Health Information Technology Project

In previous Discussions and Applications, you have explored various aspects of health information technology systems: the historic development of HIT, how data flows across HIT systems, and standards and interoperability requirements including specific terminologies used in your practice setting. In this Application Assignment, you will have the opportunity to further develop your analysis skills by closely examining the implementation of a health information technology system. As a Doctorally prepared nurse, you may find yourself in the position of leading a HIT project team; to be an effective leader and move health information technology projects forward in your organization, you must be able to logically and critically analyze the many aspects and challenges of implementing such a system and then present your insights in a succinct and professional manner. This exercise provides an opportunity to hone those skills.

Carefully review the project requirements below and plan your time accordingly. Be sure to refer to the standards of nursing informatics practice as you develop this Application, which serves as your Major Assessment for this course.

To prepare:

• Investigate      a health information technology (HIT) system or health information      technology application in your area of interest. The health information      technology system/application may be in any setting where health care      information is developed or managed. You may choose your system or      application from any organization or virtual environment.

• Examples       of health information technology systems or health information technology       applications that are acceptable include but are not limited to:

• Consumer        health applications
• Clinical        information systems
• Electronic        medical record (EMR) systems in hospitals or provider offices (SELECT THIS or)
• Home        health care applications
• School        health applications
• Patient        portal/personal health record (or SELECT THIS)
• Public        health information systems
• Telehealth        (i.e., from facility to home)
• Simulation        laboratories
• Health        care informatics research and development centers
• Discuss      your proposed health information technology system/application with your      Instructor before proceeding with your final selection. You may visit a      health care organization in person or virtually in order to make your      final choice about the health information technology system or health      information technology application of interest.
• Choose      the best strategy to gain information about your selected information      technology system/application. Some ways to gather information include      virtual visits; vendor demonstrations; on-site visits; interviews via      face-to-face, phone, or teleconference. You must conduct at least one      interview for this project.
• Complete      a literature search to gather information about your selected information      technology system. You may also need to review related scholarly articles      to help answer the questions presented below.

NOTE: In your submitted report, do not share proprietary information, personal names, or organization names without permission.

To complete:

Your deliverable is a 12- to 15-page scholarly report, not counting the title page or references. Include an introduction ending with a purpose statement and a conclusion. A successful report should leave the reader with confidence in understanding the answers to all the questions listed below. Graphics may be used to illustrate key points.

Organization Information

1) Briefly describe the health information technology system/application and the organization type (hospital, clinic, public health agency, health care software company, government health information website, private virtual health information site, etc.).

2) Is the health information technology system/application clinical, administrative, educational, or research related?

3) What were the key reasons for the development of this health information technology system/application, i.e., what made the organization believe this system/application was needed? How did this organization determine those needs? Did the organization use specific tools to conduct needs assessments, staff opinions, or workflows?

4) How did the organization determine that this specific system/application could fulfill its predetermined needs?

5) Who manages this health information technology system/application and where are they located within the organization’s administrative structure?

Information System Application Design and Development

1) Many health care systems have multiple independent entities that work together toward the common goal of providing high-quality care. How did—and do—the various stakeholders make decisions related to this health information technology system/application? Were the end users involved in the development of this health information technology system/application?

2) How are individuals trained to use the health information technology system/application?

3) How are security issues addressed? How does this health information technology system/application support a legally sound health care record?

4) Where did initial funds for this health information technology system/application come from?

5) Who manages the budget for this health information technology system/application?

6) Have organizational or political issues impacted the ongoing funding for this health information technology system/application?

7) What are the arrangements for planned or unplanned downtime?

8) How are health information technology system/application upgrades scheduled or planned?

9) How has the health information technology system/application changed in response to health care reform and related legislation?

10) What suggestions could you make regarding changes needed to support health care reform and related legislation?

Innovative Aspects of the System

1) How does the health information technology system/application utilize technology innovations?

2) What technology innovations would you recommend for this organization? What innovations presented in this course, or found through your own research, could this organization benefit from?

3) What innovations could further promote evidence-based practice and efficiency within this organization?

End Product

Your report is a scholarly paper and needs to include a minimum of 10 citations from peer-reviewed journals. Every statement made in a scholarly report must be supported by a reference. Be very cautious when stating your opinion, or using terms suggesting absolute facts, or values, as these must be supported by references. Note that textbooks, including the course texts, are composed of information cited from other sources (see the reference section in the course textbooks). With this in mind, there should be an adequate number of appropriate references (a minimum of 10). Please note that primary sources are to be used. Peer-reviewed journal articles should make up the bulk of your references (90%). If referring to a book, be sure to include all information in APA style, including specific page numbers when necessary. Note that an article referred to in a book is a secondary source. More on this topic is available in the APA Publication Manual and in the  Writing Center. See also “Policies on Academic Honesty” listed at the website.

A superior paper demonstrates breadth and depth of knowledge, and critical thinking appropriate for doctoral level scholarship. The report must follow APA Publication Manual guidelines (6th edition) and be free of typographical, spelling, and grammatical errors. This Application is the Major Assessment for this course. You will submit this document by Day 5 Friday of Week 9. By 9:00 AM

  

REQUIRED READINGS

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

• Review      Chapter 16, “Personal Health Record: Managing Personal Health”

This chapter focuses on the future of personal health records and consumerism, as well as the initiatives being developed to strengthen health literacy in the patient population. The nurse’s role in the development of personal health records is also discussed.

Reti, S. R., Feldman, H. J., Ross, S. E., & Safran, C. (2010). Improving personal health records for patient-centered care. Journal of the American Medical Informatics Association, 17(2), 192–195. 

Several key elements that designers and practitioners need to be aware of when developing patient-centered electronic health records are outlined in this article.

Schneider, J. M. (2010). Electronic and personal health records: VA’s key to patient safety. Journal of Consumer Health on the Internet, 14(1), 12–22.

This article begins with a brief overview of the benefits and challenges of EHRs and moves into an exemplary example of the record systems currently being used at the VA.

Wagner, P. J., Howard, S. M., Bentley, D. R., Seol, Y., & Sodomka, P. (2010). Incorporating patient perspectives into the personal health record: Implications for care and caring. Perspectives in Health Information Management, 7(Fall), 1–12.

Within this study, the authors integrate patients into a preexisting personal health record system to analyze the overall feelings that patients have about its design and usability options.

Madsen, M. (2010). Knowledge and information modeling. Studies in Health Technology and Informatics, 151, 84-103.

Within this article, the overall design models of information systems are linked to the metastructures, data, information, knowledge, and wisdom.

Peleg, M. (2011). The role of modeling in clinical information system development life cycle. Methods of Information in Medicine, 50(1), 7-10.

The author of this article discusses the role of conceptual modeling in health information technology systems and how it has been an effective component of system development.

Philip, A., Afolabi, B., Adeniran, O., Oluwatolani, O., & Ishaya, G. (2010). Towards an efficient information systems development process and management: A review of challenges and proposed strategies. Journal of Software Engineering and Applications, 3(10), 983-989.

This article examines the phases and methodologies found within the Systems Development Life Cycle (SDLC), and proposes a framework for establishing the crucial roles that participants must play during the SDLC.

Schlotzer, A., & Madsen, M. (2010). Health information systems: Requirements and characteristics. Studies in Health Technology and Informatics, 151, 156–166.

Use this article to examine the importance of focusing on sound design, interoperability of systems, and fulfillment of user needs when developing an effective database.

Munih, M., & Bajd, T. (2010). VI.3. Rehabilitation robotics. Studies in Health Technology and Informatics, 152, 353–366.

In this article, the authors delve into the future of rehabilitation by examining the ways that virtual reality and robotics will transform exercise and management systems used by physical therapists.

Nolan, R. P., Upshur, R. E., Lynn, H., Crichton, T., Rukholm, E., Stewart, D. E., . . . Chen, M. H. (2011). Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial. The American Journal of Cardiology, 107(5), 690–696.

The authors outline a clinical study that examined the benefits of telehealth counseling. They also analyze motivational interviewing as an agent to change daily behaviors and attitudes of those with cardiovascular disease.

Singh, R., Mathiassen, L., Stachura, M. E., & Astapova, E. V. (2010). Sustainable rural telehealth innovation: A public health case study. Health Services Research, 45(4), 985–1004.

This qualitative study examines previous telehealth implementations in efforts to improve future developments and sustainability in rural areas.

Stewart, S., Hansen, T. S., & Carey, T. A. (2010). Opportunities for people with disabilities in the virtual world of second life. Rehabilitation Nursing, 35(6), 254-259.

Use this article to examine the physical and emotional benefits that virtual realities can bring to people with disabilities.

Cisco. (n.d.). Industry solutions: Healthcare.

Retrieved October 14, 2011, from http://www.cisco.com/web/strategy/healthcare/index.html 

Investigate the ways that Cisco Industry Solutions is working to bridge the gap between communication and technology for health care environments.

Massachusetts Institute of Technology. (n.d.). MIT media lab.

Retrieved October 14, 2011, from http://www.media.mit.edu/ 

View various technology integration stories in the field of health care at this website

McKesson Corporation. (2011). ROBOT-Rx. Retrieved from http://www.mckesson.com/en_us/McKesson.com/For%2BPharmacies/Inpatient/Pharmacy%2BAutomation/ROBOT-Rx.html 

The McKesson Coporation illustrates how an automated, robotic system is revolutionizing the process of medication storage and dispensing.

Powell, J., Inglis, N., Ronnie, J., & Large, S. (2011). The characteristics and motivations of online health information seekers: Cross-sectional survey and qualitative interview study. Journal of Medical Internet Research, 13(1), e20.

View excerpts from the online questionnaires and follow-up interviews used in this study to identify common themes around motivation, challenges, strategies, and benefits regarding individuals’ use of the Internet to gather health information.

Health on the Net Foundation. (2011).

Retrieved from http://www.hon.ch/ 

Health on the Net Foundation provides consumers with navigation safety tips and the ability to search only those websites that adhere to the credibility standards of the HONcode.

The PEW Charitable Trusts. (2011). Health.

Retrieved from http://www.pewtrusts.org/our_work_category.aspx?id=184 

At this website you can find information about the consumer-centered health initiatives that the PEW group is working to challenge and improve.

Robert Wood Johnson Foundation. (2011). Publications and research. Retrieved from http://www.rwjf.org/en/research-publications.html 

Use this website to view a wide variety of research-driven publications with topics ranging from obesity to medical malpractice.

 

• Capstone Assignment Directions Capstone Assignment- HIM 305
  Thoroughly review capstone scenario to complete this assignment. 
  •  Submit an operating budget for HIM department.
  •  Respond to the questions for the capital budget scenario in a Word document.
  • Write a Request for Proposal (RFP) for the transcription and coding service referenced in the scenario conduct research for samples of request for proposals to assist with this task.
  • Complete the Excel budget spreadsheets. There will be three tabs- Tab One- lists employee salaries of department employees (yearly). Tab Two-departmental monthly expenses. Tab Three- annual budget for department.
  • Information for calculating the budget:
  • Use current dues for AHIMA (refer to AHIMA website for information).
  • Dues should be calculated for the Director and all credentialed employees in the department.
  • Director needs to budget to attend AHIMA National Convention. Find the budget information on the AHIMA website. Budget for transportation, registration and hotel. There is $45 a day allowed by organization for food.
  • Budget for luncheon for the HIP week- 12 employees at $10 per employee.
  • You must budget for employee education for CEU to maintain professional credentials. Calculate at least 10 CEU per year per coder to allow new information on coding updates to be obtained.
  • Refer to sample budget sheets for other information you may need.
  • Project a maximum 5% salary increase.
  • Project an increase in supplies of 7%.
  • Project a 5% increase in all other areas, except those discussed in the scenario.

 

• Capstone Case StudyCapstone Scenario- HIM 305
  Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital.  Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions.  It has an emergency department staffed by hospital employees.  Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31.  In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years.  Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30. 
  Financial Assumptions:
  Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.
  • No major capital projects were anticipated. 
  • In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year. 
  • Coppin State Regional Health Center does not have a large marketing department.  It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor.  In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients.  Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.
    The maternity and newborn departments have been very concerned about declining patient satisfaction.  They are worried that the current year’s  slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges. 
  • The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services.  This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.
  • The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice.  The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab.  Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.
  • Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.
  • The HIM department has recently lost several employees to retirement and promotions with the facility.  It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only.  Transcription is handled largely by the department, with an outside service processing any overflow. 
  • The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.
  •  These changes would also require the implementation of an Electronic Record System (EHR). 
• Capstone Case StudyCapstone Scenario- HIM 305
  Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital.  Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions.  It has an emergency department staffed by hospital employees.  Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31.  In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years.  Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30. 
  Financial Assumptions:
  Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.
  • No major capital projects were anticipated. 
  • In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year. 
  • Coppin State Regional Health Center does not have a large marketing department.  It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor.  In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients.  Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.
    The maternity and newborn departments have been very concerned about declining patient satisfaction.  They are worried that the current year’s  slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges. 
  • The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services.  This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.
  • The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice.  The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab.  Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.
  • Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.
  • The HIM department has recently lost several employees to retirement and promotions with the facility.  It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only.  Transcription is handled largely by the department, with an outside service processing any overflow. 
  • The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.
  •  These changes would also require the implementation of an Electronic Record System (EHR).

 

• All three departments submitted capital budget requests for the projects described.

  Budget Considerations (to be submitted in a Word document with spreadsheets):

  1. What things should be considered in conducting a cost-benefit analysis on each project?
  2. At this point in your decision making which request is most appropriate?  Request for Information, Request for Proposal or Request for a Quote?  Explain your answer.  Develop a request for proposal to send to the transcription and coding services.
  3. If the hospital can only approve one of the proposed projects, which do you think has the best chance of being approved?  Why?
  4. If you were the director of the HIM department, how would you justify your department’s project so that it is presented most favorably?  What are the benefits to selecting this project?

 

• Cost Benefit Analysis InformationCost-Benefit Analysis
  Deciding, Quantitatively, Whether to go Ahead
  (Also known as CBA and Benefit-Cost Analysis)
  http://www.mindtools.com/pages/article/newTED_08.htm
  Imagine that you’ve recently taken on a new project, and your people are struggling to keep up with the increased workload.
  You are therefore considering whether to hire a new team member. Clearly, the benefits of hiring a new person need to significantly outweigh the associated costs.
  This is where Cost-Benefit Analysis is useful.
  Note:
  Cost-Benefit Analysis is a quick and simple technique that you can use for non-critical financial decisions. Where decisions are mission-critical or large sums of money are involved, other approaches – such as use of Net Present Values and Internal Rates of Return – are often more appropriate.
  About the Tool
  Jules Dupuit, a French engineer, first introduced the concept of Cost-Benefit Analysis in the 1930s. It became popular in the 1950s as a simple way of weighing up project costs and benefits, to determine whether to go ahead with a project.
  As its name suggests, Cost-Benefit Analysis involves adding up the benefits of a course of action, and then comparing these with the costs associated with it.
  The results of the analysis are often expressed as a payback period – this is the time it takes for benefits to repay costs. Many people who use it look for payback in less than a specific period – for example, three years.
  You can use the technique in a wide variety of situations. For example, when you are:
  • Deciding whether to hire new team members.
  • Evaluating a new project or change initiative.
  • Determining the feasibility of a capital purchase.
  • However, bear in mind that it is best for making quick and simple financial decisions. More robust approaches are commonly used for more complex, business-critical or high cost decisions.
    How to Use the Tool
    Follow these steps to do a Cost-Benefit Analysis.
    Step One: Brainstorm Costs and Benefits
    First, take time to brainstorm all of the costs associated with the project, and make a list of these. Then, do the same for all of the benefits of the project. Can you think of any unexpected costs? And are there benefits that you may not initially have anticipated?
    When you come up with the costs and benefits, think about the lifetime of the project. What are the costs and benefits likely to be over time?
    Step Two: Assign a Monetary Value to the Costs
    Costs include the costs of physical resources needed, as well as the cost of the human effort involved in all phases of a project. Costs are often relatively easy to estimate (compared with revenues).
    It’s important that you think about as many related costs as you can. For example, what will any training cost? Will there be a decrease in productivity while people are learning a new system or technology, and how much will this cost?
    Remember to think about costs that will continue to be incurred once the project is finished. For example, consider whether you will need additional staff, if your team will need ongoing training, or if you’ll have increased overheads.
    Step Three: Assign a Monetary Value to the Benefits
    This step is less straightforward than step two! Firstly, it’s often very difficult to predict revenues accurately, especially for new products. Secondly, along with the financial benefits that you anticipate, there are often intangible, or soft, benefits that are important outcomes of the project.
    For instance, what is the impact on the environment, employee satisfaction, or health and safety? What is the monetary value of that impact?
    As an example, is preserving an ancient monument worth $500,000, or is it worth $5,000,000 because of its historical importance? Or, what is the value of stress-free travel to work in the morning? Here, it’s important to consult with other stakeholders and decide how you’ll value these intangible items.
    Step Four: Compare Costs and Benefits
    Finally, compare the value of your costs to the value of your benefits, and use this analysis to decide your course of action.
    To do this, calculate your total costs and your total benefits, and compare the two values to determine whether your benefits outweigh your costs. At this stage it’s important to consider the payback time, to find out how long it will take for you to reach the break even point – the point in time at which the benefits have just repaid the costs.
    For simple examples, where the same benefits are received each period, you can calculate the payback period by dividing the projected total cost of the project by the projected total revenues:
    Total cost / total revenue (or benefits) = length of time (payback period).
    Example
    Custom Graphic Works has been operating for just over a year, and sales are exceeding targets. Currently, two designers are working full-time, and the owner is considering increasing capacity to meet demand. (This would involve leasing more space and hiring two new designers.)
    He decides to complete a Cost-Benefit Analysis to explore his choices.
    Assumptions
  • Currently, the owner of the company has more work than he can cope with, and he is outsourcing to other design firms at a cost of $50 an hour. The company outsources an average of 100 hours of work each month.
  • He estimates that revenue will increase by 50 percent with increased capacity.
  • Per-person production will increase by 10 percent with more working space.
  • The analysis horizon is one year: that is, he expects benefits to accrue within the year.
  • Costs
    CategoryDetailsCost in First YearLease750 square feet available next door at $18 per square foot$13,500Leasehold improvementsKnock out walls and reconfigure office space$15,000Hire two more designersSalary, including benefits
    Recruitment costs
    Orientation and training$75,000
    $11,250
    $3,000Two additional workstationsFurniture and hardware
    Software licenses$6,000
    $1,000Construction downtimeTwo weeks at approximately $7,500 revenue per week$15,000Total$139,750Benefits
    BenefitBenefit Within
    12 Months50 percent revenue increase$195,000Paying in-house designers $15 an hour, versus $50 an hour outsourcing (100 hours per month, on average: savings equals $3,500 a month)$42,00010 percent improved productivity per designer ($7,500 + $3,750 = $11,250 revenue per week with a 10 percent increase = $1,125/week)$58,500Improved customer service and retention as a result of 100 percent in-house design$10,000Total$305,500He calculates the payback time as shown below:
    $139,750 / $305,500 = 0.46 of a year, or approximately 5.5 months.
    Inevitably, the estimates of the benefit are subjective, and there is a degree of uncertainty associated with the anticipated revenue increase. Despite this, the owner of Custom Graphic Works decides to go ahead with the expansion and hiring, given the extent to which the benefits outweigh the costs within the first year.
    Flaws of Cost-Benefit Analysis
    Cost-Benefit Analysis struggles as an approach where a project has cash flows that come in over a number of periods of time, particularly where returns vary from period to period. In these cases, use Net Present Value (NPV) and Internal Rate of Return (IRR) calculations together to evaluate the project, rather than using Cost-Benefit Analysis. (These also have the advantage of bringing “time value of money” into the calculation.)
    Also, the revenue that will be generated by a project can be very hard to predict, and the value that people place on intangible benefits can be very subjective. This can often make the assessment of possible revenues unreliable (this is a flaw in many approaches to financial evaluation). So, how realistic and objective are the benefit values used?
    Key Points
    Cost-benefit analysis is a relatively straightforward tool for deciding whether to pursue a project.
    To use the tool, first list all the anticipated costs associated with the project, and then estimate the benefits that you’ll receive from it.
    Where benefits are received over time, work out the time it will take for the benefits to repay the costs.
    You can carry out an analysis using only financial costs and benefits. However, you may decide to include intangible items within the analysis. As you must estimate a value for these items, this inevitably brings more subjectivity into the process.
     

 

Discussion: Breast Conditions

Throughout a woman’s life, her breasts go through many normal, healthy changes. However, patients do not always understand these changes and often visit health care providers for treatment. When examining these patients, you must be able to identify when a breast condition is the result of a safe and normal physiological change and when it is the result of an abnormal change requiring treatment and management. A diagnosis of a breast condition resulting from an abnormal change can be devastating for women, making emotional support as vital to women’s well-being as proper assessment, diagnosis, and management. For this Discussion, consider how you might diagnose, manage, and support the following two patients presenting with breast conditions:

Case Study 1:

You are seeing a 60-year-old Latina female, Gravida 4 Para 3104, who is concerned about a thick greenish discharge from her left breast for the past month. The discharge is spontaneous and associated with dull pain and burning. Upon questioning, she also tells you that she breastfed all her children and is currently not on any medications except for occasional Tylenol for arthritis. Her last mammogram, 14 months ago, was within normal limits. On exam, her left breast around the areola is slightly reddened and edematous. Upon palpation of the right quadrant, a greenish-black discharge exudes from the nipple. You note an ovoid, smooth, very mobile, non-tender 1 cm nodule in the RUIQ at 11:00 5 cm from the nipple. No adenopathy, dimpling, nipple discharge, or other associated findings. Her right breast is unremarkable. The patient expresses her desire to proactively decrease her risk for developing breast cancer.

 Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder. 

profileScarlett12

Field: Nursing

Posted: A Day AgoDue: 19/09/2017Budget:  $8Report Issue

Week 4: Transformational Nursing Leaders

3 3 unread replies. 3 3 replies.

Review Appendix A, Sections I–V in Finkelman (2016).

Select one of the sections and share how your chief nurse executive demonstrates expertise in these competencies.  Your comments should be about the “highest nursing leader” in your organization. Typically this is the leader who represents nurses and nursing to the governing board.

In your own words, explain the differences between a transactional nursing leader and a transformational nursing leader. What one is more like your Nurse Executive?

Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences.

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Desirae Freeze 

Friday Sep 15 at 8:18pm

Manage Discussion Entry

You may begin posting to this discussion on: Sunday, September 17, 2017

Class,

There are several sections in this appendix from which you can choose. Concentrate on one section and discuss competencies you see your Nurse Executive displaying. Keep in mind that they Nurse Executive the individual ultimately responsible for nursing and is at the top of your organization. This is not your director or nursing manager, but your Chief Nurse Executive.

Thanks,

Desirae

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Imagine you are a Program Manager or Technical Analyst, working for the World Health Organization (WHO) or Non-governmental Organization (NGO). You have been asked to put together a PowerPoint presentation  of 8-10 slides, not including title or reference slides, about what you learned at the recent World Health Summit. Each slide with content should also include 150-200 word Speaker Notes.  Be sure to include the following information in your presentation:

• Explain your job duties.  
• Describe the history and development of the Global Health Data Exchange (GHDx), and explain why it was formed. 
• Include the types of services it provides around the world.  
• Explain how the WHO, GHDx, and the World Health Summit are involved in world health, including information about how new technology is provided for foreign countries.  
• Provide and describe the types of health care technology available in foreign countries. This can include low-income, middle-income, and high-income economies.  
• Select 5 of the best health care organizations in the world, and summarize the services they provide. Explain why these are considered the best health care organizations in the world.  
• In a table, outline significant differences among 4 nations offering the best health care as compared to those that provide low-quality health care. 

Be sure to support your information by citing at least 2 scholarly references using APA format.