Comparison of U.S./Other Healthcare System Paper

750 words APA format WRITE a paper (at least 750 words) comparing and contrasting the healthcare system of your selected country and the United States (U.S.) healthcare system.

Choose one (1) country from the following list. These countries ranked high (in the top 20) on the WHO overall healthcare system rankings:

 France
 Italy
 Singapore  Spain
 Oman
 Austria
 Japan
 Norway
 Portugal
 Iceland

 Netherlands
 United Kingdom  Ireland
 Luxembourg
 Switzerland

For assistance on searching for information about your selected country, see Module 1 (Term Paper Assignment instructions). For the United States (U.S.) healthcare system and health care reform, use the following references to find information (the references below are in APA format and can be cited in your paper):

   Chua, K. (2006, February 10). Overview of the U.S. healthcare system. Retrieved from http://www.stritch.luc.edu/lumen/MedEd/IPM/ipm3/BPandJ/HealthCareSystemOverview -AMSA%2020062_25_09.pdf
Article is a little old (2006), but a concise summary of U.S. healthcare system.

   Shay, P., & Schumacher, E. (2014). U.S. health care delivery: An overview. San Antonio, TX: Trinity University.
(CLICK on POWERPOINT file: US HEALTH CARE OVERVIEW
A more recent (2014) PowerPoint presentation, includes tables and statistics on U.S. health.

   Centers for Disease Control and Prevention (CDC). (2015, July 17). FastStats: How healthy are we? Retrieved from http://www.cdc.gov/nchs/fastats/healthy.htm Up-to-date U.S. health statistics from the CDC.

    Agency for Healthcare Research and Quality (AHRQ). (2011). Disparities in healthcare quality among racial and ethnic groups: Selected findings from the 2011 National Healthcare Quality and Disparity reports. Retrieved from http://archive.ahrq.gov/research/findings/nhqrdr/nhqrdr10/minority.html

Provides tables/statistics on inequity/inequality health care issues among U.S. racial/ethnic groups.    Jackson, J., & Nolen, J. (2010, March 21). Health care reform summary: A look at what’s in the act . New York: CBS News. Retrieved from http://www.cbsnews.com/news/health-care-reform-bill-summary-a-look-at-whats-in-the- bill/

or (CLICK on the PDF file: HEALTH CARE REFORM) Provides a concise summary of the Affordable Care Act.

 

 

You MUST use the following major headings to compare the U.S. and your country. To organize the content of your paper for the “comparison” discussions, you MUST use the level heading titles & positions that are found at the end of this module. These level heading titles & positions are in APA format.

 

 

PAPER HEADING: Introduction Selection of country (name of country and reason for choice). See module readings for U.S. health care system information.

 

 

PAPER HEADING: Health Statistics and Costs Discuss the following: 1) life expectancies; 2) mortality rates; 3) major health conditions/diseases; 4) health care expenditure ($) per capita as ratio of total population; and 5) health care expenditure (% of gross domestic product) for U.S. and your selected country. For the U.S., see module readings ( Chua ; Shay & Schumacher; CDC) or more recent internet sources, if available.

 

 

PAPER HEADING: Health Care Financing Discuss the following: 1) How is health care financed for its citizens — through public sector [taxes] or the private sector [personal or employer] or a combination of both? 2) How are the funds (private & public) collected? 3) If a combination of financing, what are the percentages of private/public? 4) For the U.S., how is the new Affordable Care Act financed? For the U.S., see module readings ( Chua; Shay & Schumacher; Jackson & Nolan) or more recent internet sources, if available.

 

 

PAPER HEADING: Health Care Administration Discuss the following: Which national government agencies (major agency and its assisting agencies) a) oversee, b) regulate, and c) service the provision of health care for its citizens (i.e., employed, low income, elderly, uniformed personnel, veterans, native Americans)? For the U.S., see module readings ( Phillips; Chua) or more recent internet sources, if available. Describe agency missions/functions/purposes. Be brief: 1-2 sentences for each U.S. agency is sufficient. For your selected country, an example is the Ministry of Health (or its equivalent) along with its assisting agencies.

  PAPER HEADING: Human Resources Discuss the following: What are the total numbers and/or number (per 100,000 population) of 1) nurses; 2) physicians; and 3) hospitals/hospital beds for U.S. and your selected country? For the U.S., see module readings ( Chua) or more recent internet sources, if available.

 

 

PAPER HEADING: Conclusion: Access and Equity Issues Discuss the following: 1) Does the country have citizens/populations who are uninsured, underinsured, and/or experience health disparities? 2) Which citizens or populations (i.e, ethnic, income, and/or immigrant groups) in the U.S. and your selected country? For the U.S., see module readings ( AHRQ) or more recent internet resources, if available.

 

 

5) See below for how to format the headings . Headings levels are important in a professional paper because they provide organization and progression for the reader. APA format standardizes levels/positions, although heading levels may differ somewhat according to the type of paper and discussion. Use the APA-formatted heading levels below to differentiate your countries and include a short comparison discussion.

 

 

 

I have included an example of heading levels for your first paper:

Repeat the title of paper [centered] at top of page 2: Comparison of Health Care Systems: United States and Iceland

Introduction [Level 1] (centered) Discussion begins…. (paragraph[s] form of at least two sentences

Health Statistics and Costs [Level 2] (flush left)

A short paragraph (at least two sentences) must introduce the level 3 sub-headings you are going to discuss in this section. For example: “The discussion below provides information about and compares the health statistics and costs of the United States and Iceland. Health statistics include life expectancies and mortality rates, major health conditions and diseases, health care expenditure dollars ($) per capita, and health care expenditure as a percentage (%) of gross domestic product (GDP).”

United States . [Level 3] Level 3 heading is indented with period, only first word is capitalized (unless a proper noun), discussion begins immediately after heading….

Iceland . [Level 3] Discussion begins…. Comparison of countries . [Level 3] Discussion begins… Health Care Financing [Level 2] (flush left)

A short paragraph (at least two sentences) must introduce the level 3 sub-headings you are going to discuss in this section. See above for example.

United States . [Level 3] Level 3 heading is indented with period, only first word is capitalized (unless a proper noun), discussion begins immediately after heading….

Iceland . [Level 3] Discussion begins….

Comparison of countries . [Level 3] Discussion begins… and so on to complete the paper topics ……

Conclusion: Access and Equity Issues [ Level 1 ] (centered) Discussion begins…. ( paragraph[s] form)

References [Level 1] (new page, centered) 6)  In-text citations and a reference list MUST be found in your paper. See the Nursing Student

Writing Guidelines Checklist for APA formatting.

  8)  WRITING EVALUATION: See Rubric on Course Content page

Paper: Comparison of U.S. & Other Country Health System (100 pts)

Introduction; Comparison of: Health Statistics and Costs; Health Care Financing; Healthcare Administration; Human Resources; Conclusion: Access and Equity Issues
Critical Thinking Skills (15 pts); Content Development (15 pts); Organization (15 pts) References (15 pts); Format (15 pts); Computer/Technology Skills (25 pts) 

 

 
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Research Article Critique paper

   Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, or othenwise reuse any or all content from this article, e-mail [email protected] To purchase high-quality reprints, e-mail [email protected] Online Exclusive Article Preferences for Photographic Art Among Hospitalized Patients With Cancer Hazel Hanson, MSN, RN, ACNP-BC, OCN®, Kathtyn Schroeter, PhD, RN, CNOR, CNE, Andrew Hanson, MSN, RN, FNP-BC, CCRN, Kathryn Asmus, MSN, RN, OCN®, and Azure Grossman, BSN, RN, OCN® A lternative and complementary therapies may increase patient satisfaction, wellbeing, and outcomes and may be beneficial during extended stays. Music therapy, art therapy, massage therapy, meditation, and relaxation have helped many people v^ith cancer (American Cancer Society, 2012). Complementary therapies have been evaluated with the cancer population, but little is known about the specific impact of photography (Geue et al., 2010; Oncology Nursing Society, 2009). Many hospitals now provide patients with meditation rooms and healing gardens. Thoughtfully selected artwork, including photographs, paintings, prints, and sculptures, also are found on display throughout hospitals. Although many patients and visitors can take advantage of walking outside, patients with cancer, by virtue of their decreased white blood cell counts, often are prohibited the benefits of communing with nature. Photography, however, may be one way for patients to experience the benefits of nature. In addition, although fewer patients with cancer reqtiire hospitalization at the current study facility, those that do typically are hospitalized for extended stays. The researchers of the current study have noted that, during those stays, the patient’s quality of life (QOL) and experience of the hospital environment become vitally important. Nightingale (1860) wrote about the significance of the environment for its impact on physical health, mental health, and recovery. She recognized that to regain health, people need adequate ventilation, odor reduction, and windows for natural light and outdoor views. Nightingale (1860) believed that integrating the natural environment with views of the outdoors was a strategy to improve human comfort. More than 150 years later, the impact of the aesthetics of the hospital environment on patients and healing is still being explored. Photographic art is a form of aesthetics that may positively impact a patient’s hospital experience. The primary purpose of this descriptive Purpose/Objectives: To determine the preferences of patients with cancer for viewing photographic art in an inpatient hospital setting and to evaluate the impact of viewing photographic art. Design: Quantitative, exploratory, single-group, post-test descriptive design incorporating qualitative survey questions. Setting: An academic medical center in the midwestern United States. Sample: 80_men (n = 44) and women (n = 36) aged 19-85 years (X = 49) and hospitalized for cancer treatment. Methods: Participants viewed photographs via computers and then completed a five-instrument electronic survey. Main Research Variables: Fatigue, quality of life, performance status, perceptions of distraction and restoration, and content categories of photographs. Findings: Ninety-six percent of participants enjoyed looking at the study photographs. The photographs they preferred most often were lake sunset (76%), rocky river (66%), and autumn waterfall (66%). The most rejected photographs were amusement park (54%), farmer’s market vegetable table (51%), and kayakers (49%). The qualitative categories selected were landscape (28%), animals (15%), people (14%), entertainment (10%), imagery (10%), water (7%), spiritual (7%), flowers (6%), and landmark (3%). Some discrepancy between the quantitative and qualitative sections may be related to participants considering water to be a landscape. Conclusions: The hypothesis that patients’ preferences for a category of photographic art are affected by the psychophysical and psychological qualities of the photographs, as well as the patients’ moods and characteristics, was supported. Implications for Nursing: Nurses can play an active role in helping patients deal with the challenges of long hospital stays and life-threatening diagnoses through distraction and restoration interventions such as viewing photographic images of nature. Knowledge Translation: Nurses can use photographic imagery to provide a restorative intervention during the hospital experience. Photographic art can be used as a distraction from the hospital stay and the uncertainty of a cancer diagnosis. Having patients view photographs of nature is congruent with the core nursing values of promoting health, healing, and hope. Oncology Nursing Forum • Vol. 40, No. 4, July 2013 E337 study was to deternüne the preferences of patients with cancer for vievdng photographic art. The secondary aim of this study was to evaluate whether viewing photographic art is perceived by patients as being distracting, restorative, or both. Theoretical Framework Two theoretical frameworks. Nightingale’s (1860) and Han’s (1999), were used in this study design. Nightingale purported that nurses should manage their patients’ environments so as to assist nature in the overall reparative process. The nurse must construct environmental settings that are appropriate for the gradual restoration of the patient’s health and coordinate the external factors associated with the patient’s surroundings that can affect the patient’s life or physiologic processes (Nightingale, 1860). Han’s (1999) midrange theory. Integrated Landscape Assessment Theory, provided the current study with the foundation that identified and defined the constructs and concepts that were measured, as well as their relationships. Landscape assessment predicts “how attributes of environments relate to a wide range of cognitive, affective, and behavioral responses” (Wong, 1989, p. 6). Viewing high-quality aesthetic scenes evokes positive feelings, whereas viewing lowquality scenes evokes negative feelings. A person’s response to the scenes positively or negatively impacts his or her functioning and sense of well-being. Han’s (1999) theory explains the relationship among the physical qualities of photographs and people’s moods and preferences for specific photographs. Applied to this study, qualities of the photographs and the person’s mood determine his or her preference for types of photographs. Theoretical constructs include psychophysical factors (e.g., openness, depth, penetration), psychological factors (e.g., coherence, legibility, mystery, complexity), mood states (e.g., relaxed, anxious, fatigued, grouchy) and preferences for specific photographs (e.g., category, delivery method, viewing time). Literature Review The significance of viewing nature as a method to enhance healing was documented in a landmark study of two groups of hospitalized postoperative patients, one group with a window view of deciduous trees and the other group with a view of a brick wall (Ulrich, 1984). Findings indicated significantly shorter postoperative hospital stays and decreased pain levels in the group who viewed the trees. Ulrich and Gilpin (2003) recommended guidelines for selecting art for patients by arguing that viewing water, landscapes, flowers, and figurative art conveyed optimism and safety to patients. Kaplan (1995) also recommended inclusion of natural passages. Subject matter that portrays uncertainty, negativity, overcast scenes with ominous weather, or surreal qualities should be avoided (Hathom & Ulrich, 2001; Marberry, 1995; Ulrich, 1991). Photographs of nature have been associated with improved outcomes in patients undergoing short-term noxious procedures and treatments. Researchers studied the viewing of different forms of photography and the impact on pain associated with dressing changes (Miller, Hickman, & Lemasters, 1992), sigmoidoscopies (Lembo et al., 1998), and bronchoscopies (Diette, Lechtzin, Haponik, Devrotes, & Rubin, 2003). Changes in patient outcomes were attributed to distraction. Findings indicated an improvement in outcomes across all the studies ranging from decreased pain and discomfort, need for sedation, and side effects of therapy. Similar positive outcomes are noted in people receiving chemotherapy treatment who viewed scenes of nature via virtual reality (Schneider, Ellis, Coombs, Shonkwiler, & Folsom, 2003; Schneider & Hood, 2007). Women with breast cancer experienced a significant decrease in anxiety (Schneider et al., 2003). Participants with breast, colon, or lung cancer (men and women) enjoyed the experience and perceived the treatment as shorter, but no significant differences in symptom distress were observed (Schneider & Hood, 2007). Again, the authors postulated that the nature scenes improved participants’ outcomes because they were distracting. Other researchers believe the positive effects of viewing or being present in nature are restorative rather than distracting (Hartig, Korpela, Evans, & Gärling, 1997; Herzog, Black, Fountaine, & Knotts, 1997). Attention Restoration Theory (Kaplan, 1995, 2001; Kaplan & Kaplan, 1989) suggests one’s actual presence in or viewing of photographs of nature results in restoration from mental fatigue. Being present in nature and viewing photographs of nature is associated with positive health outcomes (Cimprich, 1993; Diette et al., 2003; Lembo et al, 1998; Miller et al., 1992; Schneider et al., 2003; Schneider & Hood, 2007). Explanations for these positive effects range from the satisfaction people experience being in a pleasant setting to an actual experience of restoration experienced when, without effort, a person who is fascinated by a picture experiences a sense of being somewhere else. In their effort to understand the restorative nature of photographic art, researchers had healthy individuals identify nature scenes they perceived as restorative (Feisten, 2009; Berman, Jonides, & Kaplan, 2008; Han, 2007; Herzog et al, 1997). Participants preferred nature rather than urban scenes (Berman et al., 2008; Herzog et al., 1997) or sports or entertainment scenes (Herzog et al., 1997) and chose photographs of tundra and coniferous forests over deserts and grasslands (Han, 2007). E338 Vol. 40, No. 4, July 2013 • Oncology Nursing Forum Patients valued art in their hospitalized rooms and preferred images of realistic art with nature content, including animals, water, flowers, and landscapes (Nanda, Eisen, & Baladandauthapani, 2008; Nanda, Ha thorn, & Neumann, 2007). Patients liked nature images offering a sense of familiarity, greenery, or environments in which they could envision themselves. In contrast, the students ranked abstract art and stylized nature significantly higher than the patients. Although positive effects have been observed, little is known about the best process to make photographic art available to hospitalized patients. Some gaps exist in the literature related to the therapeutic use of photographic art, including poor understanding of the mechanism for how photographic art works. Two mechanisms have been proposed. Photographic art works by distracting people from their current unpleasant or noxious situation or by relieving mental fatigue and restoring the person (Cimprich, 1993; Diette et al., 2003; Hartig et al., 1997; Herzog et al., 1997; Kaplan, 1995, 2001; Kaplan & Kaplan, 1989; Lembo et al., 1998; Miller et al., 1992; Schneider et al., 2003; Schneider & Hood, 2007). Another gap is the contradictory information that exists about the types of photographs people prefer and differences in preferences across ages, genders, and personal health states (Berman et al., 2008; Feisten, 2009; Han, 2007; Herzog et al., 1997; Nanda et al, 2007,2008). As a result of the literatiire analysis, the following research questions were identified. • How do patients like viewing the photographs? • What are patients’ general predispositions toward viewing photographic artwork? • What category of photographs and which specific photographs do patients prefer? • What category of photographs and which specific photographs do patients reject? • What types of delivery formats do patients prefer when viewing photographs? The authors hypothesized that patient preference for a category of photographic art (dependent variable) is affected by the psychophysical and psychological qualities of photographs and the patient’s mood and characteristics (e.g., age, gender, race or ethnicity, performance status, socioeconomic status [SES], QOL, fatigue). Methods The current study used a quantitative, exploratory, single-group, post-test descriptive design in addition to incorporating some qualitative survey questions for analysis. A convenience sample of 90 people hospitalized for treatment of cancer was recruited. Patients were eligible for this study if they were aged 18 years or older, admitted to the blood and marrow transplantation (BMT) or hematology/oncology services for at least 24 hours, medically stable, able to participate in the research as determined by the RN responsible for their care, English speaking, able to consent, and able to view the photographs on a computer screen. Setting The stiidy took place on the 12-bed BMT and 15-bed hematology/oncology inpatient units of the 450-bed Froedtert Hospital and the Medical College of Wisconsin, an academic medical center in the midwestern United States. All patient rooms for this study were single occupancy and located on the fourth floor of an eight-story wing of the hospital. Most of the rooms have an exterior window with a view of buildings and parking lots with land and trees in the distance. Six rooms on each unit face a courtyard, which contains shrubbery and trees along with a small fountain; however, trees and ñowers in the courtyard are visible only when standing or sitting in a chair next to the window. The rooms are painted beige; have healthcare information flyers, printed signs, or posters affixed to walls; and have a clock and 24-inch television mounted to the wall along with a DVD player. Neither the rooms nor hallways contained photographic art. During the patients’ stay, many kept greeting cards or pictures of family, friends, or pets on their window sills or bulletin boards. Because of their immunocompromised conditions, patients usually were confined to the vtnit except to leave for tests or procedures. The majority of patients admitted to both the BMT and hematology/oncology units have a diagnosis of leukemia, lymphoma, or multiple myeloma. The average length of stay for patients in these settings is 12.4 days for BMT and 6.8 days for hematology/oncology. The average number of patients admitted to the BMT and hematology/oncology units is 18 and 40 patients per month, respectively. Measures Several measures were used to collect and analyze data for this study. Demographic and descriptive information: Demographic and descriptive information that was collected included age, gender, diagnosis, number of days hospitalized, service, unit, race or ethnicity, and marital status. The number of days hospitalized was defined as the day of admission to the day the patient viewed the DVD that contained the photographs. That information was obtained from the unit census report. Performance status: The Eastern Cooperative Oncology Group (ECOG) Performance Status is a simple assessment tool used to measure physical functioning in patients with cancer. The ordinal scale is graded by healthcare providers (Oken et al, 1982). Patients receive a score ranging from 0 (fully active without restriction) to 5 (dead). Oncology Nursing Forum • Vol. 40, No. 4, July 2013 E339 Table 1. Participant Characteristics (N = 80) Characteristic Age (years) Length of stay (days) Characteristic Gender Male Female Marital status Married Single Divorced Widowed Live with significant other Separated Education 8th grade or less Some high school High school graduate or GFD Some college or two-year degree Four-year college graduate More than four-year college degree Race Caucasian African American Bi racial American Indian Asian Mexican Service Hematology Blood and marrow transplantation Diagnosis Leukemia Lymphoma Other Multiple myeloma ECOG score 0 1 2 3 X 49 7 SD 15.48 12.91 Range 19-85 1-107 n 44 36 51 14 7 6 1 1 2 1 14 30 19 14 72 3 2 1 1 1 54 26 27 23 19 11 47 23 3 7 FCOG—Eastern Cooperative Oncology Group Socioeconomic status: The Hollingshead (1975) Four-Factor Index of Social Status measures SES and was used as a variable predictive of health outcomes (Lawson & Boek, 1960). The Hollingshead measure is a well-researched tool that computes an individual’s SES based on education, occupation, and spouse’s education and occupation, if applicable (Cirino et al., 2002). Quality of life: Quality of life was assessed with the QOL Linear Analog Scale-Assessments (LASA), a simple tool measuring perceived level of functioning. The tool consists of five single-items, each targeting a specific domain of QOL (Brown et al., 2008). The domains include physical (e.g., fatigue, activity level), emotional (e.g., depression, anxiety, stress), spiritual (e.g., sense of meaning, relationship with God), intellectual (e.g., ability to think clearly and concentrate), and overall well-being. The 11-point linear scales range from 0 (as bad as it can be) to 10 (as good as it can be). When used with patients with cancer, the QOL LASA had a Cronbaeh alpha ranging from 0.83-0.88 (Locke et al., 2007). The results of this five-item scale are comparable with results of lengthier measures of QOL. Fatigue: As recommended by the Fatigue Guidelines Panel of the National Comprehensive Cancer Network ([NCCN], 2013) Oncology Practice Guidelines, a singleitem, numeric rating scale was used to measure general fatigue intensity during the past three days. The 11-point linear rating scale ranged from 0 (no fatigue) to 10 (worst fatigue imaginable). The simple tool is used in outpatient oncology settings and is predictive of poor outcomes (Butt et al., 2008). Visual Arts Research Survey: Based on the literature (Han, 2003,2007; Hartig et al., 1997; Kaplan & Kaplan, 1989; Ulrich & Gilpin, 2003), the researchers developed a survey to match the purpose of the study. The Visual Arts Research Survey contained 35 questions focusing on patient preferences for photographic art, mood state or emotional response, and distraction or restoration. Two open-ended questions were used to allow participants to express their preferences and to give any other comments regarding the overall study process. Participants were given two pages containing thumbnail images of all the photographs on the DVD and asked to select the images they would like to see in their hospital room and those they would not like to see. Photographs A DVD of 60 photographs was displayed on laptop computers for this study. The DVD used software allowing participants to control the length of time each photograph was displayed on the computer screen. The photographs used in this study were chosen from the personal collections of a freelance photographer and a nationally recognized photographer whose photographs have been used in previous research (Nanda et al., 2007). Han’s (2007) intricate selection criteria guided the research team in evaluating the selected photographs based on the following criteria: horizontal layout, high photographic quality, openness, variety, and complexity. Prior to making the final selection of photographs to be used in this study, a small group of people with cancer (patient advisory board) shared their thoughts on photographs. As a result of their comments, bright, cheerful colors and variety were considered in selecting the photographs. Categories for the photographs (e.g., landscapes, water, flowers, animals, landmarks, entertainment) were based on research findings and suggested guidelines for appropriate healthcare art (Nanda et al., 2008; Ulrich & Gilpin, 2003). E340 Vol. 40, No. 4, July 2013 • Oncology Nursing Forum Procedure Following approval from the Froedtert Hospital and the Medical College of Wisconsin’s institutional review board, participants were recruited via personal contact. Patients who met the eligibility requirements were invited to participate in the study by a member of the research team. RNs were used in this study as data collectors based on a previous request from the nursing staff to have more experience participating in nursing research activities. Data collectors who were RNs on the BMT or hematology/oncology units did not collect data on the unit on which they worked. Visitors were encouraged to leave the room during the study; however, visitors who remained in the room were requested to remain quiet, allowing participants the freedom to express their own thoughts and opinions. The data collector assisted the participant in unplugging or turning off the hospital phone, personal cell phone, television, personal computer, and/or radio to minimize interruptions. The data collector set up the study’s laptop computer on the participant’s bedside table and explained the procedure. Throughout the study, the data collector remained quiet in the room, timed the viewing of the DVD with a stop watch, and was available to assist with any unforeseen computer problems or participant questions. After participants viewed the 60 photographs, the data collector set up the computer for the participant to complete the Visual Arts Research Survey. The survey was conducted via a secure Internet survey site, Qualtrics^M. A three-digit identification number was assigned to each participant linking paper and electronic data. The data collector assisted the participant with the first six questions of the survey to ensure information was accurate and to assess the participant’s comfort level with the computerized survey. The data collector was permitted to assist the participant in reading questions aloud and explaining the computerized survey tool if the participant was unable to read or wanted assistance in using the computer. The paper survey results were transcribed by the data collector onto a recording sheet that included the participant identification number so that the data could be entered into a statistical program at a later date. Participants who had consented and been transferred to a different unit prior to completing the study were given the opportunity to complete the study on their new unit. The two open-ended questions were analyzed by a group of three research team members who individually grouped the participants’ responses into categories and then came together to compare categories. The group matched the participants’ responses to the categories in the study (landscape, water, flowers, animals, entertainment, and landmark) and also identified three miscellaneous categories: people, spiritual, and imagery. Results Results reflect both quantitative and qualitative data. A total of 146 patients hospitalized for treatment of cancer were eligible to participate in the study, but 66 did not participate because of refusal, increasing illness, or staffing limitations that impacted study follow-up. The final study sample was comprised of 80 adults aged 19-85 years (X = 49 years) (see Table 1). The majority (91%) of the participants had a performance status of 0-2, meaning they were ambulatory with limited ability to carry out work activities, whereas 9% of participants were classified as at least grade 3, meaning they were partially or completely confined to a bed or chair and had limited abilities for self-care. When evaluating their QOL, participants rated their spiritual and intellectual well-being during the past week the highest, with means of 8.75 (SD = 2.09) and 8.74 (SD = 1.81), respectively. Their physical well-being was rated the lowest, with a mean of 6.61 (SD = 2.28), and emotional and overall well-being were rated in the middle, with means of 7.76 (SD = 2.17) and 7.8 (SD = 2.03), respectively. Respondents rated their fatigue during the last three days at a mean of 5.39 (SD = 2.34). When asked to rate their emotional response to looking at the study photographs on a scale of 1 (not at all) to 10 (a great deal), the mean response to “grouchy” was 2.31 (SD – 2.33), whereas the mean responses to “happy” and “hopeful” were 6.63 (SD = 2.6) and 7.58 (SD = 2.32), respectively After looking at the study photographs, participants rated their perceptions of distraction and restoration (see Table 2). The vast majority of the participants (96%) Table 2. Participants’ Perceptions of Distraction and Restoration (N= 80) Variable SD Data Analysis Data from the secured Internet site were automatically extracted and transferred to SPSS®, version 17. Descriptive statistics were used, as well as qualitative analysis of specifically designed survey questions. Interested in the photographs 8.33 1.76 Thought the photographs were fascinating 8.3 1.72 Believe it is helpful for patients to look at photographs 8.29 1.79 Attention was pulled to viewing the photographs. 8.23 1.72 Photographs held their attention. 8.21 1.76 Photographs were a good distraction. 8.1 2.06 Note. Scores were on a scale ranging from 1 (not at all) to 10 (a great deal). Oncology Nursing Forum • Vol. 40, No. 4, July 2013 E341 a—amusement park; b—bridge over stream; c—decaying car; d—farmer’s market vegetable table; e—kayakers; f—lake sunset; g—rocky river; h—waterfall with backdrop of autumn trees Figure 1. Study Photographs Note. Photos courtesy of Bill Robertson (photos a, c, d, and e) and Jack Roper (photos b, f, g, and h). Used with permission. reported enjoying looking at the study photographs, with 39% (n = 31) choosing the highest ranking of 10 (a great deal). Seventy-five percent of participants reported they had photographs similar to those in the study in their home. When asked if they would like to have one of the study photographs in their hospital room or home, the mean scores were 8.21 (SD = 2.03) and 7.19 (SD = 2.98), respectively (scale ranging from of 1 [not at all] to 10 [a great deal]). The photographs that the participants selected most often were lake sunset (76%), rocky river (66%), and waterfall with backdrop of autumn trees (66%) (see Figure 1). The most rejected photographs were amusement park (54%), farmer’s market vegetable table (51%), and kayakers (49%). Of the 80 participants, 57 gave responses to the open-ended question “What other types of photos would you like to see in your hospital room?” That includes participants who responded with more than one category. The breakdown of categories is landscape (28%), animals (15%), people (14%), entertainment (10%), imagery (10%), water (7%), spiritual (7%), flowers (6%), and landmark (3%). Responses to the question asking for comments reflected participants’ opinions of the study process and the selection of the study photos, as well as relating aspects of the photos to their personal life situation. This population spent anywhere from a couple of days to a couple of months in the hospital and were facing life-threatening conditions and dealing with the uncertainty of their diagnosis. One participant stated, “Many of the photos had symbolic meaning to me in a very powerful way. The bridge over the stream was my favorite, symbolizing a means through an obstacle.” That comment reflects how the patient perceived the need to get through the obstacle of the disease and treatment. Another participant wrote, “I thought the picture with the decaying car was nice but it can be taken in a wrong way. I can see it as a piece where they are capturing the theme of time and death where everything in life has an end point. On a bad day, it would really ruin someone’s mood seeing the age of the car.” Other patients made comments related to photos in a hospital unit. “I would like to see some photos on this floor. When I go to other areas of the hospital and see the birch tree pictures, it makes for a more personal feeling rather than institutionalized,” one participant sad. Another stated, “I think photos in patients rooms would be a wonderful asset to their rooms.” Finally, one participant said, “I think photos would add a great deal to the hospital rooms . .. when I had my children, there was artwork on the walls in our rooms, and it was really nice.” These comments show the importance of the hospital environment to patients facing long hospitalizations. E342 Vol. 40, No. 4, July 2013 • Oncology Nursing Forum Another group of patients commented on their perception of fun and vacation. “I liked the carnival ride .. . the least,” one participant said. Another noted a lack of “people enjoying ‘their’ vacations.” As one participant explained, “I like the vacation pictures, but it was kind of sad … looking at them reminds me that I will not be going on vacation for a long time due to being sick.” Even so, other participants commented on the healing and distraction provided by the photos. “It was a nice break to see the photos,” one participant said. Another elaborated, “Photos, particularly sunsets, flowers, and soft scenes, can be helpful in reducing pain. They can be effective in the healing process.” That reflects the need these patients felt for a break from their daily routines related to treatment. The results support the hypothesis, indicating that patient preference for a category of photographic art is affected by the psychophysical and psychological qualities of photographs, as well as the patient’s mood and characteristics. Discussion When comparing the participants’ top answers, the write-in comments did not necessarily support the selections made in the quantitative section of the study. For example, of the top 10 photos chosen by participants to be in their hospital room (quantitative), half were in the water category and half were in the landscape category. In the open-ended question, 22 of 57 respondents said they would like landscape photographs in their room and only 6 respondents said water. Based on the categories selected for the study, the authors did not designate water as a landscape, but instead made it its own category. Some of the participants may consider water a landscape, which may explain the discrepancy between the quantitative and qualitative sections. Han’s (1999) Integrated Landscape Assessment Theory was supported in this study, as the findings related how the positive or negative responses of the participants to the various photographs impacted his or her sense of well-being. Han’s theory also illustrated the relationship between the photographs and the participants’ preferences for specific photographs, which was evident in both the qualitative narratives and the actual photograph preference data. Nightingale’s (1860) Environmental theory also is supported in the aspect of participants’ using elements in nature via the photographs from this study. A relationship between nursing practice and the environment can be seen when nurses can use select scenes from nature to create a more positively perceived healing environment for their patients. Limitations Patient acuity levels, such as patients being too sick to participate, impacted the overall number of participants. As a result, very little is known about what very ill patients would like. In addition, nurses who were trained to data collect were not consistently available, which impacted data collection and patient participation. Another limitation was related to the equipment, specifically the laptop computers and access to the Internet. At times, Internet access would falter during the participants’ viewing of the study materials, resulting in lengthening of participant time. However, no participants were eliminated, as they all chose to continue the survey. Finally, the Hollingshead (1975) tool was designed to assess participants’ SES; however, the categories on the forms appeared to confound the participants and, as a result, those data were negated. Implications for Nursing Practice and Research Nurses in general, and oncology nurses specifically, can play an active role in helping patients deal with the challenges of long hospital stays and hfe-threatening diagnoses through distraction and restoration interventions such as viewing photographic images of nature. Distraction and restoration can improve the hospital environment, which is consistent with Nightingale’s (1860) environmental theory. Having patients view photographs of natu

 
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Topic 1 DQ 1 and DQ 2

  

Module 1 DQ 1 and DQ 2

Tutor MUST have a good command of the English language

These are two discussion questions

DQ1 and DQ2 posts must be at least 150 words and have at least one reference cited for each question. In-text citation, please

Tutor MUST have a good command of the English language

Sources need to be journal/scholarly articles. 

Use only articles that are published between 2015-2018 (except for your theory articles which will be older as you must cite primary sources).

No textbook or direct quotes

Please separate the two DQ with their reference page

My project is CLABSI prevention

DQ 1

Outcome measures are significant in showing the worth of the Advanced Practice Nurse’s role in health care. Identify a practice-level outcome study and describe the expectation of its effect on health care.

DQ 2

In this week’s readings, theories of accident causation, human error, foresight, resilience, and system migration were discussed. Identify a safety theory and propose proven quality measures to improve patient safety.

 
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DQ81 RESPONSE

Nimmy James    2 posts   Re: Topic 8 DQ 1  Dependent variables are otherwise known as the outcome variables. The value of the dependent variable depends on the value of other variables. In research, the dependent variable takes on different values in response to the independent variable. The independent variable is otherwise known as the experimental or predictor variable. It is manipulated in the research to observe the effect on the dependent variable. The value of an independent variable does not rely on other variables as the independent variable can stand alone (Kusurkar, Ten Cate, van Asperen, & Croiset2011).  Using my EBP as an example, the dependent variable in the study is the rate of pressure ulcers in the facility. To measure this, I will need to collect data on the number of pressure ulcers in past three years. This data will help me to monitor how manipulating the independent variables affect pressure ulcer rate which is a dependent variable. The independent variables in this study include nurses’ knowledge about wound care and how effects of protein intake with wound healing. The EBP will manipulate theses independent variables by educating nurses on nutritional impact on pressure wound healing and by implementing extra protein into their daily diet. With a questionnaire, I will be able to collect data on nurses’ knowledge about the topic which help with planning the education and training.  

 Reference   Kusurkar, R.A., Ten Cate, TH J., van Asperen, M., Croiset, G (2011) Motivation as an independent and a dependent variable in medical education: A review of the literature.               Med Teach. 2011; 33(5): e242–e262. doi: 10.3109/0142159X.2011.558539.              Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21517676

 
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