In an APA format paper, approximately 2-4 pages in length, address the following questions. (Please note that you will continue to write in the same document you completed for part 1, 2, 3, 4, and 5 of this assignment

Based only on the evidence you gathered, make at least 2 practice recommendations (these can be either positive – we SHOULD do this, negative – we SHOULD NOT do this, or recommendations to gather more data if the evidence is insufficient) and grade the strength of your recommendations using the GRADE criteria (see GRADE working group for more information on grading your recommendations). You should reference the GRADE criteria as it relates to the strength of your recommendations

    History and Healthcare Policy in Nursing

Meg Fitzgerald 

 The policies in nursing have been largely influenced by history and politics within the larger healthcare ecosystem. Today there are close to 4 mm nurses in the U.S representing a formidable voting block but on issues close to home the profession doesn’t yield the same power and influence. Despite the history, obstacles and politics nurses are revered and valued members of the healthcare system. They own a strong position that should be leveraged for practice and pay gains.

 Data shows that in healthcare policy creation nurses face many barriers to entry. These barriers include being involved in policy development, having the right knowledge and skills, the negative image of nursing structures and processes which enhance seclusion. (Sharif, 2014). And these barriers have followed the practice of nursing since its inception.   

 The genesis of the nursing profession dates back to 300 AD when the Roman Empire built hospitals which required doctors. Those doctors needed assistance requiring a new role; the nurse. This is likely when the politics and branding around a nurse as a deputy or subordinate took hold. This structure and dynamic continues to challenge and hinder policies in the field today.

 Over the last century, the nursing profession has evolved into a more important and visible practice due some help from the Catholic Church which built hospitals to care for any sick individual. This mission aligned well with values of nursing and remains dominant theme in many of the policies supported by the profession. Many of these mission driven hospitals provided nurses the autonomy to provide a range of medical care services. Many feel these early models served as the policy jump off point for nursing policy and likely plays a role for the broad services the nurse performs today.  

 And in New York City, Lillian Wald followed this playbook harnessing the support of those in power to establish the field of public health nursing which went on to establish the National Organization of Public Health Nursing in 1912 (Mason 2016). What is remarkable about Lillian aside from her clinical leadership was her policy and business skills. Her public health efforts were cemented with the creation of powerful alliances like the American Red Cross, coupled with her fundraising and wooing of wealthy donors and foundations.  

The intersection of clinical value and policy making that Lillian pioneered is an important lesson for nurses looking to affect policy today. When the ACA was established, public health advocates and nurses used this bill to increase access to care, contain costs and push the promotion of alternative sites of care and expand the scope of nurse practitioners. Whenever there is a major policy change or upgrade from Health and Human Service, the practice of nursing needs to be close shaping the debate.

And at every turn in the history of healthcare policy, the most important factor was research and evidence. Data is the currency of healthcare policy. And it’s an area all in nursing must embrace and advance.

Nursing research has changed dramatically in the past 150 years starting with Florence Nightingale but it was not until the 1950s that nursing research began the advancement that has been seen in the past three decades (Stolley, 2000). When nursing decided to put a premium on the advanced degree the foundation for research began. And as a result of this research, funding and political support was attracted to the cause.

The profession of nursing has evolved throughout history and today nurses own the most important position in politics; trust. However, there is a growing recognition from peers, policy makers and payors that nurses need to publish and promote their value more. Every time we move forward in our practice, we must back it up with data to advance  policies that lift us. If we continue to prove that our industry drives cost savings, quality and access then money and political capital will flow our way .

                                                                              References

Mason, Diana J. Policy and Politics. In Nursing and Health Care. 7th edition 2016.

Shariff N. (2014). Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC nursing, 13, 20. https://doi.org/10.1186/1472-6955-13-20

Stolley, J. M., Buckwalter, K. C., & Garand, L. (2000). The Evolution of Nursing Research. Journal of the neuromusculoskeletal system : JNMS : a journal of the American Chiropractic Association, Inc, 8(1), 10–15.

 Reply 1

There is not a single specific point in an illness, when end-of-life care begins. It depends on an individual and progression of their illness. At stage of terminal illness, despite best care, attention and treatment. If your loved one comes to the end of their life, the focus would be to make them comfortable as possible. Depending on nature of disease, the final stage period may last weeks, months, or several years. This time palliative care help to control pain, other symptoms, shortness of breath, hospice care, support emotionally and spiritually to both patients and their families.

Dying at home a major challenge; a severe shortage of professional home care giver, the expense of hiring-quality help, the difficulties of pulling together a community of family and friend for 24-hour care, medical advances of recent decades. Depending on what is available near you, some hospice offering include in-home care, but Medicare has limited coverage. Families prefer alternatives that are expensive or require endless hours. The options come in mind is nursing homes, 5 thousands-10 thousands/month. Though, at home you have the smell of cooking, grand children coming, is more comfortable for elders. Some elders love their life at home but need more service at home. Dying at home is realistic? Sandi Hebley, an educator at faith presbyterian hospice in Dallas, shares her visit to japan and New Zealand, observed and found out that the resources at home are larger more extensive. In Great Britain, hospice movement started in 1960. Hospice advocate, Cicely Saunders placed teams that went to home with case manager several nurses. That setup made a huge difference there.

To support patient regarding end-of-life. I like the POLST paradigm, a framework to help and guide a conversation about what kind of care a patient wants when future health crisis occurs. Some changes in health care system can improve care of individual with progressive illness. For example, we should broaden end-of-life to mean the last years of life, by developing a health care pathway for chronically ill and declining people who are at their last years of life as described in “Medicaring” white paper by Dr. Jonne Lynn. The UK has developed a “Gold standard Framework” along similar lines. We can learn their work by studying their approach.

Furthermore nurse can support by communicating with members to manage family involvement t, by focusing on values by knowing wishes, help to seek financial and legal advice such as living will, attorney, address family conflicts by involving social worker or hospice specialist, preparing early by hospice and palliative care services.

Reference

Bill. W. (2018). How realistic is dying at home. The difference between where American would prefer to die and where they do?

Grand Canyon University (2018). Health assessment: foundation of effective practice.

Health assessment of aging adult. Retrieved from http// www.gcumedia.com.

Melissa. W. (2019). Late stage and end-of life care. Help guide.

Leslie. K. (2013). How we can get to better end-of life care. Practical information for aging health and family care giver

Reply 2

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend?

“Dying at home is not favored in certain cultures (due to cultural taboos) and some patients may wish not to die at home, out of concern that they might be a burden on the family.” (Stanford School of Medicine, 2020) Being a burden on family or lack of family is a big concern for many patients. Another reason many patients are not dying at home is due to the multiple physical issues requiring nursing care occurring at the time of death. (Ward, 2018) Limited coverage by Medicare for in home care during the final days is another barrier. Cost for in home care can be very expensive and if a lack of finances occurs then it would be impossible to utilize those services.

Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.

Nursing plays an important role in end-of-life care. Not only do nurses assist the patients during this difficult time but they also support the family members. Ensuring patient’s wishes are met is something the nurse needs to strive to complete during the end of life timeframe. If the patient wishes to have spiritual support, the nurse will help coordinate that. (Pathways Home Health and Hospice, 2020) Create a plan with the patient, if able, to remove the gray areas on the patient’s wishes. Nurses will act as the mediator between the family and patient in order to support the patient’s wishes. (Pathways Home Health and Hospice, 2020) “Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.” (Rights, 2016) If nurses follow the code of ethics and patient’s wishes it will provide a positive experience in this difficult end-of-life care situation.

References

Pathways Home Health and Hospice. (2020). Retrieved from https://pathwayshealth.org/hospice-topics/the-critical-role-of-nurses-in-end-of-life-care/

Rights, A. C. (2016). ANA. Retrieved from American Nurses Association: https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf

Stanford School of Medicine. (2020). Retrieved from https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/

Ward, B. (2018, December 6). Next Avenue. Retrieved from https://www.nextavenue.org/how-realistic-is-dying-at-home/

Informatics, the process of collecting and storing data. Health informatics focuses on patient healthcare information. Different avenues of health technology system and informatics include the employment of categorizing knowledge and skills in the form of devices, data recovery, website management, and computer science, telemedicine, electronic MAR systems, imaging informatics, and many more. (World Health Organization, 2015) Nursing is a field that is ever-evolving furthermore this is the age of computer technology. Technology pithing the healthcare system is evolving and growing rapidly. In healthcare today, technology is used to chart, read lab results, store information for patient healthcare, and the list goes on. Its’ almost impossible to disregard the importance of how healthcare workers use computers and other forms of technology in our everyday workspace; Computer information systems have become such an integral part of our daily tasks that it is hard to work without them. This is what makes it so important to involve nurses in the process of developing an electronic medical record system (EMAR). The EMAR is a powerful system that allows computerized charting, set critical alerts such as allergies, and more. Past medical history, insurance information, DNR are some of the may things set into the informatics system as well. Electronic computer systems also allow patients to access their medical records from any mobile device via patient portals. “Technological strides and increase knowledge in biomedicine have improved the concept of patient empowerment, now patients have the tools, resources and the access to play an active role in the delivery of their health care services.

I was first introduced to electronic charting in 2013. Because I’m familiar with computers, the transition from paper charting to electronic charting was fairly simple. I know for some of the older nurses, dinosaur nurses are what we young nurses call them, the transition was slightly more difficult. American Nurses Association presented the redirection from paper charting to EMAR in 1995. Their aim was simple, they presented Nursing Informatics as a specialty that integrates nursing science, computer, and information science to provide data communication management. The American Nurses Association (AMA) believes everyone should have access to safe and quality care. It is through informatics systems healthcare workers are able to review past medical history and provide quality care based on past medical needs. (Demiris & Kneale, 2015) The impact that electronic health records have on the quality of decision making cannot be measured. Nurses have worked in the field of informatics for almost 40years, in spite of that, the term “nursing informatics” has only been appreciated as a specialization in nursing since the 80s.

I can agree Nursing Informatics has sanctioned time for more effective decision making when providing care. (Toromanovic, Hasanovic & Masic, 2015) saving time impacts decision making hugely and positively, because it allows for more time to weigh treatment options. Knowing pre hand all medical conditions without a patient having to remember is very helpful. As a nurse, when I can refer to the information entered in the database from prior hospital encounters, this is very very helpful. Assist in time management and more accurate patient care.

While the benefits of a well-functioning electronic health record are clear, choosing and implementing a system can be very challenging. Before committing to any system, you must understand what your facility’s priorities are. It’s also essential to fully investigate your possibilities before settling on an information system. In addition, healthcare facilities are mandated by the Health Insurance Portability and Accountability Act (HIPAA) to protect all patient information and medical records. Therefore choosing the right system must also follow HIPPA guidelines. Because the electronic health records stores all patient’s vital medical information together, patients’ personal information as well (social security, dob), and just relevant information all around found in the patient medical records. With that being said, whatever electronic database the facility decides to use, must have maximum protection within the HIPPA guidelines to protect patient safety. All medical staff needs proper training once the hospital adapts a new system. Training is an ongoing process from the time the system is introduced to a facility until the end of use. Ongoing education may be necessary to ensure competent knowledge of electronic medical records due to the evolving world of technology and of healthcare. 

Technology is eternally transforming healthcare systems’ ability to overachieve patient care. Cutting edge technology assists in quality care and saving valuable time as mentioned above. Thanks to the unique expert outlook of experienced nurses’,  they embrace the role of improving healthcare through informatics and technology. And through the electronic medical record decision making in healthcare has become easier and more efficient. Nurses are key drivers in this growing advancement in health information system implementation.  

References 

Demiris, G., & Kneale, L. (2015, August 13). Informatics Systems and Tools to Facilitate 

Patient-centered Care Coordination: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587048/ (Links to an external site.). 

REPLY 2

Nursing informatics is defined as the specialization that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in the nursing professional practice (“importance of increasing health literacy content in nursing education,” 2015). The nursing career practice has undergone tremendous reforms and restructuring due to changes and developments in the health care delivery systems. The use of technology and computers plays a significant role in the health care sector. As a result of the dynamics in the in the health care system and technological advancements, new nursing roles and responsibilities are emerging (Mitchell & Hull, 2020). The application of nursing informatics is important in helping nurses to perform the roles and responsibilities. As a result of this developments, nursing informatics knowledge becomes a necessity in the career practice.

Advancing in education for nurses should be a priority for nurse. Pursuing higher levels of education exposes the nurse to new knowledge, skills, and experiences (“importance of increasing health literacy content in nursing education,” 2015). The new competences gained by the nurse are important in the evaluation and selection of the appropriate information systems to apply.  The decision on the implementation of a particular information system in influenced by the sound knowledge of nursing practice and the desired results. Implementation of nursing information system requires that the nurses have the relevant skills to use the system to improve the quality of services offered and better patients’ outcome (“importance of increasing health literacy content in nursing education,” 2015). Nurses should be encouraged to attain higher levels of education so that they remain relevant in the practice.

The primary goal of the nursing practice is to prevent illnesses and promotion of better health care. Nurses interact more with patient compared to other health care professionals. Family nurse practitioners offer services to patients of different age. The interaction with these patients is sensitive and requires more careful handling to ensure the comfortability of the patients. The information system selected should provide a conducive environment that preserves the dignity of the patients (Lin, 2017). Nurse mid-wives provide services to women and their newborns. Nurses have a role in ensuring the selected information system fulfills the requirements of the nurse mid-wife’s practice. Nurse educators are involved in the academic setting. Their role in evaluation of health care information system is very important in training nurses (Lin, 2017). Nurses should be involved in the evaluation and selection process of information system as they are more familiar with the patients’ needs and the nursing options in the market (Lin, 2017).

Priority should be given to knowledge-based decisions. This is an implementation strategy that ensure that decisions on the implementation process is based on knowledge. It ensures that the information system selected meets the requirements and serves the needs of the institution. Information system should be able to evolve with health care system (Lin, 2017). It should be able to develop patient centered data collection methods, core data elements, and system capacity for patient-based health data sets. It should be able to capture home care data for all stake holders. This strategy emphasizes on the flexibility of the information system to changes and reforms in the health care services.

The effective implementation of information systems in the health care sector is affected by certain factors that delay or hinders the implementation process. The cost of developing and maintain an information system is quite high (Sahay, Sundararaman, & Braa, 2017). This hinders the effective implementation of information systems in the health care sector. Lack of necessary knowledge among the nursing staff on the application and implementation of information systems affects the development and achievement of the desired results. Lack of proper integration, information and provider overload is another challenge affecting the full implementation of information system (Sahay, Sundararaman, & Braa, 2017). In conclusion, information systems should be encouraged and implemented in the health care to improve the quality of services offered.

References

The importance of increasing health literacy content in nursing education. (2015). American Research Journal of Nursing. doi:10.21694/2379-2922.15023

Lin, H. (2017). Nursesʼ satisfaction with using nursing information systems from technology acceptance model and information systems success model perspectives. CIN: Computers, Informatics, Nursing, 35(2), 91-99. doi:10.1097/cin.0000000000000293

Mitchell, M. B., & Hull, S. C. (2020). The alliance for nursing informatics. CIN: Computers, Informatics, Nursing, 38(1), 5-7. doi:10.1097/cin.0000000000000614

Sahay, S., Sundararaman, T., & Braa, J. (2017). Institutions as barriers and facilitators of health information systems reform. Oxford Medicine Online. doi:10.1093/med/9780198758778.003.0006

All replies must be constructive and use literature where possible.

Your assignment will be graded according to the grading rubric.

Work #1 Responses:

Actual work where 2 students given their post on this:
Write at least 500 words on fractional ownership and it’s relation to cloud computing. Use at least one example from another industry.    

Use at least three sources. Include at least 3 quotes from your sources enclosed in quotation marks and cited in-line by reference to your reference list.  Example: “words you copied” (citation) These quotes should be one full sentence not altered or paraphrased. Cite your sources using APA format. Use the quotes in your paragaphs. Stand alone quotes will not count toward the 3 required quotes.

Copying without attribution or the use of spinbot or other word substitution software will result in a grade of 0. 

Write in essay format not in bulleted, numbered or other list format. 

Do not use attachments as a submission.  

Reply to two classmates’ posting in a paragraph of at least five sentences by asking questions, reflecting on your own experience, challenging assumptions, pointing out something new you learned, offering suggestions. These peer responses are not ‘attaboys’.   

It is important that you use your own words, that you cite your sources, that you comply with the instructions regarding length of your post and that you reply to two classmates in a substantive way (not ‘nice post’ or the like).  Your goal is to help your colleagues write better. Do not use spinbot or other word replacement software. It usually results in nonsense and is not a good way to learn anything. . I will not spend a lot of my time trying to decipher nonsense. Proof read your work or have it edited. Find something interesting and/or relevant to your work to write about.  

Note: See the above bold lines for responses

We need to give 2 responses all should have proper APA, citations, and minimum one reference each for both.

Work #2 Responses:

Actual work where 2 students given their post on this:

1) Provide an example of the investment and financing decisions that financial managers make.  

2) Please identify and describe one (1) of the financial markets. 

We need to give 2 responses all should have proper APA, citations, and minimum one reference each for both.

Please find the two attachments.