Theory/Author Name and Background
1).Select a Grand or Mid-Range Theory that is appropriate to your practice setting( home care nurse).
2).Describe the theorist’s background in detail and discuss how their experiences have impacted the theory development.
3).Examine crucial references for the original and/or current work of the theorist and other authors writing about the selected theory.
4.)Identify the phenomenon of concern or problems addressed by the theory.
1.)Explain whether the theory uses deductive, inductive or retroductive reasoning. Provide evidence to support your conclusion.
2.)Describe the major concepts of the theory.Â How are they defined? (theoretically and/or operationally) Is the author consistent in the use of the concepts and other terms in the theory?
3.)Interpret how the concepts are defined.Â Implicitly or explicitly?
4.)Examine the relationships (propositions) among the major concepts.
1.)Identify explicit and implicit assumptions (values/beliefs) underlying the theory. On what assumptions does the theory build?
2.)Examine if the theory has a description of the four metaparadigm concepts of nursing. If so, how are they explained in the theory? If the metapardigm is not explained, what elements do you see as relevant to the theory and why?
3.)Discuss the clarity of the theory.Â Did it have lucidness and consistency?
1.)Examine how the theory would guide nursing actions.
2.)Describe specifically how you can use this theory in your area of nursing (Practice, Education, Informatics or Administration).
Write a critical summary of the paper, and make a suggestion for 1 or 2 other variables or factors that the author could have used in the paper
Include a “Lessons Learned” paragraph.
Return to work: A critical aspect of care coordination for younger
Jae Kennedy, Ph.D.a,*, Gilbert Gimm, Ph.D.b, and Elizabeth Blodgett, M.H.P.A.c
aDepartment of Health Policy and Administration, Washington State University, Spokane, WA 99210-1495, USA
bDepartment of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA
cDepartment of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA
Background: Annual health care costs for dual eligibles now top $300 billion. Many dual eligibles are under age 65 and their needs
differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for
Objectives: To assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence
among these subgroups of factors associated with return to work.
Methods: Population estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS).
Results: Although they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42%
of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees
(AOR 5 19.8, 95% CI 5 16.2e24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report
better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied
with the quality of the care they receive.
Conclusions: Dual eligible workers with disabilities are an important target population for coordinated services because of their high
lifetime program costs e many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment
are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on
federal disability programs. 2013 Elsevier Inc. All rights reserved.
Keywords: Medicaid; Medicare; SSDI; Disabled workers; Return to work; Coordinated care
The Medicare and Medicaid programs combined spend
over $300 billion annually for the 9.2 million adults who
are enrolled in both programs. Slowing the growth of these
costs is a priority for the Federal Coordinated Health Care
Office (FCHCO) and the Center for Medicare and Medicaid
Innovation (CMMI). At present, most cost-containment
efforts are focused on avoiding hospitalizations and nursing
home admissions among older dual eligibles. However,
42% of dual eligible beneficiaries are ‘‘working age’’
(i.e., under age 65) and therefore eligible for Medicare as
Social Security Disability Insurance (SSDI) beneficiaries.
This group has received relatively little research or policy
attention.1 In this paper, we show how the needs of lowincome
disabled workers can be quite different from those
of retired elderly dual eligibles.
Dual eligibles receive Medicaid coverage when they
meet state categorical and income eligibility criteria.
Although Medicaid is considered to be a ‘‘second payer’’
when there is an overlap in service coverage with Medicare,
many essential disability support services, like personal
assistance, are only covered through Medicaid. Most young
dual eligibles also receive Supplemental Security Income in
addition to SSDI benefit payments. Because they are
enrolled in at least three public programs, younger dual
eligibles represent a significant cost to the Social Security
Administration (SSA) and to states.2
Average annual Medicare and Medicaid costs incurred by
younger dual eligibles ($19,000) are slightly lower than
those incurred by older dual eligibles ($19,700), but younger
dual eligibles account for decades more of enrollment,
resulting in higher lifetime costs. Their financial assistance
Funding for this study was provided by the National Institute on
Disability and Rehabilitation Research (Grant H133G070055, Jae Kennedy,
PI) and the WA Life Sciences Discovery Fund (Grant LSDF
08-02, John Roll, PI). These agencies had no further role in study design,
in the collection, analysis and interpretation of data, or in the writing of the
* Corresponding author. Tel.: þ1 509 368 6971; fax: þ1 509 358 7984.
E-mail address: firstname.lastname@example.org (J. Kennedy).
1936-6574/$ – see front matter 2013 Elsevier Inc. All rights reserved.
Disability and Health Journal 6 (2013) 95e99
THIS PAPER APA FORMAT IS ABOUT 40% OF GRADE. FORMAT IS VERY IMPORTANT HERE. IM GIVING THE OUTLINE WITH EXCATLY WHERE AND HOW THIS PAPER NEEDS TO INCLUDE AND WHERE TO PUT THE INFORMATION. PLEASE THIS NEEDS TO BE EXACTLY LIKE THE OUTLINE IM INCUDING. ALL TOPICS AND FORMAT (APA) HAS TO BE 100%. I WILL DESPUTE THIS PAPER IF I END UP WITH UNDER A 80%.
For this paper, you will develop an innovative nursing care delivery model for a vulnerable population, care specialty, and setting in the United States OR a low income global country that reflects nurse managed care, collaboration, care across settings, and technology.
For your paper, it is easiest to focus on one (1) population, one (1) health issue/disease, and one (1) type of setting within a country. Be specific. If you use a low income country, name your low income country (see list at the end of this) and adjust your model to the disease(s) and conditions found within that country. Consider that low income countries will not have access to the same level of facilities, technology related to diagnostics and communication, medications, and the health care professionals found in the U.S.
–A vulnerable population include low income children & adults; elderly; homeless; migrants; immigrants; racial & ethnic minorities, people with chronic health or terminal conditions/diseases (or any group at risk for obtaining appropriate health care).
-A care specialty include preventative care; primary care; acute care; chronic care; palliative or end-of-life care (including the targeting of any disease or condition that results in a health risk).
-A setting include rural or urban community housing and/or clinic; school; specialty unit in a hospital; emergency room; health provider office; armed services facility; rehabilitation facility; hospice facility; ambulatory health care center; client home; nursing home; short term stay housing (or any setting where a vulnerable client/patient population is available for care).
LIST OF SELECTED COUNTRIES
African Republic Algeria
Dem Rep of Congo Ethiopia
Ghana Madagascar Malawi Mozambique Niger Senegal Sierra Leone South Africa Uganda Zambia Zimbabwe
Bolivia Ecuador Guatemala Haiti Nicaragua Peru
Iraq Morocco Somalia Sudan Yemen
Bangladesh North Korea Myanmar Nepal
OUTLINE OF EXACTLY HOW THE PAPER NEEDS TO BE:
Title of Paper (top of page 2, centered) Innovative Nursing Care Delivery: [Name of Your Model]
PAPER HEADING: Introduction [Level 1] What is your model’s population, setting, care specialty, and your model’s goal(s) and/or purpose(s)? For example, are you targeting a particular group or disease/condition? Choose a name for your model and include it in your paper title.
PAPER HEADING: Description of the [Name of Your Model] [Level 2] You are welcome to use your creativity in the model–develop your own or base it on an existing model. For ideas, start with the articles found with the assignment, textbook (Global Health 101) scenarios, or do literature searches on the internet. However, be sure that the model is nurse-led or nurse-managed. Registered nurses have authority to make decisions regarding nursing diagnoses, interventions, and referrals. Registered nurse practitioners have additional authority related to medical diagnoses and interventions (prescriptions).
Be sure to include the themes crucial to meeting the challenges of the future: nurse- managed care, collaboration, continuity of care and technology in describing your model. Be aware of cost-effectiveness; you could develop the “Cadillac” of models, but no one would consider implementing it because the cost would be too high.
Nurse led and nurse managed health care. [Level 3] How is your model nurse managed? Were nurses instrumental in the development and implementation of your model? Are nurses consulted and/or make decisions re: budget, personnel, and the communication, referral, and evaluation processes?
Partnerships and collaboration. [Level 3] What partnerships and collaborations exist for your model? Are they at the professional level (i.e., social workers, nutritionists, community leaders) and/or the organizational level (home health care agencies, public health departments, hospitals)?
Continuity of care across settings. [Level 3] What happens when a patient/client moves to a different setting, i.e., home, hospital, hospice, clinic, emergency room, etc. How is communication handled so the patient/family needs are consistently met when moved across settings?
Technology. [Level 3] What technology is used? Is it low-technology (basic assessment tools, screening tests) or high-technology (i.e, patient diagnostic, monitoring, and/or data processing systems) or a combination of both?
PAPER HEADING: Development/Implementation Team for the [Name of Your Model] [Level 2] Your team is important to carry out model’s goal(s). Depending on your model and setting, your team may include other registered nurses, nurse practitioners, community workers, nurse assistants, licensed practical nurses, nutritionists, physical therapists, occupational therapists, dentists, social workers, community leaders, psychologists, clergy, administrators, informatics technicians, physicians (if physicians are part of the team, they should function as consultants, not “captain of the ship”). Include your team members and briefly discuss their functions in carrying out the model goal(s)/purposes(s). How would communication and referrals be handled? Again–think about the cost effectiveness–could ancillary staff (nurse assistants, trained community workers) be used just as effectively?
PAPER HEADING: Evaluation of [Name of Your Model]: Outcome Measurement [Level 2] After implementation of the model, what outcomes would you measure Would you look at cost comparisons and/or savings? Patient satisfaction? Staff satisfaction? Fewer ER visits and/or re-hospitalizations? Decreased incidence of a particular disease/condition? Increased number of therapies? Increased knowledge of a disease or intervention?
For outcomes, be specific on what, who, when and how. For example, if you do a survey:
What type of survey is it (i.e., satisfaction, data gathering)?
Who would you survey (i.e., staff, patients, administrators)?
When would you do the survey (i.e., time period; pre/post tests)?
How would you conduct the survey (handout, mailing, computer analysis)?
What are the current incentives and disincentives faced by medical students in choosing to become primary care versus specialty-focused physicians? What is the impact of credentialing and regulation of health care professionals (both nationally and state-to-state)? How would you change the system to become more balanced; that is, how would you attract more people to become primary care physicians?
What is the accepted explanation for the nursing shortage? Consider the following explanation: “There is no ‘shortage’ of nurses; there is a shortage of people willing to put up with the conditions nurses must work under.” Do you agree? Why or why not?