Describe the difference in roles between leadership and management. Explain how the goals of management and leadership overlap and provide one example. As a nurse leader, describe how you can facilitate change by taking advantage of this overlap.

Reflect on your own cultural and linguistic competence. How confident are you in your ability to address the needs of diverse communities? How do you think you could improve your level of cultural and linguistic competence? No research citations are required for this discussion question

this course prepares the student to identify common symptoms for the diagnosis and management of common health issues. The criteria for diagnosis, including diagnostic studies, will be discussed. This course will place an emphasis on health promotion, disease prevention, and health screenings across the lifespan, and providing culturally competent care.  Professional, ethical, and legal issues are addressed.

L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.  Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.  Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.  One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.   Questions  1.What are the effects of controlling BP in people with diabetes?   2.What is the target BP for patients with diabetes and hypertension?   3.Which antihypertensive agents are recommended for patients with diabetes?

A physical therapist receives a phone call from a woman demanding to know when her daughter-in-law’s next appointment is. The therapist tells the woman that she cannot disclose any information, and the woman becomes very angry and abusive, threatening to make a complaint. After the phone call, the therapist logs into the electronic medical record system to make a note about the conversation. However, since the two women share the same last name, the therapist accidentally accesses the woman’s record instead of the daughter-in-law’s record. The therapist realizes the mistake, but not before spotting that the woman suffers from a serious mental health disorder, which might explain her behavior on the phone. The therapist mentions to her supervisor the possibility of a complaint being brought and also mentions that the woman has a history of mental health problems. Do you feel that there has been a breach of confidentiality/HIPPA? Why or why not? How should the supervisor handle this situation? Should the patient be notified?

This webpage offers a series short videos on patient confidentiality.

https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. 

Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

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The Strain of Increasing Patient Populations on Primary Care 

     One stressor affecting healthcare on a national level is increasing strain that is being placed on primary care providers. In an article published in the journal “Managed Care” titled Primary Care Continues to Feel the Strain (2012), the authors explain that providers in the primary care setting

currently only spend 15 minutes on average with each patient. With the increases in patient needs, these practices simply cannot handle taking on more patients. The demands placed on providers to incorporate preventative care into the treatment of a patient’s current illness or chronic condition are

making it difficult for providers to maintain quality care in such a short visit with a patient.  

     My current work setting is a primary care office, that provides care to patients on a sliding fee which based on income. We work to serve the uninsured and underinsured population of Eastern Idaho. With five providers currently seeing an average of forty patients a day each, our office is feeling

the strain of increasing patient populations. This strain not only affects the providers, but has added strain to the nursing staff, reception staff and medical billers.  

      Currently our providers each have their own patient population, where for primary care needs, the patient only sees the one provider. A patient needing refills on his metformin or lisinopril can only be seen by the provider that prescribed that medication currently. The problem this is creating is

the inability to schedule these patients for a follow up before they are out of refills due to a provider’s schedule being booked for weeks out.  

     The solution that has been implemented to aid in this problem is the use of nursing teams. Each provider has his or her own team of nurses. As the lead nurse for my physician, patient phone calls, questions and refill requests come to me first. We also have a care coordinator that helps to

manage patient referrals and making sure imaging appointments are made and reports are uploaded to the patient chart. In chapter 3 of the course text, it is established that successful teams use each member’s strengths to benefit of the team and to the quality of patient care (Marshall & Broome,

2017). 

Our success with these small collaborative teams is the main reason the use of primary care collaboration is being considered. This involves the use of a primary care team, instead of a single provider. Each team including a physician and one or two other providers (either nurse practitioners or

physician assistants). A literature review performed by Norful, de Jacq, Carlino &Poghosyan (2018) identified that in order for this type of arrangement to be successful, the members of the primary care team would be required to not only communicate and respect each other’s medial knowledge

and ability, but also develop a way to align their clinical methods and beliefs about medical care.  

References 

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer. 

Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. Annals of Family Medicine, 16(3), 250–256. doi:10.1370/afm.2230 

Primary care continues to feel the strain. (2012). Managed Care (Langhorne, Pa.), 21(2), 25. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=22396978&site=eds-live&scope=site