Understanding and Managing Patient Fear in the Hospital SettingInnovations2Solutions
Few regard being in the hospital as a pleasant experience. A hospital stay is usually associated with
a dual burden — the unpleasantness of the condition causing the hospitalization, as well as the discomfort associated with the state of being in a hospital. Medical research and increasingly also patient engagement can help speed and alleviate the first issue. To mitigate the second concern, hospital staff and administrators can make valuable contributions.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.
The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the stability of the physician workforce.
There has been a major decrease in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. This trend, coupled with attrition among currently practicing physicians, have already had a significant effect on patient access to primary care services.
Replacing physicians who leave practice is expensive:
estimates are $250 000 or more per physician. Even though the problem of burnout in physicians has been recognized for years, there
have been few programs targeting burnout before it leads to personal or professional impairment and very little data exist about their effectiveness.
METHODS
Study Population
All primary care physicians in the Greater Rochester, New York, community
(N=871) were invited to participate in the program through a series of mailed and electronic communications from the Monroe County Medical Society to individual physicians and local health care organizations, with follow-up telephone calls from the investigators.
While utilizing solutions such as medical transcription services can be beneficial for doctors, they should also focus on fostering certain good qualities.
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Understanding and Managing Patient Fear in the Hospital SettingInnovations2Solutions
Few regard being in the hospital as a pleasant experience. A hospital stay is usually associated with
a dual burden — the unpleasantness of the condition causing the hospitalization, as well as the discomfort associated with the state of being in a hospital. Medical research and increasingly also patient engagement can help speed and alleviate the first issue. To mitigate the second concern, hospital staff and administrators can make valuable contributions.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.
The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the stability of the physician workforce.
There has been a major decrease in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. This trend, coupled with attrition among currently practicing physicians, have already had a significant effect on patient access to primary care services.
Replacing physicians who leave practice is expensive:
estimates are $250 000 or more per physician. Even though the problem of burnout in physicians has been recognized for years, there
have been few programs targeting burnout before it leads to personal or professional impairment and very little data exist about their effectiveness.
METHODS
Study Population
All primary care physicians in the Greater Rochester, New York, community
(N=871) were invited to participate in the program through a series of mailed and electronic communications from the Monroe County Medical Society to individual physicians and local health care organizations, with follow-up telephone calls from the investigators.
While utilizing solutions such as medical transcription services can be beneficial for doctors, they should also focus on fostering certain good qualities.
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
Medical State Boards are political bodies. This presentation outlines challenges in implementing policy with, oftentimes, dysfunctional politics and poor leadership especially as it relates to physician issues. Competency issues are difficult to adjudicate on and expert opinion (the "hired guns") do not make the process any more effective. Institutional bias ends up being the basis for decision making.
35NURSING ECONOMIC$/January-February 2011/Vol. 29/No. 1
T
HE WORLD OF ARISTOTLE AND
Ptolemy believed that Earth
was positioned at the cen-
ter of the universe. Thanks
to Galileo and Copernicus’s studies
in the 16th century, we know this
is not true and that the sun is the
center of our universe. Pers -
pectives of health care have
undergone similar, radical changes
in perception. For centuries we
had a hospital-centric view; an
illness-based model, where the majority of care was
provided in hospitals, when we were ill. In the last
few decades, that model has migrated to a more con-
tinuum of care view; a wellness/health maintenance
model, where emphasis of care is outside the hospital
in other venues such as outpatient, ambulatory/clin-
ic, and home care (see Figure 1).
But as we all know, this is still not where we need
to be to support the highest quality care at the right
cost. Despite a focus on moving care out of the hospi-
tals, one only needs to think about the process of
medication reconciliation between care venues to
realize the lack of seamless integration of care deliv-
ery and the challenges of supporting interoperability
across the continuum. Hence, here I am proposing the
patient centric view, where the patient actively partic-
ipates in his or her care and we look at delivering care
from a patient’s point of view. This allows us to break
down some of the barriers we have struggled with on
our journeys to promote higher quality care through
the use of health information technology (HIT). Now
we need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital. Considering a
patient-centric point of view when implementing and
optimizing the use of HIT provides new perspectives
on the meaning of “integrated” health care.
Patient-Centric Care
It might seem odd that a health care organization
needs to be reminded to involve the patient in his or
her care. After all, this approach would certainly be
supported from a patient’s perspective. And, of
course, the health care industry has compelling rea-
sons to incorporate a strong customer and service
focus in order to improve patient satisfaction and
impact patient loyalty. But as health care systems
Patient as Center of the Health Care Universe:
A Closer Look at Patient-Centered Care
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President-
Information Services, Aurora Health Care, Milwaukee, WI; a
HIMSS Board Member; Co-Chair of the Alliance for Nursing
Informatics; a member of the federal HIT Standards Committee;
and is a Nursing Economic$ Editorial Board Member. Comments
and suggestions can be sent to [email protected]
EXECUTIVE SUMMARY
We need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital.
Considering a patient-centric point of view when
implementing and optimizing the use of health infor-
mation technology (HIT) provides new perspect.
35NURSING ECONOMIC$/January-February 2011/Vol. 29/No. 1
T
HE WORLD OF ARISTOTLE AND
Ptolemy believed that Earth
was positioned at the cen-
ter of the universe. Thanks
to Galileo and Copernicus’s studies
in the 16th century, we know this
is not true and that the sun is the
center of our universe. Pers -
pectives of health care have
undergone similar, radical changes
in perception. For centuries we
had a hospital-centric view; an
illness-based model, where the majority of care was
provided in hospitals, when we were ill. In the last
few decades, that model has migrated to a more con-
tinuum of care view; a wellness/health maintenance
model, where emphasis of care is outside the hospital
in other venues such as outpatient, ambulatory/clin-
ic, and home care (see Figure 1).
But as we all know, this is still not where we need
to be to support the highest quality care at the right
cost. Despite a focus on moving care out of the hospi-
tals, one only needs to think about the process of
medication reconciliation between care venues to
realize the lack of seamless integration of care deliv-
ery and the challenges of supporting interoperability
across the continuum. Hence, here I am proposing the
patient centric view, where the patient actively partic-
ipates in his or her care and we look at delivering care
from a patient’s point of view. This allows us to break
down some of the barriers we have struggled with on
our journeys to promote higher quality care through
the use of health information technology (HIT). Now
we need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital. Considering a
patient-centric point of view when implementing and
optimizing the use of HIT provides new perspectives
on the meaning of “integrated” health care.
Patient-Centric Care
It might seem odd that a health care organization
needs to be reminded to involve the patient in his or
her care. After all, this approach would certainly be
supported from a patient’s perspective. And, of
course, the health care industry has compelling rea-
sons to incorporate a strong customer and service
focus in order to improve patient satisfaction and
impact patient loyalty. But as health care systems
Patient as Center of the Health Care Universe:
A Closer Look at Patient-Centered Care
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President-
Information Services, Aurora Health Care, Milwaukee, WI; a
HIMSS Board Member; Co-Chair of the Alliance for Nursing
Informatics; a member of the federal HIT Standards Committee;
and is a Nursing Economic$ Editorial Board Member. Comments
and suggestions can be sent to [email protected]
EXECUTIVE SUMMARY
We need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital.
Considering a patient-centric point of view when
implementing and optimizing the use of health infor-
mation technology (HIT) provides new perspect ...
THE DYNAMIC ENVIRONMENT OF HEALTH CAREChapter 1Objecti.docxtodd701
THE DYNAMIC ENVIRONMENT OF HEALTH CARE
Chapter 1
Objectives
Describe the present healthcare environment.
Examine megatrends in the environment.
Address organizational survival.
Identify the role of the healthcare practitioner as manager.
Review the classic functions of the manager.
Define and differentiate between management as an art and a science.
Conceptualize the characteristics of an effective manager.
2
Megatrends
Client characteristics
Professional practitioners and caregivers
The healthcare marketplace and settings
Applicable laws, regulations, and standards
The impact of technology
Privacy and security considerations
Financing of health care
Social and cultural factors
Healthcare Regulation
State licensure laws for facilities
State licensure laws for professions
State-mandated healthcare planning
State laws governing reimbursement and insurance
Healthcare Regulation
Federal laws governing reimbursement
Federal laws regarding privacy and security of information
Patient Protection and Affordable Care Act
American Recovery and Reinvestment Act
5
Reimbursement and Payment
Charitable roots and the not-for-profit model
Fee-for-service
Health insurance: Non-profit and commercial
Managed care
Current legislation: Healthcare reform
The Managed Care Era
Providing access to quality care at affordable cost
Primary care physician as “gatekeeper”
Premium costs by limits on services
Arrangements between managed care groups and hospitals
Issues about denial of service or payment
Capitation
Reimbursement system under which provider is paid specific amount of money to look after all the healthcare needs of a given population
Literally, reimbursement based on so much “per head”
Reasons for Restructuring
Desire to achieve greater negotiating clout
Desire to penetrate new markets
Need for improved efficiencies
Desire to express an overall value of promoting comprehensive, readily accessible care
Mergers and Affiliations
MERGER: Two or more corporate entities blend to create one new organization
AFFILIATION: Formal agreement between facilities to coordinate and share activities while remaining separate corporate entities
Range of Service
Note the variety of services and levels of care
Examples:
Adult day care center
Hospice
Urgent care clinic
Impact of Technology
“eVisits” and “digital doctors”
Translational medicine
Data warehousing
Data mining
“Real-time” interventions
Common language and standards: Standard vocabulary and classification systems
National information infrastructure: To capture, access, use, exchange, and store data
Increased use by patients of alternative therapies and interventions
The embedded nurse representative on patient care teams
Rationing; quality-adjusted remaining years
Social and Ethical Factors
Unit supervisor; project manager; department head
Specialized division head
Manager of independent practice
Role of Healthcare Practitioner as Manager
Management Functions
Typ.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
Today we live in an era where development and innovation are the norms. With an improvement in technology, reaching out to the remote areas of the world is becoming increasingly easier. The rise in the availability and innovations of medical and healthcare facilities has resulted in more and more lives that can be saved.
3 pagesAfter reading the Cybersecurity Act of 2015, address .docxnovabroom
3 pages
After reading the
Cybersecurity Act of 2015
, address the private/public partnership with the DHS National Cybersecurity and Communications Integration Center (NCCIC), arguably the most important aspect of the act. The Cybersecurity Act of 2015 allows for private and public sharing of cybersecurity threat information.
What should the DHS NCCIC (public) share with private sector organizations? What type of threat information would enable private organizations to better secure their networks?
On the flip side, what should private organizations share with the NCCIC? As it is written, private organization sharing is completely voluntary. Should this be mandatory? If so, what are the implications to the customers' private data?
The government is not allowed to collect data on citizens. How should the act be updated to make it better and more value-added for the public-private partnership in regards to cybersecurity?
.
3 pages, 4 sourcesPaper detailsNeed a full retirement plan p.docxnovabroom
3 pages, 4 sources
Paper details
Need a full retirement plan proposal in excel with cited sources.
My career objective would be to start out of school as an associate accountant, then advance to a Director of Finance until I get promoted as CFO working in the healthcare industry in Las Vegas
.
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
Medical State Boards are political bodies. This presentation outlines challenges in implementing policy with, oftentimes, dysfunctional politics and poor leadership especially as it relates to physician issues. Competency issues are difficult to adjudicate on and expert opinion (the "hired guns") do not make the process any more effective. Institutional bias ends up being the basis for decision making.
35NURSING ECONOMIC$/January-February 2011/Vol. 29/No. 1
T
HE WORLD OF ARISTOTLE AND
Ptolemy believed that Earth
was positioned at the cen-
ter of the universe. Thanks
to Galileo and Copernicus’s studies
in the 16th century, we know this
is not true and that the sun is the
center of our universe. Pers -
pectives of health care have
undergone similar, radical changes
in perception. For centuries we
had a hospital-centric view; an
illness-based model, where the majority of care was
provided in hospitals, when we were ill. In the last
few decades, that model has migrated to a more con-
tinuum of care view; a wellness/health maintenance
model, where emphasis of care is outside the hospital
in other venues such as outpatient, ambulatory/clin-
ic, and home care (see Figure 1).
But as we all know, this is still not where we need
to be to support the highest quality care at the right
cost. Despite a focus on moving care out of the hospi-
tals, one only needs to think about the process of
medication reconciliation between care venues to
realize the lack of seamless integration of care deliv-
ery and the challenges of supporting interoperability
across the continuum. Hence, here I am proposing the
patient centric view, where the patient actively partic-
ipates in his or her care and we look at delivering care
from a patient’s point of view. This allows us to break
down some of the barriers we have struggled with on
our journeys to promote higher quality care through
the use of health information technology (HIT). Now
we need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital. Considering a
patient-centric point of view when implementing and
optimizing the use of HIT provides new perspectives
on the meaning of “integrated” health care.
Patient-Centric Care
It might seem odd that a health care organization
needs to be reminded to involve the patient in his or
her care. After all, this approach would certainly be
supported from a patient’s perspective. And, of
course, the health care industry has compelling rea-
sons to incorporate a strong customer and service
focus in order to improve patient satisfaction and
impact patient loyalty. But as health care systems
Patient as Center of the Health Care Universe:
A Closer Look at Patient-Centered Care
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President-
Information Services, Aurora Health Care, Milwaukee, WI; a
HIMSS Board Member; Co-Chair of the Alliance for Nursing
Informatics; a member of the federal HIT Standards Committee;
and is a Nursing Economic$ Editorial Board Member. Comments
and suggestions can be sent to [email protected]
EXECUTIVE SUMMARY
We need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital.
Considering a patient-centric point of view when
implementing and optimizing the use of health infor-
mation technology (HIT) provides new perspect.
35NURSING ECONOMIC$/January-February 2011/Vol. 29/No. 1
T
HE WORLD OF ARISTOTLE AND
Ptolemy believed that Earth
was positioned at the cen-
ter of the universe. Thanks
to Galileo and Copernicus’s studies
in the 16th century, we know this
is not true and that the sun is the
center of our universe. Pers -
pectives of health care have
undergone similar, radical changes
in perception. For centuries we
had a hospital-centric view; an
illness-based model, where the majority of care was
provided in hospitals, when we were ill. In the last
few decades, that model has migrated to a more con-
tinuum of care view; a wellness/health maintenance
model, where emphasis of care is outside the hospital
in other venues such as outpatient, ambulatory/clin-
ic, and home care (see Figure 1).
But as we all know, this is still not where we need
to be to support the highest quality care at the right
cost. Despite a focus on moving care out of the hospi-
tals, one only needs to think about the process of
medication reconciliation between care venues to
realize the lack of seamless integration of care deliv-
ery and the challenges of supporting interoperability
across the continuum. Hence, here I am proposing the
patient centric view, where the patient actively partic-
ipates in his or her care and we look at delivering care
from a patient’s point of view. This allows us to break
down some of the barriers we have struggled with on
our journeys to promote higher quality care through
the use of health information technology (HIT). Now
we need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital. Considering a
patient-centric point of view when implementing and
optimizing the use of HIT provides new perspectives
on the meaning of “integrated” health care.
Patient-Centric Care
It might seem odd that a health care organization
needs to be reminded to involve the patient in his or
her care. After all, this approach would certainly be
supported from a patient’s perspective. And, of
course, the health care industry has compelling rea-
sons to incorporate a strong customer and service
focus in order to improve patient satisfaction and
impact patient loyalty. But as health care systems
Patient as Center of the Health Care Universe:
A Closer Look at Patient-Centered Care
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President-
Information Services, Aurora Health Care, Milwaukee, WI; a
HIMSS Board Member; Co-Chair of the Alliance for Nursing
Informatics; a member of the federal HIT Standards Committee;
and is a Nursing Economic$ Editorial Board Member. Comments
and suggestions can be sent to [email protected]
EXECUTIVE SUMMARY
We need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital.
Considering a patient-centric point of view when
implementing and optimizing the use of health infor-
mation technology (HIT) provides new perspect ...
THE DYNAMIC ENVIRONMENT OF HEALTH CAREChapter 1Objecti.docxtodd701
THE DYNAMIC ENVIRONMENT OF HEALTH CARE
Chapter 1
Objectives
Describe the present healthcare environment.
Examine megatrends in the environment.
Address organizational survival.
Identify the role of the healthcare practitioner as manager.
Review the classic functions of the manager.
Define and differentiate between management as an art and a science.
Conceptualize the characteristics of an effective manager.
2
Megatrends
Client characteristics
Professional practitioners and caregivers
The healthcare marketplace and settings
Applicable laws, regulations, and standards
The impact of technology
Privacy and security considerations
Financing of health care
Social and cultural factors
Healthcare Regulation
State licensure laws for facilities
State licensure laws for professions
State-mandated healthcare planning
State laws governing reimbursement and insurance
Healthcare Regulation
Federal laws governing reimbursement
Federal laws regarding privacy and security of information
Patient Protection and Affordable Care Act
American Recovery and Reinvestment Act
5
Reimbursement and Payment
Charitable roots and the not-for-profit model
Fee-for-service
Health insurance: Non-profit and commercial
Managed care
Current legislation: Healthcare reform
The Managed Care Era
Providing access to quality care at affordable cost
Primary care physician as “gatekeeper”
Premium costs by limits on services
Arrangements between managed care groups and hospitals
Issues about denial of service or payment
Capitation
Reimbursement system under which provider is paid specific amount of money to look after all the healthcare needs of a given population
Literally, reimbursement based on so much “per head”
Reasons for Restructuring
Desire to achieve greater negotiating clout
Desire to penetrate new markets
Need for improved efficiencies
Desire to express an overall value of promoting comprehensive, readily accessible care
Mergers and Affiliations
MERGER: Two or more corporate entities blend to create one new organization
AFFILIATION: Formal agreement between facilities to coordinate and share activities while remaining separate corporate entities
Range of Service
Note the variety of services and levels of care
Examples:
Adult day care center
Hospice
Urgent care clinic
Impact of Technology
“eVisits” and “digital doctors”
Translational medicine
Data warehousing
Data mining
“Real-time” interventions
Common language and standards: Standard vocabulary and classification systems
National information infrastructure: To capture, access, use, exchange, and store data
Increased use by patients of alternative therapies and interventions
The embedded nurse representative on patient care teams
Rationing; quality-adjusted remaining years
Social and Ethical Factors
Unit supervisor; project manager; department head
Specialized division head
Manager of independent practice
Role of Healthcare Practitioner as Manager
Management Functions
Typ.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
Today we live in an era where development and innovation are the norms. With an improvement in technology, reaching out to the remote areas of the world is becoming increasingly easier. The rise in the availability and innovations of medical and healthcare facilities has resulted in more and more lives that can be saved.
3 pagesAfter reading the Cybersecurity Act of 2015, address .docxnovabroom
3 pages
After reading the
Cybersecurity Act of 2015
, address the private/public partnership with the DHS National Cybersecurity and Communications Integration Center (NCCIC), arguably the most important aspect of the act. The Cybersecurity Act of 2015 allows for private and public sharing of cybersecurity threat information.
What should the DHS NCCIC (public) share with private sector organizations? What type of threat information would enable private organizations to better secure their networks?
On the flip side, what should private organizations share with the NCCIC? As it is written, private organization sharing is completely voluntary. Should this be mandatory? If so, what are the implications to the customers' private data?
The government is not allowed to collect data on citizens. How should the act be updated to make it better and more value-added for the public-private partnership in regards to cybersecurity?
.
3 pages, 4 sourcesPaper detailsNeed a full retirement plan p.docxnovabroom
3 pages, 4 sources
Paper details
Need a full retirement plan proposal in excel with cited sources.
My career objective would be to start out of school as an associate accountant, then advance to a Director of Finance until I get promoted as CFO working in the healthcare industry in Las Vegas
.
3 pagesThis paper should describe, as well as compare and contra.docxnovabroom
3 pages
This paper should describe, as well as compare and contrast, Diffie Hellman and Kerberos. You should include data flow diagrams that outline the transaction of both kerberos and Diffie Hellman - one diagram each please using Microsoft Visio or Dia (free open source tool). These diagrams are NOT part of the page total required for this assignment.
single spacing
, normal margins, use 12 pt font - reference what isn't yours please
.
3 assignments listed below1. In a 350 word essay, compare a.docxnovabroom
3 assignments listed below
1.
In a 350 word essay, compare and contrast the healthcare system of the United States with the WHO’s Millennium Development Goals. Be sure that you are providing the significant components of the US system as well as the WHO'S Millennium Development Goals.
The essay must be submitted using 12 point times new roman font double spaced in APA format. You must have at least one reference on a separate reference page. The assignment must be submitted in APA format; you do not need an abstract.
2.
Children have always contributed to the total number of migrants crossing the southern border of the United States illegally, but in 2014, a steady overall increase in unaccompanied minors from Central America reached crisis proportions when tens of thousands of children from El Salvador, Guatemala, and Honduras crossed the Rio Grande and overwhelmed border patrols and local infrastructure (Dart 2014).
Since legislators passed the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 in the last days of the Bush administration, unaccompanied minors from countries that do not share a border with the United States are guaranteed a hearing with an immigration judge where they may request asylum based on a “credible” fear of persecution or torture (U.S. Congress 2008). In some cases, these children are looking for relatives and can be placed with family while awaiting a hearing on their immigration status; in other cases, they are held in processing centers until the Department of Health and Human Services makes other arrangements (Popescu 2014).
The 2014 surge placed such a strain on state resources that Texas began transferring the children to Immigration and Naturalization facilities in California and elsewhere, without incident for the most part. On July 1, 2014, however, buses carrying the migrant children were blocked by protesters in Murrietta, California, who chanted, "Go home" and "We don’t want you.” (Fox News and Associated Press 2014; Reyes 2014).
A functional perspective theorist might focus on the dysfunctions caused by the sudden influx of underage asylum seekers, while a conflict perspective theorist might look at the way social stratification influences how the members of a developed country are treating the lower-status migrants from less-developed countries in Latin America. An interactionist theorist might see the significance in the attitude of the Murrietta protesters toward the migrant children.
Respond to the following questions in a 350-word essay using 12 point times new roman font double spaced: Given the fact that these children are fleeing various kinds of violence and extreme poverty, how should the U.S. government respond? Should the government pass laws granting a general amnesty? Or should it follow a zero-tolerance policy, automatically returning any and all unaccompanied minor migrants to their countries of origin so as to discourage additional immigration tha.
/
3 Communication Challenges in a Diverse, Global Marketplace
LEARNING OBJECTIVES
After studying this chapter, you will be able to
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Discuss the opportunities and challenges of intercultural communication.
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De�ine culture, explain how culture is learned, and de�ine ethnocentrism and stereotyping.
3 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001b�b#P7001012451000000000000000001BFF)
Explain the importance of recognizing cultural variations, and list eight categories of cultural differences.
4 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001c9b#P7001012451000000000000000001CA0) List
four general guidelines for adapting to any business culture.
5 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001cc6#P7001012451000000000000000001CCA)
Identify seven steps you can take to improve your intercultural communication skills.
MyBCommLab®
Improve Your Grade!
More than 10 million students improved their results using Pearson MyLabs. Visit mybcommlab.com (http://mybcommlab.com) for simulations, tutorials, and
end-ofchapter problems.
COMMUNICATION CLOSE-UP AT
Kaiser Permanente
kp.org (http://kp.org)
Delivering quality health care is dif�icult enough, given the complexities of technology, government regulations, evolving scienti�ic and medical understanding, and
the variability of human performance. It gets even more daunting when you add the challenges of communication among medical staff and between patients and
their caregivers, which often takes place under stressful circumstances. Those communication efforts are challenging enough in an environment where everyone
speaks the same language and feels at home in a single cultural context—but they’re in�initely more complex in the United States, whose residents identify with
dozens of different cultures and speak several hundred languages.
The Oakland-based health-care system Kaiser Permanente has been embracing the challenges and opportunities of diversity since its founding in 1945. It made a
strong statement with its very �irst hospital when it refused to follow the then-common practice of segregating patients by race. Now, as the largest not-for-pro�it
health system in the United States, Kaiser’s client base includes more than 10 million members from over 100 distinct cultures.
At the core of Kaiser’s approach is culturally competent care, which it de�ines as “health care that acknowledges cultural diversity in the clinical setting, respects
members’ beliefs and practices, and ensures that cultural needs are considered and respected at every point of contact.” These priorities.
2Women with a Parasol-Madame Monet and Her SonClau.docxnovabroom
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Women with a Parasol-Madame Monet and Her Son
Claud Monet (1840-1926)
1875
Oil on Canvas
100 x 81 cm
119.4 x 99.7 cm
Image from National Gallery of Art.
Working thesis statement
- “Woman with a Parasol” is also called “The Stroll”. Painted 1875 (art, n.d.) in France Argenteuil; The character in the paint are Monet’s wife Camille Monet and his 7-year-old son.
- This paint was finished within a day; he was using the fast-visible brushstrokes to create this work. This work witnessed that Monet got away from the Academy style. (Gallery, n.d.) The theme of the paint is one of kind. (Proving the impressionism)
- “Woman with a Parasol” was exhibited in second impressionist exhibition, 1876. (Art)
- The theme and environment in the paint earned many claps and praises. The whole image provides people with a feeling of freedom and kind. (Art, nga.gov, n.d.)
The controversy parts.
· How much contribution that this paint did to the modern art world.
· The affections about the theme in this paint.
· The viewer nowadays is judging the art value of this paint.
Those controversy parts about the paint were making a progress in modern art and improve the development of art.
Bibliography:
1. “Woman with a Parasol - Madame Monet and Her Son.” Modern Painters 29, no. 1 (March 2017): 45. https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=121204182&site=eds-live.
2. Goldwater, Robert. "The Glory that was France." Art News 65 (March 1966):42, repro. cover. 1966
3. Hand, John Oliver. National Gallery of Art: Master Paintings from the Collection. Washington and New York, 2004: 382-383, no. 317, color repro. 2004
4. C. Monet Gallery “Woman with a Parasol”. https://www.cmonetgallery.com/woman-with-a-parasol.aspx
5. Woman with a Parasol, 1875 by Claude Monet, Claude Monet Paintings, biography, and Quotes. https://www.claude-monet.com/woman-with-a-parasol.jsp#prettyPhoto
6. Eelco Kappe. “Woman with a Parasol - Madame Monet and Her Son by Claude onet.” TripImprover, (2019/10/16) https://www.tripimprover.com/blog/woman-with-a-parasol-madame-monet-and-her-son-by-claude-monet#comments
7. Google Art and Culture, National Gallery of Art, Washington DC. https://artsandculture.google.com/asset/woman-with-a-parasol-madame-monet-and-her-son/EwHxeymQQnprMg
8. Charles Saatchi. “Charles Saatchi's Great Masterpieces: when a family scene was an act of rebellion.”19 March 2018. 7:00AMhttps://www.telegraph.co.uk/art/artists/charles-saatchis-great-masterpieces-family-scene-act-rebellion/
9. TotallyHistory. “Woman with a Parasol”. http://totallyhistory.com/woman-with-a-parasol/
10.Peter C. Baker. “THE REAl WORLD OF MONET”, The New York. January 10,2013. https://www.newyorker.com/books/page-turner/the-real-world-of-monet
Improving financial literacy in
college of business students:
modernizing delivery tools
Ronald Kuntze
College of Business, University of New Haven, West Haven, Connecticut, USA
Chen (Ken) Wu and Barbara Ross Wooldridge
Soules Colleg.
2The following is a list of some of the resources availabl.docxnovabroom
2
The following is a list of some of the resources available in the Trident Online Library related to the HR field.
Academic Research
Journal of Applied Psychology
This journal focuses on the applications of psychology research. This research journal is a good source for learning about the latest developments in cognitive, motivational and behavioral psychology and implications for the workplace. It is available through Business Source Complete in the Trident Online Library.
Personnel Psychology: A Journal of Applied Research
This scholarly journal has practical utility in that it centers on personnel psychology. The articles focus on the latest research on selection and recruitment, training, leadership, rewards, and diversity. It is available through Business Source Complete in the Trident Online Library.
Academy of Management Journal
This journal focuses on the management side of psychology. The articles are mainly theoretical. This journal would be a good resource for those researchers looking for new managerial theories and methods. It is available through Business Source Complete in the Trident Online Library.
The Academy of Management Review
This journal also focuses on management psychology. It is regarded as a top journal in its field and publishes theoretical and conceptual articles on management and organization theory. It is available through Business Source Complete in the Trident Online Library.
Professional Journals
Harvard Business Review
Harvard Business Review is a cornerstone business journal that has practical applications for HR professionals. This is a great resource to find case studies and expert insights on business practices. It is available through Business Source Complete in the Trident Online Library.
Human Resource Management Journal
This journal has best practices articles for HR professionals in the workplace. It is available (up to 1 year ago) through Business Source Complete in the Trident Online Library.
HRMagazine
This magazine is published by the Society for Human Resource Management. The articles are a great resource for HR professionals dealing with the most recent issues in the workplace. It is available through Business Source Complete in the Trident Online Library.
TD: Talent Development
The Association for Talent Development publishes this magazine. It is targeted to professionals in the human resource development field. It is available through Business Source Complete in the Trident Online Library.
Workforce
Solution
s Review
This magazine that focuses on many topics within human resource management. The articles included are written by industry experts and academics. They are targeted to HR professionals in the workplace. It is available through Business Source Complete in the Trident Online Library.
Adapted from: PennState University Libraries (2017). Retrieved from http://guides.libraries.psu.edu/human-resources/journals.
Assignment
Select three articles (published within the past five years),.
3 If you like to develop a computer-based DAQ measurement syst.docxnovabroom
3:
If you like to develop a computer-based DAQ measurement system or that can provide several functions in a Smart Home System, such as climate control or gas leakage detection functions, answer the following for the climate control systemfunction:
3.1 Draw the hardware connections of the system focusing on the pin connections of the system components, so that the system can provide the 'Climate Control'
function. The available devices are: (5 marks)
Microprocessor-based system (Laptop/PC).
Interface board: NI USB DAQ.
LM35 Temperature sensor Humidity sensor
Micro-switches Variable resistor LEDs Relays
Multi-output power supply
Include any required passive electronic components
3.2 Draw a flowchart for a program that can achieve both the climate control and gas leakage detection functions. (4 marks)
3.3 What are the factors that should be considered when selecting a DAQ card?
(4 marks)
3.4 Discuss the signal aliasing problem and how you can overcome this effect; supportyour answer with figures and drawings(2 marks)
3.5 What are the steps of conversion of continuous signals to digital values (ADC)?
(2 marks)
3.6 Name four types of ADC’s and choose any two to compare between them; what is the ADC type that is used in NI DAQ’s? support your answer with figures anddrawings(7 marks)
3.7 Compare between RTD (Resistance Type Device) and Thermocouples temperature sensors; support your answer with examples and drawings. The LM35 sensor can be classified as which type of temperature sensors? (5 marks)
3.8 Give examples of DAQ cards that can be used to measure the following properties and discuss the reasons for your selection.?
1- Displacement
2- Vibration
3- Strain (6 marks)
Total 35 marks4:
You are to develop a home security system that can be used to monitor a house of two doors and four windows. The output of the system should present the status of each location independently and should provide an audible warning in case of any problem - including the detection of smoke. The available devices are:
− PIC16F877 Microcontroller (given in Figure 4.1)
− two door push button switches
− four window push button switches
− one Motion Detector
− one smoke detector sensor
− eight LEDs
− one buzzer
− Include any passive electronic components required.
According to your study answer the following questions:
4.1 Draw a block diagram for the complete system. (4 marks)
4.2 Using the PIC16F877A microcontroller shown in Figure 4.1, draw the wiring diagram of the proposed system. Include any necessary electronic components required for the microcontroller to function correctly; state the function of each
element. (8 marks)
4.3 Draw a flowchart for a program that can achieve the above function. (4 marks)
4.4 Given the pin confi.
2BackgroundThe research focuses on investigating leaders fro.docxnovabroom
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Background
The research focuses on investigating leaders from highly rated managed care organizations based on their leadership practices in comparison to leaders from low rated managed care organizations. High rated organizations are managed care organizations who have attained either 4.5 or 5 Medicare Stars ratings whiles low ratings organizations are organizations who have attained 3 Stars or less.
The research design: Survey was sent to leaders from both high Medicare rated and low rated organizations. I believe I have enough sample size so the result will be significant. I have received 35 response from leaders from high rated organizations and 35 from low rated organizations (35 participants each responded, making 70 participants in total). The goal is to find out if there is a significant difference in leadership practice between leaders from highly rated organizations and low rated organizations.
The survey tool used is Leadership Practice Inventory (LPI), which has a total of 30 behavioral statements that reflect on the practices leaders regularly use in managing their organizations. The leaders were invited to complete the survey online. The 30 survey questions are grouped in 5 Models:
1. Model the Way
1. Inspire a Shared Vision
1. Challenge the Process
1. Enable Others to Act
1. Encourage the Heart
The participants completed the LPI self-test, where they must rate themselves depending on the frequency, which they believe in engaging in each of the five models. They rate themselves on a 10 point likert scale, below.
1-Almost Never
3-Seldom
5-Occasionally
7-Fairly Often
9-Very Frequently
2-Rarely
4-Once in a While
6-Sometimes
8-Usually
10-Almost always
1. Dependent Variable: Attaining high Overall Medicare Star Rating
1. Independent Variables:
1. Leadership practice Practices (Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart)
1. Years of Experience
1. Leadership Style
Abbreviations meaning:
LP- Leadership Practice
MSR – Medicare Stars Ratings
MSROs – Medicare Stars Ratings Organizations
YoE – Years of Experience
The following hypotheses has been tested, analyzed (page 4-23). SPSS software was used for data analysis.
Hypothesis 1 - There is a significant difference in LP between leaders from high (4.5 or 5) MSROs and low (3 Stars or less) MSROs.
Hypothesis 2 – There is a strong relationship between MSRs and the LP of both high and low MSROs
Hypothesis 3 - In comparison to other 4 models (thus Model the Way, Challenge the Process, Enable Others to Act, Encourage the Hearts), practicing the “Inspire A Shared Vision” model is very significant in helping leaders influence the attainment of high MSR in MCOs.
Hypothesis 4 – The leaders’ leadership style contributes to a leader’s ability to influence the achievement of high Medicare ratings for MCO.
Hypothesis 5 – The Leaders’ of Years of Experience (YoE) is effective in enabling leaders influence the attainment o.
2TITLE OF PAPERDavid B. JonesColumbia Southe.docxnovabroom
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TITLE OF PAPER
David B. Jones
Columbia Southern University
BBA: 3201 Principles of Marketing
Nancy Ely Mount
Month/Date/ 2020
Marketing is
Four Elements of Marketing:
Creating
Communicating
Delivering
Exchanging
Holistic Marketing Concept is a people oriented approach utilizing the four principles of :
Relationship
Integrated
Internal
Performance marketing
.
2To ADD names From ADD name Date ADD date Subject ADD ti.docxnovabroom
2
To: ADD names From: ADD name Date: ADD date Subject: ADD title
Introduction
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit.
Sed pellentesque sagittis diam, sit amet faucibus diam lobortis quis. Sed mattis turpis ligula, in accumsan ante pellentesque eu. Quisque ut nisl leo. Nullam ipsum odio, eleifend non orcinon, volutpat sollicitudin lacus (Cuddy, 2002). Identify Changes
Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur. Aliquam placerat molestie eros vel posuere.
This Photo by Unknown Author is licensed under CC BY-SA
Figure 1. Title (Source: www.source-of-graphic.edu )Product Offerings
Sed facilisis, lacus vel accumsan convallis, massa est ullamcorper mauris, quis feugiat eros ligula eget est. Vivamus nunc turpis, lobortis et magna a, convallis aliquam diam. Lorem ipsum dolor sit amet, consectetur adipiscing elit.
Figure 2. Title (Source of data citation)
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit. Capabilities
Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur.
References
Basu, K. K. (2015). The Leader's Role in Managing Change: Five Cases of Technology-Enabled Business Transformation. Global Business & Organizational Excellence, 34(3), 28-42. doi:10.1002/joe.21602.
Connelly, B., Dalton, T., Murphy, D., Rosales, D., Sudlow, D., & Havelka, D. (2016). Too Much of a Good Thing: User Leadership at TPAC. Information Systems Education Journal, 14(2), 34-42.
Rouse, M. (2018). Changed Block Tracking. Retrieved from Techtarget Network: https://searchvmware.techtarget.com/definition/Changed-Block-Tracking-CBT
Change the Chart Title to Fit Your Needs
Series 1 Category 1 Category 2 Category 3 Category 4 4.3 2.5 3.5 4.5 Series 2 Category 1 Category 2 Category 3 Category 4 2.4 4.4000000000000004 1.8 2.8 Series 3 Category 1 Category 2 Category 3 Category 4 2 2 3 5
Assessing Similarities and Differences in Self-Control
between Police Officers and Offenders
Ryan C. Meldrum1 & Christopher M. Donner2 & Shawna Cleary3 &
Andy Hochstetler4 & Matt DeLisi4
Received: 2 August 2019 /Accepted: 21 October 2019 /
Published online: 2 December 2019
# Southern Criminal.
2Megan Bowen02042020 Professor Cozen Comm 146Int.docxnovabroom
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Megan Bowen
02/04/2020
Professor Cozen
Comm 146
Interest Paper- Mental Health in Student Athletes
I am a communication major so must take this class to fulfill my requirements for the course, however, this class will set me up to understand the in-depth reasoning behind communication. The only rhetoric class I have taken in the past is rhetoric in English, not communication; I learnt about Plato, Socrates and all the pervious rhetors that formed the basis on how we communicate today. You could argue that learning it in English and now in communication it could be very similar or the same, but we aren’t focusing on what they wrote or spoke of but why and how. In this paper I chose to analyze a TedX talk from a student athlete Victoria Garrick called ‘Athletes and mental Health: The hidden opponent’, it discusses the challenges that she faced with mental health, and the struggles maintaining a top sport on a colligate team. The reasons behind this are based on the broad ideas and opinions people have on student athletes and mental health separately and together.
College athletics is a huge industry, an incredible achievement to get into a division 1 college on an athletic scholarship, but behind all this there are some dark truths. The TedX talk from Victoria Garrick explains these truths from an athlete’s perspective, this is conflicting to the ideas that an average student or outsider has, it explains what is happening behind closed doors. This artifact was gripping to me, it is something that I completely relate too; the artifact itself is a more personal approach to understand what is happening in regard to mental health in student athletes than just reading an article online. To me personally it is easier to find an artifact that I can easily relate too, something that is grossly underappreciated and classed as embarrassing, such a topic as mental health. There were no obstacles in retrieving artifacts for this interest, it is such a broad area that I am interested in finding more information about. There are artifacts everywhere about topics such as this, articles, speeches, documentaries, all gripping a relatable.
In this class I am aware that I have much to learn, understand the way in which we communicate and why, the best ways to communicate, and the best evidence and artifacts to find for a specific topic. Finding an artifact for a topic that you are deeply invested in is different than having to find one that your heart isn’t in. With regards to this paper I am already thinking about ideas of where I can focus my information on next, where can I understand different political views behind this topic? What are the families of these student athletes going through? Mental health and student athletes separately. With regards to this class I would like to be able to find these sources and write about them in a way that grips a reader and helps me understand the reasoning behind such communication methods.
1
2
Megan Bowen
P.
2From On the Advantage and Disadvantage of History for L.docxnovabroom
2
From On the Advantage and Disadvantage of History for Life, by Friedrich Nietzsche (1874)
Section 1:
CONSIDER the herds that are feeding yonder: they know not the meaning of yesterday or to-day; they graze and ruminate, move or rest, from morning to night, from day to day, taken up with their little loves and hates, at the mercy of the moment, feeling neither melancholy nor satiety. Man cannot see them without regret, for even in the pride of his humanity he looks enviously on the beast's happiness. He wishes simply to live without satiety or pain, like the beast; yet it is all in vain, for he will not change places with it. He may ask the beast—"Why do you look at me and not speak to me of your happiness?" The beast wants to answer—"Because I always forget what I wished to say": but he forgets this answer too, and is silent; and the man is left to wonder.
He wonders also about himself, that he cannot learn to forget, but hangs on the past: however far or fast he run, that chain runs with him. It is matter for wonder: the moment, that is here and gone, that was nothing before and nothing after, returns like a spectre to trouble the quiet of a later moment. A leaf is continually dropping out of the volume of time and fluttering away and suddenly it flutters back into the man's lap. Then he says, "I remember . . . ," and envies the beast, that forgets at once, and sees every moment really die, sink into night and mist, extinguished for ever. The beast lives unhistorically; for it "goes into" the present, like a number, without leaving any curious remainder. It cannot dissimulate, it conceals nothing; at every moment it seems what it actually is, and thus can be nothing that is not honest. But man is always resisting the great and continually increasing weight of the past; it presses him down, and bows his shoulders; he travels with a dark invisible burden that he can plausibly disown, and is only too glad to disown in converse with his fellows—in order to excite their envy. And so it hurts him, like the thought of a lost Paradise, to see a herd grazing, or, nearer still, a child, that has nothing yet of the past to disown, and plays in a happy blindness between the walls of the past and the future. And yet its play must be disturbed, and only too soon will it be summoned from its little kingdom of oblivion. Then it learns to understand the words "once upon a time," the "open sesame" that lets in battle, suffering and weariness on mankind, and reminds them what their existence really is, an imperfect tense that never becomes a present. And when death brings at last the desired forgetfulness, it abolishes life and being together, and sets the seal on the knowledge that "being" is merely a continual "has been," a thing that lives by denying and destroying and contradicting itself.
If happiness and the chase for new happiness keep alive in any sense the will to live, no philosophy has perhaps more truth than the cynic's: for the beast's happine.
257Speaking of researchGuidelines for evaluating resea.docxnovabroom
257
Speaking of research
Guidelines for evaluating research articles
Phillip Rumrill∗, Shawn Fitzgerald and
Megen Ware
Kent State University, Department of Educational
Foundations and Special Services Center for
Disability Studies, 405 White Hall, P.O. Box 5190,
Kent, OH 44242-0001, USA
The article describes the components and composition of
journal articles that report empirical research findings in the
field of rehabilitation. The authors delineate technical writing
strategies and discuss the contents of research manuscripts,
including the Title, Abstract, Introduction, Method, Results,
Discussion, and References. The article concludes with a
scale that practitioners, manuscript reviewers, educators, and
students can use in critically analyzing the content and scien-
tific merits of published rehabilitation research.
Keywords: Evaluation, research articles, guidelines for cri-
tique
1. Introduction
The purpose of this article is to examine the com-
ponents of a research article and provide guidelines
for conducting critical analyses of published works.
Distilled from the American Psychological Associa-
tion’s [1] Publication Manual and related descriptions
in several research design texts [4,8,9,12,15], descrip-
tions of how authors in rehabilitation and disability
studies address each section of a research article are
featured. The article concludes with a framework that
rehabilitation educators, graduate students, practition-
ers, and other Work readers can use in critiquing re-
search articles on the basis of their scientific merits and
practical utility.
∗Corresponding author: Tel.: +1 330 672 2294; Fax: +1 330 672
2512; E-mail: [email protected]
2. Anatomy of a research article
For nearly 50 years, the American Psychological As-
sociation has presented guidelines for authors to follow
in composing manuscripts for publication in profes-
sional journals [1]. Most journals in disability studies
and rehabilitation adhere to those style and formatting
guidelines. In the paragraphs to follow, descriptions
of each section of a standard research article are pre-
sented: Title, Abstract, Introduction, Method, Results,
Discussion, and References.
2.1. Title
As with other kinds of literature, the title of a scien-
tific or scholarly journal article is a very important fea-
ture. At the risk of contravening the age-old adage “You
can’t judge a book by its cover,” Bellini and Rumrill [4]
speculated that most articles in rehabilitation journals
are either read or not read based upon the prospective
reader’s perusal of the title. Therefore, developing a
clear, concise title that conveys the article’s key con-
cepts, hypotheses, methods, and variables under study
is critical for researchers wishing to share their findings
with a large, professional audience. A standard-length
title for a journal article in the social sciences is 12–15
words, including a sub-title if appropriate. Because so-
cial science and medical indexing systems rely hea.
2800 word count.APA formatplagiarism free paperThe paper.docxnovabroom
2800 word count.
APA format
plagiarism free paper
The paper should have:
Title with all the authors.
Introduction
Methods/Materials
Results (graphics and tables encouraged)
Discussion and conclusion
Citations.
.
28 CHAPTER 4 THE CARBON FOOTPRINT CONTROVERSY Wha.docxnovabroom
28
CHAPTER 4: THE CARBON FOOTPRINT CONTROVERSY
What is the carbon footprint controversy?
Nearly all humans consume meat, dairy, and egg products in some form. In recent years the
e i me al m eme ha ed he ece i f ed ci g e ca b f i . Ca e
reduce our footprint without changing our diet? Much controversy surrounds that question. One
very extreme view on the political-left is below.
But when it comes to bad for the environment, nothing literally compares with eating meat. The business of raising
animals for food causes about 40 percent more global warming than all cars, trucks, and planes combined. If you care
about the planet, it's actually better to eat a salad in a Hummer than a cheeseburger in a Prius.
Bill Maher, host of HBO talk show Real Time with Bill Maher, writing in the Huffington Post in 2009. Accessed April 25,
2013 at http://www.huffingtonpost.com/bill-maher/new-rule-a-hole-in-one-sh_b_259281.html.
The last decade has seen a movement advocating a vegan diet in order to reduce carbon emissions,
and in some respects the argument is logical. After all, it takes about 3.388 lbs of corn (and many
other inputs) to produce a single pound of retail beef, making meat seem relatively inefficient to
grains, thus leading to a larger carbon footprint.134 So common is this notion that some schools
e c age Mea le M da for the sake of the environment. The Meatless Monday movement
has even been adopted by the Norwegian military.135 Moreover, there is some scientific research
showing that vegan (and vegetarian) diets do result in a smaller carbon footprint.136
When dealing with issues as big as global warming i ea feel hel le , like he e li le e ca d make a
diffe e ce B he mall cha ge e make e e da ca ha e a eme d im ac . Tha h his Meatless Monday
resolution is important. Together we can better our health, the animals and the environment, one plate at a time.
Los Angeles Councilmember Ed Reyes, co-author of a Meatless Monday resolution in 2012.137
However, equally prestigious research shows that vegan diets can result in a higher carbon
footprint.138 How can this be? One reason is that some carbon footprint estimates are wrong, or
rather, interpreted incorrectly. The idea of livestock production being a large carbon emitter began
with a report by the United Nations (UN) suggesting that livestock contributes 18% f he ld
carbon footprint, more than the transportation sector,139 thus giving Bill Maher reason to point the
blame at burgers instead of Hummers.
It turns out that this 18% is fraught with errors, a lea , d e e e e c di i i he U.S.
For instance, the UN did not account for the carbon emissions involved in making the inputs used
in the transportation sector, but they did for livestock. This would be like saying the production of
tires has zero carbon emissions but the production of corn does. Also, that 18% makes a number of
contestable assumptions, especially regardi.
261
Megaregion Planning
and High-Speed Rail
Petra Todorovich
c h a p t e r 2 4
?
On April 16, 2009, President Obama stood before an audience at the Eisenhower
Executive Office Building and made an announcement that signaled a new era of
passenger rail in the United States. Months before, the American Recovery and
Reinvestment Act (ARRA) had provided $8 billion for a new program at the
Federal Railroad Administration (FRA) to issue competitive grants to states to
make capital investments in high-speed and conventional passenger rail. Little did
the president know that providing the single largest boost for intercity rail plan-
ning in this country in a generation had also motivated a sudden and giant leap for-
ward in planning and governing megaregions. Luckily, regional planners had been
studying emerging megaregions for the previous five years, in affiliation with the
New York–based Regional Plan Association’s (RPA) America 2050 program. Again
and again, the planners had identified high-speed rail as the key transportation
investment to serve megaregion economies. But high-speed rail was a distant
dream. That all changed with the passage of ARRA at the nadir of the Great
Recession. Now a federal program exists to support high-speed rail planning
and implementation. Making that program a success will largely depend on the
ability of multiple actors at the local, regional, state, and binational levels to come
together as megaregions to coordinate and leverage federal rail investments.
Revisiting Megalopolis: RPA Resurrects
the Megaregion Idea
As if planning for the Tri-State New York metropolitan region was not sufficiently
complicated, in 2005 the Regional Plan Association launched a national program
called America 2050 that focused on the emergence of a new urban scale: the
megaregion. This was not actually a new concept for RPA. In 1967 a volume of the
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Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
2. thoughts of quitting.3-5 In
certain situations, physical exhaustion and moral distress are
prominent features.6,7
Career burnout is not limited to physicians.3,5 Results of
studies in 2011 and 2014
showed that burnout indicators among the general United States
working population
remained steady at around 28%.3 During those years, however,
the percentage of
physicians suffering burnout increased from 45.5% to 54.4%.3
Because burnout by
its nature is cumulative, that percentage is probably higher
today.
Physicians in specialties at the front line of care—emergency
medicine, family medi-
cine, and general internal medicine—are at greatest risk of
burnout.5 And although
higher levels of education and professional degrees seem to
reduce the risk of burnout
in workers outside the f ield of medicine, an MD or DO degree
increases the risk.5
Causes
Aside from the often-mentioned external inf luences, the
physician’s makeup always
plays an important role: depth of commitment, upbringing, role
models, expectations,
moral values, level of stress tolerance, and resiliency.
Nevertheless, in the current
medical environment, even the best among us can be
overwhelmed by the following
external factors.
Loss of Autonomy
Especially for physicians trained during the “high-touch” era
3. (from approximately
1950 to the mid-1970s),8,9 the profession has lost much of its
human context. Not
too long ago, patient management required use of one’s brain
and senses, sometimes
followed by consultation with a colleague. Today, physicians
have become microman-
aged cogs in a machine:
Autonomy is the basic ability of individuals to exercise their
judgment in terms of
how to spend their time, attention, and resources. In the domain
of medical care,
Special
Report
Herbert L. Fred, MD, MACP
Mark S. Scheid, PhD
Key words: Burnout, pro-
fessional/epidemiology/
prevention & control; deliv-
ery of health care/ history;
documentation/methods;
electronic health records/
organization & administra-
tion; medical records sys-
tems, computerized/trends/
utilization; patient-centered
care/trends; physicians/
psychology; practice man-
agement, medical/organiza-
tion & administration; time
management; workload/
psychology
4. Dr. Fred is an Associate
Editor of the Texas Heart
Institute Journal. Dr. Scheid
is retired from Rice University,
Houston.
Reprints will not be available
from the authors.
E-mail: [email protected]
Texas Heart Institute Journal Physician Burnout 199
this could include the ability to decide when to see
each patient, how much time to spend with each
patient, what questions to ask them, when to see
them next, what kinds of tests to perform, and what
kinds of treatments to try out and for how long.
This view of autonomy is almost in direct opposi-
tion to the current practice of medicine. The cur-
rent procedures in medical reimbursement policies
and technological advances are constantly moving
physicians in the direction of less time spent with
each patient and greater f loods of information (for
example, related to a given patient or general medi-
cal information) to manage or master.10
In essence, the practice of medicine has become a
“f ixing-people production line.”10
Treating the Data, Not the Patient
Abraham Verghese recently wrote a telling vignette of
his experience as a patient in the era of the electronic
5. health record (EHR):
The nurse came in regularly, but not to visit me so
much as the screen against the wall. Her back was
to me as she asked, “On a scale of 1 to 10, with 10
being great diff iculty breathing…?” I saw her back
3 more times before I left. My visit recorded in the
EHR would have exceeded all the “Quality Indi-
cators,” measures that affect reimbursement and
hospital ratings. As for my experience, it was OK,
not great. I received care but did not feel cared for.11
Verghese’s experience illustrates the modern practice
of focusing on the monitor rather than on the actual
patient.
A World of Rules
Physicians from the “high-touch” era8 aren’t the only
ones stressed by today’s high-tech emphasis. Young
physicians, taught in medical school the traditional
Oslerian philosophy of focusing on the patient, often
experience stress as they adjust to a new environment
and learn the business aspects of medicine,12 which in-
clude rules from government, insurance companies, and
hospitals that limit the time physicians can spend with
a patient. Those rules also require that the visit comply
with the Health Information Portability and Account-
ability Act (HIPAA), Accountable Care Organizations
(ACOs), quality indicators, and other standards.13
An adverse effect of another absolute rule merits at-
tention. Compliance with the mandated work-hour
limits for trainees across all specialties necessitates re-
lentless monitoring and diligent enforcement by pro-
gram directors. This intense pressure, along with the
associated fear of losing accreditation, puts these direc-
tors at substantially increased risk of early burnout.14
6. The hospital and other medical-practice owners also
pressure physicians to remember that clicking the cor-
rect boxes on the EHR will enable “upcoding”—billing
at the highest level for each encounter.11
For all these reasons, internal and external, more than
50% of medical students, residents/fellows, and early-
career physicians are already burned out.12
Asymmetric Rewards
Because physicians have chosen a life of service, they
don’t necessarily think of “insuff icient reward” as an
important factor in career satisfaction.4 Ariely and La-
nier, however, highlight this stressor’s special impact on
the practice of medicine:
In our personal and professional lives, when we do
what is expected of us, we receive, at most, a bit
of praise. But, when we make a mistake, we are
likely to be punished strongly. And although this
asymmetry is true across the globe, it is particularly
substantial in the medical profession…. As if the
asymmetry of reward and punishment is not suff i-
ciently harmful by itself, the explosion of informa-
tion about each patient, each treatment, and each
disease exacerbates this harm.10
Sense of Powerlessness
Especially for physicians who work with populations
in poor socioeconomic situations,6,7 the inability to do
anything about the root causes of their patients’ medi-
cal issues leads to a different cause of burnout: futility.
To many people, the white coat and the prescrip-
tion pad represent the highest form of individual
agency, the very picture of social power. But, even-
7. tually, a physician will encounter patients whose
health problems derive from a wicked, multigen-
erational knot of poverty and marginalization, and
even the most astute, excellent physician may well
f ind herself outmatched. Facing patients’ adverse
social circumstances as an individual clinician is a
recipe for disillusionment: the physician who be-
lieved she was maximizing her individual agency
comes to feel utter ly powerless. No longer the lone
hero—just alone.7
Electronic Health Record Woes
“There is building resentment against the shackles of
the present EHR; every additional click inf licts a nick
on physicians’ morale.”15
For many physicians, the EHR has become the final
straw. Although intended to overcome the f laws inherent
in a paper-based system, the EHR has produced its own
set of problems, perhaps the most important of which is
the absence of social and behavioral factors fundamental
to a patient’s treatment response and health outcomes.15
200 Physician Burnout August 2018, Vol. 45, No. 4
Instead of being a mere replacement for paper re-
cords, EHRs have evolved into data-collection devices
for HIPAA and other government regulations.13 Con-
sequently, they focus more on processes than on out-
comes, adding to the physician’s workload while not
improving patient care.13 In that light, 2 recent studies
are noteworthy.
One study involved ambulatory care in 4 specialties
(family medicine, internal medicine, cardiology, and
orthopedics) in 4 states (Illinois, New Hampshire, Vir-
8. ginia, and Washington). For every hour the physicians
spent facing their patients, they spent nearly 2 addi-
tional hours facing the computer, entering data. They
also spent one to 2 hours working at home each night
to “keep up.”1
The other study involved 142 family medicine physi-
cians in Wisconsin who spent more than half their
workday, nearly 6 hours, interacting with the EHR.
Two thirds of that time was spent on clerical and inbox
work.16
Worse, most EHRs are designed to facilitate billing,
not patient care, leading the National Academy of Med-
icine to request that social determinants of health be
included in future versions of EHRs.17 And, almost 10
years after the passage of the Health Information Tech-
nology for Economic and Clinical Health (HITECH)
Act, health information technology (IT) developers still
use hundreds of different communication and nomen-
clature standards,18 preventing a substantial percentage
of records from being shared across the various compet-
ing EHR platforms.
In fact, the very point-and-click design of the EHR
prompts the physician to click more boxes, even when
they’re not completely accurate. Thus, a one-legged pa-
tient can have a chart reading “pulses intact in both
feet.”11
The ease of making a point-and-click error should
be obvious to anyone who has ever used a computer.
One of us, for example, has been urged by his insurer to
consult with a specialist about his COPD (chronic ob-
structive pulmonary disease)—which he doesn’t have—
and to schedule his routine mammogram—which, as a
male, he doesn’t need. Clearly someone, somewhere, is
clicking the wrong boxes.
Consequences
9. Physician burnout is not only expensive in monetary
terms, but also leads to a constellation of other costs,
including physical, spiritual, and emotional.
Leaving Medicine
Investigators estimate that, when physicians leave the
f ield, the practice loses $500,000 to $1,000,000 of rev-
enue. This loss is even greater in high-paying specialties.
To recruit a replacement costs an additional $90,000.11
And the costs of college and medical school often leave
physicians themselves with sizable debts, which can be
harder to pay off in a nonmedical job.
Physicians who quit because of burnout have spent
a substantial percentage of their lives in premedical
courses, medical school, residencies, and practice. Those
years are not entirely wasted, of course, but the specif ic
curricula that prepare physicians to practice medicine
do not necessarily train them to do anything else well.
Every physician who leaves the field adds to the work-
load of other physicians. This has a cascading effect—
causing more stress, leading to more burnout.
Remaining in Practice
Even when a burned-out physician continues to practice
medicine, negative consequences can follow, such as the
misuse of alcohol and drugs, broken relationships, and
suicidal ideation.5,14 These repercussions, in turn, clearly
diminish the quality of care delivered.5,14 Moreover, the
fact that roughly half of U.S. physicians have symptoms
of burnout suggests that the problem stems from en-
vironmental factors and the care-delivery system, not
from elements within the individual.5
The litany of burnout characteristics—especially
closed thinking, impaired memory, decreased attention,
10. and viewing people as objects—can easily lead to medi-
cal error. And every year, about 250,000 patients die in
the U.S. because of medical error: “the rough equivalent
of, say, a jumbo jet’s crashing every day.”11
(?) Cures
Because of burnout’s variable nature, there is no consen-
sus for preventing, treating, or curing it. Most “cures”
focus on stress-reduction training rather than on the
systemic factors that produce burnout.5
Methods suggested to help physicians in their strug-
gles against burnout include organizing a community of
practice for mutual support4 or for political action7 and
the use of cognitive behavioral therapy.4 Scribes may
reduce the data-entry workload of physicians, increase
physician satisfaction with patient visits, improve chart
quality and accuracy, and not detract from patient sat-
isfaction.19
Clearly, changes to the EHR are necessary. The EHR
was created almost 10 years ago (an eon in computer
time) to satisfy the requirements of hospitals and insur-
ers rather than physicians.2,11 There was no associated
nationwide directory or regulatory infrastructure.13 In
addition, the EHR has not “kept pace with technology
widely used to track, synthesize, and visualize informa-
tion in many other domains of modern life.”15
Re-engineering current EHRs will be diff icult. In
fact, Zulman and colleagues15 concluded that, in many
clinical situations, patient care could be improved sim-
ply by “deimplementing” the EHR.
Texas Heart Institute Journal Physician Burnout 201
11. Most authors point out that EHRs can never live up to
their potential without true cross-platform compatibil-
ity: the capability for medical data to be shared widely
across the many competing versions of the EHR.13,16,18
However, the for-profit IT developers who create and sell
the current EHRs operate in a highly competitive field
and are usually reluctant to cooperate in areas where pro-
prietary information might be shared with a competi-
tor. And it is not just a matter of getting 2 or 3 to work
together. According to the U.S. government, in 2017 no
fewer than 186 different certif ied health-IT developers
were supplying heathcare software to non-Federal acute
care hospitals alone, and 684 developers were supplying
EHRs to ambulatory care professionals.20
And because a hospital or insurer usually requests
alterations of an off-the-shelf software platform to con-
form with business practices already in use, it’s not un-
usual for physicians to f ind that they “can’t reliably get
a patient record from across town, let alone from a hos-
pital in the same state, even if both places use the same
brand of EHR.”11
Some argue—hopefully, perhaps—that inter-EHR
data-sharing could be encouraged by asking the gov-
ernment to streamline its EHR certif ication standards
to focus more on outcomes, to tie EHR certif ication
to interoperability, and to provide f inancial incentives
to the private sector to develop standard interfaces for
all aspects of patient care.13 Others argue, however, that
the time has come for a total rethinking of the EHR,
beginning with the underlying principles of patient care
rather than with compliance and f inances.2
The creation of a new physician- and patient-cen-
tered EHR would be a great improvement. But would
the government, the insurers, and the medical com-
munity be willing to admit that the f irst attempt was
a failure and simply write off the hundreds of millions
12. of dollars spent on it? We doubt it.
Conclusion
To sum up: a loss of autonomy, overreliance on comput-
er data, onerous rules, an asymmetric reward system, a
sense of powerlessness, and EHRs that are not designed
primarily for patient care have produced a climate in
which more than half of all members of the f ield, from
medical students to senior practitioners, are burned out.
As a result, physicians are quitting in large numbers,
further increasing the stress on those still practicing.
Those burned-out physicians who remain are less able
to give appropriate patient care. There appears to be no
easy solution to these problems. Sorry.
References
1. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S,
Goeders
L, et al. Allocation of physician time in ambulatory practice: a
time and motion study in 4 specialties. Ann Intern Med 2016;
165(11):753-60.
2. Downing NL, Bates DW, Longhurst CA. Physician burnout
in the electronic health record era: are we ignoring the real
cause? Ann Intern Med 2018;169(1):50-1.
3. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D,
Sloan J, West CP. Changes in burnout and satisfaction with
work-life balance in physicians and the general US working
population between 2011 and 2014 [published erratum ap-
pears in Mayo Clin Proc 2016;91(2):276]. Mayo Clin Proc
2015;90(12):1600-13.
13. 4. Byyny RL. The joy in caring. Pharos Alpha Omega Alpha
Honor Med Soc 2018;81(2):2-8.
5. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele
D, et al. Burnout and satisfaction with work-life balance
among US physicians relative to the general US population.
Arch Intern Med 2012;172(18):1377-85.
6. Cervantes L, Richardson S, Raghavan R, Hou N, Hasnain-
Wynia R, Wynia MK, et al. Clinicians’ perspectives on
providing emergency-only hemodialysis to undocumented im-
migrants: a qualitative study. Ann Intern Med 2018;169(2):
78-86.
7. Eisenstein L. To fight burnout, organize. N Engl J Med
2018;
379(6):509-11.
8. Fred HL. Medical education on the brink: 62 years of front-
line observations and opinions. Tex Heart Inst J 2012;39(3):
322-9.
9. Fred HL. The late forties and early fifties: a memorable
time
in medicine. Tex Heart Inst J 2013;40(5):508-9.
10. Ariely D, Lanier WL. Disturbing trends in physician burnout
and satisfaction with work-life balance: dealing with malady
among the nation’s healers. Mayo Clin Proc 2015;90(12):
1593-6.
11. Verghese A. How tech can turn doctors into clerical work-
ers [Internet]. Available from: https://www.nytimes.com/
interactive/2018/05/16/magazine/health-issue-what-we-lose-
with-data-driven-medicine.html [2018 May 16; cited 2018
Sep 4].
14. 12. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J,
Shanafelt TD. Burnout among U.S. medical students, resi-
dents, and early career physicians relative to the general U.S.
population. Acad Med 2014;89(3):443-51.
13. Halamka JD, Tripathi M. The HITECH era in retrospect. N
Engl J Med 2017;377(10):907-9.
14. De Oliveira GS Jr, Almeida MD, Ahmad S, Fitzgerald PC,
McCarthy RJ. Anesthesiology residency program director
burnout. J Clin Anesth 2011;23(3):176-82.
15. Zulman DM, Shah NH, Verghese A. Evolutionary pressures
on the electronic health record: caring for complexity. JAMA
2016;316(9):923-4.
16. Arndt BG, Beasley JW, Watkinson MD, Temte JL, Tuan WJ,
Sinsky CA, Gilchrist VJ. Tethered to the EHR: primary care
physician workload assessment using EHR event log data and
time-motion observations. Ann Fam Med 2017;15(5):419-26.
17. Committee on the Recommended Social and Behavioral Do-
mains and Measures for Electronic Health Records; Board on
Population Health and Public Health Practice; Institute of
Medicine. Capturing social and behavioral domains and mea-
sures in electronic health records: phase 2. Washington (DC):
National Academies Press (US); 2015 Jan.
18. Washington V, DeSalvo K, Mostashari F, Blumenthal D.
The
HITECH era and the path forward. N Engl J Med 2017;377
(10):904-6.
19. Gidwani R, Nguyen C, Kofoed A, Carragee C, Rydel T,
Nelligan I, et al. Impact of scribes on physician satisfaction,
15. patient satisfaction, and charting eff iciency: a randomized
controlled trial. Ann Fam Med 2017;15(5):427-33.
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20. Off ice of the National Coordinator for Health Information
Technology. ‘Certif ied health IT developers and editions re-
ported by health care professionals participating in the Medi-
care EHR incentive program,’ Health IT Quick-Stat #30.
Available from: dashboard.healthit.gov/quickstats/pages/FIG-
Vendors-of-EHRs-to-Participating-Professionals.php [2017
July; cited 2018 Sep 4].
Copyright of Texas Heart Institute Journal is the property of
Texas Heart Institute and its
content may not be copied or emailed to multiple sites or posted
to a listserv without the
copyright holder's express written permission. However, users
may print, download, or email
articles for individual use.
Instructions for Continuing
Nursing Education Contact Hours
Nursing Staff Turnover
Survivor Strategies
Deadline for Submission:
August 31, 2020
16. MSNN1804
To Obtain CNE Contact Hours
1. For those wishing to obtain CNE contact hours,
you must read the article and complete the
evaluation through the AMSN Online Library.
Complete your evaluation online and print your
CNE certificate immediately, or later. Simply go
to www.amsn.org/library
2. Evaluations must be completed online by August
31, 2020. Upon completion of the evaluation, a
certificate for 1.1 contact hour(s) may be printed.
Fees
Member: FREE
Regular: $20
Learning Outcome
After completing this continuing nursing educa-
tion activity, the learner will be able to describe
strategies that have been identified as providing
support to the nursing staff and combating the
nursing retention issue.
Learning Engagement Activity
After reading this article, respond to the fol-
lowing self-assessment questions:
• Is nurse retention a priority in your organization?
• Does your organization have a Nurse Residency
or Mentoring program?
17. • What strategies does your organization use to
maintain and support nursing staff?
• Is your manager or administration actively
involved in these strategies?
The author(s), editor, editorial committee, con-
tent reviewers, and education director reported no
actual or potential conflict of interest in relation to
this continuing nursing education article.
This educational activity is jointly provided by
Anthony J. Jannetti, Inc. and the Academy of
Medical-Surgical Nurses (AMSN).
Anthony J. Jannetti, Inc. is accredited as a
provider of continuing nursing education by the
American Nurses Credentialing Center’s
Commission on Accreditation.
Anthony J. Jannetti, Inc. is a provider approved
by the California Board of Registered Nursing,
provider number CEP 5387. Licensees in the state
of California must retain this certificate for four
years after the CNE activity is completed.
This article was reviewed and formatted for
contact hour credit by Rosemarie Marmion, MSN,
RN-BC, NE-BC, AMSN Education Director.
4
Nursing Staff Turnover Survivor
Strategies
18. CNE
CONTINUING
NURSING
EDUCATION
Sherry Barnard, Ed.D, MSN, RN
Nurse Retention, Survival
Strategies
Nursing continues to face ongoing
staffing shortages in many areas, includ-
ing medical-surgical units (Wieck, Dols,
& Landrum, 2010). The recently gradu-
ated nurse will take a job in a hospital
to gain experience only to leave within
one year to pursue opportunities else-
where (Kovner et al., 2016). This trend
disrupts the staffing mix and results in
inadequate nurse staffing ratios, ulti-
mately affecting patient care. Negative
outcomes have been linked to having
inadequate nurse staffing ratios
(Stanley, 2010). Many factors contribute
to staff shortages and turnover such as
high workload expectations, long
hours, working off shifts, lack of sup-
port, challenging or complex patient
care, overall job dissatisfaction, genera-
tion differences, perceptions of a lack of
power, and incivility (Chan, Tam, Lung,
Wong, & Chau, 2013; Hairr, Salisbury,
Johannsson, & Redfern-Vance, 2014;
Creakbaum, 2011). Ultimately, hospitals
and nurse leaders must be strategic in
19. their hiring practices to avoid spending
countless hours and thousands of dol-
lars on training new nurses just to have
them quickly leave (Kovner et al., 2016).
Nurse Mentor or
Residency Programs
Nurse residency programs can
help solve retention challenges.
Hospitals have developed nurse mentor
or residency programs in an effort to
improve new nurse retention. Nurse
mentor or residency programs have
been shown to improve nurse reten-
tion rates. D’Ambra and Andrews
(2014), described how the experience
of new nurses can improve significantly
when they are part of a nurse mentor
training or residency program. Both
mentoring and residency programs can
help new nurses effectively manage the
challenges they face.
Residency or mentor programs
use their most experienced nursing
staff to train and guide new graduate
nurses (Cochran, 2017). The new nurse
follows and works with the experi-
enced nurse and slowly increases the
workload of the new nurse as comfort
levels increase. Flexibility is often built
into the programs so the new nurse
can guide his or her residency length
based on their individual comfort level
20. or prior experience. Education is also
typically provided for unit specific skills
along with simulation scenarios for
more challenging skills. New nurses
learn about time management, practice
their newly learned skills with support,
and get socialized to their new role.
Additionally, incivility or lateral violence
courses are included in most of these
programs. There is greater retention
and length of commitment when new
nurses are provided residency or men-
toring type programs and training
(Cochran, 2017). A residency program
is a survival strategy that all hospitals
should pursue to be competitive in hir-
ing and retaining staff.
Generational Influences
Generational differences are
another part of the retention issues
that hospitals are facing. A mix of nurs-
ing staff from a variety of generations is
a common scenario in hospital units.
Understanding the needs, differences,
and values of each nurse generation is a
critical step in retaining nursing staff.
Valuing generational differences can
result in nurse retention. Nurses that
change jobs frequently describe that
they do not find the environment to be
rewarding or satisfying (Scammell,
2016). These influences merit a better
understanding of the differences in gen-
erations. A review of the generational
21. 5
866-877-2676 Volume 27 – Number 4
differences and how these can be
blended in the workplace is outlined in
Table 1.
Finding the Common
Ground
It is important for nurse managers
and nurse leaders to embrace the com-
monalities in the generations instead of
focusing on the differences. Nurse lead-
ers can do this by adopting a collabora-
tive environment that promotes the
strengths of the individual nurses. Each
generation can offer value to the work-
place and can play a key role in optimiz-
ing healthy practice environments.
Experienced nurses often have solid
and irrefutable experiences to bring to
the table. They are experts in the work-
force and are often able to mentor
future generations. New nurses often
come to the workplace with vitality,
energy, and are technologically savvy.
The inexperienced millennial genera-
tion is the future of the nursing profes-
sion and they must be nurtured in
order to develop them into expert
nurses. Nursing and healthcare cannot
22. survive without generationally diverse
nurse groups. Nurse managers must
promote respect, be courteous, and
have a personal interest in each nurse
to develop the blend of generations and
each unique contribution to the work-
place (Stichler, 2013). Fostering the gen-
erational differences can enhance nurs-
ing environments and promote a colle-
gial and supportive culture (Wieck,
Dols, & Landrum, 2010).
Combating Incivility
Nursing is a challenging profession.
Demanding hours, highly acute patients,
new technologies, declining resources,
and a continuously evolving healthcare
environment are only a few factors that
nurses deal with daily. These factors can
create a toxic work environment,
quickly devaluing staff and morale and
increasing the costs of unwanted
turnover. Facilities can combat incivility
by developing a “no tolerance” policy
which may promote a safer and more
inviting environment (Hoffman &
Chunta, 2015).
Promoting a positive workplace
can also help tackle this problem. Some
strategies to promote positive work
environments include displays or bul-
letin boards on nursing units to post
positive notes to nursing staff. Hospitals
23. using positive display board methods
have named such displays “appreciation
board” or “recognition board.” Staff can
put up a card with comments such as
“thank you for helping me with my
admission” or “you were a big help to
me when I was overwhelmed, you are
awesome!” (Pan, 2014). This positive
feedback has been shown to improve
the staff morale and work environment
because it encourages teamwork and
support.
Ongoing staff education can also
combat incivility by showing value and
investment in the nursing staff. One
example is a journal club where nurses
meet once a month after reading
assigned evidence based practice arti-
Veterans
Born 1925-1942
Baby Boomers
Born 1943-1960
Generation X
Born 1961-1981
Millennials
Born 1982-2000
Age range 75-92 57-74 36-56 17-37
How many in
24. the workforce
currently
(2017)
5% or less 40% 40% 15%
Characteristics
to consider
Loyal, dedicated,
hardworking,
strong work ethic
Productive,
workaholic, opti-
mistic
Independent, cyn-
ical, informal
Confident, impa-
tient, social
Generational
specifics
They grew up dur-
ing World War II,
patriotic, loyal,
understand rules,
dislike waste
Deemed the
most productive
workers, they
grew up during
25. the Vietnam War,
presidential
assassinations,
peace and love
movements, are
over achievers,
work is impor-
tant to them
Born during the
fall of the Berlin
Wall, Music
Television (MTV),
Aids epidemic,
many of these
children had
divorced parents,
latchkey genera-
tion, going home
after school with
both parents
working, less
dedicated to
work, would
rather work to
live than live to
work
Grew up with
more culture,
international ter-
rorism, tend to
be protective and
careful, social
media is impor-
tant, they are
26. computer savvy,
they have the
least religion but
are the most
educated, they
crave instant
gratification, are
very impatient,
will leave if not
happy
Workplace
strategies
Allow them to
work part-time in
supportive roles,
and or mentor
roles, provide roles
that are less physi-
cally demanding,
provide traditional
rewards
Encourage men-
toring or pre-
cepting new
graduates, pro-
mote retirement
goals, offer pri-
vate feedback for
criticism, but
praise them for a
job well done in
front of their
peers
27. Allow flexible
scheduling (i.e. 12
hour shifts), pro-
vide opportuni-
ties for skill or
leadership devel-
opment, involve
in decision mak-
ing, avoid micro-
managing
Provide frequent
and immediate
feedback, praise
them in front of
their peers, pro-
vide use of social
media and build
on their technol-
ogy expertise,
develop their
skills and intro-
duce leadership
Table 1.
Characteristics of Nurses by Generation
Stichler, 2013; Tourangeau, Cummings, Cranley, Ferron, &
Harvey, 2010
cles to discuss the material and the possibility of implement-
ing a new practice related to the article. Reading discussions
promote critical thinking and up to date knowledge that
28. nurses can apply to their valued workplace such as the med-
ical surgical floor (Wiggy, 2012).
Staffing Ratios and Retention
There is a direct correlation between nurse to patient
ratios and nurse retention (Van den Heede et al., 2013).
When nurses are expected to take high acuity patients in
large numbers due to staffing shortages, there are higher lev-
els of burnout and decreased job satisfaction. Improving
staffing ratios has been shown to improve patient outcomes,
safety, and satisfaction (Hairr et al., 2014). Nurse leaders need
to be mindful of nurse satisfaction when it comes to patient
and staff ratios. The unit or nurse manager must have a keen
knowledge of the staffing mix and utilize more experienced
nurses when more difficult patients are on the unit. There are
acuity tools and models that help charge nurses plan assign-
ments, but each unit is unique and should develop a tool that
includes skills and procedures specific to that unit. Jones
(2015) developed a tool that uses color coding for patient
acuity which can easily identify patients that need more care
and can allow for planning for nursing assignments. Using an
acuity tool for nurse staffing that matches complicated pro-
cedures and patient needs with assignment numbers can pro-
vide an evidence-based way to plan assignments (Jones,
2015). Matching experience with acuity can also help with
reducing burnout and job dissatisfaction (Needleman, 2013).
New nurses are not always prepared or ready to take on
patients that need a great deal of care. Added support and
flexibility with staffing can be useful strategies to retain an
adequate nursing workforce. A supportive staffing model can
be another survival strategy nurse managers can commit to
in order to retain nursing staff.
Conclusion
There are many areas to consider when combating
29. nurse retention and staffing issues. Retaining nurses should
be a goal of nurse managers. Preventing new nurses from
quickly leaving their positions due to poor staffing, lack of
supportive environment, and overall job dissatisfaction is
essential to healthy work environments. Nurse managers
should make it a priority to implement strategies to preserve
and support all nursing staff. Several ideas have been pre-
sented such as having a nurse residency or mentoring pro-
gram, using positive display boards, increasing experienced
nurses when acuity increases, sensitivity to generational dif-
ferences between nurses, no tolerance for lateral violence or
nurse incivility, appropriate nurse-patient ratios, and journal
discussion clubs. Programs that invest in new nurses are
often more successful in retaining them (Cochran, 2017;
Hoffman & Chunta, 2015). Finding ways to use the unique
qualities of each nurse promotes a sense of belonging and
team work (Stanley, 2010). It is the ultimate responsibility of
the nurse manager to have full awareness of the staffing abil-
ity, experience, and quality to be strategic in guiding assign-
ment planning. These survival strategies to combat nursing
retention issues are essential in making staff consistency and
job satisfaction for all nurses the new normal.
Sherry Barnard, Ed.D, MSN, RN, is an Assistant Professor
of Nursing, Vermont Technical College, Randolph Center, VT.
She may be contacted at [email protected]
References
Cochran, C. (2017). Effectiveness and best practice of nurse
residency
programs: A literature review. MEDSURG Nursing, 26(1), 53-
63.
Chan, Z. Y., Tam, W. S., Lung, M. Y., Wong, W. Y., & Chau,
C. W. (2013). A
30. systematic literature review of nurse shortage and the intention
to leave. Journal of Nursing Management, 21(4), 605-613.
doi:10.1111/j.1365-2834.2012.01437.x
Creakbaum, E. L. (2011). Creating and implementing a nursing
role for
RN retention. Journal for Nurses in Staff Development: JNSD:
Official
Journal Of The National Nursing Staff Development
Organization,
27(1), 25-28. doi:10.1097/NND.0b013e318199459f
D’Ambra, A. M. & Andrews, D. R. (2014). Incivility, retention
and new
graduate nurses: An integrated review of the literature. Journal
of
Nursing Management (22), 735–742.
Hairr, D. C., Salisbury, H., Johannsson, M., & Redfern-Vance,
N. (2014).
Nurse staffing and the relationship to job satisfaction and reten-
tion. Nursing Economics, 32(3), 142-147.
Hoffman, R. L., & Chunta, K. (2015). Workplace incivility:
Promoting zero
tolerance in nursing. Journal of Radiology Nursing, 34, 222-
227.
doi:10.1016/j.jradnu.2015.09.004
Jones, P. (2015). What works: Measuring acuity on a medical-
surgical
unit. American Nurse Today, 10(8). Retrieved from
https://www.americannursetoday.com/works-measuring-acuity-
medical-surgical-unit/
31. Kovner, C. T., Djukic, M., Fatehi, F. K., Fletcher, J., Jun, J.,
Brewer, C., &
Chacko, T. (2016). Estimating and preventing hospital internal
turnover of newly licensed nurses: A panel survey. International
Journal of Nursing Studies, 60, 251-262. doi:10.1016/
j.ijnurstu.2016.05.003
Needleman, J. (2013). Increasing acuity, increasing technology,
and the
changing demands on nurses. Nursing Economics, 31(4), 200-
202.
Pan, K. (2014). 6 ways to show nurses appreciation. Retrieved
from
http://www.mightynurse.com/6-ways-to-show-nurses-apprecia-
tion-stories/
Scammell, J. (2016). Should I stay or should I go? Stress,
burnout and
nurse retention. British Journal of Nursing, 25(17), 990.
Stanley, D. (2010). Multigenerational workforce issues and
their implica-
tions for leadership in nursing. Journal of Nursing
Management, 18(7), 846. doi:10.1111/j.1365-2834.2010.01158.x
Stichler, J. F. (2013). Healthy work environments for the aging
nursing
workforce. Journal of Nursing Management, 21(7), 956-963.
doi:10.1111/jonm.12174
Tourangeau, A., Cummings, G., Cranley, L., Ferron, E., &
Harvey, S. (2010).
Determinants of hospital nurse intention to remain employed:
Broadening our understanding. Journal of Advanced Nursing,
66(1),
32. 22-32. doi:10.1111/j.1365-2648.2009.05190.x
Van den Heede, K., Florquin, M., Bruyneel, L., Aiken, L., Diya,
L., Lesaffre,
E., & Sermeus, W. (2013). Effective strategies for nurse
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acute hospitals: A mixed method study. International Journal of
Nursing Studies, 50(2), 185-194.
doi:10.1016/j.ijnurstu.2011.12.001
Wieck, K. L., Dols, J., & Landrum, P. (2010). Retention
priorities for the
intergenerational nurse workforce. Nursing Forum, 45(1), 7-
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patient care. AORN Journal, 96(2), C5. doi:10.1016/S0001-
2092(12)00722-3
Academy of Medical-Surgical Nurses www.amsn.org
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33. HCA 502 ARTICLE APPLICATION PROJECT – SPRING 2020
(online)
As you know the articles for this course are broken down
into 6 parts (topical areas). The main purpose of this assignment
is to have you use some of these articles for various HR
initiatives that are relevant to your current or former workplace.
To accomplish this goal you need to do the following:
1) For each of the 6 parts identify ONE article that you believe
is relevant to an organization that you work (or have worked)
for. Please note you must select one article per part. You cannot
skip one part and do two articles from another part. By the end
of this course you will have selected a total of SIX articles for
this assignment.
2) For each selected article your first paragraph or two will be a
summary (about 5 or 6 sentences) of that article. Label this
section: PART 1: SUMMARY. Make sure you put the title of
the article above this section.
3) The next section will be a brief description of a company you
work at (or have worked at) and a problem that this company
has (or had) that relates to the article you selected above. For
example, your company may have had a problem with: high
turnover in a given job, poor employee morale in a certain
department, weak customer satisfaction, sexual harassment
claims, etc. This section should also be a paragraph or two.
Label this section: PART 2: PROBLEM.
4) The third section will be a description of a HR initiative
(e.g., new policy, revised procedure, additional benefit
regarding…) that is relevant to the selected article and the
situation you described above in part two. In this paragraph
please indicate why this initiative will address the
problem/issue you described in part 2. Label this section: PART
3: HR INITIATIVE.
5) In the fourth section identify the main implementation
challenge you anticipate to your HR initiative. For example will
your initiative cost the company a significant amount money?
Do you expect resistance to your initiative from any particular
34. individual or group? If yes, why? How much time might it take
to get people on board with your idea or to get your idea up and
running? Will there be any structural changes needed to the
company (e.g., division of labor, supervisory changes, revisions
to labor agreements)? Label this section: PART 4:
IMPLEMENTATION CHALLENGE.
6) The final section should describe how you would evaluate
your initiative. What criteria will be looked at to see if your
initiative was effective? How much time after implementation
should this data be collected? Who should do this assessment?
Label this section: PART 5: EVALUATION.
In summary, you are writing five sections on each of the 6
articles you select. Each article analysis should not exceed
three-spaced pages. Each article analysis will be scored based
on the scoring system below:
Scoring Guide (20% for each section)
Part 1: Article Summary
In 3 or 4 sentences the student correctly and clearly summarizes
the key points in the chosen article. Make sure the exact title of
the article and the author(s) is identified in the first sentence or
in the heading above this section.
Part 2: Problem section
In a paragraph or two the student briefly describes their current
or former company. Then the student describes a problem or
issue this company is having that relates to the article in part 1.
The student’s writing is clear, complete, and professional.
Part 3: HR initiative section
The student comes up with a HR initiative that addresses the
problem described in part 2. The student’s writing is clear,
complete, and professional.
Part 4: Implementation challenge section
The student identifies a major implementation challenge
associated with his/her initiative described in part 3. The
student’s writing is clear, complete, and professional.
Part 5: Evaluation section
The student describes how he/she would evaluate the success of
35. his/her initiative. The criteria that will be used and when the
data will be collected is also described in this section. The
student’s writing is clear, complete, and professional.
Please make sure you use these headings in your paper so it’s
clear to me when one section ends and the next one begins.
Running head: HOW TO FIND THE IDEAL CHIEF MEDICAL
OFFICER 1
HOW TO FIND THE IDEAL CHIEF MEDICAL OFFICER
2
HCA 502
King’s College
How to Find the Ideal Chief Medical Officer
John Byrnes, MD, president and CEO, Byrnes Group LLC, Ada,
Michigan
PART 1: SUMMARY.
According to John Brynes et al, the problem of hiring a wrong
physician executive who is good at their clinical work but not a
good leader is too common. These decisions can be costly as the
organization will have to incur more recruitment expenses. He
therefore suggests three steps for successful hiring of chief
medical officers. Partnering with leadership to appoint a
selection committee would help everyone on the committee to
have an input in the selection process although the CEO has the
final word. Having the selection committee read the relevant
books and articles on physician leadership provided refreshment
to those with hiring experience and introduced those who were
hiring a chief medical officer for the first time. Retaining an
experienced executive recruiter would enable successful
recruitment of the right chief medical officer which first time
physician executives often fail.
36. PART 2: PROBLEM.
I have worked at one of the IHG hospitals that is a health care
provider and the services at the hospitals were being delayed
because of poor co-ordination in management that was at the
hospital. The old Chief Medical Officer had just retired and a
new one had to be appointed. The patients suffered a lot and
there was a lot of problems due to the problem of disagreement
between the management of the hospital and the new Chief
Medical officer. Short and long-term goals for the staff were
mostly missing resulting in confusion among the staff and lack
of long-term objectives. Such cases as disease management and
insurance policies for the medical staff were missing and this
posed a huge danger to the employees at the hospital. During
this period the staff attended fewer meetings where hardly any
communication from the management was communicated as had
usually been the norm. There was also a delay in budget
development and remuneration of funds to the hospital which
caused a lot of inconveniences to the patients and most of the
patient complaints went unattended. Needless to say, policies
were never reviewed or improved during this period.
PART 3: HR INITIATIVE.
The human resource team responsible for appointing or
employing new employees or members of the management need
to come up with policies to ensure that the new employees or
appointees have a good personal and working relationship with
the existing team. They also need to revise their hiring criteria
to include the ethical behavior of the person being hired. If they
would still work under disagreement with their colleagues is
really important because disagreements seem to be present in
our every day life and may be unavoidable. Having an
experienced executive recruiter on the recruitment team would
help to identify the right person with the right ethical and work
experience for the job and avoid candidates who might be
having personal issues with the company and want to use their
positions for revenge. This would help solve the problem by
providing a proper framework of work ethics that needs to be
37. followed by all employees in their different positions
irrespective of their personal differences. It would also make
sure that only the right person who is ready to work is going to
be chosen.
PART 4: IMPLEMENTATION CHALLENGE.
The challenge likely to be encountered during the
implementation of this human resource initiative is lack of
awareness of the motive of the person being appointed, elected
or employed. It is hard to tell the intention that a person has for
the company or organization. for example, you cannot tell
whether a person has a good or bad motive until they are in
office which leads to an increase in recruitment costs. It might
also be hard to tell any existing personal grudges between the
candidates in the selection of a Chief Medical Officer and the
existing team of executives who are not on the selection
committee. Besides, the change in policy might be used
unfavorably by incompetent executives on the selection
committee to prevent or oppose selection of a Chief Medical
Officer who might be competent enough to perform their duties
even better.
PART 5: EVALUATION.
To evaluate the performance of the HR initiative, the hospital
would use self-assessment techniques as well as acquiring
information from other stakeholders such as colleagues by
performance appraisal. Questionnaires can also be given to
patients and other staff so as to gather information on the
performance of the new Chief Medical Officer.
References
Hopkins, M. M., O'Neil, D. A., & Stoller, J. K. (2015).
Distinguishing competencies of effective physician leaders.