Client Questions

Provide 1000 words APA written summary of at least two peer reviewed article related to electronic medical health records including a short history background. a. Make sure you provide the name of article and tittle b. Succinctly explains the article content c. Within your summary; explain why you choose this article? d. Explain some of the implications of electronic medical health records in nursing. Follow proper APA format and style and include a cover page, reference page, and any applicable tables or appendices.

Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.Discussion Prompt [Due Wednesday]Select ONE of the questions listed below and create a substantive initial post. Please post the question number you chose in the title of your post. (i.e. Question 1 DV)   Review the American College of Obstetrics and Gynecology website for recommendations on domestic violence screening. Identify two risk factors and describe some clinical signs you may observe in the woman who is experiencing intimate partner violence. What are the health indicators and concerns for a teen or woman who is the victim of sexual exploitation? What resources are available in your state or county to assist you if you suspect a patient in your care is being exploited?

Select a global health issue affecting the international health community. Briefly describe the global health issue and its impact on the larger public health care systems (i.e., continents, regions, countries, states, and health departments). Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues.  Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question. Due Date: Thursday 24

Discuss why nutrition is a central component in health promotion. What are some of the nutritional challenges for emerging populations? What roles do nutritional deficiency and nutritional excess play in disease?

Describe how your future practice as an advanced practice nurse can promote access to health care in your area. Be specific about the interventions that you will do?

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy.  Then, describe any specific competing needs that may impact workplace violence in healthcare.  What are the impacts, and how might policy address these competing needs?  Be specific and provide examples.

Respond to the post bellow, using one or more of the following approaches: Ask a probing question, substantiated with additional background information, and evidence. Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives. Offer and support an alternative perspective using readings from  the classroom or from your own review of the literature in the Walden  Library. Validate an idea with your own experience and additional sources. Make a suggestion based on additional evidence drawn from the readings or after synthesizing multiple postings.                                                                                  Data Collection  Data  collection methods vary greatly depending on the research question and  the type of participants, regardless of chosen methodology, data  collection must be rigorously executed to produce high-quality data.  Similarly, instruments to collect data must provide accurate, concise,  and provide quantifiable data from which clinical meaning can be  extrapolated and subsequently applied to effect improvements in  practice. In this case, research aims to assess patient satisfaction,  from the patient’s perspective. Polit & Beck (2017), report that  structured self-report instruments are widely used by nurse researchers,  and are typically formatted as either questionnaires or interviews.  Surveys provide several advantages. In comparison to interviews, they  are cost-effective, maintain the anonymity of respondents, mitigate  interviewer bias, and can be easily administered using computer  technology. Disadvantages to surveys include low response rates;  typically around 50%, exclusion of certain populations such as the  elderly and children, questions may lack depth, or be ambiguous or  confusing causing respondents to skip them altogether (Polit & Beck,  2017) Survey Instrument  Low  response rate remains a primary barrier in survey administration and  efficacy. However, when surveys are personally distributed in a  particular setting, in this case, the primary care clinic, response  rates are significantly higher. Moreover, the personal nature of a  survey tool being directly distributed to respondents has a positive  effect on participants (Polit & Beck, 2017). Keough and Tanabe  (2011) contend that although the data collected through surveys is not  as scientific as data obtained through experimentation, it is  nonetheless important and informs nursing practice. Because the clinic  is interested specifically interested in understanding the patients’  point of view, I assert that a self-report survey tool should be  designed using a Likert-type rating scale. The range of responses  available to the participants provides greater insight compared to a  simple closed-ended question. Moreover, rating scales are easy to  complete and are also efficient. However, because people may  misunderstand the concept of the Likert Scale, instructions and  statements should be clear and concise (Polit & Beck, 2017). Sampling Methodology and Participant Selection              I would employ a consecutive sampling methodology; this includes  recruiting all accessible and eligible participants over a  pre-determined time-period (Polit & Beck, 2017). There is no  specific formula for sample size. Martínez-Mesa, Bastos, Bonamigo, and  Duquia (2014) assert that sample size can be thought of in tiers. The  largest tier represents the entire population; in this case, 10,000  patients. The target population is the portion of the total population  who are of interest to the study. In this case, we would exclude very  small children or patients who are cognitively impaired. Finally, the  study population includes those who will be included in the research  (Martínez-Mesa, Bastos, Bonamigo, & Duquia, 2014).  To  optimize response rates, and to increase validity and reliability, the  survey will be administered in quarterly increments over a year.  Therefore, the target population will be all 10,000 patients. Of the  target population, it would be reasonable to assume that some patients  will not want to fill out the questionnaire and that others will be  excluded. The study population will aim to include 7,500 patients. All  eligible participants will be asked to fill out a paper and pencil,  self-administered, survey when they check into the clinic for an  appointment. This will allow adequate time for participants to complete  the survey before seeing their provider. Results will be calculated  every quarter and once at the end of the year for comparison. This  schedule will facilitate detection of variations in patient satisfaction  throughout the year, and help to identify specific variables such as  inadequate staffing that contributed to the results.    Survey Questions  Participants  will be asked to rate declarative statements using will be using the  Likert rating scale. A bipolar continuum will assess varying degrees of  satisfaction to the statements regarding patient satisfaction. The  participants will be asked to rate the following items: 1.) 1. Convenience of office hours:  o Excellent o Very Good  o Good o Fair o Poor  2.) 2. Ease of making an appointment: o Excellent o Very Good  o Good o Fair o Poor  3.) 3.  Promptness in seeing your provider: o Excellent o Very Good  o Good o Fair o Poor  4.) 4. Friendliness of staff: o Excellent o Very Good  o Good o Fair o Poor  5.) 5.  Clarity of medical instructions provided: o Excellent o Very Good  o Good o Fair o Poor  6.) 6.  Overall comfort of the office: o Excellent o Very Good  o Good o Fair o Poor  7.) 7. Help provided understanding insurance coverage: o Excellent o Very Good  o Good o Fair o Poor  8.) 8. Answers provided to address questions: Excellent  Very Good   Good  Fair  Poor   9. My overall satisfaction is: Excellent  Very Good   Good  Fair  Poor   10. Likeliness to recommend the clinic to others: Excellent  Very Good   Good  Fair  Poor  The  statements are brief, clear, and each statement identifies just one  issue. The rating scale is reflective of satisfaction rather than  agreement or importance.  Reliability and Validity  With  regard to validity, it is important to consider the content of the  survey. Items should be relevant, comprehensive, and balanced (Polit  & Beck, 2017). I believe the statements chosen address the  components of content validity. Internal validity of the survey tool is  enhanced through content validity and further enhanced by the anonymous  nature of the self-administered survey tool provided by office  personnel. The external validity is strengthened by the size of the  study population, and the quarterly implementation which provides data  for comparison. The quarterly administration schedule will also provide  statistical validity.  Reliability  concerns consistency over time (Polit & Beck, 2017). This can be  challenging when measuring patient satisfaction. Patients may be more or  less satisfied from day to day. Test reliability occurs with the  “administration of the same measure to the same people on two occasions”  (Polit & Beck, p. 303, 2017). Internal consistency occurs when the  same person provides the same results (Polit & Beck, 2017). Because  participants will visit the clinic multiple times during the year, they  will fill out the survey more than once, thereby strengthening test  reliability and internal consistency. If a sample is homogenous,  reliability is decreased (Polit & Beck, 2017). This survey will be  administered to a diverse group, increasing reliability. Because patient  satisfaction is an essential quality metric, its importance should not  be underestimated. The utilization of a self-administered survey tool on  a rolling quarterly basis is cost-effective and reliable.   References  Keough, V., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing Research. Journal of Nursing Regulation,1(4),  37-44. Retrieved from  https://class.waldenu.edu/bbcswebdav/institution/USW1/201950_27/MS_NURS/NURS_5052/readings/USW1_NURS_5052_Keough  2011.pdf. Martínez-Mesa,  J., González-Chica, D. A., Bastos, J. L., Bonamigo, R. R., &  Duquia, R. P. (2014). Sample size: how many participants do I need in my  research?. Anais brasileiros de dermatologia, 89(4), 609–615. doi:10.1590/abd1806-4841.20143705 Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

List 8  PROGRESS NOTES in SOAP format of the   Psychiatric Mental Health Nurse Practitioner Role  with  Child and Adolescents  . Describe the   activities you completed during this   time   period with patients. NOTE: ( The progress notes has to be related with what the      Psychiatric Mental Health Nurse Practitioner do with Child and      adolescents with different psychiatric conditions). 8 different  notes     with different patients scenarios.

Professional Association Membership Examine the importance of professional associations in nursing. Choose a professional nursing organization that relates to your specialty area, or a specialty area in which you are interested. In a 750-1,000 word paper, provide a detailed overview the organization and its advantages for members. Include the following: Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or “perks,” of being a member. Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses. Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.  Discuss opportunities for continuing education and professional development. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.  References:   Explore the Advocacy page of the American Nurses Association (ANA) website. URL:https://www.nursingworld.org/practice-policy/advocacy/    Read Chapter 5 in Dynamics in Nursing: Art and Science of Professional Practice. URL:https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/dynamics-in-nursing_art-and-science-of-professional-practice_1e.php this is the chapter 5     By June Helbig “… nurses provide services that maintain respect for human dignity and embrace the uniqueness of each patient and the nature of his or her health problems, without restriction with regard to social or economic status.” (American Nurses Association, n.d.a, para 1) Essential Questions What significance does joining a professional organization have on nursing practice? How can nurses contribute to legislative changes that impact nursing practice and patient outcomes? Why is evidence-based practice (EBP) the gold standard in patient care protocol improvements? Introduction According to the American Nurses Association (ANA) there are currently 3.6 million registered nurses in the United States (American Nurses Association [ANA], n.d.b, para 12). The ANA is a professional nursing organization, which began when fewer than 20 nurses attended a convention in 1896. Nurses at the time were concerned with nursing practice standards and nurse competency. The ANA has since grown into an organization with interests in improving health care and setting standards for nursing practice. All nurses are represented regardless of status within the organization. The goal of professional organizations is to support nurses and improve the profession (ANA, n.d.c). This chapter will explore the significance of joining professional organizations and how nursing can contribute to legislative changes that may affect patient outcomes as well as the work environment of the nurse. Professional nursing organizations are responsible for the development and certification of nurses interested in improving health care and providing safe quality nursing care. Through participation in professional organizations, nurses can actively contribute to legislative changes that can affect patient care and the way they conduct their work. Nurses are continually looking for and exploring new ways to provide patients with quality care. Nurses perform studies looking for new and innovative ways to provide care. The use of evidence-based practices (EBP)has become the gold standard for providing safe, quality care to patients. Standards applied to nursing care include: ANA’s Standards of Practice The Joint Commission’s National Patient Safety Goals (NPSGs) Structured communication tools Integrated health care priorities Quality and Safety Education for Nurses (QSEN) Social determinants of health Cultural competence Healthcare and Research Quality Act of 1999 Standards of Nursing Practice Standards of practice are rules and regulations that guide the nursing practice. The Nurse Practice Actis a law in each state regulating nursing practice. The National Council of State Boards of Nursing (NCSBN), founded in 1978, requires the licensed registered nurse (RN) to have specialized knowledge, skill, and independence in decision making. Originally, the NCSBN was part of the American Nurses Association Council of the State Boards of Nursing. The NCSBN was created to protect the public from incompetent or unlicensed health care personnel. “The NCSBN has the responsibility of providing regulatory excellence for public health, safety and welfare, and protecting the public by ensuring that safe and competent nursing care is provided by licensed nurses” (National Council for State Boards of Nursing [NCSBN], n.d.a, para. 1). Information about licensure is available from each state’s board of nursing as well as from Nursys. Nursys “is the only national database for verification of nurse licensure, discipline and practice privileges for RNs and LPN/VNs licensed in participating boards of nursing, including all states in the Nurse Licensure Compact” (Nursys.com, n.d., para 1). ANA’s Standards of Practice In addition to the rules and regulations that govern nursing practice, the ANA wrote the Standards of Practice, which are used along with the state Nurse Practice Act to guide safe practice. It is important for the RN with a Bachelor of Science in Nursing (BSN) degree to be aware of the rules and regulations that govern nursing. The standards of practice describe a competent level of nursing practice demonstrated by the critical-thinking model known as the nursing process (Bickford, Marion, & Gazaway, 2015). National Patient Safety Goals The National Patient Safety Goals (NPSGs) were established in 2002. The purpose of the NPSGs was to address concerns about patient safety raised by a report from the Institute of Medicine (IOM). The IOM is a Quality Health Care in America committee, which is a division of the National Academies of Science, Engineering, and Medicine. To Err Is Human The report, To Err is Human: Building a Safer Health System (Institute of Medicine [IOM], 1999) was a result of two major research studies that found that approximately 98,000 people died each year from medical errors (see Table 5.1). The IOM discovered that these patient deaths were not a result of individual errors, but from a decentralized and fragmented health care system. “Among the problems that commonly occur during the course of providing health care are adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities” (IOM, 1999, p. 1). The IOM also found that many of these errors occurred in areas such as operating rooms, intensive care units, and emergency rooms (IOM, 1999). Table 5.1 Types of Errors Diagnostic Treatment Preventive Other Error or delay in diagnosis Failure to employ indicated tests Use of outmoded tests or therapy Failure to act on results of monitoring or testing Error in the performance of an operation, procedure, or test Error in administering the treatment Error in the dose or method of using a drug Avoidable delay in treatment or in responding to an abnormal test Inappropriate (not indicated) care Failure to provide prophylactic treatment Inadequate monitoring or follow-up of treatment Failure of communication Equipment failure Other system failure Note. Adapted from To Err Is Human: Building a Safer Health System Report Brief, by the Institute of Medicine, 1999, p. 2. Copyright 1999 by the Institute of Medicine. The IOM committee developed four recommendations to lead the way to making healthcare safer. The first recommendation called for the creation of a National Center for Patient Safety within the U.S. Department of Health and Human Service’s (HHS) Agency for Healthcare Research and Quality (AHRQ). This designated organization would be responsible for establishing NSPGs and tracking their progress. The second recommendation was to create a mandatory reporting system to collect data regarding medical errors. This provided the IOM with a way to track errors and information to prevent future errors and harm. The third recommendation called upon patients, healthcare professionals, and accreditation groups to put pressure on healthcare organizations to provide a safer environment for patients. The only way to find errors within a system is to report errors and then investigate how and why the error occurred. An error causing an adverse event could have been a patient safety event or an error in documentation. No matter the reason for the adverse event, stopping its cause is paramount. The IOM (1999) report focused on errors that occurred in health care organizations that lead to patient deaths. Analysis of reported errors has revealed many hidden dangers, such as near misses, dangerous situations, and deviations or variations that point to system vulnerabilities, not intentional acts of clinician performance that may eventually cause patients harm (Wolf, 2008). Part of providing quality care is to be aware of events that could occur and could cause harm. Pressure was applied in the creation of quality indicators, which are measurements of the delivery of quality care. For example, it has been decided the development of hospital-acquired pressure ulcers is a direct indicator of poor care delivery. A patient receiving quality care should never develop a pressure ulcer. So, each month, every organization must report whether any patients developed a pressure ulcer. If so, the organization might not receive the monetary incentive for quality care delivery provided by HHS and Centers for Medicare & Medicaid Services (CMS). Organizations able to prove that zero patients acquired pressure ulcers would receive the monetary incentive. The last recommendation was to build a culture of safety. “Creating and sustaining a culture of safety would require actions by thousands of health care organizations. Hospital leadership must provide resources and time to improve safety. The organizational culture must encourage recognition and learning from errors” (Donaldson, 2008, p. 5). It is important for all RNs to participate in building and maintaining a culture of safety while working. Those in leadership positions must lead by example in maintaining a culture of safety. Health care organizations must change and adopt new ways of providing patient care while maintaining a culture of safety. New ways of providing safe care have been developed and are still being developed by conducting studies and finding new and innovative ways for RNs to provide safe, quality care. Hospitals must report errors and explore why errors occurred and what they can do to prevent errors from reoccurring. Safety is now a hospital’s priority. The Joint Commission In 2002, The Joint Commission (TJC) established the NPSGs. Health care organizations now have indicators, which are measured to assure a culture of safety. The group that developed the NPSGs was composed of nurses, physicians, and other health care professionals who had first-hand knowledge and experience regarding patient safety. They identified a wide variety of patient safety issues. This group is known as the Patient Safety Advisory Group. They work closely with TJC to continue identifying ongoing issues (The Joint Commission [TJC], 2017). When issues are found by TJC, the organization must develop action plans to correct any deficiencies that were found and report back to TJC regarding any changes that were implemented. Many times, committees composed of multidisciplinary health care professionals are formed to find solutions for the problems associated with the deficiencies. These deficiencies become the foundation for new safety procedures and regulations that were adopted to correct TJC’s findings. Crossing the Quality Chasm In 2001, the IOM published Crossing the Quality Chasm: A New Health System for the 21st Century, which has shaped the future of health care. Again, the IOM’s report found that many patients died in the hospital while receiving care. The IOM believed there was not only a gap in health care that contributed to unnecessary patient deaths but a chasm. Contributing to the problems faced by a rapidly changing system because of advancements in technology and medicine, people were living longer. Living longer leads to an increase in chronic conditions such as heart disease, respiratory illnesses, and diabetes (IOM, 2001). “Crossing the Quality Chasm: A New Health System for the 21st Century focuses on how the health system can be re-invented to foster innovation and improve the delivery of care” (IOM, 2001, p. 2). The report discussed six goals for improvement, which included safety, providing effective medical care, providing patient-centered care in a timely, efficient, and equitable way. The hope was for patients to receive care that was delivered in a safe and reliable environment producing healthier, satisfied patients. As a result, Congress established the Health Care Quality Innovation Fund. The committee listed 10 general rules to follow while redesigning the health care system to achieve safer, patient-centered care (see Table 5.2). Most of what is expected from the BSN-prepared nurse focuses on providing safer, quality care. Knowing the 10 general rules prepares the nurse for the expectation of care. Table 5.2 Ten Rules for Redesign Rule Explanation Care is based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits. Care is customized according to patient needs and values. The system should be designed to meet the most common types of needs but should have the capability to respond to individual patient choices and preferences. The patient is the source of control. Patients should be given the necessary information and opportunity to exercise the degree of control they choose over health care decisions that affect them. The system should be able to accommodate differences in patient preferences and encourage shared decision making. Knowledge is shared and information flows freely. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information. Decision making is evidence-based. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place. Safety is a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors. Transparency is necessary. The system should make available to patients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction. Needs are anticipated. The system should anticipate patient needs, rather than simply react to events. Waste is continuously decreased. The system should not waste resources or patient time. Cooperation among clinicians is a priority Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care. Note. Adapted from Crossing the Quality Chasm: A New Health System for the 21st Century Report Brief, by the Institute of Medicine, 2001, p. 3-4. Copyright 1999 by the Institute of Medicine. The reports published by the Institute of Medicine (1999; 2001) both focused on building a safer health care system by providing a culture of safety to provide patient-centered care (see Figure 5.1). The IOM defines patient-centered care as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions” (IOM, 2001, p. 3). Figure 5.1 Patient-Centered Care fullscreenClick here to enlarge Note. Adapted from “A 2020 Vision of Patient-Centered Primary Care,” by K. Davis, S. C. Schoenbaum, and A. Audet, 2005, Journal of General Internal Medicine, 20(10), 953-957. Copyright 2005 by the Journal of General Internal Medicine. Goals Set in Response to Reports As a part of the IOM reports, the Joint Commission established the first set of the NSPGs in 2002. Initially, there were six goals for the health care system to implement and 11 recommendations by the Patient Safety Advisory Group. By implementing these very specific changes to the health care system, patient care would be safe, and there would be fewer hospital-related deaths. Table 5.3 National Safety Patient Goals Implemented in 2003 Goal 1 Improve the accuracy of patient identification. Goal 2 Improve the effectiveness of communication among caregivers. Goal 3 Improve the safety of using high-alert medications. Goal 4 Eliminate wrong-site and wrong patient procedure surgery. Goal 5 Improve the safety of using infusion pumps. Goal 6 Improve the effectiveness of clinical alarm systems. Note. Adapted from “Special Edition: JCAHO Patient Safety Goals 2003,” by the National Center for Patient Safety, 2002, Topics in Patient Safety (TIPS), 2(5), p. 2-10. Copyright 2002 by the National Center for Patient Safety. Many NSPGs are well known by RNs because the goals have become a part of everyday practice. To have no hospital-acquired pressure ulcers, central-line infections, and catheter-associated urinary tract infections are three of the goals for hospitals to achieve. As BSN-prepared nurses, it is important to be knowledgeable and lead other RNs to practice and comply with the standards set forth for patient safety and professional practice. Providing a patient-centered health care experience for the patient is what health care is all about. Having baccalaureate-prepared RNs who are educated regarding the NPSGs will help ensure a culture of safety. Many of the NPSGs have not changed significantly from what they were in 2003. The goals continue to change and evolve toward providing a culture of safety as new evidence is brought forward. There was another national campaign at the time that focused on providing quality care and ensuring a safe patient environment. The 100,000 Lives Campaign was introduced by the Institute for Healthcare Improvement (IHI). This campaign’s goal was to decrease morbidity and mortality caused by medical errors nationally. The IOM has continued to focus on improving health care and the health care system. With each new report comes new and innovative ways to build a safer system. In 2010, the IOM and the Robert Wood Johnson Foundation published The Future of Nursing: Leading Change, Advancing Health, which contained four recommendations to advance the practice of nursing: “Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and information infrastructure” (National Academies of Science Engineering Medicine, 2015, para. 2). The importance of these four recommendations affect every nurse. Nurses will now be expected to practice to the full extent of their education and training. Nurse practitioners will be major providers of health care. Becoming a BSN-prepared nurse fulfills the second recommendation of achieving higher levels of education and engaging in lifelong learning. Nurses are now working as members of the health care team in a multidisciplinary environment by partnering with physicians and other health care professionals. Structured Communication Tools Structured communication is using a consistent format when providing information. Effective communication was one of the areas the IOM established as an area in need of improvement so hospitals could provide a culture of safety in which patients could receive safe care. In 2008, TJC identified effective communication as one of its NSPGs (Dunsford, 2009). Communication failures were found to result in loss of life. This goal targeted communication not only between physician and patient, but also between patient and all other health care professionals. ISBAR In 2002, a group of clinicians revised a tool used by the U.S. Navy for standardizing urgent communication in nuclear submarines (Marshall, Harrison, & Flanagan, 2008) into an effective communication tool for health professionals, which is now known as SBAR communication. Situation: Opening statement to describe the current situation Background: History about the current situation Assessment: Information found upon assessment Recommendation: What the person is requesting to be done The IHI, established in 1991 to focus on quality improvement in health care, promotes using SBAR for patient safety. The IHI (Institute for Healthcare Improvement [IHI], n.d.a) states the SBAR method of communication “allows for an easy and focused way to set expectations for what will be communicated and how it will be communicated between members of the team, which is essential for developing teamwork and fostering a culture of patient safety” (para. 3). Structured communication is an efficient and accurate method for interdisciplinary communication, which promotes a culture of safety. SBAR communication is now a widely accepted form of communication when nurses are communicating information to physicians, such as a change in the patients’ condition or reporting newly acquired laboratory values or test results. The letter I, standing for identification, is a recent addition to the SBAR tool. When employing ISBAR communication, nurses should identify themselves before any information is shared, so information is not given to the wrong person. BSN-prepared nurses are responsible for ensuring proper communication occurs between the physician and other members of the health care team. Table 5.4 ISBAR Definition Example Identification To provide your name to the receiver of information Good morning, Dr. Pasquale. This is Gina calling with information regarding Mr. Enrico. Situation Opening statement to describe the current situation Mr. Enrico is requesting pain medication for his back pain. Background History about the current situation Mr. Enrico is a 62-year-old male who was involved in a motor vehicle accident three hours ago. Assessment Information found upon assessment Mr. Enrico is complaining of severe back pain from his lower back down his left leg. B/P is 170/90, heart rate 112, and respirations are 24. He is afebrile. He has no visible injuries to his back. Recommendation What the person is requesting to be done I am requesting pain medication for my patient Mr. Enrico. Note. Adapted from SBAR Tool: Situation-Background-Assessment-Recommendation, by the IHI, n.d. Copyright n.d. by the IHI. Universal Protocol Another form of structured communication is the Universal Protocol for preventing surgery from being performed on the incorrect patient or on the incorrect site. It also prevents incorrect procedures from being performed on patients. According to the AHRQ (Agency for Healthcare Research and Quality [AHRQ], n.d.), “wrong-site surgery occurred at a rate of approximately 1 per 113,000 operations between 1985 and 2004. In July 2004, The Joint Commission enacted a Universal Protocol that was developed for preventing wrong-site, wrong-procedure, and wrong-person surgery” (para. 1). Protecting surgical patients is one of the NSPGs and is called time-out. Time-out was developed to protect the patient from harm when undergoing any procedure. The Universal Protocol starts with a preprocedure checklist to verify the correct patient, the correct procedure, and the correct site. If possible, the patient should be included in this process. The patient, along with the provider, will mark the site where surgery is being done with a marker to assure that the surgery is performed on the correct side. The time-out includes all members of the procedure team, including the physician, nurse, anesthesiologist, and any other active participants in the procedure. When the time-out begins, all members of the team must immediately stop what they are doing and pay attention to the team member who is completing the time-out duties. During the time-out, the team must all agree they have the correct patient, the correct site marked for surgery, and the right procedure to be performed on the patient. The institution where the surgery is being performed may include more verifications. At the end of the time-out, proper documentation must also be completed in the electronic health record (TJC, n.d.). Many times, it is the BSN-prepared nurse who will start the time-out process for the team. Integrated Health Care Priorities Patient safety and patient-centered care are two priorities of America’s health care system. One focus of patient care is for health professionals to start providing care in the community by educating the public about prevention of disease and illness. By providing education to the patient, the BSN-prepared nurse may prevent hospital readmissions and keep the patient healthy and at home. Health and wellness have become the priority of many health care providers. The National Center for Complementary and Integrative Health (NCCIH) is the “Federal Government’s lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” (National Center for Complementary and Integrative Health [NCCIH], 2017, para. 1). The NCCIH hopes to find new and innovative ways to provide health care by combining conventional medicine with alternative nonpharmacologic therapies. The NCCIH is conducting research to discover alternative therapies that will promote wellness and prevention (see Table 5.5). Nonpharmacologic therapies are important for the professional nurse to know so alternatives to pain medications can be suggested. The opioid problem in the United States contributes to the need for nonpharmacological alternatives. Table 5.5 Most Common Nonpharmacologic Therapies Example Example Natural Products Most Common Deep Breathing Yoga, Tai Chi, or Qi Gong Chiropractic or Osteopathic Manipulation Meditation Massage Special Diets Homeopathy Progressive Relaxation Guided Imagery Least Common Note. Adapted from “Complementary, Alternative, or Integrative Health: What’s in a Name?” by the National Center for Complementary Care and Integrative Health, 2017b, paras. 12-13, Copyright 2017 by the National Center for Complementary Care and Integrative Health. Quality and Safety Education for Nurses (QSEN) The Quality and Safety Education for Nurses (QSEN) project was started in 2005 and is funded by the Robert Wood Johnson Foundation. “The Quality and Safety Education for Nurses (QSEN) project addresses the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continuously improve the quality and safety of the health care systems within which they work” (QSEN Institute, 2017, para. 1). QSEN has been able to provide educators with information about the numerous quality competencies necessary for nurses to possess in a prelicensure program, as well as RNs who are furthering their education to become baccalaureate-prepared nurses and advanced practice nurses. QSEN also works on providing the KSAs for nurses to provide safe, competent care by educating nurse educators to provide these skills to nursing students. QSEN supports nursing to work within a multidisciplinary environment and to include ancillary services such as social work and case management to be active participants in ensuring patient-centered care. QSEN is also involved in the knowledge, skills, and attitudes for the advanced practice nurse and in strategies to promote curriculum quality. To do this, QSEN provides a repository of information for KSAs, teaching strategies, and faculty development. QSEN is available to any nursing school across the country. QSEN supplies the school with consultants who can help with program planning and curriculum development. Social Determinants of Health Social determinants are both internal and external aspects of a person’s life; from diet and lifestyle to income and geographical location. People must be responsible for their health and, therefore, responsible for everything that affects their health. Nurses must educate the public on health, prevention, and wellness, but it is truly the decision of the person to determine whether to act upon what has been taught. People must be active participants in their own health and engaged in preventative health practices. Factors such as environment and access to health care will affect the health of the patient (see Figure 5.2). The combination of genetics and lifestyle will define and dictate a person’s health during his or her lifetime. Figure 5.2 Social Determinants of Health fullscreenClick here to enlarge Note. Adapted from “Social Determinants of Health,” by HealthyPeople.gov, 2018b, Office of Disease Prevention and Health Promotion, paras. 8-9. Copyright 2018 by the Office of Disease Prevention and Health Promotion. When someone is hospitalized, the goal of the health care system is to provide individualized patient-centered care. Part of the nurses’ responsibility in caring for these patients is to provide instruction on medications, lifestyle changes, and preventive measures to remain healthy and avoid readmission. Each decision regarding compliance with medications and follow-up visits with physicians will affect patients’ health status. The goal of health care professionals is to keep the public safe while hospitalized and educate upon discharge to prevent readmission to the hospital. It is important for patients to be discharged to a safe environment and to be knowledgeable about illness and the medications that were prescribed. With education, rehospitalization rates should decrease, and the patient can continue to receive health care in the community. People need to be active participants in health to live a long and healthy life. Self-management programs focusing on day-to-day management of chronic diseases have been shown to improve health behaviors and health status significantly. Patient education significantly improves compliance with medication across a broad range of conditions and disease severities (Gold & McClung, 2006). Table 5.6 Examples of Social and Physical Determinants Examples of Social Determinants Examples of Physical Determinants Availability of resources to meet daily needs (e.g., safe housing and local food markets) Access to educational, economic, and job opportunities Access to health care services Quality of education and job training Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community) Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) Residential segregation Language/Literacy Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media) Culture Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change) Built environment, such as buildings, sidewalks, bike lanes, and roads Worksites, schools, and recreational settings Housing

I need an essay for Drug Addiction class, the paper need to be in APA stile, with a minimum of 10 references. Please follow the following instructions carefully. 1-Investigate about the different types of treatment for patients with drug abuse substance and explain in two or three sentences each treatment. 2-Choose one of this type of treatment and argument the reason why this type of treatment if effective.  3-For the treatment you have chosen argument the following: A)- Philosophy of the program (If the treatment is in patient or outpatient) B)- Clinical psycho therapeutics modalities to use in this type of treatment, for example:( medicines, nutrition, social worker, conductual orientation) C)-Time the patient should be in the chosen program to achieve the results. D)-How many times is going to be seen this patient, by the doctor during the program. (treatment frequency) E)-Through which laboratory exam are we going to monitor this patient (for example: urine test, breathalyzers, or blood test), chose only one test. F) Explain why we selected this specific test.  G)-Why we think the treatment program we choose may be successful. H)-With the information collected do a graphic organizer to show this treatment.