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Question description

In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

1. Background
2. Problem statement
3. Purpose of the change proposal
4. PICOT
5. Literature search strategy employed
6. Evaluation of the literature
7. Applicable change or nursing theory utilized
8. Proposed implementation plan with outcome measures
9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created

Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.

Background section is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. Problem statement is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Purpose of change proposal is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

PICOT is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Literature search strategy is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Literature evaluation is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Theory utilization content is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Implementation plan is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Identification of potential barriers to plan implementation with a discussion component is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Appendices are present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English.

All format elements are correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

 

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Question description

From your practice standpoint, what have you read this week in your text or in the lesson that offered a new view or appreciation for standardized terminology? Be specific.

example attached

Standardized Terminology

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What are the reasons why nurses need to be concerned about standardized terminology? In many prelicensure nursing programs, medical terminology is a required course. If it is not required, it is certainly implied that nurses be able to speak “medical.” However, using standardized terminology as it relates to nursing practice is imperative so that we can communicate among each other, other disciplines, and those who review nursing outcomes or data and provide reimbursement for services provided.

Benefits and Challenges of Standardized Terminology

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Imagine a room filled with 13 people who are all speaking different languages with no means for translation. That is what it is like for a computer to try to connect various programs when each computer is using a different terminology. Hebda and Czar (2013) offer a detailed description of the need for standardized terminology in order to collect aggregate data.

There have been many conversations over the years about the need for increased visibility of nursing activities. Nursing does not charge for individual services; therefore, patients do not see an accounting of specific nursing care that they received when they review their bills. Nurses go from one patient to the next, taking care of a multitude of needs, without documenting each and every activity or thought process for care coordination. Much of nursing care reflects the concept of data-to-wisdom that we discussed in Week 1, and it may not be documented as such.

If nursing data are to be visible, nursing activities must be retrievable, and for them to be retrievable, nursing concepts and activities have to be integrated into a Clinical Information System (CIS) or Health Information System (HIS) by using a language. That language must speak to other languages in the system, such as finance, resource management, and interdisciplinary and multidisciplinary partners. For example, we know that oral hygiene is an important personal care activity for our patients. If we want to be able to capture the nursing time, money, and resources spent on oral hygiene, first we have to be able to designate a category (personal hygiene), and then a term (oral care) that all system components are able to read.

Part of managing technological change as defined by Lorenzi and Riley (2010) is the understanding of unique aspects of nursing informatics and its application to the healthcare practice environment. A function of nurses in all practice settings is a commitment to change that is evidenced across nursing specialties and practice environments (Morrison & Symes, 2011). It is important that the nurse become familiar with nursing informatics language because it will increasingly be used in the future, particularly when it comes to meaningful use, which is a term discussed in another lesson. Nurses benefit from establishing relationships with an informatics nurse specialist who serves in one of the many roles emerging in this specialty.

A systematic approach to naming is known as a nomenclature. Such terms are typically described according to a pre-established set of rules. Examples of nursing nomenclatures important to practice include SNO-MED and ICNP© (Coenen & Kim, 2010).

Informatics nurse specialists have documented current efforts toward meeting the demand for a reference terminology of nursing concepts. These specialists are building on the foundation of existing interface and administrative terminologies, and are collaborating with efforts to develop terminology across the spectrum of healthcare. Such efforts address the “languages” spoken by nurses in a variety of practice settings. These include but are not limited to

• NANDA – North American Nursing Diagnosis Association;
• NMDS – Nursing Minimum Data Set;
• HHCC – Home Healthcare Classification;
• OMAHA system, used in home care, hospice, public health, and prisons;
• NIC/NOC – Nursing Interventions Classification (NIC)/Nursing Outcomes Classification (NOC); and
• PCDS – Patient Care Data Set.

Let’s look at each language in more detail.

NANDA. The North American Nursing Diagnosis Association (NANDA) was first developed in 1950, and to date has grown to include a multitude of diagnoses (Whitley, 2009). Prelicensure nursing education programs often include nursing diagnoses in their curricula and serve as the basis for writing nursing care plans.

NMDS. The Nursing Minimum Data Set (NMDS) was first explained in 1972 through nursing research at the University of Iowa and included a focus on nursing diagnoses, nursing interventions, nursing outcomes, and intensity of nursing care (Fetter, 2009c). The NMDS evidences support for the notion that health and nursing informatics encompasses pivotal roles of data and information. NMDS identifies and documents essential data using nursing vocabularies and ensures adequate computer-based patient record systems. Through NMDS, nursing data, information, and knowledge is accessed and built using telecommunications to support care delivery and empowering the consumer through health informatics. NMDS transforms education and enhances nursing decision making through national research agendas.

HHCC & OMAHA. The Home Healthcare Classification was developed by Saba in 1991 and includes a multitude of nursing diagnoses and interventions, while the OMAHA system was developed in 1992 and includes numerous problems with interventions and outcome measures pertinent to community health. Informatics nursing specialists suggest that the adequacy and usefulness of a proposed-type definition for nursing activity concepts is necessary for representing nursing activity concepts within a concept-oriented terminological system (Lundberg et al., 2008).

NIC/NOC. The Nursing Intervention Classification (NIC) and the Nursing Outcomes Classification (NOC) systems were first developed in 1987, with numerous interventions represented for the NIC as well as numerous outcomes represented across a variety of domains and classes for the NOC. In exploring NIC/NOC, note that the attempt to produce a scientific classification of nursing work represents one important direction for building nursing knowledge. At the same time, it represents a significant strategy for defending the profession of nursing.

PCDS. The Patient Care Data Set (PCDS) encompasses patient problems, patient care goals, goal evaluation, and patient care orders. According to Lake, Moss, and Duke (2009), there is a need to seek consensus on a common approach to the development of nursing terminology standards for use in information systems.

The aforementioned nursing languages are not the only ones. Hebda and Czar (2013, p. 304) provide a comprehensive listing of ANA-recognized nursing languages.

Table 15-5 ANA Recognized Nursing Languages

Terminology	Web site	Diagnosis/Problem	Intervention	Outcome	Other
Alternative Billing Concepts (ABC Codes)	http://www.abccodes.com	Billing Codes
Clinical Care Classification (CCC)	http://www.sabacare.com	X	X	X
International Classification of Nursing Practice (ICNP)	http://www.icn.ch/icnp.htm	X	X	X	Assessment
Logical Identifiers Names and Codes (LOINC)	http://loinc.org/	X	Assessment
North American Nursing Diagnosis International (NANDA-I)	http://www.nanda.org	X
Nursing Intervention Classification (NIC)	http://www.nursing.uiowa.edu/cnc/	X
Nursing Outcomes Classification (NOC)	http://www.nursing.uiowa.edu/cnc/	X
Nursing Management Minimum Data Set	http://www.nursing.umn.edu/ICNP/USANMMDS/home.html	Nursing Management Codes
Nursing Minimum Data Set	http://www.nursing.umn.edu/ICNP/
Omaha System	http://www.con.ufl.edu/omaha	X	X	X
Perioperative Nursing Data Set (PNDS)	http://www.aorn.org	X	X	X
SNOMED-CT	http://www.ihtsdo.org/snomed-ct	X	X	X

HEBDA, TONI LEE; CZAR, PATRICIA, HANDBOOK OF INFORMATICS FOR NURSES & HEALTHCARE PROFESSIONALS, 5th Edition, © 2013. Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ.

Reimbursement Issues

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As we have become more and more aware, properly documented nursing care drives reimbursement in our various practice settings. Using proper terminology and capturing nursing’s unique contributions to healthcare is of the utmost importance. No discussion of reimbursement is more important than the tie between nursing care and patient satisfaction.

Nurses are held to a very high standard of care, and one way that care is being rated is by HCAHPS. Nurses in acute care settings may be familiar with Hospital Consumer Assessment of Healthcare Providers (HCAHPS), which is a standardization survey that collects data for measuring patients’ hospital experiences. Many hospitals and health systems follow these standards to help improve the quality and safety of patient care. Do you know that HCAHPS scores can be accessed on their website for recommendations of the best- or worst-scoring hospitals within your area?

According to the Centers for Medicare and Medicaid Services (CMS, 2013), three broad goals have shaped HCAHPS. To begin with, the survey is designed to produce data about a patient’s perspective of care that allows for objective and meaningful comparisons of hospitals on topics that are important to patients. Secondly, public reporting of the survey results creates new incentives for hospitals to improve quality of care. And finally, public reporting serves to enhance accountability in healthcare by increasing transparency of the quality of hospital care provided in return for the public investment.

Summary: Check Your Knowledge

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Transcript

References

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Coenen, A., & Kim, T. (2010). Development of terminology subsets using ICNP. International Journal of Medical Informatics, 79(7), 530–538.

Fetter, M. (2009b). A language of precision. Issues in Mental Health Nursing, 30(2), 133–134.

Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.). Boston, MA: Pearson.

Lorenzi, N. M. & Riley, R. T. (2010). Managing technological change: Organizational aspects of health informatics. New York, NY: Springer Publishing Company.

Lundberg, C., Brokel, J., Bulechek, G., Butcher, H., Martin, K., Moorhead, S., & … Giarrizzo-Wilson, S. (2008). Selecting a standardized terminology for the electronic health record that reveals the impact of nursing on patient care. Online Journal of Nursing Informatics, 12(2).

Morrison, S. M., & Symes, L. (2011). An integrative review of expert nursing practice. Journal of Nursing Scholarship, 43(2), 163–170.

Perkins, S., & Larson, G. (2010). Navigating ICD-10: How to get from point A to point B. Health Management Technology, 31(12), 1–7.

 

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Question description

CREATING A METHODOLOGY

Background

John Compton, The president of the company, expressed his feelings quite bluntly at the executive staff meeting;

We are no longer competitive in the marketplace. Almost all of the Requests for Proposal (RFP) that we want to bid on have a requirement that we must identify in the proposal the project management methodology we will use on the contract should we be awarded the contract. We have no project management methodology. We have just a few templates we use based upon the PMBOK® Guide. All of our competitors have methodologies, but not us.

I have been asking for a methodology to be developed for more than a year now, and all I get are excuses. Some of you are obviously afraid that you might lose power and authority once the methodology is up and running. That may be true, but losing some power and authority is obviously better than losing your job. In six months I want to see a methodology in use on all projects or I will handle the situation myself. I simply cannot believe that my executive staff is afraid to develop a project management methodology.

Critical Issues

The executive staff knew this day was inevitable; they had to take the initiative in the implementation of a project management methodology. Last year, a consultant was brought in to conduct a morning three-hour session on the benefits of project management and the value of an enterprise project management methodology (EPM). As part of the session, the consultant explained that the time needed to develop and implement an EPM system can be shortened if the company has a t management office (PMO) in place to take the lead role. The consultant also explained that whichever executive gets control of the PMO may become more powerful than other executives because he or she now controls all of the project management intellectual property. The executive staff fully understood the implication of this and therefore became reluctant to visibly support project management until they could see how their organization would be affected. In the meantime, project management suffered.

Reluctantly, a PMO was formed reporting to the chief information officer. The PMO was comprised of a handful of experienced project managers that could hopefully take the lead in the development of a methodology. The PMO concluded that there were five steps that had to be done initially. After the five steps were done, the executive committee would receive a final briefing on what had been accomplished. The final briefing would be in addition to the monthly updates and progress reports. The PMO believed that getting executive support and sign offs in a timely manner would be difficult.

The first step that needed to be done was the establishment of the number of life-cycle phases. Some people interviewed wanted ten to twelve life-cycle phases. That meant that there would be ten to twelve gate review meetings and the project managers would spend a great deal of time preparing paperwork for the gate review meetings rather than managing the project. The decision was then made to have no more than six life-cycle phases.

The second step was to decide whether the methodology should be designed around rigid policies and procedures or go the more informal route of using forms, guidelines, checklists, and templates. The PMO felt that project managers needed some degree of freedom in dealing with clients and therefore the more informal approach would work best. Also, clients were asking to have the methodology designed around the client’s business needs and the more informal approach would provide the flexibility to do this.

The third step was to see what could be salvaged from the existing templates and checklists. The company had a few templates and checklists but not all of the project managers used them. The decision was made to develop a standardized set of documents in accordance with the information in the PMBOK® Guide. The project managers could then select whatever forms, guidelines, templates, and checklists were appropriate for a particular project and client.

The fourth step would be to develop a means for capturing best practices using the EPM system. Clients were now requiring in their RFP that best practices on a project must be captured and shared with the client prior to the closeout of the project. Most of the people in the PMO believed that this could be done using forms or checklists at the final project debriefing meeting.

The fifth step involved education and training. The project managers and functional organizations that would staff the projects would need to be trained in the use of the new methodology. The PMO believed that a one-day training program would suffice and the functional organizations could easily release their people for a one-day training session.

QUESTIONS

1. What can you determine about the corporate culture from the fact that they waited this long to consider the development of an EPM system?

2. Can a PMO accelerate the implementation process?

3. Is it acceptable for the PMO to report to the chief information officer or to someone else?

4. Why is it best to have six or less life-cycle phases in an EPM system?

5. Is it best to design an EPM system around flexible or inflexible elements? Generally, when first developing an EPM system, do companies prefer to use formality or informality in the design?

6. Should an EPM system have the capability of capturing best practices?

 

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Do you need a similar assignment done for you from scratch? We have qualified writers to help you. We assure you an A+ quality paper that is free from plagiarism. Order now for an Amazing Discount!
Use Discount Code "Newclient" for a 15% Discount!

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