HE003: Delivery of Services – Emmanuel is 55-year-old man Case – With Solution

Delivery of Services – Emmanuel is 55-year-old man who lives in Jackson, Mississippi. He is an office manager and receives insurance from his employer. – Solution

HE003: Delivery of Services

Instructions

Write your responses where it reads “Enter your response here.” Write as much as needed to satisfy the requirements indicated. Each item contains the Rubric which will be used to evaluate your responses. References to support your writing are required for all objectives.

 

  1. Raymond is a 54-year-old man who lives in a rural part of Mississippi. He is a skilled worker but his job does not provide health insurance. Raymond does not qualify for Medicaid, and he cannot pay for health insurance. He has not received consistent or coordinated healthcare for most of his life. The closest clinic is over 30 miles away, and he does not have the money for both the co-pays and gas. Raymond has been diagnosed with hypertension, and his family history includes pulmonary embolisms and heart disease.

Emmanuel is 55-year-old man who lives in Jackson, Mississippi. He is an office manager and receives insurance from his employer. Emmanuel has had annual medical and dental exams from the same providers for several years. Emmanuel has a family history of Type 2 diabetes and he was recently diagnosed as pre-diabetic and obese. Emmanuel received referrals to an endocrinologist and a registered dietitian, and he was instructed to increase his physical activity.

  • Describe the challenges and barriers to access; affordability; and availability for Raymond and Emmanuel. Indicate why these challenges exist (1–2 pages)
  • Describe the potential social, economic, and health outcomes for Raymond and Emmanuel if prevention had a higher priority in the US. Include how the barriers identified in Objective 1.1 can be overcome and how this could improve their outcomes (1 page)

Your Response

Geographical Accessibility

Health care systems are dispersed in different locations across the states, making them accessible to nearby populations. People living far from health care facilities find it challenging to travel, especially where they can hardly meet their day-to-day needs. Raymond lives averagely 30km away from the nearest health facility, presenting hurdles he encounters to seek medication for his pre-existing condition. He represents individuals from low-income households lacking funds and available networks to access service. 

Emmanuel has a well-paying job that can cater to his medical bills, even when without insurance. Also, a health care facility is near, meaning he can visit regularly. There exist disparities in both scenarios, with Raymond not able to access medical facilities because of his location and economic status.

Affordability

Raymond lives in a rural setting with little income that can sustain himself but does not qualify for Medicaid, and neither does his employer provide insurance. He does not have the funds to pay for his insurance and cater for travel expenses to seek medication. Health care facilities, especially the profit-making organizations, cannot make admissions for people like Raymond, who cannot pay for medicines and services. He has to seek alternative medical facilities once he finds funds to facilitate transport and medicine.

Emmanuel is financially stable is he pays and leans on his health insurance for medication. Even though his check-ups are annual, he manages to pay up without having to strain the availability of money. Disparities between Raymond and Emmanuel in the financial context shows how some people miss out on quality care. 

Availability

The availability of medical services depends on one’s orientation in society, either geographically or financially. Raymond, in the rural parts of Mississippi, is not able to get medication because there lacks hospital facilities in that area. 

Emmanuel can access medication easily since he resides in an urban area hence available medicines in a health care setting. These disparities exist because of location and lack of developments in the rural region.

Potential Social, Economic, and Health Outcomes

For Raymond, paying exclusively for either medication or health insurance will render him miserable without any other means of living. His health will likely deteriorate, and in the most severe case, could suffer from a stroke or heart attack. Moreover, Raymond will not conduct daily activities generally because of the underlying condition.

Emmanuel, on the other hand, will continue to enjoy medication catered for by his insurance, with the most severe conditions leading to change in lifestyle. Lifestyle changes will entail food and daily activities. Diabetes could cause detrimental effects and even sudden death.

Interventions

Community participation

The communities play a crucial role in health care systems as they create awareness and education activities to members in the society. Social marketing strategy helps educate and sensitize the public when to seek medication. 

Community-based interventions such as accreditations address the availability of healthcare systems.

Provision of essential services such as vaccinations and maternity services to vulnerable populations: regulation of these services should be regulated to discourage unethical practices from creeping in the system (Goudge et al., 2009). Some of the essential services include culturally sensitive care, outreach services, home maternity services, emergency transport, and peripheral health units.

Furthermore, improved management systems in the form of enhanced supervision and feedback mechanisms address accessibility to health care services.

Rubric

 0 Not Present1 Needs Improvement2 Meets Expectations3 Exceeds Expectations
Sub-Competency 1: Describe how the delivery of care is affected for those with and without insurance in relation to cost, quality, and access.
Learning Objective LO 1.1: Describe challenges and barriers to access, affordability, and availability for individuals with and without insurance.Comparisons between patients’ history of care and possible health outcomes are missing.Response inaccurately describes the different challenges and barriers to access, affordability, and availability for the individuals in the case presented. Or, issues of access, affordability, cost, and/or they exist are not discussed.   Challenges and barriers do not illuminate differences between insured and uninsured individuals.Response accurately describes the different challenges and barriers to access, affordability, and availability for the individuals in the case presented and why they exist.   Challenges and barriers illuminate differences between insured and uninsured individuals.  Response demonstrates the same level of achievement as “2,” plus the one of the following:   Response includes examples about how health insurance affects patient and population health outcomes and impacts life expectancy. or Response describes challenges and barriers for a third individual (hypothetically) to highlight additional nuances related to access, affordability, and availability of individuals with and without insurance.
Learning Objective LO 1.2: Describe potential social, economic, and health outcomes if prevention has a higher priority in the U.S.Description of potential social, economic, and health outcomes if prevention has a higher priority in the U.S. is missing.Response vaguely or inaccurately describes potential social, economic, and health outcomes for the individuals in the case presented, given an increase in preventative care in the US, or Response does not address the situations of both individuals in the case.  Response accurately describes potential social, economic, and health outcomes for the individuals in the case presented, given an increase in preventative care in the US.  Response demonstrates the same level of achievement as “2,” plus the following:   Response provides examples of two preventative care programs and how they affect social, population, economic, and health outcomes.
  • Define the continuum of care process, including objectives and the relationship to organizations and patients.

The health care system defines a continuum of care as a range of services developed and organized to address a variety of needs individuals have as they grow. This concept recognizes and considers the availability and extent of short-term and long-term care systems and services in the community and institutional settings. Included in the continuum of care are residential alternatives, in-home care, community programs, and institutional facilities.

The continuum of care also refers to the use of health care services from birth through death (Graham, & Varghese, 2012). The continuum of care is comprehensive as it includes patients who use the services over time. The biggest challenge that faces the health care delivery system is the availability of funds; Because of the high number of adults now reaching 65 and retirement age, as well as reaching the time in life when medical problems increase.

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Delivery of services
Delivery of Services

Many seniors are living alone & may need help at home as they age. Some have medical issues, and they will need or do need help with physical care & meals. Many seniors want to remain in their homes. Since many people would rather stay in their own homes, many unfortunately cannot afford to pay the medical staff. Many people need around the clock medical attention, and this is very costly. Since many people are on fixed incomes at this time in their life, getting proper medical care can be very difficult.

Rubric

Sub-Competency 2: Explain the continuum of care process in a variety of settings.
Learning Objective LO 2.1: Define the continuum of care process.Definition of the continuum of care processis missing.Response vaguely defines the continuum of care process.Response clearly defines the continuum of care process, including objectives and the relationship to organizations and patients.Response demonstrates the same level of achievement as “2,” plus the following:   Response provides examples that illustrate the benefits of the services along the continuum of care.
  • Describe the following settings and types of care, including objectives and basic components.
  • Primary care
  • Secondary (general hospital)
  • Tertiary (teaching)
  • Specialty hospitals
  • Outpatient programs (surgery, outpatient rehab)
  • Nursing homes
  • Rehabilitation settings
  • Assisted living
  • Home health
  • Hospice

Your Response

Primary Care- This is a health care approach addressing the health challenges, needs, and preferences of a patient and their family caregivers (Bodenheimer, & Pham, 2010). Diversification of primary care constitutes comprehensive treatment, rehabilitation, and palliative care.

Secondary Care- This is care given in a large and specialized facility upon referral by a primary care provider. The skilled care manifests in advanced and professional skill, knowledge, and equipment.

Tertiary Care- This is a type of specialized care provided in high-end and state-of-the-art facilities because they can give attention over a long duration. The procedures are seen in complex surgeries and therapies.

Specialty Hospital- They are hospitals set aside for patients requiring specialized treatment in complex surgical procedures, orthopedic, and cardiac conditions. They are well-equipped to meet the needs of patients.

Outpatient Program– These are treatment programs provided for patients on an outpatient basis, in that patient receive treatment from their homes and communities (McCarty et al., 2014). This method is cost-effective, especially for those who cannot afford high rates of inpatient treatment systems.

Nursing Homes– These are facilities registered by the government as they provide care for patients with chronic illnesses through skilled and primary nursing care.

Rehabilitation Settings- These are acute health care settings that help an individual regain impaired thinking and learning abilities used injury, disease, or treatment.

Assisted Living- These are facilities developed to allow people persons needing personalized care to have ready access to needed care. The systems are shared among the elderly who need help daily for exceptional living.

Home Health- This type of care is provided at the comfort one’s home and mainly administered to the elderly, illness, or injury. Receiving health care from home is cheap and convenient since you are attended to from home.

Hospice- This is health care provided for patients with severe health conditions by meeting emotional and spiritual needs (Jennings et al., 2010). Hospice care seeks to eliminate suffering and boost the quality of life.

Rubric

Sub-Competency 2: Explain the continuum of care process in a variety of settings.
Learning Objective LO 2.2: Describe various healthcare settings and types of care.Descriptions of various healthcare settings and types of care is missing.Response inaccurately describes the following settings and types of care and/or does not include objectives and basic components. Primary careSecondary (general hospital)Tertiary (teaching) Specialty hospitalsOutpatient programs (surgery, outpatient rehab)Nursing homes Rehabilitation settingsAssisted livingHome healthHospiceResponse describes the following settings and types of care, including objectives and basic components. Primary careSecondary (general hospital)Tertiary (teaching) Specialty hospitalsOutpatient programs (surgery, outpatient rehab)Nursing homesRehabilitation settingsAssisted livingHome healthHospiceResponse demonstrates the same level of achievement as “2,” plus the following:   Response describes how the services may be coordinated for a particular patient.
  • Describe the person who should be part of an interdisciplinary team that focuses on patient-centered care in an inpatient setting. List at least six disciplines and provide a rationale for including each as a member of the team. (1 page)

Your Response

  1. Nursing Aide/ Assistant- Nursing assistants play a crucial role in providing patient-centered can for patients with varied health conditions despite existing age differences. Their places of work are, but not limited to, nursing homes, home care, hospitals, and community-based long-term care. They are considered the closest to patients and, for that reason, conduct their activities under a licensed nurse’s supervision, thus the need to be involved in inpatient care.
  2. Surgical Technicians– They are members of operating room teams. They, in most cases, take up the role of circulating assistant nurses hence their importance in the group. Besides, technicians, before any surgical procedure commences, help preparation of operating rooms where they put together needed instruments, assess their functionality and initiate changes required. The technicians fulfill their duties under the supervision of assigned surgeons.
  3. Anesthesiologists– They also form part of the multidisciplinary team in a surgery process. This specialty is critical as it required knowledge and skill to facilitated outstanding perioperative care of patients, during and after surgery (Pagel, & Hudetz, 2011). The activities surrounding patient care in these crucial stages involve the use of anesthesia, pain-relieving medicines, intensive care medicines, and critical emergency medicines. 
  4. Surgeons- Surgeons are the lead experts in operations rooms as they are tasked with conducting minor to significant operations assisted by surgical technicians. They oversee all procedures to ensure care standards and safety get followed for better patient outcomes. Productive and successful surgeries are determined by the level of expertise on the whole surgical team and their input.
  5. Attending Physicians-They are medical practitioners mandated to provide quality care to specific patients during and after their hospital stay elapses. In some cases, attending physicians are categorized as private physicians because of their dedication to a single patient. Despite their stay not being fully within a hospital facility, they attend to their patients to give treatment and do follow-ups.
  6. Nurses- Professional nurses provided quality care for patients, and also work closely with therapists and family members of a patient. Their practices are slightly different from other specialties owing to their general perspective of patient care, training, and scope. The American Nurses Association protects the nurses and their rights towards a conducive working environment.

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Delivery of services
Delivery of Services

Rubric

Sub-Competency 3: Explain processes, roles, and responsibilities in the delivery of healthcare.
Learning Objective LO 3.1: Describe the disciplines that should be part of a multidisciplinary team for a particular healthcare context.Description of the disciplines that should be included in an interdisciplinary team is missing.Response vaguely describes, or describes fewer than six disciplines that should be part of a multidisciplinary team focused on patient-centered care in an inpatient setting.   Response provides limited or illogical justification for the inclusion of the disciplines chosen.Response thoroughly describes at least six disciplines that should be part of an interdisciplinary team focused on patient-centered care in an inpatient setting.   Response provides a logical justification for the choice of disciplines included in the team.Response demonstrates the same level of achievement as “2,” plus the following:   Response describes how team composition and expertise benefit patient outcomes.
  • You are assisting the human resource director at a large general hospital. As part of a report to the chief executive officer (CEO), she has asked you to outline specific essential functions/responsibilities and goals for at least three clinical, three technical, and three administrative departments (9 departments total). Describe the essential functions/responsibilities and goals of these hospital departments. (1–2 pages)

Your Response

  1. Administrative Department
  2. Public Relations Department- Health care organizations require elaborate and specialized public relations systems in managing health matters and ever-rising lawsuits. The department’s key role is to uphold the integrity of the organizations upon criticism and challenges.
  3. Public Health Department- This department focusses on essential health issues related to vaccinations, research, food inspection, and infectious diseases (Joyce et al., 2015). It ensures the well-being of the general public besides improving health standards.
  4. Mental Health Department- Inpatient and outpatient services are included and addressed in this department, notwithstanding patient location. Management systems that head the department focus primarily on individuals affected by mental health and substance abuse.
  5. Clinical Department
  6. Cardiology Department– Cardiology deals with the diagnosis, treatment, and disorders of the heart. The department concentrates on heart diseases, most notably coronary artery disease.
  7. Oncology Department- This department focusses on prevention, diagnosis, and treatment of cancer. Testing and screening activities facilitate steps towards eradicating cancer.
  8. Neurology Department- Neurologists are specialists concerned with the study, treatment, and disorders of the nervous system, brain, and spinal. The human body systems are sophisticated, requiring specialized and professional neurologists.
  9. Technical Department
  10. IT Department– Hospital IT departments in the modern-day patient care help achieve medical goals by medical staff and clinicians. The smooth running of the IT department ensures efficient management of medical software and related processes.
  11. Security Department- Security systems in any organization provide safe working environments of clinical staff and patients from being attacked by outsiders together with preventing fraudulent activity in the facility.
  12. Environment Department- Health care facilities should be kept in clean and conducive conditions to prevent further infections while creating a habitable environment. Internal and external environments are critical to the recovery of patients.

Rubric

Sub-Competency 3: Explain processes, roles, and responsibilities in the delivery of healthcare.
Learning Objective LO 3.2: Define the functions/responsibilities and goals  of clinical, technical, and administrative professions in the delivery of healthcare.Description of the functions/responsibilities and goals of hospital departments is missing.Response vaguely describes the functions/responsibilities and goals of hospital departments.Response thoroughly describes at least three functions/responsibilities and one goal of clinical, technical, and administrative departments.Response demonstrates the same level of achievement as “2,” plus the following:   Response describes how the departments work together to achieve organizational and outcome goals.
  • Admission policies can differ between various types of healthcare organizations.  Provide compare and contrast how admission policies could differ between for-profit and non-profit organizations, and how this difference relates to access to care.  

Your Response

Admission policies are different in healthcare settings, depending on whether an organization is a profit or non-profit. Profit organizations adopt admission policies that favor patients with the ability to pay for healthcare service. In contrast, non-profit institutions provide healthcare services irrespective of an individual’s or community’s financial strength (Brown et al., 2012). The non-profit groups have little or concern for commercial gains but mostly aligned to offer quality services.

Health care organizations operating on profit mechanisms seek to satisfy investors and shareholders who ensure the regular running of the institution. It is for this reason that paying before admission is crucial; hence lack of finances rules out the possibility of admission. These systems are conventional in private entities that have made considerable investments in hospital equipment, and the workforce thus works to realize returns. Moreover, they do not offer free services, not unless one can pay mandatory charges. The profit-seeking organizations have reduced patient population accessing medical services with targets being individuals who can pay for services.

Rubric

Sub-Competency 3: Explain processes, roles, and responsibilities in the delivery of healthcare.
Learning Objective LO 3.3: Explain how admission policies differ in various types of healthcare organizations and how this relates to access to care.Explanation about how admission policies differ in various types of healthcare organizations and how this relates to access to care is missing.Response vaguely explains how admission policies differ in various types of healthcare organizations and how this relates to access to care; and the differences between for-profit and not-for-profit healthcare organizations are unclear or missing; and/or only one difference is addressed.Response clearly explains two differences in admissions policies for the various types of healthcare organizations and how this relates to access to care.   Response includes differences between for-profit and not-for-profit healthcare organizations.Response demonstrates the same level of achievement as “2,” plus the following:   Response provides clearly written descriptions of two types of non-profit and two types of for-profit hospitals and the types of patients they serve.  

There are many different organizations and institutions that are major players in the healthcare system. Briefly describe how each of the following influences healthcare.  Consider both potential and negative influences when formulating your answer.  Use at least one other reference in addition to the organizations website for each organization. 

  • Pharmaceutical Research and Manufacturers of America (PhRMA)
  • Food and Drug Administration (FDA)
  • American Medical Association (AMA)
  • American Hospital Association (AHA)
  • Joint Commission (JC)
  • Centers for Medicare and Medicaid Services (CMS)
  • State Department of Health (student’s state)
  • Centers for Disease Control and Prevention (CDC)
  • U.S. Department of Health and Human Services

Your Response

  1. Pharmaceutical Research and Manufacturers of America (PhRMA)- Represents many companies involved in the pharmaceutical industry, PhRMA, advocates primarily for public policies and regulations that protect and enhance discoveries of new medicines (Khanna, 2012). The organization developed programs that provided patients with crucial information; new and free prescription drugs available in the market.
  2. Food and Drug Administration (FDA)- The organization was developed to ensure prescription drugs are used effectively besides upholding its safety standards. Despite huddles with drug approval processes, new information on drugs emanates after approval requiring the FDA to act accordingly in curbing unprecedented effects.
  3. American Medical Association (AMA)- The association focusses on healthcare reforms hence its significant input in advocacy activities. It has encouraged and championed for health insurance for all Americans, patients to have freedom of choice, freedom of practice, and universal access for patients.
  4. American Hospital Association (AHA)- The association seeks to enhance advancements and innovations in the healthcare sector by noting changes around them. Techniques used for the cause involve establishing market insights, improved partnerships, and upscaling health care practices across patient populations (Charles, Gabriel, & Furukawa, 2013). Most notable challenges being with health care systems unable to keep up with fast-rising innovations and technological advancements.
  5. Joint Commission (JC)- The joint Commission sets standards that help health care institutions objectively evaluate their processes to improve patient outcomes and institutional goals. The performance of the organization is mainly dependent on patients, health care providers, and hospice functions.
  6. Centers for Medicare and Medicaid Services (CMS)- It is a federal agency mandated to provide essential health care programs, including Medicare and Medicaid. It facilitates health care processes by collecting and studying data variables and consequently producing research reports to back their activities.
  7. State Department of Health (student’s state)- The state has enormous responsibility to its citizens, most importantly, health care provision for all. Under health departments, several activities and programs are undertaken: epidemiology, vaccinations, environmental health, and preventive medicines. The programs provide and improve health care conditions and patient outcomes.
  8. Centers for Disease Control and Prevention (CDC)- The agency focusses on enhancing and protecting public health by containing diseases and their infectious nature. Besides conducting education and awareness activities, CDC also conducts research and studies on highly contagious diseases.
  9. U.S. Department of Health and Human Services- It is a federal agency mandated to protect all Americans by improving overall health, safety, and well-being. Health care organizations are directly affected by decisions made by the agency, mainstreaming activities, and policies across health care factions.

Rubric

Sub-Competency 4: Describe the organizations and institutions that are major players in the healthcare system.
Learning Objective LO 4.1: Describe how major healthcare organizations and institutions influence healthcare.Description of how major healthcare organizations and institutions influence healthcare is missing.Response vaguely or incompletely describes how each of the following influences healthcare: Pharmaceutical Research and Manufacturers of America (PhRMA)Food and Drug Administration (FDA)American Medical Association (AMA)American Hospital Association (AHA)Joint Commission (JC)Centers for Medicare and Medicaid Services (CMS) State Department of Health (student’s state)Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human ServicesResponse clearly and accurately describes how each of the following influences healthcare: Pharmaceutical Research and Manufacturers of America (PhRMA)Food and Drug Administration (FDA)American Medical Association (AMA)American Hospital Association (AHA)Joint Commission (JC)Centers for Medicare and Medicaid Services (CMS) State Department of Health (student’s state)Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human ServicesResponse demonstrates the same level of achievement as “2,” plus the following:   Response provides examples about how patients are directly impacted by two or more of these major players.
  1. Define vertically integrated health systems and horizontally integrated systems, including the business goals and patient outcomes. Then, explain the impact these systems have on healthcare today. (1 page)

Your Response

Vertically integrated health care systems describe procedures targeted at treating given medical conditions of a patient that stream across organizational boundaries, linking community-based service generalists and specialists in the established hospital setting. The processes involved in the integration tool allow for coordination of services and grouping organizations, providing different levels of care under a similar management system (Valentijn, Schepman, Opheij, & Bruijnzeels, 2013). The system presents numerous benefits ranging from improved efficiency, continuum care, quality care, besides reducing contracting rates by patients and persons seeking hospice care. Moreover, the vertically integrated systems utilize models in the form of alliances with physicians and available health plans in achieving patient-centered care.

Horizontal integration, on the other end, incorporates coordinated activities at similar stages in operational units regarding service delivery. In essence, this system uses principles where organizations providing the same and identical level of care, are grouped under one management system. Some of the conventional models making use of vertical integration are multihospital systems, and local network systems developed from mergers between hospitals and health care institutions.

The integration systems work to achieve set business goals and improve patient outcomes through sophisticated and well-organized institutional structures. It provides alternate and preferred medical aid towards improving patient experience, especially among long-term care patients (Valentijn, Schepman, Opheij, & Bruijnzeels, 2013). The benefits of integrated systems are many but not limited to enhance communications, pharmaceutical management, enhanced community health, mainstreamed continuum care, and bolstered care management.

Rubric

 
Learning Objective LO 4.2: Define vertically and horizontally integrated health systems.Definition of vertically and horizontally integrated health systems is missing.Response vaguely defines vertically and horizontally integrated health systems and/or does not include the business goals and/or patient outcomes.   Response vaguely explains how these systems impact healthcare today.Response clearly defines vertically and horizontally integrated health systems, including the business goals and patient outcomes.   Response explains how these systems impact healthcare today.  Response demonstrates the same level of achievement as “2,” plus the following:   Response provides an example of vertically and horizontally integrated health systems.

References

Bodenheimer, T., & Pham, H. H. (2010). Primary care: current problems and proposed solutions. Health Affairs29(5), 799-805.

Brown, R. S., Peikes, D., Peterson, G., Schore, J., & Razafindrakoto, C. M. (2012). Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Affairs31(6), 1156-1166.

Charles, D., Gabriel, M., & Furukawa, M. F. (2013). Adoption of electronic health record systems among US non-federal acute care hospitals: 2008-2012. ONC data brief9, 1-9.

Goudge, J., Gilson, L., Russell, S., Gumede, T., & Mills, A. (2009). Affordability, availability, and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa. BMC health services research9(1), 75.

Graham, W. J., & Varghese, B. (2012). Quality, quality, quality: gaps in the continuum of care. The Lancet379(9811), e5-e6.

Jennings, B., Ryndes, T., D’Onofrio, C. A. R. O. L., & Baily, M. A. (2010). Access to hospice care: Expanding boundaries, overcoming barriers. Palliative care: Transforming the care of serious illness, 159-164.

Joyce, B. L., Harmon, M. J., Pilling, L. B., Johnson, R. H., Hicks, V. L., & Brown-Schott, N. (2015). The Preparation of Community/Public Health Nurses: Amplifying the Impact.

Khanna, I. (2012). Drug discovery in the pharmaceutical industry: productivity challenges and trends. Drug discovery today17(19-20), 1088-1102.

McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric Services65(6), 718-726.

Pagel, P. S., & Hudetz, J. A. (2011). An analysis of scholarly productivity in United States academic anaesthesiologists by citation bibliometrics. Anaesthesia66(10), 873-878.

Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care13.

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