A private nursing home has an agreement of a laboratory. the nursing home sent its patients to the lab for…
A private nursing home has an agreement of a laboratory. the nursing home sent its patients to the lab for test and receive a commission per patient.Is that legal?
In this discussion, you will consider how historical lenses can affect the study of a historical topic. Select one of the secondary source articles from your research. After reading that article, write a discussion post about which of the following lenses you believe the article is using: social, political, economic, or other. Use at least two quotes from your source to justify your choice of lens. Your post title should also indicate which topic you have selected.
When responding to your peers, compare and contrast the lens they identified with the lens you identified for your source. If you identified the same lens, how does the evidence you each found to justify that choice compare with each other? If you selected different lenses, discuss how your historical topic might look through the lens they identified
For your response posts (2), you must do the following:
classmates Post #1:
I chose to study more about Nelson Mandela and his lifelong wish to end apartheid in South Africa. In my research I chose to narrow the timeline to his life to prison on Robben Island. I believe my article is seen through the political lens as well as a social lens. The writer focuses on Nelson Mandela and fellow prisoners who opposed the apartheid and wanted all South Africans to have equal rights. It concentrates on how the men tried to study and understand how to better change the laws of the country that they loved while they were incarcerated. The men studied and debated during any free time they had on the island. The political climate on the island was fractious and involved inter-organizational disputes and suspicions. Once the debate got underway, however, it allowed organizations and the individuals within them to clarify important social and historical questions for themselves. (Soudien, 2015)
During incarceration Nelson Mandela and his fellow inmates tried to study using books and publications. The prison guards made it very hard for them to do so. Prisoners still persevered debating to understand the world around them. Their dream was to reshape South Africa to make it a place where people of color were treated as equals under the law. Alexander a fellow prisoner explained, ‘throughout this period, even when they took away our study privileges, when they really messed us around, we turned that prison into a university’. (Soudien, 2015)
Reference: Soudien, Crain. (April 2015) Nelson Mandela, Robben Island and the Imagination of a New South Africa. Journal of Southern African Studies.
classmates Post #2:
My research topic is the South African Apartheid. I reviewed many of the primary and secondary source articles, but for this discussion, we want to review one of my secondary source articles. There was a secondary source article in the ProQuest Central. I found an article from the Los Angeles Sentinel on Oct 1, 1992. The title of the article was “South African Talks Resume”. This particular article is using the social lens as they give us details on what is going on at this time in Johannesburg, South Africa. It doesn’t take long to come to this conclusion after reading the second paragraph which states “Disagreements between the government and the African National Congress on a new constitution have stalemated efforts to end apartheid and share power with the black majority”. This is a specific example of examing the actions and behaviors of how different groups of people interact with each other. There is another quote in this article that states ” De Klerk ask Mandela to attend a Summit after 28 ANC protesters were killed Sept. 7 when security forces in the Ciskel Black homeland fired on a protest March”. This article in the Los Angeles Sentinel on Oct 1, 1992, is definitely using the social lens here because it focuses on people and their interaction with each other. As you may already know the South African Apartheid was centered around areas of ethnicity and classes of people, but that wasn’t all this terrible law was about.
Reference: ProQuest Central: Los Angeles Sentinel on Oct 1, 1992 https://search-proquest-com.ezproxy.snhu.edu/central/docview/369407035/28075BE98C8A446DPQ/1?accountid=3783
This course is an examination of theories and research related to what is commonly referred to as the ‘Information Society.’ The objectives of this course are to look at the origins of the information society and the information industries, the micro and macro economics of information as a commodity, new forms of participation and community online, issues of informational privacy, security, intellectual property, activism, and the economic, social, cultural, and political dimensions of new media technologies.
While each week we cover individual units on information industries, participation, regulation, privacy, IP, politics, and emerging technologies, the challenge for scholars is not just to understand each of these issues, but to understand how these developments and issues are intertwined.
Wu writes about how the shape of information industries affects laws, innovation, and content. Curran writes about how the development of the internet affects what types of participation is possible and how it gave rise to advertising content. Ito writes about how emerging technologies shape our cultural experience with space and one another, Jenkins and Varnelis argue that online participation has started changing the media industry and our broader social and cultural experience. Lessig writes about how the internet has change laws, as well as how legal can be applied to regulate the internet through code. Later this semester we’ll read about Turow and Andrejevic’s argument about how the rise of the industry and the internet has allowed people to be tracked and surveilled, Boyle’s argument about how the internet challenges intellectual property law, Pariser and Gillespie’s argument about how the role that algorithms play in managing our information environment, Beyer’s argument about how the anonymity/distributedness of the internet gave rise to challenges like Wikileaks and 4Chan, Papacharissi and Morozov’s arguments about how the internet affects political movements and dissent, and finally Liao’s argument about how augmented reality technologies may be the new technology that extends and revisits all of these questions.
Your final paper research paper will require you to conduct an academic literature review tying together multiple threads, and understanding how these various authors are talking about issues that have direct implications for one another. Essentially, you have to make an argument for how one central concept of the information society might affect another. For example, you could analyze how tracking and surveillance could affect participation, identity, and politics. You could analyze how algorithms might affect our identity and social/cultural experience. You could analyze how legal/regulatory changes could affect remix culture, online participation, innovation, and harmful content/behaviors on the internet. You could analyze how augmented reality technologies change our understanding and relationship to space. These are just some of the examples that you could write about, you make a decision.
Before you can do that, you will need to do a literature review about the key issues that you are focusing on. Think about these as if you were preparing for a debate, and first you had to outline and explain the problem, issues, and discussions that were taking place. This assignment is a prerequisite to being able to write your paper.
Task One – Identifying Your Research Area (15 points total)
1. Write down in a paragraph what units you are combining and what concepts you are exploring, how you think they are interrelated, and why you are interested in this issue (5 points).
2. Identify the authors that we’ve read/will read who have tackled those particular concepts in that unit, and explain in detail what they have said about those concepts (10 points),
Task Two – Doing a Literature Search (5 points)
Each of the authors we read in any given unit is just the tip of the iceberg. Dozens if not hundreds of other authors are engaged in research and attempting to explore the same topic, some of whom are in direct conversation with one another. This step is to identify articles that are going to help you explore that concept further and identify the key perspectives and people who are engaged in that debate.
This task asks you to conduct a series of searches that will successfully identify a reasonable number of recent primary research articles published in a peer reviewed communication journal, from the following databases:
a) Communication Abstracts;
b) Communication and Mass Media Complete;
c) PsycInfo; and
d) Sage Publications
3. Doing a database search: Conduct at least three different searches in each database, combining key terms related to your topic of interest (e.g. internet advertising and surveillance), You may need to try several different search combinations for each database in order to find a relevant article to begin with; once you find search terms for a particular database that identifies at least one article, enter this term in the first line of the table below.
Then try two other search terms that come from keywords in the first set of results, or are synonyms for the concept you think may be relevant, so that you end up with a reasonable number of articles (between 10-250, less than that is probably too specific, more is probably too broad and too many to go through) – fill out the keywords on the chart on the next page (5 points).
Database Search Term(s) # of Articles
Communication Abstracts 1)
2)
3)
Communication and Mass Media Complete 1)
2)
3)
PsycInfo 1)
2)
3)
Sage Publications 1)
2)
3)
Task 3: Annotated Bibliography (75 points)
Within your searches, you will start finding articles that approach the issue from multiple different perspectives and using a variety of different methods and theories. Select total of 4 articles to read carefully (averages out to 1 article per week), and answer the following questions about each. Your articles should be split evenly amongst the two units/concepts you are analyzing
Unit 1 – Article 1:
Title:
Author:
Abstract:
1. What theories did these authors draw upon? Explain the theory and what their research questions were.
2. What were their primary findings or argument?
3. How does this article engage with the arguments/concepts in our readings?
4. How will this article help you understand your research area?
Unit 1 – Article 2:
Title:
Author:
Abstract:
1. What theories did these authors draw upon? Explain the theory and what their research questions were.
2. What were their primary findings or argument?
3. How does this article engage with the arguments/concepts in our readings?
4. How will this article help you understand your research area?
Unit 2 – Article 1:
Title:
Author:
Abstract:
1. What theories did these authors draw upon? Explain the theory and what their research questions were.
2. What were their primary findings or argument?
3. How does this article engage with the arguments/concepts in our readings?
4. How will this article help you understand your research area?
Unit 2 – Article 2:
Title:
Author:
Abstract:
1. What theories did these authors draw upon? Explain the theory and what their research questions were.
2. What were their primary findings or argument?
3. How does this article engage with the arguments/concepts in our readings?
4. How will this article help you understand your research area?
Example of what an annotated bibliography looks like:
Unit/Concept: Fan Relationships with Media, Article 1
Cohen, J. (1997). Parasocial relations and romantic attraction: Gender and dating status differences. Journal of Broadcasting & Electronic Media, 41(4), 516-529.
This empirical study attempts to connect TV viewers’ “models of attachment” with parasocial relations (PSR) established with favorite television characters. More specifically, Cohen is interested in further defining the relationship between PSR and one’s “real world” social attachments, i.e., a romantic relationship with a significant other.
1. Theories and RQ: Models of Attachment
Drawing on the cognitive psychology literature, Cohen suggests that such “models of attachment” are “cognitive representations of self and others that evolve out of experiences with attachment figures and are concerned with the regulation and the fulfillment of attachment needs” (p. 517, quoting Hazan, Collins, & Clark, 1996, p. 39). In other words, our formative experiences with parents and other adult figures create expectations for our future needs, and lead us to seek out particular types of adult relationships.
Research Questions and Hypothesis: Cohen is interested in how gender differences affect how we form para-social relationships with fictional media characters. Cohen lays out the following hypotheses (quoted from the text):
H1: The correlations between the dimensions of a subject’s attachment models and the intensity of their PSR will be stronger for dating subjects than for single subjects.
H2: Among dating men, attachment anxiety will be positively associated with the intensity of PSR.
H3: Among dating women, attachment security (depending on one’s partner and comfort with intimacy) will be positively associated with intensity of PSR.
2. Key Findings: Given the differences found in this study, Cohen suggests that more attention should be paid to the study of gender in PSR. For instance, though this study did not measure it directly (and thus cannot make related claims), it is possible that TV takes on different meanings (as well as distinct uses?) for men and women. Cohen suggests that his findings lend credence to a “notion of a socio-cognitive similarity between interpersonal and symbolic relationships” (p. 526), identifying particular factors (i.e., attachment schema, gender, relationship status) that matter in determining the interplay between interpersonal and symbolic (i.e., PSR) relationships. Thus, Cohen concludes that attachment theory (as well as social cognition and social psychological theories more generally) is a useful lens with which to understand media studies, and should be further expanded.
3. How it is related to our readings – The Cohen reading offers one explanation for why people engage in certain types of participation online related to media fan groups, which Jenkins and Ito describe as changing the role of online communities as well as the media industry itself. The Cohen particular piece found that single men and women are more likely to develop symbolic relationships with fictional characters, which begin to explain how media can encourage participation and provides an explanation for why queer-baiting as a deliberate strategy to attract audiences and participation is effective.
4. How it will help you understand your research area – will vary depending on your question
ABSTRACT
Lateral cephalometric radiographs are most commonly used as a diagnostic tool in orthognathic surgery as well as orthodontic treatment. But the limitation of lateral cephalograms is its 2 dimensional nature whereas the human body is 3 dimensional. Conventional 2D lateral cephalograms have numerous drawbacks in terms of investigating the changes in the alveolar bone and roots, particularly in the anterior region, as a consequence of the midsagittal projection. Additionally its accuracy is questionable as it has projection errors. The use of computed tomography in 3D imaging of human body is available in the field of medicine since last 30 years. CT scanning is the three dimensional imaging technique giving quantitative assessments of the buccal and lingual cortical bone plates and labiolingual width of alveolar bone with elevated accuracy and precision. But the use of computed tomography in dentistry is limited because the amount of radiation exposure with this technology is very high. Since the invention of Cone Beam Computed Tomography, the amount of radiation exposure in the patient is reduced. This enhances its use in obtaining the 3D images of the craniofacial structures. This technology helps in visualizing the hard and soft tissues of the craniofacial structures from various perspectives and helps in thorough diagnosis and treatment planning of orthognathic surgery and orthodontic patients. The principles of CBCT and its use in the field of orthodontics will be discussed in detail in this paper.
KEYWORDS:
Cone beam computed tomography, Surgical orthodontics.
INTRODUCTION
Orthodontics is a field, which places a significant amount of emphasis on the modification of abnormal craniofacial growth patterns, in addition to the correction of dental malrelationships. Successful orthodontic and surgical treatment of such anomalies naturally requires efficient and reliable imaging of the structures of the cranial complex. Ever since the advent of the Bolton cephalometer in 1931 [1], orthodontists have consistently used lateral cephalograms in evaluation of treatment as well as in diagnosis and treatment planning. In addition, postero-anterior, panoramic, occlusal and peri-apical views of the skull and teeth have been used as and when required to aid in the diagnosis. All these additional radiographic views add up to a significant quantity of radiation exposure to the patient, which can and should be avoided if possible. Also, the 2 dimensional nature of these conventional radiographic views imposes further limitations such as overlap, leading to lack of visualization of individual structures, errors due to projection, as well as the incapability to identify true skeletal asymmetries when present [2]. Thus, it has been recognized for some time now that three- dimensional imaging of the skull is the need of the hour in orthodontics.
3D Computed tomography in Orthodontics
The use of computed tomography in 3D imaging of human body is available in the field of medicine since last 30 years. But the high radiation exposure and the prohibitive cost of this technology have till now precluded its use in orthodontics. However, recent advances in CT technology have seen a dramatic decrease in radiation as well as in cost, making it a viable and desirable alternative to traditional imaging. The newer CT machines can now perform a complete scan of the head in just a few seconds and provide the patient an effective dose of only 50 micro-Sieverts, compared with about 2000 from a conventional CT scan of the entire head [3]. This follows the ALARA principle (As low as reasonably acceptable) for radiation exposure, of the American Dental Association.
Radiation exposures are further reduced when one believes that a single CT image can replace a number of conventional radiographs that are now considered essential for almost every orthodontic procedure. Thus, the routine use of CT scans for orthodontic diagnosis may not be very far away [4].
Cone Beam Computed Tomography (CBCT): Technique and Advantages
Conventional CT machines acquire image data by using either a single narrow X-ray beam or a thin broad fan-shaped X-ray beam. These X-ray beams rotate around the patient in a circular or spiral path as the patient moves through the scanning machine or as the rotating beam passes over the patient. A series of detectors register the attenuation of these X rays, and from the data gathered, the machine reconstructs the internal structure of the patient’s body [5]. 3D data of the patient’s anatomical structures is stored in the form of Voxels. These can be thought of as tiny cubes arranged next to each other. The brightness of each cube represents the density of the corresponding anatomic structure. Obtaining the final 3D object from the raw data requires a time consuming process called rendering, which is achieved using computer algorithms [6].
However, a new digital imaging breakthrough, the NewTom QR 9000 Volume Scanner (Verona, Italy) is now available for clinical practice. This CT scanner uses a cone-shaped X-ray beam that is large enough to encompass the region of interest. It produces a much focused beam, minimizing scatter, thus reducing the absorbed radiation dose to 45 microSieverts [7]. In contrast to conventional CT imaging the patient remains stationary throughout the procedure. In a single scan, the X-ray source and a reciprocating X-ray sensor rotate around the patient’s head and acquire 360 pictures (1 image per degree of rotation) in 17 seconds of exposure time. The 360 acquired images undergo a primary reconstruction to mathematically replicate the patient’s anatomy into a single 3 dimensional volume. Further, the software allows for reformatting and viewing the image data from any point of view in all 3 dimensions. Thus, from a single scan, frontal, lateral, panoramic and other views can be created. Additionally, the anatomy can be peeled away layer by layer to locate the desired section. A major advantage of CBCT-generated cephalograms is the ability to excise unwanted structures such as the cervical spine and occiput, avoiding superimposition of irrelevant structures, and providing a remarkably clear image of pertinent maxillo-facial structures [8].
Uses of 3-dimensional computed tomography in Orthodontics
The alveolar bone height is particularly important in adults and periodontally compromised patients. Assessment of available bone is necessary prior to arch expansion or labial movement of incisors. Surface irregularities due to ectopic teeth, bone dehiscences, salivary gland invaginations and other abnormalities can also be visualized in three- dimensional images. A new resource for occlusal assessment is the lingual view-as if the clinician were looking from the back of the patient’s head into the oral cavity.
Impaction (or failure of eruption) of teeth is a common orthodontic problem, which requires precise localization for the purpose of surgical exposure and guidance into the oral cavity. Conventional views such as the occlusal and periapical views cannot precisely locate such teeth. CT scans with 3 dimensional reconstructions provide an excellent means to accurately locate such teeth. In such a study done on a 21 year old girl, by Ravinder et al. [9], an impacted maxillary left canine was accurately localized, and revealed to be in a horizontal, palatal position. This was done, by obtaining various views, such as plain axial, sagittal CT slices, as well as superior, sagittal and superior- oblique views of the maxillary dentition. Walker, Enciso and Mah [10] have also reported the advantages of 3D imaging in the management of impacted canines. In addition, cysts of the jaws, supernumeraries and ectopic/buried teeth can also be visualized using this technique.
Coronal, sagittal and axial views of the temporomandibular joint obtained from the CT scan can be correlated with the occlusal views. Functional shift of the joints can be occasionally detected as differences between the left and right TMJ views. In addition, 3D CT studies on patients who underwent orthognathic surgery, have allowed better evaluation of post surgical condylar resorption [11].
Surgical planning for patients with jaw asymmetry, e.g. Hemifacial Microsomia can benefit from 3D imaging. This allows measurement of true jaw dimensions without the customary problems of magnification, superimposition and distortion, inherent in 2 D cephalograms. Use of virtual “cutting tools” and “collision tools” to plan out surgery on the 3D images, means that orthognathic surgery as well as distraction osteogenesis can be carried out with a far greater degree of precision, leading to more predictable results. [12]
A conventional photograph is a simple two- dimensional representation that is not correlated with the supporting skeleton. The 3D volume can provide any frontal, lateral or user-defined view of the face, and by altering the translucency of the image, one can determine the exact relationship of the soft tissues to the skeleton. This has major implications in the planning of tooth movements, orthodontic extractions, orthognathic surgery, and other therapies that could alter facial appearance.
Volume measurements of the tongue could provide a more objective assessment of size, to aid in the diagnosis of arch-width discrepancies and open bites.
Volume measurements of the airway could evaluate patency, particularly in patients suspected of adenoid hypertrophy, mouth-breathing or obstructive sleep apnea. Turbinates and nasal morphology can also be evidently seen in CT scans. This would mark a significant improvement over the use of 2 dimensional lateral cephalograms.
3D CT images can show areas of root resorption on central and lateral incisors adjacent to impacted canine teeth. Walker, Enciso and Mah [10] showed that incisor resorption adjacent to impacted canines is present in 66.7% of lateral incisors and 11.1 % of central incisors. A correlation was found between the proximity of impacted canines to the incisors and their resorption. Current CT machines may have too low resolution to detect early stages of root resorption as a result of orthodontic movement, but this may be possible in the future [6].
Osseo-integrated implants may be used in orthodontics either for the prosthetic replacement of missing teeth, or as stationary anchorage to facilitate tooth movement. Optimal spacing as well as correct root angulations of adjacent teeth must be achieved in order to successfully place dental implants [13]. Cone beam CT scanning could be used to accurately assess space availability, root angulations, as well as the quality of alveolar bone at the implant site. This would replace the use of panoramic and peri-apical radiographs currently used for the purpose.
Conventional 2D cephalometric measurements can also be carried out, by rendering a 2D projection of the 3 D data, resembling a radiograph. For bilateral cephalometric landmarks, the computer can calculate the midpoint between them. Certainly, new cephalometric landmarks and analyses based on 3D data shall be developed in the near future.
Conclusion
3D computed tomography represents the cutting edge of orthodontic imaging and diagnostic capability. While mainstream orthodontists are still living and practicing in a 2D world, orthodontic residents in many universities are becoming 3D sense. The several distinct advantages of 3D CT imaging, with ever-decreasing radiation doses, mean that this is where the future of orthodontic imaging lies.
References
ESSY QUESTION: Sternberg and Gardner have proposed multiple-intelligence theories against traditional theories that focused on a single view of intelligence. Critics of multiple-intelligence theories ask whether every specialized skill must have a separate intelligence. On the other hand, studies of the brain have shown that it processes different categories of data in different parts of the brain. Evolutionary psychology analyzes the functioning of the brain to explain the human mind. Do you think that the evolutionary psychology approach answers the criticism leveled against multiple-intelligence approaches? You may find articles on this approach on the Internet and in your local libraries. Also research information on how the human brain processes different categories of data in different parts of the brain. Write a reflective essay based on your research.
2 PAGES
Creditable site…NO Wiki
3+ citations
Grade Rubric:
Critical Elements Distinguished Proficient Emerging Not Evident Value
Main Elements Includes all of the main elements and requirements and cites multiple examples to illustrate each element
(23-25) Includes most of the main elements and requirements and cites many examples to illustrate each element
(20-22) Includes some of the main elements and requirements
(18-19) Does not include any of the main elements and requirements
(0-17) 25
Inquiry and Analysis
Provides in-depth analysis that demonstrates complete understanding of multiple concepts
(18-20) Provides in-depth analysis that demonstrates complete understanding of some concepts
(16-17) Provides in-depth analysis that demonstrates complete understanding of minimal concepts
(14-15) Does not provide in-depth analysis
(0-13) 20
Integration and Application All of the course concepts are correctly applied
(9-10) Most of the course concepts are correctly applied
(8) Some of the course concepts are correctly applied
(7) Does not correctly apply any of the course concepts
(0-6) 10
Critical Thinking Draws insightful conclusions that are thoroughly defended with evidence and examples
(18-20) Draws informed conclusions that are justified with evidence
(16-17) Draws logical conclusions, but does not defend with evidence
(14-15) Does not draw logical conclusions
(0-13) 20
Research Incorporates many scholarly resources effectively that reflect depth and breadth of research
(14-15) Incorporates some scholarly resources effectively that reflect depth and breadth of research
(12-13) Incorporates very few scholarly resources that reflect depth and breadth of research
(11) Does not incorporate scholarly resources that reflect depth and breadth of research
(0-10) 15
Writing
(Mechanics/Citations) No errors related to organization, grammar and style, and citations
(9-10) Minor errors related to organization, grammar and style, and citations
(8) Some errors related to organization, grammar and style, and citations
(7) Major errors related to organization, grammar and style, and citations
The Institute of Medicine report asks and answers the nation’s most important health care questions. They produced a report with recommendations for future of nursing and healthcare. It states that high-quality; patient-centered health care will require a transformation of the health care delivery system (IOM, October 2011). The committee that designed the report came up with four key points. The first three deals directly with nursing practice and these are as follows: Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training, through an improved education system that promotes seamless academic progression.
Research the various change models used by organizations today. After assessing these models, create a change model conducive to your field (Nursing), and that will work within your organization’s culture (Kaiser Permanente). This model should serve to implement a strategic process that can help your organization integrate a change and respond to the internal or external driving forces that affect organizational success.
Create a visual representation of your model using a graphic organizer of your choice (flow chart, concept map, etc.). The design of your model will be unique and relevant to your organization (Kaiser Permanente), based on a critical analysis of its culture and behavior. However, your model must demonstrate the necessary steps for realistic implementation. Your model will be assessed on the quality of strategic implementation you design, the support you present for your model, and inclusion of the following concepts:
1.Methods to evaluate the need for change
2.Approach and criteria for choosing individuals or teams necessary for a change initiative
3.Communication strategies
4.Strategies to gather stakeholder support and overcome resistance
5.Implementation strategies
6.Sustainability strategies
Once you have created your model, prepare a 15-20 slide PowerPoint presentation to present your model and demonstrate how this model is relevant to your organization and why it will work well within your organization’s culture. In conclusion, discuss why this model will lead to sustainable change when most change initiatives fail.
Phase 3: Analyzing the Aggregate Strengths and Weaknesses
Phase 3: Analyzing the Aggregate Strengths and Weaknesses
For Phase 3 of the Capstone project, analyze and describe the strengths and weaknesses of the aggregate and the community where the aggregate resides.
Be sure to apply Mobilize, Assess, Plan, Implement, Track (MAP-IT) in your assessment process.
submit your response in a 1-page Microsoft Word document.
Phase 4: Risk Assessment
For Phase 4 of your project, you will select a family in your aggregate and complete a risk assessment in the field using the information from chapter 18 “Community as Client: Assessment and Analysis” and “Appendix D Friedman Family Assessment Model (Short Form)” as a guide. Describe how the family, environment, home, and risk assessments were conducted, using your course textbook as a reference. Describe the results of the assessments, drawing conclusions about the health risks to the aggregate as you see them..
submit your response in a 2- to 3-page Microsoft Word document.
Submission Details
Combine Phase 3 and Phase 4 documents into one paper. Use bold sub-headings in the paper to distinguish Phase 3 from Phase 4.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Interprofessional practice in the hospital setting is a process that involves different professional groups- such as doctors, nurses, pharmacists, physiotherapists and occupational therapists, working together effectively. The degree to which different healthcare professionals “collaborate” can ultimately affect the quality of the health care that they provide.
Almost everyone who requires medical attention will interact with more than one health professional. The number of professionals involved, and the importance of their ability to work collaboratively increases with the complexity of the patient’s health needs (1). For example, a chronic diabetic patient may require the expertise of the dietician, podiatrist, social workers and district nurses in addition to diabetic specialists as part of their medical care package. These professionals will need to work together in order to achieve maximum success on the management of the patient’s condition, as well as being cost effective to the NHS as the government plan to cut NHS spending.
The interaction of the different professionals is crucial, giving rise to many potential positives:
It allows the development of an understanding and “respect of one’s own and others’ roles and responsibilities” (2).
It allows a more easier resolution of conflicts as a result of different approaches to patient care (2)
It allows a strong communication pathway to form between the medical team and the patient. If there is a strong collaboration, implementation of new initiatives to treatment and management can be easily fulfilled.
The establishment of a more satisfying working environment, where professionals can support one another.
Despite the attempts to have strong interprofessional collaboration, there are certain barriers to this; an intriguing barrier of which are “professional cultures”. Baxter and colleagues stated that each health care profession has a different culture, which encompasses values, attitudes, behaviours, beliefs and customs. As the different professions developed separately, the cultures evolved; and combined with different training/educational experience, a form of “tribalism” generated with “deeply rooted boundaries” between professions (3). Increasing specialization (e.g. with obstetric medicine) has led to “further immersion of the learners into the knowledge and culture of their own professional group” (4).
It is also strongly believed that inter-group stereotyping hampers effective working relationships. One negative stereotype is that “doctors cure, nurses care”; doctors having a “masculine”, objective view of their patients, whereas nurses, since the time of Florence Nightingale, having a more “feminine”, nurturing and caring view. Working close to doctors improves the nurse’s status. This in itself has given unequal power favouring doctors (5).
Other barriers include differences in medical language and jargon; differences in the professions’ schedule and routine; interprofessional rivalries; and differences in payment and reward structures (1).
Geriatric medicine is a field that requires a high level of professional collaboration in order to be successful in patient management. All of the patients not only require complex health care, but also need evaluation as to whether they are fit to be discharged back to their home, or to a nursing/residential home. It is an interesting area therefore, to hear the view points of various different professionals as well as observing the level of collaboration involved in geriatric medicine, and was subsequently chosen by myself. We interviewed and observed a physiotherapist, occupational therapist, a healthcare assistant, a ward nurse, the discharge coordinator, the pharmacist and the F2 doctor, as well as attending “white board” and multi-disciplinary meetings, on Caesar Hawkins ward.
A number of key points arose from interviewing the various professions. It was widely considered that the discharge coordinator, a highly experience nurse, was the most valuable professional to have in the team. They are important, as their role includes the allocation of patients to social workers; arranging check-list meetings and liaising with family; referrals to district nurses; TTOs; and foreseeing the best care package for the patient such that they don’t “bounce back” into the hospital (thereby being costly to the NHS). As a medical student, I was previously unaware of the duties of the discharge coordinator, but I now felt that she was a crucial part of the team because the health care of the patients flowed with her input.
The “Health Needs Assessment” was a valuable tool in bringing the team together. This is a 20+ paged form discussing the patient’s health issues- their needs, nutrition, behaviour, amongst other important management features. It requires written input from all professionals, and finally checked over by the discharge nurse. Filling this important document was deemed to be a very effective collaborative effort, as the professionals felt their expertise was valued and listened to.
The occupational therapist (OT) highly praised the team work on Caesar Hawkins. He felt that his input was considered important, and felt the team openly communicated with each other. He stated that there was a particular link between the physiotherapists and the social services. He stated that the physiotherapists got the patients “up and ready to go” whilst the OT explored “how the patient will manage in any environment” which then leads to liaison with social workers.
The physiotherapist felt the white board meeting was crucial to interprofessional working. In these meetings, the team discuss each patient, starting with a brief summary of the condition of the patient, followed by more detailed analysis on the patient’s progress in their rehabilitation, and their discharge plans. These meetings are, perhaps, more different than multi-disciplinary meetings (MDT), as the doctor has less of an input than the other different professionals. However, what was interesting was how the consultant slowed the meeting down, such that every opinion and expert advice was taken into consideration. I found this a very useful collaborative tool. The physiotherapist felt her input was well respected. She had a closer collaboration with the OT, but felt all levels of collaboration were equally important. For example, with the doctor, the two different professions assess baseline and progress in mobility; with the nurses the two professions discuss the patient’s ability to self-toilet and maintain personal hygiene. The physiotherapist works on one particular ward during each rotational block they are on, and she felt Caesar Hawkins had the best team and interprofessional collaboration.
Interviewing a nurse again portrayed good collaborative practice on Caesar Hawkins Ward. The nurse stated that he spends the majority of the time with the patients, and therefore has an important role in updating doctors on the patient’s condition. He felt the doctors relied on his input to a significant degree, thereby creating a need of good communication and interprofessional working. On observation of the level of communication between doctor and nurse, the nurse was able to explain his view and concerns on a particular patient, and action was taken quickly by the doctor, thereby providing the best health care. In MDT meetings, the nurse’s input and expertise was clearly valued- if there was a patient a doctor felt could be discharged, but the nurse disagreed upon, it was often the nurse’s opinion which had the final say. The nurse felt his expertise meant he was able to determine which environment a patient would best flourish in.
There were a few areas of concern- sometimes the nurse felt there was poor communication between nurses and administrative personnel, leading to the nurses being short-staffed. This leads to the nurses having too many patients to take care of, leading to less individual patient attention and less constructive feedback to the rest of the team. Additionally, the nurse felt there should be twice daily ward meetings for nurses alone, in order to discuss any patient that requires more focus on, or to mention any improvements or decline in a patient’s condition. Just recently St George’s have introduced a “productive ward scheme” allowing nurses from different wards to get together and discuss any issues they have in their working environment. The effect it has on interprofessional working is still too early to tell.
A health assistant to the nurses was interviewed, and her views were supportive of the high level of interprofessional working in this ward. She felt, to a fair degree, well recognised and respected for her expertise in health care; she felt she had strong collaboration with the nurses and physiotherapists; however, there were various doctors who had a negative stereotype of her role, often ignoring her valuable input to the patient’s care, and ignoring her presence even at the patient’s bedside. She feels the best way to have professionals working together is to be highly appreciative of what each different profession has to offer.
The most important member of the team is the patient, so it was crucial to have a patient’s view on their experience of interprofessional practice. The patient interviewed had a mild form of dementia, but was still aware of his health care, and felt the different professionals not only worked well together but helped each other synchronously. This was shown when he described his physiotherapy sessions, which were often entwined with occupational therapy input. The team communicated well with him, and he was always informed of the next steps in his management.
The quality of modern day health care received is largely reliant on how effective different professionals can work together. This is because it is not feasible for one professional to have all the skills and the knowledge to deal with the degree of complexity of the patient’s illness.
I found that Caesar Hawkins geriatrics ward shows an excellent example of interprofessional practice being implemented in patient health care. The feedback received was excellent, there is strong communication between all professionals, as viewed through the MDT and white board meetings; the different professionals respect one another; the environment is satisfying and supportive. There is a strong aura that the professionals acknowledge the value of sharing knowledge and their expertise. The team governing this ward are able to integrate their resources to nullify the complexity of health care in geriatric medicine.
I believe that the value of interprofessional working can be brought into the education of students in each profession right from an early stage. For example, in medicine, we are taught the fundamentals of diagnosing and treating patients; we can combine this by learning and experiencing what input the physiotherapist would provide in the given situation, or the occupational therapist, thereby learning and strengthening communicative skills and developing the concept of working as a team to fulfil health goals.
I felt that the discharge coordinator can be seen as a professional advisor, through which all the professional expertise is channelled through, helping to remove boundaries between different professionals.
Reflecting from what I was told by the health assistant, I realised that collaboration starts from the simple acknowledgement of the people that are around you. They should be considered as your day and night support team, and we should make the effort to appreciate their input in the health care of the patients. It should be a moral obligation to work interprofessionally to provide the best service and fulfil the interests of our patients; much like for “clients” in the business world.
I appreciated the value of the MDT and white board meetings. I saw them as an essential form of verbal communication. The NHS has largely relied on communication through written means such as case notes, care plans, referral letters and forms. Although this “inactive” form of communication is essential, it leads to a rigid approach from each profession for patient care. However, having regular interactive meetings removes a rather static collaboration and allows knowledge to be shared and learnt and effectively spread.
It is often stated that there is a hierarchy of power which threatens interprofessional practice. For example, it is thought that a senior, who is more experienced, has more power in the delivery of health care given, than a junior who lacks experience. I did not notice this, and from interviewing the F2 doctor, she felt she was treated with respect; her relatively lack of experience did not impact her input in the health care of patients.
There is a fear that interprofessional practice is a concept that the NHS are using in order to reduce costs. This is because one of the advantages of this practice is that medical staff are more efficiently used, and that if professionals gather knowledge from others, a particular profession may not be needed (6). I think this fear is irrational, because the knowledge of each profession is so deep that it will be impossible to exclude a particular profession. For me, I think the more different professionals working together effectively, the better the health care the NHS will provide. Other professionals that were not interviewed are dieticians and social workers, both of which being valuable resources to the NHS.
imagine that you are a health policy analyst for a state that has not elected to expand Medicaid as part of the Affordable Care Act (ACA). You have just been notified that the state leaders have agreed to reconsider their decision during an upcoming session. Go to the Kaiser Family Foundation Website, at www.kff.org, and The Commonwealth Fund website, at http://www.commonwealthfund.org/publications/blog/2014/mar/medicaid-expansion-alternative-state-approaches, for additional information on Medicaid expansion.
Write a three to four (3-4) page paper in which you:
Identify a state that has not elected to participate in the Medicaid expansion initiative under the Affordable Care Act. Critically analyze the implications of the state’s decision to opt out of Medicaid expansion on the citizens of the state.
Compare the potential opportunities and challenges of a state’s decision to opt into the Medicaid expansion.
Explore two (2) alternate approaches to expanding access to care that have been implemented or considered by states opting out of Medicaid expansion. Compare and contrast the two (2) alternate approaches to the Medicaid expansion initiative.
Provide a recommendation to the state legislature on whether or not the state should opt in to the Medicaid expansion. Provide a rationale for your recommendation.
Use at least three (3) recent (within the last five [5] years), quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as a
