A company’s culture is often buried so deeply inside rituals, assumptions, attitudes, and values that it becomes transparent to an organization’s members only when, for some reason it changes.
—Rob Goffee

Culture is embedded within every organization. Yet, because culture is woven throughout the everyday interactions and atmosphere of an organization, it can be difficult to assess and explain how the culture influences the inner workings of the organization.

As a nurse leader-manager, developing a sound understanding of an organization’s culture can help you to achieve quality improvement initiatives and identify strategies for enacting sustainable change.

For this Discussion, you analyze the culture of an organization and consider how this relates to achieving goals related to quality improvement. You may wish to focus on the same organization that you have selected for your Course Project.

To prepare:

• Review the information on organizational culture in this week’s Learning Resources.
• Reflect on the culture of an organization with which you are familiar. Consider the following:
  • What elements of the organization’s culture seem most prominent or significant to you?
  • What beliefs, dispositions, and/or actions seem to be most valued? Why do you think so?
  • What do you notice about the expectations, assumptions, and more demonstrated among people within the organization?
  • What artifacts provide clues about the culture?
  • How do these cultural elements contribute to or detract from the organization’s ability to meet prominent goals and objectives?
• Consider how you, as a nurse leader-manager, could apply your knowledge of this culture to facilitate quality improvement initiatives within this organization. How would you leverage the strengths of the culture, and address limitations or obstacles that may arise within it?
•  Post an analysis of the culture of the organization that you selected. Explain how you think this particular culture contributes to or detracts from the organization’s ability to meet goals. Explain how you, as a nurse leader-manager, could utilize your knowledge of this culture to facilitate quality improvement initiatives within this organization. 

  

Logistic Regression in Nursing Practice

To prepare:

Review the three articles in this week’s Learning Resources and evaluate their use of logistic regression. Select one article that interests you to examine more closely in this Discussion

Critically analyze the article you selected considering the following questions:

What are the goals and purposes of the research study the article describes?

How is logistic regression used in the study? What are the results of its use?

What other quantitative and statistical methods could be used to address the research issue discussed in the article?

What are the strengths and weaknesses of the study?

How could the weaknesses of the study be remedied?

How could findings from this study contribute to evidence-based practice, the nursing profession, or society?

Post 4 paragraph that addresses the following:

1.In the first line of your posting, identify the article you examined, providing its correct APA citation.

2. Post your critical analysis of the article as outlined above.

3.Propose potential remedies to address the weaknesses of each study.

4.Analyze the importance of this study to evidence-based practice, the nursing profession, or society.

Provide 3 references

1.Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

Chapter 24, “Using Statistics to Predict”

2. Statistics and Data Analysis for Nursing Research

Chapter 9, “Correlation and Simple Regression” (pp. 208–222)

3. Select One Article from below for your assignment discussion: 

Hoerster, K. D., Mayer, J. A., Gabbard, S., Kronick, R. G., Roesch, S. C., Malcarne, V. L., & Zuniga, M. L. (2011). Impact of individual-, environmental-, and policy-level factors on health care utilization among US farmworkers. American Journal of Public Health, 101(4), 685–692. doi:10.2105/AJPH.2009.190892

Tritica-Majnaric, L., Zekic-Susac, M., Sarlija, N., & Vitale, B. (2010). Prediction of influenza vaccination outcome by neural networks and logistic regression. Journal of Biomedical Informatics, 43(5), 774–781. doi:10.1016/j.jbi.2010.04.011

Xiao, Y., Griffin, M. P., Lake, D. E., & Moorman, J. R. (2010). Nearest-neighbor and logistic regression analyses of clinical and heart rate characteristics in the early diagnosis of neonatal sepsis. Medical Decision Making, 30(2), 258–266. doi:10.1177/0272989X09337791

Go to the AHRQ website and find the most current version of the national Healthcare Quality and disparities report.

Read the executive summary, and brows the rest of the report

Read articles on patient safety under content.

Based on your brief review and reading, summarize the state of healthcare quality and disparities in the United States in one or two paragraphs?

 NR 507 Week No. 5 Discussion:

 

PART No. 1:

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

  

Sodium (Na+) 

156 mEq/L H

Potassium (K+)

4.0 mEq/L N

Chloride (Cl–)

115 mEq/L H

Arterial blood gases (ABGs)

pH- 7.30; Pco2-40; Po2-70; HCO3-20

METABOLIC ACIDOSIS with respiratory compensation, High anion gap

Normal values

Sodium (Na+)

136-146 mEq/L

Potassium (K+)

3.5-5.1 mEq/L

Chloride (Cl–)

98-106 mEq/L

Arterial blood gases (ABGs)

pH- 7.35-7.45

Pco2- 35-45 mmHg

Po2-80-100 mmHg

HCO3–22-28 mEq/L

• List      three (3) reasons on why she may have become bed ridden? 
• Flu?      Pneumonia? 
• Based      on these reasons what tests would you order? 
• Accu      check? CXR? Lactic Acid level, serum and urine ketone levels
• Describe      the molecular mechanism of the development of ketoacidosis. (p. 744) *Pt’s      who develop DKA do so bc bicarbonate buffering does not occur, which      begins the development of metabolic acidosis

pH 7.30 = acid

CO2 40 = Normal

O2 70 = Low

HCO3 20 = acid

PART No. 2:

A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. The vomiting has become more frequent this past week and he is beginning to lose weight.

• Write      three (3) differential diagnoses at this time?
• Is      there any genetic component to the top of your differentials?
• What      tests would you order?

PART No. 3:

Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis?

PEER:

NR 507 Week No. 5 Quiz:

1. Aldosterone synthesis and secretion are primarily regulated by the (Points : 2)

2. A surgical individual just arrived on the unit from the postanesthesia care unit. This person’s respirations are 4 per minute and shallow. As the nurse calls for assistance, the person suddenly feels jittery and breathing quickens. Which of the following feedback loops is operating for the nurse in this situation? (Points : 2)

3. What effect does aldosterone have on fluid and electrolyte imbalances? (Points : 2)

4. What effect does hyperphosphatemia have on other electrolytes? (Points : 2)

5. Where is oxytocin synthesized? (Points : 2)

6. Which mineral is needed for the synthesis of thyroid hormones? (Points : 2)

7. The portion of the pituitary that secretes oxytocin is the _____ pituitary. (Points : 2)

8. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of a _____ effect by a hormone. (Points : 2)

9. Which of the following hormones acts on its target cell via a second messenger? (Points : 2)

10. Target cells for parathyroid hormone (PTH) are located in the (Points : 2)

11. Which hormone is involved in the regulation of serum calcium levels? (Points : 2)

12. A person who has experienced physiologic stresses will have increased levels of which hormone? (Points : 2)

13. The first lab test that indicates type 1 diabetes is causing the development of diabetic nephropathy is (Points : 2)

14. A deficiency of which of the following may result in hypothyroidism? (Points : 2)

15. Diagnosing a thyroid carcinoma is best done with (Points : 2)

16. The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute (Points : 2)

17. Which of the following clinical manifestations is not common to both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS)? (Points : 2)

18. The signs of thyroid crisis resulting from Graves disease include (Points : 2)

19. What causes the microvascular complications of clients with diabetes mellitus? (Points : 2)

20. A man with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, there is no change in his polyuria. These are indications of (Points : 2)

21. Amenorrhea, galactorrhea, hirsutism, and osteopenia are each caused by a (Points : 2)

22. The most common cause of hypoparathyroidism is (Points : 2)

23. The level of thyroid-stimulating hormone (TSH) in Graves disease is usually (Points : 2)

24. The most probable cause of low serum calcium following a thyroidectomy is (Points : 2)

25. Hyperpituitarism is generally caused by (Points : 2) 

Discussion: Integrating PHRs Into EHR Platforms

When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history.

As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.

Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.

In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.

To prepare:

• Review the media Patient-Centered Technologies, and reflect upon Dr. Simpson’s statements about the ownership of patient data.
• Review the article, “Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
• Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?

By Day 3

Post a brief description of your selected benefit (I choose Promoting data use or Promoting responsibility) or challenge and support your selection. Explain the potential impact on health care professionals and patients.

APA Style, 600 characters minimum (not including the reference on this 600 words count)

 

As I write above, I choose Promoting data use or Promoting responsibility one of those. 

Required Readings

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
Review Chapter 1, “Historical Perspectives of Nursing Informatics”
In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records. 

Chapter 25, “Care Delivery Across the Care Continuum: Hospital-Community-Home”
Chapter 25 analyzes the impact of home health on the health care system. The chapter explains the current level of home health technology and how the Patient Protection and Affordable Care Act (PPACA) changes this aspect of health care. 

Chapter 44, “Initiation and Management of Accessible, Effective Online Learning”
This chapter explores the past and present perspectives of distance education, important teractive electronic tools and essential strategies for the online learner. 

Chapter 45, “Social Media in the Connected Age: Impact on Healthcare Education and Practice”
The focus of this chapter is on the evolution of the Internet, mobile tools and the use of social media in healthcare education. 

Chapter 35, “Consumer/Patient Engagement and eHealth Resources”
As access to health care information increases, patients are becoming more informed about and engaged in their health. This chapter discusses current trends in health care, including patient empowerment, consumerism, and widespread use of computers and technologies for health.

Crilly, J. F., Keefe, R. H., & Volpe, F. (2011). Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems. American Journal of Public Health, 101(7), 1163–1167.
Retrieved from the Walden Library databases.

The authors of this article describe technologies that have been used to increase access to health care for underserved populations. The authors present strategies, benefits, and challenges of addressing this issue, and they provide examples of successful programs.

Walker, J., Leveille, S. G., Ngo, L., Vodicka, E., Darer, J. D, Dhanireddy, S., … Delbanco, T. (2011). Inviting patients to read their doctors’ notes: Patients and doctors look ahead: Patient and physician surveys. Annals of Internal Medicine, 155(12), 811–819.
Retrieved from the Walden Library databases.

In this article, the authors discuss the results of their study on the outcomes of allowing patients to read their doctors’ notes. The study highlights the benefits of sharing notes with patients and how doing so can promote better outcomes.

Wynia, M., & Dunn, K. (2010). Dreams and nightmares: Practical and ethical issues for patients and physicians using personal health records. Journal of Law, Medicine & Ethics, 38(1), 64–73.
Retrieved from the Walden Library databases.

The authors of this article highlight the primary uses and benefits of personal health records (PHRs) as an electronic health record (EHR) tool. In addition, the article presents an overview of practical and ethical issues that may emerge from integrating PHR components into EHR systems.