Describe the clinical presentation that 12 is most usually seen and what should be included in the patient assessment (focus for the PE, any labs or other diagnostic testing).

Describe the clinical presentation that 12 is most usually seen and what should be included in the patient assessment (focus for the PE, any labs or other diagnostic testing)

Guidelines for the Management of a Selected Health Problem
A Paper

The student will select a health problem topic relevant to FNP practice as it pertains to the care of the adult or geriatric population. This must be a different entity than the student?s summer health topic. The student?s topic must be submitted to their assigned grading faculty for approval no later than August 30, 2016 @ 5pm CST. Each student must choose a different topic. Topics must be submitted to faculty by email. If two students request the same topic, the student who requested the topic first will be assigned the topic and the other will have to choose another.
The paper is due October 7, by 12 MN Central Time and must be submitted via the BB Assignment Link to the grading center. A final copy of the paper minus the grading rubric and reference page will also need to be submitted to the TurnIt In link under the Assignments section by the due date. This will allow only faculty to view the originality report. The paper is an original individual student assignment, not group work. Plagiarism will result in a grade of ?0? for the assignment. The paper should include at least eight (8) references from professional peer-reviewed journals within the last 5 years (none prior to 2011). The paper must follow the outline given on the grading rubric on the next page.

The length of the paper must be between 8-10 pages (not including title page and reference list). The paper must be written in current APA format, double-spaced, headings (use sections of paper as headings), and a running head with page numbers. Use Times New Roman, 12 point font. Be sure to carefully proofread your paper before submission.

For the Clinical Management component of the paper, the student must search
appropriate professional databases to identify published clinical guidelines/evidence-based practice guidelines for the selected health problem. These guidelines must be incorporated into the clinical management section of the paper. The source
(agency organization) of the guidelines must be identified in the paper and included in
the reference list.
Internet sources are more current than textbook. Search also www.guidelines.gov.

There are several new library resources and journals available for students to search for information. Go to http://trojan.troy.edu/library/databases.html. Review the databases for relevancy to your topic and discipline.

A few recommended databases to review include Access Medicine, CINAHL Complete, Evidence-
Based Medicine, Evidence-Based Nursing, Health Source, National Guideline Clearinghouse,
Nurse Best Practices Guidelines, Ovid, ProQuest, PubMed, SAGE, and U.S. Census Bureau. Follow
the instructions to type in topic and any relevant terms to the database search engine and any
other parameters. This will allow you to view scholarly articles or texts that may pertain to your
topic and assist you in the writing of your paper.

THIS PAGE MUST BE INCLUDED AS THE LAST PAGE OF YOUR PAPER FOR GRADING PURPOSES
(5 POINTS WILL BE DEDUCTED FROM YOUR GRADE IF THIS PAGE IS NOT ATTACHED!

Name of Student__________________________________

Evaluation Criteria Points Earned

Introduction: *Overview of the problem and its 6
Significance (incidence, factors that
influence or impact)

The Problem: *Etiology/Pathophysiology of the problem 6
*Describe the clinical presentation that 12
is most usually seen and what should be
included in the patient assessment (focus for
the PE, any labs or other diagnostic testing)
*What differential diagnoses are most commonly 6
included when trying to determine this diagnosis
or problem and why would you include each?

Clinical
Management: Protocol for NP management of the 30
problem, including:

Treatment plan, which should include any
clinical guidelines you used as a basis for
management, medications used to treat
the problem, patient teaching concerning
the problem, and any health promotion
concerns and disease prevention measures
that should be utilized.

(Specify the source of the clinical guidelines
and whether they are evidence-based, talk about
the choice of your meds and how they work/are
metabolized. For such a significant number of
points, this section should be fully developed) Also include
interdisciplinary resources available to assist with guidelines
and how the NP would utilize them.

Expected Patient
Outcomes: Discuss the expected treatment outcomes for this 10
Health problem and the time frame for these outcomes.
How would you determine that the expected outcomes
Were achieved?

Discuss the point at which you as the NP would 10
stop managing this as a complex problem and how
you would plan to refer the patient
(who would you refer to and why?)

Paper Elements: Title page (1 points) 20
Use of Headings (1 points)
Grammar/Punctuation/spelling (10 points)
APA format & references (8 points)

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The post Describe the clinical presentation that 12 is most usually seen and what should be included in the patient assessment (focus for the PE, any labs or other diagnostic testing) appeared first on THE NURSING PROFESSIONALS.

Describe the clinical presentation that 12 is most usually seen and what should be included in the patient assessment (focus for the PE, any labs or other diagnostic testing)

Do employees who perform well receive larger compensation increase, while those who do not perform as well see minimal or no increase in compensation.

Do employees who perform well receive larger compensation increase, while those who do not perform as well see minimal or no increase in compensation

Order Description
Please refer to the instructions given in order number 81730355 this is the second part of that assignment.

Please respond to at least 3 postings from other class mates in a positive manner. Please respond to each post separately using at least 2 references for each post

Post One:

Author name is Oscar

Compare and Contrast an Entitlement Compensation Philosophy and a Performance Focused Compensation Philosophy
To attract and retain workers that are motivated and competent, healthcare organizations compete with each other aggressively and also other firms within the industry to hire skilled employees. This calls for the human resource departments in healthcare sector recruit competent professionals to earn a competitive advantage. The human resource strategist has to find a balance between the company priorities and competing factors and come up with a compensation system that satisfies the goals and objectives of the employees and organizations.
Entitlement compensation philosophy is common in organizations that have increasing compensation schemes each year. It helps in organizing pay rates. This compensation increases based on time one has spent with the company. Generally, according to entitlement philosophy, all employees including executives who subscribe to it ought to receive pay increase on base pay for spending more than a year working for the company. In addition, benefit programs and incentives should continue growing regardless of the changing economic conditions or industry (Flynn, Mathis, & Jackson, 2016). According to Entitlement Compensation Philosophy, a company should give the same rate of increase and uniform payout bonus for all their workers as well. According to this philosophy as the employee continues to offer his or her service, costs of employer increases, regardless of competition pressure from other organizations or performance of the employee.
On the other and Performance Focused Compensation Philosophy refers to a situation where businesses compensate employees based on the performance level achieved by each employee. Unlike Entitlement Compensation Philosophy not all employees are guaranteed a raise and also do not offer equal increases throughout the firm. Employees who perform satisfactorily obtain pay increase and each employee has his or her different rate of compensation rate (Flynn, Mathis, & Jackson, 2016). Therefore, those employees who have satisfactory performance are considered competent and the labor market compensates them more compared to those with average performance depending on the appraisal method applied (Stevens, 2014). Bonuses are given out based on the group, organization and individual performance results. In facets of compensation practices, only a few organizations are fully performance oriented.
Both entitlement compensation philosophy and performance focused compensation philosophy use direct compensation. These are tangible rewards paid for in working relationship. Health workers are paid a basic pay plus a variable pay. The variable pay is given out in the form of stock options, incentives, and bonuses (Reed &Bogardus, 2015).
In both compensation philosophies, the base pay and incentives vary depending on the task, physical effort, skills and knowledge and working conditions of the job. They both also consider external equity. External equity examines rates that other organizations are paying in a compensation program for a position that is competing in an organization. Due to the shortage of healthcare workers that are skilled having an external equity is considered very important for healthcare workers to compete effectively for employees. According to (Hernandez & O’Connor, 2010), healthcare employers that fail to provide compensation that is viewed as equitable in comparison to other organizations by the employees are more prone to a higher turnover. They will also find it challenging to recruit high demand and qualified individuals
In conclusion, an organization can use both an entitlement compensation philosophy and a performance-focused compensation philosophy. In such a scenario, they will be working in a consortium. However, currently, many healthcare facilities are trying to break up from the entitlement mode of performance oriented. This has been challenging due to the strength of trade unions and historic traditions.
?
References List
Flynn, W. J., Mathis, R. L., Jackson, J.H., Valentine, S. R. (2016). Healthcare human resource management (3rd ed.). South-Western. Thompson Chapter 12 & 13
Hernandez, S. R., & O’Connor, S. J. (2010). Strategic human resources management in health services organizations. Clifton Park, NY: Delmar Cengage Learning.
Reed, S. M., &Bogardus, A. M. (2015). PHR/SPHR Professional in Human Resources Certification deluxe study guide.
Stevens, R. (2014). The public-private health care state: Essays on the history of American health care policy. New Brunswick: Transaction Publishers.

Post 2:

Author name is Monica

The Fair Labor Standards Act (FLSA) is a federal law, passed in 1938, that affects compensation. It establishes minimum wage, overtime pay, record keeping and youth employment standards affecting employees in the private sector (United States Department of Labor [DOL], 2016). Employees are classified as exempt and nonexempt employees under the FLSA. Exempt employees usually hold executive and administrative positions, and are not paid overtime by employers. Duties of exempt employees include, primarily management duties, decision discretion/judgment and require advanced knowledge/training/education. Nonexempt positions include secretarial, clerical and salaried blue-collar positions and must be paid overtime by employers (Flynn, Jackson, Mathis & Valentine, 2016).

Employers must consider many issues regarding FLSA compliance and should research compliance requirements in the states in which they work. Issues such as overtime and exempt and nonexempt employees may seem confusing to managers and HR professionals. For example, ?comp time? is extra time worked in which employees choose time off instead of payment. However, comp time is prohibited in the private sector. Any time spent in training counts as time worked for nonexempt employees. Travel time also counts as work time if it occurs during working hours and if it is work related. An example of this would be traveling to satellite offices. If an employer requires employees to change into hospital issued scrubs or wear specialized protective equipment, a ?reasonable amount? of time must be allowed to change and is considered work time by some states (Flynn et al., 2016). Since the nursing profession is mainly women, as of 2010, employers must provide a reasonable break and a place for nursing mothers to express milk for one year after the child?s birth (DOL, 2016). These are some of the issues that affect the healthcare workforce and should be considered by administrators/managers.

Healthcare organizations must comply with laws and regulations whether it is federal, state or local. These laws and regulations affect nursing practice (Roussel, Thomas & Harris, 2016). Nurse administrators must understand and abide by these laws and regulations, which may also mandate quality and practice standards. ?Complying with regulatory and professional standards are duties of the nurse administrator at any level in all practice settings.? (American Nurses Association (ANA), 2016, p. 17)

References

American Nurses Association (2016). Nursing Administration: Scope and Standards of Practice (2nd ed.). Silver Spring, MD: American Nurses Association.

Flynn, W. J., Jackson, J. H., Mathis, R. L., & Valentine, S. R. (2016). Healthcare human resource management (3rd ed.). Boston, MA: Cengage Learning.

Roussel, L., Thomas, P. L., & Harris, J. L. (2016). Management and Leadership for Nurse Administrators (7th ed.). Burlington, MA.: Jones and Bartlett Learning.

United States Department of Labor. (2016). Compliance Assistance-Wages and the Fair Labor Standards Act Overview. Retrieved from https://www.dol.gov/whd/flsa/

Post 3:

Author name is Moises

Entitlement compensation philosophy is followed by many traditional organizations. This philosophy is based on giving an automatic increase in pay for every year of service. Most employees receive the same or nearly the same percentage increase each year. Employees and managers who subscribe to this philosophy believe that individuals who have worked another year, are entitled to a raise in pay. They also believe that all incentives and benefits programs should continue and be increased, regardless of the changing industry and economic conditions. Other ideals of entitlement philosophy include seniority based priority, across-the-board raises, guaranteed movement of scales, industry comparisons, and other expected bonuses (Flynn, 2016).

This is contrary to what a performance focused compensation philosophy is based upon. Performance oriented philosophy states that organizations do not guarantee additional or increased compensation simply for completing another year or organizational service. Instead, pay and incentives reflect performance differences among employees. Employees who perform well receive larger compensation increase, while those who do not perform as well see minimal or no increase in compensation (Flynn, 2016).

The Fair Labor Standards Act (FLSA) is the primary law affecting compensation, which was passed in 1938. Under FLSA, employees are classified as exempt or nonexempt employees, which determines which employees may be paid overtime. In health care organizations, following FLSA law is essential to prevent costly lawsuits. It is important that nursing leaders recognize the importance of this law and how it may affect direct employees that may incur overtime. Penalties for wage and hour violations often include awards of up to two years of back pay for affected current and former employees along with a monetary penalty, which can be costly to health care organizations (Flynn, 2016). Additionally, the Safe Nursing and Patient Care Act was introduced in 2001. The Act?s purpose is to prohibit certain health care employers that receive Medicare payments from requiring nurses to work overtime, and it protects nurses from discrimination if they refuse to work overtime beyond the defined overtime limits. Overtime in this Act is defined as any time worked over a scheduled daily shift, more than 12 hours in a 24-hour period, or more than 80 hours in a consecutive 14-day period. It would impose a $10,000 penalty on employers who willfully violate this Act (Crampton, 2003).

Structuring a compensation plan that attracts, rewards, and retains nurses and others in health organizations is a crucial component in keeping financial integrity within the organization. The cost of nursing turnover eats away at efforts to implement efficient processes and improve health care organizations financial health. Some organizations report an annual RN turnover rate of 40%. Experts estimate that the costs of turnover can climb to 150% (Contino, 2002).

References

Contino, D. S. (2002). Financial management. how to slash costly turnover. Nursing Management, 10-13.

Crampton, S. M. (2003). The flsa and overtime pay. Public Personnel Management, 331-354.

Flynn, W. J. (2016). Healthcare Human Resource Management. Boston: Cengage Learning.

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Do employees who perform well receive larger compensation increase, while those who do not perform as well see minimal or no increase in compensation

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008)..

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008).

Health Complications among Drug and Substance Abusers
Over the years, substance abuse treatment approaches been focusing on eliminating or reducing the use of psychoactive materials, a trend that has ignored the adverse health issues. Disregarding the impacts of substance abuse and focusing on underlying issues has resulted in an ever-growing burden of drug-related deaths and blood-borne diseases. Epidemiologists have established a significant association between use of psychoactive materials and new patterns of viral infections such as Hepatitis B and C, and HIV/AIDS (Guarino, Marsch, Deren, Straussner, & Teper, 2015). The growing concern of drug abuse has also influenced the incidence of diseases such as wound botulism and tetanus. The adverse health impacts have informed a number of solutions. Some of the popular evidenced-based approaches include matrix model, family behavior therapy, motivational enhancement therapy, cognitive-behavioral therapy, contingency management interventions, and 12-step facilitation therapy. While the efficacy of the approaches has been confirmed by the current stock of knowledge, they have not addressed the health needs of drug abusers, with many scholars suggesting that the plans are rigid in their approach, whereas the substance abuse trends are highly evolving. The supposition is supported by the contemporary effects of drug addiction, where they continue to have a significant toll on individual health and social functions in spite of massive public health spending (Degenhardt et al., 2013).
The prevalence of substance abuse has remained persistently high. The trend is explained by Alhyas et al. (2015) in their suggestion that the current generation is using psychoactive materials for the desired outcome, unlike the 20th-century abusers who did not understand the effects of indulging in drugs. The 21st-century youths are abusing substances as part of the exploratory behavior, even when they have full knowledge of the side effects. The trend has resulted in legislative measures where some states are legalizing previously outlawed substances such as Marijuana (Huddleston, 2016). However, the strategies only address the socioeconomic implications and not drug-usage complications and deaths. Against this backdrop, practitioners are starting to embrace harm reduction strategies to offset both socioeconomic and adverse health effects at both individual and community level. Harm limiting strategies are evidence-based approaches of keeping up with the dynamics of drug abuse. With the traditional methods having failed to address relative risks linked with substance abuse, focusing on offsetting the adverse effects and complications does not only offer a promising future, but also reduced mortality, negative behaviors, and morbidity rates (Toumbourou et al., 2007).
The problem-oriented approach is congruent with the principles of evidence-based practice where the focus should not only be embracing proven policies and interventions, but also adopting methods and procedures that are linked to the dynamism of the problem. Its focus is informed by trends in substance abuse, where many people continue to use drugs with full knowledge of its negative implications for the physical and psychosocial functioning (Sederer, 2016). The behavioral trend has led to a scholarly conclusion that drug will remain part of the humanity, where users will keep furthering their experiments to exploit perceived benefits such as enhancing pleasure and easing discomfort (Coon & Mitterer, 2013). The surmise is supported by recent trends, where the rate of use of opioids for non-medical purposes has been on the rise (Longo, Compton, Jones, & Baldwin, 2016). Although the impact of the misuse is a well-understood subject, individuals continue to use opioids. The trend is against the natural responses when human beings avoid harmful substances. Schatz (2016) associates the trend to Hollywood culture, where drug-related phenomenon such as sexual prowess, curiosity, enjoyment, boldness, confidences, and sound sleep are praised. With the concept of global village scenario having been realized through advanced transport and communication system, Manza (2016) suggest that the number of drug users will keep increasing as advanced technologies have resolved inaccessibility. The trend necessitates the need for a change in focus from limiting the use of substance abuse to harm minimizing strategies (van Amsterdam & van den Brink, 2013).
Harm Minimization Strategies as Evidence-Based Interventions for Drug and Substance Abusers
One of the evidence-based approaches to addressing adverse health effects and social dysfunction associated with drug abuse is harm minimization strategies. The interventions focus on empowering substance users and cushioning them against complications and the risk of contracting illnesses (Ruan et al., 2013). Harm minimization procedures entail neutralizing risks in drug taking as well as addressing elements that can affect the quality of life. The evidence-based practices are effective in addressing unprecedented effects of substance abuse such as blood-borne viruses, overdose, unintentional injury, premature drug-related death, septicemia, and dental health among others (Hickman, De Angelis, Vickerman, Hutchinson, & Martin, 2015). The issues calls for revisiting drug policies, where harm minimizing approaches should be integrated into comprehensive care plans for drug abuse treatments (van Amsterdam & van den Brink, 2013).
Harm reduction approaches entail embracing practical ideas and strategies to offset the risk and negative health impacts arising from drug use. Like other patient-centered public health and psychosocial interventions, harm minimizing strategies adopts a non-judgmental approach with drug users and the community being active participants in shaping procedures and programs around substance abuse (Harmreduction.org, 2016). The evidence-based and cost-conscious practices do not only focus on drug use control but also improving the quality of life of involved parties. The harm minimization model is informed by a widely explored supposition that substance abuse is a behavior that is influenced by a myriad of factors. The underlying elements are utilized in the execution of the activities such as peer education, counseling, overdose prevention, need and syringe programs, voluntary HIV testing, wound care, enlisting in substance abuse treatment programs, pharmacotherapy for addiction cases, and primary health care including treatment for STIs and viral diseases.
The rationale for the set of interventions is informed by Roizen’s 4-L model, where harm minimization action plans are structured to address livelihood aspects, health effects, legal issues, and relationship issues emanating from substance abuse (Hussein, 2008). Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008). Based on the two theoretical frameworks, harm minimization approaches focus on the three behavioral levels of 1) substance acquisition, 2) usage, and 3) withdrawal stage. At the acquisition level, harm minimization approaches focus on addressing violence and criminality associated with accessing psychoactive materials from the market.
Intervening at the drug abuse stage entails offsetting complications that are related to drug use. A key area of focus at the usage level is dosage and route of administration. The centrality of the two aspects is evidence-based, where the current body of literature reveals that most of the complications are contributed by the dosage as well as the route of administration. For instance, intravenous injections have been classified as the riskiest strategy as it compromises the integrity of the skin as a primary line of defense, exposing victims to opportunistic pathogens. It also leads to open wounds, vein problems, and abscesses (Del Giudice, 2004). The stage is linked to viral infections such as Hepatitis B and C and HIV/AIDs, making awareness campaigns and health education a critical cog. The health promotion methods create awareness on disease transmission and ways of effective prevention and educate users on safety procedures such as disposal of sterile and well as non-sterile materials. Uses of injectable are discouraged to offset the spread of blood-borne infections.
Harm minimization at the withdrawal level seeks to address physical symptoms as well as psychosocial aspects associated with quitting drugs. The stage focuses on establishing supportive tools and environment where professional, families and drug users interact to modify behaviors. To prevent withdrawal complications and setbacks, the intervention provides alternatives such as pharmacological antagonist drugs (Farr?, Galindo, & Torrens, 2014). The drug-substitution approach does not only reduce address usage-related risks but also initiates the road to recovery.
Identification of Measurement Outcomes for Identified Interventions
The rationale of the health promotion is ingrained in the Ron Roizen?s model, where effects of psychoactive substances are abbreviated as 4Ls (Liver, Lover, Livelihood, and Law). The four categories will be the parameters of monitoring and evaluation procedures to assess the level of efficacy of the health promotion intervention. The four categories are informed by the WHO definition of health, where it?s a state of holistic mental, physical, and social well-being and not the absence of disease or infirmity. Evaluating the four pillars is thus critical in assessing the effectiveness of the intervention in attaining complete wellbeing.
The liver category captures all aspects of personal health. The primary measurement areas are physical parameters such as engagement in activities of daily living, diet and nutrition, sleep patterns, and temperament. Visual aspects such as bodily injuries and hygiene are also important in assessing the impacts of the intervention on the health of the victims.
Lover and livelihood focus on psychosocial effects of substance abuse. A critical issue is interactional behaviors between the victim and friends, intimate partners, and family members. Another livelihood measurement outcome is engagement in activities of daily living, including professional practices and non-professional aspects. The legal issues explore observable behavioral trends such as violence.
Utilization of epidemiology principles and terminology
a) Prevalence has been used to describe the extensiveness of drug abuse as well as effects such as drug-related deaths and blood-borne diseases.
b) Incidence has been adopted to highlight new patterns of viral diseases such as Hepatitis C, Hepatitis B, HIV/AIDS, wound botulism, and tetanus infections. The terminology is used to highlight the risk of contracting the disease when one is a drug abuser.
c) Risk has been used to describe the potential of substance abuse in increasing susceptibility to bloodborne diseases
d) The rate has used to predict a downward change in frequency of the current mortality, negative behaviors, and morbidity cases if harm minimization strategies are fully embraced.
e) Mortality rate has been used to describe deaths emanating from drug abuse and associated complications
Implications of the project for the APN clinical practice
The health promotion project offers a valuable learning experience on sociomedical realities. The elements explored challenges the traditional perspective of disease causation, where only pathogens were considered in the etiopathophysiology of infections. The project offers valuable lessons on the expansiveness of the public health, where history, social, and political issues are also determinants of health. The contribution of social issues in therapeutic area challenges advanced practice nurses to adopt a broad perspective of caregiving, where history and culture should be the epicenter of nursing research and interventions to empower the community to take control over their lives. The realization that holistic functioning can be affected by an array of issues informs area of future engagement to assess impacts of sociomedical subjects such as sexuality, homelessness, immigration, and aging in the public health.
The project has also offered invaluable lessons on the importance of inter-professional collaborations in public health. While the health promotion intervention focuses on adverse health outcomes of drugs abuse, the models and proposition adopted to inform the arguments of the project are informed by anthropological, psychological, and well as sociological postulations.

References
Alhyas, L., Al Ozaibi, N., Elarabi, H., El-Kashef, A., Wanigaratne, S., & Almarzouqi, A. et al. (2015). Adolescents’ perception of substance use and factors influencing its use: a qualitative study in Abu Dhabi. JRSM Open, 6(2). http://dx.doi.org/10.1177/2054270414567167
Coon, D. & Mitterer, J. (2013). Psychology (p. 210). Boston: Cengage Learning.
Degenhardt, L., Whiteford, H., Ferrari, A., Baxter, A., Charlson, F., & Hall, W. et al. (2013). Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1564-1574. http://dx.doi.org/10.1016/s0140-6736(13)61530-5
Del Giudice, P. (2004). Cutaneous complications of intravenous drug abuse. Br J Dermatol, 150(1), 1-10. http://dx.doi.org/10.1111/j.1365-2133.2004.05607.x
Farr?, M., Galindo, L., & Torrens, M. (2014). Addiction to Hallucinogens, Dissociatives, Designer Drugs and ?Legal Highs?. Textbook Of Addiction Treatment: International Perspectives, 567-596. http://dx.doi.org/10.1007/978-88-470-5322-9_27
Guarino, H., Marsch, L., Deren, S., Straussner, S., & Teper, A. (2015). Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City. Journal Of Addictive Diseases, 34(2-3), 162-177. http://dx.doi.org/10.1080/10550887.2015.1059711
Hickman, M., De Angelis, D., Vickerman, P., Hutchinson, S., & Martin, N. (2015). Hepatitis C virus treatment as prevention in people who inject drugs. Current Opinion In Infectious Diseases, 28(6), 576-582. http://dx.doi.org/10.1097/qco.0000000000000216
Huddleston, J. (2016). This Map Shows How Legalized Marijuana Is Sweeping the U.S.. Fortune. Retrieved 4 October 2016, from http://fortune.com/2016/06/29/legal-marijuana-states-map/
Hussein, R. (2008). Alcohol and Drug Misuse ; A handbook for students and health professionals. Routledge.
Longo, D., Compton, W., Jones, C., & Baldwin, G. (2016). Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. New England Journal Of Medicine, 374(2), 154-163. http://dx.doi.org/10.1056/nejmra1508490
Manza, J. (2016). Marijuana: a gateway drug that keeps growing stronger. Eehealth.org. Retrieved 4 October 2016, from https://www.eehealth.org/blog/2016/09/marijuana-addiction-teens
Principles of Harm Reduction – Harm Reduction Coalition. (2016). Harmreduction.org. Retrieved 4 October 2016, from http://harmreduction.org/about-us/principles-of-harm-reduction/
Ruan, Y., Liang, S., Zhu, J., Li, X., Pan, S., & Liu, Q. et al. (2013). Evaluation of Harm Reduction Programs on Seroincidence of HIV, Hepatitis B and C, and Syphilis Among Intravenous Drug Users in Southwest China. Sexually Transmitted Diseases, 40(4), 323-328. http://dx.doi.org/10.1097/olq.0b013e31827fd4d4
Schatz, J. (2016). Hollywood culture perpetuates drug abuse (February 6, 2014 issue) « Collegian. Clubs.lasalle.edu. Retrieved 4 October 2016, from http://clubs.lasalle.edu/collegian/2014/02/06/hollywood-culture-perpetuates-drug-abuse-february-6-2014-issue/
Sederer, L. (2016). Ask Dr. Lloyd | Why Are Psychoactive Drugs So Popular?. Askdrlloyd.com. Retrieved 4 October 2016, from http://www.askdrlloyd.com/blog/view/addictions,%20drugs,%20substance%20abuse
Toumbourou, J., Stockwell, T., Neighbors, C., Marlatt, G., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use. The Lancet, 369(9570), 1391-1401. http://dx.doi.org/10.1016/s0140-6736(07)60369-9
Van Amsterdam, J. & van den Brink, W. (2013). The high harm score of alcohol. Time for drug policy to be revisited?. Journal Of Psychopharmacology, 27(3), 248-255. http://dx.doi.org/10.1177/0269881112472559

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The post Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008). appeared first on THE NURSING PROFESSIONALS.

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008).

Regardless of what definition or combination of definitions one espouses, the necessity of incorporating ?outcome measurements?.

Regardless of what definition or combination of definitions one espouses, the necessity of incorporating ?outcome measurements?

Outcomes Evaluation
Too often, interventional programs are initiated and implemented at great expense with no thought of how to measure the success (or failure) of these programs. Success can take many forms, and the outcome measurements utilized must be identified as part of the planning process. At all levels, from the DNP Project to NIH grants, the results of these projects and programs are of little worth without measurable, pre-planned outcomes.
According to Gordis, ?outcomes research is used to denote studies comparing the effects of two or more interventions or modalities, such as treatments, forms of health care organizations, or types and extent of insurance coverage and provider reimbursement on health or economic outcomes. Endpoints can include morbidity and mortality as well as measures of quality of life, functional status, and patient perceptions of their health status, including symptom recognition and patient satisfaction? (2013, p. 313). The American Nurses Association defines outcome measurements as “collecting and analyzing data using predetermined outcome indicators for the purpose of making decisions about healthcare? (ANA, 2004).
Healthy People (HP) 2020 has identified 12 leading health indicators to communicate high-priority health issues with respective recommended interventions and proposed outcomes. These areas include access to health services; clinical preventive services; environmental quality; injury and violence; maternal, infant, and child health; mental health; nutrition; physical activity and obesity; oral health; reproductive and sexual health; substance abuse; and tobacco use. Each of the 12 topics has indicators that will be tracked, measured, and reported on throughout the decade. HP is soliciting input from healthcare providers for innovative, cost-effective, sustainable programs to address these high-priority areas.
Regardless of what definition or combination of definitions one espouses, the necessity of incorporating ?outcome measurements? into practice cannot be minimized. Too often, interventional programs are initiated and implemented at great expense, with no thought of how to measure the success or failure of these programs. Success can take many forms (as indicated above) and the outcome measurements utilized must be identified as part of the planning process. At all levels, from small projects to NIH research, the results of these projects and programs are of little worth without measurable, pre-planned outcomes.
Frameworks:
There is a variety of frameworks that are used in nursing and healthcare to evaluate outcomes.
1. Clinical Value Compass utilizing four dimensions:
? Clinical?disease-specific outcomes
? Functional?ability to participate in activities of daily living, overall well-being
? Cost?number of encounters, length of stay, finances and resources
? Satisfaction?patient and family satisfaction (Nelson et al., 1995; Nelson, Mohr, Batalden, & Plume, 1996; Oermann & Floyd, 2001).
2. Structure, Process, and Outcomes
Measurement
Process Measurement
Process refers to recognized components of what has been identified as good care. Identifying what constitutes good care is a decision often made by an expert panel. A clinical or healthcare provider can be assessed by reviewing relevant records or by direct observation to determine to what extent the care provided meets established and accepted criteria.
The Question
What are disadvantages of using process as a measurement of “good” care?
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Outcomes Measurement
The inherent flaws of process measurement have led to the acceptance and utilization of outcomes measurements. The term outcomes denotes whether the patient actually benefits from the care provided. In the past, most outcomes were measured easily using mortality and morbidity. There has been a shift from morbidity and mortality measurements in recent years to more sensitive measures such as quality of life, independence, pain levels, ability to ambulate, and so forth.
When the literature evaluates the benefit that a patient receives from a medical intervention, three words are employed: efficacy, effectiveness, and efficiency.
Efficacy refers to the agent’s ability to produce results in a perfectly controlled environment.
Example: Some randomized clinical trials pay carefully screened volunteers to spend several days in a clinic-type environment where they receive medications administered by the staff. Their diet and all other activities are supervised and controlled. Therefore, there is a high level of confidence that any results or outcomes are due to the medications that were administered by the staff.
Effectiveness is the result of the agent when utilized in a real-life situation. Is it effective?
Example: Iron tablets may decrease anemia in pregnant women, but many patients will not take it because of the major side effects, which include constipation. Many patients may benefit from medication, but for a variety of reasons, they will not take it. Although the medication is efficacious, if patients refuse it, no benefit will result.
Efficiency considers factors that may make one effective option preferable over another.
Example: The cost-benefit ratio of a particular treatment may be considered. Is it possible to achieve the same benefits in a cheaper, better way? Costs can include financial, personal inconvenience, side effects, social acceptance, pain, time, and others.

Costs
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Efficacy
Efficacy is determined first. Once an intervention is proven efficacious in a controlled environment, it is evaluated for effectiveness in real-life situations.
Effectiveness
Effectiveness is determined next. Only effective interventions are evaluated for efficiency.
Efficiency
Efficiency is determined after efficacy and effectiveness are established. If an intervention is inefficient, it may be impractical to implement.
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According to Gordis (2009), factors that must be considered when developing outcome measures are
1. the measure must be clearly quantifiable;
2. the measure of outcome should be relatively easy to define and diagnose;
3. the measures selected should lend themselves to standardization for study purposes and replication; and
4. the population served and the comparison population must be at risk for the same condition being evaluated.
Example: Possible endpoints for measuring the success of a vaccine program are
1. the number (or proportion) of people immunized;
2. the number (or proportion) of people at high risk who are immunized;
3. the number (or proportion) of people immunized who show serologic response;
4. the number (or proportion) of people immunized, who are later exposed and the disease does not develop; and
5. the number or proportion of people immunized later, are exposed, and in whom clinical or subclinical disease does not develop.
Example: Possible endpoints for measuring the success of a throat culture program include
1. the number of cultures taken (symptomatic or asymptomatic);
2. the number (or proportion) of cultures positive for streptococcal infection;
3. the number (or proportion) of people with positive cultures for whom medical care is obtained;
4. the number (or proportion) of people with positive cultures for whom proper treatment is prescribed and taken;
5. the number (or proportion) of positive cultures followed by a relapse; and
6. the number (or proportion) of positive cultures followed by rheumatic fever.
Examples of Outcome Measures
The National Health Service (NHS) in England began the Patient Reported Outcomes Measures (PROM) in 2009 (Barham & Devlin, 2011). Up until this time, most outcomes were based on the number and speed of services delivered and any associated adverse effects. This is the first time that patients’ self-perceived quality of health was being used as an outcome. It is a self-reported measure of how patients perceive their health both before and after surgery. Patients assess and report their health periodically. These appraisals are compared to measured change in health that occurred. The information that is gathered
1. helps patients make informed decisions;
2. allows clinicians to monitor in an organized fashion;
3. improves quality;
4. informs insurance sources as to which service to prioritize; and
5. rewards good performance by providers.
In addition, this type of research offers the nurse a variety of utilization techniques. PROM can serve as a framework to develop an evidence base for nursing practice. It can also facilitate the measurement of the effectiveness of holistic nursing interventions, and it provides an opportunity to develop our own measurements to support our interventions. Evidence-based practice standards will need to measure nursing interventions to ensure that information is meaningful.
An observational outcomes study by Romley, Anupam, and Goldman (2011) was conducted at 208 California hospitals from 1999 to 2008. Approximately 2.5 million patients who had any of six major medical conditions associated with inpatient quality indicators were evaluated for mortality rates. The end-of-life hospital spending was found to have a negative correlation to mortality (i.e., the higher the spending, the lower the inpatient mortality rate). There was no variation by region or size of hospital.
The U.S. Preventative Services Task Force (USPSTF) has based its recommendations on an evidence-based model of clinical prevention (Leipzig, Whitlock, Wolff, Barton, Michael, Harris, et. al., 2010). However, patients with multifactorial serious illness may complicate outcomes research. Most outcomes measurements are based on one disease or condition and the associated outcomes. Elderly populations are increasingly likely to have comorbidities that are not considered; therefore, the results of most outcomes measurements are not easily summarized for systematic review and the development of recommendations.
Individuals vs. Groups
Outcomes are most often measured at the individual level with no consideration of the interaction and dynamics between patients in the same groups.

The Question
Do interventions that work with individuals transfer successfully to groups? Or are there intervening variables caused by group dynamics that affect the successful transfer?
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The literature is unclear about which intervention is more effective and efficient at improving health outcomes (individual or group). There is a variety of group factors that can create an influence, including leadership style, the characteristics of the individual participants, and the multiple interactions that take place within a group context. Hoddinott, Allan, Avenell, and Britten (2010) propose an in-depth framework to be utilized as an initial step toward creating interventions for groups.
Another consideration for outcomes measurement has been discussed by McLeroy, Bibeau, Steckler, and Glanz (1988). They believe that the level at which the intervention occurs needs to be evaluated because it will influence the outcome measurements. They theorize that the macro, meso, or micro levels each have variables that can affect individual and group outcomes.
Summary
There is no doubt that healthcare providers need outcome measurements to evaluate healthcare interventions for a myriad of reasons. As we search for new approaches to address the gaps in our healthcare system, outcomes will play an increasingly important role in the decision-making process regarding which interventions best serve our patients and society in a cost-effective manner. Unfortunately, the assumption that individual healthcare outcomes can be extrapolated to group healthcare outcomes has yet to be confirmed. Practitioners and policy makers would be in a better position to discern which interventions are appropriate for groups based on outcomes if they had an evidence base to support group interventions.
References
American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington, DC: Author.
Barham, L. & Devlin, N. (2011). Patient-reported outcome measures: Implications for nursing. Nursing Standard, 25(18), 42?45.
Gordis, L. (2009). Epidemiology (4th ed.). Philadelphia, PA: Elsevier Saunders.
Hoddinott, P., Allan, K., Avenell, A., & Britten, J. (2010). Group interventions to improve health outcomes. BMC Public Health, 10, 800. doi: 10.1186/1471-2458-10-800.
Leipzig, R. M., Whitlock, E. P., Wolff, T. A., Barton, M. B., Michael, Y. L., Harris, R., et. al. (2010). Making prevention recommendations relevant for an aging population. Annals of Internal Medicine, 153(12), 843?844.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective health promotion programs. Health Education & Behaviors, 15(4) 351?377. doi:10.1016/SO149-7189(97)00016-5.
Nelson, E.C., Batalden, P.B., Plume, S. K., Miheve, N.T. & Swartz, W. G. (1995). Report cards or instrument panels: Who needs what? The Joint Commission Journal on Quality Improvement, 21(4), 155?166.
Nelson, E. C., Morh, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving healthcare, part 1: The clinical value compass. Joint Commission Journal on Quality Improvement, 22(4), 243?58.
Romley, J. A., Anupam, B. J., & Goldman, D. P. (2011). Hospital spending and inpatient mortality: Evidence from California. Annals of Internal Medicine, 154(3), 160?167.

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The post Regardless of what definition or combination of definitions one espouses, the necessity of incorporating ?outcome measurements? appeared first on THE NURSING PROFESSIONALS.

Regardless of what definition or combination of definitions one espouses, the necessity of incorporating ?outcome measurements?