Category: Health

Introduction

Axiom Medical P.C. is a clinic that aims to provide top-notch care to its patients through efficient service delivery and high-class care. Being a health care provider, the institution continuously attends to patients with different diseases and conditions such as asthma, high blood pressure, diabetes, and the common cold. Part of its services includes the performance of medical procedures such as diagnosis, physical examinations, treatment, and referrals for specialty care. Consequently, Axiom Medical P.C. has the capacity to handle the majority of cases that patients would present in a health setting. While the institution strives to perform to the best of its capabilities, minor issues are bound to affect its efficiency in the long run. Therefore, by implementing measures that enhance patient flow, the clinic can effectively improve performance and lead to better patient outcomes.

Patient and employee satisfaction are great drivers of success in the healthcare industry due to the varying degrees of services offered in different institutions. As a result, the majority of health institutions have a high turnover rate, with diminishing patient loyalty (Shelton & Stirman, 2018). This means that employees are likely to move to other institutions where they can achieve more. On the other hand, patients expect better health outcomes based on the high quality of care in the facilities they visit. Therefore, small health facilities such as Axiom Medical P.C. must be prepared to improve service delivery to ensure their steady growth and better performance in the long run. This can only be achieved through a thorough process of internal analysis to identify problems and come up with appropriate measures to mitigate them (Sanjaya et al., 2019). This provides a competitive edge that not only advances the capabilities and performance of its employees but further caters to improving the health outcomes of patients.

Internal Functions and Processes at Axiom Medical P.C.

The three processes that have been identified as enhancing patient care include the effective delegation of tasks, the use of technology, and the implementation of monitoring techniques. Axiom Medical P.C. has strived to ensure that it employs a number of specialized staff members to handle each aspect of the operation. More so, it also has three doctors who are in charge of handling the various patients that visit the facility. In this regard, each employee has specific duties that they have to accomplish on a daily basis to promote the smooth running of the clinic. Such delegation of activities has helped in saving time since everyone can be able to work independently when required to achieve targets. More so, individuals further have room to develop their competencies, leading to inspired employees that strive to improve the overall performance.

Apart from that, the medical clinic further employs the use of technology in the administration of activities to improve operations. The use of tools such as Electronic Health Records (EHR) ensures that patient history can be appropriately accessed by a doctor when required (Vega et al., 2019). This is important when making decisions that affect the patient, hence promoting better health outcomes through the analysis of medical records. Additionally, the automation of various activities such as employee check-in enables the clinic to track attendance and optimize daily operations.

Another important process that enhances care at Axiom Medical P.C. is the monitoring of patient flow. This involves scrutinizing traffic and resources at the clinic to ensure minimal overcrowding and deficiencies that could affect the institutions image. Managing the processes has always been essential to ensure shorter wait times for all patients to improve overall satisfaction. Therefore, the staff is always keen on coordinating care through efficient pathways during the process, starting when a patient arrives at the clinic. Any problems arising from an increased patient flow can have significantly far-reaching consequences, including exacerbated symptoms and even mortality. Therefore, this forms an indispensable part of the facilitys mission to improve care through optimal functioning.

The Management of Patient Flow

Problems arise in medical clinics in cases where there are no structures in the procedures involving the provision of care. In most cases, Axiom Medical P.C. requires patients to make an appointment to visit the facility since the majority of the cases are non-emergencies. However, walk-ins are also accepted based on the capacity of the clinic to handle patients at any given time. However, in some instances, the number of patients can increase significantly due to longer consultations and diagnostics that affect appointments. As a result, this leads to longer wait times for patients, which ultimately affects the clinics outlook. The consequences of such situations include overcrowded hallways and waiting rooms, diversion of incoming patients, and delays in discharging.

As a result, the clinic introduced administrators to effectively handle patient flow through the scheduling of appointments and follow-ups to ensure that they spend the shortest time at the clinic, depending on the available resources at the time. A majority of this is done manually, through the input of patient data onto a computer system that enables tracking of each patient and the availability of a doctor. This is important since, at any point, the administrators can be able to identify the number of patients being attended to and those awaiting services. Previously, a paper trail was used to check the progress of patient movements which posed a significant burden, especially in the maintenance and handling of vast amounts of individual patient records. The use of the computer system improved the process but is still slow at times due to failures to consider other factors that affect patient movement.

The introduction of the monitoring system came at the right time since, previously, it was impossible to know which points of the service delivery operations were leading to delays. However, with the integration of patient flow management into the clinic, it became easier to track movements and plan for appropriate changes to improve efficiency. Scheduling posed the most important challenge since a high number of patients requested appointments earlier during the week, making them extremely busy while some days had little to no activities. More so, further identifying other aspects of administration, such as billing and procurement, that could potentially lead to delays has helped in mapping out the entire process chain. Therefore, the clinic has benefitted significantly from process management, especially in regards to employees who have learned how to flexibly operate to overcome any challenges presented.

Improving Patient Flow at Axiom Medical P.C.

Patient flow is integrated into the entire health care institution right from the point of entry to the discharge point. Therefore, all members of staff are required to work together to ensure every organizational process operates efficiently. The goal of patient care lies in reducing the waiting times of patients, minimizing any underlying costs for the facility, improving patient and staff satisfaction rates, and increasing productivity at the clinic (Destino et al., 2019). Therefore, by boosting the existing workflow, Axiom Medical P.C. can be effective in its mandate of providing world-class care for its patients.

Enhancing communication can improve patient flow by creating a network of collaboration between doctors, administrators, and other staff that work at the clinic. When every member of the team understands the process of achieving the objectives, it becomes easier to onboard solutions to problems that affect them. Therefore, having a leadership team that identifies issues, suggests viable solutions, and oversees appropriate changes, can assist in planning current bottlenecks and outline their perceived impact on performance (Rosen et al., 2018). Communication is therefore considered crucial in spearheading the call for viable change that can lead to benefits not only to the employees and facility at large but also to patient health.

Apart from that, embracing technology to prevent monotonous work is efficient in addressing time constraints for different staff to support others in achieving important goals. More so, non-clinical services that support the operations of the clinic can be integrated into the planning system, thus enhancing speed and efficiency (Browne et al., 2018). Administrative aspects such as billing, housekeeping, and procurement that form part of the patient flow must also be considered essential parts of the clinic that can be improved. This can be done through automation, such as real-time location systems that can identify the location of staff and critical equipment in the healthcare setting. As a result, both employees and their required tools can be accessed when required, thus improving response times.

Changing the policy requires the use of evidence-based results to demonstrate the efficacy of such new policy shifts. This means that it requires the identification of similar health settings that have successfully implemented such new technologies and changes. This will help in building a case for the introduction of such changes in the clinic to gain management support that would ultimately integrate it (Shelton & Stirman, 2018). Therefore, using a real-life case study will require visits to such facilities coupled with data sheets on actual throughput over a select period which can be used for base case comparisons with Axiom Medical P.C. Therefore, once it is clear that such innovations improve performance, it becomes easier to convince management to implement them.

Educating Stakeholders on the Policy Change

Change management is crucial for organizations intending to introduce new processes and procedures to enhance service delivery. Therefore, by understanding the right implementation strategies, an organization can prevent the possibility of conflicts hindering the process (Braithwaite et al., 2018). It is thus important to adequately educate team members of impending changes long before they are actualized to help them prepare beforehand.

The first step will involve the development of a basis for the change in policy on patient flow based on the challenges previously experienced at the clinic. Ensuring that individuals understand why the alterations are being brought about allays any fears that they may have about the managements intentions (Rosen et al., 2018). Subsequently, engagement of all the stakeholders will provide a platform for everyone involved with the clinic to interact with the proposed changes and provide feedback during the planning phase on the best approaches moving forward (Destino et al., 2019). This is essential in creating an environment where the views of each member are appreciated and integrated, thus increasing the acceptance rates.

The next phase will involve the development of an appropriate roadmap that outlines the steps that will be put in place to achieve the change initiative. A clear and direct route showing the role of each individual in the facility will be important in preparing for the integration of the new processes (Browne et al., 2018). This will involve provisions for the purchase of relevant systems, employment of additional staff, and resources for necessary training sessions. Ultimately, having such plans reduces rushed measures that would increase the pressure on employees and result in conflicts that would potentially delay the process.

The final step would involve the reiteration of the need for monitoring and tracking changes throughout the process. This is essential in evaluating the progress of the measures put in place to achieve improved performance in the clinic. Any identified processes that do not significantly add value would require re-evaluation to check whether they can be improved or removed from the implementation plan (Teitelbaum & Wilensky, 2019). This ensures that only the most viable solutions continue to be implemented in the facility to bolster productivity for all employees. Monitoring and evaluation thus play a critical role in ensuring that efforts and resources committed towards the processes are utilized effectively and ultimately have a great return on investment.

The above steps form part of the avenues for education to all members at Axiom Medical P.C. to help them understand the purpose of the changes. Once all members come to a consensus on the importance of improving patient flow at the clinic, it will be easier to implement the changes without disgruntles that would otherwise stall them. More so, people appreciate being informed about such measures and the possible benefits they hold to eventually gunner the required support.

Cultural and Practical Barriers to Implementing Change

The biggest barrier to the implementation of change in the facility may involve skepticism or resistance by staff members. Without the full support of the entire establishment, suggesting or making changes may be difficult and opposed by all means to maintain the status quo (Shelton & Stirman, 2018). This is because individuals may be resistant to alterations. Thus, any changes are perceived to be targeting them. It is therefore important to ensure that appropriate measures are put in place to create forums for discussions and engagement before commencing the process of change.

Apart from that, a shortage of resources may also affect the possibility of implementing meaningful change in the clinic. This is a practical barrier that can create circumstances in which the needed implementations that require an investment cannot be facilitated from an economic perspective. As a result, the concept may slow down the process leading to poor performance, thus affecting the overall outlook of the change process (Vega et al., 2019). Therefore, appropriate measures should be identified and used to reduce the substantial initial budget for the introduction of new processes and technologies. This will provide the leeway for the clinic to achieve early wins that are visible to all hence pushing the team to achieve more.

Furthermore, a lack of management support can further derail the implementation process since they are perceived to be the leaders driving the process. Employees in the clinic that implement the new processes from scratch should be able to depend on their management team to support in advice, technical issues, and addressing any problems that arise (Sanjaya et al., 2019). Without such support, junior officers may be unable to fully address critical aspects of the change process that lay the basis for the entire process. As a result, this may lead to a breakdown in the process, affecting the viability of the suggested changes.

Conclusion

Axiom Medical P.C. attends to patients with different diseases and conditions such as asthma, high blood pressure, diabetes, and the common cold. More so, its services include the performance of medical procedures such as diagnosis, physical examinations, treatment, and referrals. The clinic has strived to improve performance by employing a number of specialized staff members to handle each aspect of operation, use of technology in the administration of activities to improve tasks, and monitoring traffic and resources at the clinic to minimize aspects that could affect the institutions image. However, some challenges have still been experienced, especially in the scheduling and monitoring of patient flow based on the activities of various stakeholders. As a result, enhancing the integration of patient flow management into the clinic will enable easier tracking movements within the facility and plan for appropriate adaptations to improve efficiency.

Enhancing the patient flow requires communication between doctors, administrators, and other staff that work at the clinic, embracing technology to prevent monotonous work and the use of evidence-based results to demonstrate the efficacy of such new policy shifts. More so, by educating stakeholders to understand the need and the appropriate implementation strategies, an organization can prevent the possibility of conflicts hindering the process. Consequently, overcoming challenges such as skepticism or resistance by staff members, shortage of resources and support by management can increase the chances of success. All members at Axiom Medical P.C. must thus understand the purpose of the changes aimed at enhancing patient flow to improve operational effectiveness and efficiency of the clinic.

References

Braithwaite, J., Churruca, K., Long, J. C., Ellis, L. A., & Herkes, J. (2018). When complexity science meets implementation science: a theoretical and empirical analysis of systems change.BMC Medicine, 16(63), 1-14.

Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Smye, V., Jackson, B. E.,& Garneau, A. B. (2018). Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics.International Journal for Equity in Health, 17(154), 1-16.

Destino, L., Bennett, D., Wood, M., Acuna, C., Goodman, S., Asch, S. M., & Platchek, T. (2019). Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge. Journal of Hospital Medicine, 14(1), 22-27.

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care.American Psychologist, 73(4), 433450.

Sanjaya, G. Y., Mubasysyir, L. L., & Kusnanto, H. H. (2019). Using Hospital Claim Data to Develop Referral Decision Support Systems: Improving Patient Flow from The Primary Care.Procedia Computer Science, 161, 441-448.

Shelton, R. C., & Stirman, S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care.Annual Review of Public Health, 39, 5576.

Teitelbaum, J. B., & Wilensky, S. E. (2019). Essentials of Health Policy and Law. Burlington: Jones & Bartlett Publishers.

Vega, P., Losi, S., Sprague Martinez, L., Bovell-Ammon, A., Garg, A., James, T.,& Pelletier, P. (2019). Implementing an EHR-based Screening and Referral System to Address Social Determinants of Health in Primary Care.Medical Care, 57(133), 133-139.

Physical activity reduces hypoxia, prevents and eliminates the manifestations of most risk factors of major cardiovascular diseases, and has several other significant benefits. It increases physical and mental performance, reduces the frequency of common infectious diseases and eases their course, slows down the age-related development of immunodeficiency, and weakens manifestations of auto aggression (Sabiston et al., 2019). When a person engages in sports, his or her body produces endorphins, which positively affect the cardiovascular and nervous systems. The overall stamina increases and blood cholesterol content decreases because the lungs of people who exercise are stronger and more resilient. During physical activity, all necessary nutrients, including oxygen, flow through the blood to our organs, which helps them function properly. Recently, many diseases associated with hyperdynamics have been discovered, ranging from obesity to cardiovascular and musculoskeletal diseases. This is due to the modern way of life; people mostly spend time at home and work, either in front of the TV or at the computer.

I am at the action stage as I am actively exercising based on the physical activity guidelines for Americans. I spend about 60 minutes a day exercising, doing aerobic and strength exercises. I separate these types of activities and take turns doing them. When it comes to exercise, I feel very motivated. Although sometimes there are days when there is no desire to do anything, much energy after a workout helps me stay productive. Physical activity is a way to clear my mind and relieve stress. In todays world, when a huge amount of information and daily stress is dumped on a person, it is challenging to stay productive without sports. That is why exercise should be part of everyones routine. With this, many mental and physical health problems can be avoided.

Since then, I have had no problem finding time to exercise and have no barriers to exercise. In the future, problems such as a heavy workload and unforeseen health issues may make it impossible for me to play active sports. I will do my best to ensure that these barriers do not prevent me from taking time for my health in the future. The solution to the first barrier can be to make a schedule that I will stick to in the future. I need to treat exercise as an integral part of my day, like work or spending time with my family. Only with this approach will I be able to make time for my physical education. The solution to the second barrier could be regular visits to the doctor to prevent illness. I need to take a sensible approach to do activities and be careful to avoid injuries.

I chose my mother, who is 62 years old, as my client. She is a cancer survivor who lives a healthy lifestyle, exercises regularly, hikes and is socially active. She is in the maintenance phase, having been doing physical activity for over six months. My mother engages in a variety of physical activities, gaining several benefits. Diversity reduces the risk of emotional burnout and loss of interest in exercise, allows her to progress in several directions, and reduces the risk of injuries from overexertion; in addition, if conditions or health do not let my mother do strength training, it can be replaced by aerobic exercise.

My mother feels motivated to do an activity because it helps her stay healthy, feel good and look good. She believes that physical activitys health-promoting and preventive effects are inextricably linked to increasing the bodys reserve capacity, its protective properties, normalizing metabolism, and optimizing the interaction of motor and autonomic functions. Sports make her feel much younger and healthier.

The barriers to doing sports that I have identified with my mother are lack of time and health indicators. She works 40 hours a week full-time, so it is not easy to find free time. I help her around the house so she can find time for herself. The next barrier is joint and back pain, which keeps her from being as active as she would like. She tries not to put too much strain on herself to avoid further problems with her well-being.

I must look at each of them more deeply to find a solution to these barriers. Lack of time is related to work and the allocation of this resource. Mom needs to reconsider the distribution of responsibilities around the house so that most of them are not on her but on other family members. She can then devote time to herself and her physical education. Mom can replace her trips to work and home with walks. In this way, she will maximize the benefits to her health. The next health-related barrier is more challenging to solve. At her age, problems like joint and back pain are almost impossible to avoid. The only way out is to continue exercising regularly to prevent this problem from developing further.

Thus, exercising is very important because the body will become prettier and tighter, and the nerves will become much stronger. Regular exercise increases a persons immunity and improves his or her well-being. People of all ages should devote time to physical development to avoid the consequences of modern lifestyles. This is the only way society can fix the problem of sedentary lifestyles.

Reference

Sabiston, C. M., Pila, E., Vani, M., & Thogersen-Ntoumani, C. (2019). Body image, physical activity, and sport: A scoping review. Psychology of Sport and Exercise, 42, 48-57.

In current history, the medical profession has attempted to establish further, test, and apply suggested theoretical concepts. To use theory effectively in all realms of practice, training, and investigation, it is necessary to understand how to explain, analyze, and assess the concept. To develop the science of nursing, the nursing and midwifery council should aim to evaluate theory both inside and between cultures. Making judgments concerning the extent to which a nursing theory fits recognized criteria is part of evaluating it. These conclusions can be derived from the findings of an assessment, a documented critique of the concept, and scientific studies documenting the theorys use in reality. Theory-based assessment is a way of thinking about evaluation rather than a specific approach or methodology (Roy, 2018). It is a method of organizing and doing analysis in an evaluation. A theoretical framework describes how a particular action is intended to deliver effects.

The Promoting Health Framework consists of three aspects: personal features and circumstances, cognitive distortions and feelings related to behavior, and behavioral outcomes. According to the hypothesis, each person has distinct personal features and experiences that influence later acts (Wilson, 2021). At all phases of evolution, these activities should result in significant health, increased functional capacity, and a higher quality of life. The ultimate psychological requirement is also impacted by conflicting demands and requirements, which might derail planned health-promoting acts. Community initiatives may be centered on activities that might promote peoples well-being utilizing Penders Health Promotion Model. Primary prevention and illness prevention are more accessible to implement in the community than programs to cure common ailments. Penders concepts set the door for a new path of seeing nursing care, but it is equally important to remember that nursings therapeutic side cannot be separated from the profession.

References

Roy, C. (2018). Key issues in nursing theory: Developments, challenges, and future directions. Nursing Research, 67(2), 81-92.

Wilson, J. C. (2021). Nola J. Pender: Health Promotion Model. Nursing Theorists and Their Work E-Book, 320.

Controversy and opposite conclusions are common in scientific research as some scientists target the promotion of disease prevention and increased screening and surveillance of the population to improve its well-being. The media article written by Lomte (2022) discusses the findings from the study on the risk of SARS-CoV-2 infections in asthmatics treated with biologics. The common cause of mortality cases in people severely affected by the coronavirus disease was associated with lung malfunction. Therefore, the initial study conducted by Papaioannou et al. (2022) attempted to define whether asthma as a respiratory disease can be perceived as a risk factor for developing severe illness from the COVID-19 virus. However, in the media article, the author determined that the initial studys findings are contrary to the generally accepted opinion of the scientific community.

Part of the existing research suggests that asthma exacerbation can be triggered by SARS-CoV-2 infection. Reparatory infections present a significant risk factor for asthma exacerbation, which manifests in the form of deterioration of existing asthmatic symptoms, such as cough, dyspnea, chest tightness, or wheezing (Lomte, 2022, para. 6). Thus, it was assumed that patients with severe asthma receiving biologic therapy are at higher risk of being infected with SARS-CoV-2. However, the study by Papaioannou et al. (2022) determined that biologic therapy does not cause a higher risk of infection with SARS-CoV-2. The authors analyzed data from 591 patients in 23 clinics: 37.1% were treated with omalizumab, 60.6% with mepolizumab, and 2.4% with benralizumab (Papaioannou et al., 2022). Only 26 patients (4.4%) were infected with SARS-CoV-2, and only 5 out of 26 experienced deterioration of asthma control (Papaioannou et al., 2022). Furthermore, among 591 patients, there was only one mortality case: a woman with severe obesity and cardiovascular comorbidities died from COVID-19 complications. Thus, while biologic therapy is not a risk factor for SARS-CoV-2 infection, the asthmatics receiving biologic therapy are at elevated risk of hospitalization.

Furthermore, after examining the validity of the findings and statistics featured in the study, one could suggest that the study provides a valuable insight into coronavirus infection, presenting a more significant threat for asthmatics. However, the coverage of the study in the media has both disadvantages and advantages for the populations well-being. The first advantage is that the article addresses the myth that the use of biological therapy in patients with severe asthma during the pandemic is unsafe. Next, the article may change the minds of people who have not considered biological therapy because of the risks associated with SARS-CoV-2 infection. Biologic therapy is generally underutilized because patients perceive it as invasive and limiting (De Felice, 2019, p.2). Thus, additional assistance from the media in the popularization of biologic therapy can improve the situation.

On the contrary, the article can negatively influence the patients behavior by diminishing the risks. Patients with severe asthma should still maintain health protection measures to avoid being infected with COVID-19 because they are at risk of developing severe illness. Thus, the disadvantage of the controversy, in this case, is that it can negatively influence patients behavior. As an alternative, controversial findings can confuse the patient and reduce his level of trust in the healthcare system.

In conclusion, Advanced Practice Registered Nurses (APRNs) play a significant role in public health education. While APRNs have a wide range of responsibilities, they have a high level of medical knowledge and education and work directly with patients, which increases their opportunities to improve patients knowledge. Addressing the controversies in communication with the patient can provide a foundation for trustful relationships and improve patient cooperation. Thus, informing patients with severe asthma receiving biological therapy about the therapys safety can support public health education.

References

De Felice, K. M. (2019). Patients perception of risks and benefits of biologic therapy.Inflammatory Bowel Diseases, 26(1), 147-149.

Lomte, T. S. (2022). The risk of SARS-CoV-2 infection and disease severity in a cohort of severe asthmatics treated with biologics. News Medical.

Papaioannou, A. I., Fouka, E., Tzanakis, N., Antoniou, K., Samitas, K., Zervas, E., Kostikas, K., Bartziokas, K., Porpodis, K., Papakosta, D., Tzouvelekis, A., Gerogianni, I., Kotsiou, O., Makris, M., Vittorakis, S., Katsoulis, K., Papanikolau, I., Afthinos, A., Katsaounou, P., & Loukides, S. (2022). SARS-Cov-2 infection in severe asthma patients treated with biologics.The Journal of Allergy and Clinical Immunology: In Practice.

Introduction

Patients at Health City Cayman Islands (HCCI) have the same expectations as their Indian counterparts. This owes to the fact that HCCI provides various Indian medications and the majority of healthcare personnel, particularly medical practitioners, are Indian (Khanna & Gupta, 2014). Thus, the approaches of care and personal touch are identical in both settings. Similarly, Health City Cayman Islands is a Narayana organization in the Western hemisphere whose healthcare approach is shared by all Narayana centers. This includes how they cater to patients using programs like organized airline tickets (Khanna & Gupta, 2014). Furthermore, hospital managers at the HCCI are pushing to integrate critical aspects including task shifting and continued growth into the Narayana workplace environment. Such reforms will be accompanied by big changes in health care delivery especially when analyzed from the task-shifting perspective as discussed below.

The Implication from a Task-Shifting Standpoint

Task-shifting is the process of systematically redistributing duties and obligations within a healthcare workforce team. To optimize the capability of the existing health personnel, relevant responsibilities are transferred from highly qualified employees or healthcare professionals to those with fewer credentials. This leads to a reduction in operational costs and an improvement in patient outcomes (Khanna & Gupta, 2014). Moreover, task-shifting helps to save money while enhancing employee satisfaction. This strategy was adopted by the HCCI due to its efficacy in treating a substantial number of Indian patients.

Conclusion

Thus, judging from the task-shifting perspective, it is probable that the facility may optimize the employees capabilities, which can subsequently save costs and deliver improved patient outcomes. This will result in increased patient intake and the provision of more medical interventions. Therefore, task-shifting will result in an optimal workplace environment for employees while concurrently allowing many patients to receive subsidized treatments.

Reference

Khanna, T., & Gupta, B. (2014). Health City Cayman Islands. Harvard Business School: Case, 714-510.

The healthcare system is founded on numerous principles and concepts and represents a unified and strict framework that ensures quality care and cohesiveness of the elements. In this situation, the healthcare field often implements various approaches to make the operations run faster, more smoothly, and more efficiently. For instance, many organizations employ information systems to facilitate nursing tasks. Still, it is well known that putting health information systems (HISs) into place is a demanding and complex procedure. Digital competence, employee general capabilities, appropriate training and education, and practice time are all key aspects for deploying HIS systems. In my organization, the training provided to nurses is based on continuous education, practical cases, and peer supervision, which is then complemented by employees evaluating the systems quality.

First, when implementing the HIS, nurses must be provided with continuous learning. The personnel must be informed of any updates to the software and be able to utilize any newly added or modified functions. Concentrating on continuous training is additionally important because first training was more concerned with obtaining a foundational understanding of work requirements than with efficiency and competence (Bygholm, 2018). Therefore, continuous training may concentrate on material that has been identified as significant and problematic for users, as well as material that helps the staff utilize HIS in a fulfilling and professional manner.

Second, all employees undergoing training engage with actual cases, and practical settings, concentrate on clinical workflow and use an engaging, problem-oriented strategy. In other terms, instruction that is unrelated to clinical settings is usually perceived as insufficient training (Bygholm, 2018). The necessity of allowing personnel to practice at their own speed and creating a training environment where they may practice with certain clinical scenarios cannot be overstated (Crisan & Mihaila, 2021). Aside from promoting real-case training, computer skill assessments are often incorporated in order to evaluate nurses unique learning requirements.

Lastly, those undergoing training are supported by experts, including peer educators, advisors, and community leaders. These experts are usually professionals or nurses who operate on the unit, have the ability to train others, and have a high level of motivation (Bygholm, 2018). As a result, they serve as facilitators in each unit, assisting employees and onboarding new hires. Coworkers who undergo specialized training endorse the notion that education should be based on clinical practice.

As for the evaluation of the system, nurses participate in such a process in order to see the efficiency of the newly incorporated technology. A NIS is a tool that caregivers use to create treatment plans, carry out interventions, record patient outcomes, compile data, and evaluate the efficacy and standard of healthcare service (Moghaddasi et al., 2017). The suitable designs of such systems and how effectively they take into account the expectations and demands of nurses are key factors in their successful and efficient utilization (Moghaddasi et al., 2017). A badly designed NIS can make nurses everyday tasks more difficult and could cause issues with the adoption and usage of such systems. As a result, the opinions of the nurses are essential in this situation.

In sum, nurses get training based on ongoing education, real scenarios, and peer supervision, which is then supplemented by staff members rating the effectiveness of the system. First, nurses must get ongoing training while using the HIS, and staff members must be made aware of any software upgrades. Second, all trainees interact with real cases in realistic settings, focus on clinical processes, and use an innovative, problem-solving approach. Lastly, professionals such as peer educators, advisers, and community leaders offer assistance to people receiving training. As for the system evaluation, nurses take part in it to gauge the effectiveness of the recently added technology.

References

Bygholm A. (2018). Staff training on the use of health information systems: What do we know? Studies in Health Technology and Informatics, 247, 191195.

Crisan, E. L., & Mihaila, A. (2021). Health-care information systems adoptiona review of management practices. Vilakshan-XIMB Journal of Management, 1, 1-10.

Moghaddasi, H., Rabiei, R., Asadi, F., & Ostvan, N. (2017). Evaluation of nursing information systems: Application of usability aspects in the development of systems. Healthcare Informatics Research, 23(2), 101108.

Judging by the consequences of the flooding, there is a high chance some steps might have been missed during the planning and implementation of the Electronic Health Record (EHR) in Fountain View Hospice. First, the copy of the Hospices EHR application as a hot site was not created and given to the vendor (Sayles & Kavanaugh-Burke, 2018). That missed step is the primary reason the flood led to such a significant problem, as the Hospice now has to use many resources to improve the situation. In addition, Fountain View Hospice now has to manage the paper health record instead of utilizing EHR at least for a year or even more (Sayles & Kavanaugh-Burke, 2018). The facilitys inability to use EHR can considerably decrease its effectiveness and general performance, which, in turn, can lead to adverse patient outcomes or unsatisfactory levels of services. The inaccurate and incomplete implementation of the EHR application as a hot site has caused severe issues, and the Hospice has to deal with the consequences.

However, there are ways to improve planning during the full implementation of the EHR and prevent the occurrence of similar issues. For example, Fountain View Hospice should acquire contracts with restoration organizations (Sayles & Kavanaugh-Burke, 2018). Such companies can react quickly and help restore the damage from natural disasters, including floods. Furthermore, as mentioned previously, a copy of the EHR application should be created and stored with the backup files, far enough from the location where the original disk is stored (Sayles & Kavanaugh-Burke, 2018). That measure can be helpful in case the data cannot be restored after a particular disaster. Fountain View Hospice can use these recommendations to improve its planning and data security.

Reference

Sayles, N. B., & Kavanaugh-Burke, L. (2021). Introduction to information systems for health information technology (4^th ed.). AHIMA Press.

Alignment of Organizational Values

• According to Dunn (2002), employee satisfaction relies on:
  • Their attitudes;
  • Level of satisfaction with their work;
  • The work environment.
• It is thus essential for an organization as well as nurses to ensure that their values are aligned.
• This will ensure that the overall goals and the objectives of the nursing practice are met.
• Common organization values include in the nursing practice include:
  • Striving to meet the needs and requirements of patients.
  • Treating and curing patients.
  • Embracing a strong organizational culture.
  • Expressing passion and emotion in the nursing practice.
  • Following the principles and ethics of the nursing practice (Certo, 2002).
• To achieve organizational goals, most healthcare facilities try to ensure that nurses feel as part of the organization by:
  • Having Effective leadership mechanisms;
  • Embracing teamwork among nurses;
  • Enhancing their skills and experience through training and education.
• As a result, nurses are motivated to:
  • Help and heal patients.
  • Have passion in their work.
  • Treat fellow employees with respect.
  • Becoming advocates of their profession.
  • Value the well being of their patients.

These factors are essential since they determine the performance and the level of motivation that employees will work. In a healthcare setting therefore, the management should ensure that employees are satisfied so that they can perform their duties as per the expected standards.

It is a common to find that the organization and the management have similar values. In such an instance, the health facility is expected to operate in an effective and efficient manner hence realizing its vision, mission, goals and objectives (McShane, 2003).

The organization structure of a healthcare facility plays a critical role in determining the level of satisfaction of its workforce. Effective leadership is an essential component that needs to be consider to realize this goal. Through effective leadership, effective mechanisms will be put in place to align the values of the organization and its employees.

To further increase efficiency, the management of many organizations have adopted the concept of teamwork to ensure that its workforce have shared values (Luft, 2004). At the same time, this association will act as a platform where employees will share their skills and expertise hence improving their overall performance.

Motivation increases the overall performance of nurses. As a result, the patients will receive high quality services.

Effective Communication

• In a workplace, communication is important since it facilitates the transmission of information, hence enabling a nurse to be understood by other employees (Edgley, 2001).
• In the process, one receives a positive feedback that can either be:
  • Descriptive;
  • Evaluative;
  • Prescriptive;
  • Individual;
  • Group.
• Communication can either be verbal or non-verbal.
• However, there are factors that might act as barriers to communication. They include:
  • Environmental barriers that arise from competition for attention, multiple levels of hierarchy, power, and organization complexity.
  • Personal barriers that arise from beliefs, values, prejudices, jealousy, and selective attention.
• The following steps can be used to overcome environmental barriers:
  • Reduction in the levels of hierarchy in an organization.
  • Change in organizational culture to encourage free flow of information.
  • Placing more emphasis on attention and listening.
• The following steps can be used to overcome personal barriers:
  • Respect of other peoples values and beliefs.
  • Empathy.
  • Recognition and appreciating the fact that other people might be jealous and selective perception.

Communication ensures that the right information is conveyed in order to receive a desired outcome. In a nursing environment, communication between the nurses and the management, among the nurses, and between the nurses and their patients is essential.

Verbal communication uses spoken or written words to convey information (Guo, 2005).

Non-verbal communication uses encoded messages to convey information (Guo, 2005).

Several measures can be used to overcome environmental barriers. These measures aim at building a bridge between an individual and the people who are surrounding them.

These strategies aim at changing the attitude that an individual might have towards other people.

Personal Experience

• The organization I was working as an intern had many values.
• However, the following values brought about conflict between the management and myself:
  • The centralized organization culture that strived for excellence.
  • Striving to meet the needs and requirements of the patients.
• Due to the emphasis of the management on these values and the limited number of nurses the health facility had, I developed a negative attitude towards my work.
• This affected my performance and my level of job satisfaction.
• The patients therefore did no receive the quality of services that they expected.
• This led to a lot of complaints, especially to the management.

The organization that I was working for had a centralized form of leadership. Therefore decisions were made at the managerial levels without considering the impacts that they will have at the lower levels of management and on the patients.

Due to poor leadership and the differences in values between the management and other nurses including myself, the health facility failed at meeting the needs of the patients.

References

Certo, S. C. (2002). Modern Management: Quality, Ethics, and the Global Environment. Boston: Allyn and Bacon.

Dunn, R. (2002). Haimanns Healthcare Management. Chicago: Health Administration Press.

Edgley, G. (2001). The Dialogue Process. Association Management, 43(10), 3740.

Guo, K. (2005). Workplace Communication. London: Sage.

Luft, J. (2004). Group Processes: An Introduction to Group Dynamics. Palo Alto: Mayfield.

McShane, S. L., (2003). Organizational behavior: Emerging realities for the workplace revolution. Boston: McGraw-Hill.

Introduction

The professions of health information technologists and medical registrars require a lot of soft and hard skills, along with a relatively high level of responsibility, like any position in healthcare. In fact, my role is to support the information systems used in a medical institution and optimize its work to improve patients health and maintain the confidentiality of their personal information (Bureau of Labor Statistics, U.S. Department of Labor, n.d.). The most important skill right now is teamwork. The ability in writing, which has experienced a positive trend in recent years, was primarily aimed at communicating clearly with their team members and effectively achieving results. Business communication makes up most of the time when I use my written language, as I have to interact remotely. Integrating core teamwork skills allows my writing to get better.

Discussion

In my opinion, it is essential to maintain balance and develop emotional intelligence in the team since this work is associated with a high degree of responsibility, where the well-being of patients health is at stake. Focusing on universal values, which form the basis of any medical profession, allows for maintaining a businesslike and positive tone of communication in the team. Using technological tools is the most important milestone of my experience in the hard skills graph. Teamwork is a crucial foundation of soft skills that contribute, among other things, to motivation, involvement, and satisfaction. The implementation of professional skills is fully manifested while developing, designing, and maintaining information systems and applications for storing, editing, and working with case histories and personal information about patients. Our department should optimize the interaction between the competencies of medical specialists and the possibilities of technology to maximize the result in the form of an improvement in the condition of patients.

Presentation skills are also primarily focused on teamwork. With their help, I hone my communication skills with my department and professionals from the field of clinical medicine. When presenting a product to specialists, I adapt my language and information, focusing on the practical implementation of developments. Otherwise, I focus on the pitfalls and technical aspects of implementing potential specialist requests. In both cases, the departments interact as one knowledgeable team, and I try to be a guide between them to the best of my competence.

Conclusion

Finally, I consider research skills to be the most important for achieving my future goals. Among them are the constant optimization of technological tools for medical institutions, the creation of conditions for their affordable distribution in cities and states, and the minimization of risks in data security and patient health in general. To solve these problems in the long term, it will be necessary to constantly keep abreast of discoveries, changes in standards, and promising developments in related technological fields and, accordingly, research. Together, these skills portray a professional leader, which is also my goal. At the moment, I still have insufficient in-depth knowledge in both the field of medicine and technology, but it is the skills of a researcher that can help me achieve all of the above goals, primarily for the benefit of society. In addition, the acquired skills in these areas are key in many others, which will contribute to the development of my resume and the opportunity to master new specialties for potentially exciting jobs related to medicine and technology.

Reference

Bureau of Labor Statistics, U.S. Department of Labor. (n.d.)Occupational Outlook Handbook, Health Information Technologists and Medical Registrars. Web.

Community Description: Los Angeles

• As of 2018, the number of residents exceeded 3.990.000 people, demonstrating a steady population growth pattern. Starting from 2010, the annual population growth rate varied from 0.2% to 0.8% (World Population Review, n.d.).
• The City of Los Angeles is located near the San Gabriel mountain range and is bounded by it and the Pacific Ocean. The land area that it takes exceeds 1213km2, whereas the water area is 88km2 (WPR, n.d.).
• Los Angeles presents a cultural center of Southern California and the largest city of the County of Los Angeles. The community is located in the most populous county and the second largest metropolitan region of the United States (WPR, n.d.).
• In 2017, the average yearly earnings were $35.390 for males and $30.400 for females and depended on the educational level, whereas mean household incomes varied from $60.000 to $121.000. The Los Angeles metropolitan area has the second largest nominal GDP in the U.S.  1.043.700 million dollars (WPR, n.d.).
• The population includes 19.5% of school graduates, 21.7% of people with bachelors degrees, 17.8% of college graduates, and 11.3% of citizens with graduate degrees. About 21% of people have not graduated from high school.
• The city ranks high in ethnic diversity, but it is still considered as white-dominated. The major ethnic groups include Caucasians (52.2%), Asians (11.6%), African Americans (8.9%), people of mixed-race origin (3.5%), and American Indians (0.7%). Almost 23% of residents identify themselves as the members of some other race as a protest against the existing ethnic classification.
• Concerning phenomenology, the city is ethnically, linguistically, and culturally diverse. Economic inequality that depends on race also contributes to a cultural divide.
• Interactions: well-developed transportation system, a strong infrastructure, and peoples access to natural resources and means of communication (WPR, n.d.).
• At the governmental level, the goals include improving citizens quality of life, eliminating poverty, and implementing up-to-date approaches to construction; given the mentioned diversity, personal goals vary greatly.
• Interests: maintaining financial leadership and dominant positions in the film and entertainment industries.
• Barriers/challenges: environmental issues (more specifically, air pollution), gender and race-related wage gaps, communicable diseases, drug abuse (Garcia-Gonzales, Shamasunder, & Jerrett, 2019; WPR, n.d.).
• SDOH: race-based poverty  the poverty rate is 25-27% in Hispanics and African Americans, but it does not exceed 12% in Caucasians. Access to jobs varies based on ethnicity and education level, whereas social isolation and homelessness affect health outcomes (more than 70% of homeless people are unsheltered) (Los Angeles City Health Commission, 2017).

Functional Health Patterns: Values/Beliefs

• Funding sources: no external funding;
• Partnerships: community health nurses, the communitys authorities, and the health department (information sources).
  • Caucasians, the predominant group, do not share beliefs concerning the effectiveness of alternative treatment (WPR, n.d.).
  • Christian beliefs impact peoples dietary habits and attitudes toward family celebrations.
  • Resources: chapels, churches, Islamic centers, support groups, group therapy events, etc.
  • Peoples attitudes toward health promotion are evident from their active social participation (Health & Wellness Funfest, volunteering, etc.) (LACHC, 2017).
  • There are protest movements, so the community values a proactive approach to life, justice, and democracy (March & Rally Los Angeles, n.d.).
  • Large expenditures: housing, transportation, and alimentary products; the adequacy of funds depends on education and access to jobs (Bureau of Labor Statistics, 2018).

Health Perception/Management

• Actual and at-risk diagnoses: prediabetes in 39.7% of adult Los Angeles residents and 33.9% of the U.S. population (Centers for Disease Control and Prevention, 2018; Hales, Carroll, Kuo, & Simon, 2019).
• Recommendations: in some schools, due to caregivers personal beliefs, vaccination rates do not exceed 30-40%, which involves potential threats (Khazan, 2014).
• The state with the second lowest death rate (618/100.000 people in 2017); the leading causes of death are cancer, heart disease, and Alzheimers (Los Angeles Almanac, n.d.).
• Prevention programs (lead poisoning, childhood asthma, HIV/STI, adolescent pregnancy) are considered sufficient. A large number of specialty doctors, GPs, and mental health professionals offer their services. Common referrals to health resources, including Womens Health Services, Christian Health Centers, and UCLA Medical Center; services are used by more than 80% of residents with insurance (LACHC, 2017).

Nutrition/Metabolic

• Poverty rates contribute to nutrient deficiencies, but adult obesity rates in the county are lower than the national average (21% and 39% in 2015) (CDC, 2017).
• According to LACHC (2017), food insecurity rates are still high among homeless citizens, but food stamp programs are in use.
• A number of drinking fountains in parks have been removed recently, leading to increased risks of dehydration among the homeless (LACHC, 2017).
• Fast and junk food is easy to access, and the most popular restaurant chains are widely represented.
• Unhealthy food consumption: long queues in fast-food restaurants, child obesity.
• Based on observations, the nutritional content of food sold in educational institutions aligns with Californias Nutrition Standards (no unhealthy high-fat foods).
• Between 70% and 80% of students are eligible for federally reimbursable meals (Education Data, n.d.).

Elimination

• Particulate matter, carbon monoxide, and lead are commonly associated with respiratory disease and poor air quality (Shirmohammadi et al., 2017).
• Proper waste disposal; noise levels vary but are within the normal range.
• There are official pest control initiatives and proper community notifications.
• Laundry services are accessible and affordable, and there are enough bathrooms with hygiene supplies in public places that are cleaned 3-4 times a day.
• Health providers use universal precautions (hand hygiene, protective clothing, cleaning) according to job instructions; teachers and members do it in case of obvious risks.
• Air conditioners, heater systems, and fire safety measures are used for temperature control.
• Security guards in public places, video surveillance, and badge access control systems help to ensure safety.

Activity/Exercise

• Private and public gyms in all neighborhoods are supplied with equipment for cardiovascular exercise and weight routine, and some of them offer discounts.
• There are playgrounds, swimming pools, and ice rinks with large flows of visitors. Safety training programs based on regulations are implemented by the police, emergency agencies (Safe House, Emergency Planning, etc.), or athletic trainers in gyms.
• Traumas related to car accidents or occupational injuries are common (Citywide Law Group, n.d.). Rail transport, cars, bikes, and bicycles are popular transportation options.
• Many people are active users of the Internet, but the amount of time spent on leisure activities varies between households.

Sleep/Rest

• In dormitory districts, there are sleep routines that meet the NIH sleep hour standards (7-8 hours for adults and 9-10 for teenagers and children) (Bravata et al., 2018). With reservation of days that are national holidays, it is quiet from 9 p.m. to 8 a.m.
• Indicators: no construction works during sleep hours, community members are active during the daytime, playgrounds or teenagers and children are almost never empty.
• The majority of citizens are in the workplace from 8-9 a.m. to 4-5 p.m., but those in the entertainment sector may work night shifts. The recommended noise levels for the residential areas are strictly observed, and street lights are not too intense to affect peoples recreation and proper sleep. Except for entertainment places, the levels of crowding are quite low during nighttime.
• Few people use drugs, but some citizens can be observed smoking or consuming alcoholic beverages in bars or at home (California Health Care Foundation, 2018). Also, caffeine consumption is quite high in full-time office workers and students who combine studies, extracurricular activities, and side jobs. Peoples health may be affected by sleep-wake cycle irregularities or difficulty falling asleep.

Cognitive/Perceptual

• The population speaks more than 200 languages, but English and Spanish are used most often (WPR, n.d.). English is understood by the majority of people, but minor communication barriers may exist.
• About 86% of people in the city of L.A. are school graduates compared to the national average of 87.3% (U.S. Census Bureau, n.d.; WPR, n.d.).
• Abundant opportunities (schools, on-the-job training in more than twenty industries, GED preparation classes, etc.) (WPR, n.d.).
• State and federal mandates for English learners and opportunities for continuing education (California Department of Education, n.d.).
• Special education centers for children with physical/mental disabilities, academies for gifted students (Oak Crest, etc.). Universities and schools are equipped with computers and provide access to both physical and digital libraries.
• There are tuition reimbursement and scholarship programs for both citizens and immigrants.

Self-Perception

• Concerning age levels, the most numerous groups are men and women aged 25-35 (WPR, n.d.).
• Community improvement programs (cultural diversity, community alert, etc.) are offered by Community Build, Inc. and the state authorities.
• Initially, the citys area was inhabited by American Indian tribes. In 1781, fourteen families of different descent established a new farming area that grew into the city (The City of Los Angeles, n.d.). The intersection of cultures that contributed to the communitys development is still reflected in the citys ethnic diversity.
• Pride is evident from the popularity of exercising, the use of medical/mental health services, and the presence of daily routines.
• Published descriptions of the selected community can be found in electronic and printed encyclopedias, travel guides, and online (The City of Los Angeles, n.d.; WPR, n.d.).

Role/Relationship

• Community members interact in a friendly and open manner despite cultural differences.
• Low-income families and people with disabilities are vulnerable due to the lack of economic power, and it restricts the range of treatment options available to them.
• Church leaders, city officials, and the California State PTA hold power by managing resources needed for goal accomplishment and positively influence the community.
• Sexual harassment, as well as discrimination on the basis of age, disability, ethnicity, and gender identity is prohibited (California Department of Fair Employment and Housing, n.d.).
• The citys police stations collaborate with the L.A. County Sheriffs Department. The fire authorities response times are 6 minutes 40 seconds (EMS) and 6 minutes 20 seconds (non-EMS alarms) (Los Angeles Fire Department, n.d.). The city has its own food/blood banks and collaborates with the broader community.

Sexuality/Reproductive

• Sexual behaviors vary depending on the culture, but education related to STDs and safe sex is offered by the health authorities (Planned Parenthood L.A., etc.).
• Birth control tools (condoms, antifertility agents, etc.) are accessible, but not all products are sold without medical prescriptions. The birth rate is now 56 per 1000 women from 15 to 44 years old, abortion/miscarriage rates have also declined recently (March of Dimes, 2019).
• Citizens have access to pregnancy clinics, numerous support groups for new moms, and maternity/paternity leaves.

Coping/Stress

• There are some reductions in violence/crime issues, but poverty rates still exceed 25% among racial minorities (WPR, n.d.).
• About 17 CPS referrals daily, with general neglect and abuse by siblings as the most common causes (Kids Data, n.d.).
• 2002-2016: alcohol and drug abuse rates have grown by 2-3% (CHCF, 2018).
• Crowding and poverty as stressors; multiple support groups, psychology hotlines, and specialists in psychology, psychiatry, and psychotherapy help to deal with mental health issues.
• Past disasters: large fires, earthquakes, and floods; regular fire drills (2-4 times per year depending on the level of threat) are used to ensure workplace safety.
• The emergency management committee (city authorities, emergency services, etc.) plays essential roles in response planning, organization, and development of crisis intervention plans/policies.

Interview Summary (D., 35 Years Old, a Community Health Nurse)

Do you feel valued as a specialist when working with L.A. residents? Why or why not?

D. works in a hospital in L.A. and helps clients from different age groups. Despite her patients varying educational levels and approaches to communication, she rarely sees conflicts between providers and clients. The majority of L.A. residents are conscious of their condition and education that she provides, which makes her feel valued.

In your opinion, are there specific physical/mental health issues common in L.A.? If so, what surveillance/prevention measures require special consideration?

D. expresses concerns about some mental health issues, including depression in adults and adolescents, suicidal ideations, anxiety, and BDD in women. In reference to physical issues, she emphasizes diabetes, influenza, and STIs. She lists a range of preventive measures, including sex education in schools, school-based mental health interventions, and immunization awareness events.

As a community health nurse, how would you characterize your role in maintaining L.A. residents overall health?

The role is described with attention to the following themes: interdisciplinary collaboration, health advocacy, and patient education.

Are there specific communication difficulties linked to local peoples mentality?

D. mentions some clients overconfidence in making important health decisions.

If you communicate with NPs from other regions, are your experiences with patients different? Why or why not?

The interviewee has friends who work as nurses in other states, primarily in rural areas. Based on her assumptions, people in L. A. are more educated and more sensitive to patient rights compared to her friends clients.

Issues/Health Promotion Opportunities

Based on the assessment results, health promotion efforts related to the following topics are recommended:

• Prevention of prediabetes, diabetes, and childhood obesity (weight control, exercising, nutritional habits, age-appropriate activity, sleep hygiene, etc.);
• Childhood immunizations (parent education, handout materials, parent-nurse collaboration, and vaccination awareness campaigns).
• Drug/alcohol abuse (school-based education, access to jobs, hobby clubs/sports participation, and awareness events).

Conclusion

• Overall, people in Los Angeles have numerous educational, job, and health promotion opportunities, which contributes to peoples good physical and mental health.
• Particular problems include the prevalence of prediabetes and obesity in different age groups, as well as poor compliance with immunization recommendations and drug/alcohol use.
• Taking these findings and the interview summary into account, it is recommended to implement additional measures to promote healthy lifestyle behaviors and increase parents awareness of the benefits of timely immunization.

References

Bravata, D. M., Sico, J., Vaz Fragoso, C. A., Miech, E. J., Matthias, M. S., Lampert, R., & Tobias, L. (2018). Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease. Journal of the American Heart Association, 7(16), e008841.

Bureau of Labor Statistics. (2018). Consumer expenditures for the Los Angeles area: 2016-17. Web.

California Department of Education. (n.d.). English learners. Web.

California Department of Fair Employment and Housing. (n.d.). Employees and job applicants are protected from bias. Web.

California Health Care Foundation. (2018). California health care almanac. Substance use in California: A look at addiction and treatment. Web.

Centers for Disease Control and Prevention. (2017). Prevalence of obesity among adults and youth: United States, 20152016. Web.

Centers for Disease Control and Prevention. (2018). Prevalence of prediabetes. Web.

City of Los Angeles. (n.d.). The history of Los Angeles. Web.

Citywide Law Group. (n.d.). Los Angeles car accident statistics. Web.

Education Data. (n.d.). Los Angeles County Office of Education. Web.

Garcia-Gonzales, D. A., Shamasunder, B., & Jerrett, M. (2019). Distance decay gradients in hazardous air pollution concentrations around oil and natural gas facilities in the city of Los Angeles: A pilot study. Environmental Research, 173, 232-236.

Hales, C. M., Carroll, M. D., Kuo, T., & Simon, P. A. (2019). Diabetes and prediabetes among adults in Los Angeles County and the United States, 19992006 and 20072014. National Health Statistics Reports, 23, 1-7.

Khazan, O. (2014). Wealthy L.A. schools vaccination rates are as low as South Sudans. The Atlantic. Web.

Kids Data. (n.d.). Reports of child abuse and neglect, by type of abuse. Web.

Los Angeles Almanac. (n.d.). Deaths and death rates Los Angeles County. Web.

Los Angeles City Health Commission. (2017). Health commission report 2015-16. Web.

Los Angeles Fire Department. (n.d.). Welcome to the Los Angeles Fire Department. Web.

March & Rally Los Angeles. (n.d.). Get involved! Web.

March of Dimes. (2019). Quick facts: Births. Web.

Shirmohammadi, F., Sowlat, M. H., Hasheminassab, S., Saffari, A., Ban-Weiss, G., & Sioutas, C. (2017). Emission rates of particle number, mass and black carbon by the Los Angeles International Airport (LAX) and its impact on air quality in Los Angeles. Atmospheric Environment, 151, 82-93.

U.S. Census Bureau. (n.d.). Educational attainment: Percent high school graduate or higher. Web.

World Population Review. (n.d.). Los Angeles, California population 2019. Web.