Category: Health & Medicine

Abstract

This paper discusses and analyzes the background, content, applicability, and feasibility of Jean Watsons middle-range nursing theory, known as the Theory of Human Caring. This theory is based on the concepts perpetuating the tradition of transpersonal and humanistic psychologists, such as Abraham Maslow and Carl Rogers. It considers caring as a living human interaction based on integration and unity of all dimensions of human existence that are body, mind, and spirit.

The paper discusses the experience of applying theory-based concepts both in the entire hospitals nursing activities and in the particular caring program. These examples confirm the high applicability and effectiveness of the theory in nursing areas such as clinical practice, education, administration, and research. The theory can provide the classic nursing approach with specific transpersonal, meditative, and other spiritual techniques.

Introduction

Middle-range nursing theories include particular abstract concepts and notions, and at the same time, are applicable to nursing practice. Jean Watson started developing a Theory of Human Caring more than 35 years ago (Clark, 2016, para. 2). This nursing theory has an extensive conceptual grounding based on the ideas of humanist philosophy as well as transpersonal and existential-humanist psychology. It has evolved over time and now could be considered as a specific ethical-philosophical paradigm or science model. Therewith, this theory concerns many aspects of the application of its insights in nursing activities and is currently in extensive use. Jean Watson has an undergraduate and graduate degree in psychiatric-mental health nursing and nursing education as well as a doctorate in educational psychology and counseling from the University of Colorado (Watson, 2016).

The theory was initially published in 1979, followed by many other books and articles devoted to it. Jean Watson is a widely published author, a guest at numerous conferences and seminars around the world (Watson, 2016). Her nursing theory has had a significant impact in this field and is still discussed by nursing theorists, scientists, and practitioners.

Summary of the Theory

The theory focuses on the experiential aspects of caring and addresses them from existential-personal and transpersonal-spiritual perspectives. Researchers state that it asserts that a human being cannot be healed as an object and is an inseparable part of his/her self, environment, nature, and the larger universe (Ozan, Okumus, & Lash, 2015, p. 26). According to the theory, the caring should be based on the integration and unity of all dimensions of human existence, specifically body, mind, and spirit. The central thesis of the theory is to shift the emphasis from objective characteristics of nursing to subjective ones, including experiential and spiritual.

The theory describes in detail the ideal features of caring, revealing many dimensions of the subjective experience of caring between caregiver and patient. Initially, Jean Watson formulated ten carative factors, which were then reformulated into the Caritas processes (Ozan et al., 2015). The factors describe the fundamental ideals of nursing, while the processes reflect the attitudes that the caregiver should be guided by.

For instance, the humanistic  altruistic system of values factor corresponds to the practicing loving-kindness/compassion and equanimity for self/other process (Ozan et al., 2015, p. 27). When factors and processes are summed up, they include, among other things, maintaining an authentic presence, cultivating spiritual and meditative practices, freely expressing emotions, and allowing them to be, meeting primary human needs. They also reflect a multidisciplinary approach to problem-solving, establishing caring relationships, research and teaching, and creating a caring environment.

The theory considers caring not as a professional relationship between an employee and a client, but as a living human interaction. According to Ozan et al. (2015), it consists of four basic concepts: healing processes, interpersonal maintenance of the relationship, the caring moment, and awareness of healing (p. 26). The caring moment is a unique concept of a theory that defines a meaningful, deliberate, and a conscious encounter of two human beings with each of their phenomenal fields of subjective perception. It is the place where all human interactions, including caring, occur.

Conception and visions of Watsons theory are rooted in transpersonal and humanistic psychology. Researchers state that the development of this theory was largely influenced by several thinkers such as Abraham Maslow, Carl Rogers, and Pierre Teilhard de Chardin (Clark, 2016, para. 13). Jean Watson identified hierarchy of needs of Abraham Maslow as a description of all the necessary aspects of caring. The patient should be satisfied with physiological needs, feel safe, accepted, and loved, and develop his or her higher spiritual potential according to the need for self-actualization, which is a metaparadigm concept.

Another such concept is Carl Rogers empathy, which manifests itself in the theory as acceptance and loving kindness. According to Clark (2016), De Chardin focused on inter-relating science and faith, and he proposed that humans are moving toward higher forms of consciousness (para. 22). This is consistent with Jean Watsons multidisciplinary scientific and spiritual approach, as well as her position on developing awareness in caring that may transcend patients suffering.

Applicability

The applicability and the experience in the implementation of middle-range nursing theories are crucial in determining their value and usefulness. Brandao, Martins, Peixoto, Lopes, and Primo (2017) note the significant gap between theory and practice and a certain amount of unsuccessful experience in applying specific nursing theories. The authors argue that middle-range nursing theories should play an intermediary role in establishing a connection between concrete work hypotheses and the grand nursing theories (Brandao et al., 2017). Watsons theory meets this criterion because it has implementation experience and is highly applicable.

The theory can be applied in a wide range of nursing fields such as clinical practice, education, administration, and research. According to Norman, Rossillo, and Skelton (2016), there is a successful experience of implementing Jean Watsons theory in creating a healing environment in a particular hospital. The hospital nursing staff received intensive education during the learning sessions organized by Caritas coaches. These sessions were based on a training methodology according to which each Caritas process is matched by activity descriptions and specific examples. For instance, the creativity Caritas process corresponds to the creative problem solving and small group discussion and report (Norman et al., 2016, p. 403).

Staff members studied a Caritas language and learned the practices of loving kindness that were applied not only to patients but also to each other, which greatly influenced the administrative processes in the hospital.

Conducting learning sessions based on theory has resulted in positive working outcomes. There have been cases where a nurse discovered that one of her patients was angry and spent time with him listening to his concerns and allowing him to express his anger about his diagnosis (Norman et al., 2016, p. 404). Such cases have been described not only concerning the nurse-patient relationships but also regarding the relationships between the working staff. Norman et al. (2016) remarked an increased patient and staff member satisfaction. Thus, this experience of applying the theory can be considered successful.

However, the research article of these authors does not exhaust the experience of describing the theory implementation. Ozan et al. (2015) explored theory-based approaches to the holistic care of women with unsuccessful IVF [in vitro fertilization] treatment in their study (p. 26). A caring and healing system was developed for women with failed IVF under Jean Watsons theory. It included three caring moments: face-to-face interview before and after the pregnancy test, telephone interview upon a failed treatment, and face-to-face interview upon a failed treatment (Ozan et al., 2015, p. 28).

Each moment was matched by specific Caritas processes that guided nurses in communicating with patients. Analysis of the protocols of audio recordings of telephone and in-person conversations made during the research demonstrated that these methods helped women to overcome unsuccessful IVF (Ozan et al., 2015). Moreover, the conceptions and approaches of the theory provided the nurses with convenient and effective professional guidance.

Thus, Watsons theory was developed and enriched in the course of research efforts. Its concepts, such as caring moments, carative factors, and Caritas processes, have proven to be applicable in nursing clinical practice, intra-organizational relations of health care workers, as well as in educational settings. Based on the studies mentioned above, it should be concluded that it is applicable to both individual nursing programs and researches and entire health care institutions.

Feasibility

As has been demonstrated previously, Jean Watsons theory is easy to put into practice due to pragmatically oriented concepts that can be applied to nursing activities. Also, specific methodological instruments and concepts can enrich and increase the efficiency of post-graduate nursing education. This will allow the advanced practice nurses to use additional techniques and approaches in accordance with notions of caring moments, carative factors, and Caritas processes, as well as mind-body-soul integration. It should be noted that theory is cognitively simple to understand, but it contains a large amount of information, and therefore requires special training.

The major problem with the implementation of this theory is that it may require certain financial and organizational resources, and it may be complicated to calculate the exact benefits of its application. For example, conducting educational arrangements under the relevant methodology in the hospital amounted to $3,000 per staff member (Norman et al., 2016, p. 408). At the same time, according to Norman et al. (2016), an accurate account of the financial benefit of the caring behaviors of nurses in various practice settings in a hospital is difficult (p. 408). Nevertheless, the studies confirm the effectiveness of applying the theory to specific nursing activities and the improvement of their quality.

This theory can clearly extend the classic nursing approach, including certain transpersonal, meditative, and other spiritual techniques. For instance, researchers give an example of a mindfulness technique for nurses that requires them to close the eyes, take several deep breaths, cleanse the external world, and then make contact with the patient (Norman et al., 2016, p. 406). These methods are innovative for traditional patient care, but they are expected to be of great benefit.

Conclusion

The Theory of Human Caring by Jean Watson treats caring as a process of human interaction and uses many concepts rooted in transpersonal and humanistic psychology to describe and characterize it. There are several evidences that a theory is applicable and effective in areas of nursing activity such as clinical practice, research, administration, and education. This paper describes the examples of the successful application of innovative solutions of the theory in practice. Due to its pragmatically oriented concepts, this theory may be implemented both in ordinary and advanced nursing practice.

References

Brandao, M. A. G., Martins, J. S. A., Peixoto, M. D. A. P., Lopes, R. O. P., & Primo, C. C. (2017). Theoretical and methodological reflections for the construction of middle-range nursing theories. Texto Contexto Enferm, 26(4). Web.

Clark, C. S. (2016). Watsons human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(2). Web.

Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. AORN Journal, 104(5), 401-409.

Ozan, Y. D., Okumus, H., & Lash, A. A. (2015). Implementation of Watsons theory of human caring: A case study. International Journal of Caring Sciences, 8(1), 25-35.

Watson, J. (2016). Watson caring science institute. Health Sciences Library Photograph Collection and Special Collections, University of Colorado, Anschutz Medical Campus; Publications. Web.

One scenario in which access to data would be instrumental focuses on a hospital networks frequent encounters with negative feedback from inpatients related to communication with care professionals. To reveal the key source of discontent by instrumentalizing the right data, all participating hospitals might initiate data collection events targeted at recently discharged patients. The data to use for decision-making and deciding on new workforce education policies might include patient-reported experiences with care. Such data would be collected anonymously using the Patient Satisfaction with Nursing Care Quality Questionnaire; patients would be supposed to complete the electronic tool during the discharge procedure (Claro, 2022; Lotfi et al., 2019). The nineteen-item tool produces data on patient-perceived care quality in various domains, including attention, respect, sensitivity to care recipients needs, and other communication-related skills (Claro, 2022; Lotfi et al., 2019). The tool would also capture general demographic details, such as ethnicity and age. A nurse leader (NL) would then access raw data for the entire network in an Excel database and use it as a decision-making resource by processing it and searching for consistent trends.

The NL would be able to derive instrumental and quality-enhancing knowledge from patient satisfaction data. For instance, the average patients low satisfaction with nurse competency would reveal the need for continuous training or enhanced control by nurse supervisors (Lotfi et al., 2019). Suboptimal satisfaction with nurses demonstration of respect and kindness, especially if more common in ethnic minority patients, would generate the NLs understanding of the need for diversity and cultural competency training. To form knowledge from such information, the NL would also have to use clinical judgment/reasoning or refer to clinical facts and patient evaluation knowledge (Delle et al., 2023). For instance, understanding that geriatric clients with neurological conditions might be more demanding when it comes to behaviors, the NL might need to avoid taking all low scores as evidence of skill deficiencies. In a similar manner, experiences with minority patients might explain the role of culture-specific understandings of courtesy, including personal space norms, in overall satisfaction scores. Therefore, looking at the data through the prism of actual clinical knowledge would be essential.

References

Claro, Q. K. C. (2022). Patient satisfaction with nursing care quality in affiliated hospitals of an educational institution. Technium: Social Sciences Journal, 29, 138-161. Web.

Delle, J. M., Cross, L., Weaver, A., & Jessee, M. A. (2023). Evolving the assessment of clinical judgment: An individual or collective competency?Nurse Educator, 48(2), 76-81. Web.

Lotfi, M., Zamanzadeh, V., Valizadeh, L., & Khajehgoodari, M. (2019). Assessment of nurse-patient communication and patient satisfaction from nursing care. Nursing Open, 6(3), 1189-1196. Web.

The decision-making can be an extremely complex process in multiple situations. This is especially the case when the outcomes will have far-reaching consequences for someones life and well-being. The following paper will address the process of the decision-making based on the case of Mrs. Jones, who was offered the bypass operation due to her defective heart valve problem. Overall, the application of the decision table model and decision tree suggests that the best alternative for Mrs. Jones is to agree with the heart surgery because her chances to survive longer are much higher in this case.

The decision-making process based on the offered case should be guided by the theoretic framework, which is the decision table and decision tree (Kerzner 75; Kotler 22). The theoretic resources state that adoption of the best decision in each particular situation requires a deep analysis of the existing problem, finding all possible alternatives, identifying the expected outcomes, selecting the applicable decision model, and actually choosing the best alternative (Bourne 7; Segatto and Dante 714). These essential components apply to every decision-making graphic model whether it is the decision table or decision tree (Bowen and Murshid 223).

According to the decision tree model, the process of the decision-making in this situation will include such steps as evaluation of outcomes for every alternative and selecting the alternative with the best output (Segatto and Dante 713; Vermeulen and Pyka 2). Implementation of this theoretic information to Mrs. Jones case suggests that the first alternative which is the refusal to make an intervention has a poorer outcome for the person than the decision to have the bypass operation. The probability of surviving is higher if the person chooses alternative two. Therefore, the ultimate decision for Mrs. Jones is to agree with the medical doctors offer to undergo heart surgery.

The same conclusion can be made based on the usage of the decision table:

Fig. 2. Decision table.

This model will also demonstrate that the alternative with the best outcome for Mrs. Jones is the resolution to agree to the physicians offer.

Other Factors that Need to Be Considered

Mrs. Jones situation overview has identified the following risks: (1) failure to do the heart surgery results in only 50% chance to survive for one year, 20% chance to survive for two years, and 10% to live 8 years more; (2) 5% of patients do not survive the bypass operation or die during the recovery stage and 45% do not survive the first year; (3) at any development, the physician admits that surviving after the age of 58 is very low. With these striking data, Mrs. Jones needs to approach the decision-making process extremely seriously.

Concluding on the information mentioned above, the decision-making process requires the systemic approach to take into consideration all the factors that apply to the situation along with the possible threats and risks. The best decision is the decision of choosing the alternative with the optimal outcome. Application of this theoretic information to the given case study suggests that Mrs. Jones should choose to do the surgery because this alternative has the best outcomes for her. This conclusion can be made either with the use of the decision table or the decision tree.

Works Cited

Bourne, Liam. Stakeholder Relationship Management, Farnham, GB: Gower, 2012. Print.

Bowen, Elizabeth and Nadine Shaanta Murshid. Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy. American Journal of Public Health 106.2 (2016): 223-9. Print.

Kerzner, Harry. Project Management  Best Practices: Achieving Global Excellence, Somerset, NJ: John Wiley & Sons, Incorporated, 2014. Print.

Kotler, Peter. Marketing Management, Upper Saddle River, NJ: Prentice-Hall, 2011. Print.

Segatto, Mayara and Pinheiro Martinelli Dante. Business Process Management: A Systemic Approach? Business Process Management Journal 19.4 (2013): 698-714. Print.

Vermeulen, Ben and Andreas Pyka. Agent-Based Modeling for Decision Making in Economics Under Uncertainty. Economics 10.6 (2016): 1-33A. Print.

Introduction

Autoimmune disorders are specific types of diseases that have their own characteristic trait. These disorders happen when a body cannot find the difference between its own cells and foreign cells. As a result, the immune system causes an immune response attacking the body. Such a disease differs from infections, although the latter may cause a further autoimmune response (Sargsyan, 2020). This analysis describes insulin-dependent diabetes, also known as type 1 diabetes. It destroys healthy cells because of the inability to metabolize glucose and transform it into energy.

Description

Insulin-dependent diabetes is a chronic condition characterized by the pancreass minor activity. Because of such inefficiencies, a small amount of insulin is produced, which causes a lack of sugar level control. What makes this disease an autoimmune disorder is the fact that insulin-producing islet cells are damaged by the bodys immune system (NaPier et al., 2020). During the preliminary stages of insulin-dependent diabetes, there is a dysregulation of cytokine levels and systemic growth factors (NaPier et al., 2020). Such type of diabetes is usually diagnosed among juveniles.

Signs and Symptoms

There is a huge list of possible symptoms associated with insulin-dependent diabetes. The major symptoms are increased hunger, frequent urination, and increased thirst (Kumar et al., 2020). The reason is that there is no sufficient insulin to convert glucose from food to energy. Hence, other symptoms are the loss of weight and constantly dry months. Another frequent sign of type 1 diabetes is the impaired healing of cuts and wounds. It happens with a similar logic  the inability to metabolize sugar into energy results in a high sugar level and, subsequently, a decreased healing ability. It should be noted that type 1 diabetes may be life-threatening.

Alterations of the Immune System

Being the classical case of autoimmune disorder, insulin-dependent diabetes produces similar immune system alterations as in other cases. Non-specific defense of human bodies destroys pathogens of any type, triggering prolonged inflammation (Kumar et al., 2020). It happens because the body responds to the damage to cells and tissues by activating inflammatory responses trying to repair these damaged elements. The great role in the immune systems behavior may play genes, especially human leukocyte antigen genes (Lee & Hwang, 2019). These genes are responsible for encoding specific proteins to differentiate between self and foreign cells. Some alterations in these genes may be why the immune system attacks insulin-producing cells.

Treatment and Prognosis

The major treatment of insulin-dependent diabetes is regular insulin therapy. Such repeated insulin injection in the body is a crucial necessity to avoid life-threatening consequences (Kumar et al., 2020). However, as Kumar et al. (2020) note, the exact reason behind diabetes is to stay unknown (p. 842). Therefore, there are many other basic treatments that are prescribed for many other diseases: a healthy lifestyle, regular physical activity, and a proper diet. Although the prognosis differs from person to person, the overall perception is that accurate disease management may allow patients to live an active life.

Group Specifics

In general, type 1 diabetes is predominantly diagnosed among children and young adults. Physicians often refer to insulin-dependent diabetes as juvenile diabetes (Kumar et al., 2020, p. 838). The reason is that type 1 diabetes mostly affects those families with a history of diabetes among previous generations. Therefore, it is evident from an early age that an individual has insulin-dependent diabetes.

Conclusion

To conclude, insulin-dependent diabetes or type 1 diabetes is one of the most common autoimmune diseases among the American population. It makes innate immunity to attack bodies cells and tissues because it cannot distinguish between its own and foreign elements. The discussed disease is commonly diagnosed among juveniles and young adults and is treated by insulin therapy. In general, the proper treatments allow people to live a normal life without any health limitations.

References

Kumar, R., Saha, P., Kumar, Y., Sahana, S., Dubey, A., & Prakash, O. (2020). A review on diabetes mellitus: Type1 & type2. World Journal of Pharmacy and Pharmaceutical Sciences, 9(10), 838-850. Web.

Lee, H. S., & Hwang, J. S. (2019). Genetic aspects of type 1 diabetes. Annals of Pediatric Endocrinology & Metabolism, 24(3), 143-148. Web.

NaPier, Z., Kanim, L. E., Nelson, T. J., Salehi, K., Arabi, Y., Glaeser, J. D., Sheyn, D., & Metzger, M. F. (2020). The effect of insulin dependent diabetes on bone metabolism and growth after spinal fusion. The Spine Journal, 20(5), 800-808. Web.

Sargsyan, A. (2020). Essential notes on pathophysiology for advanced practice nurses. East Tennessee State University Press.

Introduction

Managing finances effectively in a hospital requires the collaboration of both patient care units and administrative units. Modern nursing courses involve financial management units to ensure that nurses undertake their duties in a cost-effective manner. This paper discusses how nursing units can be financially accountable and how hospitals management can enhance accountability.

Nursing unit financial management

The nursing department should be given an appropriate allocation of hospital finances according to their needs. Managing nurses should oversee the effective management of these funds and ensure that all operations are managed in a cost-effective way. Making a budget for every activity that needs to be undertaken in a certain period is crucial in ensuring that there is proper fund control within the department. Nurses have direct interaction with medical staff and the patients, they are thus in a better position to brainstorm some of the costs incurred in the hospital and devise measures to cost manage them. They can assist in establishing the costs that can be avoided or functions that can be merged. Mechanisms should be put in place that define certain functions in the unit, for example, the number of staff dresses should be regulated to ensure that they are adequate at any one time and no excess. The traditional notion that had been created in nurses that they do not have a duty in financial management should be changed and nurses made to understand for a cost-effective business it calls for the participation of all stakeholders (McHugh & Finkler, 2008).

To enhance accountability, hospital management should ensure that it is operated in a strategic manner. Strategic management involves a management system where all units are considered separate and accountable for their actions. The nursing unit should develop its own budget, have financial targets, and be managed by nurse leaders who understand the need to manage resources. When a certain allocation has been given to a nursing department, the nursing head should manage micro-teams, which will be further allocated some funds to perform operations in their particular area. For example, nurses assisting operating doctors may be given some allocation to manage, they should be held accountable for such an allocation. Another way of ensuring that resources are adequately managed is having resource management as one of the appraisal tools for nurses. They will be willing to manage the resources they have since they would like to earn a high ranking.

Frequent utilization reviews should be undertaken to ensure that there is quality and maximum utilization of funds in the nursing units. Like in the production business, any deficit or areas that lead to inefficiency should be addressed. Invention and innovation of better quality management should be implemented.

Hospitals should have an effective cost accounting system. Such a system will be used in charging patients according to the acuity of their illness. Such a system will ensure that services are not undervalued or overvalued. Adopting a patient classification system will assist a hospital in realizing which patient to admit and at what cost (Finkler, Kovner & Jones, 2007).

Conclusion

Financial management in a hospital should be a role played by all departments in their respective areas. Nursing units should be held accountable for finances allocated to them. Managing nurses or nurse leaders should ensure that nursing processes are cost-effective, by so doing the department will assist in overall hospital financial management.

References

Finkler, S.A., Kovner, C.T. & Jones, C.B.(2007). Financial management for nurse managers and executives. New York: Elsevier Health services.

McHugh, M., & Finkler, A. (2008).Budgeting concepts for nurse managers. Philadelphia: Elsevier Health Sciences.

Introduction

The Board of Registered Nursing (BRN) which is located in Sacramento, California is bestowed with the responsibility of ensuring that information regarding the scope of practice for its nurses is made available for use by nurse practitioners. The aim of this is to prevent financial or legal penalties that might come as a result of the lack of such kind of information. According to Considine, Martin, Smit, Jenkins & Winter (2006), such kind of information is meant to assist registered nurses that are now practitioners to know how to incorporate various regulations and statutes in the practice setup.

Scope of Practice for California Nurse Practitioners

For all registered nurses in California, there is a need to keep a close link with BRN so that they get the current guidelines that relate with their practice. California nurses have to observe clearly both the Nursing Practice Act (NPA) and the California Code of Regulations (CCR). The practices of the nurse practitioners are given in NPA under section 2834 as well as the CCR section 1480 (Mikos, 2004; Apold, 2007).

Nursing Practice Act (NPA)

There are clear guidelines regarding the activities that a practicing nurse should engage in as stipulated by the Business and Professions Code, Section 2725 under NPA (Guerry et al., 2005). The legal procedures are explicitly provided for purposes of clarity in this section. NPA authorizes the following:

1. Care services provided by the registered nurses, both direct and indirect, should ensure that the patient achieves utmost comfort, safety, protection, hygiene and deterrence from illnesses.
2. This care services might also involve administering therapies or medications to help patients recover from ailments, prevent those ailments or rehabilitate patients. The most important thing is to comply with the scope covered by the license of the physician under the supervision of whom the nurse is working (Packel et al., 2006).
3. Undertaking of immunizations, skin tests and withdrawing of patient blood from either the arteries or the veins.
4. Observing the prognosis of the patient i.e., reactions to medications, the signs and symptoms of the diseases and also starting emergence procedures when necessary.

California Code of Regulations (CCR)

Partin (2006) in his journal outlines the following stipulations as provided by CCR:

1. A nurse practitioner must be registered with BRN and have some supplementary skills that equip him or her in the areas of psychosocial assessment, physical diagnosis, primary healthcare management of illnesses. The nurse must also come from a preparatory body that goes in line with the guidelines of CCR, section 1484 i.e., the standards of education.
2. The nurse practitioner should be in a position to take up the accountabilities and responsibilities that come with the healthcare management irrespective of whether the illness has been stopped or is still present. This is given under CCR 1480 (b).
3. Practicing nurses in California must possess the clinical competence that is expected of professionals in clinical practice, may it be in terms of skill, learning or care. These provisions are given under CCR 1480 (c).
4. There is no further scope of practice for nurse practitioners which surpass the Registered Nurse (RN) scope. Consequently, NP depends on standardized course of action in carrying out those medical tasks that overlap. CCR section 1485 deals with this issue.

Conclusion

The scope of practice for a California nurse practitioner is regulated by the Board of Registered Nursing which ensures that the practicing nurses observe Nursing Practice Act (NPA) and California Code of Regulations (CCR). The governing body and the two authorization entities warrant that NPs are able to work within the level of training and education they have achieved. Importantly, they safeguard the benefits of patients while making certain that California NPs do not incur liability or charges as a result of malpractices or operating without licenses.

References

Apold, S. (2007). Fighting the Scope of Practice Partnership. The Journal for Nurse Practitioners, 3(2), 72-72.

Considine, J., Martin, R., Smit, D., Jenkins, J., & Winter, C. (2006). Defining the Scope of Practice of the Emergency Nurse Practitioner Role in a Metropolitan Emergency Department. International Journal of Nursing Practice, 12(4), 205-213.

Guerry, S. L., Bauer, H. M., Packel, L., Samuel, M., Chow, J., Rhew, M. (2005). Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California. Journal of General Internal Medicine, 20(12), 1102-1107.

Mikos, C. A. (2004). Inside The Nurse Practice Act. Nursing Management (Springhouse), 35(9), 20-22.

Packel, L. J., Guerry, S., Bauer, H. M., Rhew, M., Chow, J., Samuel, M. (2006). Patient-Delivered Partner Therapy for Chlamydial Infections: Attitudes and Practices of California Physicians and Nurse Practitioners. Sexually Transmitted Diseases, 33(7), 458-463.

Partin, B. (2006). Who, if not you, will determine NP Scope of Practice?. The Nurse Practitioner, 31(2), 6.

Children with developmental disorders can have a significant impact on their lives and the lives of those around them. Robin Hornik Parritz and Michael F. Troys book Disorders of Childhood: Development and Psychopathology evaluates the various developmental disorders, including those that manifest during early childhood. Intellectual disability, communication disorders, autism spectrum disorder, and attention-deficit/hyperactivity disorder are some of the most common disorders in this area (ADHD). Analyzing the disorders of early development discussed in the book by summarizing their symptoms and behaviors highlights their impacts on children.

Mental retardation, or intellectual disability, is a neurodevelopmental disorder characterized by significant limitations in adaptive behavior and intellectual functioning. Children with intellectual disabilities typically have delays in language development, difficulties with abstract thinking, and social skills issues. They may also face challenges with self-care tasks and require assistance with daily living activities (Parritz & Troy, 2019). Intellectual disability can range in severity from mild to profound, and the causes can include brain injury, genetics, and environmental factors such as malnutrition or toxic exposure.

Communication disorders are a group of developmental disorders that affect a childs capacity to interact. One type of communication disorder is a language disorder diagnosed with symptoms of difficulties with spoken or written language, such as using correct grammar or vocabulary, understanding language, or expressing ideas. Children with speech sound disorders may struggle with individual sounds like th or r, or they may struggle with entire classes of sounds like fricatives or plosives (Lang et al., 2019). Speech sound disorders can have a negative impact on a childs ability to communicate effectively, resulting in frustration and social isolation.

Another type of communication disorder is sound speech disorder, which involves difficulty pronouncing sounds, making it difficult for the child to communicate effectively with others. Fluency disorders cause children to repeat sounds, syllables, or words or to prolong sounds or syllables. These disruptions can affect a childs communication patterns leading to social anxiety and avoidance of speaking situations. However, early intervention is vital for children with communication disorders, considering that communication delays implicate other development areas (Parritz & Troy, 2019). Speech and language therapy, as well as other interventions, can help children improve their communication skills, gain confidence, and reduce the impact of their symptoms on their daily lives. Children with communication disorders may struggle with social interactions, leading to social isolation and low self-esteem. Notably, language and fluency disorders are resultant to low self-esteem.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication, interaction difficulties, and monotonous behaviors and interests. Children with ASD may exhibit various symptoms and behaviors, varying in severity and impact. First, children with ASD may struggle with social interactions, such as understanding social cues and maintaining eye contact. They may also exhibit repetitive behaviors, have an intense interest in specific topics or activities, and have high sensitivity (Lang et al., 2019). While the causes of ASD are unknown, researchers establish that genetic and environmental factors may play a role. Early diagnosis and intervention can help children with ASD improve their social and communication skills and reduce the impact of their symptoms on their daily lives.

ASD diagnosis can be difficult because there is no established medical test. A comprehensive evaluation, including assessments of a childs behavior, communication, and development, is typically used to make a diagnosis. Early detection and intervention are critical in assisting ASD children in developing communication, social, and self-regulation skills (Lord et al., 2019). Behavioral and educational therapies, such as Applied Behavior Analysis (ABA) and speech therapy, are common ASD and pharmacological interventions for specific symptoms. According to Parritz & Troy (2019), parents and caregivers play a critical role in supporting children with ASD by providing a structured and supportive environment and collaborating closely with healthcare professionals to develop individualized treatment plans.

ADHD is a neurodevelopmental disorder marked by inattention, hyperactivity, and impulsive behavior. Children with ADHD may struggle to focus on tasks, plan activities, or adhere to instructions. They may be fidgety or restless, have difficulty sitting still, and frequently interrupt others. ADHD can significantly impact a childs academic performance and social interactions, resulting in self-esteem and self-confidence issues. As Parritz & Troy (2019) emphasize, early detection and intervention are critical in assisting children with ADHD in managing their symptoms and improving their functioning at home, school, and social situations. Like other developmental disorders, ADHD has severe impacts on a childs behavior, performance, and social dynamics.

To conclude, Early development disorders, as discussed in Robin Hornik Parritz and Michael F. Troys Disorders of Childhood: Development and Psychopathology, can have a significant impact on a childs functioning and development. Among the most common disorders in this area are intellectual disability, communication disorders, autism spectrum disorder, and ADHD. Early detection and intervention are critical in assisting children with these disorders to reach their full potential and improve their quality of life. More research on the symptoms of developmental disorders can be elemental in providing appropriate support to parents, clinicians, and educators.

References

Lang, S., Bartl-Pokorny, K. D., Pokorny, F. B., Garrido, D., Mani, N., Fox-Boyer, A. V.,& & Marschik, P. B. (2019). Canonical babbling: A marker for earlier identification of late detected developmental disorders. Current developmental disorders reports, 6, 111-118. Web.

Lord, C., Elsabbagh, M., Baird, G., & Veenstra-Vanderweele, J. (2019). Autism spectrum disorder. The lancet, 392(10146), 508-520. Web.

Parritz, R. H., & Troy, M. F. (2019). Disorders of childhood: Development and psychopathology (3rd ed.). Cengage Learning.

Introduction

The medical facility, known as Peterson Healthcare Centre, will provide comprehensive medical care to patients of all ages. The center will be located in a prime area, and we will offer various services: preventive medicine, emergency care, surgery, dental care, diagnostic imaging, and laboratory services. This plan aims to improve the health of patients across the globe. The facility will offer top-quality accessible, and affordable care. Peterson medical facility is a cutting-edge healthcare provider that delivers top-quality medical services to patients in the United States and abroad. A team of experienced medical professionals will enhance customer satisfaction. However, the development of such a project requires considerable consideration of a detailed action plan, therefore, this paper proposes an analysis of the institutions operations, market, competitive offer, staffing structure and estimated costs.

Business Overview

Peterson Healthcare Facility aims to provide a wide range of healthcare services. The facility will have a team of highly qualified technicians and support staff (Heller, 2021). Equally, it will offer preventive medicine and emergency care. In addition, surgery, dental care, diagnostic imaging, and laboratory services will be offered. The facility will generate revenue through patient fees, insurance reimbursements, and government funding. It will require an initial investment of $5,500,000 to cover the costs and expenses (Moro Visconti & Morea, 2019). Significantly, expenses incurred by the facility will include construction, equipment, and staffing costs. Additionally, potential investors who will contribute the required capital have been identified. The facility will have two primary care and preventative care physicians specializing in general practice, two dentists, gynecologists, pediatricians and mental health specialists. Four registered nurses and four licensed practical nurses are included in the staff. In addition, the facility will have a team of four administrative staff, including a receptionist, medical records clerk, billing specialist, and office manager.

Market Analysis

There is a significant shortage of healthcare providers in the United States, which presents a significant opportunity for Peterson Healthcare facility to fill the market gap. In addition, the demand for the services listed in the business plan is relatively high, confirming a World Health Organization study (World Health Organization, 2020). This fact is caused by various factors, such as an increased load on the system due to the COVID pandemic, a reduction in the number of specialists due to burnout and adaptation of the educational system, and much more (World Health Organization, 2020). The critical value of accessibility is achieved by serving patients of all ages and genders (Moro Visconti & Morea, 2019). In addition, the location of the center is another key competitive advantage.

Services & Type of Practice

The facility will offer primary care practice, preventative, diagnostic, and treatment services. Equally, it will offer pediatrics, gynecology, mental health services, and preventative care. It will have a team of competent primary care physicians, nurses, and administrative staff. Significantly, primary care services will include routine checkups and physical examinations. Pediatric services include routine checkups, vaccinations, and sick visits (Heller, 2021). Gynecology services will entail routine exams, Pap smears, and birth control consultations. The medical team will also establish strong partnerships with insurance companies and healthcare providers to expand the patient base and increase revenue streams.

Management Team

A team of experienced healthcare professionals will manage the Centre. It will include a medical director, a practice manager, a billing manager, a nursing supervisor, experienced physicians, nurses, and administrative staff will be employed (World Health Organization, 2020). The entire staff will be highly trained for compassionate and high-quality care to our patients. It will also leverage the latest technology for an efficient and seamless patient experience. The technology will include electronic medical records and telemedicine capabilities (Kaye et al., 2021). The Peterson healthcare facility team comprises experienced medical professionals with a proven track record of success in the healthcare industry, good experience, and a wealth of knowledge and expertise.

Competitive Advantage

This institution has several advantages, which together form a competitive advantagestarting from a convenient and affordable location and organizational issues, such as various payment options and insurance programs, ending with the many operational services provided. There can be no compromises in health matters; therefore, the team undergoes a rigorous selection for competence, and the equipment is purchased only the latest with mandatory subsequent maintenance and quality control. Finally, the diversification of services is available for patients of all ages, indicating specialists high professional skills and an individual approach.

ROI Calculation

The return on investment (ROI) for the healthcare facility can be calculated by dividing the net income by the total investment. The second formula shows the calculation for the total investment of $5,500,000. This financial indicator is a key one for investors, especially at the stage of evaluating a project as a start-up. However, in itself it is not the only sufficient basis for making an investment decision, for which this analysis is undertaken with the construction of a business plan. A number of external and potential internal factors always create risks for projects with fairly high fixed and variable costs. The assessment of weaknesses and strengths is carried out by various types of analysis, which can be implemented after the approval of this business plan, as the main roadmap to action. Competitive threats, as well as a range of political and global determinants, are important indicators of progress in the health industry.

ROI Advantages

Peterson Healthcare Facilitys business plan will generate a significant ROI for its investors. It has projected a net income of $300,000 (Kaye et al., 2021). This facility is poised to become a leading healthcare provider in the United States by delivering top-quality medical services to needy patients. The high returns will increase its market share and profitability. The net income projection in the first year of operations is expected to increase over time. With a strong management team, solid business model, and growing market opportunity, the facility has the potential to become a significant player in the healthcare industry. We seek to bring our vision to life, realize our potential, and acquire high returns.

Why the Facility will be Successful

Primary care services are in high demand, and the healthcare facility will provide quality care to meet the patients needs. It will employ an experienced team of primary care physicians and nurses to provide quality care to patients. Moreover, this organization will accept various insurance plans, making them accessible to a broad range of patients, which in the long term increases the potential target audience and profit. Finally, the convenient location, making it easily accessible to patients, will create a competitive advantage. Technical equipment in conjunction with top specialists will contribute to efficiency and speed with the quality of services provided. Such opportunities will allow further extrapolation of this business model, scaling both vertically the number of specialists and the volume of patients per day, and horizontally  diversifying services.

Conclusion

The calculated financial return on investment is a clear proof of the payback of variable costs. However, the opening of such a center requires deeper calculations, including the construction of a breakeven point, NPV and IRR, as well as other indicators of project payback. This business plan meets the most basic needs emerging as demand in this and neighboring regions, touches on the problem of a federal scale and partly makes it possible to understand the gap between the supply of medical services and requests for them. In summary, the proposed medical facility will fill a critical need for affordable and accessible healthcare services in the region. The stakeholders are confident with the experienced team, diversified in specializations. Coupled with the Hospitals reputation, it will establish a successful and sustainable healthcare facility. Your consideration of this proposal will be appreciated, and the board looks forward to discussing it further.

References

Heller, D. (Ed.). (2021). Performance of Valuation Methods in Financial Transactions. John Wiley & Sons. Web.

Kaye, A. D., Okeagu, C. N., Pham, A. D., Silva, R. A., Hurley, J. J., Arron, B. L.,& & Cornett, E. M. (2021). Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Practice & Research Clinical Anaesthesiology, 35(3), 293-306. Web.

Moro Visconti, R., & Morea, D. (2019). Big data for the sustainability of healthcare project financing. Sustainability, 11(13), 3748. Web.

World Health Organization. (2020). Operational considerations for case management of COVID-19 in health facility and community: interim guidance, 19 March 2020 (No. WHO/2019-nCoV/HCFoperations/2020.1). World Health Organization. Web.

Nurse practitioners (NPs) should be aware of the items and documents needed before applying for certification. Similarly, physicians and care provider organizations should have unique identifiers in order to pursue their aims diligently. This paper discusses the major steps stakeholders require to obtain DEA and NPI numbers. The procedure required to apply for certification is also described.

DEA Number

Professionals who prescribe or dispense certain controlled drugs or substances should have a DEA number. This achievement means that the Drug Enforcement Administration (DEA) recognizes and allows them to administer specified medicines. The first step for professionals to consider when applying for a DEA number is to have active practicing licenses in their respective states. If a controlled permit approval or certificate is required in a practitioners state, it should be produced when applying for this approval (DEA forms, n.d.).

The second step is to visit this link: www.deadiversion.usdoj.gov. The user will them get a registration identity number (ID). Thirdly, the individual will wait for 2-3 days before the application is approved. This DEA number is usually valid for three years.

NPI Number

The National Provider Identifier (NPI) number is an identifier used on different claim forms issued to medical care providers. Such organizations should be outlined or identified as covered entity. The first step is for facilities and hospitals to visit the National Plan and Provider Enumeration System website. Those who want to use paper application are required to call this number for assistance: 800/465-3203. The second one is for all applicants to ensure that their documents are ready. These include state license data or information and social security number (Applying, n.d.). The online application process for a NPI number usually takes less than 30 minutes. There is also an option to apply by mail.

Importance

These identifiers are important because they allow practitioners, physicians, and healthcare organizations to engage in professional and ethical medical activities. The DEA number is essential since it authorizes physicians and APNs to prescribe specific drugs or controlled substances. With this identifier, they will pursue their personal and professional objectives diligently (Applying, n.d.). The NPI number is also a critical identifier for health care providers. This is the case since the identifier is indicated on every claim form. This number also simplifies application processes and claims submission. Additionally, it improves efficiency and reduces costs throughout the care delivery process.

Procedure for Certification

The first step whenever applying for certification is to create a profile after visiting the website of the selected organization. Those who want to use paper application can download the required form. Applicant should use their first and last names. Individuals should have also completed their clinical and didactic coursework (Application process, n.d.). After applying online, the second step is to complete the required certificate examination.

Practitioners should also pay applicable fees or charges during the process. The selected organization for certification application is the American Academy of Nurse Practitioners (AANP). The first reason for choosing this organization is because it has a higher passing rate. Secondly, it offers a convenient application procedure. Additionally, the organization provides clinical-based questions. These aspects explain why I will be in a position to apply for certification successfully.

Conclusion

The above discussion has revealed that physicians, practitioners, and health care providers should have unique identifiers. Such numbers are essential because they guide different stakeholders to identify each other, streamline care delivery processes, and reduce medical costs. Nursing students should also apply for certification in order to continue providing high-quality services to their patients.

References

Application process. (n.d.). Web.

Applying for your National Provider Identifier (NPI). (n.d.). Web.

DEA forms and application. (n.d.). Web.

Introduction

Healthcare organization comprises of systems, which constantly interact depending on numerous forces. Systems theory posits that organizations comprise of systems and subsystems that determining organizational processes and activities. According to Meyer and OBrien-Pallas (2010), input, throughput, and output factors interact dynamically and determine the performance of nurses and outcomes of nursing care (p. 2828). In this view, the application of systems theory in nursing unit such as critical care unit would enhance efficiency of input, throughput, and output processes of nursing. Therefore, this essay analyzes critical care unit using systems theory with a view of describing the problem and providing an appropriate intervention.

Description of Critical Care Unit

Critical care unit is a busy unit in a healthcare center because it deals with patients, who are in critical conditions and thus require intensive care. The inputs of the critical care unit are patients, critical care nurses, materials, equipment, and information. Patients form an important input of the critical care unit because they are the recipients of nursing care and determinants of outcomes. Critical care nurses offer input services of nursing care, and thus, they influence the recovery process of patients in the critical care environment. Materials such as medicines, gloves, reagents, chemicals, syringes, and other consumables are inputs of critical care unit. Since the critical care unit has special equipment like monitors, ventilators, feeding tubes, intravenous tubes, catheters, chest tubes, and pacemakers amongst others. Diagnostic information of patients comprises a significant input of the critical care unit for it forms the basis of medical history of patients, which influence medical intervention and nursing care.

Throughput is a component of a system that describes processes taking place in the system following the inputs. Meyer and OBrien-Pallas (2010) argue that transformation and reorganization of inputs into internal energies of a system create throughput. In the critical care unit, nursing care processes and activities form throughput. The nature of nursing care processes and activities is dependent on inputs and the ability of the critical care system to transform and reorganize these inputs into effective energies that drive the system. The outputs of the critical care system are quality of healthcare services, safety of care, and patient outcomes. Manojlovich, Antonakos, and Ronis (2009) assert that the nature of communication among healthcare providers and quality of nursing care determine patient outcomes. Hence, patient outcome is an important output of the critical care unit.

The functioning of the critical care unit as a system requires cycles of events such as the improvement of nursing practices, the application of the updated nursing protocols, the use of modern equipments, the continued supply of materials and resources, and the accreditation of nurses and healthcare centers. Regarding the negative feedback, the critical care unit requires to undertake corrective measures in response to its functioning and patient outcomes. The rate of recovery among patients, the prevalence of nosocomial infections, safety of nursing care, and quality of nursing care are some of the negative feedback, which determine the adjustment of inputs.

Description of Problem

Poor quality of nursing care as depicted by high incidences of nosocomial infections and negative patient outcomes is a problem that is common in the critical care unit. The inputs such as critical care nurses, information, materials, and medical devices contributes to poor quality of nursing care and the occurrence of nosocomial infections. Incompliance with evidence-based practices makes nurses to offer a poor quality of nursing services, which give negative patient outcomes. According to Manojlovich, Antonakos, and Ronis (2009) faulty communication among healthcare providers causes adverse patient outcomes. Faulty communication affects delivery of accurate information in a timely manner for the benefit of patients. Insufficient supply of materials like medicines, gloves, reagents, chemicals, syringes, and other important consumables affect the delivery of nursing care effectively. Moreover, insufficient medical devices such as catheters, ventilators, syringes, and surgical blades increase the risk of nosocomial infections.

In the aspect of throughput, systems theory shows that problem exists in the critical care unit. Owing to incompliance with evidence-based practices, nursing practices and activities in the critical care unit are wanting. The processes and activities that entail the prevention of nosocomial infections are below the required standards, and thus, patients have a high risk of these infections. Additionally, the communication between healthcare providers, including critical care nurses is faulty in the critical care unit. As a consequence, patients receive disparate nursing care, which is detrimental to their health. Krein, Kowalski, Hofer, and Saint (2012) state that lack or insufficient supply of medical devices such as impregnated catheters and equipment to sterilizer surgical devices contribute to negative patient outcomes and the occurrence of nosocomial infections.

Poor quality of healthcare services, reduced safety of care, and increase the prevalence of nosocomial infections are some of the outputs of the critical care unit, which show that there are problems in the system. These outputs emanate from the issues in input and throughput processes of the critical care system. Poor quality of health care services indicates that nurses do not comply with standard nursing practices and/or some materials and equipment are lacking. Reduced safety of patients implies that the throughput processes are not effective addressing health issues of patients. The prevalence of nosocomial infections shows that the conditions of the critical care environment and nursing practices are unhygienic (Kelly, Kutney-Lee, Lake, & Aiken, 2012). Although these negative patient outcomes provide appropriate negative feedback, lack of materials, equipment, and resources, as cycle of events, limits the critical care unit from taking appropriate feedback response.

Proposed Solution

Desired Outcome

The desired outcome is to improve positive patient outcomes in the critical care unit. To achieve the desired outcome, the critical care nurses need to apply evidence-based approaches in the treatment of patients. Evidenced-based nursing practices are central in the treatment of patients and prevention of nosocomial infections.

Goals and Objectives

• To promote communication among healthcare providers, specifically nurses and physicians in the critical care unit.
• To improve nursing practices are applicable in the treatment of patients in the critical care unit.
• To incorporate evidence-based practices in the prevention of nosocomial infections in the critical care environment.
• To apply negative feedbacks effectively in making adjustments that increases efficiency of the critical care system.
• To ensure that there is enough supply of materials and resources so that the critical care system to function effectively.

Policies and Procedures

The critical care unit needs to enhance communication among healthcare providers by adopting information technology policies and procedures. The adoption of protocols, which promote communication, storage, and retrieval of information, would enhance accuracy data and timely retrieval of information. The application of evidence-based practices is necessary to enhance effectiveness of procedures that critical care nurses apply in the treatment of diseases and prevention of nosocomial infections. Since inputs determine outcomes of nursing care, the critical care should develop feedback mechanism and respond to patient outcomes appropriately. For example, the supply of materials and resources should be in tandem with the demands of the critical care unit.

Relevant Professional Standards

Standards of professional practice that are applicable in the critical care unit are quality care, competency, collegiality, and collaboration (American Association of Critical-Care Nurses, 2014). Quality of care is an integral professional standard that critical care nurses need to improve patient outcomes. Professional competency is important because it enables nurses to apply evidence-based practices in their routine practices and activities. Collegiality and collaboration are two related standards, which require critical care nurses to cooperate with other healthcare providers and family members in the provision of quality healthcare to patients.

Mission, values, Culture, and Climate

Improvement of patient outcome in the critical care environment is in line with the mission Spotsylvania Regional Medical Center, which aims to provide quality of care, improve human life, and serve the community. Moreover, the improvement of patient outcome in the critical care environment is in tandem with the vision of the medical center that aims to be the best place to receive healthcare, practice medicine, work, and act as an asset of the community. Given that patient outcome is a key output in the critical care system, the improvement of patient outcome would transform the culture and climate of Spotsylvania Regional Medical Center to focus on the needs of patients. From the mission, vision, and philosophy, it is evident that the medical center puts patients at the center of focus.

Conclusion

The application of systems theory in the analysis of critical care unit has revealed healthcare problems. These problems emanate from inputs, outputs, and throughput processes in the critical care unit. The common problems are poor quality of care, increased nosocomial infections, and reduced safety of patients. The desired solution to these problems is the improvement of patient outcomes using input, throughput, and negative feedback processes. The improvement of patient outcome is in line with the mission and vision of Spotsylvania Regional Medical Center. Therefore, the improvement of patient outcome would transform the culture and climate of the medical center, according to its mission, vision, and philosophy.

References

American Association of Critical-Care Nurses. (2014). Standards for Acute and Critical Care Nursing Practice. Web.

Kelly, D., Kutney-Lee, A., Lake, E., & Aiken, L. (2012). The critical care work environment and nurse reported healthcare-associated infections. American Journal of Critical Care, 22(6), 482-489. Web.

Krein, S., Kowalski, C., Hofer, T., & Saint, S. (2012). Preventing hospital-acquired infections: A national survey of practices reported by the U.S. hospitals in 2005 and 2009.Journal of General Internal Medicine, 27(7):773-779. Web.

Manojlovich, M., Antonakos, C., & Ronis, D. (2009). Intensive care units, communication between nurses and physicians.American Journal of Critical Care, 18(1), 21-30. Web.

Meyer R.M. & OBrien-Pallas L.L. (2010). Nursing services delivery theory: An open system approach.Journal of Advanced Nursing, 66(12), 2828-2838. Web.