Module 01 Discussion – Clinical Judgment

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Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings.

Keeping that in mind, answer the following scenario:

You are the Charge Nurse in a large Urban Emergency Department (ED). You nursing staff include:

  1. RN with 12 years of Trauma ED experience
  2. New RN with 6 months ED experience
  3. RN from the Medical Surgical floor with 8 years of experience

The following patients are in the ED, which patient will you give to each of the nurses and why?

  1. A 76-year-old client who was involved in a motor vehicle accident and has hematuria.
  2. A 38-year-old client with kidney stones complaining of severe pain.
  3. A 24-year-old diabetic client with an acute urinary tract infection who will require discharge teaching.
  4. An 80-year-old client that has not had a bowel movement for 4 days.

 

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What is the standard error of estimate for supervisory ratings and dollar revenue? Show your calculations.

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COLLAPSE

XYZ is a new start up company that has about 150 employees. The company provides plumbing services to residential customers. The company has had a high turnover of plumbers, mostly due to the plumber’s lack of knowledge and customer service skills. In order to address this, the company wanted to strengthen their selection process. So, they followed the procedure outlined below:

1. They selected 40 of their most successful plumbers (those who received outstanding customer feedback and had near zero calls from the customers about the work performed by these plumbers).

2. The company developed a 50-items multiple choice exam with four possible answers with only one answer being the correct one. Also, the company had another 50 questions consisting of True or False choices. Thus, the test had 100 questions.

3. The company asked the 40 plumbers to take the Plumbing Knowledge Test (PKT) during their work hours (they were paid for the time). These plumbers had an average of 2.5 years of plumbing experience and their experience ranged from 1 to 6 years. After the scoring of the test, the company correlated their test scores with the supervisory rating of their job performance which was measured using 5= Excellent, 4 = Above Average, 3 = Average, 2 = Needs Improvement, and 1 = Well Below Average. This process yielded a correlation of 0.68. The company also correlated the test scores of these 40 individuals with the revenue generated by each of them ($). This process yielded a correlation of 0.43.

4. As the company decided that it is useful to use the test for future hires, they starting using it in the next round of hiring. They filled another twenty vacancies and the prospective applicants were asked to take the PKT and used a minimum cutoff score of 70% to hire the 20 plumbers. After six months, the company used the same process of correlating their test scores with supervisory rating (r = 0.52) and revenue generated in $ (r = 0.37).

Discussion Questions:

1. What are the validation strategies used by this company? Explain.

2. What are the reasons for the validity coefficients to be different for the supervisory ratings and revenue generated for both the 40 employees sample and the 20 employees sample?

XYZ is a new start up company that has about 150 employees. The company provides plumbing services to residential customers. The company has had a high turnover of plumbers, mostly due to the plumber’s lack of knowledge and customer service skills. In order to address this, the company wanted to strengthen their selection process. So, they followed the procedure outlined below:

1. They selected 40 of their most successful plumbers (those who received outstanding customer feedback and had near zero calls from the customers about the work performed by these plumbers).

2. The company developed a 50-items multiple choice exam with four possible answers with only one answer being the correct one. Also, the company had another 50 questions consisting of True or False choices. Thus, the test had 100 questions.

3. The company asked the 40 plumbers to take the Plumbing Knowledge Test (PKT) during their work hours (they were paid for the time). These plumbers had an average of 2.5 years of plumbing experience and their experience ranged from 1 to 6 years. After the scoring of the test, the company correlated their test scores with the supervisory rating of their job performance which was measured using 5= Excellent, 4 = Above Average, 3 = Average, 2 = Needs Improvement, and 1 = Well Below Average. This process yielded a correlation of 0.68. The company also correlated the test scores of these 40 individuals with the revenue generated by each of them ($). This process yielded a correlation of 0.43.

4. As the company decided that it is useful to use the test for future hires, they starting using it in the next round of hiring. They filled another twenty vacancies and the prospective applicants were asked to take the PKT and used a minimum cutoff score of 70% to hire the 20 plumbers. After six months, the performed two simple linear regression models.

a. In model 1, they used the supervisory rating as the criterion and the test scores as the predictor. They got the following equation:

Y = 1.28 + 0.38(X). The standard deviation of Y was 0.90 and the validity coefficient of the test with supervisory rating is 0.53.

b. In model 2, they used the dollar revenue as the criterion and the test scores as the predictor. They got the following equation:

Y = 358.08 + 1.70(X). The standard deviation of Y was 258.04 and the validity coefficient of the test with dollar revenue is 0.58.

Discussion Questions:

1. What is the standard error of estimate for supervisory ratings and dollar revenue? Show your calculations.

2. Assume that an applicant scored 85 on the test. What are his predicted supervisory ratings? Dollar revenue generated for the company?

3. Using the standard error of estimate you calculated above, provide the range of expected performance as indicated by the supervisory rating and dollar revenue for a person who scored 85 on the test.

 

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Health Course

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Briefly answer the following questions.  Submit inline.

 

1.  Describe the differences between chlamydia, pelvic inflammatory disease, herpes simplex virus and HIV.  What actions can be taken to limit infection risk?

2.  Hormone replacement therapy for menopause or ‘natural’  treatments or use nothing.  What does each involve.  Why is there controversy?

3.  List at least 3 signs of abuse.  Can abuse always be noticed by others?  What would you advise a friend to do if you suspect that she is a victim of abuse?

 

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Mechanism of providing health care

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QUESTIONAUG 13, 2017

Discussion board replies

Reply prompt: Respond to the two discussion questions from classmates who reached a different conclusion than you did. Identify the points of difference in your analyses and explain how your sources and analysis led you to your conclusion. Replies must be at least 450 words each discussion reply. Each reply must reference at least 3 scholarly sources and follow current APA format (including both in-text citations and a reference list). You must also support each reply with thoughtful analysis (considering assumptions, analyzing implications, and comparing/contrasting concepts and include thorough biblical worldview integration.

Discussion Question #1

Introduction

Managed health care is defined as “a mechanism of providing health care services in which a single organization takes on the management of financing, insurance, delivery and payment “(Shi &Singh, 2017). The first health maintenance organization (HMO) is said to have been the Western Clinic in Tacoma Washington in 1910. It offered a range of medical services to lumber mill owners and their employees for a cost of fifty cents per month (Fox & Kongstvedt, 2007). The HMO act of 1973 introduced the capitation system as opposed to the fee- for service system to help reduce the increasing cost to Medicare. The full effects of the act were not enacted until 1977 at which time the number of HMO’ s bean to rise. The preferred provider organization (PPO) entered the game in the late 70’s and early 80’s (Fox & Kongstvedt, 2007).

Explain the growth of managed care that began in the 1980’s

The growth of managed health care in the 1980’s was due to the out of control increases in health care. The consumer price index rose by 59% but medical care was up 117% (Shi &Singh, 2017). Most companies began to use the MCO’s to help decrease the health care costs because they were affecting the profitability of the company. Medicare and Medicaid began to use MCO’s to control costs but also to ensure quality of care based on patient need not the current fee for service where physicians would order unnecessary tests or procedures (Shi &Singh, 2017). During the last of the 1990’s MCO’s began to decline due to public opinion concerning the quality of care and the amount of control the MCO’s had over the reimbursement and utilization aspects pertaining to hospitals and physicians.

How has health care delivery evolved?

The future of health care delivery will see an increase in various types of managed care options ranging from the long time HMO and PPO to the newer Accountable Care Organization (ACO) and the Patient-Centered Medical Home (PCMH). The ACO is an integrated delivery system (IDS) that includes hospitals, physicians and post discharge care. The ACO must be a legal entity and have a governing body to provide oversight (Shi &Singh, 2017). PCMH’s focus on the patient beyond their medical needs. “Each patient is unique and will have specific needs” (Rusnuck,2017). The practice must be: physician-led, comprehensive, coordinated, accessible, and committed to quality and safety(Rusnuck,2017).

Based on the literature, what does the future hold?

As our population grows and ages we will need a solid health care system to provide the best quality care while controlling costs. As Aristotle said, “The whole is greater than the sum of its parts.” It will take a community effort on the part of the financing, insurance, delivery and payment groups to achieve the ultimate health care product. We can expect for MCO’s to continue to shape our health care system. There will be a continuing push for quality of life for   patients and incentives and accountability for health care providers.

Conclusion

Philippians 2:4-7 states “Don’t look out only for your own interests, but take an interest in others, too. You must have the same attitude that Christ Jesus had. Though he was God, he did not think of equality with God as something to cling to. Instead, he gave up his divine privileges; he took the humble position of a slave and was born as a human being. When he appeared in human form.” If we can develop a strong managed heath care plan with this verse in mind we may be able to have a plan that will benefit the investors as well as the patient. (word count 609)

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