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  • Q1:Write an informative research paper about “The impact of digital mental health interventions: effectiveness and accessibility of app-based cognitive-behavioral therapy (CBT) for the treatment of anxiety and depression. Outline: Introduction: Your introduction must include an engaging hook as your first sentence. (You may use a startling statistic, brief anecdote, fascinating quote, clarify a misconception, etc.) Background information: Provide important background information on your topic that the reader needs to know to understand your topic: When was the advancement created or implemented in your field? What are the origins or previous models (copycats) of the current advancement? What problem does the advancement solve? Or what does it accomplish? Provide a definition for unfamiliar terms, etc. Thesis Statement: The last sentence of the introduction MUST be your 3 -point- thesis (what your paper will focus on). You should state the name of your specific advancement or technological device and provide 3 key points about it. You should mention advantages and disadvantages for your advancement. Supporting paragraphs: Make sure you provide in-text citations as support for each point in your thesis. Use transitions, topic sentences, and closing sentence for each supporting paragraph. Conclusion: Insert a closing transition. Restate your thesis and main points. Make a final lasting impression upon your reader. Answer the so what? Why was it important to inform the audience about your advancement or technological device? How can this information be useful to individuals on a global scale or in the future? You may even choose to make a call to action. Ensure to cite the sources you will use to document the information provided. (from reliable databases not less than 5-10 years). Word limit: min 500 words Instructions: Plagiarism free Solutions generated from any AI platform is strictly Prohibited Referencing and formatting Style APA Need Typed Solutions only.See Answer
  • Q2:write a journal of total word limit 500-600 words || use APA Attached documents: 1) example work 2) blank journal template (answers to be filled here) References: https://nida.nih.gov/research-topics/parents-educators/lesson-plans/nurturing-my-mental-emotional-health https://school-connect.net/sc4-module-8?gad_source=1&gclid=CjwKCAjw7-SvBhB6EiwAwYdCAfoP5w4nuDZc9ZwEVqzAkXXUPf20gKaDGVXmMf4NyOjbvKi8YevM4xoC https://teachers.ab.ca/sites/default/files/2022-12/COOR-79l_CWTLessonPlans_2016-03.pdf Instructions: Plagiarism free Solutions generated from any AI platform is strictly Prohibited Referencing and formatting Style APA Need Typed Solutions only./nIntern-Memorandum of Understanding Agency Title: BRC I. Using the ABCD format, develop Three Long-Term Objectives Audience (student intern): · Director, Assistant Director Behavior to be demonstrated: . By comprehending the evolution of homelessness over time and analyzing the societal factors that contribute to its prevalence, I aim to identify the underlying societal factors and formulate strategies and solutions to tackle the problem of homelessness effectively. This understanding will equip me with insights into the nature of homelessness and guide the development of approaches to address its root causes. Condition (materials, requirements): . I will be using scholar journals, research practices, and evidence based practices to gain knowledge of the history of homelessness. Degree of mastery (acceptable/target level): · Having an in depth understanding of the history of homelessness and familiarizing myself with the policies and practices that have influenced current policies is crucial. Audience (student intern): · Director, Assistant Director Behavior to be demonstrated: · I will be developing a hypothetical transitional program; understanding the barriers that the target population will face is essential. Condition (materials, requirements): · I will conduct research, collect information from youth experiencing homelessness through surveys and interviews and collect statistics. Degree of mastery (acceptable/target level): . Gain a deeper understanding of the obstacles that youth encounter in accessing resources and services. Audience (student intern): · Director, Assistant Director Behavior to be demonstrated: · Developing networks of resources for youth experiencing homelessness. This involves establishing connections between various organizations, agencies, and community groups to provide comprehensive support. These networks aim to offer a range of services such as shelter, mental health support, education, and employment assistance to address the diverse needs of homeless youth. Condition (materials, requirements): . Conducting thorough research on resources available for youth experiencing homelessness, compiling a list of services and resources that cater to their specific needs. Degree of mastery (acceptable/target level): ● Seek to develop a more profound understanding of the resources that are available to homeless youth. II. Using the ABCD format, develop Three Short-Term Objectives. i Audience (student intern): · Director, Assistant Director Behavior to be demonstrated: · Identifying which underserved demographic to focus on in my hypothetical transitional program involves identifying which policies inadequately address their needs. My decision to research this specific population group stems from recognizing the deficiencies in existing policies and understanding the factors that drew me to explore their unique challenges. Condition (materials, requirements): · Reflecting on why I chose to study this population involves examining my personal motivations and understanding the significance of their experiences. It's important to explore how my own values, interests, and experiences influenced my decision to focus on this specific group in my research. Degree of mastery (acceptable/target level): · Gaining and exploring the factors that draw me to this group helps me comprehend my motivations and develop a greater sense of empathy and insight into their experiences. Audience (student intern): · Director, Assistant Director Behavior to be demonstrated : · Having regular supervision and having the ability to take constructive criticism and feedback through the learning process Condition (materials, requirements): · Meeting once a week with my director and assistant director. . Turning in papers assigned Degree of mastery (acceptable/target level): · Gain a better understanding of the perspectives of both peers and supervisors. This is essential for effective collaboration and professional growth. It involves being receptive to feedback, communicating openly, and recognizing the viewpoints and expertise that each individual brings to the table. Audience (student intern): · Director. Assistant Director Behavior to be demonstrated: · Enhancing my vocabulary and incorporating words that are inclusive and respectful. avoiding terms that may define people or make them uncomfortable. Instead, I aim to use language that is empowering, affirming, and fosters a sense of belonging for all individuals. Condition (materials, requirements): ● Generate study materials and flashcards. Also, going over a guide with vocabulary used in the field of homeless service that my director provided me with. Degree of mastery (acceptable/target level): · Having a greater understanding of the importance of using client center language./nLAST name _ FIRST name _ Journal # ___ Journal (up to 5 points for each journal submission) Dates From _____ To ______ Hours Completed ______________________ Agency contact: : For journal submission, include the following elements: The Long-term objective (refer to Intern-Agency Contract) addressed Audience Behavior Condition Degree of Mastery The short-term objective (refer to Intern-Agency Contract) addressed Audience Behavior Condition Degree of Mastery Describe in detail the experience, include: Activities performed Number of clients with whom you interacted and on what basis Agency staff with whom you interacted and the circumstances Name and describe staff/agency meetings attended Any other relevant interaction, etc. Rate your performance for this reporting period: ___Unacceptable ___Acceptable ___Target What Strengths did you evidence? What are your Areas for Improvement? What steps did you (or will you) take to strengthen your knowledge, skills or dispositions? Complete bibliographic entries for all materials (written, electronic, video) referenced in your internship.See Answer
  • Q3:Instructions Answer needs to be in minimum 500 words AI usage or Plagiarism will be penalised Need only typed solutions Referencing and Formatting in APA style Times new roman, 12 size, double spacing/nCNE SERIES Instructions for Continuing Nursing Education Contact Hours appear on page 314. Recruitment Attributes Important to New Nurse Graduates Employed on Adult Medical-Surgical Units Susan Steele-Moses Eileen Creel Ann Carruth W orkforce data project a national shortage of 1 million nurses by 2025, with much of this occurring in med- ical-surgical nursing (U.S. Depart- ment of Health and Human Services, 2013). The aging registered nursing workforce is a major con- tributor (Hayward, Bungay, Wolff, & MacDonald, 2016), with one-third of nurses projected to retire by 2020 (Buerhaus, Auerbach, Staiger, & Muench, 2013). Recruitment and retention of medical-surgical nurses appear critical. As part of a larger study, the qualitative findings only are reported in this article. Literature Review Relevant literature for 2012-2017 was identified through a search of ProQuest, Medline, and CINAHL using the following key words: regis- tered nurse recruitment, nurse recruit- ment, and recruitment attributes. Of 13 identified articles, seven non- research articles were eliminated. Several elements were identified as important attributes for nursing recruitment and are described here. Compensation Although hospital administra- tors may believe money recruits nurses to their facilities, there is lim- ited research to support this posi- tion. In an electronic analysis of recruitment practices in Canada, Mathews and Ryan (2015) found financial incentives, such as salary, sign-on bonuses, and relocation expense reimbursement, were Recruitment of registered nurses to a medical-surgical unit is often challenging. This study addresses attributes nurses consider when making decisions for employment on a medical-surgical unit. viewed cautiously by the nursing workforce. While nurse turnover cost approximately one-half a nurse's salary to replace the position in a prospective quantitative study (N=156), the decision to leave a position rarely was based on salary (North et al., 2013). Thus, pay is not always a motivator. Unit and Shift Preference Unit and shift preference are cited in the literature as reasons nurse graduates select their first nursing positions, with specialty units often preferred (Mathews & Ryan, 2015; Phillips, Kenny, Esterman, & Smith, 2014; Pottinger, 2016). While nurse leaders may assume nurses prefer specialty units and day shift over other options, limited literature supports this belief. Pottinger (2016) conducted a pilot program to acclimate 12 nurse graduates to the intensive care set- ting. While graduates worked rotat- ing shifts with a nurse preceptor to acclimate them to critical care nurs- ing, no one shift was cited as pre- ferred. A National Workforce analy- sis in Australia determined new nurses preferred to work in primary care based on shift consistency (Gordon et al., 2014). There was no consistent support for the percep- tion that nurses make initial employment decisions based on shift preference. Nurse Orientation Limited research has been pub- lished about hospital selection based on the availability of a resi- dency or prolonged orientation. To prepare for succession planning, Jones and co-authors (2017) used the "valuable expert knowledge and wisdom of retiring nurses" (p. 64) to facilitate new nurse orientation in a new graduate residency program. Susan Steele-Moses, DNS, APRN-CNS, is Associate Professor and Dean, School of Health Professions, Franciscan Missionaries of Our Lady University, Baton Rouge, LA. Eileen Creel, DNS, RN, is Associate Professor and Department Head, School of Nursing, Southeastern Louisiana University, Hammond, LA. Ann Carruth, DNS, RN, is Professor and Dean, College of Nursing and Allied Health, Southeastern Louisiana University, Hammond, LA. Note: This study was funded by the Louisiana State Board of Regents (HCWF-OLOLC- RECRUITMENT-FY16). September-October 2018 . Vol. 27/No. 5 MEDSURGNURSING. 310 CNE Recruitment Attributes Important to New Nurse Graduates Employed on Adult Medical-Surgical Units Background Attributes inherent to a nurse's initial employment decision to work on a medical-surgical unit are not understood. Purpose Elucidate the factors new nurse graduates consider when making their first employment decisions. Methods Nurses from five acute care facilities participated. Results from the quan- titative survey, not reported here, were used to construct interview ques- tions to provide a deeper understanding of recruitment attributes. Findings Recruitment attributes inherently important to new nurses included a supportive manager, feeling valued, and work-life balance. While equi- table pay and benefits were important, nurses were more concerned with workload, scheduling, and the hospital's reputation. Limitations and Implications The sample was limited to five acute care facilities located in the South. Findings from this study supported transcendence to a transformational leadership style with a strong emphasis on work/life balance. Further, selecting staff who complement the nurses already in place is critical to creating a positive work relationship. Conclusion Position acceptance may be predicated on nurses' belief the manager cares about them. This pilot project began with 17 nurse graduates. It combined tradi- tional orientation practices with simulation-based education. After the 12-week orientation, ongoing support continued for the first year of employment. New graduate nurse turnover decreased from 6.4% to 2% (n=1). In a secondary analysis of two qualitative data sets (eight focus group interviews [N=67]) and participant responses to open- ended questions from an electronic survey (N=392), Phillips and co- authors (2014) found nurse satisfac- tion resulted when new nurse ori- entation was thorough, sustained, and well organized. These authors also determined initial career place- ment on a specialty unit was beyond nurses' skill set and required prolonged orientation. Hospital Reputation In a slightly older study, positive word-of-mouth employment infor- mation received early in the recruit- ment process positively influenced the employment decision more than any other recruitment process (N=612; r2=0.396; p<0.01) (Van Hoye & Lievens, 2009). In a second- ary analysis by Phillips and associ- ates (2014), qualitative data from eight focus groups were analyzed to identify transitions that impacted new graduate transition. This study identified the importance of a sup- portive institutional environment that fostered mutual respect as well as a fair, equitable patient care assignment. Hayward and co- authors (2016) interviewed 12 med- ical-surgical registered nurses con- cerning factors related to turnover. Using a qualitative inductive ana- lytic approach, authors determined nurse-patient ratio was a main rea- son nurses left their positions. Further, the work relationship with others and lack of leadership sup- port left them ill-equipped to per- form their jobs. These studies were not conduct- ed with medical-surgical nurses, and findings were inconclusive and conflicting. Thus, the purpose of this study was to elucidate the attributes important to new nurse graduates when making the deci- sion to begin their careers on a medical-surgical unit. Sample Selection Of 20 nurses who volunteered to participate in the interviews, 10 scheduled an appointment. Two participants were African-American females, one an African-American male, one an Asian female, and one a White male; the remaining five nurses were White females (age range 23-59). Participants represent- ed five hospitals, worked on a med- ical-surgical unit, and had been nurses for no more than 1 year. Ethics The study was approved by Institutional Review Boards from Franciscan Missionaries of Our Lady University (study number 1527) and Southeastern Louisiana Uni- versity (study number 16-077). Interviews were conducted in a pri- vate conference room away from the nursing units. Written informed consent was obtained by the researcher from each nurse before the interview commenced, and only the investigator knew who participated. Qualitative Framework, Design, and Methods A descriptive qualitative frame- work was used for the second phase of the study, appropriate when no specific qualitative tradition is fol- lowed (Polit & Beck, 2014). Semi- structured interviews guided the data collection phase to allow flexi- bility and clarity during the inter- view process. MEDSURG URSING September-October 2018 . Vol. 27/No. 5 311 CNE Data Collection Lunch was provided and each participant received a $25.00 hono- rarium at the completion of the interview. Interviews were audio- recorded, lasted approximately 1 hour, and were transcribed verba- tim. Anecdotal notes of the researcher's initial thoughts and impressions of the participant's demeanor were written following each interview. Saturation was achieved and no new themes emerged after 10 interviews were completed. Data Analysis Qualitative content analysis was used to analyze the data (Houser, 2015; Polit & Beck, 2014). As the semi-structured interview responses were transcribed, the primary re- searcher compared recorded inter- views with transcripts to ensure accuracy of wording and authentic representation of participants' words and experiences. Subsequently, three co-researchers independently read the transcripts to identify words or sentences that were espe- cially salient. Once identified, these words and sentences were analyzed for patterns and categories were named. Individual interviews were compared to the whole to analyze how each interview fit with the other, and how each interview fit within the whole. Trustworthiness criteria were used to assure the rigor of data analysis (Lincoln & Guba, 1985). Credibility was addressed through careful review for accuracy of partic- ipant voice in verbatim transcrip- tions, completing data analysis tri- angulation with three researchers, and interviewing until data satura- tion was reached. Dependability and confirmability were ensured through a detailed audit trail outlin- ing each researcher's decisions and then consensus decisions about final themes. This audit (memo) kept during data analysis included notes on how themes were chosen, researchers' thoughts on themes, and alternative speculations. Thick, vivid description in participants' words were used to facilitate trans- ferability (Lincoln & Guba, 1985). Results Two main themes emerged from analysis of nurses' interviews: Get on the Purple Bus and Word on the Street. These themes were related to new nurses' impressions of the support provided by facility administrators and other nurses, and reputation of the facility. Theme 1: Get on the Purple Bus This theme referred to being fully present, embracing the work of the facility in a positive manner, and being part of the team (Gordon, 2007). A past nurse administrator at one of the study facilities had coined the phrase "get on the purple bus" to indicate to employees they needed to be com- mitted wholly to the work of the facility, giving the best possible care to patients, and being supportive of each other. Interviewee 9 said the purple bus was a place where people showed "the love of human life and love of patients." If you're on the purple bus, it means you want to be here. You want to be here with a smile on your face. You want to be here to take care of your patients. You want to be here to work with your co-workers. You want to be here as a fami- ly. This main theme included two subthemes: Just Culture and See Me as a Person. Just culture: This is defined as a, ... process where mistakes or errors do not result in auto- matic punishment, but rather a process to uncover the source of the error. Errors that are not deliberate or malicious result in coaching, counsel- ing, and education around the error, ultimately decreasing likelihood of a repeated error. (American Nurses Association, 2010, para 1) This subtheme was manifested through new nurses' stories about being treated in a manner they con- sidered "supportive." They indicat- ed they could ask for and would receive help, or they were offered help before even having to ask; they were allowed to make a mistake, but were not judged harshly for the mistake. Specific examples included comments from interviewee 3: "people ask me and they help me ... I always feel like they help me ... like a sense of teamwork." Interviewee 6 said her peers and nurse manager gave her "the opportunity to learn without feeling as if you're doing something wrong and you're going to be reprimanded for it ... every- one's willing to let you learn." As interviewee 7 expressed, "You're looking for everyone to like, embrace you, and take you in ... knowing someone is there to help you and teamwork ... being patient ... understanding that you are new and ... still learning." Finally, interviewees 9 and 10 indicated they felt supported by their managers. Interviewee 9 said her supervisor was "someone I can go to when I have a problem ... she was my mentor." Interviewee 10 noted, "My first manager ... pulled me into the office weekly to ask how things were going. She made me feel like I can easily open up to her and come to her with my prob- lems." See me as a person. In this sub- theme, new nurses voiced how their supervisors saw them as more than a nurse (employee). They felt seen as persons with needs outside the workplace. New nurses said the supervisors and peers recognized their needs for time for school, fam- ily, and personal needs. Interviewee 1 said, If you have something come up with family, they support you. If you want to go on different ventures, they support you and they let you grow ... when somebody meets you, they know you by name the second time they see you. Interviewee 2 stated, " ... some- one who works with your schedule ... and understands your life." Interviewee 4 said she felt an "instant connection" when she and the supervisor " ... talked about South Florida ... talked about, you know, life in general and had a nice common ground." Interviewee 2 September-October 2018 . Vol. 27/No. MEDSURG JURSING 312 CNE Recruitment Attributes Important to New Nurse Graduates Employed on Adult Medical-Surgical Units also told the researcher she had a medical condition and the willing- ness of supervisors to see her as a person with special physical needs caused her to feel "blessed" to work where she worked. Theme 2: Word on the Street The second main theme related to one reason the new nurses decid- ed to take their first nursing posi- tions and to remain in those posi- tions within 1 year of hire. The new nurses researched the facilities' rep- utation in the community. They all mentioned having asked nurses who worked at the facility or other nursing students and faculty who had clinical experiences at the facil- ity about the work culture/environ- ment. In the original quantitative ques- tionnaire, the primary researcher intended the question to address the hospital's reputation for quality of care as exemplified through measures such as Magnet® designa- tion or Hospital Consumer Assess- ment of Health Care Providers and Systems (HCAHPS) scores. However, the interviewees instead defined the reputation of the facility based on testimonials about how welcoming, nice, and supportive the nurses and other staff at the facility were toward each other. Interviewees 1 and 7 said they followed their instructors' advice about picking a medical-surgical unit as their first position. Faculty for interviewee 1 reportedly told her to, " ... work on a med-surg unit for the first year." The interviewee also said she got "insider information" and "you start to hear things ... you're gonna like working there, they're great, or they're not" when she went to different facilities as a student nurse. Interviewees 5 and 10 described experiences as student nurses that influenced their first position decisions. According to interviewee 5, " ... they [the nurses on the unit] weren't very nice to me at all" and ... they were actually nicer to me than some of the girls. They [the nurses on the unit] acted like we were in the way" and "the nurses were bothered." Interviewee 10 said, "One of the first things I looked at was reputa- tion." She compared two experi- ences at two different facilities where she had completed clinical experiences, saying about one facil- ity, " ... they were catty toward us. Their attitude toward us was nega- tive." Concerning the facility she chose for her first position, she received feedback from " ... several people who work there and they were ... upbeat and very positive about the place." Interviewee 4 also said a nurse she knew had worked as a nursing assistant at the hospital she choose for her first job: " ... he said positive things about the hos- pital as a whole, about the people, the nurses as a whole." Interviewee 3 said a hospital's Magnet designation " ... didn't cross my mind," but she noted, "[I've] ... always heard good things about [the facility she choose for her first job]." Interviewee 9 commented, "Well, people hear things ... we hear horror stories [about a named hospital] ... horror stories ... I would never even apply! They call it hell." Many participants also men- tioned nurse-patient staffing ratios as a criterion they related to the hospital's reputation. The new nurs- es would hear from nurses who worked at a given facility or see the staffing ratios when they were stu- dents in the facility. Both overarching themes related to the attitude, work culture and environment, and treatment of new nurses by their supervisors and peers. However, a broader picture emerged of courtesy, respect, civili- ty, and a just culture supported by the facility administrators and all employees as integral factors to their decision regarding the first nursing position. New nurses want- ed to be supported by work col- leagues in a just culture that allowed them to learn and grow in a non-punitive, helping environ- ment. A factor that did not emerge as a theme but often is considered a recruitment tool was financial incentives (e.g., salary, hiring bonuses, tuition reimbursement, medical benefits). Participants indi- cated salary and benefits needed to be competitive with other facilities, but none of them identified this as the primary factor when choosing their first positions. They assumed salary and benefits would be similar and fair across facilities. Interviewee 8 said, "I can't say my decision was financially based. Pretty much throughout Louisiana the pay is the same. Tuition reimbursement's pret- ty much the same ... so I can't say that's why [facility name] was my first choice." Interviewee 6 summa- rized, " ... is it really worth a couple extra dollars to not feel comfort- able?" And she said the sign-on bonus " ... locks you into a position for a year ... it's too long of a time if you dislike the place." Interviewee 3 explained her feelings towards a sign-on bonus this way, "I just didn't want to be committed for 2 years, because I'm just not sure where life was going to take me." Interviewee 4 concluded, "I didn't want to be tied down. I didn't want to sign any kind of contract." Discussion According to the interviewees in this study, of greatest importance to new graduates is a manager who sees them for what they bring to the organization and how they fit with the team. While equitable pay and benefits were viewed as important, nurses were more concerned with their anticipated workload, flexibil- ity of their schedules, and reputa- tion of the hospital, specifically their unit. Participants overwhelm- ingly chose a hospital based on what others told them or they had experienced personally. What nurs- es say about a hospital or unit, at work and in the community, thus is a stronger recruitment aid than any paid advertisement. Nurses seem to want to know that the facility lead- ers, and more importantly the man- ager, care about them. Nurses want to feel valued and accepted in the work environment. Despite the stressors faced by the majority of new graduate nurses, graduate transition can be im- proved by supportive institutional practices that foster collegial respect (Chudyk, Klein, Mummery, & Keba, MEDSURG JRSING September-October 2018 . Vol. 27/No. 5 313 CNE Instructions For Continuing Nursing Education Contact Hours Recruitment Attributes Important to New Nurse Graduates Employed on Adult Medical-Surgical Units Deadline for Submission: October 31, 2020 MSN J1815 To Obtain CNE Contact Hours 1. For those wishing to obtain CNE contact hours, you must read the article and complete the evaluation through the AMSN Online Library. Complete your evaluation online and print your CNE certificate immediately, or later. Simply go to www.amsn.org/library 2. Evaluations must be completed online by October 31, 2020. Upon completion of the evaluation, a certificate for 1.1 contact hour(s) may be printed. Learning Outcome After completing this learning activity, the learner will be able to discuss recruitment attributes nurses consider when making decisions for employment on a medical- surgical unit. Learning Engagement Activity · Identify the most important factors to new nurse graduates when making first employment decisions. · What implications does this study have related to manager leadership style? Fees - AMSN Member: FREE Regular: $20 The author(s), editor, editorial board, con- tent reviewers, and education director reported no actual or potential conflict of interest in relation to this continuing nursing education article. This educational activity is jointly provided by Anthony J. Jannetti, Inc. and the Academy of Medical-Surgical Nurses (AMSN). Anthony J. Jannetti, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Com- mission on Accreditation. Anthony J. Jannetti, Inc. is a provider approved by the California Board of Registered Nursing, provider number CEP 5387. Licensees in the state of California must retain this certificate for four years after the CNE activity is completed. This article was reviewed and formatted for contact hour credit by Rosemarie Marmion, MSN, RN-BC, NE-BC, AMSN Education Director. 2016). Hospital leaders may consid- er a transformational leadership model with a strong emphasis on how each unit's manager cares about staff well-being, especially work/life balance. Nursing Implications An inherently important factor affecting recruitment for medical- surgical units is the leadership style of the manager. When managers work collaboratively with staff in a transformational leadership style, they are more successful in recruit- ing new nurse graduates. According to Lyons and Kuron (2014), young- er nurses (ages 20-29) are interested specifically in work/life balance and see work as a means to an end, not their sole existence. These authors suggested managing a blended group of older, more experienced nurses and younger new graduates can be a challenge unless the strength of each is leveraged. The younger workforce seeks ever- changing tasks within their work environment and become easily bored without new challenges; however, work/life balance is their priority. Older, more experienced nurses may create tension between the groups because they are extremely hardworking and may criticize the younger generations for a lack of work ethic and commit- ment to the organization. To be suc- cessful, leaders must leverage the gifts and talents of all staff, identify- ing their motives and empowering them to succeed. Nurse managers also must remember they are always visible. What current and future nurses say about the nurse manager and the unit is critical to future decision making of nurse graduates. Conclusion Recruitment of qualified nurse graduates to fill open medical-surgi- cal nursing positions is essential. Nurses want to work in a culture where it is safe to make mistakes and they are treated as individuals (Koloroutis & Abelson, 2017). Nurse graduates are attracted to institu- tions and nursing units with sup- portive managers and good reputa- tions, where nurses speak favorably of the organization and the unit and nurses are genuinely happy. Impressions portrayed to nurse graduates by current employees may be the greatest recruitment impact factor. MSN REFERENCES American Nurses Association. (2010). Position statement: Just culture. Retrieved from https://www.nursing- world.org/practice-policy/nursing-excel lence/official-position-statements/id/just- culture/ Buerhaus, P., Auerbach, D., Staiger, D., & Muench, U. (2013). Projections of the long-term growth of the registered nurse workforce: A regional analysis. Nursing Economic$, 31(1), 13-17. Chudyk, R., Klein, K., Mummery, R., & Keba, C. (2016). The effect of a preceptor's atti- tude on a new graduate's transition into the intensive care unit. Canadian Journal of Critical Care Nursing, 27(2), 37-37. continued on page 328 September-October 2018 . Vol. 27/No. 5 MEDSURGNURSING. 314 New Nurse Graduates continued from page 314 Gordon, C.J., Aggar, C., Williams, A.M., Walker, L., Willcock, S.M., & Bloomfield, J. (2014). A transition program to primary health care for new graduate nurses: A strategy towards building a sustainable primary health care nurse workforce? BMC Nursing, 13(1), 1-13. doi:10. 1186/s12912-014-0034-x Gordon, J. (2007). The energy bus: 10 rules to fuel your life, work, and team with posi- tive energy. Hoboken, NJ: John Wiley and Sons. Hayward, D., Bungay, V., Wolff, A.C., & MacDonald, V. (2016). A qualitative study of experienced nurses' voluntary turnover: Learning from their perspectives. Journal of Clinical Nursing, 25(9/10), 1336-1345. doi:10.1111/jocn.13210 Houser, J. (2015). Nursing research: Reading, using, and creating evidence (3rd ed.). Burlington, MA: Jones & Bartlett Learning. Jones, S., Deckers, C.M., Strand, D., Bissmeyer, H., Bowman, W.J.W., & Mathe, D.G. (2017). Succession plan- ning: Creating a case for hiring new graduates. Nursing Economic$, 35(2), 64-69, 87. Koloroutis, M., & Abelson, D. (2017). Advancing relationship based cultures. Mineapolis, MN: Creative Healthcare Management. Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. Lyons, S., & Kuron, L. (2014). Generational differences in the workplace: A review of the evidence and directions for future research. Journal of Organizational Behavior, 35, 139-157. Mathews, M., & Ryan, D. (2015). Financial recruitment incentive programs for nurs- ing personnel in Canada. Nursing Leadership, 28(1), 41-52. North, N., Leung, W., Ashton, T., Rasmussen, E., Hughes, F., & Finlayson, M. (2013). Nurse turnover in New Zealand: Costs and relationships with staffing practises and patient outcomes. Journal of Nursing Management, 21(3), 419-428. doi:10.1111/j.1365-2834.2012.01371.x Phillips, C., Kenny, A., Esterman, A., & Smith, C. (2014). A secondary data analysis examining the needs of graduate nurses in their transition to a new role. Nurse Education in Practice, 14(2), 107-111. doi:10.1016/j.nepr.2013.07.007 Polit, D.F., & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence for nursing practice (8th ed.). Phila- delphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Pottinger, L. (2016). Critical care transition pro- gram for newly graduated nurses. Canadian Journal of Cardiovascular Nursing, 26(3), 5-5. U.S. Department of Health and Human Services. (2013). The U.S. nursing work- force: Trends in supply and education. Retrieved from https://bhw.hrsa.gov/ sites/default/files/bhw/nchwa/projec tions/nursingworkforcetrendsoct2013. pdf Van Hoye, G., & Lievens, F. (2009). Tapping the grapevine: A closer look at word-of- mouth as a recruitment source. Journal of Applied Psychology, 94(2), 341-352. September-October 2018 . Vol. 27/No. 5 MEDSURG JURSING 328See Answer
  • Q4:Instruction :- Choose a Global Health Agency/organization currently working on a global health problem. The agency should be focused on a current problem and working to improve the health of vulnerable populations (i.e., women, children, elderly, and disabled). Create a 12 slide PowerPoint presentation that includes the following: 1. Choose a Global Health organization/foundation. The agency can be either governmental or non- governmental (10pts) 2. Identify the mission of the organization. Who they are and what they do (20 pts) 3. Provide 3-5 examples of projects the organization is currently working on. (ex. The WHO health and human rights campaign) (40pts) 4. Identify 2-3 partners the organization/agency collaborate with and the objective of the partnership (ex., Financial, manpower, support services, etc.) (20pts) 5. Include a reference list of at least 2-3 references in the correct APA format. (10pts) Hide Comment Choose a Global Health Agency/organization currently working on a global health problem. The agency should be focused on a current problem and working to improve the health of vulnerable populations (i.e., women, children, elderly, and disabled). Create a 10-12 slide PowerPoint presentation that includes the following: 1. Choose a Global Health organization/foundation. The agency can be either governmental or non- governmental (10pts) 2. Identify the mission of the organization. Who they are and what they do (20 pts) 3. Provide 3-5 examples of projects the organization is currently working on. (ex. The WHO health and human rights campaign) (40pts) 4. Identify 2-3 partners the organization/agency collaborate with and the objective of the partnership (ex., Financial, manpower, support services, etc.) (20pts) 5. Include a reference list of at least 2-3 references in the correct APA format. (10pts)See Answer
  • Q5:10:31 K Assignment Details HPRS-1102.501: Wellness and Health Promotion Reminder Add due date reminder notifications about this assignment on this device. + Submission Types Text Entry or File Upload Description Mind Body SOUL shutterstock.com . 1008807274 Weekly Journal Activity: You will be creating a Wellness Journal that you will write 4 out of 7 days per week. The instructions are below, so please read carefully. You will be expected to upload your journal writings each week by Sunday evenings. Please review the goals to get a better Submit Assignment Dashboard Calendar To Do Notifications Inbox 8 000 10:31 ‹ Assignment Details HPRS-1102.501: Wellness and Health Promotion Weekly Journal Activity: You will be creating a Wellness Journal that you will write 4 out of 7 days per week. The instructions are below, so please read carefully. You will be expected to upload your journal writings each week by Sunday evenings. Please review the goals to get a better understanding as to why I have made this an assignment. Your Final Project will include a written presentation on what you have discovered by keeping a Wellness Journal, so it is required to pass this course. Goals: · To heighten the awareness of the sequence of events. · To help with self-disclosure . To provide a resource for reinforcing learning. · Personal journaling is a way to understand experiences and explore learning. . This will be a daily diary for your use and help you consider lifestyle challenges and choices. . Write an objective description of the activity (what happened) and follow this with your reaction (how I felt) Step 1: Decide where you will journal Submit Assignment 8 000 000 Dashboard Calendar To Do Notifications Inbox 10:32 Assignment Details HPRS-1102.501: Wellness and Health Promotion Step 1: Decide where you will journal Your wellness journal (WJ) can be a series of emails to yourself where you reply to each entry daily. It could be an old or brand-new notebook. It can be an online document. Choose whatever is comfortable to you and appeals to your imagination. But please note that you will need to upload images each week for an assignment, so think of that when choosing your journaling document. Step 2: Schedule a 10-minute time slot to write in your WJ every day. Early morning works for some people. Then end of your day works for others. Just ensure that you set aside 10 minutes to get your thoughts together in a quiet space where you can sit and write uninterrupted. Step 3: Write down questions that you will ask yourself. A WJ is a way for you to introduce yourself to yourself. Write questions that you can flip back to for reference. Examples: What do I want to accomplish today? What was the best thing that Submit Assignment 8 000 000 Dashboard Calendar To Do Notifications Inbox 10:32 ‹ Assignment Details HPRS-1102.501: Wellness and Health Promotion Step 3: Write down questions that you will ask yourself. A WJ is a way for you to introduce yourself to yourself. Write questions that you can flip back to for reference. Examples: What do I want to accomplish today? What was the best thing that happened to me today? What do I want to do next? What do I want to accomplish tomorrow? What puzzled me? Pick one question every night to focus on. Write down the little things that come to your mind when you read the question. Read the previous day's entry to build continuity. Step 4: Tabulate your success; brainstorm how to move on from failure. Use your WJ to write down your daily successes. When you look back, you'll be impressed with all the things you accomplished in a short time. If there were failures, brainstorm how to move past them. Acknowledge your small successes every day. Step 5: Place unique mementos within the pages of your WJ Press flowers and leaves nlace clinned articles Submit Assignment 8 000 Dashboard Calendar To Do Notifications InboxSee Answer
  • Q6:Instructions by Student: You have to write a personal statement in 500 words : I was born in Pakistan, age 21 got married came to UK I have gcse and I did nvq level 1&2 then I work in care home for 3 years older people dementia people, required personal care and act then I applied for Bradford District Care Trust mental health as staff bank I working 6 years now then I have diploma higher education level 3 , Am working part time for Trust in January I applied for community team leader I go to the clients home do the initial assessment and care plans , check on team do spot check do supervision also my role is to arrange the meeting with managers , take peoples interviews .. I am married for 19 years have 3 children's Write about me my goal I am passionate to help people why I want to do nursing course and etc. Just write in good grammar and Show the passion Course is mental health nursing I am working there as health care support worker I worked 6 years now I want to achieve more Do nursing I love my job and etc Write in best way follow by screenshot university’s requirements These 3 Universities. I need to apply Huddersfield University Bradford university, Leeds UniversitySee Answer
  • Q7: Important Note: I'm a doctorate scholar and I need help on writing my research proposal assignment, the title of my research is Capacity Building: Examining the role of leadership training and mentoring in the experience of the nurse educator to improve patient experience. Research method will be Quantitative so that you need to find a reliable validated Quantitative tool that I can use. In addition, a PPT of 10 slides of research proposal with speaker notes on each slide and in text citations and reference. The WD is the assignment details And the rest is some study materials was shared with me for reference if needed. 3000 words plus or minus 5% as detailed in the assignment 1100 for introduction, 1100 for Literature review, and 500 for the methodology. Then PPT is the second task which consists of 10 slides with speakers notes on each slide HARVARD REFERENCING STYLE. And it must be written in the UK English language With attachment of similarities and plagiarism reportSee Answer
  • Q8: Week 3- Social Justice Assignment for the Week: Readings/Activities: Tobin-Tyler and Teitelbaum (2019). Essentials of Health Justice: A Primer. Chapter 3: Population Health Disparities, pp. 33- 60. Tobin-Tyler and Teitelbaum (2019). Essentials of Health Justice: A Primer. Chapter 4: Social and Structural Barriers to Health pp 61-90, Identify either a news story or an article in the literature about one of the social or structural barriers discussed in Chapter 4. Assignment: Critical Thinking Questions For this week's assignment, read the assigned text charters and search the news/ literature as described above. Once you have completed this, answer the following critical thinking questions. Be sure to answer in your own words, and provide a comprehensive answer to each question. 1. What are the differences between individual and population health disparities? What makes a population vulnerable? Explain how each vulnerable group discussed in Chapter 3 experiences health disparities. How do health policies, laws, and the culture of the United States shape and influences these disparities? 2. Describe the relationship between poverty and inequality, as discussed in Chapter 4. What are the social and structural determinants of health, according to Tyler and Teitelbaum (2019)? Choose three determinants discussed in Chapter 4 of the text, and explain how poverty affects the determinant, and how this determinant leads to health inequities. 3. Identify either a news story or an article in the literature about one of the social or structural barriers discussed in Chapter 4. Summarize the article or story, and identify the key points addressed. How is this barrier related to social justice and health equity?See Answer
  • Q9: INSTRUCTIONS Submission Your final submission should include: A key passage of at least five sentences from one of your sources, inside quotation marks with an APA style in-text citation. Your paraphrase of the quotation in two to three sentences with a properly formatted APA style in-text citation at the end of the paragraph. A short (one sentence or less) quotation that includes an introduction, APA style in-text citation, and a one sentence explanation afterward. A list of references for your four sources in proper APA format with a URL at the end. (Note: URLs are not required for all sources in APA format, however, for this assignment, you must include one so your instructor can review your sources) using this template.[Student Name] Instructions: Replace the example wording in brackets below with your wording for each prompt. IND101 Milestone 4 Template Paraphrasing activity: Quote from source (at least 5 sentences): [Example: "The transition to electrification of vehicles will probably be gradual, for three primary reasons: consumer caution when it comes to large purchases, the high initial cost of manufacturing electric vehicles, and pushback from vested interests. There will be special circumstances, such as in Norway, where rapid transitions are possible. But in places such as the United States, where the automotive market is large and diverse, and many players are involved including the thousands of cities and states that impose rules and offer incentives the pace will be slower. Cost reductions will take time. Gasoline cars have benefited from a century of intensive development, while electric cars have been the focus of major manufacturers on a commercial scale only since about 2010" (Sperling, 2018, p. 15).] Paraphrase of the quote above (2-3 sentences): [Example: The shift from traditional vehicles to EVs (electric vehicles) was rapid in Norway, but the same pace is not expected in the United States, which has a much higher population, state and local laws to contend with, and a large and diverse auto industry. In addition, consumers are often hesitant about large purchases. This hesitance, along with the high costs for EV production, and pressure from oppositional groups, will slow the transition. While the cost of EV production will eventually decrease, this will take time; in comparison to gas-powered cars' long history, EVs have only been widely available since 2010 (Sperling, 2018).] Integrating a short quote activity: [Example: As Sperling (2018) argues, “petroleum-powered motor vehicles are a major contributor to climate change, emitting about 20 percent of all greenhouse gases worldwide” (p. 12). Reducing reliance on gasoline-powered vehicles by investing in the shift to electric vehicles can have a significant impact on climate change.] Current list of 4 references in APA format (with a URL included): [Examples: Dua, R., & White, K. (2020). Understanding latent demand for hybrid and plug-in electric vehicles using large-scale longitudinal survey data of US new vehicle buyers. Energy Efficiency, 13(6), 1063-1074. http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direc t=true&db=asn&AN=145259635&site=eds-live&scope=site Graham, J. D., Belton, K. B., & Suri, X. (2021). How China beat the US in electric vehicle manufacturing and why it's time for the United States to get serious about industrial policies. Issues in Science & Technology, 37(2), 72–79. http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direc t=true&db=tfh&AN=149318105&site=eds-live&scope=site Noori, M., & Tatari, O. (2016). Development of an agent-based model for regional market penetration projections of electric vehicles in the United States. Energy, 96, 215-230. http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direc t=true&db=edselp&AN=S0360544215016606&site=eds-live&scope=site Sperling, D. (2018). Electric vehicles: Approaching the tipping point. Bulletin of the Atomic Scientists, 74(1), 11–18. http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direc t=true&db=ulh&AN=127161734&site=eds-live&scope=site]/n ARTICLE HIPAA and Telehealth Protecting Health Information in a Digital World Author_ Melissa Kovac (melissa.kovac@terumobct.com), Terumo Blood and Cell Technologies In 1996, the Healthcare Information Portability and Accountability Act (HIPAA) was enacted to protect the privacy and security of patients' protected health information. Since then, technology has taken health information far beyond paper medical records and grainy faxes. As telehealth, in the forms of electronic health records, virtual visits, apps, and wearable devices, has increased in popularity, HIPAA clearly is no longer sufficient to guarantee the privacy of the health information it was enacted to protect. Updates to HIPAA are necessary, and those updates should be made with future technological advance- ments in mind. Telehealth, broadly defined as healthcare provided via telecommunication and dig- ital technologies, has in recent years been promoted as a way to increase access to healthcare services for rural, under-resourced, and underserved populations (Enlund 2020, 1–2). Telehealth services range from simple administrative patient portals and conve- nient apps to telephone and video visits with otherwise inaccessible specialists (US Department of Health and Human Services [HHS], n.d.). When available, it offers patients greater control and can be a convenient, time-saving, and cost-effective way to obtain medical care. Unfortunately, it also puts protected health information (PHI) at risk and is vulnerable to privacy and security breaches (Gajarawala 2021, 218-19). In the United States, the vanguard of electronic health- care information privacy regulation is the Healthcare Information Portability and Accountability Act of 1996 (HIPAA). HIPAA guarantees that individuals' PHI is kept private and secure as it travels to and from patients, health care providers, insurance companies, and approved busi- ness associates (HHS 2013). Patients have a right to access their PHI, and it may not be shared with others without the patient's explicit permission, with few exceptions. Protected health information includes medical records, reports of conversations about patient care, and insurance and billing information (HHS 2020a). There have, not surprisingly, been violations of the patient confidentiality and information security JOURNAL OF INTELLECTUAL FREEDOM AND PRIVACY _ SUMMER 2021 6 HIPAA AND TELEHEALTH_COMMENTARY guaranteed by HIPAA—messages left with the wrong per- son, PHI shared by healthcare providers outside of work, lax risk analysis and management, outright theft and penalties have included job loss, fines, and criminal pros- ecution (Tariq 2020). A 2019 review of breaches affect- ing more than five hundred patients in the United States found that 53 percent of breaches were "attributable to internal mistakes or neglect" while 47 percent of breaches were from external sources and primarily the result of hacking or other IT incidents (Jiang 2019, 266). HIPAA, however, was only the first step on the road to protecting electronic PHI, and that first step was taken twenty-five years ago. Banerjee explains: When HIPAA was enacted, healthcare service provider's medical record documents were the primary, if not the only, sources of health information. This is the reason why non- healthcare entities were not included in the purview of the law. However, increased penetration of technologies capable of generating PHI, the lack of laws to protect user data from [non-covered entities], and the increasing diversity of non- healthcare providers with access to such information, have together increased the risks of consumer data breaches and misuse. (Banerjee 2018, 7) Subsequent federal legislation has "failed to address the new privacy and security challenges presented by the dig- itization of health information" (Theodos 2021, para. 7). Notably, these new technologies function outside the purview of HHS and are not required to protect health information (Theodos 2021). According to Rosenbloom (2019), “advances in technology, diffusion of health IT across diverse sectors of health care, [and] patients' expec- tations," such as immediate availability of information and apps on mobile devices, contribute to compromises in privacy (1118, 1115). Many apps neither transmit data over a secure connection nor encrypt it, and they may legally sell to data brokers what would in other contexts be PHI (Galvin 2020, 36). Wearable devices are also of concern. Wearables mea- sure and report physiological and behavioral informa- tion as varied as heart rate, amount of sweat, and seizure activity, but that data does not belong to the user; rather, it belongs to the companies that manufacture the devices and store the data (Theodos 2021). Unfortunately, most people who use the devices are unaware of that. In one study, while 70 percent of respondents said confidentiality was important, only 28 percent reported that they were familiar with how their devices protected their privacy, and only 24 percent were familiar with how their devices transmitted and stored their data (Cilliers 2020, 4–5). The incremental growth in the use of telehealth, par- ticularly virtual visits, was upended in 2020. To limit the transmission of COVID-19, healthcare providers instituted virtual visits, either by phone or by video. Concerns about privacy were quickly acknowledged by HHS. In February 2020, the department announced that despite the pan- demic, HIPAA privacy and security rules would for the most part remain in effect (Bassan 2020, 2). However, only a month later and with the goal of encouraging the use of telehealth, HHS changed course and issued a Noti- fication of Enforcement Discretion that relaxed HIPAA rules (Bassan 2020, 5; Mortell 2020, 390). The relaxed standards apply to technologies that “include video-con- ferencing, the internet, asynchronous imaging, streaming media, landline, and wireless communications" (Bassan 2020, 5). HHS specifically stated that a healthcare pro- vider may use technologies that "may not fully comply with the requirements of the HIPAA rules," if the pro- vider makes a good faith effort to keep patient data pri- vate. Included among these technologies are FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, and Skype (HHS 2021). As of June 2021, the Notification of Enforcement Discretion has no expiration date (HHS 2020b). The use of telehealth has increased exponentially during the COVID-19 pandemic; in some hospi- tal systems, the use increased by thousands of percent (Ramaswamy 2020, 1). As Bassan writes, "Given the implementation of the technology during the pandemic, it is unlikely that the use of telehealth would disappear after the pandemic” (Bassan 2020, 11). Perhaps most impor- tantly for the future of telemedicine, outpatients were significantly more satisfied with virtual visits during the pandemic than they were with in-person visits prior to it (Ramaswamy 2020, 5); even before COVID-19, one study showed that while fewer than 4 percent of people had had a video visit with a healthcare provider, almost 50 percent were willing to do so (Fischer 2020, 5). The use of wearable devices is also increasing: in 2020, 29.8 percent of Americans reported using an electronic wearable device to track health or activity, compared with 26.7 percent in 2019 (US National Cancer Institute 2020). According to a recent Gallup poll, 32 percent of Ameri- cans have at some point tracked health data using an app (McCarthy 2019). HIPAA, even with its privacy and secu- rity rules in place, is not a sufficient guarantor of health-care information privacy and should be updated to better align “individual access to health data with the current JOURNAL OF INTELLECTUAL FREEDOM AND PRIVACY _ SUMMER 2021 7 HIPAA AND TELEHEALTH_COMMENTARY realities of electronic medical records and the expectations of modern, engaged patients" (Rosenbloom 2019, 1118). It is unreasonable to expect that patients will under- stand or even read-complicated privacy statements. Bassan suggests that HHS institute regulations like those in the California Consumer Privacy Act: companies must disclose what information they're collecting, what they're doing with it, and whether they're selling it to third par- ties, and patients should have access to all collected infor- mation and the opportunity to opt out of sharing (Bas- san 2020, 9). All healthcare providers should invest in cybersecurity and build videoconferencing products that include "security features such as encryption and may offer additional configuration settings that can be stan- dardized for the entire organization, such as requiring a waiting room with every teleconference" (Jalali 2021, 672). HHS should also extend HIPAA's existing rules to References Banerjee, Syagnik, Thomas Hemphill, and Phil Longstreet. 2018. “Wearable Devices and Healthcare: Data Sharing and Pri- vacy." The Information Society 34, no. 1: 49–57. Bassan, Sharon. 2020. "Data Privacy Considerations for Telehealth Consumers Amid COVID-19." Journal of Law and the Biosci- ences 7, no. 1: 1-12. Cilliers, Liezel. 2020. "Wearable Devices in Healthcare: Privacy and Information Security Issues." Health information Manage- ment Journal 49, no. 2-3: 150–56. Enlund, Sydne. 2020. "Tapping Into Telehealth to Expand Care." LegisBrief 28, no. 5: 1–2. Fischer, Shira H., Kristin N. Ray, Ateev Mehrotra, Erika Lit- vin Bloom, and Lori Uscher-Pines. 2020. "Prevalence and Characteristics of Telehealth Utilization in the United States." JAMA Network Open 3, no. 10: e2022302-e2022302. Gajarawala, Shilpa N., and Jessica N. Pelkowski. 2021. "Telehealth Benefits and Barriers." The Journal for Nurse Practitioners 17, no. 2: 218-21. Galvin, Hannah K., and Paul R. DeMuro. 2020. "Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019." Yearbook of Medical Informatics 29, no. 1: 32-43. Jalali, Mohammad S., Adam Landman, and William J. Gordon. 2021. “Telemedicine, Privacy, and Information Security in the Age of COVID-19." Journal of the American Medical Informatics Association 28, no. 3: 671–72. Jiang, John Xuefeng, and Ge Bai. 2019. “Evaluation of Causes of Protected Health Information Breaches." JAMA Internal Medi- cine 179, no. 2: 265–67. noncovered entities, wearable devices, and apps (Rosen- bloom 2019, 1116). Banerjee recommends that HHS cre- ate "a ‘watchdog' unit that is charged with identifying and monitoring types of new behavioral data that can be cap- tured by wearable technology," determining whether that data is identifiable, and, if necessary, adding it to HIPAA's catalog of technologies that can be used to identify a spe- cific patient (Banerjee 2018, 7). Telehealth products and services will undoubtably pro- liferate and mature over the next twenty-five years, much as they have in the twenty-five years since HIPAA was first enacted. Any new laws, regulations, and government and industry cooperative agreements must be developed with that growth in mind. Health information is some of the most intimate information there is, and patients' right to privacy and the security of their data must be preserved, no matter what the technology. McCarthy, Justin. 2019. "One in Five U.S. Adults Use Health Apps, Wearable Trackers." Gallup, December 11. https://news.gallup.com/poll/269096/one-five-adults-health-apps-wear able-trackers.aspx. Mortell, Thomas J., and Austin T. Strobel. 2020. "Changes in the Office for Civil Rights Enforcement Policy on Telehealth Remote Communications in Response to COVID-19." Journal of Pediatric Rehabilitation Medicine 13, no. 3: 389-92. Ramaswamy, Ashwin, Miko Yu, Siri Drangsholt, Eric Ng, Patrick J. Culligan, Peter N. Schlegel, and Jim C. Hu. 2020. “Patient Satisfaction With Telemedicine During the COVID-19 Pan- demic: Retrospective Cohort Study." Journal of Medical Internet Research 22, no. 9: e20786. Rosenbloom, S. Trent, Jeffery R. L. Smith, Rita Bowen, Janelle Burns, Lauren Riplinger, and Thomas H. Payne. 2019. “Updating HIPAA for the Electronic Medical Record Era." Journal of the American Medical Informatics Association 26, no. 10: 1115–19. Tariq Rayhan A., and Pamela B. Hackert. 2018 Patient Confidential- ity. Treasure Island, FL: StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK519540/. Theodos, Kim, and Scott Sittig. 2021. "Health Information Privacy Laws in the Digital Age: HIPAA Doesn't Apply.” Perspectives in Health Information Management 18 (Winter). US Department of Health and Human Services (HHS). n.d. “Tele- health." Accessed May 11, 2021. https://www.hhs.gov/hipaa /for-professionals/faq/telehealth/index.html. JOURNAL OF INTELLECTUAL FREEDOM AND PRIVACY__SUMMER 2021 8 HIPAA AND TELEHEALTH _ COMMENTARY 2013. "Summary of the HIPAA Privacy Rule.” https:// www.hhs.gov/hipaa/for-professionals/privacy/laws-regula tions/index.html. 2020a. "Your Rights Under HIPAA." https://www.hhs .gov/hipaa/for-individuals/guidance-materials-for-consumers /index.html. 2020b. "When Does the Notification of Enforcement Dis- cretion Regarding COVID-19 and Remote Telehealth Com- munications Expire?" https://www.hhs.gov/hipaa/for-pro fessionals/faq/3020/when-does-the-notification-of-enforce ment-discretion-regarding-covid-19-and-remote-telehealth -communications-expire/index.html. -. 2021. "Notification of Enforcement Discretion for Tele- health Remote Communications During the COVID-19 Nationwide Public Health Emergency." https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-pre paredness/notification-enforcement-discretion-telehealth /index.html. US National Cancer Institute. 2020. “Health Information National Trends Survey: In the Past 12 Months, Have You Used an Electronic Wearable Device to Monitor or Track Your Health or Activity?" https://hints.cancer.gov/view-questions-topics /question-details.aspx?qid=1746. JOURNAL OF INTELLECTUAL FREEDOM AND PRIVACY SUMMER 2021 9 Copyright of Journal of Intellectual Freedom & Privacy is the property of American Library Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.See Answer
  • Q10:/n European Review for Medical and Pharmacological Sciences Effect of Vitamin D supplementation in patients with liver cirrhosis having spontaneous bacterial peritonitis: a randomized controlled study A.A. MOHAMED¹, A.A. AL-KARMALAWY², A.A. EL-KHOLY³, D.A. EL-DAMAS+, H.M. ABOSTATE¹, S.M. MOSTAFA5, M. HAMADA, M.A. KHALIK ELKADY', Y. HASSAN, E. AL-HUSSAIN³, M.G. KHALIL', I. BADAWY¹0, D. ELEBEEDY¹⁰, B.A. ALSFOUK¹¹, M.M. SHAHEENL² 'Biochemistry, Molecular Biology and Biochemistry Department, National Hepatology and Tropical Medicine Research Institute, Egypt ²Department of Pharmaceutical Medicinal Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, Egypt ³Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt 4Microbiology, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt 5Department of Hepatology, National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt 'Internal Medicine Department, Faculty of Medicine, Benha University, Cairo, Egypt 2021; 25: 6908-6919 7Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Egypt Clinical Pathology Department, Faculty of Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt 'Toxicology Department, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt ¹ºPharmaceutical Biotechnology Department, Faculty of Biotechnology, Misr University for Sciences and Technology, Cairo, Egypt ¹¹Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia ¹²Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt Amal Ahmed Mohamed and Ahmed A. Al-Karmalawy contributed equally to this work Abstract. OBJECTIVE: Spontaneous Bac- terial Peritonitis (SBP) is one of the most seri- ous liver cirrhosis with ascites complications. Vitamin D (Vit D) deficiency has been associat- ed with a high risk of infection and mortality in cirrhotic patients. Herein, the assessment of Vit D level as a prognostic marker in SBP patients and the impact of Vit D supplementation on their treatment plan was studied as well. PATIENTS AND METHODS: Ascetic patients with SBP and Vit D deficiency were divided ran- domly into treatment and control groups. The control group received standard treatment with- out Vit D and the treatment group received stan- dard treatment plus Vit D. Clinical monitoring of Vit D was done over 6 months. RESULTS: At baseline, all patients in both groups revealed an elevated serum and ascetic TLC, AST, ALT, total and direct bilirubin, in addi- tion to elevation in INR and procalcitonin (PCT) level. Univariate regression analysis confirmed that deficiency of Vit D was an independent pre- 6908 dictor of infection and mortality (p < 0.01; Crude Hazard Ratio: 0.951). Over 6 months, the study revealed significant improvement in serum Vit D level in the treatment group (34.6 ± 9.2 and 18.3 ± 10.0 ng/mL; p < 0.001). Moreover, a statistical- ly significant increase in survival rate (64% vs. 42%; p<0.05) and duration (199.5 days vs. 185.5 days; p<0.05) were recorded as well. Univariate and multivariate regression analysis confirmed that Vit D supplementation was positively cor- related to survival over 6 months (p < 0.001; Ad- justed Hazard Ratio: 0.895). CONCLUSIONS: Vit D deficiency is prevalent in SBP cirrhotic patients and is used as an inde- pendent predictor of infection and death. There- fore, Vit D supplementation revealed improve- ment in their response to treatment. Key Words: Ascites, Spontaneous bacterial peritonitis, Vitamin D deficiency, Survival. Corresponding Author: Ahmed A. Al-Karmalawy, MD; e-mail: akarmalawy@horus.edu.eg Vit D supplementation in patients with liver cirrhosis and SBP Introduction Patients with liver cirrhosis had spontaneous bacterial peritonitis (SBP) infection that showed poor prognosis¹-³. Cirrhosis is the terminal stage of any chronic liver injury which accounts for the fourth major cause of mortality in central Eu- rope¹-6. Egypt has the highest age-standardized mortality rate of 72.7 deaths for every 100,000 patients. Approximately one-fifth (18.1%) of most deaths in males of age ranged from 45 to 54 years were caused by liver cirrhosis7-10. Cirrhosis manifests with the presence of vascular fibrosis and distortion resulting in increased hepatic re- sistance, which may cause portal hypertension if there was splanchnic hyperperfusion¹¹-13. Com- plications like variceal bleeding and renal dys- function may be due to portal hypertension¹4-16 Renal dysfunction and splanchnic vasodilation contribute to the development of ascites¹7-19. As- cites are frequently complicated by SBP20,2¹, most commonly due to intestinal bacterial transloca- tion, which can trigger renal failure and is associ- ated with increased mortality. New inflammation biomarkers are needed in clinical practice for the early diagnosis of SBP, such as procalcitonin (PCT)22,23. Meanwhile, the pathophysiology of SBP is not understood, since translocation of bac- teria from the gastrointestinal tract to the ascetic fluid (AF) is thought to be a crucial mechanism behind the development of SBP. Also, SBP is encouraged by impaired defensive mechanisms in cirrhotic patients. It is diagnosed by counting polymorphonuclear (PMN) cell numbers in AF of more than or equal to 250 cells/mm³, where the infectious organism is isolated in about 70% of cases24,25 Procalcitonin (PCT) is a polypeptide precursor for calcitonin synthesized in the thyroid C cells. Microbial toxins and pro-inflammatory media- tors, such as IL-1B, IL-6, and TNF-a, triggered PCT release26-28. In decompensated cirrhosis, se- rum and ascetic fluid PCT were examined and we found they were not effective as a marker in the detection of acute bacterial infection (such as SBP) compared to patients without hepatic impairment ²9-32. PCT, however, appears to be a strong marker for bacterial translocation, a well-established mechanism for decompensat- ed cirrhosis infection that can lead to bacterial infection 33,34 Combining procalcitonin (PCT), the difference in hemoglobin concentration be- tween newly formed and mature red blood cells (dCHC) and mean fluorescence intensity of ma- ture neutrophils (sNFI) in patients with cirrhosis is a valuable predictive composite marker for early detection of ascites infection ³5. The acute stage reactant proteins, such as C-reactive pro- tein (CRP) and procalcitonin (PCT), have been assessed in many clinical situations as indicators for early diagnosis of SBP. CRP and PCT are well known to rise rapidly in response to bacterial infection 36,37. So, they are used as sensitive pre- dictive and monitoring parameters for bacterial infections and controlling the use of antibiotics. In addition, cirrhotic patients usually have Vit D deficiency 38,39 The liver is a crucial organ for Vit D bio- transformation, where it is the only organ that generates the (25-OH) Vit-D3 from Vit D40,41 Low hepatocytes, reduced exposure to sunlight, low adipose tissue, malabsorption of Vit D, and altered hydroxylation of Vit D in the liver are the normal reasons for the decreased levels of Vit D in patients with cirrhosis 42. It was found that low Vit D in the ascetic fluid is related to the higher risk of AF bacterial infection in cirrhotic patients with ascites 43,44 There are few studies available concerning the impact of Vit D supplementation on people with Vit D deficiencies, particularly those with decom- pensated cirrhosis 45,46. The effect of Vit D sup- plementation on mortality rate in those patients is still unclear. The main purpose of the present work is to assess Vit D and procalcitonin levels as prognostic markers in SBP patients, besides, evaluating the effect of Vit D administration on the response of SBP patients for treatment from liver cirrhosis. Patients and Methods Study Design and Setting This study was a prospective randomized con- trolled study that included 328 ascetic patients with spontaneous bacterial peritonitis (SBP) who were admitted to the National Hepatology and Tropical Medicine Research Institute from June 2019 to December 2019. Subject Selection The inclusion criteria were: patients with liv- er cirrhosis, ascites with SBP, and aged over 18 years. The excluded patients from the study were: those with non-peritoneal infections (septicemia, skin infection, chest infection, biliary tract in- fection, urinary tract infection, gastroenteritis, 6909 A.A. Mohamed, A.A. Al-Karmalawy, A.A. El-Kholy, D.A. El-Damas, et al. dental infection, meningitis), administration of non-absorbable antibiotics in the prior 6 weeks, infection with HIV, hepatoma or other forms of malignancy, hepatorenal syndrome on admis- sion, significant cardiac and respiratory disease, pregnancy, patients prepared for transplantation, and signs of gastrointestinal bleeding or bacterial infection in the prior 6 weeks. Clinical Evaluation Detailed patient's clinical history and physi- cal examination were performed. Patients were screened for complete blood count (using Phoe- nix NCC-2310 Hematology Analyzer Device), random blood sugar, liver profile [aspartate ami- notransferase (AST), alanine aminotransferase (ALT), direct bilirubin, total serum bilirubin (TSB), alkaline phosphatase (ALP), serum al- bumin by OLYMPUS biochemistry autoanalyz- er (USA), coagulation profile (prothrombin time (PT), and international normalized ratio (INR)] by kcl delta, renal function tests (urea and serum creatinine), viral markers (HBsAg; hepatitis C vi- rus antibodies (HCV Abs) by ELISA, alpha-feto- protein (AFP) by Eliza according to manufactur- ing instructions. Values were considered normal if > 10 ng/ml. In addition, abdominal ultrasonog- raphy was done for grading of ascites. All stud- ied patients underwent diagnostic paracentesis to obtain AF samples for total leucocyte count (TLC) (polymorph nuclear leucocytes equal or more than 250 cells/mm³ considered as sponta- neous bacterial peritonitis), malignant cells, total protein, albumin, and glucose. Serum Procalcitonin and Vit D Measurements Serum procalcitonin (PCT) was measured us- ing the PCT enzyme-linked immunosorbent as- say kit for the in vitro assessment of serum PCT (Chongqing Biospes Co. Ltd, Chongqing City, China; biopsies). The Vit D level was also mea- sured by ELISA (by direct competitive chemi- luminescence immunoassay using commercially available kit Unicel® DxI 800 immunoassay sys- tems (Beckman Coulter, Inc., CA, USA) within 24 hours of admission. Patient with serum Vit D concentration < 25 ng/mL was considered as Vit D deficient or insufficient. Medication Exposure The total number of patients who participated in this study with Vit D deficiency was 328 pa- tients, randomly divided into control and treat- 6910 ment groups. The control group included patients who received standard treatment without Vit D (n=168). Whereas the treatment group included patients who received standard treatment plus Vit D (n=160). Patients in the treatment group received a dose of 300000 IU of cholecalciferol as a loading dose by intramuscular injection, fol- lowed by a maintenance dose of 800 IU/d orally with oral calcium supplementation in a dose of 1000 mg. Monitoring of Vit D, serum calcium, and phosphorus was measured every month for 6 months or until death, whichever happened first. Administration of Vit D was discontinued if signs of hypercalcemia, renal stone, or Vit D level above 80 nmol/L (> 32 ng/mL) were detected. Ethical Considerations Informed consent was received from all partic- ipants included in the study. The study protocol complied with the Ethical Guidelines set out in the Declaration of Helsinki (sixth revision, 2008) and Good Clinical Practice guidelines. The National Hepatology and Tropical Medicine Research Institute Committee approved the study (Serial: 5-2020). Statistical Analysis The data were analyzed using a statistical package for the social sciences, version 23 (IBM SPSS, Statistics for Windows, Version 23.0, IBM Corp, Armonk, NY, USA). Numerical variables were expressed as mean±SD (standard devia- tion) and median (range). Comparison between treatment and control groups was conducted as follows: for parametric data, a two-sample t-test was used while for the nonparametric data, the Mann-Whitney test was used. For analysis of survival, the log-rank test was used for binary variables while continuous variables were ana- lyzed using the Cox-proportional hazard method. A p-value below 0.05 was considered statistically significant. Results Demographic Data Out of 328 patients, 160 patients received stan- dard SBP therapy plus Vit D (treatment group) and 168 patients received only SBP standard therapy (control group). The age was expressed as mean±SD in the treatment group (51.4± 12.1), and in the control group (55.0+ 8.5) with a ratio of male to female 85:75 and 81:86, respectively. Vit D supplementation in patients with liver cirrhosis and SBP Regarding the baseline characteristics, no sig- nificant difference (p>0.05) was observed be- tween treatment and control groups, except sig- nificantly higher smoking (p<0.05) in the treat- ment group (Table I). In addition, blood test parameters and ascetic fluid composition were comparable in the control and treatment groups (p>0.05), except for HBsAg positive and AST levels, which were significantly higher in the con- trol group than in the treatment group (p< 0.05) (Table 1). Treatment and control groups showed an elevation in PCT level (1.78± 0.49), (1.84+ 0.78) and deficiency of Vit D (22.5± 11.5), (20.2+ 11.0), respectively. For both groups, there was no significant difference in those values. Effect of Vit D Supplementation After 6 months of treatment and follow-up, most of the blood test parameters and ascetic fluid composition were significantly improved in both groups. However, the level of improvement Parameters Table I. Baseline characteristics, blood tests, and ascetic fluid composition of control and treatment groups. Control group (N = 168) Age in years (Mean ± SD) Gender (Male: Female) BMI (Kg/m²) (Mean ± SD) Smoking [No. (%)] Bleeding [No. (%)] Ascites [No.(%)] Encephalopathy [No.(%)] Fever [No.(%)] Jaundice [No.(%)] HBsAg positive [No.(%)] HCV Ab positive [No.(%)] Hb (g/dL) (Mean ± SD) Serum glucose (mg/dL) (Mean ± SD) Ascetic glucose (mg/dL) (Mean ± SD) Platelet ( 109/L) (Mean ± SD) Serum Creatinine (mg/dL) (Mean ± SD) Total bilirubin (mg/dL) (Mean ± SD) Direct bilirubin (mg/dL) (Mean ± SD) ALT (IU/L) (Mean ± SD) AST(IU/L) (Mean ± SD) Serum albumin (g/dL) (Mean ± SD) Ascetic albumin (g/dL) (Mean ± SD) INR (Mean ± SD) was significantly higher in the treatment group compared to the control group (p< 0.001) (Table II). The PCT, which was investigated as an early diagnostic marker for ascites infection, showed a highly significant reduction in the treatment group than the control group (p< 0.001) (Figure 1). Furthermore, patients in the control group demonstrated an average 9.4% decrease in the mean serum Vit D level (20.2 ng/mL vs 18.3 ng/ mL) at the end of 6 months. On the other hand, patients who received Vit D showed a 53.8% in- crease in mean serum Vit D level (22.5 ng/mL vs. 34.6 ng/mL). Also, a highly significant elevation of Vit D in the treatment group in comparison with the control group (p< 0.001) was observed (Table III) (Figure 2). AFP (ng/mL) [Median (Range)] GGT (IU/L) [Median (Range)] Blood TLC ( 10¾μµL) [Median (Range)] Ascetic TLC (x 103/µL) [Median (Range)] Procalcitonin (ng/mL) (Mean ± SD) Sr.Vitamin D level (ng/mL) (Mean ± SD) Survival Rate Analysis The survival rate was significantly higher in the treatment group (64%) compared to the con- trol group (42%) (p< 0.05). The mean surviv- 55.0+ 8.5 81:86 26.02.2 62 (37.1%) 35 (21%) 167 (100%) 36 (21.6%) 43 (25.7%) 35 (21%) 24 (14.4%) 13 (7.8%) 11.8 ± 2.0 104.2 + 8.5 47.3 ± 9.2 135.5 + 27.02 1.61 ± 0.49 3.87 ± 0.81 0.93 ± 0.40 89.0 ± 23.1 149.0 + 48.3 1.86 ± 0.30 0.73 +0.23 1.32 ± 0.31 7.9 (3.1-9.2) 81.73 (12-187) 11.43 (3.71-23.37) 600 (140-7000) 1.84 ± 0.78 20.2 ± 11.0 Treatment group (N = 160) 51.4 12.1 85:75 25.9 ± 1.9 65 (40.6%) 32 (20%) 160 (100%) 31 (19.4%) 38 (23.8%) 31 (19.4%) 19 (11.9%) 10 (6.3%) 12.0+ 1.5 101.6 15.0 45.0 10.2 138.0 + 71.1 1.56 ± 0.42 3.18±0.73 0.80 ± 0.49 83.1 ± 22.2 138.0 + 46.9 1.90 ± 0.37 0.70 ±0.29 1.29 ± 0.27 8.0 (2.0-8.0) 75.4 (3.4-176.0) 12.10 (4.71-21.73) 587 (120-4300) 1.78 ± 0.49 22.5 11.5 p-value <0.05 > 0.05 > 0.05 < 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 <0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 <0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 AFP, alpha-fetoprotein; ALT, alanine transaminase; AST, aspartate transaminase; BMI, body mass index; GGT, gamma-glutamyl transferase; Hb, Hemoglobin; HBsAg, Hepatitis B surface antigen; HCV Ab, Hepatitis C virus antibodies; INR, international normalized ratio; SBP, spontaneous bacterial peritonitis; TLC, total leukocytic count. 6911 Table II. Univariate analysis comparing the control and treatment groups regarding blood tests and ascetic fluid composition after 6 months. Platelet ( 10%/L) (Mean ± SD) Serum Creatinine (mg/dL) (Mean ± SD) Total bilirubin (mg/dL) (Mean ± SD) Direct bilirubin (mg/dL) (Mean ± SD) ALT (IU/L) (Mean ± SD) AST(IU/L) (Mean ± SD) Serum albumin (g/dL) (Mean ± SD) Ascetic albumin (g/dL) (Mean ± SD) INR (Mean ± SD) AFP (ng/mL) [Median (Range)] GGT (IU/L) [Median (Range)] Blood TLC (x 10/µL) [Median (Range)] Ascetic TLC ( 10³/µL) [Median (Range)] Procalcitonin (ng/mL) (Mean ± SD) Sr.Vitamin D level (ng/mL) (Mean ± SD) Survival at 6 months: ● • Ratio (alive:dead) (%) Survival (days) [Median (Range)] A.A. Mohamed, A.A. Al-Karmalawy, A.A. El-Kholy, D.A. El-Damas, et al. SERUM PROCALCITONIN (NG/ML) 2.5 Parameters 2 1.5 0.5 al duration was (199.5 days) in the treatment group vs. (185.5 days) in the control group (p< 0.05) (Table II). For detection of the different factors that were associated with the 6 months survival of the patients, univariate and multivar- iate analyses were used. The univariate analysis confirmed that higher TLC, higher creatinine, higher bilirubin level, and higher AST level were nonsignificant predictors of death in ascetic SBP 0 6912 Control Treatment Control group (N = 168) AFP, alpha-fetoprotein; ALT, alanine transaminase; AST, aspartate transaminase; BMI, body mass index; GGT, gamma-glutamyl transferase; Hb, Hemoglobin; HBsAg, Hepatitis B surface antigen; HCV Ab, Hepatitis C virus antibodies; INR, international normalized ratio; SBP, spontaneous bacterial peritonitis; TLC, total leukocytic count. Baseline 141.0±66.8 1.30 ± 0.49 2.05 ± 0.83 0.62 ± 0.38 65.0+ 28.8 104.3 ± 53.4 After 6 months 2.76 ± 0.44 0.68 ± 0.32 1.25 +0.24 7.1 (2-32) 51 (2.9-189) 8.8 (4.5-17.0) 231 (189-291) 1.41 ± 0.86 18.3 ± 10.0 42:58 185.5 (85-535) Figure 1. Change in serum Procalcitonin level in both con- trol and treatment groups over 6 months. Results presented as the mean ± SD. (p <0.001 for each group after 6 months, *p<0.001 vs. the control). Treatment group (N = 160) 283.1 ± 89.1 0.95 ± 0.16 0.76 ± 0.19 0.15 +0.07 57.8 ± 22.4 66.3 ± 26.3 2.84 +0.36 0.54 ± 0.32 0.98 +0.07 6 (2.9-9) 35.5 (25-59) 7.5 (2.5-12.0) 124 (90-3400) 0.65± 0.57 34.6±9.2 64:36 199.5 (85-535) p-value < 0.001 < 0.001 < 0.001 < 0.001 <0.05 < 0.001 > 0.05 <0.05 <0.001 < 0.001 < 0.001 <0.001 < 0.001 < 0.001 < 0.001 Discussion <0.05 <0.05 patients (p>0.05). However, low Vit D level in those patients was the only significant predictive mortality marker (p< 0.01). On the other hand, for assessment of the effect of Vit D supplemen- tation on 6 months survival, both univariate and multivariate analysis revealed a highly significant association (p<0.001) (HR=0.895) (Table IV). Cirrhosis has a noticeable correlation with morbidity and mortality rate in developed coun- tries 47-49. Mortality is 4 times higher in a patient with cirrhosis and infection with a poor progno- sis; 30% of patients die within a month of infec- tion in addition to another 30% within a year 50,51 Spontaneous bacterial peritonitis (SBP) is one of the most frequently diagnosed infections. The ascetic fluid infection happens when there is no visceral perforation or inflammatory focus in the abdominal cavity. For SBP diagnosis, the poly- morphonuclear leukocytic count (PMNLs) from the ascetic fluid obtained through paracentesis must be more than 250 cells/mm52,54. In addition, procalcitonin (PCT) appears to be a sensitive diagnostic indicator that can be used to predict diagnosis, monitor bacterial infections, and guide the clinical use of antibiotics. Vit D may enhanceSee Answer
  • Q11: Assignment 1 Select and complete one of the four assignment options listed below. Format Each assignment should be seven to ten pages long (about 1800-2500 words), 12-point font, double-spaced. Use APA style to list and cite all sources used. Include a title page and reference list (not counted in the seven to ten pages required). K Note that you are not asked to format the entire paper in APA style; you are only using APA style to list your references and cite them in the paper. There are many online tools to help you with this. Grading The important thing is to cover your topic as thoroughly as needed to give a reader a complete picture of the issue. It's a good idea to ask a friend or family member to review your work and alert you to any information gaps-their questions show you what essential content you've left out. Your Academic Expert will, if necessary, correct and comment on grammar and spelling, but recommendations of this type are intended to help you improve your writing skills. Grades (marks) will be based mainly on the content of your work. Listed below are the primary criteria that will be used to evaluate your essay: Relevance: Does the essay pertain to the chosen topic? Definition and precision of terms: Have you clearly stated the meaning of the terms used and used them consistently throughout the assignment? Use of evidence: Do you support arguments with evidence from reliable sources? Accuracy of information: Have you made a clear distinction between supportable facts and your own opinions? Logical consistency: Are your conclusions supported by the evidence in your paper? ● ● ● ● Finding and Using Information Unit 3 talks about how to interpret information in the area of CAM. Here is additional information on how to search for sources and critically evaluate what you read. This is essential if you are to produce quality assignments. An excellent source of information for doing fast literature searches is the PubMed website, https://www.ncbi.nlm.nih.gov/pubmed/, published by the US National Library of Medicine National Institutes of Health. However, the great majority of papers generated via this website only allow you to read the abstract, not the whole paper. Start your search by clicking on the Journal Titles tab and entering the name of the journal in which the article appears in the Search box. Here are useful websites for the assignments: Mayo Clinic: www.mayoclinic.com page 1 ● ● MedlinePlus: http://medlineplus.gov/ National Center for Complementary and Integrative Health: https://nccih.nih.gov/ Evaluating What You Read When you write your assignments, you will have to gather information from various sources such as journals or the Internet. Some of the information that you come across will be reliable, while much may be lacking in credibility. It is essential that you carefully evaluate what you read and determine its reliability. Here are some of the factors you need to consider: 1. Is the author an expert? Is the author qualified to write on the subject? Is the author a credible and unbiased source of information? Consider the following people who have written an article that tells you about herb X and whether it has any value as a remedy for arthritis: Dr A is a professor of medicine at a university. Mr B is described as an "expert on natural treatments." Which has more credibility? 2. What method was used to obtain data or conduct research? If this is a report of a research study, was it carried out on rats, samples in a test tube, or people with a disease? If the results are based on actual subjects with a disease, then was the study based on anecdotal observations or was it a clinical trial using a double-blind procedure with several dozen subjects? Does it appear that the conclusion is reasonable based on the data provided? 3. Where was the information published? The article you read about herb X and its possible value as a remedy for arthritis was published in a scholarly journal? published in a magazine you obtained at a health food shop? attached to a website for a company that sells supplements? ● 4. What type of audience is the author writing to? Is this article written for the general public, for health professionals, or perhaps for some other group? 5. Is the article written in a scientific way? The author states that this latest study confirms several previous studies that were published in credible medical journals. References to those articles are given. versus The author states that "herb X speeds detoxification and stimulates the immune system." No references are given. page 2 Many times it is obvious whether the article is based on legitimate science or junk science. But often figuring it out can be quite challenging: you will have to look for subtle clues. Carefully evaluate the articles you read based on the above factors. Look at the whole story before drawing a conclusion. There are three excellent guidelines to follow: 1. If the claims seem too good to be true, they probably are. 2. If the person making the claims makes a profit by persuading you to buy a product, then be doubly dubious. 3. If the article includes statements that are contrary to accepted scientific principles, then the claims that are made are unlikely to be factual. Questions to Ask Yourself about Your Review of Literature 1. Have I formulated a specific thesis or research question that my literature review helps to provide information on? 2. What is the scope of my literature review? What types of publications am I using (e.g., journals, books, government documents, popular media)? What discipline am I working in (e.g., nursing, psychology, medicine)? 3. Has my search been wide enough to ensure that I have properly covered the topic? Have I just taken the first two or three articles I happened to come across and assumed that these represent the literature on the subject? Has my search been narrow enough to exclude irrelevant material? Is the number of sources I've used appropriate for the length of my paper? 4. Have I discussed the strengths and weaknesses of the cited material? Have I critically analyzed the literature I cited? Or have I merely summarized articles? 5. Have I cited and discussed studies contrary to my perspective? 6. Will the reader find my literature review relevant and appropriate? 7. Have I succeeded in showing that I recognize relevant information? Have I explained its relevance to the particular topic, and carried out a critical appraisal? The goal is not necessarily to get to “the truth.” With many questions, the answer may be unambiguously "This claim (or theory of proposed treatment) is clearly wrong." But many other times a more reasonable conclusion may be along these lines: "The evidence does not allow a firm conclusion. On balance the claims being made may be correct, but more research is required." Often, different experts may read the same evidence and come to very different opinions. The crucial goal you must aim for is to review the literature and draw carefully balanced conclusions that stand up to scrutiny. It is quite okay not to reach a "true/false" or "yes/no" conclusion. Please complete only one of the following four assignment options: Option 1: Critical Book Appraisal If you choose to complete Option 1, write a critical appraisal of a book that you have recently read concerning one or more particular complementary and alternative medical therapies currently practised in Canada. The book you review should be at least 100 pages in length. You should include the following sections: page 3 1. Author(s). Provide information about the author(s), including credentials and academic, organizational, or institutional affiliation. Does the author have a bias or vested interest? 2. Introduction. What is the book about? 3. Claims. Does the book make any claims about treatment? 4. Supporting evidence. What scientific evidence does the author present to support his or her claims? Assess the literature in detail. Critically assess the research in relation to the book content. 5. Risks and benefits. Discuss and critically assess the risks and/or benefits associated with the particular therapy presented in the book. 6. Conclusion. Present your conclusion. 7. References. List and cite all sources of scientific literature that you used to write this assignment using APA style. Option 2: CAM and Conventional Therapies If you choose to complete Option 2, investigate the ways in which various complementary and alternative medical therapies can be blended with conventional medicine to treat one of the following conditions: arthritis, menopause, migraine, obesity, insomnia, depression, back pain, or irritable bowel syndrome. You should include the following sections: 1. Condition. Define and describe the condition. 2. Conventional treatment. Describe the current conventional medical treatment. 3. Complementary and alternative treatment. Discuss and critically assess the CAM therapies proposed to treat the condition. 4. Combined treatment. Suggest how conventional and CAM therapies could be blended. 5. Risks and benefits. Assess the risks and/or benefits of combining conventional and CAM therapies. 6. Conclusions. Present your conclusions. 7. References. List and cite all sources that you used to write this assignment using APA style. Option 3: A Dietary Supplement If you choose to complete Option 3, write a paper on an herbal or dietary supplement that is not included in units of the Study Guide commentary, and that is used as a form of complementary and alternative medical therapy. You should include the following sections. 1. Background. Describe the background and historical use of the herb or dietary supplement. 2. Dosage. Describe the dosage, methods of use, and form of the herb or dietary supplement. 3. Benefits. Discuss the proponent's claims of benefits of the herb or dietary supplement. page 4 4. Contraindications. Discuss the contraindications for particular individuals and for particular conditions. 5. Research. Describe and critically assess the research that evaluated the effectiveness of the herb or dietary supplement. 6. Recommendations. Present your recommendations for use of the herb or dietary supplement. 7. References. List and cite all sources that you used to write this assignment using APA style. Option 4: A Complementary and/or Alternative Therapy If you choose to complete Option 4, evaluate a complementary and alternative medical therapy that is not included in the units of the Study Guide commentary. You should include the following sections: 1. Background. Describe the background and historical use of the CAM therapy. 2. Methods and training. Describe the methods of the CAM therapy and the training of the practitioners of this therapy. 3. Benefits. Discuss the proponents' claims of benefits of this CAM therapy. 4. Contraindications. Discuss the contraindications for particular individuals and for particular conditions. 5. Research. Describe and critically assess the research that evaluated the effectiveness of this therapy. 6. Recommendations. Present your recommendations for use of this therapy. 7. References. List and cite all sources that you used to write this assignment using APA style. page 5See Answer
  • Q12:1. Analyze two families you know well (other than your own) and answer the following questions: 300 words a. If the major breadwinner in this family was unable to work or lost their job, how would the family most likely respond immediately and in the long term? b. What are the strengths of the family? c. How could a nurse most effectively intervene in this situation? 2. What populations define your community? What are the needs and deficits for specific groups? Use the nursing process to assess potential or actual problems. Using data and your assessment, determine a community diagnosis. As the community/public health nurse, what are the next steps in addressing your community issues? 200 words NOTE: Must Cite two sources APA formatting./n Community Needs Assessment After completing the Windshield Survey assignment, you will determine the health needs of the population found in the low-income/underserved area. You will then develop a population care plan. Identifying the problem; making a population diagnosis with two possible outcomes, two (2) interventions from each outcome with rationales related to education, advocacy, and coordination of care. Use the Levels of Prevention pyramid. Purpose: To create an information foundation for further planning and action. A community assessment can create a sense of where a community belongs, why it exists, where it has strengths, where weaknesses lie, and what opportunities are available. How many people live in the service area? How many people live in poverty in the service area? How many people live above the poverty in the service area? 2. Where are the highest concentrations of low-income persons located? 1. 3. What forms of assistance to low-income people would help them to achieve safety and stability in their lives? 4. What forms of assistance to low-income people would help them gain greater control over their lives and support the movement toward self-sufficiency? 5. What existing resources meet the needs identified in questions 3 and 4? 6. Do the activities and services of the community action program address the needs identified in questions 3 and 4? 7. What unmet needs could the community action program address that would increase their control over their lives? 8. What transportation types are in the neighborhood? 9. What are some UNWELCOMING public spaces in the neighborhood? 10. What types of health education services are most needed 11. What medical services are most needed in the in the community? community? Alcohol abuse Alzheimer's disease Asthma Cancer screening Child abuse/family violence Diabetes Adult primary care services Alcohol and drug abuse treatment Cancer treatment Counseling/mental health services Diabetes care Diet and/or exercise Drug abuse HIV/AIDS Sexually transmitted diseases Smoking cessation and/or prevention Stress management Other Emergency/trauma care Heart care services Orthopedic care (bone and joint) Pediatric services Women's services, such as obstetrics/gynecological services Other/n/nSee Answer
  • Q13: Chapter 3: Draft Chapter 3: Draft Purpose This assignment will help you learn to propose strategies that improve organizational sustainability using health information data. Synopsis For this assignment, you will begin work on Prospectus Chapter 3 and discuss methodologies for solving the problem/question that you have identified. This assignment is not a rigorous or true-to-form research methodology section. Nevertheless, it simulates the thought process of synthesizing what you have learned in your background and literature review to target a specific source for data collection in an effort to answer a research question or uncover information about a research statement. Drawing on the reading assignments in this course, propose at least three strategies around information governance, data analysis, strategies for organizational sustainability, or data visualization methods to research and integrate with your dissertation problem or topic. As Roberts (2010) points out, the "methodology selection rests primarily on the (1) problem to be investigated, (2) purpose of the study, (3) theory base, and (4) nature of the data." Your choice of methodology must be supported through your review of the literature and be appropriate to tackle the problem you identified. You may benefit from reviewing the following resources to prepare: • Roberts (2010), Chapter 12 • The Electronic Theses and Dissertation Center (https://etd.ohiolink.edu/apexprod/rws_olink/r/1501/1) • Literature Review: Getting Started (https://guides.franklin.edu/LITREVIEW) • Literature Reviews: An Overview for Graduate Students (https://www.youtube.com/watch? v=t2d7y_r65HU) Prepare, Research, Draft Prepare Reflect on your previous work in this course and be ready to provide a brief update and overview of your completed work. This will serve as your rationale for the method chosen to collect more data on your 1/5 problem beyond the literature review. Research Using the textbook, course resources, and library databases, become familiar with research methods (methodologies) or techniques that you can access to gather more information on the specific problem or topic. Every course in your doctoral program is designed to support your dissertation either through new content knowledge or concepts that support your research question analysis. All of your papers in this class should be NEW and not contain substantial portions of previously submitted work in other courses. Use RefWorks to organize your resources. If you decide not to use a resource for this part of the prospectus, keep it, as it may be valuable later on. Draft Refer to the Graduate Research Paper Writing Guide. (https://franklin.instructure.com/courses/15037/files/2240970?wrap=1) For Chapter 3, include the following sections: Chapter 3: Draft 1. Introduction: Summarize the following elements from your work in this course: a. The research problem/question from Chapter 1. What have you learned about your research problem/question? b. The key literature review information related to the research problem/question. c. The applicable patient or population of the study and their needs. 2. Methodology: Identify the methodology you would select. Keep in mind that this is a hypothetical approach (you will not be doing any testing), but this still must be a reasonable method based on the variables selected and research question to be answered. 3. Research Design: State the research design you would select to support your selection. Refer to Roberts (2010), Chapter 12 for an example of how to describe a research design. 4. Data Collection: Develop a table that displays all possible sources (not references) that will aid in answering your research questions (people, positions, databases, locations, etc.). See the example table below. Source John Smith, CEO, Important Healthcare Corporation Instrumentation Connection Personal interview John Smith has been a leader in the field of my research question for 15 years. He has agreed to a personal interview to discuss my research question. 2/5 100 Clients at National Urgent Healthcare Inc. Survey Healthcare Chapter 3: Draft Chapter 3: Draft Over 1000 clients at Urgent Healthcare, Inc. are dealing with the issue I am researching. I will use a survey published by National Healthcare to find out how successfully they are dealing with my research question. Out of 1000 clients, I expect to a return of 100. a. Make sure to connect your data sources and methods to your research questions and/or statements from the previous section. b. For each source listed in the table, which data collection method will aid in the collection (i.e. surveys, focus, groups, observation, meta-analysis of public works, etc.)? c. Address this section as if an expert panel will review the instrumentation. 5. References: cite all sources for this section. Submission Instructions 1. Submit your assignment to Turnitin. Give yourself enough time to revise and resubmit ahead of the due date. 2. By the due date indicated, upload your final work to Turnitin. Grading Criteria Read the assignment rubric to understand how your work will be assessed. 3/5 Criteria Introduction Methodology Research Design Data Collection Critical Thinking 9 to >8.0 pts Proficient Summary of the research problem/question and description of learning is comprehensive; key literature review is comprehensive and related to the research problem/question; applicable patient or population/needs are comprehensive. 9 to >8.0 pts Proficient Methodology is comprehensive and supported by sophisticated research. 9 to >8.0 pts Proficient Research design is comprehensive and supported by sophisticated research. 9 to >8.0 pts Proficient Table displays comprehensive sources, instrumentation, and connections. 9 to >8.0 pts Proficient Demonstrates critical analysis of all cited material by drawing reasonable conclusions. Ratings 8 to >7.0 pts Acceptable Chapter 3: Draft Summary of the research problem/question and description of learning is adequate; key literature review is adequate and related to the research problem/question; applicable patient or population/needs are adequate. 8 to >7.0 pts Acceptable Methodology is adequate and supported by fundamental research. 8 to >7.0 pts Acceptable Research design is adequate and supported by fundamental research. 8 to >7.0 pts Acceptable Table displays adequate sources, instrumentation, and connections. 8 to >7.0 pts Acceptable Demonstrates critical analysis of some cited material by drawing reasonable conclusions. 7 to >0 pts Unacceptable Summary of the research problem/question is insufficient and/or description of learning is insufficient or vague; or key literature review is insufficient or unrelated to the research problem/question; or applicable patient or population/needs are insufficient. 7 to >0 pts Unacceptable Methodology is insufficient, vague, or not supported by research. 7 to >0 pts Unacceptable Research design is insufficient, vague, or not supported by research. 7 to >0 pts Unacceptable Table displays insufficient sources, instrumentation, or connections. 7 to >0 pts Unacceptable Does not demonstrate critical analysis of cited material by drawing reasonable conclusions. Pts 9 pts 9 pts 9 pts 9 pts 9 pts 4/5 Criteria Doctoral Level Writing APA Formatting 9 to >8.0 pts Proficient Demonstrates doctoral writing in all categories of spelling, grammar, sentence structure, and logical organization of the paper. 6 to >5.0 pts Proficient Applies all APA rules in format, citations, and references. Ratings 8 to >7.0 pts Acceptable Chapter 3: Draft Demonstrates doctoral writing in most categories of spelling, grammar, sentence structure, and logical organization of the paper. 5 to >4.0 pts Acceptable Applies most APA rules in format, citations, and references. 7 to >0 pts Unacceptable Does not demonstrate doctoral writing in all categories of spelling, grammar, sentence structure, and logical organization of the paper. 4 to >0 pts Unacceptable Does not adequately apply APA rules in format, citations, and references. Pts 9 pts 6 pts Total Points: 60 5/5See Answer
  • Q14: INSTRUCTIONS Topic: The future of Telemedicine. Need to do in 1500 words in APA Style, You can use your own sources Course Project - Final Paper Instructions Over the last six modules, you built toward this culminating moment: the submission of your final paper for this course project. This week you will be drafting a research paper of 3-5 pages (approximately 750-1250 words) that builds on your previous Milestone work. Use the Final Paper Template Download Final Paper Template for an example of how to create and format your final paper. Begin by reading pages 7.8 through 7.13 in the webtext before beginning the assignment. Step 1: Reflect on Previous Milestone Feedback and Make Adjustments Step 2: Use Your Outline to Draft Your Paper Using your Milestone 5 outline, begin to flesh out each of your body paragraphs by adding evidence from your sources that support your thesis (along with proper in-text citations for ideas or quotes from your sources). Remember to use the guidelines you learned in Module 4 for paraphrasing and quoting from your sources. In addition, make sure to include transitions between paragraphs and wrap up your paper with a conclusion paragraph that reiterates your thesis argument and offers some concluding thoughts. Step 3: Review and Edit Your Work Once you have a full draft written, make sure to re-read it carefully with an eye on the details like spelling, grammar, punctuation, sentence clarity, tone, and word choice. Go back to the Writing Refresher section of the course for help with any weak areas of your writing. Try reading it aloud to catch errors you might otherwise miss in print. Step 4: Submit and Review Your Turnitin Report. Make Changes If Needed and Resubmit. Resources: Final Paper Template Download Final Paper Template Library Cornerstone Research Guide Writing Refresher Submission Submit a completed 3-5 page (approx. 750-1250 words) research paper on the topic choice you made in Module 1 that incorporates your work from Milestones 1-6. The title page and reference list do not count toward the 3-5 page requirement or total word count. Use the Final Paper Template for an example of how to create and format your final paper. Your final submission should include: At least 4 references. A title page and reference page in APA style. total word count. do not count toward the 3-5 page requirement or In-text citations in APA format. An introductory paragraph with your clear, one-sentence thesis statement (this should NOT be underlined at this point). Body paragraphs that use information from the sources as evidence to prove the thesis statement. One paragraph that refutes opposing perspectives. A conclusion paragraph that offers final thoughts and reiterates the thesis statement. Proper spelling, syntax, and grammar. Improvements based on feedback from your instructor and peer (i.e. to the thesis statement, introduction, organization, use of sources, APA style, etc.). Evaluation This assignment uses Turnitin. This assignment will be evaluated according to the IND101 Course Project Final Paper Rubric. Make sure to review the rubric before submitting so you know how you will be assessed. This assignment is worth 20% of your overall course grade. This activity is used to assess several general education career competencies (GECCs) listed below. You will see additional rows in your rubric from your instructor along with assessments of Above/Meets/Does Not Meet Expectations for each competency. These rows do not factor into your grade. GECC1.2: Written Communication: Deliver written communication with appropriate content, organization, syntax, mechanics, and style for the audience and purpose. GECC3.1: Information Literacy: Locate and evaluate sources to meet an information need. GECC3.2: Information Literacy: Cite sources using appropriate academic conventions. ReferencesSee Answer
  • Q15: Assignment: Outcomes, Approach, and Budget Objective Deliverables ● ● ● ● Step 1: Capstone Project ● Identify appropriate expected outcomes for your project. Identify the strategies to implement your project. ● Step 2: Consider Write a 3-4 page (not including the title and reference pages). APA formatted paper with an introduction and conclusion. APA headings for each section of the paper. At least 5 references. ● ● Write a paper identifying the Expected Outcomes, Approach, and Budget for your capstone. Expected Outcomes at least 5 Step 3: Write O Approach O O Budget What specific questions will your project address? How are these questions related to one another? What will you actually do to address the actionable questions? What will you do to create "improved outcomes"? Write a paper that addresses the criteria above. Use the template attached below. Step 4 Save and Submit ● ● When you have completed your assignment, save a copy for yourself in an easily accessible place and submit a copy to your instructor using Dropbox. Use the template linked below to complete this assignment. 485 Outcomes, Approach, and Budget Template 7th edition Download 485 Outcomes, Approach, and Budget Template 7th edition Rubric Assignment 9.2019 Criteria This criterion is linked to a Learning Outcome Intentional Learning and Reflection 15 pts Exemplary Identifies/addresses a relevant topic and a thesis that provides direction for the content that is engaging and thought provoking. The thesis clearly and concisely states the position, premise, or hypothesis and is consistently the focal point throughout the presentation. Demonstrates a sophisticated understanding and careful, critical analysis of the research topic and thesis (argument). Compares/contrasts perspectives, considers counter arguments or opposing positions, and draws original and thoughtful conclusions with future implications. Assignment 9.2019 Ratings 10 pts Accomplished Identifies/addresses a relevant topic and a thesis that provides adequate direction for the content with some degree of interest for the reader. The thesis states the position, premise, or hypothesis, and is the focal point of the paper for the most part. Demonstrates an understanding and some critical analysis of the research topic and thesis (argument). Adequately compares/contrasts perspectives, counter- arguments, or opposing positions but broader connections and/or implications are not as thoroughly explored 5 pts Developing Identifies a research topic but may be too broad in scope and/or the thesis is somewhat unclear and needs to be developed further. Focal point is not consistently maintained throughout the paper. Demonstrates general understanding with limited critical analysis of the research topic and thesis (argument). Summarizes perspectives, counter-arguments, or opposing positions. 0 U B F re 0 a fo [ u 11 th th ST 0 Р с Criteria This criterion is linked to a Learning OutcomeDecision Making and Clinical Reasoning 15 pts Exemplary Provides compelling and accurate evidence to support in-depth analysis to the central position beyond the required (2) research sources with at least 1 source from a periodical database. Research sources are highly relevant, accurate, recent (less than 5 years old) and reliable and add to the strength of the content. Assignment 9.2019 Ratings 10 pts Accomplished Provides essential, accurate evidence to support the central position with the required (2) research sources including 1 source from a periodical database that are mostly relevant, accurate, recent (less than 5 years old) and reliable. 5 pts Developing Provides some evidence to support the central position with less than 2 acceptable research sources. Some sources may not be relevant, accurate, and reliable, greater than 5 years old and may not be from scholarly sources. 0 pts Unsatis Lacks s sources position are gene accurate numero omissio oversim Criteria This criterion is linked to a Learning OutcomeOrganization & Presentation 15 pts Exemplary Content is effectively organized. Ideas are arranged logically, flows smoothly, with a strong progression of thought from paragraph to paragraph connecting to the central position. Includes all required components (introduction, body, conclusion, citations, references, etc.). For a slide presentation, the design, font size, style, and spacing are optimal for audience viewing Assignment 9.2019 Ratings 10 pts Accomplished Content is adequately organized. Ideas are arranged reasonably with a progression of thought from paragraph to paragraph connecting to the central position. Includes required components of an introduction, body, and conclusion. For a slide presentation, one or more components of the design, font size, style, and spacing may be less than ideal for audience viewing. 5 pts Developing Content is somewhat organized. For a paper, occasionally ideas from paragraph to paragraph may not flow well and/or connect to the central position or be clear as a whole. May be missing a required component and/or components may be less than complete. For a slide presentation, multiple aspects of the design require further development for optimal audience viewing. 0 pt= Uns: Begi Con orga read idea: posi from para is m requ slide desig optin audiSee Answer
  • Q16: Assignment for the AZBN observation. Orientation Video for AZBN Paper ROLE DEVELOPMENT-1.doc Download ROLE DEVELOPMENT-1.doc ROLE DEVELOPMENT Students will submit a 4-5 page paper (APA format) summarizing the following: Cover page, abstract and reference pages do not count in the 4-5 pages of text discussing the assigned topics and Arizona State board of Nursing The 2 topics I would like to address are: Diverting controlled substances from the workplace Breaching nurse-patient confidentiality Website: http://www.azbn.gov/ Links to an external site. You may attend AZBN sessions in person or you may review meeting minutes, notes and disciplinary actions taken against nursing licenses or institutions and regulatory events. Did you know that actions taken against and nursing license or institution is public record and accessible over the internet? If you cannot attend a AZBN meeting in person, you will need to review the session notes online. Session notes links are listed below. You may also watch previous sessions of AZBN on youtube.com. I then suggest that you write down a liscen number with action taken against it and then look up the notes that AZBN has placed on online about the Nurse and actions taken against the license. ● ● https://www.azbn.gov/board/board-meetings/Links to an external site. https://www.azbn.gov/services/license-verification Links to an external site. https://www.azbn.gov/laws-rules/nurse-practice-act/Links to an external site. https://www.azbn.gov/education/student-information- nursing/Links to an external site. This needs to be included in the paper 1. Integrate the information that you gathered from this meeting to the standards related to the RN scope of practice outlined by the AZ State of Board Nursing. 2. Discuss at least 2 examples of unprofessional conduct, due process, and the disciplinary actions that the AZ State Board of Nursing may impose to a RN who is found guilty of committing unprofessional conduct. 3. Summarize the information from the board meeting and address the following items: ● ● ● ● ● ● ● ● ● Brief description or background of the organization/ association What is the purpose of the meeting? Is this a regularly scheduled meeting or is it an emergency, weekly, monthly meeting? Is it a public open meeting - how did you learn about the meeting? Or members only - how were you able to attend the meeting (by invitation only, etc)? Who are in attendance? Identify the roles of the attendees – officers, guest speaker, etc? Do not mention specific names. How is the meeting conducted? Formal or informal? Any specific method (information only, informational with open discussion, teleconference, etc)? Any rules of conduct followed? Robert's rule? How is the individual item in the agenda presented? How is each item discussed? How much time is allotted for discussion of each item? Any action or recommendation to specific item? How do the members or the attendees of the meeting resolve any issues or concerns? If you were an observer to the meeting, how is your attendance addressed? Are you asked to make comments at anytime? How will you describe the overall meeting? Discuss your learning experience from this meeting./nSee Answer
  • Q17:Write a thesis statement and essay in 5-6 pages, double-spaced with 12-point font. Also include a cover page with name, title and recitation section along with a reference page. The goal of a thesis statement is to let your reader know what your paper or essay is about. It helps your reader understand the greater context and scope of your topic, plus it lets your readers know what to expect from the rest of the work. The thesis statement is generally in the first or second paragraph of a paper. The thesis statement shows how all the paragraphs compare, contrast and come together to form an argument or a statement of interest. Be sure to follow the flow of content laid out in the first paragraph and then have a conclusion paragraph that ties it together. Be sure to have evidence to support your statements with references. Additional points to think about before writing: Where are more interpretations needed (ex. Where in the paper would it be helpful to read what the writer thinks about something)? Does the paper open in an appealing, purposeful way? How else might the paper begin, to better capture and direct our attention?/nInstructions thesis topic: Motivational interviewing Skills for Pharmacists: Basic elements Referencing style - MLA Need in 5 pages double spacedSee Answer
  • Q18: WEEK 6 HSA545 ASSIGNMENT ORGANIZATION AND SERVICE Scenario You are a nursing home administrator who has recently been assigned to oversee a skilled nursing facility built in the 1970s. You must prepare and deliver a PowerPoint presentation outlining how you intend to provide person-centered care, organization, and services. To be a good presentation, it must cover important aspects of social services, admission, and discharge, such as medical care, nursing, and rehabilitation, to name a few. Instructions Create a PowerPoint presentation (8-10 slides), with speaker notes, in which you respond to the following: 1. What are the three principles upon which resident-centered care, in a modern nursing home, is guided and relates the challenges to a full integration? 2. What are the various skills and competencies associated with social services, admission, and discharge functions? 3. What are the six main activity programs that are valuable in LTC and how can you determine their effectiveness and implementation? 4. There are several considerations to ensure the effective purchasing of food and supplies; however, three considerations are fundamental to menu planning. What are they and why are they essential? 5. Summarize your key findings on one slide. 6. Use five sources to support your writing. Sources should be recent and published within the last five years. Choose sources that are credible, relevant, and appropriate. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the library or review library guides. This course requires theSee Answer

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We understand that pursuing nursing assignment writing help for the entire coursework is not always required for students. What they seek is specific nursing assignment services as per their academic needs. Due to precise guidance, you can "pay someone to do my nursing assignment" for particular topics or subjects without paying for the entire syllabus. That makes it affordable for students and easy to avail whenever they require expert assistance.

Availability of Cost-effective learning guidance

The availability of cost-effective learning guidance offers students an affordable and accessible means to enhance their academic skills and knowledge. By providing budget-friendly online nursing homework help, study materials, and educational resources, students from diverse backgrounds can access high-quality assistance, regardless of financial constraints. They excel in studies and empower themselves to confidently pursue academic goals without taking excessive financial burdens.

Full Secured account of students personal information

TutorBin safeguards students' sensitive data, including names, contact details, and academic records. Our secure site protects information from unauthorized access or disclosure. It instills a sense of trust and confidence in students that their data are safe from privacy breaches or identity theft. Our efficient team maintains the utmost safety to ensure students can seek nursing assignment writer help to meet their academic requirements whenever needed.

Nursing Homework Help For Students From All Academic Levels

Help with nursing assignments is specially introduced by TutorBin for students of all academic levels who face numerous problems while doing their tasks. From middle school to advanced study pursuers, TutorBin online nursing assignment help is the best-suited service for all. It handles diverse tasks, including case studies, report writing, and answering nursing questions. TutorBin's subject experts offer assistance, ensuring they get the required support regardless of the subject complexity as per their academic level.

Frequently Asked Questions on Help with Nursing Assignment

Students had many requests asking if they could "pay someone to do my nursing homework." If you are looking for experts to help with nursing assignment, try TutorBin. Our homework help nursing experts try their best to offer solutions to fulfill their academic needs. Sometimes, students get worried and ask us, "is it legal to do my nursing homework?" We ensure that students get answers as our nursing help is like the professional assistance you seek offline. Here, you get expert guidance to fill the knowledge gap and excel in your academic competency to thrive in the field. We have answered some FAQs here for better understanding.

Are nursing assignment help services available for all academic levels?

Yes, assistance is typically offered for diploma, undergraduate, postgraduate, and advanced nursing programs.

What topics are covered under nursing homework help?

TutorBin's Nursing homework help expert team covers all topics. You can get assistance with tasks in anatomy, physiology, pharmacology, community health, mental health nursing, pathophysiology, and more.

Will the assignments follow proper referencing styles?

Our experts have extensive experience and efficiency. They can format your nursing homework tasks according to required styles such as APA, MLA, Harvard, or Chicago.

Can I get help with urgent nursing assignments?

TutorBin offers urgent homework help for students who need to submit their tasks on tight deadlines. This expedited service provides same-day task completion without sacrificing quality.

How much does a nursing assignment help cost?

TutorBin does not have a fixed rate for homework assistance. Although the price range starts at a nominal rate, the actual solution fees vary with task complexity, deadline, and expert availability.

Can I request revisions if needed?

When you opt for help with nursing homework, our team is available for any revisions if the task does not fully meet your original instructions, as shared with our executives.

Will my personal information remain confidential?

Our nursing homework help team adheres to a strict confidentiality policy. TutorBin uses advanced technology to ensure that all your personal data and academic service information are safe. It does not disclose information to third parties.

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