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   In shortening the length of stay for patients in almost every venue, this process can save a substantial amount of money for the government, but at what cost for many patients?

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PLEASE RESPOND TO THIS DISCUSSION APPROPRIATELY  

The average length of stay (ALOS) in hospitals, Long Term Acute Care Hospitals (LTACHs), and rehab hospitals is trending shorter and shorter.  Medicare (MCR) along with insurance companies (managed care) that contract with MCR has set their sites on shorter stays to decrease spending.  They have, in essence, created a grading rubric that ALOS is 85% of the grade. This leaves all providers and clinicians with little say as to whether the patient discharges at the appropriate time. The days of sending a patient to a rehabilitation hospital where they can receive aggressive therapy while also being medically taken care of are going away (“Length-of-Hospital”, 2017).

In mandating short stays in hospitals and not approving LTACHs and rehabilitation hospitals, one might presume that this is good for skilled nursing facilities (SNF), but that would be wrong because they have now demanded short stays in SNFs as well.  One insurance company has now mandated that a SNF has to have a patient on their service out in 17 days. In dealing with these issues daily this seems to be a trend that will be long-standing as more and more insurance companies are making these demands.

LTACHs are great places for patients to go that are in need of acute care, but for a longer length of time. Originally, LTACHs were seen as the better choice than keeping a patient in an acute hospital due to lower reimbursement. However, MCR has now changed their reimbursement for LTACHs in that the shorter the stay the more reimbursement they can receive (Kim, et al., 2015).

In shortening the length of stay for patients in almost every venue, this process can save a substantial amount of money for the government, but at what cost for many patients? Due to the rules on short stays, nurses and doctors witness patients being discharged sooner than their conditions warrants. The positive side is that SNFs have to increase their skill-set because many patients who would have went to an LTACH or rehabilitation hospital are now being denied by companies, but approved for SNF stays. This puts SNFs in a position because scope of practice laws in each state can limit what can be done in a SNF due to the fact that most nurses in SNFs are Licensed Practical Nurses and very few Registered Nurses. Even though a SNF may see a small increase in census, they are not seeing a raise in reimbursement which makes it difficult to have Registered Nurses in the facility.

There are so many aspects to these changes that many people do not know or understand, but the bottom line is the outcome of patients while trying to keep costs manageable.

How do the sampling methods and sample sizes vary for the different types of quantitative and qualitative research?

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 RELATED TO NURSING/HEALTHCARE ISSUES.

How do the sampling methods and sample sizes vary for the different types of quantitative and qualitative research? Using your research questions (qualitative and quantitative), what sampling method would you use to conduct your study? Why? How would you determine the sample type and size?

Is nursing a basic science and/or applied science?

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I need a 2 page of paper in APA format:

Instructions:Nurse scholars have claimed that nursing is both a discipline and a profession. In order to understand these claims, we must first know what it means for nursing to have a “unique body of knowledge.” If we assume that nursing does, indeed, possess a unique body of knowledge, we can claim that nursing is a “basic science,” rather than an “applied science.” Despite these claims, debate continues about nursing as discipline, profession, and science. Is nursing a discipline? A profession? Is nursing a basic science and/or applied science? In your initial post, state what you think about nursing as discipline, profession, and science. Explore the literature beyond that assigned to you for this week’s readings to help you formulate your position. Include your reference(s) in both your initial post and your reply posts. You should include the following:What is a discipline? What is a profession? What’s the difference? What are examples of each?Does nursing fit the criteria for a “discipline” and “profession”?What is a “basic science”? What is an “applied science”? What’s the difference?Is nursing a “basic” or “applied” science? Support your statements with scholarly references. You may use those from the assigned readings on the course Blackboard site, but you must also select and use (via your literature search) a minimum of 1 reference outside of assigned readings.
Present your posts and replies in a professional, scholarly manner. Use the APA publication manual to format citations and references.

Please follow the instruction and answer all question.

Discussion, as you examine personality disorders, consider therapeutic approaches you might use with clients

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Clients with personality disorders often find it difficult to overcome their problems and function in daily life. Even when these clients are aware that they have a dysfunction with their personality and are open to counseling, treatment can be challenging for both the client and the therapist. For this Discussion, as you examine personality disorders, consider therapeutic approaches you might use with clients.

Analyze therapeutic approaches to treating clients with personality disorders Select one of the personality disorders from the DSM-5. Write a 2 page paper of the personality disorder you selected. Explain a therapeutic approach (including psychotropic medications if appropriate) you might use to treat a client presenting with this disorder, including how you would share your diagnosis of this disorder to the client in order to avoid damaging the therapeutic relationship. Support your approach with evidence-based literature. APA format at least three evidenced-based references.