For health care providers, changes in governmental policies, local and national economics, and the need to integrate new technologies, tests, and procedures can all impact the financial situation of an organization. In addressing financial issues, a myriad of factors must be considered, such as the varying objectives of those providing care, resource availability, the population being served, and the implementation of government policies. As a nurse manager, you must consider the potential positive and negative impacts of new trends on your organization and all its stakeholders.

In this Discussion, you evaluate how emerging trends in the health care field impact health care decisions for patients, doctors, and nurses.

To prepare:

• Review the Learning Resources for this week, focusing on the role of nurse managers in making financial decisions.
• Conduct additional research in the Walden Library and other relevant sources, to identify three emerging trends that are affecting health care today.
• Select one trend to discuss in detail and evaluate its implications for the delivery of care from the perspective of doctors, nurses, and patients.
• Reflect on how this trend might impact quality of care.

By Day 3

Post a brief description of three emerging trends that are affecting health care today. Evaluate the implication of one of these trends on the delivery of health care from the perspectives of doctors, nurses, and patients. Explain how this trend might impact the quality of care.

 

Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.
Chapter 2, “Four Things the Healthcare Manager Needs to Know About Financial Management Systems” (pp. 11–20)
This chapter focuses on the overall financial management system within an organization and identifies the basic system elements.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.

Chapter 1, “The Context of Health Care Financial Management” (pp. 1–23)
This chapter offers differing perspectives on the causes of a “health care system in distress.” The chapter explores the factors behind rising health care costs, the efforts to control costs, and the ethical issues that affect both.
Note: This eBook is accessible through the Course Readings List located in the Course Materials section of the Syllabus.

Sanford, K. (2011). The case for nursing leadership development. Health care Financial Management, 65(3), 100–104, 106.
Retrieved from the Walden Library databases.

This article details the costs of ineffective management and leadership to a health care organization. Management and leadership are defined as “a discipline” and “an art,” requiring commitment to the organization’s goals, to the team, and to the patient.

Waldman, D. (2014). The health of healthcare, part V: Is the very freedom of providers at risk? The Journal of Medical Practice Management: MPM, 29, (6), 366-368.
Reprinted by permission of Greenbranch Publishing via the Copyright Clearance Center.

This article discusses how U. S health providers lose their fiduciary responsibility to patients when compliant with the Affordable Health Care Act.

Studer, Q. (2010). Do your nurses speak finance? Health care Financial Management, 64(6), 80–84.
Retrieved from the Walden Library databases.

This article discusses the importance of nurses understanding finance in a health care organization. The article stresses the importance of teaching clinicians the skills necessary to understand and make a difference in the current financial system of health care.

-Rebecca Crispi

Discussion Module 4

. Research and select a state or local debris management plan

2. Read the plan and conduct a critical review answering:

•What types of hazards is the state/local authority threatened by?

•

In New York, the plan mentions storm debris, flooding, droughts, spills and invasive species.

•Does the policy/plan consider the types of debris produced by those hazards?

•Does the policy/plan discuss how to collect, sort, and dispose of the debris?

•

Yes, this plan does consider the types of debris produced by the hazards and how to dispose of them. For example, the plan for storm debris mentions numerous types of cleanup, some being:

Asbestos containing materials – disposed at a “permitted municipal solid waste (MSW) landfill” as per NY State ACM Disaster Guide.

Asian Long Horned Beetle debris – trees must be chipped a certain way and then possibly quarantined.

Dead animals – disposed at a MSW landfill or “on- site.”

Electronic waste – must be recycled according to NYS Electronic Equipment Recycling & Reuse Act

Household hazardous wastes – must be stored in a safe place until it can be taken to hazardous waste facility for proper disposal.

Utility poles – these are said to be reused or taken to a MSW landfill.

•Does the policy/plan mention FEMA’s rules for reimbursement for debris management?

•

This document gives a link to FEMA website, which does explain eligibility, insurance settlement, reasonable cost. There is an entire chapter dedicated to the costs of debris removal, including different type of contracts such as piggyback contracts and prohibited contracts.

https://www.fema.gov/pdf/government/grant/pa/demagde.pdf

•How does the plan identify human and physical resources specified for the debris management function?

•

“All personnel conducting debris operations should be trained, at a minimum, on items such as identification of hazards and proper use of personal protective equipment. Additional training specific to job duties should be conducted to ensure the health and safety of the staff working at the site. Personnel should also be trained in identifying the different solid waste types, such as HHW and e-scrap, to ensure all wastes are separated and managed properly.”

This is basically saying that people who are going to be involved in debris removal and disposal need to know what they are doing, be properly trained. Not only should they be trained on how to dispose of the materials but they also need to be able to identify different types of debris and wastes so they are taken to the right place.

•Did you learn anything from reading the plan that was not explored in the course?  If so, what?

•

I learned a lot from reading this document. I never realized, nor did I ever think about, how much is involved in disposing of debris. I never thought about how there is going to be hazardous wastes and dead animals, let alone certain beetles and trees that need to be chipped to a certain dimension and then quarantined. It was a very interesting document to read because I did not know anything about debris removal beforehand.

•What is your overall assessment of the policy/plan?  (e.g., what are its strengths and weaknesses?)

•What recommendations do you have to improve the plan?

 

Overall, I find this document to be thorough and very detailed. I think it does a great job outlining the different risks, and providing links to policies and other organizations that are involved in the debris removal process. It even includes a handout that can be given to residents of the area on how to expedite and organize to efficiently remove the debris.

To be honest, I don’t know how I would improve this plan. I find it to be easily read and navigated. I find there is great detail and specifics that lets any person reading the plan get an easy grasp on what they would need to do.

 

https://www.fema.gov/pdf/government/grant/pa/demagde.pdf

http://www.dec.ny.gov/docs/materials_minerals_pdf/2015disasterdebris.pdf

http://www.dec.ny.gov/regulations/8751.html

http://www.dec.ny.gov/docs/materials_minerals_pdf/acmguidance.pdf

2- Doug Harper

As we continue along this journey together in Emergency Management, I have to admit I never until starting this Module even considered debris management, really knew anything about it, and was not aware of how as a function of a disaster it is so critical in so many ways. I have to say debris management is fascinating in itself as a byproduct of a disaster. But when taken as a whole of what we as EM managers need to consider in the recovery phase, adding debris management to the recovery phase can truly be a daunting task.

I was fortunate enough to have within Toronto’s Emergency Plan a fully accessible/transparent debris management plan/document (https://www1.toronto.ca/City%20Of%20Toronto/Office%20of%20Emergency%20Management/Files/pdf/ESFs/Debris%20Management%20ESF/Debris%20Management_Plan_ESF_A_160429.pdf). This document was refreshed and rewritten in May 2016 so it is quite current.

The document in my opinion is an example of pre-event recovery planning. I can attest to debris management as my city sustained a significant flash flood rain event in July of 2013 that dropped 126mm (5″) of rain in two hours and broke a single day rainfall record for the city (http://www.cbc.ca/news/canada/toronto/toronto-floods-leave-power-system-hanging-by-a-thread-1.1304807). The amount of debris due to flooded basements was unprecedented. I can recall seeing curbside mounds of entire basement contents street after street left for special pickups using 26 ft straight trucks and pure manpower to move into the trucks. Some areas were able to secure dump trucks and loaders, but being prime summer construction season in Southern Ontario, the availability of dump trucks was a logistical issue from the private sector. Removal of curbside household goods took months.

I do appreciate this was only a flash flood rain event. I can not imagine the damage if a F3 or greater tornado took a direct hit to Toronto. The amount of debris for a city of almost 3 million persons would be significant. Yes our housing stock does contain many brick structures, but our building codes for years were not designed for more common events to the south as seen more frequently by the southern and mid US states. I do not know of any homes built prior to the most recent generation of new construction techniques that would consider using hurricane straps on roof structures in my city. Welcome to climate change.

As we read in Chapter 4 of Dr. Phillips book there will be both direct and indirect debris to be managed. One thing that stood out was Toronto does not identify and have a plan for indirect debris (spoiled foodstuffs and public goodwill donations) much to my surprise. Toronto uses the terminology of “Phases”: (1) Make safe (2) Recovery. Pretty simple concepts indeed. I also noted right out of FEMA was the use of windshield surveys for PDA’s and the use of aerial photography surveys. All in all from my limited knowledge to date of debris management it did seem like a good starting point.

I have attempted to give a very brief reply to the 8 questions asked:

•What types of hazards is the state/local authority threatened by? Broad based and the term “situations”. They do not define specific hazards such as tornado, flood, hurricane, etc.

•Does the policy/plan consider the types of debris produced by those hazards? It does talk about trees, sand, gravel, building and construction materials, vehicles, personal property, general waste or hazardous wastes

•Does the policy/plan discuss how to collect, sort, and dispose of the debris? It does using a combination of city equipment and staff, and that of private contractors but not for the homeowners themselves (see below comments)

•Does the policy/plan mention FEMA’s rules for reimbursement for debris management? N/A due to Canadian example. However along the same thought process, there was no reference to federal funding via the Ministry of Public Safety and Emergency Preparedness Canada

•How does the plan identify human and physical resources specified for the debris management function? Very well as each municipal department that is expected to play a role in debris management is identified. These are: Solid Waste, Transportation Services, Toronto Water, Parks, and Forestry departments

•Did you learn anything from reading the plan that was not explored in the course?  If so, what? Nothing “new” stood out from the 11 page document

•What is your overall assessment of the policy/plan?  (e.g., what are its strengths and weaknesses?) I give it a B. Yes something to start the discussion. I was very impressed with the pre-planning for Temporary Debris Storage and Reduction (TDSR) sites. Toronto on a yearly basis revisits the site selections for a review. However as mentioned above no comments in regards to indirect waste. It really is a broad based document as it does not get into the minutia of setting up grids or Sectors for debris management, it does not talk about separation zones curbside by the homeowners themselves, nor does it deal with top tier government financial assistance

•What recommendations do you have to improve the plan? Drill right down into to “nuts and bolts” of how it will be done and what the homeowner will be expected to do

To summarize my city has at least spent time in the form of human resources to pre-plan for debris management. Saying that Toronto can do better. maybe an idea for my thesis???

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

As a student, you already have gained a great deal of knowledge. What you know and have experienced prior to this class will affect how you perceive, learn, and retain new information. Your learning is also affected by what you think you know. To share your current knowledge, respond to the following in a few paragraphs before you review the content in the module.

Pre-assessment question:

•How can an emergency manager keep the public involved in hazard mitigation and the implementation of a hazard mitigation plan after it has been approved and adopted?

In your reflection journal entry for this week, address the following in 2-3 paragraphs, integrating the knowledge you have gained during this week:

•What is the role of mitigation in a post-disaster scenario