NPV

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(NPV)

NPV

NPV

For this clinic scenario, the clinic is divided into three departments: the finance department, the human resource department, and the medical records department. Each department has projects categorized as high-risk, average-risk, or low-risk projects. The heads of the department are responsible for assigning the risk factor or rate for respective projects based on their risk categorization. The clinic has a cost of capital of 8%. Adopting similar adjustment amounts as in exhibit 15.8, high risk will be adjusted by 4 percentage and low risk by 2 percentage. Therefore, the clinic’s cost of capital is adjusted upward to 12 percent in the high-risk department and downward to 6% in the low-risk department. These adjustment amounts are also used in the specific departments for individual projects. After adjustments, the system has results running from 16% for the high risk project in the finance department, which is the installation of a new finance system to 4 percent for the low-risk projects in the medical records department, which is connecting medical records to patient portals. (NPV)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522956/

 
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Nursing Care Plan Form

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Nursing Care Plan Form

Nursing Care Plan Form

Student Name:                                                           Date:  

Patient Identifier:  L.D.                                        Patient Medical Diagnosis: Labor Stage IA: Latent Phase           

Nursing Diagnosis (use PES/PE format):

  1. Deficient knowledge related to information misinterpretation and lack of exposure or recall as evidenced by following through instructions inaccurately, asking a lot of questions, and misconception statements.

(Nursing Care Plan Form)

  1. Risk of ineffective coping related to personal vulnerability, situational crisis, severe pain, lack of rest, anxiety and fear as evidenced by client’s inappropriate behavior in maintaining control. (Nursing Care Plan Form)

Assessment Data

(Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)

Goals & Outcome

(Two statements are required for each nursing diagnosis.  Must be Patient and/or family focused; measurable; time-specific; and reasonable.)

 

Nursing Interventions

(List at least three nursing or collaborative interventions with rationale for each goal & outcome.)

Rationale

(Provide reason why intervention is indicated/therapeutic; provide references.)

 Outcome Evaluation & Replanning

(Was goal met?  How would you revise the plan of care according to the patient’s response to current plan ?)
  1. Patient presents with contractions and pain similar to cramping felt during period.

 

 

  1. Patient experiences back and thigh pain.

 

 

 

 

  1. Patient has blood-streaked discharge and intermittent vaginal bleeding.

 

 Statement #1

Patient is anxious, fearful, and was reluctant to report to the hospital because she has experienced cramping before but not as intense. Patient was not expecting the pain to be labor, indicating deficient knowledge, which is a condition impacting client’s decision-making and coping during early labor and before active labor. This diagnosis is indicated by client asking multiple question, inaccurate following through instructions, and misconception statements.

 

 

 

 

 

 

Statement #2

Coping allows clients to process emotions and stress during pregnancy and labor. Patient indicates risk of ineffective coping related to anxiety and fear, situational crisis, and severe pain.
  1. Evaluate the client’s basic knowledge and expectations during pregnancy.

 

  1. Inquire about the client’s preference nursing care in early labor

 

  1. Evaluate cultural aspects influencing the client’s labor experience.

 

 

 

 

 

 

 

 

 

 

 

  1. Examine uterine contraction- relaxation pattern, vaginal bleeding, fetal status, and cervical dilatation.

 

 

 

  1. Examine the client’s labor pain levels.

 

  1. Note the client’s age and a partner’s or support presence.

 

 

 

 

 

 
  1. This intervention will help develop learning needs and set priorities to help clients make informed decisions regarding their care (Martin, 2022).

 

  1. Establishing the client’s preference of nursing care will help determine whether she might benefit from specific care approaches (Hutchison & Mahdy 2019).

 

  1. Cultural factors affect the client’s experience with labor (Martin, 2022).

 

  1. This approach will help rule out potential complication that might be causing the pain or the bloody discharge (Hutchison & Mahdy 2019).
  2. Linking labor pain with typical circumstances can help client gather her resources and decide a workable pain relief intervention (Martin, 2022).

 

  1. Negative coping is associated with heightened anxiety, and the patient may request medication too early in labor. Stress and discomfort are associated with younger clients, who experience problems maintaining control (Martin, 2022).
 Outcome #1

The patient responded as expected to the nursing care and the interventions adopted. The patient verbalized psychological and physiological changes understanding, participated in making decisions, and demonstrated appropriate breathing and relaxation mechanisms. Continued monitoring is required to determine extended client’s response to current plan.

 

 

 

 

 

 

 

 

 

 

Outcome #2

Outcome two was achieved as the client identified her appropriate behavior to maintain control in early labor. The client identified ineffective coping behaviors and resultants and verbalized awareness of her coping ability. The client used the medication appropriately to manage her pain and discomfort in early labor.

 

 

 

 

(Nursing Care Plan Form)

References

Hutchison, J., & Mahdy, H. (2019). Stages of labor. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544290/#:~:text=The%20first%20stage%20starts%20when,when%20the%20placenta%20is%20delivered.

Martin, P. (2022, September 9). 45 labor stages, induced and augmented, dystocia, precipitous labor nursing care plans. https://nurseslabs.com/labor-stages-labor-induced-nursing-care-plan/

 

 
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Nursing Care Plan of a Child with Asthma

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(Nursing Care Plan of a Child with Asthma)

Student Name:                                                           Date:                                                

Patient Identifier: D.M.                                            Patient Medical Diagnosis: Asthma

Nursing Diagnosis (use PES/PE format):

Nursing Care Plan of a Child with Asthma

  1. Ineffective breathing patterns related to bronchial tubes swelling and spasm responding to irritant inhalation, allergic reaction, infection, or a drug as evidenced by continuous coughing, nasal flaring, cyanosis, and respiratory depth changes.
  2. Ineffective airway clearance related to mucosal edema, heightened pulmonary secretions, and bronchospasms as evidenced by cough, cyanosis, respiratory rate and rhythm changes, wheezes, rhonchi, and atypical arterial blood gasses. (Nursing Care Plan of a Child with Asthma)

Assessment Data

(Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)

Goals & Outcome

(Two statements are required for each nursing diagnosis.  Must be Patient and/or family focused; measurable; time-specific; and reasonable.)

 

Nursing Interventions

(List at least three nursing or collaborative interventions with rationale for each goal & outcome.)

Rationale

(Provide reason why intervention is indicated/therapeutic; provide references.)

 Outcome Evaluation & Replanning

(Was goal met?  How would you revise the plan of care according to the patient’s response to current plan ?)
Subjective

  1. Patient complains of unending cough and tightness in the chest.

Objective

 

  1. Patient is wheezing

 

  1. Patient has bronchospasms

 

  1. Patient has changing respiratory rate and rhythm

 

  1. Respiratory depth changes are noted

 

  1. Nasal flaring and cyanosis are noted

 

 Diagnosis #1

  1. The patient will achieve and maintain an optimal breathing pattern, indicated by relaxed breathing, typical respiratory rate, and dyspnea absence.
  2. The patient will achieve normal arterial blood gas outcomes and be free of cyanosis.

 

 

 

Diagnosis #2

  1. The patient will demonstrate comprehension of the cause and therapeutic management intervention.
  2. The patient will display improved airway clearance behavior.
  1. Establish rest periods between activities.

 

 

  1. Assess fatigue and stress

 

 

  1. Monitor vital signs

 

 

 

 

  1. Pace the patient’s activities

 

 

  1. Foster deep breathing and coughing exercises

 

 

  1. Advise patient to maintain appropriate positions to ease breathing

 

 

 1. This intervention helps increase breathing patterns’ effectiveness by reducing work of breathing. Rest periods help reduce fatigue that is associated with respiratory failure (Martin, 2023).

 

 

2. Fatigue is a sign of distress and can cause respiratory failure, hence the need to evaluate for fatigue and stress (Martin, 2023).

 

 

3. Assessing vital signs can help identify issues like vasoconstriction potential, hypotension, and tachycardia (Martin, 2023).

 

 

 

 

1. It is critical to pace the patient’s activities by dividing them into parts and taking rest breaks between the activities to prevent fatigue and enhance proper breathing efforts.

 

 

2. Breathing and coughing exercises help ease and spat excess secretions, contributing to effective mucus clearance from the lungs. The exercises also act as coping mechanisms to minimize air trapping (Macêdo et al., 2016).

 

 

 

3. Positions that aid or ease breathing can help reduce muscle fatigue and help with chest expansion, reducing breathing distress (Hashmi et al., 2021).

 

 

 Outcome #1

 

Outcome one was achieved when the patient achieved an optimal breathing pattern, relaxed breathing, and respiratory rate and with the disappearance of dyspnea. Outcome was also attained when the patient demonstrated normal arterial blood gas outcomes and was free of cyanosis.

 

 

 

 

 

 

 

 

Outcome #2

Outcome two was also achieved as the patient verbalized comprehension of the cause and therapeutic management intervention. The patient also demonstrated improved clearance behavior.

 

 

 

 

 

(Nursing Care Plan of a Child with Asthma)

References

Hashmi, M. F., Tariq, M., Cataletto, M. E., & Hoover, E. L. (2021). Asthma (Nursing).

Macêdo, T. M., Freitas, D. A., Chaves, G. S., Holloway, E. A., & Mendonça, K. M. (2016). Breathing exercises for children with asthma. The Cochrane database of systematic reviews, 4(4), CD011017. https://doi.org/10.1002/14651858.CD011017.pub2

Martin, P. (2023, January 3). Asthma nursing care plans. https://nurseslabs.com/asthma-nursing-care-plans/

 
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Placenta Previa Nursing Care Plan Revised

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Nursing Care Plan Form

(Placenta Previa Nursing Care Plan Revised)

Student Name:                                                Date: 1/24/2023                                               

Patient Identifier:  W.M.                               Patient Medical Diagnosis:   Placenta Previa

Nursing Diagnosis (use PES/PE format):

Placenta Previa Nursing Care Plan Revised

(Placenta Previa Nursing Care Plan Revised)

  1. Risk of fluid volume deficiency related to severe vaginal bleeding and uterine blood vessels damage.
  2. Low cardiac output related to significant blood loss as evidenced by severe vaginal bleeding.

Assessment Data

(Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)

Goals & Outcome

(Two statements are required for each nursing diagnosis.  Must be Patient and/or family focused; measurable; time-specific; and reasonable.)

 

Nursing Interventions

(List at least three nursing or collaborative interventions with rationale for each goal & outcome.)

Rationale

(Provide reason why intervention is indicated/therapeutic; provide references.)

 Outcome Evaluation & Replanning

(Was goal met?  How would you revise the plan of care according to the patient’s response to current plan ?)
  1. Patient reports blood clots on her innerwear and on the toilet bowl over the past one week.

 

 

  1. Patient reports noticing severe vaginal bleeding as she was using the bathroom in the morning she was transported to the hospital

 

  1. Patient reports feeling weak, diminished vision, and headache before being transported by an ambulance to the hospital.

 

 

 Statement #1

The patient will maintain an appropriate fluid volume, determined by assessing urinary output and stability of vital signs

 

Statement #2

The patient will stop bleeding and display homeostasis.

 

 

 

Statement #1

The patient will engage and indicate activities and activity level that lower heart workload.

 

Statement #2

The patient will achieve a hemodynamic stability.
  1. Assess blood color, odor and amount and vaginal bleeding consistency.

 

  1. Evaluate and monitor vital signs.

 

  1. Examine intake and output every hour.

 

 

 

 

  1. Monitor vital signs, particularly blood pressure.

 

  1. Monitor and closely observe the patient usual consciousness levels.

 

  1. Observe intake and output

 

 
  1. Placenta Previa is associated with painless, bright red, sudden, and abrupt bleeding (Anderson-Bagga & Sze, 2019).

 

  1. It is critical to monitor vitals to determine risk of hypovolemic shock (Vera, 2022).

 

  1. Monitoring urine output helps determine whether the patient has adequate blood volume to perfuse the kidneys (Vera, 2022).

 

 

 

  1. Monitoring blood pressure is fundamental to determine development of systemic vascular resistance (Trammel & Sapra, 2020).

 

  1. Diminished cardiac output can cause confusion, restlessness, and/or disorientation (Vera, 2022).

 

  1. Monitoring input and output allows the determination that kidneys are functioning properly or not (Vera, 2022).

 

 

 

 

 Outcome #1

The desired outcome was achieved as the patient managed to maintain appropriate fluid volume, shown by the normal urinary output and steady vital signs. The patient stopped bleeding, displaying homeostasis.

 

 

Outcome #2

The expected outcome was achieved as the patient demonstrated activities that lower heart workload. The patient also achieved hemodynamic stability.

 

 

 

 

 

 

(Placenta Previa Nursing Care Plan Revised)

References

Anderson-Bagga, F. M., & Sze, A. (2019). Placenta previa. In: StatPearls [Internet]. StatPearls Publishing.

Trammel, J. E., & Sapra, A. (2020). Physiology, Systemic Vascular Resistance. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556075/

Vera, M. (2022, September 15). Placenta Previa nursing care plans. https://nurseslabs.com/placenta-previa-nursing-care-plans/2/

 
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ASSIGNMENT ON Healthcare Finances ** CHART

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Healthcare Finances

(ASSIGNMENT ON Healthcare Finances ** CHART)

Student

Institution

Course

Instructor

ASSIGNMENT ON Healthcare Finances ** CHART

Healthcare Finances

Capital investment decisions are the most fundamental decisions in a company, involving a current outlay in return for future benefits. All companies make investments to realize benefits or profits in the future. These investments take a substantial percentage of the company’s resources, and actions are irreversible, necessitating a comprehensive decision-making process to increase the chances of success. Capital investments are planned through capital budgeting, which involves evaluating potential big projects or investments, like installing a new system or building a new plant (Gapenski & Reiter, 2016). Capital budgeting entails evaluating the project’s cash inflows and outflows to compute potential returns to be generated to meet a particular benchmark (Gapenski & Reiter, 2016). There are various methods used to appraise capital investments, including the net present value (NPV), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), and the Payback method. (ASSIGNMENT ON Healthcare Finances ** CHART)

The net present value represents the difference between the current cash inflows value and the present cash outflows value over a period (Wang, 2021). The internal rate of return helps estimate the profitability of potential capital investments (Wang, 2021). An assumption of the modified internal rate of return is that the positive cash flows are reinvested into the company’s cost of capital, and the initial cash outlay is financed at the company’s financing cost (Qi et al., 2022). The payback method assesses the period it will take for an investment to pay back or recover the capital investment. (ASSIGNMENT ON Healthcare Finances ** CHART)

To compute the NPV, a company estimates a project’s future cash flows and uses a discount rate representing the project’s cost of capital and at risk to discount them into the present value amounts. Next, all the future positive cash flows of investment are reduced into the present value amount, and the NPV is obtained by subtracting the number from the initial project’s cash outlay (Wang, 2021). The IRR helps compute the rate of return an investment will potentially generate. The IRR is computed by first recalculating the NPV equation, with the NPV factor at zero, and solving for the unknown discount rate, which becomes the IRR (Wang, 2021). Calculating the MIRR also uses the NPV formula, but it assumes the positive cash flows are reinvested at the company’s cost of capital and the initial outlays are invested at the company’s financing cost (Qi et al., 2022). According to Konstantin et al. (2018), the payback period is obtained by dividing the investment amount by the annual cash flows. (ASSIGNMENT ON Healthcare Finances ** CHART)

The NPV is often preferred over the IRR, especially when cash flow shifts from positive to negative or from negative to positive over time and when multiple discount rates are used. The IRR is more suitable when a company is comparing across many investments or projects or in circumstances where it is challenging to compute an appropriate discount rate (Yan & Zhang, 2022). However, the IRR does not consider changing factors, including different discount rates. Because the MIRR assumes positive cash flows are financed at the capital cost and the initial outlay at the company’s financing cost, it tends to be more accurate in reflecting a project’s cost and profitability than the IRR (Qi et al., 2022). The MIRR can be used to rank investments of unproportioned sizes, addressing two major flaws associated with the IRR method. The MIRR offers a single solution for a particular project and a more valid and practical reinvestment rate of positive cash flows. Managers can also use the MIRR to change the reinvestment growth rate at different project stages (Qi et al., 2022). The MIRR has its limitations, including requiring the computation of a cost of capital estimate to make a decision, which can be subjective and vary per the assumptions made. MIRR information can sometimes lead to suboptimal decisions that do not increase value when considering several investment options at a go. Individuals lacking a financial background find MIRR computation difficult to understand because its theoretical basis is disputed across academics (Qi et al., 2022). The payback method helps managers determine the time length the initial investment will take to recover. It is suitable for managers more concerned regarding cash flows. Some limitations of the payback method include not considering the time value of money and only considering the cash inflows until the project’s cash outflows are recovered (Konstantin et al., 2018). The payback method does not take into account the cash inflows after investment recovery in the analysis. (ASSIGNMENT ON Healthcare Finances ** CHART)

All methods can help determine the desirability of an investment and have varying uses with capital budgeting. The NPV is the most preferable over the other capital budgeting methods because it offers more insights into capital investment and is more refined from mathematical and time-value-of-money perspectives (Wang, 2021). It is also the basis for calculating the IRR and the MIRR. The NPV is more dynamic because it can handle different discount rates or varying cash flow directions. The NPV has higher flexibility when appraising investments for individual periods. This method is more theoretically insightful in determining whether a capital investment like an acquisition will be valuable to a firm (Yan & Zhang, 2022). The interpretation is simple because a positive NPV shows inflows are greater than outflows, and the project would add value to the company, assuming no capacity constraints, and a project or investment should not be accepted when the NPV is negative.

Clinic Scenario

For this clinic scenario, the clinic is divided into three departments: the finance department, the human resource department, and the medical records department. Each department has projects categorized as high-risk, average-risk, or low-risk projects. The heads of the department are responsible for assigning the risk factor or rate for respective projects based on their risk categorization. The clinic has a cost of capital of 8%. Adopting similar adjustment amounts as in exhibit 15.8, high risk will be adjusted by 4 percentage and low risk by 2 percentage. Therefore, the clinic’s cost of capital is adjusted upward to 12 percent in the high-risk department and downward to 6% in the low-risk department. These adjustment amounts are also used in specific departments for individual projects. After adjustments, the system has results running from 16% for the high-risk project in the finance department, which is the installation of a new finance system, to 4 percent for the low-risk projects in the medical records department, which is connecting medical records to patient portals. (ASSIGNMENT ON Healthcare Finances ** CHART)

References

Gapenski, L. C., & Reiter, K. L. (2016). Healthcare finance: An introduction to accounting & financial management.

Konstantin, P., Konstantin, M., Konstantin, P., & Konstantin, M. (2018). Investment appraisal methods. Power and Energy Systems Engineering Economics: Best Practice Manual, 39-64. https://content.e-bookshelf.de/media/reading/L-10685619-9ba9df8716.pdf

Qi, J., Wang, Y., & Xu, Y. (2022, December). Research on Project Investment: Methods of NPV, IRR and MIRR. In 2022 International Conference on mathematical statistics and economic analysis (MSEA 2022) (pp. 710-715). Atlantis Press. https://www.atlantis-press.com/proceedings/msea-22/125982665

Wang, Y. (2021, December). The development and usage of NPV and IRR and their comparison. In 2021 3rd International Conference on Economic Management and Cultural Industry (ICEMCI 2021) (pp. 2044-2048). Atlantis Press. https://www.atlantis-press.com/proceedings/icemci-21/125966320

Yan, R., & Zhang, Y. (2022, March). The Introduction of NPV and IRR. In 2022 7th International Conference on Financial Innovation and Economic Development (ICFIED 2022) (pp. 1472-1476). Atlantis Press.

 
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 Ethical SWOT Analysis of RPM

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 Ethical SWOT Analysis of RPM

LAS432 Technology, Society, and Culture

 Ethical SWOT Analysis of RPM

Ethical SWOT Analysis of Remote Patient Monitoring (RPM)

Strengths

·         Lack of physical contact reduces the risk of exposure because contact is via telecommunication.

·         Leads better utilization of human resources because one physician can see more patients in a day.

·         Teleconsultation makes primary and tertiary healthcare accesible to all even those geologically marginalized.

·         The current digitalized trends means that most patients are confortable with telecommunication. For instance, most patients know how to use a smartphone or a computer.

·         The technology requires mínimum infrastructure, only internet access and a digital device, specifically a smartphone or computer.

 

 Weaknesses

·         Internet speed, reliability, and connectivity impacts the effectiveness and efficiency of the RPM.

·         Telemedicine through RPM provides mínimum emergency services.

·         Report exchange is limited because of lack of physical contact.

·         Services might not be equitable because RPM services can be inaccessible to illeterate individuals or those without internet connectivity.

·         Most contacts made through RPM are primarily for inquiry rather than consultation.

·         Patient data collected can be of poor quality.

·         There is a shortage of trained staff to operate RPM systems.

·         The same physician might be unavailable during follow-up.

 
Opportunities

·         Increased use of RPM can help strengthen the referral mechanism, increasing healthcare utilization.

·         EHR digitazes patient’s records and helps link to patients’ Unique Health Identification Number (UHID), increasing quality of data collected and stored.

·         Patient’s geolocations can help with early disease identification, especially during an outbreak.

·         Stringest guidelines like the HIPPA can be adopted in using RPM to avoid legal issues associated with violation of privacy to enhance patient safety.

 

 Threats

·         Record keeping is an issue of concern linked to RPM because of hackers and unauthorized access.

·         Vulnerable groups can be exposed to privacy violations when communicating with physicians.

·         Poor internet speeds and connectivity impact negatively on quality of patient care.

·         Beneficiaries or patients lack awareness regarding specific services offered by the RPM system, impacting growth in use.

·         Social media trends regarding risk of patients’ privacy violations and stealing of patient data impacts the acceptance of the RPM system. Patients need assurance of the safety of their data.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300556/

 
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Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D

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(Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D

MGMT404: Project Management

Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D

Table of Contents

Introduction. 3

PART 1. 4

Section A: The Project Charter 4

Project Description. 4

Objectives. 4

Business Need. 4

Milestones. 5

Budget 5

User Acceptance Criteria. 5

High-Level Project Assumptions. 6

High-Level Project Constraints. 6

Project Exclusions. 6

Major Project Risks. 6

Key Stakeholders. 7

Section B: Stakeholder Engagement Plan. 8

Section C: Communication Management Plan. 12

Section D: The Project Scope Statement 14

Project Description. 14

Project Requirements. 14

Project Deliverables. 14

Project Exclusions. 15

Acceptance Criteria. 15

Estimated Project Schedule. 15

Resource Requirements. 16

Estimated Cost of Project 16

Project Constraints. 17

Project Assumptions. 17

Introduction

The Getta Byte Software project aims to implement a new billing system, the Getta Byte Software, to replace the current manual, inaccurate, and time-consuming system. The new software will adopt automation, increasing the speed and accuracy of operation. The new implementation will lower the cost and time of future billing cycles by 25%. The project’s primary stakeholders the CEO, Haywood U. Buzzof, the CFO, customers, members of the team, accounts payable and employees of the company, including billing and accounting staff. An agile project methodology includes specific aspects upfront and continual changes and iterations as the project progresses. The project will also adopt a predictive life cycle to ensure project phases are completed chronologically. The project team must complete a project phase before moving to the subsequent one. Having different completion phases will ease the prediction of when to accomplish particular milestones. Various internal and external factors can impact project decision-making, staff management, procedures, processes, and project management. New stakeholders can enter the project mid-course, or current ones may heighten their interest in the project after seeing the progress. It could impact the project significantly, considering that many stakeholders are already involved. For the project to be successful, people must remain committed to the shared goal and stay on the same page throughout. Networking problems can impact project development because weak connections can lead to data loss and service delays, prompting the need for a backup. Scope changes can also affect the budget and time because no one knows what can happen mid-course. (Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

 

PART 1

Section A: The Project Charter

PROJECT CHARTER
Project Name Getta Bill Software Billing System Implementation Project #:
Project Manager Ima Payne Start Date

February 27, 2022

 End Date

September 10, 2022
Project Sponsor Hatchi Kita

 

Project Description

The project intends to replace the current billing system, which is manual, slow, and inaccurate with a new billing system, which automated, cost effective, and reliable.

Objectives

  • Implementing an automated, fast, and accurate billing system
  • Ease data entry
  • Offer dynamic updates to receivables
  • Reduce labor costs by 25%
  • A 30% cut on billing cycle length

Business Need

The current billing system needs improvement, considering it is manual, slow, and inaccurate. An automation would make the new billing system fast, accurate, and reliable. The new system is more cost effective and time saving, cutting on labor costs and reducing billing cycle time, which would elevate the business to a better financial health and be more competitive in the current market. (Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

Milestones

Milestones Estimated Completion Timeframe
Identify and Meet Stakeholders March 7, 2022
Gather user requirements and project planning May, 13, 2022
Requirement analysis and project design June 10, 2022
Complete software development and testing August 15, 2022
First Pilot September 1, 2022
Final Release September 10, 2022

 

Budget

Estimated Work Cost $120,000
Estimated Material & Equipment Cost $30,000
Fixed Cost $100,000
TOTAL ESTIMATED COST $250,000

 

User Acceptance Criteria

The project will be a success if it meets the primary objective, which include successful automation of the billing system, cut on labor cost by 25%, and reducing billing cycle length by 30% (Devry Canvas, 2022). Ease of data entry and dynamic updates and receivables are also success and user acceptance criteria.

High-Level Project Assumptions

The project highly assumes that the current billing data is accurate and no customer or billing data is missing. The project management also assumes that the allocated time and budget will be adequate to complete the implementation and no scope change issues will emerge that will force a review of the budget or time allocated. The project management expects all milestones and objectives to be met within the scope, cost, and time constraints. (Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

High-Level Project Constraints

The budget of $250,000 is a high-level project constraint (Devry Canvas, 2022). The project team will strive to operate within this budget.

Project Exclusions

Accounts receivables are within the project operation area. The interface of the financial system of record will be changed to align with the new billing system but the project will not change the financial system.

Major Project Risks

Multiple risks can impact the success of the project. The most significant risk would be scope changes that would force an increase in budget and time allocated (Farkas, 2018; Kloppenborg et al., 2018). The budget might not be enough to complete the whole project, and it needs review at different project phases. Network issues are a problem in IT projects because software development and implementation require reliable internet access. Network issues create a data transfer issue. (Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

Key Stakeholders

The customers are the primary stakeholders in the project (Devry Canvas, 2022). Other key stakeholders include the CEO and the CFO, billing and accounting staff, and the project team involved in the actual development and implementation of the software.

 

Section B: Stakeholder Engagement Plan

Stakeholder Engagement Plan
Project Name: Project Manager: Date:
Stakeholder Identification Stakeholder Analysis Engagement Strategy
Stakeholder Role Category Influence
High/Low		 Interest
High/Low		 Key Interests

& Needs

 Strategy Strategic Approach Strategy Owner Frequency

& Method

(Based on needs)
Haywood U. Buzzoff CEO Key High High Company cost saving, efficiency and effectiveness improvement, and increased company competitiveness. Provide weekly updates Manage Manage closely through involvement in project decision-making. PM Weekly Meetings
 

Kent C. DeTrees

  

CFO

  

Key

  

High

  

High

 Overall company improvement and better customer service. Provide weekly updates  

MANAGE

 Manage closely through involvement in project decision-making.  

PM

  

Weekly Meetings
 

Lou Seguzi

  

Finance director

  

Key

  

High

  

High

 Company cost cutting and better financial performance. Provide weekly expenditures.  

MANAGE

 Manage closely through involvement in project decision-making.  

PM

  

Weekly Meetings
Accounts Payable Team  

Billing

  

Primary

  

High

  

High

 Better company financial performance and management. Provide weekly project expenditures.  

MANAGE

 Manage closely through involvement in project decision-making.  

PM

  

Weekly Meetings
 

Finance Department

  

Reporting

  

Primary

  

High

  

High

 Improved company financial health and value cost of service. Provide weekly project expenditures.  

MANAGE

 Manage closely through involvement in project decision-making.  

PM

  

Weekly Meetings
 

Accounting Team

  

Processing

  

Primary

  

High

  

High

 Identify variances in cost management and approve project expenses. Offer weekly project expenditures.  

MANAGE

 Manage closely through involvement in project decision-making.  

PM

  

Weekly Meetings
 

Sales Team

  

Sales

  

Secondary

  

Low

  

High

 Improved customer service, consumer engagement, and market acceptance. Share consumer expectations and requirements and offer weekly updates on project progress.  

INFORM

 Utilize high interest through involvement.  

PM

  

Weekly Phone Calls
 

Ima Payne

  

Team Member

  

Key

  

High

  

High

 Project successful completion within scope, cost, and time constraints. Provide weekly updates.  

MANAGE

 Manage closely through involvement in project decision-making.  

PM

  

Daily meetings
 

Hugh Duitt

  

Team Member

  

Key

  

Low

  

High

 Improved customer service, consumer engagement, and market acceptance. Share consumer expectations and requirements and offer weekly updates on project progress.  

INFORM

 Utilize high interest through involvement.  

PM

  

Daily Meetings
 

Nonia Bizness

  

Team Member

  

Key

  

Low

  

High

 Improved customer service, consumer engagement, and market acceptance. Share consumer expectations and requirements and offer weekly updates on project progress.  

INFORM

 Utilize high interest through involvement.  

PM

  

Daily Meetings and email memos
 

Don Testit

  

Team Member

  

Key

  

Low

  

High

 Project successful development and meet deliverables. Provide weekly updates  

INFORM

 Utilize high interest through involvement.  

PM

  

Daily Meetings
 

Kurt Anser

  

Team Member

  

Key

  

Low

  

Low

 Successful software implementation and completion within constraints. Provide weekly updates.  

MONITOR

 Monitor communications for influence and interest changes  

PM

  

Bi-weekly video conferences and emails
 

Kinshirou Kusatsu

  

Team Member

  

Key

  

Low

  

High

 Project successful development and meet deliverables. Provide weekly updates  

INFORM

 Utilize high interest through involvement.  

PM

  

Daily meetings and emails
 

Ata Ibusuki

  

Team Member

  

Key

  

Low

  

High

 Project successful development and meet deliverables. Provide weekly updates.  

INFORM

 Utilize high interest through involvement.  

PM

  

Bi-weekly video conferences
 

Uruu Seiren

  

Team Member

  

Key

  

Low

  

High

 Project successful development and meet deliverables. Provide weekly updates.  

INFORM

 Utilize high interest through involvement.  

PM

  

Weekly phone calls

 

Section C: Communication Management Plan

COMMUNICATIONS MANAGEMENT PLAN
Project Name: Getta Byte Software Billing System Implementation
Project Manager Name: Ima Payne
Project Description: Install a new billing system
ID Communication Vehicle Target Audience Description/Purpose Frequency Sender Distribution Vehicle Internal / External? Comments
 

 

1

  

 

Weekly status meeting

  

 

Project Team

  

 

Project status updates

  

 

Weekly

  

 

Project Manager

  

 

Meeting

  

 

Internal

 All team members required to attend. Other stakeholders will be invited when necessary.
 

 

 

2

  

 

 

Steering committee review

 CEO, CFO,

Finance Director, Accounting Director, Sales Director, Project Manager, Data Architect

  

 

 

Status update, barrier communication, and progress planning

  

 

 

Monthly

  

 

 

Project Manager

  

 

 

Meeting

  

 

 

Internal

 The steering community will adopt insights from the meeting to advice on the way forward if needed.
 

3

  

Weekly status report

 CEO, CFO,

Finance Director, Project Team

 Status updates milestones and deliverables check  

Weekly

  

Project Manager

  

Email

  

Internal

 The project team will ensure that milestones and deliverables are met as planned and everything is within scope.
4 Sales update calls Sales Team Current project status updates Bi-weekly Project Manager Phone calls Internal The sales team will determine whether every completed task adds value to the project and the organization and communicate with the client.
5 Daily team meetings Project Team Current status update, check progress, and set daily goals. Daily Project Manager Meeting Internal To kickstart the day and ensure everything runs as smoothly as possible
 

6

  

Team updates calls

 Individuals with low Influence but high Interest in the project, and are part of the project team. Current status updates to those involved but with minimal influence to the project.  

Bi-weekly

  

Project Manager

  

Phone calls

  

Internal

 Needed to ensure high level involvement of all stakeholders.

Section D: The Project Scope Statement

PROJECT SCOPE STATEMENT
Project Name Getta Bill Project #: 01072015
 

Project Manager

  

Ima Payne

 Start Date

February 27,

2022

 End Date September 10, 2022
Project Sponsor Hatchi Kita

 

Project Description

The Getta Byte Software Billing System Implementation project focuses on replacing the current manual, inaccurate, costly, and inefficient billing system. The new billing system will be cloud-based, accurate, easy to use, and efficient system, reducing billing errors by 15%, labor cost by 25%, and billing cycle length by 30% (Devry Canvas, 2022).

Project Requirements

The new billing system should offer audit capabilities to enable the company to generate specific, dynamic reports on the number of billed customers, total billing for various periods, and drill down for details (Devry Canvas, 2022). The reporting will allow the company to monitor the system and ensure maximum effectiveness in executing the assigned roles. The reporting will also support decision-making regarding the future of the billing system. (Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

Project Deliverables

The new billing system is cloud based, which makes it more accessible to consumers and representatives than the old system (Devry Canvas, 2022). Higher accessibility is one of the deliverables for the project. The old system was inaccurate. The new billing system is expected to reduce billing errors by 15%. Therefore, data accuracy for the customers is another deliverable for the project. (Course Project: The Getta Byte – New Billing System Project: Sections A, B, C, D)

Project Exclusions

Any changes to the Financial System of Record are out of scope, and the new billing system will only interface the financial system.

Acceptance Criteria

The project has to increase the efficiency of transactions by 30%, offer dynamic reporting, and reduce billing cycles by 30% for its to be accepted (Devry Canvas, 2022). Anything less than these will be deemed a failure and either prompt project halt or re-planning and re-execution of tasks or areas that need improvement.

Estimated Project Schedule

 

Milestones Estimated Completion Timeframe
Initial Meeting with stakeholders March 23, 2022
Finalize Requirements Gathering April 6, 2022
Purchase Software May 8, 2022
Personnel Training July 27, 2022
Complete Development August 15, 2022
Migrate Customer Data to Cloud August 25, 2022
Complete First Pilot September 1, 2022
Complete Project September 10, 2022

Resource Requirements

The project needs a project manager, at least one data architect, two developers, and several billing representatives (Devry Canvas, 2022). The project manager is responsible for leading the project team, communicating to stakeholders, and delivering the project. The project manager will run the project daily. The data architect will review and assess the data infrastructure, plan the database, and guide solutions to store and manage data to effective and efficient running of the system. Developers will help analyze the software, user needs and requirements gathered, and offer insights on how to ensure the software meets the needs and requirements. Billing representative have in-depth knowledge regarding customer needs and system requirements because they interact daily with customers and the system. Other resources needed include test machines and a test environment before releasing the new system to the company.

Estimated Cost of Project

Expense Type Description Estimated Cost
Labor o   Developers

o   Data Specialist

o   Project Manager

 $50,000.00

$50,000.00

50,000.00
Material &

Equipment Cost

 o   Software Purchase $85,000.00
o   Module development contractor $10,000.00
Fixed Cost o   Trainers and educators $5,000.00
TOTAL ESTIMATED COST OF PROJECT $250,000.00

Project Constraints

The assigned budget and schedule might hold the project back and are perceived the primary project constraints (Devry Canvas, 2022). The project communication management plan offers a theoretical depiction of how the communication will be executed, including audience, frequency, and channels. However, this might change or be more complicated on the ground due to various factors such as team conflicts, lack of availability, missing emails or someone did not see an email, did not pick the phone, and many other issues that derail communication. Therefore, communication becomes another constraint. Additionally, data transfer or migration can be challenging due to data transfer risks, including system failure or lost data and the time and energy needed to ensure complete and accurate data migration. Finally, team training to ensure competency in using the new system can be a challenge because training is complicated, members have different learning levels, and it might not be completed with the specified timeframe. Training is an ongoing process, and which needs might change during project development.

Project Assumptions

Project assumptions are that the implementation of the new billing system will not prompt troubleshooting the company’s network (Devry Canvas, 2022). The project team also assumes that the current billing or customer data is accurate, without any missing links or data and the budget will be enough to cover all costs, and all milestone sand deliverables will be fulfilled. The project team also assumes that the software acquired will meet user needs and requirements and work as expected and no software failures or return will be necessary.

 References

Devry Canvas. (2022). Getta Byte Stakeholders and Communication Management. [Video]. https://www.coursesidekick.com/information-systems/1073984

Devry Canvas. (2022). Getta Byte — Project Scope. [Video].

Devry Canvas. (2022). Getta Byte — Project Stakeholder Engagement and Communications Management Plans. [Video].

Farkas, E. B. (2018). A Guide to the Project Management Body of Knowledge (PMBOK GUIDE). Podium, (34), 85-88. https://www.works.gov.bh/English/ourstrategy/Project%20Management/Documents/Other%20PM%20Resources/PMBOKGuideFourthEdition_protected.pdf

Kloppenborg, T., Anantatmula, V. S., & Wells, K. (2018). Contemporary project management. Cengage Learning.

 
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NSG 301 Problem Statement Worksheet

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(NSG 301 Problem Statement Worksheet)

NSG 301 Problem Statement Worksheet

 

Name: ________________

Instructions: Please write your answers directly into this document and do not delete the questions or instructions. You may wish to use a different font, text color, or boldface to make your answers more visible, although it’s not required. When completed, “Save as” and add your last name to the file name.

 

Now that you’ve written a draft of your personal essay, read it as if it were written by someone else. You might try pretending that you are a nurse manager or hospital administrator, and that essay was submitted by someone who works for you—a valuable nurse who you would like to make happy and keep on your staff! Listen carefully to what the essay is telling you. (NSG 301 Problem Statement Worksheet)

 

  1. What is the primary problem in the essay?

 

The essay addresses medication administration errors. Medication administration errors include either administering medication using the wrong dose or the wrong route, administering the wrong drug to the wrong patients or at the wrong time. Dose ommissions and lack of documentation are also considered medication administration errors. The five rights, that is, right patient, medication, time, dose, and route are taught in the nursing curriculum. Nurses should identify and prevent these errors to promote patient safety. Medication administration errors can also be system generated attributed to inadequate training, system misconfiguration, distractors, and convoluted processes. Other factors associated with an increased probability of medication administration errors include burnout, work-related stress, frustrations, and lack of engagement.

NSG 301 Problem Statement Worksheet

 

  1. What other problems are mentioned in the essay or are related to the central problem? (Name at least 1, at most 3.)

 

The essay also mentions other nursing problems, including burnout, work-related stress, and lack of engagement. Nurse burnout encompasses emotional exhaustion, feelings of frustration, and lack of motivation. Causes of work-related stress include working overtime, heavy workload, conflicts with colleagues, and job insecurity. Lack of engagement involves a lack of commitment to and satisfaction with the job linked to factors such as heavy patient workloads and inadequate managerial support and communication.(NSG 301 Problem Statement Worksheet)

 

  1. What other problems are of interest to you? (Name at least 1, at most 3.) These can be completely unrelated to your personal essay. It’s your chance to change topics, if you want.

 

Work safety and inadequate staffing are problems of interest because they significantly impact nursing practice. Inadequate staffing leads to heavy patient workloads and long working hours. Work safety is associated with risks and hazards, including the possibility of infections, that impact nurses in their jobs. Hospitals should promote workplace safety to increase job satisfaction and commitment to patient care.

 

 

At this point, you should have at least 3 specific problems on this worksheet. Highlight the ONE problem you’d MOST like to focus on for the classical argument research paper. (Note that you have the opportunity to change topics. You are not required to stick with the problem central to your personal essay.) Answer the rest of the questions about the highlighted problem ONLY. (NSG 301 Problem Statement Worksheet)

 

Answers You Already Know

  1. Briefly describe the problem as it affects the specific population that you know (from your own experience, observation, or reading) is affected by this problem. Make sure you name the specific population. (Don’t discuss any solutions yet, just the problem.)

 

Everyone taking medication is considered a vulnerable population and at risk of medication administration errors. However, there are some populations perceived to be at a higher risk of experiencing these errors, including elders, children, and those with limited language skills, especially English and health literacy. The elderly population is significantly at risk, particularly those individuals taking multiple medications. Patients in surgical care, intensive care, and emergency rooms are also at increased risk of experiencing medication administration errors. (NSG 301 Problem Statement Worksheet)

 

  1. Why is it important this problem be addressed now?

 

Medication administration errors are associated with adverse drug events, complications, patient morbidity, and mortality in worse-case scenarios. These errors also affect the hospital’s and providers’ reputation and increase high institutional and healthcare system costs. Addressing medication administration errors would help prevent adverse drug events, complications, morbidity, and mortality. It would also promote a positive image of the hospital and healthcare providers and help reduce healthcare-related costs.

 

  1. What is the current practice/protocol in your workplace?

 

Current practices to limit and prevent medication administration errors at the workplace include standardized communication, optimizing nursing workflow, and focusing on high agents. The organization has also adopted computerized physician order entry to reduce the risk of medication administration errors.

 

 

Look at your answers to questions D-F and highlight at least 1 and at most 3 key words or short phrases that could help narrow your focus.

 

Asking Questions About What You DON’T Know

Asking questions is a good way to explore what you might want to research. Keep in mind that you do NOT need to know the answers at this point. In fact, you SHOULDN’T have all the answers, because the entire point of research is to find out something you don’t already know.

 

  1. What causes the problem? Consider the factors that create or exacerbate the problem. Some you may know. Others might be speculation. Write at least 3 questions about possible causes. (Try the formula: Is ____ a cause of [the problem]?)

Examples: (If my topic/problem is “violence in the ED”) 1. Do long ED wait times make patients more likely to become violent? 2. Do drug-seeking patients cause the majority of ED violence? 3. Do staff attitudes provoke violent reactions?

 

  1. What work-related factors cause medication administration errors?
  2. What individual-related factors increase the risk of medication administration errors?
  3. What system-related factors increase the risk of medication administration errors?
  4. Are managerial and leadership comptenecies linked to medication administration errors?

 

 

  1. What are the effects of the problem? Some you may know, while others may be predictions. Write at least 3 questions about possible effects. (Try the formula: Does [the problem] cause ____?)

Examples: (If my topic/problem is “violence in the ED”) 1. Does ED violence cause the hospital to lose money? 2. Does violence make it harder to retain ED nurses compared to other units? 3. If ED violence continues, will patients be afraid to seek help?   

 

  1. Do medication administration errors increase morbidity and mortality rates in the healthcare facility?
  2. Are medication administration errors associated with long hospital stays, patient readmissions, and adverse drug events observed at the healthcare facility?
  3. Is there an association between hospital ratings and medication administration errors?
  4. Do medication administration errors affect relationships between healthcare providers and their patients?

 

 

  1. Write at least 4 factual questions about your topic. If I knew nothing about your topic, what questions would I ask about it? Make a list of specific questions that ask: Who? What? When? Where? (Do not ask questions about causes or effects, since you’ve already covered that.) 

Examples: (If my topic/problem is “violence in the ED”) 1. Who are the usual perpetrators and victims of ED violence? 2. When do most violent incidents occur? 3. How often do they occur? 4. Where is risk the greatest (in waiting room or exam area)? 5. What are some security precautions taken in the ED? Etc.

 

  1. Who are associated with a high rate of medication administration errors at the healthcare facility?
  2. What time or day is associated with most medication administration errors?
  3. In which departments is the risk of medication administration errors the greatest?
  4. How often are medication administration errors at the workplace?
  5. What safety precautions are applied to address medication administration errors at the workplace?

 

 

  1. You’ll also need to know the scope of the problem. Since the questions are likely to be the same for everyone, I’m just going to give you the questions and ask you to either speculate about the answers or respond “I don’t know.” Remember that it’s OK to recognize gaps in your knowledge!
    1. Other than the population mentioned in your answer to question D above, who else might be affected by this problem?

 

The essay focuses more on the elderly population as being at the greatest risk of experiencing medication administration errors. However, children, immigrants with limited English skills, and health illterate individuals are also at an increased risk of experiencing medication administration errors.

 

  1. Is this problem limited to your unit, your institution, your region, NY state, the U.S.? Is it a global problem? Is it a particular problem in certain settings (such as rural hospitals, urban communities, developing nations, etc.)?

 

Medication administration errors are not limited to specific settings because they are reported at every healthcare facility. These errors are universal, with the only difference being the rate at different healthcare facilities.

 

  1. How long has this problem been going on or been acknowledged as a problem in the academic conversation?

 

Medication administration errors have been around since drugs were created to address healthcare problems. There are no documentations on the exact time. However, medication administration errors are recognized in academic convesartions throughout the history of medicine, associated with breakdown at any stage of the medication process.

 

  1. What is being done to address this problem in other places?

 

Medication administration errors impact patient safety, and the primary focus of healthcare reforms is promoting patient safety. Evidence-based interventions to reduce medication administration errors at the moment include staff training, standardized labelling, and clear storage requirements. Technological interventions include clinical decision support strategies and computerized physician order entry systems. Electronic health records also facilitate efforts to reduce medication administration errors by providing the correct and timely information to support prescription and administration.

 

Some questions will be interesting to you, and you’ll want to explore them further. Others may not interest you. Asking lots of questions is a good way to decide which aspects of the problem you’ll want to focus on and which you’d rather not. Look at the questions and guesses you made in response to questions G-J(d). Highlight at least 1 and at most 3 of the individual points that are most interesting to you personally. (For example, if I highlight just “Do long ED wait times make patients more likely to become violent?” that’s 1 individual point. If I highlight all 3 of my responses to question G, that would be 3 individual points.)

 

Create a Problem Statement

  1. Look at everything you have highlighted in the sections above. Identify key words or short phrases that might be valuable search terms. (For example, “ED wait times” and “patient violence” would be good selections from the example sentence above.) Copy and paste ALL the key words and phrases here: (1 problem from A-C; 1-3 keywords from D-F; 1-3 points from G-J)

Phrases and Keywords

  1. The five rights of medication administration: The right patient, medication, time, dose, and route.
  2. Medication administration errors among older adults
  3. Association between medication administration errors and adverse drug events, complications, patient morbidity, and mortality.
  4. Standardized communication and workflow optimization role in reducing medication administration errors.
  5. Work-related factors associated with medication administration errors.
  6. The prevalence of medication administration errors at the workplace.

 

 

  1. Make a claim about your problem. A good approach is to answer the question: What’s bad about the problem? The claim cannot be personal in nature, but it may be specific to your unit/institution. (If it’s specific to your workplace, name the specific place instead of using first person pronouns. For example, “the ED at Highland Hospital” is good, but “my unit” is not.) Incorporate at least 2 of the key words or phrases from your response to question K. You may include speculative details in your claim (you can always revise if the research doesn’t support the claim. Example: Excessive wait times in the ED increase the likelihood that patients will become violent.) Write only ONE SENTENCE and keep it short and simple:

 

Medication administration errors increase the risk of adverse drug events, complications, patient morbidity, and mortality. (NSG 301 Problem Statement Worksheet)

 

Believe it or not, you just wrote the first half of your thesis statement AND have prepared a list of search terms to guide your research! The Answers You Already Know and the answers you’ll find to the Questions About What You DON’T Know will be more than enough to fill the introduction and background sections of your classical argument paper. You’ve made a lot of progress! Go get a healthy snack and a glass of water to celebrate.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764714/

 
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9-1 Final Project Submission: Assessment Analysis

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(9-1 Final Project Submission: Assessment Analysis)

PSY 550 Milestone One

The chosen vignette involves a 33-year-old single Caucasia female, code-named Ms G. Ms G is present to assess and elucidate her diagnosis issues and plan for her vocational and educational goals. Ms G has congenital spina bifida. She uses a wheelchair for ambulation and has no developmental concerns. She did not receive a tailored individualized education plan (IEP) or special education. During college, she had a leave of absence after two years of study, which was challenging. She wants guidance on continuing her studies, considering she struggles academically and does not fit in with her peers. She has been on and off counselling for her mental health issues. She is taking Zoloft and Xanax to manage her anxiety and depression. She reports general anxiety and depression but has experienced three severe occasions of depression. She fears vomiting and is concerned with her inability to secure employment, for which she feels helpless. She does not know why she has been losing friends. She needs support with her psychological status, i.e., depression, anxiety, and social concerns. This essay aims to research and understand the Wechsler Adult Intelligence Scale and Millon Clinical Multiaxial Inventory tests concerning the client’s case and determine their significance in understanding the client. (9-1 Final Project Submission: Assessment Analysis)

Test and Assessment Development Analysis: Test One

WAIS-IV is a self-administered and norm-reference test, such that it can be scored with software or manually and takes 60-90 minutes to score. WAIS-IV determines a person’s cognitive or intellectual ability. It is commonly used as a normed-referenced test for a comprehensive intelligence assessment in older adolescents and adults aged 16 to 90, 11 months (Valentine et al., 2020). Variations of this test, the Wechsler Intelligence Scale for Children aged 6-16 and the Wechsler Preschool and Primary Scale of Intelligence for children between three months old to 7 years, are used for individuals below 16 years. Index scores include working memory, perceptual reasoning, verbal comprehension, and processing speed.

WAIS-IV has strong validity and reliability scores. In preliminary tests, WAIS-IV has a high consistency with a test re-test reliability that ranges between 0.7 to 0.9 in subscales, and inter-scorer coefficients are high, >.90 (Valentine et al., 2020). The reliability scores for full-scale IQ range from .94 to .98, while primary index scores range from .94 to .96 (Valentine et al., 2020). The test re-test scores are strong for full-scale IQ, .96, and primary indexes scores range from .87 to .96. These ratings have been corroborated in various studies and populations. The reliability score for full-scale IQ measurements based on a standardized sample is .98, which suggests good internal consistency (Drozdick et al., 2018). Drozdick et al. (2018) established a test re-test reliability score of .96 with a 22-day mean interval. Therefore, WAIS-IV provides robust evidence when measuring general intelligence based on mixed clinical and non-clinical samples. (9-1 Final Project Submission: Assessment Analysis)

Test and Assessment Development Analysis: Test Two

The Millon Clinical Multiaxial Inventory (MCMI – III) was the second test administered. MCMI-III is typically administered and scored by mental health personnel. False versions can be taken manually, computer, or online and reviewed by a licensed mental health professional. MCMI-III takes 25 to 30 minutes to complete. MCMI-III is a self-report measure for psychopathology associated with personality disorders and associated clinical symptoms (Andrews & Bender, 2020). MCMI-III is designed for adults ages >18 years in outpatient or inpatient clinical settings or inmate correctional settings with at least an eighth-grade reading level (Andrews & Bender, 2020). MCMI-III provides a comprehensive assessment of diagnostic and treatment data for mental health personnel for individuals with personality disorders and associated clinical syndromes (Andrews & Bender, 2020).

Besides, the MCMI-III provides mental health personnel with a client’s emotional and interpersonal insight (Andrews & Bender, 2020). Therefore, MCMI-III can be used to substantiate clinical diagnoses based on a client’s historical data and mental status examination and guide the mental health personnel on treatment recommendations. MCMI-III has strong validity and reliability. According to a study by Alareqe et al. (2021), MCMI-III has reliability ranging from .84 on the anxiety scale and .96 on the somatoform scale. Moreover, the stability of the median coefficient was established at .91, suggesting higher stability of MCMI-III in short periods (Alareqe et al., 2021). The study established an overall internal consistency of .83, scoring .78 for the masochistic personality disorder to .87 for histrionic personality disorder and compulsive personality disorder. For the three severe personality disorders, the test acquired an overall reliability of .84, ranging from .71 to .83 for schizotypal personality disorder and paranoid personality disorder, respectively (Alareqe et al., 2021). It had an overall reliability score of .91 for the three clinical syndromes, ranging from .84 to .70 for thought disorder to .86 for delusional disorder. (9-1 Final Project Submission: Assessment Analysis)

Research and Clinical Formulation

  1. Test and Assessment Development Analysis: Test One
  2. Cut scores

9-1 Final Project Submission: Assessment Analysis

The WAIS-IV measures five aspects of intelligence, Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). These indexes are designed to have a mean score of 100 and 15 IQ points as standard deviation. A 100 IQ defines an average adult’s performance at that age. Most adults (2/3) have an IQ of 85 to 115 (Arizona Forensics, 2022). Approximately 95 percent score between 70 and 130 and 99 percent between 55 and 145. Normal scores on the scale range between 90 to 110, at-risk scores between 70 and 89, and clinically significant scores below 69.

The diagnostic labels and associated numerical limits regarding IQs and percentages are:

IQ Classification
130 and above Very Superior
120-129 Superior
110-119 High Average
90-109 Average
80-89 Low Average
70-79 Borderline
69 and below Mentally Retarded

 

The following are the corresponding scores for the patient:

Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average
  1. Cultural concerns

Cultural factors like language barriers may significantly affect the administration of the WAIS-IV test. Language differences among equally intelligent respondents may result in variations in mean scores on each item, producing biased results (Duggan et al., 2019). The respondents may poorly translate the items or be unfamiliar with them, or the original items may be ambiguous, causing biases. Besides, behavioral differences across cultures may also affect the tests. Western cultures believe intelligent people have skilled reasoning, while African cultures (Kenya) believe that appropriately dressed and behaved children are intelligent.

  1. Ethical Issues

Low reliability among individuals with an IQ below 50, cultural bias, and poor scores for culturally deprived children are among the ethical issues linked to using WAIS-IV. Other ethical concerns include the forceful administration of the tests to unwilling individuals, which may increase the test results’ bias. Autonomy is an important ethical principle in disease evaluation, diagnosis, and treatment, and no patient should be coerced into forceful test administration. Most patients suspect and are ambivalent towards psychological tests, and the physician should take patient preferences, needs, culture, and beliefs into perspective. For example, some schools can administer the tests without the children’s or their parent’s consent. Besides, Goldstein, Allen, and DeLuca (2019) observe that poor translations may result in discrepancies distorting the final intelligence measures, hence the need for extreme caution when using results based on translated items. These ethical considerations should be addressed during the assessment and results interpretation.

  1. Methods

Practitioners should extract accurate information from their assessment, develop inferences from patient data, and accurately and appropriately communicate the information to the patient to make understanding and interpretation easier. Interpretation and communication of the test results should incorporate competency, theory, and clinical skills (Goldstein, Allen & DeLuca, 2019). The interpreters should clearly outline any discrepancies between the profiles of different participants while comparing them with matched controls. Standard error of measurement linked to confidence should also be a factor when communicating assessment results to help the patient understand the results and test results’ limitations. The comparison group selected to assess performance and the associated standardized test scores should be communicated to the client. (9-1 Final Project Submission: Assessment Analysis)

III. Test and Assessment Development Analysis: Test Two

  1. Cut Scores

MCMI-III identifies symptom disorders and personality disorders. It comprises three validity scales, ten basic personality scales, three severe personality scales, six clinical syndrome scales, and three severe clinical syndrome scales (Alareqe et al., 2021). The test uses base rate scores, critical values ranging between 75 and 85. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. A base rate of 85 or higher indicates a personality disorder presence. Similar values on the symptoms scale indicate that the disorder is severe or significant. A base rate of 60 represents the median score. The lowest possible BR score is 0, and the highest is 115. The cut scores for the Millon Clinical Multiaxial Inventory (MCMI – III) scale produced a mean score of 60, with normal scores averaging 60-74. High-risk scores averaged between 75-84, while scores between 85-115 were clinically significant.

The corresponding results for the patient are:

Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average
  1. Cultural Concerns

Differences in languages and translations in distinguishing personality disorders may affect the reliability and administration of the tests (Goldstein, Allen & DeLuca, 2019). Errors are likely to occur when translating the original items of MCMI-III, causing varying understandings of the identified disorders across cultures. Also, social norms influence interpersonal functioning, which is crucial in diagnosing borderline personality disorders (Kramer, Bernstein & Phares, 2019). Failure to consider the interpersonal traits of the individuals taking the test may produce biased results.

  1. Ethical Issues

Kramer, Bernstein, and Phares (2019) observe that ethical issues may include administering the test to individuals who do not require them, resulting in harmful labelling of clients, especially when sharing the test results with them. Besides, some test administrators may ignore confidentiality and privacy limits and share the tests with third parties (Kramer, Bernstein & Phares, 2019). Also, there can be concerns related to the incompetency of the administrators, whereby some of them may not use the tests for recommended purposes, like measuring the stable traits of the patient.

  1. Methods

The test administrators should be competent and employ actuarial and clinical judgment when interpreting and communicating the tests (Kramer, Bernstein & Phares, 2019). They must use appropriate standards to ensure that the produced tests are valid and reliable. The interpretation of the MCMI-III assessment information is based on base rate (BR) scores, with 60 being the median score, zero being the lowest possible score, 75-84 the critical level, and 85-115 the significant score. The practitioner should determine whether points above the waterline indicate a disorder, stressors, or symptoms affected by multiple issues under the waterline. The communication should be culturally sensitive and avoid any form of cultural bias. The patient should be involved throughout the assessment to enhance understanding and interpretation of the results. The practitioner should provide the patient with an appropriate handout to take with them for continued processing.

 

 

  1. Clinical Formulation
  2. Results
  3. WAIS-IV Scales
Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average

 

Based on the WAIS-IV scales, the patient scored 94 on the Full-Scale IQ (FSIQ). A score of 94 is within the average range of most human beings, indicating that the patient can effectively solve problems, manage situations, and employ abstract thinking in making decisions. The patient scores for PSI (81) and PRI (82) were low average, indicating problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without errors (Goldstein, Allen & DeLuca, 2019). However, the problems are insignificant and cannot be interpreted as an intellectual disability. The patient had average scores in Working memory Index (WMI) (108), GAI (95), and VCI (107), indicating typical or a normal person’s ability to sustain attention, concentration, apply mental control, measure verbal reasoning and concept development.

  1. MCMI-III Scales
Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average

Consequently, based on the MCMI-III scales, the patient scored 75 on depressive, 85 on anxiety, 81 on schizoid, and 79 on major depression. Other scores include 81 (dependent), 80 (masochistic), and 75 (desirability). These scores indicate higher levels of personality disorders. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. Values between 85-115 indicate the presence of a disorder. In this case, the patient might have a problematic personality trait or symptoms associated with depression, schizoid, major depression, masochistic, and desirability. The patient’s scores indicate she is positive on the anxiety scale and suffers from anxiety disorders.

Diagnosis

Based on the WAIS-IV scales, the patient has problems forming nonverbal concepts, visual perception and organization, learning, visual-motor coordination, visual stimuli and processing simple and routine visual materials without error. However, the scores are above the median score, indicating that the problems are not significant and can be found in an average human being; hence do not indicate the presence of a disorder. However, these symptoms might show that a personality disorder is secondary. Most scores in MCMI-III scales are average, therefore, not implying the presence of a disorder but problematic personality traits or symptoms associated with a disorder. The score on the anxiety scale is 85, indicating the presence of anxiety disorders, promoting further assessment and testing to establish the exact anxiety disorder.

  1. Psychometric Data

The results indicate the patient has problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without error, which do not necessarily indicate the presence of a cognitive disorder but might indicate problems associated with intellectual disability. The confirmed diagnosis is an anxiety disorder. There are multiple anxiety disorders, prompting further assessment to determine the accurate diagnosis of anxiety disorder. Tools such as GAD-7 can be used. The presence of anxiety disorders justifies the referral for further assessment to develop an accurate diagnosis and a proper treatment plan for the patient.

 

  1. Recommendations

The client is indicated as experiencing symptoms associated with intellectual disability but not indicating the presence of a disorder. However, the assessment indicates that the client is experiencing an anxiety disorder. The appropriate step after this analysis is to refer the patient for further assessments to develop an accurate diagnosis and proper treatment plan, which is critical in managing anxiety disorders. Anxiety disorders are linked to a significant burden of illness. Multiple secondary symptoms presented by the patient might be signs of the confirmed disorder or other secondary disorders that can co-occur with anxiety disorders. DMS-5 and ICD-10 classification will help with the accurate diagnosis of the disorder following their criteria of symptomology indicating the presence of anxiety disorder. A correct diagnosis of the disorder will help develop a treatment and management plan that includes a combination of psychological therapy and pharmacotherapy (Bandelow et al., 2018). Cognitive behavioural therapy is the primary therapy recommended for this patient because it has the highest level of evidence (Bandelow et al., 2018). Changing thinking and behaviour patterns will help the patient manage anxiety-related challenges.

Both pharmacological and non-pharmacological interventions or approaches have ethical implications. Ethical concerns associated with exposure to these interventions include fear of symptom worsening, client safety issues, boundary lines between patients and practitioners, and a high treatment dropout rate (Marks et al., 2021). Nonmaleficence, respect for persons, confidentiality, and veracity are concerns during treatment. Applying these principles can help the practitioner navigate successfully through the treatment and management process despite many uncertainties associated with the treatment of mental health disorders (Marks et al., 2021), particularly dealing with anxious patients. The treatment must be delivered within this ethical framework to obtain desirable outcomes.

The primary purpose of communicating the results is to let the patient know their mental health state, what disorder they are experiencing, and to help them understand the circumstances or options surrounding the disorder. The presentation of results should be in a format and language that the patient can easily understand (Washington Medical Commission, 2022). It should be done in a timely manner, either in writing, by telephone, in person, or electronically. For an initial diagnosis, in-person communication is the most effective, but the practitioner should ask the patient how they would like to hear the results. Understanding the patient’s mental state and ensuring they are comfortable is also important. The practitioner should consider a culturally sensitive format, avoid bias, and demonstrate empathy. Most importantly, the practitioner should document everything and share additional resources with the patient.

The results of the assessment necessitate further assessments to develop a correct diagnosis. Various limitations are linked to the assessment and data analysis, including the time needed to measure or administer some subsets, especially those requiring comprehension of the WAIS-IV scales. Just like WAIS-IV, MCMI-III is a self-reported test associated with a high probability or potential for response bias, affecting the reliability of the results. Further assessments are required to determine the correct diagnosis and the validity of the results on a patient basis. (9-1 Final Project Submission: Assessment Analysis)

References

Alareqe, N. A., Roslan, S., Nordin, M. S., Ahmad, N. A., & Taresh, S. M. (2021). Psychometric Properties of the Millon Clinical Multiaxial Inventory–III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.562619

Andrews, J., & Bender, S. (2020). Millon Clinical Multiaxial Inventory (MCMI). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 287-292. https://doi.org/10.1002/9781119547167.ch120

Arizona Forensics. (2022). Wechsler adult intelligence scale – IV (WAIS-IV). Arizona Forensics, LLC – Forensic Psychologist, Tucson AZ. https://arizonaforensics.com/wechsler-adult-intelligence-scale-iv-wais-iv/

Bandelow, B., Michaelis, S., & Wedekind, D. (2018). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2018.19.2/bbandelow

Drozdick, L. W., Raiford, S. E., Wahlstrom, D., & Weiss, L. G. (2018). The Wechsler Adult Intelligence Scale—Fourth Edition and the Wechsler Memory Scale—Fourth Edition. In D. P. Flanagan & E. M. McDonough (Eds.), Contemporary intellectual assessment: Theories, tests, and issues (pp. 486–511). The Guilford Press.

Duggan, E. C., Awakon, L. M., Loaiza, C. C., & Garcia-Barrera, M. A. (2019). Contributing towards a cultural neuropsychology assessment decision-making framework: Comparison of WAIS-IV norms from Colombia, Chile, Mexico, Spain, United States, and Canada. Archives of Clinical Neuropsychology, 34(5), 657-681. https://doi.org/10.1093/arclin/acy074

Goldstein, G. Allen, D. N. & DeLuca, J. (2019). Handbook of psychological assessment (4th ed.). London: Academic Press. ISBN: 9780128022030

Kramer, G. P., Bernstein, D. A. & Phares, V. (2019). Introduction to Clinical Psychology. Cambridge University Press. ISBN: 9781108705141

Marks, J. A., Rosenblatt, S., & Knoll IV, J. L. (2021). Ethical Challenges in the Treatment of Anxiety. Focus, 19(2), 212-216.

Valentine, T., Block, C., Eversole, K., Boxley, L., & Dawson, E. (2020). Wechsler Adult Intelligence Scale‐IV (WAIS‐IV). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 457-463. https://doi.org/10.1002/9781118970843.ch146

Washington Medical Commission. (2022). Communicating diagnostic test results to patients. https://wmc.wa.gov/sites/default/files/public/Communicating%20Diagnostic%20Test%20Results%20to%20Patients_GUI%202016-02_revised.pdf

 
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The Safe Staffing for Nurse and Patient Safety Act of 2018

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The Safe Staffing for Nurse and Patient Safety Act of 2018

Assignment 2

The Safe Staffing for Nurse and Patient Safety Act of 2018

The core of nurse advocacy is promoting and enacting legislation that benefits nurses and patients. Nurses voice on behalf of their patients, communities, and profession every day. Still, it is also critical that they offer their knowledge to elected officials when they create and approve legislation that affects nursing. A bill that would enhance treatment and help keep nurses and patients safe was presented by bipartisan supporters of the American Nurses Association in the House of Representatives and the Senate (ANA Capitol Beat, 2018). The Safe Staffing for Nurse and Patient Safety Act of 2018 was introduced by supporters including Rep. David Joyce (R-OH-14), Suzan DelBene (D-WA-10), Suzanne Bonamici (D-OR-1), and Tulsi Gabbard (D-HI-2) (S. 2446, H.R. 5052).

According to the legislation, hospitals must form a committee with a minimum of 55 percent of direct care nurses to develop unit-specific nurse staffing plans. Nurses around the nation know that when units are understaffed, patients risk prolonged hospital stays, a rise in infections, and unnecessary injuries (ANA Capitol Beat, 2018). A decrease in nurse retention and increased injury and burnout rates are all consequences of understaffing. The quality of patients’ care is significantly impacted by the presence of registered nurses (RNs). Appropriate nurse staffing reduces the risk of death while keeping patients secure and safeguarding them from avoidable complications. The Safe Staffing for Nurse and Patient Safety Act gives direct care nurses the authority to identify their patients’ particular and changing needs to guarantee their safety and the effectiveness of the treatment they get (ANA Capitol Beat, 2018). However, the U.S. still experiences nurse shortages or understaffing in specific practice areas such as emergency departments. Additional steps to address understaffing include:

  • Improving and simplifying the hiring process.
  • Employing data-driven hiring decisions.
  • Increasing retention by reducing and preventing nurse burnout.
  • Creating clear career growth and development paths.

References

ANA Capitol Beat. (2018). Introducing the Safe Staffing for Nurse and Patient Safety Act. https://anacapitolbeat.org/2018/03/01/introducing-the-safe-staffing-for-nurse-and-patient-safety-act/

 
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