...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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...different methods are meant for the development as well as the clarification of their own concepts in their different fields. The methods may at one time share a scholarly view of the problems of concept as well as the methodology, however, since they are discipline specific, they too may also be in need of various modifications before they could be of use and applicable to the different fields in which they are meant to be used. In nursing science, the art of concept analysis is at a greater height seen as an integral part of the development of a theory and a discipline of the science of nursing. This paper evaluate the nursing concept of care in nursing. Caring in nursing Caring in nursing is the active support as well as involvement of the patients receiving treatment and their relatives, family inclusive, in the designation of models of health care as well as in the making of decisions about individual options that the patient would have for treatment. In accordance to Jean Watson’s theory on caring in nursing, it stated on the assumptions that, caring environment is that which offers the development of...
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...of stay, increased risk of complications and adverse events. The key practices that support integration include: single point of entry, “at risk” screening, comprehensive assessment, service coordination and case management, care planning including advance care planning, clear communication processes including shared health records, patient empowerment and self-management, quality use of medications and ongoing monitoring. The healthcare system is complex and people have difficulty navigating the system due to inadequate linkage between organisations and services People with complex needs require a comprehensive range of services, delivered across organisational boundaries, with clear assessment processes, access routes and pathways through services. Both overseas and Australian experience indicate that case management is ideally targeted to individuals who are likely to receive the most benefit i.e. those with complex needs requiring intense management from a range of different organisations, as this is where case management is deemed most cost effective. Therefore, the focus of many integrated care projects is on service coordination as a way of integrating care management and creating care pathways through the system. The move towards models of integrated care is an effort to manage the labyrinth of the healthcare system that has become increasingly complicated as additional services and funding streams have been introduced to encourage innovation, change traditional...
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...of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.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...
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...THE SELF-CARE MODEL OF DOROTHEA OREM Introduction The purpose of this paper is to discuss the application of Dorothea Orem’s Self-Care Model of Nursing to clinical nurse practice. The central thesis of the paper is that Orem’s theory has strong utility for application to modern day clinical practice and can be applied to most any case in order to attain the desired medical and caring outcomes. The presented discussion will support this perspective of Orem’s theory. The paper begins with a brief overview of the theory which is then followed by a delineation of a non-nursing theory that supports one or more of Orem’s self-care notions. The next section of the paper presents a historical overview of the evolution of Orem’s theory, a delineation of the concepts central to the metaparadigm, and an exploration of the theory’s usefulness in education and research. The final section of the paper applies the theory to a particular case. A model of the theory is presented in Appendix A. Orem’s Self-Care Theory Alligood and Marriner-Tomey (2001) state that conceptual or theoretical models of nurse practice are pivotal to the field, providing the profession with a guide to patient care and with a general frame of reference that connects the structural environment to the patters of behavior and relationships within the organization. The Orem Self-Care Model of Nursing (Orem, Taylor & McLaughlin, 2003) is one such model. According to Seedhouse (2000), the Orem Self-Care Model of Nursing...
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...instead of comprehending, applying, and transferring knowledge to practice. In addition, students rely on teachers to provide lecture notes and may not be adequately prepared to participate in class discussions. Case studies, which are an effective way of connecting critical thinking, problem solving, and decision-making to practice (Baumberger-Henry, 2003; Campbell, 2004), enhance students’ participation in class discussions. Conceptual models of nursing provide a unique body of knowledge that can be used to guide construction of case studies and enhance application of didactic course content to nursing practice. Students tend to undervalue the contributions of a nursing conceptual model to guide practice. By integrating a nursing conceptual model into the organization of course content and construction of case studies, students are exposed to how conceptual models can guide nursing practice. The purpose of this column is to explore the use of case studies for a senior level medical-surgical nursing course constructed within the context of the Roy adaptation model. Roy Adaptation Model The Roy adaptation model is a conceptual model of nursing that provides a solid foundation for nursing practice (Roy & Andrews, 1999). The philosophical and scientific assumptions of Roy’s model assert that the person is a holistic Nursing Science Quarterly, Vol. 20 No. 4, October 2007, 324-326 DOI: 10.1177/0894318407307159 © 2007 Sage Publications...
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...PSYCHOLOGY AQA A – UNIT 1 Attachment is an emotional bond between two people, it is a 2 way process that endures over time, serving the function of protecting the infant and leading to certain behaviours (seeking proximity, distress on separation, pleasure on reunion and general orientation of behaviour) There is a Primary attachment figure (PAF) EXPLANATIONS OF ATTACHMENT: LEARNING THEORY Learnt rather than inborn Classical: Association Proposes that food (UCS) naturally produces a feeling of pleasure (UCR). The feeder (NS) becomes associated with the food (UCS) when the infant is fed. The mother eventually produces the sense of pleasure associated with the food. Pleasure is now a Conditioned Response which causes attachment Operant: Reinforcement (DOLLARD AND MILLER 1950) When an infant if hungry, they feel uncomfortable and I drive is produced to reduce this discomfort. When the infant in fed, the drive is reduced and this produces a feeling of pleasure. The infant learns that the food is rewarding (Primary Reinforcer) and begins to recognise the person that provided the food (Secondary reinforcer). Attachment occurs because the infants seeks to be around the person that supplied the award. Evaluating learning theory Research by Harlow (1959) suggests attachment may not totally based upon the provision of food. Harlow removed baby rhesus monkeys from their mothers, and placed them into a cage. In the cage there were 2 wire mesh cylinders. One covered in towelling...
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...Richard, Ph.D. September 2009 foreward Not everyone in the United States enjoys the same health opportunities. Studies show that minority Americans experience poorer than average health outcomes from cradle to the grave. They are much more likely to die as infants, have higher rates of diseases and disabilities, and have shorter life spans. As the U.S. Congress and the Obama Administration work toward enactment of legislation to reform America’s health care system, a central focus of the debate has been the projected cost of ensuring accessible and affordable health care to every citizen. While some have struggled with the premise that health care reform can actually reduce health-related spending, the experience of racial and ethnic minorities under our current health care system is a strong indication that improving opportunities for good health – and minimizing inequities in health care access and outcomes – may well be good for the nation’s fiscal health, as well. This study, commissioned by the Joint Center for Political and Economic Studies and carried out by leading researchers from Johns Hopkins University and the University of Maryland, provides important insight into how much of a financial burden racial disparities are putting on our health care system and society at large. The researchers examined the direct costs associated with the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity...
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...Case report: Paediatric Orthopaedic Clinic 1- What is capacity utilization at every step in the process? What is the direct resource utilization? Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. Activity | # of Staff | Available time | Activity time | Number of Patients | Time needed | Utilization10 | | | /Staff | Total | N | F | N | F | N | F | Total | | 1. Front Desk | | | | | | | | | | | | a. Registration | 3 | 180 | 540 | 5 | 5 | 32 | 48 | 160 | 240 | 400 | 74 % | b. Verification | 3 | 255 | 765 | 9 | 4 | 32 | 48 | 288 | 192 | 480 | 63 % | 2. Radiology Department | | | | | | | | | | | | a. X-ray imaging | 6 | 240 | 9603 | 11 | 11 | 32 | 40.8 | 352 | 448.8 | 800.8 | 83 % | b. Development of X-rat | -1 | 240 | 9604 | 7 | 7 | 32 | 40.8 | 224 | 285.6 | 509.6 | 53%8 | c. Diagnostic reading and comments | 3 | 240 | 4805 | 5 | 5 | 32 | 40.8 | 160 | 204 | 364 | 76% | 3. Hand-off X-ray to Clinic | | | | | | | | | | | | a. Collection of X-ray | 3 | 2556 | 7657 | 2 | 2 | 32 | 40.8 | 64 | 81.6 | 145.6 | 19% 9 | b. Filing/exam room prep | 1 | 255 | 255 | 2 | 2 | 32 | 48 | 64 | 96 | 160 | 63% | 4. Examination Room | | | | | | | | | | | | a. Surgeon | 1 | 255 | 255 | 7 | 4 | 32 | 14.4 | 224 | 57.6 | 281.6 | 110% | b. Resident | 1(2)2 | 255 | 255 | - | 7 | - | 33.6 | - | 235.2 | 235.2 | 92% | c. Cast technician...
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...MANAGEMENT CASE STUDY ON ARAVIND EYE HOSPITALS DR. BHUPINDER CHAUDHARY*; DR. ASHWIN G. MODI**; DR. KALYAN REDDY*** *Assistant Professor, Department of Hospital Management, H.N.G. University, Patan (Gujarat)-384265. **Co-ordinator, Department of Hospital Management, H.N.G. University, Patan (Gujarat)-384265. ***Assistant Professor, Department of Hospital Management, H.N.G. University, Patan (Gujarat)-384265. ABSTRACT With the aim of providing affordable eye care services to a country which has about 20 million blind citizens and 80% of it due to curable cataracts, at the age of 58, Dr. V. Started, the Aravind Eye Hospital. Popularly known as the McDonald‘s of cataract surgery, with a bed strength of more than 4000 beds and serving 0.25 million patients every year, this is one of the world‘s largest eye care systems catering largely to the poor population. Poor people with cataract can regain their eye-sight at a price as low as $40 or even free, if they can‘t afford. It was demonstrated by this non-profit system that it is practically possible to combine high quality, low cost, world scale and sustainability. It has been seen as a unique business model by many Organizations and has proven that care provided at low cost can also yield sustainability and even profitability. Aravind system's successful manufacturing unit, Aurolab, has produced 6%-7% of the low-cost lenses world-wide in 2002, which were sold in more than 100 countries. This Organization has been a source of case studies...
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...Clinic Thomas R. Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient clinics is a very common way for patients to access health care. These clinics typically schedule appointments...
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...Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient clinics is a very common way for patients to access health care. These clinics typically schedule...
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...critical care review Transfusion-Related Acute Lung Injury* A Review Mark R. Looney, MD; Michael A. Gropper, MD, PhD, FCCP; and Michael A. Matthay, MD, FCCP Transfusion-related acute lung injury (TRALI) is an underreported complication of transfusion therapy, and it is the third most common cause of transfusion-associated death. TRALI is defined as noncardiogenic pulmonary edema temporally related to transfusion therapy. The diagnosis of TRALI relies on excluding other diagnoses such as sepsis, volume overload, and cardiogenic pulmonary edema. Supportive diagnostic evidence includes identifying neutrophil or human leukocyte antigen (HLA) antibodies in the donor or recipient plasma. All plasma-containing blood products have been implicated in TRALI, with the majority of cases linked to whole blood, packed RBCs, platelets, and fresh-frozen plasma. The pathogenesis of TRALI may be explained by a “two-hit” hypothesis, with the first “hit” being a predisposing inflammatory condition commonly present in the operating room or ICU. The second hit may involve the passive transfer of neutrophil or HLA antibodies from the donor or the transfusion of biologically active lipids from older, cellular blood products. Treatment is supportive, with a prognosis substantially better than most causes of clinical acute lung injury. (CHEST 2004; 126:249 –258) Key words: ARDS; lung injury; pulmonary edema; transfusion; transfusion-related acute lung injury Abbreviations: ALI acute lung injury;...
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...The purpose of this paper is to submit a case study of a single parent facing health choices with limited resources and apply the Health Psychology four key frameworks. Fatima is the young mother who is making the choice to first feed her family and in the process is not addressing her own health symptoms that may put her at risk for serious consequences. In this paper we will look at options in her decision making that may improve both her health and her children’s and improve the family health future. The strategies will be developed from the text of Dr. Jane Ogden in The Psychology of Health and Illness and the Dr. Robert M Kaplan, “Health Psychology: Where Are We And Where Do We Go From Here?” and with the insightful work by Dr. Gabor Mate in When the Body Says NO: Exploring the Stress-Disease Connection Fatima and Health Challenges of a Single Parent...
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...Describe the current nursing practice. An instrument specifically designed to aid health care workers evaluate the dangers of pressure sores that a patient faces is called the Braden Scale. After assessment, the victim is categorized depending on six aspects: capability of physical activity, hydration and nutrition status, capacity to alter position, the ability to respond after sensing discomfort related to pressure, shearing or exposure of the skin to friction during locomotion, and skin exposure to moisture. If the overall score is lower it means the risk of pressure sore is higher (Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, n.d). Prior to this Change, Skin assessment was based on non- formalized risk assessment which varies with each clinical practice. 2. Discuss why the current nursing practice needs to be changed Using non-formalized risk assessment in Predicting pressure ulcer resulted in non-uniformity and personal clinical judgement which varies from one person to another. Using Clinical judgement is more effective where the staffs are experienced and their experience assist in appropriate predictability, but with novice staff, the use of clinical judgment is inappropriate. In a multisite trial, Braden scale was tested by clinics bringing together skilled nursing facilities, Veterans Administration or VA medical centers and hospitals providing tertiary care. Of those who took part, none had experienced pressure sores earlier. Nurses evaluated...
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