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Discussion 3 Question 1
There are three core functions of public health namely assessment, assurance and policy development (Centers for Disease Control and Prevention, 2011). Under assessment, nurses monitor the health and environmental status so as to identify and develop solutions for the community environmental health problems. Additionally, nurses in their practice roles diagnose and further investigate health hazards and environmental health problems within the community (Centers for Disease Control and Prevention, 2011). An example of a nursing practice role that contributes to this core function is assessment. Nurses are involved in collecting, analyzing and synthesizing of data, thereby determining the health status of an individual. It takes on a holistic perspective by assessing different dimensions such as spiritual, emotional, physical and environmental (Suny Broome Community College, n.d.).
With regards to assurance, nurses are involved in carrying out studies in order to evaluate innovative solutions and new insights to environmental health problems. Additionally, they provide a link to the necessary environmental health services. Other elements include the evaluation of the accessibility, effectiveness and quality of population-based and personal environmental health services (Centers for Disease Control and Prevention, 2011). An example of a nursing role that adds to this core function is clinical decision making. It involves the evaluation of methods and information in order to inform clinical judgments (Suny Broome Community College, n.d.).
Policy development is the other core function of public health. This entails education, information and empowerment of people regarding environmental health issues. It also entails mobilizing community actions and partnerships in order to not only identify, but also solve the environmental health issues. Finally, this core function entails policy formulation and development of plans that offer support to the environmental health efforts both on the individual and community level (Centers for Disease Control and Prevention, 2011). An example of a nursing practice role that contributes to this core function is learning and teaching. In this role, nurses are involved in health promotion and risk reduction through education (Suny Broome Community College, n.d.).
The three roles highlighted in the discussion meet QSEN standards. Patient safety is an important QSEN standard (Durham, 2014). The clinical decision making standard meets this standard because collecting and analyzing information helps the nurses make the correct judgments. Informatics is another QSEN standard (Durham, 2014). Through the teaching and learning role, nurses are able to manage knowledge, enhance decision making and also mitigate errors in nursing practice.
Durham, C. (2014). QSEN & INACSL Standards – examples of Research in Simulation. San Diego. International Nursing Association for Clinical Simulation & Learning.
Centers for Disease Control and Prevention. (2011). Core Functions of Public Health and How They Relate to the 10 Essential Services. Retrieved 30 Jan. 2015 from http://www.cdc.gov/nceh/ehs/ephli/core_ess.htm
Suny Broome Community College. (n.d.). Nursing practice roles. Retrieved 26 Jan. 2015 from https://www.sunybroome.edu/nursing-practice-roles
Discussion 3 Question 2
Natural disasters such as earthquakes, avalanches, typhoons and tsunamis and man-made disasters such as wars, collapsed buildings and civil unrests put pressure in healthcare systems. It is important the response from public health officers and other agencies within the healthcare systems reflect a revel of preparedness in order to mitigate the effect of these disaster emergencies. In this regard, public health professionals require several critical competencies when dealing with these disaster emergencies, whether natural or man-made (Ruder, 2012).
The first core competency describing the role that public health professionals play in the various disaster emergencies that might occur. By describing their role, public health professionals are able to collaborate effectively with other professionals who might be involved in disaster response and mitigation. The second core competency is describing the chain of command that is applied during disaster response. This is important for cohesion and leadership during response. It is important for public health professionals to know to who to look up for decision making to whom to report (Ruder, 2012).
The third core competency is the identifying and locating the emergency response plans of one’s agency. This is important because it highlights the response plan in different types of emergencies. The forth core competency is describing the individual functional roles during emergency response. Part of this competency also entails demonstrating these functional roles during regular drills. This is important in order to hone the skills and perfect the roles. The fifth competency is demonstrating the correct and appropriate use of the communication equipment that is used during emergency communication. This is necessary in order to ensure that the communication equipment is in order and that the public health professionals can use them effectively (Ruder, 2012).
The sixth core competency is describing the communication roles during emergency response. This ensures that the public health professionals know their communication roles within the agency, with the media, general public and the families using the established communication systems. The seventh core competency is the identification of individual limits to authority, knowledge and skill. This is important for the identification of the key systems and resources to which matters that exceed the limits can be referred (Ruder, 2012).
The eight core competency for public health professionals is recognizing unusual events that often give an indication of emergencies. This is important so that the public health professionals can describe the appropriate actions for these unusual events. The ninth core competency is the application of flexible thinking and creative problem solving when faced with unusual challenges that fall within an individual’s functional role. This is important for the evaluation of the effectiveness of various actions taken (Gebbie et al., 2013).
Ruder, S. (2012). Emergency preparedness for home healthcare providers. Home healthcare nurse, 30(6): 355-363.
Gebbie, K., Weist, E., McElligott, J., Biesiadecki, L., Gotsch, A. Keck,W and Ablah, E. (2013). Implications of Preparedness and Response Core Competencies for Public Health. Journal of Public Health Management Practice, 19(3), 224–230
Designing care is a multifaceted approach where various variables are considered. For instance, I considered several variables such as subjective information from the patient, chief complaints, past medical history, physical impairment and its effect on earning a living and the medical and rehabilitation situation at the time. All this is important in order to design a holistic approach to care. I also reviewed medical records from other health professionals in order to inform my approach and the expected outcomes.
Even with my competencies, this was still a learning process. I had not designed care previously for individuals, or even groups for that matter. So even with the help of the online software, I still needed to consult with more experienced colleagues. Patient safety is one of the core competencies of QSEN and IOM (Rubenfeld & Scheffer, 2010), and as a baccalaureate prepared nurse, I was well aware. Consultation was especially important when it came to interpreting findings by physicians in the medical records and preparing treatment regimes based on the prescriptions of the attending physician.
While the experience was tasking, as a baccalaureate prepared nurse, I understood the concepts of a multidisciplinary team. By applying my interpersonal skills, I was able to get the assistance I required. I found this collaboration to be very helpful because I was able to make corrections in the life care plan. If I were to design another care plan now, I would be more efficient owing to the previous experience and the new knowledge I have acquired since.
Rubenfeld, M. G., & Scheffer, B.K. (2010). Critical thinking TACTICS for nurses: Achieving the IOM competencies (2nd ed.). Sudbury, MA: Jones and Bartlett
Wise, R. (2014). Chronic Obstructive Pulmonary Disease (COPD). Retrieved 30 Dec. 2014 from http://www.merckmanuals.com/professional/pulmonary_disorders/chronic _obstructive_pulmonary_disease_and_related_disorders/chronic_obstructive_pulmonary _disease_copd.html
Implementation of a Case Management Protocol
I had previously prepared a case management protocol to be rolled out in the community. While this implementation highlight a few of the requisite processes, be it on a general level, specific details are required. In preparing this paper, I arm myself with the implementation skills that will serve me in my professional life. The paper will feature a summary of the implementation plan, the outcomes of the plan, the benefits to the organization, potential budgetary and resource requirements, an action plan with a timeline and the evaluation strategies.
Summary of the Implementation Plan
The project for which this implementation plan was developed was a case management protocol for the community to be run from Hudson Valley Hospital Center. The implementation of the case management protocol will follow the population-based care management model (Finkelman, 2011). Under this model, the population in the community will be divided into three distinct classes namely the well patients, the at-risk patients and those patients who are unstable (Finkelman, 2011). The focus of the case management protocol will be on the at-risk group in order to aid their transition to the well patients group. Under the population-based care management model, the implementation of the case management protocol will take eleven steps. Prior to the development of this action plan, some of these steps have been performed. For instance, the second step involves the determination of the model to be used in the implementation process. The other steps as envisioned in the implementation plan include a scoping exercise to determine the number of patients in the at-risk group, developing a workforce strategy with various elements such as recruitment, training and retention.
Included in the steps is also the standardization of the core elements in the case management protocol, outlining the structure of the services to be offered in the case management protocol, the definition of the core functions and various role of the staff, altering the role of the patient in case management protocol, definition and development of support roles, creating support systems for the changes emanating from the implementation of the case management protocol, monitoring and evaluation and cost benefit analysis.
The implementation of the program will be done at Hudson Valley Hospital Center. This institution is located at Crompond Road, Cortlandt, in Buchanan, New York City, the United States of America.
The implementation of this case management protocol is outcome-based. The monitoring and evaluation of the implementation process with consider many indicators. Among the indicators considered is the achievement of the expected outcomes. The implementation of the case management protocol is expected to deliver three key outcomes. The first outcome that is expected from the implementation of the case management protocol is the reduction in the individual and overall period of hospitalization for the patients who are identified for the project. The use of this outcome in the monitoring and evaluation phase is based on literature. Finkelman (2011) argues that one of the functions for which case management is intended is the reduction in the period of hospitalization. The specific metric that will be used to evaluate this expected outcome is a 35% reduction in the period of hospitalization for the patients who are identified for the implementation of the case management protocol. The other expected outcome from the implementation of the case management protocol is a reduction in the frequency and number of emergency hospitalizations for the patients identified for the implementation of this project. The use of this expected outcome from the implementation of the case management protocol is also based on literature.
Finkelman (2011) argues that another function for which the design of case management was intended was the reduction in the exacerbations in the symptoms of chronic disease conditions. The specific metric for the evaluation of this expected outcome from the implementation of the case management protocol is a 35% reduction in the frequency and number of emergency hospitalizations as a result of the chronic disease conditions. The final expected outcome from the implementation of the case management protocol is the increase in the size of the case lists for the various case managers. This expected outcome will be evaluated individually and collectively for the institution. This is important in order to determine the rate at which new patients are recruited into the case management protocol.
Benefits of the Plan to the Institution
The implementation of the case management protocol is very beneficial to the institution. It is important to note that the definition of benefit in this case is based in the achievement of improve patient outcomes. As such, the benefit that the institution derives from this protocol is that it is an elaborate strategy for the improvement of patient outcomes, especially for patients with chronic conditions. A research conducted by the Agency for Healthcare Research and Quality (2013) found that case management helps improve the quality of care, more so for patients who are on long term treatment for chronic conditions. Another benefit to the organization from the implementation of the case management protocol is the improvement in medical adherence for the patients. This is also coupled by an improvement in the self-management skills for the patients.
The implementation of this plan is resource intensive. In addition to this, the required resources are varied in nature. One of the resources that is required for the implementation of the case management protocol is the human resource. The implementation of this plan will require a lot of personnel. Ideally, all nurse case managers in the institution will be incorporated into the plan. This is because the implementation of the plan is right in their domain. Additional personnel will be required for the scoping exercise highlighted in the implementation plan. Ideally, the other nursing personnel in the institution will be trained for this purpose among other skilled activities in the plan. These skilled activities include the activities envisioned in every step of the implementation plan.
The other resource required for the implementation of this plan is space. The successful implementation of the plan requires the training of health personnel on their roles and core functions with regards to the execution of the case management protocol. The facilitation of this training will require space within or without the institution. Additionally, office space will be required for the running of this project in the institution. It is expected that one nurse case manager will be appointed to oversee the implementation and day-to-day running of the project.
The other resource required for the implementation of the plan is time. It is not expected that the project will take off immediately after it is rolled out in the institution. Time is required to carry out the preliminary activities in readiness for the earnest start of the project. The preliminary activities for which time is required include the training of personnel, the scoping exercise, and administrative responsibilities among others. Even after the preliminary activities are carried out and the project is ready to begin, more time is required before the results of the project can be felt and determined through monitoring and evaluation.
The other resource that is required for the implementation of the plan is money. Funding is required for every step in the implementation plan. The infrastructure that is required for the implementation of the plan required substantial capital to acquired. The preparation of the preliminaries also requires money. For instance, the training of the personnel on their different roles with regards to the case management protocol requires money.
Timeline for Implementing the Plan
As highlighted earlier, significant time is required for the implementation of this plan. The approximate timeline for the preliminary phase of the project is four months. This tome is required because this is the time when the foundation of the project is established. For instance, the scoping exercise will be carried out for a period of two months. The scoping exercise will be overseen by the head nurse case manager. The other personnel who will be involved in this exercise include the triage nurses, social workers and community health extension officers. This will ensure that a wide net is cast so that even people who do not access the facility are incorporated into the project. The training of the personnel involved in the implementation of the plan will be done in a period of three weeks. The training of the personnel will be facilitated by the case managers in the institution. Monitoring and evaluation will be done on a continuous basis. It is the responsibility head nurse case manager to carry out periodic monitoring an evaluation through the reports submitted by the other case managers (Murphy & Roberts, 2008).
Measures of Success
The following metrics will be used to evaluate the success of the plan:
A 35% reduction in the frequency and number of emergency hospitalizations as a result of the chronic disease conditions.
A 35% reduction in the period of hospitalization for the patients who are identified for the implementation of the case management protocol.
A 10% increase in the size of the case lists for the various case managers.
The success of the case management protocol is dependent on the availability of resources and the input of all parties involved. The implementation plan is detailed in its design. The various elements highlighted in the plan all work towards an elaborate plan for a case management protocol. It is a fact that the implementation of this plan is resource intensive. However, the potential benefits of the plan far outweigh the opportunity cost. The implementation of the plan will be evaluated through specific metrics. The achievement of these metrics will show that the plan has been implemented successfully.
Agency for Healthcare Research and Quality. (2013). Benefits of case management for chronic illness limited. Retrieved 1 Feb. 2015 from http://www.ahrq.gov/news/newsletters/ research-activities/13feb/0213RA15.html
Finkelman, A. (2011). Case management for nurses. Upper Saddle River. Pearson Education Inc.
Murphy, N., & Roberts, D. (2008). Nurse leaders as stewards at the point of service. Nursing Ethics, 15(2), 243-253.
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