Tag: Health care

Comprehensive patient assessment

Comprehensive patient assessment
Comprehensive patient assessment
General Patient Information

Name: Mrs. Joy Smith

Age: 38 y/o

Gender: Female

Ethnic group: African American

Chief complaint

“I feel increasing pain around the left thigh and buttock. I feel fatigued and have noticed some swelling in the affected part.”

History of Present Illness

 Joy reports that the pain and swelling in her left hip and buttocks that begun a week ago. The 38 y/o African American has been experiencing pain and swelling in multiple joints for the past three months. She has experienced active bilateral synovitis in her wrists and ankles. She has also observed small nodules on her left elbows. The hip joint swelling began five days ago.

She has been treating the pain using acetaminophen. Since then, she has been experiencing increasingly severe pain and edema in the affected region. The pain is relieved by rest but aggravated by mobility and physical activity. She reports the pain at scale 8 in 0-10 pain scale. She denied any history of trauma. She occasionally experiences morning stiffness that lasts for 30 minutes and low back pain that usually worsen at night. She has not experienced had any flares.

She is asthmatic and suffers from seasonal allergies. She is also allergic to aspirin as it causes gastrointestinal discomfort. The medication she has used recently is acetaminophen 500mg for pain management and Proventil HFA to manage an asthma attack. She has no chronic illness and has not undergone any surgeries. The only time she has been hospitalized is during delivery of her two daughters.

She does not smoke but occasionally takes a glass or two of wine. She has no appetite changes. She has been experiencing urinary tract infections occasionally but has no history of sexually transmitted illness. She denies no psychological disorders.

She began her menarche at age 13 years. Her LMP was last month, which she describes as a regular flow that lasted for three days. She is Gravida 2POO2. She carried all her pregnancy with no complication and breastfed all her children. She has sex 2 to 3 times a week but with no protection. She has been using IUD method of contraception which she removed six months ago.

She does not engage in any health maintenance screenings such as mammogram or Pap test.  Her father is 72 years old and hypertensive. Her mother is 68 years old and is diagnosed with diabetes.  She is happily married and lives with her husband and two daughters. She lives with her husband and her two daughters (age 12 and eight years old).  She is a housewife whereas her husband works as sales manager at a local supermarket.

She has a good rapport with her neighbors and is actively involved in local community programs especially those that promote healthy living. Her family is financially and socially stable. She is physically active and tries to eat homemade food as much as possible.

Review of systems

 The patient is alert and oriented. She denies fever or chills. She has no skin rashes, lesions or any discolorations. She uses corrective lenses and denies any changes in her vision and has the normal hearing ability. She denies dental complications, throat pains, dysphagia or nose bleeds. She denies skin discolorations, breast lumps, and breast masses. She denies SOB, chest pains, palpitations, or edema. This indicates that her respiratory system is in great shape. She denies wheezing, dysponea or hemoptysis. She has no history of pneumonia or TB.

She feeds on homemade foods. She denies any changes in appetite. She denies NVD. She has not seen any changes in bowel movement and elimination frequency.  She denies heartburn, constipation or presence of hemorrhoids.  She denies changes in urine quality and quantity. She denies hematuria. She complains of frequent muscle pain and complaints of a backache.

She has no history of fracture or trauma.  She reports that she is unable to lift her arms without extreme pain in the shoulder. In the last five days, it has been difficult to stand for long periods of time due to ankle and foot pain. Although acetaminophen 500 mg three times a day has helped her manage the pain and stiffness, it is no longer effective. 

She denies syncope of transient paralysis and seizures. She denies bleeding and has never been diagnosed with anemia. She denies presence swollen glands or excessive thirst. She looks slightly distressed but denies the history of psychosocial disorders or depression.

Objective data

 The patient is in acute distress. However, she is well groomed, alert and oriented. Her vital signs are as follows;   Weight 220 lb, Height 5’3”, BMI 39, BP 130/70 (taken on the right arm when seated), HR 80, RR 18 unlabored, T 97.5, SATs 99% at room temperature. The patient skin is moist and warm. No discoloration observed. The skin color is normal, intact and with no rashes, lesions or bruises. 

The head is normocephalic and atraumatic. EOMs and PERRLA are intact with no lesions. The ears have positive reflex, bilateral TMS with no discharge or infection. Umbo and short process are visible with no foreign body. Nose canals are bilateral with no rhinitis in both of the nares. The nasals turbinate’s are not swollen.

The oral-pharyngeal mucosa is moist and non-erythmatous pharynx. No nodules or dental prosthesis observed. S1 and S2 are regular with normal rate. No murmurs or peripheral edema noted.  The respirations are normal and unlabored. Wheezing sounds are absent in all of the four quadrants. She has normal bowel in all four quadrants.  The abdomen is soft and non- tender. No palpable masses noted. 

The chest and breast region is unremarkable with no lymphadenopathy.  The bladder is non-distended. No changes in urine quality or quantity. No hematuria. The gait is not normal. She is limping as she walks across the exam room which indicates discomfort or pain in the affected limb. The left hip is swollen and painful. The pelvic exams indicated no inguinal adenopathy, lesions or erythma on the genitalia. Vaginal discharge is normal.

The cervix is normal without palpable masses. The lower quadrants are tender. The adnexal and uterine are tender. No pain is indicated with cervical motion. The anterior and midline of the uterus is smooth and not enlarged. She has clear speech, good tone and intact cranial nerves II.  She appropriately maintains eye contact.

Differential diagnosis

 Based on the signs and symptoms, the patient is likely to be suffering from infections arthritis, psoriatic arthritis, gout or osteoarthritis. This is because these diseases are collectively grouped as arthritis as they commonly affect the small joints, hips, hands, lumber and cervical spine. Differentiating these diseases is challenging as they all present with joint stiffness and pain that worsen with activity (Buttaro, et al., 2013).

Psoriatic arthritis is suspected because of clinical manifestations such as generalized fatigue, swollen and painful joints, and limited range of motion. The disease will be confirmed by laboratory tests. Similar to Psoriatic arthritis, Rheumatoid arthritis and infection arthritis is suspected because of the presence of signs and symptoms such as joint stiffness, pain, fatigue, tenderness and limited range of motions.

Gout is suspected because of patient’s complaints about intense throbbing joint pains, discomfort and inflammation. However, gouts normally affect the large joints of the big toe. The disease will be confirmed by the laboratory findings. Similar to out, the patient may experience joint pain that hurt during and after movement. Joint stiffness is noticeable especially in the morning or after long periods of physical inactivity (Buttaro et al., 2013).

To reach a definitive diagnosis, it is important to undertake differentiating diagnostic investigations. For instance, diagnosis of psoriatic arthritis is supported by skin biopsy of the affected lesions. Infectious arthritis is self-resolving within six weeks whereas gout is confirmed by serum uric acid that is above 416 micromols/L. Rheumatoid arthritis, on the other hand, is confirmed by whereas osteoarthritis is distinguished from others by the rheumatoid factor, C-reactive protein, and erythrocyte sedimentation whereas osteoarthritis by radiographs that indicate loss of joints space, osteophytes and subchondral sclerosis (Kordasiabi et al., 2016).

Lab tests

Diagnosis should be conducted as early as possible to optimize patient’s outcomes. The patient presents with painful and swollen hip joint. In this case, appropriate laboratory tests include; CBC,  Renal function, erythrocyte sedimentation (ESR),  C- reactive protein (CRP), Level of RhF and citrullinated peptide antibody (CCP). Imaging tests such as radiography and X-rays will also be ordered to make the definitive diagnosis. Also, these tests are used to evaluate the particular erosive changes to assess the disease progression (Buttaro et al., 2013).

According to my preceptor, some lab tests such as complete blood count and renal function are necessary as they influence treatment options. For instance, if the patient is diagnosed with renal insufficient or thrombocytopenia, the healthcare provider must avoid prescribing a non-steroidal anti-inflammatory drug (NSAID). Some medications are also contraindicated with some hepatic disease.

Definitive diagnosis: Rheumatoid arthritis

The onset of the disease peaks between the ages of 30 and 50 years. It is the most common cause of disability in the USA. It is reported that 35% of people diagnosed with RA reports disability within ten years (Centers for Disease Control and Prevention, 2013). RA typically presents with pain and stiffness in multiple joints in the body. As the disease progress, other small joints including the interphalangeal joints and metacarpophalangeal become affected.

In most patients, they may experience morning stiffness that may last more than 30 minutes. In some cases, Boggy swelling may become visible caused by synovitis and subtle synovial thickening. Systemic symptoms include low-grade fever, fatigue and weight loss (Buttaro et al., 2013).

 According to the American College of Rheumatology and European League against Rheumatism 2010, RA diagnostic criteria are as indicated below (Aletaha et al., 2010):

Image result for rheumatoid arthritis diagnostic criteria

(Source: Aletaha et al., 2010)

The laboratory findings were as follows; CRP 5.7 mg/ dL(normal 0.1-0.9 mg/ dL); ERS 26 mm/h (normal 0-15mm/h) RhF 33.4 (normal 0-29 IU/mL) and CCP 40 (normal0-20).  Radiography results were still pending. The other parameters were within the normal limits. Rheumatoid arthritis (RA) is the most common type of arthritis. Based on this guideline, the patient complaint is 1-3 small joints with the involvement of a large joint (score 2); the serology tests indicates low positive RhF and High positive ACPA (score 3) and abnormal CRP and ESR levels (score 1).

The total score is 6 out of 10 which is the score needed for classification of the patient as having RA.  RA is a progressive disease, and it is difficult to know when the disease first developed. Most patients experience periods of alternating bothersome symptoms. Onset, severity and disease symptoms vary greatly from one person to another. Therefore, treatment should b tailored to meet individual medical needs (Buttaro et al., 2013).

Treatment and management of the disease

Once diagnosed, the initial treatment and evaluation should begin immediately. Due to different disease presentations, a patient specific and effective care plan was developed. The goal of this treatment was to minimize joint pain and swelling, slow disease progression, prevention of deformity and maintenance of quality of life. With the help of my preceptor, the pharmacological treatment was initiated using oral Methotrexate (MTX) 7.5mg per week (divided in 2.5 mg orally after 12 hours in 3 doses) plus 5 mg Prednisone per day. She was also given Diclofenac 50mg three times a day. She was advised to continue using acetaminophen when required.

 Secondly, I noted that the patient was obese (BMI 39). Therefore, the patient was advised to feed on healthy diets and to perform regular exercises. The diets recommended for this patient include eating plenty of fruits, whole grain cereals, and vegetables. The patient was also advised to feed on foods rich in omega -3 such as fish oils, and to feed a low-fat diet. She was also advised to limit alcohol intake and to consume moderate sugars and foods that have added sugars (Dains, Baumann, & Scheibel, 2012).

Whereas there is limited evidence-based practice on the impact of diet on RA, my preceptor advised that patient education on dietary modifications is acceptable. Therefore, it is always important to encourage parents to adopt and maintain healthy diet and weight. This intervention is particularly important for this patient because she has high body mass index (BMI).

Moreover, weight reduction helps reduce the weight bearing of joints and prevention of other disease comorbidities such as high blood pressure. It has also been indicated that people with unhealthy weight have poorer functional status; further emphasizing the need for healthy weight control in general disease management (Kordasiabi et al., 2016).

 Another important factor in weight control is physical activeness. The patient was referred to a physiotherapist for services relating to exercises s it has been statistically shown significant improvements in patients diagnosed with RA body functions and social component.  This is because exercises are well accepted to have a big role in combating the adverse effects associated with RA on muscle endurance, strength and aerobic capacity (Rudan et al., 2015).

However, fatigue is also common in patients diagnosed with RA.  The patient was advised to rest their inflamed joints. The patient was also advised on other strategies such as the application of heat and cold therapy to relieve pain. The patient was also advised on passive and active exercises to maintain range of motion in the affected joints (Dains, Baumann, & Scheibel, 2012).

Complementary therapies have been associated with some favorable outcomes. These include the use of acupuncture, use of gamma-linolenic acid from black currant seed oil, evening primrose and thunder god vine. However, the patient was informed about the potential adverse effects associated with the herbal therapy (Kordasiabi et al., 2016). 

The patient was also given folate or folic acid (400 mg). This is important because some RA medications such as methotrexate interfere with absorption of folic acid. Research also indicates that patients under corticosteroids make it difficult to absorb calcium; therefore, the patient was given calcium supplements (Buttaro et al., 2013).

Patient education

The main goal of health promotion is to empower patients with practices that empower them and makes them improve their well-being holistically ranging from mental and spiritual mental wellbeing. The patient was educated on the importance of participating in preventive care such as Pap test and mammogram screening. She was advised to perform Pap test and mammogram screening at least twice a year to facilitate early detection of the disease and effective management of the disease (CDC, 2013).

 The patient stated that she had removed IUD six months ago as it was making her bleed uncontrollably and developed frequent urinary tract infections. When asked if she is ready to have another child, she was hesitant saying that they had planned to have only two children. I advised her on the alternative contraceptive methods such as hormonal birth control methods that have been found to be effective.

These contraception methods cause the cervical mucus to thicken making it difficult for the sperm and pathogens to reach the uterus. The patient was also taught about hygiene practices such as wiping herself front to back after visiting the toilet to avoid introducing colon pathogens into her vagina (Buttaro et al., 2013).

Follow up care

Remission occurs in 10 to 50% of RA patients. It is more likely in males, people below 40 years, nonsmokers and the late onset of the disease. If the disease is well controlled, the medication dosages will be cautiously reduced to the minimum amount necessary (Healthy People 2020, 2013). Long-term monitoring of the disease is important because although RA is considered a disease of joints, it is also the disease that involves multiple organ systems.

For instance, patients diagnosed with RA are likely to have increased risk of lymphoma which is believed to be caused by underling inflammation and not a consequence of the disease. Patients diagnosed with RA have increased risk factors such as high blood pressure, high cholesterol. Also, caution is needed with the continued use of DMARDs as it is associated with malignancy. Lastly, the disease is associated with depression which affects more than 40% of people diagnosed with RA; which is associated with long-term use of corticosteroids (Kordasiabi et al., 2016).

 Therefore, ongoing monitoring of the patient will be done after every two weeks. This is important in assessing the patient progress and the overall management goals such as treatment efficacy, disease activity, other comorbidities and patient’s quality of life in general. It is also important to run the laboratory tests to monitor toxicity and adverse effects of the modification. The referral was made to a rheumatologist for further evaluation.

References

Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., … & Combe, B. (2010). 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 62(9), 2569-2581.    

Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013). Primary Care: A collaborative practice. Elsevier Health Sciences.

Dains, J, E., Baumann, L.C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4ed.) St. Louis, Mo.: Elsevier Mosby.

Centers for Disease Control and Prevention (CDC. (2013). State prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation. Retrieved from https://www.cdc.gov/arthritis/data_statistics/national-statistics.html

Healthy People.gov. (2013). Arthritis, osteoporosis and chronic back conditions. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Arthritis-Osteoporosis-and-Chronic-Back-Conditions/objectives

Kordasiabi, M. C., Akhlaghi, M., Baghianimoghadam, M. H., Morowatisharifabad, M. A., Askarishahi, M., Enjezab, B., & Pajouhi, Z. (2016). Self-Management Behaviors in Rheumatoid Arthritis Patients and Associated Factors in Tehran 2013. Global Journal of Health Science, 8(3), 156–167. http://doi.org/10.5539/gjhs.v8n3p156

Rudan, I., Sidhu, S., Papana, A., Meng, S., Xin–Wei, Y., Wang, W., … Global Health Epidemiology Reference Group (GHERG). (2015). Prevalence of rheumatoid arthritis in low– and middle–income countries: A systematic review and analysis. Journal of Global Health, 5(1), 010409. http://doi.org/10.7189/jogh.05.010409

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The Parietal Lobe

The Parietal Lobe
The Parietal Lobe

The Parietal Lobe

Question 1

The parietal lobe is located at the top region near the back of the brain. There are two parietal lobes – left and right parietal lobe. This part of the cerebral cortex is involved in vision, speech, sensation and interaction with other regions to connect sensory input from external environment and interpretation of the stimuli. Parietal lobe stroke occurs when the blood vessel supplying blood to this region ruptures or gets blocked.

This interferes with sensation of the entire opposite sides.  This is because motor system of the brain is mainly found in the frontal lobes (Knoefel, 2011). It starts with promoter regions for coordination of complex movements to the primary motor cortex where output is transmitted into the spinal cord leading to contraction and movement of the muscles.

The primary motor cortex located on the left side of the brain is responsible for the movement and muscle contractions in the right side of a person’s body and the primary motor cortex on the right controls movement of the left side. This explains why patient with right parietal stroke gets return of voluntary movement in the left hand (Migliaccio et al., 2014).

Question 2

Fronto parietal stroke affects the frontal and parietal lobes part of the brain. A right fronto-parietal stroke patient with better movement in the left hand side is also likely to may not necessarily have better attention of the side. This is because the frontal lobe is responsible for solving skills, emotions, and selective attention behavior. On the other hand, the parietal lobes control sensations such as touch and pressure.

Therefore, the indication of stroke will depend on the region of the brain involved. Stroke on the right hemisphere cerebrum affects left side whereas stroke in the left hemisphere affects the right side.  In addition, injury in the left lobe disrupts the patient understanding of the written and spoken word (Knoefel, 2011).

Question 3:

Visual motor integration refers to a person’s ability to perceive visual information, process it and move the motor system accordingly.  The idea that the front ends of visual system is responsible for breaking down stimulus for down into their constituent’s parts such as pattern, shape, motion, color and to glue the feature in the parietal lobe neuron.

Therefore, patients with right front parietal stroke make it challenging to grasp coordination. Visual- motor integration involves three processes; a) visual stimulus analysis, b) fine-motor control and c) conceptualization. Deficit in any of the three processes influence the final outcome. For instance, if fine motor control and visual analysis are within the normal range, then the challenge lies in the conceptualization (Johansson, 2012).

Question 4:

It can be challenging to farm with Parkinson’s disease because of tremors and rigidity that makes it difficult to hold hand tools and increases the likelihood of accidental injuries to self and others. In addition, the increased diminishing balance can increase risk for secondary injuries due to fall, slip or trip.

In addition, the medications used to treat the disease are associated with light headedness, confusion, insomnia and dizziness can dramatically reduce the patient’s energy. Therefore, these are the safety risks to consider when supporting the patient engage in his chosen hobby (Santos-García & de la Fuente-Fernández, 2013).

Question 5

Parkinson disease is a neurodegenerative disease described by non motor and motor symptoms that negatively impact the patient’s quality of life.  Most of PD patients are stigmatized because of the visible motor and non motor symptoms. The symptoms of this disease are difficult to hide and are perceived as unscrupulous by the public. This includes observable traits such as gait difficulties, tremor and drooling. These symptoms disrupt the autonomous integration into the society due to their exterior conditions. In addition, the deteriorated self esteem evokes feelings of embarrassment and shame which results into isolation (Santos-García & de la Fuente-Fernández, 2013).

In addition, stigma and seclusion is not only associated with the observable signs and symptoms but also due to progressive loss of functionality. This factor further contributes to bad self image, self efficacy and autonomy. In fact when interviewed about their life history, most of the patients explain symptoms as the key issue for seclusion and low self esteem due to increased physical dependence.

Stigma also arises from awkwardness and inability to do activities that require simple motor actions. This reduction to functionality results into increased social disengagement associated to stigmatization. Stigmatization may also occur due to hindrances to communication.  PD patients may be mislabeled for instance as drunkards. In addition, the delayed thinking and difficulty to convey their opinions easily can make them feel frustrated and isolated. The difficultness to decipher PD patient’s mute expressions makes them feel alienated and disconnected from others (Maffoni et al., 2017).

References

Johansson, B. B. (2012). Multisensory Stimulation in Stroke Rehabilitation. Frontiers in Human Neuroscience, 6, 60. http://doi.org/10.3389/fnhum.2012.00060

Knoefel, J. E. (2011). Clinical neurology of aging. Oxford University Press.

Maffoni, M.,  Giardini, A.,  Pierobon, A., Ferrazzoli, D., and Frazzitta, G.  (2017). “Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies,” Parkinson’s Disease, Article ID 7203259, doi:10.1155/2017/7203259

Migliaccio, R., Bouhali, F., Rastelli, F., Ferrieux, S., Arbizu, C., Vincent, S., … & Bartolomeo, P. (2014). Damage to the medial motor system in stroke patients with motor neglect. Frontiers in human neuroscience, 8, 408.

Santos-García, D., & de la Fuente-Fernández, R. (2013). Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. Journal of the neurological sciences, 332(1), 136-140.

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Nursing fundamentals

Nursing fundamentals
Nursing fundamentals

Facilitating Learning in the 21st Century

  1. Four Competency Statements

The Nursing Fundamentals course will be guided by competency statements which are based on contemporary professional nursing standards and guidelines. The four competency statements that are unique to the Nursing Fundamentals course include;

  1. The Nursing Fundamentals course must prepare graduates to make clinical decisions using current best evidence.
  2. The course must train graduates to demonstrate the ability to work efficiently with inter-professional and nursing teams and to make clinical decisions that are aimed at achieving quality patient care. 
  3. The Nursing Fundamentals course must prepare graduates to maximize benefits and minimize risks for patients through improved individual performance and system effectiveness.
  4. The course must teach graduates to use information and technology to support clinical decisions and to minimize medical errors.
A1. Nursing Fundamentals: Explanation of Four Competencies

            The four competencies listed in part A above are aligned with the national nursing standards and guidelines documented by the Quality and Safety Education for Nurses (QSEN). Competences i, ii, iii, and iv are aligned with QSEN standards related to evidence-based practice, teamwork and collaboration, safety, and informatics respectively. First, the nurse educator for the Nursing Fundamentals course will have to teach learners how to use current best evidence to make clinical decisions.

This will help the institution to maintain compliance with QSEN’s evidence-based practice standards. Moreover, nurse educator for the course will have to ensure that graduate nurses are competent enough to function with inter-professional and nursing teams to share knowledge that is aimed at achieving quality patient care. This way, the institution will have observed QSEN’s standard related to teamwork and collaboration (Rosenblum and Sprague-McRae, 2014)

Additionally, the nurse educator for the Nursing Fundamentals course will be compelled to teach graduates to maximize benefits and minimize risks for patients through improved individual performance and system effectiveness.

This will help the academic institution to comply with the safety standards set by QSEN. Furthermore, the nurse educator will ensure that graduate nurses are competent in using information and technology to mitigate medical errors and to promote improved care delivery. This will enable the institution to demonstrate adherence to QSEN’s standard related to informatics (Lewis, Stephens and Ciak, 2016).

A2. Three Learning Objectives

            Clear learning objectives must be developed for the Nursing Fundamentals course to help students to master the four competencies listed above. The three learning objectives for course competency number ‘iv’ which is related to informatics are outlined below;

 At the end of the course;

  1. The learner must be able to explain the importance of information and technology skills in promoting safe and quality patient care.
  2. Also, the student must be able to identify crucial health information that should be kept in electronic systems to support patient care
  3. the learner must have the capacity to describe the relationship between patient safety and effective management of electronic health information

A2a. Discussion of Criterion

            The criterion that will be used to select appropriate learning resources to achieve the learning objectives listed in part A2 is consistency. The chosen learning resources must be consistent with educational standards set by national, state, and local agencies. According to Burns, Noonan, Jenkins, and Bernardo (2017), an effective learning resource for a nursing course must be coherent and consistent with the standards set by national, states, and local agencies in the nursing education sector.

Furthermore, the content of these learning resources must match the needs of learners irrespective of the program level in which they are to be used. By focusing on consistency when selecting learning materials for the Nursing Fundamentals Course, the nurse educator will choose only those resources that highlight the specific contexts in which they are to be used, and that explicitly explain nursing concepts that are to be covered in the course.

Furthermore, the nurse educator will be sure to select learning resources that specify the types of learners who can utilize those resources. Also, the nurse educator should consider the appropriate method of instruction that must be used in the classroom to ensure compliance with educational standards set by national, state, and local agencies (Burns et. al., 2017).

A3. Approaches to Course Design

            The Nursing Fundamentals course will be developed based on the principles of the contemporary approach to course design. The contemporary approach to course design that will be used to develop the course is the learning-centered approach. According to Ihm, Choi, and Roh (2017), a learning-centered approach is based on the principle that the ability of a student to efficiently acquire new knowledge is mainly dependent on the teaching process utilized by the instructor.

Here, the learner uses the information provided by the instructor to build upon a given concept based on the knowledge that had been acquired previously. Learning-centered approach to course design is appropriate for learners who are being taught to achieve certain competencies which have been set by relevant accreditation bodies (Ihm, Choi, and Roh, 2017).

In the Nursing Fundamentals Course, nursing students are expected to achieve the competencies outlined by QSEN. As a contemporary approach to course design, the learning-centered approach will help learners in the Nursing Fundamentals Course to acquire the competencies listed in part A of this paper.

B. Strategies to Evaluate Learning Outcomes  Role playing, as well as papers and essays, will be used to evaluate whether students have achieved the intended learning outcomes in the Nursing Fundamentals Course. Papers and essays is an evaluation strategy that involves the issuance of exam topics to students and asking them to write their answers on papers in essay form.

It is a form of summative assessment because it often conducted at the end of a course and it covers all topics covered in the course. Using papers and essays evaluation strategy, the nurse educator will judge student performance in the Nursing Fundamentals Course based on documented standards (Harrison, Konings, Schuwirtg, Wass & Vleuten, 2017).

C1. Criterion-Referenced Tests

            Criterion-referenced tests will be used in the Nursing Fundamentals Course to evaluate student outcomes. When using criterion-referenced tests, the nurse educator will document learning standards which students will be expected to meet for them to be considered competent. Only students who meet the set standards after answering given tests will be deemed proficient (Lock, McNaught and Young, 2015).

C2. Norm-Referenced Tests

            Apart from criterion-referenced tests, norm-referenced tests will be used to assess student outcomes in the Nursing Fundamentals Course. When using norm-referenced tests, the nurse educator will compare student performance with that of an imaginary average student who will be selected from a group of learners who had completed similar tests before. Students who manage to perform better that the imaginary average student will have passed their exams. Conversely, learners who score grades below that of the imaginary average student will have failed the test (Lock, McNaught and Young, 2015).

D1. Advantages of True-False Test Items

            Advantages of true-false test items will influence their use in the Nursing Fundamentals Course. The nurse educator may choose to use true-false test items because individual test items are easy to compose and organize. Also, true-false test items are easy to tally because they display students’ answers very clearly. Moreover, true-false test items will enable the nurse educator to examine students on some concepts because they allow sampling of information from several topics (Javid, 2014).

D3. Advantages of Multiple-Choice Test Items

 One of the advantages of using multiple-choice test items of the course is that they will allow the nurse educator to assess many learning objectives in a single examination. Also, when multiple choice test items are used, the nurse educator will easily evaluate results of a large population of learners. Moreover, using multiple-choice tests in the Nursing Fundamentals Course will help to improve student performance in subsequent tests (Sutherland, Schwartz and Dickison, 2012).

F. Cultural and Societal Factors            

The ability of students to effectively learn the Nursing Fundamentals Course in the classroom can be impacted by both cultural and societal factors. In this regard, a student’s learning ability may either improve or decline as a result of influence from factors inherent in their cultures (Shawwa, Abulaban, and Balkhoyor, 2015). For example, the level of concentration of a female student who comes from a community that does not support girl-child education may negatively be affected because such student will face rejection from the community.

G2. Learning Activity Meeting Learning Styles

            The learning activity described in part G1 effectively meets kinesthetic learning style of students in the Nursing Fundamentals Course. According to Kharb, Samanta, and Singh (2013), students who apply kinesthetic learning style enjoy learning through movement and making contact. These students always want to engage in activities that make them move their hands during the lesson as this helps to break teaching boredom. The activity in part G1 will get learners moving and will help them to break from teaching monotony.

H. Importance of Learning Activity Promoting Critical Thinking Skills

            When teaching Nursing Fundamentals Course, the nurse educator will create learning activities that improve critical thinking skills of learners. According to Papathanasiou, Kleisiaris, and Kourkouta (2014), today’s nursing institutions must strive to promote critical thinking skills of students to produce graduates who can effectively keep up with the rapid technological advancements in the contemporary world.

Therefore, learning activities that improve critical thinking skills of learners are important because they will enable students to understand and analyze issues more effectively, with the aim of solving complex problems that they increasingly encounter in the ever-changing world (Papathanasiou, Kleisiaris, and Kourkouta, 2014).

H1. Critical Thinking Strategy            

The nurse educator will use collaborative learning to facilitate the development of self-reflection skills among students in the Nursing Fundamentals Course. Collaborative learning is a critical thinking strategy that involves allowing nursing students to work in teams to solve complex problems related to specific course concepts that they have been taught in the classroom.

H2. Implementation of Selected Strategy

 Collaborative learning strategy will be implemented in the Nursing Fundamentals Course by following four steps chronologically. First, the nurse educator will teach students a new course concept and allow them to ask questions. Second, the nurse educator will identify an article that talks about a complex issue related to the taught concept. Third, he or she will ask students to form groups.

Each group will be invited to read the article, analyze its contents, identify the problem, and come up with a solution or solutions to the identified problem. Fourth, the nurse educator will use the solutions generated by each group to help students to understand the course concept further (Rosenblum and Sprague-McRae, 2014).

I. Examples of a Best Practice

 The nurse educator should have a system in place to provide feedback to learners in the clinical setting. There are several acceptable approaches for providing feedback to students. For instance, in the Nursing Fundamentals Course, the nurse educator can provide written feedback to learners at the end of the course, that is, in a summative manner. The feedback should contain an explanation of observed desirable behaviors as well as undesirable behaviors and actions that students can take to improve on them (Anderson, 2012).

C1. Evaluation Method

 Formative evaluation method will be used to assess if the curriculum design is effective for the Nursing Fundamentals Course. This assessment strategy involves assessment of the curriculum design during implementation. Formative evaluation of curriculum design will enable the nurse educator to make relevant changes that match ongoing trends in the nursing education field (Burns, et. al., 2017).

References

Anderson, P. A. (2012). Giving feedback on clinical skills: Are we starving our young? Journal of Graduate Medical Education, 4(2): 154-158. doi:10.4300/JGME-D-11-000295.1. Retrieved from PubMed Central.

Burns, H., Noonan, L., Jenkins, D. P. & Bernardo, L. M. (2017). Using research findings to design an evidence-based practice curriculum. Journal of Continuing Education in Nursing, 48 (4): 184-189. doi: 10.3928/00220124-20170321-09. Retrieved from PubMed.

Harrison, C., Konings, K., Schuwirtg, L., Wass, V. & Vleuten, C. (2017). Changing the culture of assessment: The dominance of the summative assessment paradigm. BMC Medical Education, 17:73. doi: 10.1186/s12909-017-0912-5. Retrieved from BioMed Central.

Ierardi, J. A. (2014). Taking the ‘sting’ out of examination reviews: A student-centered approach. Journal of Nursing Education, 53(7): 428. doi:10.3928/01484834-20140619-13. Retrieved from PubMed Central.

Ihm, J., Choi, H. & Roh, S. (2017). Flipped-learning course design and evaluation through student self-assessment in a predental science class. Korean Journal of Medical Education, 29(2):93-100. doi: 10.3946/kjme.2017.56. Retrieved from PubMed Central.

Javid, L. (2014). The comparison between multiple-choice (MC) and multiple true-false (MTF) test formats in Irarian intermediate EFL learners’ vocabulary learning. Procedia: Social and Behavioral Sciences, 98(6):784-788. Retrieved from ScienceDirect.

Kharb, P., Samanta, P. & Singh, V. (2013). The learning styles and the preferred teaching: Learning strategies of first-year medical students. Journal of Clinical and Diagnostic Research: JCDR, 7(6):1089-1092.doi:10.7860/JCDR/2013/5809.3090. Retrieved from PubMed Central.

Lewis, D., Stephens, K. & Ciak, A. (2016). QSEN: Curriculum integration and bridging the gap to practice. Nursing Education Perspectives, 37(2): 97-100. Retrieved from PubMed.

Lock, B., McNaught, C. & Young, K. (2015). Criterion-referenced and norm-referenced assessments: Compatibility and complementarity. Assessment & Evaluation in Higher Education, 41(3):450-465. doi: 10.1080/02602938.2015.1022136. Retrieved from PubMed Central.

Papathanasiou, I. V., Kleisiaris, C. F. & Kourkouta, L. (2014). Critical thinking: The development of an essential skill for nursing students. Acta Informatica Medica, 22(4):283-286. doi:10.5455/aim.2014.22.283-286. Retrieved from PubMed.

Quinn, B. & Peters, A. (2017). Strategies to reduce nursing students test anxiety: A literature review. Journal of Nursing Education, 56(3): 145-151. doi: 10.3928/01484834-20170222-05. Retrieved from PubMed.

Rosenblum, R. & Sprague-McRae, J. (2014). Using principles of Quality and Safety Education for Nurses in school nurse continuing education. The Journal of School Nursing, 30(2): 97-102. Retrieved from PubMed.

Shawwa, L., Abulaban, A. & Balkhoyor, A. (2015). Factors potentially influencing academic performance among medical students. Advances in Medical Education and Practice, 6: 65-75. doi:10.2147/AMEP.S69304. Retrieved from PubMed Central.

Sutherland, K., Schwartz, J. & Dickison, P. (2012). Best practices for writing test items. Journal of Nursing  Regulation, doi: 10.1016/S2155-8256(15)30217-9. Retrieved from PubMed Central.

Yengo-Kahn, A., Backer, C. E. & Lomis, A. K. (2017). Medical students’ perspective on implementing curriculum change at one institution. Academic Medicine, 92(4):455-461. Doi:10.1097/ACM.0000000000001569. Retrieved from PubMed.

Health Care Accreditation

Health Care Accreditation
Health Care Accreditation

Health Care Accreditation

Accreditation

 Mayo Clinic, Wisconsin receives accreditation from Wisconsin Accreditation Organization for Hospitals and The Joint Commission. Before offering accreditation, The Joint Commission evaluates health care organizations for compliance with the set standards. Wisconsin Accreditation Organization for Hospitals evaluates health care organizations at an interval of three years.

Accrediting is mandatory for Mayo Clinic, Wisconsin because the organization cannot be allowed to provide medical services to patients if it is not accredited. The main purpose of accrediting, therefore, is to validate if the Clinic meets quality standards documented by the two accrediting bodies. Accreditation supports Mayo Clinic to make improvements on its systems to meet the set quality standards (Mayo Clinic Health System, 2016).

            Accrediting of Mayo Clinic by Wisconsin Accreditation Organization for Hospitals and The Joint Commission is important to heath care because it results in improved care across all departments of the organization. Additionally, accreditation helps patients to receive the highest and best quality health care.

Furthermore, accrediting influences Mayo Clinic, Wisconsin to engage in socially responsible behaviors thereby promoting the safety of the community. Again, since Accreditation encourages Mayo Clinic to maximize quality in all its health care delivery processes, it has contributed significantly to the clinic’s expansion and growth (Alkhenizan and Shaw, 2011).

The accrediting requirements for Mayo Clinic include safe and high-quality patient care, effective communication with stakeholders, high level of coordination and planning to promote mitigation of risks, facility safety, and effective leadership. Mayo Clinic, Wisconsin requires highly performing technology systems and competent employees to maintain accreditation. If the organization loses accreditation, it will lose clients due to reduced quality of care and compromised patient safety. Failure to make improvements on its systems will result in closure (Mayo Clinic Health System, 2016).

Mayo Clinic should be accredited to offer medical services related to prevention, treatment, and control of infections. The organization requires licensure in the following areas; perinatal care, disease-specific care, palliative care, medication compounding, and health care staffing (Mayo Clinic Health System, 2016).

Licensure

            Mayo Clinic has been licensed to provide Acute Stroke Management and Diabetes Management services which fall under disease-specific care. These two licensures are mandatory because, without them, the clinic will not be authorized to offer acute stroke management and diabetes management services. The purpose of the licensures is to confirm that Mayo Clinic meets the standards required for an organization to offer acute stroke management and diabetes management services (Mayo Clinic Health System, 2016).

The licensures are important to Mayo Clinic because they help it to implement strategies that are aimed at improving the quality of care for acute stroke and diabetes management. Furthermore, the licensures contribute to the provision of the highest and best quality health care for patients (Alkhenizan and Shaw, 2011).

Moreover, they are essential to heath care in the sense that, it results in improved health care across all departments of the organization. Additionally, the licensures help Mayo Clinic, Wisconsin to become a socially responsible organization by influencing it to engage in activities that promote safety of the community (Rooney and Ostenberg, 1999)

 The licensure requirements for Mayo Clinic about the provision of acute stroke and diabetes management services include care delivery, admission, discharge and referrals, a continuum of care, and emergency management. Mayo Clinic, Wisconsin needs three significant resources to maintain these licensures, and they include competent and enough medical practitioners, highly performing technological systems, and a safe facility (Mayo Clinic Health System, 2016).

Suppose the Clinic loses the licensure, it will no longer be authorized to provide acute stroke and diabetes management services. While the loss of accreditation will prevent Mayo Clinic from serving as a health care organization in Wisconsin, loss of licensure will only prevent the organization from providing care services related to acute stroke management and diabetes management (Rooney and Ostenberg, 1999).

References

Alkhenizan, A. & Shaw, C. (2011) Impact of accreditation on the quality of healthcare services: A systematic review of the literature. Annals of Saudi Medicine, 31(4): 407-416. doi:10.4103/0256-4947.83204.

Mayo Clinic Health System (2016). Accreditation. Retrieved from mayoclinichealthsystem.org

Rooney, A. & Ostenberg, P. (1999). Licensure, accreditation, and certification: Approaches to health services quality. Wisconsin: Bethesda

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MENTAL HEALTH CARE

Mental health care
Mental health care

Mental health care

DIFFERENCE BETWEEN HISTORICAL AND CONTEMPORARY MENTAL HEALTH CARE

  1. INTRODUCTION

Mental health care practice began several years ago when relatively simple approaches to care were still being utilized. Like any other form of health care, mental health care can be evaluated based on a range of theories and models which have extensively been used to inform mental health nursing practice. This paper discusses the difference between historical and contemporary mental health care as it applies to nursing models and the nursing process.

This paper has described in details, the concepts of “nursing process” and “nursing model” and how they have evolved since conception. Moreover, this paper uses a case study to describe how the nursing process and a nursing model have been applied in nursing care provision for a patient who is suffering from a sexually transmitted infection characterized by depression.

  1. CONTEMPORARY AND HISTORICAL MENTAL HEALTH CARE

2.1 The Nursing Process and how it has Evolved since Conception

The principles of nursing process largely dominate mental health care practice in today’s nursing and health industry. The term “nursing process” is defined as the application of a scientific approach to care provision that involves strict adherence to distinct steps which are aimed at generating positive health outcomes for patients (Perez-Rivas, Martin-Iqlesias, Pacheco del Cerro, Arenas, Lopez and Lagos, 2016, p. 43).

According to Perez-Rivas et. al., (2016, p. 43), for a nursing process to be considered effective, the health care practitioner must complete all the documented steps because information gained from one step results into the success of subsequent steps. Approaching mental health care based on the principles of “nursing process” helps to develop critical thinking skills of nurses, which eventually translates into improved problem-solving and positive health outcomes for mentally-ill patients (Perez-Rivas et. al., 2016, p. 44).

Nursing process and its application in mental health care has greatly evolved from when it was introduced up to date. Traditionally, the nursing process extensively emphasized on health care assessment, implementation of intervention, and planning as the only phases involved in mental health care delivery. In those days, the process did not recognize the significant role played by cognitive processes in influencing decision making during care (Zamanzadeh et. al., 2015, p. 411).

However, as nurses continued to utilize the historical principles of the nursing process into practice, increasingly advanced nursing processes were integrated and this has greatly improved the overall image of the nursing process. For instance, the advanced nursing process currently integrates diagnostic reasoning that facilitates decision making which was absent in the traditional nursing process.

Through continued nursing research and practice, nursing professionals have contributed greatly to the evolution of the nursing process by identifying the need to incorporate health outcomes identification and planning into the nursing process. To date, health care professionals who handle mental health cases view the nursing process as an advanced form or practice that involves five steps: “assessment, diagnosis, outcome identification and planning, intervention implementation, and evaluation (Zamanzadeh et. al., 2015, p. 412).

2.2 How the Nursing Process was First Developed and How it is used in Contemporary Nursing

            The nursing process that is used in contemporary nursing differs significantly from the one used in traditional nursing as it applies to mental health care. This is attributed to the changes that have been made on the “nursing process” since it was developed (Perez-Rivas et. al., 2016, p. 44).  Nursing was first viewed as a process rather than a distinct activity in 1955 by Lydia Hall from United Kingdom.

Although many professionals in the nursing field were not sure as to whether Hall’s views were right, a few of them dwelled extensively on the topic and they began to refer to nursing as a process. Examples of authors who supported Hull in describing nursing as a process include Johnson, Orlando, and Wiedenbach and their opinions on the nursing process are available in their publications of 1959, 1961, and 1963 respectively.

By then, only three steps were used to define the nursing process and they include, “assessment, planning, and evaluation (Zamanzadeh et. al., 2015, p. 411).” These three steps provided the basis of the nursing process that traditional nurses used to deliver mental health care to patients.

            Later on in 1967, an additional step described as implementation of intervention was added to the nursing process by Walsh and Yura. It is not until 1973 when the American Nurses Association (ANA) felt in necessary to incorporate diagnosis into the nursing process. During the final revision and publication of the ANA standards in 1991, another step known as identification of outcome was integrated into the nursing process.

The step was made part of the planning phase and this resulted into the generation of a nursing process that comprised of five steps namely; “assessment, diagnosis, outcome identification and planning, intervention implementation, and evaluation (Zamanzadeh et. al., 2015, p. 412).” The development of the nursing process has progressed through a number of steps which have been modified across years to generate the process that is currently used in contemporary nursing to provide care for mentally-ill patients.

Based on the nursing process, contemporary nurses frequently assess, diagnose, identity outcomes, implement interventions, and finally evaluate the effectiveness of interventions whenever they are delivering mental health care to patients.

2.3 The Nursing Model and How they Have Evolved Since Conception

            Nursing models play a very important role in nursing practice in the sense that, they largely influence decision making processes by nurses concerning the most appropriate ways through which patients should be handled. A nursing model is defined as a framework of nursing concepts that act as a foundation for nursing care and that describe how given health care practices should be performed (Murphy, Williams and Pridmore, 2010, p. 23).  

Nursing models have been developed to help direct nurses on the best approaches they should take to improve patient outcomes and to explain why certain approaches as relevant. Different nursing models exist and their goal is to assist nurses to achieve various nursing components based on the nature of a mental health issue they are handling at any given time (Springer and Casey-Lockyer, 2016, p. 647).

            Nursing models have significantly evolved since their conception due to constant changes in patients’ needs and due to rapid technological advancements in the contemporary world which tend to change approaches to care. Nursing models were first developed in the United States way back in 1960s (Murphy, Williams and Pridmore, 2010, p. 23). In 1960, the United States was characterized by a number of cultural, technological and social transformations which influenced nursing professionals to make changes that were aimed at improving nursing practice.

For this reason, traditional nursing models were developed based on their effectiveness in meeting basic medical goals. For instance, the “medical model” provided a foundation only for the management of physical health problems. Nurses in the United Kingdom began to apply nursing models into practice in 1970s (Murphy, Williams and Pridmore, 2010, p. 24).

Since then, significant transformations in the world have helped nurses to build a body of knowledge that has been used to develop modern nursing models. Nursing models which are used in contemporary nursing to deliver mental health care have been developed to guide nurses on how they can handle patients with a wide variety of health problems as opposed to traditional models (Springer and Casey-Lockyer, 2016, p. 660).

2.4 Total Patient Care: A Historical Nursing Model

            An example of a historical nursing model that is rarely used by today’s nurses is Total Patient Care which is also known as Private Duty Nurses. Total Patient Care is a nursing model that conceptualizes that, for nurses to deliver quality patient care, they must have a small number of patients that they can effectively handle at any given time. The nurse should then work in collaboration with other registered nurses to ensure that the patients being attended to receive maximum care.  

Total Patient Care model guided traditional nurses to work with small groups of mentally-ill patients that they could effectively handle at any given time. Although Total Patient Care can still be used to guide clinical decisions in today’s health care settings, today’s health care organizations rarely utilize this model to deliver mental health care (Mary and Sandra, 2004, p. 291).

2.5 Watson’s Theory of Caring: A Contemporary Nursing Model

            Through his theory of caring, Jean Watson greatly influences clinical decision making processes by today’s nurses, especially those who deliver care to patients with mental health problems. This contemporary nursing theory conceptualizes that there are four major factors that determine positive patient outcome during care delivery. These factors include the personality of the care giver, the patient’s health status, the environment in which care is delivered, and the nursing process (Ozan, Okumus and Aytekin, 2015, p. 26).

These factors influenced Watson to assume that the most effective form of care is that which is delivered interpersonally. In addition, the nurse should take time to understand specific health problem that a patient is suffering from. Again, it is the responsibility of the nurse to create caring environment for his or her patient. Furthermore, nursing lies at the center of caring and intended health outcomes will only be achieved if the right nursing processes are followed. Watson’s theory of caring is widely used in nursing practice today (Ozan, Okumus and Aytekin, 2015, p. 25).

  1. SERVICE USER’S HISTORY

            A service user whom I have cared for in the past is a female patient aged 16 years and who suspected that she was suffering from a sexually transmitted infection and was therefore in need of medical care. I had to take historical data before I could identify the best component of the nursing process to use in order to confirm presence or absence of a sexually transmitted infection.

My patient was an orphan who stayed with her uncle at the time of visit. At the time of visit, she was feeling depressed and psychologically disturbed because of her health condition. In addition, she was part of a group of commercial sex workers in the city despite her young age, and she uses money earned from the business to earn a living. She had also been in an intimate relation with different partners without protection.

Her uncle used to beat her up every time he was at home and therefore, she feared staying at home. The patient had not taken any medication prior to visiting the health care facility. I applied the nursing process to deliver the most appropriate nursing care for the patient.

When I was handling my patient, I greatly relied on the nursing process that is majorly used in contemporary nursing. By following the five steps of the nursing process, contemporary nurses are able to provide quality care that addresses specific patients’ needs. During assessment phase, the contemporary nurse collects, verifies, organizes, interprets, and documents patients’ health data that will be used to accomplish the subsequent steps.

After collecting relevant data, the contemporary nurse ensues to diagnosis phase where he or she analyzes the collected data to make a clinical judgment which is aimed at identifying a specific health problem that the patient is suffering from (Perez-Rivas et. al., 2016, p. 44).

Once a specific health problem is identified, the contemporary nurse proceeds to the third phase where he or she identifies the most appropriate health outcomes that the patient should be assisted to achieve. It is in this phase where the nurse documents a plan of how the patient can be helped to achieve the proposed outcomes. In the fourth phase, the contemporary nurse implements the right intervention as documented in the plan (Zamanzadeh et. al., 2015, p. 416).

The nurse then proceeds to the fifth phase where he or she evaluates the effectiveness of the implemented intervention in generating the proposed health outcomes for the patient. In case the proposed health outcomes are not realized following intervention implementation, the nurse is compelled to change the intervention until the intended results are obtained (Perez-Rivas et. al., 2016, p. 44). 

            A component of the nursing process that I used to exercise care for the patient was taken from the Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE) model described above, considering the fact that it is the one that is widely used in contemporary nursing.  I decided to use Diagnosis component of the ADPIE to maximize nursing care for my patient.  

By choosing diagnosis component, I wanted to bring together all the historical data that I had gathered into meaningful information. Specifically, when conducting diagnosis on the patient, I used the data that I had already collected to make clinical judgment about my patient and the family. This enabled me to understand that risk factors that exposed by patient to acquiring sexually transmitted infections.

Furthermore, I was able to predict possible responses that she could receive from family members if she approached them with her health problem. Generally, diagnosis provided me with the basis for selecting the most appropriate nursing intervention that could generate positive health outcomes for my patient.

            The type of diagnosis that I conducted on the patient was possible nursing diagnosis. A possible nursing diagnosis is conducted when a patient’s problem requires additional analysis for the presence or absence of a health problem to be confirmed (Perez-Rivas et. al., 2016, p. 44). In the case that I was handling, it was not yet confirmed that the patient was suffering from sexually transmitted infections. The client was worried that she might have acquired sexually transmitted infections owing to her sexual behaviours in the recent past.      Such thoughts had severe impact on her mental health. Data obtained from this diagnosis helped me to confirm presence of a sexually transmitted infection (Zamanzadeh et. al., 2015, p. 416).

            Diagnosis was a very important component of ADPIE for my patient because it acted as a link to the other aspects of the nursing process namely; planning, implementation, and evaluation. The diagnosis was the second phase of the nursing process that was performed after collecting data in the assessment phase. Information gathered during diagnosis phase was extremely useful in the subsequent steps because I utilized it to identify the best health outcomes for my patient and to select a nursing intervention that could generate those outcomes for my patients. Diagnosis was very important in the overall nursing process because it helped me to come up with the right interventions that were intended to generate improved health outcomes for the patient (Zamanzadeh et. al., 2015, p. 416).  

When I was providing nursing care to my patient, I paid greatest attention to Watson’s Theory of Caring mode. I utilized the four major factors that determine positive patient outcome during care delivery as described in Watson’s theory of caring. Specifically, I strived to; build strong interpersonal relationship with the client, establish specific health problem the patient was suffering prove, create an environment suitable for nursing care, and to adhere to all steps of the nursing process (Ozan, Okumus and Aytekin, 2015, p. 25).

  1. CONCLUSION

Historical and contemporary mental health care differ significantly due to evolutions in nursing theories and models which have taken place over the years. For instance, while traditional mental health care was delivered using a nursing process that only involved three steps, delivery of contemporary mental care utilizes a nursing process with five steps.

Additionally, while traditional mental health care was based on historical nursing models, today’s mental health care is guided by contemporary nursing models such as Watson’s theory of caring model. The evolutions of the nursing process and the developments of nursing models have brought about significant improvements in health care delivery particularly in mental health care.

From this case study, I have learnt the importance of implementing contemporary nursing processes and nursing models in care delivery. I will utilize this knowledge to improve the quality of mental health care that I will deliver in future. As a student nurse, I will take my time to evaluate and understand changes in nursing models and components of the nursing process as they apply to mental health care.

References

Mary, T. & Sandra, L. 2004, “Traditional models of care delivery: What have we learned?” Journal of Nursing Administration, vol. 34, issue 6, pp 291-297.

Murphy, N., Williams, A. & Pridmore, J. A. 2010, “Nursing models and contemporary nursing 1: The development, uses and limitations,” Nursing Times, vol. 1, issue 106, p. 23-24.

Ozan, Y., Okumus, H., & Aytekin, A. 2015, “Implementation of Watson’s theory of human caring: A case study,” International Journal of Caring Sciences, vol. 8, issue 1, pp. 25-35.

Perez-Rivas, F., Martin-Iqlesias, S., Pacheco del Cerro, K., Arenas, C., Lopez, M. & Lagos, M. B. 2016 “Effectiveness of nursing process use in primary care,” International Journal of Nursing Knowledge, vol. 27, no. 1, pp. 43-47.

Springer, J. & Casey-Lockyer, M. 2016, “Evolution of a nursing model for identifying client needs in a disaster shelter: A case study with the American Red Cross,” Nursing Clinics of North America, vol. 15, no. 4, pp. 647-662.

Zamanzadeh, V., Valizadeh, L., Tabrizi, F., Behshid, M. & Lotfi, M. 2015 “Challenges associated with the implementation of the nursing process: A systematic review,” Irarian Journal of Midewifery Research, vol. 20, no. 4, pp. 411-419.

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Evolving Nursing Practice and Patient Care Delivery Models

Evolving Nursing Practice
Evolving Nursing Practice
Evolving Nursing Practice and Patient Care Delivery Models

“This presentation will begin by welcoming remarks that are extended to everyone who is present in this session. The topic that will be explored in this presentation is, ‘The anticipated growth and changes in nursing practice over the coming years.”If you take your time to compare the health care delivery in traditional health care organizations with the one used in contemporary organizations, you will learn that modern approaches to care are better than the ones that were used in the past.

It is also important to recognize that the mode of care delivery in future will be far much better than it is today. Rapid health care reforms are currently taking place to enable nurses to provide care that meets the needs of the ever-changing population. As nurses, we must be conversant with the changes and growth that are expected to take place in nursing practice in the near future for us to be in a position to contribute positively to the reorganization of the United States’ health care delivery system (Salmond and Echevarria, 2017).

            For instance, it is anticipated that the number of nurses who will be required to deliver care in acute care hospitals will decrease while the number of those nurses who will be required to serve in the community will increase. Furthermore, it is expected that future health care organizations will reward nurses based on the quality of care they deliver, a system known as Accountable Care Organizations (Song, 2014).

In order to effectively meet the health care needs of the future community, nurses will be required to posses the right knowledge and skills to enable them to deliver quality care in accountable care organizations. Nurses are required to prepare adequately to deliver care both in hospital-based and community-based settings. The best way through which nurses can prepare for the future is by obtaining the highest level of academic qualifications from relevant academic institutions which have been accredited to provide nursing education in the United States. This way, they will adequately be equipped to deliver quality care that matches the trends and issues in United States healthcare system (Shortell, Colla, and Ramsay, 2017).

            Today’s society needs clinical advice on how it can effectively manage new infections that have a negative impact on health. As Kovner and Walani (2010) point out, the increasing need for health education among the current and future populations greatly influences the creation of nurse-managed clinics in the community. Advanced practice nurses will be assigned clinical roles in nurse-managed clinics from where they will be required to educate community members on how they can effectively manage infections which are affecting their health.

Since more jobs will be available in nurse-managed clinics in the community, nurses must be prepared enough to work as community nurses and to teach clients on how they can prevent and manage infections (Kovner and Walani, 2010).

            We should also recognize that the rates of deaths that are associated with chronic infections are on the rise in today’s society. It is anticipated that incidences of chronic infections such as cancer and diabetes will continue to rise in the near future due to the anticipated changes in lifestyle and because very few people are adequately informed of how they can effectively manage their health problems outside the hospital setting (Suter, Oelke and Armitage, 2009).

Therefore, advanced practice nurses will be expected to possess the right knowledge and skills to provide a continuum of care to patients who need clinical guidance after they will have been discharged from the hospital. In this manner, nurses will play a big role in reducing deaths that occur from ineffectively managed chronic infections (Haggerty, Reid and McKendry, 2003).

            It is anticipated that the future community will be in need of more personalized care than the current society. As Scribner and Kehoe (2017) explain, it is expected that patient-centered medical homes will be used more than hospitals in the next few years. From these medical homes, nurses will be deployed to offer constant personalized care as well as medical consultations to the community. For this reason, nurses will only be able to retain their job positions if they are competent enough to work in patient-centered medical homes and in hospital settings (Reynolds, Klink and Davis, 2015).

Based on the anticipated growth and changes in nursing practice over the coming years, I urge all of you to seek for training on how to deliver quality care in areas related to Accountable care organizations, nurse-managed clinics, continuum of care, and patient-centered medical homes in order to prepare adequately to fit in the job market in future. Thank you.”            

Nurse One supports the idea that nursing practice is expected to change and grow in the next few years, and that nurses are required to prepare adequately to deliver health care that will meet the needs of the future generation. According to Nurse One, the rate of deaths that occur as a result of chronic infections is on the rise in today’s society. It is reported everywhere in the media that the number of people who die of cancer, diabetes, and high blood pressure continue to increase each day as a result of poor health management practices.

The main reason why the number of deaths associated with chronic infections continues to rise is due to lack of knowledge on how these conditions can be managed once a patient leaves the hospital. For instance, some patients may suffer severe health consequence associated with either drug side effects or non-adherence to drugs.  In order to reduce deaths that are associated with chronic health problems from affecting the community in future, nurses will be expected to be competent enough to deliver continuum care to clients in the community.

Additionally, the number of nurses who will be expected to provide health care services in nurse-managed homes will be greater than that required to serve in hospitals. In Nurse One’s opinions, nursing practice is expected to grow and change in the next few years and only competent nurses will be able to find jobs.

Nurse One supports the idea that nursing practice is expected to change and grow in the next few years, and that nurses are required to prepare adequately to deliver health care that will meet the needs of the future generation. According to Nurse One, the rate of deaths that occur as a result of chronic infections is on the rise in today’s society. It is reported everywhere in the media that the number of people who die of cancer, diabetes, and high blood pressure continue to increase each day as a result of poor health management practices.

The main reason why the number of deaths associated with chronic infections continues to rise is due to lack of knowledge on how these conditions can be managed once a patient leaves the hospital. For instance, some patients may suffer severe health consequence associated with either drug side effects or non-adherence to drugs.  In order to reduce deaths that are associated with chronic health problems from affecting the community in future, nurses will be expected to be competent enough to deliver continuum care to clients in the community.

Additionally, the number of nurses who will be expected to provide health care services in nurse-managed homes will be greater than that required to serve in hospitals. In Nurse One’s opinions, nursing practice is expected to grow and change in the next few years and only competent nurses will be able to find jobs. The views of this nurse are consistent with ideas presented by Haggerty Reid and McKendry (2003) and by Suter, Oelke, and Armitage (2009) concerning the need for nurses to be prepared to deliver continuum care in the community over the coming years.

 References

Haggerty, J. L., Reid, R. & McKendry, R. (2003). Continuity of care: A multidisciplinary review. The British Medical Journal, 327(7425): 1219-1221.

Kovner, C. & Walani, S. (2010). Nurse-managed health centers. Nursing Research Network: Robert Wood Johnson Foundation.

Reynolds, P., Klink, K. & Davis, M. (2015). The patient-centered medical home: Preparation of the workforce, more questions than answers. Journal of General Internal Medicine, 30(7): 1013-1017.

Salmond, S. & Echevarria, M. (2017). Health care transformation and changing roles for nursing. Orthopedic Nursing, 36(1): 12-25.

Scribner, M. N. & Kehoe, K. (2017). Establishing successful patient-centered medical homes in rural Hawaii: Three strategies to consider. Hawaii Journal of Medicine & Public Health, 76(3): 18-23.

Shortell, S., Colla, C. & Ramsay, P. (2017). Accountable care organizations: The national landscape. Journal of Health Politics, Policy, and Law, 40 (4): 647-668.

Song, Z. (2014). Accountable care organizations in the US health care system. Journal of Clinical Outcomes Management: JCOM, 21(8):364-371.

Suter, E., Oelke, N. & Armitage, G. (2009). Key principles for successful health systems integration. Healthcare Quarterly, 13(1): 16-23.

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Disparities in Health Outcomes Between India and China

Disparities in Health Outcomes Between India and China
Disparities in Health Outcomes Between India and China

Disparities in Health Outcomes Between India and China

Disparities in Health Outcomes Between India and China

Introduction

            There are significant health disparities between India and China as well as within their populations. At the end of World War I, health outcomes of both China and India were almost comparable. However, the health system of China improved more tremendously than that of India roughly thirty years after the war. The health progress in India thirty years ago is surprisingly better than that of China despite the fact that India is still one of the countries of the world whose economy is highly impacted by the problem of food insecurity (Yip and Mahal, 2008). Ideally, India and China have had varied experiences in health outcomes in the last 50 years

Variations in Health Outcomes between China and India

            In the last 50 years, China and India have experienced significant differences in life expectancy rates as well as in rates of parasitic and infectious diseases. The most important measure of life expectancy is infant mortality, while the measure of infectious disease burden is adjustments in life years among the population (Bardhan, 2008). Since the early 1970s, India has been experiencing lower life expectancy, as evidenced by higher infant mortality rates, than China (Kanjilal, Mazumdar, Mukherjee and Rahman, 2010).

By the year 2000, the rate of deaths among children aged five years and below was 46 percent in India and only 8 percent in China. These are deaths that resulted from children who are born if they are underweight (Bardhan, 2008). According to Yip and Mahal (2008), the burden of infectious diseases in India is higher than that of China. Considering these variations, the health care systems of both India and China can only perform effectively if appropriate actions are taken to improve health outcomes about life expectancy and burden of parasitic and infectious diseases.

Reasons Behind the Health Outcome Disparities Between India and China

            The two leading causes of health outcome disparities between India and China are variations in health literacy and implementation of public health policies. According to Yip and Mahal (2008), India has been experiencing low life expectancy over the years because of limited health literacy among its population. Yip and Mahal (2008) further assert that the health literacy level in India at the moment is far much lower than it was in China more than ten years ago.

Due to limited health literacy among Indian population, families cannot implement basic health promotion strategies such as proper nutrition and home hygiene practices. The overall impact is an increased burden of infectious diseases coupled with high infant mortality rates in the country (Ma and Neeraj, 2008).

            Furthermore, the Chinese government is more committed than the Indian government at funding public health projects that are aimed at improving health outcomes of its population. Over the past fifty years, life expectancy in China has been increasing rapidly from approximately 39 percent to about 68 percent (Tang, Meng, Chen, Bekedam, Evana, and Whitehead, 2008). This has occurred due to the effort made by the Chinese government to support the implementation of public health policies.

The most recognizable initiative that was widely supported by the government is the Health China 2020, which was meant to address the problem of social inequality in health care and to improve the Chinese health care (Tang et al., 2008).  Conversely, India is suffering from inadequate public health support accompanied by significant disparities in the country’s health care system.

Consequently, poor implementation of public health policies in India is attributed to the higher mortality rates and burden of infectious diseases in India than in China (Mukherjee, Haddad and Narayana, 2011). Despite these differences, health outcomes of both India and China are greatly impacted by social and health care disparities in the two countries (Balarajan, Selvaraj, and Subramanian, 2011; & World Health Organization, 2005).

Comparison of Health Outcomes in Kerala and India

            Kerala state is located in India towards the southern regions of the country.  Surprisingly, the health outcomes of Kerala state are better than those of other parts of India, and this is evidenced by variations in both health and social indicators. As Mukherjee, Haddad and Narayana, (2011) explain, Kerala has experienced high life expectancy rates as well as reduced burden of infectious diseases in the last half century. Kerala became a “model India State” because of exhibiting a demographic health pattern that matches those of developed countries like the United States.

The main reasons for improved health outcomes in Kerala are educational equality, increased access to primary health care, and effective implementation of public health policies (Mukherjee, Haddad and Narayana, 2011). Educational equality in Kerala state contributes to an increase in health care literacy among the state’s population.

Furthermore, effective implementation of public health policies in the region has greatly improved the quality of care offered by health care organizations, and this translates into high life expectancy rates and reduced burden of infectious diseases (Mukherjee, Haddad and Narayana, 2011).

Conclusion

India and China are among countries of the world that are currently experiencing almost similar rates of economic growth. However, the two nations have experienced different health outcomes in the last fifty years. The main reasons behind variations in health outcomes between China and India are differences in health literacy levels and implementation of health care policy between the two countries. Although Kerala is a state in India, its health outcomes differ considerably from the rest of India.

References

Balarajan, Y., Selvaraj, S. & Subramanian, S. V. (2011). Health care and equity in India. Lancet, 377(9764): 505-515.

Bardhan, P. (2008). The state of health services in China and India in a larger context. Health Affairs, Retrieved from https://pdfs.semanticscholar.org/f9bd/1636dfa085748821241535eda868b8db4e2c.pdf

Kanjilal, B., Mazumdar, P., Mukherjee, M. & Rahman, M. (2010). Nutritional status of children in India: Household socio-economic condition as the contextual determinant. International Journal for Equity in Health, 9(1): 19-31.

Ma, S. & Neeraj, S. (2008). A comparison of the health systems in China and India. Santa Monice, CA: RAND Corporation.

Mukherjee, S., Haddad, S. & Narayana, D. (2011). Social class related inequalities in household health expenditure and economic burden: Evidence from Kerala, South India. International Journal for Equity in Health, 10(1):1-13.

Tang, S., Meng, Q., Chen, L., Bekedam, H., Evana, T. & Whitehead, M. (2008). Tackling the challenges to health equity in China. Lancet, 372(9648): 1493-1501.

World Health Organization. (2005). China: Health, poverty, and economic development. Retrieved from http://www.who.int/macrohealth/action/CMH_China.pdf

Yip, W. & Mahal, A. (2008). The health care systems of China and India: Performance and future challenges. Health Affairs, 27(4): 921-932.

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Health care cost: Burden to low income earners

health care cost
health care cost

Financial Management

Health care cost

Patient care financial problem is one of the reasons why today’s populations are unable to receive high quality care that they need to achieve improved health outcomes. The problem of huge health care cost is a big burden to low income earners who always lack adequate finances to purchase drugs and to pay for hospital bills (Kelley, McGarry, Georges, and Skinner, 2015). It becomes even worse for patients who are suffering from chronic health conditions such as diabetes and cancer.

According to Kelley et al., (2015), dementia is one of the chronic diseases that are attracting large social costs for patients in the United State. For this reason, being a fatal health condition, many dementia patients in the United States are dying due to patient care financial problem. Patient care financial problem has an impact on federal and national budgets. Nurses play a very big role in ensuring that patient care financial problems are integrated into the national and federal budgets by analyzing information that may be required for budget development (Luga & McGuire, 2014)

Health care cost: Heath insurance

Lack of health care insurance and high costs of prescription drugs are the most common patient care financial problems in today’s society. According to Saksena, Hsu and Evans (2014), health care coverage helps to protect patients from financial risks, and lack of it becomes a big burden for many populations. In addition, paying for health care through out-of-pocket payments prevents many people around the world from accessing care.

Although lack of health care insurance is a financial problem for patients, it is always associated with both non-financial and financial health-related impacts to public health. For instance, limited access to quality health care as a result of lack of health care coverage, results into negative health outcomes for the population. This is a good example of a non-financial impact associated with lack of health insurance (Luga & McGuire, 2014).

With regard to financial-related impact, an increase in disease burden among populations is of great financial impact to the public health sector, which must allocate additional funds to clear disease from the society (Saksena, Hsu and Evans, 2014).

The other financial problem that is related to patient care is high costs of prescription drugs. Many patients and their families really have to struggle in order to meet health care costs, especially medication costs. According to Walkom, Loxton, and Robertson, (2013) in a study conducted with the aim of assessing the impact of high medication costs on patients’ ability to adhere to prescription drugs, it has been discovered that 27 percent of participants from Australia and 36 percent of subjects from the United States tend to skip their drug doses because they are unable to purchase drugs which are charged at extremely high prices.

In addition, the need to purchase prescription drugs through out-of-pocket payments is one of the contributing factors to poor health among populations in today’s society (Luga & McGuire, 2014).

Lack of insurance as well as high costs of prescription drugs have an impact on federal and national budgets. This is because the government has to integrate health care costs into its budget to help low income earners to access care and to achieve improved health outcomes (Saksena, Hsu and Evans, 2014). According to Saksena, Hsu and Evans (2014), the number of uninsured citizens is on the rise in the United States because many people are reluctant to join available Medicare and Medicaid programs following increased uncertainties that continue to surround their use.

If the current trend persists, the federal government will be compelled to integrate patients’ health care costs into its budget in order to increase the percentage of United States citizens who receive quality care. As Kelley et al., (2015) explain, there is great need for the federal government to increase budget that it allocates for helping the society to manage chronic illnesses, considering the fact that chronic health conditions become more severe among the uninsured patients than among patients with health care coverage.

Similarly, high costs of prescription drugs have an impact on federal and national budget because the government has to increase its spending on these drugs to promote positive health among its population, especially the low income earners (Luga & McGuire, 2014).  

Nurses play a very crucial role in solving patient care financial problems because they are charged with the responsibility of analyzing public health information that is needed for budget development. The federal government depends on information collected by nurses regarding health care costs to make a decision on the most appropriate funds that should be allocated for patient care (Salmond and Echevarria, 2017).

In order to ensure that the right information is used for budget development, nurses must be sure to collect accurate and specific information as this will help the government to distinguish between funds that are allocated for health care coverage from those that are designated for prescription drugs. The staff nurse plays the role of collecting data directly from the community and presents it to the nurse manager.

The nurse manager analyzes the presented information and evaluates its relevance before passing it to the chief nurse. The chief nurse analyzes the information and forwards it to the agencies responsible for budget development, stating the reasons why it should be included in the budget (Salmond and Echevarria, 2017).

References

Kelley, A. S., McGarry, K., Georges, R. & Skinner, J. S. (2015). The burden of health care costs for patients with dementia in the last 5 years of life. Annals of International Medicine, 163(10): 729-736. doi: 10.7326/M15-0381.

Luga, A. O. & McGuire, M. J. (2014). Adherence and health care costs. Risk Management and Healthcare Policy, 7: 35-44. doi:  10.2147/RMHP.S19801

Salmond, S. W. & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1): 12-25.  doi:  10.1097/NOR.0000000000000308

Saksena, P., Hsu, J. & Evans, D. B. (2014). Financial risk protection and universal health coverage: Evidence and measurement challenges. PLoS Med, 11(9): e1001701. https://doi.org/10.1371/journal.pmed.1001701

Walkom, E., J., Loxton, D. & Robertson, J. (2013). Costs of medicine and health care: A concern for Australian women across the ages. BMC Health Services Research, 13: 484. doi:  10.1186/1472-6963-13-484

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Financial Management: Health Care Workers Compensation

Financial Management: Health Care Workers Compensation
Financial Management: Health Care Workers Compensation

Financial Management

Overview of the Financial Issue

While a reduction in compensation of health care workers may be influenced by organizational constraints, health care organizations may at times be compelled to trim workers’ wages and salaries due to poor financial management (Bai, Gu, Chen, Xiao, Liu, and Tang, 2017). The most recently reported financial management issue is a reduction in nurses’ compensation from 300 to 250 United States per month due to improper allocation of funds, which resulted in purchase of equipment that is not urgently needed by the organization. 

RacKol Health Care organization specializes in delivering cancer care to the community. The company has been experiencing a rapid rise in nurse turnover rates over the past two months. This has resulted in an increase in patient mortality rate from an average of 3 people week to 10 people every week. It is anticipated that the number of nurses who are leaving the organization is on the rise due to the recent reduction in their salaries that is majorly attributed to poor financial management (Dong, 2015).

To determine the actual cause of the financial issue, the Chief Finance Officer and the Senior Accountant have been interviewed, and they have been asked to share their opinions concerning a possibility of mismanagement of funds in the organization. The Chief Finance Officer is charged with the responsibility of preparing financial plans for the organization and for keeping records of those plans.

The Senior Accountant is responsible for compiling accounts information of the organization by checking whether there is a balance between assets and liabilities (Johns, 2013). According to the Chief Finance Officer and the Senior Accountant, the recent reduction in nurses’ compensation is solely attributed to improper allocation of funds during budgeting that made the organization to purchase cancer care equipment for pediatrics. The two interviewees have explained that the organization has tried to address the current issue for the past one month.

Finanacial Management: Measures that have Been Taken to Address the Issue

Officials in the finance department have taken two measures to address the financial management issue that is currently faced by RacKol Health Care. One of the measures is a move to align organizational plans with available funds without compromising the performance of health care workers. Initially, the health care organization did not take any actions to evaluate whether it has available funds to help it accomplish future financial plans.

Since they faced the challenge of compensating nurses, the Chief Finance Officer in collaboration with the Senior Accountant has begun to align future financial plans of the organization with available funds at any given time, as this helps the organization to only allocate funds to useful projects (Dong, 2015). The other measure that is currently implemented by the organization to prevent improper allocation of funds is involvement of departmental heads in financial decision-making.

Before the current financial issue, officials in the finance department did not involve heads of other departments in making financial decisions. As supported by Walsh (2016), involving departmental heads in financial decision-making facilitates proper allocation of funds because it prevents the purchase of equipment that is not urgently needed by the organization.

Future Steps that Have Been Planned to Address the Issue

RacKol Health Care is highly committed to ensuring that the current financial issue does not repeat itself in future. For this reason, officials in the finance department have documented a plan of how they will improve financial management in the organization over the coming months. For instance, they have a plan to hire an Information Technology professional with competent knowledge of data analytics.

The organization anticipates that with an expert in data analytics, it will be able to understand the specific financial needs of various departments and allocate funds based on the urgency of these requirements. In this manner, it will be able to avoid using funds to make purchases that are not urgently needed by the organization (Walsh, 2016).

Moreover, RacKol Health Care is planning to create a feedback loop that will allow free reporting between executives and the management. With a properly implemented feedback loop, executives on the finance department will be able to understand and strive to address concerns of various departments as far as quick financial allocation is concerned (Dong, 2015).

Potential Blocks in Resolving the Issue

 The Chief Finance Officer and senior accountant, however, foresee some problems that may prevent the organization from successfully addressing the financial issue that it is currently facing. One of the problems is the lack of motivation by departmental heads, which may make them to be reluctant to take part in financial decision-making and the creation of the feedback loop.

Moreover, these officials feel that heads of various departments in the organization may lack sufficient training on important issues related to financial management (Bai et al., 2017). Again, managers may lack knowledge and skills to apply in financial management due to unavailability of sufficient financial, managerial tools for use as a reference.

To mitigate these challenges, RacKol Health Care should train all heads of department on basic issues related to financial management. This will enable them to utilize the acquired knowledge and skills to prevent the occurrence of similar financial issues in future (Bai et al., 2017). Personal perception on the current financial issue is similar to the perception of those who are working on finances in the organization.

References

Bai, Y., Gu, C., Chen, Q., Xiao, J., Liu, D. & Tang, S. (2017). The challenges that head nurses confront on financial management today: A qualitative study. International Journal of Nursing Sciences, 4(2): 122-127. https://doi.org/10.1016/j.ijnss.2017.03.007

Dong, G. N. (2015). Performing well in financial management and quality of care: Evidence from hospital process measures for treatment of cardiovascular disease. BMC Health Services Research, 15: 45. doi:  10.1186/s12913-015-0690-x

Johns, M. (2013). Breaking the glass ceiling: Structural, cultural, and organizational barriers preventing women from achieving senior and executive positions. Perspectives in Health Information Management, 10(Winter): 1e.

Walsh, K. (2016). Managing a budget in healthcare professional education. Annals of Medical & Health Sciences Research, 6(2): 71-73. doi:  10.4103/2141-9248.181841

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