...com/viewarticle/771215_print This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many that looked at prediction ability. The LACE+ index is a model that looks at length of stay, acuity, the Charlson comorbidity score and age, to predict readmissions. They found that no one model was appropriate in predicting the 30-day readmission rates, although using a combination of the models was an improvement to that predictor. The authors are all physicians, PhDs, or have a Master’s degree- helping to establish credibility. The authors also make a statement as to the funding of the project and that they (the authors) were solely responsible for all data collection, design and submission approval writing for the project, also lending credibility to the study. The references used for this study were appropriate in age, of the 28; 13 were within the last five years. Statistical data was gathered by experts and calculations made through third party experts, lending validity to the study. This article does not use the words ‘Evidence-Based Practice’ (EBP), but the CMC model is an EBP model, and many of the newer references make note to EBP. Although this was an interesting article, I may not use this in my final project. I...
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...be compliant with their discharge instructions. III. Facts 1. In order to prove negligence or medical malpractice, the plaintiff must prove the: A. The requisite standard of care. B. A deviation from the standard of care C. A causal connection between the deviation and the claimed injury. 2. The hospitals rules, regulations, and policies do not establish a standard of care. However, a hospital’s failure to follow its own rules, regulations, and policies is evidence of negligence. 3. Discharge instructions can be construed to be part of a hospital’s rules, regulations and policies. 4. Unclear, or ambiguous discharge instructions can place the hospital at risk for increased liability for negligence if a casual connection can be made to a patient’s injury. Therefore, to protect itself, hospitals should be proactive in establishing clear discharge protocols and individualized discharge instructions. IV. Review of the Law In the case of Earline Therry, et al v. State of Louisiana, through the Department of Health and Hospitals and University Medical Center of Lafayette, Louisiana, a summary judgment was granted for the defendants based upon the plaintiff’s inability to establish a causal connection between a breach of the standard of care and any resultant injuries. In this case, Mrs. Therry accused the Defendants of negligence for allowing her to develop digitalis toxicity due to a one-day delay in returning to the hospital. Mrs. Therry’s discharge instructions...
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...‟ “CASE STUDY: MARRIOTT GROUP OF HOTEL‟S EFFORT TO ATTRACT MEDICAL TOURISTS” RAMAMOORTHY PANDIAN STUDENT ID: 09004669 DISSERTATION SUPERVISOR THOMAS REEVES SUBMITTED IN PART FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF BUSINESS ADMINISTRATION UNIVERSITY OF WALES INSTITUTE, CARDIFF FEB 2010 1 ACKNOWLEDGEMENT First and foremost, I would like to thank my supervisor Thomas Reeves for his valuable professional advice and guidance as well as for rendering his kindness, endless patience and continuous encouragement towards my dissertation. I would like to thank interviewees in the Marriott Group of hotels and its branches, without which this study could not have been reached its conclusion. A handful of thanks to all the lecturers of my concern for their teaching, without them, I can‟t learn so much knowledge. This dissertation could not have been completed without continuous support, encouragement, and caring of all my friends and my family members. I would wish them many a thanks too. Finally, I would like to express my sincere appreciation to those who provided me with great support and encouragement during my studies in UK. Thanks again to all of them. 2 ABSTRACT The aim is to find out the most possible means that recession would affect the tourism industry globally and also to pay attention towards the various measures taken over by the UK hotels to overcome those tough times and to analyze the same through the case study...
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...male was identified for case management during his admission to the hospital for weakness of the left upper extremity and - slurred speech. Claimant was being treated in local hospitals, by multiple physicians without the benefit of currently recommended drug protocol for AIDS, including protease inhibitors. Approval was obtained from the plan administrator and the hospitals agreed to submit claims for prompt payment through the case manager, who would expedite process. The claimant stopped the use of heroin at the time of the HIV diagnosis and up until 1 year prior to the hospital admission had received no consistent medical care. The claimant did agree and the case manager made the arrangements and attended the appointment with him and his wife....
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...education and practice. This paper will explore a variety of nursing theories including that of Florence Nightingale, Virginia Henderson, and Lydia Hall. Developing care plans and referencing case studies, the theories of Hiligard Peplau, Joyce Travelbee, and Ida Jean Orlando will also be observed. This exploration is meant to enlighten the reader of theories structuring nursing as a practice. Case study #1 The following case study is based on community healthcare visitation to a home for a post-partum follow-up involving a young woman, Isabel. Isabel was a mother of two children, Jerry her two-year old son and Pearl her three-week old daughter. The scene of Isabel’s unclean, ill maintained, single room and so-called home now, was a challenging observation for the visiting nurse. Despite the horrendous site of an overflowing box of dirty cat litter, the dirty diapers, dried food, and spoiled bottles of formula; the nurse was drawn to the values of Florence nightingale. This approach allowed a great deal of compassion for the depressed, frustrated, and exhausted young mother. Fostering receptivity would be a priority in creating a plan of care. First, the nurse knew she must gain Isabel’s confidence in her skill, noting her compassion. Only with acceptance, she realized her instructions would be applied, resulting in self-care. Opening the windows for some fresh air, the nurse observed the children’s instant reaction to the sunlight. Without a second thought, the nurse insisted on...
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...Health Behavior There is strong evidence that the preventive medicine practice of screening for diseases is very effective in saving lives, reducing suffering and health care costs. In light of this the federal government in collaboration with states launched the Every Woman Matters (EWM) program to help improve public awareness of the need for early detection of breast and cervical cancer and also to improve access to screening services for low income women, through the removal of the barrier to preventive breast and cervical cancer screening in these communities. By design EWM aligned with participating practices to help them implement the program. Eligible women received clinical breast examination, mammography, and papanicolaou smear from these practices at reduced or no cost. Unfortunately EWM program failed short of its objectives. The possible reasons for the ineffectiveness of the EWM program were largely design-based. A study conducted by Backer et al in collaboration with the Nebraska Health and Human Services EWM program helped elucidate some of the design flaws of this program. The group collected and analyzed both qualitative and quantitative data from 7 participating practices, in addition to in-depth interviews with physicians and staff at participating practices. By design this study was intended to: * Identify barriers to delivery of breast and cervical cancer screening services * Enhance understanding of the attitudes of physicians and staff towards...
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...Oxford journals Impact of a community-based integrated management of childhood illnesses (IMCI) programme in Gegharkunik, Armenia Results The assessment confirmed the population's poor health status and limited knowledge and application of recommended child care practices. The campaign reached its target: at follow-up, 67% had seen media messages within the past month, 82% had received the IMCI informational booklet, and 30% had seen other materials. Evidence of the success of the programme included the following: exclusive breastfeeding increased 31.4%, maternal knowledge of child illness signs increased 30%, knowledge of HIV increased 28.5%, and physician attended deliveries increased 15%. Conclusions This evaluation documented the significant and substantial impact of the community IMCI programme on both knowledge and practice in rural areas of Armenia. Consideration should be given to continuing and expanding this project as a complement to health sector development activities in this region. Impact of a community-based integrated management of childhood illnesses (IMCI) programme in Gegharkunik, Armenia 1. Michael E Thompson1,* and 2. Tsovinar L Harutyunyan2 +Author Affiliations 1. 1 Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA. 2. 2 Center for Health Services Research and Development, American University of Armenia, Yerevan, Armenia. 1. * Corresponding author. Department of Public...
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...is approximately 8.3 billion for medical, mental hygiene and lost productivity. IPV is connected to harmful health behaviors. Victims may try to adjust their stress in unhealthy ways such as smoking and drinking. The primary goal of IPV is prevention before the occurrence. Previous studies have shown that nurses working in primary health care settings are not well trained enough to identify and provide proper intervention to IPV. When the abuse remains undetected the victim may face long term consequences. The aim of the study was to assess nurses’ awareness and early detection of IPV and to also provide appropriate care to victims who visit the primary care settings. Protection of Human Participants The participants of the research were told about their voluntary participation and withdrawal from the study at any time. Participants were informed that all collected information will be kept confidential. Moreover, the volunteers were alerted that the study could bring up some depressing memories so lists of psychological support centers were also included in the study. Approval from the appropriate Ethical Board at Karolinska Institute, Stockholm was obtained prior to the study. Method of the Study The data...
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...Work Related Project Analysis Part I Work-Related Project Analysis Part I Great Plains Regional Medical Center in North Platte, Nebraska during the time of this case study had 116 beds, offered a full service health system; provided care services for over 25 specialties, a referral center for eight critical care hospitals. Great Plains Regional Medical Center’s emergency department medical records was a paper system. They invested in an emergency department (ED) specific technology. This technology was needed to improve care management and continuity, clinician collaboration, and physician alignment (Anderson, 2011). This essay will overview the business system at the departmental level for Great Plains Regional Medical Center. Additionally, an overview of information gathering technique used and design method used. Finally, the impact of the project in terms of success will be discussed. Information Gathering Techniques Used Information gathering by analysts can involve watching people who will be using the system or interviewing people who will be using the system. Information can also be gathered by reviewing documents; either from planning, policies, or existing systems (Satzinger, Jackson, & Burd, 2009). Information gathering technique for this study was not specifically revealed. However, there was pertinent information gathered and noted. When patients transferred from the ED department to the inpatient unit, tertiary facility, or sent home...
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...Ethics Case Study HCS478 January 6, 2010 Barbara Scheibe, RNC, MSN Ethics Case Study Healthcare professionals are faced with ethical dilemmas and issues on a regular basis especially in the emergency department. The purpose of this paper is to identify ethical issues within a case study. This case study involves an eight month old infant who presents to the emergency department with injuries. After arriving at the emergency department it is noted that the infant has bilateral fractured femurs. The ethical issue identified within this case study is the possibility of child abuse by either the mother or a worker at the daycare facility. The nurse makes notes of her concerns within the patients chart as well as verbalizes concern to the emergency room physician regarding the injuries to the infant. It appears to be a lack of follow-up with these concerns so this presents an ethical issue. There are eight ethical principles that a nurse should learn to apply to each situation that he or she feels there is an ethical decision that needs to be made. The eight principles to apply are autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others (Guido, 2010). Within the nursing field advocacy plays a critical role in keeping the patients safe throughout their encounters with the health care system (Beyea, 2005). One of the conflicts noted in the situation listed is, more research should have been conducted to investigate...
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...In the ever-changing world of the “world-wide web,” healthcare is in the forefront of innovative computerized management systems and the provision of excellence in quality care is dually the journey and goal to enhance patient safety. Before venturing out this journey, it is of importance to understand the ‘why’ and the “how” and “what” will come naturally in succession. The patient is the “why” clinical information transformation is the push for all care providers within the four walls of a hospital, and private and satellite physician offices. Patient safety is the shared vision why pioneers of Health Information Technology (HIT) created computerized systems such as Electronic Health Record to meet the demands of healthcare today and tomorrow. As an example, Cerner Corporation and Dell Corporation- two big giants in the IT industry- are in a continuum to enhance their products and services. In addition, these products, services, and “solutions” are the “platform” that shell the delivery of safe patient outcomes and equip multi-disciplinary clinicians to guide and drive this patient-centered care; best practice and evidenced-care medicine is now the expected and standard of care for what is right for the patient. Furthermore, the present millennial generation drives or is driven by the “cloud’ world and the product is fast and smart, safe and secure, information gathering and sharing that is access anytime and anywhere. For example, a mobile device- IPhone- allows...
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...chart of the case study of Lilly Walden presented by Jamie Mills “The clinical microsystem is the place where patients, families, and caregivers meet. It is the lotus of value creation in healthcare.”(Nelson, Batalden, et.al, 2011) Lilly Walden describes herself as an active, athletic, and healthy woman. In her mid-forties she continues to run 2–3 miles 5 days per week. Lilly is married with three children and is employed by the local school district as a speech therapist. Lilly describes herself as health-conscious. Her diet is balanced, and she is a nonsmoker and drinks wine on rare social occasions. Lilly has a history of asthma, triggered by environmental changes, and it typically requires antibiotic therapy for bronchial infections 2–3 times per year. This presentation will review the following: 1. Priority care needs of the patient at the center of the case study 2. Priority care needs of the family care providers 3. The disruption that this acute illness has caused for the patient, family members, and clinical microsystem 4. The experiential features of acuity 5. The elements that the clinical microsystem 6. Potential barriers to providing care 7. The communication strategies that were used in the delivery of care 8. Well-defined (but flexible) roles within the clinical microsystem 9. Potential strategies for unexpected changes 10. The Deployment Flowchart Priority care needs of the patient require the organization to take good care of the patient...
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...This student sample is not to be considered more authoritative than the final project instructions & rubric. It is simply a picture of how a fellow-PACOneer successfully completed this learning activity. Though some proofreading, format, APA glitches, and missed expectations (e.g., body of paper was 15 pages vs. 14 page expectation) were present, this sample did satisfactorily organize cumulative work with a noticeably fresh synthesis of a solution-based, short-term pastoral counseling scenario. In like fashion, make every effort to do original work!] Abstract The Final Project applies the distinctive features of a solution-based, short-term pastoral counseling strategy to a counseling scenario with a pre-determined care-seeker, Brody, from the case study Crossroads: A Story of Forgiveness. It is the purpose of this writer to artificially move Brody through an abridged counseling process. The student counselor, Mercy Me, is the youth minister of an American Baptist Church with approximately 150 active members located in the close-knit, small community of Shingle Hollow, NC. Mercy’s hallmark purpose, glorifying God by being and imitator of Christ, guides, directs, and develops the process of tailoring her I/S DISC relational style to best demonstrate fit and build rapport with Brody’s C/S DISC relational style. The solution-based, short-term pastoral counseling strategy is utilized to move Brody from an attending position in phase one to a willing position in phase two. The...
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...Economics of an Urgent Care Center in a Market of Emergency Departments One of the contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members. The question I asked myself is, “Why does Group Health have urgent care for their insurance plan members and the major hospitals in Seattle do not.” Urgent vs. Emergency Care A study by the CDC showed that approximately 70 % of emergency department visits can be treated in a typical primary care or urgent care setting and another study by National Center for Policy Analysis demonstrated that only 13% of patients that sought treatment in the emergency department were clinically appropriate. Reasons for non-emergency visits to the ED range from access issues to primary care providers (wait times, no primary care provider assigned, or no insurance) to a lack of knowledge that they could have been treated at an urgent care or primary care setting. There are good reasons to visit the emergency department: * Trauma due to an accident or assault | * A wound that will not stop bleeding | * Shortness of breath | * Vomiting blood | * Chest pain | * Sudden loss of consciousness...
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...and Legal Issues in Nursing In this paper ethical and legal issues will be reviewed concerning the decisions and responsibilities of the nurse in the case of Marianne who has had a stroke and the decisions that the family is facing for treatment or end of life care. The legal and ethical issues in a malpractice case that occurred several years ago and the responsibility of the nurse to her employer, the nurse being sued, the client in question, and the institution’s client will be reviewed. The areas that will be reviewed include how the American Nurses Association Code of Ethics would influence a final decision in each case study, how personal and societal values can influence the ethical decision making, the fundamental legal aspects of each case study, and the legal responsibility of the nurse in the work setting. The ANA code of Ethics must be followed in practice and is an especially useful tool when there are difficult legal and ethical issues that arise in nursing practice. In the example of the malpractice case for negligence, as a witness to questionable practice, it is the nurse’s primary responsibility to protect the safety of the patient. Although the nurse was correct in reporting the episode to administration, she also had a duty to counsel the nurse about the inappropriate standard of care. The ANA is clear that when a nurse is aware of questionable practice the person must be confronted with the concern ("Code Of Ethics for Nurses With Interpretive...
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