Details: Reflective Analysis: Risk Management and the Role of Managed Care

Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.Addressing the knowledge, you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 250-500 word reflection to incorporate the following:1. What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?2. What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.3. What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?In addition to your textbook, you are required to support your analysis with a minimum of four peer-reviewed referencesBook used by school. Risk Management in Health Care Institutions: Limiting Liability and Enhancing Care, 3rd Edition.

 
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Care plan #2

create a care plan for a patient diagnosed with AIDS.:incude a summary of chief complaint, HPI, PMHx and PElist 5 nursing diagnoses related to your patientlist 5 goals planned for this patientlist 5 inteventions to achieve your goals

 
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U7A1

Disaster Response PlanFor this assignment you will be developing a disaster plan to address a hypothetical disaster that could plausibly strike the community that you observed for your Windshield Survey.A disaster can come in many forms. We might tend to associate disasters with mass natural disaster, like Hurricane Katrina or the 2011 earthquake and tsunami that struck Japan. However, disasters also include relatively small man-made disasters, such as a fire in an apartment building or a gas leak in a factory (Maurer & Smith, 2013).You will also be asked to select one of the articles from the list below that addresses a response to a disaster, or provides guidelines for creating a disaster response plan. You will briefly evaluate the article’s disaster response practices and also explain aspects for the article’s disaster response that would be appropriate to incorporate into your plan, as well as aspects that would not be feasible to incorporate. By evaluating responses to disasters in communities outside of your own, you will be able to bring in global perspectives as well as gain a deeper understanding of aspects of disaster response plans that are universal, as well as aspects that are only primarily applicable to specific communities.Choose one of the following articles (see the Resources area for links to these articles):•Almutairi and Rondney’s 2013 article, “Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care,” from Advances in Nursing Science, volume 36, issue 3, pages 200–212.•ÖztekÄ°n, et al.’s 2014 article, “Educational Needs Concerning Disaster Preparedness and Response: A Comparison of Undergraduate Nursing Students From Istanbul, Turkey, and Miyazaki, Japan,” from Japan Journal of Nursing Science, volume 11, issue 2, pages 94–101. •Yamashita & Kudo’s 2014 article, “How Should We Prepare Differently for the Next Disaster?” from Nursing and Health Sciences, volume 16, issue 1, pages 56–59.•Zaré, et al.’s 2012 article, “Crisis Management of Tohoku; Japan Earthquake and Tsunami, 11 March 2011,” from Iranian Journal of Public Health, volume 41, issue 6, pages 12–20.Your plan should address and include the following:Section 1: Article Evaluation (1–2 pages)•An evaluation of the disaster response presented in the article you selected from the provided list.•An explanation of aspects of the article’s disaster response that you plan on incorporating into your own Disaster Response Plan. Please include your rationale for why you are choosing to incorporate these aspects into your plan.•An explanation of aspects of the article’s disaster response that would not be appropriate or plausible to include in your disaster response plan. Please include your rationale for why these aspects would not be appropriate or plausible to incorporate these aspects into your plan.Section 2: Community Disaster Response Plan (5–7 pages)•Describe the hypothetical disaster for your surveyed community that your plan will be addressing. Be sure to include details such as:◦Scope of the disaster.◦Intensity of the disaster.◾Effects on the community environment as a result of the disaster.◾Immediate health impacts on people in the community.◾Medium and long-term health impacts on people in the community.•Communication procedures: When and how should public health department nurses communicate with each other in a disaster? When should they communicate with other first responders, law enforcement, and other resources/responders in a disaster?•Communication procedures for coordinating care with hospitals and other resources.◦Note: During disasters, acute care hospitals become overwhelmed—less critical patients may be treated at field hospitals, leaving room for critical patients in functioning acute care facilities. Identify who will communicate with whom.•The triage system you would use for assessing victims.•How will you address the needs of vulnerable populations (the elderly, children, mentally ill, homeless, and so on)?•How will you address cultural groups and non-English speaking persons?•Housing and shelter:◦How will you let the residents of your community know where to go?◦What system will you use to fill shelters?◦How will you communicate shelter capacity to prevent overcrowding the shelters? What resources will you use to help staff shelters?◦How many nurses will you allocate for shelters? Will you use nurses to staff shelters?◦Will you use other nursing resources to staff shelters, such as Red Cross, U.S. Commissioned Corps, military nurses, and so on?•What resources will you use to help provide food, water, and toilet facilities for victims?◦Who will you call and when will you call?•What procedures will you implement to prevent disease outbreak?•How will you care for the needs of the public health department nursing staff?  Other requirements and considerations:•Your plan should be as detailed as possible.•Use a minimum of four peer-reviewed journal articles (the article you select from the provided list counts as one of the four) to support the effectiveness of your plan. Be sure to use proper APA style and formatting. •Include a title page.•Include a reference page.Be sure to use proper APA style and formatting.•Times New Roman font, 12 pt.

 
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King’s theory

Assignment:King’s Conceptual System TheoryWrite a 1250-1500 word APA paper addressing each of the following points. Be sure to completely answer all the questions for each bullet point. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least two (2) outside sources and the textbook using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.Discuss and explain King’s Conceptual System Theory.First explain the 3 systems and provide examples of each systemExplain how the systems influence goal attainmentHow could King’s theory help define a clinical quality problem?Apply this theory to a potential practice quality improvement initiative within your clinical practice.How could a quality committee align outcomes with King’s Conceptual System Theory?What additional nursing theory from our readings could also align with an improved quality of practice initiative?Assignment Expectations:Length: 1250 – 1500 wordsStructure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) outside scholarly sources and the textbook are required for this assignment.Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

 
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Failed Physician-Nurse Communication case study

Click on the link belowhttps://www.rmf.harvard.edu/Clinician-Resources/Article/2008/Medical-Malpractice-Cases-Involving-NursesAfter reviewing the article, please respond to the following questions using the example format in Course Resources:1. Do you think the nurse was liable in this case? Why or why not?2. If you were the defense nurse expert, what points would you bring forward to support the nurse’s actions in this case?3. If you were the plaintiff nurse expert, what points would you bring forward to support the patient’s family claims of malpractice/negligence in this case?Please answer all questions 250 to 300 wordAPA formatplagiarism free

 
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Case Study

Mr. James is a 62 year old male in a primary care practice being seen for a health maintenance visit (last visit was over 10 years ago).  His only complaint of note is fatigue but generally feels well.  He denies any limitations in “doing the things I like to do”, including yard work and fishing.  He works full time as a supervisor for a commercial construction company.  He is married and has 2 daughters.  His oldest daughter is expecting their first grandchild.He has a history of “recreational” IV drug use when he was in his early 20s while he was in the military.  Denies any drug use since that time.  He indicates “minimal” alcohol use – generally no more than 2-3 beers or glasses of wine a week.  He has no chronic illnesses and does not take any medicines on a regular basis.Physical exam:Vitals: 38.1-97-18-183/139Normocephalic.  Alert & Oriented x3.Eyes: PERL. No nystagmus, no icterus.Neck: Supple, no cervical lymphadenopathyCardiovascular: Normal Rate and rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. No jugular venous distension.  No edema.Pulmonary: Lungs are clear. No dyspnea or orthopnea.Abdomen: Soft and nontender, active bowel sounds. No liver enlargement; abdomen flat. No striae.Skin: Warm and dry; no rashes.  Multiple tattoos on both arms.Rectal exam: Stool is brown, no rectal masses.Lab results:CBC:  WBC 9,000; RBC 5.10; Hemoglobin 15.3 g/dL Hematocrit 46%; MCV 90; Platelets 152,000.Electrolyte Panel:  Sodium  136 mEq/L; Potassium 3.7 mEq/L; Creatinine 1.1 mg/dL; BUN 12 mg/dL;  Glucose 115mg/dLAlanine aminotransferase (ALT) 36Aspartate aminotransferase (AST) 50Bilirubin (total) 0.9 mg/dLHepatitis A IgM negative; IgG positiveHepatitis B surface antigen negative; surface antibody positive; core antibody negativeHepatitis C (HCV) antibody reactive (positive), Hepatitis C RNA positive with an undetectable viral load.APA FormatInformation is presented in a scholarly manner (clear, grammatically correct) and reflects synthesis of information from sources.  APA format is correctly used for citations and references. Submission follows assignment guidelines; does not exceed page limit (6 pages, excluding title and reference pages). (15 pts)UTA Title page (5 pts)Respond to the following questions regarding the Case Study1. The clinical scenario is most consistent with which type of hepatitis? Please list your answer below using a bullet point format.  This does not have to be in a complete sentence.  A citation is not required. (10 pts)2. What specific data in the clinical scenario supports your diagnosis? You may list your answers below using bullet point format.  This does not have to be in a complete sentence. A citation is not required. (10 pts)3. What is the most likely cause of this patient’s diagnosis you noted in Question 1? You may list your answer below using a bullet point format. This does not have to be in a complete sentence.  A citation is not required. (10 pts)4. Describe key pathophysiologic concepts that relate to the diagnosis in question 1. To answer this question completely,you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.***Citations are required for each answer to each question using APA format.You MAY NOT use direct quotes.a. How does Hepatitis lead to an increased risk of hepatocellular carcinoma?Describehow the virus affects the hepatocytes and may lead to cancer.  ( 10 pts)b. How does Hepatitis lead to cirrhosis of the liver?Describethe pathologic steps of how cirrhosis develops and how cellular changes can lead to liver failure.  ( 10 pts)c.  One of the negative sequela of liver failure is increased bleeding.  Why do individuals with liver failure experience potentially life threatening bleeding?Describehow liver failure leads to coagulopathy. ( 10 pts)d.  Portal hypertension is also a negative sequela of liver failure.Describehow liver failure leads to portal hypertensionANDhow portal hypertension manifests.  (10 pts)5. Mr. James is concerned that he will transmit the virus to his new granddaughter after she is born.What is the likelihood of transmitting the virus to his granddaughter?  Providea single sentence that includes your rationale.  A citation is not required.  (10 pts)

 
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END OF LIFE CARE

Discussion # 2 : End of Life iEnd-of-Life Care (including advanced directives, palliation) Topics to review: Article: Nurses roles and responsibilities Providing care and support at end of life. https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics /endoflife-positionstatement.pdfFor your initial post/ threat choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life managementUsing the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.Practice1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.Education1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.Research1. Increase the integration of evidence-based care across the dimensions of end-of-life care.2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.Administration1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.4. Support the development and integration of palliative care services for all in- and outpatients and their families.

 
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philosophy

Important IdeaConsidering only the Introduction to Chapter 5, in terms of developing critical thinking and reasoning, what do you consider is the most valuable and important idea in that section? You can either summarize or directly quote the text; then, briefly explain why you find this idea important and valuable.Critical ThinkingIn Chapter 5, the section “Making Arguments” states: “In some ways applying our core critical thinking skills to analysis can be more difficult than offering an evaluative opinion. Analysis, like interpretation, is understanding at a deep level (p. 89)”What concepts discussed in Chapter 4 might make analysis of a statement difficult – and why?BeliefsWhy do you believe what you believe?What is your “evidence”?Test one of your beliefs by asking yourself, “Why?” As you answer each “why,” go down another layer – four layers will probably give you a good idea of why you believe what you believe.Your product should show a well-reasoned and logical basis for your belief. Stay away from the big stuff, like believing in God, or who to vote for in the next election, and don’t look for sources – this is about what you believe and why you believe it. After all, this is only an 8-week course, and we can’t settle everything!Click on the following link for an example of layers of why:

 
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HCM 337 DBR 3-4

**Write a 100-word reply to the 4 individual questions below.**To help you with your discussion, please consider the following questions:What clarification do you need regarding the posting?What differences or similarities do you see between your posting and other classmates’ postings?What additional questions do you have after reading the posting?What item you found to be compelling and enlightening.1.Katrina- In my opinion the court decision is warranted because, doctors are not obligated to disclose to patients “miracle treatments” or any drug or treatment not yet approved by the FDA. Now there are cases where FDA approved drugs have been used in specific treatments that isn’t approved for that particular drug this is called “off label drugs”. The use of non-FDA approve medicines increases the physician chance of medical malpractice liability. These particular drugs and/or treatment were illegal and not approved by the FDA in the patient state of resident for a reason. Non-FDA approved prescription drugs may present a significant threat to individuals seeking care since these drugs most certainly has not endured evaluation by the FDA for “safety, effectiveness or quality” (FDA.gov). If the FDA did not evaluate drugs, there wouldn’t be any means to determine if these medicines are harmless and beneficial for use. The FDA also evaluates to make certain that prescription drugs are formulated in a way that the drug quality is consistent and if the drugs label is absolute and accurate. FDA unapproved drugs have ensued in injury to the patient. The FDA focus on protecting patients from the injuries associated with non-approved drugs. These standards are put in place to protect both the patient and the physician.The treating physician need not to be held accountable for not advising patients of treatment options that are illegal or not successfully proven because, technically these treatment options are not available to the patient. The informed consent doctrine requires the physician to inform the patient of the benefits, inherent, material risks, and alternatives of a medical intervention. “The doctrine of informed consent is the legal basis for informed consent and is usually outlined in a state’s medical practice acts” (Judson, K 2020). Informed consent entails the patient’s right to receive all pertinent information in relation to the condition and then to make a decision regarding treatment based on that knowledge. (Judson, K 2020). The informed consent doctrine does not include disclosure for illegal treatments or illegal prescription drugs. “The physician’s obligation is to give medical facts accurately to the patient and to make recommendations for management in accordance with good medical practice” (AMA 2010). Disclosing illegal treatment options or even illegal prescription drugs do not fall under good medical practices and the physician should not be held responsible for not disclosing this information to the patients.2. TennehIn my own opinion toward this case, the court’s judgment does not really appear to be justified. That is because the doctor informed the woman about the chemotherapy negative effects and cautioned her that her IQ would be permanently damaged. The woman on the other hand, elected to go forward with the procedure. The patient’s claims are unjustifiable because the medicine, as the woman recently discovered, it unlawful in her state and is not even being approved by the FDA. It would have been prohibited to inform the patient of this. The doctor’s only responsibility is to inform the woman about all the available therapies that have been demonstrated to work and have been approved by the FDA. That’s because if a doctor advises a patient about an unlawful therapy, the doctor will be held accountable for deceiving the patient if the patient tries it and something bad happens to them. As a result, the doctor is prohibited from informing the patients about unapproved therapy options. In the aforesaid case the court wasn’t really warranted in issuing a summary judgment since the doctor had the authority not to tell the patient about the alternative treatment options that were not legal. Instead of giving a summary judgment the doctor has right to be heard and have his reasons considered. All patient and doctor have a constitutional protection that should be protected; thus, the court should hear both parties prior to making a decision.3. Jessy LeePatient’s Bill of RightsThe Patients’ Bill of Rights have evolved over the years, especially after the enactment of the Accountable Care Act in 2010.  With this enactment, patients became increasingly aware of their rights in receiving proper care/information as well as knowing their role in the process of healthcare delivery. These “rights” allow for improved patient-provider communication and overall relationship.  It assists the patient to know what to expect from their healthcare providers/insurance as well as what is expected of the patient from the provider as well.  I see this as a mutual exchange of information and collaboration between the two parties.   Currently, there is no universal bill of rights, although the original version of this was created by the Centers for Medicare & Medicaid Services shortly after the Accountable Care Act (M.U.S.E, Patient’s Bill of Rights). I thought it was interesting to learn that according to M.U.S.E, Rights in Ethical and Legal Disclosures, “bills of patient rights have no legal impact; rather they set an ethical tone for an HCO’s relationship with those it serves.”   It is with this ethical manner, that patients have a right to considerate and respectful care, acknowledging one’s “cultural, psychosocial, and spiritual values” and following through with those preferences.The Joint Commission has a brochure called “Speak Up” which has an extensive checklist of patient’s “rights” and “your role in your healthcare.”  Based on my research, they all have similar themes and rights such as: being informed of one’s care and consenting or refusing to such care/treatment, maintaining confidentiality and keeping medical records private/secure, receiving discrimination-free care, making decisions about End-of-Life Care, accessing various patient support services if you have an impairment in vision, speech, hearing, or mental capacity (jointcommission.org).  This also includes being educated on available financial resources and knowing an estimation of charges prior to treatment with an explanation of said charges if requested. Finally, expressing complaints if the above rights appear to have been violated.  There certainly more bill of rights we can include here but these are some of the main ones.On the other hand, the patient’s bill of rights also includes the active role of the patient and his/her responsibilities.  For example, disclosing all medical and family history in order for the provider to render a diagnosis/treatment, being honest and courteous, ask questions if you need clarification, use healthcare services appropriately as well as keeping/cancelling appointments in a timely manner, and being attentive to instructions that are provided by the physician/clinician.  There are more we can add to this list but this is a good basis of the important role a patient has in their own health care delivery process.In summary, I believe these bills of rights are definitely necessary in helping patients receive the best outcome for their health care. Both the patients’ rights as well as what is expected of them, helps with communication, trust, and cooperation in the patient-provider relationship.  It also allows the healthcare organization to continue to build patient satisfaction with the community they serve.  The patient’s bill or rights is a win-win for all involved in delivering healthcare and will minimize possible complaints and lawsuits.4. Katrina-The “Patient’s Bill of Rights” (MUSE. 2021) is simply documentation which informs patients about the details on how they can anticipate being managed at their healthcare visits. This documentation is not legally binding. This document simply supplies patients with intent and expectancy for their treatment. The “Patient’s Bills of Rights” (MUSE. 2021) not long ago changed its name to the “Patient Care Partnership” (Bedolla, M. 2016). The “Patient’s Bill of Rights” (MUSE. 2021) was invented by the “American Hospital Association” (Bedolla, M. 2016) in 1970’s and amended in 1990’s. A short time ago the “Patient’s Bill of Rights” (MUSE. 2021) got a crucial revamping from “Obamacare” (Bedolla, M. 2016). The “Patient’s Bill of Rights” (MUSE. 2021) provides protection to patients by expressing what resources are required to be presented and accessible to you and being provided honest and trustworthy healthcare. The “Patient’s Bill of Rights” (MUSE. 2021) also gives the patient options, this simply refers to the fact that you have the freedom to ultimately have the final decision about your healthcare.The “Patient’s Bill of Rights” (MUSE. 2021) is necessary because, it grants the patient added authority over their health maintenance. It prohibits medical indemnity companies from restricting medical care and coming betwixt doctor and patient. A few “Patient’s Bill of Rights” (MUSE. 2021) most outstanding features are healthcare companies cannot deny coverage to a patient with pre-existing conditions. Healthcare companies cannot withdraw a patient’s healthcare coverage in case of sickness. Healthcare companies cannot place a limitation on a patient’s lifetime limits or their annual healthcare coverage limits. Patients have the choice to select any PCP or Pediatrician within network. Females have the option to visit any obstetrician or gynecologist within the network without the need of referrals. Pre-approvals are not needed from the health insurance company to receive emergency treatment at healthcare facilities not within network. Obamacare place patients in control about their personal medical care. Bounded by legislation the “Patient’s Bill of Rights” (MUSE. 2021) hand patients’ strength as well as versatility which is needed to produce advised decisions about their healthcare.In regard to the universal “Patient’s Bill of Rights” (MUSE. 2021) if it did exist, in my opinion no provisions needs to be added. Being universal and prohibits to everyone worldwide is the only thing the patient’s bill of right is missing. Overall, the “Patient’s Bill of Rights” (MUSE. 2021) is a great addition to the healthcare industry. Something more added for the protection of the patient and to provide better healthcare. To assist patients in feeling more optimistic about the healthcare structure and to ensure healthcare meets the patient’s necessities. It also provides the patients an outlet to communicate issues without hesitation.

 
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Chapter 14

1-Do you think it is important for nurses to be involved in their professional organizations? Why or why not?2. The Affordable Care Act (“ObamaCare”) has been both praised and vilified. Debate the pros and cons of this legislation and of health-care reform in general.3. What is your vision of nursing’s future? How will you contribute to shaping it?4. Interview a nurse educated in a diploma program at least 20 years ago.a-How did that nurse’s education differ from your education today?5. Locate the website of a professional organization related to nursing. Bring a copy of the organization’s mission, membership criteria, and standards of practice.6. Ask five people of different ages and gender who do not work in the health-care field what they think most nurses do. Compile their answers with the answers your classmates collected and summarize them. Compare the summary to what you know nurses actually do.a-Were the answers realistic?b-Did they over- or underestimate the responsibilities most nurses have?c-Did they recognize the wide variety of things nurses do?d-Was there a difference by age or gender of the person answering the question?e-What do the results tell you about the public’s image of nursing?f-What do you think influences their image the most? Explain your answer.7. Describe the nurse of the future.a-What does he or she do?b-Do you think nursing will become a more powerful force in health care?c-Why or why not?Essentials of Nursing Leadership & Management6th EditionSally A. Weiss  MSN, EdD, RN, CNE, ANEFRuth M. Tappen  EdD, RN, FAANISBN-13: 978-0-8036-3663-7

 
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