Competency

Apply statistics to different quality methods in healthcare.

Course Scenario

Chaparral Regional Hospital is a small, urban hospital of approximately 60 beds, and offers the following:

• Emergency room services
• Intensive care
• Surgical care
• Obstetrics
• Diagnostic services
• Some rehabilitation therapies
• Inpatient pharmacy services
• Geriatric services and
• Consumer physician referral      services

Recently, the CEO has been hearing complaints from both patients and staff. You have been hired to design and implement a Quality Improvement Plan to help uncover quality problems and satisfactorily resolve them.

Scenario Continued

Your CEO has requested that you provide employee training on Quality Improvement. You have done an initial survey of patient satisfaction, and the CEO has asked you to explain how the data will be analyzed, using this initial data.

Given the variety of complaints coming from both employees and patients, it is critical for everyone to understand the importance of conducting the survey and obtaining solid data. 

Instructions

You are to create an agenda for the training and a memo with bullet points to present the statistical analysis of the initial data. The memo should include an explanation of each of the statistical results. In particular, you should be able to explain what the results mean to the facility.

Determine the percentages of the following:

• Percent who responded with a 5      (Great) on “Overall impression of the visit”
• Percent who responded with a 2      (Fair) or 1 (Poor) on “Overall impression of the visit”
• Percent who responded with a 5      (Great) on “Willingness to return”
• Percent who responded with less      than 5 on “Willingness to return”
• In the area of “Facility and      Convenience,” which indicator had the highest percentage of 5 (Great)      responses? Which had the lowest?
• In the area of “Staff,”      which indicator had the highest percentage of 5 (Great) responses? Which      had the lowest?

What is the mean waiting time in the reception area?

What is the mean waiting time to see a healthcare professional?

Microsoft Word has many memo templates. In your memo, be sure to address each statistical analysis and what it means to the facility. Why ask these questions? How could the data be used for quality improvement?

NOTE – APA formatting, and proper grammar, punctuation, and form required.

Please answer the following Discussion Question.  Please be certain to answer the three questions on this week DQ and to provide a well-developed and complete answer to receive credit. 

Case Study, Chapter 3, Developing Effective Leaders to Meet 21st-Century Health Care Challenges

An experienced registered professional nurse has just been promoted as the nurse manager of a nursing unit. The nurse had been a very effective leader on the unit prior to the promotion of becoming the nurse manager. The new nurse manager is making a list of essential characteristic of effective leaders.

1. What are factors that are driving the need for innovative and transformational leaders in health care for the 21st century?

2. What are essential characteristics of an effective leader that the new nurse manager needs to incorporate into the nursing unit culture?

3. The nurse manager is reviewing the strengths and weaknesses of three leadership models: transactional, transformational, and complexity. What are the essential characteristics of the three leadership models? Which model do you think is most effective to use in leading a nursing unit? Why?  

In this Assignment, you will continue developing your Academic Success and Professional Development Plan by appending the original document you began in the previous Assignment to develop the second component—academic resources and strategies. To accomplish this:

• Identify and describe at least three academic resources or strategies that can be applied to the MSN program
• Identify and describe at least three professional resources that can be applied to success in the nursing practice in general or your specialty in particular
• Explain how you intend to use these resources, and how they might benefit you academically and professionally.

Complete the following:

• Amish case study
• Jewish Case study #1
• JEWISH CASE STUDY #1
  Selecting a “typical” Jewish cl
  ient is difficult. An ultra-Or
  thodox Jew has a particular set
  of special needs. Yet, it is more common
  to see a Jew who is a middle-of-the-road
  Conservative.
  Sarah is an 80-year-old woman who is
  a first-generation American. She was
  raised in a traditional Conservative home. Her husband died after 50 years of a strong
  marriage. She has three children. Although her home is not kosher, she practices a
  variation of kosher-style eating, avoiding por
  k and not making dishes that combine
  meat and milk.
  Two months ago, she was diagnosed w
  ith pancreatic cancer. Surgery was
  attempted, but the cancer was already in an advanced stage. Chemotherapy was started,
  but the cancer has progressed and is not re
  sponding to the medications. She is having
  difficulty eating because of the pressure of
  the tumor on the gastrointestinal tract.
  Discussions are being held to determine
  whether or not treatme
  nts should be stopped
  and whether hospice care should be initiated.
  Her hospital room is always filled with visitors.
  Study Questions
  1.    What must you anticipate in discussi
  ng with Sarah her wi
  shes regarding the
  continuation of medical care?
  2.    How would you respond to
  her initial decision to ha
  ve surgery and initiate
  chemotherapy?

  3.    What questions do you need to ask in
  the initial patient interview to assess her
  degree of religious practice? How will
  you determine her spirituality needs?
  4.    What is your understanding of the reas
  on she has so many visitors in her room?
  5.    Is hospice care appropriate for this patient?
  6.
    Sarah dies with her family at her bedsid
  e. What interventions can you take at the
  time of death to demonstrate religious sens
  itivity to the family? What questions do
  you need to ask the family?
  7.    Describe three genetic or heredita
  ry diseases common with Ashkenazi Jews.
  8.    Describe Jewish burial
  rituals and grieving process.
  9.    Discuss the laws of Kashrut in regard to
  food practices for observant Jewish clients.
  10.
  What should the health-care provider keep
  in mind when entering a Jewish home to
  provide care?
  11.   Distinguish between the terms
  Sephardic
  and
  Ashkenazi
  .
  12.   How might a non-Jewish and a Jewish cowo
  rker share holidays in the workforce?
  13.   What is the official language
  the Jewish people use for prayer? 

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AMISH CASE STUDY
Elmer and Mary Miller, both 35 years old, liv
e with their five children in the main
house on the family farmstead in one of th
e largest Amish settlements in Indiana.
Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’
cottage. Mary is the youngest of their ei
ght children, and when she married, she and
Elmer moved into the grandparents’ cottage
with the intention that Elmer would take
over the farm when Aaron wanted to retire.
Eight years ago, they traded living space.
Now, Aaron continues to help with
the farm work, despite increasing pain in hi
s hip, which the doctor advises should be
replaced. Most of Mary’s and Elmer’s sibli
ngs live in the area, though not in the same
church district or settlement. Two of Elmer’s brothers and their families recently
moved to Tennessee, where farms are less expensive and where they are helping to
start a new church district.
Mary and Elmer’s fifth child, Melvin,
was born 6 weeks prematurely and is 1
month old. Sarah, aged 13, Martin, aged
12, and Wayne, aged 8, attend the Amish
elementary school located 1 mile from thei
r home. Lucille, aged 4, is staying with
Mary’s sister and her family for a w
eek because baby Melvin has been having
respiratory problems and their physician told
the family he will need to be hospitalized
if he does not get better within 2 days.
At the doctor’s office, Mary suggested
to one nurse, who often talks with Mary
about “Amish ways,” that Menno Martin, an
Amish man who “gives treatments,” may
be able to help. He uses “warm hands” to
treat people and is
especially good with

babies because he can feel what is wrong. Th
e nurse noticed that Mary carefully placed
the baby on a pillow as she prepared to leave.
Elmer and Mary do not carry any hea
lth insurance and are concerned about
paying the doctor and hospital bills associat
ed with this complicated pregnancy. In
addition, they have an appointment for Wayne
to be seen at Rile
y Children’s Hospital,
3 hours away at the University Medical Cent
er in Indianapolis, for a recurring cyst
located behind his left ear. Plans are being
made for a driver to take Mary, Elmer,
Wayne, Aaron, Annie, and two of Mary’s sist
ers to Indianapolis
for the appointment.
Because it is on the way, they plan to stop in
Fort Wayne to see an Amish healer who
gives nutritional advice and does “treatment
s.” Aaron, Annie, and Elmer have been
there before, and the other women are considering having treatments, too. Many
Amish and non-Amish go there and tell others
how much better they feel after the
treatments.
They know their medical expenses seem minor in comparison to the family
who last week lost their barn in a fire
and to the young couple whose 10-year-old child
had brain surgery after a fall from the hayl
oft. Elmer gave mone
y to help with the
expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s
sisters will help to cook for the barn raisi
ng, but Mary will not help this time because
of the need to care for her newborn.
The state health department is concer
ned about the low immunization rates in
the Amish communities. One community-health nurse, who works in the area where
Elmer and Mary live, has volunteered to talk
with Elmer, who is on the Amish school
board. The nurse wants to learn how the health
department can work more closely with

the Amish and also learn more about what
the people know about immunizations. The
county health commissioner thinks this is a wast
e of time and that what they need to do
is let the Amish know that they are creating
a health hazard by ne
glecting or refusing
to have their children immunized.
Study Questions
1.
Develop three open-ended questions or
statements to guide you in your
understanding of Mary and Elmer and what
health and caring mean
to them and to
the Amish culture.
2.    List four or five areas of perinatal
care that you would want to discuss with Mary.
3.    Why do you think Mary placed the baby
on a pillow as she was leaving the doctor’s
office?
4.     If you were the nurse to whom Mrs. Mill
er confided her interest in taking the baby
to the folk healer, what would you do to le
arn more about their simultaneous use of
folk and professiona
l health services?
5.     List three items to discuss with the M
illers to prepare them fo
r their consultation at
the medical center.
6.    If you were preparing the reference fo
r consultation, what would you mention about
the Millers that would help to promote cu
lturally congruent ca
re at the medical
center?
7.    Imagine yourself participa
ting in a meeting with state
and local health department
officials and several local physicians and nur
ses to develop a plan to increase the

immunization rates in the
counties with large Amish
populations. What would you
suggest as ways to accomplish this goal?
8.
Discuss two reasons why many Old Orde
r Amish choose not to carry health
insurance.
9.
Name three health problems with genetic
links that are prevalent in some Amish
communities.
10.
How might health-care providers use the
Amish values of the three-generational
family and their visiting patterns in pr
omoting health in the Amish community?
11.   List three Amish values to consid
er in prenatal education classes.
12.
Develop a nutritional guide for Amish wome
n who are interested in losing weight.
Consider Amish values, daily lifestyl
e, and food production and preparation
patterns.
13.   List three ways in which Amish express caring.

APPALACHIAN CASE STUDY #1
William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an
isolated rural area of northern Appalachia
to Denver, Colorado, because of Gloria’s
failing health. Mrs. Kapp has had pulmonary t
uberculosis for several years. They decided
to move to New Mexico because they heard that the climate was better for Mrs. Kapp’s
pulmonary condition. For an unknown reason, they stayed in Denver, where William
obtained employment making machine parts.
The Kapp’s oldest daughter, Ruth, ag
ed 20, Ruth’s husband, Roy, aged 24, and
their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for
her ailing mother. After 2 months, Roy return
ed to northern Appalachia because he was
unable to find work in Denver. Ruth is 3 months’ pregnant.
Because Mrs. Kapp has been feeling “mor
e poorly” in the last few days, she has
come to the clinic and is accompanied by her husband, William, her daughter Ruth, and
her granddaughter, Rebecca. On admission, Glor
ia is expectorating greenish sputum,
which her husband estimates to be about a teac
upful each day. Gloria is 5 ft 5 in. tall and
weighs 92 pounds. Her temperature is 101.4°F,
her pulse is regular at 96 beats per
minute, and her respirations are 30 per minute
and labored. Her skin is dry and scaly with
poor turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional
historical and demographic da
ta from Mr. Kapp and Ruth. Th
e nurse finds that Ruth has
had no prenatal care and that her first chil
d, Rebecca, was delivered at home with the
assistance of a neighbor. Rebecca is pale and
suffers from frequent bouts of diarrhea and
paper needs to be written in a paper format-not just a list of the questions and replies.

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When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

To Prepare:

• Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.
• Review the health policy you identified and reflect on the background and development of this health policy.

By Day 3 of Week 7

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.