The document discusses pharmacological treatments for type 2 diabetes, including commonly prescribed medications like metformin, sulfonylureas, and meglitinides, outlining their actions, side effects, and implications for patient management. It emphasizes the importance of lifestyle changes and patient education in enhancing treatment effectiveness, while also addressing monitoring practices and controversies around medication guidelines. Additionally, it highlights the challenges faced by patients in adhering to treatment regimens due to factors such as cost and lifestyle adjustments.

1. PHARMACOLOGICAL TREATMENT
Samantha M. Tallarine
Capella University
BSN-FP4016
1
AGENDA
The presentation covers:
Identification of the disease
Identification of three most commonly used drugs
Types of actions, side effects and indications of the medications
Description of the treatment regime
Impact of the treatment regime on patients
How nurses should monitor clients and
Controversies associated with the medication
The presentation will focus on the issues identified. Addressing
the issues provides an opportunity to identify and evaluate the
selected disease in order to understand the issues affecting the
patients, healthcare professional and the healthcare industry as a
whole.
2
IDENTIFICATION OF THE DESEASE
The identified disease is:
Type 2 Diabetes

2. It’s a health condition that affects:
The body’s ability to process sugar
Mostly common for nurses among
High risk population such as those who are obese or overweight
The disease identified for the assignment is Type 2 diabetes.
The disease is a health condition resulting from the inability of
the body to process sugar. Even though screening is
recommended for those who are 45 years and older, those who
are under the age of 45 and are overweight are recommended to
go for screening to determine if one is exposed to the condition
and if so, the type of the condition, whether type 1 or type 2,
(Fuchsberger et al., 2016).
Image sourced from:
https://www.medicalnewstoday.com/articles/317769.php
3
DRUGS MOST OFTEN USED
Metformin (Glumetza , Glucophage, among others)
Generally the first prescription for the condition
Sulfonylureas
Helps the body to produce more insulin
Meglitinides
Stimulates the pancreas to produce more insulin
Metformin works by lowering the production of glucose in the
liver thus improving the sensitivity of the body to insulin which
improves its efficient use in the body. Sulfonylureas work by
helping the body to produce more insulin thus meeting the body

3. needs efficiently. Meglitinides also work by stimulating the
production of insulin from the pancreas thus meeting the deficit
by the body.
4
TYPES OF ACTIONS, SIDE EFFECTS, INDICATIONS, AND
CONTRAINDICATIONS
Metformin (Glumetza , Glucophage, among others)
Possible side effects include:
Nausea and diarrhea
Sulfonylureas
Possible side effects include:
Low blood sugar and
Weight gain
The side effects of Metformin include nausea and diarrhea. The
side effects disappear after the body of the patient gets used to
the medication or when the medication is taken alongside a
meal. Other oral medications can also be administered alongside
the drug to promote positive outcomes as argued by Borries et
al. (2019). The side effects of Sulfonylureas include
experiences low blood sugar among the patients using the
medication.
5
CONTINUATION…
Meglitinides
Faster acting medication
Thus shorted duration and effect on the body
Side effects include:
Low blood pressure and
Weight gain

4. The drug acts faster compared to the other drugs. This makes it
have a shorted acting duration in the body. However, the
medication also has side effects which may result in low blood
pressure and weight gain to the patients taking the prescription.
These side effects may further affect the health and overall
well-being of the patient if not checked.
6
TREATMENT REGIME MOST OFTEN PRESCRIBED
The most prescribed treatment regime include:
Medication
Prescribed medication
Lifestyle changes
Increasing body activity to manage sugar and fat in the body
Exercise
The most prescribed treatment regime for diabetes type 2 is
medication complimented by lifestyle changes. The medications
include prescription of Metformin which is also the most
prescribed medication for dealing with the condition. Lifestyle
changes are focused on reducing the health risks associated with
the condition thus improving the effectiveness of the treatment
interventions, (Fuchsberger et al., 2016).
Image sourced from: https://www.everydayhealth.com/type-2-
diabetes/treatment/managing/
7
IMPACT OF TREATMENT REGIME ON CLIENT LIFESTYLE
High frequency of taking medications
Medications taken daily
Thus the need to adhere to the dosage requirements
High cost of medication
Insulin costs an average of $450 monthly per patient

5. This reduces patients disposable income
The impact of taking the diabetes type 2 medication is that the
high frequency of taking the medication can overwhelm the
patient as they are required to take the medication once or twice
everyday. This means that the individual has to ensure that they
remember to take their medication which might prevent them
from engaging in other productive activities. The high cost of
insulin present major challenges, particularly for those patients
originating from lower social class within the community or
society, (Toschi et al. 2016).
8
CONTINUATION…
Lifestyle changes affect the normal life of the patient
The need to create time for activities such as exercise
Affects the patient daily activities such as:
Work and
Feeding habits
Lifestyle changes require individuals to make changes to their
daily lives in order to realize the desired outcomes. Achieving
this may require the patient to make significant changes in their
life which may affect how they go about their day to day
activities, (Borries et al. ,2019). For instance, the need for
physical exercise makes it necessary for the patient to find time
to engage in the activities. This might be difficult if the patient
faces challenges such as tight work schedules.
Image sourced from:
https://www.health.harvard.edu/blog/intensive-lifestyle-change-
it-works-and-its-more-than-diet-and-exercise-2017082112287

6. 9
MONITORING A PATIENT ON TREATMENT
Encouraging patients to join self monitoring groups
Improves the effectiveness of monitoring
Improving patient nurse-relationship
Improve communication between patient and nurse
Thus understanding specific health needs of the patient
Regularly performing the HbA1c test
To measure the blood sugar levels the patient
Encouraging patient to join self-monitoring groups helps them
to identify the most effective groups to help them adhere to the
treatment as well as monitoring their sugar levels. Improving
the patient-nurse relationship helps to improve communication
between the two parties thus improving the overall effectiveness
of the treatment interventions as argued by Marso et al. (2016).
This is the case base patients are able to explain to the nurses
how they are feeling and the nurse will determine how best to
manage the situation at for the short and long terms. Regularly
performing the HbA1c test helps to determine the sugar levels
of the patient thus determining the most effective solution to be
explored.
10
CONTROVERSIES ASSOCIATED WITH THE DRUG
There are controversies on the use of drugs for lowering blood
sugar levels
According to American College of Physicians (ACP),
Reducing blood sugar below 7 % could have detrimental effects
It recommends a goal of between 7-8%.

7. The American College of Physicians (ACP) argues that reducing
the blood sugar levels of patients diagnosed with type 2
diabetes could have more harm than good to the patient. The
organization points out that the current recommended level of 7
percent may not be a good idea since the level of 5.5 is
considered to be normal. As such, the organization recommends
a maintaining blood sugar level of between 7-8% to obtain the
desired healthcare outcomes.
11
REFERENCES
Borries, T. M., Dunbar, A., Bhukhen, A., Rismany, J., Kilham,
J., Feinn, R., & Meehan Sr, T. P. (2019). The impact of
telemedicine on patient self-management processes and clinical
outcomes for patients with Types I or II Diabetes Mellitus in the
United States: A scoping review. Diabetes & Metabolic
Syndrome: Clinical Research & Reviews.
Fuchsberger, C., Flannick, J., Teslovich, T. M., Mahajan, A.,
Agarwala, V., Gaulton, K. J., ... & Rivas, M. A. (2016). The
genetic architecture of type 2 diabetes. Nature, 536(7614), 41.
Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G.,
Jódar, E., Leiter, L. A., ... & Woo, V. (2016). Semaglutide and
cardiovascular outcomes in patients with type 2 diabetes. New
England Journal of Medicine, 375(19), 1834-1844.
Toschi, E., & Wolpert, H. (2016). Utility of continuous glucose
monitoring in type 1 and type 2 diabetes. Endocrinology and
Metabolism Clinics, 45(4), 895-904.
Running head: PATIENT EDUCATION1
[Type text][Type text][Type text]
PATIENT EDUCATION2

8. Patient Education
Samantha M. Tallarine
Capella University
BSN-FP4016
Pharmacology for Patient Safety
July, 2019
Part 1 – Patient Education Tool
Patient education is an essential element in the treatment
process as it is through patient education that patients and
caregivers are imparted with knowledge on the disease
prevention, as well as the treatment plan that needs to be
observed. For this exercise, I am going to focus on the topic of
Antibiotics (Amoxil/Amoxicillin) for pediatric ear infections.
Below is a patient education tool for the same as presented
below.
An ear infection is an inflammation of the middle ear, caused by
bacteria. It is also common in people with a weakened immune
system. It is treated through the administration of antibiotics,
commonly amoxicillin, which should be taken for a minimum of
seven days, or maximum of ten days. During this period of
treatment, it is essential to take the whole dose to ensure that all
bacteria are eliminated. Failure to finish the dose may lead to
the development of resistance by the bacteria. It is important
that one takes the right amount of the drug as prescribed by the
doctor, as taking under dose or overdose may decrease the

9. efficiency of the medication. Age and weight are the most
common factors that will affect the efficiency of the medication
in this dose, and therefore, it is important to provide the correct
information so the doctor can choose the most effective dose.
While giving your child these drugs, it is important to be aware
of the possible side effects of this drug. Nausea, diarrhea, and
headache are some of the side effects that you should anticipate
in your child during the medication period. When handling the
drug, it is important to ensure that this drug is stored in a cool,
dry place away from any form of contamination or out of child’s
reach to avoid dangers that may arise from children taking the
drug. During the period of treatment, it is important to ensure
that your child eats well.
Part 2 – Evidence-Based Practice
According to Lorig (1996), patient education is a procedure
through which people with health occupations tend to impart
knowledge to the patients and the caregivers on the best
practices to observe to prevent and respond to diseases,
especially during the treatment process. The main objective of
patient education is to allow the patients to improve on their
health through a change of health-related behavior and also
ensuring that patients and the caregivers follow the due process
in the administration of medicine to a patient. Health education
is mainly promoted through health education tools, as created in
the previous part of this assignment. It encompassed a set of
guidelines that patients and the caregivers need to observe to
ensure that they follow the instruction as prescribed by the
doctor. It also creates awareness on matters such as the side
effects of the medicine used.
Patient education tool contains some sets of instructions to be
followed; these instructions are a form of vital information that
is beneficial for the patient and the caregivers for the process of
treatment. Information, such as side effects of the medicine
used, helps to do away with fears that arise when one uses a
particular drug, for this case, the use of Amoxicillin in the
treatment of ear infections in children can lead to nausea,

10. diarrhea, and vomiting. This is an essential piece of information
that is a form of awareness to the patients and their caregivers.
With such information, one can take the necessary measures if
such instances occur, unlike when one may not have the
information. When a person is equipped with this, it is easier
for one to take good response in case one reports the said side
effects when using the drug; it also removes panic among
patients when taking the same medication.
On the matter of storing and handling of the drug is an
important measure that greatly boosts the safety of the patients
and people who may live with the patient through the
information. The drug should be stored in a cool, dry place
ensuring that the drug does not get contaminated.
Contamination of the drug can be lead to pediatric severe
methadone poisoning through the patient education tool, this
awareness is created, and patients are equipped with the
necessary knowledge on what they need to observe when storing
medicine to avoid incidences that may result from
contamination of the medicine. Keeping the drugs out of the
reach of children also serves to ensure that children do not take
the drugs in a dangerous dose. When poorly stored, children can
gain access to the amoxicillin; this can be fatal, especially when
taken in large doses.
Through the patient education tool, the quality of the healthcare
services provided to the patients is greatly improved. Through
this tool, patients are emphasized on the need to take the whole
dose even after they feel to have fully recovered. This ensures
that the bacteria causing the disease is suppressed and reduces
the chance of the bacteria developing resistance according to
research. Failure to finish the dosage by patients has increased
the resistance of diseases causing organizations, and this has
rendered many drugs to be ineffective in treating patients
(Gruman et al., 2010). Having emphasized the importance of
finishing the dosage prescribed by the doctor, it is possible to
improve the quality of the healthcare services offered to the
patients. Adherence to the dosage instruction can improve the

11. recovery period by making it even shorter than anticipated.
Through this, the quality of healthcare services accorded to
people is not only improved but also made effective.
The tool is essential, as it does not have the barrier in its
relevancy and its ability to impart knowledge to various groups
within society. The information conveyed applies to all groups
in society regardless of their gender, religion, and cultural
norms. Focusing on some pieces of information passed through
this tool, patients are urged to ensure that they finish the dose
as instructed by the physician. This information applies to all
people in the society as indeed it is true that failure to finish the
dosage may lead to the bacteria developing resistance to the
drug. Another important aspect of this patient education tool is
that the information on good eating while taking the medication
is essential and follows the principles and practices of cultural
competence, this emphasis cuts across all groups in the society
In summary, the health education tool serves to be an important
element in the promotion of the patients’ understanding of
essential practices that they need to observe to ensure they
remain safe and also improve the quality of the healthcare
accorded to them by the physicians. It is through this tool that
many incidences that may result from a lack of information by
the patients on the matters about taking drugs. Through this tool
the observance of the practices and the cultural competencies, it
becomes easier for the information shared through the tool to be
promoted and embraced by many people as it obeys these basic
concepts and principles. Through the patient's education tools,
patients are emphasized on the need to finish the dosage, store
the drugs properly among many other vital guidelines hence
improving on the quality of the healthcare services offered to
them.

12. Resources
Gruman, J., Rovner, M. H., French, M. E., Jeffress, D., Sofaer,
S., Shaller, D., & Prager, D. J. (2010). From patient education
to patient engagement: implications for the field of patient
education. Patient education and counseling, 78(3), 350-356.
Lorig, K. (1996). Patient education: a practical approach. Jones
& Bartlett Publishers.
Running head: IMPACT REPORT 1
IMPACT REPORT 2
Impact Report on the Immigrant Population
Samantha M. Tallarine
Capella University
BSN-FP4016
Pharmacology for Patient Safety
July, 2019
Impact Report on the Immigrant Population
Movement of people from one place to another is one of the
major factors that have to be considered when dealing with
issues of pharmacology, cultural beliefs, and treatment
procedures put in place to ensure that the society is effectively

13. taken care of. Therefore, in this report, the Sab-Saharan region
will be identified as the place in which the population will be
coming from. As such, this report entirely revolves around the
cultural values, beliefs, pharmacology and treatment remedies
that these group of people face.
Health Concerns and Issues for the Population
Sub-Saharan region is one of the most impoverished regions in
the world, and the standard of living is below the recommended
standards. This has meant that most of the people from this
region face numerous challenges, not only because they lack
resources to take care of their health conditions, but they also
face poor conditions, limited access to education and exposure
and thus live in some of the most primitive ways that have
exposed them to more dangers in their lives. Therefore, one of
the major health concerns for the population of Sub-Saharan
region is the fact that they have limited knowledge on the
HIV/AIDS prevention measures thus making them become more
exposed to the HIV/AIDS pandemic (Griffiths, et al. 2010).
Besides that, these people are also susceptible to the other
major pandemics in the region, pneumonia and tuberculosis. In
this case, 50% of the children who die due to pneumonia and
tuberculosis on the global stage are from Sab-Saharan Africa
people. Therefore, these issues and health concerns make some
of the major issues for the people from this region.
Current Pharmacological Treatment Regimens
Sub-Saharan region has had significant improvements in terms
of fighting HIV/AIDS pandemic. However, inadequate exposure
to ways of managing and preventing the spread of pandemic has
always proved to make it difficult to manage the issue. In this
case, the region just like any other parts of the world has been
exposed to the use of ant-retroviral drugs to help boost their
immunity and thus have a longer lifespan.
In addition, there have also been modern drugs that are being
used in the management of pneumonia and tuberculosis. The
only challenge becomes the accessibility of these services and
the drugs required for these diseases. Therefore, through these

14. drugs, the health concerns are easily managed and the
population lives on happily.
Traditional Beliefs and Practices
The Sub-Saharan population has hugely been impacted by the
traditional beliefs and practices that they engage in. For
instance, they practice wife inheritance without considering the
cause of death that led to their partners. This leads to an
increase in the spread of the HIV/AIDS pandemic in the region.
Besides that, practices such as female genital mutilations in
some of the communities in these regions are usually conducted
under unhygienic conditions that also increase the spread of
HIV/AIDS pandemic (Griffiths, et al. 2010).
In addition, by the virtue that education is not valued in the
region, it becomes difficult for these people to understand the
best methods that can be used to manage HIV/AIDS among
those living with the deadly virus. Additionally, they can also
be able to manage pneumonia and tuberculosis issues if they
only get the right measures and medications required. However,
due to the fact that most of these people have limited access to
education, it becomes difficult to manage these issues of
concern.
In contrast, most of the illiterate and those not exposed to the
use of anti-retroviral drugs usually end up using some crude
techniques to manage these pandemics. For instance, HIV/AIDS
is believed not to be a scientific disease, but a disease caused
by witchcraft in which most of the people end up engaging in
traditional healers and herbalists who end up making their
conditions worse.
Cultural Values and Traditional Practices
The cultural values and traditional practices among the Sub-
Saharan population might affect the pharmacology treatment
process put in place by the relevant authorities in various ways.
For instance, there are those that do not believe that HIV causes
AIDS, but they believe it's a curse that requires cleansing,
which makes the treatment of such individuals difficult. In
addition, traditional practices such as body piercing, and FGM

15. among young girls and women in general also leads to an
increase in the spread of the virus rather than help curb it down
(Elaine, Congress, & Manny, 2012).
Additionally, practices such as polygamous marriages and wife
inheritance among these people are also another reason that's
bound to make it more difficult to manage these issues. These
practices have no safety outcomes for the patients, have no
quality management of those who are infected, and there are no
appropriate use of the recommended pharmacology treatment
process, as the people do not believe in it.
Evidence-Based, Culturally Sensitive Strategies
However, over time these regions are gradually showing some
glimpse of improvement in the management of the healthcare
issues of concern. There have been numerous advocates for the
eradication of illiteracy in the region which has led to an
increase in the number of scholars. Therefore, there are
significant improvements in the use of anti-retroviral drugs and
use of treated mosquito nets, which have helped reduce cases of
spread of malaria among these people.
Therefore, despite taking longer to ensure that these sections of
the world catch up with the rest of the developing world. The
region has gradually made significant development in the use of
modern tools and equipment to fight these issues of concern.
This is evident with the reduced mortality rate among children
below five years in the region and a significant increase in the
lifespan of the people in the region (Hollingsworth, 2013).
Evidence-Based, Culturally Sensitive Strategies
There is a need to use evidence-based cultural sensitive
strategies to ensure that there is a good fight against these
pandemics. In this regard, the first consideration is the social
advocate for the use of condoms as a prevention measure among
sexually active individuals. Studies have shown that public
campaigns on the use of condoms have greatly helped reduce
the spread of the virus in the region. This is coupled with the
easy accessibility of these products and the creation of public
awareness among all individuals in society.

16. Besides that, for effective results to be met there is need to have
target groups. In this case, when targeting young men and
women and educating them against practices such FGM, wife
inheritance and body piercing by the use of crude weapons
ensures that the future generation has limited chances of
conducting such practices (Tadele & Kloos, 2013).
Conclusion
The pharmacological treatment of the Sub-Saharan people by
the use of modern tools and equipment has been one of the
major challenges for these people in the fight against health
concerns and issues in the region. However, with time this has
gradually changed and these people gradually accept the change
that has come with time.

17. Resources
Elaine P. Congress, M., & Manny J. Gonzalez, D. (2012).
Multicultural Perspectives In Social Work Practice with
Families, 3rd Edition. New York, NY: Springer Publishing
Company.
Griffiths, J., Maguire, J. H., Heggenhougen, K., & Quah, S. R.
(2010). Public Health and Infectious Diseases. Amsterdam,
Netherlands: Elsevier.
Hollingsworth, J. W. (2013). The Social Problems of Children
in Sub-Saharan Africa. Newcastle upon Tyne, United Kingdom:
Cambridge Scholars Publishing.
Tadele, G., & Kloos, H. (2013). Vulnerabilities, Impacts, and
Responses to HIV/AIDS in Sub-Saharan Africa. Basingstoke,
England: Springer.
Running head: MEDICAL MARIJUANA
1
MEDICAL MARIJUANA
2

18. Medical Marijuana
Samantha M. Tallarine
Capella University
BSN-FP4016
Pharmacology for Patient Safety
July, 2019
Medical Marijuana
Marijuana is a famous drug that is known all over the world.
Some people use it on an every day basis, both recreationally
and medically. The drug is famous for its influence with drug
lords and drug traffickers that have entered our streets and used
the drug abusively making millions of dollars. The drug is
banned in most countries of the world, leaving it with a bad
reputation. Nevertheless, marijuana has some very intriguing
medical benefits. These medical benefits have keep the drug on
the map and most pharmacologists are forced to see it just as
another form of medication to prescribe to patients. This paper
will explore the medical use of marijuana, its benefit to the
community, as well as the challenges it has brought to the
community. Also, the paper will explore the effects of the drug
on a patient and organization in terms of promoting health and
wellness. Furthermore, it will assess whether there is any
limitation on who should have the access to the drug and why.
The appropriate use of the pharmacology related to the topic,
health concerns associated with the topic and the efficacy and
applicability of the pharmacology
Medical marijuana is the same marijuana that is abused, yet this
time it is only used under medical guidance. The drug is very
strong and can become hazardous when used in the wrong way.
Medical marijuana can only be used when one has permission

19. from the medical doctor and they have a card to show that the
doctor knows. The drug is used to treat certain diseases such as
cancer, crohn’s disease, eating disorders, epilepsy and glaucoma
(Lankenau, 2018). Doctors can also prescribe marijuana to treat
muscle spasms caused by multiple sclerosis, nausea from cancer
chemotherapy, poor appetite and weight loss by chronic illness
such as HIV and also seizure disorders (Lankenau, 2018).
The efficiency and applicability of marijuana to these disease is
not guaranteed. So far, the FDA has only legalized the use of
marijuana on two specific treatments and that is Dravet
syndrome and Lennox-Gastaut syndrome (Lankenau, 2018). No
more research has been done on the topic, since one needs a
special kind of license to be able to perform the research. The
license acquisition has limited the number of studies done on
marijuana. Also, the amount of studies already done have not
reached the threshold that the FDA needs in order to legalize its
use.
The relationship between quality patient outcomes, patient
safety, and use of the pharmacology related to the topic
Patient outcomes are never guaranteed with the prescription of
marijuana. Nevertheless, doctors’ always prescribe the drug in
cases where they feel it will benefit the patient. Most patients
ask for medication because of pain and in cases where
marijuana can significantly reduce the pain, the doctor
prescribes it most often in these cases. Patient safety is ensured
through the giving of a card if one is prescribed to use the drug
(Shih, 2019). This is the case since the drug can be abused and
become fatal to the patient. Therefore, safety is always
maintained in that manner.
Medical marijuana has been argued to even have less effects
than opioids which are administered after a surgery. Though the
rumor is not proven as facts or approved by the FDA the
concern comes from the doctors thus, medical marijuana seems

20. to have an impact on this side (Shih, 2019). Also, the reduction
of side effects from chemotherapy are very dire and marijuana
is seen as a solution to some of them. Therefore, the drug
cannot entirely be dismissed when it comes to the provision of
quality and safety to patients
Benefits and limitations of the pharmacology in terms of
specific diseases and populations
Medical marijuana has a lot of cannabinoids that acts as
chemicals of treatment. These are the agents that are used as
medical chemicals in the body. These cannabinoids are involved
in appetite, memory, pain and movement (Lim & Kirchhof,
2019). The benefits of medical marijuana include: reduction of
anxiety, reduction of inflammation and pain, they also kill
cancer cells and slow down tumor growth. They also relax the
muscles in people with multiple sclerosis. Over the years, there
have been reports from parents that the drug helps stop seizures
in their children.
The limitations of marijuana are also very dire. During
prolonged use, the drug can lead to memory loss since it affects
the elements in the brain that are responsible for such processes.
Heart complications can also arise since studies have shown that
the use of marijuana increases the heart rate. These can be very
fatal for patients with a history of heart disease. Marijuana can
also lead to lung cancer when smoked for a long time and hence
lead to death (Lim & Kirchhof, 2019). Also, addiction is a
moral limitation that the drug exhibits since its users become
dependent on the drug.
How the topic affects both the community and the organization
in terms of promoting health and wellness.
Despite the many myths about marijuana on what it can do and
what it cannot do, the community ends up with the load of
relieving the people who have been afflicted by the drug.

21. Therefore, the community should be concerned on how the drug
is performing. Medical marijuana is regulated as we can see
today. Thus, if given the legal chance then it can be used to
relieve so many diseases, pain, and reduce the number of
patients going to hospitals to get medication for reducing pain.
Wellness in the community can be significantly improved by
medical marijuana, just from the little evidence that is observed
to have taken place.
Describe any inequities regarding access to the pharmacology
related to the topic and Access limited to specific groups or
populations
The discrimination of the drug has been taught both in our
school and the community, abd has taken that mantle and made
it clear that marijuana is a no go zone. The drug has been
abused so much so that its medical value is not visible or even
mostly talked about. This has led to the banning of marijuana in
many states and prison is the destination for anyone caught
selling the product.
The access of marijuana is only limited to specific group of
patients who have a card from the doctor to legalize their use of
the drug (Gostin, 2018). Patients use the cards to stop any form
of arrest from happening to them. Over time people have begun
to understand the benefit of the drug and we are observing more
and more states continue to legalize marijuana. These states
include: Florida Hawaii, Maine, Maryland, Michigan, Missouri,
New York, New Jersey, Ohio, Oklahoma, Utah and Washington.
In total medical marijuana has been legalized in 33 states.
Marijuana access and its influence on choice
Access of the drug is determined by the state that govern. They
are the ones that choose whether the drug should be used or not.
The base of the regulation is used to show that the drug can be
abused and surpass the medical use put into other harmful uses.
Therefore, these states take the precaution of not just allowing

22. anyone to use the drug unless under guidance from the doctor.
Access of the drug definitely affects the choice. It causes people
to abuse the drug behind closed doors and since the state keeps
the keys to that access.
In conclusion, medical marijuana is a drug that has both
pharmacological benefits and another harmful side just like any
other drug. There should not be so much hate on the drug.
States should also look forward to legalize medical marijuana
and help patients benefit from its uses. Medical marijuana
should also be allowed to be treated like most drugs without a
special license to allow more discoveries that might save lives
in the future. Therefore, medical marijuana is a drug just like
any other drug and should be respected for its medical use.
Resources
Gostin, L. O. (2018). Enforcing federal drug laws in states
where medical marijuana is lawful. Jama, 319(14).
Lankenau, S. E. (2018). Becoming a medical marijuana user.
International Journal of Drug Policy.
Lim, M., & Kirchhof, M. G. (2019). Dermatology-Related Uses
of Medical Cannabis Promoted by Dispensaries in Canada,
Europe, and the United States. Journal of cutaneous medicine
and surgery.
Shih, R. A. (2019). Associations between Young Adult
Marijuana Outcomes and Availability of Medical Marijuana
Dispensaries and Storefront Signage. Addiction.
MOBILIZATION PLAN
SAMANTHA TALLARINE
CAPELLA UNIVERSITY
ORGANIZATIONAL AND SYSTEMS MANAGEMENT FOR
QUALITY OUTCOMES
JULY, 2018

23. Mobilization plan in place for international medical mission
Topics addressed:
Identifying stakeholders and effect plan will take on them
Impact on staffing
Mission statement, and distribution of power
Assurance of quality of care and safety for participants
Breaking barriers in a potentially hostile environment
MEDICAL MISSION FOR NURSING PROFESSIONALS
“Medical mission teams provide healthcare goods, services, and
education to help fill the gap where access to care is extremely
limited.” (Hawkins, 2013)
Scenario:
A nursing facility has recently committed 20 nurses to

24. participate in a 4-month long multinational effort to treat
patients exposed to a highly contagious virus in a “hot zone” in
Africa. There will be physicians, as well as administrative staff
that will also take place in the mission. Nursing professionals
will make up the majority of the staff because they handle will
be handling administering treatment as well as monitoring the
patients for the physicians.
This mobilization plan will tackle the following:
Identifying the major stakeholders within the health care system
that will be affected.
Analyze the mobilization efforts impact on staffing and nursing
care in the home nursing facility.
Describing the organizational structure that will be in place, and
the distribution of power.
Assessing the effect of the organizational structure on the staff,
and how to empower each level.
Evaluating potential power conflicts when dealing with health
care personnel from Africa.
Evaluating the potential for issues that personnel may come
across, and how to avoid future mishaps.
2
Stakeholders affected by mobilization:
Hospital board members
Investors
Organizational leadership and management team
Nursing Leadership
Physicians
Patients
Impact on staffing patterns and nursing care?
Potential for further staff shortages
Stakeholders

25. Stakeholders affected by mobilization plan:
Hospital board members
Investors
Organizational leadership and management team
Nursing leadership
Physicians
Patients
How will staffing patterns and nursing care be impacted?
Staff shortages can occur due to nursing professionals making
up the majority of the team
Nurses who stay behind will face the potential for:
Longer shifts
Working shifts or days they aren’t accustomed to
Increased need for float nurses
Overall increased workload
“The social structure of an organization influences the flow of
information, resources, and power among its members.” (Meyer
& Huber, 2014) Therefore, each stakeholder has the potential to
be impacted by the mobilization plan. In order to effectively
complete this medical mission, everybody needs to be on board
and be willing to pick up the slack that will be left behind due
to the different staff members taking temporary leave.
3
Recruitment of Per Diem hospital staff
Float pools
Form unit teams

26. Leadership training
Shared governance
Softening the Impact on Staffing Patterns and Nursing Care
Mobilizing 20 healthcare professionals will leave behind a big
gap in the medical center. In order to alleviate the pressure for
the staff left behind there are different approaches that can be
taken; one specific thing is not going to keep the hospital
running, but if all interdisciplinary members band together and
work to improve in all areas this can become possible.
Recruitment of Per Diem hospital staff
Since the majority of the members of the mobilization team are
going to be nursing professionals, the nursing staff is going to
take the greatest hit. Per diem nurses who are experienced can
be a major asset to the team while also ensuring that the nurses
who left come home to their respective positions. I would
suggest that a minimum of 5 years nursing experience be
required, only because the full time nurses on the unit will
already be stretched too thin to have to accommodate a new
nurse. Experienced nurses will also bring better insight into
patient care, and ensure that the patients do not feel the strain
of the limited nursing personnel. “The major goal of staffing
management is to provide the right number of nursing staff with
the right qualifications to deliver safe, high-quality and cost-
effective nursing care to a group of patients and their families
as evidenced by positive clinical outcomes, satisfaction with
care, and progression across the care continuum. (Birmingham,

27. Pickard, Carson & Huber, 2014)
Float Pools
Increasing the number of nurses within the float pool will ease
the needs of units who may suffer from the medical mission.
“Pool nurses are assigned each day to one of the units in the
pool, where a pool typically contains between 3 and 7 units.”
(Maass, Liu, Daskin, Duck, Wang, Mwenesi, Schapiro, 2015)
This allows for nurses from multiple units to be part of the
medical mission without one unit taking too much of a hit. It
also allows for the mission team to have a well rounded team
with different aspects of experience. By increasing our float
pool, it allows the float nurses to help pick up the slack and
keep each unit running smoothly.
Form Unit Teams:
A team is defined as “a small number of people with
complementary skills who are committed to a common purpose,
performance goals, and approach for which they hold
themselves mutually accountable.” (Huber, 2014) In this case,
teams will be formed within each unit in order to ease the loss
of staff. There will be a nurse manager in charge, and the rest of
the staff will be paired off in order to help each other pick up
the slack. Unit teams will help everybody stay on task, and
allow for a smoother work day. It will help the staff to work
collaboratively and interdependently, as well as ensuring safe
patient care. This is especially helpful when float nurses are
being implemented because it will allow them to be paired with
a nurse who works on the unit regularly, allowing for a
seamless transition.
Leadership Training:
In order to effectively lead, nurse managers should be required
to go through leadership training. This will allow managers to
experience different leadership types, and can help guide them
to see what approach they want to take to lead their staff.

28. “Determining the structure is a key responsibility of leaders and
managers in planning an organization that is conductive to high-
quality nursing care.” (Meyer & Huber, 2014) Mandatory
leadership training will be effective in shaping how a unit will
be run, and will help to develop strong leaders that will be able
to lead during the potential staff shortage during the medical
mission; it will also help to give them a sense of empowerment.
Shared Governance:
“A dynamic process for achieving organizational effectiveness
by promoting decision-making and accountability for practice
through empowerment.” (Hoying & Huber, 2014) That is the
definition of shared governance. Many people would describe it
as a framework to help nurses feel a sense of empowerment
which would lead to an increase in autonomy and confidence. In
implementing shared governance a support structure needs to be
put into place, and continuous support from upper management
is a must. This will give our staff nurses the opportunity to
perform autonomously in certain aspects of their job, and allow
nurse leaders some breathing room while handling the staffing
aspect of their unit. This has the potential to help the unit run
smoother during the absence of the staff on the medical mission.
4
Shared governance
Hierarchical decentralization
Open system theory
Organizational Structure of the Medical Mission Team

29. In order to effectively complete this medical mission
communication needs to be excellent, and everybody needs to
have a clear vision of their role within the team. When team
members know their roles it allows for a good work
environment with little to no conflict. By pulling examples from
different theories and organizational structures it can provide a
well rounded structure for the medical mission team to follow
Shared Governance:
This will create the framework of the structure and allow for
empowerment of all mission team members. All team members
will be responsible for their own actions and allow for full
accountability. This will bring together all team members
regardless of title because shared governance promotes no
transfer of power which lets nurses acquire legitimate power
and authority. Respect and trust will be easy to come by among
all team members when everybody feels a sense of autonomy
and empowerment.
Hierarchical Decentralization:
Hierarchical decentralization goes hand in hand with shared
governance; allowing for authority to be spread down through
the hierarchy. Instead of leaving all decisions to be made within
the upper management team, this structure allows for all
members of the interdisciplinary team to work together as well
as having a sense of autonomy. The medical mission team will
be composed of a number of different healthcare professionals
so in order to keep each member happy and working as a team,
allowing each member to control their own outcomes will help
the team atmosphere. It will reduce any added conflict in what
is sure to be an already high stress environment. Each staff
member will in turn feel empowered to take control, and
Open System Theory:
The health care organization is “characterized by energy
transformation, a dynamic steady state, negative entropy, event

30. cycles, negative feedback, differentiation, integration and
coordination, and equifinality.” (Meyer & Huber, 2014) In order
to be effective, the different units need to be willing to adapt to
whatever environment they’re in. This is specifically effective
for a medical mission because the atmosphere is so
unpredictable and the staff needs to always be on top of their
game. In implementing the structure around an open system our
staff will have the autonomy necessary to man their own
stations of the “hot zone” which will cause them to feel
empowered. The boost in confidence will help the staff to keep
pushing through their time away in Africa, and ensure peak
patient care and quality outcomes.
5
Organizational Structure of the Medical Mission Team
Mission Coordinator: Person in charge of organizing the entire
medical mission team. This person is the top of the leadership
structure, and will be the liaison between the other
multinational teams that are present in the “hot zone”. They will
be the person that is in touch will all members of the
interdisciplinary team and be in charge of creating the plan both
before hand and while on the ground.
Leading Physician: This will be the main point of contact for
physicians, and will also work hand in hand with the rest of the

31. leading staff to coordinate patient care, and how supplies will
be used. They will disperse daily tasks, and handle the
scheduling of the physicians in the team.
Physicians: Supportive staff to the lead physician. They will
work together with the nursing professionals to provide optimal
patient care.
Leading Nursing Professionals: Main point of contact for the
nursing professionals. They will also be working with the other
leading staff to coordinate patient care, and how supplies will
be used. They will disperse daily tasks, and handle the
scheduling of the nursing professionals in the team.
Nursing Professionals: Supportive staff to the lead nursing
professional, as well as the physicians. They will work hand in
hand with the physicians and supportive staff to provide optimal
patient care.
Leading Administrator: Main point of contact for administrative
staff/supportive staff. They will be handling taking inventory
before the trip as well as throughout, assisting with making
schedules, and managing all resources. They will also be held
accountable for maintaining communication throughout the
mission between interdisciplinary team members, as well as
communication with our home base in the hospital.
Administrative/Support Staff: Assist all team members in tasks
that require help, and help the day to day operations run
smoothly.
All staff will work together to maintain an effective work
environment and to ensure quality patient care. Day to day
operations will be inclusive of all team members, and there will
be constant communication throughout each assignment.

32. Although there are leadership positions incorporated, all team
members will have some degree of autonomy, and will be able
to work within the scope of their practice to make decisions and
empower each other. Daily meetings will take place among
leadership as well as team members to ensure that the patients
are receiving everything they need, and to give each team
member a voice.
6
Mission Coordinator
Leading Physician
Leading Admin.
Nursing Professionals
Leading Nursing Professional
Physicians
Admin./Support Staff

33. Leadership is all inclusive when dealing with team members
Shared governance and hierarchical decentralization model is
carried out effectively
Empowerment = key leadership component
Empowerment within Team Members
“Empowerment is defined as giving people the authority,
responsibility, and freedom to act on what they know and
instilling in them belief and confidence in their own ability to
achieve and succeed.” (Cox & Huber, 2014) It entails two steps;
transfer of actual power, and inspiration of self-confidence. A

34. work environment which empowers its workers allows the staff
to come to work with a positive attitude, and it has been shown
to give employees the opinion that their work holds a greater
meaning for them.
This medical mission team will be all inclusive, and allow for
all team members to have a voice. There will be experienced
leaders in place, but that is just the framework to help other
members who may not have been in a leadership role
previously. All team members will have a degree of autonomy,
and this will help build confidence as well as improve upon
communication skills. Leaders will be involved with team
members to ensure all members stay within their scope of
practice, and to lend a helping hand when needed. Supplies,
resources, and staff will experience shortages so in creating a
decentralized hierarchy we can ensure that staffing levels are
optimized to deliver effective patient care.
7
Key actions that can be taken in order to keep patients and
personnel safe and receiving the best care:
Patient-Centered Care
Collaborative Leadership
Safety Climate
Conflict Resolution
Appropriate Training
Assuring Quality Care and Patient Safety

35. Patient-Centered Care
“The re-design of patient care in the acute care setting so that
hospital resources and personnel are organized around the
patient’s health care needs.” (Huber, 2014) Participating in
patient-centered care allows for the patients to always be
number one, while allowing for the health care team to take care
of both the patient and family members collaboratively. It
ensures that decisions are based solely on patient needs, and
will optimize the way treatment is delivered..
Collaborative Leadership
Shared governance can help to incorporate a collaborative
leadership approach within the medical mission team. All team
members must collaborate, not only just the leadership with
each other, but all staff must work to have constant
communication within the other departments. “Collaborative
leadership in health care has been associated with improved
patient outcomes, a reduction in medical errors, and lower staff
turnover; it may also reduce the amount of workplace bullying
and disruptive behavior.” (Hoying & Huber, 2014)
Safety Climate
By pushing a safety climate, it will allow all members of the
medical mission to focus on safety within the team, as well as
the organization within the “hot zone”. This will be
implemented to keep both health care professionals, and the
patients safe. The focus is on making sure that nurses
specifically are able to identify what is normal for the patients
within the medical mission, so that they can recognize any
deviations from baseline. “Regardless of whether the focus of
safety is on the patient or the nurse, the likelihood of injury can
be lessened where there is a cohesive team.” (Bellot & Huber,
2014)
Conflict Resolution
If conflict is to arise during the mission, resolution needs to be

36. swift and effective in order to keep our patients receiving
constant quality care. This is where leadership will come into
play most to provide techniques to give all parties involved an
opportunity to speak their peace. Leadership will ensure that
communication is open, and that all methods are exhausted if
needed to resolve the problem.
Appropriate Training
In working with a different culture, the health care team needs
to make sure they are undergoing the correct training to get a
better idea of what they will encounter once on the ground in
Africa. Whether that be sensitivity training in order to deal
effectively with what they will see, or if they need specific
medical training to deal with the virus. Doing a simulation lab
to better prepare for the mission also can be helpful, and will
allow for team members to work together before real patients
are involved.
8
Working with team members who have never worked together,
as well as dealing with multinational contingents can cause the
following issues:
Internal conflict of power
Cultural differences
Jurisdiction issues
Unwillingness to participate in shared governance model
Potential Power Issues
Nurses specifically will need to fight to maintain their power

37. throughout the mission because other cultures may not be used
to nurses working autonomously as has been outlined in this
presentation. Also, physicians within the team may not be used
to nurses having a say and manning their own unit teams.
Culturally, all team members may not be able to be cognizant of
actions that are potentially offensive to the other multinational
teams present, or the people of Africa. There also may be an
issue when it comes to making decisions that include other
health care teams. Leaders from different areas may feel they
are entitled to make decisions, while other team leaders feel
they are; working together and communicating efficiently will
be the most productive way to get through the 4-month mission.
9
Language barriers
Unawareness of cultural practices
Different standards of practice
Potential Multicultural and Diversity Issues
Language barriers will be the number one issue faced while on
this mission. Although translators will be part of the
interdisciplinary team that is being sent to Africa, there are so
many different dialects that there is always the potential for
miscommunication. 20 health care team members with all
different backgrounds are being brought together to enter this
“hot zone”, and although there will be training before leaving
it’s impossible to completely grasp the culture they’ll be
experiencing. A lot of the knowledge they gain will be through
experiences, so there is potential to offend the people they will

38. be working with. Protocol will also be completely different, and
will take time to get used to.
The mission team’s top priority is to respect the people and the
culture of Africa, and provide patients with the best quality care
possible. There may be issues that come about, but as long as
they are dealt with in a timely and respectful manner the
mission will be productive.
10
Planning a medical mission is no easy feat. There are bound to
be hiccups along the way, but ensuring that team members get
to know each other prior to embarking on the journey, and
allowing each member to work autonomously will allow for a
less hostile work environment. When it comes to working as a
unit with other health care teams, our members need to be
culturally aware of who they are dealing with, and learn how to
be respectful. Our team needs to feel empowered in order to
provide quality patient care, and help to get this virus under
control.
Conclusion
11
Bellot, J. (2014). Organizational climate and culture. In D. L.
Huber (Author), Leadership & nursing care management (pp.
55-64). St. Louis: Elsevier.
Cox, K. B. (2014). Power and conflict. In D. L. Huber

39. (Author), Leadership & nursing care management(pp. 159-185).
St. Louis: Elsevier.
Hawkins, J. (2013). Potential Pitfalls of Short-Term Medical
Missions : Journal of Christian Nursing. Retrieved from
https://journals.lww.com/journalofchristiannursing/Fulltext/201
3/12000/Potential_Pitfalls_of_Short_Term_Medical_Missions.2
3.aspx
References
12
Hoying, C. (2014). Decentralization and shared governance. In
D. L. Huber (Author), Leadership & nursing care management
(pp. 246-255). St. Louis: Elsevier.
Huber, D. L. (2014). Professional practice models.
In Leadership & nursing care management (pp. 256-273). St.
Louis: Elsevier.
Maass, K. L., Liu, B., Daskin, M. S., Duck, M., Wang, Z.,
Mwenesi, R., & Schapiro, H. (2017). Incorporating nurse
absenteeism into staffing with demand uncertainty. Health Care
Management Science, 20(1), 141-155.
doi:http://dx.doi.org.library.capella.edu/10.1007/s10729-015-
9345-z
References

40. Manion, J., & Huber, D. L. (2014). Team building and working
with effective groups. In Leadership & nursing care
management (pp. 128-146). St. Louis: Elsevier.
Meyer, R. M. (2014). Organizational structure. In D. L. Huber
(Author), Leadership & nursing care management (pp. 226-245).
St. Louis: Elsevier.
Noguchi, N., Inoue, S., Shimanoe, C., Shibayama, K., &
Shinchi, K. (2016). Factors associated with nursing activities in
humanitarian aid and disaster relief. PLoS One, 11(3)
doi:http://dx.doi.org.library.capella.edu/10.1371/journal.pone.0
151170
References
Running head: SAFETY SCORE IMPROVEMENT PLAN1
SAFETY SCORE IMPROVEMENT PLAN9

41. Safety Score Improvement Plan for Newark Beth Israel
Samantha M. Tallarine
Capella University
Organizational and Systems Management for Quality Outcomes
Safety Score Improvement Plan
July, 2018
Safety Score Improvement Plan for Newark Beth Israel
Newark Beth Israel Medical Center is the largest hospital in
Newark, New Jersey. They have 480 total staffed beds, and are
at the forefront of medicine when it comes to heart, as well as
lung transplantation. Although they have a B rating according to
the Hospital Safety Score Web Site, they do have some areas to
improve upon; an example of this is patient falls. Their score of
0.541 is just below the average (0.371) however, still
unacceptable.
The drop in average of patient falls negatively impacts the
image of the hospital, which can lead to decrease in patients,
and a drop in funding. Although Newark Beth Israel is
functioning at an above average level, there is always room for

42. improvement. Improving upon the fall protocol on each unit,
and educating nurses, doctors, and other members of the
interdisciplinary team, we can all work together to make patient
falls a thing of the past.
Contributing Factors to Patient Falls
“According to the Agency for Healthcare Research and Quality,
more than 1 million patient falls occur each year in the United
States.” (Murphy, Murphy, Hastings, & Olberding, 2015) Falls
are something that have become common in the healthcare field,
but can often become deadly to a patient; “10% result in serious
injuries such as fractures or head trauma.” (Murphy, Murphy,
Hastings, & Olberding, 2015) What isn’t discussed about patient
falls is that they also lead to an increased stay for patients,
making them more susceptible to infections that they may have
never come across if they were being cared for at home. Also, if
a patient falls while in the care of the healthcare professionals
in the hospital, Medicare and Medicaid do not reimburse the
hospital for costs associated with that injury. Therefore, the
higher fall rate during hospitalizations, the more of a loss the
hospital is working at.
Stubbs, and Sikes explored falls on inpatient pediatric units,
and were able to pinpoint some factors that were found to
increase the likelihood of falls. “Increased length of stay, need
for antiepileptic medication, seizure disorders, physical therapy
or occupational therapy assistance, and musculoskeletal
conditions. Other studies have shown that pediatric inpatients at
greatest risk for falls are either less than 3 years old or an
adolescent with a neurological diagnosis.” (Stubbs & Sikes,
2017) Adult patients also face similar risks when faced with
these conditions, and increasing age is the most prevalent.
Protocols currently in place in hospitals are also questionable,
and many nurses believe that there is not enough being done to
inform members of the healthcare team of a patient’s risk level.
Another issue is that units aren’t staffed efficiently enough to
monitor the patients throughout their hospital stay. Family
members can be incorporated into the care plan, but the level of

43. their competency needs to be measured before any
responsibility is placed upon them. This would require more
counseling, as well as more staff for evaluation and
implementation. Falls cannot be reduced and eventually
eradicated within the hospital until all members of the
interdisciplinary team are on the same page and willing to work
together.
Nurse Leaderships Role in Fall Prevention
The upper management within the nursing department needs to
dedicate themselves to staying on top of their current employees
to be monitoring patients at all times. They need to make sure
that they are following protocols in place, as well as being open
to listen to any suggestions that may be made. Nursing leaders
need to offer an open platform for all employees, and be willing
to implement changes that are needed to suit the needs of both
the staff and the patients. Also, future employees should go
through a rigorous orientation period, which equips them with
the tools they need to assess for the risk of falls occurring, as
well as being trained to step in at any moment that a fall does
occur.
Policies and Procedures
Within the Newark Beth Israel Medical Center, policies and
procedures need to be amended to ensure patient safety. Upon
researching what they are doing to reduce their number of falls,
I came across a serious lack of policy regarding the matter. It
seems they are more concerned of any legal action that would
be taken against them after the fact, rather than trying to
eliminate the risk in the first place. Nursing leadership, as well
as the floor nurses need to take matters into their own hands and
start the process to implement a new policy to help protect their
patients, which helps the nurses in the long run. Patient falls are
considered “a nurse sensitive measure and nurses play a key
role in this component of care.” (Quigley & White, 2013) That
being said, nurses have everything to gain by implementing
changes within their units to help patients get optimal care, as
well as protecting their own license.

44. Systems Theory
“Complex adaptive system theory, and outgrowth of complexity
theory, suggests that the relationship between elements or
agents within any system is nonlinear and that these elements
are the key players in changing settings or outcomes.” (Marquis
& Huston, 2017) This means that if an individual acts one way,
they may not act the same way the next time they’re faced with
the same scenario. As humans, we learn from our mistakes as
well as our triumphs; nobody knows how they will react in a
certain situation, until faced with it. This is relevant to the issue
with patient falls because it theorizes that if a nurse is properly
trained and goes through a rigorous orientation and possible
simulations, they will be better equipped to handle all aspects
of their jobs, particularly falls.
That being said, if nurses start implementing new policies
within this organization we will have policies and procedures
that come from first-hand experience. Nurses are taught to
always advocate for their patients, and this opportunity allows
them to do that for all their patients at once, both current and
future. Having seasoned nurses bring their experiences one by
one to the nursing leadership will ensure that we will have new
policies that fit the needs of both the patients and the nurses.
Although nurses receive majority of the blame for when a
patient experiences a fall, some patients are prone to falls
regardless of receiving excellent care. Having a policy that
which protects the nurse from being wrongfully accused, as well
as one that protects patients from any negligence is the ultimate
goal.
Recommendations for Safety
Through my research, I’ve come across many different
suggestions to reduce the growing number of falls reported
during hospitalizations. There are a number of different ideas
that all could work if implemented correctly. A system also
needs to be put in place to monitor the effectiveness of these
strategies. Nursing leadership working hand in hand with their
subordinates, as well as the rest of the interdisciplinary teams

45. can lead to greater patient safety which in turn will lead to
higher reviews for the hospital, and will allow for full
reimbursement for stays from Medicare and Medicaid.
6-Pack Prevention Plan
One proposed solution is to have a prevention program in place
that “includes a fall-risk tool; ‘falls alert’ signs; supervision of
patients in the bathroom; ensuring patients’ walking aid are
within reach; toileting regimens; low-low beds; and bed/chair
alarms.” (Barker, Morello, Ayton, Hill, Brand, Livingston &
Botti, 2017) The study received positive reviews amongst the
nursing staff, and with proper implementation can be extremely
productive. If this were to be put into place, there would need to
be proper training sessions before implementation. Nurses
should be paired up in order to help each other properly survey
their patients, and assess their risk level. Pairing up nurses,
preferably a seasoned nurse with a new nurse, allows the proper
amount of surveillance, and will provide extra hands on deck to
care for patients effectively.
In order to measure the effectiveness of this program, data
would need to be conducted of what the fall percentage is prior
to implementation, as well as the fall rate at least one year after
implementing it. Also important, is to make sure your staff is
happy as well. Surveys would need to be conducted of the
employees, as well as patients and their families to monitor how
the new protocols are being perceived.
Roundtable Debriefings
In 2012, a Falls Roundtable intervention was brought into
discussion to be implemented in the emergency department in
an urban hospital. The whole point of this was to allow for
debriefing when an incident occurs to achieve fall-reduction
rates. This leads to actually confronting the issue, and speaking
about what happened, as well as figuring out a way to prevent
future incidents. It is a meeting held weekly and includes “1
nursing quality outcomes coordinator, 2 acute care clinical
nurse specialists, the director of acute care nursing services, 1
physical therapist, 1 education and development nurse, and 1

46. pharmacy resident.” (Murphy, Murphy, Hastings, & Olberding,
2015) The nurse who was caring for the patient at the time of
the fall was always part of the debriefing as well, in order to get
the complete picture of what occurred and could lead to a better
overall outcome.
This plan only works in conjunction with other fall precautions;
alone, it was not found to consistently keep fall rates decreased.
It did however, lead to the staff becoming more engaged in
implementing new fall-prevention measures, and being more
focused on their individual patient outcomes. Nurse leadership
can use this as one of the tools to reduce falls, and boost morale
among the staff. Instead of automatically penalizing nurses for
their patients experiencing a fall, it allows them a safe space to
explain what happened, and different perspectives among
healthcare professionals to come up with new and ever changing
protocols.
Red Light, Green Light
This proposed solution brings all members of the healthcare
team together, as well as the family members of the patients.
The process started with physical therapists assessing the
patient’s functionality and if they were at risk or not, and then
assessing family member’s ability to assist the patient. A status
of either red light, or green light was then assigned to each
patient and their family to help further the nurse’s knowledge of
which level of care needed to be administered. This was an
ongoing process, and patients were repeatedly assessed in order
to keep their status up to date. With this protocol in place, “the
fall rate decreased from 8.8 falls per 1,000 patient days in 2009
to 3.8 falls per 1,000 patient days.” (Stubbs & Sikes, 2017)
This was implemented by making training sessions mandatory
for all team members involved in patient care. New employees
were also trained specifically in transferring patients, as well as
with the equipment they would be using. Mandating training
sessions allows for nurses to gain confidence before even seeing
any patients, which will lead to sharpening their skills as well.
Implementing Change

47. The current system in place is that if a patient experiences a
fall, an incident report is supposed to be filed. It is unknown if
falls that do not result in any further injury are always reported.
One way to ensure that patients are being treated fairly, and
incidents are always reported is to have cameras within the
rooms. This would ensure that nothing was missed, and can also
be used for training purposes for new hires. There can be bi-
weekly, or monthly progress meetings where a nurse meets with
their managers and other members of the nursing leadership to
review tapes of their actions.
Although cameras in patient rooms can be very beneficial, there
are obstacles the hospital would need to go through to
implement it. We would need patient consent for them to be
watched under constant surveillance. Also, knowing you are
being filmed can cause stress on the nurse, and may actually
lead to more mistakes being made; especially in new graduates.
Conclusion
In regarding patient falls, it is obvious that something needs to
be done. Besides the fact that reimbursement for falls doesn’t
occur, but our patients need to feel safe in our hands. A patient
who feels confident in their doctors, and nurses will feel
hopeful, and work towards their goals of complete rehabilitation
from their injury or illness. No one proposed solution has been
proven to be the answer to all of our problems, but in picking
and choosing from each theory we can come up with new
protocols. Nurse leaders will be at the forefront of fall
reduction, and will motivate their subordinates to partake in
leadership roles as well. Our patients and their families will
also play integral parts in their welfare, leading to a well-
rounded and well thought out care plan. We need to help our
patients to help ourselves in the long run.
References
Barker, A. L., Morello, R. T., Ayton, D. R., Hill, K. D., Brand,
C. A., Livingston, P. M., & Botti, M. (2017). Acceptability of
the 6-PACK falls prevention program: A pre-implementation

48. study in hospitals participating in a cluster randomized
controlled trial. PLoS One, 12(2)
doi:http://dx.doi.org.library.capella.edu/10.1371/journal.pone.0
172005
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
management functions in nursing: Theory and application.
Philadelphia, PA: Lippincott Williams & Wilkins.
Murphy, L. M., Murphy, S. O., Hastings, M. A., & Olberding,
A. (2015). Are interprofessional roundtable debriefings useful
in decreasing ED fall rates? findings from a quality-
improvement project. Journal of Emergency Nursing, 41(5),
375-380.
doi:http://dx.doi.org.library.capella.edu/10.1016/j.jen.2015.02.0
05
Pelletier, L. R. (2014). Quality and safety. In D. L. Huber
(Author), Leadership & nursing care management (pp. 291-321).
St. Louis: Elsevier.
Quigley, Patricia A, PhD, MPH, CRRN,F.A.A.N., F.A.A.N.P.,
& White, Susan V, PhD, RN, CPHQ,F.N.A.H.Q., N.E.A.-B.C.
(2013). Hospital-based fall program measurement and
improvement in high reliability organizations. Online Journal of
Issues in Nursing, 18(2), 19-5. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.p
roquest.com%2Fdocview%2F1449497122%3Faccountid%3D279
65
Stubbs, K. E., & Sikes, L. (2017). Interdisciplinary approach to
fall prevention in a high-risk inpatient pediatric population:
Quality improvement project. Physical Therapy, 97(1), 97-104.
Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.p
roquest.com%2Fdocview%2F1862642901%3Faccountid%3D279
65
Running head: EXEC. SUMMARY OF ORG. DIVERSITY1
EXEC. SUMMARY OF ORG. DIVERSITY2

49. Executive Summary of Organizational Diversity
Samantha M. Tallarine
Capella University
Organizational and Systems Management for Quality Outcomes
Executive Summary of Organizational Diversity
August, 2018
Executive Summary of Organizational Diversity
The field of nursing is such a broad field that can take its

50. members in any direction of healthcare. There are so many
different sub-specialties that nurses can partake in, and they
have the opportunity to care for patients from all different
cultural and spiritual backgrounds. When working in a hospital
setting, nurses must be trained to deal with all possible
populations in order to effectively care for their patients.
Culturally competent care ensures that patients are receiving the
optimal treatment they deserve. “Patient-centered care is much
more complicated than what white papers and policies call for;
it entails a consideration of what it really means to respect
every culture as equal rather than for the dominant culture to
dictate what is right and wrong. As a society, patient-centered
care calls for some soul searching and accepting that other
cultures have a right to exist.” (Ong-Flaherty, 2015)
The Impact of a Diverse Workforce on Patient Outcomes
Since the 1990s, the American Association of Colleges of
Nursing (AACN) has supported and endorsed training its nurses
in cultural competence. A nursing workforce needs to be
inclusive of all cultures, but also needs to be inclusive all of all
lifestyle types as well. The LGBTQ community is continuously
growing, and we as healthcare workers need to educate
ourselves on how to care for this population effectively. When
patients deal with healthcare professionals who can relate to
their culture, or speak their language it makes them more
comfortable, and can promote a healing environment. “Non-
English speaking clients may be more likely to keep follow-up
appointments when working with health care providers who
speak their language, contributing to better treatment
utilization.” (Noone, Wros, Cortex, Najjar & Magdaleno, 2016)
A major transplant center hospital on the East Coast focuses
their resources on providing an environment full of diversity
and inclusion. They consider diversity, inclusion, and health
equality as part of their mission statement. Diversity is defined
as a variety of patterns which includes but is not limited to
values, customs, differences, and similarities. Inclusion is a
proactive approach to leveraging diversity by consciously

51. inviting, welcoming, respecting, and engaging each other
without bias. Health equity is defined as the results from
delivering high quality patient care to our diverse patients and
our diverse communities in ways that accommodate their
cultural, social, and physical differences. The same healthcare
center has also spearheaded a campaign for LGBTQ healthcare
equality; they have implemented safe spaces, as well as
adjusting policies to reflect the needs of, and protect the rights
and privileges of patients, employees, and physicians as well as
the surrounding community.
Integration of Multiculturalism and Diversity into
Organizational Practices and Staffing
The organization being described has a very diverse workforce,
and many of their department heads are of the minority
population. During the hiring process, they take into account if
the potential employee can speak any other languages. The
hospital is in an urban setting with a high population of patients
that speak Creole, so they strive to hire nurses, as well as
nursing assistants who can help to communicate with this
population of patients. They also promote a shared governance
structure, and evidence based practice and research strategies.
In order to care for the growing immigrant population this
healthcare organization has been changing the way they care for
patients, as well as how they communicate with the surrounding
population. They have just recently implemented community
outreach programs that are run by bilingual physicians and
nurses to ensure that all aspects of the health care process are
being met for non-English speakers. In doing this, they are
forming relationships and bonds with their patients, and easing
them into the healthcare system. These patients are now
reporting that they feel more comfortable seeking help knowing
that they will not face a language barrier.
In order to provide competent care, a hospital should be using
the systems theory to have a checks and balance within the
organization. “A key principle of systems theory is that changes
in one part of the system affect other parts, creating a ripple

52. effect within the whole.” (Huber, 2014) This organization in
question has recently implemented NetLearning competencies
that need to be met by all employees. These NetLearning
courses consist of HIPPA refreshers, LGBTQ training, gender
equality, culturally competent care, as well as many other
subject areas. These courses are assigned on a monthly basis,
and are ongoing throughout your whole employment. In
providing these ongoing courses, they are working towards
ensuring their employees are constantly reminded of the
standards they set for their staff, as well as keeping educated on
the most recent policies that are being implemented to ensure
competent care in all parts of the healthcare process.
Evidence-Based Proposals for Empowerment of a Diverse
Workforce
In order to make sure the surrounding community is receiving
the optimal healthcare, we need to understand not only their
medical needs, but their cultural and spiritual needs as well.
The main issue that they have experienced is language barriers.
There has been such an influx of immigrants from all different
countries, so the rapidly changing community needs a
healthcare organization that adapts to their needs just as
rapidly. Community outreach needs to increase, and the hospital
needs to be aware of which cultures they will predominantly be
dealing with. In accessing this information, they can then
recruit staff specifically tailored to deal with their community
population.
The organization can also look into implementing a clinical area
that has specific days and times where non-English speaking
patients can come receive preventive care from healthcare
workers of the same descent. In providing culturally competent
preventive care, we can help to reduce the amount of chronic
illnesses that may be seen in the future. As far as on the
multiple units in the hospital, leadership needs to continue to
hire diversely, and make sure they are enforcing the continuing
education of its staff members; especially on the subject of
being culturally competent, and handling the LGBTQ

53. community.
Conclusion
Culturally competent care is one of the most important things
we can provide for our patients as healthcare professionals. One
sure way to do this is to provide a diverse workforce, as well as
properly educated staff. “In childhood, the culture in which we
are nurtured influences our perspectives, morals, beliefs,
thoughts, and behaviors.” (Ong-Flaherty, 2015) That being said,
it is the duty of nurses and other healthcare workers to make
sure they are caring for their patients in the ways they need and
want. It is important to realize that you should not be caring for
your patients the way that you would want to be treated, but in
the way that they want to be treated. The healthcare
organization that was evaluated in this paper has taken steps to
ensure cultural competency, but there is always room for
improvement. Until healthcare professionals are aware of the
populations that they serve there will always be a gap between
them and their ever changing communities.
References
Almutairi, A. F., Adlan, A. A., & Nasim, M. (2017).
Perceptions of the critical cultural competence of registered
nurses in canada. BMC Nursing, 16
doi:http://dx.doi.org.library.capella.edu/10.1186/s12912-017-
0242-2
Huber, D. L. (2014). Leadership and management principles.
In Leadership & nursing care management (pp. 1-36). St. Louis:
Elsevier.
Munro, E., & Hubbard, A. (2011). A systems approach to
evaluating organisational change in children's social
care. British Journal of Social Work, 41(4), 726–743.
Njie-Mokonya, N. (2016). Internationally educated nurses' and

54. their contributions to the patient experience. Online Journal of
Issues in Nursing, 21(1), B1-B9.
doi:http://dx.doi.org.library.capella.edu/10.3912/OJIN.Vol21No
01Man05
Noone, J., Wros, P., Cortez, D., Najjar, R., & Magdaleno, L.
(2016). Advancing health equity through student empowerment
and professional success: A statewide approach. Journal of
Nursing Education, 55(6), 316-322.
doi:http://dx.doi.org.library.capella.edu/10.3928/01484834-
20160516-03
Ong-Flaherty, C. (2015, October). Critical cultural awareness
and diversity in nursing: A minority perspective. Retrieved from
https://ac-els-cdn-
com.library.capella.edu/S1541461215000968/1-s2.0-
S1541461215000968-main.pdf?_tid=a87d670f-5dc8-438f-a263-
6d75514bbeb8&acdnat=1534788103_77fbb7e180e5479ed7688b
511cb0e317
Popper-Giveon, A., Keshet, Y., & Liberman, I. (2015,
November/December). Increasing gender and ethnic diversity in
the health care workforce: The case of arab male nurses in
israel. Retrieved from https://ac-els-cdn-
com.library.capella.edu/S0029655415002559/1-s2.0-
S0029655415002559-main.pdf?_tid=b513174b-3ce8-4178-83ce-
716f433dda13&acdnat=1534789230_aefce479a71b477c91689ee
75bbf714e
Schmidt, B. J., MacWilliams, B. R., & Neal-Boylan, L. (2016,
March/April). Becoming inclusive: A code of conduct for
inclusion and diversity. Retrieved from https://ac-els-cdn-
com.library.capella.edu/S8755722316301302/1-s2.0-
S8755722316301302-main.pdf?_tid=97a554f0-dc02-424c-af2d-
74162a930313&acdnat=1534788157_17327c978115054c092297
f0589cbe11
Running head: STAFF SHORTAGE1

55. STAFF SHORTAGE2
Staffing Shortages in the World of Nursing
Samantha M. Tallarine
Capella University
Organizational and Systems Management for Quality Outcomes
Impact Report to Senior Leadership
June, 2018
Impact Report to Senior Leadership
Employees are only as good as the managers that lead them.

56. This is especially true within the field of nursing due to its
necessity for teamwork, and problem solving. According to
Diane Huber, “quality of life depends on the quality of leaders.”
(Huber, 2018, p. 1) There have been debates on the differences
between management and leadership, but in order to provide
exemplary patient care they both need to come into play. Many
theories have been proposed as to what the exact qualities of a
leader are, but there are so many different types of leaders that
nobody has been able to agree on a concrete list of “leadership
traits”.
Ideally, a manager would take on the role of a leader, but time
and time again we have come across those people who rise to
the challenge and fit perfectly into a leadership role. Whoever
the leader may be, they need to work on the issue of nursing
staff shortages because it is a problem that doesn’t seem to be
going away. Staff shortages not only effect patient care, but the
overall day to day operations of the hospital. It is up to the
managers and the leaders of the nursing staff, as well as the
leaders of the hospital to staff each floor safely and effectively.
It is extremely important to recognize when the staff is
inadequate on certain units, especially in the emergency room.
This will be researched using the struggles of a hospital in a
suburb of a major city. The hospital in question is an award
winning, teaching hospital with 745 beds and two campuses.
Despite their awards, they have faced an immense nursing
shortage which has led to patient’s complaints, and loss of trust
in the hospital.
The Nursing Challenge
Staffing shortages in the nursing profession cause extra stress
on both the patients, and the healthcare workers themselves.
Registered nurses make up the largest population within the
healthcare field (almost 3.1 million U.S. registered nurses), yet
we still see staffing issues. There are many factors that go into
the consideration of a unit being “understaffed”, and number of
employees is surprisingly not the main one. Most of the
resources I used talk about the issue of having brand new nurses

57. on units that they are not necessarily ready for, and without
senior staff to guide them it causes a major safety issue for
patients. As a graduate nurse just about to enter my first nursing
job, I can immensely relate to this. Although I am confident I
am educated enough to understand what is going on with my
patients, actually being solely responsible for their care, and
doing everything on my own is an anxiety ridden task.
Confidence comes with experience, and like all professions, the
experience comes from on the job training. The difference with
healthcare professions is that we learn while we have people’s
lives on our hands and do not have room for error.
The System/Organization
This organization is one of the nation’s healthcare institutions,
and has grown into a major teaching hospital as well as a
tertiary care center. Through their mission statement they vow
to care for the community in an effective and safe process, but
being short staffed contradicts that. They are the preferred
hospital to go to within the county, but more so because of lack
of options. The hospitals upper management has done the best
with what they have available, but there is so much room for
improvement when it comes to staffing.
Systems theory tells us that “changes in one part of the system
affect other parts, creating a ripple effect within the whole.”
(Huber, 2018, p. 30) That being said, if a hospital is short
staffed you will see patient care suffering, doctors and nurses
taking on more than they’re used to, and eventually ratings for
the hospital will go down. Having a hospital getting bad reviews
is unacceptable, especially within a community that is already
frustrated with it. This will cause people to have a mistrust in
the healthcare delivery system, and can lead to people not even
seeking help.
The organization is trying to take steps to better qualify their
already existing staff members. They offer tuition
reimbursement for nurses who want to pursue an advanced
practice degree. This will lead to more skilled and educated
nurses who can train new nurses, and provide the appropriate

58. level of care needed; especially in high pressure units such as
the ER, or ICU.
SWOT Analysis
This hospital, has gone through changes to accommodate a
growing population, and they have both benefits and setbacks
from this. This SWOT analysis will put into perspective the
things that are positive and should continue, as well as the
things that need to be changed.Strengths
· Located in small community, and best option available
· Large facility and receives federal funding
· Multiple specialty centers
· Participates in community outreach
· Affordable care offered (FAP)
· Working to ensure meaningful access to healthcare services
for people who are not fluent in English, or hearing impaired
patients
· Multiple awards won for performanceWeaknesses
· At least 55-minute wait time in ER (even during an asthma
attack)
· One nurse may have up to 20 patients in 1 shift
· Teaching hospital so has a large influx of new graduates with
little to no experience
· Population within the community is growing, and people are
living longer so more chronic illnesses seen
· Lack of communication between different nursing units
· Float pool lacks depthOpportunities
· Offers tuition reimbursement for nurses to advance degree
· Creation of new nurse leadership position to integrate change
and effective staffing
· More detailed orientation to the unit staff will be working on
· Team building exercises throughout the different units, not
just one specifically
Threats
· Health care programs have been dealing with budget cuts
· Lack of nurses pursuing advanced degrees
· High nurse to patient ratio leads to “burn-out”, and higher

59. stress levels which leads to nurses leaving the organization for a
more relaxed work environment
In order to bring the hospital to its full potential, the SWOT
analysis can help to laser in on what exactly needs to be
changed. Leadership needs to come to terms with the fact that
nurses are not superheroes, and need to be given the proper
resources to care for their patients effectively and efficiently.
The New Leadership Position
The new position that will be created within the organization is
Chief Nursing Officer (CNO). In order to be eligible for the
position, the candidate must be a Doctor of Nursing Practice
(DNP) with at least 10 years of nursing experience; past
leadership experience will be preferred. The candidate chosen
will work side by side with hospital management to ensure that
the nurses are being heard, and that staffing is adequate for the
level of intensity of each unit.
The CNO will give the nursing staff a voice with the higher ups
of the hospital, as well as working with the nurse managers and
charge nurses to hear the needs of the employees themselves.
On top of just advocating for current employees, the CNO will
also weigh in on new hires, and ensure that they are being
trained adequately and effectively. Also, a mentorship program
will be put into place; allowing graduate nurses to work directly
with seasoned, experienced nurses. This will boost morale,
influence teamwork, and also help new nurses gain the
confidence they need to do their best work. Happy nurses will
lead to improved patient care, and an overall increase in patient
satisfaction.
Conclusion
The nursing field will always be one that is high pressure, and
high stress, but with a change in how we staff our units, we can
make the work environment more efficient. “The major goal of
staffing management is to provide the right number of nursing
staff with the right qualifications to deliver safe, high-quality
and cost-effective nursing care to a group of patients and their

60. families as evidenced by positive clinical outcomes, satisfaction
with care, and progression across the care continuum.” (Pickard,
Carson, Huber, 2018, p. 367) Ensuring that the hospital has a
CNO with all the qualifications and capability to run a smooth
operation will lead to a solution to nursing shortages, and
increases in patient satisfaction.
References
Huber, D. (2014). Leadership and management principles.
In Leadership & nursing care management (pp. 1-36). St. Louis:
Elsevier.
Huber, D., & Workman, L. L. (2018). Confronting the Nursing
Shortage. In Leadership & nursing care management (pp. 339-
366). St. Louis: Elsevier.
Johnson, W. G., PhD., Butler, R., PhD., Harootunian, G.,
M.S.(c), Wilson, B., PhD., & Linan, Margaret, M.S., M.P.H.

61. (2016). Registered nurses: The curious case of a persistent
shortage. Journal of Nursing Scholarship, 48(4), 387-396.
doi:http://dx.doi.org.library.capella.edu/10.1111/jnu.12218
Kerfoot, K. M. (2017). A legacy of improving staffing and
scheduling: An interview with carol ann cavouras. Nursing
Economics, 35(4), 201-204. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.p
roquest.com%2Fdocview%2F1929679336%3Facc
Pickard, B., & Carson, L. (2018). Staffing and Scheduling. In
D. Huber & S. E. Birmingham (Authors), Leadership & nursing
care management (pp. 367-386). St. Louis: Elsevier.
Porpora, T. (2015, May 11). ERs in critical condition, nurses
say; patients cite long waits. Retrieved from
https://www.silive.com/news/2015/05/nurse_staffing_issues_res
ult_i.html
Wolf, L. A., Perhats, C., Delao, A. M., Clark, P. R., & Moon,
M. D. (2017). On the threshold of safety: A qualitative
exploration of nurses’ perceptions of factors involved in safe
staffing levels in emergency departments. Journal of Emergency
Nursing, 43(2), 150-157.
doi:http://dx.doi.org.library.capella.edu/10.1016/j.jen.2016.09.0
03
Nursing Practice and School Health Privacy
Samantha M. Tallarine
Capella University
BSN-FP4006
Policy, Law, Ethics, and Regulations
Health and Wellness Issues Affecting Adolescents
Mental Health
Early pregnancy and Childbirth
Alcohol and Drugs

62. Obesity
Bullying
HIV/AIDS and other Infectious Diseases
Mental health - According to the studies carried out by WHO,
depression is one of the leading causes of illness among the
adolescence, followed by suicide. Other factors such as poverty
and humiliation can increase the risk of developing mental
problems. However, creating life skills among adolescents and
offering them psychological support in their institution and
community, can help boost their mental health. Also, programs
can be organized to create awareness among them regarding
such issues and how to avoid them.
Early Pregnancy and Childbirth- It is evident that girls aged
between 15-19 years die out of complications related to
pregnancy and childbirth globally. However, approximately
11% of these girls are from the low and middle-income
countries.
Alcohol and drugs - This is one of the primary concerns in most
countries across the world. It reduces the self-control among
adolescents and also exposes them to some risky activities such
as reckless driving and unsafe sex.
Obesity – Due to an increase in technology, teenagers are more
likely to spend time on their computers, phones, and playing
video games than partaking in physical activity. On top of the
increase of sedentary lifestyles, access to fast food is increasing
adolescents chances of becoming obese. This places children at
higher risk for cardiovascular diseases, and diabetes at a young
age.

63. Bullying - one of the most significant issues adolescence are
experiencing. This could come from their peers due to various
factors like how they look, their backgrounds, or their academic
excellence among other factors. In Australia, it is estimated that
one out of six children is bullied. The influx of social media has
increased the likelihood of being bullied because people do not
have to do it face to face, and now can take place in cyber
bullying all across the world.
HIV/AIDS- According to the estimation in 2016, 2.1 million
adolescents were living with HIV. A good number of them were
exposed to HIV/AIDS during birth and live with this status
unaware.
2
Privacy Law and its impact on School Nurses
Definition
Refers to the laws that are aimed at regulating, storing and
using personal information of individuals that that can be
collectable to the government, public and private organization.
It is considered in the context of a person privacy rights or at
reasonable expectations of privacy.
Impact of privacy law to school nurse
It allows the nurse to retain the information regarding the
patient and keep it confidential.
It also protects the nurse from community or peers who may
need to access the information of a certain patient.
Students are also protected and their information is preserved as
private and confidential and cannot be accessed without their
consent.
CONT..
A patient’s right to privacy entails all confidential information
that is related to the patient. When dealing with adolescence, it
is essential to maintain this as many deal with several issues

64. that require to be protected from their peers. As a school nurse,
one needs to maintain a high degree of discretion, and storing
the information of each patient without disclosure. All countries
are seeking to ensure that privacy of every individual is being
protected, and therefore, laws and regulations are being set to
take care of such issues regarding the patients (Taylor, Williams
& Blythe, 2015)
3
Laws that relate to adolescence safety and health
Health Insurance Portability & Accountability Act (HIPAA).
It was approved by US legislature in 1966 to improve the
effectiveness and efficiency in health care systems
Family Educational Rights and Privacy Act of 1974 (FERPA)
It is a state law that aims at protecting the student privacy in
regard to education records
Children's Online Privacy Protection Act (COPPA)
This law was formulated to safeguard the children aged below
13 years against site web operators.
Confidentiality issues are increased during the adolescence
stage and can be critical barriers to the young adults when it
comes to receiving health care. It should be noted that health
care providers should be aware of laws that affect the
confidentiality of the individuals. The Privacy rule, based on
requirements contained in HIPPA of 1996 provides the
protection against parents accessing protected health
information for the young adults and liberated minors. It also
protects them when a parent or guardian assents an agreement of
confidentiality between the health care provider and the
adolescent. On the other hand, FERPA gives parents and
students’ basic rights such as right to inspect and evaluate all
records of a student maintained by the school. Right to consent
in writing to reveal some personal information from the records

65. of students and many other rights. COPPA allows parents to
have an access on what their children view online. Further, it
requires that site operators give parents permission to evaluate
any information obtained from their children.
4
Benefits of Privacy Laws
Privacy law is essential as it helps to encourage vital values
such as
Personal independence
Respect
Dignity of human being
Cont...
5
Benefit to Students
Students are protected against malicious individuals and all
their information is maintained as private and confidential.
They are also protected from site operators who may disclose or
use their information for ill purposes. This is facilitated through
COPPA law which allows parents to review all information on
their children
The law offers freedom as they can do what they like under
unfair influence or control
Security – students are not bothered since their information is
protected. This could be either their health status or an issue
they are struggling with
Benefits to School
The school is able to collect information that is relevant without
being held liable
In cases, where some students are involved in crime activities it
is allowed that such information br disclosed without
limitations and the school will not be held liable

66. Cont…
It is the right of people to be free from intrusion into personal
matters. The students’ privacy right covers education records,
conducts and admission. When such is disclosed this is termed
as violation of privacy rights. Also, in regard to benefit of
privacy laws in schools is that it protects them. In cases of
where a certain student is involved in crime such information
can be disclosed and be helpful to the society. Additionally, the
school nurses are also protected and have the right to preserve
all the information of their patient (Smith & Stepanov, 2014).
6
Benefits to school nurse
They can freely maintain confidential information of their
patient without being coerced to reveal such information
The privacy role is also of great benefit when dealing with
parents of certain students who want critical information
regarding their children who are not minors.
Develops trust
The Evidence-based ethical strategies
Electronic Health Records (EHR) and meaningful use
It increases the privacy of the students information especially
on sensitive matters
Increases the accessibility to care among adolescence
Creating awareness to the parents and young adult on the
policies and laws
Every body is aware of their rights
Nurses are able to work efficiently and with clear cut

67. guidelines. Students may feel hesitant to seek healthcare advice
because they are afraid of their parents being notified, but if we
ensure them that we will keep the meeting as confidential as
possible (barring any life threatening scenarios), they will feel
more comfortable. Parents can also rest assured that their
children will receive optimal healthcare in a safe space.
8
Conclusion
School nursing is a critical practice that ensures the wellness,
lifelong achievement and the academic excellence of the
students. Ensuring students are healthy and safe while in school
should be the first priority for the school and health care
providers.
Resources
Brewin, D., Koren, A., Morgan, B., Shipley, S., & Hardy, R. L.
(2014). Behind closed doors: School nurses and sexual
education. The Journal of School Nursing, 30(1), 31–41.
Smith, M. K., & Stepanov, N. (2014). School-based youth
health nurses and adolescent decision-making concerning
reproductive and sexual health advice: How can the law guide
healthcare practitioners in this context? Contemporary Nurse:
A Journal for the Australian Nursing Profession, 47(1/2), 42–
50.
Taylor, J. F., Williams, R. L., & Blythe, M. J.
(2015). Healthcare reform, EHRs, and adolescent
confidentiality. Contemporary OB/GYN, 60(8), 34, 36–37.
Running Head: WORKPLACE VIOLENCE 1
WORKPLACE VIOLENCE 5

68. Nursing and Workplace Violence
Samantha M. Tallarine
Capella University
Policy, Law, Ethics, and Regulations
May, 2019
According to the occupational safety and health administration
(OSHA), more than 2 million workers are victims of violence in
the workplace every year. Violence can arise in any workplace,
and it may emanate from violent acts by coworkers, patients,
their family members, criminals, and visitors, causing concerns
about personal safety (Dehghan-Chaloshtari & Ghodousi, 2017).
In the healthcare setting, violence can take different forms like
physical assault, verbal aggression, or even the use of deadly
weapons against patients, physicians, and other workers.
Besides all these aspects, the employers in the healthcare
setting have an obligation to provide a safe working
environment that is free from recognized hazards.
The risk factors for workplace violence vary from one hospital
setting to another, and some of the common factors include
failure to train staff and facilitate policies that will prevent and
manage a crisis in times of violent acts within the hospital
setting and accessibility to firearms. Nurses, for instance, have
experienced violence for a long time, and they have been told it
is part of their job in the past. Currently, awareness is being
raised that violence is not part of their job, and they do not have
to be assaulted (Abdellah & Salama, 2017). There has been

69. reluctance by the federal, states and local governments
lawmakers to pass and approve legislation that will offer
healthcare workers legal protection from workplace violence
despite continuous advocacy by professional bodies in
healthcare. In most states, violent assaults have been classified
as 'class A misdemeanors,' but with effective law and advocacy,
the assaults for instance in Texas have been classified as 'third-
degree felonies' (Docksai, 2018).
Guns in the U.S. have been a highly politicized issue hindering
effective regulation. They are easily accessible to patients,
family members, among others, and contribute to healthcare
workplace violence. On November 19th, 2018, in a Chicago
based Mercy Hospital & Medical Center, four people died in a
gun-related shooting (Rappleye, 2018). As a result of such kind
of shootings and deaths, social workers, nurses, and physicians
have joined hands to seek funds and lobby for government
support for legal support against gun violence through
facilitating effective violence prevention strategies.
There are other factors that contribute to workplace violence
such as inadequate security, working directly with people who
are volatile, for instance patients who are under the influence of
alcohol, drugs, and others may have a history of violence,
patients having to wait for long to be served and work
environments that are poorly designed (Cdc.gov, 2019).
OSHA recommends that to protect against violence in the
healthcare setting; providers develop an effective program that
will prevent workplace violence (OSHA.gov, 2019). The
program is to include;
· Commitment by the management and participation from
workers: the management needs first to recognize that
workplace violence is a safety and health hazard and also
provide the needed resources to and motivation to workers to
facilitate dealing effectively with workplace violence. Regular
committees and team meetings can be held to ensure that
violence prevention program is in operation (OSHA.gov, 2019).
· Analyzing the workplace and identifying hazards: this

70. involves an assessment of the workplace to identify potential
and existing hazards for workplace violence. The team should
set the time within which a comprehensive workplace analysis
should be done to single out the hazard and new situations that
could result in violence.
· Preventing and controlling hazards: this is a guideline in
which appropriate steps are taken to control or prevent hazards
that were identified. The implemented controls should be
evaluated more often to facilitate any needed updates
(OSHA.gov, 2019).
· Enhancing training programs on safety and health: these
programs will ensure that healthcare workers are aware of the
potential hazards and how they can protect themselves. The
training content can be reviewed on an annual basis to integrate
other new relevant information.
· The final guideline is keeping records and evaluating the
violence prevention program. This will be essential for the
identification of any deficiencies or any changes that need to be
made.
Concerning personal and shared roles as well as those of
employers and registered nurses, the position of the American
Nursing Association (ANA) is to create and maintain a culture
of respect that is free from "incivility, bullying and workplace
violence" (Nursingworld.org, 2015). The employers and the
registered nurses have a legal, moral and ethical responsibility
of facilitating a work environment that is healthy and safe for
patients and their families, but also for all members of the
healthcare team. The ANA intends to protect nurses from the
different types of violence through the use of resources, policy,
and advocacy, among other methods. The ANA has zero
tolerance on workplace violence and its policies compared to
those that healthcare organizations put in place concerning
workplace violence. Some of the policies in its position
statement include;
· Offering education programs on bullying and incivility as well
as prevention strategies.

71. · Offering a mechanism through which RNs can seek support
when they feel threatened.
· Encourage the registered nurses to report any incidence of
violence, participate in educational programs, and learn the
policies and procedures within the organization.
· The nurses and their employers should establish a shared
commitment that will promote a safe environment, which will
enhance dignity and respect (Nursingworld.org, 2015).
The employers should be in the forefront to prevent violence,
and they, therefore, need to implement OSHA's safety and
health program. This program should be evaluated periodically
and enhance the specific prevention strategies and safety
policies in different areas such as environmental designs,
administrative controls, provide the hospital workers with
safety tips and modifying their behavior (Cdc.gov, 2019).
Employers can install metal detectors like security devices, and
this will prevent people who are armed, e.g., with guns from
entering the hospital environment. Good lighting in the
hallways and cameras can be installed for security purposes.
Monitoring, alarms, and signaling systems can be developed for
use during an emergency. The healthcare employer should
design and install a system in which the security personnel can
be alerted in case of violence.
When responding to violence, hospital workers should watch for
signals such as the presence of a weapon, threatening gestures,
anger, and frustration. In return, they should maintain behavior
that will dissolve the rage, such as avoiding giving orders,
matching the threats, or avoiding any aggressive behavior
(Cdc.gov, 2019). Safety policies and prevention strategies have
been proven to be effective, and therefore, hospitals should
develop a violence prevention program that is comprehensive to
provide healthcare workers with a safer working environment.

72. Resources
Abdellah, R. F., & Salama, K. M. (2017). Prevalence and risk
factors of workplace violence against health care workers in
emergency department in Ismailia, Egypt. Pan African medical
journal , 26(1), 1-8.
Cdc.gov. (2019). The National Institute for Occupational Safety
and Health (NIOSH): Violence Occupational Hazards in
Hospitals. Retrieved 2019 йил 16-05 from Centers For Disease
Conntrol and Prevention: https://www.cdc.gov/niosh/docs/2002-
101/#What%20are%20the%20risk%20factors%20for%20violenc
e?
Dehghan-Chaloshtari, S., & Ghodousi, A. (2017). Factors and
characteristics of workplace violence against nurses: a study in
Iran. Journal of interpersonal violence , 0886260516683175.
Docksai, R. (2018). Lawmakers and Hospitals Take Action to
Curb Violence Against Nurses. Retrieved 2019 йил 16-05 from
Nursing Licensure Organization:
https://www.nursinglicensure.org/articles/workplace-
violence.html
Nursingworld.org. (2015 йил 22-07). ANA Positio
Statement:Incivility, Bullying, and Workplace Violence.
Retrieved 2019 йил 16-05 from American Nurses Association:
https://www.nursingworld.org/practice-policy/nursing-
excellence/official-position-statements/id/incivility-bullying-
and-workplace-violence/
OSHA.gov. (2019). Guidelines for Preventing workplace
violence for Healthcare and Social Service Workers.

73. (https://www.osha.gov/Publications/osha3148.pdf).
Rappleye, E. (2018 йил 20-11). Perspective: Addressing gun
violence is 'professional, moral and ethical duty' of healthcare
providers. Retrieved 2019 йил 16-05 from Hospital Review:
https://www.beckershospitalreview.com/hospital-physician-
relationships/perspective-addressing-gun-violence-is-
professional-moral-and-ethical-duty-of-healthcare-
providers.html
RUNNING HEAD: END-OF-LIFE DECISIONS 1
END-OF-LIFE DECISIONS 2
End-of-Life Decisions
Samantha M. Tallarine
Capella University
Policy, Law, Ethics, and Regulations
May, 2019

74. Role of the Nurse in End-of-Life Decision-Making
“End-of-life nursing encompasses many aspects of care: pain
and symptom management, culturally sensitive practices,
assisting patients and their families through the death and dying
process, and ethical decision-making” (Hebert, Moore &
Rooney, 2011). Nurses are playing crucial roles in the in end-
of-life decision making regarding the patients and other
members of family. Clarification of the family roles is the first
role that is played by nurses. The families of the patients
sometimes also develop some roles which are majorly informal.
For instance, there are roles that are dedicated to the members
of family regarding provision of primary care. Suppose a person
becomes seriously ill, before their stay in the Intensive Care
Unit, there is always a member of the family who is supposed to
act as the primary caregiver. However, the individual acting as
the primary caregiver may serve as the primary decision maker
or not. Moreover, nurses play another part in the process of
deciding end-of-life by advocating for their patients, and
communicating with the patients and their family members.
It is extremely important that patients facing the end of their
life remains comfortable, and if possible “have some pleasure in
daily life” (Nakano, Sato, Katayama & Miyashita, 2013). In
helping the patients and administering palliative care, or
assisting them in making their plans, nurses help the patient to
remain autonomous. Nurses spend the most time with the
patients, so it works best to have them help patients and their
family members in this time of need to understand all their
options. That is one of the biggest roles that the nurse can play
when it comes to patient’s making decisions about their end-of-
life care.
Legislation that generated end-of-life health care policies
Patient Self Determination Act (PSDA) is the legislation that
led to the generation of the end-of-life healthcare policies;
Congress enacted it in the year 1991. The act mandates that the
facilities of healthcare that were receiving Medicare funding or
aid were required to provide the patients with written

75. information indicating the rights of the patients to get involved
in the medical decision making alongside writing advanced
directives. The legislation was as a result of concern from
various persons who were having significant concerns with the
policies of health care and not for a medical case that was
specified. The people who were concerned in the healthcare
policies had interests in ensuring that patients are allowed to
take part in the process of making decisions. The healthcare,
proxies, and living wills alongside all other advanced directives
are enabling the patients to decide on the kind of measures they
do or do not want to be used if they become debilitated.
Primary policies regarding current health care practices
Oregon’s Death with Dignity Law is one of the policies that was
put in place in 1997 to allow adult Oregonians who were
terminally-ill to utilize self-administration of doses of
medications which are lethal. Secondly, there is a policy of
death with dignity act that Oregon passed about healthcare
decision-making. The law was enacted to allow patients who
were dying with choices of ending their lives and ensuring that
the patient remains autonomous throughout the rest of their life.
This can help those with agonizing terminal illnesses escape
some of their inevitable suffering.
Ethical Considerations that have influenced policy decisions
Autonomous Decision Making is one of these ethical
considerations. Making this decision is one of the processes of
thoughts that are complex and is setting up various challenges
for both the patients and their members of families towards
coming up with healthcare decision regarding the end of life.
People have the chance to make decisions regarding there end of
life treatment preferences. Additionally, there is ethical
consideration that is influencing decision policy with reference
to the end-of-life healthcare decisions in directives that are
advanced are usually allowing persons who are competent to
prototype as well as engage in the documentation of the
decision plan with regard to healthcare in advance directives
suppose they become incapacitated in the future Healthwise

76. (Leach, 2016, p. 39).
Resources
Hebert, K., Moore, H., & Rooney, J. (2011). The Nurse
Advocate in End-of-Life Care. The Ochsner journal, 11(4), 325–
329.
Leach, D. R., (2016). Ethics and end of life issues. Oxford
Medicine Online.
Meyers, D. E., & Goodlin, S. J., (2016). End-of-Life Decisions
and Palliative Care in Advanced Heart Failure. Canadian
Journal of Cardiology, 32(9), 1148-1156.
Nakano, K., Sato, K., Katayama, H., & Miyashita, M. (2013).
Living with pleasure in daily life at the end of life:
Recommended care strategy for cancer patients from the
perspective of physicians and nurses. Palliative & Supportive
Care, 11(5), 405-13.
doi:http://dx.doi.org.library.capella.edu/10.1017/S14789515120
00442
Norlander, L. (2014). To comfort always a nurse's guide to end-
of-life care. Retrieved from https://ebookcentral-proquest-
com.library.capella.edu
Zaal-Schuller, I., Willems, D., Ewals, F., Van Goudoever, J., &
De Vos, M. (2016). How parents and physicians experience end-
of-life decision-making for children with profound intellectual

77. and multiple disabilities. Research in Developmental
Disabilities, 59, 283-293.
RUNNING HEAD: MORAL DILEMMA & ETHICS1
MORAL DILEMMA & ETHICS2
RUNNING HEAD: MORAL DILEMMA & ETHICS3
Moral Dilemmas and Ethical Decisions
Samantha M. Tallarine
Capella University
Policy, Law, Ethics, and Regulations
May, 2019
Looking after patients in an emergency room brings forth
ethical dilemmas. Owing to the limited time and the condition
of the victim in addition to the absence of treatment history,
difficulties usually occur. The nurse is faced with minimal time
to analyse all the details regarding the patient in question. It is
therefore recommended that the nurse should make a quick
assessment and take the necessary action which is by the
hospital protocol. This chaos that occurs in emergency rooms
poses a distinct ethical challenge, which calls for nurses to
familiarize themselves with ethical principles as well as

78. concepts.
Health care protocols and policies guiding triage attention in the
event of an emergency
“Nursing intuition and subjective decision making are required
even with the most advanced triage systems, further leading to
variability in triage processes and outcomes. Given the
associated risk in the triage environment, as our patient
demands evolve, so must our nursing practice to ensure
optimum patient outcomes” (Domagala & Vets, 2015). Nurses
expect to treat patients and also save lives. While assessing
patients and beginning the triage process, nurses must be able to
separate patients into emergent, urgent, and non-urgent. In
effectively classifying the patients in this way they can assure
that the most serious injuries and illnesses are being treated
first in order to save lives.
Strategies Used During Triage
According to Aacharya, Gastmans, and Denier there are
numerous different strategies that can be implemented when
triaging patients. “The most commonly used guidelines for ED
triage on the international literature are The Manchester Triage
Score, The Canadian Triage and Acuity Scale (CTAS), The
Australasian Triage Scale (ATS), and Emergency severity
Index. In ESI, there are five-levels of these triage score. In
addition national and institutional guidelines are also developed
and used in practice” (Aacharya, Gastmans & Denier, 2011).
CTAS and ATS break down their triage system into 5 tiers;
Resuscitation – Level 1 (0 minute wait), Emergency – Level 2
(10-15 minute wait), Urgent – Level 3 (30 minute wait), Semi-
urgent/less urgent – Level 4 (60 minute wait), Nonurgent –
Level 5 (120 minute wait). Manchester Triage Score goes as
following; Immediate (Red) – Level 1 (0 minutes), Very urgent
(Orange) – Level 2 (10 minutes), Urgent (Yellow) – Level 3 (60
minutes), Standard (Green) – Level 4 (120 minutes), Nonurgent
(Blue) – Level 5 (240 minutes). All the systems use a 5-tiered
system, but differ on the time expected for patients to see the
provider.

79. The Emergency Service Index (ESI) is what is most commonly
used in United States hospitals. It is also a 5-tiered system that
relies on nurses to triage patients effectively into the
appropriate category using both their judgment and diagnostic
testing. Level one requires immediate life-saving interventions,
level two consists of high-risk patients (i.e. dyspnea, confusion,
extreme pain, lethargy, etc.), and the following three tiers are
non-emergent cases that can afford to wait for medical
treatment. In learning the ESI effectively, nurses can efficiently
triage patients and ensure people are receiving the correct level
of care.
Medical attention disparities effects on treatment decisions
Unfortunately, it is not uncommon to hear that someone died in
a particular hospital as a result of neglect by the clinicians.
Treatment disparities occur as a result of institutionalised
inequities and not technology, medication or access. Even
though the process helps make swift decisions, it serves as an
avenue through which impressions and assumptions flow which
in effect brings about biased treatment judgments on the part of
the practitioner (Griffith, 2018). Nurses are human, and with
that comes imperfections. It is very possible that a nurse can
have underlying biases that they may not even be conscious of.
This can come through when they are treating patients who may
be homeless, or have mental illness. This is why there should be
more than one nurse that is in charge of doing triage.
Health care policies directed towards the care of uninsured
patients
Health care across different nations provides little priced safety
nets, which include free clinics, community health centers, as
well as public hospitals. Here, the uninsured patients receive
medical attention at a low price irrespective of their differences.
Whether the uninsured patients are low-income earners or high-
income earners, they are always aware of the existence of low
cost and high price medical centers respectively.
There are also policies that exist to allow any patient to receive
medical attention in the event of an emergency. There is no

80. valid reason to discriminate an individual based on their
financial condition during a crisis (Christakis, 2014). The
responsibility for uninsured patients is also widely recognized
through offering high-class major safety nets, which include
educational health centers and free clinics. It can, therefore, be
concluded that in the event an uninsured person falls sick, there
are many places to receive medical attention.
Moral and ethical challenges faced by nurses when enacting
hospital protocols and policies.
In every country of the world, nurses have encountered ethical
difficulties in the pursuit of patient’s health care. It is also by
the nursing profession that they should uphold principles, moral
virtues and duties which have become increasingly sophisticated
in the face of immense pressures and moral choices incurred in
the line of duty (Jones, 2016). The demand for nurses to meet
the multifaceted requirements for the patients creates a very
complex nursing environment. The nurses must ensure that the
rights of the patients are upheld irrespective of the
multidimensional differences.
Unethical practices in emergency rooms and other areas should
be avoided at any cost to maintain the image of the firm. It is
also a moral obligation to ensure that end of life concerns are
well taken care of, alongside preserving the confidentiality of
the patients towards health care. These honest and ethical
obligations result in more stress among nurses. There is also a
conflict of interest that arises if an uninsured patient comes
along. Although nurses have the obligation to treat each patient
fairly regardless of race, sex or income, they may receive
pressure from the organization to treat insured patients first,
regardless of acuity.
Strategies for managing the care of the uninsured and indigent
population
The number of uninsured patients has been on the rise for a few
decades as a result of the premiums paid for life insurance,
which is far beyond the budgets or natural population. Their
governments through the public health sector can support the

81. non-working, uninsured patients.
The funds to finance medical activities are raised from taxes,
and this results in high fees amongst the employed as well as
the business sector. General tax revenues which may include
income tax, import duties and sales tax can be preferred. The
medically uninsurable population comprises of a small group of
the general population. Their health care demands can be met
through incentives or taxes or both (Kolodner, 2014). The
uninsured working group can be mandated to take insurance
policies since they can afford them. The employers should
ensure that their employees pay a regular amount towards their
insurance policy.
In conclusion, it is therefore clear that many steps are involved
in triage nursing. There already exists health care policies and
protocols that have to be adhered to in case of an emergency.
The general nursing environment is also a major factor that
affect the treatment decisions made by nurses. Conflicts of
interest and maintaining confidence of patients are some of the
ethical challenges faced by nurses. However , the uninsured
patients can be taken care of through numerous strategies which
can be adopted by the various states.
Resources

82. Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency
department triage: An ethical analysis. BMC Emergency
Medicine, 11, 16.
doi:http://dx.doi.org.library.capella.edu/10.1186/1471-227X-11-
16
Asch DA, Jedrziewski K, Christakis NA. Response rates to mail
surveys published in medical journals. Journal of Clinical
Epidemiology. 2014;50(10):1129–1136.
Burns JP, Mitchell C, Griffith JL, Troug RD. End-of-life care in
the pediatric intensive care unit: Attitudes and practices of
pediatric critical care physicians and nurses. Critical Care
Medicine. 2015;29(3):658–664.
Butz A, Redman BK, Fry ST, Kolodner K. Ethical conflicts
experienced by certified pediatric nurse practitioners in
ambulatory settings. Journal of Pediatric Health
Care. 2014;12(4):183–190.
Domagala, S. E., & Vets, J. (2015). Emergency nursing triage:
Keeping it safe: JEN JEN. Journal of Emergency Nursing,
41(4), 313-316.
doi:http://dx.doi.org.library.capella.edu/10.1016/j.jen.2015.01.0
22
Grady C, Soeken KL, Danis M, O'Donnell P, Taylor C, Farrar
A, Ulrich CM. Does ethics education influence moral action of
practicing nurses and social workers. American Journal of
Bioethics. 2018; 8(4):4–11.
Jones TM. Ethical decision-making by individuals in
organizations: An issue-contingent model. Academy of
Management Review. 2016;16:366–395.
Informatics And The Application Of New Knowledge
Samantha M. Tallarine
Capella University

83. Nursing Research & Informatics
BSN-FP4004
1
A Major Change in the Nursing Field
The change entails the ability to offer services to healthcare
consumers even when there exists physical distances between
the patient and the nurse.
For patients with less complex health conditions, a nurse can
engage them and provide over platforms provided by the new
technologies.
In the last two years, the nursing practice has changed in a
number of ways as a result of the emerging technologies. The
change entails the ability to offer services to healthcare
consumers even when there exists a physical distance between
the patient and the nurse. Today, healthcare consumers must not
check in facilities to receive care, there are now services called
“TeleMed” or “TeleDoc” that allow you see doctors, nurses, and
nurse practitioners from the comfort of your own home via
mobile phone, or computer camera. This change has brought
about benefits as nurses do not need to visit patients but can
offer services more effectively and even for a greater number of
patients.
2
Telenursing

84. From a general point of view, Telenursing is what was
previously known as counselling over the phone. However, in
the modern era, technology has advanced and there are
computers, visual accessories, telephones, and audio accessories
that enable interactions between the nurse and the patients
(Wade, Gray & Carati, 2017). They can see face-to-face hence it
is easier to offer instruction and guide the patient through the
various interventions and prescriptions.
3
How Theory Supports Telenursing
A theory/model that supports Telenursing is the Technology
Acceptance Model (TAM) which states that a user’s intention to
take up or adopt a technology is usually based on two major
concepts which are perceived usefulness and ease of use. In the
field of Telenursing, it is seen that the two concepts correlate
with intention. Patients are preferring the technology as it easy
to use and is extremely useful. It is only about video
communication at the convenience of the patient (Kowitlawakul,
2011).
4
How Research Exploration Supports Telenursing
Research has shown consumers are continually adopting
Telenursing.
Information technology research is focusing on newer
technologies that will achieve even closer interactions in the
future.
Research has shown that though the cost of treatment is higher,
patient outcomes have improved.

85. Research has continued focusing on the Telenursing area where
it has major in a number of areas as follows. First, research is
looking into motivators that are making healthcare consumers
prefer Telenursing as opposed to visiting the facilities. Second,
research is focusing on newer technologies that will improve
interactions between nurses and the consumers. Third, the
research is focusing on the effect of Telenursing on cost of
healthcare and patient outcomes. The recent results indicate an
increasing cost of treatment but improved outcomes. It is
however freeing up emergency rooms for actual emergencies
instead of certain illnesses that can take time and resources
away from life threatening situations.
5
How Information Technology Supports Telenursing
Information technology is actually the major driver of
Telenursing.
There are companies which are developing information
technology tools for easier interactions between a nurse and the
patient.
It is expected that in the future, the technology will allow even
for easier interactions leading to improved results and reduced
costs.
Information technology is actually the major driver of
Telenursing. There are companies which are developing
information technology tools for easier interactions between a
nurse and the patient. Such include video and audio accessories
which create visual communication between the nurse and the
consumer. It is expected that in the future, the technology will
allow for even easier interactions leading to improved results
and reduced costs (Wade et al., 2017). More so, tools that can

86. be used even in remote areas will be required in the future. Wi-
Fi signals need to be strengthened in more rural areas to ensure
that everybody is receiving the benefits that Telenursing can
provide.
6
Difference between Research and Evidence-Based Practice
Research – exploration, discovery, and investigation
Evidence-based Practice (EBP) – translating evidence and
research, and applying it to clinical decisions.
Research whether qualitative or quantitative refers to generation
of new knowledge or in some cases validation of existing
knowledge majorly based on a particular theory. Research
practices are systemic and scientific inquiries that aim at
answering questions or testing hypothesis. In essence, a
research is about exploration, discovery, and investigation. On
the other hand, EBP refers to translating evidence and applying
it to clinical decisions. This means that the purpose of EBP is to
use evidence with the aim of making the patient-care decisions.
Notably, the evidence used in most cases come from research.
This is to ensure that care is being delivered in the most up to
date, and patient safe way. By constantly altering the way
healthcare is provided based off of evidence-based practice, we
are ensuring patients are being treated effectively and safely.
7
Continued….
Research is about seeking new knowledge or validating the
existing one while EBP is about application of existing
knowledge during clinical practice.
EBP goes beyond the evidence and includes clinical expertise as
well as other aspects such as values and the preferences of the

87. patients.
In essence, researches main aim is to develop knowledge
whereas EBP is about translating best evidence into clinical
practice.
From the above definitions, it is clear that research is about
seeking new knowledge or validating the existing one, while
EBP is about application of existing knowledge during clinical
practice. Additionally, it is imperative to note that EBP goes
beyond the evidence and includes clinical expertise as well as
other aspects such as values and the preferences of the patients
(Wade et al., 2017). Research main aim is to develop knowledge
whereas EBP is about translating best evidence into clinical
practice.
8
How Nurse Leaders Use Communication Technologies for
Stakeholder engagement
The Telenursing technologies have options for connecting with
other professionals such as physicians.
In the event there is a need for an intervention by a colleague,
they can quickly connect with the colleague who then connect
with the patients.
The platforms allow a nurse to gather and collect data which is
then shared with other professionals.
In relation to Telenursing, it is worth noting that nurses have
been using the technology for enabling interprofessional
stakeholder engagement. The Telenursing technologies have
options for connecting with other professionals such as
physicians. In the event that a nurse realizes there is a need for
an intervention by a colleague, they can quickly connect with

88. the colleague who then connect with the patients. Additionally,
the interactive platforms allow a nurse to gather and collect data
which is then shared with other professionals such as fellow
nurses, lab experts, and physicians.
9
How Nurse Leaders Use EBP
Meeting performance goals and making clinical decisions.
Oversee clinical trials
Data collection and analysis
Nurse leaders have been using EBP so as to drive realization of
better outcomes. They work with researchers and scholars who
provide evidence that is then acted on when meeting
performance goals. They also oversee clinical trials which aim
at ascertaining that a particular new approach will be effective
for a particular category of patients. They monitor and assess to
ensure that improved goals are being attained. Finally, the
nurses are involved in data collection and analysis with the aim
of finding new evidence that will be integrated in the various
clinical practices (Wilmoth & Shapiro, 2014).
10
Summary
Telenursing is a new and important development that is seeing
improved outcomes but increased cost of care.
However, more research is undertaken so as to see realization of
better approaches that are evidence-based.
More so, technological tools need to be more advanced to allow
for more effective and rapid interactions between the nurse and
the patients.

89. From the above slides, it can be seen that Telenursing is
actually a new and important development that is seeing
improved outcomes but increased cost of care. The physical
distance barrier is not a hindrance to nursing. However, it is
imperative that more research is undertaken so as to see
realization of better approaches that are evidence-based. More
so, technological tools need to be more advanced to allow for
more effective and rapid interactions between the nurse and the
patients.
11
References
Kuperman, G. J., Gardner, R. M., & Pryor, T. A. (2013). HELP:
A Dynamic Hospital Information System. New York, NY:
Springer.
Kowitlawakul, Y. (2011). The technology acceptance model:
Predicting nurses’ intention to use telemedicine technology
(eICU). Comput Inform Nurs 29(1), 411-418.
Wade, V., Gray, L., & Carati, C. (2017). Theoretical
frameworks in telemedicine research. Journal of Telemedicine
and Telecare 23(1), 181-187.
Wilmoth, M., & Shapiro, S. E. (2014). The Intentional
Development of Nurses as Leaders: A Proposed Framework.
Journal of Nursing Administration 44(6), 333-338.
Running head: TECHNOLOGY CONTINUUM1
TECHNOLOGY CONTINUUM4

90. Technology Across the Care Continuum
Samantha M. Tallarine
Capella University
Nursing Research & Informatics
Technology Across the Care Continuum
May, 2019
Technology Across the Care Continuum
Nurses are the most trusted healthcare professionals within the
healthcare continuum. They spend the most time with the
patients, and are constantly doing assessments and charting.
This is especially true when it comes to the home care setting,

91. where patients are basically only seeing their nurses.
Technologies like patient and portal access being introduced by
the healthcare care system to keep the patient at the center of
the healthcare. The portal will help the nurses to perform better
by having the information about their patient on previous
admissions, and their routines at home. These patient portals
will also help to have an accurate and detailed history,
especially with medications, all in one spot so that all
interdisciplinary team members can access it.
Some of the services needed for home care include therapy, and
short-term nursing or rehabilitation. Licensed nurses, medical
social personnel, psychotherapists, physical therapists, and
speech and linguistic pathologists offer different medical
treatment needs. Home care can help recovering seniors or
pediatric patients who require care, but do not necessarily need
hospitalization. This allows patients to receive care in the
comfort of their own home, and also keeps them away from the
hospital where they are more likely to contract an infection. In
order to effectively treat the patient, all members of the
interdisciplinary team need to be up to date on the patient’s
care. Electronic medical records allow for this, giving all
healthcare members the same information and also ensuring that
the patient’s privacy is protected.
Electronic health records allow the use of technology for nurses
and other healthcare members to record the patient history.
Through this, the work of nurses is now more efficient and they
can spend more time doing actual patient care. Also, with the
implementation of wireless computers nurses can scan both the
patient and medications being administered to ensure the patient
is receiving the right medication and right dose. This adds to
patient safety, and also convenience for the nurses because they
can bring their computers with them to each room and chart on
their patient while doing an assessment. These electronic health
records make it easier to save the patient data, which is non-
erasable and easily accessible to any member of the healthcare
team. Charting can also be done in real time so in case of an

92. emergency, all team members can have up to date information.
The evolution of technology is a “patient engagement tool”
which enhances the patient’s autonomy, and that is gained
through the use of e-Health tools and resources. Patient
engagement increases the rate of positive feedback
automatically.
Improving patient outcomes goes hand in hand with improving
technology used by healthcare workers. Medication
administration has become much safer with the implementation
of medication dispensing Pyxis machines, and also being able to
scan the patient and medication. It allows nurses to practice the
five rights of medication administration (right patient, right
drug, right time, right dose, and right route) effectively. This
helps to decrease the chance of making medication errors, and
keeps patients safe. Also, as stated before, implementing EMR’s
allows for the protection of patients privacy, as well as keeping
all team members up to date. The patient can receive optimal
and safe care when technology is utilized.
Kurt Lewin had a change theory that involved three stages of
change – unfreeze, change, refreeze. In this theory the basic
idea is that in order to implement change you need to do away
with current practices, implement the change, and then continue
on with the new changes. In breaking down the system to see
what technological advances are needed to help both the nurses
and patients, and implementing new guidelines and procedures
to correct this problem, we are benefiting both the patients and
the facility. The main focus is to optimize the patient’s health,
and to also provide quality care to as many people in need as
possible. In dealing specifically with informatics, the
organization needs to get rid of their current practices, train the
staff effectively and timely, and then roll out the program that
is implemented based off of evidence-based practice.
There are also some weaknesses that can be identified with
using technology. Newer nurses may be more fluent in
technology, but unlike seasoned nurses, they have never worked
without it. When a company rolls out a new program such as

93. these, it has the potential to receive a lot of backlash for the
above stated reason. Nursing is a career that requires a lot of
time management, so for nurses to have to learn a new program
and face potential roadblocks to their work, it can cause high
anxiety in the work place. In order to help ease this anxiety, the
company should implement mandatory training sessions in
simulation labs before the program is actually rolled out. In
doing so, nurses can become comfortable with the new program
in different scenarios without the high pressure of patients or
other team members waiting on them. Without gaining the
support of the nurses and helping to make them feel comfortable
there can be a dramatic drop in staff members due to them
leaving.
Patient portals are the platforms where patients can be regularly
updated about their health. It allows the patient to schedule
appointments, review test results, and provide feedback on their
experiences. EMR’s allow for real time assessment data and test
results, and helps to ensure patient confidentiality. Patient
engagement tools are working on increasing the patient
engagement in their health related issues, and making sure they
remain autonomous. Technology is making healthcare system
more composed and efficient, but it can be improved. Software
companies can make the technology more user-friendly, and
also dispatch representatives of the company to their partners to
ensure they are teaching the use effectively.
Resources
Alan Barnard Rn Ba Ma Phd Mrcna. (2002). Philosophy of
technology and nursing. Nursing Philosophy,3(1), 15-26.
doi:10.1046/j.1466-769x.2002.00078.x
Barnard, A., & Sandelowski, M. (2001). Technology and
humane nursing care: (ir)reconcilable or invented difference?
Journal of Advanced Nursing,34(3), 367-375.
doi:10.1046/j.1365- 2648.2001.01768.x
EarlySense. (n.d.). Post-Acute Nursing Shortages? Technology
May be Your Best

94. Solution
. Retrieved from https://blog.earlysense.com/post-acute-
nursing-shortages-technology-may-be-your-best-solution
Grissinger, M. (2010, October). The Five Rights: A Destination
Without a Map. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957754/
Psqh. (n.d.). Transforming the Continuum of Care With
Technology. Retrieved from
https://www.psqh.com/analysis/transforming-the-continuum-of-
care-with-technology/
Tiffany, C. R. (1994). Analysis of planned change
theories. Nursing Management, 25(2), 60. Retrieved from
http://library.capella.edu/login?url=https://search-proquest-
com.library.capella.edu/docview/231415471?accountid=27965
Running Head: INFORMATICS BEST PRACTICES1
INFORMATICS BEST PRACTICES2

95. Nursing Informatics Best Practices
Samantha M. Tallarine
Capella University
Nursing Research & Informatics
Nursing Informatics Best Practices
May, 2019
This paper seeks to exemplify the need for secure information
in a healthcare organization. The best practice overall is to
secure the healthcare data and confidentiality of patients that is

96. stored within the electronic medical record (EMR). This
security is pertinent, not only for it being a legal obligation, but
also as an ethical core value for healthcare practitioners. This
paper also gives a closer look at the role of the government,
non-governmental organizations and other regulatory agencies
in ensuring quality and effective health services. It is beyond
reasonable doubt that technological advancements have greatly
revolutionized the healthcare sector, particularly in the manner
of how information is handled. The knowledge of design,
development, adoption, application and security of IT-based
innovations in healthcare services delivery, management, and
planning is of great importance not only to the healthcare
practitioners but to the healthcare organization at large (U.S.
National Library of Medicine).
Healthcare organizations have undergone changes in the manner
of collection and analysis of data, and this has influenced the
daily operations of hospitals and healthcare personnel by
increasing the quality delivery of services. However, there have
been instances where criminals have breached into health
information and committed medical identity theft or in some
rare cases, healthcare employees have also intruded into
patient’s records without consent. Such unauthorized access to
patient’s information has the potential of ruining organizations
reputations, which can lead to the loss of patients trust. With
the ever-rising cyber attacks on healthcare organizations,

97. cybercriminals develop more sophisticated tools each day with
different methods to attack healthcare organizations. Healthcare
data security has never been more important as it is in this era.
Healthcare organizations are left with the duty of securing
sensitive patients information as well as other data. As part of
informatics best practices, medical practitioners have the ethical
responsibility, as well as legal duty to honor and protect
patient’s confidentiality. The Amsterdam Declaration
recognized dignity as a main right for patients (World Health
Organization [WHO], 1994).
Education of staff members is the number one thing that
healthcare organizations can do to ensure that EMR’s are
protected within the four walls of the hospital. A good number
of healthcare breaches reported involved employees, therefore,
the first step to securing healthcare information is through
training of employees on how to choose passwords, the
consequences of intentional breach into patient’s data, as well
as knowledge on how to avoid attacks that target employees.
Protection of network is a good idea when it comes to securing
information; this might include partitioning of network systems,
such that attempted intrusion into one area does not necessarily
affect the other area. Security tools such as anti-viruses and
firewalls should be deployed. Physical security controls still
hold true when it comes to data protection, CCTV cameras
should be positioned where important information is held, and

98. doors and file cabinets must be locked to enhance security
within the healthcare organization.
Encryption of mobile storage devices, computers and servers is
also a great step to ensuring security of data within the
healthcare organization. In addition to provision of encrypted
devices to employees, it is a good idea to formulate strict
policies against storing information pertaining to patients on
unencrypted personal devices. Reduced physical movements in
organizations means that organizations are shifting to wireless
networks due to its advantages. However, wireless networks are
vulnerable to hacking. It is therefore important for the
organization to use secure wireless networks with secure
password networks while at the same time blocking
unauthorized devices from accessing the network.
Some of the ethical standards needed to protect the patients
information is non-maleficence first and foremost, but
autonomy also needs to come into play as well. In educating the
staff efficiently and continuously checking their competency,
the organization can allow them to work autonomously. In doing
so, the staff can be more productive and focus on practicing
non-maleficence both physically and with their electronic health
records. Patients and their families will feel more at ease
knowing that their information is secure, which gives them one
less thing to worry about. Healthcare workers can aid in this
ease by ensuring that the patient and their families feel

99. comfortable with the information that is being shared and with
who, and by always following all the rules of confidentiality
when dealing with them. All of these practices can also help to
gain trust between interdisciplinary team members knowing that
everyone is being trained properly and following the correct
protocols.
The Joint Commission [formerly known as the Joint
Commission on Accreditation of Healthcare Organizations
(JCAHO)] is the regulating body within healthcare
organizations in the United States. Healthcare organizations are
accredited by JCAHO on a 3-year accreditation cycle. If a
healthcare organization is deemed fit, they will become
accredited and monitored by JCAHO, and this ensures that the
hospital has a positive reputation. According to their website,
JCAHO has the following stance on EMR protection, “The Joint
Commission standards require organizations to comply with
applicable law and regulation to ensure the privacy and integrity
of protected health information (PHI) are maintained. When an
organization's staff is not present to monitor medical records
storage areas, alternative approaches must be employed to
protect privacy and confidentiality of this information. Keeping
such information secure when staff is not present generally
requires a process that includes a locking mechanism” (TJC,
2018). That being said, they are consistently monitoring their
healthcare organizations and ensuring that they are up to date

100. with their security protocols, and that they are protecting their
patients both physically, and electronically.
With the rising implementation of health information
technology in healthcare settings, the nursing staff represents
the first group of healthcare professionals to use these
technologies. This means nurse leader competencies are of
importance when it comes to healthcare information technology.
Nurse managers and leaders should be the champions of better
information usage in the healthcare centers, and each unit can
have an informatics representative. This will ensure that
between nursing upper management and staff nurses, that people
are being educated on a rolling basis. Nurse leaders should have
basic computer competencies, the concept of computer
technology and how to incorporate these systems into the
organization. Nurse leaders must be information literate, having
understanding of the nature of information as well as the ability
to evaluate information sources.

101. Resources
Marchev M., Medical malpractice and medical error disclosure:
balancing facts and fears. Portland, ME: National Academy for
State Health Policy; 2003 Dec.
"35.240.80: IT applications in health care technology". ISO.
Miner, L., Bolding, P., Hilbe, J., Goldstein, M., Hill, T., Nisbet,
R., Walton, N., & Miner, G. (2014). Practical predictive
analytics and decisioning systems for medicine : Informatics
accuracy and cost-effectiveness for healthcare administration
and delivery including medical research. Retrieved from
https://ebookcentral-proquest-com.library.capella.edu
Nadri H, Rahimi B, Timpka T, Sedghi S (August 2017). "The
Top 100 Articles in the Medical Informatics: a Bibliometric
Analysis". Journal of Medical Systems. 41 (10): 150.
doi:10.1007/s10916-017-0794-4. PMID 28825158.
O'Donoghue, John; et al. (2011). "Modified early warning
scorecard: the role of data/information quality within the
decision making process". Electronic Journal Information
Systems Evaluation. 14 (1).
Riley T, Rosenthal J. Patient safety and medical errors: a road

102. map for State action. Portland, ME; National Academy for State
Health Policy (NASHP); 2001.
Rosenthal F, Booth M. Defining reportable events: a guide for
States tracking medical errors. Portland, ME: National Academy
for State Health Policy; 2003.
Riley T. Improving patient safety: what States can do about
medical errors. Portland, ME:
Rosenthal J, Booth M, Flowers L, et al. Current State programs
addressing medical errors: an analysis of mandatory reporting
and other initiatives. Portland, ME: National Academy for State
Health Policy; 2001.
The joint commission - standards FAQ details. (n.d.). Retrieved
from
https://www.jointcommission.org/standards_information/jcfaqde
tails.aspx?StandardsFAQId=1738
Running Head: CARE360 SOFTWARE
1
CARE360 SOFTWARE 2

103. Information Systems in Nursing
Samantha M. Tallarine
Capella University
Nursing Research & Informatics
May, 2019
Technological advancement has seen the digitalization of many
sectors, healthcare being one of them. Previously, nurses in
many hospitals would record the patient's details in manual files
that were getting hectic in the hospital data stores, and had the
potential of being lost or stolen. These manual operations were
not efficient in hospitals, and it required the nurses to move
from their points of work to the doctor's office so that they
could convey the patient's medical records before the doctor
could administer treatment to the patients. In the current state
of affairs, we are heading towards a state where the adoption of
technology has become inevitable.

104. Technology makes it easier to run the affairs of any given
institution, and hospitals have become the leading adopters of
technology. The idea of having information systems in the
hospitals has pushed for the development of the software that
will be responsible for the storage and transmission of patients
medical records from one clinic station to another in any given
hospital. Therefore, as a result of this need, information systems
software's were developed that are being used in hospitals, to
ease the operations and deliver services as fast as possible to
the patients. To be precise, there are various software’s that are
in existence and used in Electronic Health Records. They
include; Therapy Notes, Care360, Cerner, Epic Care,
AdvancedMD and many others. For this paper, the focus will
be on the Care360 Software, which has been widely used in
most hospitals as information systems software.
Care360 Software is a web-based software that is used for most
of the Electronic Health Records work in hospitals, most
specifically for ambulatory services. The software is created
and marketed by Quest Diagnostic, and includes the patient
scheduling module and the medical billing module. The
software also avails the patient’s data quickly at any given point
and place. (Middel, 2008) It also focuses on the storage of the
medical records of the patient. Once a patient visits a hospital,
his or her medical information is fed and stored in the software.
Once a patient's information is stored in the software, it will be

105. very easy to access between multidisciplinary team members,
and the information will also be available if the patient visits
the hospital again. The software plays a role in making services
easier in the hospital, and also easier to treat patients with their
medical history at the healthcare workers fingertips. The errors
that were being committed by the nurses in the manual
registration of the patients were eased with the arrival of the
Care360 software. The software is designed to ensure maximum
accuracy since the health of the patient is the main objective of
any hospital; any mistake in the records can compromise the
patient's health. (Middel, 2008)
Evidence based nursing is an approach that involves taking
measures that are well drafted in order to come up with
decisions that are well informed so as to give the patient the
best treatment. Care360 is an information system software that
eases the burden on nurses, and continue to practice evidence-
based nursing. The information stored in the Care360 software
system will allow the doctors and nurses to review the patient's
medical records so as to determine the best treatment approach
to use on the said patient.
In most of the hospitals, Care360 acts as the first point of
patients’ registration when they check into the hospital. Various
details that define the patients are taken by the nurse in-charge
to help ease the navigation when the patient reaches the
treatment desk. Mainly, the patient's data types that the

106. hospitals are concerned with included; a medical history of the
patient, age, gender, immunization details, allergies, results of
laboratory tests, weight and even the home address of the
patient. These kinds of information are helpful to the doctors
since they are able to get an overall picture of the patient’s
health situation before administering any kind of treatment.
Consideration of information such as past medical records and
allergies, as well as up to date notes from other
interdisciplinary team members will put the doctor in a good
position to understand the health situation of the patient.
(DesRoches et al., 2008)
The data in the Care360 software are tracked through the
establishment of the patient portal on the Care360 website that
is accessible by authorized people only. Once the patient portal
has been created for a patient, his or her details will be fed on
the portal which will be accessed at any time when the data is
needed. The patient is usually given a username and password
that they use to access the portal, which contains a number of
things like test results, and billing information to name a few.
With these patient portals, both doctors and patients are able to
view their patient's medical records, the treatment plans and the
date of appointment so that the patient's health can be
prioritized. The medical records are stored in the patient's
portals and trended with the relevant authorities anytime they
are needed (DesRoches et al., 2008). The data stored in the

107. Care360 software are confidential between the patient and the
hospital. Even though hospitals are allowed to access the data,
they must do so with the knowledge of the patient so as not to
compromise the security of personal medical records. The
Care360 incorporates various security measures within the
software that are meant to keep the data safe and secure from
access by unauthorized people.
In current times, technology is very essential in ensuring that
the safety and security of the patients is guaranteed. The
Care360 software is a one of a kind technology in the hospital
that is essential in ensuring the safety of the patients in regard
to the medical treatment outcome. The Care360 software allows
patient follow up which helps to make sure that the medical
appointments of the doctor are made possible. Patient safety is
made a priority since these forms of information systems that
are used in hospitals makes it possible for the patient to book
appointments online with doctors. Such facilities make it easy
for the patients to be treated since they come to the hospital at
the time that they are scheduled to have their appointment with
the doctors. (Cohen, 2010)
Also, the Care360 software enables the nurses and doctors to
have a quality check on their services. This is because a patient
has a tab on their patient portals to rate the services that they
receive from the hospitals and doctors, giving patients the sense
of autonomy in choosing whom they want to see and when they

108. want to see them. Once the nurses and doctors get such
responses, they are able to access their weakness and strengths
points which will enable them to improve on service delivery
which is very essential on the outcome of the patient. Since the
patient's safety is the ultimate goal of every hospital, the
Care360 software is very important in actualizing this goal and
objective of the hospitals.
At the hospital level, the nurses are the most likely people to
handle any health-related technology that is introduced in the
hospital. This makes it necessary for nurses to be involved in
the development of any form of technology that is intended to
be used in hospitals. Nurses have the ability to enhance hospital
technology through their participation in the development and
use of technology. The involvement of the nurses in the
development of Care360 software will ensure that the software
that is developed are made easy for the nurses to use, which will
increase the efficiency in delivering the medical services to
patients.
Resources
Blumenthal, D., & Tavenner, M. (2010). The “Meaningful Use”

109. Regulation for Electronic Health Records. New England Journal
Of Medicine, 363(6), 501-504. doi: 10.1056/nejmp1006114
Cohen, E. (2010). Use of Electronic Health Records in U.S.
Hospitals. Yearbook Of Ophthalmology, 2010, 271-272. doi:
10.1016/s0084-392x(10)79279-0
DesRoches, C., Campbell, E., Rao, S., Donelan, K., Ferris, T.,
& Jha, A. et al. (2008). Electronic Health Records in
Ambulatory Care — A National Survey of Physicians. New
England Journal Of Medicine, 359(1), 50-60. doi:
10.1056/nejmsa0802005
Middel, B. (2008). The impact of electronic health records on
time efficiency of physicians and nurses: a systematic
review1). Nederlands Tijdschrift Voor Evidence Based
Practice, 6(1), 14-16. doi: 10.1007/bf03077155
MyQuest Patient Portal. (n.d.). Retrieved from
https://www.questdiagnostics.com/home/physicians/technology/
care360/practice-solutions/Patient-Portal.html