Assigned Readings:  Chapter 4

Answer the following questions:

1. For a hospital to operate efficiently and effectively, the three important influences in its governance, medical staff, board of trustees, and administration, must work together in reasonable harmony. What factors might contribute to tensions among these groups?
2. As the nursing profession has expanded through advanced degrees, specialization, and clinical practice, nurses’ salaries and responsibilities have also increased. Now, hospitals substitute non-nurses for nurses to perform all but the most technical tasks. What are the implications for the nursing profession? Have nurses lost their traditional role of hands-on patient care and, if so, is that to their advantage or disadvantage?
3. The traditional management style of hospitals has been hierarchical and internally focused.  What are three important challenges that face hospitals to accommodate new payer and consumer expectations?
4. The availability of hospital insurance removed an important cost constraint from hospital services and charges. What were some positive and negative consequences of that development?
5. The organization and practices of modern hospitals reflect the promotion of specialization and sub-specialization by academic health centers. What were the advantages and disadvantages to patients of increasing the number of physicians who limit their activities to narrower fields of practice?
6. With significant oversupply of hospital beds in the U.S. what is the rationale for taxpayer support of the separate and costly hospital system of the Department of Veterans Affairs?

Directions*** week 9 and 10 are separate assignments and each need their own reference list. At least 2 references requires for each week. APA format. No certain page requirement as long as it covers the topics

 

Week 9 Journal

 

An advance directive is a legal document that defines a patient’s wishes for medical care. This document is a way for patients to share their wishes with family members and health care providers when their illness or mental capacity prevents them from making decisions. As an advanced practice nurse who has care discussions with patients and their families, you need to not only be familiar with the process of completing an advance directive, but also understand how this document might impact your role in patient care and treatment.

 

Journal Entry Part 1

 

For the first part of your journal entry, reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document. (**I will message you the state i live in) Then, explain how your experience of completing your Five Wishes advance directive will help you guide discussions with patients and their families. Finally, explain how you might apply the Five Wishes advance directives to your nursing practice. Include how this advance directive might benefit patients in decision making for specialized areas of care.

 

** Five wishes reference https://class.waldenu.edu/bbcswebdav/institution/USW1/201750_27/MS_NURS/NURS_6540/readings/USW1_NURS_6540_fiveWishSample_Week%209.pdf

 

 

 

Journal Entry Part 2

 

For the second part of your journal entry, reflect on geriatric patients from your practicum site with disorders related to specialized areas of care, such as oncology, nephrology, urology, gynecology, and neurology. Describe a case of a frail elder patient who must make decisions related to specialized areas of care. Then, explain potential patient outcomes and include whether treatments would be beneficial and how they would impact the patient’s quality of life. Finally, describe the patient’s wishes in terms of treatments and interventions for the disorder (Was there an advanced directive?) and how the patient might want to spend any remaining time. Include how environmental factors, such as family, caregivers, ethnicity, culture, religion, and/or personal values, might impact decision making for treatments and interventions. If you did not have an opportunity to evaluate a patient with this background during the last 9 weeks, you can select a related case study or reflect on previous clinical experiences.

 

 

 

Week 10 Journal

 

Elder abuse is any intentional or negligent behavior that results in physical, sexual, emotional, pharmacological, and/or financial abuse. Unfortunately, abuse is sometimes difficult to identify, and elders are often hesitant or unable to report abuse themselves (Administration on Aging, n.d.). This makes it important for health care providers to regularly monitor for signs of abuse and react according to local and state laws.

 

Journal Entry Part 1

 

For the first part of your journal entry, select and describe one of the following types of elder abuse: physical, sexual, mental/emotional/verbal, pharmacological, or financial. Explain strategies for identifying this abuse. Then, explain how you would proceed based on your local and state laws once you have identified this abuse in a patient. Describe resources in your community that assist victims of this type of abuse and explain how you, as the advanced practice nurse, might apply these resources for abused elders who are identified in the clinical setting.

 

Journal Entry Part 2

 

For the second part of your journal entry, reflect on the different cultures—ethnic, religious, regional, or generational—of the elder patient population at your practicum site. Describe the cultures you have observed and explain the influence of these cultures on the prevalence and detection of elder abuse. Then, explain how culture might impact the way you would implement resources for preventing or addressing abuse.