Diagnostic Impression: You must begin to narrow your differential diagnosis to your diagnostic impression.  You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression.  You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References 

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

Assessment 4

Informatics and Nursing-Sensitive Quality Indicators

Instructions- Prepare an 8–10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.

Introduction- The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.

Preparation- As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.

This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:

· Select a single nursing-sensitive quality indicator that you see as important to a selected type of health care system. Choose from the following list:

·
Staffing measures.

· Nursing hours per patient day.

· RN education/certification.

· Skill mix.

· Nurse turnover.

· Nursing care hours in emergency departments, perioperative units, and perinatal units.

·

·

· Skill mix in emergency departments, perioperative units, and perinatal units.

·
Quality measures.

· Patient falls.

· Patient falls with injury.

· Pressure ulcer prevalence.

· Health care-associated infections.

· Catheter-associated urinary tract infection.

· Central line catheter associated blood stream infection.

· Ventilator-associated pneumonia.

· Ventilator- associated events.

· Psychiatric physical/sexual assault rate.

· Restraint prevalence.

· Pediatric peripheral intravenous infiltration rate.

· Pediatric pain assessment, intervention, reassessment (air) cycle.

· Falls in ambulatory settings.

· Pressure ulcer incidence rates from electronic health records.

· Hospital readmission rate

· RN satisfaction survey options.

· Job satisfaction scales.

· Job satisfaction scales – short form.

· Practice environment scale.

· Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.

· Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data.
 You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:

· What is your experience with collecting data and entering it into a database?

· What challenges have you experienced?

· How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?

· What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process?

· Watch the 

Informatics and Nursing-Sensitive Quality Indicators Video Exemplar
.

Recording Your Presentation

To prepare to record the audio for your presentation, complete the following:

· Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone.

· Practice using the equipment to ensure the audio quality is sufficient.

· Review 

Using Kaltura
 for Kaltura to record your presentation.

· View 

Creating a Presentation: A Guide to Writing and Speaking
. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage.

Notes:

· You may use other tools to record your tutorial. You will, however, need to consult 

Using Kaltura
 for instructions on how to upload your audio-recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access.

· You may also choose to create a video of your tutorial, but this is not required.

· If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact 

[email protected]
 to request accommodations.

Instructions- For this assessment, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.

The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.

As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.

You determine that you will cover the following topics in your audio tutorial script:

Introduction: Nursing-Sensitive Quality Indicator

· What is the National Database of Nursing-Sensitive Quality Indicators?

· What are nursing-sensitive quality indicators?

· Which particular quality indicator did you select to address in your tutorial?

· Why is this quality indicator important to monitor?

· Be sure to address the impact of this indicator on the quality of care and patient safety.

· Why do new nurses need to be familiar with this particular quality indicator when providing patient care?

Collection and Distribution of Quality Indicator Data

· According to your interview and other resources, how does your organization collect data on this quality indicator?

· How does the organization disseminate aggregate data?

· What role do nurses play in supporting accurate reporting and high-quality results?

· As an example, consider the importance of accurately entering data regarding nursing interventions.

After completing your script, practice delivering your tutorial several times before recording it.

·
Additional Requirements-Audio communication: Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.

·
Length: 8–10 minute audio recording. Use Kaltura to upload your recording to the courseroom, or provide a working link your instructor can access.

·
Script: A separate document with the script or speaker's notes is required. 
Important: Submissions that do not include the script or speaker's notes will be returned as a non-performance.

·
References: Cite a minimum of three scholarly and/or authoritative sources.

·
APA: Submit, along with the recording, a separate reference page that follows APA style and formatting guidelines. For an APA refresher, consult the 

Evidence and APA
 page on Campus.

Context-The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.

NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.

The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018).

Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.

Reference

Grove, S. K., Gray, J. R., Jay, G. W., Jay, H. M., & Burns, N. (2018). 
Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.

Competencies Measured-By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 1: Describe nurses' and the interdisciplinary team's role in informatics with a focus on electronic health information and patient care technology to support decision making.

· Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.

· Competency 3: Evaluate the impact of patient care technologies on desired outcomes.

· Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.

· Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.

· Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.

· Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.

· Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.

· Follow APA style and formatting guidelines for citations and references.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated.

Informatics and Nursing-Sensitive Quality Indicators Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.

Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.

Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.

Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.

Follow APA style and formatting guidelines for citations and references.

·

Please see attachment

  

Please provide positive comments with reference to each paragraph. Thanks

1-Cognitive techniques are a group of tools that psychotherapists use to give the patient the opportunity to identify and modify thought patterns and beliefs that guide the way we interpret situations and determine our feelings and emotions regarding these events. 

2-Exposure Therapy: Exposure therapy is a logical and progressive strategy of facing perceived or avoided situations, entities, or thoughts. Controlled exposure helps people face and manage their concerns, reducing distress and improving coping skills. Exposure treatment is crucial to treating phobias, PTSD, OCD, and other anxiety disorders 

Module 06 Discussion – Common Medication-Nutrient (Food) Interactions

Directions:

For this discussion forum, find three interactions between medications and nutrients (food). List the interaction, foods to avoid while taking the medication, and describe key points that should be included in client education regarding the interactions.

You can use Epocrates to find your information https://online.epocrates.com/, or Medline Plus http://www.nlm.nih.gov/medlineplus/druginformation.html, or any other evidence based resource.