In today’s fast-paced and global community, most organizations are faced with constant change. Research contemporary organizations that are currently responding to a significant change within the industry, (preferably an organization in healthcare)such as disruptive technology; state, government, or industry regulations; environmental constraints; judicial or legislative rulings; etc.

Choose one organization from your research that has recently responded to major change, or is currently responding to change. Write a paper (1,250-1,500 words) discussing how well the organization is responding to the change dynamics. Include the following:

1. Describe the organization and the change to which it is responding.

2. Discuss the degree to which the change has been disruptive and how the organization has responded to the dynamics created by this change.

3. Evaluate the strategies the organization used in its change plan and determine the level of success the organization experienced with the strategies.

4. Determine the effect the change had on stakeholders, and to what degree stakeholders have resisted. Assess how well stakeholder resistance was addressed.

5. Evaluate the overall implications the change had on interdepartmental collaboration.

6. In your opinion, how well did the leaders of the organization respond and prepare for the change? What worked and what did not work with the strategies they implemented?

7. What modifications would you suggest the leaders of the organization make in order to better address the change dynamics? What additional strategies would you recommend to assist the organization through this change?

APA format with References

Case Study 

Diabetic Ketoacidosis

Patient Profile.

N.B., a 34 year-old Native American man, was admitted to the emergency department after he was found unconscious by his wife in their home.

Subjective Data

· Was diagnosed with type 1 diabetes mellitus 12 months ago

· Was taking 50 units of insulin daily; 5 units of lispro insulin with breakfast, 5 units with lunch and 10 units with supper plus 30 units of glargine insulin at bedtime

· Has a history of flu for 1 week with vomiting and anorexia

· Stopped taking insulin 2 days ago when he was unable to eat

Objective Data

Physical Examination

· Breathing is deep and rapid

· Acetone smell on breath

· Skin flushed and dry

Diagnostic Studies

· Blood glucose level of 730 mg/dL (40.5 mmol/L)

· Blood pH of 7.26

Discussion Questions

1. Briefly explain the pathophysiology of the development of diabetic ketoacidosis (DKA) in this patient

2. What clinical manifestations of DKA does this patient exhibit?

3. What factors precipitated this patient’s DKA?

4. Priority Decision: What is the priority nursing intervention for N.B.?

5. What distinguishes this case history from one of hyperosmolar hyperglycemic syndrome (HHS) or hypoglycemia?

6. Priority Decision: What is the priority teaching that should be done with this patient and his family?

7. What role should N.B.’s wife have in the management of his diabetes?

8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

4 postsRe: Topic 3 DQ 1

A vulnerable population is a group of people who need special considerations in regard to their health and overall welfare (Falkner, 2018).Vulnerable populations are individuals who are not able to advocate for themselves due to physical, cognitive or mental disability, emotionally unstable people, children and incarcerated individuals.These populations usually have several social determinants of health(SDOH) that contribute to their vulnerability.These SDOH can include poverty, socioeconomic status, race and ethnicity, sexual orientation and no insurance or the underinsured.

 In the United States there are many vulnerable populations.One group that gets a significant amount of media coverage is the lesbian/gay/bisexual/transgender/questioning (LGBTQ) population.The inequality and hardship this group often encounters within the medical community and the higher instance of medical conditions such as Hepatitis B, HIV and AIDS is what makes this population considered vulnerable (Falkner, 2018).In the US, it is estimated that 10 million adults identify as LGBTQ (American Nurses Association [ANA], 2018).Many individuals within the population have reported prejudice from medical providers, leading to reluctance to seek care or delay in treatment due to the bias experienced.The stigma in society, discrimination and failure to recognize the unique civil and human rights deters individual self-determination and access to care which causes negative health outcomes and overall increase in morbidity and mortality (ANA, 2018).All nurses, not just CHN need to understand their own preconceptions and bias when caring for this vulnerable population.Ethically, nurses have a responsibility to provide safe, competent care to all individuals regardless of age, sex, sexual preference, race, ethnicity or socioeconomic status.

1 postsRe: Topic 3 DQ 1

A group is considered as a “vulnerable population” if it has continuing or more aggravating factors that maintains their poor health status compared to an “at- risk” group. There is a significant disproportionate risk of poor health outcomes for vulnerable populations which would include those living in poverty, homeless, disabled, severe cognitive impairment or extremes of age (Maurer & Smith, 2013, p.527). While at risk groups have a chance of being affected, the vulnerable group has many variables that attribute to the susceptibility of poor health. “A vulnerable population is more likely to develop health-related problems, have more difficulty accessing health care” (Maurer & Smith, 2013, p. 528). Vulnerable groups are “more likely to experience a poor outcome or shorter life span because of those health conditions” (Maurer & Smith, 2013, p. 528).

For example, a person is considered vulnerable if he/she suffers from a disease, but also has an income below the poverty level, no health insurance, and stressors related to their living conditions, such as homeless people (Maurer and Smith, 2013).

One example of vulnerable population group in The United States is the children who lives in poverty or parent has very low income to satisfy their necessities. It is estimated that about 387 million children worldwide live in extreme poverty wherein the household income is estimated to be around less than 2 dollars per day. Worldwide, about 19.5% of children compared to only 9.2% of adults are in extreme poverty (UNICEF, 2013). In the United States, poverty is an increasing problem such as from 2009 to 2010, there is almost a 1 million increase of children living in poverty. Child poverty has many effects on the child such as inadequate nutrition, poor academic performance, lack of health care insurance behavioral, social and emotional problems which also makes them further at risk for abuse and/or neglect (American Psychological Association, 2018).

Nurses may need to help advocate for these very young children who live in poverty by helping provide them knowledge and access to appropriate health care and nutritional services. This entails being familiar with existing laws that helps protect their rights and knowledge of existing services that they are eligible to receive (Maurer & Smith, 2013, p.151). Aside from providing health promotion and education, nurses help further by educating vulnerable families on how to access available resources and referral to social services. According to United States Department of Agriculture Food and Nutrition Service (2018), there are several federal programs which help provide nutrition assistance such as Women, Infants, and Children (WIC).

Children from low-income families are most vulnerable of suffering from consuming empty calories. One ethical issue is the involvement of the government in improving school lunches being provided in schools which is being aimed at combating obesity and malnutrition. In 2010, the Hunger-Free Kids Act mandates improving school lunches to provide nutritious foods as recommended by the federal dietary guidelines. This involves increasing fruits, vegetables, non-fat milk and whole grains while decreasing high fat, salt and sugary foods. This bring about the ethical issue of not allowing children to choose the foods they prefer to consume (Crawford, Gosliner & Kayman, 2011). This appears to be a good initiative from the government to implement healthy school meals to ensure that children, especially those from low-income families, are able to meet the recommended nutritional requirement to prevent malnutrition and the possible long-term health problems associated with it. It may be important that nurses also help educate families on the importance of having a nutritious diet and avoid consuming empty calories which may lead to obesity and health problems.nurses also help to educate families on the importance of having a nutritious diet and avoid consuming empty calories which may lead to obesity and health problems.

“Community health nurses can advocate on the behalf of vulnerable groups by writing and calling government representatives and speaking to professional and community organizations about the problems and needs of high-risk groups” (Maurer and Smith, 2013).

Calculations: Analytic Methods for Financial Decision Making

Determining how to make a capital investment decision using financial techniques is an essential aspect of long-term financial decision making.

To prepare for the Calculations, review the sections of Chapter 7 (“The Investment Decision”) from your Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts, and Applications textbook that explain how to analyze capital investment decisions using financial techniques. (The pertinent section of Chapter 7 to review for each type of Calculation is identified in the below list of Calculations.) Then, read scenario #15 (Kaiser Oakland Practice) on page 329, which contains the information that you will use to populate and perform the Calculations.

Complete the following Calculations and submit your completed Calculations in an Excel spreadsheet with three tabs—one tab for each of the following Calculations and with that particular tab reflecting only the result of that particular Calculation.

1. Determine the payback for both projects.

Note: For detailed information on how to perform this type of Calculation, review the section “Payback Method” and Exhibit 7-2 “Cash flows for two alternative project investments” and Exhibit 7-3 “Calculation of payback year for two alternative investments” on pages 308 and 309, respectively, of the Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts, and Applications textbook.

2. Determine the IRR for both projects.

Note: For detailed information on how to perform this type of Calculation, review the section “Unequal cash flows” and Exhibit 7-8 “Using Excel to Calculate the IRR…that yields unequal operating cash flows…” (This can also be used for equal cash flows) on page 318-319 of the Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts, and Applications textbook.

3. Determine the NPV at a cost of capital of 12 percent for both projects. Which project should be chosen? Explain.

Note: For detailed information on how to perform this type of Calculation, review the section “Using spreadsheets to calculate NPV” and Exhibit 7-6 “Using Excel to calculate the net present value of unequal annual cash flows” (This can also be used for equal annual cash flows) on page 316 of the Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts, and Applications textbook.