Preliminary Data
Definition of Staffing Terms: To build a body of knowledge regarding the development of a staffing budget and later be able to create actual staffing plans, the registered nurse must first be familiar with the following terms and their definitions.
Nursing Hours Per Patient Day (NHPPD): A unit of measure that defines the average number of hours of nursing care delivered to each patient in a 24-hour period.
Hours Per Workload Unit (HPWU): A unit of measure that defines the average number of hours worked per workload unit. The workload unit can be number of visits, number of meals served, number of square feet cleaned, number of operating room minutes, and others, depending on the department worked.
There is a direct relationship between the workload and the amount of resources (RNs, LVNs, Aides, Dietary Aides, OR staff, etc.) needed.
Patient Day (PD): One patient occupying one bed for one day. Typically, counted at midnight. For example, a patient admitted to a nursing care unit at 11:50 p.m. will be counted in the midnight census for that unit; therefore will be counted as one patient day.
Average Daily Census: Patient days in a given time period (daily, weekly, monthly, or annual) divided by the number of days in the time period. It is also used to define the average number of total inpatients on any given day.
Variable Hours of Care: A component of NHPPD that measures the amount, in time, of care directly provided to the patient by a caregiver, e.g. RN, LVN, aide. It does not take into account fixed hours of care. Variable hours of care are also referred to as caregiver hours.
Fixed Hours of Care: A component of NHPPD that reflects the indirect care provided by nursing staff, e.g. unit secretary, nurse manager, clinical nurse specialist. This unit of measure is a constant, meaning that it is not dependent upon the acuity of the patient, or the volume of patients when calculating the staffing pattern.
Full-Time Equivalent (FTE): The equivalent of one full-time employee working for one year. It is calculated based upon 40 hours per week for 52 weeks, or 2080 hours. It includes both productive and nonproductive time. One employee, working full-time for one year (2080 hours) is one FTE. Two employees, each working 20 hours per week for one year (1040 hours each), are the equivalent of one FTE.
Replacement FTE: The number of FTEs required to replace non-worked hours.
Worked Hours: The actual number of hours worked, including both regular and overtime hours, orientation hours, on-call hours, callback hours, and training/education hours. Also known as productive hours.
Non-Worked Hours: The hours for which an employee is paid, but are not worked. Examples include vacation, sick, jury duty, holidays, funeral leave, paid time off, etc. The Fair Labor Standards Act dictates what an institution must include as non-worked hours. Also known as nonproductive hours.
Paid Hours: The total amount of worked and non-worked hours an employee is paid for.
Position: One person working one job, regardless of the number of hours that person works. A position is not the same as an FTE.
Shift: A designated number of hours that an employee works in a 24-hour period. A shift could be 4, 8, 10, 12, or even 16 hours in length. In this module, one shift will be considered as 8 hours.
Paid to Worked Ratio (PWR): Paid hours divided by the difference between paid and non-worked (nonproductive) hours. The PWR is calculated to determine the number of paid FTEs required. For example, one FTE is paid 2080 hours in one year. This FTE has 265 nonproductive hours (vacation, holiday, sick, etc.). PWR=2080/(2080-265)=1.15.
Worked FTE: The number of FTEs required to provide patient care on a daily, weekly, monthly, or annual basis.
Paid FTE: The actual number of worked FTEs plus the replacement FTEs needed during vacation, education, training, etc. to staff a cost center.
Cost Center: A unit or department in an organization.
Putting the Definitions to Use
Use the Excel™ Spreadsheet provided to document your answers. All calculations must be done using formulas in the spreadsheet, where applicable. Be sure to check your worksheet before submitting the assignment to ensure that when the reader clicks in a cell, the formula used to calculate the response is visible in the function bar.
Calculating an FTE
Remember, an FTE is based upon the designated number of hours needed to cover a specified number of shifts during a specific time period. The time period may be per week, per pay period (usually two weeks) or per year. A shift is 8 hours of worked time. Below are some examples of how an FTE is calculated:
· FTE = Number of shifts assigned to work every pay period. A Full-time employee works 10 shifts every two weeks, and this equals 80 hours in a pay period. An employee who is full-time would not necessarily have to work 10 shifts as long as they worked 80 hours. However, for the purposes of this module, all shifts are to be considered 8 hours long, so the employee must work 10 shifts to be considered full-time.
· FTE = Worked hours hours per pay period for full-time employee
FTE = 40 worked hours 80 hours = 0.50 FTE
· Hours = FTE x Hours paid per pay period for full-time employee
· Hours = 0.50 FTE x 80 = 40 hours (number of hours that a 0.50 FTE would be scheduled to work in a pay period)
· Shifts = Hours per pay period Hours in a shift
Shifts = 80 hours per pay period 8 hours = 10 shifts per pay period
10 shifts = 80 hours per pay period = 1.00 FTE
9 shifts = 72 hours per pay period = 0.90 FTE
8 shifts = 64 hours per pay period = 0.80 FTE
7 shifts = 56 hours per pay period = 0.70 FTE
6 shifts = 48 hours per pay period = 0.60 FTE
5 shifts = 40 hours per pay period = 0.50 FTE
4 shifts = 32 hours per pay period = 0.40 FTE
3 shifts = 24 hours per pay period = 0.30 FTE
2 shifts = 16 hours per pay period = 0.20 FTE
1 shift = 8 hours per pay period = 0.10 FTE
For each of the following scenarios, complete your answers using your knowledge of Excel basic formulas on the Worksheet provided in the Assignment Drop Box:
| FTEs |
ONE WEEK
HOURS |
ONE WEEK
SHIFTS |
ONE PAY PERIOD HOURS |
ONE PAY PERIOD SHIFTS |
| 0.2 |
8 |
1 |
16 |
2 |
| 0.4 |
|
|
|
|
| 0.6 |
|
|
|
|
| 0.8 |
|
|
|
|
| 1.0 |
|
|
|
|
| 2.0 |
|
|
|
|
Great!!! You have now mastered being able to calculate the number of shifts and hours that a designated FTW works in one week and in one pay period. Using the same principles, you could also calculate the number of hours and shifts an FTE would work in a month, quarter, or year.
The next step is to be able to compute the number of FTEs needed to staff for one week based on the number of shifts required. To be able to calculate this number, you need to know the following:
· FTEs = Total Shifts 5 shifts (shifts worked by 1 FTE per week)
· FTEs = An RN works 5 shifts per week. How many FTEs are required?
FTE = 5 5 = 1.00 FTE
Now, it’s your turn again!!! Fill in the missing shifts and FTEs, using Excel formulas:
| STAFF |
S |
M |
T |
W |
T |
F |
S |
SHIFTS |
FTEs* |
| NM |
0 |
1 |
1 |
1 |
1 |
1 |
0 |
5 |
1.0 |
| RN |
5 |
6 |
6 |
6 |
6 |
6 |
5 |
|
|
| LVN |
4 |
3 |
3 |
3 |
3 |
3 |
4 |
|
|
| NA |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
|
|
| US |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
|
|
| TOTAL |
14 |
15 |
15 |
15 |
15 |
15 |
14 |
|
|
*Format FTEs to 1 decimal place.
Calculating NHPPD
Were the previous calculation exercises easy for you to complete? Great!! The next few are just as easy, but they begin to combine the elements of required nursing hours per patient day and the unit’s FTE requirements. But, before we get to that, you need to know how to derive the NHPPD and its related components.
Let’s get started!
The numbers of FTEs allocated to a nursing unit are based upon the NHPPD for that particular unit’s patient population and acuity. A variety of sources are available to compare your unit’s NHPPD with other units. In many cases there are national nursing standards that can be used as comparative data (like units, with the same type of patient population, are compared to each other). These units with the same or similar patient types usually have common nursing care requirements. When this is true, those nursing unit’s NHPPD are averaged to create a standard NHPPD. This number can only be used as a guide to determine the NHPPD for your unit, because differences such as geography, nursing care delivery system, support services available, and other variables may not be accounted for.
Why is it important for RNs to understand the concept of NHPPD and know their unit’s hours? Simply put, NHPPD defines how much nursing care each patient on the unit requires in a 24-hour period. In a sense, it defines the level of care required. Without it, the staffing might be based upon volume, rather than patient needs, and nursing care in acute care units should be based upon the needs of the patient.
In one example, a total of 103 shifts were worked by the distribution of staff given for one week. For a particular week, this unit experienced 85 patient days. From this data, one can calculate the NHPPD:
· NHPPD = Total shifts per week x 8 hours per shift
Number of Patient Days
NHPPD = 103 x 8 = 9.69
85
Now, here is one for you to figure out. Please calculate the NHPPD for the following unit, using Excel formulas to complete your calculations:
Unit 3A has had 61 patient days in the past week, with a total of 98 shifts staffed. What was 3A’s NHPPD for that time period?
NHPPD* = ___________________________________
*Format NHPPD to 2 decimal places.
As we said earlier, NHPPD is a compilation of different types of hours, one of which is Variable Hours of Care or Caregiver Hours. Remember, variable hours of care delineates those hours of care that are directly provided to the patient by a caregiver, defined as the RN, LVN, or nurse aide. Calculating Caregiver Hours gives us how many hours within the NHPPD are spent providing direct nursing care. It is calculated:
· Caregiver Hours = Total shifts of RNs, LVNs, & NAs x 8 hours per shift
Patient Days
In one example, the total shifts calculated = 103. There were 12 non-caregiver shifts (NM and US), which leaves 91 Caregiver shifts. Assuming the same number of patient days (85) from above, calculate the Caregiver Hours:
Caregiver Hours = 91 x 8 = 8.56
85
Using the situation described previously for Unit 3A, calculate the Caregiver Hours where there were 54 RN shifts, 14 LVN shifts, and 13 NA shifts. Use formulas in Excel for your calculations.
Caregiver Hours* = __________________________
*Format the Variable Hours of Care (Caregiver Hours) calculation to 2 decimal places.
We hope that you noticed that your Variable Hours of Care did not equal the number you got for NHPPD. Great!! That is because we have not taken into account yet the Fixed Hours. Fixed Hours of Care are the hours required for indirect care for every patient on a unit. Fixed hours are comprised of the secretarial work, management of the unit, and non-direct patient care (e.g. patient teaching done by a CNS). Remember, this number is constant, since it is not affected by acuity or volume.
· Fixed Hours of Care = Total shifts of NM, US, etc x 8 hours per shift
Patient Days
From our first example, calculate the number of shifts worked by the NM and US. Using the same patient days of 85, calculate Fixed Hours of Care for this unit:
Fixed Hours of Care = 12 x 8 = 1.13
85
Are you ready? Using the same situation for 3A and knowing that there are 5 Nurse Manager shifts, 5 CNS shifts, and 7 Unit Secretary shifts, calculate the Fixed Hours of Care: Again, use formulas in Excel to complete your calculations.
Fixed Hours of Care* = ______________________
*Format calculation to 2 decimal places.
Hopefully, when you add your answers for the Caregiver Hours and Fixed Hours of Care, you came up with the answer you originally got for your NHPPD. Remember, this occurs because NHPPD is a combination of Variable (Caregiver) Hours and Fixed Hours of Care.
Calculating Paid FTEs and Positions
WOW!!! Your brain is probably already on overload, but the best is yet to come!!! Now, if you believe that, we have some beach front property in Arizona for sale… Interested?
Seriously, to complete the determination of staffing process, you must know how to figure paid FTEs and the number and type of positions needed. Paid FTEs differ from the FTEs you have previously figured because paid FTEs include both worked and non-worked hours. What you have done so far is to calculate worked FTEs.
· Non-worked Hours = Total shifts non-worked x 8 hours per shift
An example of calculating Non-worked Hours for a full-time employee is as follows:
Sick leave = 10 shifts per year
Vacation = 15 shifts per year
Holidays = 8 shifts per year
Training = 5 shifts per year
Misc. = 2 shifts per year
Total = 40 shifts per year
Non-worked Hours = 40 shifts x 8 hours = 320 hours per employee
Note: The number of non-worked hours for an employee is determined by the organization, which ensures consistent allocation of non-worked hours allocated. Although employees with seniority might have more vacation hours than new employees, for the purposes of this module, all employees have the same allocation of non-worked hours.
Here goes! Is your computer smoking yet??? Calculate the number of Non-worked Hours for any employee of 3A, using formulas in Excel, based upon the following data:
Sick leave = 12 shifts per year
Vacation = 10 shifts per year
Holidays = 6 shifts per year
Training = 3 shifts per year
Misc. = 3 shifts per year
Total = 34 shifts per year
Non-worked Hours = _________________
Calculating the non-worked hours is essential prior to figuring the Paid-to-Worked Ratio (PWR) for an organization. The PWR allows you to determine the total number of paid FTEs required to staff your nursing unit. As explained earlier, paid FTEs is a combination of worked FTEs and the replacement FTEs needed when, for example, someone is on vacation, ill, or at an education seminar. Replacement FTEs are necessary in order to maintain established staffing patterns by replacing an employee (who is calculated in Caregiver Hours) who is off, on vacation, etc. with a person of equal skill classification (RN for RN, LVN for LVN, etc.). Replacement FTEs need to be budgeted when the staffing pattern is established so that you are not using overtime to staff the unit, or staffing at levels below requirements. Paid FTEs is a requirement for being able to put a dollar figure to a staffing plan.
· PWR = Annual Paid Hours for a full-time employee
(Annual Paid Hours) – (Non-worked Hours)
Using an example of 320 non-worked hours per employee,
PWR = __2080___ = 2080
2080-320 1760
PWR = 1.18
To calculate paid FTEs required, multiply the worked FTEs for each classification of employee times the PWR.
· Paid FTEs = Worked FTEs x PWR
Using an example of having 6.6 worked FTEs of NA, and the PWR calculated above, calculate the number of Paid FTEs required:
Paid FTEs = 6.6 x 1.18 = 7.79
*Format Paid FTEs to 2 decimal places
Remember that when an employee who is off is not replaced with another comparable employee, such as the nurse manager or clinical specialist, the Paid FTEs are equal to Worked FTEs.
Calculate the Paid FTEs (Worked FTEs plus replacement) in the following staffing plan, using PWR = 1.18. Put your formula in the appropriate cells in Excel.
| STAFF |
S |
M |
T |
W |
T |
F |
S |
SHIFTS |
WORKED FTEs |
PAID FTEs* |
| NM |
0 |
1 |
1 |
1 |
1 |
1 |
0 |
5 |
1.0 |
|
| RN |
5 |
6 |
6 |
6 |
6 |
6 |
5 |
40 |
8.0 |
|
| LVN |
4 |
3 |
3 |
3 |
3 |
3 |
4 |
23 |
4.6 |
|
| NA |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
28 |
5.6 |
|
| US |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
7 |
1.4 |
|
| TOTAL |
14 |
15 |
15 |
15 |
15 |
15 |
14 |
103 |
20.6 |
|
*Format Paid FTEs to 2 decimal places.
Easy, isn’t it? Well, you are almost done with this section. Close your eyes, take a deep breath, and forge onward! Now we are going to learn how to assign positions to a staffing pattern.
Positions do not designate time: they designate space or the number of employees needed for a specific skill type, e.g. RN. A position is not the same thing as a FTE! As obvious as it may seem, let us say that it is important to have the correct number of positions so that you will have the correct number of staff to implement the staffing pattern.
In a staffing pattern that gives every other weekend off, the number of positions required is equal to the total number of shifts worked on weekends. As before, assume each shift worked is an 8-hour shift. Let’s say that on a typical nursing unit at your facility the number of RN shifts worked every Saturday and Sunday are five, and six RN shifts are worked Monday through Friday. The number of RN positions required would be 10. For positions that are not replaced by another comparable employee (e.g. Nurse managers), the number of positions needed for that skill classification is equal to the actual number of employees in that classification. For example, if you have one Nurse Manager, you only need one position of NM.
Determine the number positions required for each skill classification in the staffing pattern below. Watch out!! If you determine the total number of positions needed by adding the total shifts for Saturday and Sunday you will be WRONG because the NM doesn’t work on those days; you will not have counted that “position!” To get the accurate number of total positions, add the column of positions for each skill classification:
| STAFF |
S |
M |
T |
W |
T |
F |
S |
SHIFTS |
WORKED
FTEs |
PAID FTEs |
POSITIONS |
| NM |
0 |
1 |
1 |
1 |
1 |
1 |
0 |
5 |
1.0 |
1.0 |
1 |
| CNS |
0 |
1 |
1 |
1 |
1 |
1 |
0 |
5 |
1.0 |
1.0 |
1 |
| RN |
2 |
3 |
3 |
3 |
3 |
3 |
2 |
19 |
3.8 |
4.48 |
4 |
| LVN |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
21 |
4.2 |
4.96 |
|
| NA |
2 |
4 |
4 |
4 |
4 |
4 |
2 |
24 |
4.8 |
5.66 |
|
| US |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
21 |
4.2 |
4.96 |
|
| TOTAL |
10 |
15 |
15 |
15 |
15 |
15 |
10 |
95 |
19.0 |
22.06 |
|
PWR = 1.18
Putting it all Together
Okay. Now it’s time to give you a real brain teaser. Let’s see if you can put it all together.
Complete the information for the following staffing pattern. Assume 8 hour shifts, PWR = 1.15, and 220 patient days for a one-week period:
| STAFF |
S |
M |
T |
W |
T |
F |
S |
SHIFTS |
WORKED
FTEs |
PAID FTEs |
POSITIONS |
| NM |
0 |
1 |
1 |
1 |
1 |
1 |
0 |
|
|
|
|
| CNS |
0 |
1 |
1 |
1 |
1 |
1 |
0 |
|
|
|
|
| RN |
6 |
6 |
6 |
6 |
6 |
6 |
6 |
|
|
|
|
| LVN |
2 |
3 |
3 |
3 |
3 |
3 |
2 |
|
|
|
|
| NA |
6 |
8 |
8 |
8 |
8 |
8 |
6 |
|
|
|
|
| US |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
|
|
|
|
| TOTAL |
|
|
|
|
|
|
|
|
|
|
|
Inserting the appropriate data from above, calculate the following using formulas in Excel:
Calculate NHPPD: _____________________
Calculate Variable Hours: _________________
Calculate Fixed Hours: ____________________
Determining Paid NHPPD
Up to this point, you have been learning how to determine Worked NHPPD and its components. Below are formulas for calculating the Paid NHPPD. For each question below, use formulas in the Excel answer sheet to display your answer.
· Paid NHPPD = Worked NHPPD x PWR
Using an example where a unit had a NHPPD of 9.69, and the allocated PWR of 1.12, calculate the Paid NHPPD:
Paid NHPPD = 9.69 x 1.12 = 10.85
What is the Paid NHPPD with a Worked NHPPD of 15?
· Paid Caregiver Hours = Worked Caregiver Hours x PWR
The Variable Hours for that unit was 8.56. With a PWR of 1.12, calculate the Paid Caregiver Hours:
Paid Caregiver Hours = 8.56 x 1.12 = 9.59
What are the Paid Caregiver Hours with Worked Caregiver Hours of 7.25?
· Paid Fixed Hours = Worked Fixed Hours x PWR
The Fixed Hours for our earlier example was 1.13. With a PWR of 1.12, calculate the Paid Fixed Hours:
Paid Fixed Hours = 1.13 x 1.12 = 1.26
What are the Paid Fixed Hours with Worked Fixed Hours of 1.6?
Note that you can calculate the Worked elements of NHPPD by dividing the paid NHPPD by the PWR. For example, if you know the Paid NHPPD is 10.85 and the PWR is 1.12, then the Worked NHPPD is 10.85 1.12 = 9.69.
Acuity and its Influence
Just knowing your average daily census (ADC) and NHPPD may not be enough to create an accurate staffing pattern because these elements do not take into account the actual severity of the patients. If you are currently using an acuity system that assigns a numerical score to the severity level of the patients on your unit, you can adjust your staffing pattern to take into account the influence of patient severity.
· Acuity = Average Acuity Score x Patient Volume for a Specified Time
The Specified Time Period
You have calculated 12.85 NHPPD for a unit that has 61 patient days in one week (ADC=8.7). Assume an acuity on that unit of 2 (on average, each patient requires 2 RVUs); calculate Adjusted Daily Census (reflects acuity):
Acuity = 2 x 3176 Annual Patient Days
365 Days
Acuity = 6352 Adjusted Patient Days
365 Days
Acuity = 17.4 Adjusted Daily Census
This value equals an adjusted average daily census that reflects the acuity of that patient population. The staffing pattern is then configured based on this adjusted average daily census. For example, with an ADC of 8.7 and NHPPD of 12.85, you would need 13.97 FTE. Factoring in the acuity value would indicate that you now need 27.9 FTE (17.4 patients * 12.85 NHPPD ÷ 8 hour shifts) to care for those 8.7 patients because of the acuity level.
To further see how FTEs change in relation to the addition of acuity, please follow this example:
A nursing unit has been told that they must maintain a worked NHPPD of 6.62 hours. The baseline workload unit volume is 12,500 patient days, requiring 39.78 worked FTEs. Remember how to calculate that? 6.62 NHPPD x 12,500 patient days = 82,750 hours/year. 82,750 2080 (hours worked by 1 FTE) = 39.78 worked FTEs. The workload unit volume, with an acuity of 1.08 factored, is now 13,500 patient days. The worked FTEs that would be required to care for this adjusted patient day volume would be:
FTEs = NHPPD x Adjusted Workload Volume
2080 hours
FTEs = 6.62 x 13,500 = 42.97
2080
An additional 3.19 FTEs are needed to account for the acuity of the patient population and to maintain a worked NHPPD of 6.62.
How many more FTEs would be needed with an acuity level of 3.0 for this same volume of patients and 6.62 NHPPD? Use formulas in Excel to calculate your answer.
The Map should be about Left-Sided Heart Failure
/in CIPS /by adminThe Map should be about Left-Sided Heart Failure
Below are the Sub-heading that needs to be in the Concept Map.
Disease
Definition
AETIOLOGY
PATHOGENESIS
PATHOGENESIS
DIAGNOSIS
TREATMENT
COURSE OF DISEASE
PROGNOSIS
PREVENTION
· The separate Reference page for Concept Map. You may have more than 2 reference
· Visually Stimulating, add pictures in the background and visually attractive. Below is an sample example but this concept map needs to look unique and visually very appealing, please.
· Add pictures of heart, lungs what ever connects to the Map and its information.
· I have attached a sample of the concept map of another topic to guide you what information requires in the map.
· 500 words and it is worth 25 Marks.
Please see attach other files for questions and Marking Criteria.
Pros and cons of mandatory continuing nursing education
/in Nursing /by adminobjectives
Discuss the pros and cons of continuing education in nursing in the following areas:
Impact on competency.
Impact on knowledge and attitudes.
Relationship to professional certification.
Relationship to ANA Scope and Standards of Practice.
Relationship to ANA Code of Ethics.
Impact on competency
Pros: Cons:
Increased personal knowledge Time
Increased use of EBP treatments Cost
Improved patient outcomes
Increased confidence
Developing and maintaining skills
Professional Networking
“Currently in many states, a nurse is determined to be competent when initially licensed and thereafter unless proven otherwise. Yet many believe this is not enough and are exploring other approaches to assure continuing competence in today’s environment where technology and practice are continually changing, new health care systems are evolving and consumers are pressing for providers who are competent” (Whittaker, Carson, & Smolenski, 2000).
“The ultimate outcomes of continuing nursing education (CNE) activities are to improve the professional practice of nursing and thereby the care that is provided by registered nurses to patients” (American Nurses Credentialing Center’, 2014)
Effective workplace learning, based on current evidence, appears to show potential to prevent errors, support health professional reflection on practice and performance, foster ongoing professional development, and sustain improved individual and organization performance outcomes.
Cost- “Continuing education can be costly. For instance, it is costly to pay employees to attend a nursing lecture or conference and to be away from the patients’ bedside. Additionally, purchasing videos or subscribing to magazines does require an associated payment. Lastly, implementing a change is costly it requires training and often new equipment. Without question, cost is a confounding variable” (Ward, 2013)
Time- This can be time away from work and family. For the employer ‘implementing a change in practice does require time, as does completing continuing education credit hours. This could mean time away from the patient which, in most instances, is frowned upon” (Ward, 2013)
3
Pros of higher education in nursing
Enhance patients’ outcome.
Reduces medication errors.
Update with new trends.
Increased knowledge on technology use.
Treatment evaluation and recovery.
Enhance collaboration and networking.
Widens employment opportunities for nurses (University of Saint Mary,2017).
Higher nursing education prepares nurses to make a difference in delivering safe and effective care to patients, nurses gain the skills needed to safely administer medication while eliminating or reducing medication errors, monitoring and assessing the patient’s response to medications (University of Saint Mary, 2017). Nurses acquire proficiency on the use of new technologies because higher education programs explores the latest technology. Nurses are updated on the new trends in healthcare to keep up with patients’ changing needs. Nurses are able to effectively and proficiently coordinate patients’ care by collaborating and communicating with other health care teams, gain new knowledge through networking; nurses are exposed to seminars where they meet and interact with other healthcare professional.
Nurses are prepared to evaluate patients’ response to treatment and follow up after discharge to improve the quality of patients lives (University of Saint Mary, 2017). Nurses who have higher education certificates have more employment opportunities. Most hospitals requiring nurses to go back to school to get BSN, and preferring to hire nurses who have BSN.
4
Cons and attitudes of not continuing with higher education in nursing
Limited career opportunities and positions.
Poor patient outcome.
Lack of confidence.
Limited Knowledge, competency and skills.
Lack of opportunities for collaboration.
There are several disadvantage of not pursing higher education in nursing, nurses are most times denied of a job or a position due to the level of their education. Nurses who starts as staff nurses are promoted to a higher position with experience, good performance and continuous education (College Grad, 2017). Studies have linked poor patients outcome to lack of nursing skills and knowledge; Thus to enhance patient’s safety and quality care, nurses are required to go for a higher education or study as recommended in Institute of medicine report . Higher education does not only benefit the patients but also boost the confidence of nurses. Lack of confidence decrease self-esteem, every nurses needs to believe in him/herself to work effectively and efficiently while collaborating with other health care team. Lack of education limits learning new skills and opportunity to grow in knowledge and also could hinder opportunities to fellowship or collaborate effectively with other health care professionals.
5
Pros of continuing higher education related to the relationship to professional certification
Increases knowledge and quality of care in nursing practice.
Enhances nurses’ ability to compete in the job market.
Develops a nurses’ confidence and professionalism.
Defines nursing practice and attests to ongoing qualifications (Brunt).
The ANA defines certification as an achievement of exemplary nursing knowledge; therefore, continuing education promotes the above noted benefits. The question of mandatory continuing education for nurses has been brewing since the 1960s (Brunt). The National League for Nursing supports that mandatory continuing education should be required for relicensure. Currently, there are more than 68 various certifications available to nurses, and most of them require continuing education programs.
6
CONS OF CONTINUING HIGHER EDUCATION RELATED TO THE RELATIONSHIP TO PROFESSIONAL CERTIFICATION
Cons include:
Education does not assure competence.
Continuing education is expensive.
Evaluation tools are ineffective and not always accurate (Brunt).
Continuing education does not show evidence of better patient-care outcomes (Eustace, 2001).
Those opposed to mandatory continuing education maintain that as professionals, nurses are personally responsible to identify and acquire appropriate education (Brunt). Some have pointed out that mandatory continuing education does not necessarily address advanced practice nurses, or those in administration, research, and education. Others argue that it may be difficult to obtain continuing education in remote areas, and that most healthcare practitioners already take part in continuing education on their own (Brunt).
7
PROS TO CONTINUING EDUCATION RELATED TO ANA SCOPE AND STANDARDS OF PRACTICE
Improves quality of patient care
Expands knowledge and contribute to career growth
Ensures competency in practice
Providing best evidence based nursing care
The scope of practice is defined by the , “who”, “what”, “where”, “when”, “why”, and “how” of nursing practice. The practice of nursing requires specialized knowledge, skills and independent decision making. Every nurse should be knowledgeable and up to date with the latest evidence based practice in order to provide the best care to their patients. With higher education nurses are able to take on leadership roles. Leadership roles are important to help lead change to transform health care, and for “public, private, and governmental health care decision makers at every level” to “include representation from nursing on boards (Campaign for Action, 2014).
8
CONS TO CONTINUING EDUCATION RELATED TO ANA SCOPE AND STANDARDS OF CARE
Cost of Tuition
Balancing Personal life
Lack of appropriate knowledge on the subject
Lack of a guarantee that the continuing education standards will assist the nurse in the nursing field
The cost of going back to school can be very expensive. There are programs to help pay for some of the cost for tuition, but you still are responsible for a portion of the tuition. Some may not even know about the different programs to help you pay for school. They may be paying out of pocket. And we all know once we graduate, loan repayment will be waiting on us.
Another disadvantage of returning to school is balancing personal life. Some of us work full time jobs and have kids like myself. I also have a part time job as well. It can become very difficult squeezing classes in on top of our already busy schedule. Sometimes I don’t get a chance to do my work until the last minute when its due. I know there were plenty of times I felt like just giving up on classes because I don’t have enough time in a day to get every thing done. Then I start thinking of all the benefits of higher education
9
CODE OF ETHICS provision 5 related to Continuing Education
As outlined by the ANA, provision 5 includes that nurses owe the same duties to self as others, this includes responsibility to preserve integrity and safety, maintain competence, and to continue personal professional growth (Fowler and American Nurse Association, 2010).
PROS
Fair and equal treatment
Safe patient care
Be competent
Be educated to provide the best care
Grow professional and personally
Expand career knowledge and skills
Integrity
Builds confidence
Helps guide better decision making
Creates trust
Extends positive influence
CONS
Personal and professional growth requires a time commitment
Being competent and advancing can include a financial commitment
Growing pains
Feeling out of comfort zone
The Code of Ethics is a public expression of what a nurse commits oneself to when entering the workforce as a nurse. The Code expresses values, duties, and commitments that all nurses will strive for (ANA, 2010). There are many pros and a few cons to nurses agreeing to follow the Code of Ethics. The pros mentioned above can greatly outweigh the cons. As nurses we are here to serve people, we extend ourselves to care for others. In caring for others we must also care for our self in the process. The ANA outlines for professional growth a nurse is responsible for “continued reading, study, observation, and investigation” (2010). All of the above are outlined by the ANA.
10
CODE OF ETHICS PROVISION 7 RELATED TO CONTINING EDUCATION
Fowler and the American Nurses Association defined provision 7 as, a nurses participation in the advancement of the profession through contributions to practice, education, administration, and knowledge development (2010).
PROS
Advancements
In education
In practices of care
In administration
Knowledge
CONS
Having the need to want advancement
Time commitment
Possible financial commitment
Growing pains
Being pushed out of your comfort zone
Nurses are the forefront of advancement for the medical field. We hold many positions from floor nursing, administration and educators within the health care system. For the field of nursing and nurses to continue to grow and advance we all must pledge to participate in advancing the profession with education, and the search of knowledge. Examples of ways that nursing has advanced from the past is nurses now have advanced degrees such as: Master and doctoral level educations and also Nurse Practitioners. The ANA provides specifics on where nurses can advance the profession; be involved in healthcare policy, develop, maintain and implement professional standards in clinical practice, administration and education practices, and apply knowledge development, dissemination and application to practice (2010). As nurses the ANA Code of Ethics provides a pathway to things that will improve nursing practice as a whole.
11
CODE OF ETHICS
CONCLUSION
References
American Nurses Credentialing Center. (2014). The Importance of Evaluating the Impact of Continuing Nursing Education on Outcomes:Professional Nursing Practice and Patient Care. Retrieved from http://www.nurse.credentialing.org/Accreditation/
Fowler, M. D., & American Nurses Association. (2010). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association.
Ward, J. (2013, January 23). The Pros and Cons of Getting Nursing CEUs. Retrieved from Nurse Together: http://
www.nursetogether.com/pros-and-cons-getting-nursing-ceus
Whittaker, S., Carson , W., & Smolenski, M. C. (2000, September). Assuring Continued Competence – Policy Questions and Approaches: How Should the Profession Respond? Online Journal of Issues in Nursing. Retrieved from : http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
Brunt, B. The importance of lifelong learning in managing risks. The Nursing
Risk Management Series(3). Retrieved from http://ana.nursingworld.org/mods/archive/mod311
Eustace, L. (2001). Mandatory continuing education:past, present, and future trends & issues.
The Journal of Continuing Education in Nursing 32(3).
References
Nursing: Scope and Standard of Practice. Retrieved from www.nursingworld.org
ANA Leadership – American Nurses Foundation. Retrieved from www.anfonline.org
University of Saint Mary. (2017) Higher Nursing Education and its Impact on Patient Safety. Retrieved on September 21st from http://online.stmary.edu/rn-bsn/resources/higher-nursing-education-impact-on-patient-safety
College Grad (2017) Registered nurses. Retrieved September 24th, from https://collegegrad.com/careers/registered-nurses
Soap Note # Main Diagnosis Diabetes Mellitus type 2
/in Nursing /by adminPATIENT INFORMATION
Name: Mr. ET
Age: 56-year-old
Gender at Birth: Female
Gender Identity: Female
Source: Patient
Allergies: Penicillins
Current Medications:
· Multi-Vitamin Centrum Silver
· Lisinopril 10 mg daily
· PMH: HTN
Diabetes mellitus type 2
Immunizations:
Preventive Care: Coloscopy 3 years ago (Negative)
Surgical History: laparoscopic cholecystectomy
Family History: Father alive
Mother-alive, 90 years old, Diabetes Mellitus, HTN
Daughter-alive, 21 years old, healthy
Social History: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, she lives alone.
Sexual Orientation: Straight
Nutrition History: Diets off and on
Subjective Data:
Chief Complaint: “I cannot stop to drink water and to pee, I need to see my labs”
Symptom analysis/HPI:
The patient is 56 years old female who complaining of she cannot stop to drink water and to pee. Patient noticed the problem started 1 month ago and sometimes it is accompanied by anxious for eat. She states that she has been under stress because her daughter for the last month. Patient denies pain, or another symptom. She makes some labs and coming to see the results.
Review of Systems (ROS)
CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizziness as describe above. Denies changes in LOC. Denies history of tremors or seizures.
HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.
RESPIRATORY: Patient denies shortness of breath, cough or hemoptysis.
CARDIOVASCULAR: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal
dyspnea.
GASTROINTESTINAL: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or diarrhea.
GENITOURINARY: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.
MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.
SKIN: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.
Objective Data:
VITAL SIGNS and Lab valuesTemperature: 97.5 °F, Pulse: 84, BP: 142/82 mmhg, RR 20, PO2-98% on room air, Ht- fill, Wt fill lb, BMI 37.2. No report pain 0/10.
HbA1C 9.5 %.
Serum creatinine 1.2 mg/dl, add more
GENERAL APPREARANCE: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.
HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,. Lids non-remarkable and appropriate for race.
Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.
CARDIOVASCULAR: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.
RESPIRATORY: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.
GASTROINTESTINAL: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation
MUSKULOSKELETAL: No pain to palpation. Active and passive ROM within normal limits, no stiffness.
INTEGUMENTARY: intact, no lesions or rashes, no cyanosis or jaundice.
ASSESSMENT:
Main Diagnosis: Diabetes mellitus type 2 explain why
Obesity, HTN
Differential diagnosis: Put 3 and explain
PLAN: Metformin 500 mg one tablet daily in addition to daily style modifications. This dose can be increased to twice daily as needed or as tolerated every 1 o 2 weeks, until a maximum of 2 grams daily.
Hydrochlorothiazide (thiazide diuretic) 1 tablet daily added to the treatment for HTN to better control.
Labs and Diagnostic Test to be ordered:
· CMP
· Complete blood count (CBC)
· Lipid profile
· Liver function test (because the metformin requires routine monitoring)
· Serum creatinine
· Potassium because the ACE inhibitors requires monitoring of electrolytes
· Urinalysis with Micro
· Electrocardiogram (EKG 12 lead)
· Urine to monitor ketone and glucose
Pharmacological treatment:
· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.
· Lisinopril 10mg PO Daily
· Metformin tab 500 mg one tablet daily.
Non-Pharmacologic treatment:
· Weight changes must be done to manage better the Diabetes
· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat
· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults
· Enhanced intake of dietary potassium
· Exercises must be done at least 3 times per week like: walking, swimming or running
· Measures to release stress and effective coping mechanisms.
Education
· Provide with nutrition/dietary information.
· To avoid GI side effects, take the Metformin with foods.
· Instruction about medication intake compliance.
· Avoid drinking alcohol: Alcohol has a negative interaction with Metformin and contribute to hyperglycemia.
· Education of possible complications of Diabetes such as stroke, heart attack, and other problems.
· Educate to the importance to foot examination and to choose diabetes footwear.
Follow-ups/Referrals
· Follow up appointment 1 weeks for managing blood sugars: It is important to target levels of A1C less than 7 %, so labs will be every 3 months.
· Follow up nutritionist to…..
References(acerca de la enfermedad y el tratamiento, en alfabetico orden, en APA
Common Health Conditions with Implications for Women
/in Nursing /by adminSelect a patient that you examined during the last four weeks as a Nurse Practitioner. Select a female patient with common endocrine or musculoskeletal conditions, Evaluate differential diagnoses for common endocrine or musculoskeletal conditions you chose .With this patient in mind, address the following in a SOAP Note:
Subjective: What details did the patient provide regarding or her personal and medical history?
Objective: What observations did you make during the physical assessment?
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up appointment with the provider, as well as a rationale for this treatment and management plan.
Reflection notes: What would you do differently in a similar patient evaluation? And how can you relate this to your class and clinical readings.
References
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
Chapter 22, “Urinary Tract Infection in Women” (pp. 535–546)
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Review: Chapter 8, “Primary Care in Women’s Health” (pp. 431–560)
Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/
National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/
Philosophy of Nursing
/in Nursing /by adminUse the questions in the table in chapter 3 on page 101 of your textbook as a guide as you write your personal philosophy of nursing. The paper should be three typewritten double spaced pages following APA style guidelines. The paper should address the following:
Grading criteria for the Personal Philosophy of Nursing Paper:
Introduction 10%
Definition of Nursing 20%
Assumptions and beliefs 20%
Definitions and examples of domains of nursing 30%
Summary 20%
Total 100%
Running Head: PHILOSOPHY OF NURSING
PHILOSOPHY OF NURSING 5
I am a nurse practitioner working at Texas Health Hospital. I am an autonomous and licensed clinician who focuses on managing the health conditions of the people and shunning the diseases. In most of the times, I specialize in offering health care services to the patients. I work directly with patients who are experiencing chronic diseases with the aim of diagnosing and managing their health conditions.
Additionally, according to the International Council of Nurses, nursing can be termed as the central or integral component of the health care system which entails promotion of the health, illnesses’ prevention, taking care of disabled people, mentally ill, and physically one in the healthcare settings (Alligood, 2017). The nursing typically exists just to make sure that public health of the people is upheld by the nurses. Nursing exists to take care of health conditions of the public, prevent people from illness, and upholding healthy society. More so, I practice nursing with a passion for seeing a transformed society where most of the people are living a healthy life. It is my profession, and I wish to deliver the best out of me just for the sake of lives of people and to meet my goals as a nurse practitioner of making people live healthy lives.
According to my beliefs regarding nurse, I believe that as a nurse a unique role or function is diagnosing, managing, and curing various kinds of illnesses. Furthermore, I also believe that a nurse is that person who happens to complete the basic and generalized nursing education, and later being authorized by a regulatory body or authority to practice the nursing in the country (Alligood, 2017). Additionally, the patients can be termed as the person or individual who is registered to receive the medical treatment. Furthermore, other healthcare providers, are the personnel who are always available to offer health care services to the people to the people. A healthcare provider can be termed as any person who is working at the healthcare facility, and his or her purpose is diagnosing and managing illnesses faced by the clients. More so, communities can be termed as all entities that take part in the delivery of the healthcare services. The community is made up of health care providers, nurses, doctors, patients etc.
In the nursing, metaparadigm, it is made of the four key concepts, namely: health, person, nursing, and environment. Firstly, the person is known for putting the focus on the patient is believed to be the recipient of the care (Branch et al., 2016). More so, the metaparadigm of a person may consist of person’s family, culture, spirituality, friends etc. Secondly, the environment refers to external and internal factors that are linked to the patient. This consists of the interaction that is established between the visitors and patients and more so, their surroundings. In addition, when we consider the metaparadigm of health it can be termed as the quality and the wellness of the patients (Branch et al., 2016). This entails accessibility of health care by the patients.
Summary
After researching on the domains of nursing, these domains are connected in different ways. For instance, when we consider the person, they can be termed as the health care providers who offer the health care services to the patients. In addition, when we consider the patients they are offered health care services by the persons (health care providers). More so, the metaparadigm of health is the one that determines the wellness of the patients to determine the kind and quality of health care services to be offered to the patients. Furthermore, the health status of the patient is affected by the environment which one lives at. Environmental factors are key factors that affect the health conditions of the patient (Blais, 2015). More so, when I consider the vision of nursing in future, I expect the fled of medicine to invest in research with the aim of researching more regarding the different kinds of diseases and modes of treatment that should be adopted to improve the public health. The challenge is curing the new diseases that may arise as a result of poor living, and new kinds of foods people are eating. In future, it is expected that types of diseases will increase. Thus, it requires serious attention to address kind of behaviours people are involved in curbing future diseases. In my career, I expected to advance my education and specialized in surgery for the sake of curing the most daring and deadly diseases and taking care of the people who might be suffering from accidents. In my childhood, I wished to become a surgeon; thus, bearing in mind that I am in line with my passion, I would ultimately pursue my childhood goal.
References
Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.
Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.
Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four Nursing Metaparadigms. IU South Bend Undergraduate Research Journal, 16, 123-132.
Fetal Abnormality
/in Nursing /by adminBased on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:
Remember to support your responses with the topic study materials.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Rubric
Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear, thorough, and explained with a deep understanding of the connection between them. Explanation is supported by topic study materials. 30%
The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws insightful relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples. 15%
Explanation of how the theory determines or influences each of their recommendations for action is clear, insightful, and demonstrates a deep understanding of the theory and its impact on recommendation for action. Explanation is supported by topic study materials. 15%
Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear, relevant, and insightful. 10%
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Writer is clearly in command of standard, written, academic English.
All format elements are correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Here is a link to the Khan video on Moral Status. It will help explain the five theories discussed in the lecture:
https://www.khanacademy.org/partner-content/wi-phi/wiphi-value-theory/wiphi-ethics/v/moral-status
N5341 Staffing Module Assignment
/in Nursing /by adminPreliminary Data
Definition of Staffing Terms: To build a body of knowledge regarding the development of a staffing budget and later be able to create actual staffing plans, the registered nurse must first be familiar with the following terms and their definitions.
Nursing Hours Per Patient Day (NHPPD): A unit of measure that defines the average number of hours of nursing care delivered to each patient in a 24-hour period.
Hours Per Workload Unit (HPWU): A unit of measure that defines the average number of hours worked per workload unit. The workload unit can be number of visits, number of meals served, number of square feet cleaned, number of operating room minutes, and others, depending on the department worked.
There is a direct relationship between the workload and the amount of resources (RNs, LVNs, Aides, Dietary Aides, OR staff, etc.) needed.
Patient Day (PD): One patient occupying one bed for one day. Typically, counted at midnight. For example, a patient admitted to a nursing care unit at 11:50 p.m. will be counted in the midnight census for that unit; therefore will be counted as one patient day.
Average Daily Census: Patient days in a given time period (daily, weekly, monthly, or annual) divided by the number of days in the time period. It is also used to define the average number of total inpatients on any given day.
Variable Hours of Care: A component of NHPPD that measures the amount, in time, of care directly provided to the patient by a caregiver, e.g. RN, LVN, aide. It does not take into account fixed hours of care. Variable hours of care are also referred to as caregiver hours.
Fixed Hours of Care: A component of NHPPD that reflects the indirect care provided by nursing staff, e.g. unit secretary, nurse manager, clinical nurse specialist. This unit of measure is a constant, meaning that it is not dependent upon the acuity of the patient, or the volume of patients when calculating the staffing pattern.
Full-Time Equivalent (FTE): The equivalent of one full-time employee working for one year. It is calculated based upon 40 hours per week for 52 weeks, or 2080 hours. It includes both productive and nonproductive time. One employee, working full-time for one year (2080 hours) is one FTE. Two employees, each working 20 hours per week for one year (1040 hours each), are the equivalent of one FTE.
Replacement FTE: The number of FTEs required to replace non-worked hours.
Worked Hours: The actual number of hours worked, including both regular and overtime hours, orientation hours, on-call hours, callback hours, and training/education hours. Also known as productive hours.
Non-Worked Hours: The hours for which an employee is paid, but are not worked. Examples include vacation, sick, jury duty, holidays, funeral leave, paid time off, etc. The Fair Labor Standards Act dictates what an institution must include as non-worked hours. Also known as nonproductive hours.
Paid Hours: The total amount of worked and non-worked hours an employee is paid for.
Position: One person working one job, regardless of the number of hours that person works. A position is not the same as an FTE.
Shift: A designated number of hours that an employee works in a 24-hour period. A shift could be 4, 8, 10, 12, or even 16 hours in length. In this module, one shift will be considered as 8 hours.
Paid to Worked Ratio (PWR): Paid hours divided by the difference between paid and non-worked (nonproductive) hours. The PWR is calculated to determine the number of paid FTEs required. For example, one FTE is paid 2080 hours in one year. This FTE has 265 nonproductive hours (vacation, holiday, sick, etc.). PWR=2080/(2080-265)=1.15.
Worked FTE: The number of FTEs required to provide patient care on a daily, weekly, monthly, or annual basis.
Paid FTE: The actual number of worked FTEs plus the replacement FTEs needed during vacation, education, training, etc. to staff a cost center.
Cost Center: A unit or department in an organization.
Putting the Definitions to Use
Use the Excel™ Spreadsheet provided to document your answers. All calculations must be done using formulas in the spreadsheet, where applicable. Be sure to check your worksheet before submitting the assignment to ensure that when the reader clicks in a cell, the formula used to calculate the response is visible in the function bar.
Calculating an FTE
Remember, an FTE is based upon the designated number of hours needed to cover a specified number of shifts during a specific time period. The time period may be per week, per pay period (usually two weeks) or per year. A shift is 8 hours of worked time. Below are some examples of how an FTE is calculated:
· FTE = Number of shifts assigned to work every pay period. A Full-time employee works 10 shifts every two weeks, and this equals 80 hours in a pay period. An employee who is full-time would not necessarily have to work 10 shifts as long as they worked 80 hours. However, for the purposes of this module, all shifts are to be considered 8 hours long, so the employee must work 10 shifts to be considered full-time.
· FTE = Worked hours hours per pay period for full-time employee
FTE = 40 worked hours 80 hours = 0.50 FTE
· Hours = FTE x Hours paid per pay period for full-time employee
· Hours = 0.50 FTE x 80 = 40 hours (number of hours that a 0.50 FTE would be scheduled to work in a pay period)
· Shifts = Hours per pay period Hours in a shift
Shifts = 80 hours per pay period 8 hours = 10 shifts per pay period
10 shifts = 80 hours per pay period = 1.00 FTE
9 shifts = 72 hours per pay period = 0.90 FTE
8 shifts = 64 hours per pay period = 0.80 FTE
7 shifts = 56 hours per pay period = 0.70 FTE
6 shifts = 48 hours per pay period = 0.60 FTE
5 shifts = 40 hours per pay period = 0.50 FTE
4 shifts = 32 hours per pay period = 0.40 FTE
3 shifts = 24 hours per pay period = 0.30 FTE
2 shifts = 16 hours per pay period = 0.20 FTE
1 shift = 8 hours per pay period = 0.10 FTE
For each of the following scenarios, complete your answers using your knowledge of Excel basic formulas on the Worksheet provided in the Assignment Drop Box:
HOURS
SHIFTS
Great!!! You have now mastered being able to calculate the number of shifts and hours that a designated FTW works in one week and in one pay period. Using the same principles, you could also calculate the number of hours and shifts an FTE would work in a month, quarter, or year.
The next step is to be able to compute the number of FTEs needed to staff for one week based on the number of shifts required. To be able to calculate this number, you need to know the following:
· FTEs = Total Shifts 5 shifts (shifts worked by 1 FTE per week)
· FTEs = An RN works 5 shifts per week. How many FTEs are required?
FTE = 5 5 = 1.00 FTE
Now, it’s your turn again!!! Fill in the missing shifts and FTEs, using Excel formulas:
*Format FTEs to 1 decimal place.
Calculating NHPPD
Were the previous calculation exercises easy for you to complete? Great!! The next few are just as easy, but they begin to combine the elements of required nursing hours per patient day and the unit’s FTE requirements. But, before we get to that, you need to know how to derive the NHPPD and its related components.
Let’s get started!
The numbers of FTEs allocated to a nursing unit are based upon the NHPPD for that particular unit’s patient population and acuity. A variety of sources are available to compare your unit’s NHPPD with other units. In many cases there are national nursing standards that can be used as comparative data (like units, with the same type of patient population, are compared to each other). These units with the same or similar patient types usually have common nursing care requirements. When this is true, those nursing unit’s NHPPD are averaged to create a standard NHPPD. This number can only be used as a guide to determine the NHPPD for your unit, because differences such as geography, nursing care delivery system, support services available, and other variables may not be accounted for.
Why is it important for RNs to understand the concept of NHPPD and know their unit’s hours? Simply put, NHPPD defines how much nursing care each patient on the unit requires in a 24-hour period. In a sense, it defines the level of care required. Without it, the staffing might be based upon volume, rather than patient needs, and nursing care in acute care units should be based upon the needs of the patient.
In one example, a total of 103 shifts were worked by the distribution of staff given for one week. For a particular week, this unit experienced 85 patient days. From this data, one can calculate the NHPPD:
· NHPPD = Total shifts per week x 8 hours per shift
Number of Patient Days
NHPPD = 103 x 8 = 9.69
85
Now, here is one for you to figure out. Please calculate the NHPPD for the following unit, using Excel formulas to complete your calculations:
Unit 3A has had 61 patient days in the past week, with a total of 98 shifts staffed. What was 3A’s NHPPD for that time period?
NHPPD* = ___________________________________
*Format NHPPD to 2 decimal places.
As we said earlier, NHPPD is a compilation of different types of hours, one of which is Variable Hours of Care or Caregiver Hours. Remember, variable hours of care delineates those hours of care that are directly provided to the patient by a caregiver, defined as the RN, LVN, or nurse aide. Calculating Caregiver Hours gives us how many hours within the NHPPD are spent providing direct nursing care. It is calculated:
· Caregiver Hours = Total shifts of RNs, LVNs, & NAs x 8 hours per shift
Patient Days
In one example, the total shifts calculated = 103. There were 12 non-caregiver shifts (NM and US), which leaves 91 Caregiver shifts. Assuming the same number of patient days (85) from above, calculate the Caregiver Hours:
Caregiver Hours = 91 x 8 = 8.56
85
Using the situation described previously for Unit 3A, calculate the Caregiver Hours where there were 54 RN shifts, 14 LVN shifts, and 13 NA shifts. Use formulas in Excel for your calculations.
Caregiver Hours* = __________________________
*Format the Variable Hours of Care (Caregiver Hours) calculation to 2 decimal places.
We hope that you noticed that your Variable Hours of Care did not equal the number you got for NHPPD. Great!! That is because we have not taken into account yet the Fixed Hours. Fixed Hours of Care are the hours required for indirect care for every patient on a unit. Fixed hours are comprised of the secretarial work, management of the unit, and non-direct patient care (e.g. patient teaching done by a CNS). Remember, this number is constant, since it is not affected by acuity or volume.
· Fixed Hours of Care = Total shifts of NM, US, etc x 8 hours per shift
Patient Days
From our first example, calculate the number of shifts worked by the NM and US. Using the same patient days of 85, calculate Fixed Hours of Care for this unit:
Fixed Hours of Care = 12 x 8 = 1.13
85
Are you ready? Using the same situation for 3A and knowing that there are 5 Nurse Manager shifts, 5 CNS shifts, and 7 Unit Secretary shifts, calculate the Fixed Hours of Care: Again, use formulas in Excel to complete your calculations.
Fixed Hours of Care* = ______________________
*Format calculation to 2 decimal places.
Hopefully, when you add your answers for the Caregiver Hours and Fixed Hours of Care, you came up with the answer you originally got for your NHPPD. Remember, this occurs because NHPPD is a combination of Variable (Caregiver) Hours and Fixed Hours of Care.
Calculating Paid FTEs and Positions
WOW!!! Your brain is probably already on overload, but the best is yet to come!!! Now, if you believe that, we have some beach front property in Arizona for sale… Interested?
Seriously, to complete the determination of staffing process, you must know how to figure paid FTEs and the number and type of positions needed. Paid FTEs differ from the FTEs you have previously figured because paid FTEs include both worked and non-worked hours. What you have done so far is to calculate worked FTEs.
· Non-worked Hours = Total shifts non-worked x 8 hours per shift
An example of calculating Non-worked Hours for a full-time employee is as follows:
Sick leave = 10 shifts per year
Vacation = 15 shifts per year
Holidays = 8 shifts per year
Training = 5 shifts per year
Misc. = 2 shifts per year
Total = 40 shifts per year
Non-worked Hours = 40 shifts x 8 hours = 320 hours per employee
Note: The number of non-worked hours for an employee is determined by the organization, which ensures consistent allocation of non-worked hours allocated. Although employees with seniority might have more vacation hours than new employees, for the purposes of this module, all employees have the same allocation of non-worked hours.
Here goes! Is your computer smoking yet??? Calculate the number of Non-worked Hours for any employee of 3A, using formulas in Excel, based upon the following data:
Sick leave = 12 shifts per year
Vacation = 10 shifts per year
Holidays = 6 shifts per year
Training = 3 shifts per year
Misc. = 3 shifts per year
Total = 34 shifts per year
Non-worked Hours = _________________
Calculating the non-worked hours is essential prior to figuring the Paid-to-Worked Ratio (PWR) for an organization. The PWR allows you to determine the total number of paid FTEs required to staff your nursing unit. As explained earlier, paid FTEs is a combination of worked FTEs and the replacement FTEs needed when, for example, someone is on vacation, ill, or at an education seminar. Replacement FTEs are necessary in order to maintain established staffing patterns by replacing an employee (who is calculated in Caregiver Hours) who is off, on vacation, etc. with a person of equal skill classification (RN for RN, LVN for LVN, etc.). Replacement FTEs need to be budgeted when the staffing pattern is established so that you are not using overtime to staff the unit, or staffing at levels below requirements. Paid FTEs is a requirement for being able to put a dollar figure to a staffing plan.
· PWR = Annual Paid Hours for a full-time employee
(Annual Paid Hours) – (Non-worked Hours)
Using an example of 320 non-worked hours per employee,
PWR = __2080___ = 2080
2080-320 1760
PWR = 1.18
To calculate paid FTEs required, multiply the worked FTEs for each classification of employee times the PWR.
· Paid FTEs = Worked FTEs x PWR
Using an example of having 6.6 worked FTEs of NA, and the PWR calculated above, calculate the number of Paid FTEs required:
Paid FTEs = 6.6 x 1.18 = 7.79
*Format Paid FTEs to 2 decimal places
Remember that when an employee who is off is not replaced with another comparable employee, such as the nurse manager or clinical specialist, the Paid FTEs are equal to Worked FTEs.
Calculate the Paid FTEs (Worked FTEs plus replacement) in the following staffing plan, using PWR = 1.18. Put your formula in the appropriate cells in Excel.
*Format Paid FTEs to 2 decimal places.
Easy, isn’t it? Well, you are almost done with this section. Close your eyes, take a deep breath, and forge onward! Now we are going to learn how to assign positions to a staffing pattern.
Positions do not designate time: they designate space or the number of employees needed for a specific skill type, e.g. RN. A position is not the same thing as a FTE! As obvious as it may seem, let us say that it is important to have the correct number of positions so that you will have the correct number of staff to implement the staffing pattern.
In a staffing pattern that gives every other weekend off, the number of positions required is equal to the total number of shifts worked on weekends. As before, assume each shift worked is an 8-hour shift. Let’s say that on a typical nursing unit at your facility the number of RN shifts worked every Saturday and Sunday are five, and six RN shifts are worked Monday through Friday. The number of RN positions required would be 10. For positions that are not replaced by another comparable employee (e.g. Nurse managers), the number of positions needed for that skill classification is equal to the actual number of employees in that classification. For example, if you have one Nurse Manager, you only need one position of NM.
Determine the number positions required for each skill classification in the staffing pattern below. Watch out!! If you determine the total number of positions needed by adding the total shifts for Saturday and Sunday you will be WRONG because the NM doesn’t work on those days; you will not have counted that “position!” To get the accurate number of total positions, add the column of positions for each skill classification:
FTEs
PWR = 1.18
Putting it all Together
Okay. Now it’s time to give you a real brain teaser. Let’s see if you can put it all together.
Complete the information for the following staffing pattern. Assume 8 hour shifts, PWR = 1.15, and 220 patient days for a one-week period:
FTEs
Inserting the appropriate data from above, calculate the following using formulas in Excel:
Calculate NHPPD: _____________________
Calculate Variable Hours: _________________
Calculate Fixed Hours: ____________________
Determining Paid NHPPD
Up to this point, you have been learning how to determine Worked NHPPD and its components. Below are formulas for calculating the Paid NHPPD. For each question below, use formulas in the Excel answer sheet to display your answer.
· Paid NHPPD = Worked NHPPD x PWR
Using an example where a unit had a NHPPD of 9.69, and the allocated PWR of 1.12, calculate the Paid NHPPD:
Paid NHPPD = 9.69 x 1.12 = 10.85
What is the Paid NHPPD with a Worked NHPPD of 15?
· Paid Caregiver Hours = Worked Caregiver Hours x PWR
The Variable Hours for that unit was 8.56. With a PWR of 1.12, calculate the Paid Caregiver Hours:
Paid Caregiver Hours = 8.56 x 1.12 = 9.59
What are the Paid Caregiver Hours with Worked Caregiver Hours of 7.25?
· Paid Fixed Hours = Worked Fixed Hours x PWR
The Fixed Hours for our earlier example was 1.13. With a PWR of 1.12, calculate the Paid Fixed Hours:
Paid Fixed Hours = 1.13 x 1.12 = 1.26
What are the Paid Fixed Hours with Worked Fixed Hours of 1.6?
Note that you can calculate the Worked elements of NHPPD by dividing the paid NHPPD by the PWR. For example, if you know the Paid NHPPD is 10.85 and the PWR is 1.12, then the Worked NHPPD is 10.85 1.12 = 9.69.
Acuity and its Influence
Just knowing your average daily census (ADC) and NHPPD may not be enough to create an accurate staffing pattern because these elements do not take into account the actual severity of the patients. If you are currently using an acuity system that assigns a numerical score to the severity level of the patients on your unit, you can adjust your staffing pattern to take into account the influence of patient severity.
· Acuity = Average Acuity Score x Patient Volume for a Specified Time
The Specified Time Period
You have calculated 12.85 NHPPD for a unit that has 61 patient days in one week (ADC=8.7). Assume an acuity on that unit of 2 (on average, each patient requires 2 RVUs); calculate Adjusted Daily Census (reflects acuity):
Acuity = 2 x 3176 Annual Patient Days
365 Days
Acuity = 6352 Adjusted Patient Days
365 Days
Acuity = 17.4 Adjusted Daily Census
This value equals an adjusted average daily census that reflects the acuity of that patient population. The staffing pattern is then configured based on this adjusted average daily census. For example, with an ADC of 8.7 and NHPPD of 12.85, you would need 13.97 FTE. Factoring in the acuity value would indicate that you now need 27.9 FTE (17.4 patients * 12.85 NHPPD ÷ 8 hour shifts) to care for those 8.7 patients because of the acuity level.
To further see how FTEs change in relation to the addition of acuity, please follow this example:
A nursing unit has been told that they must maintain a worked NHPPD of 6.62 hours. The baseline workload unit volume is 12,500 patient days, requiring 39.78 worked FTEs. Remember how to calculate that? 6.62 NHPPD x 12,500 patient days = 82,750 hours/year. 82,750 2080 (hours worked by 1 FTE) = 39.78 worked FTEs. The workload unit volume, with an acuity of 1.08 factored, is now 13,500 patient days. The worked FTEs that would be required to care for this adjusted patient day volume would be:
FTEs = NHPPD x Adjusted Workload Volume
2080 hours
FTEs = 6.62 x 13,500 = 42.97
2080
An additional 3.19 FTEs are needed to account for the acuity of the patient population and to maintain a worked NHPPD of 6.62.
How many more FTEs would be needed with an acuity level of 3.0 for this same volume of patients and 6.62 NHPPD? Use formulas in Excel to calculate your answer.
PMH: Hypercholesterolemia
/in Nursing /by adminSoap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.
Example:
PATIENT INFORMATION
Name: Mr. W.S.
Age: 65-year-old
Sex: Male
Source: Patient
Allergies: None
Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime
PMH: Hypercholesterolemia
Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.
Surgical History: Appendectomy 47 years ago.
Family History: Father- died 81 does not report information
Mother-alive, 88 years old, Diabetes Mellitus, HTN
Daughter-alive, 34 years old, healthy
Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.
SUBJECTIVE:
Chief complain: “headaches” that started two weeks ago
Symptom analysis/HPI:
The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness.He states that he has been under stress in his workplace for the last month.
Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.
ROS:
CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.
HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.
Respiratory:Patient denies shortness of breath, cough or hemoptysis.
Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal
dyspnea.
Gastrointestinal:Denies abdominal pain or discomfort.Denies flatulence, nausea, vomiting or
diarrhea.
Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.
MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.
Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.
Objective Data
CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.
General appearance: The patient is alert and oriented x 3. No acute distress noted.NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.
HEENT:Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.
Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.
Cardiovascular:S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.
Respiratory:No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.
Gastrointestinal:No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no reboundno distention or organomegaly noted on palpation
Musculoskeletal:No pain to palpation. Active and passive ROM within normal limits, no stiffness.
Integumentary:intact, no lesions or rashes, no cyanosis or jaundice.
Assessment
Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.
Differential diagnosis:
Ø Renal artery stenosis(ICD10 I70.1)
Ø Chronic kidney disease(ICD10 I12.9)
Ø Hyperthyroidism (ICD10 E05.90)
Plan
Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.
These basic laboratory tests are:
· CMP
· Complete blood count
· Lipid profile
· Thyroid-stimulating hormone
· Urinalysis
· Electrocardiogram
Ø Pharmacological treatment:
The treatment of choice in this case would be:
Thiazide-like diuretic and/or a CCB
· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.
Ø Non-Pharmacologic treatment:
· Weight loss
· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat
· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults
· Enhanced intake of dietary potassium
· Regular physical activity (Aerobic): 90–150 min/wk
· Tobacco cessation
· Measures to release stress and effective coping mechanisms.
Education
· Provide with nutrition/dietary information.
· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP
· Instruction about medication intake compliance.
· Education of possible complications such as stroke, heart attack, and other problems.
· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all
Follow-ups/Referrals
· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.
· No referrals needed at this time.
References
Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).
Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0
reflection essay of your experience with the Shadow Health virtual assignment
/in Nursing /by adminCase Study: Healing and Autonomy
/in Nursing /by adminIn addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment.
Answer the following questions about a patient’s spiritual needs in light of the Christian worldview.
Remember to support your responses with the topic study materials.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. You are required to submit this assignment to LopesWrite.
Rubric:
1. Decisions that need to be made by the physician and the father are analyzed from both perspectives with a deep understanding of the complexity of the principle of autonomy. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses. 20%
2. Decisions that need to be made by the physician and the father are analyzed with deep understanding of the complexity of the Christian perspective, as well as with the principles of beneficence and nonmaleficence. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses. 20%
3. How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is clearly analyzed with a deep understanding of the connection between a spiritual needs assessment and providing appropriate interventions. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses. 30%
4. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 7%
5. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 8%
6. Writer is clearly in command of standard, written, academic English. 5%
7. All format elements are correct. 5%
8. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 5%
There are three different parts to this paper:
· Part one deals with Mike’s decision-making capabilities.
· Part two deals with how to think issues related to sickness and health.
· Part three deals with a spiritual assessment.
Read “Doing a Culturally Sensitive Spiritual Assessment: Recognizing Spiritual Themes and Using the HOPE Questions,” by Anandarajah, from AMA Journal of Ethics(2005).
https://journalofethics.ama-assn.org/article/doing-culturally-sensitive-spiritual-assessment-recognizing-spiritual-themes-and-using-hope/2005-05
Read “End of Life and Sanctity of Life,” by Reichman, from American Medical Association Journal of Ethics, formerly Virtual Mentor (2005).
http://journalofethics.ama-assn.org/2005/05/ccas2-0505.html