What causes the accumulation of fluids in tissues and how does this fluid become lymph?

At one point or another we have all bumped our heads, stubbed our toes or had a mosquito bite. We all know the result which is swelling or inflammation. Using the medical terminology that you’ve learned this week discussed the following questions.

What causes the accumulation of fluids in tissues and how does this fluid become lymph?

The initial discussion post must be at least 250 words of content, referencing the reading of the week, and include a scholarly source.

 
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Quality Measurement and Assessment in Healthcare

Project: Promoting Health Care Quality  Section 3:    

  Quality Measurement and Assessment  Measuring and assessing quality provides a foundation for identifying needs for improvement, developing effective interventions, and then monitoring progress toward desired results.   In the Sadeghi, Barzi, Mikhail, and Shabot text, the authors assert that an effort to improve quality “calls for setting outcome and performance targets (goals and expectations) beginning with the end in mind, and then formulating initiatives and actions (processes) that can serve as a bridge to take the organization from its current performance to its desired performance” (p. 182).   Having this “end in mind” can provide justification for dedicating valuable resources toward the effort, and help to lay a clear, concrete path that takes the organization from uncovering gaps between current performance and evidence-based targets to actually achieving those goals.  In this section of the Course Project, you focus on what you would measure—and how you would measure it—relative to your previously identified quality improvement issue. Note: This section of the Course Project will serve as the Portfolio Assignment for this course.       Course Project: Section 3: Quality Measurement and Assessment: write a 3-5 page paper to introduce your quality improvement plan. For more details on this project, see the Week 7 Project area for specifics to include for this paper.     I have attached my paper from week 4 for the continuation of the project.     To prepare: •Review the Learning Resources. Also conduct a search of the literature related to your selected quality improvement issue and complete the Evidence Matrix (provided in this week’s Learning Resources).   •Evaluate the evidence presented in the research literature and the quality standards proposed by various organizations, including the IOM’s six aims for quality improvement.   •Based on this review and your knowledge of the organization that you have selected, determine appropriate measures and indicators of performance related to your identified quality improvement issue.   •Consider how you could gather and use historical evidence of the organization’s performance related to the quality improvement issue. Also consider methods for gathering and assessing current quantitative and qualitative data, including those currently in use by the organization (e.g., chart audit data, staff surveys, quality indicators that are monitored, observations). If possible, examine actual data to assess your selected organization’s performance related to the issue.   •Think about what, specifically, you would like to achieve related to this issue. Establish realistic, evidence-based quality performance targets.   •Analyze gap(s) between the organization’s current performance and the performance targets.   •As you do this, you may wish to create a graphic organizer/alignment chart for your own use that illustrates:   •The measures and indicators that you would evaluate   •Current and historical data related to this quality issue—either actual data or methods for how you would collect and analyze the data   •Methods for collecting and analyzing data in the future (including when you would do this)   •Realistic, evidence-based targets

 
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Post Jessica

 

Respond to the post bellow, using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from  the classroom or from your own review of the literature in the Walden  Library.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from the readings or after synthesizing multiple postings.

 

                                        

                                      Data Collection 

Data  collection methods vary greatly depending on the research question and  the type of participants, regardless of chosen methodology, data  collection must be rigorously executed to produce high-quality data.  Similarly, instruments to collect data must provide accurate, concise,  and provide quantifiable data from which clinical meaning can be  extrapolated and subsequently applied to effect improvements in  practice. In this case, research aims to assess patient satisfaction,  from the patient’s perspective. Polit & Beck (2017), report that  structured self-report instruments are widely used by nurse researchers,  and are typically formatted as either questionnaires or interviews.  Surveys provide several advantages. In comparison to interviews, they  are cost-effective, maintain the anonymity of respondents, mitigate  interviewer bias, and can be easily administered using computer  technology. Disadvantages to surveys include low response rates;  typically around 50%, exclusion of certain populations such as the  elderly and children, questions may lack depth, or be ambiguous or  confusing causing respondents to skip them altogether (Polit & Beck,  2017)

Survey Instrument 

Low  response rate remains a primary barrier in survey administration and  efficacy. However, when surveys are personally distributed in a  particular setting, in this case, the primary care clinic, response  rates are significantly higher. Moreover, the personal nature of a  survey tool being directly distributed to respondents has a positive  effect on participants (Polit & Beck, 2017). Keough and Tanabe  (2011) contend that although the data collected through surveys is not  as scientific as data obtained through experimentation, it is  nonetheless important and informs nursing practice. Because the clinic  is interested specifically interested in understanding the patients’  point of view, I assert that a self-report survey tool should be  designed using a Likert-type rating scale. The range of responses  available to the participants provides greater insight compared to a  simple closed-ended question. Moreover, rating scales are easy to  complete and are also efficient. However, because people may  misunderstand the concept of the Likert Scale, instructions and  statements should be clear and concise (Polit & Beck, 2017).

Sampling Methodology and Participant Selection

             I would employ a consecutive sampling methodology; this includes  recruiting all accessible and eligible participants over a  pre-determined time-period (Polit & Beck, 2017). There is no  specific formula for sample size. Martínez-Mesa, Bastos, Bonamigo, and  Duquia (2014) assert that sample size can be thought of in tiers. The  largest tier represents the entire population; in this case, 10,000  patients. The target population is the portion of the total population  who are of interest to the study. In this case, we would exclude very  small children or patients who are cognitively impaired. Finally, the  study population includes those who will be included in the research  (Martínez-Mesa, Bastos, Bonamigo, & Duquia, 2014). 

To  optimize response rates, and to increase validity and reliability, the  survey will be administered in quarterly increments over a year.  Therefore, the target population will be all 10,000 patients. Of the  target population, it would be reasonable to assume that some patients  will not want to fill out the questionnaire and that others will be  excluded. The study population will aim to include 7,500 patients. All  eligible participants will be asked to fill out a paper and pencil,  self-administered, survey when they check into the clinic for an  appointment. This will allow adequate time for participants to complete  the survey before seeing their provider. Results will be calculated  every quarter and once at the end of the year for comparison. This  schedule will facilitate detection of variations in patient satisfaction  throughout the year, and help to identify specific variables such as  inadequate staffing that contributed to the results.   

Survey Questions 

Participants  will be asked to rate declarative statements using will be using the  Likert rating scale. A bipolar continuum will assess varying degrees of  satisfaction to the statements regarding patient satisfaction. The  participants will be asked to rate the following items:

1.) 1. Convenience of office hours: 

o Excellent

o Very Good 

o Good

o Fair

o Poor 

2.) 2. Ease of making an appointment:

o Excellent

o Very Good 

o Good

o Fair

o Poor 

3.) 3.  Promptness in seeing your provider:

o Excellent

o Very Good 

o Good

o Fair

o Poor 

4.) 4. Friendliness of staff:

o Excellent

o Very Good 

o Good

o Fair

o Poor 

5.) 5.  Clarity of medical instructions provided:

o Excellent

o Very Good 

o Good

o Fair

o Poor 

6.) 6.  Overall comfort of the office:

o Excellent

o Very Good 

o Good

o Fair

o Poor 

7.) 7. Help provided understanding insurance coverage:

o Excellent

o Very Good 

o Good

o Fair

o Poor 

8.) 8. Answers provided to address questions: Excellent  Very Good   Good  Fair  Poor  

9. My overall satisfaction is: Excellent  Very Good   Good  Fair  Poor  

10. Likeliness to recommend the clinic to others: Excellent  Very Good   Good  Fair  Poor 

The  statements are brief, clear, and each statement identifies just one  issue. The rating scale is reflective of satisfaction rather than  agreement or importance. 

Reliability and Validity 

With  regard to validity, it is important to consider the content of the  survey. Items should be relevant, comprehensive, and balanced (Polit  & Beck, 2017). I believe the statements chosen address the  components of content validity. Internal validity of the survey tool is  enhanced through content validity and further enhanced by the anonymous  nature of the self-administered survey tool provided by office  personnel. The external validity is strengthened by the size of the  study population, and the quarterly implementation which provides data  for comparison. The quarterly administration schedule will also provide  statistical validity. 

Reliability  concerns consistency over time (Polit & Beck, 2017). This can be  challenging when measuring patient satisfaction. Patients may be more or  less satisfied from day to day. Test reliability occurs with the  “administration of the same measure to the same people on two occasions”  (Polit & Beck, p. 303, 2017). Internal consistency occurs when the  same person provides the same results (Polit & Beck, 2017). Because  participants will visit the clinic multiple times during the year, they  will fill out the survey more than once, thereby strengthening test  reliability and internal consistency. If a sample is homogenous,  reliability is decreased (Polit & Beck, 2017). This survey will be  administered to a diverse group, increasing reliability. Because patient  satisfaction is an essential quality metric, its importance should not  be underestimated. The utilization of a self-administered survey tool on  a rolling quarterly basis is cost-effective and reliable.  

References 

Keough, V., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing Research. Journal of Nursing Regulation,1(4),  37-44. Retrieved from  https://class.waldenu.edu/bbcswebdav/institution/USW1/201950_27/MS_NURS/NURS_5052/readings/USW1_NURS_5052_Keough  2011.pdf.

Martínez-Mesa,  J., González-Chica, D. A., Bastos, J. L., Bonamigo, R. R., &  Duquia, R. P. (2014). Sample size: how many participants do I need in my  research?. Anais brasileiros de dermatologia, 89(4), 609–615. doi:10.1590/abd1806-4841.20143705

Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

 
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Discussion Case study Apa style two references. See attachment

  

     Now that you have identified the treatment for onychomycosis and labs for baseline and follow up therapy. For Week 6, please address the following:

1. Specify when to refer the patient after therapy and why? Provide rationale.

2. According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis?

3. Provide patient education. Keep in mind the past medical history of this patient.

 
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