The document describes a study that analyzed video recordings of standard hospice interdisciplinary team meetings and meetings that included family caregiver participation via videoconferencing (ACTIVE meetings). Standard meetings were shorter and more task-focused, while ACTIVE meetings emphasized biomedical education, relationship-building, and increased socioemotional talk from social workers and chaplains. The inclusion of family caregivers in team meetings via videoconferencing led to longer, more collaborative meetings that addressed psychosocial needs in addition to medical issues.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t ...
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
Communication and Work in Nursing Essay Paper.docx4934bk
The document discusses effective communication and inter-professional collaboration in nursing. It states that as healthcare becomes more complex, professionals must work as an interdisciplinary team to meet patient needs. Effective communication is key to successful collaboration, requiring both verbal and non-verbal communication as well as active listening. When communication is lacking, it can compromise patient care and outcomes. Developing mutual trust and respect also facilitates collaboration between professionals from different backgrounds. Standardizing communication methods, like SBAR, has been shown to improve information sharing and reduce errors.
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
This document is a 12,610 word research dissertation that examines the welfare of adult caregivers in domiciliary (home care) and residential services. It explores how caregiver susceptibility to anxiety and depressive symptomology compares between these populations and a non-caregiver control group. Additionally, it examines the extent to which psychological factors like locus of control, empathy, perceived organizational support, and self-esteem can predict anxiety and depression levels in caregivers. Through a cross-sectional questionnaire study comparing 51 domiciliary, 85 residential caregivers, and 67 non-caregivers, the dissertation aims to better understand the impact of poor organizational support practices on caregiver well-being.
JOB SATISFATION AND NURSE PATIENT RATIO24Table of Contents.docxchristiandean12115
This document provides an overview of a research study that examines the relationship between nurse job satisfaction, nurse-patient ratios, and nurse fatigue. It includes an introduction that outlines the background, problem statement, purpose, significance and research questions. It also presents hypotheses and a brief literature review. The methodology chapter describes the research design, sample, instruments and data analysis plan. Results, discussion and conclusions chapters are also outlined. The document provides a framework to guide the proposed empirical study on the key factors relating to nurse fatigue.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t ...
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
Communication and Work in Nursing Essay Paper.docx4934bk
The document discusses effective communication and inter-professional collaboration in nursing. It states that as healthcare becomes more complex, professionals must work as an interdisciplinary team to meet patient needs. Effective communication is key to successful collaboration, requiring both verbal and non-verbal communication as well as active listening. When communication is lacking, it can compromise patient care and outcomes. Developing mutual trust and respect also facilitates collaboration between professionals from different backgrounds. Standardizing communication methods, like SBAR, has been shown to improve information sharing and reduce errors.
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
This document is a 12,610 word research dissertation that examines the welfare of adult caregivers in domiciliary (home care) and residential services. It explores how caregiver susceptibility to anxiety and depressive symptomology compares between these populations and a non-caregiver control group. Additionally, it examines the extent to which psychological factors like locus of control, empathy, perceived organizational support, and self-esteem can predict anxiety and depression levels in caregivers. Through a cross-sectional questionnaire study comparing 51 domiciliary, 85 residential caregivers, and 67 non-caregivers, the dissertation aims to better understand the impact of poor organizational support practices on caregiver well-being.
JOB SATISFATION AND NURSE PATIENT RATIO24Table of Contents.docxchristiandean12115
This document provides an overview of a research study that examines the relationship between nurse job satisfaction, nurse-patient ratios, and nurse fatigue. It includes an introduction that outlines the background, problem statement, purpose, significance and research questions. It also presents hypotheses and a brief literature review. The methodology chapter describes the research design, sample, instruments and data analysis plan. Results, discussion and conclusions chapters are also outlined. The document provides a framework to guide the proposed empirical study on the key factors relating to nurse fatigue.
SeptemberOctober 2020 Volume 38 Number 5 267Nursing Eco.docxbagotjesusa
September/October 2020 | Volume 38 Number 5 267
Nursing Economic$
Patients spend more time with nurses than any other healthcare
professional. The primary
conduit of information between
the patient and healthcare team
are nurses; therefore, nurses
need to be good
communicators. Careful listening
is at the core of good
communication and is a key
element of patient safety and
experience (Balik & Dopkiss,
2010). A key component of
nurse-patient communication is
the patient’s perception of their
experience with the nurse
listening. Despite the known
importance and impact on
patient experience, quality
outcomes, and reimbursement,
there is a gap in research on
effective nurse communication
from the patient’s perspective.
Healthcare’s shift from
volume to value requires
hospitals to focus on
performance and quality
outcomes, such as patient
experience, as measured by the
Hospital Consumer Assessment
of Healthcare Providers and
Systems (HCAHPS) survey. The
nursing communication domain
within the survey has the
greatest impact on the patient’s
overall experience score (Studer
Group, 2012). The first series of
HCAHPS survey questions focus
on patient care received from
nurses (Centers Medicare &
Medicaid Services [CMS], 2020).
It asks about being treated with
courtesy and respect, nurse
listening, and the nurse’s ability
to explain things in a way the
patient can understand.
Patient experience, a key
hospital performance metric, is a
component of value-based
purchasing (VBP), which holds
providers accountable by linking
Medicare reimbursement to
outcomes. For FY17, the VBP
program affected 2% of the base
operating payments to hospitals.
This resulted in $1.7 billion in
Medicare payments being
withheld from hospitals because
of poor performance on the
HCAHPS survey measuring
patient experience (Becker’s
Hospital Review, 2017).
Research by Press Ganey®
revealed hospitals focusing on
improving the nurse
communication metric could
potentially influence 15% of
Nurses’ Active Empathetic Listening
Behaviors from the Voice of the
Patient
Karen K. Myers
Rebecca Krepper
Ainslie Nibert
Robin Toms
Effective nurse communication,
including listening skills, is
essential to a positive nurse-
patient relationship. This two-
group comparative study
identified how adult hospitalized
patients perceived effective and
ineffective nurse active
empathetic listening (AEL)
behaviors. Participants identified
the AEL behavior most important
to them, providing guidance to
prioritize interventions to
enhance the perception of being
listened to.
September/October 2020 | Volume 38 Number 5268
their VBP incentive payment
(Rodak, 2013). The financial
consequences of poor patient
experience influenced by nurse
communication further support
the need to address the gap in
nursing science.
Press Ganey (2013)
conducted a hierarchical variable
clustering analysis on all eight
HCAHPS .
This document provides a framework for improving collaboration between primary care and mental health services globally. It takes a three-step approach:
1. Identifying mental health services that can be delivered in primary care settings by primary care providers, with or without support from mental health professionals.
2. Outlining ways that effective collaboration can enhance primary mental health care, such as integrating mental health services within primary care settings or coordinating care when services are separate.
3. Examining system changes needed to support new roles and activities, and how collaboration can help address challenges facing all mental health systems.
Reply to the following two posts. In your replies, discuss what su.docxaudeleypearl
Reply to the following two posts. In your replies, discuss what surprised you about the theory your peers wrote about, and how it’s integrated into the study? What other type of research might this theory be useful in?
There is not an amount of words required. Just reply to post 1, and post 2.
FREE OF PLAGIARISM.
Post # 1: Michelle
The article I chose to analyze was “Making a connection: Family experiences with bedside rounds in the intensive care unit. The article examined the experience of families with a loved one in the intensive care unit and whether or not the families' participation in daily rounds decreased their anxiety and increased their overall positive perspective. The theoretical framework utilized by the authors Cody, Sullivan-Bolyai, and Reid-Ponte was the Family Management Style Framework.
The Family Management Style Framework was developed by Knafl and Deatrick in 1990 in order to better understand the coping style of families with children who had chronic health conditions (Knafl & Deatrick, 2003). The FMSF looked at the management behaviors and patterns of response to childhood chronic illness (Knafl & Deatrick, 2003). There are three major components in the FMSF, Definition of the situation, Management behaviors, and Sociocultural context (Knafl & Deatrick, 2003). The framework also describes five family management styles, thriving, accommodating, enduring, struggling and floundering (Knafl & Deatrick, 2003). The relationship between the family members, healthcare professionals, and their coping strategies is the basis for the framework.
The research study used the FMSF to look at which families participated in bedside rounds and which opted not to and the overall result. The framework looks specifically at the intersection of the management of chronic illness and the impact on family life (Knafl, et al., 2012). The finding was that the inclusion and willingness of families to participate in bedside rounds ultimately reduced their fear of the unknown and distrust in the healthcare providers. In the end, the families that attended the bedside rounds were better prepared for their loved one's discharge. The concept of the FMSF was woven throughout the study. The targeted areas of familial response to chronic illness were based on the three identified components of the definition of the situation or illness, management and coping behaviors of the individuals, and the perceived outcomes. The overarching finding of the study was that clear, consistent communication by the healthcare team to the families significantly decreased anxiety, and fear and increased trust in the healthcare professionals. The end result was an improved experience for the family.
King’s theory of Goal Attainment cis another framework that would be effective in this study. King’s theory examines individuals as they relate to personal, interpersonal and social systems (Petiprin, 2016). King noted that human beings function as dy ...
This document summarizes and analyzes research on family presence during CPR and invasive medical procedures. It discusses a study by Jensen and Kosowan that surveyed 169 medical professionals on their attitudes towards family presence. The study found that while acceptance of family presence was under 50%, most supported developing policies around it. Other research presented had mixed findings. The document concludes by discussing how nurses can advocate for developing family presence policies based on the evolving research.
Patient and family centered care is a model that places the patient and family at the center of the healthcare team. It aims to include patients and families in decision making by providing education so they are well informed. This model focuses on individualizing care according to a patient's needs, values and preferences. Several healthcare disciplines are involved in ensuring patient and family centered care is provided. Key aspects include collaboration, leadership, and cultural competency among the healthcare team.
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxransayo
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated that more than 60% of patient
visits to primary care physicians (PCPs) include mental health concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint (Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986; Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other researchers and practitioners have
written books that serve as a guide to other mental health practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn et al., 1996).
The specialty of family medicine, which arose in the 1960s, embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of caring for the whole person
within his or her family, social context, and life cycle stage (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat their patients’ mental health
problems. By definition of their specialty, FPs are trained to integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle, Maine; Deanna Linville, PhD, Couples and
Family Therapy .
Discussion 1 GeorgeIntroduction Teamwork is a significant aVinaOconner450
Discussion 1 George
Introduction
Teamwork is a significant aspect of health care delivery. With the increasing complexity and specialization of clinical care, healthcare workers have
to learn more complicated methods and procedures to achieve the desired patient outcomes. Teamwork is associated with reduced medical errors and
improve patient safety. Additionally, teamwork reduces staff burnout since a healthcare professional team is responsible for patient welfare (Zajac et al.,
2021). Various strategies are key to ensuring effective teamwork for better patient outcomes.
Strategies for effective teamwork during patient care
Effective communication across staff members of a clinical team increases teamwork efficacy, leading to improved patient outcomes. Working
towards a common goal, effective communication expands the traditional roles of each member to make decisions as a team (Zajac et al., 2021). One
particular strategy that worked for my clinical team is goal setting at the beginning of the scheduled activities so that each member has a clear purpose
for their roles for the day. Several studies also agree that goal setting provides the direction for implementing procedures and coordinated care.
Organizing regular meetings and using digital communication platforms such as emails and WhatsApp groups to convey information relating to patient
care to team members and debate suggestion is key to improving performance and, ultimately, patient outcomes.
Another effective team strategy is collaboration. By definition, health care involves multiple disciplines- nurses, doctors, and health care specialists
in different fields, working together, communicating often, and sharing resources (Zajac et al., 2021). A clinical team is made up of professionals of
different health specialities and responsibilities. Cumulatively, these differences contribute to the overall patient well-being and safety. The different
teams contribute to patient outcomes by understanding the patient presenting illness, asking them probing questions regarding their situation, making
an initial evaluation, discussing, and providing a recommendation based on their findings.
Strategies for ineffective teamwork during patient care
It is common for challenges to arise during teamwork. According to Hendrick et al. (2017), some of the most common challenges that impede a
team’s efforts to improve patient care include a lack of commitment of team members, different individual team members’ goals, and conflict
about how the team members individually relate to the patient. The input of individual members is vital to realizing the overall team’s goal. Therefore,
each member must demonstrate full commitment to the course of the team. Also, if the goals of the individual members do not align with the team’s
goal, then they might be less committed to achieving the team’s goal (Rawlinson et al., 2021). The healthcare team should help the patient understand
that their care is multidisci ...
RUNNING HEAD THE ART OF LISTENING as a THERAPUTIC TECHNIQUE .docxagnesdcarey33086
RUNNING HEAD: THE ART OF LISTENING as a THERAPUTIC TECHNIQUE 1
The Art of Listening as a Therapeutic Technique. 5
The Art of Listening as a Therapeutic Technique
Cheri Cable
HHS307: Comm Skills for Health & Human Service Personnel
Instructor: Beth Delaney
August 24, 2015
In the very beginning of everyone’s lives we are taught to speak but not necessarily to listen. Throughout history listening has been studied and a conclusion has been made that in fact being a good listener can allow one to challenge the information that is heard. Studies have shown that effective listening is a critical tool that is so often not used. “In the health care setting the communication technique such as the quality of listening provides both therapeutic value in the patient and the provider,” Banar, M. (2011). There are many different ways to be an active and effective listener, one of which is the therapeutic technique. “Therapeutic listening is an interpersonal confirmation process, involving all the senses, in which the therapist attends with empathy to the client's verbal and nonverbal messages to facilitate the understanding, synthesis, and interpretation of the client's situation,” according to the NCBI website. This paper will be taking an exploratory view of communication as a whole, effective health communication and focusing on the therapeutic technique of listening.
Let’s begin by examining what interpersonal communication can bring to the health care setting. Interpersonal communication consists of four principles which describes that interpersonal communication is irreversible, contextual, inescapable and complicated, thus meaning that communication cannot be avoided nor taken back once begun. Interpersonal communication is up close and personal and consists of verbal and nonverbal communication as well as listening. In order to have effective interpersonal communication one needs to consider these key areas, emotions, habits, needs, personalities and values of others. “Effective interpersonal communication skills are said to be the gateway to the development of other important life skills,” (Servellen 1).
Clear and effective communication is of great importance in order for patients to be enabled to properly and completely understand health information, without this ability adequate healthcare cannot be achieved. “Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors” according to the Institute for Healthcare Communication web site. A client that feels as though the provider is truly interested in their total care and well-being is more likely to follow the treatment .
1. Open communication and information sharing between healthcare providers, patients, and families. This includes involving families in rounds and decision-making.
2. Collaboration where patients and families are viewed as integral parts of the care team and participate in care activities and decisions.
3. Recognition that patients exist within social networks of family and friends whose needs should also be addressed to provide holistic, supportive care.
Harvard style research paper nursing evidenced based practiceCustomEssayOrder
This document discusses evidence-based practice in health and social care. It defines evidence-based practice as using the best available research evidence to guide decisions about patient care and service delivery. The document outlines how evidence-based practice helps improve patient outcomes and keep practices current. It also examines how social care providers are expected to demonstrate the effectiveness and accountability of their services.
Development and evaluation of an intervention to support family caregivers of...beatriz9911
This study aimed to develop and evaluate an intervention to support family caregivers of cancer patients providing home-based end-of-life care. In Phase 1, interviews with 29 caregivers identified their needs for practical information and support skills. Based on these findings, the researchers created an informational booklet as the preferred format. In Phase 2, 31 caregivers and 14 nurses evaluated the booklet. Caregivers reported feeling more positive, reassured, and competent in their caregiving role after using the booklet. Nurses found the booklet useful and received fewer calls from caregivers who used it. However, caregivers indicated they would have benefited from receiving the booklet earlier in the care trajectory. The researchers concluded the
Mental Health Shared Care between private and public providers poses specific logistic and cultural issues. This powerpoint based on my Masters Thesis, examines the use of a culture carrier.
Chapter 33 professional communication and team collaborationMirza Baig
This document discusses the importance of communication and team collaboration in healthcare. It notes that poor communication can lead to medical errors and harm patients. Effective teams are characterized by trust, respect, and collaboration. While barriers like hierarchies and cultural differences can interfere with communication, tools from other high-risk fields like aviation crew resource management have shown that standardized communication techniques can improve outcomes by reducing errors.
Healthy thanks to communication . Belim & Vaz de AlmeidaISCSP
This document discusses a model of communication competencies that can optimize health literacy. The model focuses on assertiveness, clear language, and positivity used by healthcare professionals in interactions with patients. The research validating the model included a literature review and focus group with medical experts. The focus group validated the three key concepts of the model and emphasized assertiveness includes active listening, clear language uses simple words and verbs, and positivity involves a positive approach with patients. The results confirm investing in these communication competencies improves patient health literacy and clinical outcomes.
This document summarizes a proposed research study that aims to evaluate the in-home mediator model of autism intervention. Specifically, the study will conduct in-depth interviews with 10-15 parents who recently completed an autism intervention program to understand their experiences as mediators and identify any factors that influenced the effectiveness of the intervention. Insights from the interviews will be used to inform improvements to the services provided and guide future research comparing the mediator model to in-clinic treatment models. The interviews will be structured around five factors identified in previous research as influencing interventions: the home environment, training received, skills developed, perceptions/emotions, and areas for service improvement.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
This study examined aspects of sustainability among Swiss psychiatrists by assessing levels of cooperation, job satisfaction, and burnout. The researchers surveyed 352 psychiatrists. They found that cooperation was highest with general practitioners and lowest with community mental health providers. Overall job satisfaction was assessed as high, while burnout rates were below concerning thresholds. Both job satisfaction and burnout correlated inversely, with higher satisfaction associated with lower burnout. Cooperation was positively associated with job satisfaction and inversely with burnout. The study concludes that fostering sustainability in outpatient psychiatric care requires considering personal, organizational, and supportive factors that can influence cooperation, satisfaction, and burnout.
The Impact of Chronic Illness refers to the wide-ranging effects and consequences that chronic illnesses have on individuals, their families, and society as a whole. Chronic illnesses are long-term health conditions that often require ongoing medical care and management.
The impact of chronic illness can be multifaceted and encompass various aspects of a person's life. Physically, chronic illnesses can result in persistent symptoms, pain, fatigue, and limitations in daily activities. These health challenges may require individuals to make adjustments to their lifestyle, such as adopting medication regimens, dietary changes, or incorporating regular medical appointments and treatments.
Emotionally, chronic illnesses can lead to psychological distress, including feelings of sadness, anxiety, frustration, or even depression. Coping with the uncertainties and limitations imposed by the illness can significantly impact a person's mental well-being.
Socially, chronic illnesses can disrupt social relationships, as individuals may face difficulties participating in social activities, maintaining employment, or fulfilling family roles. The need for accommodations and support can create challenges in personal relationships and may require adjustments in work environments.
1) The study examined factors that influence oncology nurses' perceived quality of work life and risk of compassion fatigue. It explored the relationship between nurse characteristics and quality of work life, the impact of personal life stress on quality of work life, and nurses' beliefs about their risk of compassion fatigue.
2) Personal life stressors were found to impact 30% of nurses' well-being, theoretically placing them at risk for compassion fatigue. However, qualitative data did not support this and 55% of nurses described their work as life-affirming and rewarding.
3) Nurses reported multiple sources of work-related stress, including issues with communication, their work environment, and factors related to patient care. However,
httpswww.azed.govoelaselpsUse this to see the English Lang.docxpooleavelina
https://www.azed.gov/oelas/elps/
Use this to see the English Language Proficiency Standards of Arizona-Pick a grade level
https://cms.azed.gov/home/GetDocumentFile?id=54de1d88aadebe14a87070f0
http://www.corestandards.org/ELA-Literacy/introduction/how-to-read-the-standards/
how to read standards
Week 04
Acquisition and Customer Lifetime Value (CLV)
https://www.smh.com.au/politics/federal/nbn-customers-face-higher-prices-or-poorer-internet-connection-audit-warns-20190813-p52go7.html
Customer Relationship Management?
CRM is the process of carefully managing detailed information about individual
customers and all customer touch points to maximize customer loyalty.
Now closely associated with data warehousing and mining
Relationship
Relationship
Identifying good customers: RFM Model
Recency
Frequency
Monetary Value
Time/purchase occasions since the last purchase
Number of purchase occasions since first purchase
Amount spent since the first purchase
R
F
M
Total RFM Score: R Score + F score + M Score
CASE: Database for BookBinders Book Club
Predict response to a mailing for the book, Art History of Florence, based on the
following variables accumulated in the database and the responses to a test mailing:
Gender
Amount purchased
Months since first purchase
Months since last purchase
Frequency of purchase
Past purchases of art books
Past purchases of children’s books
Past purchases of cook books
Past purchases of DIY books
Past purchases of youth books
Recency
Frequency
Monetary
Example: RFM Model Scoring Criteria
R
Months from last
purchase
13-max 10-12 7-9 3-6 0-2
Score 5pts 10 15 20 25
F
Frequency > 30 21-30 16-20 11-15 0-10
Score 25pts 20 15 10 5
M
Amount
purchased
> 400 301-400 201-300 101- 200 100
Score 50 45 30 15 10
Implement using Nested If statements in Excel
Decile Classification
• Standard Assessment Method
• Apply the results of approach and
calculate the “score” of each individual
• Order the customers based on “score”
from the highest to the lowest
• Divide into deciles
• Calculate profits per deciles
Customer 1 Score 1.00
Customer 2 Score 0.99
….
Customer 230 Score 0.92
Customer 2300 Score 0.00
Decile1
Decile10
…
..
…
..
Output for Bookbinders club
Decile Score RFM No. of Mailings Cost of mailing RFM Units sold RFM Profit
10 17.6% 5000 $3,250 783 $4,733
20 34.8% 10000 $6,500 1,543 $9,243
30 46.1% 15000 $9,750 2,043 $11,093
40 53.4% 20000 $13,000 2,370 $11,170
50 65.2% 25000 $16,250 2,891 $13,241
60 77.9% 30000 $19,500 3,457 $15,757
70 83.3% 35000 $22,750 3,696 $14,946
80 91.7% 40000 $26,000 4,065 $15,465
90 97.5% 45000 $29,250 4,326 $14,876
100 100.0% 50000 $32,500 4,435 $12,735
Note: Market Potential = 4435 units and margin = $10.20
Leaky bucket
New customer
acquisition
Purchase increase by
current customers
Purchase decrease by
current customers
Lost customers
Lost customers
Credit Card Rewards Program ...
SeptemberOctober 2020 Volume 38 Number 5 267Nursing Eco.docxbagotjesusa
September/October 2020 | Volume 38 Number 5 267
Nursing Economic$
Patients spend more time with nurses than any other healthcare
professional. The primary
conduit of information between
the patient and healthcare team
are nurses; therefore, nurses
need to be good
communicators. Careful listening
is at the core of good
communication and is a key
element of patient safety and
experience (Balik & Dopkiss,
2010). A key component of
nurse-patient communication is
the patient’s perception of their
experience with the nurse
listening. Despite the known
importance and impact on
patient experience, quality
outcomes, and reimbursement,
there is a gap in research on
effective nurse communication
from the patient’s perspective.
Healthcare’s shift from
volume to value requires
hospitals to focus on
performance and quality
outcomes, such as patient
experience, as measured by the
Hospital Consumer Assessment
of Healthcare Providers and
Systems (HCAHPS) survey. The
nursing communication domain
within the survey has the
greatest impact on the patient’s
overall experience score (Studer
Group, 2012). The first series of
HCAHPS survey questions focus
on patient care received from
nurses (Centers Medicare &
Medicaid Services [CMS], 2020).
It asks about being treated with
courtesy and respect, nurse
listening, and the nurse’s ability
to explain things in a way the
patient can understand.
Patient experience, a key
hospital performance metric, is a
component of value-based
purchasing (VBP), which holds
providers accountable by linking
Medicare reimbursement to
outcomes. For FY17, the VBP
program affected 2% of the base
operating payments to hospitals.
This resulted in $1.7 billion in
Medicare payments being
withheld from hospitals because
of poor performance on the
HCAHPS survey measuring
patient experience (Becker’s
Hospital Review, 2017).
Research by Press Ganey®
revealed hospitals focusing on
improving the nurse
communication metric could
potentially influence 15% of
Nurses’ Active Empathetic Listening
Behaviors from the Voice of the
Patient
Karen K. Myers
Rebecca Krepper
Ainslie Nibert
Robin Toms
Effective nurse communication,
including listening skills, is
essential to a positive nurse-
patient relationship. This two-
group comparative study
identified how adult hospitalized
patients perceived effective and
ineffective nurse active
empathetic listening (AEL)
behaviors. Participants identified
the AEL behavior most important
to them, providing guidance to
prioritize interventions to
enhance the perception of being
listened to.
September/October 2020 | Volume 38 Number 5268
their VBP incentive payment
(Rodak, 2013). The financial
consequences of poor patient
experience influenced by nurse
communication further support
the need to address the gap in
nursing science.
Press Ganey (2013)
conducted a hierarchical variable
clustering analysis on all eight
HCAHPS .
This document provides a framework for improving collaboration between primary care and mental health services globally. It takes a three-step approach:
1. Identifying mental health services that can be delivered in primary care settings by primary care providers, with or without support from mental health professionals.
2. Outlining ways that effective collaboration can enhance primary mental health care, such as integrating mental health services within primary care settings or coordinating care when services are separate.
3. Examining system changes needed to support new roles and activities, and how collaboration can help address challenges facing all mental health systems.
Reply to the following two posts. In your replies, discuss what su.docxaudeleypearl
Reply to the following two posts. In your replies, discuss what surprised you about the theory your peers wrote about, and how it’s integrated into the study? What other type of research might this theory be useful in?
There is not an amount of words required. Just reply to post 1, and post 2.
FREE OF PLAGIARISM.
Post # 1: Michelle
The article I chose to analyze was “Making a connection: Family experiences with bedside rounds in the intensive care unit. The article examined the experience of families with a loved one in the intensive care unit and whether or not the families' participation in daily rounds decreased their anxiety and increased their overall positive perspective. The theoretical framework utilized by the authors Cody, Sullivan-Bolyai, and Reid-Ponte was the Family Management Style Framework.
The Family Management Style Framework was developed by Knafl and Deatrick in 1990 in order to better understand the coping style of families with children who had chronic health conditions (Knafl & Deatrick, 2003). The FMSF looked at the management behaviors and patterns of response to childhood chronic illness (Knafl & Deatrick, 2003). There are three major components in the FMSF, Definition of the situation, Management behaviors, and Sociocultural context (Knafl & Deatrick, 2003). The framework also describes five family management styles, thriving, accommodating, enduring, struggling and floundering (Knafl & Deatrick, 2003). The relationship between the family members, healthcare professionals, and their coping strategies is the basis for the framework.
The research study used the FMSF to look at which families participated in bedside rounds and which opted not to and the overall result. The framework looks specifically at the intersection of the management of chronic illness and the impact on family life (Knafl, et al., 2012). The finding was that the inclusion and willingness of families to participate in bedside rounds ultimately reduced their fear of the unknown and distrust in the healthcare providers. In the end, the families that attended the bedside rounds were better prepared for their loved one's discharge. The concept of the FMSF was woven throughout the study. The targeted areas of familial response to chronic illness were based on the three identified components of the definition of the situation or illness, management and coping behaviors of the individuals, and the perceived outcomes. The overarching finding of the study was that clear, consistent communication by the healthcare team to the families significantly decreased anxiety, and fear and increased trust in the healthcare professionals. The end result was an improved experience for the family.
King’s theory of Goal Attainment cis another framework that would be effective in this study. King’s theory examines individuals as they relate to personal, interpersonal and social systems (Petiprin, 2016). King noted that human beings function as dy ...
This document summarizes and analyzes research on family presence during CPR and invasive medical procedures. It discusses a study by Jensen and Kosowan that surveyed 169 medical professionals on their attitudes towards family presence. The study found that while acceptance of family presence was under 50%, most supported developing policies around it. Other research presented had mixed findings. The document concludes by discussing how nurses can advocate for developing family presence policies based on the evolving research.
Patient and family centered care is a model that places the patient and family at the center of the healthcare team. It aims to include patients and families in decision making by providing education so they are well informed. This model focuses on individualizing care according to a patient's needs, values and preferences. Several healthcare disciplines are involved in ensuring patient and family centered care is provided. Key aspects include collaboration, leadership, and cultural competency among the healthcare team.
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxransayo
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated that more than 60% of patient
visits to primary care physicians (PCPs) include mental health concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint (Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986; Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other researchers and practitioners have
written books that serve as a guide to other mental health practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn et al., 1996).
The specialty of family medicine, which arose in the 1960s, embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of caring for the whole person
within his or her family, social context, and life cycle stage (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat their patients’ mental health
problems. By definition of their specialty, FPs are trained to integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle, Maine; Deanna Linville, PhD, Couples and
Family Therapy .
Discussion 1 GeorgeIntroduction Teamwork is a significant aVinaOconner450
Discussion 1 George
Introduction
Teamwork is a significant aspect of health care delivery. With the increasing complexity and specialization of clinical care, healthcare workers have
to learn more complicated methods and procedures to achieve the desired patient outcomes. Teamwork is associated with reduced medical errors and
improve patient safety. Additionally, teamwork reduces staff burnout since a healthcare professional team is responsible for patient welfare (Zajac et al.,
2021). Various strategies are key to ensuring effective teamwork for better patient outcomes.
Strategies for effective teamwork during patient care
Effective communication across staff members of a clinical team increases teamwork efficacy, leading to improved patient outcomes. Working
towards a common goal, effective communication expands the traditional roles of each member to make decisions as a team (Zajac et al., 2021). One
particular strategy that worked for my clinical team is goal setting at the beginning of the scheduled activities so that each member has a clear purpose
for their roles for the day. Several studies also agree that goal setting provides the direction for implementing procedures and coordinated care.
Organizing regular meetings and using digital communication platforms such as emails and WhatsApp groups to convey information relating to patient
care to team members and debate suggestion is key to improving performance and, ultimately, patient outcomes.
Another effective team strategy is collaboration. By definition, health care involves multiple disciplines- nurses, doctors, and health care specialists
in different fields, working together, communicating often, and sharing resources (Zajac et al., 2021). A clinical team is made up of professionals of
different health specialities and responsibilities. Cumulatively, these differences contribute to the overall patient well-being and safety. The different
teams contribute to patient outcomes by understanding the patient presenting illness, asking them probing questions regarding their situation, making
an initial evaluation, discussing, and providing a recommendation based on their findings.
Strategies for ineffective teamwork during patient care
It is common for challenges to arise during teamwork. According to Hendrick et al. (2017), some of the most common challenges that impede a
team’s efforts to improve patient care include a lack of commitment of team members, different individual team members’ goals, and conflict
about how the team members individually relate to the patient. The input of individual members is vital to realizing the overall team’s goal. Therefore,
each member must demonstrate full commitment to the course of the team. Also, if the goals of the individual members do not align with the team’s
goal, then they might be less committed to achieving the team’s goal (Rawlinson et al., 2021). The healthcare team should help the patient understand
that their care is multidisci ...
RUNNING HEAD THE ART OF LISTENING as a THERAPUTIC TECHNIQUE .docxagnesdcarey33086
RUNNING HEAD: THE ART OF LISTENING as a THERAPUTIC TECHNIQUE 1
The Art of Listening as a Therapeutic Technique. 5
The Art of Listening as a Therapeutic Technique
Cheri Cable
HHS307: Comm Skills for Health & Human Service Personnel
Instructor: Beth Delaney
August 24, 2015
In the very beginning of everyone’s lives we are taught to speak but not necessarily to listen. Throughout history listening has been studied and a conclusion has been made that in fact being a good listener can allow one to challenge the information that is heard. Studies have shown that effective listening is a critical tool that is so often not used. “In the health care setting the communication technique such as the quality of listening provides both therapeutic value in the patient and the provider,” Banar, M. (2011). There are many different ways to be an active and effective listener, one of which is the therapeutic technique. “Therapeutic listening is an interpersonal confirmation process, involving all the senses, in which the therapist attends with empathy to the client's verbal and nonverbal messages to facilitate the understanding, synthesis, and interpretation of the client's situation,” according to the NCBI website. This paper will be taking an exploratory view of communication as a whole, effective health communication and focusing on the therapeutic technique of listening.
Let’s begin by examining what interpersonal communication can bring to the health care setting. Interpersonal communication consists of four principles which describes that interpersonal communication is irreversible, contextual, inescapable and complicated, thus meaning that communication cannot be avoided nor taken back once begun. Interpersonal communication is up close and personal and consists of verbal and nonverbal communication as well as listening. In order to have effective interpersonal communication one needs to consider these key areas, emotions, habits, needs, personalities and values of others. “Effective interpersonal communication skills are said to be the gateway to the development of other important life skills,” (Servellen 1).
Clear and effective communication is of great importance in order for patients to be enabled to properly and completely understand health information, without this ability adequate healthcare cannot be achieved. “Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors” according to the Institute for Healthcare Communication web site. A client that feels as though the provider is truly interested in their total care and well-being is more likely to follow the treatment .
1. Open communication and information sharing between healthcare providers, patients, and families. This includes involving families in rounds and decision-making.
2. Collaboration where patients and families are viewed as integral parts of the care team and participate in care activities and decisions.
3. Recognition that patients exist within social networks of family and friends whose needs should also be addressed to provide holistic, supportive care.
Harvard style research paper nursing evidenced based practiceCustomEssayOrder
This document discusses evidence-based practice in health and social care. It defines evidence-based practice as using the best available research evidence to guide decisions about patient care and service delivery. The document outlines how evidence-based practice helps improve patient outcomes and keep practices current. It also examines how social care providers are expected to demonstrate the effectiveness and accountability of their services.
Development and evaluation of an intervention to support family caregivers of...beatriz9911
This study aimed to develop and evaluate an intervention to support family caregivers of cancer patients providing home-based end-of-life care. In Phase 1, interviews with 29 caregivers identified their needs for practical information and support skills. Based on these findings, the researchers created an informational booklet as the preferred format. In Phase 2, 31 caregivers and 14 nurses evaluated the booklet. Caregivers reported feeling more positive, reassured, and competent in their caregiving role after using the booklet. Nurses found the booklet useful and received fewer calls from caregivers who used it. However, caregivers indicated they would have benefited from receiving the booklet earlier in the care trajectory. The researchers concluded the
Mental Health Shared Care between private and public providers poses specific logistic and cultural issues. This powerpoint based on my Masters Thesis, examines the use of a culture carrier.
Chapter 33 professional communication and team collaborationMirza Baig
This document discusses the importance of communication and team collaboration in healthcare. It notes that poor communication can lead to medical errors and harm patients. Effective teams are characterized by trust, respect, and collaboration. While barriers like hierarchies and cultural differences can interfere with communication, tools from other high-risk fields like aviation crew resource management have shown that standardized communication techniques can improve outcomes by reducing errors.
Healthy thanks to communication . Belim & Vaz de AlmeidaISCSP
This document discusses a model of communication competencies that can optimize health literacy. The model focuses on assertiveness, clear language, and positivity used by healthcare professionals in interactions with patients. The research validating the model included a literature review and focus group with medical experts. The focus group validated the three key concepts of the model and emphasized assertiveness includes active listening, clear language uses simple words and verbs, and positivity involves a positive approach with patients. The results confirm investing in these communication competencies improves patient health literacy and clinical outcomes.
This document summarizes a proposed research study that aims to evaluate the in-home mediator model of autism intervention. Specifically, the study will conduct in-depth interviews with 10-15 parents who recently completed an autism intervention program to understand their experiences as mediators and identify any factors that influenced the effectiveness of the intervention. Insights from the interviews will be used to inform improvements to the services provided and guide future research comparing the mediator model to in-clinic treatment models. The interviews will be structured around five factors identified in previous research as influencing interventions: the home environment, training received, skills developed, perceptions/emotions, and areas for service improvement.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
This study examined aspects of sustainability among Swiss psychiatrists by assessing levels of cooperation, job satisfaction, and burnout. The researchers surveyed 352 psychiatrists. They found that cooperation was highest with general practitioners and lowest with community mental health providers. Overall job satisfaction was assessed as high, while burnout rates were below concerning thresholds. Both job satisfaction and burnout correlated inversely, with higher satisfaction associated with lower burnout. Cooperation was positively associated with job satisfaction and inversely with burnout. The study concludes that fostering sustainability in outpatient psychiatric care requires considering personal, organizational, and supportive factors that can influence cooperation, satisfaction, and burnout.
The Impact of Chronic Illness refers to the wide-ranging effects and consequences that chronic illnesses have on individuals, their families, and society as a whole. Chronic illnesses are long-term health conditions that often require ongoing medical care and management.
The impact of chronic illness can be multifaceted and encompass various aspects of a person's life. Physically, chronic illnesses can result in persistent symptoms, pain, fatigue, and limitations in daily activities. These health challenges may require individuals to make adjustments to their lifestyle, such as adopting medication regimens, dietary changes, or incorporating regular medical appointments and treatments.
Emotionally, chronic illnesses can lead to psychological distress, including feelings of sadness, anxiety, frustration, or even depression. Coping with the uncertainties and limitations imposed by the illness can significantly impact a person's mental well-being.
Socially, chronic illnesses can disrupt social relationships, as individuals may face difficulties participating in social activities, maintaining employment, or fulfilling family roles. The need for accommodations and support can create challenges in personal relationships and may require adjustments in work environments.
1) The study examined factors that influence oncology nurses' perceived quality of work life and risk of compassion fatigue. It explored the relationship between nurse characteristics and quality of work life, the impact of personal life stress on quality of work life, and nurses' beliefs about their risk of compassion fatigue.
2) Personal life stressors were found to impact 30% of nurses' well-being, theoretically placing them at risk for compassion fatigue. However, qualitative data did not support this and 55% of nurses described their work as life-affirming and rewarding.
3) Nurses reported multiple sources of work-related stress, including issues with communication, their work environment, and factors related to patient care. However,
httpswww.azed.govoelaselpsUse this to see the English Lang.docxpooleavelina
https://www.azed.gov/oelas/elps/
Use this to see the English Language Proficiency Standards of Arizona-Pick a grade level
https://cms.azed.gov/home/GetDocumentFile?id=54de1d88aadebe14a87070f0
http://www.corestandards.org/ELA-Literacy/introduction/how-to-read-the-standards/
how to read standards
Week 04
Acquisition and Customer Lifetime Value (CLV)
https://www.smh.com.au/politics/federal/nbn-customers-face-higher-prices-or-poorer-internet-connection-audit-warns-20190813-p52go7.html
Customer Relationship Management?
CRM is the process of carefully managing detailed information about individual
customers and all customer touch points to maximize customer loyalty.
Now closely associated with data warehousing and mining
Relationship
Relationship
Identifying good customers: RFM Model
Recency
Frequency
Monetary Value
Time/purchase occasions since the last purchase
Number of purchase occasions since first purchase
Amount spent since the first purchase
R
F
M
Total RFM Score: R Score + F score + M Score
CASE: Database for BookBinders Book Club
Predict response to a mailing for the book, Art History of Florence, based on the
following variables accumulated in the database and the responses to a test mailing:
Gender
Amount purchased
Months since first purchase
Months since last purchase
Frequency of purchase
Past purchases of art books
Past purchases of children’s books
Past purchases of cook books
Past purchases of DIY books
Past purchases of youth books
Recency
Frequency
Monetary
Example: RFM Model Scoring Criteria
R
Months from last
purchase
13-max 10-12 7-9 3-6 0-2
Score 5pts 10 15 20 25
F
Frequency > 30 21-30 16-20 11-15 0-10
Score 25pts 20 15 10 5
M
Amount
purchased
> 400 301-400 201-300 101- 200 100
Score 50 45 30 15 10
Implement using Nested If statements in Excel
Decile Classification
• Standard Assessment Method
• Apply the results of approach and
calculate the “score” of each individual
• Order the customers based on “score”
from the highest to the lowest
• Divide into deciles
• Calculate profits per deciles
Customer 1 Score 1.00
Customer 2 Score 0.99
….
Customer 230 Score 0.92
Customer 2300 Score 0.00
Decile1
Decile10
…
..
…
..
Output for Bookbinders club
Decile Score RFM No. of Mailings Cost of mailing RFM Units sold RFM Profit
10 17.6% 5000 $3,250 783 $4,733
20 34.8% 10000 $6,500 1,543 $9,243
30 46.1% 15000 $9,750 2,043 $11,093
40 53.4% 20000 $13,000 2,370 $11,170
50 65.2% 25000 $16,250 2,891 $13,241
60 77.9% 30000 $19,500 3,457 $15,757
70 83.3% 35000 $22,750 3,696 $14,946
80 91.7% 40000 $26,000 4,065 $15,465
90 97.5% 45000 $29,250 4,326 $14,876
100 100.0% 50000 $32,500 4,435 $12,735
Note: Market Potential = 4435 units and margin = $10.20
Leaky bucket
New customer
acquisition
Purchase increase by
current customers
Purchase decrease by
current customers
Lost customers
Lost customers
Credit Card Rewards Program ...
The 30 June 2019 local elections in Albania took place in a context of deep political polarization and crisis. The main opposition parties boycotted the elections and called on voters to abstain. As a result, many mayoral races were uncontested. The elections suffered from a lack of trust in the impartiality of the election administration due to its unbalanced composition. While voting and counting were carried out efficiently on election day, the broader process failed to provide voters with a genuine choice between political alternatives. The elections did not resolve the underlying political disputes and the country remained in a state of political uncertainty.
httpfmx.sagepub.comField Methods DOI 10.117715258.docxpooleavelina
http://fmx.sagepub.com
Field Methods
DOI: 10.1177/1525822X04269550
2005; 17; 30 Field Methods
Don A. Dillman and Leah Melani Christian
Survey Mode as a Source of Instability in Responses across Surveys
http://fmx.sagepub.com/cgi/content/abstract/17/1/30
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Published by:
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10.1177/1525822X04269550FIELD METHODSDillman, Christian / SURVEY MODE AS SOURCE OF INSTABILITY
Survey Mode as a Source of Instability
in Responses across Surveys
DON A. DILLMAN
LEAH MELANI CHRISTIAN
Washington State University
Changes in survey mode for conducting panel surveys may contribute significantly to
survey error. This article explores the causes and consequences of such changes in
survey mode. The authors describe how and why the choice of survey mode often
causes changes to be made to the wording of questions, as well as the reasons that
identically worded questions often produce different answers when administered
through different modes. The authors provide evidence that answers may change as a
result of different visual layouts for otherwise identical questions and suggest ways
to keep measurement the same despite changes in survey mode.
Keywords: survey mode; questionnaire; panel survey; measurement; survey error
Most panel studies require measurement of the same variables at different
times. Often, participants are asked questions, several days, weeks, months,
or years apart to measure change in some characteristics of interest to the
investigation. These characteristics might include political attitudes, satis-
faction with a health care provider, frequency of a behavior, ownership of
financial resources, or level of educational attainment. Whatever the charac-
teristic of interest, it is important that the question used to ascertain it perform
the same across multiple data collections.
In addition, declining survey response rates, particularly for telephone
surveys, have encouraged researchers to use multiple modes of data collec-
tion during the administration of a single cross-sectional survey. Encouraged
by the availability of more survey modes than in the past and evidence that a
change in modes produces higher response rates (Dillman 2002), surveyors
This is a revision of a paper presented at t ...
https://iexaminer.org/fake-news-personal-responsibility-must-trump-intellectual-laziness/
Fake news: Personal responsibility must trump intellectual laziness
By Matt Chan January 4, 2017
Where do you get your news? That question has become incredibly important given the results of our Presidential Election. How many times have you heard, “I read a news story on Facebook and …” The problem: Facebook is not a news service; it’s a “social media” site whose purpose is to connect like-minded friends and family, to provide you with social connections, and online entertainment.
For Asian Americans social media provides an important and useful way of connecting socially and in some cases politically, but there is a downside. The downside is how social media actually works. These sites employ elaborate algorithms to track and analyze your posts, likes, and dislikes to provide you with a custom experience unique to you. The truth is you are being marketed to, not informed. What looks like news, is not really news, it’s personal validation. All in an attempt to keep you on the site longer, to click a few more things, to make you feel good about what you’re reading. It makes it seem like most people agree with you because you’re only fed information and stories that validate your worldview.
On the other hand, real news is hard work. Its fact-based information presented by people who have checked, researched, and documented what they are presenting as the truth. Real news can be verified.
“Fake News” is, well, fake, often times entirely made-up or containing a hint of truth. Social media was largely responsible for pushing “fake news” stories that were entirely made up to drive clicks on websites. These clicks in turn generated money for the people promoting the stories. The more outrageous the story, the more clicks, the more revenue. When you factor in the algorithms that feed you what you like, you can clearly see the more “fake news” you consume on social media, the more is pushed your way. There’s an abundance of pseudo news sites that merely re-post and curate existing stories, adding their bias to validate their audience’s beliefs, no matter how crazy or mainstream. It is curated solely for you. Now factor in that nearly 44% of Americans obtain some or most of their news from social media and you have a very toxic mix.
The mainstream news media has also fallen into this validation trap. You have one news network that solely reflects the right wing, others that take the view of the left-center leaning, and what is lost are the facts and context, the balance we need to evaluate, learn, and understand the world. People seeking fact-based journalism lose, because the more extreme the media becomes to entice consumers with provocative headlines and click-bait to earn more money, the less their news is fact-based and becomes more opinion driven.
There was a time when fact-based reporting was required of broadcast news. It was called “The Fairness Doctrin ...
http1500cms.comBECAUSE THIS FORM IS USED BY VARIOUS .docxpooleavelina
http://1500cms.com/
BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE HEALTH PROGRAMS, SEE SEPARATE INSTRUCTIONS ISSUED BY
APPLICABLE PROGRAMS.
NOTICE: Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may
be guilty of a criminal act punishable under law and may be subject to civil penalties.
REFERS TO GOVERNMENT PROGRAMS ONLY
MEDICARE AND CHAMPUS PAYMENTS: A patient’s signature requests that payment be made and authorizes release of any information necessary to process
the claim and certifies that the information provided in Blocks 1 through 12 is true, accurate and complete. In the case of a Medicare claim, the patient’s signature
authorizes any entity to release to Medicare medical and nonmedical information, including employment status, and whether the person has employer group health
insurance, liability, no-fault, worker’s compensation or other insurance which is responsible to pay for the services for which the Medicare claim is made. See 42
CFR 411.24(a). If item 9 is completed, the patient’s signature authorizes release of the information to the health plan or agency shown. In Medicare assigned or
CHAMPUS participation cases, the physician agrees to accept the charge determination of the Medicare carrier or CHAMPUS fiscal intermediary as the full charge,
and the patient is responsible only for the deductible, coinsurance and noncovered services. Coinsurance and the deductible are based upon the charge
determination of the Medicare carrier or CHAMPUS fiscal intermediary if this is less than the charge submitted. CHAMPUS is not a health insurance program but
makes payment for health benefits provided through certain affiliations with the Uniformed Services. Information on the patient’s sponsor should be provided in those
items captioned in “Insured”; i.e., items 1a, 4, 6, 7, 9, and 11.
BLACK LUNG AND FECA CLAIMS
The provider agrees to accept the amount paid by the Government as payment in full. See Black Lung and FECA instructions regarding required procedure and
diagnosis coding systems.
SIGNATURE OF PHYSICIAN OR SUPPLIER (MEDICARE, CHAMPUS, FECA AND BLACK LUNG)
I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished
incident to my professional service by my employee under my immediate personal supervision, except as otherwise expressly permitted by Medicare or CHAMPUS
regulations.
For services to be considered as “incident” to a physician’s professional service, 1) they must be rendered under the physician’s immediate personal supervision
by his/her employee, 2) they must be an integral, although incidental part of a covered physician’s service, 3) they must be of kinds commonly furnished in physician’s
offices, and 4) the services of nonphysicians must be included on the physician’s bills.
For CHA ...
https://www.medicalnewstoday.com/articles/323444.php
https://ascopubs.org/doi/full/10.1200/JCO.2008.16.0333
https://journals.lww.com/co-hematology/Abstract/2007/03000/Influence_of_new_molecular_prognostic_markers_in.5.aspx
Influence of new molecular prognostic markers in patients with karyotypically normal acute myeloid leukemia: recent advances
Mrózek, Krzysztofa; Döhner, Hartmutb; Bloomfield, Clara Da
Current Opinion in Hematology: March 2007 - Volume 14 - Issue 2 - p 106–114
doi: 10.1097/MOH.0b013e32801684c7
Myeloid disease
Purpose of review Molecular study of cytogenetically normal acute myeloid leukemia is among the most active areas of leukemia research. Despite having the same normal karyotype, adults with de-novo cytogenetically normal acute myeloid leukemia who constitute the largest cytogenetic group of acute myeloid leukemia, are very diverse with respect to acquired gene mutations and gene expression changes. These genetic alterations affect clinical outcome and may assist in selection of proper treatment. Herein we critically summarize recent clinically relevant molecular genetic studies of cytogenetically normal acute myeloid leukemia.
Recent findings NPM1 gene mutations causing aberrant cytoplasmic localization of nucleophosmin have been demonstrated to be the most frequent submicroscopic alterations in cytogenetically normal acute myeloid leukemia and to confer improved prognosis, especially in patients without a concomitant FLT3 gene internal tandem duplication. Overexpressed BAALC, ERG and MN1 genes and expression of breast cancer resistance protein have been shown to confer poor prognosis. A gene-expression signature previously suggested to separate cytogenetically normal acute myeloid leukemia patients into prognostic subgroups has been validated on a different microarray platform, although gene-expression signature-based classifiers predicting outcome for individual patients with greater accuracy are still needed.
Summary The discovery of new prognostic markers has increased our understanding of leukemogenesis and may lead to improved prognostication and generation of novel risk-adapted therapies.
http://www.bloodjournal.org/content/127/1/53?sso-checked=true
An update of current treatments for adult acute myeloid leukemia
Hervé Dombret and Claude Gardin
Abstract
Recent advances in acute myeloid leukemia (AML) biology and its genetic landscape should ultimately lead to more subset-specific AML therapies, ideally tailored to each patient's disease. Although a growing number of distinct AML subsets have been increasingly characterized, patient management has remained disappointingly uniform. If one excludes acute promyelocytic leukemia, current AML management still relies largely on intensive chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT), at least in younger patients who can tolerate such intensive treatments. Nevertheless, progress has been made, notably in terms of standard drug dose in ...
httpstheater.nytimes.com mem theater treview.htmlres=9902e6.docxpooleavelina
https://theater.nytimes.com/ mem/ theater/ treview.html?res=9902e6db1639f931a25753c1a962948260
THEATER: WILSON'S 'MA RAINEY'S' OPENS
By FRANK RICH
Published: October 12, 1984, Friday
LATE in Act I of ''Ma Rainey's Black Bottom,'' a somber, aging band trombonist (Joe Seneca) tilts his head heavenward to sing the blues. The setting is a dilapidated Chicago recording studio of 1927, and the song sounds as old as time. ''If I had my way,'' goes the lyric, ''I would tear this old building down.''
Once the play has ended, that lyric has almost become a prophecy. In ''Ma Rainey's Black Bottom,'' the writer August Wilson sends the entire history of black America crashing down upon our heads. This play is a searing inside account of what white racism does to its victims - and it floats on the same authentic artistry as the blues music it celebrates. Harrowing as ''Ma Rainey's'' can be, it is also funny, salty, carnal and lyrical. Like his real-life heroine, the legendary singer Gertrude (Ma) Rainey, Mr. Wilson articulates a legacy of unspeakable agony and rage in a spellbinding voice.
The play is Mr. Wilson's first to arrive in New York, and it reached here, via the Yale Repertory Theater, under the sensitive hand of the man who was born to direct it, Lloyd Richards. On Broadway, Mr. Richards has honed ''Ma Rainey's'' to its finest form. What's more, the director brings us an exciting young actor - Charles S. Dutton - along with his extraordinary dramatist. One wonders if the electricity at the Cort is the same that audiences felt when Mr. Richards, Lorraine Hansberry and Sidney Poitier stormed into Broadway with ''A Raisin in the Sun'' a quarter-century ago.
As ''Ma Rainey's'' shares its director and Chicago setting with ''Raisin,'' so it builds on Hansberry's themes: Mr. Wilson's characters want to make it in white America. And, to a degree, they have. Ma Rainey (1886-1939) was among the first black singers to get a recording contract - albeit with a white company's ''race'' division. Mr. Wilson gives us Ma (Theresa Merritt) at the height of her fame. A mountain of glitter and feathers, she has become a despotic, temperamental star, complete with a retinue of flunkies, a fancy car and a kept young lesbian lover.
The evening's framework is a Paramount-label recording session that actually happened, but whose details and supporting players have been invented by the author. As the action swings between the studio and the band's warm-up room - designed by Charles Henry McClennahan as if they might be the festering last- chance saloon of ''The Iceman Cometh'' - Ma and her four accompanying musicians overcome various mishaps to record ''Ma Rainey's Black Bottom'' and other songs. During the delays, the band members smoke reefers, joke around and reminisce about past gigs on a well-traveled road stretching through whorehouses and church socials from New Orleans to Fat Back, Ark.
The musicians' speeches are like improvised band solos - variously fiz ...
https://fitsmallbusiness.com/employee-compensation-plan/
The puzzle of motivation | Dan Pink [Video file]. Retrieved from https://www.youtube.com/watch?v=rrkrvAUbU9Y
Refining the total rewards package through employee input at MillerCoors [Video file]. Retrieved from https://www.youtube.com/watch?v=_I7nv0B4_NU&feature=youtu.be
How to design an employee compensation plan [SlideShare slides]. Retrieved from http://www.slideshare.net/FitSmallBusiness/how-to-design-a-compensation-plan-dave?ref=http://fitsmallbusiness.com/how-to-pay-employees/
Compensation strategies [Video file]. Retrieved from https://youtu.be/U2wjvBigs7w
· Expectations for Power Point Presentations in Units IV and V
I would like to provide information about what needs to be included in presentations. Please review the rubric prior to submitting any assignment. If you don't know where to find this, please contact me.
1. You need a title slide.
2. You need an overview of the presentation slide (slide after the title slide). This is how you would organize a presentation if you were presenting it at work.
3. You need a summary slide (before the reference slide); same reason as above.
4. Please do not forget to cite on slides where you are writing about something related to what you have read. Please consider each slide a paragraph. You can cite on the slides or in the notes. If you do not cite, you will not get credit for the slide.
- Direct quotes should not be used in this presentation as they are not analysis.
5. Remember, all I can evaluate is what you submit, so please consider using notes to explain what you are writing in further detail. Bullets are great and you can use these but then provide more detail in the notes.
6. Graphics - Please include graphics/charts/graphs as this is evaluated in the rubric (quality of the presentation).
7. References - For all references, you need citations. For all citations, you need references. They must match. All must be formatted using APA requirements. Please review the Quick Reference Guide that was posted in the announcements.
Please never hesitate to email me with any questions. If you need further clarification about feedback or if you do not agree with any of the feedback, please contact me. My door is always open.
Assignment 1
Positioning Statement and Motto
Use the provided information, as well as your own research, to assess one (1) of the stated brands (Tesla, SmoothieKing, Suave, or Nintendo) by completing the questions below with an ORIGINAL response to each. At the end of the worksheet, be sure to develop a new ORIGINAL positioning statement and motto for the brand you selected. Submit the completed template in the Week 4 assignment submission link.
Name:
Professor’s Name:
Course Title:
Date:
Company/Brand Selected (Tesla, SmoothieKing, Suave or Nintendo):
1. Target Customers/Users
Who are the target customers for the company/brand? Make sure you tell why you selected each item that you did. (NOTE: DO NO ...
This document provides instructions for students completing a research paper for an introductory radiography course. It outlines requirements for the paper, including length of 3 pages, use of 3 scholarly sources from 2008-present, and APA formatting. Key topics that must be addressed are introduced, including the chosen research topic, importance of the topic, and evidence of research through in-text citations on every page and a reference list. Formatting guidelines specify use of a cover page, introduction, body, and summary. The instructions emphasize accurately citing all sources to avoid plagiarism. Students are encouraged to visit the campus writing center for assistance meeting the standards.
https://www.worldbank.org/en/country/vietnam/overview
-------------- Context ----------------
Vietnam’s development over the past 30 years has been remarkable. Economic and political reforms under Đổi Mới, launched in 1986, have spurred rapid economic growth, transforming what was then one of the world’s poorest nations into a lower middle-income country. Between 2002 and 2018, more than 45 million people were lifted out of poverty. Poverty rates declined sharply from over 70% to below 6% (US$3.2/day PPP), and GDP per capita increased by 2.5 times, standing over US$2,500 in 2018.
In the medium-term, Vietnam’s economic outlook is positive, despite signs of cyclical moderation in growth. After peaking at 7.1% in 2018, real GDP growth in 2019 is projected to slightly decelerate in 2019, led by weaker external demand and continued tightening of credit and fiscal policies. Real GDP growth is projected to remain robust at around 6.5% in 2020 and 2021. Annual headline inflation has been stable for the seven consecutive years – at single digits, trending towards 4% and below in recent years. The external balance remains under control and should continue to be financed by strong FDI inflows which reached almost US$18 billion in 2018 – accounting for almost 24% of total investment in the economy.
Vietnam is experiencing rapid demographic and social change. Its population reached 97 million in 2018 (up from about 60 million in 1986) and is expected to expand to 120 million before moderating around 2050. Today, 70% of the population is under 35 years of age, with a life expectancy of 76 years, the highest among countries in the region at similar income levels. But the population is rapidly aging. And an emerging middle class, currently accounting for 13% of the population, is expected to reach 26% by 2026.
Vietnam ranks 48 out of 157 countries on the human capital index (HCI), second in ASEAN behind Singapore. A Vietnamese child born today will be 67% as productive when she grows up as she could be if she enjoyed complete education and full health. Vietnam’s HCI is highest among middle-income countries, but there are some disparities within the country, especially for ethnic minorities. There would also be a need to upgrade the skill of the workforce to create productive jobs at a large scale in the future.
Over the last thirty years, the provision of basic services has significantly improved. Access of households to modern infrastructure services has increased dramatically. As of 2016, 99% of the population used electricity as their main source of lighting, up from 14 % in 1993. Access to clean water in rural areas has also improved, up from 17% in 1993 to 70% in 2016, while that figure for urban areas is above 95%.
Vietnam performs well on general education. Coverage and learning outcomes are high and equitably achieved in primary schools — evidenced by remarkably high scores in the Program for International Student Assessment (PISA) in 2012 and 2015, ...
HTML WEB Page solutionAbout.htmlQuantum PhysicsHomeServicesAbou.docxpooleavelina
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This website gives a detail inward look in quantam physics as it is a evolving field now-a-days and has many upcoming changes that is going to leave the world in shock. There has been a lot of confusion lately related to this topics in people so it is encourage that people visit this website and get to know more about this field and explore the horizons there is yet to come.
HTML WEB Page solution/FirstLastHomePage.htmlQuantum PhysicsHomeServicesAboutContact Me
Definition
Quantum mechanics is the part of material science identifying with the little.
It brings about what may have all the earmarks of being some extremely peculiar decisions about the physical world. At the size of particles and electrons, a significant number of the conditions of old style mechanics, which depict how things move at ordinary sizes and speeds, stop to be helpful. In traditional mechanics, objects exist in a particular spot at a particular time. Be that as it may, in quantum mechanics, protests rather exist in a fog of likelihood; they have a specific possibility of being at point An, another possibility of being at point B, etc.Three revolutionary principles
Quantum mechanics (QM) created over numerous decades, starting as a lot of questionable scientific clarifications of tests that the math of old style mechanics couldn't clarify. It started at the turn of the twentieth century, around a similar time that Albert Einstein distributed his hypothesis of relativity, a different numerical unrest in material science that portrays the movement of things at high speeds. In contrast to relativity, nonetheless, the sources of QM can't be credited to any one researcher. Or maybe, various researchers added to an establishment of three progressive rules that bit by bit picked up acknowledgment and exploratory confirmation somewhere in the range of 1900 and 1930. They are:
Quantized properties:
Certain properties, for example, position, speed and shading, can once in a while just happen in explicit, set sums, much like a dial that "clicks" from number to number. This tested a crucial presumption of old style mechanics, which said that such properties should exist on a smooth, ceaseless range. To portray the possibility that a few properties "clicked" like a dial with explicit settings, researchers begat the word "quantized".
Particles of light:
Light can now and again act as a molecule. This was at first met with unforgiving analysis, as it negated 200 years of trials indicating that light acted as a wave; much like waves on the outside of a quiet lake. Light acts comparatively in that it ricochets off dividers and twists around corners, and that the peaks and troughs of the wave can include or counteract. Included wave peaks bring about more splendid light, while waves that counterbalance produce obscurity. A light source can be thought of ...
https://www.huffpost.com/entry/online-dating-vs-offline_b_4037867
For your initial post, provide a sentence to share which article you are referring to so that you can best communicate with your peers. Include a link to your selection.
· Explain how the argument contains or avoids bias.
i. Provide specific examples to support your explanation.
ii. What assumptions does it make?
· Discuss the credibility of the overall argument.
i. Were the resources the argument was built upon credible?
ii. Does the credibility support or undermine the article’s claims in any important ways?
In response to your peers, provide an additional resource to support or refute the argument your peer makes. Do you agree with their claims of credibility? Are there any other possible bias not identified?
Response #1
Allysa Tantala posted Sep 22, 2019 10:17 PM
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The article that I am looking at is Online Dating Vs. Offline Dating: Pros and Cons.It was written by Julie Spira, an online dating expert, bestselling author, and CEO of Cyber-Dating Expert. The name of the article is spot on in describing what it is about. The author goes through the pros and cons of dating online and offline in today’s day and age. The author avoids bias because she looks at both options in both their positive and negative attributes. She comes at the issues from both angles and I believe she does a very good job at remaining unbiased. She states that “if you're serious about meeting someone special, you must include a combination of both online and offline dating in your routine” (Spira, 2013, par. 18). She’s stating that both options have their pros and cons and that really a combination of both is needed to find someone. The only bias I could see anyone pointing out would be that she is a woman, so you do not get the male perspective on these things. That being said, I one hundred percent think she covers all of the questions people may have about online and offline dating in today’s world. The only assumption being made here is that the reader wants to be out in the dating world and they need to know what is best. But, the title of the article is pretty self-explanatory so if someone did not want to know these things, they would not have to waste their time reading it all because they could tell what it would be about by the title.
The resource that she used was herself, and like I stated above, she is an online dating expert, bestselling author, and CEO of Cyber-Dating Expert; so she is more than qualified to give her perspective on these issues. I find her to be credible and thought provoking. Her credibility supports everything the article says and makes the reader feel like they are being told the truth by someone who completely understands all of the pros and cons.
Resource:
Spira, J. (2013, December 3). Online Dating Vs. Offline Dating: Pros and Cons. Retrieved from https://www.huffpost.com/entry/online-dating-vs-offline_b_4037867
Response #2
Jennifer Caforio posted Se ...
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THE ASSIGNMENT IS BASED ON CHAPTER 1 (ONE)
Login : [email protected]
Password: Greekyogurt13!
1
3Defining the Problem
Rigina CochranMPA/593
August 19, 2019
Peter ReevesDefining the Problem
The health care system in Colorado is a composition of medical professionals providing services such as diagnosis, treatment, as well as preventive measures to mental illness and injuries ("Healthcare policy in Colorado - Ballotpedia," 2019). Health care policy involves the establishment and implementation of legislation and other regulations that the states use to manage its health care system effectively. Further, this sector consists of other participants, such as insurance and health information technology. The cost citizens pay for medical care and also the access to quality care influence the overall health care providers in Colorado. Therefore, the need for the creation and implementation of laws that help the state maintain efficiency in the health sector in Colorado.
Problem Statement
The declining standards of medical care within the United States has caused significant concern in the world. Due to these rising concerns, there have been various policies implemented, leading to mixed reactions among the different states. Some of the active policies implemented offer a long-term solution to this problem including Medicaid and Medicare. After acquiring state control, the Republicans dismissed the idea to expand and create medical insurance for Medicaid in Colorado. Sustaining the structure of the health care payroll calls for the deductions from the employees and the employers, which may lead to loss of jobs and increased burden of expenditure (Garcia, 2019).
Identify the Methodology
The main objective of this policy plan is to investigate the role of legislation in the management of the health care sector in the United States. Due to the need for achieving in-depth exploration, this paper uses a combination of both qualitative and quantitative methods of data collection by addressing both practical and theoretical aspects of the research. Based on the answers that the policy requires, choosing survey as the research design. This method involves collecting and analyzing data from a few people who represent the principal group within health care. However, the survey method faces some challenges such as attitudes and perception of the health workers leading to the delimitation of the study. The target population for the study includes the nurses within the health sectors in Colorado. The selection of the participants involved in the use of stratified random sampling.
Identify your Stakeholders
The major stakeholders in the creation and implementation of the policy plan include the legislatures, local government, patients, and other private parties such as the insurance companies. Collectively, these bodies are involved in the makin ...
Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder characterized by avoidance of food due to sensory characteristics, fear of aversive consequences, or lack of interest in eating. This results in insufficient calorie or nutrient intake leading to issues like weight loss, nutritional deficiencies, or interference with functioning. Treatments that have shown promise for ARFID include family-based treatment involving parents supporting exposure to new foods, cognitive-behavioral therapy with elements like food exposure and relaxation training, and hospital-based refeeding programs, some of which utilize tube feeding for severe cases. However, more research is still needed, as existing studies on treating ARFID are limited and no single approach has been proven
https://www.youtube.com/watch?time_continue=59&v=Bh_oEYX1zNM&feature=emb_logo
BA 325 Pivot Table Assignment Answer Sheet
Name:
Before you do anything fill out your name on the assignment and save your file as BA325 Firstname Lastname (use your actual name).
The table has all of the questions from the DuPont Assignment. Fill in your answers to the questions in the corresponding cell in the Answer column. Below the table there is a spot for the Screen Clippings from both the Practice Assignment, and the DuPont Assignment.
After you have filled out all of the answers and Screen Clippings submit the file to the Assignments folder in D2L.
Q Number
Question
Answer
Q1
How much was American Airlines’ Net Revenues in 2013?
Q2
What was the Return on Equity for Apple in 2015?
Q3
Which company had the highest Net Income and in which year? What was the value?
Q4
Which company had the lowest Net Income and in which year? What was the value?
Q5
How many unique companies in your sample had Net Losses exceeding one billion dollars? Which companies, and what years?
Q6
What was the Sum of the Net Income for all companies in the sample for 2015?
Q7
Which company had the highest total Net Income over the three year period? What was the value?
Q8
Which company had the lowest total Net Income over the three year period? What was the value?
Q9
Which industry had the highest Average Profit Margin over the three year period? What was the value?
Q10
In which year was the Average Profit Margin the highest for the entire sample? What was the value?
Q11
For how many companies do you have Profit Margin ratio data in 2013?
Q12
For what Industry do you have the most Profit Margin ratio data in the sample? What was the value? For that Industry what year was the highest? What was the value?
Q13
Which Industry has the highest Average Asset Turnover over the three year period? What was the value?
Q14
Which of the remaining Industries has the highest Asset Turnover in 2014? What was the value?
Q15
Which Industry has the highest Average Financial Leverage over the three year period? What was the value?
Q16
Which Industry has the lowest Average Financial Leverage that does not include negative numbers in any year? What was the value?
Q17
What is the Average Financial Leverage for the Transportation Industry in 2013?
Note: The answer is odd. You will have to use Data Cleaning to resolve the issue.
Q18
Which Industry has the highest Average Return on Equity over the three year period and which company is the highest within that Industry? What are the values?
Q19
Which two companies in the Public Utilities Industry have the highest Average Return on Equity during the period? What are the values?
Q20
Which Industry had the largest decrease in Average Return on Equity between 2013 and 2014? What was the value?
Q21
Which Industry had the largest increase in Average Return on Equity between 2014 and 2015? What was the value?
Q22
Bonus Question 1: How many industrie ...
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
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Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
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2. Department of Communication Studies
University of North Texas
Collaboration between family caregivers and health care
providers is necessary to ensure
patient-centered care, especially for hospice patients. During
hospice care, interdisciplinary
team members meet biweekly to collaborate and develop
holistic care plans that address the
physical, spiritual, psychological, and social needs of patients
and families. The purpose of
this study was to explore team communication when video-
conferencing is used to facilitate
the family caregiver’s participation in a hospice team meeting.
Video-recorded team meetings
with and without family caregiver participation were analyzed
for communication patterns
using the Roter Interaction Analysis System. Standard meetings
that did not include caregivers
were shorter in duration and task-focused, with little
participation from social workers and
chaplains. Meetings that included caregivers revealed an
emphasis on biomedical education
and relationship-building between participants, little
psychosocial counseling, and increased
socioemotional talk from social workers and chaplains.
Implications for family participation
in hospice team meetings are highlighted.
Correspondence should be addressed to Elaine Wittenberg-
Lyles, University of Kentucky, Markey Cancer Center and
Department of Communication,
741 S. Limestone, B357 BBSRB, Lexington, KY 40506-0509.
E-mail: [email protected]
3. HOSPICE FAMILY CAREGIVERS 111
Hospice care is provided to both the patient and family,
and includes attention to the physical, psychological,
spiritual, and emotional needs of the dying and their
loved ones (Centers for Medicare and Medicaid Services,
2008). Physicians, patients, families, and other health care
providers agree that preparation for the end of life includes
ensuring that the family is prepared for the loved one’s
death (Steinhauser et al., 2001). Family members are most
satisfied with hospice services when they are informed
regularly and receive social support from staff (Rhodes,
Mitchell, Miller, Connor, & Teno, 2008). Family members
also feel satisfied with hospice services when they are
informed about their loved one’s condition on a regular
basis, feel that the team provides them social support, and
are able to identify one nurse as being in charge of the
patient’s care (Rhodes et al., 2008).
However, communication between family caregivers and
providers continues to be problematic (Bowman, Rose,
Radziewicz, O’Toole, & Berila, 2009). Caregivers report that
they need more information, more support, and increased
communication with staff (Dougherty, 2010). Bereaved
caregivers of long-term care patients reported that they
did not receive enough information when their loved one
was dying, that they did not understand what the clin-
ician had told them about what to expect, and that the
physician did not always discuss the patient’s end-of-life
wishes (Biola et al., 2007). Hospice providers report that
communication with caregivers can be difficult due to the
caregiver’s impaired concentration, the caregiver’s propen-
sity to engage in silence, the caregiver’s desire not to
bother clinicians, the caregiver’s rejection of support ser-
4. vices, and timing and amount of information received dur-
ing an encounter (Hudson, Aranda, & Kristjanson, 2004).
Inadequacies in communication with caregivers can also
result from interdisciplinary relationships among team mem-
bers that emerge from turf-type issues, the inability of the
team to provide a common message to the patient/family,
and inefficient communication processes within the care sys-
tem (Kirk, Kirk, Kuziemsky, & Wagar, 2010). This study
investigated ACTIVE team meetings, when one or more
family members virtually participate in team meetings, to
examine how caregiver participation in interdisciplinary
team meetings affected team communication with family
caregivers.
INTERDISCIPLINARY TEAMS AND
PATIENT-CENTERED CARE
The theoretical framework for this study combines a model
for the participation of family on healthcare teams and
interdisciplinary collaboration, an approach called ACTIVE:
Assessing Caregivers for Team Intervention through Video
Encounters (Parker Oliver, Demiris, Wittenberg-Lyles,
& Porock, 2010). Similar to the input–process–output
framework detailed by Real and Poole (2011)—which
considers communication structures that shape commu-
nication processes and how these processes influence
health care outcomes—the ACTIVE framework combines
a model of interdisciplinary collaboration that includes
families proposed by Saltz and Schaefer (1996) and
incorporates Bronstein (2003), who identified important
components to the team process that impact successful
collaboration.
According to Saltz and Schaefer (1996), the model inter-
disciplinary team enacts patient-centered care by includ-
5. ing the patient and family as core members of the health
care team. Team structures determine whether family mem-
bers are viewed as “lay” team members (without detailed
knowledge) or “specialists” (with a tremendous amount of
knowledge regarding the patient). Bronstein (2003) further
details team processes by providing an outline for suc-
cessful collaboration between hospice staff members. The
framework identifies four components to interdisciplinary
collaboration processes: (1) interdependence and flexibility;
(2) newly created professional activities; (3) collective own-
ership of goals; and (4) reflection on process. Bronstein’s
model for interdisciplinary collaboration when combined
with the work of Saltz and Schaefer (1996) supports inclu-
sion of patients and family, as the team will become inter-
dependent with patient/family goals and will create new
activities and roles for patients/families within the team,
requiring flexibility among individual members’ role def-
initions. The patient/family involvement will require col-
lective ownership of all goals by all team members, and
the care outcomes will be evaluated through a reflection on
the team process, again including feedback from patients/
families.
The Role of Telemedicine in Interdisciplinary Team
Communication
Telemedicine tools, such as advanced communication tech-
nology, offer the potential to improve team communication
and collaboration by facilitating caregiver involvement in
team meetings. Attendance and participation in team meet-
ings are problematic for many hospice caregivers due to the
care needs of the patient, geographic distance and travel to
the hospice office, confidentiality issues as people wait in
the office, and the time involved for team members (Parker
Oliver, Porock, Demiris, & Courtney, 2005). Consequently,
family caregivers are rarely included in hospice team meet-
6. ings. ACTIVE team meetings offer caregivers the opportu-
nity to utilize video-conferencing technology to participate
in hospice interdisciplinary team meetings and overcome
barriers to participation.
Previous research on telemedicine interactions has
included family members, but little is known about their
participation. One study found that while family members
participated in 48% of interactions, they contributed only
112 WITTENBERG-LYLES ET AL.
10% of talk during the interaction (Nelson, Miller, & Larson,
2010). Similarly, another study found that companions (fam-
ily or friends of the patient) contributed only 7% of talk
in face-to-face interactions and 9% in telemedicine inter-
actions (Agha, Roter, & Schapira, 2009). The majority of
talk shared by companions during telemedicine encounters
involves sharing the patient’s medical symptoms and thera-
peutic regimen, followed by lifestyle and psychosocial status
and agreement statements (Agha et al., 2009). One reason for
the low involvement of family members is that telemedicine
interactions are typically structured as a dyadic encounter
between the patient and a physician. Consequently, it
has been suggested that telemedicine interactions are less
patient-centered than in-person visits because physicians
tend to dominate discussions with biomedical talk and limit
exchanges about psychosocial and lifestyle issues (Agha
et al., 2009).
ACTIVE meetings are unique because the caregiver is
the primary spokesperson on behalf of the patient and the
goal of the meeting is to collaborate rather than to provide
direct patient care. The goal of this study was to investigate
7. how family involvement influences interdisciplinary team
communication. Specifically, we questioned:
RQ1: How does communication differ between standard
interdisciplinary team meetings and ACTIVE team
meetings?
RQ2: How do caregivers and team members engage in
collaborative communication during ACTIVE team
meetings?
METHODS
Data for this study were drawn from a larger, ongoing
randomized controlled trial that assesses caregiver clin-
ical outcomes associated with participation in ACTIVE
meetings. In this study, hospice family caregivers are ran-
domly assigned to one of two study conditions: standard
hospice care that consists of biweekly team meeting dis-
cussions of the patient’s case, or the ACTIVE meeting,
which involves the use of Web-based video-conferencing to
enable caregivers to virtually participate in team meetings.
Participants randomized to the ACTIVE meeting (interven-
tion group) are invited to participate in biweekly meetings
for the duration of their loved one’s hospice care. During
these team meetings, caregivers are asked whether they
have any questions or concerns to share with the hospice
team. In the standard care arm of the study, hospice patients
are discussed at the regular biweekly interdisciplinary team
meetings, but caregivers are not specifically asked to par-
ticipate. The location of hospice care is unchanged for
both groups. The study was approved by both the insti-
tutional review board at the supporting university and the
participating hospices.
Participants
8. Caregivers were recruited from two hospices in the
Midwestern United States. To participate in the study,
caregivers had to be at least 18 years of age and be the desig-
nated primary caregiver for a hospice patient (as determined
by hospice staff). The telemedicine component required a
high-speed Internet connection with a computer to partic-
ipate in the ACTIVE meeting with video. However, audio
participation was available with any telephone device.
Procedure
Following referral by hospice staff, a member of the research
team visited the family caregiver’s home to describe the
study and obtain informed consent to participate. Once con-
sent was obtained, all participating caregivers for the patient
were randomized into standard care or participation in
ACTIVE meetings. For those randomized to ACTIVE meet-
ings, the caregivers’ residential infrastructure was assessed
to determine technology needs. Caregivers with high-speed
Internet and a computer were provided with an instruc-
tional manual and given the website address and pass-
word for the video-conferencing website. ACTIVE meetings
were facilitated through Virtually InterACTIVE Families
(www.vifamilies.com), a company that provides secure,
encrypted, password-protected video-conferencing services.
To enhance technical quality, caregivers were loaned a Web
camera (webcam) and headphones to use during team meet-
ing participation. Caregivers who lacked adequate technol-
ogy to support video-conferencing were asked to participate
via telephone. Family caregivers were provided a designated
time and date to participate in each ACTIVE meeting, but
were not trained on what to do or say during the video
conference.
Standard team meeting discussions and ACTIVE team
9. meeting discussions for a random selection of consent-
ing caregivers were video-recorded. Standard team meet-
ings were recorded using a webcam and laptop computer.
To enable ACTIVE meetings in the hospice office, a web
camera was connected to a laptop computer with high-speed
Internet and the screen image was projected onto a televi-
sion screen for the view of the entire hospice team. This
connection allowed family members to have a visual image
of the team as well as a two-way conversation with them.
Software on the laptop video-recorded the interaction. The
research team member who recorded meetings also com-
pleted a seating chart of team members, identified only by
their profession.
Coding Instrument
The Roter Interaction Analysis System adapted for
telemedicine (RIAS-Telemed) (Miller & Nelson, 2005;
Nelson et al., 2010) was used to code video-recordings of
HOSPICE FAMILY CAREGIVERS 113
standard and ACTIVE team meetings. The RIAS tool is used
to study dialogue in medical interactions by treating talk,
defined in terms of utterances (sentences comprising a com-
plete thought), as the unit of analysis (Wakefield et al., 2008).
Using two primary categories of talk, task and
socioemotional, the RIAS is used to code utterances between
participants and classify utterances into a mutually exclusive
category concerning the function of the talk in the inter-
action. Socioemotional talk captures the affective dimen-
sion of the interaction and includes social talk (nonmed-
ical chitchat), positive talk (agreements, jokes), negative
10. talk (disagreements, criticism), emotional talk (concern,
empathy, reassurance), and participatory facilitators such as
asking for opinion and checking for understanding. Task-
focused behaviors include talk related to medical problem-
solving. The specific communication features of task-
focused behavior are data gathering and patient education
and counseling. Task-focused talk includes question asking,
information giving by the provider or the caregiver, para-
phrasing, transitioning, and counseling or directing behavior.
Within these functions, content areas are detailed and include
biomedical and psychosocial topics. The RIAS-Telemed
allows utterances that are technology specific (conversation
directly related to technological aspects of the interaction)
to be coded within RIAS categories. For example, partici-
pants who asked a question related to technical quality (“Can
you hear me, now?”) were coded as asking a closed-ended
technology-related question. Finally, because the RIAS had
not been used in a team setting, we added intrateam com-
munication as a category to capture instances when team
members spoke to each other as part of the interaction.
Examples include a team member telling another team mem-
ber that they would be visiting the patient on a certain day or
taking responsibility for overseeing a specific care task.
Coding was conducted directly from video recordings.
Using the RIAS-Telemed, three members of the research
team (EWL, AG, and KW) watched video-recordings of
standard hospice team meetings and ACTIVE team meet-
ings and categorized utterances by all participants (team
members and caregivers) into one of the RIAS-Telemed cat-
egories. To ensure intercoder reliability, coders participated
in six hours of training using eight team meeting discus-
sions that were not included in this data analysis. Coders
first independently coded three cases and then met to dis-
cuss and resolve differences and refine coding categories.
Next the coders independently coded five interactions and
11. Pearson’s r reliability statistic was used to test for intercoder
reliability. This resulted in an average reliability of r =.87
for all categories. Coders engaged in more discussion about
differences and developed definitive coding rules for future
coding. Each video-recorded team meeting in the data set
was double-coded by members of the research team and
all differences resolved through extended discussion. The
study’s small sample size prohibited assessment of reliability
statistics for specific categories.
Analysis
To compare communication differences between standard
and ACTIVE meetings, the number and percentage of utter-
ances in all categories were calculated (socioemotional,
task-focused, technology-related). The three general RIAS
categories are used to discern differences in collaborative
practices between medical team members (medical directors
and nurses) and nonmedical team members (social workers
and chaplains). We compared the number of utterances for
socioemotional and task-focused talk by each team mem-
ber between the two groups using paired t-tests. Finally, to
examine how caregivers and team members engage in collab-
orative communication during ACTIVE meetings, the mean,
range, and percentage for specific utterances and topic of
utterance were calculated.
RESULTS
A total of 40 team meeting discussions (20 standard,
20 ACTIVE) comprised the data set. With the excep-
tion of one ACTIVE team meeting, caregivers participated
via video-conferencing (one caregiver participated via tele-
phone). Table 1 provides an overview of caregiver and
patient demographics for the team meeting discussions
analyzed for this study. The average length of standard
12. meeting discussion of a patient’s case was 3 minutes 38 sec-
onds, ranging from 50 seconds to 6 minutes 40 seconds.
Comparatively, the average length of the ACTIVE meet-
ings was 9 minutes, ranging from 4 minutes to 19 minutes.
There were 385 utterances in standard team meetings and
1,186 utterances in ACTIVE team meetings, reflecting the
difference in meeting length. To explore communication
differences between standard and ACTIVE team meetings
(research question 1), we examined utterances by partic-
ipant (team member’s discipline, caregiver) and by the
two primary types of talk identified by the RIAS (task
and socioemotional). The total utterances for each meet-
ing type by participant categories and talk are shown in
Table 2.
Standard and ACTIVE team meeting discussions were
predominantly task focused (89% of talk in standard, 54%
of talk in ACTIVE), with more socioemotional talk clearly
occurring during ACTIVE meetings (32% of talk compared
to 11% in standard meetings). Social workers and chaplains
did not contribute socioemotional talk during standard team
meetings, yet 32% of social worker talk and 50% of chaplain
talk focused on socioemotional issues during ACTIVE meet-
ings. Nurses also devoted more socioemotional talk (28%
of talk) in ACTIVE meetings compared to standard meet-
ings (10%). Medical directors exhibited little change in talk
between meeting types. In ACTIVE meetings, only 13.7% of
talk related to the use of technology.
114 WITTENBERG-LYLES ET AL.
TABLE 1
Summary demographic variables for patients and caregivers
13. Variable Caregiver (n = 25) Patient (n = 23)
Diagnosis Not applicable
Cancer 17% (4)
Dementia 13% (3)
Other 69% (16)
Patient residency Not applicable
Home 48% (11)
Nursing home 52% (12)
Mean age 59.2 years (range 35–81) 85.5 years (range 64–96)
Sex
Female 80% (20) 78% (18)
Male 20% (5) 21% (5)
Race
White/Caucasian 84% (21) 83% (19)
Black/African-American 16% (4) 17% (4)
Education
Less than high school 8% (2) Not captured
High school 24% (6)
Some college 28% (7)
Undergraduate college
degree
16% (4)
Graduate/professional
degree
24% (6)
Caregiver employment
Not employed 8% (2)
14. Part-time 20% (5)
Full-time 28% (7)
Other 8% (2)
Retired 36% (9)
Relationship to patient
Spouse/partner 12% (3)
Adult child 64% (16)
Sibling 4% (1)
Other relative 20% (5)
TABLE 2
Summary table of utterances by participants and by meeting
type (n, %)
Standard meeting, type of talk Active meeting, Type of Talk
Team Members Socioemotional Task-Focused Total
Socioemotional Task-Focused Technology-Related Total
Medical
directors
20 (12%) 144 (88%) 164 (43%) 11 (13%) 73 (85%) 2 (2%) 86
(7%)
Nurses 16 (10%) 140 (90%) 156 (41%) 101 (28%) 236 (67%) 17
(5%) 354 (30%)
Social workers 0 15 (100%) 15 (4%) 29 (32%) 55 (60%) 7 (8%)
91 (8%)
Chaplains 0 6 (100%) 6 (1%) 17 (50%) 16 (47%) 1 (3%) 34
(3%)
Othera 6 (14%) 38 (84%) 44 (11%) 39 (28%) 39 (28%) 60
(43%) 138 (12%)
Caregivers 185 (38%) 222 (46%) 76 (16%) 483 (41%)
Total 42 (11%) 343 (89%) 385 (100%) 382 (32%) 641 (54%)
15. 163 (14%) 1, 186 (100%)
aHospice director/administrator and research personnel who
were responsible for facilitating use of the technology.
There was a noticeable change in contribution among
participants between standard and ACTIVE team meet-
ings. Social workers and chaplains were less verbally
active in standard team meetings, contributing only 5% of
talk in these discussions and contributing only task-related
talk. However, their overall contribution to team meeting
discussions doubled in ACTIVE meetings to 11% of total
talk. In contrast, nurses talked less overall (41% of all
HOSPICE FAMILY CAREGIVERS 115
utterances in standard; 30% of all utterances in ACTIVE).
The biggest decrease in contribution came from medical
directors, who went from 43% of total talk in standard meet-
ings to 7% of all talk during ACTIVE meetings. Caregivers
clearly dominated ACTIVE meetings with 483 utterances
(41% of all talk).
The between-group difference in mean number of
socioemotional and task-related utterances differed sig-
nificantly for some team members (Table 3). Mean
socioemotional utterances were higher in ACTIVE meet-
ings for nurses (p = .001), social workers (p < .001), and
chaplains (p = .005), but not for physicians or other partici-
pants. Mean task-related utterances were higher in ACTIVE
meetings for social workers (p = .009) but not for other team
members.
16. Communication between interdisciplinary team members
and family caregivers during ACTIVE meetings (research
question two) is summarized in Table 4. Physicians and
nurses engaged in more biomedical education than social
workers and chaplains, with nurses substantially domi-
nating caregiver education (an average of 4.45 utterances
per encounter). Social workers provided considerably more
psychosocial counseling, although psychosocial counseling
to caregivers was limited overall. Nurses asked the most
questions, with the majority of questions devoted to biomed-
ical rather than psychosocial topics. Nurses also dominated
rapport-building by engaging in emotional talk and positive
talk (e.g., complimenting the work of the caregiver), while
social workers and chaplains provided some emotional talk.
Medical directors engaged in little rapport-building with
caregivers compared to other team members. All team mem-
bers, with the exception of chaplains (0%), devoted 4% of
talk to partnering with caregivers by asking for their opin-
ion, understanding, or paraphrasing discussion. Procedural
TABLE 3
Comparison of utterances of socioemotional or task-related talk
between ACTIVE and standard
meetings, by type of team member [mean (95% confidence
interval)]
Team Member Type of Talk ACTIVE meeting Standard Meeting
p Valuea
RN Socioemotional 5.05 (3.14–6.96) 0.8 (0.29–1.31) .001
Task-related 11.8 (9.63–14.0) 7.0 (3.26–10.74) .08
Social worker Socioemotional 1.45 (0.84–2.06) 0.0 <.001
Task-related 2.75 (1.68–3.82) 0.75 (0.12–1.38) .009
17. Chaplain Socioemotional 0.85 (0.33–1.37) 0.0 .005
Task-related 0.80 (0.34–1.26) 0.3 (–0.05 to 0.65) .154
Physician Socioemotional 0.55 (0.09–1.01) 1.0 (0.08–1.92) .446
Task-related 3.65 (1.15–6.15) 7.2 (2.43–11.97) .223
Other Socioemotional 1.95 (0.31–3.59) 0.3 (–0.02 to 0.62) .065
Task-related 1.95 (0.10–3.80) 1.9 (1.05–2.75) .961
aPaired t-tests between ACTIVE and standard meetings, by
team member and type of communication. Utterances
by caregivers and technology-related utterances are not
included.
TABLE 4
Communication categories of utterances used by hospice
interdisciplinary team members and family caregivers during
ACTIVE meetings
Team member
Medical Directors Nurses Social Workers Chaplains Caregivers
RIAS category M R % M R % M R % M R % M R %
Education and counseling 24% 29% 47.5% 33% 38%
Biomedical .7 0–5 4.45 0–9 .6 0–4 .15 0–2 6.05 2–16
Psychosocial .25 0–3 .35 0–1 1.3 0–4 .40 0–2 1.7 0–7
Data gathering 11% 23% 9% 12% 11%
Biomedical .25 0–4 3.35 0–8 .1 0–1 .05 0–1 1.55 0–6
Psychosocial .2 0–3 .4 0–1 .25 0–2 .15 0–1 .75 0–2
Building a relationship 14% 29% 36% 52% 45%
Social .1 0–1 1.6 0–5 .5 0–3 .4 0–2 2.7 1–6
18. Positive .1 0–2 1.25 0–4 .5 0–3 .15 0–1 5.15 1–11
Emotional .35 0–3 1.9 0–11 .45 0–2 .3 0–2 1.25 0–6
Negative 0 0 0 0 0 0 0 0 .15 0–3
Partnering .15 0–3 4% .8 0–4 4% .15 0–2 4% 0 0 0 .3 0–1 2%
Procedural .15 0–3 4% .75 0–3 4.5% .05 0–1 1% 0 0 0 .2 0–2
1%
Intrateam communication 1.7 0–10 43% 1.75 0–8 10.5% .1 0–1
2.5% .05 0–1 3% n/a n/a n/a
Request for service n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a
.55 0–4 3%
Note. M = mean, R = range. Team member totals do not include
uninterpretable utterances, utterances related to technology, and
utterances made by
research staff and hospice administrators (n = 255). Caregiver
totals do not include uninterpretable utterances and utterances
related to technology (n = 76).
116 WITTENBERG-LYLES ET AL.
communication was also minimal and did not include con-
tributions by chaplains. Finally, medical directors and nurses
engaged in substantially more intrateam communication than
social workers and chaplains.
Similar to the team’s profile, biomedical education dom-
inated caregiver talk, with 3.5 times more biomedical dis-
closure occurring than psychosocial. Caregivers were also
twice as likely to ask questions about biomedical concerns
compared to psychosocial topics. Caregivers predominantly
worked to build a relationship with the health care team (45%
of all talk). Positive and social talk were substantially higher
than negative and emotional talk, corresponding with find-
19. ings regarding the team’s rapport-building profile, and illus-
trate acknowledgment of the team’s comments. Interestingly,
only 3% of caregiver talk was a request for service.
DISCUSSION
Family involvement in team meetings created a new pro-
fessional role for nurses, who emerged as informal lead-
ers. Although physicians have long been considered the
hierarchical figure in health care teams, hospice services
are largely nurse-driven, and this study illustrates nurses’
dominant role in hospice care. The large number of utter-
ances between medical directors and nurses suggests that
hospice nurses negotiate the role of subordinate-yet-equal
team members during standard team meetings, supporting
earlier work on nurse–physician relationships (Apker, Propp,
& Ford, 2005). Given that task talk was the focus of stan-
dard hospice team meetings, it was not surprising that the
biomedical focus of ACTIVE meetings was influenced by
nurses, who asked the most questions and provided the most
education and counseling on biomedical topics.
Hospice medical directors talked much less during
ACTIVE team meetings than during standard meet-
ings, neglecting the opportunity for rapport-building with
caregivers and instead opting to focus more on intrateam
communication. Unlike nurses, hospice medical directors
typically do not make home visits or assume the role of the
attending physician and thus do not develop relationships
with caregivers. The high presence of intrateam communi-
cation by medical directors illustrates that family involve-
ment enhances team member interdependence and flexibility.
By engaging in intrateam communication, medical directors
accommodate the nurse’s hierarchical position by maintain-
ing autonomy and contributing to patient or team goals as
peers rather then as leaders (Apker, Propp, & Ford, 2005).
20. With new regulations now requiring face-to-face visits by
medical directors, more attention will need to be paid to
a visit’s impact on family caregiver communication, care
planning, and caregiver satisfaction.
While family involvement removes the supportive nature
of the nurse’s role in the medical director–nurse relation-
ship, it also enacts the nurse’s position as superior to other
lower status team members (Apker, Propp, & Ford, 2005).
Hospice social workers and chaplains spoke considerably
less than nurses and medical directors did in both standard
and ACTIVE meetings. The lack of participation among
these nonmedical team members reveals a lack of collective
ownership of goals. However, family involvement increased
participation from social workers and chaplains who con-
tributed socioemotional talk. Although collaboration among
hospice team members commonly occurs outside of team
meetings, social workers had higher task-related talk in
ACTIVE meetings. Although limited, contribution among
all team members as well as caregivers during ACTIVE
meetings suggests collective ownership of goals among all
parties.
The organizational context and team structure influenced
communication between caregivers and team members.
Caregivers were invited to participate in already scheduled,
predetermined team meeting discussions. Caregivers did not
have flexibility regarding team meeting day, time or duration.
Consequently, ACTIVE meetings were similar to physician–
patient interactions, as caregivers and team members were
mutually influenced by one another and primarily engaged
in positive and social talk to facilitate the interaction. While
this resulted in an increase in socioemotional talk compared
to standard meetings, it is important to note that this was
primarily due to social etiquette and limited to greetings.
21. Caregiver positive talk was five times more likely than emo-
tional talk, revealing that socioemotional talk overall was
still restricted.
Appropriate introductions of all team members were pro-
vided to family caregivers in order to reduce anxiety and
increase understanding. However, there were often team
members on call for other team members, and caregivers
were not always clear on the roles of team members (i.e.,
specific disciplines). It may be helpful to provide caregivers
with a handout about their role in hospice care in terms of the
team structure and a template of participating team mem-
bers. Anecdotally, when caregivers were asked if they had
any concerns, many reported that there were no concerns but
they worried about the patient. More work needs to be done
to determine concrete caregiver task needs from emotional
support needs.
Important implications for how team meeting commu-
nication impacts care outcomes should be noted from the
study results. In hospice care, the team’s reflection on out-
comes should emphasize holistic pain control (physical,
psychological, social, spiritual) and caregiver bereavement
and satisfaction. Previous work has found that hospice
interdisciplinary teams engage in little collaboration dur-
ing care planning discussions and there are deficiencies
in information sharing between team members (Demiris,
Washington, Parker Oliver, & Wittenberg-Lyles, 2008).
Standard team meetings in this study predominantly con-
sisted of medical directors and nurses talking about the
patient’s case; the absence of contribution by social workers
HOSPICE FAMILY CAREGIVERS 117
22. and chaplains provides further evidence for collaboration
deficiencies. Holistic pain control cannot be accomplished
if nonmedical and medical team members do not contribute
equally during team meetings and if socioemotional aspects
of care are not addressed during care planning.
With few tele-health interventions specifically designed
for hospice care, this study has several implications
for telemedicine delivery (Demiris, Parker Oliver, &
Wittenberg-Lyles, 2011). First, the study shows that the use
of technology among a variety of hospice end users, includ-
ing different professional disciplines and family caregivers,
is feasible. The diffusion of technological tools in hospice
care is impacted by challenges such as user acceptance and
privacy. The low use of technology-related categories in this
study was congruent with other telemedicine research using
the RIAS instrument (Nelson et al., 2010), and caregivers in
this study demonstrate technological utilization among fam-
ily caregivers. More importantly, this study extends the use
and function of technology in hospice care as a communica-
tion tool rather then a tool to deliver one time primary care.
Our findings demonstrate that a video-conferencing platform
can facilitate the virtual participation of caregivers, allowing
them to communicate with all team members and engage in
meaningful conversations.
Second, staff members who use tele-health technology
need to learn how to practice patient-centered commu-
nication via video-conferencing (Wakefield et al., 2008).
Congruent with similar investigations of telemedicine inter-
actions, hospice team members had the most utterances
and directed the conversation (Nelson et al., 2010). In par-
ticular, nurses played a dominant role in ACTIVE meet-
ings. Prior research has found that nurses are more likely
to ask open-ended questions, communicate listening, and
make jokes on the telephone when compared to video-
23. mediated interactions (Wakefield et al., 2008). More research
is needed to train team members to elicit caregiver participa-
tion and engage in patient-centered communication during
telemedicine encounters.
Limitations
Communication patterns found in this study may be unique
to the hospice setting. Federally required team meetings sus-
tain an exclusive context for collaborative care planning.
A limitation of this study is that care planning discussions
for all patients were not captured; video-recordings of team
meetings only occurred for discussions about patients who
provided consent for the study. As a result, some team
talk could not be included for study analysis. Additionally,
study results could have benefitted from further examina-
tion of specific team documentation about care planning.
Care planning discussions are recorded in patient medical
charts and a comparison between the team’s perceived col-
laboration, and actual occurrences might have revealed the
team’s perceptions of the caregivers and whether or not
caregiver involvement impacted care planning documenta-
tion. Finally, the number of team members varied between
the participating hospice agencies and this study did not
take into account the size of the hospice team involved in
ACTIVE meetings. Larger groups might have influenced the
caregiver’s willingness and ability to participate in ACTIVE
meetings. Although this study is limited by a small sample
size of limited diversity, it provides insight on caregiver–
clinician interaction and raises questions about hospice team
meetings.
ACKNOWLEDGMENTS
This project was supported by award R01NR011472 from
24. the National Institute of Nursing Research. The content is
solely the responsibility of the authors and does not neces-
sarily represent the official views of the National Institute of
Nursing Research or the National Institutes of Health.
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