Week 8 Assignment NURS 6211: FINANCE AND ECONOMICS IN HEALTH CARE DELIVERY 2025

Assignment: Using Variance Analysis in Decision Making Having a budget is critical for the financial stability of an organization. Keeping track of how well the organization is actually adhering to the budget, and subsequent identification of why the budget numbers are being missed is equally important. Without this critical “why” piece, it is difficult to make the necessary adjustments to the budget or to organizational behavior that might be promoting overspending. A good budget is built with thoughtful consideration of future costs and revenue. Though your budget is formulated with expected figures in mind, the actual resulting values may vary considerably. This variance–from projected to actual–can be a pleasant surprise or a fiscal nightmare and can make financial decision making difficult. Fortunately, variance analysis can enable management to determine why variance occurred and what can be done to mitigate its effects. For those not comfortable with the use of Microsoft Excel, this week’s Optional Resources suggest several tutorials. To prepare: Review the information in this week’s Learning Resources dealing with variance analysis, how it is calculated, and how it can be used in decision making. View the video Week 8 Application Assignment Tutorial: Variance Analysis, provided in this week’s Learning Resources. Use the Week 8 Application Assignment Template , provided in this week’s Learning Resources, to complete this assignment. Carefully examine the information in each of the scenarios and provide the necessary calculations. Using this information will help you answer the questions. By Day 7 Note: For those Assignments in this course that require you to perform calculations you must: Use the Excel spreadsheet template for the Week 8 assignment Show all your calculations and formulas in the spreadsheet. Answer any questions included with the problems (as text in the Excel spreadsheet). A title and reference page are NOT needed in this assignment. Put your name and assignment at the top of the Excel spreadsheet. Use the Week 8 Application Assignment Template for the Week 8 assignment Salary Variance Scenario For this Assignment run a variance analysis. Based on the information you obtain: assess the results of the analysis, suggest potential causes of the budget variances and an explanation for addressing the situation. Using the following performance data calculate the volume adjusted labor rate variance and volume adjusted efficiency variance. Your Variable Expense Factor is 40% and your Volume Change Factor is 50%. Note: Submit the Excel spreadsheet containing your Salary Variance Scenario calculations to the Assignment submission link.

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NURS 6640 Week 11 Final Exam (2019) 2025

IMPORTANT: AFTER PURCHASE, OPEN THIS PAGE AGAIN AND SCROLL DOWN BELOW TO DOWNLOAD FILES WITH ANSWERS. A PMHNP is using Gestalt therapy to communicate with a 50-year-old patient who is going through a divorce. As he is calmly sharing the details of his divorce, the PMHNP notices that Dave is tapping his fingers on his legs. What is an appropriate response by the PMHNP using the technique of focusing? A 25-year-old female states, “I really need to lose weight. I know I’m the cause of our problems, if I could just lose weight he might be more attracted to me. Then we could start a family and we would be happy. I’m sure of it, right, we would definitely be happy!” Which statement shows the PMHNP’s ability to apply “summarizing”? As part of the PMHNP’s role in the clinic, the PMHNP oversees students that gain clinical experience at the agency. The student is instructed to use the supportive psychodynamic therapy approach with the patient. Which action made by the student causes the PMHNP to intervene, after observing the student interacting with the patient? A PMHNP is using motivational interviewing (MI) with a 50-year-old patient named Dave to commit to a healthy drug-free lifestyle. By using “change talk,” the PMHNP hopes to help the patient build self-esteem and hope. True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order for MI to be successful. The PMHNP is actively listening to Ms. Thomas who is detoxing from alcohol. Ms. Thomas is currently discussing with the PMHNP the reasons why she feels guilty about her drinking. Ms. Thomas tearfully states, “I have driven my family and friends away with this terrible habit. I have no one left. I had more than enough chances and now my children won’t even talk to me.” Which of the following statements demonstrate a simple reflection? A PMHNP is using Gestalt therapy to communicate with a 42-year-old patient who is upset with her mother. She says, “I want to tell her how hurt I feel when she doesn’t call me, but I don’t want to upset her.” What technique can the PMHNP use to help Sasha express herself? The PMHNP is meeting with an older, female adult patient and her daughter. The patient has early onset dementia. The daughter expresses concern, saying, “I don’t want you to just stick my mother in a home and give her medicine. I’m worried that’s what people are going to want to do.” What is the best response by the PMHNP to the daughter? The PMHNP meets with a 31-year-old woman who reports feeling as though she is “at her breaking point” with work. The PMHNP learns that the woman works 12-hour days, including one day on the weekend, because she is nervous about company layoffs. “I feel like I need to work myself to death in order to prove that I am valuable to the organization,” the woman says. Using the supportive psychodynamic therapy approach, how does the PMHNP respond? When preparing to terminate a patient, what does the PMHNP do to organize thoughts about the patient’s progress made during treatment? Linda is a 65-year-old patient who has completed initial treatment for alcohol addiction and anxiety problems. She is motivated to continue her treatment gains and have a healthy lifestyle. How would the PMHNP apply a mindfulness approach to this case? The PMHNP is caring for a young adult patient with whom the PMHNP decides to use a dynamic supportive therapy approach in addition to pharmacological intervention. Which therapeutic action will the PMHNP take to employ the strategy of holding and containing the patient? The PMHNP is caring for an adult male patient whose wife left him several months ago. He recently learned that his ex-wife is dating someone much younger. The man feels belittled, sad, and lonely. He talks about trying to meet other women, but says, “I can’t compete with the younger guys these days, with the cool clothes and the vegan diets. I’m bald and overweight, and what woman is going to want to be with me?” How does the PMHNP help raise the man’s self-esteem? A 43-year-old single mother is seeing the PMHNP at the request of her sister. “My sister thinks I need to come here to talk about my feelings,” the patient reports. The PMHNP learns that the patient has three children from three different men, but is unable to collect appropriate child support payments from any of the biological fathers. Additionally, the woman is barely able to afford her apartment or utilities payments. What is the appropriate response from the PMHNP when using the psychodynamic psychotherapy technique? The PMHNP has been providing interpersonal psychotherapy (IPT) for a patient who the PMHNP observes implementing new ways of being, such as interacting more with peers and being less isolated in social scenarios. The PMHNP understands that the patient is approaching termination. How does the PMHNP address termination with this patient? A PMHNP has been treating a 14-year-old patient using interpersonal psychotherapy. The patient has been depressed since the death of his grandmother. To help the patient recover, the PMHNP has told the parents: In the planning phase of change, a 42-year-old male client who struggles with gambling discusses how he plans to abstain from gambling. He tells the PMHNP, “I am no longer going to carry cash to the casino because you can’t spend what you don’t have.” The PMHNP uses an affirming communication skill when she states: The PMHNP is assessing a patient who has been receiving months of outpatient psychotherapy. According to the PMHNP’s assessment, the patient is nearing the termination phase of their therapeutic relationship because the patient’s symptoms have improved, and the patient shows progress managing behaviors and decision-making abilities according to the diagnosis. How does the PMHNP approach termination with this patient? The PMHNP is caring for a patient who is histrionic. Using the supportive psychodynamic therapy model, what is the best statement made by the PMHNP? A cocaine-addicted female patient is entering residential treatment for substance abuse. Using the 10 guiding principles of recovery, an appropriate step by the PMHNP is to ______________. A PMHNP is assessing a 40-year-old patient named Sarah who has a severe cocaine addiction and mild depression. Using the four-quadrant model, what would be the most appropriate setting to help the patient A 21-year-old patient has been having trouble adjusting to college life. She tells the PMHNP that she had five alcoholic drinks at a party this past weekend. She also acknowledges that she drank the same amount of alcohol at a party the previous month. Based on this information, what would the PMHNP most likely recommend? A PMHNP is using emotion-focused therapy to help a 38-year-old patient who says, “I’ve been feeling angry lately, but I’m not sure why.” The first attempt by the PMHNP is to say: The PMHNP uses the Adult Attachment Interview (AAI) with a male patient who reports having had a difficult time being separated from his parents during his childhood. He explains that going to school or visiting his relatives without his parents was troublesome. The PMHNP characterizes the patient as unresolved/disorganized, according to his outcomes on the AAI. What does the PMHNP anticipate from the patient? The PMHNP is interviewing a patient who is in the process of successfully completing a substance abuse program. During the interview, the patient states, “I wish I was strong enough to keep the same friends I had before I came here for treatment. I’m really afraid of being discharged because I’ll probably run into my old friends again.” The PMHNP offers a complex reflection when she states the following: A PMHNP is using interpersonal psychotherapy with a 40-year-old patient having relationship problems with his extended family. The patient shares that he has been using the strategies they identified to reduce his distress, but they have not been helping. He is frustrated and is considering stopping treatment. What would be an appropriate step by the PMHNP? An 8-year-old has been having trouble making friends at school. His parents initiated treatment when he also started acting out at home. Which is the most appropriate step that the PMHNP takes during the assessment process when using an integrated approach? The PMHNP is treating an older adult patient who reports symptoms of late-life anxiety. What type of treatment(s) will the PMHNP consider? The PMHNP is assessing a patient who requires cognitive behavioral therapy (CBT). Which of the following statements made by the PMHNP approach the termination phase for this patient? A patient’s depression is affecting her relationship with her spouse. What might the PMHNP ask during the initial sessions of interpersonal psychotherapy treatment? A PMHNP is treating a 10-year-old boy who is exhibiting signs of aggression and attention problems. What type of intervention will the PMHNP consider using a common elements approach? The PMHNP who practices motivational interviewing understands its relationship to patient behaviors and/or outcomes to mean which of the following? A PMHNP is treating a 12-year-old girl who witnessed the physical abuse of her sibling. She has been anxious and irritable since the experience. After speaking with the PMHNP, the patient says she keeps having anxiety-causing thoughts about the experience. Using the PRACTICE technique, which skill will best help the patient interrupt these negative thoughts? The PMHNP is working with a patient who describes having a painful and traumatic childhood experience, which causes her to have anxiety as an adult. When asked how she manages her anxiety, the patient dismisses it and denies that it is a problem. Using the supportive psychotherapy approach, the PMHNP will do which of the following when assessing the patient’s ego strength? The PMHNP uses therapeutic communication skills while ensuring that the patient understands that he has choices. The PMHNP comprehends and practices motivational interviewing. This is best understood as which of the following? While assessing a patient using a humanistic-existential approach, a patient tells the PMHNP, “For the past few weeks, I’ve felt anxious almost every single day.” What would be an appropriate next step by the PMHNP? The PMHNP is meeting with a patient who has been diagnosed with depression. The patient is having trouble adjusting to her new job and hasn’t made any new friends there. What would an appropriate response be by the PMHNP using the interpersonal psychotherapy approach? A 38-year-old patient tells the PMHNP that her father went to jail for selling drugs when she was a child. The patient is visibly upset when discussing what happened. Using a humanistic-existential approach to psychotherapy, which of the following is the most appropriate response by the PMHNP? The PMHNP is assessing an older adult male patient with depression and comorbidities. According to the medical chart, the patient takes medication to manage joint and bone pain. The patient reports feeling “forgetful” and complains that he has a hard time remembering where he puts things. What is the primary action by the PMHNP? A 35-year-old male patient is being treated for alcohol addiction. He asks for the PMHNP’s cell phone number to use in case of an emergency. When the PMHNP responds that giving her number would be against therapeutic rules, the patient threatens an act of violence to the therapist. What would be the most appropriate response by the PMHNP? The PMHNP is caring for a geriatric patient who expresses symptoms of gastrointestinal problems, aches and pains, and loss of appetite. The patient reports feeling lonely, as more of his friends have been passing away over the recent months and years. The PMHNP focuses on which therapeutic approach for this patient? A 12-year-old girl was referred for treatment after witnessing the physical abuse of her sibling by their mother. The patient has been anxious and irritable since the experience. What evidence-based treatment would be most appropriate for the PMHNP to use? The PMHNP uses the cognitive behavioral therapy model with Gerald, an older adult patient who is being treated for depression and mood disorder. What will the PMHNP do with the patient during the first three sessions? The PMHNP is initiating a plan of care for a patient who requires comprehensive psychotherapy to manage his depression and mood disorder. Throughout the initial sessions, the patient reports feeling as though he cannot be helped. The PMHNP is concerned about premature termination initiated by the patient. What strategy can the PMHNP employ to prevent or reduce premature termination? How does the PMHNP approach termination with the patient who has been receiving intermittent therapy? A PMHNP is treating a 25-year-old patient who has a compulsive urge to exercise to excess. When asked to describe why she does so much exercise, she says, “I like the compliments I receive from others on my new level of fitness, and the excitement of getting more attention.” The PMHNP can use feeling-state therapy to help Monique ___________. The PMHNP is assessing a 30-year-old client who reports feeling stressed out due to his current employment situation. When asked about how he manages this work-related stress, the patient says that exercise helps him feel less anxious, so he often spends 2 or more hours at the gym each night. After completing the patient assessment, the PMHNP has determined that an existential psychotherapy approach may best benefit this client. What is the PMHNP’s goal in employing this treatment approach? The PMHNP is interviewing a patient with a history of substance abuse. He has attempted to stop abusing drugs three times before. He states to the PMHNP, “I just cannot change. How can you help me?!” As it applies to change, the PMHNP understands the principle of evocation to mean: A PMHNP has been working with a 50-year-old patient who has a stressful job and goes to the casino on weekends to play poker with his friends, which he says relieves his stress. Tim admits that he sometimes misses work on Monday when he stays out too late at the casino on Sunday nights. In addition, he once was an avid runner, and has given up running to spend more time gambling. True or false: According to the PMHNP, the desired goal after treatment is not complete abstinence from gambling, but reaching a healthy level of the behavior. The PMHNP is caring for a patient who experiences depression caused by the traumatic experience of her dog passing away. She reports not being able to eat or sleep, and sometimes doesn’t want to leave the house at all. Which statement is most appropriate for the PMHNP to maximize the patient’s adaptive coping mechanisms? A 13-year-old patient and his parents are meeting with a PMHNP. When the PMHNP says hello, the boy just nods. His parents tell the PMHNP that he didn’t want to come to the session, but they insisted. They explain that their son has been moody and depressed at home, but is still getting good grades at school. Which of the following would be the best response by the PMHNP? The PMHNP is initiating a plan of care for Holly, a 73-year-old female patient who has late-life bipolar disorder and reports consuming alcoholic beverages four times per week. What is the focus of Holly’s therapy going to be? The PMHNP continues to meet with Gerald, who is the patient with depression and mood disorder. The PMHNP uses the CBT approach. Gerald is now meeting with the PMHNP for his fifth session and feels comfortable with how the therapy works. What does the PMHNP plan to do with Gerald over the course of the next several sessions? Mia is a 75-year-old patient who has completed initial treatment for depression. What might a PMHNP ask Mia when using a solution-focused therapy approach?

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pharmacology 2025

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs: · Synthroid 100 mcg daily · Nifedipine 30 mg daily · Prednisone 10 mg daily Write a 2-page paper that addresses the following: · Explain your diagnosis for the patient, including your rationale for the diagnosis. · Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. · Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

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Assessment 2: 2025

Create a 5–7 slide presentation (with detailed speaker’s notes) on how you would select, foster collaboration among, and educate a team dedicated to solving a diversity issue. Assessments 1 and 2 are scenario-based, so you must complete them in the order in which they are presented. Finding, organizing, and motivating teams is a key leadership skill as is the ability to communicate and present information. SHOW LESS By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: Competency 1: Apply qualities, skills and practices used by effective healthcare leaders. Outline goals and initial priorities that reasonably reflect the project. Competency 2: Apply practices that facilitate effective interprofessional collaboration. Outline a plan that effectively fosters interprofessional group collaboration. Competency 3: Apply ethical codes and diversity best practices in health care organizations. Define the composition of a team with characteristics that could effectively address a diversity issue. Describe the basic characteristics of a diverse and inclusive workplace. Explain the benefits of promoting and supporting diversity within an organization using scholarly resources. Competency 4: Produce clear, coherent, and professional written work, in accordance with Capella’s writing standards. Create an organized presentation that clearly communicates all specified content. Suggested Resources The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The NHS-FP5004 – Collaboration, Communication, and Case Analysis for Health Care Master’s Learners Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you. Assessment Example Assessment 2 Example [PPTX] . Diversity and Cultural Competence Diversity, inclusion, cultural competence must be a focus of all health care professionals. The following resources discuss the importance of diversity and the role of a leader. Dreachslin, J. L., Weech-Maldonado, R., Gail, J., Epané, J. P., & Wainio, J. A. (2017). Blueprint for sustainable change in diversity management and cultural competence: Lessons from the National Center for Healthcare Leadership diversity demonstration project . Journal of Healthcare Management , 62 (3), 171–183. Gotsis, G., & Grimani, K. (2016). Diversity as an aspect of effective leadership: Integrating and moving forward . Leadership & Organization Development Journal , 37 (2), 241–264. Downey, S. N., Werff, L., Thomas, K. M., & Plaut, V. C. (2015). The role of diversity practices and inclusion in promoting trust and employee engagement . Journal of Applied Social Psychology , 45 (1), 35–44. Debiasi, L. B., & Selleck, C. S. (2017). Cultural competency training for primary care nurse practitioners: An intervention to increase culturally competent care . Journal of Cultural Diversity , 24 (2), 39–45. Holck, L., Muhr, S. L., & Villesèche, F. (2016). Identity, diversity and diversity management: On theoretical connections, assumptions and implications for practice . Equality, Diversity and Inclusion: An International Journal, 35 (1), 48–64. Lawton, D. S., & Carlos Tasso, E. D. A. (2016). Diversity in the workplace and the impact of work values on the effectiveness of multi-generational teams . I-Manager’s Journal on Management, 10 (3), 20–28. Culture, Diversity, and Out-Groups in Leadership . Complete this survey to help identify your attitudes toward out-group members and to explore how you, as a leader, respond to members of the out-group. Leadership and Teambuilding The textbook references below provide information on team-building and collaboration. Rubino, L. G., Esparza, S. J., & Reid Chassiakos, Y. S. (2020). New leadership for today’s health care professionals: Concepts and cases (2nd ed.). Burlington, MA: Jones & Bartlett Learning. Available in the courseroom via the VitalSource Bookshelf link. Chapter 7, “Building a Successful Team.” Chapter 9, “Collaborative Leadership.” PowerPoint Review the following PowerPoint template if you need practice in creating presentations. PowerPoint Presentation Template and Instructions . Assessment Instructions Overview In this assessment you will continue your work on the project by creating a 5–7 slide PowerPoint presentation for the diversity project kickoff meeting. Preparation View the PowerPoint Presentation Instructions for guidelines and hints for an effective presentation. Download the PowerPoint Template found in the resources and use it to complete this assessment. Scenario Imagine that Lynette follows up with you in an e-mail shortly after reading your views on leadership and collaboration: Hi, Thanks for sending me your thoughts last week on the diversity issue at the clinic. Your next step is to select a team of professionals who can help you in this project and prepare an introduction of the project for a first meeting with them. I want you to prepare a presentation to serve as a brief, but substantive introduction for the first meeting with a group of 4–5 members who will participate on the committee tasked with addressing the diversity issue. Once I review more information about the proposed team I can help you with the recruitment. The presentation should be 5–7 minutes and use 6–8 slides with detailed speaker’s notes so I can understand your approach. Not a lot of time or space, so keep things pretty high level. Do the following: Briefly outline the project goals and highlight 2–3 of the initial priorities to be addressed by the group. Also, explain why they are important. Explain the composition of the team and why you chose them. Note that you will not know the exact individuals yet, but assume we will recruit the people with the desired qualities and characteristics that you outline in the presentation. Consider the following: Include a group of professionals you believe can help define the problem and ultimately make recommendations on how to address it. Make sure each member is either trained in, sensitive to, or has experience with the concept of workplace diversity. Give some thought to having some members from outside the organization. Provide member profiles: their diversity, qualifications, experience, internal versus external, and so forth. Explain your role and describe how the committee will work together and achieve effective interprofessional collaboration. Describe how the group will communicate. How and when they will meet. Describe how ideas will be shared and decisions made. Describe roles, group function, and structure. Describe the basic characteristics of a diverse workplace. Provide a convincing argument regarding the benefits of a diverse workforce using support from current research. Thanks, Lynette Instructions Create a 5–7 slide presentation in response to the content defined in the above scenario and submit it in the courseroom. Presentation Guidelines Length: 5–7 PowerPoint slides (not including title slide) that would accompany an approximately 5-minute oral presentation. Notes: Prepare detailed speaker’s notes describing items on each slide so that the viewer can accurately interpret the deeper meanings and intentions that would have been conveyed orally. Support your claims, arguments, and conclusions with credible evidence from 2–3 current, scholarly or professional sources. Visuals: Create visuals that are easily read and interpreted. Use colors, fonts, and formatting and other design principles that make the information clear and generally add to the aesthetic of the presentation. Please refer to the scoring guide for details on how your assessment will be evaluated. Note: Your instructor may use the Writing Feedback Tool when grading this assignment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.

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Organizational Policies and Practices to Support Healthcare Issues 2025

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations. For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care? In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue. To Prepare: Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1. Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined. By Day 3 of Week 3 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 the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples. By Day 6 of Week 3 Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described. Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message. The main discussion will need at least 3 references and also in APA 7 format The two discussions below will need at least three references all in APA 7 format each Thomas discussion Competing needs in the world of healthcare exist on a number of levels including the national level and also at the most local levels. I normally work on a COVID free orthopedic unit that focuses mostly on diabetic amputations, elective joint replacements and surgeries following orthopedic trauma. Initially during the pandemic, we halted our elective surgeries which was consistent with national guidelines (Diaz et al., 2020). As numbers stabilized, we began elective surgeries again, but recently we have seen numbers of COVID cases increase locally. In the past few weeks, we have started taking on more medical/surgical patients in order to make room for COVID patients on other medical surgical floors. The competing needs in this situation include the needs of the hospital in terms of freeing up beds for COVID patients, staffing needs on my unit as we are taking on more patients, and also resources that we need in order to care for this new group of patients. The competing needs of the hospital in this case with regard to caring for COVID patients and also caring for other medical surgical patients resulted in a policy change on my unit. The policy change in this case was our switch from a unit that cared for orthopedic patients only to one that was more inclusive of other medical/surgical patients. The stressor that I selected for the previous discussion was care of the elderly. One area of conflict that I constantly see is the desire of family members to provide care for patients in the home when they are unable to fully meet the needs of the patient. Some patients require 24 hour care and unfortunately many families are not able to fully provide that care. Caring for the frail elderly in the home is often preferred. However, informal care providers are often presented with the challenges of self-care, educating themselves about how to provide care, finding additional support, and a lack of societal recognition for the role that they play in healthcare (Plöthner et al., 2019). Despite the best efforts of family members and assistance from home care services, the level of care is still lacking, which places the patient at risk for declining health status. The competing need in this instance is the medical needs of the patient, competing with the ability of the family to provide those services or at least set up home care. A review by Hirschman and Hodgson (2018) identified several evidence-based approaches that may help to delay transition of care to skilled nursing facilities among patients with dementia. Programs such as the New York University Care Giver Intervention, Goals of Care intervention, MIND at home and Partners in Dementia Care help families to obtain the skills and resources required to provide adequate care to the dementia population in the home setting. The overarching theme is that while competing needs do exist in this area, education can help to reduce the burden on families and possibly help them to achieve the goal of home care for their loved ones. Fortunately, policies are in place that prevent elderly patients from living at home when they are unable to receive adequate care. Recently I worked with at patient that suffered from severe dementia and his wife and children were working very hard to get approval to have him stay at home as opposed to being discharged to a skilled nursing facility. The patient is still on our unit, but it is questionable how the scenario will play out. At this point, a hearing is pending to determine if the patient requires a conservator. In the state of Connecticut, a conservator of the person is assigned to individuals determined to be unable to competently care for themselves. The conservator of the person is responsible for all matters including those related to finances and healthcare (“Conservatorships,” n.d.). Policy in this case will overrule the desires of the family to keep the patient at home and ultimately, the patient will be placed in the appropriate care environment. Conservatorships. (n.d.). Retrieved from https://www.ctprobate.gov/Pages/Conservatorships.aspx. Diaz, A., Sarac, B. A., Schoenbrunner, A. R., Janis, J. E., & Pawlik, T. M. (2020). Elective surgery in the time of COVID-19. The American Journal of Surgery, 220(2), 300-302. Retrieved from https://www.americanjournalofsurgery.com/article/S0002-9610(20)30218-X/pdf. Hirschman, K. B., & Hodgson, N. A. (2018). Evidence-based interventions for transitions in care for individuals living with dementia. The Gerontologist, 58(suppl_1), S129-S140. https://doi.org/10.1093/geront/gnx152. Plöthner, M., Schmidt, K., De Jong, L., Zeidler, J., & Damm, K. (2019). Needs and preferences of informal caregivers regarding outpatient care for the elderly: A systematic literature review. BMC geriatrics, 19(1), 82. https://doi.org/10.1186/s12877-019-1068-4. Bill’s discussion Organizational Policies and Practices to Support Healthcare Issues Competing Needs Competing needs can have a significant impact on the development of policy. This is mainly because the policy’s primary objective is to align with the needs (Tinetti et al. 2019). Therefore, in cases where there are competing needs, such as the needs of the patients, workforce, and resources, policy development can be challenging. For example, a policy to ensure the efficiency of service needs to consider the issue of nurses’ workload, stress, and burnout. Therefore, the policy would be required to address burnout, anxiety, and workload before proposing efficient health care strategies. Specific Competing Need Quality is a specific competing need in health care that affects nurse burnout. In health care organizations, nurses are expected to provide high-quality service that ensures the client’s safety and satisfaction (Saban et al. 2019). However, the issue of nurse burnouts in different health organizations affects this need. Thus, despite being expected to deliver high-quality services, the nurses could be limited to various problems such as stress and lack of motivation due to burnout. The significant impacts of the competing needs include medical errors, nurse turnover, depletion of organization resources, and patient dissatisfaction. A high nurse turnover would require the organization to invest in new hires, which often require comprehensive training before adapting to the organization’s culture. Due to the stress and exhaustion associated with burnouts, the nurses will deliver lo quality services, which can result in increased errors and patient dissatisfaction. How Policy Address the Issue A policy can address these issues by ensuring that the nurses and the patient’s needs are addressed. In most cases, the nurses’ needs are a prerequisite to meeting patients’ needs. Nurses satisfied with their work will often be motivated, thus delivering high-quality work as observed by De Simone et al. (2018). In this case, the policy should address the nurse’s issues, such as reduced workload and shift hours to reduce burnout cases. This will, in turn, reduce the turnover rates as well as improve patient satisfaction rates. References De Simone, S., Planta, A., & Cicotto, G. (2018). The role of job satisfaction, work engagement, self-efficacy and agentic capacities on nurses’ turnover intention and patient satisfaction. Applied Nursing Research , 39 , 130-140. Saban, M., Dagan, E., & Drach-Zahavy, A. (2019). The relationship between mindfulness, triage accuracy, and patient satisfaction in the emergency department: A moderation-mediation model. Journal of Emergency Nursing , 45 (6), 644-660. Tinetti, M. E., Naik, A. D., Dindo, L., Costello, D. M., Esterson, J., Geda, M., … & Kang, G. (2019). Association of patient priorities–aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Internal Medicine , 179 (12), 1688-1697.

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