How you will you respond to complaints made about you to the Director of Nursing and/or Nursing Midwifery Board of Australia as a consequence taking such an action?

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The Nursing and Midwifery Board of Australia, emphasises the professional accountability of nurses. Nursing is governed by professional codes and practice standards. There are times in practice where you may be asked to
do work that you consider being unsafe or risky. For example, being asked to care for patients in a speciality area that you are unfamiliar with, or being assigned patients who have a highly infectious communicable disease.
This assignment asks you to consider an ethical dilemma � the decision by registered nurses of refusing a patient allocation. This is a complex decision and may have implications for an individual�s practice as a healthcare professional.
In this assignment you are to address the following:
Is refusing a patient allocation an option for a registered nurse? If so, why? If not, why not?
How you will you respond to complaints made about you to the Director of Nursing and/or Nursing Midwifery Board of Australia as a consequence taking such an action?
In your response you are to critically address the questions with reference to the academic literature and regulatory standards and codes.

Identify within your operating budget what key positions that you would need to hire for this new venture.

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HCAD 635
Finance Case Study
�The Opening of Bright Horizons�
A new continuing care retirement community (CCRC) is currently under construction in the City of Hope located in a growing area of southern Florida. This is a growing area of the state with a population within 30 miles of the new community of 1.25 million people. Because of the low taxes and mild climate, it has become a very popular retirement destination. Currently, about 32 % of the population is over age 60 and the number of retirees seems to be increasing monthly. The average household income in this area is $102,000 which is much higher than the national average. This community was started by a very generous donation of $ 5 million from the estate of Mrs. Logan who had retired to this area of Florida and spent her last year of life in a nursing home. Because her mother had a bad experience, her son wanted to use some of the proceeds from her estate to open a CCRC where residents could stay in familiar surroundings and age in place.
With the donation, an operator was found with experience in the development and operation of long term care facilities within the continuum. The developer has just hired you as the new Executive Director of this community. You were selected because of your 15 years of experience in this industry and your master�s degree in health care administration from UMUC. You also met the requirements because you are a licensed nursing home administrator in the state of Florida.
This new community is going to be operated as a for-profit corporation under the guidance of a 10 member board of trustees. The project is scheduled to have a luxury apartment complex with 150 one bedroom apartments for seniors who are able to live independently. These apartments will cost about $ 1000 a month in rent and provide excellent security with a concierge around the clock and will also have a van with a driver to transport the residents for shopping and entertainment. Because of the growth of the senior population, it is anticipated that these units will be fully occupied within six months of opening. Residents will use their personal income to pay for these apartments and they can leave without penalty after their lease of one year is complete.
There will be a second building on this campus which will house 50 Assisted Living Apartments for residents who require significant assistance with their Activities of Daily Living. The Assisted Living Area will have apartments without kitchens that open to a central living area and community dining room. Nursing staff will be onsite 24 hours a day and licensed nurses will monitor and oversee the administration of medications for these patients. Residents will pay $2000 a month each to utilize these services. On the other side of the building connected by a central atrium, a 50 bed nursing home will be located. This nursing home is projected to charge $9,000 per month. The owner has projected that 50 % of these costs will be covered by Medicare Reimbursement and 50% will be covered by private pay. Based on your experience, you are certain that the facility should plan for a payer mix as follows: 50% Medicare or other insurance, 20% private pay and 30% Medicaid. Because of the demographic in the area, you are comfortable with market projections that indicate that both the Assisted Living Facility and the Nursing Home should be at 90 % capacity at the end of the first year of operation. Based on market projections, the other nursing facilities are at capacity and the largest provider just had some very negative press due to significant life safety violations cited when residents had to be evacuated because their air conditioning system failed and could not be repaired timely.
As the new Executive Director, the Board Chairman asks that you prepare a budget for the first year of operation and provide a projection on when the CCRC will achieve profitability.
Case Study Questions:
1. Prepare a budget for the first year of operation assuming that the CCRC will be fully open as of January 1st. Please make assumptions where you do not specific facts as you will be evaluated based on the logic and realism of your assumptions. Please make sure to consider staffing costs, revenue and overhead expenses.
2. Identify within your operating budget what key positions that you would need to hire for this new venture.
3. A part of your presentation to the Board, provide feedback to them regarding whether you believe that profitability can be achieved within one year and your rationale.

How does evidence based practice improve patient outcomes?

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TOPICS:
Students will be required to develop an individual position statement related to one of the three topics below. Please choose only ONE topic.
Information contained in the statement should clearly demonstrate the student’s
perspective, which should be supported by current relevant evidence and reflect current policy and practice within the Australian nursing context with clear reference and linkage to the Nursing & Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice.
Topic 1
Evidence based practice (EBP) is the clinical decision making process which is based upon the best available evidence, new research findings, clinical experience and patient preferences. Nurses are expected to implement research findings into their practice, but many are not trained on how to do this. Therefore, it should not be expected that nurses are at the forefront of EBP implementation in the clinical setting.
Hint:
How does evidence based practice improve patient outcomes?
How is evidence based practice applied theoretically and clinically?
Is it feasible to expect RNs to implement EBP in the clinical setting without training/support?Topic 2
Reflective practice is more than just thinking about practice, it is an active process of reflecting, analysing and learning. Reflection is a necessary attribute for the development of autonomous practice. Reflective practice should be a continuous cycle in which experience and reflection on experiences are inter-related.
Hint:
Clinically how is reflective practice applied? How does the patient benefit from reflective thinking of the nurse? What are the key components of reflective practice in nursing?
Topic 3
Nurses have a right to refuse to participate in procedures which they judge on strongly held religious, moral and ethical beliefs, to be unacceptable.
Fear, personal convenience or preference, are not sufficient basis for conscientious objection.
Hint:
When would a nurse refuse patient care? Why?
How does this relate to the nurses’ ethical responsibilities?
Is this considered in the best interest of the patient? Why? How?

explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

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Case Studies 1–3
Respiratory disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies.
Case Study 1:
A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased. Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal. There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive.
Case Study 2:
Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using a short-acting beta agonist every 3 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid, but the prescription ran out, and he forgot to get it refilled. He says he came today because he woke up at 2 a.m. coughing and couldn’t stop, thus preventing him from going back to sleep. Over-the-counter cough suppressants don’t help. He denies cigarette smoking, but his clothing smells like smoke. His respiratory rate is 18 and he has prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. All other exam findings are normal.
Case Study 3:
A father presents his 9-year-old with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment. Physical examination reveals the following: respiratory rate is 18, lungs are clear to auscultation, patient is able to take deep breaths without coughing, there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.
Case Studies 4–6
Assessing, diagnosing, and treating pediatric patients for many cardiovascular and genetic disorders can be challenging. As an advanced practice nurse who facilitates care for patients presenting with these types of disorders, you must be familiar with current evidence-based clinical guidelines. Because of the clinical implications, you have to know when to treat patients with these disorders and when to refer them for specialized care. In this Discussion, you examine the following case studies and consider appropriate treatment and management plans.
Case Study 4:
Miguel is a 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball. He is 6 feet 5 inches tall and weighs 198 pounds. You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.
Case Study 5:
Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20. Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia.
Case Study 6:
You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.
To prepare:
Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
Review and select one of the six provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.
By Day 3
Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.