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What factors might your classmates consider for refinement, improvement or proposed in their professional settings for further consideration?

Please respond to each student post separately, reference each student post separately with at least two references. Comment to two of your classmate’s posts. What seems logical? What factors might your classmates consider for refinement, improvement or proposed in their professional settings for further consideration? Provide a critical appraisal of your peer posts written in a professional and constructive manner. Post should include one to two cited references and consist of 300-450 words. STUDENT POST NUMBER ONE, STUDENT NAME IS ANNETTE Quality Improvement Quality improvement has been a focus in healthcare for many years. As a healthcare provider since 1990, I have seen how quality and improvement has come to the forefront of healthcare and how this has improved so many of the processes we do on a daily basis. From inserting central lines, inserting foley catheters, and inserting ET tubeswe have learned so many things. We have learned to monitor our practice, change our practice, monitor the changes, and then see if those changes made any improvement. That is what quality improvement is all about. As a Future DNP-Why Is Quality Improvement Important In the video with Don Berwick he noted that children are very good at systems thinking (Evans, 2014). He noted that children think about the possibilities that can occur and question. They think in steps and what can happen as they question and explore versus what is happening now and they have a more open or systems thinking mindset (Evans, 2014). Systems thinking lets us look at the whole, rather than the parts of an issue (Trbovich, 2014). It lets us identify the connectiveness and relationships that links systems within healthcare. Systems thinking identifies the elements within a system, how they work together and are interconnected, and how they are related in the overall continuum of care. Systems thinking requires collaboration among heath givers who must work together to develop innovative interventions to improve healthcare (Trbovich, 2014), Importance of Genomic Applications in Healthcare The impact of genomic information and technology has the potential to improve healthcare outcomes, quality, and safety, and result in cost savings. These outcomes are directly dependent on optimizing the use of information technology in the healthcare system, including the EHR (McCormick, 2016, p. 23). I think this quote says it all. The information obtained through genomics can be utilized in improving healthcare in a variety of settings. Through the use of the electronic medical record (EMR) and information gained during assessment, the nurse can have knowledge about genetics and the patient and how this may influence their care or diagnosis. It is about putting the information learned into practice to provide the best quality outcomes to the patient based on their specific and unique characteristics or genetics (McCormick, 2016) Quality Subject of Study I selected the patient with a chronic condition in a rural setting and how patient centered care can impact their outcome. Why this was Selected Chronic disease is a current issue in rural health care (Rural Health Information Hub, 2017). It impacts the residents in the form of quality of life, mortality, and healthcare costs. Those in rural communities tend to be older and have higher healthcare costs, multiple chronic conditions and fewer resources to obtain preventative care (Rural Health Information Hub, 2017). Those in rural communities are more likely to die prematurely from the five leading causes of death than those in urban areas (Center for Disease Control and Prevention (CDC), 2018). In addition, rural communities have fewer healthcare providers and specialists, which causes limited access for patients to be served (CDC, 2018). As a rural healthcare provider in the Emergency Department (ED) of a rural critical access hospital, I see patients daily that come in for emergency care that just need chronic disease management. I think as providers, through the concepts of patient centered care, we can do a much better job of caring for these patients. We need to follow up on patients, provide referrals, set up primary care referrals, and provide education. We cannot accept that our job is done when they leave the ED. We must have a systems thinking view of healthcare and how we can impact the patients care beyond the doors of the ED. Importance As healthcare practitioners, we must look at healthcare in a global perspective and see how ones environment affects healthcare outcomes. Those in rural environments have barriers to healthcare that are not experienced by those in an urban setting. We have to have a global perspective and see what we need to do to ensure a continuum of care is provided to all, regardless of their living situation. We must think outside the box and look at the obstacles to care faced by those in rural settings and develop tools and processes to provide patient centered care that provides positive outcomes with regards to the chronic disease management and the continuum of care. Experience As a nurse in a rural ED, I see multiple patients daily that come in for care of chronic conditions. These patients either have no primary health care provider or do not feel they have the financial ability to see their provider. As a critical access hospital, a recently designated healthcare taxing authority, and a clinic network designated as a rural healthcare provider, we have many opportunities and options available to our rural healthcare patients. We also have an obligation to our tax payers to provide care to those in our community that are in need, while ensure tax payer dollars are utilized in the most appropriate way. I feel as an ED nurse and as a hospital provider we should do more for our patients that come to the ED for management of chronic health conditions. Processes should be put in place to follow up with the patients to ensure they are being placed with a primary care provider to follow their chronic health condition. I believe this is where the concept of patient centered care comes into play. I think through processes developed within the organization, patient centered care can be a focus, which will lead to improved quality outcomes, a decrease in unnecessary ED visits, and an overall improved quality of health in the community. Two Takeaways from Video (Evans, 2014) and Readings for Future Healthcare My two takeaways from the video and reading: First: I have been in healthcare for a long time and have been very involved in the IHI campaigns. I have been very fortunate to work with IHI on a personal basis, developing and writing a paper that was published by The Joint Commission on fall prevention several years ago. I think their philosophy and concepts are wonderful. I am a firm believer in continuous quality improvement and never being okay with the current status, but always striving for more. I was very intrigued by the information on big date when it talked about getting information from social media. It was a little scare to think that the information that was put on social media was being utilized for medical purposes to determine incidence of disease and chronic health conditions in the community (Luo, Wu, Gopukumar, & Zhao, 2016). References Center for Disease Control and Prevention (2018). Preventing chronic diseases and promoting health in rural communities. Retrieved from Evans, M. (2014, ). Quality improvement in healthcare. [Video file]. Retrieved from Luo, J., Wu, M., Gopukumar, D., & Zhao, Y. (2016). Big data application in biomedical research and health care: A literature review. Biomedical Informatics Insights, 8, 1-10. McCormick, K. A. (2016). The impact of genomics on health outcomes, quality, and safety. Nurse Manager, 47, 23-26. doi:10.1097/ Rural Health Information Hub (2017). Chronic disease in rural America. Retrieved from Trbovich, P. (2014). Five ways to incorporate systems thinking into healthcare organizations. STUDENT POST NUMBER TWO, STUDENT NAME IS PEYMANEH ndiagnosed Chronic Kidney Disease (CKD) in the Elderly Population One disease not emphasized by physicians in gerontology is CKD. Unfortunately, neither physicians nor patients pay attention to risk factors such as polypharmacy due to a lack of completeness in the entire approach to patient care. I work with middle- and low-income patients in the community who are poorly educated. These patients do not visit a physician unless they are in pain. Sadly, during my clinical experience I have worked with patients who developed complications related to CKD even though they were unaware of their undiagnosed condition. Most of the time, I have had to refer them to a specialist due to comorbidities. This topic is important because in recent years chronic kidney disease (CKD) has become epidemic and has become a major health problem (Mangione & Dal Canton, 2011). Chronic kidney disease leads to an increase in mortality and morbidity, especially in gerontology (Sonnerstam, Sjolander, & Gustafsson, 2016). I believe quality improvement should focus on early diagnosis and preventive methods for these elderly patients rather than dealing with high costs and painful treatments after the diagnosis has already been made. Two Main Takeaways related to Technology and Genomic Applications Technology plays an important role in improving health care delivery by uncovering new data and creating methods to enhance the quality of health care (Luo, Wu, Gopukumar & Zhao, 2016). Utilizing the genomic revolution in the health care industry helps in early diagnoses and preventing the leading chronic diseases in the country (CDC, 2018). It is fascinating to see how modern technology benefits populations in health promotions. Implementation of technology delivers a safe and high quality of standards, which promotes good health. Benchmark is important in motivating health care professionals to compare their work with standards and make positive changes in their practices (. Department of Health and Human Service, 2013). My concerns are that we have few to no supportive systems from health care organizations and policy holders, no access to current technology and no accessible continuing education for health care workers to implement this Benchmark system. I believe cost is one concerning factor for policy makers in emerging technologies across all health care settings. Politicians need to consider this as a benefit to be included in future budgets. The established supervising committees exist to make sure all clinical settings are hiring staff for managing agencies. Policy holders need to consider using biomedical and genomics to increase quality of care in health care systems that benefit not only society but also health care systems by reducing debility, mortality and complications related to preventive diseases like CKD. References Centers for Disease Control and Prevention (CDC). (2018). About Us. Retrieved from (Links to an external site.) Luo, J., Wu, M., Gopukumar, D. & Zhao, Y. (2016). Big data application in biomedical research and health care: A literature review. Biomedical informatics Insights, (8), 1-10. Retrieved (Links to an external site.) Mangione, F. & Dal Canton, A. (2011). Chronic kidney disease epidemic: Myth and reality. Internal &Emergency Medicine, 6, 69-76. Retrieved from (Links to an external site.) Sonnerstam, E., Sjolander, M., & Gustafsson, M. (2016). Inappropriate prescription and renal function among older patients with cognitive impairment. Drugs & Aging, 33 (12), 889-899. Retrieved from (Links to an external site.) . Department of Health and Human Service (2013). Practice Facilitation Handbook. Retrieved from (Links to an external site.)