A 39-year-old homeless man presents to the emergency department for cough and fever. He says that his illness has been worsening over the past 2 weeks. He originally had dyspnea on exertion and now is short of breath at rest. On questioning, he tells you that he lives in a homeless shelter when he can, but he frequently sleeps on the streets. He has used IV drugs (primarily heroin) “on and off” for many years. He denies medical history but the only time he gets medical attention is when he comes to the emergency department for an illness or injury. On review of systems, he complains of fatigue, weight loss, and diarrhea. On examination, he is a thin, disheveled man appearing much older than his stated age. His temperature is 100.5°F (38.0°C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. His initial oxygen saturation is 89% on room air, which comes up to 94% on 4 L of oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tachycardic but regular cardiac rhythm, a benign abdomen, and generally wastedappearing extremities. His pulmonary examination is significant for tachypnea and fine crackles bilaterally, but no visible signs of cyanosis. His chest x-ray is read by the radiologist as having diffuse, bilateral,

interstitial infiltrates that look like “ground glass.”

Answer the following questions

What is the most likely cause of this patient’s current pulmonary

complaints?

➤ What underlying illness does this patient most likely have?

➤ What testing and treatment should be started now?

TOPIC —   Pressure Ulcers and the Vulnerable Elderly Population at Mary Manning Walsh

II. Community Assessment A. What resources exist within the systems of this community? Consider health and social services, educational services, safety, religion, and politics, among others. i. Be sure to identify resources at the local level. What influences these resources? Why are they considered social determinants of health? ii. Include resources at the regional level. How are the influences on these resources different than the influences on resources at the local level? Justify your reasoning. iii. How are healthcare resources in both the local and regional areas around this community influenced by healthcare policy? Provide support for your answer. iv. Are the healthcare resources in this community different according to the varying demographics? Why or why not? Be sure to support your answer using research or data. B. Analyze the community based on data collected from reliable resources. For example, you might utilize data from the Centers for Disease Control and Prevention, the Community Health Status Indicators website, or even recent census data. i. What are the strengths and weaknesses of the community that would be integral in the formulation of a community health strategy? Support your answer with data and research. ii. What barriers have been identified that may impact successful implementation of that strategy? Support your answer with data and research. iii. What areas of opportunity exist for improving the health of the community? Support your answer with data and research

For additional details, please refer to the MILESTONE TWO GUIDELINES AND RUBRIC.

 
System AdminMax Points: 10.0

Find an article on a societal factor that is affecting nursing/patient education curriculum. Summarize your article for your classmates in one or two paragraphs. Discuss why you chose the article and what can be learned from this trend – how would you use it to improve the quality of nursing/patient education? This article and those posted by your classmates may become the foundation of your paper due in Topic 2. Be sure to include the entire citation in APA format. The article you select cannot be from any of the course materials or supplemental readings. Please note: It is a violation of copyright law to post the entire text of the article to an online discussion board. So be sure to post only the citation information so that the article can be located if someone is interested in reading more. The article should come from a graduate-level journal, like an advanced practice journal or nursing education journal – not an entry-level journal like AJN, RN, Nursing, etc.

 

Recent data from your unit shows that only 78% of the nurses are engaging in routine hand-washing. What activities should the RN engage in to increase compliance with hand-washing in order to improve (quality) patient outcomes in terms of personal activity, supervision of others, accountability to patients, education of other members of the interdisciplinary team on the unit, etc.?

 

  

Quality Improvement Initiative

 When attempting to garner support for a quality improvement initiative, it is important to demonstrate how the initiative supports the organization’s mission, vision, and values, as well as external factors that influence an organization’s priorities. Delivering a proposal for a quality improvement initiative requires clear, concise communication of the plan.

By tomorrow Tuesday 01/09/18 by 10 pm, write a minimum of 550 words essay with at least 2 references in APA format. Include the level one headings as numbered below:

1) Choose a QI initiative which has been the subject of focus in any healthcare setting. Explain the rationale that your senior leaders used in selecting this initiative for attention and focus.

2) Explain how adverse events are handled in your organization from the public’s perspective and well as internally.

3) Find a scholarly article or one from the public press, published within the last 5 years which recounts a serious error. Relate this error to any organization with which you have some familiarity.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 11: “Patient Safety and Medical Errors”

Clarke, C. M., & Persaud, D. D. (2011). Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. Journal of Patient Safety, 7(1), 11–18. doi:10.1097/PTS.0b013e31820c98a8

Designed for leaders who want to improve quality care, this article focuses on clinical handovers that occur within acute care facilities. It provides a model for improvement and is intended to be a supplemental resource that can be used with the existing research and literature on this topic.

Sennett, C. (2010). Healthcare reform: Quality outcomes measurement and reporting. American Health & Drug Benefits. Retrieved from http://www.ahdbonline.com/article/healthcare-reform-quality-outcomes-measurement-and-reporting 

The article on this website discusses features of the Patient Protection and Affordable Care Act (PPACA), focusing on the outcomes and implications for quality outcomes measuring and reporting.

Lazarus, I.R. (2011). What will It take? Exploiting trends in strategic planning to prepare for reform. Journal of Healthcare Management, 56(2), 89–93.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Organizational priorities for quality improvement. Baltimore: Author.

Note: The approximate length of this media piece is 9 minutes.

This video provides an overview of organizational factors that influence quality. Lillee Gelinas discusses the importance of teamwork and enlisting leadership to help move quality initiatives forward. Other topics addressed include the role of stakeholders in improving patient safety and the responsibility of hospital board members in setting the quality and safety agenda.