The document appears to be a team project for a class on creating change within organizations. It discusses osteoporosis prevention guidelines and implementing them within a healthcare organization. It covers assessing organizational readiness for change, developing an implementation plan including education and screening programs, and evaluating the outcomes of guideline implementation.
The document discusses quality improvement in healthcare and defines it as using systems-based approaches to evaluate and implement change. It notes that professions are defined by continuously improving what they do, not just doing it well. A common model for quality improvement is presented as identifying deficits, analyzing them, and developing improvement plans. Learning methods discussed include learning packages, in-services, reflection/debriefing, and situated learning through authentic contexts and social interaction within communities of practice.
Colin Jones presented a case study on his client Eileen, a 68-year-old woman diagnosed with Guillain-Barré syndrome. Eileen was dependent on others for activities of daily living and mobility following her illness. The occupational therapy process included assessments, goal setting to improve independence, and recommending Eileen for rehabilitation. Interventions targeted improving upper limb function and mobility to allow Eileen to return safely to her two-story home.
Characteristics of successful changes in health care organizations: an interv...BenDarling7
Health care organizations are constantly changing as a result of technological advancements, ageing
populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and
policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable
environment. The present study poses the question: what characterizes successful organizational changes in health
care? The aim was to investigate the characteristics of changes of relevance for the work of health care
professionals that they deemed successful
An Evidence-Based Synthesis of Dementia Caregiver Interventionsjgaugler
The document summarizes the author's evidence-based review of interventions for dementia caregivers. The author conducted a systematic search and appraisal of the literature. They analyzed the evidence for different intervention types, including psychoeducation, support groups, respite care, psychotherapy, and multi-component interventions. The evidence was mixed, but multi-component, individualized interventions that were flexible and ongoing showed the most benefit in improving caregiver outcomes and delaying nursing home placement. The author concludes more research is still needed due to limitations in existing studies.
1) The document discusses the importance of developing core outcome sets (COS) for clinical trials through consensus processes that meaningfully incorporate input from patients. COS ensure consistency across trials by specifying a minimum set of outcomes to measure.
2) Involving patients in determining what health outcomes to measure in COS is crucial because patients can identify which outcomes have the greatest impact on their lives. Their input also helps prevent selective reporting of outcomes in trials.
3) Developing COS through consensus processes that engage patients, healthcare providers, and other stakeholders from the beginning can launch trials with outcomes relevant to all groups. This maximizes the usefulness of research data.
Therapeutic Use of Technology: Case-based Clinical Reasoning with Everyday Te...umrobot
This document provides an overview of using technology therapeutically in occupational therapy. It begins with learning objectives around describing, relating, analyzing, and integrating the therapeutic use of technology. It then discusses using both traditional and innovative technology-based interventions. The rest of the document discusses various technologies like virtual reality and their effectiveness for stroke rehabilitation. It also discusses limitations, considerations for clinical practice, and case studies applying a clinical reasoning process to select appropriate technologies.
Gender Perspectives Improve Reproductive Health Outcomes: New Evidence Dr Lendy Spires
In 2004, the Inter-agency Gender Working Group (IGWG) published The “So What?” Report: A Look at Whether Integrating a Gender Focus into Programs Makes a Difference to Outcomes. The 2004 report presented evidence of the value of integrating gender into programs for promoting positive reproductive health (RH) and gender outcomes.
The purpose of this new 2009 review is to assemble the latest data and update the evidence as to what difference it makes when a gender perspective is incorporated into RH programs. The review focuses on five components of reproductive health programs, including interventions related to: n Unintended pregnancy; n Maternal health; n HIV/AIDS and other STIs; n Harmful practices, including early marriage, female genital mutilation/cutting, and gender- based violence; and n Youth.
The authors examined gender-related barriers to each component of reproductive health and the strategies undertaken by programs to address the barriers. Out of nearly 200 interventions reviewed, 40 are included here as examples of programs that integrate gender to improve reproductive health outcomes.
The interventions selected for inclusion were limited to those that have been evaluated— meaning they established criteria for assessment that were related to the goals of the intervention and followed an evaluation design—and that used accommodating or trans-formative approaches. The results of these pro-grams suggest that the field is evolving toward a deeper understanding of what gender equality entails and a stronger commitment to pursue this equality in reproductive health programs. Reducing Unintended Pregnancies Several of the projects to reduce unintended pregnancy countered the traditional practice of aiming family planning (FP) services at women only; they encouraged husbands and other males to take more responsibility in this area.
The strategies included enlistment of men who hold power, such as community or religious leaders, to support FP; influencing husbands to encourage their wives to use FP services; and providing a male-controlled contraceptive method. Other projects encouraged joint decision making, shared responsibility in FP, and the institutionalization of gender into RH services.
The document discusses quality improvement in healthcare and defines it as using systems-based approaches to evaluate and implement change. It notes that professions are defined by continuously improving what they do, not just doing it well. A common model for quality improvement is presented as identifying deficits, analyzing them, and developing improvement plans. Learning methods discussed include learning packages, in-services, reflection/debriefing, and situated learning through authentic contexts and social interaction within communities of practice.
Colin Jones presented a case study on his client Eileen, a 68-year-old woman diagnosed with Guillain-Barré syndrome. Eileen was dependent on others for activities of daily living and mobility following her illness. The occupational therapy process included assessments, goal setting to improve independence, and recommending Eileen for rehabilitation. Interventions targeted improving upper limb function and mobility to allow Eileen to return safely to her two-story home.
Characteristics of successful changes in health care organizations: an interv...BenDarling7
Health care organizations are constantly changing as a result of technological advancements, ageing
populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and
policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable
environment. The present study poses the question: what characterizes successful organizational changes in health
care? The aim was to investigate the characteristics of changes of relevance for the work of health care
professionals that they deemed successful
An Evidence-Based Synthesis of Dementia Caregiver Interventionsjgaugler
The document summarizes the author's evidence-based review of interventions for dementia caregivers. The author conducted a systematic search and appraisal of the literature. They analyzed the evidence for different intervention types, including psychoeducation, support groups, respite care, psychotherapy, and multi-component interventions. The evidence was mixed, but multi-component, individualized interventions that were flexible and ongoing showed the most benefit in improving caregiver outcomes and delaying nursing home placement. The author concludes more research is still needed due to limitations in existing studies.
1) The document discusses the importance of developing core outcome sets (COS) for clinical trials through consensus processes that meaningfully incorporate input from patients. COS ensure consistency across trials by specifying a minimum set of outcomes to measure.
2) Involving patients in determining what health outcomes to measure in COS is crucial because patients can identify which outcomes have the greatest impact on their lives. Their input also helps prevent selective reporting of outcomes in trials.
3) Developing COS through consensus processes that engage patients, healthcare providers, and other stakeholders from the beginning can launch trials with outcomes relevant to all groups. This maximizes the usefulness of research data.
Therapeutic Use of Technology: Case-based Clinical Reasoning with Everyday Te...umrobot
This document provides an overview of using technology therapeutically in occupational therapy. It begins with learning objectives around describing, relating, analyzing, and integrating the therapeutic use of technology. It then discusses using both traditional and innovative technology-based interventions. The rest of the document discusses various technologies like virtual reality and their effectiveness for stroke rehabilitation. It also discusses limitations, considerations for clinical practice, and case studies applying a clinical reasoning process to select appropriate technologies.
Gender Perspectives Improve Reproductive Health Outcomes: New Evidence Dr Lendy Spires
In 2004, the Inter-agency Gender Working Group (IGWG) published The “So What?” Report: A Look at Whether Integrating a Gender Focus into Programs Makes a Difference to Outcomes. The 2004 report presented evidence of the value of integrating gender into programs for promoting positive reproductive health (RH) and gender outcomes.
The purpose of this new 2009 review is to assemble the latest data and update the evidence as to what difference it makes when a gender perspective is incorporated into RH programs. The review focuses on five components of reproductive health programs, including interventions related to: n Unintended pregnancy; n Maternal health; n HIV/AIDS and other STIs; n Harmful practices, including early marriage, female genital mutilation/cutting, and gender- based violence; and n Youth.
The authors examined gender-related barriers to each component of reproductive health and the strategies undertaken by programs to address the barriers. Out of nearly 200 interventions reviewed, 40 are included here as examples of programs that integrate gender to improve reproductive health outcomes.
The interventions selected for inclusion were limited to those that have been evaluated— meaning they established criteria for assessment that were related to the goals of the intervention and followed an evaluation design—and that used accommodating or trans-formative approaches. The results of these pro-grams suggest that the field is evolving toward a deeper understanding of what gender equality entails and a stronger commitment to pursue this equality in reproductive health programs. Reducing Unintended Pregnancies Several of the projects to reduce unintended pregnancy countered the traditional practice of aiming family planning (FP) services at women only; they encouraged husbands and other males to take more responsibility in this area.
The strategies included enlistment of men who hold power, such as community or religious leaders, to support FP; influencing husbands to encourage their wives to use FP services; and providing a male-controlled contraceptive method. Other projects encouraged joint decision making, shared responsibility in FP, and the institutionalization of gender into RH services.
For elderly patients at risk of falls in long-term care, a nurse-led exercise program aimed at improving strength and balance, conducted twice weekly for six months, may reduce fall incidence compared to no such program. The proposed program would train nurses to lead classes incorporating balance, coordination, and lower body exercises shown to lower fall risks. Patients' balance, strength, self-efficacy, and fall risks would be measured before, during, and after the six-month program to evaluate its effectiveness in reducing falls.
This document discusses the Magnet Recognition Program (MRP), which is a designation given by the American Nurses Credentialing Center (ANCC) to healthcare organizations that meet standards of nursing excellence. The MRP promotes transformational leadership, empowered nurses, and the dissemination of best nursing practices. Achieving Magnet Designation requires undergoing a rigorous application and review process. Doing so helps organizations improve nurse retention, satisfaction, and outcomes for patients.
The document summarizes a presentation about the Wellness Network at The University of Texas at Austin. The Wellness Network is a campus-wide coalition committed to assessing and addressing the health and wellness needs of students, faculty, and staff. It brings together advocates from across campus to share resources and strategies. Its goal is to create a healthy campus environment where healthy choices are easy. The Network has an executive committee and various members from across campus involved in subcommittees. It conducts assessments of campus health and wellness needs, communicates resources to the community, and develops programs and policies to address priority health issues through collaboration.
This document discusses an integrative training model that creates partnerships between resident physicians and behavioral science trainees. The model aims to provide integrated training to address the biopsychosocial aspects of healthcare. Behavioral science trainees take on clinical, consultation, educational, and research roles within medical residency programs. Strategies are discussed for infusing integrative training using the ACGME core competencies and creating healthcare partnerships after training to meet patient needs.
This document provides descriptions of 10 fall prevention programs. The programs aim to improve balance, strength, and mobility and reduce fall risk through physical activity and education. They vary in intensity, components, target audiences, and evidence of effectiveness. Most show improvements in factors like balance, mobility, and strength, with some demonstrating reduced fall rates. The document is intended to help providers select suitable programs given client needs and resource constraints.
Tolson, jennifer mental health services and weight loss surgery nfjca v4... (1)William Kritsonis
Dr. William Allan Kritsonis has served as an elementary school teacher, elementary and middle school principal, superintendent of schools, director of student teaching and field experiences, professor, author, consultant, and journal editor. Dr. Kritsonis has considerable experience in chairing PhD dissertations and master thesis and has supervised practicums for teacher candidates, curriculum supervisors, central office personnel, principals, and superintendents. He also has experience in teaching in doctoral and masters programs in elementary and secondary education as well as educational leadership and supervision. He has earned the rank as professor at three universities in two states, including successful post-tenure reviews.
Steve Iliffe: Encouraging innovative approaches and policies to improve prima...The King's Fund
Steve Iliffe, Professor of Primary Care for Older People at University College London, spoke at our conference Making health and care services fit for an ageing population. Steve championed an innovative approach to primary care and explains what we need to do to achieve this.
This document outlines a plan to implement daily family-centered interdisciplinary rounds (FCIR) in a 116-bed general pediatrics unit. A project team consisting of medical and nursing administrators and staff will lead the implementation. They will assess client needs, staff willingness to change, and existing workflows. An operational change model will be used, starting with gathering information, getting feedback, building consensus, creating an action plan, and monitoring performance. Challenges may include time constraints, changes to daily routines, and resistance to change. Both top-down and bottom-up strategic approaches will be considered.
- The team focused on how untimely patient report delivery has affected the organization's reputation and devised strategies to address this problem.
- They also considered the best leadership style to apply in this situation to achieve better outcomes, determining that a transformational or contingency leadership approach would be most effective.
- Addressing the root causes of delays through rational decision-making was proposed as the best way to solve this multifaceted issue.
Presented before the International Council of Nurses in Durban, South Africa. Contact me for more information on creating a Positive Practice Environment.
This webinar discussed tools developed by AHRQ to measure and evaluate clinical-community relationships. An expert panel developed a conceptual framework and used it to create an Atlas with 22 existing measures of relationships. They also produced a Roadmap identifying priority areas of study to improve care coordination between clinical and community settings. The tools are meant to help build the evidence base around partnerships that promote integrated preventive services and fill gaps in needed care.
American Research Journal of Humanities & Social Science (ARJHSS) is a double blind peer reviewed, open access journal published by (ARJHSS).
The main objective of ARJHSS is to provide an intellectual platform for the international scholars. ARJHSS aims to promote interdisciplinary studies in Humanities & Social Science and become the leading journal in Humanities & Social Science in the world.
At the end of this presentation, the readers will be able to:
Define what is shared governance
Concepts of shared governance in nursing
History of shared governance
Contributing factors towards shared governance
Action towards shared governance
Growing needs in shared governance for collaboration, engagement in HealthCare Practices
Governance Models
Appreciate shared governance
Implementation of shared governance
This document discusses systems and microsystems in healthcare. It defines a microsystem as a small group of people who work together regularly to provide services to patients. Microsystems aim to do work, meet patient needs, and maintain themselves while producing quality, safety, and cost outcomes. The document presents theories of systems and microsystems, how microsystems fit within larger healthcare systems, and characteristics of clinical microsystems. It provides an example of how improving microsystems can improve overall healthcare quality and the patient experience.
This document summarizes microsystem tools used in health care. It begins with an overview of microsystems and their elements, including health professional teams, defined target populations, knowledge support, and support staff/equipment. Several tools are then described, including the 5 P Tool, Clinical Microsystem Assessment Tool, Clinical Compass Worksheet, Clinical Improvement Worksheet, and STAR Mapping Worksheet. An example case study application of the Clinical Improvement Worksheet during a care delivery model redesign is provided. References conclude the summary.
The document discusses clinical microsystems, which are small groups of healthcare professionals and staff who work together to provide care for a defined patient population. A clinical microsystem has shared goals, processes, an information environment, and is responsible for performance outcomes. The microsystem framework can be used to analyze various care settings from outpatient clinics to hospital units. Implementing microsystem approaches can improve patient safety, staff engagement, and overall performance.
This document defines a clinical microsystem as a small group of clinicians and staff who work together to provide care for a defined patient population. It discusses the key components of clinical microsystems, including their purpose, processes, patients, people, and patterns. The document also outlines the benefits of using a microsystem approach to improve quality, safety, efficiency and staff satisfaction. Some negatives discussed are that microsystems can be complex and dynamic, and some may blame failures on the system.
Positive Work Environments Arthur Pease NURS 750 Paper RArthur Pease MS RN
This document summarizes research on creating positive work environments for nurses. It begins by discussing the Job Demand Control Support model developed by Karasek and Theorell in 1981 and 1992, which found that work environments with high demands, low control, and little support are associated with increased stress and poor health outcomes. Several studies are then summarized that apply this model to nursing and examine how factors like bullying, individual characteristics, learning opportunities, and authentic leadership can impact work environment and job satisfaction. The document concludes by discussing recommendations for improving retention of new nurses through supportive work environments.
Riskilaste konverents 2012: Willy Tore Morch: Integrated services in primary...Sotsiaalministeerium
The document describes an integrated service model called "The Family's House" for providing primary health care and social services to children, adolescents, and families. The Family's House coordinates these services locally to improve health outcomes through universal, selective, and indicated prevention programs. Implementation involves assessing community needs, gaining agency support, training staff, and long-term supervision to ensure high-quality, sustainable services.
This document discusses the importance of evaluating a clinical microsystem before implementing quality improvement changes. It defines a microsystem as a small team that provides care to a discrete patient population. Evaluating the microsystem using the "5 P's" - purpose, patients, professionals, processes, and patterns - provides an understanding of the current state. This understanding is necessary to develop effective improvements and avoid unintended consequences.
nursing professions' current and future international roleStingray67
This document discusses the current and future international role of the nursing profession. It addresses several key areas for the nursing profession globally, including the delivery of evidence-based care, continuing professional development, and increasing political involvement in policy development. It also emphasizes the need for standardized nursing education and licensure internationally. The document notes that a major global healthcare crisis is the nursing shortage, which compromises patient safety and the ability to provide excellent care. It stresses the importance of focusing on continuing education and awareness of cultural diversity for nurses internationally.
This document provides information and guidance for staff education on chest pain. It discusses the target audience which includes ER nurses, student nurses, and other hospital staff. Generational differences in communication and learning styles are reviewed. Diversity among staff in terms of language, skills, beliefs, and other factors is addressed. Teaching methods like demonstrations, discussions of EKG rhythms, and skills practice are proposed. Evaluation of learning objectives can involve observations, student/instructor feedback, and skills assessments. Consideration of diverse learners and effective instructional design is emphasized.
For elderly patients at risk of falls in long-term care, a nurse-led exercise program aimed at improving strength and balance, conducted twice weekly for six months, may reduce fall incidence compared to no such program. The proposed program would train nurses to lead classes incorporating balance, coordination, and lower body exercises shown to lower fall risks. Patients' balance, strength, self-efficacy, and fall risks would be measured before, during, and after the six-month program to evaluate its effectiveness in reducing falls.
This document discusses the Magnet Recognition Program (MRP), which is a designation given by the American Nurses Credentialing Center (ANCC) to healthcare organizations that meet standards of nursing excellence. The MRP promotes transformational leadership, empowered nurses, and the dissemination of best nursing practices. Achieving Magnet Designation requires undergoing a rigorous application and review process. Doing so helps organizations improve nurse retention, satisfaction, and outcomes for patients.
The document summarizes a presentation about the Wellness Network at The University of Texas at Austin. The Wellness Network is a campus-wide coalition committed to assessing and addressing the health and wellness needs of students, faculty, and staff. It brings together advocates from across campus to share resources and strategies. Its goal is to create a healthy campus environment where healthy choices are easy. The Network has an executive committee and various members from across campus involved in subcommittees. It conducts assessments of campus health and wellness needs, communicates resources to the community, and develops programs and policies to address priority health issues through collaboration.
This document discusses an integrative training model that creates partnerships between resident physicians and behavioral science trainees. The model aims to provide integrated training to address the biopsychosocial aspects of healthcare. Behavioral science trainees take on clinical, consultation, educational, and research roles within medical residency programs. Strategies are discussed for infusing integrative training using the ACGME core competencies and creating healthcare partnerships after training to meet patient needs.
This document provides descriptions of 10 fall prevention programs. The programs aim to improve balance, strength, and mobility and reduce fall risk through physical activity and education. They vary in intensity, components, target audiences, and evidence of effectiveness. Most show improvements in factors like balance, mobility, and strength, with some demonstrating reduced fall rates. The document is intended to help providers select suitable programs given client needs and resource constraints.
Tolson, jennifer mental health services and weight loss surgery nfjca v4... (1)William Kritsonis
Dr. William Allan Kritsonis has served as an elementary school teacher, elementary and middle school principal, superintendent of schools, director of student teaching and field experiences, professor, author, consultant, and journal editor. Dr. Kritsonis has considerable experience in chairing PhD dissertations and master thesis and has supervised practicums for teacher candidates, curriculum supervisors, central office personnel, principals, and superintendents. He also has experience in teaching in doctoral and masters programs in elementary and secondary education as well as educational leadership and supervision. He has earned the rank as professor at three universities in two states, including successful post-tenure reviews.
Steve Iliffe: Encouraging innovative approaches and policies to improve prima...The King's Fund
Steve Iliffe, Professor of Primary Care for Older People at University College London, spoke at our conference Making health and care services fit for an ageing population. Steve championed an innovative approach to primary care and explains what we need to do to achieve this.
This document outlines a plan to implement daily family-centered interdisciplinary rounds (FCIR) in a 116-bed general pediatrics unit. A project team consisting of medical and nursing administrators and staff will lead the implementation. They will assess client needs, staff willingness to change, and existing workflows. An operational change model will be used, starting with gathering information, getting feedback, building consensus, creating an action plan, and monitoring performance. Challenges may include time constraints, changes to daily routines, and resistance to change. Both top-down and bottom-up strategic approaches will be considered.
- The team focused on how untimely patient report delivery has affected the organization's reputation and devised strategies to address this problem.
- They also considered the best leadership style to apply in this situation to achieve better outcomes, determining that a transformational or contingency leadership approach would be most effective.
- Addressing the root causes of delays through rational decision-making was proposed as the best way to solve this multifaceted issue.
Presented before the International Council of Nurses in Durban, South Africa. Contact me for more information on creating a Positive Practice Environment.
This webinar discussed tools developed by AHRQ to measure and evaluate clinical-community relationships. An expert panel developed a conceptual framework and used it to create an Atlas with 22 existing measures of relationships. They also produced a Roadmap identifying priority areas of study to improve care coordination between clinical and community settings. The tools are meant to help build the evidence base around partnerships that promote integrated preventive services and fill gaps in needed care.
American Research Journal of Humanities & Social Science (ARJHSS) is a double blind peer reviewed, open access journal published by (ARJHSS).
The main objective of ARJHSS is to provide an intellectual platform for the international scholars. ARJHSS aims to promote interdisciplinary studies in Humanities & Social Science and become the leading journal in Humanities & Social Science in the world.
At the end of this presentation, the readers will be able to:
Define what is shared governance
Concepts of shared governance in nursing
History of shared governance
Contributing factors towards shared governance
Action towards shared governance
Growing needs in shared governance for collaboration, engagement in HealthCare Practices
Governance Models
Appreciate shared governance
Implementation of shared governance
This document discusses systems and microsystems in healthcare. It defines a microsystem as a small group of people who work together regularly to provide services to patients. Microsystems aim to do work, meet patient needs, and maintain themselves while producing quality, safety, and cost outcomes. The document presents theories of systems and microsystems, how microsystems fit within larger healthcare systems, and characteristics of clinical microsystems. It provides an example of how improving microsystems can improve overall healthcare quality and the patient experience.
This document summarizes microsystem tools used in health care. It begins with an overview of microsystems and their elements, including health professional teams, defined target populations, knowledge support, and support staff/equipment. Several tools are then described, including the 5 P Tool, Clinical Microsystem Assessment Tool, Clinical Compass Worksheet, Clinical Improvement Worksheet, and STAR Mapping Worksheet. An example case study application of the Clinical Improvement Worksheet during a care delivery model redesign is provided. References conclude the summary.
The document discusses clinical microsystems, which are small groups of healthcare professionals and staff who work together to provide care for a defined patient population. A clinical microsystem has shared goals, processes, an information environment, and is responsible for performance outcomes. The microsystem framework can be used to analyze various care settings from outpatient clinics to hospital units. Implementing microsystem approaches can improve patient safety, staff engagement, and overall performance.
This document defines a clinical microsystem as a small group of clinicians and staff who work together to provide care for a defined patient population. It discusses the key components of clinical microsystems, including their purpose, processes, patients, people, and patterns. The document also outlines the benefits of using a microsystem approach to improve quality, safety, efficiency and staff satisfaction. Some negatives discussed are that microsystems can be complex and dynamic, and some may blame failures on the system.
Positive Work Environments Arthur Pease NURS 750 Paper RArthur Pease MS RN
This document summarizes research on creating positive work environments for nurses. It begins by discussing the Job Demand Control Support model developed by Karasek and Theorell in 1981 and 1992, which found that work environments with high demands, low control, and little support are associated with increased stress and poor health outcomes. Several studies are then summarized that apply this model to nursing and examine how factors like bullying, individual characteristics, learning opportunities, and authentic leadership can impact work environment and job satisfaction. The document concludes by discussing recommendations for improving retention of new nurses through supportive work environments.
Riskilaste konverents 2012: Willy Tore Morch: Integrated services in primary...Sotsiaalministeerium
The document describes an integrated service model called "The Family's House" for providing primary health care and social services to children, adolescents, and families. The Family's House coordinates these services locally to improve health outcomes through universal, selective, and indicated prevention programs. Implementation involves assessing community needs, gaining agency support, training staff, and long-term supervision to ensure high-quality, sustainable services.
This document discusses the importance of evaluating a clinical microsystem before implementing quality improvement changes. It defines a microsystem as a small team that provides care to a discrete patient population. Evaluating the microsystem using the "5 P's" - purpose, patients, professionals, processes, and patterns - provides an understanding of the current state. This understanding is necessary to develop effective improvements and avoid unintended consequences.
nursing professions' current and future international roleStingray67
This document discusses the current and future international role of the nursing profession. It addresses several key areas for the nursing profession globally, including the delivery of evidence-based care, continuing professional development, and increasing political involvement in policy development. It also emphasizes the need for standardized nursing education and licensure internationally. The document notes that a major global healthcare crisis is the nursing shortage, which compromises patient safety and the ability to provide excellent care. It stresses the importance of focusing on continuing education and awareness of cultural diversity for nurses internationally.
This document provides information and guidance for staff education on chest pain. It discusses the target audience which includes ER nurses, student nurses, and other hospital staff. Generational differences in communication and learning styles are reviewed. Diversity among staff in terms of language, skills, beliefs, and other factors is addressed. Teaching methods like demonstrations, discussions of EKG rhythms, and skills practice are proposed. Evaluation of learning objectives can involve observations, student/instructor feedback, and skills assessments. Consideration of diverse learners and effective instructional design is emphasized.
The document discusses Barbara McDonagh's work as an asthma clinic nurse. It provides information on asthma as a chronic disease, common symptoms, nursing assessments of asthma patients, evidence-based interventions nurses provide including teaching self-management skills and using asthma action plans, and facts about the prevalence and costs of asthma in the United States.
This document provides an overview of Chinese culture and health beliefs and practices. It discusses that China has over 1 billion people and the Chinese population worldwide is the largest. Chinese traditional medicine focuses on balance and views illness as an imbalance. The Chinese may use both traditional and Western medicines. The document also examines health issues like depression and alcoholism among Chinese populations and assesses the use of transcultural nursing theories to provide culturally competent care.
The Health Systems Administration program at Georgetown has its students complete case projects for a fictional community, Middleboro. Throughout the program we created several deliverables: Community Profile, Community Health Assessment, Strategic Plan, Marketing Plan, and Business Plan.
The document provides a business plan for a proposed Community Health Clinic (CHC) operated by 2BWell, Inc. The plan outlines the problem of needing to increase patient volume at the current clinic to become self-sustaining. It then analyzes the target market, competitors, and identifies opportunities to increase revenue and reduce costs for the CHC, including maintaining the status quo, establishing an associateship practice for recent graduates, donating space to a local naturopathic college, operating the CHC on Saturdays, or integrating CHC patients into the private practice. Financial projections are provided for several of the opportunities. The overall goal is for the CHC to operate independently from 2BWell and be financially self-
The document describes plans to establish an Asthma Clinic within the emergency center of DHA Medical Center. The clinic will provide rapid treatment to patients experiencing asthma exacerbation and other respiratory issues. It will be led by the Emergency Center Director of Nurses and Medical Director. The clinic aims to treat 10% of emergency center patients and generate over $5 million in annual revenue while preventing worsening symptoms and issues. Operations will be evaluated weekly, monthly and annually to ensure objectives are met.
Bringing the Social Media Revolution to Health Care (and Denmark)Lee Aase
My slides from a presentation at Mayo Clinic in Rochester, Minn. to visitors from Odense University Hospital and the Institute of Clinical Research at the University of Southern Denmark.
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
This document discusses factors related to developing and implementing a diversity and inclusion template for sustainability across settings in healthcare. It identifies several key factors to consider, including the characteristics of the intervention, contextual factors in the environment, and strategies to promote sustainability. Methods for measuring adoption, outcomes and effectiveness are discussed. Frameworks for evaluating sustainability at the organizational and system level are also presented. The document provides references to support the concepts discussed.
This document provides an introduction to evidence-based practice (EBP) for nurses. It defines EBP as incorporating the best available scientific evidence, clinical expertise, and patient preferences. The document notes that while EBP is crucial for improving quality of care, only 15% of current nursing practice is scientifically validated. Barriers to EBP include limited time and lack of skills/confidence to implement it. The document recommends regular education programs to teach nurses how to find, evaluate, and apply research evidence through the five steps of EBP. Implementing EBP can empower nurses and improve patient outcomes, clinical excellence, and job satisfaction.
The document discusses engaging decision makers in comparative effectiveness research (CER). It outlines calls for a National Institute of CER and defines CER. It describes how CER differs from traditional research by being more politically insulated and transparent. The document emphasizes that CER evidence enterprises must be designed around decision makers' needs and that they must be meaningfully engaged at all stages for limited success. It provides examples of organizations that have meaningfully engaged decision makers and outlines strategies for doing so, including selecting smart, energetic participants and valuing different perspectives.
HXR 2016: FAST TRACK: Prove It: The role of Evidence and Insights in Health I...HxRefactored
Using evidence and insights during the post-intervention phase allows for:
1) Evaluating the impact of the intervention by measuring changes in determinants, behaviors, and health outcomes.
2) Iteratively improving the intervention design based on lessons learned.
3) Determining if the intervention worked as intended and should be continued, modified, or discontinued.
Evidence Based Practice Lecture 7_slidesZakCooper1
This document discusses how evidence-based practice is used in clinical settings through clinical practice guidelines and decision analysis. It defines clinical practice guidelines as a series of steps for providing clinical care and decision analysis as a formal structure for integrating evidence about treatment options. Clinical practice guidelines aim to standardize and improve care but have limitations such as not applying to complex patients. Decision analysis allows for elucidating optimal individual decisions but requires significant time and resources. Overall, evidence-based practice provides tools and approaches to inform clinical decision-making.
The document discusses topics for health systems research and strengthening health systems. It provides an overview of suggested research topics such as human resources, health care delivery, private sector approaches, and governance. It also outlines different models for health policy including rationalist, incremental, and problem identification approaches. The document emphasizes translating evidence into action and factors that influence using research evidence in policymaking. It recommends researchers provide brief summaries, ensure timely and relevant research, and argue the relevance to policymaker demands.
Introduction Lecture for Implementation ScienceMartha Seife
This document provides an overview of a workshop on implementation science held in Hawassa University from August 21-25, 2017. The purpose of the workshop was to familiarize participants with implementation science concepts and methods and help them develop individual implementation science projects. Topics covered included an introduction to implementation science, the know-do gap between evidence and practice, definitions of implementation science, and examples of social and system interventions to reduce perinatal mortality. Implementation challenges and the role of evidence-based practices in implementation science were also discussed.
Knowledge transfer, and evidence informed health policy-minster's meetingDr Ghaiath Hussein
This document discusses knowledge transfer between researchers and policymakers. It begins with an overview of the knowledge cycle and evidence-based healthcare. It notes that while researchers seek truth and policymakers seek compromise, their common goal is improving public health. The document recommends establishing units to facilitate knowledge transfer and decision support. It also suggests training policymakers to identify how research can help and accessing evidence to inform decisions. The overall message is that researchers and policymakers must understand each other and work together toward their shared goal of improving health outcomes.
This document provides an overview of a presentation on health research. It defines research and outlines its aims and classifications. It discusses identifying research problems and the knowledge management cycle. It emphasizes that research should address real community problems and be action-oriented to inform policymakers and ultimately improve public health.
Guidelines - what difference do they make? A Dutch perspectiveepicyclops
This lecture was given by Dr Raymond Ostelo of the EMGO Institute, VU University Medical Center, Amsterdam, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. His lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
I need between 100-120 words for each assignment, and I want ind.docxflorriezhamphrey3065
I need between 100-120 words for each assignment, and I want individual references with each response. Please, no plagiarized work
Module 1
DQ 1
Outcome measures are significant in showing the worth of the Doctor of Nursing Practice's role in health care. Identify a practice-level outcome study or project and describe the expectation of its effect on health care. Which outcome measure do you think aligns with your DPI project (Quality Improvement Project)? Why? Provide examples and literature support.
DQ 2
In this week's readings, theories of accident causation, human error, foresight, resilience, and system migration were discussed. Identify a safety theory and propose quality measures to improve patient safety. Which theory or framework are you using to guide your DPI Project's intervention and outcome? Please define what constructs of your chosen DPI Project theory will help you change/improve clinical practice to improve a specific patient outcome? Provide examples and literature support.
Resources
Henneman, E. A. (2017). Recognizing the ordinary as extraordinary: Insight into the “way we work” to improve patient safety outcomes.
American Journal of Critical Care
,
26
(4), 272–277. doi:10.4037/ajcc2017812
Smith, S. A., Yount, N., & Sorra, J. (2017). Exploring relationships between hospital patient safety culture and Consumer Reports safety scores.
BMC Health Services Research
,
17,
1-9. doi:10.1186/s12913-017-2078-6
Module 2
DQ 1
Discuss economic methodology, including the concept of cost-based analysis. If you will not be addressing this in your DPI Project, provide an example of a program where it could be used to show outcomes. Provide examples and literature support.
DQ 2
Discuss a change theory and how it can be or has been applied in nursing practice to integrate care delivery sustainability. How will you use change theory in the design of your project to support the sustainability of your practice improvement intervention? Provide examples and literature support.
Resources
Uluskan, M., McCreery, J. K., & Rothenberg, L. (2018). Impact of quality management practices on change readiness due to new quality implementations.
International Journal of Lean Six Sigma
,
9
(3), 351-373. doi:10.1108/IJLSS-05-2017-0049
Steele Gray, C., Wilkinson, A., Alvaro, C., Wilkinson, K., & Harvey, M. (2015). Building resilience and organizational readiness during healthcare facility redevelopment transitions: Is it possible to thrive?
HERD: Health Environments Research & Design Journal
,
9
(1), 10-33. doi:10.1177/1937586715593552
Allen, B. (2016). Effective design, implementation and management of change in healthcare.
Nursing Standard
,
31
(3), 58. doi:10.7748/ns.2016.e10375
Module 3
DQ 1
New health care delivery models are being presented to accommodate the shift in health care objectives. Many of these models are community-based and focused on improving quality outcomes, population health, and reducing readmissions.
This document discusses opportunities in transforming healthcare through a personalized, preventative approach. It notes rising healthcare costs driven by chronic diseases and recommends stratifying populations to personalize care using predictive analytics and engaging consumers through participatory approaches. Transforming healthcare will require reducing variability, activating patients, analyzing data to create knowledge, and applying network principles.
Evidence-Informed Public Health Decisions Made Easier: Take it one Step at a ...Health Evidence™
The document outlines the steps involved in evidence-informed public health decision making. It discusses defining a focused question, efficiently searching for relevant research evidence such as from systematic reviews, critically appraising the research methods, interpreting the results and adapting the information to the local context, deciding whether and how to implement changes, and evaluating the effectiveness of changes made. The goal is to integrate the best available research evidence with local factors to inform public health policies and practices.
Beyond Reporting: Monitoring and Evaluation as a Health Systems Strengthening...MEASURE Evaluation
This document discusses monitoring and evaluation (M&E) as a health systems strengthening intervention. It presents the World Health Organization's health systems framework, which depicts six building blocks of a health system: service delivery, health workforce, information, medical products and technologies, financing, and leadership and governance. The document argues that strengthening M&E systems can improve all six building blocks by increasing accountability, management, and use of data to strengthen programs. It acknowledges challenges like transitioning to more robust M&E systems and maintaining momentum for improvement.
Application 3 Becoming a Leader in the Translation of Evidence GrazynaBroyles24
Application 3: Becoming a Leader in the Translation of Evidence to Practice
Reflect on your growth, professionally and personally, since you embarked on your DNP journey. The AACN believes that one of the benefits of a practice doctorate is that it enhances your leadership skills to “strengthen practice and health care delivery” (2006, p. 5). As you continue to engage in your practicum experience, be cognizant of your growth in these areas.
In Week 6, you were asked to reflect on your leadership skills for this Assignment. This week, you continue your reflection on leadership and how you can lead the translation of evidence to practice through contribution to policy development.
Prepare
for this week’s section of Application 3 as follows:
Building on the work you began in Week 6 for this Application, review this week’s Discussion posting, and consider how you can lead policy development to address your EBP Project issue.
To complete:
Due tomorrow 10/11/18 before midnight
Write a 2- to 3-page paper in APA format with a minimum of 5 scholarly references less than 5 years old that synthesizes (
DO NOT GO OVER THREE PAGES):
Your vision of yourself as a leader—specifically:
1) How you would continue to increase your knowledge and awareness of financial, economic, and other concerns related to new practice approaches (
see week 6 discussion attached you did for me
, except focus on the critics the professor added for me [see bold and underlined professor critique below] which you failed to include in this discussion
2) How translating evidence would enable you to affect or strengthen health care delivery and nursing practice
3)
How you would advocate for the use of new evidence-based practice approaches through the policy arena
(see week 7 discussion attached you did for me)
Professor Critics in week 6 on the cost and financial impact of the implementation of the project
Dear student: Thank you for your contribution to this week’s discussion. You brought forward potential costs associated with increased mobilization of ICU patients….namely the need for more nurse time. Do you have some hard numbers you can provide on the potential cost of this? Do you have any local or national information on the cost of not mobilizing the patients (longer stays, increased infection, readmission)? Calculating approximate cost associated with the practice change versus the cost of not changing is important. This will help stakeholders see the value in the investment.
Required Readings
White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016).
Translation of evidence into nursing and health care practice
(2nd ed.). New York, NY: Springer.
Chapter 6, “Translation of Evidence for Leadership”
Balakas, K., Sparks, L., Steurer, L., & Bryant, T. (2013). An outcome of evidence-based practiced education: Sustained clinical decision-making among bedside nurses.
Journal of Pediatric Nursing
, 28, 479-485.
...
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. Team C:
Susan Vitus RNC, BSN Carol Taylor RN
RuthAnne Skinner RN
Dorothy Alford RN, BSMT Debra Austin RN BSN
University of Phoenix
Creating Change Within Organizations
HCS587
Terresa Randolph MSN, MA Psy
March 30, 2008
2. National Guidelines Clearinghouse ™ (NGC)
Evidence-based clinical practice guidelines and
related documents
Mission: provide detailed information on clinical
practice guidelines and to further their
dissemination, implementation, and use.
3.
4.
5. Decreased bone mass
Bone fractures
Type I
Type II
6. Affects women over the age of 50
Long-term impairment, disability, or
death
Undiagnosed, untreated
Increased health-care costs
7. Being female
Menopausal
Over 50 years of age
Health conditions
Smokers
Family history
Asian or white
Inactivity
8. Taking bone-active agents that inhibit bone
loss
Calcium
Vitamin D
Exercise
Fall Prevention Techniques
Diet
Prevent fractures
9. Healthy Diet
Regular exercise regime
Calcium supplements
Bone density tests
Quit smoking
Avoid alcohol and caffeine
Get regular check-ups that include
being measured
10. Importance:
Women over 50 at higher risk
Men also at risk
Need for more accessible screening
Need for better insurance reimbursement
Need for more preventative information
Preventative activities
Need for recommended interventional modalities
Pros and cons
Alternative therapies
11. ORGANIZATIONAL READINESS
Organizational assessment:
Logical precursor to planning and implementing large
scale change
External environmental analysis
Internal environment analysis
12. ORGANIZATIONAL READINESS
Change readiness
“Cognitive precursor to the behaviors of either resistance
to, or support for, a change effort” (Armenakis, et al., as
cited in By, 2007, p3)
Conscious vs. unconscious
Must be change ready before implementing change
Organizational culture
Beliefs, attitudes, intentions regarding need for change
13. ORGANIZATIONAL READINESS
Internal analysis
Management philosophy
Worker satisfaction and perceived support
Policies and procedures
Mission and values
Mindset of personnel
Need for guideline adoption
Willingness to utilize guideline as
part of preventative care
14. ORGANIZATIONAL READINESS
External analysis
Financially feasible
Market analysis
Financial resources
Return on investment is positive
Incorporate into benefit packages
Competitive benefits in community
Adequate insurance reimbursement
Perceived community need for preventative screening
and treatment
16. IMPLEMENTATION
Preventative Plan
Organize a Participatory Action Research group
Create client information packs
Display osteoporosis awareness-raising display
boards
Set up formal health information
referral process
Provide osteoporosis continuing
education classes for staff
17. IMPLEMENTATION
Reform Activity
Hire an osteoporosis nurse specialist
Implement a fall reduction program
Organize fund-raising for new osteoporosis
scanner
Set up osteoporosis education days
Provide preventative exercise
classes
19. EVALUATION
Quantitative
Evaluates both process and outcome
indicators
Qualitative
Determines and documents the
effectiveness of the program’s
activities and services
21. By, R. T. (2007). Ready or not.... Journal of Change Management, 7(1), 3-11. Retrieved
March 27, 2008, from EBSCOhost database.
Cody, M. C. (2005). Creating a national osteoporosis awareness campaign. Business Briefing:
North American Pharmacotherapy. Retrieved March 26, 2008, from
http://www.touchbriefings.com/pdf/1442/ACF199.pdf
Gajda, R. & Jewiss, J. (2004). Thinking about how to evaluate your program? These
strategies will get you started. Practical Assessment, Research & Evaluation, 9(8).
Retrieved March 30, 2008 from http://PAREonline.net/getvn.asp?v=9&n=8
Health Conditions .(2008). Osteoporosis, what are the risk factors. Drug Digest. Retrieved
March 25, 2008 ,from http://www.drugdigest.org/DD/HC/RiskFactors
John Muir Health. (2008). Managing osteoporosis. Health Reference Library. Retrieved
March 27, 2008, from http://johnmuirhealth.com/index.php
The National Guidelines Clearinghouse. (n.d.). About NGC. Retrieved March 24, 2008, from
http://www.guideline.gov.
The National Guidelines Clearinghouse. (n.d.). Management and prevention of osteoporosis.
Retrieved March 10, 2008, from http://www.guideline.gov.
National Osteoporosis Foundation. (2008). Proposed bill to protect patient access to
osteoporosis testing by reversing cuts in medicare reimbursement . Retrieved March 28,
2008, from www.nof.org
22. Pellettiere, V. (2006). Organizational self assessment to determine the readiness and risk for a
planned change. Organizational Development Journal, 24(4), 38-43. Retrieved March
27, 2008, from EBSCOhost database.
Readers Digest (2005). 15 Tips for preventing osteoporosis. Retrieved from
http://www.rd.com/healthy-living/health/15tips-for-preventing-osteoporosis
Susiniene, D., & Vanagas, P. (2006). Development of stakeholder relationships by integrating
their needs into organization' goals and objectives. Engineering Economics, 3(48), 83-
87. Retrieved March 27, 2008 from EBSCOhost database.
Wadsworth, Y. (1998). What is participatory action research? Action Research International.
Retrieved March 30, 2008, from
http://www.scu.edu.au/schools/gcm/ar/ari/pywadsorth98.html
Weber, S. (2005). Is your organization ready for change? Geospatial Solutions, 26-29.
Retrieved March 27, 2008, from EBSCOhost database.
Whitehead, D., Keast, J., Montgomery, V., & Hayman, S. (2004). A multidisciplinary
osteoporosis service-based action research study. Health Education Journal, 63(4),
347-361.
William, C. S. (2007). Osteoporosis: What is osteoporosis? MedicineNet.com. Retrieved
March 26, 2008, from http://www.medicinenet.com/osteoporosis/article.htm
Editor's Notes
Hello and welcome to Learning Team C’s presentation on Guidelines for the Management and Prevention of Osteoporosis. Our presenters today are: Susan Vitus RNC, BSN, Carol Taylor RN, RuthAnne Skinner RN, Dorothy Alford RN, BSMT, and Debra Austin RN.
The guidelines used for this presentation are based from National Guidelines Clearinghouse™ (NGC). The definition and mission as described in www.guideline.gov is as follows; The National Guidelines Clearinghouse™ is a comprehensive database of evidence-based clinical practice guidelines and related documents. The NGC mission is to provide physicians, nurses, and other health providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.
According to the NGC website; The National Guideline Clearinghouse™ (NGC) is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGS was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans [AHIP]).
According to NGC’s guidelines for management and prevention of osteoporosis, the objectives for the guidelines are: aims to achieve significant, measurable improvements in the management and prevention of osteoporosis through development and implementation of common evidence-based clinical practice guidelines, and to design concise guidelines that are focused on key management and prevention components of osteoporosis to improve outcomes.
Osteoporosis is distinguished by a thinning and weakening of normal bone resulting in a decreased bone mass density and increased risk for bone fractures. There are two types of osteoporosis: Type I and Type II. Type I occurs in post-menopausal women and is the result in a decrease of estrogen. Although most commonly found in women, Type II occurs in both men and women. This type is due to aging and the loss of calcium over many years. (William, 2007)
Osteoporosis “affects one in every two women over the age of 50” (Cody, 2005, p. 1). It is foremost as a source of fractures in older adults which results in long-term impairment, disability, or death. In spite of this, many at risk women are undiagnosed and untreated. As a result, there are increased health-care costs and an ongoing need to distribute information on its causes and prevention. (Cody)
Osteoporosis can be a debilitating disease but if caught early enough, can be preventable. There are many risk factors associated with osteoporosis: being female, menopausal, over 50 years of age, health conditions, smokers, family history, Asian or white, sedentary lifestyle, vitamin D deficiency, never having children, excessive alcohol and caffeine consumption, even men with low testosterone levels are at risk. (Drug Digest, 2008) There are treatments to help prevent or lesson the effects that osteoporosis has on one’s body. Early detection is so important because the early one starts their treatment for this disease, the better the outcome.
Managing osteoporosis is not as hard to prevent or correct as people believe. There are many new medications on the market today, some that only have to be taken once per month. Taking bone-active agents that inhibit bone loss will help make bones stronger. Calcium with vitamin D is a wonderful source that helps build strong bones. Early detection and treatment makes a big difference in the final results. Exercise on a regular basis helps build strong bones and muscles that surround those bones, making the person much stronger. Using good body mechanics is essential for ones back and legs. Preventing fractures is the first line of defense for osteoporosis.
Prevention of osteoporosis is a healthy lifestyle away. There are many supplements on the market that offer an easy solution to adding calcium to ones diet. Eating food such as fish, greens, soy, onions, broccoli, and many more wonderful foods out there will help in the prevention of osteoporosis. Lifestyle changes such as quitting smoking, adding regular exercise to ones life, taking supplements and eating right will all help in the prevention or slowing down of this disease.
The scenario was decided on, because some of us are in the at risk group, with at least one team member with a concerning screening value. There are many risk factors, including women who are perimenopausal or menopausal. Other risk factors include chronic glucocorticoid therapy, as seen in asthmatics and arthritic diseases, organ transplantation, gonadal dysfunction in men and women, increased fall risk, underweight, deficient calcium and vitamin D in one’s diet, and family history of fractures. (NGC, 2007), along with other risk factors mentioned on a previous slide. Blacks have lower risk, as they enter menopause with a higher bone mass density . The statistics of the National Osteoporosis Foundation reveal 50% women and 25% men over age 50 will break a bone due to osteoporosis. (2008) Accessible screening is a problem in our time strapped society, to complete the necessary screenings which include mammograms, well woman exams, physical exams, colorectal screenings, and lipid profiles. It is difficult to fit in so many appointments into days off work and family commitments. Costs for all the co-pays are also a negative factor. Medicare has drastically cut reimbursement in 2006 for the DEXA scan, the gold standard for diagnosing osteoporosis. Legislation is being introduced to reverse this decision for two reasons. One, less people will seek screening in a very risky elderly population. The second reason is the cost savings of over $18 billion in direct care. Nursing home placements, social isolation, pain, and immobility would be decreased by better reimbursements for bone density testing. (National Osteoporosis Foundation, 2008) Preventative information is lacking for the general population. Seldom do we read or hear about osteoporosis. It is a screening test that needs to be advertised, so patients can be proactive when discussing their needs with their physician. Discussions with physicians should assess diet, exercise, risk factors and initial bone density screening. If osteoporosis or osteopenia is diagnosed, treatment modalities and regular screening tests need to be discussed, along with side effects of the various drugs recommended by the NGC guideline (2007). Alternative therapies should be explored and incorporated if feasible.
Lewin (1947), as discussed by Pellettiere (2006) in his Force Field Analysis Model, points out the importance of assessing the positive forces or drivers along with the negative forces. Knowing an organization’s strengths and weaknesses, up front, will make way for discovering novel ways to implement the osteoporosis guideline strategies in a positive manner, limiting conflict and resistance throughout the organization. No organization is completely ready for change. Senior management must be visible and supportive. Stakeholders need to be communicated to as to impending change and employees need to know their expectations and role in the guideline adoption. Mutual cooperation will stimulate success. (Susniene & Vanagas, 2006)
A conscious approach to change is proactive, driven by an awareness , choice and decision to adopt the NGC guideline into the organization. It is the foundation of the organization’ change culture. With the conscious approach in an organization, there is a greater probability of successful implementation of the guideline, because the organization’s members are psychologically ready for the change. Unconscious handling of change is reactive, driven by organizational crisis, fear and chance. Little thought goes into preparing the organization, with members going through the motions with implementation, dooming the adoption of the guideline to failure. (By, 2007)
The humanistic side of readiness for change begins with assessing a need for change and the likeliness of an organization’s personnel using the guideline to develop and utilize services. Policies and procedures within the organization need to be able to absorb the guideline. Management needs the philosophy that technology is available and useful in keeping their employees healthy and available to do their work. The organization’s mission and value statements should be supportive of the guideline implementation.
A need for change arises from available technology, market forces, competition between and within organizations for improved osteoporosis screening and treatment. The costs must be analyzed and monies found for need assessment and equipment purchases. The initial costs of improving insurance, benefits for employees, and equipment to perform bone density will be expensive. The return on investment will be realized by market analysis of costs prevented by implementing the guideline. Costs prevented most likely will outweigh the startup cost. Examples of major cost prevention are less sick pay, lost man hours and overtime reduced, benefit costs decreased because prevention is less expensive than short or long term disability cost effects on future insurance costs, and happier personnel and community, affecting competition and the bottom line. (Weber,2005)
Organizational readiness can not be hurried, as you can see. Done properly and thoroughly, the successful stage for implementation and evaluation can take place. We’ve prepared the organizational field, now it is time to reap the benefits by digging in with our implementation. .
Whitehead et al. (2004) recommends creating a preventative plan and a reform activity plan in order to prevent osteoporosis and decrease side effects of the disease and the disease process. The steps to implement are also based upon Whitehead et al. guidelines. By creating and organizing a Participatory Action Research (PAR) group, one creates means for evaluation and progress in the future. Create client information packets. These packets can contain information focused on lifestyle changes such as diet, exercise, and fall prevention. It is also important to have contact phone numbers for the National Osteoporosis Society (NOS) as well as self-referral information. The organization will provide these information packets in the women’s health, orthopedic, and elderly ward settings. Display osteoporosis awareness-raising display boards in prominent areas of each chosen clinical area. It is also recommended to develop in-house posters for placing around the hospital with contact details of osteoporosis services centers. (Whitehead et al., 2004) It is important to set up a formal health information referral process for at risk clients and their relatives with local osteoporosis specialists. By reaching at risk populations, care can be brought to where it is needed. Because most nurses and medical staff require continuing education classes to keep their license current, it is recommended to provided continuing education classes about osteoporosis.
Reform activities should be implemented along side of the preventative program. Preventative program activities will actually complement the reform activities. The organization should hire an osteoporosis nurse specialist. Major drug companies have provided short-term funding for the employment of osteoporosis nurse specialist for the initial set up until funding can be established for long-term funding. (Whitehead et al., 2004) Research has shown that implementation of a fall reduction program has decreased side effects of the osteoporosis disease process. (Whitehead et al., 2004) The organization is encouraged to implement a fall reduction program for all in-house patients. A new osteoporosis scanner will help create awareness to the medical community. It is recommended to set up a formal fund-raising group for a new osteoporosis scanner and involve members of research teams and local support groups. There is a need to set up a continuous program of osteoporosis awareness days at the organization with local physiotherapists. Finally, the organization should provided preventative exercise classes. “An ongoing and increasing level of preventative exercise classes linked to referred osteoporosis service clients” (Whitehead et al., 2004, p. 353). These classes can be run by a volunteer in the PAR group.
The Participatory Action Research group implemented allows for the organization group members to improve the performance quality of the changes. “Essentially Participatory Action Research (PAR) is research which involves all relevant parties in actively examining together current action (which they experience as problematic) in order to change and improve it” (Wadworth, 1998,¶10). PAR continues through repeated cycles to verify the effectiveness of the changes made. The success of the implementation of the osteoporosis guidelines depends on the continuous cycle of assessing, planning, implementing, and evaluating patient and staff satisfaction, as well as a evaluating the decrease in signs and symptoms of the osteoporosis disease process in at risk clients.
“ Typically, quantity measures are numerical descriptions of program activities and achievements, while quality measures often portray program activities and achievements through narrative descriptions (Gajda & Jewiss, 2004, ¶17). The organization’s program leaders will be concerned with determining if they decrease the patient population complications of osteoporosis, for quantitative evaluation, and documenting the personal perspectives of staff and patients receptiveness to the changes, for qualitative evaluation. “ Quantity measures are used to evaluate both process and outcome indicators. Very early on in the first stage of program implementation it will be important to establish and document what tools and strategies will be used to collect data that corresponds with each process and outcome indicator” (Gajda & Jewiss, ¶22). Quantity measures may examine how many people are being served and how often. “ Quality measures determine and document the effectiveness of the program’s activities and services. Evidence of a program’s quality can be gathered and reported through the use of narrative and/or numerical approaches. Mechanisms for gathering narrative information include individual or focus group interviews, open-ended survey questions, and observations of the program in action” (Gajda & Jewiss, ¶20). The perspectives of program participants, program staff, and other stakeholders can be obtained through interviews, surveys, or observations about the program’s quality through close-ended survey questions, such as those that ask participants to rate their level of satisfaction with the services and information provided. More powerful evidence is often generated when survey participants are asked to rate the degree to which they have gained new skills or information, or changed their behavior as a result of their involvement in the program (Gaida & Jewiss). As is the case with most initiatives and implementations, quality measure are important. Specifically for these osteoporosis guidelines, the project leaders anticipate that providers will report through written surveys and in interviews that activities will continue without problem and assist in tackling osteoporosis issues before they become a serious health concern.
Promoting a health awareness program to educate employees and patients regarding the prevention, diagnosis, and treatment of osteoporosis is important for early identification of osteoporosis. Education is the key for developing strategies for increasing knowledge of osteoporosis, health beliefs, and prevention behaviors.