gerontology Essay Paper In 2005, 12% of students in California social work programs were taking courses on aging compared with a national report of 7% by the Council on Social Work Education and an earlier 1993 national survey of 3%. Still, the number of social work students training in gerontology remains less than the needed numbers (Damron-Rodriguez, Ranney, Goodman, Min, & Takahashi et al., 2013, p. 235). Most students in social work programs say that they plan to work with children, but given the jobs available, many of these students end up working with older adults. It is inevitable in our society. Beaulieu’s book, originally published in 2002, clearly articulates what on-the-ground nursing home social work practice involves. According to Beaulieu, social workers who work in nursing homes are faced with two key challenges (a) the health care system bias toward community care rather than nursing home/institutional care; and (b) the press of national regulations in shaping nursing home care. This book is divided into six parts: Social Work in Nursing Facilities; The Interdisciplinary Team; Nursing Facilities and Governing Oversights; Diagnosis, Treatment, and Care Issues; Ethics; and Community Liaisons. The appendix provides examples of standardized forms that are part of the social worker’s responsibility, and the book includes online resources and a glossary of terms and abbreviations. These resources are useful as it is rare to be exposed to this type of information or detail during one’s educational training. In the Basic Orientation chapter (Chapter 2), Beaulieu presents the landscape of responsibilities for social workers in the nursing home setting, which includes counseling, resource allocations, advocacy, planning and treatment, mediation, and of course psychosocial factors. The importance of these supportive roles is underscored by the experiences of the Learning by Living students, who reported that social workers often aided them in their adjustment to nursing home living Nursing Gerontology Essay Paper Between 1900 and 2000, life expectancy in the United States increased from 51 to 80 years for women and from 48 to 74 years from men (Population Reference Bureau, 2002). As Americans have increased their years of life, the prevalence of chronic conditions associated with age has also increased. It is estimated that by 2040, almost 160 million people in the US, most of them elderly, will be living with chronic conditions (National Academy on an Aging Society, 1999). Chronic cond

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NURS 6210 – Healthcare Finance and Budgeting Research Paper NURS 6210 – Healthcare Finance and Budgeting Research Paper This course explores healthcare specific financial policies and issues, analytical framework and economic transformation for financial decisions (such as investment and working capital), methods of financial management, insurance coverage and financing. In addition, the course focuses on the ability to apply economic and population health models to address health service issues and problems. NURS 6210 – Healthcare Finance and Budgeting Research Paper You will use the knowledge gained in this course to financially structure and evaluate the opening of a private primary care medical practice with one physician provider. You will prepare an operating and capital budget as well as a narrative summary of at least 1,000 words to show your financial findings and recommendations. You will provide supporting documentation to support your findings and recommendations. Prior to writing your narrative summary you will need to prepare an operating and capital budget for the project. The well-prepared operating and capital budgets will demonstrate a keen knowledge of the market, pricing, activity, revenues, expenses, and potential impact on cash-flow and/or profitability. The capital budget will similarly demonstrate an awareness of the capital items and associated costs for project start-up. NURS 6210 – Healthcare Finance and Budgeting Research Paper Permalink: https://nursingpaperessays.com/ nurs-6210-health…research-paper / Prepare an annual statistical report that includes the following: Volume of patient visits Revenues (percentage of reimbursement from Medicare, Medicaid, Commercial Insurance and Self Pay) Expenses (Labor, Equipment, Supply, Overhead) Provide your assumptions to justify all volumes, revenues and expenses Prepare a three-year operating budget that includes the following: An estimate of revenue each year An estimate of expenses for each year The cash flow (negative or positive) generated from revenues and expenses Prepare a start-up capital budget listing the equipment you may need for this project including the cost and annual depreciation From your operating budget calculating the following: Projected cash flow over 3 years Break-even analysis Internal rate of return (IRR) Net present value (NPV) From your calculations, evaluate the financial risk involved with this project and make a recommendation as to whether this project is financially viable. NURS 6210 – Healthcare Finance and Budgeting Research Paper Prepare a 1000-word minimum narrative summary of your financial findings and recommendations. You will provide supporting documentation to support your findings and recommendations. Key points on budgeting in health No country has made significant progress towards universal health coverage (UHC) without increasing the extent to which its health system relies on public revenue sources. NURS 6210 – Healthcare Finance and Budgeting Research Paper Framing the approach to health financing policy in this way places the health sector within the overall public budgeting system and underscores the crucial role that the budget plays, or should play, for UHC. Historically, health financing discussions have been largely driven by demands to raise revenues and find new sources of funds, with much less discussion of overall public sector financial management and budgeting issues. An understanding of the core principles of public budgeting is essential for those who have an active interest in health financing reform because the budget is a primary instrument for strategic resource allocation. Even in contexts where health insurance funds manage a core part of health expenditure, budgeting rules continue to influence flows of funds and transfers to purchasing agencies and/or health facilities. Firstly, robust public budgeting in health, especially through the development of multi-year plans, is likely to improve predictability in the sector’s resources, which in turn increases the likelihood that defined plans can be translated in policy actions on the ground. NURS 6210 – Healthcare Finance and Budgeting Research Paper Secondly, proactive engagement of health ministries in the budgeting process can facilitate alignment of budget allocations with sector priorities, as laid out in national health strategies and plans. In doing so, allocate efficiency within the sector’s resource envelope can be improved. Thirdly, if budgets are better defined, budget execution can improve, which means that under spending – a common issue in low income countries – can decrease in the sector (i.e. budget is implemented according to the plan, which is defined and articulated with national priorities). Fourthly, if the health budget is formulated according to goals and the execution rules align with this logic, it will allow a certain degree of spending flexibility and make budgets more responsive to sector needs. Engaging in budget preparation, understanding the guiding principles of budgeting as well as the political dynamics that enable the budget elaboration and approval process, is essential for health planning stakeholders. Although health is financed by public and private funds, to make progress toward universal health coverage (UHC), a predominant reliance on public, compulsory, prepaid funds is necessary. Therefore, the way budgets are formulated, allocated and used in the health sector is at the core of the UHC agenda. This chapter outlines the overall budget process for the public sector, discusses the specific role of health within it, in particular the role of the ministry of health and other health sector stakeholders, to provide timely inputs into the budgeting process. NURS 6210 – Healthcare Finance and Budgeting Research Paper Several surveys have been administered over the last 40 plus years to learn about capital budgeting practices of healthcare organizations. In this report, we analyze and synthesize these surveys in a four-stage framework of the capital budgeting process: identification, development, selections, and post-audit. We examine three issues in particular: (1) efficiency of for-profit hospitals relative to not-for-profit hospitals, (2) capital budgeting practices of the healthcare industry vis-à-vis other industries, and (3) effects of healthcare mergers and acquisitions on capital budgeting decisions. We found indirect evidence that for-profit hospitals exhibited greater efficiency than not-for-profit hospitals in recent years. The acquisition of not-for-profits by for-profits is credited as the primary reason for growth of multi hospital systems; these acquisitions may have contributed to the more efficient capital budgeting practices. One unique attribute of healthcare is the dominant role of physicians in almost all aspects of the capital budgeting process. In agreement with some researchers, we conclude that the disproportionate influence of physicians is likely to impede efficient decision making in capital budgeting, especially for nonprofit organizations. The healthcare industry faces new challenges daily. Advancements in care keeps the field exciting and rewarding, while an increased population and a large generation of aging patients make healthcare tough. NURS 6210 – Healthcare Finance and Budgeting Research Paper It isn’t just patient care that makes the field a challenge. The administrative side of healthcare has its own concerns. These concerns aren’t always centered on financials, but financial planning and healthcare budgeting can play a huge role in helping doctors, hospitals, and other healthcare facilities address some of their biggest challenges head-on. Value-Based Payments A staggering truth about the healthcare industry is that half of hospital bills are never paid. Some of this is because of issues between insurers or Medicare and the providers. Others are due to confusion about bills or lack of ability to pay on the part of patients. To simplify the process, the federal government passed the Medical Access and Chip Re authorization Act, or MACRA, which is meant to move providers to a more value-based payment system. In other words, the better patients are served, the better healthcare providers are paid. For the first few years, providers will have the option to participate or not. The program will be fully rolled out in 2019 and will impact all hospitals as well as healthcare providers that service a significant number of Medicare patients. The effect on a facility’s bottom line, however, will vary throughout the roll out. NURS 6210 – Healthcare Finance and Budgeting Research Paper To accommodate the changes, healthcare administrators that can run different scenarios with their budgets and plans will be the ones best prepared to deal with the results of value-based payments. Being able to ask “what if?” and run multiple views of a financial plan will set healthcare providers up for success as the changes related to MACRA go into effect. Practice Cost Management Medical professionals understand cash flow issues and how they can affect their operations, but they also understand that cash flow is important to an organization’s financial well-being. Day to day obligations like salaries, supplies, legal fees, tools and equipment, and so on must be balanced with co-pays, insurance reimbursements and patient payments. Budgeting expenses against cash flow – and controlling costs – is a critical concern for healthcare administrators. NURS 6210 – Healthcare Finance and Budgeting Research Paper Understanding where and how money is spent requires slicing and dicing of data and analyzing where savings can be found. Reviewing budget data against actual s and utilizing easy to understand dashboards can point to expenses that can be improved on. Shifting Requirements and Regulations As government regulations and laws change surrounding healthcare, it is difficult to know what will be required of providers and how payment models and overages will change. Between the financial demands of becoming compliant with technology regulations and the shifting landscape of the ACA, providers must be flexible in planning and budgeting. NURS 6210 – Healthcare Finance and Budgeting Research Paper Volatility in financials requires systems that can change quickly and accurately. Unfortunately, spreadsheet budgets can be rigid with small errors resulting in potentially large miscalculations or reporting issues. Healthcare providers need FP&A systems that provide for rapid changes and projections. Some providers may even consider switching to rolling forecasts, allowing for changes to be incorporated more quickly. Healthcare providers face change and uncertainty, but must still plan financials like any other business. The key to doing so effectively is having a system that tolerates changes well, is flexible without adding significant operational overhead, provides accurate and easy to understand reporting and offers scenario planning. With these tools available to administrators, providers can be prepared for whatever lies ahead. NURS 6210 – Healthcare Finance and Budgeting Research Paper Funding for fundamental science and early-stage translation al medicine is becoming scarcer, and at the worst possible time—when we now have the scientific and engineering expertise to make major breakthroughs in our understanding of the molecular basis of many deadly diseases and how to treat or prevent them. The dearth of funding for translation al medicine in the so-called “Valley of Death” can be attributed to several factors, but a common thread among them is increasing financial risks in the bio pharma industry and greater uncertainty surrounding the economic, regulatory, and political environments within the biomedical ecosystem. Increasing risk and uncertainty inevitably leads to an outflow of capital as investors and other stakeholders seek more attractive opportunities in other industries. By applying financial techniques such as portfolio theory, secularization, and option pricing to biomedical contexts, more efficient funding structures can be developed to reduce financial risks, lower the cost of capital, and bring more life-saving therapies to patients faster. By taking this course, students will gain the background, resources, and framework to influence the healthcare industry. Health systems financing Health financing systems are critical for reaching universal health coverage. Health financing levers to move closer to universal health coverage lie in three interrelated areas: NURS 6210 – Healthcare Finance and Budgeting Research Paper raising funds for health; reducing financial barriers to access through prepayment and subsequent pooling of funds in preference to direct out-of-pocket payments; and allocating or using funds in a way that promotes efficiency and equity. Developments in these key health financing areas will determine whether health services exist and are available for everyone and whether people can afford to use health services when they need them. Guided by the World Health Assembly resolution WHA64.9 from May 2011 and based on the recommendations from the World Health Report 2010 “Health systems financing: The path to universal coverage”, WHO is supporting countries in developing of health financing systems that can bring them closer to universal coverage. Health financing system A good health financing system raises adequate funds for health, in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. [1] Health financing systems that achieve universal coverage in this way also encourage the provision and use of an effective and efficient mix of personal and non-personal services. NURS 6210 – Healthcare Finance and Budgeting Research Paper Three interrelated functions are involved in order to achieve this: the collection of revenues from households, companies or external agencies; the pooling of prepaid revenues in ways that allow risks to be shared – including decisions on benefit coverage and entitlement; and purchasing; the process by which interventions are selected and services are paid for or providers are paid. The interaction between all three functions determines the effectiveness, efficiency and equity of health financing systems. Health system inputs: from financial resources to health interventionsLike all aspects of health system strengthening, changes in health financing must be tailored to the history, institutions and traditions of each country. Most systems involve a mix of public and private financing and public and private provision, and there is no one template for action. However, important principles to guide any country’s approach to financing include: raising additional funds where health needs are high, revenues insufficient and where accountability mechanisms can ensure transparent and effective use of resources; reducing reliance on out-of-pocket payments where they are high, by moving towards prepayment systems involving pooling of financial risks across population groups (taxation and the various forms of health insurance are all forms of prepayment); NURS 6210 – Healthcare Finance and Budgeting Research Paper taking additional steps, where needed, to improve social protection by ensuring the poor and other vulnerable groups have access to needed services, and that paying for care does not result in financial catastrophe; improving efficiency of resource use by focusing on the appropriate mix of activities and interventions to fund and inputs to purchase; aligning provider payment methods with organizational arrangements for service providers and other incentives for efficient service provision and use, including contracting; strengthening financial and other relationships with the private sector and addressing fragmentation of financing arrangements for different types of services; promoting transparency and accountability in health financing systems; improving generation of information on the health financing system and its policy use. Health Care Funding In the United States, health care providers (such as doctors and hospitals) are paid by the following: Private insurance Government insurance programs People themselves (personal, out-of-pocket funds) In addition, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service. Private insurance Private insurance can be purchased from for-profit and not-for-profit insurance companies. Although there are many health insurance companies in the United States, a given state tends to have a limited number. NURS 6210 – Healthcare Finance and Budgeting Research Paper Most private insurance is purchased by corporations as a benefit for employees. Costs are typically shared by employers and employees. The amount of money employers spend on an employee’s health insurance is not considered taxable income for the employee. In effect, the government is subsidizing this insurance to some degree. People may also purchase private health insurance themselves. The Patient Protection and Affordable Care Act (PPACA, or Affordable Care Act [ACA]), which became effective in 2014, is U.S. health care reform legislation intended, among other things, to increase the availability, affordability, and use of health insurance (see also the U.S. Department of Health & Human Services ACA official site). Many of the ACA’s provisions involve an expansion of the private insurance market. It creates incentives for employers to provide health insurance and requires that nearly all people not covered by their employer or a government insurance program (for example, Medicare or Medicaid) purchase private health insurance (individual mandate). NURS 6210 – Healthcare Finance and Budgeting Research Paper The ACA requires creation of health insurance exchanges, which are government-regulated, standardized health plans that are administered and sold by private insurance companies. Exchanges may be established within each state, or states may join together to run multistate exchanges. The federal government also may establish exchanges in states that do not do so themselves. There are separate exchanges for individuals and small businesses. The ACA requires that private insurance plans do the following: Put no annual or lifetime limits on coverage Have no exclusions for preexisting conditions (guaranteed issue) Allow children to remain on their parent’s health insurance up to age 26 Provide limited variations in price (premiums can vary based only on age, geographic area, tobacco use, and number of family members) Allow for limited out-of-pocket expenses (currently $5950 for individuals and $11,900 for families) Not discontinue coverage (called rescission) except in cases of fraud Cover certain defined preventive services with no cost-sharing Spend at least 80% to 85% of premiums on medical costs Recent and impending changes that will affect the ACA include: Stopping government funding of premium tax credits and cost-sharing reductions Expansion of association health plans (AHPs) and health reimbursement arrangements (HRAs), which are less expensive and less comprehensive than ACA marketplace plans Reduced regulatory burden imposed by the Notice of Benefit and Payment Parameters (NBPP), which will give states more leeway in defining essential health benefits NURS 6210 – Healthcare Finance and Budgeting Research Paper Repeal of the individual mandate These changes are intended to reduce government and individual spending on health plans, but some authors warn that overall spending on health care may not be reduced and that there may be increased numbers of uninsured or inadequately insured people. Alternative financing methods User fees User fees – direct charges to users for health services – have been implemented in many countries for a number of years now. Proponents of user fees suggest that fees could make the health system more efficient by guiding demand to cost-effective health care at the appropriate levels. Further, they could improve equity if revenues generated from fees are allocated to addressing the health needs of the poor. Others, though, argue that this reallocation is not guaranteed, and in the absence of exemption policies or other forms of financial protection, user fees actually price the poor out of the market for health care. The discussion paper below reviews the African experience with user fees. NURS 6210 – Healthcare Finance and Budgeting Research Paper Innovative financing methods In addition to the traditional methods of financial risk protection, there are a variety of other financing mechanisms with which countries are experimenting. The need for these additional sources of funds is driven by rising demand for health care services, escalating costs of care, rapid increases in technology, and a limit on how much can be raised through a traditional tax base. Some of these methods are nationally based, such as: hypothetical taxes, e.g. ‘sin taxes’ for tobacco and alcohol national and state lotteries dedicated to health public-private partnerships between governments and the private sector to co-fund health care. Other mechanisms are internationally focused, such as: the (recently proposed) International Finance Facility (IFF). This would front-load development assistance by selling government bonds secured by future aids flows debt for health swaps, in which both public and private financial institutions can be involved in the conversion of the debt the use of public-private partnerships to develop new products using capital markets. NURS 6210 – Healthcare Finance and Budgeting Research Paper It is clear that with the rising costs of health care, countries will begin to explore more of these ideas to augment traditional sources of health financing. Budgeting in health care systems During the last decade there has been a recognition that all health care systems, public and private, are characterized by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. NURS 6210 – Healthcare Finance and Budgeting Research Paper The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economize in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence. Budgeting is important in any organization. In healthcare, department level budgeting is often managed by healthcare professionals and managers with little or no financial background. Managers may be promoted from the front lines as they have demonstrated a strong understanding of department function, or are hired with significant work-related experience and/ or possess advanced education. Unfortunately, many healthcare managers that are placed in entry level management positions lack either formal or informal training for financial management. These managers generally possess a strong understanding of how to deliver quality patient care services but are not adequately prepared to operate the department respecting a business model. A basic foundation in financial management is critical to ensure that department management goals are aligned with the strategic vision of the organization and operate with projected budgetary targets. NURS 6210 – Healthcare Finance and Budgeting Research Paper Managers must possess or obtain a basic understanding of financial principles such as: financial statements, operating budgets, capital budgets, and how to perform a basic analysis of this information to make sound business decisions. Budgeting requires careful consideration and effective planning. Budgeting is considered an essential component of management to ensure that the department operates effectively and ensure the organization remains solvent. In most developed countries, two factors are certain: first, health care costs are consistently exceeding GDP growth year after year; and second, health care resources are increasingly scarce and competitive. Managers must understand that many factors that may impact or influence the operating budget and capital budget decisions. In the U.S., budgets available to various departments depend on many organizational factors which may include billing and coding practices, shareholder investment, potential to increase capital, potential for return on investment from equipment or services, percentage of private insured payers versus Medicaid or Medicare clients, impact of competition on the bottom line, availability of new or updated technology, and many other factors. The solvency of the organization can significantly impact budgets from year to year and even threaten the future of a department or service if it proves unprofitable or expendable. NURS 6210 – Healthcare Finance and Budgeting Research Paper Managers must have some basic knowledge of where costs fit into the budget. They must understand the difference between an operating budget and a capital budget. Durham-Taylor and Pinczuk (2006) explain that an operating budget covers day-to-day operations and may include such things as wages, office or medical supplies, equipment rental, and education,etc. Gruen, and Howarth (2005) explain that staff costs is the largest “cost item” in a healthcare operating budget and managers must understand how hiring decisions can affect the budget. Although staffing is generally a ‘fixed’ cost and is relatively static, managers must understand the impact of payout of overtime hours, overstaffing, and agency hiring to replace staff, on their overall operating budget. After salaries and benefits, the second largest cost for many units relates to supplies. Understanding how to cost audit and analyze budgetary items can have a significant positive impact on the department goal of staying within an operating budget. This differs from capital budgeting that covers fixed assets such as land, buildings, and long-life capital projects financed over two or more years. MacLean (2003) explains that capital budgeting is based on the overall operating plan and is part of the strategic vision for the organization. Bett (2010) states “capital budgeting refers to the analysis of investment alternatives involving cash flows received or paid over a certain period of time” (para 2). Capital projects are often funded from a combination of internal savings and/or through external sources of funding via financing or grants. Understanding how a capital budget for fixed assets differs from an operating budget for day-to-day operations is critical to understand how and why management, executives, trustees, accountants and other key stakeholders make the decisions that they do. NURS 6210 – Healthcare Finance and Budgeting Research Paper Bull (1993) explains that capital budget and planning has become increasingly important due to competition and a focus on long-term stability of the organization. Twenty years on, this is critically important, particularly in healthcare organizations where resources are increasingly scarce. Gairns (2006) cites Dufresne stating “capital planning is a way of defining how you’re going to spend money to get the most impact for your organization and its mission… Capital budgeting is knowing what you’re going to spend your money on in the next year (or two or three)” (para 2). Boundless.com (n.d.) explains that capital budget planning is essential to determine if investments and expenditures are worth pursuing. An investment appraisal helps decision-makers discern between proposed projects and prioritize its investment decisions. Ongoing care and maintenance of equipment and human resource costs must also be factored into capital budget proposals and decisions. NURS 6210 – Healthcare Finance and Budgeting Research Paper Healthcare Budget Variance Budgeting is an important activity within every healthcare organization. The particular challenges encountered, however, can vary depending on the type of organization. A state or federally funded organization, for example, will likely have a budget that is allocated to it, and it needs to follow specific guidelines on how the money can be used. A for-profit organization, by contrast, will typically have more influence and flexibility in setting up its budget and making choices on matters such as how much to spend on marketing, patient care, or incentives for employees. In addition to preparing budgets, as a healthcare administrator, you must also be able to evaluate whether or not you have achieved your budget using variance analysis. This is important because variance analysis measures the differences between the budget and actual results, and provides administrators with a starting point for correcting financial performance. For this Assignment, you conduct a variance analysis for a healthcare organization. NURS 6210 – Healthcare Finance and Budgeting Research Paper To prepare for this Assignment, review the Week 7 Assignment document provided to you by the Instructor. Examine the budgeted and actual revenues and expenses for a hospital. Reflect on concepts of budgeting and variance. Refer to Chapter 10 and Chapter 11 of Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts and Applications Using an Excel spreadsheet to show your calculations, address the following: •Determine the total variance between the planned and actual budgets for Surgical Volume. Is the variance favorable or unfavorable? NURS 6210 – Healthcare Finance and Budgeting Research Paper •Determine the total variance between the planned and actual budgets for Patient Days. Is the variance favorable or unfavorable? •Determine the service-related variance for Surgical Volume. •Determine the service-related variance for Patient Days. •Prepare a flexible budget estimate. Present side-by-side budget, flexible budget estimate, and the actual Surgical Revenues. •Prepare a flexible budget estimate. Present a side-by-side budget, flexible budget estimate, and the actual Patient Expenses. •Determine what variances are due to change in volume and what variances are due to change in rates. steps for creating a health care budget It may seem odd at first to come up with a budget for something so important, and sometimes unpredictable, as your health.

Nursing

Describe two cultural or social considerations when communicating with individuals identified as needing LLN support. Describe two cultural or social considerations when communicating with individuals identified as needing LLN support. ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Describe two cultural or social considerations when communicating with individuals identified as needing LLN support. Describes the skills and knowledge a vocational trainer or assessor requires to identify language, literacy and numeracy (LLN) skill requirements of training and the work environment, and to use resources and strategies that meet the needs of the learner group. Assessment Task National Unit Details Unit Code TAELLN411 Unit Title Address adult language, literacy and numeracy needs Assessment Information Qualifications TAE40116 Certificate IV in Training and Assessment Type Task 1: Knowledge questions Task 2: Identify LLN skills needed to perform a workplace task Task 3: Identify a learner’s LLN needs Task 4: Select instructional and assessment strategies that address identified LLN needs Task 5: Customise learning resources Task 6: Work with LLN specialists Task 7: Select, use and review LLN support strategies Due Date 6 weeks from last day of workshop General Information Decision Making Rules All assessment criteria within the task must be satisfactorily completed for the task to be assessed as satisfactorily completed. Reasonable adjustment Reasonable adjustment for assessment tasks for a unit may be requested by the student for consideration by the facilitator for the methods by which evidence is collected. However, the evidence criteria for making competent/not yet competent decisions must be the same irrespective of the group and/or individual being assessed. Reasonable adjustment usually involves varying: · the processes for conducting the assessment (eg: allowing additional time, varying the venue) · the evidence gathering techniques (eg: oral rather than written questioning, use of a scribe, modifications to equipment) Special Consideration Students can apply for special consideration if personal circumstances or illness have adversely affected their result in an assessment, or their ability to undertake an assessment. If they wish to seek special consideration, a special consideration form must be completed no later than 3 days after the due date of the assessment and submitted via e-mail to [email protected] 1. Unit requirements and Assessment conditions Application TAELLN411 Address adult language, literacy and numeracy needs This unit describes the skills and knowledge a vocational trainer or assessor requires to identify language, literacy and numeracy (LLN) skill requirements of training and the work environment, and to use resources and strategies that meet the needs of the learner group. The unit applies to individuals who teach, train, assess and develop resources. Competence in this unit does not indicate that a person is a qualified specialist adult language, literacy or numeracy practitioner. Conditions TAELLN411 Address adult language, literacy and numeracy needs Gather evidence to demonstrate consistent performance in conditions that are safe and replicate the workplace. Conditions must be typical of those experienced in the training and assessment environment and include access to: · texts and tasks typically found in the workplace · specialist LLN practitioners for consultation and verification of approaches · training and assessment tools based on the ACSF levels · training package support materials · workplace-specific tools, equipment, materials and industry software packages (where applicable). Skills must be demonstrated with real vocational learners. All trainers and assessors delivering any TAE training products must hold one of · TAE50111 Diploma of Vocational Education and Training or its successor or · TAE50211 Diploma of Training Design and Development or it successor or · TAE550216 or A higher level qualification in adult education. As per clauses 1.22 – 1.23 item 7 of Schedule 1 of the Standards for Registered Organisations (RTOs) Amendment 2017. Submission Details When submitting your work, please ensure you have signed the Declaration on the first page. Your responses may be typed directly into this document, with any additional documentation provided as attachments Please title each attachment (i.e. Attachment A, B etc) and, reference these in the main document with an explanation of their relevance. All assessment tasks should be submitted via Blackboard, our online learning management system. Please note: · Assessment due dates are to be 6 weeks from the final day of the learning workshop. · Feedback will be provided by your assessor within 3 weeks following the due date for submission. · If resubmission of work is required, this must be submitted within 2 weeks of receiving feedback from your assessor · Final feedback will be provided by your assessor within 2 weeks of resubmission. Extensions to the due date will be granted under exceptional circumstances. If you need an extension please contact your designated assessor at least one week before the due date. Assessment results Your assessment will be marked using the following scale on Blackboard: Result Code Result Certification Description PU Achieved Competency NU Not Yet Competent NEN No Engagement in Unit SEN Stopped Engagement in Unit In addition to the results, you will also get detailed feedback from your assessor on each key aspect of your assessment. This will be provided to you via Blackboard and can be accessed via “my grades”. Should you have any questions about the assessment process please feel free to contact your designated assessor. Assessment support Your Assessor for this program is contactable via email for any questions, queries or concerns you may have through the assessment process. You also have the option of undertaking one 15 minute support coaching session to be scheduled between yourself and your Assessor. To confirm a mutually agreeable time, please contact your Assessor via email. National Unit Details Unit Code TAELLN411 Unit Title Address adult language, literacy and numeracy needs Assessment Cover Sheet Students must include the following information and declaration of original authorship with their submission. student name: email: mobile: qualification: TAE40116 Certificate IV in Training and Assessment unit code & title: TAELLN411 Address adult language, literacy and numeracy needs Student Declaration · I understand that competency will not be given if I do not meet the assessment evidence and activity requirements. · I declare that this is my own work in accordance with Swinburne Plagiarism policy, as found on: https://www.swinburne.edu.au/current-students/manage-course/exams-results-assessment/plagiarism-academic-integrity/plagiarism-misconduct/ · I declare all documents submitted for assessment are my own work. Where I have used other sources, acknowledgements have been made. Student signature: Date: Task 1: Knowledge questions When preparing written responses to each of the knowledge questions, use examples to support wherever possible. These examples should be based on your own experiences and demonstrate your understanding of key concepts. Acknowledge any sources of information you have used (websites, books etc.) by referencing the original source. Task Task title Task requirements/Questions 1.1 Strategies and resources you use to identify learners’ LLN needs: a. Describe two specific examples of how you could find out the level of LLN skills held by a learner group before or at the start of training you deliver. b. Name and describe one quality-approved LLN pre-training assessment tool that is (or could be) used in your workplace, OR research and identify an assessment tool available from outside your workplace that is suitable, given the training you deliver (or hope to deliver). c. Explain why you selected the LLN assessment tool described in question 1b above. 1.2 Interact with individuals needing LLN support a. Describe two cultural or social considerations when communicating with individuals identified as needing LLN support. b. Describe how to approach and interact with individuals needing LLN support, to maintain a safe and positive learning experience. 1.3 Source LLN support a. Research and describe at least two resources available to help you support learners and build their LLN skills—e.g. consider relevant reference materials or other resources to help you help learners, or resources that you could direct learners to. b. Research, identify and describe how and from where you could access an LLN specialist to support you and/or your learners. 1.4 Evaluation Describe best practice techniques you use (or could use) to evaluate the effectiveness of LLN support provided within your own training and assessment practice. Task 2: Identify LLN skills needed to perform a workplace task Obtain one copy of a training benchmark that describes a workplace task relevant to your industry or area of expertise—e.g. unit of competency, standard operating procedure, program outcomes, etc. · Analyse the training benchmark—identify what people must learn, read, write, listen to and speak about, calculate, estimate, or measure, in order to perform the benchmark to the standard of performance expected in the workplace. · Over write the benchmark in some way either by hand or in soft copy to show what core skills are embedded in your training benchmark. · Submit a copy of the analysed benchmark with your post-training portfolio. · Document your findings by completing the template A. Template A: LLN skills needed to perform a workplace task Benchmark name What must learners… LLN demands identified ACSF level Learn What learning or research strategies must be used? Read Write Listen to Say Estimate, calculate or measure Task 3: Identify a learner’s LLN needs This task requires you to read the scenario information below and: · Review the LLN (core skill) assessments that Arthur completed (see over) · Identify Arthur’s core skill levels · Describe Arthur’s LLN needs. Scenario There-On-Time Buses There-On-Time Buses (TOT) is a private charter bus company. It is also a Registered Training Organisation. TOT is implementing a new initiative in which experienced drivers are assigned as mentors for new drivers. The aim of this initiative is to help new drivers develop the full range of knowledge, skills and work habits needed for their role, in a shorter time frame than the current average. TOT management has nominated eight (8) experienced drivers to be promoted to the role of workplace mentors. Training TOT’s learning and development team will deliver a Workplace Mentoring program to the eight (8) nominated workplace mentors. Training will address the unit of competency, TAEDEL404 Mentor in the workplace. The eight nominated program participants must achieve competence in TAEDEL404 before TOT will offer the promotion to the Workplace Mentor position. Arthur Arthur is 45 years old and has lived in Australia all his life. He has always lived in an urban area, either Brisbane or Sydney. English is his first language and he doesn’t speak any other languages. Arthur left school after year 10, which he successfully completed. He has not participated in any formal education or training since leaving school. Arthur has been with There-On-Time buses since the age of 19. He started there as a cleaner, then became a bus driver when he was 21. Arthur has a relaxed and easy-going manner. He is popular, both with customers and TOT staff. Clients often specifically request him for charter work. He enjoys driving buses, and does it well. He says, “I like being ‘out and about’ all day, getting to know new people. A desk job with lots of paperwork wouldn’t suit me.” Like most participants, Arthur is excited about this opportunity, but unsure as to whether or not he will be able to cope with the increased responsibilities. Core skill assessments The L&D department asked Arthur to complete the following core skill assessments: 1. Verbal interview— ACSF core skills covered: oral communication and learning 2. Written assessments (2)— ACSF core skills covered: reading, writing, learning and numeracy. Copies and transcripts of Arthur’s competed assessments are below. Review the core skill assessments Arthur completed Assessment 1: Verbal Interview Below is a typed transcript of the verbal interview. The transcript was typed word-for-word from an audio recording of the interview: 1. Why do you think we identified you for the workplace mentor role? “Well, I guess I’ve been around here long enough to know what I’m doin’, ya know? And I like the job. I think I’d make someone else like it too.” 2. Tell us what excites you about this new role. “I think it’d make me feel good, knowing I was helping a new driver along. Back in the day when I started, we just had to figure it out, and I remember some things were tough—like I remember the first time I drove Route 599 in the morning, I wasn’t sure which stops to stop at. I remember stopping at a stop that I shouldn’t have, and one passenger yelled at me, told me he was late for work. It’d be good to save someone else that grief, you know?” 3. What questions do you have? “I’d still want to drive my own routes sometimes, a nd not always be with the mentee . If we do this mentor thing, can I still do that? (response given). And I saw that I have to write reports. What kind of reports? I can fill in forms okay—incident forms, time sheets and such—but I haven’t had to write an essay in years.” Assessments 2 & 3: Written assessments Arthur completed two written assessments: 1. Assessment 2: Reading Covers ACSF core skills of reading, learning and to a very limited extent, numeracy 2. Assessment 3: Writing instructions Covers ACSF core skill of writing Copies of Arthur’s completed written assessments follow. Arthur’s: core skill assessment 2: Reading Assessment 2 : R eading Instructions Read the incident report below, then answer the questions that follow: Incident Report Form: There-on-Time Buses Details of the person completing this form Name Rajesh Doright Position Shift Supervisor: mechanics Date completed 18 November Signature R ajesh Doright Work phone 9999 9999 Email rdoright @tot.com.au Details of the injured person Name Raymond Rayonne Position Mechanic Sex Male Female Experience in job 12 years DOB 24 May 1987 Address 123 Lovely Lane, Anywhere NSW 8888 Details of the incident Date 17 November Time 3:45pm Location Garage #2 Description of incident Raymond was returning from his afternoon break. He was walking through the garage to resume work on the bus he was working on. Just before he got to the bus, he slipped and fell backward. He tried to break his fall but landed hard on the ground. Injuries sustained Broken wrist and sore back. 1st aid given He said his back was stiff so we didn’t move him. We brought him an ice pack within 1 minute and held it on his wrist while we called the first aid team. The team wrapped his wrist in a tensor bandage, and then organised for him to go to the hospital for X-Rays. Details of witnesses (if any) Name Rajesh Doright (me) Contact details As above Name Clyde Climber Contact details [email protected] This form submitted to Name Steven Saveall Position Safety Officer Method Internal mail Email (attached) Other: ____________ Follow up action: to be completed by the person to whom this form is submitted Description of actions to be taken Raymond to be given minimum 6 weeks’ leave with pay—his condition is to be re-evaluated at the end of 6 weeks . Internal investigation to be initiated. Arthur’s core skill assessment 3: writing instructions Skill Assessment: Writing Instructions Write a set of instructions to explain how to perform a pre-driving check on a bus: Identify Arthur’s core skill levels a. Review the four profiles below b. Select the profile that shows Arthur’s core skill levels suggested by his completed assessments c. Tick the box () in the top right corner of the profile you believe to be correct Profile 1 ? Profile 2 ? Profile 3 ? Profile 4 ? d. Explain or justify your choice: Describe Arthur’s LLN needs The core skill profile below shows the core skill levels Arthur will need to meet requirements of TAEDEL404 Mentor in the workplace and ultimately fulfil his role as a workplace mentor for TOT Buses. Black squares () indicate the required level of each core skill. a. On the core skill profile below, plot the core skills Arthur holds, as revealed by the core skill assessments he completed. To do this, place ‘ X ’s or equivalent in the profile below, to match the core skill profile you selected in Part 3 of this task. Level of performance 5 4 3 2 1 Learning Reading Writing Oral Communication Numeracy b. Compare the core skills Arthur holds with the core skills he will need to fulfil his role as a mentor in his workplace. c. Describe the two most significant skill needs (gaps) you notice: Task 4: Select instructional and assessment strategies that address identified LLN needs This task has two parts: Part 1: Instructional strategies that address identified LLN needs Part 2: Assessment strategies that cater to identified LLN needs. · Read the scenarios that follow. Assume that you are the trainer/assessor of the learners described in each scenario. · Answer the questions that follow each scenario. Part 1. Instructional strategies Scenario 1 Reading Jake is 33 years old and of Australian Caucasian descent. He has worked as a cook in a family-owned restaurant for 15 years and has been head cook for the past 3 years. He is well known in the community and is a popular ‘face’ of the restaurant. He is famous for his fried chicken and for his lively banter with waiters as they exchange information about customer orders. Waiters know him as ‘the guy who remembers everything’—Jake can prepare and keep track of all orders without needing to reference the notes waiters take about each order. The owners have recently hired you as their new kitchen manager. You are also a qualified trainer. You introduce a new, efficient, computer-based ordering system. Waiters upload all orders to the system. Orders appear on a large monitor mounted high on a wall in the kitchen. A typical screen for each order looks like this: The kitchen staff use a touch-screen tablet device to manage orders. Using the tablet, they press ‘next’ to view each successive order. As orders are filled, kitchen staff use the tablet to highlight items that have been served ( ). For example, once starters are served at table 1, the screen for table 1 will look like this when it next appears: Table 1 Customer Starter Main Dessert Notes 1 – Family fried chicken Chocolate cake with ice cream 2 Chicken wings Family fried chicken Vanilla ice cream with chocolate sauce 3 Soup of day – – No nuts The day the new system goes live, Jake’s on-the-job performance plummets. He gets orders mixed up and misses two orders altogether. Table 1 Customer Starter Main Dessert Notes 1 – Family fried chicken Chocolate cake with ice cream 2 Chicken wings Family fried chicken Vanilla ice cream with chocolate sauce 3 Soup of day – – No nuts You organise a private coaching session with Jake to help him learn to use the system. You soon discover that Jake cannot read the orders. He recognises his own name and highly familiar, simple words and phrases. On the screen above, he recognises numbers in digit form and understands ‘fried chicken.’ He deduces that three people are sitting at table 1. He sees ‘fried chicken’ listed twice, which leads him to guess that two people ordered fried chicken. He does not understand other information given. Questions a. Describe Jake’s needs (gaps) in reading: b. Describe one example of a strategy you could use when coaching Jake to: · upskill Jake in the reading skills he needs to use the new ordering system · support Jake’s efforts Scenario 2 Oral Communication (speaking and listening) A large electronics retail store has just promoted two IT technicians—Rajesh (Indian) and Alain (French)—to the position of Product Expert. As Product Experts, they will answer customer questions and help customers choose the right product/s for them. You have been hired to coach Rajesh and Alain in ‘communication skills.’ Training will be face-to-face. Both learners hold masters’ degrees in IT and have extensive technical knowledge of all products. English is their second language, but both understand written and verbal English and can engage in simple conversations. They use technical jargon easily, but lack the English language vocabulary to answer questions and provide product information in plain English. They also struggle to pronounce some English words clearly. Questions a. Describe Rajesh and Alain’s needs (gaps) in oral communication: b. Describe one example of a strategy you could use when coaching Rajesh and Alain: · to upskill Rajesh and Alain in the oral communication skills they need to converse with customers and respond to their questions in a way the customers understand: · support Rajesh and Alain’s efforts Scenario 3 Numeracy You are a trainer for an outdoor adventure company that is also a registered training organisation. Your RTO delivers SIS31015 Certificate III in Aquatics and Community Recreation. Most people who enrol in this qualification are outdoor enthusiasts of varying ages, from late teens to fifties. They are usually personable and have strong oral communication skills. Levels of education usually vary from year 10 to university. One unit covered in this qualification is, SISXFIN001 Develop and review budgets for activities or projects. Based on past experience, you know that learners often struggle with the ‘numbers’ needed to develop a budget. Key skills they struggle with are the ability to: · identify items that must be included in the budget for a recreational program · analyse data and calculate costs to organise and implement the program · calculate a retail cost per program participant. Questions a. Describe the learners’ needs (gaps) in numeracy: b. Describe one example of a strategy you could use when delivering this topic to: · upskill the learners in the numeracy skills they need to develop a budget: · support the learners’ efforts Part 2. Assessment strategies Scenario 4 Learning You deliver Certificate IV in Training and Assessment for a local community college. You are three months into the six-month program. One learner—Daniella—has not been meeting assessment deadlines, and often comes unprepared for class. She has strong reading, writing and oral communication skills, so did not anticipate that she would have any problems with assessment. You and Daniella chat after today’s class. She says she is overwhelmed by the volume of information and doesn’t know where to start with her assessment tasks, especially since she has now fallen behind. Questions a. Describe Daniella’s needs (gaps) in Learning: b. How can you support Daniella with her assessment? Scenario 5 Writing You have just begun delivering an online program to a group of eight learners. The program covers the unit, BSBADM405 Organise meetings. This unit requires the ability to type meeting agendas and minutes. Program activities include one two-hour webinar per week for four weeks. Participants complete summative assessment tasks after the conclusion of training. They must: · organise one meeting in their workplace or community group · type the agenda for that meeting · attend the meeting and type minutes, ready for distribution within one week. Pre-training assessment results revealed that six of the eight learners have slight gaps in writing. English is the first language of most. All can write simple but grammatically correct sentences about familiar topics, but vocabulary used is too familiar for workplace documents, and there are many spelling mistakes. Questions a. Describe the six learners’ needs (gaps) in writing: b. How can you support these learners with their assessment? Task 5: Customise learning resources Modify the handout below so that anyone—especially people with reading gaps—can more easily understand information provided. Present your re-designed handout as a separatewith your submission. In case of emergency, evacuation procedure is as follows: On being given an alert signal, secure confidential and valuable items. Then proceed to floor/area assembly point. You will be instructed by the Safety Officer . On being given an evacuation signal, you will be asked to leave the building via the designated exit or nearest safe exit, and proceed to the nominated assembly area. Emergency telephone number is 000. Describe three (or more) techniques you used to improve readability of the handout whilst retaining the original depth and meaning of the text. Task 6: Work with LLN specialists Identify a scenario from LLN task 4 in which you felt that the learner/s would have benefitted from support from an LLN specialist. Scenarios covered were: Scenario 1—Reading (Jake) Scenario 2—Oral communication (Alain and Rajesh) Scenario 3—Numeracy (group training covering how to prepare a budget) Scenario 4—Learning (Daniella) Scenario 5—Writing (online training covering how to organise meetings) Assume that in the scenario you select: · you are the trainer and assessor · a LLN specialist is available to work with you and/or the learners both before and throughout training. Review the scenario you have selected. Describe how a LLN specialist could work with you and/or your learners to: · identify needs, support or build LLN skills before training begins · measure progress, support or build LLN skills throughout training ( Note your responses in the template B. Template B: LLN specialist support How LLN specialist support could best be integrated Before training begins Throughout training —i.e. during and/or between training sessions Task 7: Select, use and review LLN support strategies Deliver a 30-minute vocational training session to a group that includes at least one learner with identified needs in at least one core skill— learning, reading, writing, oral communication or numeracy OR Reflect on your recent delivery of a vocational training session to a group that included at least one learner with identified needs in at least one core skill This task aims to help you consolidate and apply what you have learned on this program, to your own training and assessment practice. Therefore, please select a training topic relevant to your industry or area of expertise. In your session, select and use the following strategies that explicitly target and address the LLN needs identified: · at least one instructional strategy to support learners and build the core skills targeted · at least one assessment support strategy—identify a suitable assessment support strategy and either discuss or use this with the learner/s in the session · at least one learning or assessment resource, customised to support the learner/s. Task Task title Task requirements/Questions 7.1 Background information a. Questions about the training session: · What was the vocational training topic? · When and where did you deliver the session? b. Questions about the learner group: · How many people were in the learner group? · Describe key characteristics of the learner/s—e.g. industry, experience, age, gender, cultural background or any other characteristics that influenced how you delivered your session. c. Questions about the learners’ LLN needs: · How many learners in your group had identified LLN needs? · Name the core skill/s you targeted in your session—learning, reading, writing, oral communication or numeracy · Describe the learners’ gaps in these core skill/s. d. Questions about targeted instructional strategy/ies used: · Describe at least one instructional strategy you used in your session to support and upskill learner/s in the targeted core skill/s. · Explain or justify why you chose this strategy. e. Questions about targeted assessment strategy/ies used: · Describe at least one targeted assessment strategy you offered or used in your session, to address the identified LLN needs. · Explain or justify why you chose this strategy. 7.2 Customised learning or assessment resource Submit one learning or assessment resource, modified and used in your session to support the learner/s with identified LLN needs. Submit the original document and modified copy. b. Explain or justify why you chose or developed this resource. 7.3 Self-reflection After delivery, reflect on your session. Answer the questions below. a. Questions about targeted instructional strategy/ies used: · Describe the strengths and weaknesses of the instructional strategy/ies used to address identified LLN needs · How would you improve the effectiveness of the targeted instructional strategy/ies if you were to deliver this session again? Explain or justify your answer. b. Questions about targeted assessment strategy/ies used: · Describe the strengths and weaknesses of the assessment strategy/ies you offered or used to address identified LLN needs · How would you improve the effectiveness of the assessment strategy/ies offered or used if you were to deliver this session again? Explain or justify your answer. c. Questions about the customised learning or assessment resource used to address identified LLN needs: · Describe the effectiveness of the customised learning or assessment resource used to address identified LLN needs · What improvements would you make to this resource if you were to use it again? Explain or justify your answer. d. Questions about how you can use skills and knowledge gained in this program, in your own training and assessment practice. Reflect on this task and on this program: · identify the three most useful strategies or insights you have gained about how to address LLN needs of adult learners · describe in detail how you will apply each strategy or insight identified above, in your role as a workplace trainer and assessor. 7.4 Explain or justify why you chose or developed this resource. Ask a suitable third party to sign the declaration below. · Choose a third party referee who is familiar with the session you delivered and described in this task. · Show your referee your completed work for parts 1-3 of this task before they complete the declaration. Task 7.4: Third Party Declaration Instructions for the third party referee Thank you for helping the candidate with their assessment. What to do: 1. Verify that you are a suitable third party referee—see criteria under Item 1 of the declaration below. If you are, continue as follows: 2. Complete all sections of this one-page form (hard or soft copy) 3. Sign below, where indicated (if you completed the form in soft copy, print this page before signing—we require a real signature) 4. Return the completed and signed third party declaration to the candidate. Candidate name Name of third party referee Questions about your relationship with the candidate What is your relationship with the candidate? I am the candidate’s TAE trainer or assessor ? I am a supervisor or colleague of the candidate ? Other (explain): ? How long have you known the candidate? Third party declaration I declare that: 1. I am a suitable choice of third party referee because: · I am not related to the candidate, either by birth or by marriage · I work with the candidate or I am the candidate’s TAE trainer/assessor

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