Crisis Counseling

Crisis Counseling (Obj. 5.1 and 5.5)

Sometimes clients come into the counseling session with an immediate crisis. They need an immediate solution to a problem. Counseling in these situations needs to be focused and goal oriented.

Jamila has been working with her counselor on learning to better manage her 9-year-old son. Last night, her son was hit by a car and is in the hospital. This has created a number of problems:

1.     She has to arrange childcare for her daughter so she can stay with her son in the hospital.

2.     He will need some special care when he gets home because he will be in a wheelchair.

3.     She is fearful that she will lose her job as a teacher’s aide in the local public school.

Write a 500-750-word paper addressing the following:

1.     How would you prioritize Jamila’s concerns in the counseling session? What would you address first?

2.     What steps would you take in this session to make sure that Jamila has the resources she needs right now?

3.     How would you help Jamila develop a plan to manage the current crisis?

Include at least three scholarly references in your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Crisis Counseling


A person is viewed to be in a crisis when they experience a situation which is considered too difficult for them to handle. This issue occurs due to personal inadequacies or insufficient resources. The above factors may make the situation to exceed the individual’s tolerance capabilities. Crisis counseling is therefore a technique that may offer immediate help to an individual in a crisis. To achieve this goal, there are various priorities and models that counselors may use during the intervention (Taylor, & Gibson, 2016).  The essay intends to develop suitable priorities, design ways of creating efficient resources, and develop a suitable management plan for a presented case.

Case Overview

The crisis counseling session focus on a client whose name is Jamila. The client is a teacher’s aide and has two children; a boy and a girl. The son is involved in an accident and needs special care from the mother. In addition, the daughter needs to be placed in a childcare facility to provide time for her son’s care. By caring for her son, Jamila risks her losing her job.

Prioritizing Client’s Concerns

In the scenario, every element is crucial to the client, thereby creating a dilemma to her. From the client’s time and finances are essential concerns for her. Therefore, it would be important to prioritize Jamila’s concerns basing on time and finances. Moreover, it would also focus on the impact of the issue to other issues. The counselor may need to address her job concern first. This is because it would affect her ability to pay for her son’s hospital bill and her daughter’s daycare fees. In addition development of a suitable job schedule may help the client to care for her son without problems. The second issue to be addressed will be son’s care. This concern has been ongoing for the client; hence it is more urgent than her daughter’s daycare concern (Taylor, & Gibson, 2016).

Steps for Attainment of Resources

A systematic approach is suitable in enabling the client to attain resources for controlling the problem. The six-step crisis intervention model will be useful in helping Jamila. In the model, the first step involves defining the problem and understanding it from the client’s perspective. The second step is focused at ensuring the client’s safety. In the scenario, this step focuses on the psychological danger that Jamila may face. Thirdly, the counselor will provide support to the client through suitable communication skills (Silva, Siegmund, & Bredemeier, 2015).

The fourth phase involves examination of different resource alternatives. It may involve assessment of the client’s situational support or involving people close to her. Fifthly, the counselor will engage in making detailed plans and outline the persons and other referral resources that can enhance support to the client. Lastly, the counselor needs to obtain commitment from the client to ensure that the crisis counseling session is effective (Silva, Siegmund, & Bredemeier, 2015).

Developing a Management Plan

Developing a management plan needs suitable strategies. However, there are two broad frameworks that the assistance will follow; nondirective and collaborative counseling. If the client is able to initiate and develop their own management plans, nondirective counseling will be used. Contrarily, collaborative counseling will be suitable if the counselor has established a reliable partnership with the client. A suitable strategy for enhancing proper management planning is creation of awareness. This strategy attempts to bring to the clients thoughts and behaviors that may solve her crisis. In addition, provision of support is essential throughout the six-step process as it validates and expands on suggestions for controlling the situation. Lastly, the practitioner may provide guidance and direction on how to use the resources to manage the crisis (Crosby, Cwik, & Riddle, 2015).


Crises are a common occurrence in people’s lives. However, it is often difficult to manage these challenges without the help of other people. The paper tries to show the role of counselors in helping clients solve their crisis issues. From the paper, it can be shown that using a systematic approach is suitable in helping clients manage their crises. In addition, one can depict that the counseling strategies such as support of clients and offering clients are beneficial tin crisis counseling management.


Crosby B. M., Cwik, M. F., & Riddle, M. A. (2015). Awareness, attitudes, and use of

crisis hotlines among youth at‐risk for suicide. Suicide and LifeThreatening Behavior45(2), 192-198.

Silva, J. A. M. D., Siegmund, G., & Bredemeier, J. (2015). Crisis interventions in online

psychological counseling. Trends in Psychiatry and Psychotherapy37(4), 171-182.

Taylor, J. V., & Gibson, D. M. (2016). Crisis on campus: eating disorder intervention from a

developmental-ecological perspective. Journal of American College Health64(3), 251-255.

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Nursing PICOT Study

Unveiling the Nursing PICOT Study: A Journey Towards Evidence-Based Practice

PICOT is a format used to formulate research questions in Evidence-Based Practice (EBP) in nursing. It stands for:

  • P: Population/Patient Problem: Who is your patient?
  • I: Intervention: What is the intervention or exposure being considered?
  • C: Comparison: What is the alternative to the intervention or exposure?
  • O: Outcome: What is the desired outcome?
  • T: Time: What is the time frame for the outcome?

The quest for knowledge in the field of nursing is comparable to setting off on an exciting trip. Nurses use evidence-based practice (EBP) like an expert mapper to explore unexplored territory and find vital healthcare-related information. The nursing PICOT study is an essential resource in this endeavour. Similar to how a compass directs an explorer, the PICOT framework directs scientists in the direction of a distinct and narrow path, revealing the way to game-changing discoveries.

Clinicians frequently find themselves enthralled by the astonishing results they see in their practice, like inquisitive travellers poised at the edge of undiscovered territory. These amazing treatment success stories inspire people to learn more and start a research path that will give voice to their personal experiences. It is impossible to resist the pull of the possibility of opening up new vistas of knowledge, both for their own profession and the larger healthcare system. But as these practitioners make their first hesitant steps toward the research community, they could run into a confusing obstacle: the query, “What is your research question?” voiced by seasoned researchers and ringing through the halls of academia. This encounter might end up being a brief one without a compass to help traverse this strange area.

The PICOT question format is a consistent “formula” for developing answerable, researchable questions. The PICOT process starts with a particular case, and the question is couched to develop an intervention or therapy. A clinical question that is composed using the PICO or PICOT format will help you to focus your search and help you to develop your research skills which are essential in finding the best available evidence. Incorporating best evidence into nursing requires a systematic approach.

The PICOT format is a helpful approach for summarizing research questions that explore the effect of therapy:

  • (P) – Population refers to the sample of subjects you wish to recruit for your study. There may be a fine balance between defining a sample that is most likely to respond to your intervention (e.g. no co-morbidity) and one that can be generalized to patients that are likely to be seen in actual practice.
  • (I) – Intervention refers to the treatment that will be provided to subjects enrolled in your study.
  • (C) – Comparison identifies what you plan on using as a reference group to compare with your treatment intervention. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then this should be the comparison group.
  • (O) – Outcome represents what result you plan on measuring to examine the effectiveness of your intervention. Familiar and validated outcome measurement tools relevant to common chiropractic patient populations may include the Neck Disability Index or Roland-Morris Questionnaire. There are, typically, a multitude of outcome tools available for different clinical populations, each having strengths and weaknesses.
  • (T) – Time describes the duration for your data collection.

Here is a brief historical evolution of the PICOT framework

The PICOT framework was first introduced in 2005 by Dr. Gordon Guyatt and his colleagues at McMaster University in Canada

The framework was developed as a way to help clinicians formulate well-built clinical questions for evidence-based inquiry

The PICOT framework has since become a standard format for developing research questions in nursing and other healthcare fields

The framework has evolved over time to include the addition of the “T” component, which stands for Time, to help specify the timeframe for the outcome being studied

The PICOT framework has been shown to be effective in helping nurses to develop focused, well-built, and searchable clinical questions, leading to better patient outcomes and higher quality care.

Developing a strong clinical question for evidence-based inquiry is necessary for developing nurse PICOT research. Using the PICO (T) structure, the initial stage in EBP is rephrasing a clinical patient care concern into a targeted, searchable, and responsive query. In evidence-based medicine, the PICO (T) approach is frequently used to create a targeted, well-structured, and searchable clinical question.

How To Formulate a PICO T Study.

  1. Identify the Population (P): The first step is to clearly define the specific population or group of interest for your study. This could include factors such as age, gender, medical condition, or any other defining characteristics that help narrow down the focus of your research.
  2. Determine the Intervention (I): Next, you need to identify the intervention or treatment that you want to investigate. This could be a specific therapy, medication, procedure, or any other intervention that you believe has the potential to impact the health outcomes of the identified population.
  3. Establish the Comparison (C): To evaluate the effectiveness of the intervention, you need to establish a comparison group or alternative intervention. This could be a placebo, standard care, or another treatment option that is commonly used in practice. The comparison allows for a meaningful evaluation of the intervention’s effects.
  4. Define the Outcome (O): What is the desired outcome you wish to measure or observe in relation to the intervention? Clearly define the specific outcome you want to assess, whether it is a clinical parameter, patient satisfaction, quality of life, or any other measurable outcome that reflects the impact of the intervention.
  1. Determine the Timeframe (T): Specify the timeframe within which you will conduct your study. This could be a specific duration of treatment, follow-up period, or a defined timeline for data collection. Timeframe considerations are crucial for capturing the temporal aspects of the intervention and outcome


Template for Making PICOT Questions

For an intervention/therapy:

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

For etiology:

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Diagnosis or diagnostic test:

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?


For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?


Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?


How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?


This is an example of a PICOT question that is wrong in all facets. A dissection of the question will help identify the poorly written components.

In hospitalized geriatric patients more than 65 years of age with dementia (P), how does providing distraction activities (I) compared with providing traditional hospital care (C) decrease agitation (O)?

P: hospitalized geriatric patients more than 65 years of age with dementia

I: providing distraction activities

C: providing traditional hospital care

O: decrease agitation

  1. The terms in this PICO question are too wordy. The words placed into the search database are the exact words the computer is going to scan in the literature, so the more words, the less you will find.
  2. By including the word “providing” in the I and C search, you would miss any study where the title included words such as “implementing” or “utilizing” because the computer would be looking specifically for “providing.”
  3. This PICOT is not written in past tense; as such, it is a research question.
  4. PICOT questions should not include any directional words. They will cause a biased search.

The correctly written PICOT question to yield the most efficient search would be:

In geriatric patients with dementia (P), how did distraction activities (I) compared with traditional care (C) affect agitation (O)?

In summary, the PICOT framework was developed in 2005 as a way to help clinicians formulate well-built clinical questions for evidence-based inquiry. Since then, it has become a standard format for developing research questions in nursing and other healthcare fields. The framework has evolved over time to include the “T” component, and it has been shown to be effective in improving patient outcomes and promoting higher quality care.

Tips for Writing Well-Designed PICOT questions.

PICOT questions should not be wordy.

Instead of a “P” of “hospitalized geriatric patients with dementia,” a “P” that would lead to a better search is “geriatric patients with dementia” OR “geriatric dementia patients” because you want to search for and find all the literature about the “P” (population) of interest. Your intent may be to implement the evidence found on this population when they are in the hospital, but that is your project not your question.

PICOT questions should not include unnecessary words. Instead, PICOT questions should include only the key term(s) you are interested in. Instead of an “I” of “applying a sterile dressing,” an “I” of “sterile dressing” will lead to a better search. Extra words such as “provide,” “implement,” “use,” “deliver,” or “apply” add more words for the search engine to look for that are not important. Only include the key words that matter.

PICOT questions should not be used to find evidence to support the solutions that clinicians have already decided is the right answer.

Instead, PICOT questions should be used to find out what is the best practice. Instead of an “I” of “providing distraction activities,” an “I” that would lead to a better search is “interventions” OR “strategies” because the best practice is often something that you (and your committee or task force or council) did not know about or consider. For instance, what if the best intervention for addressing agitation in dementia patients is music therapy? You would never discover the right answer if you only searched for something that you had already decided on. This critical error leads people to search for evidence to support their idea, and it may not be—and often is not—the best idea. This mistake can be made inadvertently or with true intention. In the first scenario, you do not realize that you are making the mistake. In the second scenario, you intentionally look for evidence to support your idea and intentionally do not look for anything else. Either way, this problem needs to be avoided.

PICOT questions are always written in the past tense. You are searching for things that have already occurred. Research questions, on the other hand, are written in the present tense.

PICOT questions never include a directional term such as “increased” or “improved.” Once a directional term is included, the search is biased; if you only look for studies where a particular intervention “increased” an outcome of interest, you will miss all the articles where the intervention “decreased” that outcome. This is a dangerous mistake.

PICOT questions cannot be changed once you have started searching. More PICOT questions can be written for the same inquiry, but you cannot change a question that you have already used. That question is already part of your EBP adventure and needs to be included in your story.

Your PICOT question does not always match the change project or initiative you originally imagined or planned. That is because a well-written PICOT question leads you to the best practice to answer your inquiry, not the answer you were thinking about or for which you had hoped.

It is critical to invest time in writing a great PICOT question, as it is the gateway to an efficient, effective search and, ultimately, to making robust, evidence-based recommendations with confidence to assure the best decision-making possible and to improve care and outcomes.

The PICOT framework is a valuable tool in nursing research that offers several benefits. Here are some advantages and benefits of using the PICOT framework:

  1. Promotes clarity and precision
  • The PICOT framework promotes clarity and precision in formulating research questions. By specifying the population, intervention, comparison, outcome, and time of the study, researchers can avoid vague, broad, or untestable questions that may lead to inconclusive or irrelevant results
  1. Focuses research questions
  • The PICOT framework helps to focus research questions on specific patient populations, interventions, and outcomes. This focus can lead to more meaningful and impactful studies that can guide evidence-based practice and improve patient outcomes
  1. Provides a structured search strategy
  • The PICOT framework provides a structured search strategy that is derived from a clinical scenario and provides a framework for asking well-worded questions. This structured approach can assist in identifying the best available evidence to improve healthcare outcomes
  1. Translates evidence to practice
  • The PICOT framework can help clinicians translate evidence to practice by assisting with the decision-making process. Findings from research using the PICOT framework could ultimately lead to changes in a patient’s treatment for a particular condition, an alteration of his or her lifestyle choices, or to a better quality of life.
  1. Real-life impact
  • By gathering the best literature through a clinically-driven search strategy, research using the PICOT framework can have real-life impact. The PICOT framework can help researchers identify the terms to be used to search for the best evidence to answer a research question

What are Some Common Challenges in Formulating a Nursing PICOT Study?

  • Defining each component of the PICOT question:

One of the challenges in formulating a nursing PICOT study is defining each component of the question, including the population or patient problem, intervention, comparison, outcome, and timeframe.

  • Cost and feasibility:

Many research questions are costly, time-consuming, and difficult to conduct, especially with a randomized controlled trial (RCT) study design. Therefore, it is important to consider the cost and feasibility of the study before formulating the PICOT question.

  • Lack of knowledge:

Not knowing how to correctly write a PICOT question can be a challenge, especially for novice researchers.

  • Difficulty in identifying appropriate search terms and databases:

Identifying appropriate search terms and databases to use in the search for evidence can be a challenge, especially for those who are new to evidence-based practice.

  • Lack of clarity in the research question:

Lack of clarity in the research question can be a challenge, as it can lead to difficulties in identifying relevant evidence and conducting a thorough analysis.

Overcoming Challenges in Formulating a Nursing PICOT Study:

Formulating a nursing PICOT study can be challenging, but there are ways to overcome these challenges. Here are some tips based on the search results:

  1. Clearly define each component of the PICOT question:
  • To create a well-built and focused clinical question, each component of the PICOT question must be clearly defined. This includes the population or patient problem, intervention, comparison, outcome, and timeframe.
  1. Consider the feasibility of the study:
  • Many research questions are costly, time-consuming, and difficult to conduct, especially with a randomized controlled trial (RCT) study design. Therefore, it is important to consider the feasibility of the study before formulating the PICOT question.
  1. Seek guidance from experts:
  • If you are struggling to formulate a PICOT question, seek guidance from experts in the field. This could include nursing professors, clinical experts, or librarians who specialize in evidence-based practice.
  1. Use available resources:
  • There are many resources available to help nurses formulate PICOT questions, including online guides, videos, and databases. These resources can help you identify appropriate search terms and databases to use in your search for evidence.
  1. Practice:
  • Formulating a well-built PICOT question takes practice. The more you practice, the easier it will become to identify the key components of a clinical question and develop a focused and searchable research question.

By following these tips, nurses can overcome the challenges of formulating a nursing PICOT study and develop well-built clinical questions that can guide evidence-based practice and improve patient outcomes.


As we conclude this discussion, we would like to express our gratitude to our esteemed partner,, for their support in bringing you this informative content. Their dedication to empowering nurses and promoting excellence in nursing research has made this exploration possible.

Remember, as William Shakespeare once said, “We know what we are, but know not what we may be.” With the nursing PICOT study as our guide, we have the potential to transform the future of nursing, unlocking new horizons and embracing the endless possibilities of evidence-based care.

We encourage you to continue exploring our blog posts, where you will discover a treasure trove of valuable insights, practical tips, and engaging discussions on various topics related to nursing and evidence-based practice. Whether you’re a seasoned nurse, a nursing student, or a healthcare professional seeking to expand your knowledge, we have something for everyone.

Stay tuned for upcoming articles that delve deeper into specific aspects of nursing research, offer expert advice, and provide inspiration for your professional journey. Together, let’s embrace the power of knowledge, fuel our passion for nursing, and strive for excellence in evidence-based practice.

Thank you for joining us on this enlightening exploration of the Nursing PICOT study. We look forward to embarking on many more learning adventures with you. Happy reading!

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Quality Improvement Initiatives

Quality Improvement Initiatives

You have been asked to prepare and deliver an analysis of an existing quality improvement initiative at your workplace. The QI initiative you choose to analyze should be related to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics.

Your target audience consists of nurses and other health professionals with specializations or interest in your selected condition, disease, or issue. In your report, you will define the disease, analyze how the condition is managed, identify the core performance measurements used to treat or manage the condition, and evaluate the impact of the quality indicators on the health care facility:

Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

  1. Analyze a current quality improvement initiative in a health care setting.
    • Evaluate a QI initiative and explain what prompted the implementation. Detail problems that were not addressed and any issues that arose from the initiative.
  2. Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures.
    • Analyze the benchmarks that were used to evaluate success. Detail what was the most successful, as well as what outcome measures are missing or could be added.
  3. Incorporate interprofessional perspectives related to initiative functionality and outcomes.
    • Integrate the perspectives of interprofessional team members involved in the initiative. Detail who you talked to, their professions, and the impact of their perspectives on your analysis.
  4. Recommend additional indicators and protocols to improve and expand quality outcomes of a quality initiative.
    • Recommend specific process or protocol changes as well as added technologies that would improve quality outcomes.
  5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Submission Requirements

  • Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
  • Number of references: Cite a minimum of four sources (no older than seven years, unless seminal work) of scholarly peer reviewed or professional evidence that support your interpretation and analysis.
  • APA formatting: Resources and citations are formatted according to current APA style and formatting.



The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Nurses and other health professionals with specializations and/or interest in the condition, disease, or the selected issue are your target audience.



As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect upon data use in your organization as it relates to adverse events and near-miss incidents.

  • How does your organization manage and report on adverse events or near-miss incidents?
  • What data from your organization’s dashboards help inform adverse events and near-miss incidents?
  • What additional metrics or technology are you aware of that would help ensure patient safety?
  • What changes would you like to see implemented to help the interprofessional team better understand data use and data trends as quality and safety improvement tools?



Quality Improvement Initiative Evaluation

            A Quality Improvement (QI) program is a set of activities designed to monitor, analyze and improve the quality of procedures in healthcare facilities in order to improve health outcomes for all stakeholders involved. Despite their proliferation, QI initiatives take place in the background and are incorporated in the organization’s day-to-day activities (Abrampah et al. 2018). Often times, patients never realize that a QI program is in effect. QI initiatives are critical because they strive to improve outcomes for patients, maintain staff efficiency and reduce waste due to process failures. Effective QI programs have set targets that focus on improving safety, effectiveness, access and are patient-centered (Abrampah et al. 2018). Additionally, effective QI programs always align their priorities with the organization’s strategic plan and provide detailed key performance indicators to track progress towards goal achievement.

In line with its goal of improving operations and reducing wastage, Bethany health center initiated the “no to tubes” program focused on reducing the use of catheters in the facility. After conducting an annual audit of the facility’s operations, the health center realized that catheters were being given to patients who did not need them. More alarming than that was the fact that these catheters were being left in for longer periods of time. In line with this realization, the facility developed the “no to tubes” program with the aim of reducing the increasing number of catheter-associated urinary tract infections (CAUTI) caused by catheters that are left in for too long. In addition, the QI program aimed at reducing resource wastage and improving overall operations at the facility. Using the “no to tubes” QI program as an example, the report will assess how specific quality indicators improve patient outcomes, reduce costs and improve organizational efficiency.

Analysis of the Quality Improvement Initiative

The “no to tubes” QI initiative was designed to reduce the occurrence of CAUTI at

Bethany Health Center. Over the following couple of months, the facility implemented a new system of nursing documentation and clinician orders. The nursing documentation system ensured that the patients who needed catheters received them and when the time came for them to be removed, the system would send alerts to nurses prompting them to remove the catheters. The initiative successfully reduced CAUTI rates in the facility from 3.2 per month to less than 1 per month. In addition to implementing the nursing documentation system, the nurses carried out regular and systemic check-ins. The check-ins further reduced infection rates and improved overall quality of care. To further reduce infection rates at the facility, the “no to tubes” initiative implemented an electronic health record catheter identification system, interdisciplinary training was also conducted and clinician education heightened. Measuring the rate of CAUTI is challenging and resource intensive. To mitigate the challenges, Bethany Health Center implemented an electronic CAUTI surveillance system. The system monitored the presence of urinary catheters and fever in patients and used natural language processing (NLP) to include subjective symptoms which were documented in clinical notes (Sanger et al. 2017).

Quality Improvement Initiatives

To evaluate the “no to tubes” initiative, the analysis will use benchmarks and outcome measures.

Evaluation of the QI Initiative through Recognized Benchmarks and Outcome Measures

Quality of healthcare initiatives is usually assessed by using processes and outcome measures. Measuring outcomes of QI initiatives facilitates the decision-making process and improves public accountability (Kampstra et al. 2018). The key feature of benchmarking is to integrate with comprehensive quality improvement policies. Additionally, benchmarking involves measuring results and comparing them to set standards to evaluate organizational performance. There are two key benchmarking activities that Bethany Health Center employed to measure the results of the “no to tubes” initiative. They include: internal benchmarking which identifies best practices in the organization and compares them to the current initiative; external or competitive benchmarking that involves the use of comparative data between healthcare facilities to gauge performance of the initiative and identify areas for improvement (Lovaglio, 2014). Patient quality has always been at the forefront of all the activities at Bethany Health Center. It is with this goal in mind that the facility has successfully implemented previous QI initiatives and used them to benchmark the “no to tubes” initiative.

Outcome measures are changes in the health of individuals, groups of people or populations that are attributed to interventions or series of interventions by the healthcare facility. Effectiveness of care outcome measures evaluate compliance with the best care practices and analyzes achieved outcomes (Kampstra et al. 2018). After implementing the nursing documentation system and the CAUTI surveillance system, Bethany Health Center experienced reduced rates of CAUTIs. Additionally, patient-reported outcome measures (PROMs) were used to measure patient experiences. The patient’s experiences and their perceptions about the care they received at the facility were analyzed. The results showed that patients were generally satisfied with the “no to tubes” initiative and the care they received from healthcare professionals at the facility.

Quality Improvement Initiatives

Interprofessional Perspective on Initiative Functionality and Outcomes

Interprofessional collaboration occurs when healthcare workers from different professional backgrounds unite and work together with patients, their families and the community to deliver high quality care (Garth et al. 2018). Interprofessional teamwork is a core clinical skill that identifies the benefits of collaboration to address the unmet needs of healthcare systems. With the goal of integrating quality improvement and maintaining patient safety efforts with graduate medical education, Scottsdale Healthcare facility participated in the Alliance of Independent Academic Medical Centers (AIAMC) National Initiative IV between 2013 and 2015. The AIAMC implemented several initiatives to reduce unnecessary use of urinary catheters in hospitals. The initiative focused on a multidisciplinary medical education conference that centered on CAUTI prevention (Bell, Alaestante & Finch, 2016). In addition, the facility embarked on the emergency department initiative that saw emergency department nurses and physicians receive intensive education on the reduction of urinary catheter use. Patient tracking was also involved in the initiative and the patients who had urinary catheters were tracked and the information uploaded in the nursing staff daily management system. The results of the initiative show that by incorporating all the stakeholders, Scottsdale Healthcare facility saw a dramatic decrease in urinary catheter insertions and an overall decline in CAUTI cases (Bell, Alaestante & Finch, 2016). The study results further prove that interdisciplinary interaction and collaboration in healthcare further improve patient outcomes and reduce the spread of infections.


The “no to tubes” initiative would benefit from analyzing staff perspectives towards CAUTI. According to an analysis carried out by Niederhauser at colleagues (2018), there are significant changes in staff perceptions after the implementation of evidence-based interventions. Efforts should therefore be directed towards sustaining the changes so that the intervention implemented becomes an integral part of the organization’s culture. To maintain this culture, staff knowledge about the intervention, their perception of current practices, self-reported responsibility and behavior determinants should be regularly assessed (Niederhauser et al. 2018). To further strengthen the “no to tubes” initiative and obtain the best results, Bethany Health Center should implement a multimodal bundle of interventions that incorporates an evidence-based intervention, daily re-evaluation of catheter use, training and education of all healthcare providers.

Additional Indicators and Protocols to Improve Quality Outcomes

By introducing a nursing documentation system and an electronic health record catheter identification system and encouraging a culture of interdisciplinary training and education, Bethany Health Center has successfully reduced the rate of CAUTI infections and has improved overall quality of care offered to patients. While both the internal and external benchmarking tools have been used to gauge success of the “no to tubes” initiative, additional indicators of quality can improve quality outcomes. The goal of healthcare systems is to improve the quality of care they offer to patients. Successful quality improvement might be challenging. However, by implementing key essentials of success quality improvement can be maintained.

Quality Improvement Initiatives

The first requirements is that health facilities should have a culture of adaptive leadership and governance. Individuals within the health system should have the aptitude to make continuous improvements. Likewise, staff members should be dedicated to the organization and its goals. However, individual efforts are not enough to sustain quality (Tinker & Hough, 2016). There needs to be senior leadership support, an adaptive learning culture and data-driven initiatives for quality improvement. Analytics is a crucial ingredient used to sustain quality in the quality improvement lifecycle. Analytics is incorporated into baseline measurements, problem descriptions and system implementation processes. Analytics should never be mistaken for measurements. The third and critical essential to improve quality is the adoption of evidence and consensus-based best practices. Evidence-based practices are the foundation upon which best practices that improve quality are built (Tinker & Hough, 2016). While the aforementioned practices are designed to improve quality, they will not be successful unless resources are dedicated to implement outcome initiatives. Bethany Health Center should set aside resources towards performance evaluation practices and organizational incentives.

The Lean Six Sigma model is a combined toolkit that provides a systemic approach to help organizations improve their problem-solving skills. The model is based on a scientific method that supports organizations that are looking to improve their problem-solving culture (Lighter, 2014). By adopting the Lean Six Sigma model, Bethany Health center will be able to streamline the “no to tubes” initiative results and improve patient satisfaction levels. Additionally, the model will help the facility engage staff members, improve staff morale and standardize processes. The model will also help the facility better understand the current state of affairs and remove barriers to success. The model focuses on eliminating defects, improving patient safety and maintaining quality. By using the Define-Measure-Analyze-Improve-Control five-step process improvement structure, the Lean Six Sigma model improves patient experiences and makes sure processes consistently deliver desired results (Lighter, 2014).

Quality Improvement Initiatives


Despite their importance and proliferation, quality improvement initiatives often go on in the background and are integrated into the day-to-day operations of healthcare facilities. Quality improvement initiatives are the primary means for improving operations and maintaining high quality care. QI initiatives like the “no to tubes” initiative designed to reduce the rate of CAUTIs set targets aimed at improving patient safety, access to care and guarantee delivery of effective and patient-centered care. To ensure success of QI initiatives, healthcare facilities must evaluate their effectives by using recognized internal and external benchmarks and outcome measures. To reduce the risk of failure, QI initiative must incorporate interprofessional perspectives and set protocols and indicators that are relevant to the implemented QI initiative. Lastly, evidence-based models like the Lean Six Sigma model will help healthcare facilities eliminate defects and maintain staff morale.




Abrampah, N.M. et al. (2018). Quality Improvement and Emerging Global Health Priorities. International Journal for Quality in Health Care, 30(suppl 1), 5-9. Doi: 10.1093/intqhc/mzy007

Bell, M.M., Alaestante, G. & Finch, C. (2016). A Multidisciplinary Intervention to Prevent Catheter-Associated Urinary Tract Infections using Education, Continuum of Care and System wide Buy-in.  The Ochsner Journal, 16(1), 96-100. Retrieved from

Garth, M., Millet, A., Shearer, E. et al. (2018). Interprofessional Collaboration: A Qualitative Study of Non-Physician Perspectives on Resident competency. Journal of General Internal Medicine, 33(4), 487-492. Doi: 10.1007/s11606-017-4238-0

Kampstra, N.A. et al. (2018). Health Outcomes Measurement and Organizational Readiness Support Quality Improvement: A Systematic Review. BMC Health Services Research, 18(1005). Doi: 10.1186/s12913-018-3828-9

Lovaglio, P.G. (2014). Benchmarking Strategies for Measuring the Quality of Healthcare: Problems and Prospects. The Scientific World Journal Volume, 13. Doi: 10.1100/2012/606154

Lighter, D.E. (2014). The Application of Lean Six Sigma to Provide High-Quality, Reliable Pediatric Care. International Journal of Pediatrics and Adolescent Medicine, 1(1), 8-10. Doi: 10.1016/j.ijpam.2014.09.009

Niederhauser, A., Zuillig, S., Marschall, J. et al. (2018). Change in Staff Perspectives on indwelling Urinary Catheter use after Implementation of an Intervention Bundle in Seven Swiss Acute Care Hospitals: Results of a before/after Survey Study. BMJ Open, 9(10). Doi: 10.1136/bmjopen-2018-028740

Sanger, P.C., Granich, M. et al. (2017). Electronic Surveillance for Catheter-Associated Urinary Tract Infection Using Natural Language Processing. AMIA Annual Symposium Proceedings, 1507-1516. Retrieved from

Tinker, A. & Hough, L. (2016). The Top Five Essentials for Outcomes Improvement. Health Catalyst. Retrieved from

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Incorporating Technology in health-centered learning

Incorporating Technology in health-centered learning

  • Reflect on the health-centered learning needs of patients in your community, communities with which you are familiar, or communities abroad. Consider not only patients grouped by geographic location, but also those that represent a functional community, such as expectant mothers or patients with breast cancer or muscular dystrophy.
  • Reflect on the mobile applications and social networking sites you have used for both personal and professional reasons. How might these technologies help to address patient learning needs?
  • Select either a geographic community or functional community to further investigate.
  • Using the websites in this week’s Learning Resources and your own scholarly research, identify specific learning needs of your selected community of patients. The learning need that you select might be associated with a health concern, preventative care practices, health management, or basic patient education.
  • Browse the Internet to select a mobile application, social networking site, or other technology that might be appropriate for your patient community. Once selected, save pictures, videos, and/or capture screenshots that highlight the benefits of this technology.
  • Review the section Guidelines for PowerPoint in Chapter 8 of the Herrman course text.
  • Describe how you would construct a PowerPoint that explains the following:
    • Learning needs of the community, as well as their relevance (i.e. why does this matter? Why should patients and nurses care to address this learning need?)
    • A mobile application (i.e. handheld tablet or smart phone) or social media website that could help to address this need and why
    • Suggestions for using this technology
    • Any concerns or potential problems that might be associated with this technology
    • Follow-up activities to increase the success of patient/nurse integration into daily activities



Incorporating Technology in Community-Based Learning

The use of mobile devices in nursing has led to the development of medical software apps and applications to improve patient care. Mobile devices have helped in medical coding and billing, practice management, diagnosis and treatment, and electronic prescription (West, 2012). Therefore, mobile apps can help nurses answer clinical questions and provide resourceful information that can improve healthcare delivery without visiting the hospital (West, 2012). Therefore, mobile apps are ultimately cost-effective because they help nurses to reach more patients.

Incorporating Technology in health-centered learning

Johns Hopkins Antibiotic Guide (JHABx) is an evidence-based software app that helps in medical education; information gathering, consulting, communication, and health record maintenance and access (Boudreaux et al., 2014). The app allows nurses to identify diagnostic possibilities, appropriate scans and tests to order, reducing cost of care and decreasing unnecessary procedures. The app is essential for helping patients to identify preventive measures, counseling, improving practice efficiency and knowledge and ensuring the quality of data management and accessibility.


 The main advantage of using Johns Hopkins Antibiotic Guide (JHABx) as a medical app is that it provides numerous conveniences, including rapid access to information, better clinical decision-making, improve accuracy, efficiency, and productivity (Boudreaux et al., 2014). On the other hand, the major challenge of the app is that lack of privacy and protecting patient data, their lack of reliability for making clinical decisions, increased medicolegal and ethical implications, and its impact on the doctor-patient relationship (Boudreaux et al., 2014).

Johns Hopkins Antibiotic Guide (JHABx is a valuable tool in clinical practice and delivery of health care. However, the app requires the rigorous development of best-practice standards, evaluation, and validation to ensure their safety and quality level in the delivery of healthcare.




Boudreaux, E. D., Waring, M. E., Hayes, R. B., Sadasivam, R. S., Mullen, S., & Pagoto, S.

(2014). Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations. Translational behavioral medicine4(4), 363-371.

West, D. (2012). How mobile devices are transforming healthcare. Issues in technology

innovation18(1), 1-11.

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Sociological inquiry at an African wedding ceremony

Sociological inquiry at an African wedding ceremony

Snapshot of what to do:

1- Pick a location/event to attend to observe social behaviors among people for at least 30 minutes. (Dog park, park, church, grocery store, pool, baseball game etc.) – ANY EVENT WHERE YOU CAN SIMPLY SIT BACK & OBSERVE SOCIAL BEHAVIORS AMONG PEOPLE.

2- At the location/event you should take notes. Look for common behaviors (what everyone does-Normal social behavior) and look for outliers or abnormal behaviors (things that seem odd or out of place-what we would thing is typically not normal behavior for that setting).

3- Write up your paper. To do this you need to  follow the directions in the assignment description and rubric because those are the components I am looking for when I grade.

*First, start by writing a few sentences about the activity itself – what the event was, how long you observed, and why you chose it.

*Next, summarize your observations using sociological inquiry. Discuss your thoughts on the common social interaction patterns between the people.

*Describe any behaviors that stand out.

Note: Your writing should illustrate your understanding of the content from Units 1 and 2, and it should use 2-3 relevant concepts from those units. This means that I should see you referencing the OpenStax book and infusing that information with what you observed.
Your paper should be without grammar and spelling mistakes and have a references page at the end.


The purpose of this assignment is to identify common patterns of social behavior within a specific social event or a social setting. Your writing will illustrate your ability to interpret human interactions via a social lens, using the content from units one through four.



Conduct a participant observation procedure by observation a group/social event. The event could be a trip to a theme park, enjoying a play at a theater, or a dinner with family at a restaurant. It could also be attending a religious gathering, hanging out with friends at a coffee shop, attending a sports event like a baseball or a basketball game, celebrating a cultural holiday, or attending a meeting at your workplace.

The paper should have a title page in APA format. First, start by writing a few sentences about the activity itself – what the event was, how long it was, and why you chose it. Next, summarize your observations using sociological inquiry. Discuss your thoughts on the common social interaction patterns between the people. Describe any behaviors that stand out. Your writing should illustrate your understanding of the content from Units 1-3, and it should use 2-3 relevant concepts from those units. Your paper should be without grammar and spelling mistakes and have a references page at the end.



Sociological inquiry at an African wedding ceremony in our community

The activity that was selected was a wedding ceremony that took place at the community center. The wedding was between two individuals of African ancestry. Their origin was determined by the different aspects such as the dressing code that was mainly African and the music that was played as well as the cuisine. Although there were other guests of other races including Whites and Indians, there was a heavy presence of Africans among the guests. The event involved the wedding itself, where the groom and bride took their vows and swore to be together through different circumstances and the people in the audience served as witnesses to the bond that was created. The exchange of vows was followed by a reception that took place at the same venue.

I chose the wedding mainly because weddings are diverse and also involve a wide range of people as compared to other events such as cooperate meetings that would have people of similar characteristics. Also, weddings are events that take so much effort in the preparations such as the decorations, food, music as well as the party and they would serve as a heightened example of front stage behavior. Weddings are also social performances and involve several aspects of performance. They include the guests who come to witness the marriage, and the wedding party made up of the couple getting married, their parents and bridal party. Also, there is the priest or person who officiates the marriage and the performance also has costumes that come out as differing based on the roles that people are playing. In addition to the host and the party, there are several other people such as the associates and friends who represent different things.

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I attended the reception because by the time I arrived, the exchange of vows was over and the procession was heading towards the reception ceremony. This session of the event involved eating and drinking as well as music and dance as well as different presentations aimed at entertaining the newly married couple as well as the guests. I was at the event for about one hour and I was able to observe different behaviors among the people in the event.

There was a mix of different behaviors and included both normal and deviant behaviors. One of the norms of weddings is the attire that people wear to weddings. The majorities of the guests had decent attires and were all dressed to impress. There was clear evidence of elegance among the guests and especially the ladies. However, amid the guests was one lady that was putting on ripped jeans, T-shirt, and flip-flops. At any point that she passed, people stared and beckoned others to see her, indicating that the outfit that she was wearing was not suitable for the kind of event that she was in.


During the ceremony, there were opportunities to offer congratulations to the bride and groom. Many people visited them at the point where they were standing and would spend a few minutes with them and pave way for others to take a turn to offer the congratulatory messages. One thing that struck my attention as a particular woman that visited the couple and seemed to hog them. She kept talking to them, and wiping the bride’s face and adjusting the groom’s tie and kept hugging them for longer than what others took. The people that were behind her in the line were getting agitated and some of them began going back to their seats. It took the intervention of the mother of the bride, who politely asked her to leave but a scuffle ensued as she was taken away from the couple creating an awkward moment.

Sociological inquiry at an African wedding ceremony

The ceremony involved dance and people took different turns to dance to their favorite tunes and also entertain the couple by joining them. Most of the people kept o the rhythm and engaged in graceful moves in line with the beats of the traditional songs that were playing. Out of the blues, there came a group of four youths who joined the dance and started showing their moves. They took turns outdoing each other as the rest of the audience cheered them on. This went on for a while until a point when the dance moves seemed to be inappropriate as was evidenced by the response from the audience. Many of the women started covering their eyes in shame and the cheering reduced. They danced in a manner that was explicit and involved moves made by throwing or thrusting their hips back or shaking their buttocks, often in a low squatting stance. This made the majority of the guests and especially the elderly to appear uncomfortable. One of them walked up to the deejay and asked him to switch off the music and play something “decent” and “appropriate” for the ceremony.

Another behavior that came out during the ceremony was the way people enjoyed the drinks. There was champagne around every corner and consequently, it was difficult to resist a celebratory cocktail. Some people were clam about it and were able to sit calmly, while others drank as they mingled with others happily. However, some got so drunk and they made fools of themselves. Some of them became too emotional and started shouting and crying and this made everyone uncomfortable.

Sociological inquiry at an African wedding ceremony

In conclusion, the exercise made me realize that weddings have various sociological meanings about how people should behave and the meanings of certain rituals. Some of the behaviors that were seen as deviant included, a wardrobe malfunction, excessively drunk relatives and friends, guests that hogged the time spent by the couple as well as the group that danced inappropriately. However, the majority of the guests conformed to the norms of a wedding and everyone was very happy for the couple.





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Labor Management

Labor Management

Part 2: Objective information:Fetal heart tones are 130, with minimal variabilityVaginal exam is 4 cm/90%effaced/ -1 stationShe is complaining of pain – 8/10 on a numerical scale.An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm.

How can you provide non pharmacological comfort to this patient?What are the pharmacological methods to use?Without prenatal records or history GBS is unknown. What must you provide?Contractions are 5 minutes apart and you receive an order to augment labor – what non pharmacological methods can you employ (or ask the MD to provide?)Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?



Labor Management

The pain of labor is a phenomenon that is recognized universally and is brought about by the contractions of the uterus. Both pharmacotherapy and non-pharmacotherapy options can be considered to help the laboring woman to cope with the pain as well as build confidence in the process (Dhakal, Shah, and Singh, 2017). The non-pharmacological technique that would be employed for this patient involves Breathing techniques and massage which have been established as useful in pain management but also helps in increasing the likelihood of continuing breastfeeding (Adams, et al. 2015). The pharmacological method that would be used includes the administration of pain killers to help manage the pain that the laboring woman is in.

Labor Management

The GBS of the patient is not known because the medical history of the patient is unknown. Therefore, it is necessary to take samples of the laboring woman and carry out tests such as the VDRL, serology, blood group, urinalysis among other basic tests.  It is important to also provide information such as the fetal NST and also any decelerations or any tachycardia or bradycardia.


With contractions about five minutes apart, the non-pharmacological option that would be used is the Lamaze technique. This is a technique that is used in the labor process and it involves exercises and breathing control to give pain relief without drugs (Parthasarathy, and Doula, 2018). The main aim of the process is to help the mother’s confidence to improve and also reassure them that they are capable of going through the natural process.  This psycho-prophylactic method helps the woman to gain a better understanding of how to cope with the pain of childbirth and most importantly, facilitates labor and promotes comfort. The main strategies involved include relaxation techniques, as well as movement and massage.

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Pitocin, synthetic oxytocin, is a natural hormone that helps your uterus contract during labor and has been recommended for this patient. The use, in this case, is to augment labor because the contractions are not moving fast enough and therefore, present the risk of infection and other problems. 10 to 40 units of Pitocin will be added to 1,000 mL of a non-hydrating diluent and run at a necessary rate



Adams, J., Frawley, J., Steel, A., Broom, A., & Sibbritt, D. (2015). Use of pharmacological and

non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery, 31(4), 458-463. Doi: 10.1016/j.midw.2014.12.012

Dhakal, A., Shah, S., & Singh, B. (2017). Assessment of knowledge on non-pharmacological

methods of pain relief during labour among nurses working in maternity and children hospital, Nepal. Journal of Chitwan Medical College7(3), 25-28. Doi: 10.3126/jcmc.v7i3.23691

Parthasarathy, S., & Doula, P. (2018). Beyond Lamaze: Are We Missing the Key to Unlock

Women’s Potential? The Journal of Perinatal Education, 27(1). Doi: 10.1891/1058-1243.27.1.6

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Role description for a graduate-level nurse

Role description for a graduate-level nurse

Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team.

To Prepare:

  • Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented.
  • Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology.

The Assignment: (2-3 pages)

In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps:

  • Planning and requirements definition
  • Analysis
  • Design of the new system
  • Implementation
  • Post-implementation support



The Role of the RN/APRN in Policy Evaluation

Two significant opportunities that RNs and APRNs nurses have to enable them to participate in policy reviews include their capacity to influence health delivery and the professional organizations that they identify with as members (Milstead & Short, 2019). As professionals, nurses contribute towards caregiving for the sick. In this way, they bring into perspective a platform that enables them to care for the patients adequately. Equally, the entry of nurses into areas such as the American Nurses Organization presents a significant opportunity for them realize crucial opportunities in their professional undertaking to enhance policy reviews.

Nursing Paper Help

The opportunities that exist of the nurses may present diverse challenges such as issues pertaining to entry to the professional organizations. The professes of subscribing into those bodies may either be complex or have barriers that make entry difficult especially if the nurses fail to meet the minimum requirements (Shiramizu, Shambaugh, Petrovich, Seto, Ho, Mokuau & Hedges, 2016). Overcoming such a challenge requires the organizations to give clear guidelines on membership criteria. Equally, providing guidance during the registration process would bring many nurses on board. On the other hand, in their capacity to influence health delivery, and ultimately policy reviews, the professionals may lack adequate information to implement the necessary details. Thus, providing the relevant information and making it available for the nurses to use would prove effective in dealing with the impending challenge.


When communicating the opportunities that are available for the professional nurses to enable them adequately participate in policy reviews, the best strategies to implement are timing and leadership (Williams & Anderson, 2018). Through proper timing, it is possible to know when and when not to facilitate those reviews. In this way, it becomes easy to avoid the negative adversities associated with writing timing. Equally, having in place astute leadership would go a long way in facilitating policy reviews. Leadership is an integral ingredient in ensuring that policy review is done accordingly.



Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities. Journal of Racial and Ethnic Health Disparities, 4(5), 983–991. doi:10.1007/s40615-016-0302-4

Williams, J. K., & Anderson, C. M. (2018). Omics research ethics considerations. Nursing Outlook, 66(4), 386–393. doi:10.1016/j.outlook.2018.05.003

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Operating and Financial Performance Indicators peer post

Operating and Financial Performance Indicators peer post

I have attached the selected peer posts that are needing a response.

Health care leaders depend on sound operating and financial performance indicators to make decisions regarding working capital management, capital budgeting, and resource allocation. These indicators help organizations maximize performance and strategically plan for new initiatives. For this Discussion, you select a health care organization and examine how its leaders and managers use operating and financial performance indicators in their decision making.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by providing additional insights or alternative perspectives.



Operating and Financial Performance Indicators peer post

LaChella Smith 

Week-7 discussion



Grady Memorial Hospital, frequently referred to as Grady Hospital or simply Grady, is the largest hospital in the state of Georgia and the public hospital for the city of Atlanta. It is the fifth-largest public hospital in the United States, as well as one of the busiest Level I trauma centers in the country with 697,000 patient visits each year (Grady, n.d.). Grady health system provides health care mostly to the low-income residents in Atlanta and the surrounding areas. Grady’s cash and cash equivalent for 2017 was $220,964 and 2018 it was $181,150. Grady’s accounts receivable for 2017was $61,165 and $71,281 for 2018 (Gradyhealth, n.d.).  Days cash on hand equals the cash and cash equivalent, and it’s an important liquidity (Walston, 2018). It evaluates how many days a company could pay its daily operating expenses without collecting additional cashflows (Walston, 2018).

As a leader making decisions about the working capital management as it pertains to the cash and cash equivalent would depend on the current assets and current liabilities. Again, the cash and cash equivalent are the amounts of cash on hand, and the working capital management monitors the current assets and current liabilities. So, as a leader the cash and cash equivalent would help decide how much current assets (cash on hand) to pay the current liabilities (debts/bills). Capital budgeting includes the cost of major equipment and forecasts the impact that the projects will have on the organization’s finances , patients, clinical staff, and community (Walston, 2018).  And, the resource allocation is putting resources (cash) where it’s needed to the cover liabilities.


And, accounts receivable are monies customers owe to a business for goods and services they have recovered (Walston, 2018). As a leader, accounts receivable in working capital budget management will allow them to budget according to what’s outstanding. This would give them an idea of what is owed and what has been paid. The allocation of funds as it pertains to accounts receivable will allow funds to distributed into areas where they may be lacking funds. And, capital budgeting will help them make decisions on what major equipment can be purchased now and what will have to wait due to the outstanding debts/lack of funds.


Grady (n.d.). About us. Retrieved from

Walston, S. L. (2018). Strategic healthcare management: Planning and execution (2nd ed.). Chicago, IL: Health Administration.




Cash and cash equivalents refer to the value of a company’s assets that are in cash or can be converted into cash immediately. Cash and cash equivalent indicator can help in coming up with a metric to calculate an organization’s ability to repay its short-term debt. This information is not only useful to the organization itself but also to the creditors when deciding how much money, they can offer the organization as a loan. Thus, Cash and cash equivalents indicator can help in determining the financial condition of Grady Memorial Hospital. The indicator can be used to determine the organization’s value at any given time and raise a red flag when the organization is facing its worst condition. It shows what the company can quickly recover from its investment if need be. Cash and cash equivalent is important for funding a business in the short term and can be used to help finance inventory, operating expenses as well as capital purchases.



Cash equivalents. Retrieved from



India Seawright 



Hospitals and governments have a long tradition of using financial indicators to assess fiscal and operational activities. Financial indicators are frequently expressed as financial ratios. Ratios are a strategic management tool that provides key stakeholders with a concise and systematic way to organize the voluminous data contained in financial statements. The Mayo Clinic is part of a system of 60 sites in Minnesota, Wisconsin and Iowa, the local medical center serves the community through routine and specialized care services, as well as on- and off-site wellness support and community engagement. In their organization in Waseca, the average length of stay following a total knee replacement is five days, the average length of stay following a total hip replacement is seven days, and 85% of all of their patients are able to return home independently. As far as financial performance indicators their cash and cash equivalents for the year of 2018 were 29 million and their account receivables for other medical services were $1,828,000,000. (Mayo Clinic, 2018)

Operating and Financial Performance Indicators peer post

Monitoring financial performance and predicting financial problems are important contributions of financial ratio analysis and have been demonstrated to help hospitals and local governments reduce costs, increase profits, and continue operations. (Suarez, 2011) This is very important for leaders to know when making decisions about working capital management, capital budgeting, and resource allocation.



Mayo Clinic. (December 31, 2018). Consolidated Financial Report. Retrieved from

Mayo Clinic. (2018). Length of stay. Retrieved from

Suarez, V., Lesneski, C., & Denison, D. (2011). Making the case for using financial indicators in local public health agencies. American journal of public health101(3), 419–425. doi:10.2105/AJPH.2010.194555



Monitoring financial performance for an organization on a regular basis is one of the most important tasks for any organization to be successful. Financial indicators help the management to understand where the business currently stands from a performance standpoint. It also helps in predicting where the business is heading based on its current performance. The management can therefore make key decisions based on the financial indicators that can help to improve the business’s performance over the long term. In Mayo Clinic’s case, the cash and cash equivalents and the account receivable indicators can help the management in making decisions in certainty and confidence (DolfinBlue, 2019). This helps the management to foresee any issue that may affect the organization growth and mitigate it.

Operating and Financial Performance Indicators peer post



DolfinBlue (2019). The importance of monitoring financial performance. Retrieved from




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Group Therapy Progress Note – Mr & Mrs WW

Group Therapy Progress Note – Mr & Mrs WW

Students will:

  • Develop effective documentation skills for family therapy sessions *
  • Develop diagnoses for clients receiving family psychotherapy *
  • Evaluate the efficacy of solution-focused therapy and cognitive behavioral therapy for families *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

NOTE TO WRITER:  You can make up the family session and please use initials when talking about the individuals

Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session. Do not select the same family you selected for Week 2.

Group Therapy Progress Note – Mr & Mrs WW

Then, address in your Practicum Journal the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session. (See the progress note downloaded in the additional materials area).
  • Describe each client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether solution-focused or cognitive behavioral therapy would be more effective with this family. Include expected outcomes based on these therapeutic approaches.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.



Group Therapy Progress Note American Psychological Association

Client: Mr. and Mrs. WW                                                   Date: 10/10/19

Group name:  God’s people                                         Minutes: 45

Group session: 1                                                Meeting attended for this client: 1

Number present in group 2 of 2      scheduled Start time: 10:00 AM           End time: 10:45

Assessment of client

  1. Participation level: ❑ Active/eager Variable ❑ only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ sharing Attentive ❑ Intrusive ❑ monopolizing ❑ Resistant ❑ other: _____________________________________
  3. Mood: ❑ Normal Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  4. Affect: ❑ Normal ❑ Intense Blunted ❑ Inappropriate ❑ Labile ❑ Other: _______________
  5. Mental status: Normal ❑ Lack awareness ❑ Memory problems ❑ disoriented ❑ confused ❑ disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: __________________
  6. Suicide/violence risk: Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  7. Change in stressors: less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  8. Change in coping ability/skills: ❑ No change Improved ❑ Less able ❑ Much less able
  9. Change in symptoms: ❑ same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
  10. Other observations/evaluations:

The group session is made up of two people who are an older couple and is experiencing challenges in their marriage. The presenting problem is that the couple have been having challenges in the past few years and arte unable to enjoy their marriage. Mrs. WW is a 59 year old woman who is a born again Christian and lives with her husband Mr. WW. She explains that the she feels neglected by the husband whom she accuses of preferring to be in church instead of being at home with her. This makes her to feel lonely and sad because there is no one else at home. She has been feeling depressed for some time and even had a session with a counseling psychologists and psychotherapy was offered. She was also given some pills and she confesses that she took more pills than prescribed. She also describes that she came from a family where the parents had a divorce that was turbulent and it has affected her over the years. She is so afraid of having a divorce because she does not want to go through what her parents went through.



Mr. WW is a 60 year old man who is also passionate about serving Jesus Christ and is committed to the church. He has been married to Mrs. WW for the last thirty years and he says that although there have been challenges; the two have remained together because divorce has never been an option. He expresses that he prefers to stay away from home because his wife is always negative, which pushes him away. He therefore seeks solace in church by getting involved in church activities. He says that eh recently feels sad about his marriage as they are always arguing although he loves the wife so much. He has no history of substance abuse and has not been treated for any mental issue.

An assessment into the family genogram brings out that the two are from families that had experienced tumultuous divorces. The events in their life may have had an impact on them and may have caused trauma hence assessment will be done in consideration of stress-related issues. According to the diagnostic and statistical manual of mental disorders, (2013), the clients have mental issues that arise from their past. Mr. and Mrs. WW are both diagnosed with post-traumatic stress disorder, which is as a result of the tumultuous divorce that the parents went through. The first criterion for diagnosis of PTSD is when the clients have experienced an actual exposure to a stressful event. In this case, the couple has both been exposed to a situation where their parents had to separate and this may have had negative effects on them Individuals with PTSD have high chances of exhibiting another mental issue such as depressive disorders, anxiety-related disorders, and substance use (Smith, Goldstein, and Grant, 2016). It therefore come out that Mrs. WW also has anxiety and she is excessively worried that her marriage may come to an end.  For this session, there is anxiety and there are also some complains about the symptoms still being prevalent.

Group Therapy Progress Note – Mr & Mrs WW

In-session procedures:

For this couple Cognitive-behavioral therapy (CBT) will be employed and it involves activities that will aim at exploring the negative thoughts that an individual has and replaces them with thoughts that are positive and that will play a role in creating favorable behaviors and emotions ( Patterson, 2014). It expounds on the fact that numerous issues in the lives of people arise from the distortions that they have had.  The main goals is to establish better relationships by improving the quality of interpersonal relationships and social function (Cuijpers et al. 2016), the focus for these couple is on the  distress that they face and therapy seeks to will provide an opportunity for them to resolve their problems.

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The in session procedures include:

  • After assessment and history taking, agenda-setting will be considered
  • Interviews that will focus on identifying the interpersonal issues that are prevalent and addressing them in order of importance.
  • The couple will verbalize the issues that they would like to be addressed. The family and the therapist will then have a collaborative decision about the issues that will be tackled and the time frames
  • Practice of interpersonal skills including leadership, active listening, teamwork and patience among others.
  • A religious item such as prayers since the couple is religious.


  1. To think about the things that they love about each other and those that they don’t
  2. Come up with a comparison of the things they enjoy versus those that they dislike
  3. Carry out activities together to ensure that they tolerate each other and engage each other
  4. Appreciate each other more

Group Therapy Progress Note – Mr & Mrs WW

Other comments:

Legal and ethical issues have been considered. The couple has signed an informed consent and has shown that they are willing to go ahead with the treatment procedure. Privacy and confidentiality has been ensured as this is a requirement for psychotherapists hence everything that is discussed will be kept secret and will not be disseminated to any other person. In addition, although marriages have challenges, old age also presents challenges since the couple is older. There is a need to discuss the issue of the empty nest.


Signatures     …………………………                              Date………/………../……….



American Psychiatric Association (2013).   Diagnostic and Statistical Manual of Mental

Disorders, DSM-5.   (5th edition).   Washington, DC   American Psychiatric Association.    ISBN-13: 978-8123923796

Betan, E. J., & Binder, J. L. (2016). Psychodynamic Therapies in Practice: Time-Limited

Dynamic Psychotherapy. Comprehensive Textbook of Psychotherapy: Theory and Practice, 45.

Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal

Psychotherapy for mental health problems: a comprehensive meta-analysis. American Journal of Psychiatry, 173(7), 680-687.

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of

Family Psychotherapy, 25(2), 132-144. DOI: 10.1080/08975353.2014.910023

Smith, S. M., Goldstein, R. B., & Grant, B. F. (2016). The association between post-traumatic

Stress disorder and lifetime DSM-5 psychiatric disorders among veterans: data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Journal of psychiatric research, 82, 16-22.





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Community Health Promotion

Community Health Promotion

A two-page (500-word) paper that summarizes the resources that are available in your community and recommendations for future programs


a. Write a paper that focuses on resources.


Address the following prompts in your paper:


· Describe the resources that promote health promotion that are available in your community.

o Include the level of community participation.

o Explain the specific health promotion resources that are available across the lifespan.

o Include the level of participation for and any particular characteristics of the populations that use the resources.


· Recommend a health promotion idea or ideas that may be developed into a health promotion program or programs in your community.

Identify the targeted populations with rationale to support the choice.



Community Health Promotion

Health promotion is the process through which the well-being of individuals within a community is improved and protected. Health is regarded as a resource that is essential for everyday living. As a result, the emphasis on increasing control and enhancing the concept of health is not only the responsibility of the health sector but also the people of a given community. Comprehensive achievement of physical, social, and mental well-being requires the individuals in the community to understand and evaluate their health needs, and how they can be satisfied. Community participation forms the basis of successful health promotion. It reduces the vulnerability to disasters and promotes a quick response as well as improved planning in preparedness for calamities. The paper focuses on the community in Florida, which is highly regarded as the gateway city to Latin America.

The community has various resources that facilitate public participation in health promotion. They include the Dade Area Health Education Center (HEC), children’s homes societies, services for the elderly, and mental health programs, among others. The AHEC facility promotes easy access to affordable healthcare services, important health education to the residents, and recruitment and training of healthcare providers for the community. The facility mainly focuses on marginalized groups like the uninsured, economically undeserving, and patients with critical illnesses to provide them with improved access to comprehensive care (El-Amin et Al., 2016). AHEC also offers a wide range of academic programs to the students from within and outside the community to incorporate health-enhancing behaviors, achieving health literacy, and promoting the health of others.


The Catholic Charities of the Archdiocese also assists in health promotion within the community. The program is involved in providing adult day care services to the elderly. The program accepts adults diagnosed with medical, mental, or psychological disabilities, and provides them with an environment where they can interact with their loved ones and other patients with similar conditions. The program provides them with food, local field trips, and professional nursing care accompanied by counseling. The patients are engaged in activities like games and exercises to help in stimulating their mental functionality (Barrueco et Al., 2016). To be enrolled in Catholic Charities, one has to be a disabled adult of about 60 years or older and probably demonstrating signs of mild stages of Alzheimer’s. The eligibility is not dependent on a patient’s nationality, gender, religion, or political beliefs.

The Douglas Gardens Community Mental Health Center is another resource that aids in health promotion. The center offers extensive behavioral healthcare programs and services to people with mental illness. The resource has medical professionals with the necessary skills to handle individuals struggling with substance abuse and assist them in their management and recovery journey. The treatment processes in the center use assessment tools and Evidence-Based Practice (EBP) modules to manage the symptoms and help the patients to live comfortably within the community (Graham et Al., 2018). Interestingly, most of the services within the center are covered by private insurance, Medicare, and Medicaid.

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One of the recommendations that can be offered to the community would be to include smoking sensation programs detailing the adverse side effects of smoking. The plans may revolve around quit activities and brief interventions through written and audio-visual resources. The program would be of tremendous help because smoking of tobacco products is one of the leading causes of premature deaths globally. The targeted population for the program will mostly be high school students (who constitute 10% of the smoking population) and adults between 45-65 years old (who form 18% of the smoking population).



Barrueco, S., Wall, S. M., Mayer, L. M., & Blinka, M. (2016). Addressing the Needs of Young Children and Families: Early Childhood Education and Services in Catholic Schools and Catholic Charities. Journal of Catholic Education20(1), n1. Doi:10.2337/dc13-2195

El-Amin, S., Suther, S., Kiros, G. E., &Zaw, K. (2016). Practice Patterns for Sexual History-taking among Florida Nurses. Florida Public Health Review13(1), 17. Doi: 10.7748/nm.21.6.13.s14

Graham, R., Hodgetts, D., Stolte, O., & Chamberlain, K. (2018). Community meal provision and mental well-being. The Handbook of Mental Health and Space: Community and Clinical Applications. 10(E26). Doi: 10.5888/pcd10.120180



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