reply to each discussion posts with at least 250 words EACH and apa format

QUESTION

#1 Ana Maria Miller

J.R. is trying to achieve secondary prevention when she encourages her patient population to attend blood pressure screening events. J.R. serves an urban Chinese patient population that is at high risk for hypertension. Secondary prevention helps treat medical conditions and diseases in the early stages to prevent further complications. Secondary prevention guidelines have been developed that recommend lifestyle changes for ongoing management of cardiovascular risk factors, including a healthier diet (reduction of salt, eating more fruits and vegetables), regular physical activity, medications, and cessation of tobacco use and harmful intake of alcohol (Talevski et al, 2023). Primary prevention aims to prevent disease or illness of individuals at risk of developing it. An example of primary intervention is getting vaccinations as a child to prevent diseases in the future. Another example is for high-risk women in the US, FDA-approved primary prevention strategies include surgical removal of the breasts and/or ovaries and the use of anti-estrogen therapies (Zaluzec, & Sempere, 2024). Tertiary prevention is used for people who have a disease or medical condition already and trying to prevent further complications. An example of this would be a common screening that I perform at work as a registered nurse. Patients who have diabetes mellitus are at risk for diabetic foot ulcers. When diabetic patients come to the hospital with a diabetic foot ulcer, I can educate the patient on managing their ulcer to prevent further complications such as infection or gangrene. I will also perform wound care and offload the foot to help heal the wound. Many of my patients have benefited from this teaching as they were not aware of possible complications such as amputation. It is challenging to educate some diabetic patients as my hospital has many readmissions of non-compliant patients even when education and resources are provided at discharge.

Identify the Different Roles and Responsibilities of the Nurse

The nurse in this case study is responsible for the health and well-being of this patient population. The nurse is responsible for staying up to date on evidence-based research when providing care and educating patients. The nurse still has to provide preventative education on healthcare even though she encounters difficulty educating this patient population as they do not adhere to their treatment regimens because of mistrust of Western medicine. The nurse can try to collaborate with the patients’ traditional healer if they have one for the benefit of the community’s healthcare. The nurse can try to incorporate safe medications into the patient’s treatment plan that do not affect the homeopathic treatments they learned in China as children and the Chinese herbs they prefer to take.

Please discuss the challenges you anticipate facing when fulfilling the various roles of a nurse practitioner. How would you work to improve your weaknesses? Identify your strengths.

The challenges I anticipate facing when fulfilling the various roles of a nurse practitioner are to have my patients comply with the treatment plan prescribed and prevent readmissions. As mentioned, my community hospital has many readmissions, and I am from a small town that is now developing more. Many of the patients at risk for readmission I see at work are people who poorly manage their blood pressure, diabetes, weight, and congestive heart failure (CHF). I hope to help these members of my community with thorough education and a strong emphasis on disease management and lifestyle changes.

Which patient population is most likely to experience health disparities and why?

The patient population that is most likely to experience health disparities is the people who live in poverty. Their home environment may not be safe, and they may not have necessities for life such as shelter, food, and clean water. These patients may present as malnourished and dehydrated. Providing resources for them at discharge is a priority. Their socioeconomic status may prevent them from obtaining healthcare regularly and may present to the healthcare provider with serious health problems. Their living conditions make them more susceptible to communicable diseases and health risk behaviors such as excessive alcohol, tobacco, or drug use. Increased risk for chronic conditions is likely due to factors such as unhealthy eating patterns from cheaper processed foods. The healthcare provider must assess a patient from this population with understanding and compassion to build a trusting relationship so that open communication can be used.

#2 Leslie Perez

L.W. is a nurse practitioner in an urban community. Many of her clients recently immigrated to the United States from various countries. She is challenged by the many different cultures she encounters and the different values and beliefs they hold toward Western medicine.

She is determined to earn her clients’ trust. She does this by providing health care services that are respectful of each client’s health beliefs and practices and cultural needs. She knows she must set aside her own values and beliefs to focus on what is important to her clients in order for them to have successful outcomes.

Give at least two examples of emerging populations in the United States and describe their cultural characteristics that might interfere with their healthcare.

In the United States, there are two emerging populations that providers should become more familiar with, which are refugee, immigrant, and migrant, or RIM, populations and lesbian, gay, bisexual, transgender, and queer, or LGBTQ, populations. These two groups are becoming more prevalent in the United States and both have cultural needs and characteristics that should be considered when attending to their healthcare.

The RIM population struggles with many disparities that interferes with their healthcare. Members of this population come from other countries that may struggle with violence, brutality, and prosecution, leading to fear of the government and thus, fear of seeking out healthcare as it could lead to deportation. This population also struggles with language barriers and financial security, leading to difficulties navigating the system of a foreign country in order to obtain the healthcare they need.

It is important to consider the health issues many patients within the RIM population struggle with. This includes, but is not limited to, communicable diseases such as tuberculosis and hepatitis, anxiety, depression, and post traumatic stress disorder, and diabetes, hypertension, and high cholesterol. These health issues are likely linked to their financial status, the healthcare available in their native country, and the work they are able to do in the United States. In order to bridge the gap and assist this population, providers should ensure patients have access to an interpreter, educational materials in their native language, access to healthcare and community resources to address any disparities related to their finances and housing (Daniels et al., 2022).

The LGBTQ community has always been prevalent, but the visibility of this population has changed drastically as attitudes have shifted to be more accepting. The LGBTQ population has dealt with many health disparities due to discrimination and lack of safe spaces. However, in recent decades, there has been more research done to consider the needs and characteristics of this population in order to provide adequate healthcare to meet their needs. Members of this population often struggle finding healthcare that is unbiased, affirming, and educational in a way that is specific to their needs.

When treating LGBTQ patients, providers must consider the health issues specific to this population. It is important to note that this population is diverse and is comprised of people from all walks of life, therefore, it is key to listen to the patient and get a full understanding of their needs rather than simply putting them into a box based off of their sexual orientation or gender identity. This population struggles with accessing gender affirming care due to laws set in place that will either restrict access or ban it. Additionally, this population tends to live alone and can benefit from support systems within their community. Sexually transmitted diseases, including HIV/AIDs, are also important to consider. Mental health is of utmost importance for this population as many patients struggle with anxiety, depression, and suicidal ideation due to the discrimination they may face. Providers can help this population by offering LGBTQ friendly resources, such as clinics for this population specifically, free and accessible STD testing, and conducting more research. There is a huge gap in what we know about health disparities in the LGBTQ population due to the lack of research within this field (Kuzma et al., 2019).

Identify the different roles and responsibilities of the nurse.

The nurse has many roles and responsibilities including communicating effectively, respecting the patient and their space, fully assessing the patient and their needs, ensuring the patient receives proper care, reducing harm as much as possible, and educating the patient to ensure they are aware about their diagnosis, treatment, and at home care.

Please discuss the challenges you anticipate facing when fulfilling the various roles of a nurse practitioner. How would you work to improve your weaknesses? Identify your strengths.

As a nurse practitioner, the biggest challenge I anticipate facing is diagnosing my patient. I believe this to be a challenge in that I want to ensure I do not overlook something that could lead to harm. I would improve my weakness by consulting with the provider in the event I have any doubts or concerns. I have strong communication skills and I am not afraid to speak up when I feel that something is missing or off.

Which patient population is most likely to experience health disparities and why?

The LGBTQ population is most likely to experience health disparities due to the lack of research we have pertaining to this population. It is also such a wide spectrum which allows for plenty of areas to learn about. Finally, there is still discrimination all around us, including laws banning or preventing affirming care, which deters this population from seeking healthcare as often as they should.

child 120

QUESTION

Childbirth education in this country began in the 1970s as a grassroots movement, in order to give expectant parents information and support while giving birth. The movement grew out of the belief that mothers did not have to be medicated to give birth and that they could have someone they loved with them in the delivery room. Almost all expectant parents attended childbirth classes. Recently, prepared childbirth seems to have fallen out of practice, many young couples are choosing not to attend childbirth classes and come to the hospital not really knowing what to expect or they are underprepared for the experience. Just a few years ago this was not the case. Up until the mid-90s 84% of mothers and their spouses/partners/or birth coaches took childbirth classes prior to the birth of the baby. By 2012 this number had dropped to about 54%. Why do you think this trend has changed? 

Now read about these different methods of childbirth and then comment in the discussion board on  1) the one you or your partner would most like to experience (or have experienced) and 2) why would you choose it. 3) Now share why do you think more and more expectant parents are choosing not to attend childbirth classes?  4) Please respond to at least 1 of your classmates this week. 

LAMAZE

The Lamaze method is typically known for controlled breathing techniques, but it includes a number of comfort strategies that can be used during labor. Breathing techniques increase relaxation and decrease the perception of pain. In addition to breathing, other information about preparing for childbirth is covered. Lamaze is taught in a series of classes attended by both the mother and her partner, when possible. The Lamaze method doesn’t explicitly encourage or discourage medications but seeks to educate women about their options so they can make a birth plan that suits their individual needs.

Benefits of the Lamaze Method

Lamaze training prepares the mother and her partner with a number of tools to use to get through labor and delivery naturally.

The breathing and relaxation techniques reduce the perception of pain and keep labor moving smoothly.

The Lamaze courses help the couple be prepared with what to expect over the first few days and weeks together.

Disadvantages of the Lamaze Method

Learning the Lamaze method takes time. The couple must plan ahead and attend classes starting in the second trimester of pregnancy.

  • BRADLEY
  • The Bradley method focuses on preparing the mother for natural childbirth coached by her partner. The emphasis is on being prepared for an unassisted vaginal birth without medication. The method is taught over 12 weeks along with reading a workbook. Midwives often recommend the Bradley method preparation classes. In addition to learning ways to reduce the pain of vaginal birth, the method teaches about nutrition and other aspects of natural health.
  • Benefits of the Bradley Method

The Bradley method is beneficial to prepare parents for unassisted births.

It helps the couple be prepared with techniques to reduce the perception of pain and stay relaxed through natural unmedicated childbirth.

  • It also teaches the couple about things they need to know to take care of themselves as new parents and what to expect when the infant arrives.

Disadvantages of the Bradley Method

For couples who are uncertain if they want to try for an unassisted vaginal birth without medication, the Bradley method might not be best. The course and training take quite a long time. Couples need to begin classes in the second trimester of pregnancy. 

HOME BIRTH

Only about 2% of women in the U.S. opt for a home birth. It can be a safe and relaxing natural childbirth delivery method for women with a normal, low-risk pregnancy. Home births are vaginal deliveries with no medication, and a variety of mind-body techniques and preparation methods are used to reduce childbirth pain. Usually, a licensed midwife or doula will assist in the birthing process and many times the couple will have family and/or close friends present at the birth.

Advantages of home birth

  • Many women find it relaxing and comforting to be in their own home environment. Other advantages include:
  • Not having to worry about being transported to the hospital while in labor or being transported home after the baby’s birth
  • Having a baby at home means having all of the comforts of home, including snacks and changes of clothing readily available.

The recovery and transition to breastfeeding can be easy because the environment is comfortable and familiar.

The mother can invite whomever she wants to attend the birth.

Many women feel more comfortable with home birth if they need to yell or vocalize.

Disadvantages of home birth

If special birthing assistance, such as a water birth tub, is desired, this will need to be brought to the home and prepared in advance.

If the home is very remote or the weather is bad, it may be difficult for the midwife to reach the home in time (although it would be difficult to drive to the hospital in these same circumstances).

If the birth plan does not progress normally, it may require transport to a hospital.

Some women are not comfortable with home birth, and it is not a good option unless it is a low-risk pregnancy, and the mother prefers it.

  • UNMEDICATED BIRTH at home or in the hospital
  • Benefits of unmedicated delivery
  • Infants born naturally tend to have fewer respiratory problems.
  • Other benefits of an unmedicated delivery include a quicker recovery for the mother and avoidance of abdominal surgery and the associated risks that come with a C-section.
  • Unmedicated childbirth has a lower rate of infection and a shorter hospital stay.

Disadvantages of unmedicated delivery

The disadvantages of an unmedicated birth may include tearing of the perineum.

  • Sometimes, a natural birth may not be recommended for medical reasons.
  • WATER BIRTH at home, birth center, or in the hospital 
  • A water birth means the mother goes through some or all of the stages of childbirth in a portable tub similar to a hot tub. The baby can be delivered underwater or the mother can get out of the water and deliver in a different position. Women chose water births because it can be more relaxing, and less painful to be in the water. Birthing tubs can be brought into the home for a home birth, and they are often found in birthing centers. Some hospitals may have birthing tubs as well.
  • Benefits of water birth

A water birth is thought to be less painful and more relaxed for many women. It allows the woman to move into a variety of positions that can feel more natural and less painful.

The partner can also get into the tub with the mother to support the delivery.

Disadvantages of water birth

Some critics say a water birth can increase the risk of infection, but as long as the water is fresh and clean, water births are not any riskier than non-water births.

  • Unless the water birth takes place in a birth center with established tubs, there are logistics involved in setting up the tub and warming the water for a water birth.
  • If the birth plan at home does not progress normally, it may require transport to a hospital
  • DELIVERY AT A BIRTH CENTER

Some people consider a birthing center delivery the best of both worlds. The setting is relaxing and home-like, and mind-body support options for childbirth pain such as hypnosis, water births, and doulas are readily available. Unassisted deliveries using these support techniques are the focus. The emphasis is on ensuring the mother has the birth experience she wants. All of the labor and delivery options we have discussed thus far are available in birthing centers except C-sections. Typically, women are transferred to the hospital (or to a different part of the facility if the birth center is within a hospital) if they require an unexpected C-section.

HOSPITAL BIRTH typically a medicated birth

  • Women giving birth in the hospital have most of the same options as home births, she has quicker access to surgical interventions if an emergency occurs. Women giving birth in a hospital or birth center have the option to attempt a vaginal delivery with or without medication.
  • Benefits of hospital delivery

The benefits of a hospital birth include

ready access to emergency interventions such as a Cesarean section,

advanced monitoring for high-risk pregnancies

more pain-management options including epidural anesthesia.

Disadvantages of hospital delivery

  • The risks of a hospital delivery can include a higher chance of unwanted intervention.
  • Sometimes the hospital setting can lead to rushing through the stages of labor, resulting in a higher chance of incision of the perineum during childbirth, and requiring a Cesarean.

Other risks of hospital childbirth (and any stay in the hospital) include a higher chance of infection.

Natural births are not always an option, and if a complication develops, women now have a number of options to assist them with a safe birth. Sometimes C-sections are planned in advance. The other assisted options discussed here typically apply in the case of unexpected complications.

  • C-SECTION in the hospital
  • According to the Centers for Disease Control (CDC), about 1/3 of births are delivered by C-section, although rates are highly variable by hospital and region.3 The World Health Organization (WHO) says the rate of Cesarean deliveries should be about 10%-15%; the higher level is because of both elective Cesareans and overuse in the U.S.4 A C-section involves a horizontal incision across the lower abdomen through which the infant is delivered. The typical hospital stay is three days after a Cesarean to ensure the incision is healing. Full recovery can take 8 weeks. One advantage of a C-section is that the delivery date can be planned ahead of time.
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ReplyReply to W4 Discussion Various Birth Methods

Fundamentals of Finance Discussion

Question

Based upon the content in Topic 3, what is the current shape of the yield curve for Treasury securities and what does it tell you about the current view of economic growth and inflation in the U.S.?

Has the spread on corporate bonds and Treasury securities narrowed or widened over the past year?

  1. What events or apparent changes in market conditions triggered such a change in the spread between the yields on corporate bonds and treasury securities? Yield Curve
    Introduction
    The yield curve (term structure of interest rates) accounts for the variability of bond returns (bond yields) attributable to differing maturities. As you read this section, think about why yields on short-term treasury bonds are typically lower than returns or yields on long-term treasury bonds and why the yield curve is normally sloping upward.Now we are going to hold the risk structure of interest rates—default risk, liquidity, and taxes—constant and concentrate on what economists call the term structure of interest rates, the variability of returns due to differing maturities. Even bonds from the same issuer, in this case, the U.S. government, can have yields that vary according to the length of time they have to run before their principals are repaid. Note that the general postwar trend is upward followed by an equally dramatic slide. Sometimes short-term treasury bonds have lower yields than long-term ones, sometimes they have about the same yield, and sometimes they have higher yields.To study this phenomenon more closely, economists and market watchers use a tool called a yield curve, which is basically a snapshot of yields of bonds of different maturities at a given moment. The current yield curve can also be viewed many places online, including Bloomberg, the Wall Street Journal, and the U.S. Treasury itself. What observers have discovered is that the yields of bonds of different maturities (but identical risk structures) tend to move in tandem. They also note that yield curves usually slope upward. In other words, short-term rates are usually lower than long-term rates.Sometimes, however, the yield “curve” is actually flat—yields for bonds of different maturities are identical, or nearly so. Sometimes, particularly when short-term rates are higher than normal, the curve inverts or slopes downward, indicating that the yield on short-term bonds is higher than that on long-term bonds. And sometimes the curve goes up and down, resembling a sideways S (sometimes tilted on its face and sometimes its back) or Z. What explains this? Figure 2.22 shows treasury yield curves.Figure 2.22 Treasury Yield Curves
    Treasury yield curve© Reuters
    Theory and empirical evidence both point to the same conclusion: Bonds of different maturities are partial substitutes for each other—not perfect substitutes, but not completely segmented either. Generally, investors prefer short-term bonds to long-term ones, but they reverse their preference if the interest rate goes unusually high. Investors are willing to pay more for short-term bonds, other factors (like “the” interest rate and the risk structure) held constant, because longer-term bonds are more subject to interest rate risk. Or, to put it another way, investors need a premium (in the form of a lower price or higher yield) to hold long-term bonds. (This notion has been called liquidity preference—the name of one of the theories that economists use to explain the yield curve that emphasizes the fact that investors typically prefer more liquid, shorter-term bonds to longer-term ones, because it stresses that investors prefer shorter-term or more liquid bonds.) Ergo, the yield curve usually slopes upward.But what about those times when the curve is flat or inverted? Investors give up their preference for short-term bonds when they expect a high interest rate for a short period. (This idea has been called preferred habitat—the theory that economists use to explain the yield curve that emphasizes the fact that short- and long-term bonds are partial substitutes. Investors’ usual preference for short-term bonds are reversed under some circumstances, like when interest rates are thought to be temporarily high—because it suggests that short- and long-term bonds are, to some extent, substitutes, and whichever is preferred can change under the right circumstances or in the right habitat.) Investors can think of a long-term bond yield as the average of the yields on shorter-term obligations. When the interest rate is high by historical norms but expected after a year or so to revert to some long-term mean, they will prefer long-term bonds and will buy them at much higher prices (lower yields) than short-term bonds, which is in anticipation of relatively large price increases in long-term bonds when interest rates decrease. More formally, investors believe thatwherein = interest rate today on a bond that matures in n yearsin = interest rate today on a bond that matures in n yearsiex = expected interest rate at time × (0, 1, 2, 3,…through n)ixe = expected interest rate at time × (0, 1, 2, 3,…through n)? = the liquidity or term premium for an n?period bond (it is always positive and increases with n)? = the liquidity or term premium for an n?period bond (it is always positive and increases with n)So the yield today of a bond with 5 years to maturity, if the liquidity premium is .5 percent and the expected interest rate each year is 4, is 4.5:i5 = (4 + 4 + 4 + 4 + 4)/5 + .5 = 20/5 + .5 = 4.5, implying an upward sloping yield curve because 4 < 4.5.If the interest rate is expected to rise over the next 5 years, the yield curve slopes upward yet more steeply:i5 = (4 + 5 + 6 + 7 + 8)/5 + .5 = 30/5 + .5 = 6.5, again implying an upward sloping curve because 4 < 6.5.If, on the other hand, interest rates are expected to fall over the next 5 years, the yield curve will slope downward, as in this example:i5 = (12 + 10 + 8 + 5 + 5)/5 + .5 = 40/5 + .5 = 8.5, implying an inverted yield curve because 12 > 8.5.Investors may also realize that long-term bonds will increase in price when interest rates fall, so they are willing to pay more for them now.In the nineteenth century, the yield curve was usually flat under normal conditions. (It inverted during financial panics.) In other words, short-term and long-term bonds issued by the same economic entity did not often differ much in price. Why might that have been?One possibility is that there was no liquidity premium then. Then, as now, short-term bonds suffered less interest rate risk than long-term bonds, but investors often complained of extremely high levels of reinvestment risk, of their inability to easily and cheaply reinvest the principal of bonds and mortgages when they were repaid. Often, lenders urged good borrowers not to repay (but to continue to service their obligations, of course). Another not mutually exclusive possibility is that the long-term price level stability engendered by the specie standard made the interest rate less volatile. The expectation was that the interest rate would not long stray from its long-term tendency.The neat thing about this theory is that it reveals the yield curve as the market’s prediction of future short-term interest rates, making it, by extension, an economic forecasting tool. Where the curve slopes sharply upward, the market expects future short-term interest rates to rise. Where it slopes slightly upward, the market expects future short-term rates to remain the same. Where the curve is flat, rates, it is thought, will fall moderately in the future. Inversion of the curve means short-term interest rates should fall sharply, as in the numerical example above. The simplest way to remember this is to realize that the prediction equals the yield curve minus ?n, the term premium.Empirical research suggests that the yield curve is a good predictor of future interest rates in the very short term, the next few months, and the long term, but not in between. Part of the difficulty is that ?n is not well understood nor is it easily observable. It may change over time and/or not increase much from one maturity to the next on the short end of the curve. Nevertheless, economic forecasters use the yield curve to make predictions about inflation and the business cycle. A flat or inverted curve, for instance, portends lower short-term interest rates in the future, which is consistent with a recession but also with lower inflation rates. A curve sloped steeply upward, by contrast, portends higher future interest rates, which might be brought about by an increase in inflation rates or an economic boom.Key Takeaway
  2. The term structure of interest rates explains why bonds issued by the same economic entity but of different maturities sometimes have different yields.
  3. Plotting yield against maturity produces an important analytical tool called the yield curve.

The yield curve is a snapshot of the term structure of interest rates created by plotting yield against maturity for a single class of bonds, like Treasuries or Munies, which reveals the market’s prediction of future short-term interest rates, and by extension, are used to make inferences about inflation and business cycle expectations.

case study global Medical coverage?

QUESTION

CASE 5: Global Medical Coverage

Background

Blue Ridge Paper Products, Inc. (BRPP) in Canton, North Carolina, was a paper company whose predominant product was food and beverage packaging (it continues to operate under a different name with new ownership). It was the largest employer in Western North Carolina in 2006, with 1300 covered employees in the state and 800 elsewhere. Started as the Champion Paper plant in 1908, it was purchased by the employees and their union (a United Steelworkers local) in May 1999 with the assistance of a venture capital firm. It operated under an employee stock ownership plan (ESOP). To purchase the plant, the employees agreed to a 15% wage cut and frozen wages and benefits for 7 years. From the buyout through the end of 2005, the company lost $92 million and paid out $107 million in healthcare claims. It became profitable in 2006. Maintaining health benefits for members and retirees was a very high priority with the employee-owners and the union, although retiree medical benefits were eliminated for salaried employees hired after March 1, 2005. The venture capital firm that financed the ESOP retained 55% ownership with 40% going to the employees and 5% to senior management. Profitability varied from year to year as the company expanded capacity and improved productivity of its single-serving drink carton lines and was caught up in a number of suits over water pollution problems at its Canton, North Carolina plant.

The majority of BRPP employees were male, older than age 48, and had several health risk factors. Most employees worked 12-hour, rotating shifts, making it extremely difficult to manage health conditions or improve lifestyle (Blackley, 2006). The ESOP worked hard to reduce its self-insured healthcare costs. Health insurance claims for 2006 had been estimated at $36 million, but were closer to $24 million, which was still 75% above the 2000 numbers. A volunteer benefits task force composed of union and nonunion employees worked to redesign a complex benefit system. After 2 years of 18% healthcare cost increases, the rate of growth dropped to 2% in 2003. It was 5% in 2004 and ?3% in 2005.

Programs initiated in 2001 included a plan offering free diabetic medications and supplies in return for compliance, and a tobacco cessation plan with cash rewards. In 2004, the company opened a full-service pharmacy and medical center with a pharmacist, internist, and nurses. In 2005, it began a population health management program. Covered employees and spouses who completed a health risk assessment were rewarded with $100 and assigned a “personal nurse coach.” The nurse coach assisted those who were ready to change to set individual health goals and to choose from among one or more of 14 available health programs, which included reduced co-pays on medications, free self-help medical aids/equipment, and educational materials.

Where BRPP could not seem to make headway was with the prices paid to local providers. Community physicians refused deeper discounts. Even banding together in a buying cooperative with other companies could not move the local tertiary hospital to match discounts offered to regionally dominant insurers. This hospital was not distressed and had above-average operating margins.

Articles on “medical tourism” in the press and on television attracted the attention of benefits management. Reports were of high-quality care at 80% or less of U.S. prices with good outcomes. BRPP contacted a company offering services at hospitals in India, IndUShealth in Raleigh, North Carolina, and began working on a plan to make its services available to BRPP employees.

IndUShealth

IndUShealth provides a complete package to its U.S. and Canadian clients, including access to Indian superspecialty hospitals that are Joint Commission International accredited and to specialists and supporting physicians with U.S. or U.K. board certification. It arranges for postoperative care in India and for travel, lodging, and meals for the patient and an accompanying family member—all for a single package price. For example, it represents the Wockhardt hospitals in India, which are Joint Commission International accredited and affiliated with Harvard Medical International. Other Indian hospitals boast affiliations with the Johns Hopkins Medical Center and the Cleveland Clinic.

Mitral Valve Replacement

One of the first cases considered was a mitral valve replacement. IndUShealth and BRPP sought package quotes from a number of domestic medical centers and could get only one estimate. That quote, from the University of Iowa academic medical center, was in the $68,000 to $98,000 range. The quote from India was for $18,000 and included travel, food, and lodging for the patient and one companion. Testifying before the U.S. Senate Special Committee on Aging, Mr. Rajesh Rao, IndUShealth’s CEO (2006), cited the following costs:

Employee Participation

To encourage employee participation, BRPP prepared a DVD on its medical tourism initiative, which it called Global Health Coverage. It outlined the opportunities and described the Indian facilities and credentials. The next step was to be a trip by an employee “due diligence” committee to India to inspect facilities and talk with doctors. Then they would discuss how to handle the option in the next set of union negotiations.

Senate Hearings

On June 27, 2006, the U.S. Senate Special Committee on Aging held hearings titled “The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?” Both BRPP and IndUShealth testified for the committee. When testifying to the Senate subcommittee, Bonnie Grissom Blackley, benefits director for BRPP, concluded:

Should I need a surgical procedure, provide me and my spouse with an all expense-paid trip to a Joint Commission International-approved hospital, that compares to a 5-star hotel, a surgeon educated and credentialed in the U.S., no hospital staph infections, a registered nurse around the clock, no one pushing me out of the hospital after 2 or 3 days, a several-day recovery period at a beach resort, email access, cell phone, great food, touring, etc., etc. for 25% of the savings up to $10,000 and I won’t be able to get out my passport fast enough.

Blue Ridge Paper Product’s Test Case

The test case under the new arrangement was a volunteer, Carl Garrett, a 60-year-old BRPP paper-making technician who needed a gallbladder removal and a shoulder repair. He reportedly was looking forward to the trip in September 2006, accompanied by his fiancée. A 40-year employee approaching retirement, he would be the first company-sponsored U.S. worker to receive health care in India. The two operations would have cost $100,000 in the United States, but would cost only $20,000 in India. The arrangement was that the company would pay for the entire thing, waive the 20% co-payment, give Garrett about a $10,000 incentive, and still save $50,000.

However, the United Steel Workers Union (USW) national office objected strongly to the whole idea and threatened to file for an injunction. The local district representative commented, “We made it clear that if healthcare was going to be resolved, it would be resolved by modifying the system in the U.S., not by offshoring or exporting our own people.” USW President Leo Gerard said, “No U.S. citizen should be exposed to the risk involved in travel internationally for health care services.” The USW sent a letter to members of Congress that included the following (Parks, 2006):

Our members, along with thousands of unrepresented workers, are now being confronted with proposals to literally export themselves to have certain “expensive” medical procedures provided in India.

With companies now proposing to send their own American employees abroad for less expensive health care services, there can be no doubt that the U.S. health care system is in immediate need of massive reform.

The right to safe, secure, and dependable health care in one’s own country should not be surrendered for any reason, certainly not to fatten the profit margins of corporate investors.

Parks (2006)

The union also cited the lack of comparable malpractice coverage in other countries. The company agreed to find a domestic source of care for Mr. Garrett, but considered continuing the experiment with its salaried, non-union employees. Carl Garrett responded unhappily. “The company dropped the ball … people have given me so much encouragement,” he said, “so much positive response, and they’re devastated. A lot of people were waiting for me to report back on how it went and perhaps go themselves. This leaves them in limbo too” (Jonsson, 2006, p. 2).

In 2007, Rank Group, a New Zealand-based company, purchased the company by buying out the ESOP, paying the former employee-owners, on average, approximately $20,000 each. Rank renamed the company Evergreen Packaging Group.

Case Study: Global Medical Coverage

Read the case study “Case 5: Global Medical Coverage” in your textbook, Health policy analysis: An interdisciplinary approach (3rd ed.). In a 4-5 page paper, answer the questions below:

What difference did it probably make that BRPP is an ESOP owned by the union members or that the national union is busy recruiting healthcare workers as members?

What are the ethical implications of a reward of up to $10,000 for the employee to go to India for a major procedure?

If you were a hospital administrator, how would you react when a number of patients and companies began to ask to bargain about prices, including presenting price quotes from companies like IndUShealth?

What would be the difference in the bargaining position of an academic medical center and a large tertiary community hospital system?

  • How might state and national governments respond to this increasingly popular phenomenon?

Discussion #1 and # 2

Question

Discussion #1

Discuss the benefits and disadvantages of a facility using supplemental and floating staff. 

         Supplemental and floating staff play pivotal roles in addressing staffing needs within facilities, offering both advantages and drawbacks. Supplemental staff consists of temporary or agency workers. They are utilized to provide flexibility and meet the demands of any rapid fluctuation in workload. This adaptability guarantees that the facility can keep up a smooth functioning even in the face of unforeseen spikes in demand. Reliance on temporary help, however, could result in a lack of continuity and familiarity with the facility’s protocols, which could affect the standard of treatment and care. The floating staff or pool are internal employees trained to work across various departments such as Medical-surgical, Tele, Stepdown, BHU, etc. The use of the floating pool enhances overall staff versatility, enabling better resource allocation and improved responsiveness to the changing demands. The downside of frequent rotation is decreased specialization, potentially affecting the ability of them gaining much expertise in specific areas.  

        A benefit of supplemental staff is reducing staff burnout during busy periods, ensuring that the essential services are uninterrupted (Griffiths et al., 2020) . This can contribute to increased employee satisfaction and retention. On the other hand, the downside includes potential resistance from permanent staff, who may perceive supplemental workers as a threat to job stability or a compromise in quality. The floating pool brings advantages because it brings familiarity with the facility’s protocols, reducing the learning curve when moving between departments. This familiarity helps to create a cohesive work atmosphere and makes transitions easier when there are staffing shortages. However, it can be difficult to sufficiently train staff members to be competent in several positions, which could result in a dilution of expertise or omissions in some areas. 

         Financially speaking, it is more costly to hire supplemental staff because it can be more expensive due to agency fees and higher hourly rates. Even though the cost is based on the demand, it can still be more costly (Butler et al., 2019). Although the floating staff are internal employees that require additional training, the long-term cost is lower. Additional staff can positively affect patient care since they can help reduce delays in services or treatment. However, a lack of reliable staff can make it more difficult for patients and providers to develop enduring relationships, which could lower the standard of individualized care.  Facilities can preserve operating efficiency by responding to unforeseen circumstances with more agility thanks to floating staff. However, the frequent shifting of employees across departments could result in a lack of accountability or ownership, which could undermine the general dedication to excellence in any field. 

Compare and contrast how a staffing plan would differ with different nursing units. How does that affect the staffing budget? 

         Staffing plans for nursing units vary based on the specific needs and demands of each unit. Staffing plan considers patient acuities, required skill sets, and the patient care provided. Medical-surgical units have a variety of patients requiring certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Staffing plans and assignments utilize a matrix to help with staffing. Units such as ICU demand a higher ratio of highly skilled RNs because the patients are more critical and require continuous monitoring. Mother baby and labor and delivery units use a specialized team that includes obstetric nurses, midwives, and neonatal nurses (Lasater et al., 2021) . This matrix considers the unpredictability of labor and delivery. In pediatric units, the focus turns to the specialized pediatric nurses who have expertise in working with children. Pediatric units may need a higher nurse-to-patient ratio to ensure appropriate care and management is provided when dealing with young patients and their families. Psych units need a distinct skill set in nursing staff when dealing with mental health patients. The nurses must know how to deal with challenging situations and how to de-escalate situations. Long term care units like nursing homes and rehabs utilize CNAs, LPNs, and RNs. The staffing plan at the long-term care facilities leans towards continuity of care, building relationships between staff and residents. 

         The requirements of each unit have a big impact on the staging budget, which distributes financial resources for staffing among several units. Meanwhile, medical-surgical units may concentrate on cost containment through a variety of nursing positions. In the meanwhile, medical-surgical units may concentrate on cost containment through the use of a variety of nursing positions. Given their focus on providing specialized care for children, pediatric units may choose to dedicate budgetary resources to continuing education and training for their nursing staff so they can remain up to date on pediatric practices. While keeping a core team for everyday care, maternity facilities may allot resources to support additional staff during periods of high birth. Psychiatric units may set aside funds in their budgets for continuous staff training in mental health management and crisis intervention. A consistent team of CNAs may be maintained with resources provided by long-term care facilities, which place a strong emphasis on continuity and assistance with everyday life activities. 

Discussion #2

Benefits and Drawbacks of Supplemental and Floating Staff

Staffing is crucial to patient care in healthcare. Healthcare institutions use supplementary and floating workers to meet staffing needs within budget. Advantages and drawbacks come with these tactics. The paper examines the pros and cons of additional and floating healthcare workers. It will also include how nursing unit staffing goals affect the staffing budget.

Benefits of Using Supplemental and Floating Staff

Supplemental and floating workers provide important flexibility in the fast-paced and unpredictable world of healthcare. These staffing options help hospitals adjust to changing conditions and prioritize patient care. Maintaining proper nurse-to-patient ratios is a major benefit. Supplemental personnel may quickly fill in for sick or otherwise absent workers during peak patient volumes. This ensures patients get great treatment without sacrificing. Other important benefits include controlling costs (Fagefors et al., 2022). Agency nurses are usually hired as required. Eliminating full-time staff and their benefits streamlines the budget. Healthcare institutions may better deploy cash to where they’re required.

In addition, preventing nurse burnout with additional and floating personnel improves patient care. Nurses under pressure might provide poor treatment. Supplemental workers assist in spreading the burden, decreasing fatigue, and ensuring patients get quality treatment. Moreover, supplemental workers also provide unique expertise and healthcare experience (Fagefors et al., 2022). This information is especially useful in critical care and newborn care facilities. It expands the facility’s expertise, improving patient care.

Drawbacks of Using Supplemental and Floating Staff

Using supplementary and floating personnel in hospitals has pros and cons. These staff workers may not know the facility’s rules, procedures, or culture, which is concerning. This unfamiliarity may cause care delivery and communication problems, which can hurt patient satisfaction and healthcare team collaboration. Healthcare institutions must also spend time and money training and orienting auxiliary and floating personnel. The initial training and time needed to acclimate new hires might strain the budget (Griffiths et al., 2019). In addition, permanent staff members who regularly float to different units or see a high dependency on temporary workers may feel overworked and burned out. Staff morale and treatment quality may suffer. Finally, personnel demands and expenses might vary, making it difficult for healthcare institutions to plan and distribute resources. Thus, although additional and floating workers provide flexibility, they also create familiarity, training, staff fatigue, and budget management difficulties (Griffiths et al., 2019).

Differences in Staffing Plans Across Nursing Units

Healthcare staffing strategies vary widely between nursing units due to numerous key considerations. Due to patient criticality, Intensive Care Units (ICUs) need a greater nurse-to-patient ratio. These units need more RNs and maybe nurse practitioners or clinical nurse specialists. Conversely, medical-surgical units may use RNs, LPNs, and CNAs to meet the requirements of a variety of patients with different acuity levels (Butler et al., 2019). Pediatric units need specially trained nurses to meet the needs of children and adolescents. Labor and delivery units, which commonly include obstetricians, nurse midwives, and specialized nurses, must adjust their staffing plans to childbirth’s unpredictability. Staffing plans vary per nursing unit based on acuity, patient demographic, and care complexity to ensure each unit provides the best care customized to its requirements.

Impact on the Staffing Budget

Healthcare institutions’ staffing budgets depend on staffing plans and supplementary and floating workers. These tactics save expenses by eliminating full-time workers, but also increase budget variability. Healthcare institutions must budget for agency worker training and orientation (Fagefors et al., 2022).

In conclusion, healthcare institutions using supplementary and floating personnel have pros and cons. These solutions provide flexibility, cost management, and improved patient care, but familiarity, training, staff burnout, and budget fluctuation may be issues. Each nursing unit requires a customized staffing strategy, which affects the budget. Healthcare institutions must balance these aspects to provide high-quality treatment and manage finances.

History 1010

QUESTION

Creating a Slide Presentation

SCENARIO: You represent your company at a service organization dealing with one of these two issues:

Facing Economic Change

Engaging Civil Rights

  • Your supervisor asked you to research information related to the history of one of these issues for your organization to help new employees and volunteers understand it better. You will need to create a slide presentation that summarizes your findings and recommendations.
  • ASSIGNMENT: Back in Unit 2, you chose your issue and your sources and used the critical thinking process to begin to formulate an argument about your topic. Now you will refine your argument and create a slide presentation that’s due at the end of Unit 3.

PRESENTATION REQUIREMENTS: Your presentation must be 11 slides long, not including the title and sources slides. It must include the following slides:

title

outline

topic

  • evidence (4–8 slides with both text and images)
  • argument (making connections between past and present)
  • sources
  • Please use PowerPoint 
  • Before you get started, let’s look at how you’ll be building the presentation, step by step.
  • In order to foster learning and growth, all work you submit must be newly written specifically for this course. Any plagiarized or recycled work will result in a Plagiarism Detected alert. Review Touchstones: Academic Integrity Guidelines for more about plagiarism and the Plagiarism Detected alert. For guidance on the use of generative AI technology, review Ethical Standards and Appropriate Use of AI.

A. Directions

STEP 1: REVIEW TOUCHSTONE 2

Review the scenario and your work from Touchstone 2. You will need to use the research question and your primary and secondary sources, along with the critical thinking process you completed in that touchstone.

STEP 2: CREATE PRESENTATION SLIDES

Use a presentation tool like PowerPoint or Google Slides to outline and organize a presentation for new employees and volunteers to help them understand better how key historical events in U.S. History are connected to their work and impact society today.

SlideComponentTitle SlideYour title slide will be the first slide and should give the viewer an idea of what your presentation will be about.Outline SlideAn outline slide lets your audience know what to expect from your presentation. This doesn’t need to be the kind of detailed or thorough outline that you might use to plan out a research report. It just needs to include the main idea that each slide will cover—it might even just be the time period covered by that slide.Topic SlideYour topic is the same as the research question you selected in Unit 2.

Define the historical challenges you are presenting on and expand on the topic of your presentation. What questions will you answer? What historical events and approaches will you explore?Evidence Slides
(4-8 slides with both text and images)Now that you’ve reviewed your outline, it’s time to add information to your evidence slides. Use simple bullet points for slide text and leave room for pictures! Use speaker notes to describe the historical challenges, approaches and strategies with supporting evidence. Also, remember to include information from your primary or secondary sources.

Add appropriate visuals that help to communicate main ideas. Use images, charts, photos, and infographics to help answer the research question. If you use infographics, make sure any text in the infographics is large enough to read. Make sure images are not blurry or too small to see.Connection SlideYour connections slide should connect past events to current events related to your issue and research question. Think of this slide as showing lessons you’ve learned from your research. What are the takeaways? How should people in your organization apply history to the present and the future? Include historical evidence in the speaker notes to explain these lessons.

Try to think of four lessons from the past that you can connect to the present and the future.Sources SlideNow it’s time to add the primary and secondary sources you selected from Touchstone 2 to a slide, following APA format. (Note: the sources provided to you in Touchstone 2 were already in APA format). Click here for a guideline to help you with APA formatting if you selected any outside sources. Also following APA formatting, your sources should appear in alphabetical order.

STEP 3: ADD SPEAKER NOTES

Recall that your supervisor asked you to research information related to the history of one of the above issues for your organization to help new employees and volunteers understand it better. For this assignment, you are not actually giving the presentation, but rather just preparing a slide deck that summarizes your findings and recommendations.

An important step in the preparation of a speech is writing speaker notes. Use speaker notes to develop historical evidence and explain your historical challenges, strategies, and connections:

Use evidence to clearly identify challenges throughout US history that are related to your topic.

Analyze how challenges were tackled throughout US history that are related to your topic, using historical evidence.

Analyze the connection between historical strategies and a current issue using supporting evidence (Connections slide).

Your speaker notes will be used to evaluate your project, so make sure you write in complete sentences and pay attention to spelling and grammar. If you were giving an oral presentation, these notes wouldn’t be visible to your audience when you’re in Presenter View. But you would be able to see them, and they would guide you through your presentation.

STEP 4: ADD IN-TEXT CITATIONS

Make sure you’re citing the information from your sources using in-text citations in APA style. These citations should include the author’s last name and the year of publication for the source, for example: (Mitchell, 2014).

STEP 5: SUBMIT PRESENTATION

Once you have completed your slides and corresponding speaker notes, it is time to submit your presentation. If you are using PowerPoint, you simply need to save your presentation and upload this file to Sophia. If you are using another slide presentation technology, download the slide deck as a Microsoft PowerPoint (.pptx) and upload this version to Sophia.

B. Rubric

Advanced (100%)Proficient (85%)Acceptable (75%)Needs Improvement (50%)Non-Performance (0%)

HISTORICAL CHALLENGES (20 POINTS)

Historical challenges are clearly defined and supported with evidence.Uses evidence to clearly identify challenges throughout US history that are related to their topic.Clearly identifies challenges throughout US history that are related to their topic.Partially identifies challenges throughout US history that are related to their topic.Identifies challenges or events throughout US history that are only indirectly related to their topic.Fails to identify challenges throughout US history that are related to their topic.

HISTORICAL APPROACHES AND STRATEGIES (20 POINTS)

Historical approaches and strategies are clearly analyzed and supported with evidence.

Analyzes how challenges were tackled throughout US history that are related to their topic, using historical evidence.Describes how challenges were tackled throughout US history that are related to their topic, using historical evidence.Identifies or lists how challenges were tackled throughout US history that are related to their topic.Gives a general overview of tackling challenges, or identifies how challenges were tackled throughout US history that are only indirectly related to their topic.Fails to identify how challenges were tackled throughout US history.

CONNECTIONS (20 POINTS)

Clear connection is made between historical strategies and events and current issues/events.

Analyzes the connection between historical strategies and their current issue using supporting evidence.Describes the connection between historical strategies and their current issue.Identifies, but does not describe, a connection between historical strategies and their current issue.Identifies only an indirect connection between historical strategies and their current issue.Fails to make any connection between historical strategies and their current issue.

HISTORICAL SOURCES (20 POINTS)

Relevant historical sources are properly cited.

Accurately cites at least four relevant historical sources (two primary and two secondary sources) on the sources slide. Uses in-text citations with evidence from sources.Accurately cites at least four relevant historical sources (two primary and two secondary sources) on the sources slide. Uses in-text citations with evidence from sources. Citations may include minor errors.Accurately cites 2-3 relevant historical sources; primarily uses in-text citations with evidence from sources.Accurately cites 1 relevant historical source; in-text citations may be missing.Fails to cite sources or sources are cited inaccurately. In-text citations are missing.

ORGANIZATION 

Slide presentation is organized and the visual presentation effectively communicates the main ideas.

Effectively organizes information throughout presentation; with appropriate visuals that help to communicate main ideas. All required slides are included. Uses speaker notes with most or all evidence slides.Adequately organizes information throughout presentation and provides some visuals. All required slides are included. Uses speaker notes with most evidence slides.Adequately organizes information throughout presentation. All required slides are included. Primarily uses speaker notes with evidence slides.Fails to organize some of the information throughout the presentation. One or more required slides are omitted. Speaker notes may be missing from most evidence slides.Fails to organize most or all of the information throughout the presentation. Several required slides are not included. Speaker notes are missing from most or all evidence slides.

Discussion replies #1 and #2

Question

Submission Instructions:

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. 

All replies must be constructive and use literature where possible.

Discussion #1

  • Difference Between Not- For-Profit and For-Profit Organizations
  • There is a grey area between the two terms when it comes to describing the nature of for profit and not-for-profit organizations. The purpose of each of these organizations is where they diverge the most. While for-profit businesses cater to niche markets by providing valuable goods and services, non-profit healthcare organizations prioritize social and humanitarian causes (Ogochi et al., 2022). Typically, these goods and services are offered by businesses with the intention of making a profit.

More distinctions may be drawn between for-profit and non-profit entities. Ownership, principal and secondary missions, income sources, employees, responsibility, and tax status are all possible factors that contribute to the variation. Under some circumstances, healthcare organizations that are not for profit are not taxed, although for-profit companies are always taxed. A primary goal of not-for-profits is to serve society rather than generate profit to share among shareholders, in contrast to for-profit organizations. Donations and grants support non-profit organizations, whereas investment profits and product sales fuel for-profit enterprises. Both paid and unpaid workers make up the staff of non-profits, while for-profits rely only on paid workers.

What Happens if an NFP Organization Makes a Profit

For non-for-profit businesses, taxation is a bigger issue when they make profit. In most cases, non-for-profit organizations do not have to pay income taxes. The rationale for the exemption is that these groups primarily serve to benefit society, rather than for financial gain (Zare et al., 2022). It is possible, nevertheless, for non-profits to make money via their operations. When this occurs, the funds might be used to pay for certain costs. Nevertheless, tax issues may only be expressed when an organization’s actions depart from its original objective and purpose. Consequently, no amount that might be considered a “profit” from an organization’s operations would be subject to taxes (Rosko et al., 2020). The existence of the company depends on the profits made from its operations.

Advantages and Disadvantages of For-Profit vs Not for Profit

One major perk of being a nonprofit organization is being free from paying taxes. Also, limited liability companies offer legal protection for nonprofits since they are distinct legal entities. The owner is shielded from legal responsibility in the event of a breach of contract since the business is liable for its own contractual and other legal duties, unlike when the firm is under the control of a single individual. The members, executives, and directors of a limited liability corporation are shielded from personal responsibility in any legal action against the business (Treinta et al., 2020).

It takes a lot of time and money to create a non-profit organization, which is a major drawback. Additionally, the organization will need to pay extra to get your tax exemption status applied for. The process of applying for a tax exemption may be lengthy and expensive, especially when the services of an accountant, lawyer, or other specialist are required.

Establishing a business with the express purpose of making a profit is a smart move. The group can earn a profit because it can sell products and services. One potential benefit of launching a for-profit business is the opportunity to earn capital that may be reinvested or share among the different owners or shareholders. But businesses can’t apply for some exemptions or grants from the government if they’re structured as for-profits. There are no tax breaks for contributors and investors in for-profit businesses, in contrast to non-profits (Cronin et al., 2021).

Risk Management Influence on Nursing Documentation

The purpose of risk management in healthcare is to detect potential dangers and make plans to deal with them. In order to prevent risks from becoming more damaging to the community and businesses, effective risk management helps in identifying them and then putting measures in place to prevent and deal with them. Legal actions alleging misconduct by nurses pose a substantial threat to healthcare companies. That is why it is fundamental and critical to document patient care in order to make known the actual patients’ health condition and interventions that were performed (Bunting & de Klerk, 2022). Nurses are responsible for providing safe and exceptional care, and this can, most of the time, only be verified by good nursing documentation.  

Discussion #2

Discuss the difference between not-for-profit and for-profit organizations. 

         Healthcare organizations classified as for-profit or not-for-profit primarily differ in their goals and financial structures.  Healthcare companies that are for-profit (FP) function to make money for their owners or shareholders (Horwitz, 2005). Any revenue beyond operating expenses is liable to be allocated as profit. Non-profit organizations (NFPs) are guided by a mission. Reinvesting surplus income helps the organization fulfill its objective, as opposed to giving it to owners or shareholders. Financial gain is an FP organization’s main goal. One of the main objectives is to maximize profits, and market forces and shareholder interests frequently influence decision-making. Northshore Medical Center, Florida Medical Center, and Palmetto General are a few FP healthcare organizations. 

         Non-profit organizations focus on a specific mission or purpose, for example education, or providing healthcare services. The money the organization gets supports its mission rather than individual gain. For-profit organizations must incorporate income taxes and other taxes on profits. NFPs are exempt from taxes because their mission is charitable.  For-profits are governed by shareholders and board of directors that must financially keep the hospital or facility at bay. Not-for profit is governed by a board of trustees or directors, with a focus on fulfilling the organization’s mission and serving the community. Jackson Memorial Hospital is an example of an NFP in Miami.  

What happens if an NFP organization makes a profit? 

        If a not-for profit (NFP) organization generates surplus or profit, it does not distribute these funds to owners or shareholders, as there are typically none. Instead, the surplus is reinvested back into the organization to further its mission and objectives. This reinvestment helps the NFP organization enhance its services, expand programs, improve facilities, or support its charitable purposes. Reinvesting profits into the organization allows NFPs to achieve long-term sustainability and better fulfill their mission. It distinguishes them from for-profit entities, where profits are distributed to shareholders or owners. It’s important to note that NFP organizations still need to manage their finances responsibly and transparently.  

What are the advantages and disadvantages of each type of organization? 

         For-profit has many advantages. FPs have the potential for significant financial gains, attracting investors and facilitating access to capital (Mogyorósy, 2004). The profit motive can drive efficiency and innovation, as organizations aim to optimize operations for financial success. FPs can quickly adapt to market demands and changes, responding to consumer needs. Prioritizing profit may sometimes lead to decisions that prioritize financial gain over patient care or community service. Profit-driven models may contribute to healthcare inequalities, as services may be directed toward more profitable demographics. Not-for-profit (NFP) organizations are guided by a mission or purpose, emphasizing the provision of community service and addressing societal needs. Enjoying tax-exempt status allows NFPs to allocate more resources to their mission. NFPs build strong community trust by demonstrating a commitment to social causes. The disadvantages of an NFP vary. NFPs may face financial limitations, relying on donations and grants, which can affect their ability to invest in technology or facilities. Due to the mission-driven focus, decision-making may involve more bureaucracy, slowing down certain processes. In a competitive healthcare environment, NFPs may face challenges in recruiting and retaining talent due to potentially slowing down certain processes.  

Describe two specific examples of how risk management has influenced nursing documentation. 

          Risk management ensures the safety of the patients and the staff. A risk management initiative is to decrease medication errors in a healthcare facility. In response, nursing documentation protocols were enhanced to include additional checks and verifications when administering medications. Nurses were required to document not only the administration of medication but also the specific steps taken to verify the right patient, medication, dose, route, and time. This improved to reduce the risk of medication errors, enhance patient safety, and provide clear record of the safety measures taken. Another example is preventing falls throughout the hospital. Risk management aids in the prevention of falls by making sure the nurses know the proper steps to take when there are risk for fall patients. The proper steps should be followed. A patient should have a bed alarm first, medication next, and a sitter last. Nurses and PCTS are educated on reporting and following the proper steps to prevent falls.   

English Question

QUESTION

Argumentative Essay

BEFORE YOU START

Consider revisiting the tutorial Supporting an Argumentative Thesis. Just like in previous Touchstones, your stance needs to be stated in a thesis statement and your evidence in body paragraphs should work to support your claim. For help citing evidence in body paragraphs, revisit the tutorial Source and Quotation Formatting in APA to learn how to quote and paraphrase sources using APA style.
ASSIGNMENT: Write a 4-6 page (approximately 1000-1500 words) argumentative essay arguing one side or stance of an academically appropriate debate using the classical model supported by evidence and research. If the writing exceeds the 1500 word maximum, it will be returned back for revision.

Sample Argumentative Essay

In order to foster learning and growth, all work you submit must be newly written specifically for this course. Any plagiarized or recycled work will result in a Plagiarism Detected alert. Review Touchstones: Academic Integrity Guidelines for more about plagiarism and the Plagiarism Detected alert. For guidance on the use of generative AI technology, review Ethical Standards and Appropriate Use of AI.

CopyLeaks Originality Checker: All writing will be checked for originality. Ensure that all references are credible and include page and paragraph numbers if the source is longer than four pages. If a source cannot be accessed by a grader, you might need to provide digital proof that you possess the source (for example, a photo of the print book). Text from any third party source is prohibited, including internet or chatbot searches, without proper APA-style citations. Focus on developing your own ideas and use evidence sparingly to support your own original claims, following the classical model of argumentation.

A. Directions

Step 1. Choose a Topic

Today, there are many different debates being had all around the world about topics that affect our personal, professional, civic, and/or academic lives. Some of these debates have been such hot topics for so long that it has become very difficult to add to the conversation with new and original ideas or stances to take. To move beyond this trend, we have created a list of topics that may not be written about for this Touchstone. This includes example topics that are used in Unit 4. Feel free to access a tutor if you would like support choosing a topic for this essay.

Please AVOID choosing any of the following topics:

Abortion Rights

Animal Testing (Unit 4 example)

Climate Change (Unit 4 example)

Belief in God(s) or Afterlife(s)

Death Penalty / Capital Punishment

Euthanasia / Assisted Suicide

Fad Diets (e.g., Keto, etc.)

Funding/Defunding Law Enforcement

Immigration

Legal Alcohol/Tobacco Age

Legalization of Marijuana

Legalization of Sex Work

Paying Student Athletes

Second Amendment Rights (i.e., Gun Control)

  • Social Media’s Impact on Mental Health
  • Universal Healthcare
  • Vaccines
  • Choosing to write about any of the above topics will result in a non-passing score.
  • Step 2. Write an Argumentative Essay
  • Remember the word “argument” does not mean a fight in a writing context. An academic argument is more like a thoughtful conversation between two people with differing viewpoints on a debatable issue. However, you are required to take a position on one side of a debatable issue that is informed by academically appropriate evidence.
  • For the purposes of this assignment, expressing or relying on your personal opinion of a debate is discouraged. Rather, the essay must argue one side or stance of the debate using the rhetorical appeals (logos, ethos, and pathos) and be supported by academic or scholarly sources. These include physical sources in public libraries, digital sources in academic libraries, online sources (excludes unreliable sources like procon.org and wikipedia.org, which are discouraged), and published expert reports, preferably peer-reviewed by experts in the field to maintain utmost credibility. Consider revisiting the tutorial Finding Sources for more information on appropriate sources for argumentative writing.
  • Your submission must include an APA style in-text citations and a reference page following the essay. In your research, you will need at least 2 and no more than 4 credible primary or secondary sources to use as support in your essay. 
  • All sources cited in the writing submitted must be locatable by a grader; include hyperlinks to the sources in the reference page. 
  • The use of any source that requires payment for access is strictly prohibited for this assignment.
  • Avoid using sources that exceed 20 pages in length, as they may be overly extensive for the purposes of this assignment. 
  • Including more than four sources may cause delays, and you might be asked to provide additional evidence of the credibility for each source.
  • The following resources will be helpful to you as you work on this assignment:
  • Purdue Online Writing Lab’s APA Formatting and Style Guide
  • This site includes a comprehensive overview of APA style, as well as individual pages with guidelines for specific citation types.
  • Frequently Asked Questions About APA Style
  • This page on the official APA website addresses common questions related to APA formatting. The “References,” “Punctuation,” and “Grammar and Writing Style” sections will be the most useful to your work in this course.

APA Style: Quick Answers—References

This page on the official APA Style website provides numerous examples of reference list formatting for various source types.

Step 3. Think About Your Writing

On a separate page, below your reference page, include thoughtful answers to the Think About Your Writing questions. References and Think About Your Writing questions are NOT included in the word count for this essay.

Below your reference page, include answers to all of the following reflection questions. 

What have you learned about how to present a strong argument? How could/will you apply this knowledge in your professional or everyday life (3-4 sentences)? Sophia says: Think about the specific skills and techniques that you used while developing and writing your essay. What tools will you take with you from this experience?

Consider the English Composition I course as a whole. What have you learned about yourself as a writer (5-6 sentences)? Sophia says: What did you learn that surprised you? Is there anything that you have struggled with in the past that you now feel more confident about?

Step 4. Review Rubric and Checklist

Your composition and reflection will be scored according to the Touchstone 4 Rubric, which evaluates the argumentative topic and thesis statement, argument development and support, organization, flow, research, style, use of conventions (grammar, punctuation, etc.), and your answers to the “Think About your Writing” questions above.

Refer to the checklist below throughout the writing process. Do not submit your Touchstone until it meets these guidelines.

  • Argumentative Topic and Thesis Statement
    ? Have you included a thesis that takes a clear, specific position on one side of an academically appropriate, debatable issue?
  • Argument Development
    ? Are all of the details relevant to the purpose of your essay?
    ? Is the argument supported using rhetorical appeals and credible, academic source material?
    ? Is your essay 4-6 pages (approximately 1000-1500 words)? If not, which details do you need to add or delete? 
  • Research
    ? Have you cited outside sources effectively using quotation, summary, or paraphrase?
    ? Are the sources incorporated smoothly, providing the reader with signal phrases and context for the source information?
    ? Are the sources explained with regard to your topic and how they relate to the argument?
    ? Have you referenced at least 2 and no more than 4 credible sources?
    ? Have you included an APA style reference page below your essay?
    ? Have you included a hyperlink to each source in the reference page?
  • Organization and Flow
    ? Is there an introduction, conclusion, adequate body paragraphs, and a counterargument?
    ? Do the topic and concluding sentences reiterate the argument to maintain a sharp focus on the purpose of the essay?
    ? Is the argument presented in a logical order and easy for the reader to follow?
    ? Are there transitions within and between paragraphs?

Style
? Are the word choices accurate and effective?
? Are the sentence structures varied?

Conventions and Formatting
? Have you properly cited your sources according to APA style guidelines?
? Have you double-checked for correct grammar, punctuation, spelling, formatting, and capitalization?
? Have you proofread for typos?

  1. Before You Submit
    ? Have you answered all of the Think About Your Writing questions on a separate page below your reference page? Are your answers thoughtful and included insights, observations, and/or examples in all responses?
    ? Does your submission include your essay, followed by your reference page, followed by your Think About Your Writing questions?

Develop “groupthink-No-More” guidelines

Question

Develop “Groupthink-No-More” guidelines for teams and complete Option 1 or Option 2 for the second deliverable.

Expand All

Introduction

Many organizations aspire to be “innovative environments,” but are plagued with suboptimal outcomes. The executive team may decide to hire a social psychologist to identify the root causes of poor decisions and provide coaching on creative and independent thinking.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

Describe the process of group formation, including why and how groups are formed.

How does cohesion influence groupthink?

Can conflict within a group ever be productive?

Preparation

This assessment has two deliverables. Read the Assessment 4 Context document for information about the subject of this assessment.

  • Many organizations and institutions launch initiatives to promote independent, creative, and innovative thinking within management and teams. The reality, however, may fall far short of the ideal. “Groupthink” occurs when group members pressure each other to avoid conflict because the culture values and rewards consensus and penalizes in some way those who dare to disagree or challenge assumptions. Disagreement does not have to be an unpleasant or intimidating experience. Conflict directed toward producing a positive outcome can improve decision-making throughout the workplace.
  • Use the Capella library and the Internet to research social psychology theory related to group process, group formation, group cohesion, group belonging, conflict and individual behaviors within groups, and Groupthink and intervention activities that promote effective teams.
  • Instructions

Assume the consultant role in the scenario below.

Scenario

The executive director of a large hospital-based mental health center with three private practice-model outpatient offices in three neighboring communities has hired you as an outside consultant to help increase client referrals to these three private practice offices. These private practice outpatient offices are managed by a medical director and staffed with support staff, counseling and clinical psychologists, neuropsychologists, psychometrists, social workers, Licensed Master’s level therapists, and specialists in substance abuse treatment. Historically, the referral base has been the hospital staff physicians.
Despite the fact that the private practice offices are all losing money due to low rates of referral and changes in insurance reimbursement, the staff continues to follow the directions of the medical director to make referrals. This medical director insists that the physicians on the hospital’s medical staff need to “step up to the plate” and increase referrals to the outpatient clinics. Referral development meetings continue to focus on this medical-based referral system largely because none of the non-physician staff will present a different perspective to the well-loved medical director.
Groupthink is alive and well in this group.
There are five hospitals within easy driving distance, and another dozen within an hour’s drive, most with their own counseling/therapy offices and experiencing the same decline in referrals. In addition, the neighboring communities have all the normal and expected social services, community and family services, institutions, schools, and religious organizations we expect to see in established communities with a comfortable mix of lower, middle, and upper socioeconomic classes.

Deliverables

For this assessment.

Develop “Groupthink-No-More” guidelines for teams.

Complete either Option 1 or Option 2 for the second deliverable.

Use the professional format of your choice.

Address issues of groupthink as well as ways to expand thinking beyond the narrow, referral-based perspective currently monopolizing this hospital-based system.

Analyze a workplace problem by applying social psychology principles related to group processes.

How does this research affect teams?

Under what conditions does groupthink occur?

Assess the influence of the social context on individual emotions and behavior in group decision-making.

How would you instruct an individual to be more or less conforming, compliant, or obedient given society’s need for some conformity, compliance, and obedience, and humanity’s need to sometimes question authority?

How does personality play a role?

How do people react to conflict?

How do these principles relate to creativity and innovation in a group?

  • Integrate social psychology principles and research to develop guidelines for minimizing groupthink.
  • How should teams be constructed?

What is the role of conflict?

What cultural shift needs to occur within the organization?

Option 1: Develop one original, research-based individual activity to use in a group training workshop that demonstrates how to maximize independent, creative, and innovative thinking in a group.

Option 2: Propose a research-based team-training program with a minimum of three activities that demonstrate how to maximize independent, creative, and innovative thinking in a group.

The following criteria apply to both Option 1 and Option 2:

Integrate methods and principles of social psychology to develop training that promotes independent, creative, and innovative thinking.

Support guidelines and training with references from scholarly and professional literature.

Context
Groups
A group is defined as two or more individuals who influence one another through social interaction. Groups evolve norms, or shared perceptions, of what constitutes appropriate behavior. Groups also tend to develop expectations and either formal or informal roles about how each individual member of the group should behave. Group members also depend on one another to achieve group goals and therefore influence each other greatly.One important aspect of groups is the amount of cohesiveness they display. Cohesiveness is the strength of the relationship that links members of the group to one another. Many researchers (including Carless & DePaola, 2000; Dion, 2001) have looked at factors related to group cohesiveness.Understanding Organizations Using Social Psychology
It is useful to identify how educational programs and other organizations are studied and understood. One aspect of this process is the theory of planned behavior. You may be surprised to find out that attitudes do not always predict behavior. LaPiere (1934) was the first to document that, often, attitudes and behaviors do not match. Since that time, many researchers (Ajzen & Fishbein, 1977; Ajzen, 1991) have looked at factors that determine whether attitudes will be predictive of behavior.A systemic methodology based on sociocultural analysis of change using sociocultural tools is cultural historical activity theory (Engeström, 1987). Activity theory identifies the impact of mediational tools to a system undergoing change (Vygotsky, 1978). These tools can be both technical, such as a computer, and psychological, such as dialog. Both types of tools provide an immediate link between human activity and an external object. Wertsch (1998) maintained that a fundamental claim of sociocultural learning theory is the focus on human action mediated by cultural tools within the cultural, institutional, and historical context in which that action occurs. Cultural tools are “both material and symbolic; they regulate interaction with one’s environment and oneself” (Cole & Engeström, 1993, p. 9). This methodology is used to understand, from a sociocultural perspective, the integration of technologies into varied settings.This perspective has the potential to define the interactions in an organization based on the changes in the social dynamic through the integration of new tools, as well as providing a reasoned evaluation of the potential for change in varied settings (Russell, 2008).There are several theories concerning the interpersonal and individual dynamics of understanding organizations. As a result of reviewing these studies and related concepts, one might develop new awareness of one’s role in developing findings from observations of a social dynamic; for example, how does understanding fundamental attribution error reduce the potential of an error in an analysis of data and the definition of findings?References
Ajzen, I., & Fishbein, M. (1977). Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin, 84, 888-918.Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.Carless, S. A., & DePaola, C. (2000). The measurement of cohesion in work teams. Small Group Research, 31(1), 71-88.Cole, M., & Engeström, Y. (1993). A cultural-historical approach to distributed cognition. In G. Salomon (Ed.), Distributed cognition: Psychological and educational considerations. Cambridge University Press.Dion, K. L. (2001). Group cohesion: From “field of forces” to multidimensional construct. Group Dynamics: Theory, Research and Practice, 5(1), 7-26.Engeström, Y. (1987). Learning by expanding: An activity-theoretical approach to developmental research. Orienta-Konsultit Oy.LaPiere, R. T. (1934). Attitudes vs. action. Social Forces, 13, 230-237.Russell, D. (2008). The mediated action of educational reform: An inquiry into collaborative online professional development. In C. Ramesh, C. Sharma, & S. Mishra (Eds.), Cases on global e-learning practices: Successes and pitfalls (pp. 108-122). IDEA Group.Skiba, D. J. (2010). Back to school: What’s in your students’ backpacks? Nursing Education Perspectives, 31(5), 318-320.Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Harvard University Press.Wertsch, J. V. (1998). Mind as action. Oxford University Press.

POCCCCC SIM – 02

QUESTION

About

SIM Country Government is an Assignment where you unpack the term government and compare the governments of three countries.

What is Government?

According to Government – WikipediaLinks to an external site. , “A government is the system or group of people governing an organized community, generally a state.” Typically, when we think of “government” the concepts of democracies and dictatorships come to mind because these are readily held concepts. However, government is more complicated than simply labeling a country as a democracy or dictatorship.

A broader definition of government used by the Central Intelligence Agency’s World FactbookLinks to an external site. “includes the entries dealing with the system for the adoption and administration of public policy.”

Government includes the following:

Country name

Government type

Capital

Administrative divisions

Dependent areas

Independence

National holiday

Constitution

Legal system

International law organization participation

Diplomatic representation (in the and from the US)

Citizenship

Suffrage

Executive branch

Legislative branch

Judicial branch

Political parties and leaders

  1. International organization participation
  2. Flag QUESTION
  3. National symbol(s)
  4. National anthem
  5. What are different government types?
  6. According to References :: Definitions and Notes — The World Factbook – Central Intelligence Agency (cia.gov)Links to an external site., the following are definitions of major government types:
  7. Absolute monarchy– a form of government where the monarch rules unhindered, i.e., without any laws, constitution, or legally organized opposition.
  8. Anarchy– a condition of lawlessness or political disorder brought about by the absence of governmental authority.
  9. Authoritarian– a form of government in which state authority is imposed onto many aspects of citizens’ lives.
  10. Commonwealth– a nation, state, or other political entity founded on law and united by a compact of the people for the common good.
  11. Communist– a system of government in which the state plans and controls the economy and a single – often authoritarian – party holds power; state controls are imposed with the elimination of private ownership of property or capital while claiming to make progress toward a higher social order in which all goods are equally shared by the people (i.e., a classless society).
  12. Confederacy (Confederation)– a union by compact or treaty between states, provinces, or territories, that creates a central government with limited powers; the constituent entities retain supreme authority over all matters except those delegated to the central government.
  13. Constitutional– a government by or operating under an authoritative document (constitution) that sets forth the system of fundamental laws and principles that determines the nature, functions, and limits of that government.
  14. Constitutional democracy– a form of government in which the sovereign power of the people is spelled out in a governing constitution.
  15. Constitutional monarchy– a system of government in which a monarch is guided by a constitution whereby his/her rights, duties, and responsibilities are spelled out in written law or by custom.
  16. Democracy– a form of government in which the supreme power is retained by the people, but which is usually exercised indirectly through a system of representation and delegated authority periodically renewed.
  17. Democratic republic– a state in which the supreme power rests in the body of citizens entitled to vote for officers and representatives responsible to them.
  18. Dictatorship– a form of government in which a ruler or small clique wield absolute power (not restricted by a constitution or laws).
  19. Ecclesiastical– a government administrated by a church.
  20. Emirate– similar to a monarchy or sultanate, but a government in which the supreme power is in the hands of an emir (the ruler of a Muslim state); the emir may be an absolute overlord or a sovereign with constitutionally limited authority.
  21. Federal (Federation)– a form of government in which sovereign power is formally divided – usually by means of a constitution – between a central authority and a number of constituent regions (states, colonies, or provinces) so that each region retains some management of its internal affairs; differs from a confederacy in that the central government exerts influence directly upon both individuals as well as upon the regional units.

Federal republic– a state in which the powers of the central government are restricted and in which the component parts (states, colonies, or provinces) retain a degree of self-government; ultimate sovereign power rests with the voters who chose their governmental representatives.

Islamic republic– a particular form of government adopted by some Muslim states; although such a state is, in theory, a theocracy, it remains a republic, but its laws are required to be compatible with the laws of Islam.

Maoism– the theory and practice of Marxism-Leninism developed in China by Mao Zedong (Mao Tse-tung), which states that a continuous revolution is necessary if the leaders of a communist state are to keep in touch with the people.

Marxism– the political, economic, and social principles espoused by 19th century economist Karl Marx; he viewed the struggle of workers as a progression of historical forces that would proceed from a class struggle of the proletariat (workers) exploited by capitalists (business owners), to a socialist “dictatorship of the proletariat,” to, finally, a classless society – Communism.

Marxism-Leninism– an expanded form of communism developed by Lenin from doctrines of Karl Marx; Lenin saw imperialism as the final stage of capitalism and shifted the focus of workers’ struggle from developed to underdeveloped countries.

Monarchy– a government in which the supreme power is lodged in the hands of a monarch who reigns over a state or territory, usually for life and by hereditary right; the monarch may be either a sole absolute ruler or a sovereign – such as a king, queen, or prince – with constitutionally limited authority.

Oligarchy– a government in which control is exercised by a small group of individuals whose authority generally is based on wealth or power.

Parliamentary democracy– a political system in which the legislature (parliament) selects the government – a prime minister, premier, or chancellor along with the cabinet ministers – according to party strength as expressed in elections; by this system, the government acquires a dual responsibility: to the people as well as to the parliament.

Parliamentary government (Cabinet-Parliamentary government)– a government in which members of an executive branch (the cabinet and its leader – a prime minister, premier, or chancellor) are nominated to their positions by a legislature or parliament, and are directly responsible to it; this type of government can be dissolved at will by the parliament (legislature) by means of a no confidence vote or the leader of the cabinet may dissolve the parliament if it can no longer function.

Parliamentary monarchy– a state headed by a monarch who is not actively involved in policy formation or implementation (i.e., the exercise of sovereign powers by a monarch in a ceremonial capacity); true governmental leadership is carried out by a cabinet and its head – a prime minister, premier, or chancellor – who are drawn from a legislature (parliament).

  1. Presidential– a system of government where the executive branch exists separately from a legislature (to which it is generally not accountable).

Republic– a representative democracy in which the people’s elected deputies (representatives), not the people themselves, vote on legislation.

  1. Socialism– a government in which the means of planning, producing, and distributing goods is controlled by a central government that theoretically seeks a more just and equitable distribution of property and labor; in actuality, most socialist governments have ended up being no more than dictatorships over workers by a ruling elite.

Sultanate– similar to a monarchy, but a government in which the supreme power is in the hands of a sultan (the head of a Muslim state); the sultan may be an absolute ruler or a sovereign with constitutionally limited authority.

  1. Theocracy– a form of government in which a Deity is recognized as the supreme civil ruler, but the Deity’s laws are interpreted by ecclesiastical authorities (bishops, mullahs, etc.); a government subject to religious authority.

Totalitarian– a government that seeks to subordinate the individual to the state by controlling not only all political and economic matters, but also the attitudes, values, and beliefs of its population.

  1. Instructions

Step 1: Select two countries to learn about their “government type”

  1. Go to Country Summaries – The World Factbook (cia.gov).Links to an external site.

Select two different countries that you want to learn more about.

  1. Step 2: Review the United States’ Summary @ The World Factbook (cia.gov)Links to an external site.

Step 3: Explain each of the following comparisons in 3 or more sentences.

  1. Compare government type of country 1 to the United States.

Compare government type of country 2 to the United States.

  1. Compare government type of country 1 to country 2.