China’s economy
中国经济
http://worldmap.harvard.edu/chinamap/
How has China’s economy changed 1949-present?
What is the structure of PR China’s economy?
What are some major agricultural issues in China?
What are some industrial issues in China?
What is the Belt and Road Initiative?
What are the economic forces at work in China?
How has the economic reform policy progressed in China?
How has China’s economy changed 1949-present?
Economy Timeline
Mao 1950s Land reform, Collectivization, Great Leap Forward, 1960s Cultural Revolution
1976 Four Modernizations
Deng Reforms
1980s Agricultural Responsibility System
Socialist Economy with Chinese Characteristics
Exports
1992 Deng’s Southern tour
Regional Development, Coast, Interior
2000 Develop the West
2010 Moderate Prosperity, Technology, Green
2013 Third Plenum - China Dream
http://www.bbc.co.uk/news/business-25033622
http://www.bbc.com/news/world-asia-china-31744373
Videos
China in the Red
http://www.pbs.org/wgbh/pages/frontline/shows/red/
http://www.dailymotion.com/video/xen5f7_pbs-china-in-the-red-9-11_news
What are the lives of people like?
Form of Economy
Mixed Economy
Market-Leninism
Transition: Elements of Socialism, Market & Capitalism
What is the structure of PR China’s economy?
Ownership types: State, Collective, Private and individual, Foreign
Economic Indicators
GDP Trillion $25.36
GDP per capita $18, 200
GDP growth 6.9% GDP Composition
Agriculture 8%, Industry 40% Service 52%
Labor Composition
Agriculture 28%, Industry 29% Service 43%
Poverty 3.3%, <RMB2300 ( US$400)
Trade
Exports (number 1):
US 19, Hong Kong 12, Japan 6, South Korea 5
Electrical, computers, apparel, furniture, textiles
Imports ( number 2):
South Korea 10, Japan 9, US 9, Germany 5, Australia 5
Electrical, oil, medical, ore, vehicle, soybean
Structure of China’s Transitional Economy 1
Structure of China’s Transitional Economy
Industrial structure (compare to Japan and S. Korea)
Enterprise groups – SOE State Operated Enterprise
state support/control, losing money, 25% industry
Collective enterprises – independent of state
manager bought company from state
40% industry
TVE Enterprises – Township and Village Enterprises (former collective)
Owned operated by rural - Dynamic element of economy
Structure of China’s Transitional Economy 2
Private Entrepreneurs - small business, 20% industry
services/manufactures Difficult taxes, legality, politics
Foreign Ventures – partnerships, 10% industry
– commerce, industry
Agriculture - backbone of economy 8% econ
employment / food supply
Responsibility system, state out of agriculture
have right to work land
Food price control and some subsidies still exist
Economic Dualism
Industrial v. non-industrial : worker - peasant
Coastal & open cities v. hinterland “backward”
City v. country
urban v. rural
China Inc?
Simplified form
CCP
Business Bureaucracy
(SOE, Coll., TVE) (State Council)
Rural .
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
The paper intends to assess the level of utilization and socio-economic factors influencing adherence to utilization of Anti Retroviral Therapy (ART) for People Living with HIV/AIDS in Dodoma Municipality and Kongwa District in Tanzania. Documentary review, interview and Focus Group Discussion were used in collecting data. A total of 140 respondents (99 PLWHIV/AIDS and 41 key informants) from four hospitals, two health centers and one dispensary were selected and interviewed as representatives for the purpose of this study. Quantitative data were collected and analyzed by using SPSS version 16 software. The study revealed 100% of PLWHIV/AIDS used ART drugs in Dodoma General Hospital, Kongwa Hospital, Mkoka Health Center and Makole Health Center while 40% in St. Gemma Hospital. Also the study indicated there were high dropout from utilization of ART drugs among PLWHIV/AIDS, 60% in Mirembe hospital, (50%) in Mkoka health center and (44%) in St. Gemma hospital as compared to the rest health centers and hospitals. The drop out caused by ART drugs side effects such as vomiting (25.1%), frequently sickness (19.9%) and decrease in CD 4 (11.2%). Lastly the study revealed four main socio-economic factors influencing adherence to utilization of ART services among PLHIV/AIDS including lack of employment support (66.7 %,) lack of confidentiality (50 %,) patient’s preference to traditional medicines (30%) and cultural belief (29.3%). The study recommends all PLWHIV/AIDS with side effects should report their cases to health centers and hospitals because not all side effects require a change of drugs or discontinuation, PLWHIV/AIDS should be assisted by Government and Non-Government Organizations and family members to secure soft loans that will enable them to establish income generation activities, education on patients confidentiality should be provided to services providers in hospitals and health centers
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
The paper intends to assess the level of utilization and socio-economic factors influencing adherence to utilization of Anti Retroviral Therapy (ART) for People Living with HIV/AIDS in Dodoma Municipality and Kongwa District in Tanzania. Documentary review, interview and Focus Group Discussion were used in collecting data. A total of 140 respondents (99 PLWHIV/AIDS and 41 key informants) from four hospitals, two health centers and one dispensary were selected and interviewed as representatives for the purpose of this study. Quantitative data were collected and analyzed by using SPSS version 16 software. The study revealed 100% of PLWHIV/AIDS used ART drugs in Dodoma General Hospital, Kongwa Hospital, Mkoka Health Center and Makole Health Center while 40% in St. Gemma Hospital. Also the study indicated there were high dropout from utilization of ART drugs among PLWHIV/AIDS, 60% in Mirembe hospital, (50%) in Mkoka health center and (44%) in St. Gemma hospital as compared to the rest health centers and hospitals. The drop out caused by ART drugs side effects such as vomiting (25.1%), frequently sickness (19.9%) and decrease in CD 4 (11.2%). Lastly the study revealed four main socio-economic factors influencing adherence to utilization of ART services among PLHIV/AIDS including lack of employment support (66.7 %,) lack of confidentiality (50 %,) patient’s preference to traditional medicines (30%) and cultural belief (29.3%). The study recommends all PLWHIV/AIDS with side effects should report their cases to health centers and hospitals because not all side effects require a change of drugs or discontinuation, PLWHIV/AIDS should be assisted by Government and Non-Government Organizations and family members to secure soft loans that will enable them to establish income generation activities, education on patients confidentiality should be provided to services providers in hospitals and health centers
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
C
o
p
y
r
i
g
h
t
2
0
1
7
.
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
http://www.wpro.who.int/asia_pacific_observatory/hits/myanmar_pns1_en.pdf
What are the challenges facing Myanmar in progressing towards Universal Health Coverage?
https://www.irrawaddy.com/specials/challenges-impede-development-of-myanmars-public-health.html
Challenges Impede Development of Myanmar’s Public Health
https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/document/health-sector-reforms-myanmar-giving-more-space-public-health-interventions-ncds
Health Sector Reforms in Myanmar, giving more space for public health interventions for NCDs
The Kingdom of Tonga has had one of the best overall levels of health within the Pacific as a result of a dramatic reduction in communicable diseases and maternal and child mortality since the 1950s. It is also on target to achieve the Millennium Development Goals (MDG) around maternal and child mortality. Adapting its strong primary health-care system to deal with the large financial burden associated with chronic and noncommunicable diseases and ensuring quality primary health-care services in remote areas are the main health sector challenges facing Tonga.
Current healthcare trends and jobs outlook for 2025needppthelp
This is a team assignment for HCAD 600 for the MS program in Healthcare Administration by UMUC. This presentation is a analysis of the current healthcare trends and job outlook for 2025 to be presented to the HR committee of Board of Directors of a healthcare organization to address workforce shortages in key healthcare areas.
Change in Practice of using Inhalers for Outpatients have Chronic Obstructive...AI Publications
Objectives: To evaluate changes in the practice of using inhalers for outpatients have chronic obstructive pulmonary at Nam Dinh General Hospital after the intervention. To compare the effectiveness between intervention methods of direct consultation (DC) and direct counseling method incorporating information technology (DC – IT). Subject and method: Intervention study on two groups of patients, 30 patients have chronic obstructive pulmonary in each group with similar characteristics who were treated at Nam Dinh General Hospital from October 2019 to May 2020. Two research groups analyzed and compared the practice of patients at two times, the first time (T1) before the intervention and the second time (T2) after the intervention was 3 months with 3 consecutive interventions (each intervention was 1 month). One group intervened with the direct consultation method; one group intervened with the direct counseling method incorporating information technology. Data were collected by the observational method, using the inhaler procedure and entered and processed on SPSS 20.0 software. Results: The group of patients was intervened with the direct counseling method about practice using inhalers increased after the intervention, the average point of inhaler practice before the intervention was 6.50 ± 1.63 and after the intervention was 8.57 ± 0.63 with p <0.05. The group of patients who intervened with direct counseling method incorporating information technology about using an inhaler increased after the intervention from 6.70 ± 1.29 (before the intervention) to 8.80 ± 0.61 (after intervention), with p <0.05. The efficiency index of using the inhaler dose of (DC – IT) group was higher than the DC group at 63%. Conclusion: The average of the two groups increased significantly after the intervention. However, the intervention method of DC – IT was more effective than the DC method.
Running head U.S. HEALTHCARE EXECUTIVES 1U.S. HEALTHCARE EX.docxjenkinsmandie
Running head: U.S. HEALTHCARE EXECUTIVES
1
U.S. HEALTHCARE EXECUTIVES
7
Week 2 Assignment-Operational challenges, trends and issues for the U.S. Healthcare Executives
Student’s Name
Institutional Affiliation
Introduction
A healthcare system is an organization of funds, individuals, and institutions which provide healthcare to satisfy the health requirements of a society. Globally, healthcare systems vary depending on the specific healthcare needs of particular states. Nevertheless, the common aspects of public and private care are often similar (Drummond, Sculpher, Claxton, Stoddart & Torrance, 2015). Over the years, we have witnessed the systems evolving, and with this constant change, it is vital to analyze operational challenges, trends, and issues for the U.S. healthcare executives. In this paper, the main areas that will be discussed are operational challenges, trends, and problems experienced in the United States health care executives.
Challenges experienced in the healthcare workplace
Various problems have been experienced in the healthcare workplace relating to healthcare provision in the United States. Financial difficulties are one of the main challenges being experienced in the healthcare workplace in the United States. The vital financial problems arise due to lack of enough finances for implementation of new technologies to improve healthcare delivery process (Mayes, 2017). Most healthcare facilities lack adequate funds to implement advanced technologies that can be used to increase the quality of healthcare delivery. As a result, this has reduced healthcare quality improvement plans in the United States. Therefore, there is a need for federal governments to meek proper arrangements to fund all healthcare activities to improve services delivery in the health sector.
Besides, healthcare professionals to comply with federal requirements for electronic health records is another challenge that has been experienced in the United States healthcare workplace. For the past year, some healthcare professionals have failed to comply with federal government guidelines regarding health care delivery (Mayes, 2017). Furthermore, the increasing number of patients who cannot pay for health care services is a significant challenge that has been experienced in the United States healthcare delivery systems. These finance challenges adversely affect healthcare delivery system in the United States.
Work overload is another major challenge that has been experienced in the United States health sectors (Mayes, 2017). Observations for past years reveal that work overload at the workplace affects the performance of health care professionals in the United States. Most healthcare professionals are assigned many responsibilities at workplaces, which reduces their efficiency.
Another cause of the rising cost of healthcare is the introduction of government programs. For example, Medicare assists those without insurance, which led to an incre.
Choose a National Transportation Safety Board (NTSB) report of a w.docxspoonerneddy
Choose a National Transportation Safety Board (NTSB) report of a
weather-related accident/incident
and, along with at least
five
other sources, investigate what happened in the accident/incident, offer the causes, and the recommendations for the future in order to prevent such an accident/incident.
The following components must be present within your report. Please be sure to follow the template provided.
1. Cover Page
2. Introduction
3. Synopsis of Incident
4. Causation
5. Decision Criteria
6. Analysis
7. Implications
8. Recommendations
9. Personal Narrative
10. Conclusion
11. References
.
Choose a global health issue. For this assignment, you will introduc.docxspoonerneddy
Choose a global health issue. For this assignment, you will introduce the health issue and discuss the interventions necessary to prevent the issue and promote health.
Some topics to consider may include:
Anthrax
Bioterrorism
Cholera
Clostridium
botulinum
infection
Community-associated methicillin-resistant
Staphylococcus
Ebola virus disease
Escherichia
coli
Human immunodeficiency virus disease
Malaria
Plague
Severe respiratory distress syndrome
Small pox
Suicide
Tuberculosis
Vancomycin-resistant enterococcus infection
West Nile virus
Include the following in your paper:
Introduction/overview of the health issue and the prevalence in the United States and worldwide
Contributing factors
Prevention strategies
Signs and symptoms
Diagnostic tests (if applicable)
Advanced practice nursing role and management strategies
Medical/pharmacological management (if applicable)
Follow-up care
Conclusion
Write a 3–4 page paper following APA format. You must include 2–3 scholarly sources in your citations and references.
Review the rubric for further information on how your assignment will be graded.
Due: Sunday, 11:59 p.m. (Pacific time)
Points: 100
.
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DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
http://www.wpro.who.int/asia_pacific_observatory/hits/myanmar_pns1_en.pdf
What are the challenges facing Myanmar in progressing towards Universal Health Coverage?
https://www.irrawaddy.com/specials/challenges-impede-development-of-myanmars-public-health.html
Challenges Impede Development of Myanmar’s Public Health
https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/document/health-sector-reforms-myanmar-giving-more-space-public-health-interventions-ncds
Health Sector Reforms in Myanmar, giving more space for public health interventions for NCDs
The Kingdom of Tonga has had one of the best overall levels of health within the Pacific as a result of a dramatic reduction in communicable diseases and maternal and child mortality since the 1950s. It is also on target to achieve the Millennium Development Goals (MDG) around maternal and child mortality. Adapting its strong primary health-care system to deal with the large financial burden associated with chronic and noncommunicable diseases and ensuring quality primary health-care services in remote areas are the main health sector challenges facing Tonga.
Current healthcare trends and jobs outlook for 2025needppthelp
This is a team assignment for HCAD 600 for the MS program in Healthcare Administration by UMUC. This presentation is a analysis of the current healthcare trends and job outlook for 2025 to be presented to the HR committee of Board of Directors of a healthcare organization to address workforce shortages in key healthcare areas.
Change in Practice of using Inhalers for Outpatients have Chronic Obstructive...AI Publications
Objectives: To evaluate changes in the practice of using inhalers for outpatients have chronic obstructive pulmonary at Nam Dinh General Hospital after the intervention. To compare the effectiveness between intervention methods of direct consultation (DC) and direct counseling method incorporating information technology (DC – IT). Subject and method: Intervention study on two groups of patients, 30 patients have chronic obstructive pulmonary in each group with similar characteristics who were treated at Nam Dinh General Hospital from October 2019 to May 2020. Two research groups analyzed and compared the practice of patients at two times, the first time (T1) before the intervention and the second time (T2) after the intervention was 3 months with 3 consecutive interventions (each intervention was 1 month). One group intervened with the direct consultation method; one group intervened with the direct counseling method incorporating information technology. Data were collected by the observational method, using the inhaler procedure and entered and processed on SPSS 20.0 software. Results: The group of patients was intervened with the direct counseling method about practice using inhalers increased after the intervention, the average point of inhaler practice before the intervention was 6.50 ± 1.63 and after the intervention was 8.57 ± 0.63 with p <0.05. The group of patients who intervened with direct counseling method incorporating information technology about using an inhaler increased after the intervention from 6.70 ± 1.29 (before the intervention) to 8.80 ± 0.61 (after intervention), with p <0.05. The efficiency index of using the inhaler dose of (DC – IT) group was higher than the DC group at 63%. Conclusion: The average of the two groups increased significantly after the intervention. However, the intervention method of DC – IT was more effective than the DC method.
Running head U.S. HEALTHCARE EXECUTIVES 1U.S. HEALTHCARE EX.docxjenkinsmandie
Running head: U.S. HEALTHCARE EXECUTIVES
1
U.S. HEALTHCARE EXECUTIVES
7
Week 2 Assignment-Operational challenges, trends and issues for the U.S. Healthcare Executives
Student’s Name
Institutional Affiliation
Introduction
A healthcare system is an organization of funds, individuals, and institutions which provide healthcare to satisfy the health requirements of a society. Globally, healthcare systems vary depending on the specific healthcare needs of particular states. Nevertheless, the common aspects of public and private care are often similar (Drummond, Sculpher, Claxton, Stoddart & Torrance, 2015). Over the years, we have witnessed the systems evolving, and with this constant change, it is vital to analyze operational challenges, trends, and issues for the U.S. healthcare executives. In this paper, the main areas that will be discussed are operational challenges, trends, and problems experienced in the United States health care executives.
Challenges experienced in the healthcare workplace
Various problems have been experienced in the healthcare workplace relating to healthcare provision in the United States. Financial difficulties are one of the main challenges being experienced in the healthcare workplace in the United States. The vital financial problems arise due to lack of enough finances for implementation of new technologies to improve healthcare delivery process (Mayes, 2017). Most healthcare facilities lack adequate funds to implement advanced technologies that can be used to increase the quality of healthcare delivery. As a result, this has reduced healthcare quality improvement plans in the United States. Therefore, there is a need for federal governments to meek proper arrangements to fund all healthcare activities to improve services delivery in the health sector.
Besides, healthcare professionals to comply with federal requirements for electronic health records is another challenge that has been experienced in the United States healthcare workplace. For the past year, some healthcare professionals have failed to comply with federal government guidelines regarding health care delivery (Mayes, 2017). Furthermore, the increasing number of patients who cannot pay for health care services is a significant challenge that has been experienced in the United States healthcare delivery systems. These finance challenges adversely affect healthcare delivery system in the United States.
Work overload is another major challenge that has been experienced in the United States health sectors (Mayes, 2017). Observations for past years reveal that work overload at the workplace affects the performance of health care professionals in the United States. Most healthcare professionals are assigned many responsibilities at workplaces, which reduces their efficiency.
Another cause of the rising cost of healthcare is the introduction of government programs. For example, Medicare assists those without insurance, which led to an incre.
Choose a National Transportation Safety Board (NTSB) report of a w.docxspoonerneddy
Choose a National Transportation Safety Board (NTSB) report of a
weather-related accident/incident
and, along with at least
five
other sources, investigate what happened in the accident/incident, offer the causes, and the recommendations for the future in order to prevent such an accident/incident.
The following components must be present within your report. Please be sure to follow the template provided.
1. Cover Page
2. Introduction
3. Synopsis of Incident
4. Causation
5. Decision Criteria
6. Analysis
7. Implications
8. Recommendations
9. Personal Narrative
10. Conclusion
11. References
.
Choose a global health issue. For this assignment, you will introduc.docxspoonerneddy
Choose a global health issue. For this assignment, you will introduce the health issue and discuss the interventions necessary to prevent the issue and promote health.
Some topics to consider may include:
Anthrax
Bioterrorism
Cholera
Clostridium
botulinum
infection
Community-associated methicillin-resistant
Staphylococcus
Ebola virus disease
Escherichia
coli
Human immunodeficiency virus disease
Malaria
Plague
Severe respiratory distress syndrome
Small pox
Suicide
Tuberculosis
Vancomycin-resistant enterococcus infection
West Nile virus
Include the following in your paper:
Introduction/overview of the health issue and the prevalence in the United States and worldwide
Contributing factors
Prevention strategies
Signs and symptoms
Diagnostic tests (if applicable)
Advanced practice nursing role and management strategies
Medical/pharmacological management (if applicable)
Follow-up care
Conclusion
Write a 3–4 page paper following APA format. You must include 2–3 scholarly sources in your citations and references.
Review the rubric for further information on how your assignment will be graded.
Due: Sunday, 11:59 p.m. (Pacific time)
Points: 100
.
Choose a geographic community of interest (Hyde park, Illinois) and .docxspoonerneddy
Choose a geographic community of interest (Hyde park, Illinois) and go to the corresponding website. Gather information on the population (race, sex, age, educational level, employment), health resources, major grocery stores and transportation. Students must make an initial post describing the official name and geographic boundaries, along with some of the findings (at least 5 facts) from the website, like overall appearance, upkeep, trash/cleanliness, type of housing (apartments vs. homes) in the area.
.
Choose a disease condition of the gastrointestinal tract, describe.docxspoonerneddy
Choose a disease condition of the gastrointestinal tract, described in your own words. Please use at least two sentences. Include a digestive system medical term with a combining form, suffix and prefix that relates to your disease condition. Define the term both literally and officially using the glossary to define the word parts and the mobile medical dictionary to define the term. Remember to use dash and slash!
.
Choose a few health issues in your community that can be used to pla.docxspoonerneddy
Choose a few health issues in your community that can be used to plan community health interventions. Briefly identify urgent health issues and non-urgent health issues. What makes health issues urgent and a priority? Which needs are not a priority and why? Who determines this or should determine this (identify internal and external stakeholders)? How would you document and present this to your community?
.
Choose a current member of Congress and research their background. P.docxspoonerneddy
Choose a current member of Congress and research their background. Prepare a 1-page analysis of their background including their views, policy choices and opinions on current issues.
Post your paper to the Discussion Area with a short introduction. Spend time reviewing other students’ papers. Comment on at least 2 students’ papers. What impact does the congressional member’s background (social, economic, educational, ethnic, gender, ideological, etc.) have on your opinion of them? Be specific. Provide concrete examples.
.
Choose a couple of ways how your life would be different without the.docxspoonerneddy
Choose a couple of ways how your life would be different without the Internet. How would the business world be different? Think of the job you have now, a job you’ve had previously, or the job you’d really like to have and discuss what you think the impact would be based on your understanding of equipment used to support Internet access such as switches and routers.
.
Choose a countrydifferent fromyournative country,and.docxspoonerneddy
Choose a country
different from
your
native country,
and
write about
three interesting
or
exotic
(touristy or not)
places
that you want to visit in that country.
As follows:
1.
Write
what features
make those places
interesting or exotic
TO YOU, NOT THE REST OF THE WORLD
Give enough details of the features of the places so you can make
readers picture those interesting or exotic places in their mind.
.
Choose 5 questions and answer them with my materials onlyD.docxspoonerneddy
Choose 5 questions and answer them with my materials only
Dispossession
1- What is meant by “dispossession”?
2- What does and does not change in this process?
Forced Movements
1- Name three ways Native Americans were moved from their homeplace?
Reservations
1- What was meant by, “kill the Indian, save the man”?
2- How was religion involved in reservations?
3- After being removed from their “spiritual homeplace”, how might this affect American Indian religion?
Christianity
1- Name one way Native Americans were “converted” to Christianity, and why they chose to do so?
2- To some American Indians, what was missing in the Christian perspective or practices?
Two Faces of History
1- Name opposing views of the world between Native Americans and Europeans? Is this evident today?
Leading Figures
1- Describe a “leading figure” according to a Native American perspective. Give three examples.
2- Who are the notable leaders we learn about in school? Why them? What do they often have in common?
.
Choose a communication situation you recently experienced at you.docxspoonerneddy
Choose a communication situation you recently experienced at your workplace or other organization you are affiliated with. Use the human communication process described in your text, starting on page 11, "Human Communication: Message and Constitutive Processes," to analyze why—or why not—a shared reality was experienced as an end result. Summarize your experience and include your analysis as an attachment in this assignment thread. Consider the following items in your analysis:
Identify the source and the receiver.
What was the message and what type of message function was it serving?
How was it encoded?
How was it decoded?
What channel was used to transmit the message?
What type of noise was experienced?
Comment on the competencies, fields of experience, and culture of the participants involved.
Identify the communication context of this situation.
What was the intended effect versus the actual effect of the message?
Was a shared reality constructed? If not, what needed to change?
.
Choose 5 interconnected leadership task (listed below). Tell why each task is important to understand as a leader that is involved with the strategic planning process.
Explain what each process means and what is involved with the five that you picked.
Interconnected Leadership task:
1)Understanding the context
2)Understanding the people involved, including oneself
3)Sponsoring Process
4)Championing the process
5)Facilitating the process
6)Fostering collective leadership
7)Using dialogue and discussion
8)Making and implementing policy decisions
9)Enforcing norms, settling disputes, and managing residual conflict
10) Pulling it all together
Outline:
Cover Page
Abstract
Introduction: (Overview what you will discuss)
Body (2 FULL Pages of Content)
Reference Page (2-3 references)
.
Choose 5 out of the first 10 questions, 5 pages essay1. Where do.docxspoonerneddy
Choose 5 out of the first 10 questions, 5 pages essay
1. Where do American Indians believe they come from?
2. As a student, how would you approach going to a ceremony?
3. How would “I” (meaning Mr. Madril), define/describe an American Indian “church”?
4. Why is the idea of the ‘circle’ valued by some American Indian people?
5. Define ‘ontology’
6. How do some American Indian people view eagles/eagle feathers?
7. How has Christianity and American Indian people interacted?
8. Name or describe some ‘sacred places’/sacred spaces
9. Name some ‘ceremonies’
10. What is a ‘holy person’?
.
Choose 3 or 4 poems from Elizabeth Bishop. You may choose any poems .docxspoonerneddy
Choose 3 or 4 poems from Elizabeth Bishop. You may choose any poems that you want, whether in our eText or from another source, but be sure to use proper citations for each of them. Discuss how the poet’s life has influenced her or his poetry. You may find context from the poet’s childhood, personal experiences, etc. and link them to poems of your choice.
Be careful not to give me five pages of biography!
When referencing poems, you may quote specific lines but
do not
type the entire poem into your essay.
MLA Format
5-6 pages, double spaced, not including Works Cited page
Works Cited page
Proper in-text citations
.
Choose 1 topic to write an essay. Dont restate all the time. Write .docxspoonerneddy
Choose 1 topic to write an essay. Don't restate all the time. Write your own thoughts. 800 words.
1. Jesus was both a person of his times and a figure whose teachings have obviously transcended his specific context. How did Jesus’s life and teachings better fit the first century? How do Jesus’s life and teachings seem to apply today? Which do you think better characterizes Jesus’s actual life and teachings? Is it more convincing to you that the first century Jesus resists our expectations, or that he anticipates them?
2. Jesus and the early Christians were a part of the larger Jewish context. At the same time, they also brought a number of innovations and new combinations. Compare Jesus’s life and message to that of the Pharisees, Essenes, followers of John the Baptist, Sadducees, priests, and/or the temple. How did Jesus and the early Christians fit with these other Jewish groups? How did they challenge them? Is it more convincing to you that Jesus and the early Christians were part of first century Judaism, or that they pushed to create a new religion?
3. Jesus avoided political attention for most of his life and work. Whatever he taught, he taught it skillfully and carefully enough that political figures allowed him to continue when many others were crucified. And yet, at the end, he too was crucified, but alone. Describe both the ways in which the historical Jesus avoided political confrontation and the ways in which he touched on politically sensitive ideas. Which gives us a better portrait of Jesus—the one who was politically cautious, or the rebel?
.
Choose 1 focal point from each subcategory of practice, educatio.docxspoonerneddy
Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management
Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.
Practice
1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.
2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.
3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.
4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.
Education
1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.
2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.
3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.
4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.
Research
1. Increase the integration of evidence-based care across the dimensions of end-of-life care.
2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.
3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.
4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.
5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.
Administration
1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.
2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.
3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.
4. Suppo.
Choose 1 focal point from each subcategory of practice, education, r.docxspoonerneddy
Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.
Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.
Practice
1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.
2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.
3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.
4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.
Education
1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.
2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.
3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.
4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.
Research
1. Increase the integration of evidence-based care across the dimensions of end-of-life care.
2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.
3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.
4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.
5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.
Administration
1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.
2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.
3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.
4. Sup.
Chinese HistoryBased on the lecture on Chinese History and Marxi.docxspoonerneddy
Chinese History
Based on the lecture on Chinese History and Marxist Historiography that we can observe that women’s values for love and marriage have changed dramatically. China entered different periods from the feudal system to the opening of China. In the feudal period, people attached importance to family ethics took the land as the main interest and lived a life according to family rules. However, after China entered the capitalist era, capitalism encouraged people to pursue money and material life.
Marriage and love are very important to a woman. However, at different times, a woman has a completely different way of life. For example, Yulian lived in a feudal period dominated by family so she put her husband's family first. In my opinion, Yulian sacrificed her love and happiness for putting family first, which is a great thing but not worth it. However, Jia Jia from the beginning of the gold digger because of a series of events and become a brave pursuit of their own love and life woman is very worthy of praise.
With the passage of time, people's concept has changed gradually, from the old conservative value of family to the priority of their own ideas, from the pursuit of land as the interest standard to the pursuit of money and material life as the most important goal, which is an important symbol of the changing times.
Jia Jia and Julian have something in common. They all focus on who can give them a stable and good life. However, the difference is that Yulian follows the traditional idea of giving priority to her family but Jia Jia is based on their own ideas to live out their own life.
Marxist Historiography
1. Marxist Historiography has five different stages. The first stage is Primitive Communism, People at this stage use hunting as raw meat, which is the most important asset. The second stage is Oriental Slavery, the agricultural development began, and people willing to fight elsewhere and take slaves to cultivate for themselves. The most valuable is the slave. The third stage is Feudalism, serfs or peasants serve for their king and pay the rent or tax. Capitalism is the four-stage, the most important asset is money. The five-stage is Communism, for this stage that no more private ownership and it will be a world of peace and no war.
2. Base on Marxist Historiography lecture, the era of Yulian's life is very important to the family. She listens to her family's arrangements to get married and takes care of her husband's family after marriage. So I think Yulian is in the third stage of the Marxism Feudalism stage because people at this stage serve the king, they obedient and obey the rules. Yulian's life all follow her husband’s family and obey her family. Jia Jia emphasized that she has money from the beginning of the film. Anything she wants that she just use money to get it. All Jia Jia thinks that she can buy it with money. Therefore, Jia Jia is the fourth stage Capitalism stage in Marxism.
3. On the stage of Yulian so be .
Children need an Aesthetics Experience from the teacher and in the c.docxspoonerneddy
Children need an Aesthetics Experience from the teacher and in the classroom. The above document is a brief summary of Aesthetic and some key terms.
Do the following:
1. Read the document completely
2. Study the Key Terms
3. Use the key terms and determine which words can be used in a Early Childhood Classroom and which words can be used with an An Art Conversation with a child. Give a brief explanation of your reasoning
.
Childrens Health Insurance Program CHIP. Respond to the 5 questions.docxspoonerneddy
Children's Health Insurance Program CHIP. Respond to the 5 questions in 200 words per question using at least 4 source.
1. What is the CHIP program? When and how was it established? how does it benefit children’s health and wellbeing and that of the overall population?
2. How could the CHIP program continue to be successfully funded?
3. Who do you feel should be covered in the program?
4. How should the qualifications be set for being accepted?
5. Revise one evidence-based article regarding this program and the impact it has.
.
Chief complaint My right great toe has been hurting for ab.docxspoonerneddy
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries:
None
Allergies:
Augmentin
Medication:
Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional:
Negative for fever. Negative for chills.
Respiratory:
No Shortness of breath. No Orthopnea
Cardiovascular:
Regular rhythm.
Skin:
Right great toe swollen, itchy, painful and discolored.
Psychiatric
: No anxiety. No depression.
Physical examination:
Vital Signs
Height:
5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK:
Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS:
No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART:
Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN:
No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY:
No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL:
Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH:
Normal affect. Cooperative.
Labs:
Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab
:
Fungal culture confirms.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
1. China’s economy
中国经济
http://worldmap.harvard.edu/chinamap/
How has China’s economy changed 1949-present?
What is the structure of PR China’s economy?
What are some major agricultural issues in China?
What are some industrial issues in China?
What is the Belt and Road Initiative?
What are the economic forces at work in China?
How has the economic reform policy progressed in China?
How has China’s economy changed 1949-present?
Economy Timeline
Mao 1950s Land reform, Collectivization, Great Leap Forward,
1960s Cultural Revolution
1976 Four Modernizations
Deng Reforms
1980s Agricultural Responsibility System
Socialist Economy with Chinese Characteristics
Exports
1992 Deng’s Southern tour
2. Regional Development, Coast, Interior
2000 Develop the West
2010 Moderate Prosperity, Technology, Green
2013 Third Plenum - China Dream
http://www.bbc.co.uk/news/business-25033622
http://www.bbc.com/news/world-asia-china-31744373
Videos
China in the Red
http://www.pbs.org/wgbh/pages/frontline/shows/red/
http://www.dailymotion.com/video/xen5f7_pbs-china-in-the-
red-9-11_news
What are the lives of people like?
Form of Economy
Mixed Economy
Market-Leninism
Transition: Elements of Socialism, Market & Capitalism
What is the structure of PR China’s economy?
Ownership types: State, Collective, Private and individual,
Foreign
3. Economic Indicators
GDP Trillion $25.36
GDP per capita $18, 200
GDP growth 6.9% GDP Composition
Agriculture 8%, Industry 40% Service 52%
Labor Composition
Agriculture 28%, Industry 29% Service 43%
Poverty 3.3%, <RMB2300 ( US$400)
Trade
Exports (number 1):
US 19, Hong Kong 12, Japan 6, South Korea 5
Electrical, computers, apparel, furniture, textiles
Imports ( number 2):
South Korea 10, Japan 9, US 9, Germany 5, Australia 5
Electrical, oil, medical, ore, vehicle, soybean
Structure of China’s Transitional Economy 1
Structure of China’s Transitional Economy
Industrial structure (compare to Japan and S. Korea)
Enterprise groups – SOE State Operated Enterprise
state support/control, losing money, 25% industry
4. Collective enterprises – independent of state
manager bought company from state
40% industry
TVE Enterprises – Township and Village Enterprises (former
collective)
Owned operated by rural - Dynamic element of economy
Structure of China’s Transitional Economy 2
Private Entrepreneurs - small business, 20% industry
services/manufactures Difficult taxes, legality, politics
Foreign Ventures – partnerships, 10% industry
– commerce, industry
Agriculture - backbone of economy 8% econ
employment / food supply
Responsibility system, state out of agriculture
have right to work land
Food price control and some subsidies still exist
Economic Dualism
Industrial v. non-industrial : worker - peasant
Coastal & open cities v. hinterland “backward”
City v. country
urban v. rural
China Inc?
Simplified form
CCP
6. What are some major Industrial Issues in China?
Market reform: local, national and international markets
Control: local, regional, national, foreign, global
Labor: jobs, training, skills, lay-offs, rural labor looking for
work
Land: encroachment on farmlands
Capital: less of problem, foreign investment
Technology: more mechanization, less need for labor
Environment: land degradation, air pollution, water pollution;
water usage
8. Routes and Ports of entry
http://www.wsj.com/articles/chinas-new-trade-routes-center-it-
on-geopolitical-map-1415559290
China and Kazakhstan
Khorgos- highway
Alataw Pass- rail
China and Kyrgyz Republic
Torugart- highway
What are the economic Forces at work in China?
Trade Export #1, Import #2
Investment #7
Aid #1
Tourism arr.#4, dep.#1
9. HEALTH CARE POLICY AND SYSTEMS
1
Key words
Patient safety, quality improvement,
evidence-based practice, medication
administration errors, intervention research,
focus group, drug round tabard
Accepted: May 3, 2014
doi: 10.1111/jnu.12092
Abstract
Background: The use of drug round tabards is a widespread
intervention that
is implemented to reduce the number of interruptions and
medication admin-
istration errors (MAEs) by nurses; however, evidence for their
effectiveness is
scarce.
Purpose: Evaluation of the effect of drug round tabards on the
frequency and
type of interruptions, MAEs, the linearity between interruptions
and MAEs, as
well as to explore nurses’ experiences with the tabards.
Study Design: A mixed methods before-after study, with three
observation
periods on three wards of a Dutch university hospital, combined
11. that require action by the hospitals (Institute for Safe
Medication Practices, 2014; World Health Organization
High 5, 2014).
Literature indicates that the ME rate may vary from
5% to 25% in all episodes of in-hospital drug admin-
istration, but only 19% are reported (Antonow, Smith,
& Silver, 2000; Krahenbuhl-Melcher et al., 2007; West-
brook, Woods, Rob, Dunsmuir, & Day, 2010). This could
indicate that the actual incidence rates might be higher.
Therefore, MEs endanger the safety of patients. MEs
occur in every stage of the medication process, with
50% of them associated with medication administration
(Krahenbuhl-Melcher et al., 2007). In hospitals, nurses
are generally responsible for this stage in the medication
process.
In general, interruptions or distractions are recognized
to reduce efficiency and contribute to errors (Brixey et al.,
2007). In specific, interruptions appear to be a promi-
nent causative factor for medication administration er-
rors (MAEs; Biron, Loiselle, & Lavoie-Tremblay, 2009;
Freeman, McKee, Lee-Lehner, & Pesenecker, 2012; Tr-
bovich, Prakash, Stewart, Trip, & Savage, 2010; West-
brook et al., 2010).
The literature describes several initiatives that in-
fluence nursing medication practice to reduce MAEs
(Hodgkinson, Koch, Nay, & Nichols, 2006; Raban &
Westbrook, 2013). One of these interventions includes
tabards, or vests, with the inscription “do not disturb” or
visible signage.
The use of drug round tabards is a widespread, in-
expensive intervention that is thought to reduce the
12. number of interruptions during drug rounds and MAEs.
However, in practice the tabards are unpopular among
nurses; they doubt their effectiveness and do not feel
comfortable wearing them. Additionally, the evidence
on effectiveness of using tabards is limited (Raban &
Westbrook, 2013; Scott, Williams, Ingram, & Mackenzie,
2010). When evidence is lacking, the incentive to wear
a tabard will be especially weak and one can become re-
luctant to implement interventions (Glasziou, Ogrinc, &
Goodman, 2011; Smeulers, Onderwater, van Zwieten, &
Vermeulen, 2014). If the effectiveness of these tabards
can be established and barriers and facilitators can be
identified, implementation in clinical practice will be fa-
cilitated and endorsed. Therefore, the aim of our study
is to evaluate the effect of drug round tabards on (a)
the frequency and type of interruptions, (b) the number
and type of MAEs, and (c) the magnitude of the relation
between interruptions and MAEs during the process of
preparation, distribution, and administration of medica-
tion in hospital wards. In addition, we explored nurses’
perspectives and experiences with drug round tabards to
identify barriers and facilitators for implementation.
Methods
Setting
Three wards in a Dutch 1,024-bed university hospi-
tal contributed to this study: neurology, neurosurgery,
and a combined ward with dermatology, ophthalmol-
ogy, and ENT services. In total, these wards contain 60
beds. Each ward has a closed medication storage and
preparation room where medication carts are stored for
use during drug rounds. These carts are equipped with
drawers and files containing computer-printed medica-
tion prescriptions for each patient. All oral medications
13. are distributed for 24 hr and are checked once by the
ward’s night shift. Fluids, intravenous medications, and
other medications for injection are prepared and double-
checked during each drug round directly before drug ad-
ministration.
Population
The participants were all registered nurses. Each had
an individual responsibility for distributing medications
to their assigned patients.
Study Design
We performed a mixed method study, using a before-
after design to collect the number of interruptions and
MAEs during drug rounds before the implementation of
the tabard in April 2012 (period 1), as well as 2 weeks
and 4 months after tabard implementation (i.e., in May
and September 2012, respectively periods 2 and 3). An
interruption or a distraction was defined as an event ini-
tiated by another professional(s) or something else, and
when a nurse interrupted him- or herself. In this study,
the term interruption was used for distractions as well as
for interruptions. MAEs are defined as a breach of one of
the seven rights of medication administration: correct pa-
tient, drug, dose, time, route, reason, and documentation
(Pape, 2003).
During period 2, nurses’ perspectives regarding the
tabard were collected by documenting spontaneous re-
marks and asking a single question at the end of the ob-
servation: “What is your experience with the drug round
tabard?” In period 3, in-depth information on nurses’
perspectives, experiences, and views was collected in a
focus group setting to gain insight in barriers and facilita-
15. All observers (n = 6) were final phase baccalaure-
ate nursing students who have followed approximately
2 years of apprenticeship. The observers got instruction
on how to score and interpret the items on the obser-
vation checklist and also to interfere if they observed
MAEs that might be harmful to the patient. Although
the students had not graduated yet at the time of the
study, we were convinced that they had sufficient knowl-
edge and awareness to assess the severity of clinical
situations.
Data Collection
Quantitative data were collected on eight different
categories of interruptions that are grouped into either
verbal or nonverbal interruptions, based on a previ-
ously published observation form (Table 1; Smeulers,
Hoekstra, van Dijk, Overkamp, & Vermeulen, 2013). To
observe the frequency and type of MAEs, we merged it
with the “seven right” items of Pape et al. (2003) that
we converted into “seven wrongs”: wrong patient, dose,
medication, timing, route, indication, and reporting. In a
pilot phase, the observers performed eight observations in
pairs to validate the checklist. To determine observation
agreement on the counting of interruptions and MAEs,
the interobserver agreement was calculated using the in-
terclass correlation coefficient (ICC). Of the 14 items, 12
items scored an ICC > .80 (almost perfect agreement)
and 2 items (i.e., verbal interruptions caused by patients
and nonverbal interruptions caused by the surrounding)
scored an ICC between .55 and .60 (moderate agreement;
Table 1. Definition of Interruptions During Medication
Preparation and
Administration
16. Category Description
Verbal colleague Colleague initiates a dialog with nurse
Verbal person Nurse initiates a dialog
Verbal patient Patient initiates a dialog with nurse
Nonverbal colleague Colleagues initiates an interruption,
e.g., getting supplies in the vicinity
Nonverbal person Nurse initiates interruption, e.g.,
helping a colleague, pager response
Nonverbal patient Patient initiates interruption, e.g.,
being in the vicinity of the nurse
Nonverbal surrounding Surrounding environment, e.g.,
cleaning or stock working staff
Nonverbal logistics Missing supplies for preparing the
medications
Table 2. Focus Group Topics
Topics Subheadings
Drug round tabards and safe
medication administration
17. Experience positive/negative and
why?
Do you wear the tabard and why?
What additional interventions will
contribute to medication safety?
What do you think of checklists,
visual reminders, and a do not
disturb zone?
Colleagues who do not wear
the tabard
Do you or don’t you confront your
colleagues when they do not
cooperate and why?
Pros and cons regarding
implementation
What factors contribute to your
choice whether to wear or not
to wear the tabard?
19. Table 3. Demographics
Period 1 Period 2 Period 3 Total
n (%) n (%) n (%) n (%)
Observations 105 104 104 313
Gender Male 16 (15) 27 (26) 14 (13) 57 (18)
Female 89 (85) 77 (74) 90 (87) 256 (82)
Age (year) Median (range) 40 (22–64) 42.5 (22–63) 45 (22–62)
42 (22–64)
Education Bachelor’s 41 (39) 46 (45) 53 (51) 140 (45)
Community
college
17 (16) 15 (14) 5 (5) 37 (12)
Inservice 45 (42) 43 (41) 46 (44) 134 (42)
Other 2 (2) 0 0 2 (1)
Observations/ward Neurology 39 (37) 36 (35) 37 (35) 112 (36)
Neurosurgery 35 (33) 40 (38) 33 (32) 108 (34)
Dermatology-
Ophthalmology-
20. ENT
31 (30) 28 (27) 34 (33) 93 (30)
Medication rounds 8.00 20 (20) 19 (18) 19 (18) 58 (19)
12.00 20 (19) 20 (20) 19 (18) 59 (19)
16.00 22 (21) 20 (20) 26 (25) 68 (21)
18.00 14 (13) 15 (14) 16 (15) 45 (14)
20.00 14 (13) 15 (14) 11 (11) 40 (13)
22.00 15 (14) 15 (14) 13 (13) 43 (14)
The focus group was led by a moderator and an observer.
The moderator facilitated an open discussion, which was
structured around the derived topics. Special attention
was paid to all participants contributing their opinions.
The focus group session was taped and transcribed.
Data Entry and Crosscheck
The six observers entered their own data, and they
cross-checked each other. One researcher compared all
entered data with the original observation.
Sample Size and Data Analysis
Because the effect of tabards on MAEs is unknown, we
were unable to calculate the sample size based on this
end point; therefore, we used the effects on interruptions.
Based on previously published interruption rates of 15%
to 50%, we hypothesized an average reduction of 30%
for the power calculation (Scott et al., 2010; Smeulers
21. et al., 2013; Trbovich et al., 2010). A sample size of 100
observations before and 100 observations after the inter-
vention would have 90% power to detect the effect of the
tabards with a .05 significance level.
Descriptive statistics were used to summarize the de-
mographics and frequencies of different types of inter-
ruptions and MAEs. A Kruskal-Wallis test was performed
to compare the interruptions and MAEs due to a skewed
distribution of the data. After a natural logarithmic trans-
formation, we performed a univariable linear regression
analysis of MAEs (dependent) on interruptions (indepen-
dent). All statistical analyses were performed using IBM
SPSS statistics version 18.0 (SPSS Inc., Chicago, IL, USA).
Data collected during the observations and the focus
group session were analyzed iteratively by four of the six
observers. By discussing the interview and focus group
items, they coded topics and built a coding tree. Next
they grouped the topics and identified the most rele-
vant themes related to nurses’ experiences with the drug
round tabards regarding barriers and facilitators for im-
plementation (Boeije, 2008; Lucassen & Hartman olde,
2007).
Results
A total of 313 medication administrations were ob-
served. Distribution of data collection and observations
on each ward was distributed evenly on all rounds and
for each period, with 40% of the observations occurring
during the evening rounds (6 p.m., 8 p.m., and 10 p.m.)
and 20% during the weekend rounds. The characteristics
of the observed nurses were equally distributed during
each period as well (Table 3).
23. Nonverbal surrounding 94 0 (1) 112 1 (2) 14 0 (0) <.05
Total 517 4 (5) 448 4 (4) 112 1 (2) <.05
Note. IQR interquartile range; NA not applicable.
Figure 1. Mean interruptions per medication administration
round.
observed during period 1 were of verbal origin, and most
were caused and initiated by colleagues and persons other
than patients. The most common nonverbal interruptions
were caused by the surroundings (e.g., the telephone, ra-
dio, or conversations of others nearby). In period 2, there
were fewer interruptions than in period 1. The median
total verbal interruptions were reduced over the peri-
ods. The median nonverbal interruptions were only re-
duced in period 3. A significant effect of the tabards was
found for both the verbal and nonverbal interruption
rates. The individual interruptions showed a significant
decrease, with the exception of verbal and nonverbal in-
terruptions initiated by patients. Most decreases in inter-
ruptions were seen at the drug rounds occurring at 8 a.m.,
12 p.m., and 6 p.m. For the drug rounds at 8 p.m. and
10 p.m., we observed a slight increase in interruptions in
period 2, although in period 3 a further decrease occurred
(see Figure 1).
Medication Administration Errors
A 66%, and significant, reduction in MAEs was found
after implementing the tabards (Table 5, Figure 2).
The most frequent procedural MAEs are the absence of
patient identification, incorrect administration time (ei-
ther too early or too late), and not reporting in accor-
25. Wrong route 4 0 (0) 4 0 (0) 0 NA .13
Wrong indication 0 NA 1 0 (0) 0 NA .37
Wrong reporting 126 1 (2) 82 0 (1) 0 NA <.05
Total 432 3 (3) 349 2.5 (3) 120 1 (1) <.05
Note. IQR interquartile range; NA not applicable.
Figure 2. Mean MAEs per medication administration round.
Table 6. Parameter Estimate for Intercept Medication
Administration
Errors and Variable Interruptions
Parameter Standard Test
Variable estimate (B) error statistic p
Intercept .800 .065 12.361 <.05
Interruptions .271 .045 6.005 <.05
Table 6). The R2 of the model is 10.4%, which indicates
that approximately one tenth of the MAEs can be ex-
plained by interruptions.
Nurses’ Experiences With Wearing the Tabard
By documenting remarks during the drug rounds and
asking a single interview question at the end of drug
rounds, we collected nurses’ experiences with and opin-
ions about wearing the tabards. The reactions ranged
from positive and enthusiastic to negative and even re-
fusal to wear the tabard. Experiences with wearing the
27. and because of this, it attracts patients’ and visitors’
attention, and this results in questions about the reason
for wearing the tabard, which distracts eventually from
your medication task. But overall, they are an excellent
idea.
Effectiveness considerations. Perspectives on the
effectiveness of the tabard varied. Some felt that it did
not work at all: “I think it is nonsense and don’t think it
is effective.” Other nurses mentioned that the tabard was
only useful at certain times:
It is a very good idea, especially during daytime. It will
make people think about “do not disturb,” but I think
that during evening shifts it is more efficacious, that is
the time when there are many visitors. I really think it
is a good idea!
The intervention works as a signal for colleagues, they
realise that you are doing medication. However, I do
not think the tabard is effective in an evening shift
when there are many visitors, no secretary to answer
telephone calls etc.
Six of the nine invited nurses were able to attend and
participate in the focus group discussion. They discussed
the prominent color of the tabard as a barrier for use
as some patients complained about the fluorescent yel-
low color. The participants suggested another color might
solve this. Hygiene issues were not considered a problem
for exchanging the tabard among nurses; nevertheless,
the participants found it important to establish a cleaning
protocol for the tabards with the hospital laundry service.
All participants frequently were asked questions about
the purpose of the tabards from visitors and patients.
These questions distracted them from their tasks. There-
28. fore, they suggested informing patients and visitors about
the tabard upon admission or entry to the hospital. In ad-
dition to the drug round tabards, they expressed thoughts
about the importance of focusing on team culture, where
it is considered normal to not disturb each other during
tasks and where it is acceptable to address disturbances
when they do occur. The group also discussed the impor-
tance of leadership and team member role models as they
considered this to be an important stimulus and good mo-
tivation for nurses to wear the tabard.
Discussion
This study shows a significant effect of drug round
tabards on interruptions and MAE rate and a significant
linearity between interruptions and MAEs (R2 of 10.4%).
Therefore, we can conclude that the tabards were effec-
tive in improving medication administration safety. How-
ever, from the nurses’ experiences it became clear that
they have mixed emotions about wearing the tabard.
Nurses feel awkward and uncomfortable in the tabard,
but they are prepared to wear the tabard if its effective-
ness can be demonstrated, as also found by Scott et al.
(2010). In the focus group, suggestions were made to
change the color and appearance of the tabard. When
asked about the effectiveness of the tabard, some nurses
had positive experiences, but others expressed doubts
about its effectiveness. Patients are not always aware of
the tabard’s purpose, and wearing a tabard did not change
the patients’ attempts to attract the nurses’ attention.
This was confirmed by the quantitative outcomes that
showed a nonsignificant effect of the tabard on interrup-
tions caused by patients. The nurses also expressed their
opinion that patients should always feel free to ask the
nurses questions. Additionally, the nurses reported that
the main sources of interruptions during drug rounds
30. during drug rounds. They were eager to reduce MAEs
and wanted to contribute to the study. These factors
may have caused nurses to realize the importance of
their task. Because previously published studies have sug-
gested that nurses should change their behavior to reduce
interruptions and MAEs, the drug round tabard can be
considered a tool for changing nurses’ behavior (Biron
et al., 2009; Relihan, O’Brien, O’Hara, & Silke, 2010).
In conclusion, the drug round tabards created an ob-
served effect on MAEs that was most likely not only the
result of the tabards. This explains the significant results
on both MAEs and interruptions and the low regression
model R2.
To obtain representative results, we observed all drug
rounds, with the exception of night shifts, on both surgi-
cal and internal medicine wards. The mixed method ap-
proach with a combination of quantitative data collection
on the effect of the tabards with experiences and per-
spectives of the participants in a mixed methods design
proved a valuable research design because it uncovered
all incentives (Glasziou et al., 2011; Seidl & Newhouse,
2012). The combined checklist was validated during this
study using a nested interobserver agreement test (ICC)
where 2 of the 14 observation items scored moderate
agreement among observers, which could be considered a
weakness for the observation process. However, 12 items
scored almost perfect agreement, and after discussing the
interpretation of the two moderate scored items, we con-
sidered the checklist reliable. Furthermore, this study has
some limitations. Although some form of observer effect
could not be eliminated in our study, we assume that
this hardly influenced the effects since Barker, Flynn, and
Pepper (2002) stated that observations are a valid, effi-
cient, and accurate method of detecting MAEs and that
31. there is no significant effect of observers on the observed
personnel. Secondly, all observers were final phase nurs-
ing students, and one can argue their ability to observe
the complex task of medication preparation and admin-
istration. However, they are trained and experienced in
medication management, and since they have no rela-
tionship with the team under observation, they are able
to get unbiased information and observations. Lastly, in
a before-after design, one cannot correct for changes
over time. Although we carefully selected the observa-
tion periods, we could not prevent the influence of low
bed occupancy on all three observed wards during the
different observation periods. In future research, one
could consider more robust study designs to address this
issue (e.g., a cluster randomized controlled trial or a con-
trolled before-after study; Raban & Westbrook, 2013). In
contrast to previous studies on multifaceted strategies, we
would recommend analyzing the single contribution of
each intervention to avoid the implementation of unnec-
essary and non-evidence-based interventions (Freeman
et al., 2012; Relihan et al., 2010; Tomietto et al., 2012).
Conclusions and Implications for Further
Research
Acknowledgments
We would like to thank Mirthe van Loon, Manon
Boers, Nousjka Westerlaken, Heleen van Essen, Milou
Bakker, Lisa Appelman, Andrea Kuckert, and Marjoke
Hoekstra for their contributions to our study.
Clinical Resources
Medication safety:
32. � World Health Organization, Action on Pa-
tient Safety - High 5s: http://www.who.int/
patientsafety/implementation/solutions/high5s/en/
� Institute for Safe Medication Practices, Medications
Safety Tools & Resources: http://www.ismp.org/
� ECRI Institute, Patient Safety, Risk, and Qual-
ity Assessment Services: https://www.ecri.org/
Products/PatientSafetyQualityRiskManagement/
Pages/Assessment-Services.aspx
� The National Coordinating Council for Med-
ication Error Reporting and …
Writing Conclusions to Nursing Studies
Definition: The conclusions are the statements that synthesize
the findings from the
study. They are used to tell the reader how the purpose of the
study has been met.
33. Characteristics of Conclusions: When the conclusions are
developed, consider the
following:
was completed.
might help staff
nurses provide a better quality of care
to groups that are
very similar to the sample in the study
from here?
Avoid cause and effect statements: Even in tightly
controlled clinical trials it is
very difficult to conclude there was a 1:1 cause and effect
result. Studies rarely
prove anything, but the findings do add to what is known about
a topic.
Examples of Conclusions
Research Question Conclusions
Does drinking diet soda contribute to
obesity in adolescents?
The results of the study found adolescents who drink
diet soda weigh on average 5.4 lbs. more than the
adolescents who do not drink diet soda in this sample
of 100 junior high students in a Midwestern U.S. city.
The study did not measure dietary patterns or activity
levels, and these variables would need to be included
35. this content and start your first paragraph here.
Conclusions
Propose three conclusions drawn from the findings in the
study considering limitations of the study. It would be best for
each conclusion to have its own paragraph so that it is clearly
delineated. (three short paragraphs)
Implications for Practice
This section should include three implications for clinical
practice. This section should also be three short paragraphs that
delineate each implication. Support from the literature is
recommended.
Conclusion
A short paragraph concluding the paper.
References
(Please note that the following references are intended as
examples only.) Remove instructions prior to submission
Gray, J. R., Grove, S.K., & Sutherland, S. (2017). The Practice
of Nursing Research, (8th
ed.). St. Louis, MO: Elsevier
Verweij, L., Smeulers, M., Maaskant, J. M., & Vermeulen, H.
(2014). Quiet please! Drug round
tabards: Are they effective and accepted? A mixed method
study. Journal of Nursing
36. Scolarship, 46(5), 340. Doi: 10.1111/jnu.12092
Instructions for Assignment
For this Assignment, review the Research Methods and Findings
of the Verweij study conducted in 2014 in this week’s
resources. The primary purpose of this quantitative research
study was to investigate the effectiveness of an intervention to
decrease medication errors in a hospital. The citation and
discussion/conclusion information is intentionally deleted so
you can draw your own conclusions.
In a 3- to 4-page, double-spaced paper, describe three
conclusions you have drawn from the findings in this study,
taking into consideration the limitations of the study. Next
describe three implications for clinical practice
Level I Heading for your paper (see template): Follow the
grading rubric requirement for each section of the paper.
· Title of the paper
(Under this heading include the following: Introduces
information on the study: includes purpose of the study,
methods and findings, which is typically one to two brief
paragraphs.
· Conclusions form the Study
(3 conclusions) (It is best to write a separate paragraph for
each conclusion. Make sure to write a topical sentence that
clearly identifies the conclusions. This will help identify your
three required conclusions.
· Implications for Clinical Practice
This section should also be three short paragraphs that delineate
each implication. Support from the literature is
recommended. (Make sure that each three implications are
identified).
· Conclusion
37. (Summary of main points of the paper with a closing statement)
If you need clarification or assistance, post a question in the
Ask the Instructor or email private concerns. Good luck on the
week 6 assignment and much success moving forward through
the program.
Instructions for Assignment
For this Assignment, review the Research Methods and Findings
of th
e Verweij study conducted
in 2014 in this week’s resources. The primary purpose of this
quantitative research study was to
investigate the effectiveness of an intervention to decrease
medication errors in a hospital. The
citation and discussion/conclusion
information is intentionally deleted so you can draw your own
conclusions.
In a 3
-
to 4
-
page, double
-
spaced paper, describe three conclusions you have drawn from
the
findings in this study, taking into consideration the limitations
of the study. Next descr
ibe three
implications for clinical practice
47. and
much
success
moving
forward
through
the
progr
am.
Instructions for Assignment
For this Assignment, review the Research Methods and Findings
of the Verweij study conducted
in 2014 in this week’s resources. The primary purpose of this
quantitative research study was to
investigate the effectiveness of an intervention to decrease
medication errors in a hospital. The
citation and discussion/conclusion information is intentionally
deleted so you can draw your own
conclusions.
In a 3- to 4-page, double-spaced paper, describe three
conclusions you have drawn from the
findings in this study, taking into consideration the limitations
of the study. Next describe three
implications for clinical practice
48. Level I Heading for your paper (see template): Follow the
grading rubric
requirement for each section of the paper.
(Under this heading include the following: Introduces
information on the
study: includes purpose of the study, methods and findings,
which is
typically one to two brief paragraphs.
(3 conclusions) (It is best to write a separate paragraph for
each
conclusion. Make sure to write a topical sentence that clearly
identifies the
conclusions. This will help identify your three required
conclusions.
This section should also be three short paragraphs that delineate
each
implication. Support from the literature is recommended. (Make
sure that
each three implications are identified).
(Summary of main points of the paper with a closing statement)
If you need clarification or assistance, post a question in the
Ask the Instructor or email
private concerns. Good luck on the week 6 assignment and
much success moving forward
through the program.
Post a short paragraph (150 words) on issues in China's
economy answering at least one of the questions.
China’s economy Ch 5
1. What's the point of China becoming the world's second-
49. largest economy?
2. What is the impact of China's rapid economic development?
Or what are the advantages and disadvantages?
3. What is that mean about Mixed Economy?
4. Do you agree with the focus of China's economic
development from agriculture to manufacturing? Why?
1. How has China’s economy changed 1949-present?
2. What is the structure of PR China’s economy?
3. What are some major agricultural issues in China?
4. What are some industrial issues in China?
5. What is the Belt and Road Initiative?
6. What are the economic forces at work in China?
7. How has the economic reform policy progressed in China?
Post
a
short
paragraph
(1
5
0
words)
on
issues
in
China's
economy
answering
at
least
one
of
the
questions.
China