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The conversation about the influence of culture on health is unabating. The term culture, according to Kaakinen et al. (2018), refers to the shared customs, norms, values, language and jargon used by a specific group of population. The values and customs are diverse from one social group to the other, which brings the aspect of cultural diversity. Accordingly, cultural diversity means the differences in ethnicity, race, socioeconomic group, language, religion, education and sexual orientation (Kaakinen et al., 2018). The difference is evident from the most basic unit of a society, which is the family. The study of culture is crucial in understanding a family role, adaptations, responses and organization. Therefore, to achieve a safe and an effective nursing practice, cultural competency among healthcare providers is vital.
The interviews reflect cultural differences among two different families. Various parameters of culture are illustrated, for example, religion, education, marriage, gender roles, communication, and perception about death. The reason for selection of the two different families is to explicitly show the rich diversity that exists between them. The aspect of cultural diversity is depicted clearly from the two interviews.
The interviewees represent two different families and societies. This selection is further based on the fact that the smallest unit in a society to learn culture is the family. A family agrees on specific norms, values, religion and traditions, which in turn influence the surrounding community and the general human culture (Kaakinen et al., 2018). Therefore, listening to the voices from both families enables the interviewer to discern the differences and the similarities between the two diverse cultures. Other than highlighting the summary of the responses from the two interviews, the purpose of this paper is also to identify the similarities and differences between the cultures, and to explain how family roles affect cultural domains and relationships.
The interviews conducted aimed at identifying various aspects of cultures from two different families, and the diversity that exist between the two families. The interviewees include my family member, from the extended family, and a coworker who comes from a different culture and community. The interview consisted of various domains of culture. The identified domains include gender, education, occupational status, marriage, religion differences, and spiritual beliefs surrounding death and dying, and communication. The subject from the extended family is a mother who assumes the role of the head of the family in a community that recognizes a man as the pillar of the home. The other interviewee, a coworker is a first born in a family of five children raised by a mother whose husband is deceased.
The answers provided by the two interviewees clearly show a difference in cultural background. A major discovery during the two interviews is that the majority of communities recognize a man as the head of the family. The only exception as evident in the coworker’s interview is a deceased father. Further, in the extended family member interview, the mother reports to be the head of the house. She, however, recognizes that she comes from a culture where a man is the head of the household. Additional major common findings include marriage and religion being crucial structures in societies. Both the interviewees exhibited appropriate decorum during the conversation. They answered the questions openly and with a lot of ease notwithstanding the difference in educational levels and understanding. There was no unusual mannerism observed during the entire interview.
Both families report the woman to be the head of the house. This is different from majority of the traditional communities where a man is the head of the family. An exception under which a woman is allowed to be the head of a home is evident in the interview. In one interview, the father is deceased, and the mother has to assume the role. The ancient books, for example the Bible, affirm that a man is awarded the noble task of ruling, leading and being an overseer of a family (Hazel & Kleyman, 2019). Further, both families attest that education is crucial, observing however, that it should not be accompanied with pressure or compulsion to pursue it. Giorgetti, Campbell and Arslan (2017) denote a causal relationship between culture and education.
Examining the human history, a more educated community has a higher level of civilization as compared to communities mediocre in academics (Giorgetti et al., 2017). Additionally, both cultures acknowledge living together either through marriage or through cohabitation. Contemporary communities are defying marriages as the only way of union and are beginning to accept the concepts of cohabitation (Kaakinen et al., 2018). Moreover, both cultures use verbal communication as the preferred methods for conversing.
Despite the similarities, the two families differ in various ways. The major areas of differences include religion and perception towards death and dying. One family has a staunch foundation in Christianity while the other one believes in Lord Swaminarayan. Religion, from Zimmer’s (2019) perspective, is an indicator of health and health-seeking behaviors. This seemed to be a shared belief in all religions, and which fosters the religious identities of the interviewees. Additionally, other communities recommend seeking traditional medicine rather than the contemporary medicine. Religion has also been associated with positive health benefits such as creating a sense of well-being and encouraging gratitude, compassion and forgiveness (Zimmer et al., 2019).
Perception about death also varies across the two families. The family with a Christian foundation believes in life after death, that dead people go to Christ. Contrarily, the other family conducts a Besnu (burial ceremony) to perform a ritual and cremate the body of the deceased. Irrespective of the differences among communities, the ultimate goal is to have a culture of caring (Kaakinen et al., 2018). Understanding the different cultures of various communities is a strategy to mitigate healthcare inequalities and diversity challenges (Dell’Aversana & Bruno, 2017). It is therefore an integral role of a health practitioner to be culturally competent to ensure a safe and quality delivery of care.
Despite being the smallest unit within a society, a family plays a big role in influencing the culture of an entire community. A family unit agrees on specific ways of leading their lives, including customs, education, perceptions towards health and alternative lifestyles. The unit culture therefore expands to influence the neighbors and the surrounding environment.
The family unit also determines the nature of relationships that cultures adopt. For example, majority of communities recognize a man as the head of a family, a belief that has lasted through time in most cultures. Additionally, newborns are molded into a culture they are born. Therefore, as they grow, their perception towards bad, good, wrong or right depends on the family’s beliefs, traditions and values. The family cultures are not static but experience changes as the family grows. The constant transitions families undergo include cycles of life such as births, marriages, divorce and deaths which have an effect on the family roles and relationships.
The variation in trauma presentation and outcomes present various diagnostic and interventional challenges. In the family setting, trauma presents various trajectories as trauma may be experienced by an indirect victim. This paper assessed various incidences of trauma in my nuclear and extended family. Trauma incidences included school bullying, motor vehicle accident, emotional trauma, bereavement, and traumatic war experiences.
The coping strategies varied with the age of the trauma victim and the family involvement. Coping strategies included self-controlling, avoidance, seeking social support and religion, distancing, confrontive coping, and planful problem-solving. Among the children, outcomes of the trauma included mood changes while most adults engaged in alcohol use. The role of counseling was appreciated in most cases as it yielded some relief for the victims. The late recognition of trauma in children yields the need for research in this area.
Trauma varies in etiology, severity, and nature in all settings. Physical and emotional trauma are the most common types of traumas we encounter during our lifetime. A family is usually considered the basic social unit in most cultures. Trauma in the family setting has individual and group outcomes. Trauma evokes a myriad of responses at the personal and family levels. Various coping strategies are adopted by the victims to try and overcome traumatic experiences. My extended family is a patrilineal and cohesive one with various codes of social conduct.
The codes of conduct are in tandem with the social codes in my community. The family members have suffered some degree of trauma at least once in their lifetime. The subjective severity of their trauma, coping strategies, and circumstances have varied with each incidence of trauma. This paper describes six family members who underwent significant trauma in the past and describes their coping strategies as well as special circumstances surrounding these traumas.
Ryan is my fourteen-year-old nephew who lives with my mother. He is currently in middle school. His parents live in the countryside. Ryan moved to the city at age seven when my sister (her mother) desired that he studies in an urban-based setting to get adequate ‘exposure.’ Ryan was admitted to a nearby middle school two years ago but has been silent of school issues ever since. In his first year of schooling, his teachers appraised him for his good academic performance but noted a lack of involvement in extracurricular activities.
In the second year in that school, my mother was called by Ryan’s teacher to report on his occasional absence from school. One year ago, Ryan hinted at a dislike for a group of his classmates but her grandmother advised him to take it easy on his classmates. During this incident when his grandmother was to report to school to explain Ryan’s recent behavior, it was realized that ran has endured various episodes of bullying from the aforementioned group of his classmates. School bullying is a common occurrence in middle schools among adolescents and children. the victim usually experiences different outcomes (Oseldman, 2017).
Ryan’s traumatic incidences have been recurrent. The outcomes have been witnessed in the academic outcomes and the recent moods changes. At home, Ryan had been withdrawn of late and appeared stressed before he was sent to call his grandmother to school. According to Ngo et al. (2021), bullying has been associated with reduced quality of life, social withdrawal, and increased risk of depression in urban settings.
Ryan had been missing school to stay at home without the knowledge of his grandmother. Staying at home and missing school were the main coping strategies used to avoid the school bullies. According to Armitage (2021), the outcomes of bullying are always negative and can include education, mental, and adulthood consequences (Haraldstad et al., 2019). Mental outcomes seen in Ryan represent the most severe forms of outcomes. By avoiding the assailant of this trauma, the victims tend to find relief from the outcomes.
Riley is my 32-year-old cousin who lives in the same neighborhood as me. We have shared most of our childhood moments with her before she went moved out. Two years ago, Riley got involved in a motor vehicle accident after a road trip with her boyfriend. She suffered multiple fractures that led to her four-week hospitalization. During this traumatic incident, Riley had not put on her safety belt. Her partner did not suffer severe injuries as hers. Upon recovery, Riley did not want to relive those moments and recounted them as the worst period of her life.
Outcomes of the Incident
The traumatic incident did not yield any positive outcomes to Riley and the family. She developed a fear for private transport and would prefer walking for short distances, even to work. Fortunately, Riley recovered well without developing disabilities or deformities. She would resume her physical activities as usual but her emotional life was not restored. She was diagnosed with PTSD the same year for which she was treated on medications and trauma-focused cognitive behavior therapy. Her situation was special in that she had just gotten her professional employment and her first salary. Her start of life setting up a family was faced by a setback from the trauma.
Coping Strategies
Riley had the best coping strategies of the family members that I have discussed and yet to discuss. Having achieved her tertiary education graduated with skills in social work and sociology, Riley was able to open up to the family in the time before the outcomes worsened. The family provided constant emotional, financial, and physical support for her in the recuperating and post-recovery periods. PTSD is one of the mental health outcomes of trauma. Involvement of family promotes coping with the outcomes in trauma according to Viana Machado et al. (2020). The occurrence of stress and related symptoms following trauma were significantly reduced.
The elderly individuals have also encountered various forms of trauma in my family. Bob, 83 years old is my paternal grandfather. He is a veteran that returned home early before turning sixty years. He fought in the various wars in the Middle East during the terminal periods before the war ended. During his five years stay in the camp, he sustained various injuries and witnessed many traumatic incidents. He went into the war in his mid-forties and could story tell most of his war experiences and trauma. His case is unique because most veterans return home and undergo certain degrees of psychological complications. Most war veterans during his time would be neglected as he recalls. However, he was well taken being assessed by the psychologists regularly courtesy of his eldest son, my father. Just like Riley, my cousin, he was diagnosed with mild symptoms of posttraumatic stress disorder.
Outcomes of the Trauma
Bob’s case as opposed to earlier assessed cases, had positive outcomes. His case was an eye-opener to the family about mental health and post-traumatic mental health sequelae. The need for a prompt health assessment following suspected psychological complications of trauma was established by the family at that time. His trauma was, therefore, detected and managed in time. Just a few years after returning from the war, he started developing sleep problems. Viana Machado et al. (2020) associates sleep disturbances as early signs of impending posttraumatic sequelae. This was the only danger sign that prompted Bob’s psychiatric evaluation.
Coping Strategies
Bob was taken in by a psychologist who is now retired and has remained his personal friend to date. Bob’s coping structure was a direct one. He indirectly turned to the social system for support. He became a strong church member and would attend most church social gatherings regularly. Indirectly, bob sought social and religious interventions before his posttraumatic sequelae worsened. According to Stanis?awski (2019), special systems have been adopted indirectly by various victims of trauma with aim of surviving their foreseen mental deterioration. The belief in divine intervention and family care confers them some comfort from the traumatic events. He loves storytelling and opening up to his family about his personal life and this has made it easy for family members to intervene and provide the necessary support.
Matt is my fourteen-year-old nephew who sustained a head injury following a fall from his bike on his way. I remember visiting him in the hospital where he was admitted for four days following six hours of loss of consciousness. Matt sustained the head injury when he was nine years. He did not undergo any surgery after the incident. His recovery was uneventful. However, his case was unique in that he didn’t develop the usual primary brain injury. Mild brain contusions were reported and were managed conservatively. Turgut (2018) reports that the outcomes of head injury in the young have lower mortality rates and good outcomes as opposed to the elderly.
Outcomes of the Incident
Two months after the incident, Matt developed partial seizures that were attributed to the trauma. According to Turgut (2018), seizures are one of the complications of trauma. Despite receiving prophylaxis for convulsions, he still developed seizures. His nuclear family got traumatized psychologically as they had to live with the complications of this accidental trauma. Fortunately, the frequency of seizure occurrence went down rapidly six months later after medications. Having to keep Matt on medications worried his mother a lot.
Coping Strategies
Acceptance was the main family coping strategy. Matt’s mother had to accept the complications of the trauma. She then developed a planful problem-solving strategy (Stanis?awski, 2019) to cope with the situation. She planned to occasionally visit the family therapist regularly as advised by the physician. Matt was her only child and she would go the extra mile to ensure their social and physical wellbeing as a parent. They received counseling services as part of her planful coping strategy. This was associated with the positive outcomes of the patient’s medical therapy as it would ensure medication adherence and reduction of family stress from the post-traumatic events.
Joy was engaged with her partner Jimmy for three years. They lived together in the same town as my family. Joy is also my cousin. Their association was yet to be blessed with a child but this seemed to worry Jimmy who wanted a child as soon as possible. None of them was willing to seek medical help for fertility-related issues. There was no evidence of intimate partner violence. However, Joy report suspected instances of her partner’s infidelity.
She feels traumatized by these events in her courtship and states that her partner seemed to have lost interest in their courtship. The nature of her trauma is unique in that there is no actual evidence that the trauma occurred but the psychological outcome suggests an underlying emotional trauma. Emotional trauma from intimate partners reveals in various forms and often goes unnoticed. Joy’s case would as well be classified as emotional abuse.
Outcomes of the Trauma
Joy has recently been indulging in alcohol abuse. During my last encounter with her, she discussed work issues but was hesitant to discuss relationship issues. She had started drinking about three months ago because she thought that her relationship has hit the rock bottom and was unsalvageable. She would drink late at night to forget about her spouse. Kleber (2019) associated substances with various emotional trauma in the adult population. In this case, Joy’s drinking was maladaptive. She also reported she has missed some days at work and faces dispensation by her boss. This would be attributed to her drinking and emotional stress from her relationship.
Coping strategies
Joy’s personal attempts to cope with her trauma involved drinking to forget about her relationship stress. Her coping strategy uses an escape-avoidance method. She believes that by drinking daily she would escape her marital stress and avoid the adverse outcomes that come with separation or emotional trauma. In this coping strategy, the victim wishfully thinks that avoiding the situation. Her behavior seems maladaptive but, in some way, it is her coping strategy. She is yet to receive counseling services.
Her coping strategy would also be considered a distancing strategy. She is purposefully distancing her emotional self from the situation to create comfort but the outcomes are not favorable. In an ideal distancing strategy, the victim usually aims at creating a positive outlook (Stanis?awski, 2019). Joy needs counseling services as well as medical attention together with her spouse. Managing her trauma complications without sorting out the underlying etiology for emotional trauma would not be efficacious
The last trauma assessment case is of Jon, my maternal uncle. John is now 51. At age 46, he lost his wife to uterine sarcoma. Before her demise, they had only one child. John appeared traumatized by the loss exaggeratedly. Even though he was not diagnosed with complicated grief, Jon was abnormally depressed for seven months and had lost a significant portion of his weight. His trauma was unique he stayed too long in the denial phase before the demise. His wife was taken for palliative care because of an advanced stage of the disease but Jon was not willing to admit the diagnosis. The demise was inevitable and the complications were expected.
Outcomes of the Trauma
Jon indulged in alcohol use following the death of his wife. Before the death, Jon was a social drinker who would use less than two beer bottles on an occasion. As aforementioned, alcohol use is an outcome of trauma from various causes. Jon’s case is also maladaptive but would be greatly associated with his trauma from the loss. To justify his trauma, Jon’s response to the loss suggested a direct response to trauma experienced by a close family member. Sometimes, the trauma may not be directly experienced by the victim but witnessing the suffering and outcomes of the trauma justifies the occurrence.
Initially, Jon showed self-controlling as a coping strategy. Stanis?awski (2019) interprets self-controlling as the regulation of one’s feelings and actions. His coping can also be seen as confrontive coping. Confrontive coping involves aggressive attempts to alter the traumatic situation (Stanis?awski, 2019). His drinking escalated quickly and aggressively. The end goal was to make his emotional complications go away. His family offered necessary support before realizing that Jon was not holding up well anymore. He received cognitive-based counseling that yielded positive outcomes in her thoughts and emotions. His drinking gradually improved and he no longer takes alcohol.
The assessment of my family, both nuclear and extended family, has shown varying degrees of trauma and related outcomes. The degrees of coping are also varied and complicated. Most assessed trauma situations involved the adults who experienced trauma directly or indirectly. The trauma in children seemed to have taken an indolent course but the outcomes were out of proportion. Matt and Ryan are children who suffered health injury and school bullying respectively. Riley, 32, suffered physical trauma, Bob, 83, is a veteran, and Jon 51 suffered trauma related to bereavement and grief response. The etiologies were different but the need for intervention was seen in all cases.
Special incidences of trauma were also noted in this assessment. The role of the family in providing social and emotional stability has been appreciated. In Ryan’s case, the problem was detected by the teacher. The role of the family was not evident in providing support for him. School bullying can yield severe traumatic incidence but the victim may try to conceal the emotionally traumatic responses to themselves. Ryan’s response would also be considered social phobia at first. Missing the school would have suggested other reasons. Further research is needed to scientifically delineate social anxiety or phobias and child coping strategies or traumatic responses to school bullying. Understanding the reasons for traumatic responses would promote early intervention and improved coping with these situations
After completing the reading, what are your thoughts on practice differences between the RN and the BSN-prepared nurse? What have you heard (if anything)? Think about the differences between the 2-year RN and the BSN… If you have no experience or contact to draw upon, ask someone! (a nurse you might know, someone else at the college, check online resources, etc.)
Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Communication is so very important. There are multiple ways to communicate with me:
Value-based care in nursing refers to the quality of healthcare services offered to patients. It is a system of care that was introduced to tackle the problem of a shift in the demographics, rampant poor quality outcomes, and the ballooning cost of healthcare. In contrast, the fee-for-value system is where health outcomes/quality is measured based on what the customer can afford. In simple terms, value means that high-end customers get high-quality healthcare services whereas low-end customers get a lower quality of healthcare services. Fee for value is a highly controversial system because the model is simply a reward for expensive interventions.
Value-based care creates room for Interprofessional collaboration leading to improved patient outcomes. In the fee-for-value system, healthcare facilities work against each other to increase their profits. In this system, patients are merely seen as customers who bring in money. Thus, the more customers the higher the profitability. Based on this analogy, healthcare facilities work in competition against each other. Conversely, in a value-based system, the focus is on improving the health of patients which means that doctors and nurses from the same and different healthcare facilities collaborate with the view of improving patient outcomes.
Value-based care reduces costs for patients while it advocates for better outcomes. The words value and quality are the lifeblood of value-based care which means patients pay less for quality healthcare services. In most cases, the focus of value-based care is preventative care which is less costly compared to treating chronic ailments such as diabetes, hypertension, or cancer. Based on this analogy, value-based care aims to educate and sensitize members of the public to adopt a healthy lifestyle that would prevent them from contracting these chronic diseases.
Besides advocating for the members of the public to live healthy lifestyles, value-based care uses models of treatment that make patients spend less on medication as they get their health back on track. By focusing on prevention as its core modus operandi, value-based care ensures that patients use less money for medication because they are healthy. For example, value-based care helps to eliminate poor habits such as smoking, obesity, excessive alcohol consumption, and overeating. These factors are the biggest contributors to chronic conditions.
Value-based care promotes patient satisfaction which is a critical benchmark in the provision of quality healthcare. Healthcare facilities can use patient satisfaction as a measurement for their performance. Duly, healthcare facilities that satisfy their customers through high-quality healthcare get rewarded with a good reputation. Value-based care’s sole focus is the health of patients which means the overall long-term goal of this model is improving the quality of life of societies (World Health Organization, 2017).
This model of operation runs on the mantra that the healthier the nation, the less money is spent on healthcare. This statement is true because most developed countries today have a huge budgetary allocation for health especially for treating people suffering from chronic diseases that could have been prevented if people adopted a healthier lifestyle.
The model of value-based care has transformed the practice of medicine due to a reduction in medical errors. As mentioned earlier, the focus of value-based care is the quality of healthcare accorded to patients. For this reason, value-based care has adopted the core values of professional nursing that impact the quality of care (Gray, 2017). The core values of nursing practice used in value-based care include; altruism, autonomy, human dignity, integrity, and social justice. These core nursing practices define how nurses, physicians, and other medical professionals dispense their duties. These core values require medical professionals to dispense their duties with the utmost care, professionalism, justice, and knowledge.
In the fee-for-service model, physicians, nurses, and hospitals are paid based on the number of services provided each day. For example, if a doctor sees ten patients in a day, he gets paid for those ten patients based on the price of each treatment. In simple terms, doctors, nurses, and hospitals are paid based on the number of patients they attend each day, thus, the higher the number of customers, the better. The healthcare providers working under the fee-for-service model get compensated on the number of visits, tests, and medical procedures. Consequently, this model seeks to increase the number of patients/customers because they are profit-motivated.
On contrary, physicians and nurses under the value-based care model are compensated for the quality of care they provide, not quantity. This type of model is customer-centered and takes a more team-oriented approach where different health professionals and healthcare facilities collaborate to improve patient outcomes (Gray, 2017). Another critical feature of value-based care is that the health professionals under this model have more accountability because the expectations put on them concerning patient outcomes are much higher than their colleagues -for working in the fee-for-value model.
Value-based care boosts the reputation of healthcare facilities. Today, patient safety is one of the parameters for judging healthcare facilities. Patient safety is at the top of many hospitals because patients do not want to go to healthcare facilities that have a bad reputation concerning safety (World Health Organization, 2017). Many patients would rather pay more to get medication from hospitals with good quality patient care.
The quality of healthcare to patients is impacted by the environment where the care is given. The relationship between nurses and physicians directly impacts the quality of care to patients. Strained relationships between nurses and physicians adversely affect the quality of care whereas positive relationships between nurses and physicians result in positive patient outcomes. While tensions are common in any workplace, however, these can be solved through proper communication between co-workers. Proper communication between nurses and doctors can alleviate unnecessary conflicts and misunderstandings (Siedlecki, & Hixson, 2017). For example, doctors must make clear orders to nurses so that there are no misunderstandings when attending to patients. Most importantly, there must be mutual respect between physicians and nurses for a conducive work environment to prevail.
Physicians must treat nurses as equal partners in dispensing healthcare to patients. The truth is that doctors cannot operate without nurses and the reverse is also true. Based on this analogy, nurses and physicians must work closely together to offer quality healthcare to patients (Siedlecki, & Hixson, 2017). In terms of ranking, physicians rank higher than nurses in any healthcare-giving facility. However, in terms of dispensing their duties to patients, the two must work closely together sharing power, skills, and knowledge, in the effort to provide quality care to patients.
Shared power between nurses and physicians enhances patient safety. Patient safety in hospitals reduces risks of harm or injury. The objective of patient safety is to curb risks and harm that may happen to patients during their stay or visit to healthcare facilities (Burgener, 2020). Patient safety is a critical factor in quality care while reducing errors that harm both patients and hospitals (Burgener, 2020). Today, patient safety is a phenomenon that healthcare facilities cannot ignore. Facilities that do not take patient safety seriously suffer from costly lawsuits and damaged reputations.
Value-based care has numerous benefits to patients and healthcare facilities. To patients, the biggest advantage of this health model is improved outcomes, safety, and quality of care. Concerning quality, value-based care provides quality care to patients because all systems work together in collaboration for the benefit of patients. For healthcare facilities, the idea of patient satisfaction creates a good reputation which in turn translates into profitability. Another critical advantage of value-based care is that it reduces the cost of medication.
The fact that this model of healthcare emphasizes primary prevention means that people spend less money on health. In contrast, the fee-to-service health model emphasizes quantity rather than quality. This means that physicians and nurses are compensated based on the number of patients they attend. This type of care does not emphasize the quality of care provided. Its mode of operation is that customers get different quality of care depending on their pocket.
Value-based care in nursing refers to the quality of healthcare services offered to patients. It is a system of care that was introduced to tackle the problem of a shift in the demographics, rampant poor-quality outcomes, and the ballooning cost of healthcare. In contrast, the basis for fee-for-value system rests on measuring health outcomes/quality based on what the customer can afford. In simple terms, value means that high-end customers get high-quality healthcare services whereas low-end customers get lower quality of healthcare services. Fee-for-value is a highly controversial system because the model is simply a reward for expensive interventions.
Value-based care creates room for interprofessional collaboration leading to improved patient outcomes. In the fee-for-value system, healthcare facilities work against each other to increase their profits. In this system, patients are merely seen as customers who bring in money. Thus, the more customers the higher the profitability. Based on this analogy, healthcare facilities work in competition against each other. Conversely, in a value-based system, the focus is on improving the health of patients which means that doctors and nurses from the same and different healthcare facilities collaborate with the view of improving patient outcomes.
Value-based care reduces costs for patients while it advocates for better outcomes. The words value and quality are the lifeblood of value-based care which means patients pay less for quality healthcare services. In most cases, the focus of value-based care is preventative care which is less costly compared to treating chronic ailments such as diabetes, hypertension, or cancer. Based on this analogy, value-based care aims to educate and sensitize members of the public to adopt a healthy lifestyle that would prevent them from contracting these chronic diseases.
Besides advocating for the members of the public to live healthy lifestyles, value-based care uses models of treatment that make patients spend less on medication as they get their health back on track. By focusing on prevention as its core modus operandi, value-based care ensures that patients use less money for medication because they are healthy. For example, value-based care helps to eliminate poor habits such as smoking, obesity, excessive alcohol consumption, and overeating. These factors are the biggest contributors to chronic conditions.
Value-based care promotes patient satisfaction which is a critical benchmark in the provision of quality healthcare. Healthcare facilities can use patient satisfaction as a measurement for their performance. Duly, healthcare facilities that satisfy their customers through high-quality healthcare get rewarded with a good reputation. Value-based care’s sole focus is the health of patients which means the overall long-term goal of this model is improving the quality of life of societies (World Health Organization, 2017).
This model of operation runs on the mantra that the healthier the nation, the less money is spent on healthcare. This statement is true because most developed countries today have a huge budgetary allocation for health especially for treating people suffering from chronic diseases that could have been prevented if people adopted a healthier lifestyle.
The model of value-based care has transformed the practice of medicine due to a reduction in medical errors. As mentioned earlier, the focus of value-based care is the quality of healthcare accorded to patients. For this reason, value-based care has adopted the core values of professional nursing that impact the quality of care (Gray, 2017). The core values of nursing practice used in value-based care include altruism, autonomy, human dignity, integrity, and social justice. These core nursing practices define how nurses, physicians, and other medical professionals dispense their duties. These core values require medical professionals to dispense their duties with the utmost care, professionalism, justice, and knowledge.
In the fee-for-service model, physicians, nurses, and hospitals are paid based on the number of services provided each day. For example, if a doctor sees ten patients in a day, he gets paid for those ten patients based on the price of each treatment. In simple terms, doctors, nurses, and hospitals are paid based on the number of patients they attend each day, thus, the higher the number of customers, the better. The healthcare providers working under the fee-for-service model get compensated on the number of visits, tests, and medical procedures. Consequently, this model seeks to increase the number of patients/customers because they are profit motivated.
On the contrary, physicians and nurses under the value-based care model are compensated for the quality of care they provide, not quantity. According to Gray (2017), this model is customer-centered and takes a more team-oriented approach where different health professionals and healthcare facilities collaborate to improve patient outcomes.
Another critical feature of value-based care is that the health professionals under this model have more accountability because the expectations put on them concerning patient outcomes are much higher than their colleagues working under the fee-for-value model. Value-based care boosts the reputation of healthcare facilities. Today, patient safety is one of the parameters for judging healthcare facilities. Patient safety is at the top of many hospitals because patients do not want to go to healthcare facilities that have a bad reputation concerning safety (World Health Organization, 2017). Many patients would rather pay more to get medication from hospitals with good quality patient care.
A number of factors impact the quality of healthcare offered to patients, among them, the environment where the care is given. The relationship between nurses and physicians directly impacts the quality of care to patients. Strained relationships between nurses and physicians adversely affect the quality of care whereas positive relationships between nurses and physicians result in positive patient outcomes. While tensions are common in any workplace, it is possible to resolve them through proper communication between co-workers. Arguably, Siedlecki and Hixson (2017) contend that proper communication between nurses and doctors can alleviate unnecessary conflicts and misunderstandings. For example, doctors must make clear orders to nurses so that there are no misunderstandings when attending to patients. Most importantly, there must be mutual respect between physicians and nurses for a conducive work environment to prevail.
Physicians must treat nurses as equal partners in dispensing healthcare to patients. The truth is that doctors cannot operate without nurses and the converse is also true. Based on this analogy, nurses and physicians must work closely together to offer quality healthcare to patients (Siedlecki, & Hixson, 2017). In terms of ranking, physicians rank higher than nurses in any healthcare facility. However, in terms of dispensing their duties to patients, the two must work closely together sharing power, skills, and knowledge in the effort to provide quality care to patients.
Shared power between nurses and physicians enhances patient safety. Patient safety in hospitals reduces risks of harm or injury. The objective of patient safety, according to Burgener (2020) is to curb risks and harm that may happen to patients during their stay or visit to healthcare facilities. Today, patient safety is a phenomenon that healthcare facilities cannot ignore. Facilities that do not take patient safety seriously run the risks of encountering costly lawsuits and damaged reputations.
Value-based care has numerous benefits to patients and healthcare facilities. To patients, the biggest advantage of this health model are improved outcomes, safety, and quality of care. Concerning quality, value-based care provides quality care to patients because all systems work together in collaboration for the benefit of patients. For healthcare facilities, the idea of patient satisfaction creates a good reputation which in turn translates into profitability. Another critical advantage of value-based care is that it reduces the cost of medication.
The fact that this model emphasizes primary prevention means that people spend less money on health. In contrast, the fee-to-service health model emphasizes quantity rather than quality. This means that physicians and nurses are compensated based on the number of patients they handle. This type of care does not emphasize the quality of care provided. Its mode of operation is that customers get different quality of care depending on their pocket.
Please note: In the writing of this Capstone paper, avoid the use of first person. Examples of first person are the following: I, me, we, our, and us. You may refer to yourself as the author or the student.
Please identify a nursing problem within your specialty track: Nursing Education or Nursing Leadership and Management. Discuss why the problem requires an evidence-based practice change, quality improvement, or innovation. How did you identify the problem? Is it a nurse sensitive indicator that you or your peers have identified? What observations of your own or comments made by your peer group, management team, and other members of the transprofessional team help identify this problem?
For project ideas, please see your Field Experience Course of Study – Introduction section. The scope of your project must address all aspects included in the course evaluation rubric. The Field Experience Course is designed to guide you to the successful completion of your Capstone project planning. You will plan an evidence-based practice change, quality improvement, or innovation during the Field Experience course; this may require up to 12 weeks. Then you will implement your evidence-based practice change, quality improvement, or innovation within your Capstone course; this may require up to 6 weeks. Your project should be completed within 18 weeks from start to completion, including writing your project report. If you are considering a large-scale project within your work setting that will exceed these time frames, you should identify a way to narrow the scope of the project to meet these course requirements. Your project must be REASONABLE with the goal of graduation in mind.
This section will include a general description of the evidence-based practice change, quality improvement, or innovation that your organization is interested in, actively engaged in, or willing to support. This will provide a framework for your actual Capstone project, which is comprised of the action steps that you will actually, complete (or have completed) in support of your organization’s practice change, quality improvement, or innovation. You will need to be specific. For example, your organization may be interested in changing the policy or approach to patient triage in your emergency department. However, this policy change/process improvement will take several months and system wide resources to complete. You will not have sufficient time or resources to complete the entire policy change/process improvement within the scope of your Capstone project.
In addition, due to organizational constraints or your position in the organization, you may not have the capacity to effect the policy/process improvement in its entirety. Nevertheless, you are in a position to influence change by developing a specific component in support of changing the triage process. Therefore, your project will involve a smaller scope, which you must fully develop. Your part of the project may involve the following: 1) Developing a schematic for the new triage process, 2) Developing a new policy for implementing the new triage process, 3) Developing a new educational offering about the new triage process, and/or 4) Providing a presentation of the evidence that supports changing the triage process to stakeholders that are in a position to effect the change that you are advocating.
Your Capstone project will then focus on what you will do (or did) to influence change within your organization; your specific component can be part of the larger change that is taking place within your organization. The goal is for you to be succinct, yet provide sufficient detail to ensure readers have a clear understanding of what your specific contribution to the organization’s practice change, quality improvement, or innovation is all about.
This section includes a description of why the change, quality improvement, or innovation is required. Please respond in paragraph format. A paragraph contains a minimum of five sentences. Each paragraph supports a separate and distinct idea.
This section involves factors, issues, or phenomenon that helped to create the problem. Please respond in narrative paragraph format. Each paragraph supports a separate and distinct idea. What is the cause of the problem in your area of practice? What are you and/or your peers seeing in your practice setting? What factors contribute to the problem?
Your stakeholders are people internal or external to your organization that have a key interest in or can have a significant impact on your proposed change. Examples of stakeholders include, but are not limited to patients, nurses, physicians, administrators, support or ancillary care staff, family members, volunteers, etc. You will need to include the positions or roles each of the stakeholders hold in your discussion. For example, the CNO, unit manager, staff nurse, educator, quality improvement office, spouse, etc.
Stakeholders’ interest, power, and influence. This section involves a more detailed discussion about the specific interest, power, and influence (role) that each stakeholder has in relation to your proposed change. For example, hospital administration or the administration of a university can be stakeholders. They would have a heavy interest in any changes made within their facilities and have the power to approve or deny your project. Physicians, practitioners, or nurses may have a positive or negative influence on your project. Informal leaders also have power and influence. Your challenge is to identify the specific interest, power, and influence each of the identified stakeholders has in relation to your specific project. Please be sure to address all three aspects of interest, power, and influence for each stakeholder group identified.
This section should include a detailed description of what the proposed evidence-based practice change, quality improvement, or innovation will accomplish. What specific change will your project bring about? What do you hope to accomplish for the organization and/or stakeholders by implementing your proposed change?
This section involves presenting a succinct and clear description or statement of your proposed evidence-based practice change, quality improvement, or innovation. The description must include specific information about what you intend to do (change). Based on your current position within the organization, this may also involve what you plan to do to influence change. You may serve as a change agent within your organization. Your proposed solution should include who will be involved, what will be done, and where your proposed project will take place.
This involves a narrative discussion summarizing the five scholarly sources that were reviewed. The Evidence Summary should not be an Annotated Bibliography (separate critique) of the five sources. Instead, it should identify the areas where consensus among the various authors of the sources exists. The findings, positions, and recommendations included in your Evidence Summary should be consistent with the recommendations you are proposing for your Capstone project. This section will require the use of in-text citations using each of the five sources. A reference list for the evidence summary in APA format that includes five scholarly, peer-reviewed sources that were published within the last five years will be included in the References section of the paper. Remember, this evidence summary is your preliminary support for your project. Be sure your support is adequate.
Plan of Action
This section should provide a detailed plan of action. You will need to provide information about the specific steps that will be required to complete your Capstone project. This section may also include a description of meetings and agreements (support commitments or negotiations) in preparation for your project prior to actual implementation. You should include proposed meetings with your preceptor and/or stakeholders, plans for educating stakeholders (if necessary), goals, and any additional steps for the successful implementation of this project. While an exact step-by-step plan is not needed and may not be possible to include at this phase of your project development, you must provide a clear, succinct explanation of your proposed plan of action.
Timeline
Your proposed timeline should include general information about when the various milestones in your project are anticipated to be achieved. For example, Week 1 of the project will include…. Weeks 2-4 will involve….. Week 5 will involve…. Weeks 6 and 7 will provide for…. etc. The timeline can be displayed using a variety of options including tables, graphics, in addition to a narrative discussion of the milestones. You do not need to provide specific dates, however; you should provide an estimation of the time involved with each step.
Required Resources and Personnel
This section involves a narrative discussion about any resources required for the planning and implementation of your project. Resources may include financial support, time, classroom space, printing costs, equipment, personnel adjustments, or reallocation of staffing.
Proposed Change Theory
This discussion should identify the specific change theory you have chosen to guide and inform your project. You will need to include the details of the change theory you believe will be most effective in your area of nursing practice. This detailed discussion should correlate the actions/activities relevant to your project with each stage/phase/step of the Change Theory you identify. In-text citation(s) are required in this section.
Barriers to Implementation
This section involves a discussion about potential barriers you may encounter with the implementation of your project. This discussion may include ways you plan to address or mitigate the potential barriers.
NOTE: This section only applies to Education Specialty track students. This section requires a description of the learning objectives and anticipated outcomes associated with your Capstone project. For example, you will need to identify objectives and outcomes if you are planning an education offering, training module, simulation, training exercise, return demonstration activity, new or revised course or curriculum. Learning objectives and outcomes should be articulated in clear and concise terms. In-text citations may be required to support your chosen objectives and outcomes.
Please note that this document outline is only a guide. The written paper, including all in-text citations, must be written in proper APA style. All references (sources) should be identified using in-text citations in the body (narrative portion) of the paper. All of the included sources should be included in the References section.
A patient has filed a $3 million medical malpractice lawsuit against St. Patrick Hospital. In light of the patient’s litigious background and the facts of the case, hospital administration is adamant that it is not liable. It has instructed its legal counsel to proceed toward trial, where it may be absolved of liability.
Please number your responses so that I know which questions you are answering. Questions 1 and 3 probably only require one sentence. The remaining questions require a few sentences or a paragraph! Be sure to cite your sources!
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.
Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
The approval by the project’s sponsor and host facility is complete. Approval was attained by reviewing the charter and signing against the titles of assigned parties. The scope and charter of the project consisted of implementing a standardized accurate integumentary informatics system for assessing and documenting Pressure Injuries, PrI. Reinventing the practicum site facility’s electronic medical records was mandatory. The first phase of intervention entailed educating physicians and nurses on approaches of utilizing CMS QRM in reporting PrI (Eslami, Sardar & Abbasabadi, 2020). The second phase was training the care providers on dual skin management and assessment via admitting the nurses and physicians in an accredited wound ostomy department.
All organizational governance processes were executed as required. Proper communication procedure were applied to convey information to all stakeholders, including the sponsors, project manager, IT manager, team members, nurses and physicians (Muszynska, 2016). Communication involved reporting the progress, alerting team members of upcoming events, serving as reminder for meetings and acting as reminder for training sessions during the processes of project initiation and implementation.
The defined project management processes were applied avidly. The Gantt Chart provided a graphical representation that assisted the process of planning, coordination and tracking the EMRA gateway project (Baim-Lance, Onwuegbuzie & Wisdom, 2020). The managers applied change management improvement via teams, measuring change processes, risk management and a reliable communication plan.
The parties involved completed the administrative closing of all procurements and contracts, while all contractual obligations toward each other were signed off. In addition, completion of the project was formally recognized including transition of operations. Significant components of the closure include monitoring and controlling measures as well as reviews. Worth-noting, the benefits of the projects were validated against the business case. The specific advantages of the project consist of augmentation of documentation and identification of PrI, with consequent increase in competency and accuracy in documentation and treatment (Eslami, Sardar & Abbasabadi, 2020). Also, integration of EMR will assist in identifying and documenting PrI.
Notable lessons were completed including the roles of teams in project implementation, establishment of adequate risk management strategies and assignment of tasks to project teams to meet the project schedule (Baim-Lance, Onwuegbuzie & Wisdom, 2020). Engagement of different stakeholders in the project could be done better, particularly the executive management such as the facility’s Chief Executive Officer and governmental agencies.
The project resources were disbanded, making them free for other projects. The resources included the Electronic Medical Record Algorithm, additional desktop computers and stationery for the health personnel to use during the training. Nonetheless, the facility had existing desktop computers with an EMR that has been running efficiently. The incorporated algorithm was added as an update to the latest version of the CMS QRM software.
The project deliverables to the consumer demonstrate seamless operations and support. Regular updates and trainings to the health care providers ensure that the Electronic Medical Record Systems are reliable and free from redundancy, besides other complications. Providing the required skills to the technical teams ensures proper running of EMR systems for a more satisfying patient experience.
Final Project Closure Assessment – Appendix A
Type of Project Closure _________ Project Manager____________ Date:
Health history and physical examination are integral in diagnosing patients. The questions asked during the two procedures determine the outcome and diagnosis made during an assessment. Nurses must be keen when taking the health history so that they do not miss important patient health details. This essay analyzes essential questions for a patient in health history and physical examination that informed a diagnosis and necessary confirmatory diagnostic tests.
The crucial questions include what is the duration of the cough? The question helps differentiate between chronic and acute cough because they have different etiologies. What are the cough characteristics? The severity, intensity, and characteristic of the sputum help determine the underlying cause.
In this case, thick phlegm could indicate other problems such as tuberculosis. A prolonged dry cough could be indicative of other problems such as asthma and pertussis (O’Grady et al., 2017). What are the aggravating and relieving factors? The question helps determine an already working therapy and informs patient education. They also help rule out other respiratory problems such as allergies
Have you had exposure to people with similar symptoms? Exposure to sick individuals coupled with poor hygiene leads to infection with communicable diseases. What are the associated symptoms? Different diseases have different symptoms associated with cough, and in this case, the symptoms are synonymous with PNA. Are you active? Diseases affect an individual’s activity level depending on the severity and virulence of the disease-causing microorganism.
Do you have ear problems? Ear, nose, and throat infections are often synonymous and quickly spread among the three organs. Family history of respiratory illnesses is another vital question. Some diseases carry some genetic predisposition, such as cystic fibrosis (Haga & Orlando, 2020). Family history helps rule out some of these diseases.
Diagnostics studies are integral as adjunct or confirmatory tests for specific diagnoses. These tests include radiologic and blood tests (Kosack, Page, & Klatser, 2017). The most common tests are blood tests. In this case, a complete blood count with white blood cells differentials is an important diagnostic test. A chest X-ray is also required to check for inflammation of the lungs. Pulse oximetry readings are also essential to determine if the patient is in any respiratory distress. These diagnostic tests also help determine severity of a disease and thus, inform treatment and other interventions.
Health history taking and physical examination reveal much information, as seen above. Nurses must be proactive in health history taking because it contains valuable health information. In addition, diagnostic tests are necessary in many conditions. The diagnostic tests also inform patient management, as seen.
A client presents with a chief complaint of a cough that has lasted for a while. The cough was accompanied by fever and green sputum. However, recenty, the sputum has been blood-stained. The presenting problems mainly stem from the respiratory system. For this patient with respiratory system problems, a focused respiratory system health history and a focused physical examination are integral to determine the diagnosis and prognosis.
A focused health history narrows down assessment to a specific system or organ/body region to detect possible errors without wasting time on non-affected areas (Wan & Zeng, 2020). According to the presenting problems, the patient has problems with the respiratory system; hence a focused respiratory system history is integral. The onset, duration, and frequency of the symptoms are integral in determining the primary diagnosis and severity of the condition. History of past respiratory illnesses such as asthma, tuberculosis, and pneumonia can be suggestive recurrence or etiology of current disease.
Tonsils and adenoids for this client were removed in her childhood Family history of respiratory illnesses, smoking history, and environmental exposures are also integral etiological factors. Additional information necessary in the patient’s history includes dyspnea, cough/sputum and its characteristics, fever, chills, chest pain for inflammation diagnosis, current and past medications, and exacerbating and relieving factors. The information is integral in informing the diagnosis and treatment.
The focused physical examination reveals finer details unknown to the patient, informing the diagnosis and treatment (Cox & Ham, 2017). The focused physical examination is divided into four:
Inspection: Inspect the use of accessory muscles and labored breathing which could indicate congestion. Chest symmetry with breathing could reveal any injuries to the chest and conditions such as pneumonia, atelectasis, and fractured ribs. Inspecting the rate and depth of breathing is also vital. The color of the face, lips, and hands indicates oxygen levels and respiratory compromise. In addition, inspect for nasal flaring and an anxious look, which would indicate respiratory distress. Measuring the peripheral oxygen concentration is integral at this point (Cox & Ham, 2017).
Auscultation: Auscultating reveals problems in the lungs and respiratory tract problems through abnormal breath sounds. These breath sounds include fine crackles (asthma and COPD), coarse crackles (pulmonary edema), wheezes (asthma, emphysema, and bronchitis), rhonchi (pneumonia), and creaking (pleurisy) (Cox & Ham, 2017). Auscultation should be on both the anterior and posterior chest.
Palpation: Palpation of the chest reveals tenderness (due to pain and inflammation), asymmetry (with injury or severe diseases), diaphragmatic excursion, crepitus (lung inflammation and exudate formation), and vocal fremitus. Vocal fremitus is vibrations with talking, and breathing and areas where it is higher than others may indicate denser tissues in cases such as pneumonia or malignancy.
Percussion: Chest percussion will help elicit sounds to determine the underlying tissue. The characteristic sound produced is the resonant sound. Hyper resonance/ tympanic sounds indicate pneumothorax. The techniques used in the focus examination reveal characteristics of the chest integral in making a diagnosis.