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External Environment and Healthcare Planning

External Environment and Healthcare Planning

Accountable health care leaders must respond to external factors in a way that is advantageous for the organization and the community. While health care organizations must strive to improve their financial positions, it should never be at the expense of the populations they are serving. For this Assignment, examine the following scenario and consider strategies to limit the negative impact of external factors and improve organizational success.

Scenario: A small independent hospital in rural Georgia is seeking to attain Magnet Status. This designation demonstrates to stakeholders that the organization is committed to delivering high-quality patient care. With this designation, the organization can easily attract and retain a highly-engaged clinical staff. Moreover, it provides the organization an opportunity to market itself to potential patients as the place to receive top-quality care. This means that the organization could realize a greater market share of insured and private pay patients traveling as far as 100 miles just to receive the quality services. It also positions the organization to enter into joint ventures with physician groups eager to provide new services, which would lead to increased revenue streams.

External Environment and Healthcare Planning

Although the designation sounds like a great opportunity for the organization, the board of directors is split on their support of this designation. The board members in support of the designation understand the great value that this program will bring to the facility; however, those in opposition learned from a research study that non-magnet hospitals had better infection control and less post-operative sepsis. They also learned from another study that working conditions in a magnet facility are not better than those in non-magnet facilities. Therefore, the dissenting directors have concluded that the organization should not invest its time and resources to seek this credential. The CEO must get support from an overwhelming majority of the board to move forward with pursuing this designation.

To prepare:

Review the provided scenario and consider external environmental factors that may impact the organization’s strategic planning (e.g., policy and economics, laws and ethics, health care quality, and population health).

Note: Your Assignment should show effective application of triangulation of content and resources in your conclusion and recommendations.

The Assignment

In a 2-page executive summary, do the following:

  • Identify and evaluate the impact of external environmental factors on the strategic planning of the organization in the scenario.
  • Recommend strategies to address these external factors and limit their influence on organizational operations.

Required Readings

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

  • Chapter 7, “The External Environment and Its Relationship to Strategy” (pp. 151-180) Note: This chapter was assigned in Week 3. Please review it for this week.

Wayland, M. S., & McDonald, W. G. (2016). Strategic analysis for healthcare: Concepts and practical applications. Chicago, IL: Health Administration Press.

  • Chapter 6, ““Five Forces in an Industry” (pp. 33–38)
  • Chapter 7, “PEST Analysis of the Environment” (pp. 43–45)
  • Chapter 23, “Ansoff Matrix” (pp. 151–152)

Cheng, W.-H., Kadir, K. A., & Bohari, A. M. (2014). The strategic planning of SMES in Malaysia: A view of external environmental scanning. International Journal of Business and Society, 15(3), 437–446.

Note: Retrieved from Walden Library databases.

Górecka, D., & Szalucka, M. (2014). Application of MCDA methods and stochastic dominance rules in the entry mode selection process in international expansion. Multiple Criteria Decision Making, 9, 5–31.

Note: Retrieved from Walden Library databases.

Metcalfe, L., & Lapenta, A. (2014). Partnerships as strategic choices in public management. Journal of Management & Governance, 18(1), 51–76.

Note: Retrieved from Walden Library databases.

Pliskie, J., & Wallenfang, L. (2014). How geographical information systems analysis influences the continuum of patient care. The Journal of Medical Practice Management, 29(5), 282–285.

Note: Retrieved from Walden Library databases.

Rajan, D., Kalambay, H., Mossoko, M., Kwete, D., Bulakali, J., Lokonga, J.-P., … Schmets, G. (2014). Health service planning contributes to policy dialogue around strengthening district health systems: An example from DR Congo 2008–2013. BMC Health Services Research, 14, 522–536.

Note: Retrieved from Walden Library databases.

Urban, B., & Mothusiwa, M. (2014). Planning flexibility and entrepreneurial orientation: A focus on SME performance and the influence of environmental perceptions. Management Dynamics, 23(1), 58–73.

Note: Retrieved from Walden Library databases.

 

SAMPLE ANSWER

External Environment and Healthcare Planning

Introduction

Like other businesses, the operations of healthcare facilities are surrounded by both internal and external environment.  Unlike internal factors, external factors emanate from outside and the firm does not have control over them. Better knowledge on external factors influencing the operations of the facility can enhance development of better strategies for improving services (Walston, 2018). The paper tries to depict issues related to the external environment of a small rural hospital in Georgia.

Impact of External Environmental Factors

Firstly, the facility’s strategic development will be affected by the legal environment. Policies set by healthcare controlling institutions at the State and Federal level require that facilities should engage in quality and safe practice. To get higher patient ratings and support of evidence-based activities, the facility needs to attain the Magnet Status. Secondly, the economic environment is also essential. In the scenario, the facility operates in the rural area, which has a lower economic status than the urban area. Under the current status, it is small in size, making it hard to enjoy economies of scale. Therefore, the firm needs to make a decision that will enable it to be sustainable under the economic environment (Cheng, Kadir, & Bohari, 2014)

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In terms of technological factors, many facilities in the United States are applying technologies such as robotic surgery, virtual information storage, and online payment of patient services. This feature makes it necessary for the management to develop strategies to align with the current technological applications in healthcare.  From another perspective, the firm is small in size and is situated in the rural area. This issue affects its competitive position in terms of rivalry with other facilities and its bargaining power to the customers. An increase of larger facilities in the region will make it difficult for the organization to operate well. Therefore, it needs to change its style of operations to increase its competitiveness. The facility is also affected by demographics as the population needs require better health outcomes (Vecchiato, 2015).

Strategies to Address the Factors

A significant strategy to address the issues is a change in the cultural and structural set up. This strategy is aimed at having a culture that appreciates changes in the environment. The organization my also need to develop overall cost leadership through aggressive development of efficient-scale operations, engagement in cost reduction, and reduction of other activities that would lead to more economic challenges. In addition, the facility should also engage in differentiation strategy. This plan involves developing something new. From this perspective, having a magnet status may be essential as many facilities in the rural areas may be lacking it (Vecchiato, 2015).

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The facility also needs to engage in market development. Being a rural organization, it needs to engage in more aggressive ways of promoting its services to a wider area. This would enable it to penetrate to other areas t the State and Federal levels (Vecchiato, 2015). The firm also needs to improve its information system. This would enable it to provide suitable information to all stakeholders and enhance better decision making. Innovation is also another strategy that may improve the status of the firm. This aspect needs the firm to engage in creative operations.  When complemented by a change in the organization’s culture, it will enable the facility to have sustainable operations with the changing external environment (Urban & Mothusiwa, 2014).

Conclusion

The scenario reveals that external environmental factors are important in determining the types of strategic plans for organizations. The healthcare sector is a dynamic area where shifts in external environment occur frequently. For the facility to improve its operations, aligning its strategies to the environmental changes is paramount.

 

References

Cheng, W.-H., Kadir, K. A., & Bohari, A. M. (2014). The strategic planning of SMES in

Malaysia: A view of external environmental scanning. International Journal of Business and Society, 15(3), 437–446.

Urban, B., & Mothusiwa, M. (2014). Planning flexibility and entrepreneurial orientation: A focus

on SME performance and the influence of environmental perceptions. Management Dynamics, 23(1), 58–73.

Vecchiato, R. (2015). Creating value through foresight: First mover advantages and strategic

agility. Technological Forecasting and Social Change101, 25-36.

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

Chicago, IL: Health Administration.

 

 

 

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Practicum Journal Entry

Practicum Journal Entry

Learning Objectives

Students will:

  • Apply documentation skills to examine family therapy sessions *
  • Develop diagnoses for clients receiving family psychotherapy *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

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.

NOTE TO WRITER:  You can make up any two clients that are related that were seen for drug or alcohol addiction therapy along with making up their histories or medications.  And please use the group therapy progress note in the additional materials.

Then, address in your Practicum Journal the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session.
  • Describe (without violating HIPAA regulations) each client, and identify any pertinent history or medical information, including prescribed medications.
  • Using the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), explain and justify your diagnosis for each client.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature

 

SAMPLE ANSWER

Practicum Journal Entry

The journal entry focuses on documentation skills during a therapy session. The paper diagnoses two clients under psychotherapy and analyzes the legal and ethical implications of the therapy used to counsel the patients.

Client #1

Michael Darwin is a 30-year-old Caucasian male working at APS. He was raised by a single parent, and her mother is dead after committing suicide due to anxiety and depression.

Presenting Problems: Depression and Mood Disorders

Michael is a withdrawn individual during therapy sessions. His hair and clothes are clean, and he denies suicidal ideation. However, he admits struggling working due to lack of concentration due to lack of enough sleep.

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Medical History

The patient struggles with depression and often isolates himself from friends and family members. There are no issues of both psychological and physical abuse, but he was diagnosed with depression at 17 years old.  The patient uses Zoloft 100mg daily for depression.

 Diagnosis

The patient has experienced a loss of pleasure and depressed mood for about two weeks. The symptoms cause lack of concentration at work and other activities during the day.  Impairment in social work-related activities is caused by depressed mood, recurrent thoughts of death, insomnia, diminished interest and agitation (American Psychiatric Association, 2013).

 

Group Therapy Progress Note

Client:  Michael Darwin                                                       Date: 9-21-2019

Group name: Psychological Health Group

 Minutes: 45 

Group session: # 2    

Meeting attended is #: 4 for this client.

Number present in group: 2 of 4 scheduled

Start time:  11: 00 AM         

 End time: 11: 50 AM

Assessment of client

  1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

  1. Mood: ❑ Normal ❑ Anxious ❑ Depressed Angry ❑ Euphoric ❑ Other: _______________
  2. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other:_______________
  3. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other:__________________

  1. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  2. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  3. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  4. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse

 

  1. Other observations/evaluations:_________________________________

In-session procedures

Expression of feelings experienced

Discussion on coping skills

Home Work

Provision of a book on psychological and physical coping mechanisms

Other Comments

Anger management, loss of mood, and withdrawal are critical issues that the patient need to manage through Cognitive Behavioral Therapy.

Practicum Journal Entry

 

 

Client #2

Lynn Turner is a 34-year-old Hispanic female working as a nurse in a Community Center of Trauma. She has two children and lives in a gated community with low levels of crime.  Her husband died in a rock accident while working as a truck driver.

Presenting Problem: Depression, Anxiety, and PTSD

The patient is alert, oriented, and attentive during therapy sessions. His mood seems depressed and anxious. However, she denies having thoughts of committing homicide or suicide. But the client admits having memory problems and lack of awareness during work.

Medical History

The client mentions that she has seen a psychological therapist as a child. Ever since there have never been issues with depression and anxiety until she lost her husband in a truck accident. The client uses Xanax 1 mg and Paxil 40mg daily to relieve severe stress.

Diagnosis

The client is suffering from a Posttraumatic Stress Disorder due to the psychological trauma and other clinical symptoms she faces. PTSD is caused through the following experiences of traumatic events: exposure to stressor, intrusion symptoms, persistent avoidance, and negative alterations in mood and cognition (American Psychiatric Association, 2013).

Group Therapy Progress Note

Client:  Lynn Turner                                                  Date: 9-21-2019

Group name: Psychological Health Group

 Minutes: 45 

Group session: # 2    

Meeting attended is #: 3 for this client.

Number present in group: 2 of 4 scheduled

Start time:  11: 00 AM         

 End time: 11: 50 AM

Assessment of client

  1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

  1. Mood: ❑ Normal ❑ Anxious Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  2. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other:_______________
  3. Mental status: ❑ Normal Lack awarenessMemory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other:__________________

  1. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  2. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  3. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  4. Change in symptoms: ❑ same ❑ Less severe ❑ Resolved ❑ More severe Much worse
  5. Other observations/evaluations:________________________________________________________

In-session procedures

Expression of feelings experienced

Discuss what relaxation means

Discussion on coping skills

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Home Work

Provision of a book on psychological and physical coping mechanisms

Practicum Journal Entry

Other Comments

Anger management, loss of mood, and withdrawal are critical issues that the patient need to manage through Cognitive Behavioral Therapy.

Legal and Ethical Implications

The Health Insurance Portability and Accountability Act (HIPAA) is a health care act that ensures client health information is protected during the provision of healthcare services. Confidentiality is critical during the provision of group therapy. However, psychiatrists do not have control of the patient’s information and ensuring patients privacy often become challenging. Therefore, the psychiatrists need to educate their patients on the importance of group therapy. Trust among group members ensures good relations and flow of information to guarantee quality care and counseling.

Appropriateness of Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a critical therapy for clients with psychological needs. It aims to develop coping requirements that help in the management of anxiety, PTSD, and depression (Keane, 2018). CBT is made up of three levels: negative automatic thoughts, core beliefs, and dysfunctional assumptions (McLeod, 2015). Thus, CBT focuses on self-discovery and help patients conceptualize and understand the reason behind their mental conditions and thoughts, thereby encouraging positive changes.

 

References

 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders.

Washington, DC: Author.

Fenn, K., & Byrne, M. (2013). The key principles of cognitive-behavioral therapy. Education

and inspiration for general practice, 6(9), 579-585. DOI:10.1177/1755738012471029

Keane, H. (2018). Facing addiction in America: The Surgeon General’s Report on Alcohol,

Drugs, and Health U.S. Department Of Health And Human Services, Office Of The Surgeon General Washington, DC, USA: U.S. Department of Health and Human Services, 2016 382 pp. Drug and Alcohol Review, 37(2), 282-283. DOI:10.1111/dar.12578

 

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Experiential Interventions

Experiential Interventions

Read “Topic 6: Vargas Family Case Study.” Develop three experiential interventions that you would use with the Vargas family.

It’s time to get creative! You have noticed that the Vargas family struggles with emotional expression, particularly with congruent emotional expression (i.e., words, actions, and body language being congruent). Using the Experiential Interventions Template, create three unique experiential interventions that you would use with the family and describe how they would be helpful to the family. It may be helpful to refer to the library articles for ideas and inspiration, but do not copy existing interventions. Be sure to fully address each section in the template for each of the three interventions in your paper:

1. Title of your Intervention

2. General Goals

3. Materials Needed

4. Advance Preparation Needed

5. Description of the Intervention with the Vargas family

6. Discussion of the Benefits of the Intervention to the Vargas Family

7. References (if any)

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.

 

SAMPLE ANSWER

PCN-521 Topic 6: Experiential Interventions

Intervention 1

Title of your Intervention:

Act and talk it out

General Goals:

-The main goal of this intervention is to allow the direct sharing of messages between family members.

-Additionally, the intervention aims to heighten emotional experiences between the Vargas family members

-enactments will redesign new interactions among the family members

-the intervention will create positive cycles of responsiveness

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Materials Needed:

-chairs

Advance Preparation Needed:

Critical knowledge of the family’s history will help the therapist know which family members have a problem with expressing their emotions. Additionally, an analysis of successful implementation of previous enactments in family therapy will help the therapist to customize activities for the Vargas family.

Description of the Intervention with the Vargas family:

The therapist will direct the family members to interact with each other to be able to observe presenting problems. Since every member of the family has narrated how they feel about each other, in this intervention, they will tell each other how they feel. For example, Elizabeth is disappointed in the way Bob counteracts her decisions about disciplining Frank. Instead of telling the therapist, Elizabeth should recreate the scenario during the picnic where she felt disrespected and tell Bob about it.

Discuss the benefits of the Intervention to the Vargas family:

-it will help them express their emotions better

-it will reduce stress

Citation for references (if any):

(Pagano, 2018)

Intervention 2

Title of your Intervention:

Soccer for the mind

General Goals:

-to reduce stress in the family

-to reduce symptoms of ADHD

-to reduce anxiety

Materials Needed:

-a ball

-playing field

Advance Preparation Needed:

-Bob will have to take time off work in the afternoon to play soccer with the family

Description of the Intervention with the Vargas family:

For three times a week, the family will meet up and play soccer for at least thirty minutes. Every family member will be expected to participate.

Discuss the benefits of the Intervention to the Vargas family:

-physical activity and more specifically soccer is a good way of reducing stress and depression

-soccer is fun and thus reduces anxiety

-Frank loves soccer, therefore, he will enjoy this activity

-the commitment to play soccer will increase family bonding and improve relationships among all family members

Citation for references (if any):

Sharma, Madaan & Petty, 2016

Intervention 3

Title of your Intervention:

Paint your feelings

General Goals:

-to examine emotional undertones in the paintings

-to help the family members better understand their feelings and behavior

Materials Needed:

-paint

-painting brush

-canvas

Advance Preparation Needed:

-there is no artistic talent needed for this exercise

Description of the Intervention with the Vargas family:

Color and texture play an important role in the therapeutic process. Painting and drawing will help the family reveal their thoughts and feelings. Every member of the family will be encouraged to participate in this intervention. During the next therapy session, canvas, paint and other materials will be provided and the family will engage in the activity for the duration of the therapy session. The therapist will not intervene during this activity.

Discuss the benefits of the Intervention to the Vargas family:

-relieves stress

-improves symptoms of anxiety

-it is fun for all family members especially Frank and Heidi

-helps every family member explore their emotions

Citation for references (if any):

Regev & Cohen-Yatziv, 2018

 

References

Pagano, C.J. (2018). Exploring the Therapist’s Use of Self: Enactments, Improvisation and Affect in Psychodynamic Psychotherapy. The American Journal of Psychotherapy, https://doi.org/10.1176/appi.psychotherapy.2012.66.3.205

Regev, D. & Cohen-Yatziv, L. (2018). Effectiveness of Art Therapy with Adult Clients in 2018-What Progress has Been Made? Frontiers in Psychology, 9, 1531. Doi: 10.3389/fpsyg.2018.01531

Sharma, A., Madaan, V. & Petty, F. D. (2016). Exercise for Mental Health. Priamry Care Companion to the Journal of Clinical Psychiatry, 8(3), 106.

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Vargas Family Case Study: Fifth Session

Vargas Family Case Study: Fifth Session

Read “Topic 5: Vargas Family Case Study.” Write a 750-1,000-word paper in which you demonstrate how therapists apply Strategic Family Therapy theories to analyze the presenting problems and choose appropriate interventions.

Be sure to answer the following questions in your paper:

1. How would Jay Haley or Chloe Madanes approach the current presenting problem? Identify and describe two interventions that he/she may use and why.

2. How would an MRI-style therapist approach the current presenting problem? Identify and describe two interventions that would be used and why.

3. How would a Milan-style therapist approach the current presenting problem? Identify and describe two interventions that would be used and why.

Cite at least three academic sources (peer-reviewed journal articles, books, etc.).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center

 

SAMPLE ANSWER

Vargas Family Case Study: Fifth Session

Introduction

Strategic family therapy has been significantly influenced by concepts found in the Bateson’s cybernetics model. Based on both family and brief psychotherapy, the model focuses on transforming behavior rather than changing insight as seen in other creative interventions (Tramonti, 2018). Under the Bateson’s cybernetics model are three models including; the mental research institute (MRI) model, Haley and Madanes strategic approach and the Milan model. According to Jay Haley, strategic therapy is a form of therapy where the therapist initiates the entire therapy session, designs approaches for every family member with a presenting problem, and takes responsibility about the care offered (Szapocznik et al. 2015). The MRI approach is based on the view that the client’s complaint is the main problem and it is not a symptom of other issues (Ray, 2018). The Milan Family System model views the family as a single functioning unit throughout the entire therapeutic process (Brown, 2015). By using the aforementioned strategic family therapy theories, appropriate interventions will be provided to facilitate a state of wellness for the Vargas family members.

Haley and Madanes Strategic Approach

The Haley and Madanes strategic approach is more concerned with symptoms and the function they serve in the therapy process. After analyzing triadic interactions over long periods of time, Haley was more concerned with power struggles and formulated rules following a hierarchical order (Szapocznik et al. 2015). Madanes on the other hand, was more concerned with incongruous hierarchies where children use symptoms to change the behaviors of their parents. Additionally, this strategic approach believes that families go through dysfunctional stages to be able to get to functional stages. The approach also posits four categories of problems arising from; a desire to dominate, control, be loved, love and to protect others and a desire to repent and forgive (Szapocznik et al. 2015). Therefore, the model focuses on both short and long-term sequences to reflect on chronic structural problems.

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The Haley and Madanes approach to family therapy focuses more on increasing the family members’ ability to love and soothe than to dominate or gain control over other family members. With this objective in mind, the love-first approach to intervention is the most effective strategy to use when addressing the Vargas Family. This approach encourages the family to provide love to each other throughout the treatment process (“Types of Intervention Methods”, 2019). The Haley and Madanes model also recognizes the role that children play in affecting their parent’s behavior. As such, the systematic family model of intervention which highlights the influence that one family member has on other members of the family is an effective intervention. By doing this, the highlighted family member responds better to treatment.

MRI Style Therapist Approach

This approach is based on the view that problems arise from the way difficulties in life are handled by an individual or by other members of the family (Rohrbaugh & Shoham, 2013). The therapist’s main aim is to gather adequate information about the presented problems and establish minimal goals towards change. The focus of all interventions is on solving the presenting problem rather than seeking changes in the entire family system. With this in mind, the most effective intervention for Frank Vargas will require the interruption of ionic processes that take place during repeated attempts to address his behavior. Ionic problem solution loops should be used to assess the intervention (Rohrbaugh & Shoham, 2013). In addition to interrupting ionic processes, the therapist can carry out activities that encourage family members to ritualize specific scenarios that result in conflict using objects like hats. The therapist then uses the information to interrupt the problem sequence and allow the family members to reconfigure themselves (Mloispro, 2017).

Milan-Style Therapist Approach

The Milan-style therapist approach shifts the focus away from interactive sequences in the family and directs it towards questioning the family’s belief systems. Therefore, the model strives to help families examine their thoughts and belief systems instead of helping the family transform their behavior (Loras, Bertrando & Ness, 2017). In line with this, two key interventions are identified that could benefit the Vargas family. They include; positive connotations and family rituals. Positive connotation involves reframing the problematic behavior in the family where the symptoms are viewed as positive since they help facilitate the family’s well-being. Family rituals like weddings and funerals play a central role in the family’s life. Therapeutically, these rituals may be used to establish family patterns and alter beliefs (Loras, Bertrando & Ness, 2017).

Conclusion

The Haley and Madanes strategic model, the MRI style approach and the Milan-style therapist approach all draw fundamental concepts from the Bateson’s Cybernetics model. By focusing on the effects that children have on their parent’s behavior, Haley and Madanes model provides interventions that focus on the effect that one family member has on other members. The MRI interventions on the other hand interrupt ionic processes to control behaviors. Lastly, the Milan intervention concentrates on family rituals and uses them to transform behavior.

 

References

Brown, J. M. (2015). The Milan Principles of Hypothesizing, Circularity and Neutrality in Dialogical Family Therapy. Australian and New Zealand Journal of Family Therapy, 31(3). https://doi.org/10.1375/anft.31.3.248

Loras, L., Bertrando, P. & Ness, O. (2017). Researching Systematic Therapy History: In Search of a Definition. Journal of Family Psychotherapy, 28(2), 134-149. Doi: 10.1080/08975353.2017.1285656

Mloispro. (2017). Mental Research Institute (MRI) Systemic Therapy. Mindfully, Retrieved from https://mindfullyhealing.com/mental-research-institute-mri-systemic-therapy/

Ray, W.A. (2018). Bateson’s Cybernetics: The Basis of MRI Brief Therapy: Prologue. Researchgate, 36(8), 859-870. Doi: 10.1108/03684920710777388

Rohrbaugh, M.J. & Shoham, V. (2013). Brief Therapy Based on Interrupting Ironic Processes: The Palo Alto Model. Clinical Psychology (New York), 8(1), 66-81.

Szapocznik, J., Muir, J.A., Duff, J.H., Schwartz, S.J. & Brown, H. (2015). Brief Strategic Family Therapy: Implementing Evidence-based Models in Community Settings. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 25(1), 121-133. Doi: 10.1080/10503307.2013.856044

Tramonti, F. (2018). Steps to an Ecology of Psychotherapy: The Legacy of Gregory Bateson. Systems Research and Behavioral Science, 36(1). Doi: 10.1002/sres.2549

“Types of Intervention Methods”. (2019). Ridgefieldrecovery. Retrieved from www.ridgefieldrecovery.com/intervention-guide/intervention-methods/

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Rhetorical Reading Strategies

Rhetorical Reading Strategies

Review the sample argument article and answer the following questions:

1 -Why did the author write this article (what was their purpose)? Provide evidence from the article that- supports your answer Do you agree with the author’s position on the topic? Is this a problem that you can help to solve? How?

2- Identify yourself with these students, Seth, Kara, and Bob. Think about how each of these students reads, and reflects, and thinks, and writes. Why do you identify yourself with that person?

3- which type of student seems to be the best type of rhetorical reader or critical thinker or analytic type of reader and writer? why exactly that particular student is the better one? What is it that that student is doing that the other students are not?

4- The three strategies identified are strategies for constructing meaning, are content strategy, function/feature strategy, and rhetorical reading strategy. Explain them.

5- The Role of Rhetorical Reading, this is really Haas and Flower reflecting on this idea of rhetorical reading. What are its benefits? What are its uses? How can teachers teach rhetorical reading? What are the various drawbacks and conflicts that arise when this type of reading is being implemented in instruction, and how beneficial is it really, compared to other types of reading?

 

SAMPLE ANSWER

 

Rhetorical Reading Strategies and the Construction of Meaning

  1. Why did the author write this article (What are their purposes?) Provide evidence from the article that supports your answer. Do you agree with the author’s position on the topic? Is this a problem you can solve? How?

The purpose of the article is to create an understanding of rhetorical reading strategies and their meaning. He explains that reading is a discourse act and for the readers to construct the meaning of a text, they must do it in the context of a discourse situation which involves other readers, the writers of the text, the history of the discourse and the meaning of rhetorical reading. I agree with the author’s position on the topic because to understand the content in a text, and the reading process must be constructive. Readings should be seen as a discourse act and readers can only understand most of the text meanings based on the discourse situation. Constructive interpretation should mostly apply in the colleges and universities where students find it challenging to understand hard and complicated documents, which in turn affects their performance in studies. The knowledge on how interpretative reading process is carried out is limited among most of the college tutors (Haas & Flower, 1988). It is difficult for the tutors to teach students about the constructive and productive interpretive reading process if they do not understand it. Tutors can only teach what they understand based on the readings to convey it in the best way and the right manner. I can solve this problem is by first researching and understanding what a constructive reading process is all about and how other students can apply it. Understanding the topic would help the tutor convey the meaning of the text in a manner that students understand.

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  1. Identify yourself with these students, Seth, Kara, and Bob. Think of how each of these students reads, reflects, thinks, and writes. Why do you identify yourself with that person?

Kara is unsure about the meaning of a particular word when reading the text. She is content-oriented as she only paraphrases the passage. Kara’s content is limited as compared to other readers since she does not include all the crucial parts of the constructive rhetorical process. Bob reading, reflection, thinking, and writing process is more constructive compared to that of Kara. Bob builds structure and content representations (Haas & Flower, 1988). He tries to connect his text reading with his beliefs or what is already know but does not include the illustrations of other readers and the writer of the original text. Seth has a more satisfactory rhetorical process as is concerned with the entire content of the text. He identifies the intentions of the writer of the text, recognizes the missing book and also concerns himself with the experimental situation (Haas & Flower, 1988). He also thinks about what knowledge he lacks and which he already has and relates it to his past reading experiences. He is concerned with text’s multi-dimensions such as presentation of the function and structure of the text, representation of the text’s content, representation of the intentions of the author and his knowledge and experience as a reader (Haas & Flower, 1988).The material obtained by the three students were different in quantity depending on the way each one of the read, though, reflected and wrote the text after reading. I identify myself with the person because the understanding of each person is different regardless of the topic presented.

  1. Which student seems to be the best type of rhetorical reader or critical thinker or analytic kind of reader and thinker? Why exactly is that student the better one? What is that the students are doing that the others are not?

Seth is the best type of rhetorical reader, critical thinker, and analytic kind of reader and writer. He understands and applies almost the whole process of constructive reading. When compared to other students such as Kara, he comes up with a high amount of content after reading. Kara only paraphrases a text after she is uncertain with the meaning of a word, and she is then satisfied by just reading what she has written (Haas & Flower, 1988). On the other hand, Bob builds the representations of the content and the structure of the text and tries to relate his beliefs with his reading. However, Bob also does not apply most of the process required for the effective rhetorical operation. Seth is also concerned with the content of the text and includes both the functions of the parts of the book as well as the whole text and the intentions of the author. He also reviews missing text and experimental situations (Haas & Flower, 1988). Also, he relates to his previous reading experience and knowledge. Therefore, multidimensional consideration of the book is what makes Seth the best rhetorical reader and critical thinker and writer among the three students. He considers the representation of the author’s intention, description of the function and structure of the text, his knowledge and experience as a text reader, and representation of the content. Such characteristics are what good students do in order to understand while others ignore or do not focus on when reading and representing the topic content.

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  1. The three strategies identified are the strategies for constructing meaning, content strategy, function/feature strategy, and rhetorical reading strategy. Explain them.

Content strategies are concerned with the information or the content of the topic. That is, what the text is all about. The main objective of the reader in using content strategies is to obtain information from the text. Kara is an excellent example of a student or a reader using content strategy as she paraphrases the passage to gets its content when she fails or is unsure of the meaning of a word in the text.  Feature of function strategies is used to refer to generic or convectional functions of the text (Haas & Flower, 1988).. This is done by, for example naming parts of the texts, marking particular words, large parts of the text or even sentences. For instance, “this is the example,” “This is the main point” and “I think this is the introduction.” Feature strategies are also used to state what a text is doing. Functional strategies are used primarily in high schools and junior high curricula where students are not yet experienced readers, and they are taught to identify parts of texts such as the introduction, the body and the conclusion among others. Rhetorical strategies are beyond the content and parts of the book. They are concerned with the intentions of the author, the context, and the effect of the text to the audience.  Therefore, readers need to use the context, the effect of the text and the content strategies to obtain information from the text in a manner that can be understood and displayed in a more logical way.

  1. The role of rhetorical reading, this is Haas and Flower, reflecting on the idea of the rhetorical text. What are its benefits? What are its uses? How can teachers teach rhetorical reading? What are the various drawbacks that arise when this type of reading is being implemented in instruction and how beneficial is it really, compared to other types of reading?

One of the benefits of rhetorical reading is that readers understand writers make different choices about structure, content, and style, depending on the context they are operating. Also, readers can differentiate their process of reading depending on their reading purpose by matching their strategies with the content in the text. Rhetorical reading is used to identify the intentions of the authors, representing the content, the function, the prior knowledge and experience of the reader, that is, rhetorical reading focuses on the multidimensional roles of a particular text. Teachers can teach rhetorical reading by helping students ask themselves questions such as: Who is the author? Who is the audience? What is the content of the text? How does the writer represent the argument? The significant drawbacks of rhetorical reading mainly when used in instructions is that it may be difficult and time consuming for the readers as compared to other types of reading. Sometimes it takes time to understand the context of the reading or what is being discussed in the text. Therefore, may need more time for readers to understand what is being conveyed.  However, it is highly beneficial in terms of understanding the meaning of a text, the author, and their intentions and connecting the knowledge and experience of the learner with the book (Haas & Flower, 1988). Also, the reader can learn the functions of different parts of the text since rhetorical reading is multidimensional and may have different meanings and understanding.

  1. Discuss the problem Haas and Flower have with students identified as “good readers.”

Good readers have a problem because they sometimes miss a given point within a text and they unwilling or unable to critically read the passage. It is true that good readers are rich in vocabularies and they can easily identify parts of a text such as the introduction, the body and the conclusion (Haas & Flower, 1988). However, they do not analyze or criticize texts but just paraphrase and summarize them.

 

Works Cited

Haas, C., & Flower, L. (1988). Rhetorical reading strategies and the construction of meaning.

College Composition and Communication, 39.2(1988): 167-183.

 

 

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Simulation Technology

 

Simulation technology has been transformative in nursing education. Through the use of simulation, nurses can repeatedly practice skills and gain clinical confidence in a risk-free environment. Simulation, however, is not just for health care professionals. How can nurses leverage simulation technology for patient and family education? Share your experiences and ideas for leveraging simulation technology for patient education.

 

SAMPLE ANSWER

Simulation technology has been critical in the nursing profession. The technology helped me throughout the time I was doing my associate nursing degree. The university I attended helped me to gain practical skills that gave me confidence when working with patients. The institution had a lab with all simulation technologies to help students present real-life situations and prepare them from the beautiful and stressful life in nursing profession. For example, my classmates and I were presented with a patient with the condition that we were to determine based on the signs and symptoms presented. Using the simulation technology, we were able to run a code that helped us to establish that the patient had a heart attack and the technology was so effective in reducing the risk of losing the patient. According to Foronda et al., (2017) it can increase student’s confidence and knowledge when caring for critical patients. Besides, it is estimated that simulation technology could eliminate about 50% of clinical time, without having any adverse effects on both patient care and learning outcomes (Hayden Padilha, Machado, Ribeiro, & Ramos, 2018).

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Patient education is also a critical element of simulation technology. Patients can benefit from simulation technology through education by helping them to understand clinical situations including, personal care, adherence to medication, and their outcome and wellbeing. Based on my experience when working with simulation technology, we were able to teach parents how to carry out CPR on their children during emergency.  We used a video about how CPR should be conducted on infants and asked them to explain and relay what they learned about performing CPR. It is therefore an excellent instructional strategy that can help nursing students to practice psychomotor skills, critical thinking, and clinical decision making without risking the life f a potential patient.

 

References

Foronda, C. L., Alfes, C. M., Dev, P., Kleinheksel, A. J., Nelson Jr, D. A., O’Donnell, J.

M., & Samosky, J. T. (2017). Virtually nursing: Emerging technologies in nursing education. Nurse Educator42(1), 14-17. doi: 10.1097/NNE.0000000000000295

Padilha, J. M., Machado, P. P., Ribeiro, A. L., & Ramos, J. L. (2018). Clinical virtual

simulation in nursing education. Clinical Simulation in Nursing15, 13-18. https://doi.org/10.1016/j.ecns.2017.09.005

 

 

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Improving Transition to Telenursing and Telemedicine

Improving Transition to Telenursing and Telemedicine

Telenursing and telemedicine will only be successful if patients engage in the program. You have been asked by your manager toImproving Transition to Telenursing and Telemedicine pilot a program aimed at improving transitions of care using the new telemedicine system recently implemented at your hospital. What are some of the ways that you can encourage both patient and provider engagement to ensure the pilot program success? Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA style website through the APA icon below.

 

SAMPLE ANSWER

Improving Transition to Telenursing and Telemedicine

For patients and caregivers to reap the full benefits of telemedicine, they must wholly embrace the revolutionary technology. The engagement of the patient and care-giver is paramount for the effective use of telemedicine since it relies on the ability of stakeholders to use the system (Dantu & Mahapatra, 2013, 3) Collecting from and providing information to users will increase the involvement of both patients and care providers in the integration of telemedicine.

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Educating caregivers and patients on the uses and benefits of telemedicine will increase the engagement in the pilot and subsequent roll out of the program. Dispelling myths, and providing knowledge on how to use the system provides all stakeholders with the required information to practice telehealth. Skepticism on compatibility, fear of losing face to face interactions and security concerns are some of the popular myths among physicians (Dantu & Mahapatra, 2013, 3) Providing information to the stakeholders will encourage them to get more involved because patients and providers have knowledge on how to use the system and understand the potential benefits.

Conducting research prior to designing and rolling out implementation strategies is critical in the adoption of the proposed procedures. The data collected informs on preferences and possible barriers to the acceptance of telemedicine. Collecting data from stakeholders ensures that their views are incorporated in making the pilot thus it is more acceptable. Both providers and patients will participate more knowing that their input is valued and will be included in the execution of telehealth procedures.

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Patient and provider engagement can be increased through improving communication to and from stakeholders. Transition of care is an important aspect for the recovery of patients and it can benefit greatly from the use of telemedicine While a pilot program designed to improve the transition of care using telehealth systems is a noble initiative, stakeholders in the medical field must be fully engaged in the process to capitalize on the advantage

 

References

Dantu, R., & Mahapatra, R. (2013). Adoption of telemedicine – challenges and opportunities. Retrieved from https://pdfs.semanticscholar.org/8267/cb4b468233850adfe1eab1387ef2d1202e5d.pdf

 

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Evaluation of Research Ethics

 

Evaluation of Research Ethics

Search the GCU Library and find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the Topic Materials or textbook.

Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template. See Chapter 5 of your textbook as needed, for assistance.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

 

SAMPLE ANSWER

Article Analysis and Evaluation of Research Ethics

Article Citation and Permalink

(APA format)

Article 1

Lori, M. (2017). Are Patients Satisfied with Telehealth in Home Health Care? A Quantitative Research Study in Congestive Heart Failure Patients. SM Gerontology and Geriatric Research, 1(2). Retrieved from https://smjournals.com/gerontology-geriatric-research/download.php?file=fulltext/smggr-v1-1009.pdf

Point Description
Broad Topic Area/Title Telehealth technology in home healthcare
Problem Statement

(What is the problem research is addressing?)

Whether using telehealth in home healthcare enhances patient satisfaction
Purpose Statement

(What is the purpose of the study?)

To determine the extent of patient satisfaction when the telehealth technology is used in home health care particularly with respect to congestive heart failure patients.
Research Questions

(What questions does the research seek to answer?)

What is the difference in patient satisfaction for patients using either telehealth vs. usual home health services in patients diagnosed with heart failure after removing the effect of age, gender, prior home health services and living alone status?
Define Hypothesis

(Or state the correct hypothesis based upon variables used)

Patients receiving telehealth care would be as satisfied or more satisfied with their home health care.
Identify Dependent and Independent Variables and Type of Data for the Variables The dependent variable was patient satisfaction score, while the independent variable was telehealth home healthcare services
Population of Interest for Study Patients with heart failure receiving home health care and aged more than 18 years
Sample 176 participants
Sampling Method Random
Identify Data Collection

Identify how data were collected

Surveys
Summarize Data Collection Approach Surveys were sent to the participants who met the criteria of the study.
Discuss Data Analysis

Include what types of statistical tests were used for the variables.

ANCOVA, analysis of frequencies and description
Summarize Results of Study Telehealth in home healthcare is a cost effective approach that enhances patient satisfaction particularly in the management of chronic diseases.
Summary of Assumptions and Limitations

Identify the assumptions and limitations from the article.

Report other potential assumptions and limitations of your review not listed by the author.

Some of the assumptions include that other factors may not affect the outcomes of the study. For instance, it was assumed that other element that may affect the quality of home healthcare did not affect patient outcomes.

 

Study limitations that were identified in this research were the descriptive, quasi-experimental design with convenience sampling inhibiting the ability to generalize the findings to a larger population. This design did not support a cause and effect relationship for the findings.

 

Ethical Considerations

The study involved human subjects. As such, one of the ethical issues that would have arisen is the breach of the privacy of these patients. Ethics demands that the privacy of human subjects is preserved, hence errors or negligence by the researchers may have caused ethical concerns.  Furthermore, issues related to biases would have occurred during the sampling and data collection phases of the study. Biases involved allowing elements such as prejudice to affect a study, thus affecting its objectivity and leading to results that may be inaccurate. Additionally, another potential ethical consideration is errors during the process of data analysis. Errors during this stage may result in findings that are not representatives of the views of the study participants.

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Additionally, another ethical consideration during the study is failing to use the appropriate sampling method. In most instances, random sampling is the ideal method since it ensures that the entire population is represented, and elements such as biases avoided. Therefore, during the sampling phase, it was possible for the incorrect sampling method to be used, which would have led to inaccurate results. Moreover, when publishing the results, there was a possibility of some errors occurring, this included typing errors, which would have led to inaccuracies. At the same time, the participants’ private data may have leaked to the wrong parties during the publishing phase of the study, which would have caused ethical concerns. Therefore, it was imperative for the researcher to take various measures to ensure that the ethical considerations are observed during the various phases of the study.

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Staff Shortage and the Importance of Adequate Staffing Level

Staff Shortage and the Importance of Adequate Staffing Level

Unit – Professional Issues and Policies in Nursing and Specialisations

Please write in simple academic language.

Please use ebscoHost and google scholar for literature search.

2750 words

APA format and references

Please write with sub headings.

Students will explore an area of concern in their professional practice, identify the problems or issues, and undertake an in-depth exploration of the problems or issues of concern. This exploration should be in the form of a critical analysis which focuses on the these identified problems or issues and how they have led to a policy

Please write about staff shortage and the importance of adequate staffing level (in Australia)

Problems associated with low staffing levels are

poor quality of care,

Medication errors

Increased stress level

Workload to other staff and so on.

Select a literature/ research article that provide the strongest evidence for your topic. Your articles must be ? 5 years old.

• Your assignment must have an introduction, a body (which is the content of the issues) and a conclusion.

• USE APA FORMAT APA guidelines. Information cited from an unreliable websites, pamphlets or magazines is not acceptable for this paper.

Marking criteria

Introduction

• Student provides a clear and adequate description of the area of interest in their professional practice that has been translated into a policy ( 5)

Content and Analysis

• Provides a critical analysis of the selected problem or issue(s) (10)

• Explanation of concepts is based on scholarly literature (5)

• Provides and integrates at least 10 references in the paper, with at least 5 of which are peer reviewed journal articles (10)

• Information is gathered and synthesized to interpret the problem/issue(s (10)

Presentation

• Logical and sequential arrangement of arguments and discussions (5)

• Conclusion provides summary of the paper; no new information is provided. (5)

According to our college, whatever we are writing, except common knowledge, we have to provide in-text citation, and bibliography.Therefore, if you are giving any facts or other than common knowlege please provide references. We can have up to 20 references.

 

SAMPLE ANSWER

Staff Shortage and the Importance of Adequate Staffing Level

Introduction

The nursing shortage is a worldwide issue that poses challenges to the nursing profession and the facility planners. The ever-changing needs of customers and the way healthcare is delivered continue to force planners to rethink the estimates of nursing workforce. The main impact on the provision of nursing services includes an increase in complexity and insight of hospitalized patients, the number of severely ill patients, improved life expectancy, and more chronic lifestyle diseases (Marć, et al., 2019). The environment that nurses offer care has become complex and patients are more informed than before. The typical lack of available bed in most health care institutions has also led to many challenges that burden both the nurses and the institutions. For example, most emergency units are often full thereby increasing tensions among the staff groups (Hegney et al., 2019). Therefore, nurses often deal with issues that are unknown or unfamiliar to them. The constant workload has increased the constant burnout and emotional stress among nurses, which prevent them from providing more quality and holistic care (Combes, Elliott, & Skåtun, 2018). Besides, the increased lack of qualified and skilled nurses also remains a significant challenge to health care institutions in Australia. Although there is no enough data in Australia that depict the reasons for nursing shortage, many flags and indicators from the researchers carried out abroad can help inform decision-makers. This paper analyses the staff shortage and the importance of adequate staffing levels concerning Australia.

The Nursing Workforce

The nursing workforce continues to evolve and undergo critical changes. Australia has seen a decrease in enrolment of nurses for a few years (Sutcliffe & Dhakal, 2018). However, it is estimated that the 2018 enrolment increased and decision-makers are unsure if the trend will be sustained in the coming years.  About 40% of nurses in Australia are 40 years and above making aging a critical aspect as it depicts the potential of nurses to retire faster before belling replaced (Sutcliffe & Dhakal, 2018). This is further affected by the fewer number of students entering nursing careers in the country. Therefore, Australia remains uncertain on the supply side of the nurses in the country.

Nursing shortage is further increased by the increasingly better-qualified nurse managers and clinicians who are well placed and marketable in sectors outside health. Australia has multiple career options that weaken the demand for individual looking to enter the nursing programs (Sutcliffe & Dhakal, 2018). This can be seen among students from non-English speaking countries. Finally, the increasing demand for expertise and skills in nursing has increased in recent years (Press, Wong, & Gibson, 2015). Thus, nursing experience and qualifications are transportable and valuable assets needed in the nursing industries

Causes of Staff Shortage

  1. Workload and work environment

Work environment and workload are the significant factors that cause nursing shortage in Australia. Safety issues and unsafe working environment including harassment and bullying negatively affects the retention of nurses (Hegney et al., 2019). Recent studies show that workloads, burnout, job demands, safety issues, job dissatisfaction, lack of autonomy, and low morale are the main factors that cause nursing turnover (Press, Wong, & Gibson, 2015). The National Review of Nursing Education considers that improved treatment of nurses always leads to better nurses and patient outcome. Burnout and dissatisfaction increased due to the decline in nurse’s ability to provide quality care leading to decisions that force the nurses the leave.

Although Australia has a population of nurses who are well qualified, they are prevented from making clinical decisions that are critical in the job duties of a nurse. Autonomy in nursing practice can help retain nurses, and when nurses can make their own decisions that can improve patient’s outcome, they become part and parcel of the clinical practice and keep their jobs (Combes, Elliott, & Skåtun, 2018). Besides, respect of nurses from both the patients and institutional administrators is essential in reducing turnover rates. Thus, workload often increases when nurses leave their work including double shifts and employment of casual employees.

  1. Management Systems and Organizational Structures

The understanding of nursing shortage in Australia can be determined using two factors, management systems, and organizational structures. Restructuring is considered to lead to low staff morale and a decrease in nurses’ loyalty to the institution, leading to increased rate of turnover. According to Hegney et al (2019), restructuring of nursing units and awards always lead to improved patient mortality due to loss of experienced nurses. For example, in Canada and United States, loyalty and trust of employers have been lost through structuring initiatives in the institutions. This leads to the loss of skills and knowledge as most nurses often seek employment in other healthcare institutions (Hegney et al., 2019).  Australia also faces divisional structures because the nurse executives are responsible for the quality services provided in the organization.  For example, downsizing may happen to decrease the number of nursing and to increase the number of administrators leading to the question of the primary function of health care institutions and the staff with is tasked with providing care (Sutcliffe, & Dhakal, 2018). Besides, the problem of having difficulty in resource planning and accessing administrative database for research purposes is an issue that causes turnover in Australia. For example, in Western Sidney, most administrative and registration databases cannot be accessed by nurses to be used in nursing studies.

Problems Associated with Low Staffing Levels

Nursing shortage often leads to more adverse events such as higher rates of readmission, patient dissatisfaction, and longer lengths of stays, which decrease quality of care (McNeil, Mitchell, & Parker, 2015). By focusing on optimal nurse staffing, health care institutions will be able to deliver more cost-effective and high-quality care. As long as there are nurses who can handle patient issues, patients may have experiences which influence their health negatively. According to Barber, (2016), the following problems are linked with low staffing levels:

  1. Patient outcomes

A study by Jones, and Ramsbottom, (2017) found that for every additional patient being cared for by a nurse, there is a risk of 7% of one of the patients succumbing to death within 30 days of readmission. Besides, the authors found that there was a high risk of nurse’s failure to rescue patients if they have additional patients to care for. Therefore, nurse shortage below the recommended target levels was associated with increased mortality among patients.

Staff Shortage and the Importance of Adequate Staffing Level

According to Combes, Elliott, and Skåtun (2018), patients who were admitted for cardiac issues were more likely to survive and get discharged in healthcare settings with proper levels of nurse staffs. Besides, the study found that patients who were under surgery with optimal nurse staffing were more likely to receive quality care at low cost compared to other health care institutions with less nurse staffing (Combes, Elliott, & Skåtun, 2018). Therefore, having fewer nurses who care for many patients may lead to complications caused by stress and burnout, leading to increased medical costs, low-quality care and reduced patient outcomes. Besides, enough staffing further reduces patient falls in emergency departments which also improves patient’s outcome.

  1. Patient Satisfaction

According to Hudgins, (2016), a conducive environment and adequate staffing are linked to higher scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS scores are primarily used to determine patient experience to determine the rate of reimbursement for each healthcare institution. The ratings are used by the Centers for Medicare & Medicaid Services (CMS) in establishing a hospital’s reimbursement rates (Hudgins, 2016). Therefore, nursing shortages have an impact on the experience of care in all health care institutions in Australia.

A study carried out in Los Angeles found that a statistical link between short staffing and patient satisfaction (Jones, & Ramsbottom, 2017). Patients can only be satisfied if they are provided with quality and holistic care regularly. The patient to nurse ration must be equal to ensure patients have the best experience during care. Thus, the level of staffing in healthcare institutions influence patient satisfaction level or influence the ability of the health care institutions to provide care in a more cost-effective manner.

  • Readmissions

Many studies have examined the influence of nurse shortages on the level of patient readmissions in hospitals. A study by Cheng et al., (2015) found that the readmission rate was higher by about 8% with heart failure due to the additional patient per nurse which increases the workload of nurses. The study interventions also aimed to help improve the rate of mortality among patients, and his study found that a 20% increase in nurse staffing had about 18 fewer deaths for every 1000 discharged patients (Cheng et al., 2015). Therefore, the higher rate of staffing has a lower hospital readmission and lower post-discharge emergency department visits.

Staff Shortage and the Importance of Adequate Staffing Level

The main goal of nurses is to offer high quality and safe care to patients. An increase in staffing may provide nurses an opportunity to better engage in discharge activities which are critical in preventing the rate of readmission (Press, Wong, & Gibson, 2015).  The readmission activities may include facilitating transitions to outpatient care, medications for disease management, delivering discharge education, and identifying changes in patient conditions that may need interventions(Press, Wong, & Gibson, 2015).Therefore, inadequate staffing makes it hard for nurses to provide adequate care, leading to medical errors and missed care.   Although adequate staffing does not guarantee competence in nursing care or nursing delivery, it increases the ability of nurses to engage in other aspects of nursing care including patient’s discharge.

  1. Nurse Burnout

Nurse burnout is primarily caused by job stressors in all health care departments. A heavy workload often causes distress including exhaustion, anger, and cynicism. Nurses facing burnout or stress may not perform their roles and responsibilities in the right manner since their cognitive and physical resources are reduced leading to inferior performance (McNeil, Mitchell, & Parker, 2015).  This means that nurses need a conducive environment for working and adequate staffing may help reduce workload in health care delivery.

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A study by Liu, While, Li, and Ye, (2015) found that nurses who cared for additional patients were linked with about 28% of increased nurse burnout and 20% of the increased level of dissatisfaction. The study also showed that there is a correlation between nurse burnout and inadequate staffing (Liu, While, Li, & Ye, 2015). Besides, nurse burnout often increases nurse turnover which usually cost healthcare institutions thousands of dollars every year. Thus, inadequate staffing often reduces the quality of care and increases the cost of healthcare.

Reducing nurse-to-patient ratios will help increase the quality of care. Such an instance reduces work and improves quality, which also influences the life of nurses (Liu, While, Li, & Ye, 2015). Organizations in Australia need to adopt minimum nurse-to-patient ratios despite the difficult implementation and widespread scepticism in healthcare sector.

Importance of Adequate Staffing Level

The national benchmark in Australia regarding nurse-patient ration is unknown because of the legal vagaries seen from one state to another. However, healthcare institutions in Australia are required to operate with adequate number of nurses who are registered or licensed. The hospital departments are needed to conduct supervisions to ensure there is sufficient availability of nurses who can offer appropriate care to all patients.

i.               The Right Ratio

The Australian Association of Nurses supports the support provided to nurses to empower and ensure adequate staffing in every unit. This enables healthcare organizations to develop staffing levels based on account of patients, the number of admissions, and availability of resources including technology and ancillary staff, layout of the unit, the experience of nurses, and the transfers and discharge during shifts (Sutcliffe, & Dhakal, 2018). Therefore, Australian government needs to develop the required minimum nurse-to-patient ratios to bring sanity in the healthcare institutions.  For example, in care units, nurse-to-patient ratio is recommended to be in the ration of between 1:2 or 1:4 or fewer to ensure all patients are cared for in a more cost-effective and holistic way (Sutcliffe, & Dhakal, 2018).

ii.              Improved Safety

The national campaign on the patient to nurses’ ration looks to ensure safe staffing for both patients and nurses across the world. Recent research has indicated that appropriate staffing is critical in reducing burnout among nurses, reducing healthcare costs, increasing safety outcomes, reducing readmission rates and medical errors, enhancing both patient and nurse satisfaction levels and improving the HCAHPS scores (Press, Wong, & Gibson, 2015).Adequate staffing helps to improve patient outcomes and get the maximum value from nurses. The nurse-to-patient ratios need to be adjusted to guarantee the provision of quality care. Health care institution can develop career development programs that require aspiring nurses to further their career and encourage other individuals to join the nursing profession. The Australian health care sector needs reforms that can help develop more holistic approaches that may cater to patient’s needs.

Staff Shortage and the Importance of Adequate Staffing Level

Policy Responses to Nurse Staffing Shortages

The growth of employment of registered nurses and enrolment in nursing schools has shown an ease in nursing shortage in Australia. However, inadequate staffing remains to be a health care concern since the supply of nurses is less compared to their demand in the healthcare sector. Many policies can be implemented to deal with nursing shortage in Australia as explained below:

i.                Mandatory staff to patient staffing Ratios

Nurse to patient ratios are aimed to reduce the nurse workload and guarantee the provision of quality care. The development of nurse to patient ratios as state laws would help reduce the additional patient nurses are assigned to in hospitals (Watson, 2016).   This will address the imbalance between nursing resources and patient needs. In the United States, the Massachusetts Association of Registered Nurses advocate that the mandatory nurse to staffing ratio should be 1:4 for all health care institutions (Watson, 2016).  However, the policy may reduce staff flexibility and scheduling. Besides, mandatory ratios may increase the cost required to employ more nurses. The policy will also burden smaller community health care organizations because they have patients with less chronic conditions.

ii.              Nursing Intensity Billing

Rather than using Nurse-to patient ratio, the Massachusetts Association of Registered Nurses recommends the use of Nursing Intensity Billing as the best policy to address issues of nursing shortages (Watson, 2016).   The policy considers the intensity of care that should be given to a particular patient. Since hospital financial decisions are based on payments received from patent care, changing nursing profession to a revenue center from a cost center would help change the relationship between nurses and hospitals. For example, the intensive unit care costs and routine care unit costs should be put in different categories (Watson, 2016).  The use of revenue codes for billing would help differentiate between ancillary services and accommodation services. Thus, Medicare and other players in the health sector need to reimburse health care organizations based on a given nursing care instead of bundling care within a room. This will help hospitals to benefit from a more equitable system of payment because the charges used in caring would be the same as those used to care for individual patients.

            A policy to develop a national model for reimbursement and nursing intensity billing would correct the issue of considering nursing care as a fixed cost. Thus the nursing intensity billing would unbundle nursing care billing and costs from the traditional room and board charge and determine costs based on the care received by each patient (Watson, 2016). This brings in the cost-to-charge ratio to determine payment since the Australian pays for actual costs and not based on the services delivered. The major advantage of the policy is that it will pay on the basis of performance to help solve the issue of nurse shortage. As a reimbursement mechanism or a value-based-purchasing, it will pay for the performance of nurses (Watson, 2016). However, the major disadvantage is that it may lead to poor care and prevent care in the rural settings.

iii.             Recruitment of temporary staff

The temporary staff policy can be used by healthcare institutions in Australia to cater for nursing shortages in the country. Traveling nurses and per diem nurses can be used based on the contracts they sign to help fill and accommodate the short-term staffing needs in health care institutions.  However, despite the prevalence of these nurses, most health care institutions in the US have reduced the use and reliance of temporary employees because of the issues with quality and costs (Barber, 2016). However, with the lack of nurses in the industry, most health care organizations continue to rely on temporary staff.

Staff Shortage and the Importance of Adequate Staffing Level

Other studies have reported the use of float pools or internal staffing agencies to help meet their staffing requirements. This has helped in cost saving since the internal-agency nurses are paid lower compared to other staff nurses who perform similar tasks (Barber, 2016). The private pools often source for nurses looking for flexibility or fewer hours helping hospitals to achieve greater confidence in caring for patients. This strategy may help hospitals to reduce temporary staffs and allow staffs who want extra shifts with lower staff nursing rates.

Staff Shortage and the Importance of Adequate Staffing Level

  1. Development of undergraduate nursing education

Training of student nurses is a critical strategy to help health care institutions grow and develop their nurses. Hospitals need to develop training initiatives by opening new schools or expanding training capacity to help increase the performance and commitment of employees (Jones & Ramsbottom, 2017).The St. Joseph’s Hospital and Medical Center in the United States developed a nursing intern program aimed to prepare student nurses who later become employees in the hospital (Jones & Ramsbottom, 2017).

Conclusion

The nursing shortage poses challenges to the nursing profession and the facility planners. The constant workload has increased the constant burnout and emotional stress among nurses, which prevent them from providing more quality and holistic care. Safety issues and unsafe working environment including harassment and bullying negatively affects the retention of nurses.  Besides workloads, burnout, job demands, safety issues, job dissatisfaction, lack of autonomy, and low morale are the main factors that cause nursing turnover. Besides, respect of nurses from both the patients and institutional administrators is essential in reducing turnover rates. Thus, the level of staffing in healthcare institutions influence patient satisfaction level or influence the ability of the health care institutions to provide care in a more cost-effective manner. Australian hospitals need to develop the required minimum nurse-to-patient ratios to bring sanity in the healthcare institutions.  This would improve patient outcomes and get the maximum value from nurses.

 

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