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Case Study 2: Mortgage Approval Time Study

Week 8 Case Study 2

Read the following case study:

A major financial services company wishes to better understand its mortgage approval process. In particular, the company is interested in learning about the effects of credit history (good versus fair), the size of the mortgage (<$500,000 versus >$500,000), and the region of the United States (western versus eastern) on the amount of time it takes to get a mortgage approved. The database of mortgages approved in the last year is accessed, and a random sample of five approved mortgages is selected for each of the eight combinations of the three variables. The data are shown in the table

Mortgage Approval Time Study     

Credit History    Mortgage Size   Region             Approval Times (Days)

Good                <$500,000        Western            59        50        64        62        47

Fair                  <$500,000        Western            81        58        69        65        74

Good                >$500,000        Western            38        52        58        60        65

Fair                  >$500,000        Western            146      159      133      143      129

Good                <$500,000        Eastern             28        26        38        41        21

Fair                  <$500,000        Eastern             42        53        40        50        64

Good                >$500,000        Eastern             49        31        49        42        38

Fair                  >$500,000        Eastern             106      115      126      118      138

First, conduct an analysis using the following steps:

  1. Use the data shown in the table to conduct a design of experiment (DOE) in Microsoft Excel in order determine the nature and magnitude of the effects of the three variables on mortgage approval times. What are the key drivers of this process?
  2. Determine the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Provide a rationale for your response.
  3. Assess the data sampling method. Our sample contained only five mortgages per combination. Under what circumstances would it have been appropriate to select a larger sample? Is a sample of five mortgages adequate to access the relative magnitudes of the effects of the variables? What sample size would you recommend? What could you learn from a larger sample size? (Hint: Look back at chapter 2, 3, 5, and 6 for discussion of sampling.)
  4. Provide other variable responses that might be of interest to measure and study. (Hint: If you were getting a mortgage or a loan, what are the two and most important measures of the process you would have to go through?)
  5. Propose one overall recommendation to the financial services company, based on the DOE, that could help reduce mortgage approval times.
  6. Use http://research.strayer.edu to identify at least two (2) quality references to support your discussion. Note: Wikipedia and other Websites do not qualify as academic resources.

Second, create a PPT presentation to communicate the data analysis you completed. Your presentation must follow these formatting requirements:

  • A PPT presentation with at least 10 slides that include the answers to questions 1 through 5.
  • A reference slide which follows APA format. Check with your professor for any additional instructions.
  • Formatting of the slides should be consistent and easy to read.
  • Cover slide containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date.

Note: The cover slides and the reference slides are not included in the required assignment slides length.

The specific course learning outcome associated with this assignment is:

  • Develop recommendations to improve business processes, using statistical tools and analysis.

Grading for this assignment will be based on answer quality, logic / organization of the paper, and language and writing skills, using the following rubric:

Points: 190Case Study 2: Mortgage Approval Time Study
CriteriaUnacceptable Below 70% FFair 70-79% CProficient 80-89% BExemplary 90-100% A
1. Use the data shown in the table to conduct a design of experiment (DOE) in order to test cause-and-effect relationships in the mortgage approval time for the financial services company.   Weight: 16%Did not submit or incompletely used the data shown in the table to conduct a design of experiment (DOE) in order to test cause-and-effect relationships in the mortgage approval time for the financial services company.Partially used the data shown in the table to conduct a design of experiment (DOE) in order to test cause-and-effect relationships in the mortgage approval time for the financial services company.Satisfactorily used the data shown in the table to conduct a design of experiment (DOE) in order to test cause-and-effect relationships in the mortgage approval time for the financial services company.Thoroughly used the data shown in the table to conduct a design of experiment (DOE) in order to test cause-and-effect relationships in the mortgage approval time for the financial services company.
2. Determine the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Provide a rationale for your response.
Weight: 16%
Did not submit or incompletely determined the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Did not submit or incompletely provided a rationale for your response.Partially determined the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Partially provided a rationale for your response.Satisfactorily determined the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Satisfactorily provided a rationale for your response.Thoroughly determined the graphical display tool (e.g., Interaction Effects Chart, Scatter Chart, etc.) that you would use to present the results of the DOE that you conducted in Question 1. Thoroughly provided a rationale for your response.
3. Assess the data sampling method by determining if the sample size is sufficient, determining if effects of variables can be measured, recommending a sample size for future study, and stating what analysis can be done with larger sample sizes.   Weight: 16%Did not submit or incompletely assessed the data sampling method by determining if the sample size is sufficient, determining if effects of variables can be measured, recommending a sample size for future study, and stating what analysis can be done with larger sample sizes.Partially assessed the data sampling method by determining if the sample size is sufficient, determining if effects of variables can be measured, recommending a sample size for future study, and stating what analysis can be done with larger sample sizes.Satisfactorily assessed the data sampling method by determining if the sample size is sufficient, determining if effects of variables can be measured, recommending a sample size for future study, and stating what analysis can be done with larger sample sizes.Thoroughly assessed the data sampling method by determining if the sample size is sufficient, determining if effects of variables can be measured, recommending a sample size for future study, and stating what analysis can be done with larger sample sizes.
4. Provide other variable responses that might be of interest to measure and study.   Weight: 16%Did not submit or incompletely provided other variable responses that might be of interest to measure and study.Partially provided other variable responses that might be of interest to measure and study.Satisfactorily provided other variable responses that might be of interest to measure and study.Thoroughly provided other variable responses that might be of interest to measure and study.
5. Propose one overall recommendation to the financial services company, based on the DOE, that could help reduce mortgage approval times.   Weight: 16%Did not submit or incompletely proposed one overall recommendation to the financial services company, based on the DOE, that could help reduce mortgage approval times. Did not submit or incompletely provided a rationale for your response.Partially proposed one overall recommendation to the financial services company, based on the DOE, that could help reduce mortgage approval times.  Partially provided a rationale for your response.Satisfactorily proposed one overall recommendation to the financial services company, based on the DOE, that could help reduce mortgage approval times.  Satisfactorily provided a rationale for your response.Thoroughly proposed one overall recommendation to the financial services company, based on the DOE, that could help reduce mortgage approval times.  Thoroughly provided a rationale for your response.
6. Presentation Requirements   Weight: 10%Presentation does not have 10 slides in addition to a cover slide and a reference slide. There is no consistent theme or design and slides are difficult to read.Presentation does not have 10 slides in addition to a cover slide and a reference slide and/or there is no consistent theme or design in the presentation. Some slides may be difficult to read.Presentation includes at least 10 slides in addition to a cover slide and a reference slide. There is a theme or design throughout the presentation, but some slides may contain too much information to be easily read.Presentation includes 10 or more slides in addition to a cover slide and a reference slide. There is a consistent theme or design throughout, and all slides are easy to read.
7. Writing / Support for Ideas   Weight: 5%Rarely uses reasons and evidence that logically support ideas.Partially uses reasons and evidence that logically support ideas.Mostly uses reasons and evidence that logically support ideas.Consistently uses reasons and evidence that logically support ideas.
8. Writing / Grammar and Mechanics   Weight: 5%Numerous errors in grammar, spelling, and punctuation.Partially free of errors in grammar, spelling, and punctuation.Mostly free of errors in grammar, spelling, and punctuation.Free of errors in grammar, spelling, and punctuation.

The IT Professional Assignment

Competency

In this project, you will demonstrate your mastery of the following competency:

  • Articulate the roles and functions of the information technology professional

Scenario

Whether you are just beginning your career in information technology or taking the next step in your career path, it is vital to understand the numerous opportunities available to you within this field. In this project, you will be conducting a survey of the information technology field that includes several career options aligned with your interests and begins to sketch out the training and certifications necessary for those roles.IT professional at work.

Directions

The Information Technology Field: Before you explore career options in information technology, it is important to distinguish between the various disciplines that exist within this field. In this section, you will be considering these disciplines, as well as two primary tools for information technology professionals: programming and scripting.

  • IT Disciplines: To begin your report on careers within the information technology field, define the distinction between computer science, information systems, engineering, and information technology. In your description, first define each discipline and then describe how that discipline is related to others within IT. In your definition, address the following:
    • What roles and careers within the IT field are related to these disciplines?
    • What tools and technologies are most applicable to these disciplines?
  • Programming and Scripting: Following your description of the different disciplines within information technology, explain the relationship between programming and scripting and their uses within the IT field. In your explanation, first define scripting and programming, then address the following:
    • What distinguishes a script from a program?
    • How would an IT professional use scripting in their work? How would they use programming?
    • Describe a potential case where an IT professional would use a scripting language in their work. Describe a potential case where an IT professional would use a programming language in their work.

Information Technology Careers: Once you have defined the fields available in the world of information technology, it is time to start examining careers. For this section, you will be examining three positions within your chosen area of interest.

  • Careers of Interest: First, identify careers of interest within the IT field. You will choose an appropriate entry-level position, mid-level position, and ultimately the position you will strive to achieve. Then, determine whether each position is most closely aligned with information technology, computer science, information systems, or engineering. In your report, describe the roles and responsibilities of each of these careers. As evidence, ensure that you are submitting the job postings referenced in your report.
  • Tools and Technologies: Next, within each of your identified careers, describe the tools and technologies specific to your chosen IT roles. For each career, identify and describe various tools, including hardware and software, that a professional working in that career would use.
  • Training and Certifications: Finally, identify education, training, and certifications necessary for chosen IT roles. For your identified roles, describe these trainings and certifications, using the information in your identified job postings and descriptions as a reference. For each training and certification, describe its utility in the information technology field and sketch out how an interested person would obtain each certification. Finally, describe the transferable skills within these certifications and how they might prepare you for other careers and fields within the information technology profession.

What to Submit

To complete this project, you must submit the following:

Information Technology Career Report
You will create a report describing the information technology field, including distinguishing between the various disciplines within the IT field and identifying at least three careers of interest within the field. This report should be between 800–1,200 words. You should also include copies of your selected job postings for your instructor’s reference.

CriteriaExemplary (100%)Proficient (85%)Needs Improvement (55%)Not Evident (0%)Value
IT DisciplinesExceeds proficiency in an exceptionally clear, insightful, sophisticated, or creative mannerDefines the distinction between computer science, information systems, engineering, and information technologyShows progress toward proficiency, but with errors or omissions; areas for improvement may include accuracy, clarity, logic, and detailDoes not attempt criterion18
Programming and ScriptingExceeds proficiency in an exceptionally clear, insightful, sophisticated, or creative mannerExplains the relationship between programming and scripting and their uses within the IT fieldShows progress toward proficiency, but with errors or omissions; areas for improvement may include accuracy, clarity, logic, detail, and thoroughnessDoes not attempt criterion18
Careers of InterestExceeds proficiency in an exceptionally clear, insightful, sophisticated, or creative mannerIdentifies careers of interest within the IT field and describes their roles, responsibilities, and qualificationsShows progress toward proficiency, but with errors or omissions; areas for improvement may include accuracy, clarity, logic, and detailDoes not attempt criterion18
Tools and TechnologiesExceeds proficiency in an exceptionally clear, insightful, sophisticated, or creative mannerDescribes the tools and technologies specific to chosen IT rolesShows progress toward proficiency, but with errors or omissions; areas for improvement may include accuracy, clarity, logic, detail and correct alignment of tools to IT rolesDoes not attempt criterion18
Training and CertificationsExceeds proficiency in an exceptionally clear, insightful, sophisticated, or creative mannerIdentifies education, training, and certifications necessary for chosen IT rolesShows progress toward proficiency, but with errors or omissions; areas for improvement may include accuracy, clarity, logic, and detailDoes not attempt criterion18
Articulation of ResponseExceeds proficiency in an exceptionally clear, insightful, sophisticated, or creative mannerClearly conveys meaning with correct grammar, sentence structure, and spelling, demonstrating an understanding of audience and purposeShows progress toward proficiency, but with errors in grammar, sentence structure, and spelling, negatively impacting readabilitySubmission has critical errors in grammar, sentence structure, and spelling, preventing understanding of ideas5
Citations and AttributionsAttributes sources where applicable using citation methods with very few minor errorsAttributes sources where applicable, but with consistent minor errorsAttributes sources where applicable, but with major errorsDoes not attribute sources where applicable5
Total:100%

4.3 Unit Assignment: Retirement Planning. — Business

PLEASE COMPLETE ALL THE ASSESSMENT CRITERIA AT THE BOTTOM

Introduction

This assignment gives practice in simulation with two data points over time. You will be calculating potential portfolio returns over many years and need to incorporate uncertainty about wage growth and market performance into the model.

Instructions

To assist with this assignment, first read the following scenario:

You have been hired as a financial planner for your friend Grace. Her current annual salary is $60,000 and she has $100,000 in her portfolio currently. She would like to retire in 25 years with a nest egg of at least $2,000,000.

Grace can save 6% of her annual salary to her portfolio, and her portfolio invests solely in an index fund that tracks the S&P 500. She is hoping you can help her plan for retirement with a better understanding of her wage growth and portfolio returns.2

  • Based on this scenario:Submit both the report and the MS Excel file 

Assessment Criteria

Assessed ItemPoints
The report is written with business stakeholders as the intended audience and is of sufficient length to address the prompt.10
The population statistics were calculated correctly and an appropriate distribution was selected.20
Future wage growth and portfolio returns were calculated correctly.20
The report discusses the risks inherent with the simulations and provides sound advice for Grace’s savings goals and retirement date.30
Total Points80

Pre-Departure Training Paper

For this assignment, imagine again that you work for the global company you chose in your first assignment. You are in charge of improving the training and development for employees who are selected for international assignments.

Develop a 3–4 page (plus the cover page and reference page) outline of pre-departure training with a thorough description and explanation of the training programs that you suggest for improving expatriate performance.

Your assignment must address the following:

Articulate the training needs of new expatriate employees and the components of pre-departure training that will address those needs.
Determine the areas of emphasis and the details of the training.
Describe how the training will improve the expatriate experience for the new assignment.
Provide citations and references from the textbook and a minimum of two sources found on the Strayer databases at the Strayer Library.
Your assignment must:

Be typed, double-spaced, using Times New Roman font (size 12), with 1-inch margins on all sides.
Include a cover page containing the title of the assignment, your name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
This course requires the use of Strayer Writing Standards.

CIPD Candidate Assessment Activity

Title of unit/s  Using Information in Human Resources
Unit No/s  
Level5
Credit value4
Assessment method(s)  Written Business Report
Expiry date 
Learning outcomes: Understand the research process and different research approaches.Be able toconduct a critical review of information sources in an area of HR/business practice and analyse the findings.Be able todraw meaningful conclusions and evaluate options for change. 4    Know how todeliver clear, business-focused reports on an HR issue.
Assessment brief/activity   Activity 1 Your CEO has asked each departmental head to undertake a critical review of their systems, processes and practices as part of a major organisational change agenda.  You have been asked to review an area of HR/business practice and present a business report to key stakeholders with recommendations for improving practice.  To provide the basis for your report, you have been asked to conduct a critical review of information sources relevant to the area of practice. You should:

Select an area of HR/business practice and give the reason for your choice   Undertake a critical review of different information sources (at least four) e.g. research digests, academic and professional literature, online databases, key texts relevant to the selected area of practice.   Draw meaningful conclusions from the review of the different information sources.Make justified recommendations to named stakeholders for sustaining and/or improving practice.   Your report structure should include: Title page (report title and their name, submission date)Executive summary (overview, methods of analysis, findings, recommendations)Table of contents (list of numbered sections)Introduction (terms of reference)Main body (headings and sub-headings – these could be for each information source reviewed). Candidates should use a mix of narrative and diagrammatic formats to present their findings.Conclusions RecommendationsReference list/BibliographyAppendix if used i.e. information supporting their analysis but not essential to its explanation.   Activity 2 Summarise the key stages of the research process.  Compare two different research methods.    
Assessment Criteria

    4.1         2.1     2.2

 
3.1               4.1                   1.1
Evidence to be produced/required

A written business report for stakeholders and written answers to activity two of approximately 2600 words.  The title page, executive summary, reference list and any appendices are excluded from the word count.   You should relate academic concepts, theories and professional practice to the way organisations operate, in a critical and informed way, and with reference to key texts, articles and other publications and by using organisational examples for illustration.   All reference sources should be acknowledged correctly, and a bibliography provided where appropriate (these should be excluded from the word count).  

Assessment Guidance

Using Information in Human Resources – LOs 1, 2, 3 & 4   To pass, candidates should provide a written business report for stakeholders of approximately 2600 words which reflects the guidance given below.    The title page, executive summary, reference list and any appendices are excluded from the word count.   Candidates should relate academic concepts, theories and professional practice to the way organisations operate, in a critical and informed way, and with reference to key texts, articles and other publications and by using organisational examples for illustration.   All reference sources should be acknowledged correctly, and a bibliography provided where appropriate (these should be excluded from the word count).
AC 2.1




AC 2.2, 1.1
              AC 4.1, 3.1
Candidates should identify an area of HR/business practice for the focus of their literature review e.g. good practice in employee engagement, recruitment and selection, pay and reward, learning and development, they should explain why they have selected the particular area e.g. to benchmark their own organisational practice against good practice reported in the literature   Candidates should then review different information sources relevant to the area of practice with a justification for the information sources chosen. They should show evidence of engaging critically with each of the sources by: Summarising the focus of the sourceExamining the methodology used (quantitative or qualitative)Evaluating the conclusions from each source based on the methodology used and evidence presented.

Candidates should write a business report for identified stakeholders e.g. CEO, executive team, shareholders. A typical structure would be:

Title page (report title and their name, submission date)Executive summary (overview, methods of analysis, findings, recommendations)Table of contents (list of numbered sections)Introduction (terms of reference)Main body (headings and sub-headings – these could be for each information source reviewed). Candidates should use a mix of narrative and diagrammatic formats where appropriate to present their findings.Conclusion (including major inferences and recommendations for change)Reference list using appropriate scholarly conventionBibliography if appropriateAppendix if used i.e. information supporting their analysis but not essential to its explanation.

Fact Pattern Assignment Solution

Instructions

You are a judge.  The defendant stands before you charged with murder. The Crown has agreed that she can be tried by a judge alone, without a jury. The following factual scenario summarizes the evidence that has emerged over the course of the trial.  It is now time for you to render a verdict and give your reasons.

Review the factual scenario carefully, and then write a judgment explaining whether the defendant should be convicted of the offence with which she is charged, or of a lesser offence, or should be acquitted.

You should begin with a brief summary of the relevant facts.  If facts are unclear or open to competing interpretations, consider all possibilities and state any conclusions you are reaching and why. 

You should also be sure to discuss all relevant points of law, including the Charter, case law and Criminal Code provisions outlining the elements of the offences in question, and apply them to the facts of this case.  If the state of the law is unclear or undecided, or if there are important dissenting opinions, discuss.  Be sure to address both the Crown and defence positions and identify and assess their relative strengths and weaknesses.

Format

Your assignment can be a maximum of 12 pages in length and must adhere to the following format:

  • Double spaced, 12-point font with 1 inch (2.54 cm) margins on all sides
  • Accompanied by a cover page that includes the date of submission, your name and student number (not included in the 12 page maximum)

Use headings (just as in the judgments you’ve read) to assist in organizing your analysis.

Factual Scenario

Hyun-mi and Maja are both brilliant and innovative pharmaceutical engineers. They have been fierce rivals since they met 20 years ago as undergraduate students in the biomedical engineering program at U of T and competed with one another for the top spot in their anatomy class.  They both went on to medical school and then earned their PhDs, Hyun-mi at Stanford and Maja at MIT.

They are now employed by rival pharmaceutical companies.  Hyun-mi works for Xetopa Medical, while Maja works for Genam Biotechnology.  Both Hyun-mi and Maja and their respective companies have been hard at work developing a new “tumour agnostic” cancer drug – a drug that could be used to treat any kind of cancer, regardless of where it is in the body, so long as the tumor has the specific molecular alteration that the drug targets. If these efforts are successful they would revolutionize cancer treatment – and be worth billions of dollars to the company that develops and patents the drug first. 

Both Hyun-mi and Maja have entered the clinical trial phase and are close to perfecting their drugs.  Unfortunately for Maja, although the drug she has developed is highly effective it also causes serious side-effects. Health Canada has been threatening to shut down her trial. Desperate to continue her work and beat Hyun-mi, Maja offers Roy, a member of Hyun-mi’s team, $100,000 if he will smuggle out a sample of their drug.  Maja is confident that even with a very small sample she will be able to reverse engineer her competitor’s version and correct the errors in her own.

After several days, Roy reports to Maja that it is simply impossible for him to smuggle a sample of the drug out of the lab.  There are always at least two team members present throughout the work day, and with the intense pressure to perfect and patent the drug, Hyun-mi has taken to sleeping on a cot in the lab so she can monitor things overnight.  Hyun-mi only goes home on Sunday afternoons, when the maintenance crew comes to clean the lab. Maja thanks Roy for the information and begins to formulate an alternative plan. She offers him $20,000 to loan her his pass card over the weekend, which will give her access to the building, and an extra $5000 to tell her the code to unlock the lab.  Roy accepts the offer, but reminds Maja that Hyun-mi is there basically all the time.  Maja tells him not to worry about Hyun-mi because she’ll take care of her.

On Friday night Maja gets Roy’s pass card and drives to Xetopa Medical.  She carefully parks several blocks away and makes her way to the building on foot.  Just before she gets in range of the security cameras she pulls on a chemical protective hood and visor she brought with her from her lab.  She’s carefully blacked out most of the visor so only her eyes show.  Maja pulls out the heavy flashlight she’s brought with her and makes her way up to the lab.  She punches in the code Roy gave her, and opening the door a crack, peers inside.  Hyun-mi is there, with her back to the door, staring intently into a microscope.  She’s wearing head phones and doesn’t look up as Maja opens the door further and steps into the lab.

Maja creeps up behind Hyun-mi and hits her over the head with the flashlight. Hyun-mi falls to the ground unconscious.  Maja rolls over an office chair, maneuvers Hyun-mi into it, and ties her hands behind the chair back and her feet to the base. Maja then makes her way to the refrigerator where the drug is stored and takes several vials.  She returns to check on Hyun-mi, who is still unconscious. She rolls the chair over to a table and places a two-litre bottle of water in front of it.  She opens the bottle, puts a straw in it, and crouching next to Hyun-mi confirms that it’s possible to reach the straw from Hyun-mi’s position. Satisfied that Hyun-mi will have access to water even if she’s not untied until the maintenance team arrives on Sunday morning, Maja leaves.

Maja drops the pass card in Roy’s mailbox, and then drives straight to her lab where she spends the rest of the weekend working on reverse engineering the samples she took. She barely pauses to eat or sleep until late Sunday night when she falls asleep at her desk. She’s awoken early Monday morning by the sound of her phone ringing repeatedly.  When she answers it’s Roy, and he’s hysterical.  It takes a while for her to understand what he’s saying but eventually she grasps that the maintenance crew found Hyun-mi unconscious on Sunday afternoon.  She had clearly regained consciousness at some point: the water had been drunk and there were signs that she had tried to free her hands, but she was still tied to the chair when she was found.  She was rushed to hospital, where a CT angiogram revealed that she had suffered a massive pulmonary embolism.  She was taken to surgery immediately but the damage to her heart and lungs was too extensive and she died.

Maja says, “But I left her water and she was only alone for 36 hours! I don’t understand how this could have happened!” Roy replies, “They ran some blood tests and she had Factor V Leiden.” With her background and training, Maja immediately understands that this means that Hyun-mi would be prone to hypercoagulation and thus at greater risk both for blood clots forming in her legs, and for any clots that did form travelling to her lungs. 

Maja begs Roy not to say anything but Roy is overcome with guilt for assisting her and confesses everything to the police.  Maja is charged with murder under s 229(c) of the Criminal Code in relation to the death of Hyun-mi.

At trial, the pathologist who conducted the postmortem examination confirms that the cause of death was a blood clot that formed in Hyun-mi’s leg and travelled to her lung.  The pathologist also testifies that while the risk is increased exponentially for individuals with Factor V Leiden, prolonged immobility – defined as sitting for more than four hours at a time – increases the risk of blood clots forming in anyone’s legs. Finally, the pathologist states that anyone with medical training would know of the general risk of blood clots resulting from prolonged immobility, and the resulting risk of pulmonary embolism.

Relevant  Charter Provisions

7           Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

11         Any person charged with an offence has the right…

(d)        to be presumed innocent until proven guilty according to law in a fair and public hearing                          by an independent and impartial tribunal

Relevant Criminal Code Provisions

Definitions

2           “Steal” means to commit theft

Homicide

222 (1) A person commits homicide when, directly or indirectly, by any means, he causes the death of a human being.

(2) Homicide is culpable or not culpable.

(3) Homicide that is not culpable is not an offence.

(4) Culpable homicide is murder or manslaughter or infanticide.

(5) A person commits culpable homicide when he causes the death of a human being,

  • by means of an unlawful act;
  • by criminal negligence;
  • by causing that human being, by threats or fear of violence or by deception, to do anything that causes his death; or
  • by wilfully frightening that human being, in the case of a child or sick person.

229 Culpable homicide is murder

  • where the person who causes the death of a human being
  • means to cause his death, or
  • means to cause him bodily harm that he knows is likely to cause his death, and is reckless whether death ensues or not;
  • where a person, meaning to cause death to a human being or meaning to cause him bodily harm that he knows is likely to cause his death, and being reckless whether death ensues or not, by accident or mistake causes death to another human being, notwithstanding that he does not mean to cause death or bodily harm to that human being; or
  • where a person, for an unlawful object, does anything that he knows or ought to know is likely to cause death, and thereby causes death to a human being, notwithstanding that he desires to effect his object without causing death or bodily harm to any human being.

231 (1) Murder is first degree murder or second degree murder.

(2) Murder is first degree murder when it is planned and deliberate.

(7) All murder that is not first degree murder is second degree murder.

Theft

322 (1) Every one commits theft who fraudulently and without colour of right takes, or fraudulently and without colour of right converts to his use or to the use of another person, anything, whether animate or inanimate, with intent

  • to deprive, temporarily or absolutely, the owner of it, or a person who has a special property or interest in it, of the thing or of his property or interest in it; …

Robbery

343 Every one commits robbery who

  • steals, and for the purpose of extorting whatever is stolen or to prevent or overcome resistance to the stealing, uses violence or threats of violence to a person or property;
  • steals from any person and, at the time he steals or immediately before or immediately thereafter, wounds, beats, strikes or uses any personal violence to that person;
  • assaults any person with intent to steal from him; or
  • steals from any person while armed with an offensive weapon or imitation thereof.

WEEK 5 DISCUSSION Memory

CLINICAL PSYCHOLOGY 
WEEK 5 DISCUSSION Memory 
Memory Distortions
Consider eyewitness testimony, a facet of the judicial system that relies on the soundness of memory for its effectiveness. The following story demonstrates the grave consequences inherent in certain kinds of memory distortion.
In the days following Jennifer Thompson’s 1984 rape by an unknown assailant, law enforcement officials presented her with a “photographic lineup.” It was composed of local individuals who loosely fit Thompson’s description, including one man the police considered a likely suspect in the attack. Police and the prosecution relied on Thompson’s eyewitness testimony as a critical building block in the case against Ronald Cotton. Thompson’s memory-based selection of Cotton’s image eventually brought him to trial as a defendant.
Jennifer Thompson’s eyewitness testimony led to the conviction of Ronald Cotton for rape. Thompson described memorizing the details her attacker’s appearance that fateful night so that she might later help to catch him. Based on Thompson’s testimony, the prosecution won, and Cotton received a sentence of life plus 54 years in prison.
After serving nearly 11 years, Cotton was exonerated on the basis of DNA evidence. In the years since Cotton’s release from prison, he and Thompson have reconciled. They now travel together throughout the United States, speaking about the lack of reliability of eyewitness testimony in criminal cases. Unreliable eyewitness accounts of crimes serve as one example of memory distortion. Consider factors in the Cotton case that may have affected the accuracy of Thompson’s memory.
In this Discussion, you examine factors that might influence and create distortions of memory. You also explain potential consequences of memory distortion on eyewitness testimony.
With these thoughts in mind:
Post by Day 4 a brief description of factors that might influence and create distortions of memory. Then explain how one of those factors might create a memory distortion. Provide an example to support your response. Finally, explain three consequences of memory distortion in the context of eyewitness testimony. Justify your response using the Learning Resources and current literature.
Be sure to support your postings and responses with specific references to the Learning Resources.

Creating a Plan of Care

Preview the document

This discussion post begins with creating a plan of care, using the Plan of Care Template, for one of the two patients described below:

Client Madison is a 15-year-old who comes to the clinic to see the nurse. She is shy and embarrassed, but she confides that her new boyfriend asked her to come in to be tested. She is very much in love and he will not have physical contact with her until she is seen by someone. She is not sure why, but he mentioned chalmydia. 

Client Patricia is a 39-year-old who is employed as an administrator at the clinic. She is ready to start a family and has been trying to conceive for fourteen months. Her husband has a teenage son from a previous relationship, but he would like at least one child with her. She is becoming frustrated every month when she gets her menstrual period.  

Select from the following list of nursing diagnoses to use when developing your care plan:

  • Chronic sorrow
  • Ineffective health management
  • Powerlessness
  • Ineffective sexuality pattern
  • Readiness for enhanced knowledge
  • Impaired comfort
  • Social isolation

Your initial post is due by Thursday at 11:59 PM EST.  Your responses are due by Sunday at 11:59 PM EST.

Response to Others

After you have posted, read through the postings of your peers.  In response to at least two other students, select a patient different from your chosen patient. Suggest one additional intervention that would make the plan more patient-centered and provide a rationale for your suggestion.

Discussion Guidelines

Posts need to be written in a professional manner. The content should have a clear beginning, middle, and end. Professionals communicate using correct grammar and spelling. It is acceptable to use a grammar or spelling editor prior to submitting your post. Language that is disrespectful or discourteous is not acceptable. Your posts should be of sufficient length to answer the question, but information that is extraneous or irrelevant will not strengthen your post.

The purpose of the discussion is to explore topics and to share information. Your original thought about the question is important. It is acceptable to use personal experiences from a professional standpoint. Your information and opinions should have support from the textbooks, professional position statements, and journals. It is not acceptable to copy and paste information from outside sources without using direct quotes. It is preferable to paraphrase information. When you restate the information in your own words by paraphrasing, you demonstrate that you have read about the topic and that it has meaning to you. You are showing that you can apply the information.

Evaluation

Kidney and Urinary Disorders

You are a clinical coordinator of a medical unit specializing in the care of patients with kidney and urinary tract disorders. You are charged with making assignments for this unit for the day shift. Your discussion post should be focused on the appropriate assignments of staff members to client groups. Your unit has 12 beds. Currently, your census is 11, with one empty bed. Please include your assignments for the shift with your rationale for making those assignments. Include your personal role as the coordinator during this shift. You may wish to review course materials from Nursing 108 on delegation and supervision. 

The staff for the next shift includes:

  • Raul; an experienced RN.
  • Tara; an RN orientee assigned with Raul for the shift. It is her third day on the unit.
  • Monique; a supplemental RN. The last assignment in this unit was three weeks ago.
  • Dorothy; an experienced LPN.
  • Timmy; an experienced nursing assistant.
  • Val; unit secretary, split between your unit and the one next door as your secretary called in sick.

Patients currently on unit:

#2201: PP, a 51-year-old female with T1DM (type one diabetes) who has ESKD (end-stage kidney disease). She was admitted for a revision of her A-V fistula. She has a temporary Hemodialysis catheter in place. She’s scheduled for hemodialysis this morning. 

#2202: RP, a 72-year-old male patient with a CBI (continuous bladder irrigation) who is post-op from a TURP yesterday. He has had many clots passed through the CBI and has needed the catheter manually irrigated three times during the past shift. 

#2203: empty bed.

#2204: MG, an 88-year-old female patient admitted two days ago with urosepsis. She’s currently getting IV antibiotics through a peripheral IV every eight hours. She has been incontinent of urine twice during the past shift. She is currently complaining about pain at the site of her IV. 

#2205: MW, a 44-year-old female patient who had a cystoscopy yesterday for a biopsy of her bladder. Cancer is suspected. She is currently waiting for the provider to write her discharge orders so she can go home today. 

#2206: JS, a 69-year-old male patient with uncontrolled hypertension and chronic kidney disease admitted last evening. He has a history of non-adherence to his medications at home and comes into the hospital every four to five months with chest pain, high BP readings, and weight gain. He’s been prescribed Lasix, Lisinopril, and metoprolol. His provider would like to send him home tomorrow. He has not been evaluated by the case-manager on your unit yet.

#2207: AM, a 21-year-old female patient with an acute kidney infection. She was admitted during the night. The patient currently has IV of NSS infusing at 100 ml/hr via peripheral IV and is complaining of 9 out of 10 back pain. Is febrile with a temp of 100.6 F 

#2208: MS, a 60-year-old male patient with a renal calculi diagnosed by CT scan. Being medicated with IV Fentanyl every three hours for 10 out of 10 pain reported by the patient. Receiving IV fluids and needs assistance to the bathroom. Urine must be strained each time the patient voids. 

#2209: SS a 72-year-old male admitted with hematuria. He is having diagnostic testing completed for renal carcinoma. The patient has a history of leukemia as a 40-year-old. This patient and his family are very upset by the diagnosis and the patient is intermittently tearful. 

#2210: CT, a 55-year-old female admitted with community-acquired pneumonia. She is currently on 4 L NC and has a 02 saturation of 92% at rest. She is short of breath and has been ringing for the nurse frequently as she is frightened of dying when she gets SOB. She is receiving Levaquin IV every 24 hours for her pneumonia. This patient also has an ileal conduit with a drainage bag attached. She had her bladder removed ten years ago due to cancer. 

#2211: RM, a 76-year-old male patient with cellulitis on his left shin. He’s on contact precautions for MRSA. He has been receiving continuous peritoneal dialysis at night, he’s assigned to your unit, as your staff has the training to use the PD equipment.

#2212: AF, a 40-year-old female patient with an intellectual disability from a group home setting. She was admitted with pyelonephritis during the night. She is scheduled for discharge today. She will need her IV discontinued and discharge instructions will need to be given to the patient and her caregiver. 

Please assign these patients to staff, being mindful of the scope of practice and ability levels of staff members. What nursing intervention is the top priority for each patient? Please indicate if the staff member is able to complete that priority independently, or if you (the charge nurse) need to assign it to another staff member. 

Include information about how you will assign yourself and your support staff during the shift. Keep in mind that an empty bed will mean somebody will get admission during the shift

Your initial post is due by Thursday at 11:59 PM EST. Your response to a peer is due by Sunday at 11:59 PM EST.

Discussion Guidelines

Posts need to be written in a professional manner. The content should have a clear beginning, middle, and end. Professionals communicate using correct grammar and spelling. It is acceptable to use a grammar or spelling editor prior to submitting your post. Any language that is disrespectful or discourteous is not acceptable. Your posts should be of sufficient length to answer the question, but information that is extraneous or irrelevant will not strengthen your post.

The purpose of the discussion is to explore topics and to share information. Your original thought about the question is important. It is acceptable to use personal experiences from a professional standpoint. Your information and opinions should have support from the textbooks, professional position statements, and journals. It is not acceptable to copy and paste information from outside sources without using direct quotes. It is preferable to paraphrase information. When you restate the information in your own words by paraphrasing, you demonstrate that you have read about the topic and that it has meaning to you. You are showing that you can apply the information.

Evaluation

Your work in the discussion will be assessed using the AD Discussion Rubric. All discussions combined are worth 25% of your grade; each individual discussion is worth 3.57%.

References

Outcomes

Post-Op Pneumonia

Post-Op Pneumonia Project

 

Abstract

Pneumonia in the post-operative setting is a challenging condition which can cause serious health complications for patients who are already recovering from a surgical procedure and can delay this process in a variety of ways. Patients face a greater risk of the disease in this setting due to their lower immunity and a limited ability to fight different types of infection during hospitalization. Advanced practice nurses who work with these patients often experience difficult challenges which can impact the course of their patient’s recovery. It is important to develop and implement targeted interventions in the immediate post-operative phase  to reduce the risk of developing pneumonia. This study explores this phenomenon to determine if targeted interventions have the desired impact on patients and can lead to improved outcomes and recovery rates using the Roy Adaptation Model of nursing practice to evaluate nurse-led interventions in the post-operative setting.

 

Overview of Post-Op Pneumonia

Post-operative pneumonia is defined as an infection that develops within the tissue of the lungs during hospitalization after patients have undergone a surgical procedure, and its most common symptoms include shortness of breath, cough, fever, and chest pain (Arozullah, Khuri, Henderson, & Daley, 2001). Pneumonia, along with infections of the urinary tract and in open wounds, are the most common types of infections that occur in the post-operative setting and cause serious complications for patients, along with an increased risk of higher mortality rates (Arozullah et al., 2001). However, the risk of post-operative pneumonia must be better understood and provide additional information regarding individual patient risk because the severity of the disease can contribute to a higher risk of mortality among patients (Arozullah et al., 2001). Prevention of pneumonia in the immediate post op phase is of critical importance and requires an examination of key interventions which can have a positive and lasting impact on patients, using the knowledge, experience, and resources of advanced practice nurses to accomplish these objectives. However, these interventions can pose challenges for nurses and require a targeted approach to ensure that they are successful in preventing the risk of infection among patients and will have the desired impact in reducing the risk of mortality and in improving recovery rates.

Problem Statement

In the surgical unit, there is an elevated rate of pneumonia cases in the post-operative setting, due to the risk factors and compromised immunity of patients within this environment. This phenomenon can negatively impact recovery rates and quality of life in patients and contribute to increased costs of keeping patients hospitalized for longer periods. The development of targeted interventions may provide a potential strategy for nurses who work with these patients, but the effectiveness of these interventions is not well known.

Purpose Statement

The primary objective of this research study is to examine the clinical efficacy of targeted interventions for post-op patients to prevent the risk of pneumonia in these settings. These interventions require expert knowledge and resources utilized by advanced practice nurses to facilitate patient recovery and reduce the risks of developing pneumonia in post-op patients. This quantitative research study will evaluate if targeted interventions in the post-op setting have the desired effect on patients in comparison to delayed interventions in the prevention of pneumonia. The proposed hypothesis for this quantitative research study is the following: What is the impact of a targeted intervention that includes ambulation, eating out of bed, and an incentive spirometer in the immediate post-op phase to prevent pneumonia? It is anticipated that the development of a successful intervention to prevent post-operative pneumonia requires the expert knowledge of nurses and an understanding of the key factors that will have lasting impact on the organization and on patients who face significant risk due to complications from surgery and the risk of infection. However, the chosen intervention method should encompass a variety of different perspectives based upon available evidence and provide nurses with feedback and data regarding the effectiveness of the protocol and if fewer cases of post-operative pneumonia are observed.

Health Phenomenon and Nursing Conceptual Model

The risk of post-op pneumonia is significant for patients in these settings; therefore, a multidisciplinary team-based approach is necessary to ensure that patient care is not compromised and quality of care improves with an effective cultural framework in place (Khan et al., 2016). A key component of this practice is the delivery of targeted interventions by nurses who have the knowledge, experience, and resources to minimize pneumonia risk among post-op patients and can ensure that prevention strategies are optimized in this setting to improve patient outcomes and promote greater cost efficiency (Khan et al., 2016). A structured program within the nursing practice is likely to have a positive impact on patients and provide resources that will reduce infection risk and utilize evidence-based practice tools to improve quality of life and reduce mortality rates (Talley, Lamb, Hart, Lorenz, & Green, 2016). With an increased risk of hospital-acquired pneumonia among post-op patients, preventive strategies must begin with a nursing-based framework that will have the desired impact on patients and provide sufficient resources to conduct a successful intervention (Kollef, 2007). A key factor of the intervention is understanding pneumonia risk among post-op patients and how to best accommodate their needs with a strategy that will utilize prior evidence to support an intervention to prevent additional cases of pneumonia and related complications among this patient population (Park, Kang, Moon, Yang, Kim, & Byun, 2017).

Preventing pneumonia among post-op patients requires a theoretical framework which supports nursing-based interventions that will have the desired impact and will improve recovery rates. Specifically, the Roy Adaptation Model is applicable to this scenario because patients must learn to adapt to their surroundings with the support and guidance of nurses in their presence; therefore, nurse-led interventions can be useful in addressing these needs in an effective manner by offering tools to overcome illness and promote recovery at a high level (Phillips & Harris, 2014). When stimuli from the surrounding environment affect patients, nurses have the responsibility to investigate these issues and to establish procedures to guide patients to prevent pneumonia (Phillips & Harris, 2014). Roy’s Adaptation Model supports patients’ capacity to adapt to their surroundings, and their ability is either compromised, compensatory, or integrated, depending on the environment (Phillips & Harris, 2014). When environmental stimuli are present, patients respond via coping mechanisms which are designated as regulator (internal system functions) versus cognator (cognitive-emotive) responses (Phillips & Harris, 2014).

From an advanced practice nursing perspective, the Roy Adaptation Model serves as a “goal-oriented, problem-solving approach to guide the provision of comprehensive, competent nursing care to a person or groups of persons” (Phillips & Harris, 2014, p. 266). Therefore, several steps must be considered as critical to this process and include the following: an assessment of the behavior in question; an evaluation of the stimuli which have led to the behavior; the development of a definitive nursing diagnosis for a patient; the development of goal-setting activities to achieve the desired results; conducting the intervention with the chosen strategy in place; and evaluating the success or failure of the strategy based upon the outcomes that are generated (Phillips & Harris, 2014). These conditions are important in determining how patients can be impacted by a targeted intervention to prevent post-operative pneumonia when nurses develop the intervention using this model and determining if it is effective in preventing this risk for patients in this setting (Phillips & Harris, 2014). It is believed that “nursing theory directs the practitioner toward important aspects of assessing, planning, goal setting, implementation, and evaluation” (Phillips & Harris, 2014, p. 266). This process is essential to the success of a targeted intervention for post-operative pneumonia and in determining if this intervention will have the desired impact on patients who are recovering from surgery (Phillips & Harris, 2014). Roy’s Adaptation Model  also utilizes inherent nursing-based knowledge and resources to implement the proposed intervention and to ensure that the organization is prepared to accommodate patient care needs effectively (Philips & Harris, 2014). This Model is an important step towards understanding the key risk factors related to post-operative pneumonia risk and how patients are perceived in this setting (Phillips & Harris, 2014).

Review of Literature

Post-operative pneumonia is a serious health issue which can increase mortality rates among patients and may be identified in one of two forms: ventilator-associated pneumonia within 48-72 hours after intubation has occurred; and hospital-acquired pneumonia, which occurs within 48-72 hours after a patient has been admitted to the hospital (Chughtai et al., 2017). This condition typically requires an extended length of stay for many patients and can cost an additional $40,000 for treatment, and there are increased measures to minimize the risk of infection due to penalties associated with reduced reimbursement by Medicare when hospital readmissions occur due to pneumonia (Chughtai et al., 2017). Based upon these concepts, it is important for advanced practice nurses to develop targeted interventions to reduce the risk of infection and to improve patients’ quality of life in the process (Chughtai et al., 2017). One of the issues to consider is the following: “there may be differences between hospitals in pneumonia prevention protocols, such as frequency of incentive spirometry use, or variance in utilization of methods such as oral cleansing and suctioning (pre-operatively vs. postoperatively vs. both pre- and postoperatively)” (Chughtai et al., 2017). From this perspective, advanced practice nurses may not always agree on the appropriate intervention strategy to implement and may find it difficult to achieve consistent success with an intervention when patients still contract the infection after surgery (Chughtai et al., 2017). Therefore, identification of the appropriate intervention must serve as the first step in understanding the key risk factors that affect patients and in advancing the intervention to the next level once it has been tested on patients and is deemed successful (Chughtai et al., 2017).

A study by Kazaure, Martin, & Yoon (2014) addressed the significance of a prevention program for post-operative pneumonia in the surgical ward which encompassed the following components: education for all nurses on staff in the surgical unit; the use of an incentive spirometer to promote coughing as well as deep breathing; the use of chlorhexidine on a twice-daily basis for hygienic purposes; improved ambulation by patients post-surgery and maintaining strong control over pain episodes; sitting up to eat all meals and elevating the head at an angle of 30 degrees or more; discussing the outcomes of the program among nursing staff on a quarterly basis; recording the pneumonia bundle as part of the patient health record; and the use of an “automated computerized physician pneumonia prevention order” in the electronic ordering system. This was conducted as a quality improvement study to determine the effectiveness of the pneumonia bundle in the post-operative setting and if this process has the desired impact on patients, including any diagnoses of pneumonia that occur while this bundle was implemented (Kazaure et al., 2014). Based upon the results of this study over a five-year period, it was determined that the study was largely effective in dramatically reducing the post-operative pneumonia rate among patients and contributing to cost savings for hospitals and insurers (Kazaure et al., 2014). These characteristics demonstrate that a similar bundle implementation in another environment could have a comparable impact and reduce the risk of infections in patients in the post-operative setting (Kazaure et al., 2014).

It is known that ambulation is a critical component in the prevention of post-operative pneumonia because this process can be effective on day zero after surgery or within the first 12 hours (Currier, TeKolste, & Wheatley, 2018). It is proposed that “improved nursing staff education may be necessary to encourage adherence to ambulation protocols and policy change. Early ambulation has the potential to positively impact the patient’s physical, psychological, and social outcomes” (Currier et al., 2018, p. 5). Under these conditions, advanced practice nurses have a responsibility to make ambulation a routine practice method during the first 12 hours after surgery to ensure that patients receive the best possible options to prevent post-operative pneumonia and to improve quality of life in these patients (Currier et al., 2018). As part of a larger framework, ambulation should serve as a key factor in advancing the objectives of an intervention to prevent the disease and to facilitate the development of a protocol that will target post-operative patients to prevent further complications (Currier et al., 2018). Furthermore, assessing the protocol requires an examination of the type of surgery that was required and any other complications that have emerged which can lead to problematic circumstances for patients (Currier et al., 2018).

Boev & Xia (2015) recognized the importance of collaborative efforts between nurses and physicians to facilitate positive treatment and recovery outcomes for post-operative patients. In this context, the organization must focus on the development of different programs as created by advanced practice nurses and physicians to solve important problems such as the risk of post-operative pneumonia (Boev & Xia, 2015). Nurses are likely to experience greater satisfaction in their roles if they develop and implement procedures or protocols which are successful in the clinical setting and which translate into positive outcomes for patients (Boev & Xia, 2015). However, when nurses lack cohesion in their ideas and collaborations with physicians or do not communicate their ideas or expectations, these can cause serious complications for patients because protocols to reduce infection risk may be delayed, poorly executed, or unsuccessful within the patient care environment (Boev & Xia, 2015). Once the problem is identified, a collaborative solution is necessary to ensure that all parties contribute to solving the problem and implementing a successful strategy going forward (Boev & Xia, 2015). This exercise offers an important opportunity for an organization to consider the options that are available and to identify an effective means of disease prevention which includes the bundling of services and treatments for patients (Boev & Xia, 2015). However, perhaps the most important approach to solving the problem should be conducted by advanced practice nurses in collaboration because they are generally on the same page with the process; in addition, when physicians become involved for different reasons in an effort to solve the problem, this is not always successful and may contribute to poor patient outcomes (Boev & Xia, 2015). It is known that “Nurses, as the recipient of the orders, may find true collaboration difficult because of the inherent barriers related to the hierarchy within hospitals” (Boev & Xia, 2015, p. 71). These circumstances reflect the importance of accomplishing cohesive intervention strategies which limit communication barriers and provide the best possible resources to prevent disease (Boev & Xia, 2015).

Plan for Assessment of the Problem

Implementing an intervention to prevent post-operative pneumonia requires an examination of key factors which may be useful in addressing this issue and in providing sufficient options for patients to prevent the disease and to promote recovery. Therefore, quality improvement programs in this area must include collaborative efforts between Advanced Practice Nurses and physicians to ensure that all possible options are explored to improve quality of care and patient treatment strategies (Moore, Conway, Thomas, Cummings, & Atkinson, 2017). There is a risk of complications up to 40 percent in patients who have had surgery; therefore, it is necessary to identify specific prevention mechanisms that will target prevention and limit complications (Moore et al., 2017). In examining the problem and the interventions that appropriate, advanced practice nurses must demonstrate their understanding of the condition and how they can be effective in improving recovery rates for patients while using specific intervention bundles (Moore et al., 2017). Assessing the problem supports a greater understanding of the impact of the intervention and how it can contribute to effective outcomes for patients and allow advanced practice nurses to utilize their skills and experience for the greater good of their patients who are at risk of the disease after surgery (Moore et al., 2017).

Clinical Implementation and Assessment Methods

Implementing a nursing-based protocol to prevent post-operative pneumonia requires the integration of vital signs, including measurement and documentation of incentive spirometry and progress as well as monitoring lab values and adequate pain assessment including a function assessment of pain and adequate pain management.  The current nursing practice data will be collected and then compared to the immediate post -op targeted interventions to be implemented. With the protocol in place, the clinical needs of each patient must be considered and the practice should stimulate rather than deter recovery. Furthermore, this process requires nurses’ continuous feedback to improve the protocol and to make any changes that will positively impact patients. At the same time, implementing a protocol in the surgical environment requires a pilot period whereby each step of the protocol is implemented and feedback is provided to determine if the process is effective in preventing post-operative pneumonia in a larger group of patients.

The development of an assessment tool is required to ensure that advanced practice nurses can evaluate the intervention tool and determine if is effective in reducing pneumonia risk. This requires the collection of patient data to identify the number of cases of pneumonia that occurred prior to the implementation of the protocol and after the protocol has been used. A comparison of this data is necessary to determine if the protocol is successful and if it accomplishes the necessary goals and objectives in preventing post-operative pneumonia. As part of their training and in gaining new experience, the implementation tool must be evaluated and any changes must be made which indicate that part of the protocol has not been successful. Nurses will acquire additional knowledge and a critical understanding of the impact of pneumonia on surgical patients. The assessment tool must demonstrate that the organization has the appropriate tools in place to prevent pneumonia and to encourage employees to adhere to all steps of the protocol in a timely manner. This process is important because patients rely on care and treatment mechanisms which will aid in the prevention of disease and reduce the number of hospital readmissions in the future.

Post-operative pneumonia is a very serious health condition which is acquired during hospitalization and after surgery, requiring an extended length of stay and additional costs for treatment. Advanced practice nurses must develop opportunities to conduct interventions among this population group to prevent the risk of developing post-operative pneumonia in patients and provide them with the best possible resources to maximize their survival, reduce mortality rates, and improve recovery times. It is important for Advanced Practice Nurses to conduct interventions which involve the use of ambulation, eating out of bed, and an incentive spirometer to prevent post-operative pneumonia in the immediate post-op phase. This implementation should be based upon the characteristics of the Roy Adaptation Model to ensure that patients receive the targeted intervention as instructed and are evaluated in accordance with the intervention to determine its overall effectiveness. This process is critical in determining how to implement this type of intervention on a widespread basis and to facilitate outcomes that will be favorable for patients and which will prevent post-operative pneumonia and related complications.

 

 

 

References

Arozullah, A. M., Khuri, S. F., Henderson, W. G., & Daley, J. (2001). Development and

validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Annals of internal medicine135(10), 847-857.

Boev, C., & Xia, Y. (2015). Nurse-physician collaboration and hospital-acquired infections in

critical care. Critical Care Nurse35(2), 66-72.

Chughtai, M., Gwam, C. U., Mohamed, N., Khlopas, A., Newman, J. M., Khan, R., … & Mont,

  1. A. (2017). The epidemiology and risk factors for postoperative pneumonia. Journal of clinical medicine research9(6), 466.

Currier, D. (2018). WHY DAY ZERO MATTERS IN EARLY AMBULATION FOR

POSTOPERATIVE (Doctoral dissertation, Nebraska Methodist College).

Kazaure, H. S., Martin, M., Yoon, J. K., & Wren, S. M. (2014). Long-term results of a

postoperative pneumonia prevention program for the inpatient surgical ward. JAMA surgery149(9), 914-918.

Khan, R., Al-Dorzi, H. M., Al-Attas, K., Ahmed, F. W., Marini, A. M., Mundekkadan, S., … &

Tamim, H. M. (2016). The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. American journal of infection control44(3), 320-326.

Kollef, M. H. (2007). Prevention of postoperative pneumonia. Hospital Physician64, 47-60.

 

Park, H. O., Kang, D. H., Moon, S. H., Yang, J. H., Kim, S. H., & Byun, J. H. (2017). Risk

factors for pneumonia in ventilated trauma patients with multiple rib fractures. The Korean journal of thoracic and cardiovascular surgery50(5), 346.

Moore, J. A., Conway, D. H., Thomas, N., Cummings, D., & Atkinson, D. (2017). Impact of a

peri‐operative quality improvement programme on postoperative pulmonary complications. Anaesthesia72(3), 317-327.

Phillips, K. D., & Harris, R. (2014). Roy’s adaptation model in nursing practice. MR Alligood

(Ed) Nursing Theory Utilization and Application, 263-284

Quinn, B., Baker, D. L., Cohen, S., Stewart, J. L., Lima, C. A., & Parise, C. (2014). Basic

nursing care to prevent nonventilator hospital‐acquired pneumonia. Journal of Nursing Scholarship46(1), 11-19.

Talley, L., Lamb, J., Harl, J., Lorenz, H., & Green, L. (2016). Hap prevention for nonventilated

adults in acute care: Can a structured oral care program reduce infection incidence? Nursing Management47(12), 42-48