Health Care Delivery Models and Nursing Practice

2 DQ 2The Patient Protection and Affordable Care Act of 2010 (PPACA) contains many provisions that seek to intertwine the quality of care with the cost of care. Nurses’ education, skills and professional scope make them indispensable contributors to the successful implementation of evolving patient–centred care delivery models. One of the innovative healthcare delivery models is Accountable Care Organizations (ACOs). It is a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility for the quality and cost of care provided to its patients (HPI, n.d.). It is a group of providers that promotes accountability patient population and coordinates items and services under Medicare and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.The largest benefit that accountable care could bring for the healthcare industry is to garner cost savings or reduce spending.  Another major benefit of ACOs is their ability to improve population health management and patient outcomes. A brief from the Center for Health Care Strategies and the Urban Health Research and Practice at Northeastern University shows that new healthcare delivery models like ACOs offer innovative methods for payers and providers to achieve better population health outcomes. Medicaid ACOs, for instance, have shown a greater focus on preventing disease and promoting wellness, which leads to stronger population health improvements. This reduces the likelihood that a disease would progress and lead to more costly hospital stays. The community gains a wide number of advantages including, improved patient outcomes, the better quality of care, greater engagement with providers, and an overall reduction in out-of-pocket costs.Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.

 
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Reflective Essay Nursing Profession

Respond reflective essay nursing profession questions below: Ask a profession or Imagine speaking to nursing profession.1. Why did you choose nursing as a profession?2. What was nursing school like for him or her? Ask them:a. How they managed and balanced work, family and life and the difficulties.b. The level of commitment to school required to be successful (hrs. required for studying, social life, workload,etc)c. What their clinical and lab experiences were like.d. How they prepared for examinations and the NCLEX.3. Describe their top three patient memories and why they are memorable.4. What does the phrase “NurseLife” mean to this nurse?5. What is the hardest thing about being a nurse?6. Reflect and discuss what your thoughts are about the interview. Did the interview change your perspective on nursing, on nursing school or life?Review assignment attachment

 
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Quality Improvement Proposal

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.Include the following:Provide an overview the problem and the setting in which the problem or issue occurs.Explain why a quality improvement initiative is needed in this area and the expected outcome.Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.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.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 LopesWrite Technical Support articles for assistance

 
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class discussion 3/1

Please use the attached reading material to complete work.Remember to include an open-ended follow-up question with each response. This is a required part of substantive participation that encourages further discussion.When you post responses to your peers the response needs to be “substantive” to receive credit. Substantive posting criteria includes: Acknowledge what your peer stated (agree or disagree). Include additional information. End the post with an open-ended follow up question. This is important to encourage further discussion.

 
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Public Speaking 8.1

Public SpeakingDetailsAssignment 8.1: CORE CompetencyThis assignment supports the following lesson objective:1.5 Use effective speaking style and language when delivering a speechAssignment OverviewThis practice exercise explores four styles that effective speakers use when delivering speeches. Completing this exercise will help you prepare to use elements of the four styles when delivering speeches to maximize the impact of your message.DeliverablesA one- to two-page document (12-point font, 300 to 600 words) written in a word processor, such as MS WordAssignment DetailsIn this activity, you will read transcripts of sections from three different speeches. Then you’ll select the speech excerpt that is the most interesting to you and answer some questions related to the speaker’s style and language choices.Perform the following tasks:Step 1: Review the information presented in the lesson that explores styles used to deliver presentations.In particular, focus on the styles identified as the CORE styles:Clear StyleOral StyleRhetorical StyleEloquent StyleStep 2: Read the following excerpts from three different speeches.Analyze each speaker’s style and language strategies. Identify which CORE style(s) each speaker uses.Oprah Winfrey Receives the first Bob Hope Humanitarian Award – September 22, 2002 (fromhttp://famous-speeches-and-speech-topics.info/famous-speeches-by-women/oprah-winfrey-speech.htm (Links to an external site.))”Thank you everybody. Thank you Tom, and Bob and Dolores, who are home watching I hope, thank you so much, and to everyone who voted for me.There really is nothing more important to me than striving to be a good human being. So, to be here tonight and be acknowledged as the first to receive this honor is beyond expression in words for me. ‘I am a human being, nothing human is alien to me.’ Terence said that in 154 B.C., and when I first read it many years ago, I had no idea of the depth of that meaning.I grew up in Nashville with a father who owned a barbershop, Winfrey’s Barber Shop, he still does, I can’t get him to retire. And every holiday, every holiday, all of the transients and the guys who I thought were just losers who hung out at the shop, and were always bumming haircuts from my father and borrowing money from my dad, all those guys always ended up at our dinner table. They were a cast of real characters—it was Fox and Shorty and Bootsy and Slim. And I would say, ‘Bootsy, could you pass the peas please?’ And I would often say to my father afterwards, ‘Dad, why can’t we just have regular people at our Christmas dinner?’—because I was looking for the Currier & Ives version. And my father said to me, ‘They are regular people. They’re just like you. They want the same thing you want.’ And I would say, ‘What?’ And he’d say, ‘To be fed.’ And at the time, I just thought he was talking about dinner. But I have since learned how profound he really was, because we all are just regular people seeking the same thing. The guy on the street, the woman in the classroom, the Israeli, the Afghani, the Zuni, the Apache, the Irish, the Protestant, the Catholic, the gay, the straight, you, me—we all just want to know that we matter. We want validation. We want the same things. We want safety, and we want to live a long life. We want to find somebody to love. Stedman, thank you. We want to find somebody to laugh with and have the power and the place to cry with when necessary.The greatest pain in life is to be invisible. What I’ve learned is that we all just want to be heard. And I thank all the people who continue to let me hear your stories, and by sharing your stories, you let other people see themselves and for a moment, glimpse the power to change and the power to triumph.Maya Angelou said, ‘When you learn, teach. When you get, give.’ I want you to know that this award to me means that I will continue to strive to give back to the world what it has given to me, so that I might even be more worthy of tonight’s honor.Thank you.”President Obama’s Speech to a Joint Session Of Congress, February 24, 2009 (fromhttp://www.cbsnews.com/stories/2009/02/24/politics/main4826494.shtml#ccmm (Links to an external site.))“Now, I understand that when the last administration asked this Congress to provide assistance for struggling banks, Democrats and Republicans alike were infuriated by the mismanagement and the results that followed. So were the American taxpayers. So was I. So I know how unpopular it is to be seen as helping banks right now, especially when everyone is suffering in part from their bad decisions. I promise you—I get it.But I also know that in a time of crisis, we cannot afford to govern out of anger, or yield to the politics of the moment. (Applause.) My job—our job—is to solve the problem. Our job is to govern with a sense of responsibility. I will not send—I will not spend a single penny for the purpose of rewarding a single Wall Street executive, but I will do whatever it takes to help the small business that can’t pay its workers, or the family that has saved and still can’t get a mortgage. (Applause.)That’s what this is about. It’s not about helping banks, it’s about helping people. (Applause.) It’s not about helping banks, it’s about helping people. Because when credit is available again, that young family can finally buy a new home. And then some company will hire workers to build it. And then those workers will have money to spend. And if they can get a loan, too, maybe they’ll finally buy that car, or open their own business. Investors will return to the market, and American families will see their retirement secured once more. Slowly, but surely, confidence will return, and our economy will recover. (Applause.)So I ask this Congress to join me in doing whatever proves necessary. Because we cannot consign our nation to an open-ended recession. And to ensure that a crisis of this magnitude never happens again, I ask Congress to move quickly on legislation that will finally reform our outdated regulatory system. (Applause.) It is time—it is time to put in place tough, new common-sense rules of the road so that our financial market rewards drive and innovation, and punishes short-cuts and abuse.The recovery plan and the financial stability plan are the immediate steps we’re taking to revive our economy in the short term. But the only way to fully restore America’s economic strength is to make the long-term investments that will lead to new jobs, new industries, and a renewed ability to compete with the rest of the world. The only way this century will be another American century is if we confront at last the price of our dependence on oil and the high cost of health care; the schools that aren’t preparing our children and the mountain of debt they stand to inherit. That is our responsibility.”Response to President Obama’s Speech to Congress from Louisiana Governor Bobby Jindal (fromhttp://www.cnn.com/2009/POLITICS/02/24/sotn.jindal.transcript/ (Links to an external site.))“Today in Washington, some are promising that government will rescue us from the economic storms raging all around us.Those of us who lived through Hurricane Katrina—we have our doubts.Let me tell you a story.During Katrina, I visited Sheriff Harry Lee, a Democrat and a good friend of mine. When I walked into his makeshift office, I’d never seen him so angry. He was yelling into the phone: ‘Well, I’m the Sheriff and if you don’t like it you can come and arrest me!’ I asked him: ‘Sheriff, what’s got you so mad?’ He told me that he had put out a call for volunteers to come with their boats to rescue people who were trapped on their rooftops by the floodwaters. The boats were all lined up ready to go, when some bureaucrat showed up and told them they couldn’t go out on the water unless they had proof of insurance and registration. I told him, ‘Sheriff, that’s ridiculous.’ And before I knew it, he was yelling into the phone: ‘Congressman Jindal is here, and he says you can come and arrest him too!’ Harry just told the boaters to ignore the bureaucrats and go start rescuing people.There is a lesson in this experience: The strength of America is not found in our government. It is found in the compassionate hearts and the enterprising spirit of our citizens. We are grateful for the support we have received from across the nation for the ongoing recovery efforts. This spirit got Louisiana through the hurricanes and this spirit will get our nation through the storms we face today.To solve our current problems, Washington must lead. But the way to lead is not to raise taxes and not to just put more money and power in hands of Washington politicians. The way to lead is by empowering you, the American people. Because we believe that Americans can do anything.”Step 3: Copy and paste the following questions into a word processing document:Which speech excerpt did you select? Who was the speaker, and what was that speaker’s main topic?What CORE style(s) does the speaker use in his or her speech? Cite the choice of word phrases and other clues from his or her speech to justify your answer.Based on reading the transcript of the speech, write what you believe to be the speech’s specific purpose.What strategies did the speaker use to achieve the specific purpose of the speech?Based on the portion of the speech transcript that you read, do you believe the speaker was successful in achieving the specific purpose of the speech?How does style and word choice in this speech impact the effectiveness of the message?Step 4: Enter answers to the questions based on the speech excerpt you found most appealing.Step 5: Save and submit your document.When you have completed the assignment, save a copy for yourself in an easily accessible place and submit a copy to your instructor using the drop box

 
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response to peers

Peer 1Nurses influence through engaging in activism act as a drive to health care policy changes enhancing improvement of the quality of care by increasing accessibility of the necessary resources as well as opportunities. Political activism skills are considered essential for the nurses as it enables them to protect the nursing profession as well as their practice (Buck-McFadyen & MacDonnell, 2017). Nurses can serve in elected positions within the state or the national levels to present the broad healthcare aspects of concern and ensure they are integrated within the healthcare policies.Unionization of nurses is considered to be pertinent as the union offers the nurses the strength and power to bargain on the enforceable contracts such as the acceptable ratio of nurse to patient, their specific roles in maintaining quality of care as well as nurses overtime working hours and pay scale. Besides, joining nursing union provides an opportunity for the nurses to engage in political activism by lobbying private bodies and the government to advocate for policy changes that enhance improved patient care as well as participating in campaigns to create awareness on the importance of nurses thereby improving patient outcome (Ulrich & Kear, 2014). Nursing unions incorporate strategies that not only increase the nurse’s voice in advocating for improved care practices but also encourages nurses’ effective involvement in patient care through making informed decisions thereby creating a workforce culture of safety. One of the Masters of Science in nursing essential is the ability of the nurses to positively influence health policy and advocacy. The masters nursing program ensures that the nurses can effectively integrate nursing concepts at the system level to not only participate in the policy development process but also utilize advocacy strategies to impact change in health care policies.ViviankaPeer 2Unionized nurses refer to nurses who belong in labor organizations that are meant to protect the nurses’ welfare and advocate for the improvement of the healthcare system. Nurses should be provided with the opportunity to join work environment unions at will. Work environment unions range from large national unions to smaller organizations created to address specific issues in specific healthcare facilities (Dube, Kaplan, & Thompson, 2014).Nurses’ organizations come with the benefits of coming together to address matters relating to healthcare and welfare of nurses such as proper wages, job security, benefits, staffing ratios, and patient rights (Dube, Kaplan, & Thompson, 2014). Nurses account for a significant proportion of any health facility’s budget, which makes them an easy target especially during the economic restructuring. Large budget for nurses often creates workforce shortages and unconventional staffing ratios. Unions can also advocate for motivational benefits such as medical and dental insurance, educational leave, sick pay and vacation. We can, therefore, argue that unions are an essential tool in enhancing the safety of nurses through negotiating for better wages, worker protection benefits, against unfair laying offs and terminations and proper amount of workload for the nurses (Higgins, 2016).Similar to the nurses’ welfare, unions can be instrumental in advocating for a proper health system that enhances patient care (Giovanetto, 2017).  Advocating for proper staffing ratios, for example, advances the interest of patients. Proper staffing ratio is key improving patient outcome because nurses can make proper follow up on patients even after discharge. Benefits such as educational leave also facilitate lifelong learning which is key in strengthening the skills possessed by nurses and hence the quality of healthcare and safety of patients. Nurses’ unions can also engage in advocacy relating patient safety by seeking change in management practices that relate to health care equipment, patient diet, hygiene, and patient rights such as privacy and informed consent (Higgins, 2016).  In conclusion, unions provide nurses with enhanced strength in numbers that can be used to advocate for nurses and patient safety.Response must be minimum 150 words each, doble space, APA(6th) no more than 5 years.Bellow is the original activity if you needed:As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. Examine the following questions, should nurses be unionizedandhow does being unionized impact a workforce culture of safety? Be sure to include one MSN Essential in your discussion that relates to this topic.

 
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Pharmacology

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?These are some of the questions you might consider when selecting a treatment plan for a patient.As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.To PrepareReview the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.Review the scenario assigned by your Instructor for this Assignment.Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.senarioAs a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.Write a 2- to 3-page paper that addresses the following:Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.Explain the process of writing prescriptions, including strategies to minimize medication errors.

 
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Health care in the US

Search the web to research what patient outcomes are negatively impacted by nursing staff reduction. After you have found the necessary information, please write a short response (4-5 sentences) answering the question below.After researching the impact of patient outcomes and nursing ratios, what conclusion did you come to?     Were your findings expected, or were there startling discoveries made in the midst of your research?

 
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For Essays Guru – Innate and Adaptive Immunity Case Study

Innate and Adaptive ImmunityMelissa is a 15-year-old high school student. Over the last week, she had been feeling tired and found it difficult to stay awake in class. By the time the weekend had arrived, she developed a sore throat that made it difficult to eat and even drink. Melissa was too tired to get out of bed, and she said her head ached. On Monday morning, her mother took her to her doctor. Upon completing the physical exam, he told Melissa the lymph nodes were enlarged in her neck and she had a fever. He ordered blood tests and told Melissa he thought she had mononucleosis, a viral infection requiring much bed rest.Innate and adaptive immune defenses work collectively in destroying invasive microorganisms. What is the interaction between macrophages and T lymphocytes during the presentation of antigen?Melissa’s illness is caused by a virus. Where are type I interferons produced, and why are they important in combating viral infections?Humoral immunity involves the activation of B lymphocytes and production of antibodies. What are the general mechanisms of action that make antibodies a key component of an immune response?4 pages APA not including title page and reference page

 
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response

I need a response for the following peers1.Differential diagnosis in the analyzed clinical situation should first of all include benign breast formations, in particular, cysts (fibrocystic breast disease), galactocele (also called milk retention cysts), fibroadenoma, abscess and cystic form of carcinoma of this organ (Brkic et al., 2016). Unambiguously, taking into account the fact that just on medical history the patient had 2 pregnancies and more than 2 years of breastfeeding, and also taking into account the fact that after puncture of the formation, the latter disappeared and the clinicians received an opaque fluid, which indicates the cystic nature of this formation (Kumar & Prasad, 2019). The most likely causes are fibrocystic breast disease (the main causes are hormonal changes, which are especially symptomatic during periods of the menstrual cycle), as well as a retention cyst such as galactocele, which is formed as a result of a violation of the outflow of fluid through the milk ducts, more often during lactation.Unambiguously, after medical practitioners receive the associated fluid from the lumen of the cystic formation, the latter should be subjected to cytological examination (screening) in order to possibly identify malignant atypical cells, or other cells in cellular elements that can give an important clue regarding the benignity of this tumor (Cottrell & Fisher, 2016). A biopsy of a breast mass is the most accurate method for excluding malignant growth in case of detecting suspicious signs in a cytological smear. In the case of confirmation of such a diagnosis as fibrocystic breast changes, the patient, in the absence of pain or other symptoms, does not need additional treatment, but at the same time, if breast cancer is suspected, psychological intervention or a neoadjuvant course of chemotherapy or radiation may be required. therapy, depending on the immune phenotypic characteristics of the tumor.Given this burdened family history, the patient clearly has an increased risk of certain cancers, including breast cancer. Especially dangerous are the genetic forms of this disease, which are associated with mutations in the BRCA1 or 2 genes (Kumar & Prasad, 2019). But at the same time, in the case of adherence to the recommendations regarding screening (early detection of possible neoplasms using mammography and further biopsy), the patient will have a favorable prognosis for life.2.Coding and Billing IssuesBilling for nurse practitioner services is intricate and involves maneuvering through rules, policies, laws, and exceptions. Coding and billing errors have a significant impact on an organization’s bottom line. According to Oyeleye (2019), the billing and coding system in the United State is complex and practitioners are prone to make errors. Some of the errors can lead to disciplinary or legal actions.One of the issues is have encountered involves incident-to billing, especially when it involves billing an NP’s service under a physician’s NPI. Medicare rules allow “incident-to” billing in states that have a supervisory model of advanced practice registered nurses. Under this model, services provided by a supervised nurse practitioner can be billed under a physician’s NPI. Billing services as “incident-to” allows the services to be reimbursed at 100% of the Physician Fee Schedule rate. However, the rules of billing are complex. For instance, the physician is expected to have performed the initial service and subsequent services of a frequency that reflect their active participation in the management of the patient. Defining what constitutes “active participation” is challenging. For instance, a female patient was seen by a physician and treated for a recurrent urinary tract infection. After two weeks, the same patient returned to the clinic for follow-up, but upon the assessment and diagnostic tests, a new infection UTI was identified. A billing such as a client under “incident-to” was challenging because the physician had not participated in the management of the newly diagnosed condition. Another case involved a 57-year old woman visiting the clinic for her appointment. She had challenges managing her blood glucose and her adherence to medications was suboptimal. Her attending physician was not available. The challenge was to whether to bill the newly prescribed plan of care, which included metformin, under the physician NPI or NPs. I have also encountered issues billing and coding telehealth services, including incorrect use of modifiers. According to Barners et al., (2017), most of the billing errors and challenges facing nurse practitioners are related to state scope of practice and payment policies. Torren et al., (2020) identify payment policies as some of the significant barriers to APRN full practice in primary care.One of the fundamental objectives of the Health Insurance Portability and Accountability Act was to simplify administrative processes. As a result, it led to the creation of a single identifier unique to every licensed health care provider that is used by all health insurers to facilitate billing. The Department of Health and Human Services and Center for Medicaid and Medicare Services (CMS) developed a system that assigns each provider a single number (National Provider Identifier, NPI), to help identify electronic transactions. The role of NPI is to uniquely identify providers in health care claims. NPIs are also used to track and identify providers prescription, in internal files to link proprietary provider identification numbers. The system covers all providers, including those working in hospitals. NPI is critical for nurse practitioners and advanced practice registered nurses who can bill patients. APRNs must apply for NPI to bill for their services. Once assigned, NPI is permanent and does not change based on practice settings or job. It is a 10-position numeric that does not contain specific information on the specialty or geographic location of the provider. APRNs must be aware of when to use their NPI to bill for services. This is may be influenced by geographic location of their practice, type of services and state scope of practice. It is critical for APRNs to update their knowledge of billing and coding systems because they keep on evolving.

 
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