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Nursing Process – Case Study

Nursing Process – Case Study. I need help with a Marketing question. All explanations and answers will be used to help me learn.

Answer the three attached questions
Question One
Module 04 Written Assignment Nursing Process – Case Study Please read the following case study and complete the questions below.
Daniel is a 16 year old boy who is an identical twin. He and his brother Jeff are very close and do most things together. While Daniel excels at sports he believe his brother is much better at most everything. Daniel, his brother, and their two sisters live with their parents in the Midwest. Recently Daniel has been feeling more tired than usual. He thought it was because of his schedule and school work, which he is fairly good at. He gets mostly Bs, but his grades have been slipping of late. One day he fainted while getting ready for a game. His coach called his parents to let them know Daniel was taken to the Emergency Room. While there the doctor decided to admit Daniel to the hospital for observation. At the time he was running a slight fever, his breathing was shallow, and he was sweating. He was also very sleepy and his blood pressure was high. He did have some abnormal laboratory work, but his doctor was not too concerned at present. Daniel also stated that he felt achy.
You are assigned to take care of Daniel today and when you walk into his room, his mother and brother Jeff are there. Daniel appears to be sleeping. In your written assignment, respond to the following questions applying the nursing process:
Assessment: What type of objective and subjective data can you collect with what you know? How will you collect these data? What further evidence do you need?
Analysis and Identification of the Problem: What do you believe Daniel’s problem(s) are? What might be the nursing diagnoses? Use the following for identification.
Planning: Identify two goals and one nursing intervention for each, based on your nursing diagnoses.
While you will not be able to implement or evaluate, how well do you think your nursing interventions might help with Daniel’s care.
Nursing Process – Case Study

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You’ll analyze two data sets in SPSS:http://calcnet.mth.cmich.edu/org/spss/Prj_carsdata.htm andhttp://calcnet.mth.cmich.edu/org/spss/Prj_diseaseData.htm1. Perform a multiple regression analysis, make a correlation table, provide descriptives (i.e., means, standard deviations)2. Perform logistic regression analysis, make a correlation table, provide descriptives. Also, compare means across disease states.3. What do you know based on this data? Demonstrate your understanding of what is happening.You will also analyze the data I have attached. Import your data into SPSS. And tell me the following:Which two friends have the strongest correlation with each other? The weakest?Who should Captain Planet trust the most? The least?Produce a correlation table, a descriptives table, and a regression analysis consisting of all five Planeteers’ ratings as independent variables.Captain Planet Example.xlsx
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Table of Contents Introduction Background Literature Data Research analysis Results explanation Further analysis Summary and conclusion Works Cited Introduction Just like any other part of the world, Portugal has a well-established social security system, which many of her people depend on for their welfare. Like in the US, social security system in Portugal covers a wide range of programs. Some of these programs include retirement pension scheme that covers employees from both public and private sectors, social assistance program that includes benefits for the unemployed and their dependencies among other programs. The social security system in Portugal experiences problems such as non-contributory coverage, dealing with many survivors and disability beneficiaries (Barrows 25). Generally, the system experiences a problem of dealing with large number of people requiring assistance – an unrelenting problem that seems to affect many of the social security systems across the world. Large proportion of inflow comes from PAYE funds, as it is the case of the United States. Taxes from the payroll can be termed as the backbone of the Portuguese social security system; however, there is a problem based on ‘baby boomers’ experience. After Second World War, populations across Europe blossomed and such large populations joined the social security systems, which also thrived. However, as the ‘baby boomers’ generation approaches retirement, the current working population is smaller and cannot sustain the current social security system, firmly established by the ‘baby boomers.’ Moreover, many contributors do not see any positive relationship between what they contribute and what they get at the end of the day. Indeed, according to many employees, the taxes reduce their private savings and disposable income and hence the capital formation. This paper will analyze financial sustainability of the Portuguese social security system mainly by comparing the revenue contributed and the cost required to maintain it. The research will use secondary data to analyze the trend of income and expenditures of the system for a period of fifty years from 1999 and 2050. Background Literature Social security system in Portugal comprises of three components; family allowances benefit systems and social welfare allowances for citizens. The allowance component compensates citizens when their earnings decline due to the following reasons; unemployment, sickness, disability, death, old age, and work accidents just to mention a few. Employees, both self-employed and the employed, benefit from this system. Non-working and unemployed individuals however, have the right to subscribe if they so wish. For one to enjoy the benefits of social security system, he/she must meet two conditions. First, one must register and secondly, the individual must meet his/her monthly contributions just like the employed. Get your 100% original paper on any topic done in as little as 3 hours Learn More Though the Portuguese social security system has improved over the years, it continues to face many problems. Financial instability is the major problem. Those people who contribute each month to the social security system suspect misappropriation of these funds; hence, they do not get the expected benefits from this scheme. Many employees would therefore prefer some structural reforms in the system for it to meet their needs effectively. Portugal needs to change her current scheme of ‘pay as go used go’ and adopt a capitalization system. In this type of system, every employee has his or her own account where all the contributions made goes into this personal account. When the employee attains the age of retirement, then he or she can withdraw all the money deposited in the personal account. This will help to address dissatisfaction by many employees who question the efficiency of the current system. As Barrow claims, capitalization regime will ensure direct relationship between the benefits and contribution. This will eliminate the perception that the contribution to the social security system is just as tax deducted on the labor income (26). Capitalization regime will ensure that there is no sharing of the social security system’s funds from one single pool. Every employee will sustain his or her pool and in case of anything, he/she will withdraw the money from the personal account. Failure to do that will perpetuate the worsening the financial position of the system as more and more beneficiaries depend on insufficient funds contributed by just a small proportion of the population now and in future. As Pereira da Silva, Calado, and Maria put it, there is a looming financial problem facing the social security system in Portugal; the government needs to address it urgently before it gets out of hand (418). There is a large gap between the benefits and the declining rate of contribution and subscriptions. The active population does not benefit from their huge contributions to the social security system. The founders of the Social security trust fund in 1995 aimed to reinforce the social security system, but this has not solved the problem of financial instability. The government also introduced partial capitalization program in 1989 in which it invested the contributed funds in the different ways such as in financial markets. This also aimed to stabilize the financial status of this system. The returns from these investments would cater for future raise in costs. According to Pereira da Silva, Calado and Maria these stabilization funds created by the government are not in a position to counter the financial challenges facing the system and therefore it ought not to be the focus of the stakeholders (418). As mentioned earlier in the research, it is not Portugal alone whose social security systems are facing challenges. Yasar argues that social security systems in US also face the same challenges. Economists attribute the US challenges to the increased number of baby boomers attaining the age of retirement (843). We will write a custom Research Paper on The Portuguese Financial Sustainability of Social Security System specifically for you! Get your first paper with 15% OFF Learn More Currently the debate is going on in US among the reformers and other groups over the appropriate reforms in the social security system to meet the raising demand of beneficiaries. Reformists are advocating for the change of the system and adoption of a fully funded retirement plan with clear definitions. Other groups are arguing that demographic problems, which justify the privatization of the system, are wrong. Irrespective of which group is right, the fact remains that there is a challenge in the social security system in US which may even become worse in the future as more and more people attain the age of retirement. Puckett argues that managing social security system is a challenge not only for today but also for yesterday and tomorrow (25).Thus even as we analyze the case of the Portuguese social security system it is important that we have it in mind that these systems are facing challenges in all the parts of the world. Data To analyze the financial sustainability of the social security system in Portugal, this study will use secondary sources of data mainly from the international association for the study of insurance economics 2004 among other sources. This study chose these sources of the data for various reasons, which include; first, the sources are reliable and thus provide reliable data for valid conclusion. Secondly, this data is very relevant to the topic of the study since it provide all the required information about the Portuguese social security system. Data about the contributions and distribution of benefits in this social security system is very relevant to this study, which these sources adequately provide. This data will make it easy to analyze financial sustainability of the Portuguese social security system by comparing the rate of growth of revenue collected from the citizens and growth rate of the fund’s beneficiaries. The data clearly portrays the gap between the rate of fund’s growth and cost rate for easier comparisons. The data also compare the difference between synthetic cost and income rate, which helps to predict the future of this social security system. The data also helps to show the projected accumulated funds as well as the growth trend for the next forty or so years. This will help to show or measure whether this system will become more sustainable or less sustainable in future. In addition, this data will help to show the account of the social security benefits to the current and future’s GDP of Portugal. All this will assist in coming up with a valid conclusion in this research. Research analysis From the various tables given in this research, it is possible to observe the trend of social security system in Portugal. To start with, Table 1 shows the comparison of rate of revenue and rate of cost from 1999 to 2050. From this table, we can observe the following; accumulated asset funds will attain their maximum level by 2012 where the rate of revenue growth will be approximately 0.285 per cent. The rate of revenue has been growing consistently from 1999 though by a small margin until 2012 when it reaches the maximum point. Thereafter the growth rate of revenue starts to decline from maximum level attained in 2012 to about 0.26 percent by the year 2020. This trend remains constant for the next 30 years; table predicts the same rate of revenue growth by 2050. Not sure if you can write a paper on The Portuguese Financial Sustainability of Social Security System by yourself? We can help you for only $16.05 $11/page Learn More Contrary to growth rate of revenue, the cost rate grows steadily throughout the research period and there is no record of decline in growth. The growth in cost rate in 1999 is 0.24 per cent and continues to grow consistently year after another until it reaches a maximum level of 0.36 percent by 2050. The current growth rate of revenue is 0.34 percent, which is a large increase from 0.24 percent in 1999. This rate does not fluctuate much in the next forty years since the projected growth in the rate of cost by 2050 is 0.36 per cent. Again, this table notes the trend in differences of cost and revenue. From 1999 to 2005, the rate of growth in revenue exceeds the rate of growth in cost. This means that during this period, the rate of growth of contributions collected in the system was less that the number of beneficiaries. However, from 2008 onward, the rate of growth of cost is more than the rate of growth of revenue. This means that the rate of growth of beneficiaries of the social security funds is exceeding the rate of contribution. This may lead to financial problems in the system. Results explanation The data portrayed in this table shows a move from equilibrium to disequilibrium since 2008. There is acute imbalance between the growth rate of contributions and beneficiaries of the social security funds. The data shows that before 2008, the system was sustainable and it could support all the beneficiaries since there was more revenue than cost. When the beneficiaries started to exceed the contributors in 2008, the financial however instability started. Though the country never experienced population boom like other countries, which had participated in the Second World War, the number of children born after the war were many. This generation started attaining the age of retirement in 2010. Predictions show that this trend is likely to remain for the next ten years. This has already started exerting pressure to the social security system funds since the amount going out is more than the amount coming in. The subscriptions and contributions have already started to decline as more and more members continue to retire. By 2025, economists expect that the benefits of the funds will not be enough to cover all the benefits, management and the administration costs. Further projections show that by 2050 this deficit may reach to about 38.5 per cent. This will be equivalent to about 2.25 percent of the country’s total GDP. This means that to minimize this deficit, there is need for some action to close the gap between the rate of revenue and costs. Two options are possible, either to increase the rate of contributions or decrease the rate of expenditures. The government may reduce the rate of expenditure by 0.7 percent or increase contribution rate by 10 per cent in order to attain equilibrium by 2050. These two options are possible but not easy especially on the side of the government. For instance, to increase the rate of contribution, government will need to improve its efficiency in recruiting and collecting more contributions from the citizens or coming up with a legal provision that will raise the amount contributed by each member. The latter will have an opportunity cost to the economy in terms of savings and investments. The government may also consider implementing the two methods simultaneously to increase the amount of contribution to the social security system. The second option of reducing the expenditure by 0.7 percent will also be costly to the government and the citizens. Lowering the benefits may result into suffering of some people. Members of the social security schemes may not get the expected amount after retirement even after dedicating themselves to contribute during their working days due to shortage of the funds. The system may not be able to finance fully some cases such as accident, sickness, and maternity of the active contributors due to this policy. This option will also have some consequences, which may be too costly to the members and the government. Further analysis Table 2 compares the rate of fund’s growth with the ratio of the fund. The rate of fund’s growth reaches the maximum point in 2005 and starts to decline consistently until it reaches the lowest point in 2020 where it shows a negative growth. From there the growth rate remains constant at 0 percent showing no growth in the next thirty years up to 2050. The ratio of the fund grows consistently until it reaches a maximum in 2011. It then starts to decline until it reaches 0 percent in 2035. The high rate of unemployment is the attribute to the decline of the growth rate of fund. Increased number of employees who are retiring can also lead to low contribution rate. At the beginning, the fund ratio is high since the number of people remitting their contribution is increasing but later the trend decrease as more people reach their age of retirement. Table 3 compares the rate of growth of synthetic effective income and synthetic effective cost. Synthetic effective income increases steadily until it reaches a point where it starts to decline. It manifests the highest rate in 2040 and thereafter it starts to decline. The rate of synthetic effective cost increases steadily and reaches the maximum (30 percent) by 2050. The difference between the two rates decrease from positive side and then start to increase steadily on the negative side. Effective income rate shows “taxable payroll to the income ratio and it will increase so long as the income of the employee is increasing” (Puckett 76). As a result, the rate increases despite the cost increase. The effective rate of cost shows the ratio of taxable payroll to expenditure and continues to increase steadily so long as the expenditures are increasing. The differences between the two rates change due to fluctuating income and expenditure for the entire research period. Summary and conclusion From this study, it is evident that the current social security system in Portugal is not sustainable. The analysis of the data shows that by 2050, the deficit in the system will have risen to 38.5 percent, a significant proportion of the total GDP of Portugal. The gap between the growth rate of revenue contributed and the cost demanded from the funds has continued to increase over the years and projections show its increase in future. This condition may be attributed to high rate of retirement as large proportion of the population, which was born after Second World War, currently attain the age of retirement. Other factors such as high rate of unemployment have contributed to this problem; there are few people joining the system to increase the revenue collection. The government has come up with various programs to address the problem; however, the outcome is of little significance. Initiatives such as investing the contributed funds in various ways have not helped much in addressing the problem. To address the problem, the government may either look for ways to increase the contributions such as recruiting more members and increasing the rate of contribution per member or coming up with ways to reduce the expenditure of the social security system. The two options are not easy for the government given that they have their opportunity costs in terms of saving and investment. However, an urgent action is necessary to prevent the situation from deteriorating in future; actually if unchecked, the situation will degenerate into a crisis and the retiring will go home uncompensated as the system crumbles under the weight unsustainable demands due to poor policymaking. Nevertheless, a swift well-planned and executed strategy will ensure that the social security system in Portugal is sustainable for now and in future. Works Cited Barrows, Jen. “Portugal’s Social Security System: The Efficacy of Reforms.” Yale Economic Review 6.1 (2010): 25-27. Print. Pereira da Silva, Carlos, Calado, Joao, and Maria, Teresa.“The Financial Sustainability of the Portuguese Social Security System.” Geneva Papers on Risk
HA 425 PGU Operational Analysis and Quality Improvement Paper.

The long-term success and prosperity of an organization is linked to
the strategy it pursues over time. A firm understanding of the
environment within which the organization exists is a critical
ingredient in the strategy development process. You are tasked with
researching the history of quality improvement programs to better
understand how you approach improving quality in your healthcare
organization.InstructionsResearch and write a paper on the following question. Your response
should be between at least 1000 words. Your work should follow the
conventions of Standard English (correct grammar, punctuation, etc.).
Your writing should be well ordered, logical and unified, as well as
original and insightful. Your responses should include at least three
scholarly references and a references section. Furthermore, all sources
used should be properly cited using APA formatting.Question:Explain the historical evolution of healthcare quality improvement
programs. How the performance has challenges, healthcare reform efforts,
and the need for cost containment contributed to this development?
Select the areas you find most important to improve quality and create
performance targets and explain why.RequirementsExplain the historical evolution of healthcare quality improvement programs.Examine the performance challenges, healthcare reform efforts, and
the need for cost containment contributed to this development.Select the areas most important to improve quality and create performance targets and explain why.Academic Tools includes resources to assist you with meeting APA expectations for written Assignments.
HA 425 PGU Operational Analysis and Quality Improvement Paper

Programming Program Theory and Inspiration Porn Questions Discussion

Programming Program Theory and Inspiration Porn Questions Discussion.

1. What factors motivate youth participation in programming? How will you take these into account for your program?2. Draw your program’s theory of change. This should follow the guidelines set forth in last week’s guide for an adequate theory of change. The third chapter of Logic-Model-Development-Guide will be very useful for you to create TOC. An additional resource was posted in this week’s module for additional assistance. https://knowhow.ncvo.org.uk/organisation/impact/plan-your-impact-and-evaluation/identify-the-difference-you-want-to-make-1/example-theories-of-change3. What is “inspiration porn” and why does the author critique it?4. How might inspiration porn uphold ableist beliefs in society?5. Archive A – Find an example of inspiration porn from the sporting world. Be sure to describe how this reflects inspiration porn6. What were the benefits of children with a disability who participated in sports? Why is this significant?7. Archive B – Find a local adaptive sports organization/opportunity in your local community (New York). Post the link to their website. You don’t have to discuss this organization, but I do recommend you review the offerings in your community
Programming Program Theory and Inspiration Porn Questions Discussion

Business homework help

term paper help Business homework help. The basic cause of terrorism is the failure of governments in providing justice to the people- Discuss., Corruption in countries such as Nigeria and Afghanistan lead to terror groups running rampant throughout.,The basic cause of terrorism is the failure of governments,●     ,Topic,: The basic cause of terrorism is the failure of governments in providing justice to the people- Discuss., ○     Corruption in countries such as Nigeria and Afghanistan lead to terror groups running rampant throughout.,■  ,   Key word:, radical islam / sharia law,■     ,Key word:, western education,○     Government exploitation such as in India have fueled terrorist groups to attack the state,■     ,Key word:, Naxalism,○     Political corruption such as in Ireland with denying them limited form of elected representation,■     ,Key word:, Home rule,■    , Key word:, ,Potato Famine,●     ,Importance of this Topic:, This topic shows the correlation between having a corrupt government system and the outbreak of terrorism within a country.,●     ,Conclusion:, Terrorism feeds off of the lack of stability in governments across the world. Using the failures that governments have made to pin its people against it.  In the countries examined, it was observed how each government had a level of instability and lack of care for its people that in return led to an outbreak of radical groups. Finally, to end terrorism in these countries, the governments need to formulate and provide the needs being demanded from its people.,References,Archana, P. “India: Rural Roots of Naxalite-Maoist Insurgency.” Crisis and Conflict in, Agriculture, pp. 203–213., doi:10.1079/9781786393647.0203., Campbell, John. “Boko Haram: Origins, Challenges and Responses.” Norwegian Peacebuilding, Resource Centre, Oct. 2014., Knick, Karen Ann. “Causes of Terrorism in Northern Ireland, 1969-1972.”, doi:10.18130/v36w1h.,The format of your abstract is improper. Also, you do not need keywords for each region. You should also combine these failures of the government to present a cohesive argument with examples from these countries.,Furthermore, the outline suggests that you are limiting yourself to the contents of readings done for the class. You have already answered them through your assignments and essays and at this stage it is expected that you display your knowledge by widening your scope. In all the three countries the genesis of terrorism is wider than simply the issue of government corruption. The regional focus of the terrorist groups suggests a rational approach based upon geography, history and also many other factors.,The objectives of establishing a communist state in India, an Islamic Sharia governed state in Nigerian and a Catholic dominated region in N Ireland further suggest reasons other than government failures are also factors in violence adopted by these groups. Try and apply the concept of human rights to a wider perspective with examples from other countries while using these three also. Since terrorism is a politically driven use of violence, emphasis upon human rights by the government address the political grievances and hence diffuse the need for violence.,Attachments,Click Here To Download,Business homework help

Political Science homework help

Political Science homework help. Identification of Opportunities and LimitationsJust as no two system implementations are the same, no two evaluation plans are, either. Every system implementation has unique attributes that require the development of a unique evaluation plan; however, nurse informaticists may be able to reuse parts of evaluation plans in similar practice settings or expanded research efforts. When considering existing evaluation plans for future use, it is important not to overlook a plan?s limitations. These limitations may lead to unintended consequences if they are not examined with a keen eye.In this Discussion, you analyze the limitations of your evaluation plan and opportunities for future application. In addition, you develop strategies for minimizing unintended consequences resulting from your own evaluation plan.To prepare:Review this week?s Learning Resources, focusing on the limitations and opportunities highlighted in the research articles.Review your evaluation plan, assessing the possible limitations.Consider the plan?s contributions to your organization and to nursing as a whole. Assess future opportunities for building on this research.Research the Walden Library for an article detailing unintended consequences of an HIT implementation. Consider strategies for minimizing unintended consequences resulting from your evaluation plan.By tomorrow Tuesday 1/31/17, post minimum of 550 words in APA format with a minimum of 3 references from the list below. Include the level one headers as numbered below:1)ÿÿÿÿÿ A brief summary of the limitations of your evaluation plan. 2)ÿÿÿÿÿ Also describe future opportunities that could build upon your evaluation plan. 3)ÿÿÿÿÿ Summarize the article you identified that deals with unintended consequences, and outline strategies for avoiding unintended consequences stemming from your own evaluation plan. Include the reference in proper APA format. (See Attached PDF)Required Readingsÿÿÿ Bethell, C. D., Kogan, M. D., Strickland, B. B., Schor, E. L., Robertson, J., & Newacheck, P. W. (2011). A national and state profile of leading health problems and health care quality for US children: Key insurance disparities and across-state variations. Academic Pediatrics, 11(Supp 3), S22?S33.ÿÿÿ Retrieved from the Walden Library databases.This article describes a study that evaluated the commonality of health problems and special health care needs in children at the national and state levels in the United States. The study examined issues surrounding health care quality in relation to insurance, access to care, special needs, and demographics.ÿBloomrosen, M., Starren, J., Lorenzi, N. M., Ash, J. S., Patel, V. L., & Shortliffe, E. H. (2011). Anticipating and addressing the unintended consequences of health IT and policy: A report from the AMIA 2009 Health Policy Meeting. Journal of the American Medical Informatics Association, 18(1), 82?90.Retrieved from the Walden Library databases.The authors of this article highlight discussions from the American Medical Informatics Association?s 2009 Annual Health Policy Meeting. In the article, the authors outline the conference?s recommendations for coping with unintended, unanticipated, and undesirable consequences of health information technology implementation.ÿÿÿ Jimmieson, N. L., & Griffin, M. A. (1998). Linking client and employee perceptions of the organization: A study of client satisfaction with health care services. Journal of Occupational and Organizational Psychology, 71(1), 81?96.Retrieved from the Walden Library databases.The authors of this article describe a study that sought to determine how organizational characteristics may serve as predictors of client satisfaction. In addition, the authors make recommendations for future research involving employee perceptions of working environments.ÿÿÿ Novak, L. L., Anders, S., Gadd, C. S., & Lorenzi, N. M. (2012). Mediation of adoption and use: A key strategy for mitigating unintended consequences of health IT implementation. Journal of the American Medical Informatics Association, 19(6), 1043?1049.Retrieved from the Walden Library databases. ÿÿÿ In this article, the authors explore the work of nurses who serve as mediators of the adoption and use of a Bar Code Medication Administration (BCMA) system. The authors identify three key themes that are critical to mediation work.ÿÿÿ Romano, M. J., & Stafford, R. S. (2011). Electronic health records and clinical decision support systems: Impact on national ambulatory care quality. Archives of Internal Medicine, 171(10), 897?903. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=227364ÿThis article describes an analysis of data from the 2005?2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The analysis focuses on whether a higher quality of care can be correlated with the introduction of electronic health records and clinical decision support systems.ÿÿÿ Walden University. (2012). Presentations. Retrieved from http://writingcenter.waldenu.edu/1331.htmThis site gives suggestions for creating an effective presentation. It includes tips on such things as the use of contrast, repetition, and alignment in your presentation.Political Science homework help

Organizational Systems and Quality Leadership-Root cause analysis and Failure mode and effects analysis

Organizational Systems and Quality Leadership-Root cause analysis and Failure mode and effects analysis. Paper details INTRODUCTION Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. SCENARIO It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B. Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders. After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B. Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored. Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading. Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc. At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected. A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care. Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died. Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day. REQUIREMENTS Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide. You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. A. Explain the general purpose of conducting a root cause analysis (RCA). A1. Explain each of the six steps used to conduct an RCA, as defined by IHI. A2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome. B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome. B1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan. C. Explain the general purpose of the failure mode and effects analysis (FMEA) process. C1. Describe the steps of the FMEA process as defined by IHI. C2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. Note: You are not expected to carry out the full FMEA. D. Explain how you would test the interventions from the process improvement plan from part B to improve care. E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas: • promoting quality care • improving patient outcomes • influencing quality improvement activities E1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities. F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized. G. Demonstrate professional communication in the content and presentation of your submission. RUBRIC A:ROOT CAUSE ANALYSIS NOT EVIDENT-An explanation of the general purpose of conducting an RCA is not provided. APPROACHING COMPETENCE-The explanation does not accurately describe the general purpose for conducting an RCA. COMPETENT-The explanation accurately describes the general purpose for conducting an RCA. A1:RCA STEPS NOT EVIDENT-An explanation of 6 RCA steps is not provided. APPROACHING COMPETENCE-The explanation does not accurately identify or does not logically describe one or more of the 6 steps used to conduct an RCA, as defined by IHI. COMPETENT-The explanation accurately identifies and logically describes each of the 6 steps used to conduct an RCA, as defined by IHI. A2:CAUSATIVE AND CONTRIBUTING FACTORS NOT EVIDENT-An application of the RCA process to the scenario is not provided. APPROACHING COMPETENCE-The application of the RCA process to the scenario does not accurately describe causative or contributing factors that led to the sentinel event outcome, or the application does not accurately differentiate between causative and contributing factors. COMPETENT-The application of the RCA process to the scenario accurately describes the causative and contributing factors that led to the sentinel event outcome. B:IMPROVEMENT PLAN NOT EVIDENT-A proposed process improvement plan is not provided. APPROACHING COMPETENCE-The proposal does not outline a logical process improvement plan, or the proposal does not logically discuss how the proposed plan will decrease the likelihood of a reoccurrence of the scenario outcome. COMPETENT-The proposal outlines a logical process improvement plan and logically discusses how the proposed plan will decrease the likelihood of a reoccurrence of the scenario outcome. B1:CHANGE THEORY NOT EVIDENT-A discussion of the application of Lewin’s change theory is not provided. APPROACHING COMPETENCE-The discussion does not logically describe how Lewin’s change theory could be applied to the proposed improvement plan, or the discussion does not describe each phase of the theory. COMPETENT-The discussion logically describes how each phase of Lewin’s change theory could be applied to the proposed improvement plan. C:GENERAL PURPOSE OF FMEA NOT EVIDENT-An explanation of the general purpose of the FMEA process is not provided. APPROACHING COMPETENCE-The explanation does not accurately describe a general purpose of the FMEA process, or the explanation does not logically discuss why the FMEA process would be used. COMPETENT-The explanation accurately describes a general purpose of the FMEA process and logically discusses why the FMEA process would be used. C1:STEPS OF FMEA PROCESS NOT EVIDENT-A description of the steps is not provided. APPROACHING COMPETENCE-The description of the steps of the FMEA process does not accurately define each of the steps. COMPETENT-The description accurately defines each of the steps of the FMEA process. C2:FMEA TABLE NOT EVIDENT-A completed FMEA table is not provided. APPROACHING COMPETENCE-The FMEA table is incomplete, does not identify appropriate failure modes related to the improvement plan proposed in prompt B, or does not accurately apply the scales of severity, occurrence, and detection in evaluating the identified failure modes. COMPETENT-The completed FMEA table appropriately identifies failure modes related to the improvement plan proposed in part B and demonstrates accurate application of the scales of severity, occurrence, and detection in evaluating the identified failure modes. D:INTERVENTION TESTING NOT EVIDENT-An explanation of intervention testing is not provided. APPROACHING COMPETENCE-The explanation does not describe steps of an appropriate testing procedure or practice that would be used by the candidate to test interventions from the process improvement plan in part B, or the explanation does not logically describe how the intervention testing procedures or practices would improve care. COMPETENT-The explanation describes steps of the testing procedures or practices that the candidate would use that are appropriate for testing the interventions from the process improvement plan in part B. The explanation logically describes how the intervention testing procedures or practices would improve care. E:DEMONSTRATE LEADERSHIP NOT EVIDENT-An explanation of how a professional nurse demonstrates leadership is not provided. APPROACHING COMPETENCE-The explanation does not logically describe how a professional nurse competently demonstrates leadership in one or more of the given areas. COMPETENT-The explanation logically describes how a professional nurse competently demonstrates leadership in each of the given areas. E1:INVOLVING PROFESSIONAL NURSE IN RCA AND FMEA PROCESSES NOT EVIDENT-A discussion of involvement in the RCA and FMEA processes is not provided. APPROACHING COMPETENCE-The discussion does not logically describe how the involvement of the professional nurse in either the RCA process or the FMEA process demonstrates leadership qualities. COMPETENT-The discussion logically describes how the involvement of the professional nurse in both the RCA and FMEA processes demonstrates leadership qualities. F:SOURCES NOT EVIDENT-The submission does not include both in-text citations and a reference list for sources that are quoted, paraphrased, or summarized. APPROACHING COMPETENCE-The submission includes in-text citations for sources that are quoted, paraphrased, or summarized and a reference list; however, the citations or reference list is incomplete or inaccurate. COMPETENT-The submission includes in-text citations for sources that are properly quoted, paraphrased, or summarized and a reference list that accurately identifies the author, date, title, and source location as available. G:PROFESSIONAL COMMUNICATION NOT EVIDENT-Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic. APPROACHING COMPETENCE-Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective. COMPETENT-Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.Organizational Systems and Quality Leadership-Root cause analysis and Failure mode and effects analysis