Week 4 DiscussionLong-Term Care in the U.S.Determine the average daily cost of nursing home care in your state. Discuss the funding options (public and private) that exist to pay for long-term care. What policy and financing recommendations would you make to ensure that long-term care is available for everyone who needs the services in the U.S.? Please justify your answer.Rationing of Healthcare ServicesHealthcare services can be rationed by governmental rationing or by allowing those who can afford the services to purchase the services. If you were the chairperson of a medical ethics committee faced with the decision concerning which of the following patients would receive a heart transplant what decision would you make and what justification would you give to the families of each of the patients for making that decision?Patient 2: A forty-six-year-old unemployed auto worker with a history of alcohol use and smoking suffered a heart attack and will die within one month if he does not receive a heart transplant. The patient does not have health insurance nor does he have the resources to pay for the procedure.

The McGill Model of Nursing is a theory that looks at the patient as a whole person and not just through the eyes of disease and sickness.This theory helps identify the patient with loving family members involved in the care as an individual person and as a person with desires and goals in life (Wright & Gross 2012).A study conducted on the end of life care on patients using the McGill Model focused the study on family members of dying patients and how the transition from palliative to hospice care affected them.Furthermore the study revealed the APNs transition with the family from having hope of saving the patient to finding peace in the dying patient (Wright & Gross 2012). The APN walks through this transition with the patient and family constantly observing the needs of the patient and family while making sure all the medical needs are meant as well.The Gestalt Theory is based on a persons perception of a situation or event.This theory focuses on an event that people experience together but how differently each person can perceive the event (Butts & Rich 2013 p 210).People tend to filter what they see and experience differently from one another much like when a family goes through the death of a loved one.Each family member shows different emotions or has different perspectives for example one person may be angry and resentful of the situation while another might be the one at peace with it (Shaha et el. 2011).Even though these two theories are unrelated they both can be utilized by the APN. The McGill Model looks at the patient and the family members involved in patients care as if they are all the same whereas the Gestalt Theory focuses on individuals perception of the same situation but appreciates the different views of each person.These theories demonstrate a holistic approach on caring for the patient and can provide more meaningful care when combined.(Butts J. B. & Rich K. L. (2013). Philosophies and Theories for Advanced Nursing Practice (2nd ed). Burlington MA: Jones & Bartlett Publishers.Shaha M. Cox C. L. Belcher A. & Cohen M. Z. (2011). Transitoriness: patients’ perception of life after a diagnosis of cancer: Maya Shaha and colleagues discuss the importance of understanding how people come to terms with the finality of life in the context of evidence-based care. Cancer Nursing Practice (4) 24.Wright D. K. & Gros C. P. (2012). Theory inspired practice for end-of-life cancer care: An exploration of the McGill Model of Nursing. Canadian Oncology Nursing Journal 22(3) 175-181.

A year after declaring bankruptcy and moving with her daughter back into her parents’ home Nancy Silbermann is about to get a degree in nursing. As she starts out in a new career she also wants to begin a new life. One built on a solid financial base. Nancy will be starting out as a full-time nurse at a salary of $52 000 a year and she plans to continue working at a second (part-time) nursing job with an annual income of $10 500. SheII be paying back $24 000 in bankruptcy debts and wants to be able to move into an apartment within a year and then buy a condo or house in five years. Nancy won’t have to pay rent for the time that she lives with her parents. She also will have child care at no cost which will continue after she and her daughter are able to move out on their own. While the Jiving arrangement with her parents is great financially the accommodations are tight and Nancy’s work hours interfere with her parents’ routines. Everyone agrees that one more year of this is about all the family can take. However before Nancy is able to make a move-even into a rented apartment she will have to re-establish credit over and above paying off her bankruptcy debts. To rent the kind of place she’d like she needs to have a good credit record for a year; to buy a home she must sustain that credit standing for at least three to five years. 1. In addition to opening checking and savings accounts what else might Nancy do to begin establishing credit with a bank? 2. Although Nancy is unlikely to be able to obtain a major bank credit card for at least a year how might she begin establishing credit with local merchants? 3. What’s one way she might be able to obtain a bank credit card? Explain. 4. How often should Nancy monitor her credit standing with credit reporting services

Capstone Project Milestone 2:
Design for Change Proposal Guidelines
Purpose
You are
to create a Design for Change proposal inclusive of your Practice Issue and
Evidence Summary worksheet from your Capstone Project Milestone 1. Your plan is
to convince your management team of a nursing problem you have uncovered and
you feel is significant enough to change the way something is currently
practiced. In the event you are not currently working as a nurse, please use a
hypothetical clinical situation you experienced in nursing school, or nursing
education issue you identified in your nursing program.
Course
Outcomes
This assignment
enables the student to meet the following course outcomes.

CO1:
Applies the theories and principles of nursing and related disciplines to
individuals, families, aggregates, and communities from entry to the healthcare
system through long-term planning. (PO #1)

CO2:
Proposes leadership and collaboration strategies for use with consumers and
other healthcare providers in managing care and/or delegating responsibilities
for health promotion, illness prevention, health restoration and maintenance,
and rehabilitative activities. (PO #2)
Due
Date
Milestone
2 consists of the proposal for your Design for Change Capstone Project. Submit
this assignment to the Dropbox by the end of Week 4.
Points
Milestone
2 is worth 225 points.
Directions
1.
Create a proposal for your Design for Change
Capstone Project. Open the NR451_Milestone2_Design_Proposal_ template in Course
Resources to create your paper. You will include the information from Milestone
1, your practice issue and evidence summary worksheets, as you compose this
proposal. Your plan is to convince your management team of a practice problem
you have uncovered that is significant enough to change current practice.

2.
The format for this proposal
will be a paper following the Publication
manual of APA 6th edition.
3.
The paper is to be FIVE to
six-pages excluding the Title page and Reference page.
4.
As you organize your information
and evidence, include the following topics.
a.
Introduction:
Write
an introduction but do not use Introduction as a heading in accordance with
the rules put forth in the Publication manual of the American Psychological
Association(2010, p. 63). Introduce the reader to the
plan with evidence-based problem identification and solution.
b.
Change
Model Overview:Overview of the ACE Star model (the model we have been
discussing this session); define the scope of the EBP; identify the
stakeholders, and determine the responsibility of the team members.
c.
Evidence:
Conduct internal and external searches of evidence; integrate
and summarize the evidence summary worksheet from Milestone 1; develop a
recommendation for change.
d.
Translation:
develop a hypothetical action plan; include measurable
outcomes, reporting to stakeholders; identify next steps and disseminate the
findings.
e.
Conclusion:
Provide
a clear and concise summary, inclusive of the problem issue,the five
points of the ACE Star change model; and ways to maintain
the change plan.

5. Citations
and References
must be included to support the
information within each topic area. Refer to the APA manual, Chapter 7, for
examples of proper reference format. In-text citations are to be noted for all
information contained in your paper that is not your original idea or thought.
Ask yourself, How do I know this? and then cite the source. Scholarly sources
are expected, which means using peer-reviewed journals and credible websites.
6. Tables
and Figures may be added
as appropriate to the project. They should be embedded within the body of the
paper (see your APA manual for how to format and cite). Creating tables and
figures offers visual aids to the reader and enhances understanding of your
literature review and design for change.
Grading
Criteria: Design for Change Capstone Project

Category

Points

%

Description

Introduction

25

11%

Introduction to the plan is nursing focused, with evidence-based
problem identification and potential solutions clearly identified.

Change Model Overview

50

22%

Practice issue is identified and is nursing focused. An overview of
the ACE Star model is given. The need for change is evident. Stakeholders are
identified.Practice area, team members and their role are identified
and discussed. Scope of the problem is identified.State
how nurses should use this model as a guide to facilitate change.

Evidence

50

22%

Evidence is provided thru basic information that indicates a change is
needed. For example, there have been 6 urinary tract infections over the last
two months and there were none present the last two years at the same time
period. What are some of the evidence-based interventions you discovered in
your Evidence Summary that do you plan to use?

Translation

50

22%

Activities to achieve the final steps of change are fully described.
What is needed to achieve. How do you translate what information you have
gathered into practice? How do you inform staff? What is your plan of action
to pilot the plan? What is the timeline?

Conclusion

25

11%

Clear, solid summary summarizing the key points and steps of the
change plan is included; ways to sustain the change plan are described.

APA Format

25

11%

Minimal errors.

Total

225 points

100%

Grading Rubric: Capstone Project
Milestone 2

Assignment
Criteria

A (100%)
Exceptional

Outstanding or
highest level of performance

B (88%)
Exceeds

Very good or
high level of performance

C (80%)
Meets

Competent or
satisfactory level of performance

NI (38%)
Needs
Improvement
Poor or failing
level of performance

F (0%)
Developing

Unsatisfactory
level of performance

Introduction
25
points

Introduction to the plan is nursing focused, and evidence-based. Potential
interventions clearly identified.
25
points ?

Introduction to the plan is nursing focused, and evidence-based
solutions identified but not clear.
22
points ?

Introduction to the plan is provided; however, the plan is not nursing
focused and evidence-based solutions are not convincing.
20
points ?

Introduction lacks evidence to support need for change and/or
potential solution is not evidenced-based.
10
points ?

Introduction is missing.
0
points ?

Change Model
Overview
50
points

Practice issue is nursing focused.
Overview of the ACE Star model is given. Rationale for change is
present.
Stakeholders are identified.Practice area, team
members and role are discussed.
Scope
of problem is identified.
50
points ?

Practice issue is nursing focused.
Overview of the ACE Star model is given. Rationale for change is not
present.
Stakeholders are identified.Practice area, team
members and role are discussed.
Scope
of problem is identified.
44
points ?

Practice issue is nursing focused.
Overview of the ACE Star model is given. Rationale for change is not
present.
Stakeholders are not identified.Practice
area, team members and role are discussed but without detail.
Scope
of problem is identified.
40
points ?