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Change within the healthcare setting is inevitable and as a nurse leader understanding how change occurs and strategically determining the change process or model needed to best suit the needs of the change is a valuable skill to possess.  In this situation a change is needed surrounding the current organizational structure at a facility.  This situation indicates that there is an in-proportionate number of leaders to staff creating a “top heavy” environment where multiple people are in charge of a single unit(s).  This type of a change consists of organizational restructuring and can create threats to decision-making strategies, including information flow, relationships, and priority setting (Spiers, Lo, Hofmeyer, & Cummings, 2016).  Restructuring the organizational structure will create a feelings of uncertainty among staff and this type of change should be mapped out and well communicated to ensure a smooth transition.  With a top heavy scenario the goal of the organizational restructuring is to ultimately create a more streamlined and direct line of authority, eliminate any duplicate leaders and flatten out the line to reduce the expense.  

The three change models discussed could theoretically all be used in this scenario however the one I opted to implement is the PDSA model of change.  This scenario requires a rapid change in organizational structure and Kotter and Roger’s are by design a more slow measured change process.  This organizational restructure requires a plan of action which is restructuring the leadership or reducing the number of leaders within each unit/department.  The plan is then implemented by restructuring leadership or by eliminating excessive leadership in order to create a more direct line of authority and lessen the redundancy of leaders.  If a alteration of the plan is needed upon further eval then the cycle continues.  Flattening out the leadership or reducing the number of leaders is difficult but must be done in a precise manner, enacted upon evaluated and then adjusted if needed.  Kotter and Rogers change models could be applied here but in my opinion the PDSA model and the quick four cycle process works best to implement a rapid change in leadership that is needed in this scenario.  

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 Develop a three to five-page paper excluding references using one of the following topics or issues.  Use five to ten peer reviewed or reputable references to support your paper.  Wikipedia references will not be accepted.   Here are the paper options   According to Robert Wood Foundation, Medicaid paid 62.3 percent of the total U.S. cost of long-term care in 2011, or $131.4 billion. From this statistics, it is clear Medicaid paid disproportionate share of long-term care.  What alternate sources of funding for LTC care?  You can propose new sources.  Given the sensitivity of living wills and advanced directives, should health care facilities continue to be forced to discuss them with patients? Or should patients be required (subject to exceptions) to have it prepared before ever getting hospitalized or resident in health care facilities? Baby boomers and the generations after them are more educated and technologically more savvy, and economically well off than the generations before them. Is the current LTC model sufficient to take care of them or should LTC redefine itself to accommodate the needs of them?  There is no right or wrong answer, just take a position and convincingly support your views. Is Long-term Care Insurance worth it? Given the cost of premium and sometimes limited benefits over limited time, is the assurance work it or should there be LTC care payroll deduction just like Medicare over an adult working life? Is the quality of care in LTC associated with low resources and low staffs pay? 

• Type of paper Essay (Any Type)
   
• Subject Healthcare
   
• Number of pages 7
   
• Format of citation APA
   
• Number of cited resources  5
   
• Type of service  Writing
   

Identify an  effective health care organization that utilizes information technology.   •Analyze the components and requirements of its information systems  technology program. •Explain the requirements for health care information technology systems  to comply with federal, state, and local laws governing patient  information security. •Assess the risks and affected stakeholders in the event of a system  breach or failure, and recommend approaches that can be used to  safeguard confidential information.

Create a research question related to nursing (to be used for this discussion question only). Identify the independent and dependent variables. Next, create a hypothesis or set of hypotheses to go along with your research Question. Identify your hypothesis as one of each of the four categories below and explain why your hypothesis fits into these categories:

1. Associative or causal

2. Simple or complex

3. Nondirectional vs directional

4. Null vs research

Answer critical Thinking question #2 for chapter 6 on page 180. Answers should be submitted in word document with any associated references used

1 E.Coli was incubated with aeration in a nutrient medium containing two carbon sources, and the following growth curve was made from this culture

A) Explain what happened at the time marked x

B) Which substrate provided “better” growth condition for the bacteria? How can you tell?

2  Assume that after washing your hands you leave ten bacterial cells on a new bar of soap. You then decided to do a plate count of a soap after it was left in soap dish for 24 hours. You dilute one gram of the soap 1:106 and plate it on heterotrophic plate count agar. After 24 hours of incubation, there are 168 colonies. How many bacterial were on the soap? How did they get there?

3) Heat lamps are commonly used to maintain food at about 50 degree C for as long as 12 hours in cafeteria serving lines . The following experiment was conducted to determine whether this practice poses a potential health hazard.

Beef cubes were surface-inoculated with 500,000 bacterial cells and incubated at 43-53degree C to establish temperature limits for bacterial growth. The following results were obtained from heterotrophic plate counts performed on beef cubes at 6 and 12 hours after incubation.