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Tag: Model Answer

  • [Solved] Question

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    There are different ways to reveal meaning in a literary work. The first method we will use is reader-response. This is a subjective way to understand and interpret a literary work. Reader-response includes sharing impressions of a literary work. The purpose of reader-response in this course is to f…

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    There are different ways to reveal meaning in a literary work.  The first method we will use is reader-response.  This is a subjective way to understand and interpret a literary work.  Reader-response includes sharing impressions of a literary work.  The purpose of reader-response in this course is to familiarize ourselves with the literary work and to thoughtfully and critically interact with the work.  To that end, complete the following:
    – Share your general impressions of “How it Feels to be Colored Me” by      answering at least one of the questions below.
    What did you think about the work?
    Did you like or dislike the work?  Why?
    What was your experience when reading the work?
    Did you relate to the work—setting, characters, plot—in any way?  How so?
    Another way is to learn about the context of the work.  Context is information about or related to the work.  Learning about the context can help us better understand the meaning of a work. To that end, after reading “Harlem Renaissance.  American Literature and Art” and “About Zora Neale Hurston”, post two items of information that you learned about the context of “How it Feels to be Colored Me”.

  • [Solved] Leadership

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  • [Solved] Advocating for the Specialty Area

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    For this assignment, please define and describe advocacy in the context of your counseling specialty. As you think through the role of being an advocate in your specialty area (clinical mental health), what challenges or needs in your specialty area might require your advocacy work at the local, sta…

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    For this assignment, please define and describe advocacy in the context of your counseling
    specialty. As you think through the role of being an advocate in your specialty area (clinical
    mental health), what challenges or needs in your specialty area might
    require your advocacy work at the local, state, and national level? For example, you might face
    a challenge related to inadequate funding for services in your area, or administrators who are not
    supportive of your efforts, or lack of access to appropriate services due to geography. List at least
    one challenge you might face in your counseling work at all three levels: Local, State, and
    National. For each challenge that you identified, describe specific ways you might advocate to
    bring about positive change. Also, describe to whom you would direct your advocacy efforts at
    each level. See attachment for further instructions.
    \
    AdvocatingfortheSpecialtyAreaAssignmentScoringGuide1.pdf](https://www.sweetstudy.com/files/advocatingforthespecialtyareaassignmentscoringguide1-pdf "AdvocatingfortheSpecialtyAreaAssignmentScoringGuide1.pdf")

  • [Solved] Applying Theories of Employee Motivation

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    – ## Assignment1.docx **## Assignment1.docx** **Assignment 1: Applying Theories of Employee Motivation** **Overview** This assignment is worth **_20% of your overall grade_** _._ You will choose **_ONE_** _theory of employee motivation_ from Chapter 8 of your _textbook:_ · _Needs Theory_ · _Expectan…

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    – ## Assignment1.docx

    **## Assignment1.docx**

    **Assignment 1: Applying Theories of Employee Motivation**

    **Overview**

    This assignment is worth
    **_20% of your overall grade_** _._ You will choose
    **_ONE_** _theory of employee motivation_ from Chapter 8 of your
    _textbook:_

    ·
    _Needs Theory_

    ·
    _Expectancy Theory_

    ·
    _Self-Efficacy Theory_

    ·
    _Justice Theories_

    ·
    _Goal-Setting Theory_

    ·
    _Control Theory_

    ·
    _Action Theory._

    Your task is to
    **apply the theory** creatively, show that you understand it, and make it personal — either by connecting it to your own experiences, to organizations you know, or to an imagined scenario.

    This is
    **not a research paper**. Instead, you will show mastery through analysis, application, and creativity.

    The assignment will be
    **open from August 25, 2025 – October 19, 2025**. During the final week (October 13–19), this assignment will be your sole focus — no other assignments will be due. Please plan ahead accordingly, as late submissions will not be accepted except for officially documented, university-sanctioned reasons.
    **Note:** last-minute Wi-Fi or technology issues do
    _not_ qualify as university-sanctioned reasons.

    Additionally, we will
    **not** formally cover these theories in class until
    **_Week 5_** _,_ but I encourage you to preview the chapter early and begin planning your project. I also encourage you to take detailed notes.

    **Assignment Objectives**

    By the end of this project, you should be able to:

    ·
    **Demonstrate understanding** of one motivational theory.

    ·
    **Apply the theory** to a practical, real-world, or personal scenario.

    ·
    **Think critically** about the strengths and weaknesses of the theory.

    ·
    **Engage creatively**, using a format other than a traditional paper.

    **What You’ll Do**

    1.
    **Choose a Theory: Pick ONE**

    ·
    _Needs Theory_

    ·
    _Expectancy Theory_

    ·
    _Self-Efficacy Theory_

    ·
    _Justice Theories_

    ·
    _Goal-Setting Theory_

    ·
    _Control Theory_

    ·
    _Action Theory._

    1.
    **Explain the Theory (Briefly)**

    · Provide a clear, accessible explanation of your chosen theory in your own words. Keep this concise — imagine you’re explaining it to someone who has never heard of it. Additionally, make sure you use terminology from the textbook/ video lecture (paraphrase)

    1.
    **Apply the Theory**

    · Apply the theory in a way that feels meaningful and creative to you. Some options include:

    1. Connecting it to your personal experiences (school, sports, volunteer work, jobs, or even family roles).

    2. Designing a program or strategy an organization could use (a company, sports team, nonprofit, or even a club you imagine).

    3. Showing how the theory could guide someone’s personal goal-setting or self-improvement.

    · Your application should include practical examples, not just theory.

    1.
    **Critique the Theory**

    · Every theory has strengths and limits. What works well about your chosen theory? Where might it fall short? Why? (Think about different workplaces, generations, or life situations.)

    1.
    **Creative Presentation Format –** _Please make sure to include a PDF version of your final project and the link (if there is one) in your final submission._
    Instead of a paper, you’ll present your project in one of these formats.

    · Digital infographic

    · Magazine or newspaper-style article

    · PowerPoint / Canva presentation

    · Creative personal reflection journal (with visuals, stories, etc.)

    1.
    **References and Citations.**

    · Please be sure to cite the textbook as well as any other sources you use. If you choose to use ChatGPT or another AI tool, ensure that the information aligns with the theories and concepts presented in the textbook. Do not copy and paste directly from the AI tool. Instead, use it as a research aid—paraphrase the information in your own words and cite the source appropriately, including AI-generated content. Moreover, all assignments will be scanned for plagiarism and A.I be careful.

    **## Assignment1.docx**

    **Assignment 1: Applying Theories of Employee Motivation**

    **Overview**

    This assignment is worth
    **_20% of your overall grade_** _._ You will choose
    **_ONE_** _theory of employee motivation_ from Chapter 8 of your
    _textbook:_

    ·
    _Needs Theory_

    ·
    _Expectancy Theory_

    ·
    _Self-Efficacy Theory_

    ·
    _Justice Theories_

    ·
    _Goal-Setting Theory_

    ·
    _Control Theory_

    ·
    _Action Theory._

    Your task is to
    **apply the theory** creatively, show that you understand it, and make it personal — either by connecting it to your own experiences, to organizations you know, or to an imagined scenario.

    This is
    **not a research paper**. Instead, you will show mastery through analysis, application, and creativity.

    The assignment will be
    **open from August 25, 2025 – October 19, 2025**. During the final week (October 13–19), this assignment will be your sole focus — no other assignments will be due. Please plan ahead accordingly, as late submissions will not be accepted except for officially documented, university-sanctioned reasons.
    **Note:** last-minute Wi-Fi or technology issues do
    _not_ qualify as university-sanctioned reasons.

    Additionally, we will
    **not** formally cover these theories in class until
    **_Week 5_** _,_ but I encourage you to preview the chapter early and begin planning your project. I also encourage you to take detailed notes.

    **Assignment Objectives**

    By the end of this project, you should be able to:

    ·
    **Demonstrate understanding** of one motivational theory.

    ·
    **Apply the theory** to a practical, real-world, or personal scenario.

    ·
    **Think critically** about the strengths and weaknesses of the theory.

    ·
    **Engage creatively**, using a format other than a traditional paper.

    **What You’ll Do**

    1.
    **Choose a Theory: Pick ONE**

    ·
    _Needs Theory_

    ·
    _Expectancy Theory_

    ·
    _Self-Efficacy Theory_

    ·
    _Justice Theories_

    ·
    _Goal-Setting Theory_

    ·
    _Control Theory_

    ·
    _Action Theory._

    1.
    **Explain the Theory (Briefly)**

    · Provide a clear, accessible explanation of your chosen theory in your own words. Keep this concise — imagine you’re explaining it to someone who has never heard of it. Additionally, make sure you use terminology from the textbook/ video lecture (paraphrase)

    1.
    **Apply the Theory**

    · Apply the theory in a way that feels meaningful and creative to you. Some options include:

    1. Connecting it to your personal experiences (school, sports, volunteer work, jobs, or even family roles).

    2. Designing a program or strategy an organization could use (a company, sports team, nonprofit, or even a club you imagine).

    3. Showing how the theory could guide someone’s personal goal-setting or self-improvement.

    · Your application should include practical examples, not just theory.

    1.
    **Critique the Theory**

    · Every theory has strengths and limits. What works well about your chosen theory? Where might it fall short? Why? (Think about different workplaces, generations, or life situations.)

    1.
    **Creative Presentation Format –** _Please make sure to include a PDF version of your final project and the link (if there is one) in your final submission._
    Instead of a paper, you’ll present your project in one of these formats.

    · Digital infographic

    · Magazine or newspaper-style article

    · PowerPoint / Canva presentation

    · Creative personal reflection journal (with visuals, stories, etc.)

    1.
    **References and Citations.**

    · Please be sure to cite the textbook as well as any other sources you use. If you choose to use ChatGPT or another AI tool, ensure that the information aligns with the theories and concepts presented in the textbook. Do not copy and paste directly from the AI tool. Instead, use it as a research aid—paraphrase the information in your own words and cite the source appropriately, including AI-generated content. Moreover, all assignments will be scanned for plagiarism and A.I be careful.

  • [Solved] 601 health promo

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  • [Solved] Week 2

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  • [Solved] 504 advanced health mod 1 responses

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  • [Solved] DB help

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  • [Solved] nursing outcome

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    – ## APAResources.docx – ## EBPPowerpointBasicTemplate.pptx – ## Step3EBPProjectEvaluation.docx – ## EvidenceBasedPracticePrepAssignment.docx – ## ReflectiveJournal_ClinicalII.docx – ## FinalClinicalSummativeSelf-Evaluation_ADNG2100_ClinicalII.docx – ClinicalIISIM4CaseStudies.docx – HolisticAsses…

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    – ## APAResources.docx

    – ## EBPPowerpointBasicTemplate.pptx

    – ## Step3EBPProjectEvaluation.docx

    – ## EvidenceBasedPracticePrepAssignment.docx

    – ## ReflectiveJournal_ClinicalII.docx

    – ## FinalClinicalSummativeSelf-Evaluation_ADNG2100_ClinicalII.docx

    – ClinicalIISIM4CaseStudies.docx
    – HolisticAssessment-FHP-HealthHistoryAssignmentGuide.docx
    – Step2EvidenceBasedPracticeProject.docx
    – HolisticAssessment-FHPtemplate.docx

    **## APAResources.docx**

    **APA Resources**

    Welcome to nursing! You will find that in nursing the standard for writing and referencing documents is different than options you may have used in the past. The standard for professional writing in nursing is APA (American Psychological Association). Below is a lit of potential resources that you may utilize to assure you are using APA correctly.

    Websites:

    Grammarly – APA and Plagiarism Checker –
    [https://www.grammarly.com/](https://www.grammarly.com/)

    Purdue Owl – APA Help –
    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Book:

    Publication Manual 7th Edition of the American Psychological Association

    · If you plan to continue in nursing for your BSN, it is recommended that you buy this book.

    · You can buy this book online or through the BSU bookstore.

    **## EBPPowerpointBasicTemplate.pptx**

    Title Page

    Section I – Introduction

    Section II – History of Nursing Practice

    Section III – Review of Literature – 1st article

    Section III – Review of Literature – 2nd article

    Section IV – Take a Stand

    Section V – Barriers & Recommendations

    Barriers

    Recommedation

    Section VI – Conclusion

    References

    **## Step3EBPProjectEvaluation.docx**

    **Step 3: EBP Project – Evaluation**

    (Outcome Assignment – must achieve minimum of 80%)

    **Evaluation of the Presentation:** _(Spirit of Inquiry & Professional Identity)_

    Upon completion of the presentation, the learner will collect, and review completed evaluation forms (these evaluation forms do NOT need to be submitted).

    **DON’T FORGET THIS PART! – YOU’RE NOT DONE YET! –** following the presentation
    **:**

    **Self-evaluation:** (Answer the following questions USING THIS TEMPLATE and submit it in the appropriate D2L assignment folder.)

    1. Discuss what you would change if you had the opportunity to do this assignment again.

    2. Review data from the peer evaluations submitted by those in attendance and submit a summary of your presentation strengths and weaknesses based on the evaluations.

    · Strengths:

    · Weaknesses:

    3. Conduct a self-evaluation of your skills as a presenter by reflecting on each evaluation criteria (refer to peer evaluation forms when reflecting on what the evaluation criteria are) and discussing strengths and opportunities for improvement.

    · Strengths:

    · Opportunities for improvement:

    **Instructor Evaluation:**

    Your clinical instructor will submit an evaluation of your presentation according to the presentation evaluation guidelines.  You will be evaluated on your skill as a presenter, your ability to meet the expectations of the presentation guidelines above, and the thoroughness and accuracy of your own self-evaluation.

    **## EvidenceBasedPracticePrepAssignment.docx**

    Step 1: Evidence Based Practice
    **Prep** Assignment

    · This will be due shortly after your first clinical week/weekend. See due date document for specifics.

    · You will need to answer and discuss each question below
    **ON THIS TEMPLATE** and submit it to the appropriate assignment folder in D2L. Your clinical faculty will then indicate paper topic approval or disapproval. This is a REQUIRED pass/fail assignment.

    · Purpose: To gain skills in research. To determine EBP paper topic and receive instructor feedback as to whether or not topic is reasonable and acceptable for formal EBP paper.

    Assignment Overview:

    1. Choose a nursing intervention commonly used in nursing practice.  Use your clinical time to identify an intervention that you have seen that may not be supported by current evidence or that is not consistently followed. A suggestion might be to explore interventions listed in Nurse’s Pocket Guide in Nursing Central. There is also a resource in D2L of some possible EBP topics.

    · Example: The issue of testing pH of gastric contents for confirmation of NG placement is well researched and the problems of auscultation for insufflation of air are well documented, yet the practice continues, why?  Is the practice based on research, if not, why does it continue?

    · You will be doing research to determine what literature says SHOULD be done and if it’s not being done, analyze why it is not being done.

    ·
    **List your topic here:___________________________________________________________**

    2. Find and analyze one scholarly, research-based article that supports or challenges the use of this intervention and find and analyze one scholarly, research-based article that identifies a new evidence-based intervention to address the issue. (Minimum of 2 articles total)

    Article #1:

    Article #2:

    3. What key words did you use in the search bar?

    4. How many results came up during your initial search?

    5. How did you change/refine your initial search to get the information you needed?

    6. Is your topic too narrow or too broad? How will you expand or limit your scope in order to complete the requirements of the paper?

    7. Obtain approval of topic by instructor via D2L
    _PRIOR_ to beginning project.

    8. If the topic is not approved, work with instructor to refine and approve topic to begin paper.

    **## ReflectiveJournal_ClinicalII.docx**

    **Reflective Journal**

    Objectives:

    1. Reflect on thoughts, ideas, experiences, and insights related to the course.

    2. Examine personal skills, frames of reference, and assumptions about the provision of care.

    3. Gain insight on how students views themselves in relationship to others when engaged in therapeutic and professional communication.

    4. Identify areas for students to further develop their abilities and understanding related to bedside practice.

    Directions: (Professional Identity and Spirit of Inquiry)

    Respond to
    all 5 of the questions below using the same number points. You will be submitting this assignment as a word document. Grading is based on word count & thoroughness of reflection, consider utilizing about 300 words for each prompt to reach 1500 word goal.

    Emotional Competence Reflective Prompts:

    ## 1. Journal prompt 1 (self-awareness domain)

    What are your feelings as you begin this clinical experience? Make sure you identify feelings, not thoughts. Complete the following statement: "l feel…" What past experiences, perceptions, and thoughts might be contributing to the above feelings? What personal qualities, strengths, and talents do you bring to this clinical experience? Identify one goal for the semester related to your personal self-awareness and growth.

    ## 2. Journal prompt 2 (self-awareness domain)

    Describe a situation you experienced in clinical this week: Describe your thoughts in this situation. Describe your feelings in this situation. Describe the way your body felt physically in this situation. What was more difficult to identify—your thoughts or feelings? Explain why you think this may be. How do your feelings relate to your thoughts in this situation? Were you aware of this at the time? Reread and reflect on your entry. Identify one specific strategy you will use to focus your attention on your internal states during your next clinical day.

    ## 3. Journal prompt 3 (self-awareness and social awareness domains)

    Judgment is making opinions as to the value of someone or something, considered to be lacking in tolerance and objectivity.

    a) Describe in detail a situation in which you felt you were being judged. Describe how you felt about this.

    b) Describe in detail a situation in which you had judged someone else. Describe how you feel about this.

    c) How did judging another impact your sense of self in a positive way? In a negative way? How might judging another have impacted that person's sense of self in a positive way? In a negative way? Describe how being judged affected your subsequent behavior?

    4.
    Journal prompt 4 (self-awareness, self and relationship management domains)

    a) Situation: Think about a situation in which you experienced frustration or anger.

    b) Identify the behaviors of others in this situation that you reacted to with frustration or anger.

    c) Response: How did you respond? How would you have liked to respond?

    d) Analysis: Explore and discuss reasons for the differences and similarities in your actual and desired responses in this situation.

    e) Future Implications: Discuss one strategy for coping with the emotion you experienced in a future situation.

    5.
    Journal prompt 5 (self-awareness and self-management domains)

    a) Locate on NTC library site and read: Henson, J.S. (2017). When Compassion is Lost.
    _MedSurg Nursing_, 26(2).

    b) Describe one new insight you have into the relationship between your self-care and your effectiveness as a nurse. Identify one specific, measurable, and realistic strategy related to your self-care that you could implement during the clinical day.

    Harrison, P.A. & Fopma-Loy, J.L (2010). Reflective Journal Prompts: A Vehicle for Stimulating Emotional Competence in Nursing.
    _Journal of Nursing Education_, 49(11). doi:10.3928/01484834-20100730-07

    Reflective Journal Grading Rubric (15 points)

    | | | | | | |
    | — | — | — | — | — | — |
    | | Level 5 | Level 4 | Level 3 | Level 2 | Level 1 |
    | Complete (7.5 points) | · Thoroughly addresses all 5 questions.<br>· Entry is at least 1500 total words and not more than 2000. | · Addresses all 3 questions with fair amount of depth.<br>· Entry is at least 1250 total words. | · Somewhat addresses at least 2 of the 3 questions.<br>· Entry is at least 1000 total words. | · Somewhat addresses 1 question.<br>· Answers are not complete. <br>· Entry is at least 750 total words. | · Entry does not clearly address any of the questions provided.<br>· Entry is a recitation of significant experiences in clinical, OR<br>· Entry is less than 750 total words. |
    | Reflection<br>(7.5 points) | · Reflection demonstrates insight and the ability to connect personal experience with theory on all questions. <br>· Discussion on all questions draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Reflection usually (2 of 3) demonstrates insight and ability to connect personal experience with theory. <br>· Discussion usually (2 of 3) draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Reflection at times (1 question) demonstrates ability to connect personal experience with theory but 2 of 3 questions are superficially answered.<br>· Discussion at least once draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Entry does not reflect application of theory or genuine insight on behavior. <br>· Objectively shares experience, but reflection is vague, lacks depth or insight. <br>· Does not draw upon self- knowledge, self-awareness, or experience to enhance professional growth. | · There is minimal evidence of reflection<br>· No evidence of ability to draw upon self-knowledge, self-awareness and past experience to gain insight.<br>· Entry merely recites what was done/ learned during clinical. |

    **## FinalClinicalSummativeSelf-Evaluation_ADNG2100_ClinicalII.docx**

    **Level 2:**
    **Clinical Performance Evaluation- ADNG 2100 Clinical II**

    · Student will complete a self-evaluation of each student learning outcome below using the criteria on the left found under each outcome. Briefly summarize, either in bullet point or paragraph form, your own evaluation of performance in each. Be specific, give examples. In areas you identify as needing growth, provide specific strategies for improvement in your next clinical course.

    · Submit to the Clinical Performance Evaluation assignment folder in your clinical course by the assigned due date.

    | | |
    | — | — |
    | **HUMAN FLOURISHING**<br>**Apply knowledge and skills learned in the program to uphold patients’ right of self-determination and promote holistic well-being of client and family.**<br>QSEN#1- Provide patient-centered care |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Apply therapeutic communication skills in interactions with client and family <br>· Identify behaviors that threaten or protect client autonomy, dignity, and rights<br>●Respect client autonomy and recognize opportunities for client advocacy<br>· Illustrate how individual differences and values affect client outcomes | |
    | **Objective Data:** Holistic Assessment & Application of Nursing Process, Reflective Journal | |
    | **NURSING JUDGMENT**<br>**Make judgments in practice, supported by evidence, that integrate nursing science in the provision of safe, quality care.**<br>QSEN#2- Safety, Patient and Healthcare Provider<br>QSEN#3-Informatics |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | ●Utilize the nursing process to develop an individualized plan of care<br>●Provide valid rationales for nursing interventions<br>●Communicate assessment findings to instructor and healthcare team members<br>●Submit daily care plan to instructor for review in post-clinical<br>●Utilize effective judgment and available<br>resources to provide interventions (mediation administration, dressing changes, catheterization, etc.) in a safe, efficient manner to assigned client<br>· Provide accurate client education when need arises<br>●Utilize the EMR to accurately document care provided | |
    | **Objective Data:** EBP Project & Presentation, Holistic Assessment & Application of Nursing Process, Reflective Journal | |
    | **PROFESSIONAL IDENTITY**<br>**Implement one’s role as a nurse in a manner that reflects the ideals of the profession while developing an identity committed to evidence-based practice, in the provision of compassionate, culturally sensitive, holistic care to a diverse population.**<br>QSEN#4- Teamwork and Multi-disciplinary Collaboration |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Actively participate in post-clinical discussion and learning activities<br>· Exhibit professional appearance and behavior (punctuality, uniform standards, equipment, etc.)<br>· Demonstrate behaviors that reflect the values and ethics of the nursing profession<br>· Exhibit professionalism in interactions with multidisciplinary team-members, peers, clients, and faculty<br>· Manages conflict effectively as it arises with mentoring from faculty and/or staff | |
    | **Objective Data:** EBP Project & Presentation, Reflective Journal | |
    | **SPIRIT OF INQUIRY**<br>**Examine the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities (NLN, 2010).**<br>QSEN #5- Quality Improvement<br>QSEN #6- Evidence based practice |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Identify opportunities to improve quality client care<br>· Accept responsibility for the learning process, utilizing feedback to improve practice<br>· Remain effective when confronted with change<br>· Utilize understanding of pathophysiology of disease to predict priority evidence-based interventions<br>· Apply knowledge of and appropriate use of asepsis to create a safe care environment that results in high quality patient outcomes (medication administration, handwashing, invasive procedures, etc.) | |
    | **Objective Data:** EBP Project & Presentation, Holistic Assessment & Application of Nursing Process, Reflective Journal | |

    **ClinicalIISIM4CaseStudies.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/clinicaliisim4casestudies-docx)

    **HolisticAssessment-FHP-HealthHistoryAssignmentGuide.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhp-healthhistoryassignmentguide-docx)

    **Step2EvidenceBasedPracticeProject.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/step2evidencebasedpracticeproject-docx-10383621)

    **HolisticAssessment-FHPtemplate.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhptemplate-docx)

    **HolisticAssessment-FHPtemplate.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhptemplate-docx)

    **## APAResources.docx**

    **APA Resources**

    Welcome to nursing! You will find that in nursing the standard for writing and referencing documents is different than options you may have used in the past. The standard for professional writing in nursing is APA (American Psychological Association). Below is a lit of potential resources that you may utilize to assure you are using APA correctly.

    Websites:

    Grammarly – APA and Plagiarism Checker –
    [https://www.grammarly.com/](https://www.grammarly.com/)

    Purdue Owl – APA Help –
    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Book:

    Publication Manual 7th Edition of the American Psychological Association

    · If you plan to continue in nursing for your BSN, it is recommended that you buy this book.

    · You can buy this book online or through the BSU bookstore.

    **## EBPPowerpointBasicTemplate.pptx**

    Title Page

    Section I – Introduction

    Section II – History of Nursing Practice

    Section III – Review of Literature – 1st article

    Section III – Review of Literature – 2nd article

    Section IV – Take a Stand

    Section V – Barriers & Recommendations

    Barriers

    Recommedation

    Section VI – Conclusion

    References

    **## Step3EBPProjectEvaluation.docx**

    **Step 3: EBP Project – Evaluation**

    (Outcome Assignment – must achieve minimum of 80%)

    **Evaluation of the Presentation:** _(Spirit of Inquiry & Professional Identity)_

    Upon completion of the presentation, the learner will collect, and review completed evaluation forms (these evaluation forms do NOT need to be submitted).

    **DON’T FORGET THIS PART! – YOU’RE NOT DONE YET! –** following the presentation
    **:**

    **Self-evaluation:** (Answer the following questions USING THIS TEMPLATE and submit it in the appropriate D2L assignment folder.)

    1. Discuss what you would change if you had the opportunity to do this assignment again.

    2. Review data from the peer evaluations submitted by those in attendance and submit a summary of your presentation strengths and weaknesses based on the evaluations.

    · Strengths:

    · Weaknesses:

    3. Conduct a self-evaluation of your skills as a presenter by reflecting on each evaluation criteria (refer to peer evaluation forms when reflecting on what the evaluation criteria are) and discussing strengths and opportunities for improvement.

    · Strengths:

    · Opportunities for improvement:

    **Instructor Evaluation:**

    Your clinical instructor will submit an evaluation of your presentation according to the presentation evaluation guidelines.  You will be evaluated on your skill as a presenter, your ability to meet the expectations of the presentation guidelines above, and the thoroughness and accuracy of your own self-evaluation.

    **## EvidenceBasedPracticePrepAssignment.docx**

    Step 1: Evidence Based Practice
    **Prep** Assignment

    · This will be due shortly after your first clinical week/weekend. See due date document for specifics.

    · You will need to answer and discuss each question below
    **ON THIS TEMPLATE** and submit it to the appropriate assignment folder in D2L. Your clinical faculty will then indicate paper topic approval or disapproval. This is a REQUIRED pass/fail assignment.

    · Purpose: To gain skills in research. To determine EBP paper topic and receive instructor feedback as to whether or not topic is reasonable and acceptable for formal EBP paper.

    Assignment Overview:

    1. Choose a nursing intervention commonly used in nursing practice.  Use your clinical time to identify an intervention that you have seen that may not be supported by current evidence or that is not consistently followed. A suggestion might be to explore interventions listed in Nurse’s Pocket Guide in Nursing Central. There is also a resource in D2L of some possible EBP topics.

    · Example: The issue of testing pH of gastric contents for confirmation of NG placement is well researched and the problems of auscultation for insufflation of air are well documented, yet the practice continues, why?  Is the practice based on research, if not, why does it continue?

    · You will be doing research to determine what literature says SHOULD be done and if it’s not being done, analyze why it is not being done.

    ·
    **List your topic here:___________________________________________________________**

    2. Find and analyze one scholarly, research-based article that supports or challenges the use of this intervention and find and analyze one scholarly, research-based article that identifies a new evidence-based intervention to address the issue. (Minimum of 2 articles total)

    Article #1:

    Article #2:

    3. What key words did you use in the search bar?

    4. How many results came up during your initial search?

    5. How did you change/refine your initial search to get the information you needed?

    6. Is your topic too narrow or too broad? How will you expand or limit your scope in order to complete the requirements of the paper?

    7. Obtain approval of topic by instructor via D2L
    _PRIOR_ to beginning project.

    8. If the topic is not approved, work with instructor to refine and approve topic to begin paper.

    **## ReflectiveJournal_ClinicalII.docx**

    **Reflective Journal**

    Objectives:

    1. Reflect on thoughts, ideas, experiences, and insights related to the course.

    2. Examine personal skills, frames of reference, and assumptions about the provision of care.

    3. Gain insight on how students views themselves in relationship to others when engaged in therapeutic and professional communication.

    4. Identify areas for students to further develop their abilities and understanding related to bedside practice.

    Directions: (Professional Identity and Spirit of Inquiry)

    Respond to
    all 5 of the questions below using the same number points. You will be submitting this assignment as a word document. Grading is based on word count & thoroughness of reflection, consider utilizing about 300 words for each prompt to reach 1500 word goal.

    Emotional Competence Reflective Prompts:

    ## 1. Journal prompt 1 (self-awareness domain)

    What are your feelings as you begin this clinical experience? Make sure you identify feelings, not thoughts. Complete the following statement: "l feel…" What past experiences, perceptions, and thoughts might be contributing to the above feelings? What personal qualities, strengths, and talents do you bring to this clinical experience? Identify one goal for the semester related to your personal self-awareness and growth.

    ## 2. Journal prompt 2 (self-awareness domain)

    Describe a situation you experienced in clinical this week: Describe your thoughts in this situation. Describe your feelings in this situation. Describe the way your body felt physically in this situation. What was more difficult to identify—your thoughts or feelings? Explain why you think this may be. How do your feelings relate to your thoughts in this situation? Were you aware of this at the time? Reread and reflect on your entry. Identify one specific strategy you will use to focus your attention on your internal states during your next clinical day.

    ## 3. Journal prompt 3 (self-awareness and social awareness domains)

    Judgment is making opinions as to the value of someone or something, considered to be lacking in tolerance and objectivity.

    a) Describe in detail a situation in which you felt you were being judged. Describe how you felt about this.

    b) Describe in detail a situation in which you had judged someone else. Describe how you feel about this.

    c) How did judging another impact your sense of self in a positive way? In a negative way? How might judging another have impacted that person's sense of self in a positive way? In a negative way? Describe how being judged affected your subsequent behavior?

    4.
    Journal prompt 4 (self-awareness, self and relationship management domains)

    a) Situation: Think about a situation in which you experienced frustration or anger.

    b) Identify the behaviors of others in this situation that you reacted to with frustration or anger.

    c) Response: How did you respond? How would you have liked to respond?

    d) Analysis: Explore and discuss reasons for the differences and similarities in your actual and desired responses in this situation.

    e) Future Implications: Discuss one strategy for coping with the emotion you experienced in a future situation.

    5.
    Journal prompt 5 (self-awareness and self-management domains)

    a) Locate on NTC library site and read: Henson, J.S. (2017). When Compassion is Lost.
    _MedSurg Nursing_, 26(2).

    b) Describe one new insight you have into the relationship between your self-care and your effectiveness as a nurse. Identify one specific, measurable, and realistic strategy related to your self-care that you could implement during the clinical day.

    Harrison, P.A. & Fopma-Loy, J.L (2010). Reflective Journal Prompts: A Vehicle for Stimulating Emotional Competence in Nursing.
    _Journal of Nursing Education_, 49(11). doi:10.3928/01484834-20100730-07

    Reflective Journal Grading Rubric (15 points)

    | | | | | | |
    | — | — | — | — | — | — |
    | | Level 5 | Level 4 | Level 3 | Level 2 | Level 1 |
    | Complete (7.5 points) | · Thoroughly addresses all 5 questions.<br>· Entry is at least 1500 total words and not more than 2000. | · Addresses all 3 questions with fair amount of depth.<br>· Entry is at least 1250 total words. | · Somewhat addresses at least 2 of the 3 questions.<br>· Entry is at least 1000 total words. | · Somewhat addresses 1 question.<br>· Answers are not complete. <br>· Entry is at least 750 total words. | · Entry does not clearly address any of the questions provided.<br>· Entry is a recitation of significant experiences in clinical, OR<br>· Entry is less than 750 total words. |
    | Reflection<br>(7.5 points) | · Reflection demonstrates insight and the ability to connect personal experience with theory on all questions. <br>· Discussion on all questions draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Reflection usually (2 of 3) demonstrates insight and ability to connect personal experience with theory. <br>· Discussion usually (2 of 3) draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Reflection at times (1 question) demonstrates ability to connect personal experience with theory but 2 of 3 questions are superficially answered.<br>· Discussion at least once draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Entry does not reflect application of theory or genuine insight on behavior. <br>· Objectively shares experience, but reflection is vague, lacks depth or insight. <br>· Does not draw upon self- knowledge, self-awareness, or experience to enhance professional growth. | · There is minimal evidence of reflection<br>· No evidence of ability to draw upon self-knowledge, self-awareness and past experience to gain insight.<br>· Entry merely recites what was done/ learned during clinical. |

    **## FinalClinicalSummativeSelf-Evaluation_ADNG2100_ClinicalII.docx**

    **Level 2:**
    **Clinical Performance Evaluation- ADNG 2100 Clinical II**

    · Student will complete a self-evaluation of each student learning outcome below using the criteria on the left found under each outcome. Briefly summarize, either in bullet point or paragraph form, your own evaluation of performance in each. Be specific, give examples. In areas you identify as needing growth, provide specific strategies for improvement in your next clinical course.

    · Submit to the Clinical Performance Evaluation assignment folder in your clinical course by the assigned due date.

    | | |
    | — | — |
    | **HUMAN FLOURISHING**<br>**Apply knowledge and skills learned in the program to uphold patients’ right of self-determination and promote holistic well-being of client and family.**<br>QSEN#1- Provide patient-centered care |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Apply therapeutic communication skills in interactions with client and family <br>· Identify behaviors that threaten or protect client autonomy, dignity, and rights<br>●Respect client autonomy and recognize opportunities for client advocacy<br>· Illustrate how individual differences and values affect client outcomes | |
    | **Objective Data:** Holistic Assessment & Application of Nursing Process, Reflective Journal | |
    | **NURSING JUDGMENT**<br>**Make judgments in practice, supported by evidence, that integrate nursing science in the provision of safe, quality care.**<br>QSEN#2- Safety, Patient and Healthcare Provider<br>QSEN#3-Informatics |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | ●Utilize the nursing process to develop an individualized plan of care<br>●Provide valid rationales for nursing interventions<br>●Communicate assessment findings to instructor and healthcare team members<br>●Submit daily care plan to instructor for review in post-clinical<br>●Utilize effective judgment and available<br>resources to provide interventions (mediation administration, dressing changes, catheterization, etc.) in a safe, efficient manner to assigned client<br>· Provide accurate client education when need arises<br>●Utilize the EMR to accurately document care provided | |
    | **Objective Data:** EBP Project & Presentation, Holistic Assessment & Application of Nursing Process, Reflective Journal | |
    | **PROFESSIONAL IDENTITY**<br>**Implement one’s role as a nurse in a manner that reflects the ideals of the profession while developing an identity committed to evidence-based practice, in the provision of compassionate, culturally sensitive, holistic care to a diverse population.**<br>QSEN#4- Teamwork and Multi-disciplinary Collaboration |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Actively participate in post-clinical discussion and learning activities<br>· Exhibit professional appearance and behavior (punctuality, uniform standards, equipment, etc.)<br>· Demonstrate behaviors that reflect the values and ethics of the nursing profession<br>· Exhibit professionalism in interactions with multidisciplinary team-members, peers, clients, and faculty<br>· Manages conflict effectively as it arises with mentoring from faculty and/or staff | |
    | **Objective Data:** EBP Project & Presentation, Reflective Journal | |
    | **SPIRIT OF INQUIRY**<br>**Examine the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities (NLN, 2010).**<br>QSEN #5- Quality Improvement<br>QSEN #6- Evidence based practice |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Identify opportunities to improve quality client care<br>· Accept responsibility for the learning process, utilizing feedback to improve practice<br>· Remain effective when confronted with change<br>· Utilize understanding of pathophysiology of disease to predict priority evidence-based interventions<br>· Apply knowledge of and appropriate use of asepsis to create a safe care environment that results in high quality patient outcomes (medication administration, handwashing, invasive procedures, etc.) | |
    | **Objective Data:** EBP Project & Presentation, Holistic Assessment & Application of Nursing Process, Reflective Journal | |

    **ClinicalIISIM4CaseStudies.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/clinicaliisim4casestudies-docx)

    **HolisticAssessment-FHP-HealthHistoryAssignmentGuide.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhp-healthhistoryassignmentguide-docx)

    **Step2EvidenceBasedPracticeProject.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/step2evidencebasedpracticeproject-docx-10383621)

    **HolisticAssessment-FHPtemplate.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhptemplate-docx)

    **## APAResources.docx**

    **APA Resources**

    Welcome to nursing! You will find that in nursing the standard for writing and referencing documents is different than options you may have used in the past. The standard for professional writing in nursing is APA (American Psychological Association). Below is a lit of potential resources that you may utilize to assure you are using APA correctly.

    Websites:

    Grammarly – APA and Plagiarism Checker –
    [https://www.grammarly.com/](https://www.grammarly.com/)

    Purdue Owl – APA Help –
    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Book:

    Publication Manual 7th Edition of the American Psychological Association

    · If you plan to continue in nursing for your BSN, it is recommended that you buy this book.

    · You can buy this book online or through the BSU bookstore.

    **## EBPPowerpointBasicTemplate.pptx**

    Title Page

    Section I – Introduction

    Section II – History of Nursing Practice

    Section III – Review of Literature – 1st article

    Section III – Review of Literature – 2nd article

    Section IV – Take a Stand

    Section V – Barriers & Recommendations

    Barriers

    Recommedation

    Section VI – Conclusion

    References

    **## Step3EBPProjectEvaluation.docx**

    **Step 3: EBP Project – Evaluation**

    (Outcome Assignment – must achieve minimum of 80%)

    **Evaluation of the Presentation:** _(Spirit of Inquiry & Professional Identity)_

    Upon completion of the presentation, the learner will collect, and review completed evaluation forms (these evaluation forms do NOT need to be submitted).

    **DON’T FORGET THIS PART! – YOU’RE NOT DONE YET! –** following the presentation
    **:**

    **Self-evaluation:** (Answer the following questions USING THIS TEMPLATE and submit it in the appropriate D2L assignment folder.)

    1. Discuss what you would change if you had the opportunity to do this assignment again.

    2. Review data from the peer evaluations submitted by those in attendance and submit a summary of your presentation strengths and weaknesses based on the evaluations.

    · Strengths:

    · Weaknesses:

    3. Conduct a self-evaluation of your skills as a presenter by reflecting on each evaluation criteria (refer to peer evaluation forms when reflecting on what the evaluation criteria are) and discussing strengths and opportunities for improvement.

    · Strengths:

    · Opportunities for improvement:

    **Instructor Evaluation:**

    Your clinical instructor will submit an evaluation of your presentation according to the presentation evaluation guidelines.  You will be evaluated on your skill as a presenter, your ability to meet the expectations of the presentation guidelines above, and the thoroughness and accuracy of your own self-evaluation.

    **## EvidenceBasedPracticePrepAssignment.docx**

    Step 1: Evidence Based Practice
    **Prep** Assignment

    · This will be due shortly after your first clinical week/weekend. See due date document for specifics.

    · You will need to answer and discuss each question below
    **ON THIS TEMPLATE** and submit it to the appropriate assignment folder in D2L. Your clinical faculty will then indicate paper topic approval or disapproval. This is a REQUIRED pass/fail assignment.

    · Purpose: To gain skills in research. To determine EBP paper topic and receive instructor feedback as to whether or not topic is reasonable and acceptable for formal EBP paper.

    Assignment Overview:

    1. Choose a nursing intervention commonly used in nursing practice.  Use your clinical time to identify an intervention that you have seen that may not be supported by current evidence or that is not consistently followed. A suggestion might be to explore interventions listed in Nurse’s Pocket Guide in Nursing Central. There is also a resource in D2L of some possible EBP topics.

    · Example: The issue of testing pH of gastric contents for confirmation of NG placement is well researched and the problems of auscultation for insufflation of air are well documented, yet the practice continues, why?  Is the practice based on research, if not, why does it continue?

    · You will be doing research to determine what literature says SHOULD be done and if it’s not being done, analyze why it is not being done.

    ·
    **List your topic here:___________________________________________________________**

    2. Find and analyze one scholarly, research-based article that supports or challenges the use of this intervention and find and analyze one scholarly, research-based article that identifies a new evidence-based intervention to address the issue. (Minimum of 2 articles total)

    Article #1:

    Article #2:

    3. What key words did you use in the search bar?

    4. How many results came up during your initial search?

    5. How did you change/refine your initial search to get the information you needed?

    6. Is your topic too narrow or too broad? How will you expand or limit your scope in order to complete the requirements of the paper?

    7. Obtain approval of topic by instructor via D2L
    _PRIOR_ to beginning project.

    8. If the topic is not approved, work with instructor to refine and approve topic to begin paper.

    **## ReflectiveJournal_ClinicalII.docx**

    **Reflective Journal**

    Objectives:

    1. Reflect on thoughts, ideas, experiences, and insights related to the course.

    2. Examine personal skills, frames of reference, and assumptions about the provision of care.

    3. Gain insight on how students views themselves in relationship to others when engaged in therapeutic and professional communication.

    4. Identify areas for students to further develop their abilities and understanding related to bedside practice.

    Directions: (Professional Identity and Spirit of Inquiry)

    Respond to
    all 5 of the questions below using the same number points. You will be submitting this assignment as a word document. Grading is based on word count & thoroughness of reflection, consider utilizing about 300 words for each prompt to reach 1500 word goal.

    Emotional Competence Reflective Prompts:

    ## 1. Journal prompt 1 (self-awareness domain)

    What are your feelings as you begin this clinical experience? Make sure you identify feelings, not thoughts. Complete the following statement: "l feel…" What past experiences, perceptions, and thoughts might be contributing to the above feelings? What personal qualities, strengths, and talents do you bring to this clinical experience? Identify one goal for the semester related to your personal self-awareness and growth.

    ## 2. Journal prompt 2 (self-awareness domain)

    Describe a situation you experienced in clinical this week: Describe your thoughts in this situation. Describe your feelings in this situation. Describe the way your body felt physically in this situation. What was more difficult to identify—your thoughts or feelings? Explain why you think this may be. How do your feelings relate to your thoughts in this situation? Were you aware of this at the time? Reread and reflect on your entry. Identify one specific strategy you will use to focus your attention on your internal states during your next clinical day.

    ## 3. Journal prompt 3 (self-awareness and social awareness domains)

    Judgment is making opinions as to the value of someone or something, considered to be lacking in tolerance and objectivity.

    a) Describe in detail a situation in which you felt you were being judged. Describe how you felt about this.

    b) Describe in detail a situation in which you had judged someone else. Describe how you feel about this.

    c) How did judging another impact your sense of self in a positive way? In a negative way? How might judging another have impacted that person's sense of self in a positive way? In a negative way? Describe how being judged affected your subsequent behavior?

    4.
    Journal prompt 4 (self-awareness, self and relationship management domains)

    a) Situation: Think about a situation in which you experienced frustration or anger.

    b) Identify the behaviors of others in this situation that you reacted to with frustration or anger.

    c) Response: How did you respond? How would you have liked to respond?

    d) Analysis: Explore and discuss reasons for the differences and similarities in your actual and desired responses in this situation.

    e) Future Implications: Discuss one strategy for coping with the emotion you experienced in a future situation.

    5.
    Journal prompt 5 (self-awareness and self-management domains)

    a) Locate on NTC library site and read: Henson, J.S. (2017). When Compassion is Lost.
    _MedSurg Nursing_, 26(2).

    b) Describe one new insight you have into the relationship between your self-care and your effectiveness as a nurse. Identify one specific, measurable, and realistic strategy related to your self-care that you could implement during the clinical day.

    Harrison, P.A. & Fopma-Loy, J.L (2010). Reflective Journal Prompts: A Vehicle for Stimulating Emotional Competence in Nursing.
    _Journal of Nursing Education_, 49(11). doi:10.3928/01484834-20100730-07

    Reflective Journal Grading Rubric (15 points)

    | | | | | | |
    | — | — | — | — | — | — |
    | | Level 5 | Level 4 | Level 3 | Level 2 | Level 1 |
    | Complete (7.5 points) | · Thoroughly addresses all 5 questions.<br>· Entry is at least 1500 total words and not more than 2000. | · Addresses all 3 questions with fair amount of depth.<br>· Entry is at least 1250 total words. | · Somewhat addresses at least 2 of the 3 questions.<br>· Entry is at least 1000 total words. | · Somewhat addresses 1 question.<br>· Answers are not complete. <br>· Entry is at least 750 total words. | · Entry does not clearly address any of the questions provided.<br>· Entry is a recitation of significant experiences in clinical, OR<br>· Entry is less than 750 total words. |
    | Reflection<br>(7.5 points) | · Reflection demonstrates insight and the ability to connect personal experience with theory on all questions. <br>· Discussion on all questions draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Reflection usually (2 of 3) demonstrates insight and ability to connect personal experience with theory. <br>· Discussion usually (2 of 3) draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Reflection at times (1 question) demonstrates ability to connect personal experience with theory but 2 of 3 questions are superficially answered.<br>· Discussion at least once draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth. | · Entry does not reflect application of theory or genuine insight on behavior. <br>· Objectively shares experience, but reflection is vague, lacks depth or insight. <br>· Does not draw upon self- knowledge, self-awareness, or experience to enhance professional growth. | · There is minimal evidence of reflection<br>· No evidence of ability to draw upon self-knowledge, self-awareness and past experience to gain insight.<br>· Entry merely recites what was done/ learned during clinical. |

    **## FinalClinicalSummativeSelf-Evaluation_ADNG2100_ClinicalII.docx**

    **Level 2:**
    **Clinical Performance Evaluation- ADNG 2100 Clinical II**

    · Student will complete a self-evaluation of each student learning outcome below using the criteria on the left found under each outcome. Briefly summarize, either in bullet point or paragraph form, your own evaluation of performance in each. Be specific, give examples. In areas you identify as needing growth, provide specific strategies for improvement in your next clinical course.

    · Submit to the Clinical Performance Evaluation assignment folder in your clinical course by the assigned due date.

    | | |
    | — | — |
    | **HUMAN FLOURISHING**<br>**Apply knowledge and skills learned in the program to uphold patients’ right of self-determination and promote holistic well-being of client and family.**<br>QSEN#1- Provide patient-centered care |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Apply therapeutic communication skills in interactions with client and family <br>· Identify behaviors that threaten or protect client autonomy, dignity, and rights<br>●Respect client autonomy and recognize opportunities for client advocacy<br>· Illustrate how individual differences and values affect client outcomes | |
    | **Objective Data:** Holistic Assessment & Application of Nursing Process, Reflective Journal | |
    | **NURSING JUDGMENT**<br>**Make judgments in practice, supported by evidence, that integrate nursing science in the provision of safe, quality care.**<br>QSEN#2- Safety, Patient and Healthcare Provider<br>QSEN#3-Informatics |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | ●Utilize the nursing process to develop an individualized plan of care<br>●Provide valid rationales for nursing interventions<br>●Communicate assessment findings to instructor and healthcare team members<br>●Submit daily care plan to instructor for review in post-clinical<br>●Utilize effective judgment and available<br>resources to provide interventions (mediation administration, dressing changes, catheterization, etc.) in a safe, efficient manner to assigned client<br>· Provide accurate client education when need arises<br>●Utilize the EMR to accurately document care provided | |
    | **Objective Data:** EBP Project & Presentation, Holistic Assessment & Application of Nursing Process, Reflective Journal | |
    | **PROFESSIONAL IDENTITY**<br>**Implement one’s role as a nurse in a manner that reflects the ideals of the profession while developing an identity committed to evidence-based practice, in the provision of compassionate, culturally sensitive, holistic care to a diverse population.**<br>QSEN#4- Teamwork and Multi-disciplinary Collaboration |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Actively participate in post-clinical discussion and learning activities<br>· Exhibit professional appearance and behavior (punctuality, uniform standards, equipment, etc.)<br>· Demonstrate behaviors that reflect the values and ethics of the nursing profession<br>· Exhibit professionalism in interactions with multidisciplinary team-members, peers, clients, and faculty<br>· Manages conflict effectively as it arises with mentoring from faculty and/or staff | |
    | **Objective Data:** EBP Project & Presentation, Reflective Journal | |
    | **SPIRIT OF INQUIRY**<br>**Examine the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities (NLN, 2010).**<br>QSEN #5- Quality Improvement<br>QSEN #6- Evidence based practice |
    | **Expected Satisfactory Behaviors** | **Student Self-Evaluation** |
    | · Identify opportunities to improve quality client care<br>· Accept responsibility for the learning process, utilizing feedback to improve practice<br>· Remain effective when confronted with change<br>· Utilize understanding of pathophysiology of disease to predict priority evidence-based interventions<br>· Apply knowledge of and appropriate use of asepsis to create a safe care environment that results in high quality patient outcomes (medication administration, handwashing, invasive procedures, etc.) | |
    | **Objective Data:** EBP Project & Presentation, Holistic Assessment & Application of Nursing Process, Reflective Journal | |

    **ClinicalIISIM4CaseStudies.docx**

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  • [Solved] WK3 DISCUSSION1 HP-214

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    COMPLETE IN DETAIL 250 WORDS – ## WK3DISCUSSION1HP-214.docx – ## WK3DISCUSSION1INFOHP-214PPT.pptx **## WK3DISCUSSION1HP-214.docx** WK3 DISCUSSION1 HP-214 The Day Sheet (Daysheet) Before the widespread use of computers, and in some small practices today, office finances were monitored with a system c…

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    **## WK3DISCUSSION1HP-214.docx**

    WK3 DISCUSSION1 HP-214

    The Day Sheet (Daysheet)

    Before the widespread use of computers, and in some small practices today, office finances were monitored with a system called the “pegboard”. The pegboard, or write-it-once, bookkeeping system uses a board with pegs running down the left side. The pegs hold a daysheet, or daily journal, in place on the board. All transactions for the day are recorded on this daysheet. Each patient has a ledger card (record of the patient's financial activities). When a patient transaction occurs, the bookkeeper places the ledger card over the daysheet and the charge slip (preprinted patient bill) over the ledger card on the next available entry line and makes the appropriate entry on the ledger card. At the end of the day, all the transactions have been added to the daysheet, allowing for easy tracking of charges, payments, and adjustments.

    Your text describes the importance of the daysheet but does not elaborate on the value that the financial information can provide to the office staff.  An example can be found when the daysheet includes a column for the CPT code for the service provided.  The office manager, or billing specialist, can observe what codes are used most often by each provider. If one provider charges more often for a higher-level code (E&M office visit) than their peers (other providers) this may be a flag that indicates the need to verify chart documentation to ensure that it supports the higher services or may indicate the benefit of providing a “coding in-service” to providers. In other words, the daysheet can be instrumental for process evaluation purposes.

    Refer to the daysheet example on
    **slide # 35** of this week’s PowerPoint.

    1. Compare the different patient information on the sheet and explain the information following the name Timothy Taylor.

    2. Review if the daysheet did include the CPT codes and there was an indication that one provider was either upcoding or downcoding (not intentionally of course)

    3. New information to keep in mind is that this practice has 4 providers and 3 exam rooms. Mentally, add a column for the CPT codes and a column for the provider’s initials. (You will not be turning in a revised daysheet, only discussing possibilities.) Be sure to explain your reasoning…. Any answer can be correct if it is well supported.

    Model the process for tracking finances in a medical office.

    Include the following aspects in the discussion:

    · What do we know about Timothy Taylor?

    · Discuss how you would suggest to providers the benefit of a meeting to review E&M coding.

    · Discuss one suggestion for how to present a coding in-service to the providers.

    · Name one other way that we can use the daysheet as an evaluation tool.

    ·
    Make an educated guess for one way that we could use the daysheet as a process evaluation tool

    **## WK3DISCUSSION1INFOHP-214PPT.pptx**

    REIMBURSEMENT METHODOLOGIES

    Revenue Cycle Management

    Also known as

    Accounts Receivable Management

    Week 3

    Development resource obtained from www.cengage.com

    Revenue Management Cycle

    Strong performing businesses will often use a CQI model (Continuous Quality Improvement). For a medical office this would mean tracking every step that a patient takes from the moment they have contact with the office and walk in the door to the moment they leave including all follow-up contacts and billing.

    The revenue cycle, or accounts receivable, management not only improves the financial outcome but can help to provide quality services to patients.

    The completion of each step, using caution to ensure accuracy, is very important.

    Important Forms

    First, let’s look at the forms that you will be using both in the office setting and in this course

    Sample Portion of Patient Registration Form

    Provides unique information for patient identification and billing.

    Forms you will use

    Insurance verification form – Note, you can think of this form as a sandwich where the meat is in the middle.

    The plan type (HMO vs PPO, etc.) is important if the office is helping to setup diagnostic testing or an appointment with a specialist. Knowing the plan type may indicate the need for a preauthorization.

    The patient’s deductible, and if that deductible has been met, directly impacts the patient’s charge for today’s visit.

    Whether the patient has a flat rate copayment or has coinsurance that is a percentage of the total bill also directly impacts the charge to the patient for today’s service.

    Forms you will use

    The Encounter Form (superbill)

    Generated for each appointment

    Provider marks procedures performed and diagnosis for each service

    Used by biller to fill out the CMS 1500 form which will be submitted to the insurance company for payment in the outpatient setting.

    Forms you will use

    CMS 1500 claim form used for billing insurance

    The UB-04 is a similar form used to bill insurance in the hospital setting.

    Revenue Cycle – Step 1

    Physician’s order in the hospital setting or

    Patient calls to schedule appointment in the office setting

    \*\* Because there are more coding and billing positions in the outpatient setting, and because these positions typically require the employee to take on several roles, we will focus from the perspective of the outpatient setting.

    Revenue Cycle – Step 2

    Patient Registration

    Established Patient – 3 steps

    Verify patient registration
    information.

    Collect copayment from patient.

    Generate encounter form for
    current visit.

    New patient – 8 steps (continued)

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Preregister new patient and ensure PAR status (participating provider)

    On day of appointment patient completes registration form, which is inspected for completeness and accuracy. (form on slide 3)

    Photocopy front and back of patient’s
    insurance identification card(s). (example on slide 10)

    File copy in patient’s financial record.

    Typical Information on Insurance Card

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Confirm patient’s insurance information by contacting payer via
    telephone, Internet, or fax. (form on slide 5)

    Collect copayment from the patient.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Verify information with patient.

    Make appropriate changes.

    Perform coordination of benefits (COB)
    when patient has more than one policy.

    \*\* The COB is VERY important and there are consistent rules for you to know and follow:

    COB
    Rules for knowing which insurance to bill first:

    For Adults Primary is the insurance where the patient is the policyholder versus secondary insurance the patient is listed as a dependent. (example: married heterosexual couple when patient is the wife then bill her insurance. The husband’s insurance will be secondary.)

    For Children

    Children of divorced parents – custodial parent’s plan is primary

    If parents are remarried – custodial parent is primary, custodial step-parent is secondary and the non-custodial parent is tertiary.

    Children living with both parents

    Each parent has different insurance then follow the birthdate rule = parent whose DOB month and day (not year) comes first in the calendar year is primary. (if parents both born on same month and year then oldest policy is primary)

    Gender rule for parents – some self-funded insurance plans use the father as primary

    So, you may need to verify with the insurance plan which rule they follow.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Create new patient medical record.

    Generate patient encounter form. (slide 5)

    Collect copayment

    Revenue Cycle – Step 3

    Charge Capture – may be done via a “chargemaster”, “encounter form” or computer program.

    Chargemaster

    Also called charge description master (CDM)

    List of procedures with charges for each procedure.

    Revenue Cycle – Step 4

    Diagnosis and procedure coding by completing the “Encounter Form” which is then given to the coder/biller.

    Revenue Cycle – Step 5

    Patient Discharge Processing

    Discharge instructions (hospital)

    Schedule follow-up visit

    Begin preauthorization process if needed for appointment with specialist or diagnostic testing.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 7) for outpatient visit or UB-04 for hospital visit

    \*\* When this step is performed accurately and completely the Revenue Cycle is shortened saving frustration, time, labor and costs. No errors when filling out the claim (producing a “clean claim”) means that claims will not need to be “resubmitted” or “appealed” for non-medical reasons.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 6) for outpatient visit or UB-04 for hospital visit

    Signature of patient and provider required

    SIGNATURE ON FILE can be substituted for patient’s signature (if patient’s signature is on file in the office).

    Completed claim is proofread for accuracy.

    Supporting documentation is attached to claim (if needed).

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Often providers will use a “clearinghouse” where errors can be caught, claim information is encrypted to ensure PHI is intact and submitted to the insurance provider.

    **A clearinghouse can be compared to the post office where letters are checked for completed addresses and a stamp.

    Claim
    Processing

    The typical route for a claim from the office to the insurance company.

    Important for HIPAA/HITECH compliance

    Revenue Cycle – Step 7

    Resubmitting Claims – needed due to initial errors or missing information, which leads to a claim rejection.

    A rejected claim will be accompanied by a “RA” from the insurance company that will explain the missing information.

    RA = Remittance Advice

    Correct and resubmit

    Claim
    Processing

    Insurance Adjudication Process

    {

    Why Claims are Denied

    Procedure/service not medically necessary

    Incorrect codes or incorrectly linked codes were reported.

    Preexisting condition not covered or failure to
    obtain preauthorization

    Noncovered benefit or termination of coverage

    Out-of-network provider used

    Lower level of care could have been provided

    Bundled service or global period service is not eligible for separate payment.

    Claim contained incomplete information or another insurance plan is primary.

    A Clean Claim

    The revenue cycle for a “Clean Claim” (without errors or omissions) will look like this:

    Revenue Cycle – Step 8

    Third-Party Payer Reimbursement Posting

    First party = patient

    Second party = provider of care

    Third party = insurance, workman’s comp, auto policy following accident, etc.

    \*\* Post the insurance payment to patient’s account

    RA and EOB

    The Insurance company will send the provider a RA (remittance advice) explaining the payment or denial and will send the patient an EOB (explanation of benefits).

    The RA may look very similar to the EOB except the EOB will always say, “This is not a bill.”

    Example EOB on next slide

    Example EOB

    Revenue Cycle – Step 9

    Appeals process for denied claims

    Rejected claim = missing information

    Denied claim = coding error, lack of medical necessity, data error, patient not covered

    Revenue Cycle – Step 10

    Patient Billing only needed if:

    Did not collect copay at time of visit

    Patient has “coinsurance” that is a percentage of the bill not a flat copay

    Patient has no insurance and did not pay at time of appointment

    Revenue Cycle – Step 11

    Patient payment is posted to their account.

    Steps 12 & 13

    Collections and collections reimbursement posting Have a standardized “collections

    procedure”. Example on pg 108 of text.

    Sample Patient Ledger

    The patient ledger will contain all charges, payments and write-offs (adjustment for charge that is not “allowed” by the contract agreement between the provider and the insurance company)

    This software tracks each “visit” as a transaction number. Some software will group by date of service.

    In both visits logged above, it took over one month to receive payment from the insurance company.

    Sample Day Sheet

    What does this day sheet tell us:

    There is only 1 NPI so we know that this is for one provider only.

    The charge is for one procedure (adding a column for the CPT code would be helpful).

    The “adjustment” is the difference between what the office charges and what the insurance contract allows.

    The “credit” is what the insurance allows and the amount that should be pending from insurance.

    The “Net Change” is the amount paid by the patient.

    The Day Sheet is filled out each day and represents all patient visits for that day.

    The day sheet can be used to provide a monthly report “at a glance” by carrying the totals from the previous day to top the list on the next day.

    Sample Insurance Claims Registry

    The Insurance Claims Registry is important for tracking all pending insurance payments. When an insurance claim is submitted it is logged in the registry. When the payment is received that too is logged in the registry.

    The registry can be used to track payments that have not yet been received and indicates a claim that requires further investigation.

    A claim that is more than 30 days old

    A claim that is more than 60 days old, etc.

    n67

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    **## WK3DISCUSSION1INFOHP-214PPT.pptx**

    REIMBURSEMENT METHODOLOGIES

    Revenue Cycle Management

    Also known as

    Accounts Receivable Management

    Week 3

    Development resource obtained from www.cengage.com

    Revenue Management Cycle

    Strong performing businesses will often use a CQI model (Continuous Quality Improvement). For a medical office this would mean tracking every step that a patient takes from the moment they have contact with the office and walk in the door to the moment they leave including all follow-up contacts and billing.

    The revenue cycle, or accounts receivable, management not only improves the financial outcome but can help to provide quality services to patients.

    The completion of each step, using caution to ensure accuracy, is very important.

    Important Forms

    First, let’s look at the forms that you will be using both in the office setting and in this course

    Sample Portion of Patient Registration Form

    Provides unique information for patient identification and billing.

    Forms you will use

    Insurance verification form – Note, you can think of this form as a sandwich where the meat is in the middle.

    The plan type (HMO vs PPO, etc.) is important if the office is helping to setup diagnostic testing or an appointment with a specialist. Knowing the plan type may indicate the need for a preauthorization.

    The patient’s deductible, and if that deductible has been met, directly impacts the patient’s charge for today’s visit.

    Whether the patient has a flat rate copayment or has coinsurance that is a percentage of the total bill also directly impacts the charge to the patient for today’s service.

    Forms you will use

    The Encounter Form (superbill)

    Generated for each appointment

    Provider marks procedures performed and diagnosis for each service

    Used by biller to fill out the CMS 1500 form which will be submitted to the insurance company for payment in the outpatient setting.

    Forms you will use

    CMS 1500 claim form used for billing insurance

    The UB-04 is a similar form used to bill insurance in the hospital setting.

    Revenue Cycle – Step 1

    Physician’s order in the hospital setting or

    Patient calls to schedule appointment in the office setting

    \*\* Because there are more coding and billing positions in the outpatient setting, and because these positions typically require the employee to take on several roles, we will focus from the perspective of the outpatient setting.

    Revenue Cycle – Step 2

    Patient Registration

    Established Patient – 3 steps

    Verify patient registration
    information.

    Collect copayment from patient.

    Generate encounter form for
    current visit.

    New patient – 8 steps (continued)

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Preregister new patient and ensure PAR status (participating provider)

    On day of appointment patient completes registration form, which is inspected for completeness and accuracy. (form on slide 3)

    Photocopy front and back of patient’s
    insurance identification card(s). (example on slide 10)

    File copy in patient’s financial record.

    Typical Information on Insurance Card

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Confirm patient’s insurance information by contacting payer via
    telephone, Internet, or fax. (form on slide 5)

    Collect copayment from the patient.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Verify information with patient.

    Make appropriate changes.

    Perform coordination of benefits (COB)
    when patient has more than one policy.

    \*\* The COB is VERY important and there are consistent rules for you to know and follow:

    COB
    Rules for knowing which insurance to bill first:

    For Adults Primary is the insurance where the patient is the policyholder versus secondary insurance the patient is listed as a dependent. (example: married heterosexual couple when patient is the wife then bill her insurance. The husband’s insurance will be secondary.)

    For Children

    Children of divorced parents – custodial parent’s plan is primary

    If parents are remarried – custodial parent is primary, custodial step-parent is secondary and the non-custodial parent is tertiary.

    Children living with both parents

    Each parent has different insurance then follow the birthdate rule = parent whose DOB month and day (not year) comes first in the calendar year is primary. (if parents both born on same month and year then oldest policy is primary)

    Gender rule for parents – some self-funded insurance plans use the father as primary

    So, you may need to verify with the insurance plan which rule they follow.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Create new patient medical record.

    Generate patient encounter form. (slide 5)

    Collect copayment

    Revenue Cycle – Step 3

    Charge Capture – may be done via a “chargemaster”, “encounter form” or computer program.

    Chargemaster

    Also called charge description master (CDM)

    List of procedures with charges for each procedure.

    Revenue Cycle – Step 4

    Diagnosis and procedure coding by completing the “Encounter Form” which is then given to the coder/biller.

    Revenue Cycle – Step 5

    Patient Discharge Processing

    Discharge instructions (hospital)

    Schedule follow-up visit

    Begin preauthorization process if needed for appointment with specialist or diagnostic testing.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 7) for outpatient visit or UB-04 for hospital visit

    \*\* When this step is performed accurately and completely the Revenue Cycle is shortened saving frustration, time, labor and costs. No errors when filling out the claim (producing a “clean claim”) means that claims will not need to be “resubmitted” or “appealed” for non-medical reasons.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 6) for outpatient visit or UB-04 for hospital visit

    Signature of patient and provider required

    SIGNATURE ON FILE can be substituted for patient’s signature (if patient’s signature is on file in the office).

    Completed claim is proofread for accuracy.

    Supporting documentation is attached to claim (if needed).

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Often providers will use a “clearinghouse” where errors can be caught, claim information is encrypted to ensure PHI is intact and submitted to the insurance provider.

    **A clearinghouse can be compared to the post office where letters are checked for completed addresses and a stamp.

    Claim
    Processing

    The typical route for a claim from the office to the insurance company.

    Important for HIPAA/HITECH compliance

    Revenue Cycle – Step 7

    Resubmitting Claims – needed due to initial errors or missing information, which leads to a claim rejection.

    A rejected claim will be accompanied by a “RA” from the insurance company that will explain the missing information.

    RA = Remittance Advice

    Correct and resubmit

    Claim
    Processing

    Insurance Adjudication Process

    {

    Why Claims are Denied

    Procedure/service not medically necessary

    Incorrect codes or incorrectly linked codes were reported.

    Preexisting condition not covered or failure to
    obtain preauthorization

    Noncovered benefit or termination of coverage

    Out-of-network provider used

    Lower level of care could have been provided

    Bundled service or global period service is not eligible for separate payment.

    Claim contained incomplete information or another insurance plan is primary.

    A Clean Claim

    The revenue cycle for a “Clean Claim” (without errors or omissions) will look like this:

    Revenue Cycle – Step 8

    Third-Party Payer Reimbursement Posting

    First party = patient

    Second party = provider of care

    Third party = insurance, workman’s comp, auto policy following accident, etc.

    \*\* Post the insurance payment to patient’s account

    RA and EOB

    The Insurance company will send the provider a RA (remittance advice) explaining the payment or denial and will send the patient an EOB (explanation of benefits).

    The RA may look very similar to the EOB except the EOB will always say, “This is not a bill.”

    Example EOB on next slide

    Example EOB

    Revenue Cycle – Step 9

    Appeals process for denied claims

    Rejected claim = missing information

    Denied claim = coding error, lack of medical necessity, data error, patient not covered

    Revenue Cycle – Step 10

    Patient Billing only needed if:

    Did not collect copay at time of visit

    Patient has “coinsurance” that is a percentage of the bill not a flat copay

    Patient has no insurance and did not pay at time of appointment

    Revenue Cycle – Step 11

    Patient payment is posted to their account.

    Steps 12 & 13

    Collections and collections reimbursement posting Have a standardized “collections

    procedure”. Example on pg 108 of text.

    Sample Patient Ledger

    The patient ledger will contain all charges, payments and write-offs (adjustment for charge that is not “allowed” by the contract agreement between the provider and the insurance company)

    This software tracks each “visit” as a transaction number. Some software will group by date of service.

    In both visits logged above, it took over one month to receive payment from the insurance company.

    Sample Day Sheet

    What does this day sheet tell us:

    There is only 1 NPI so we know that this is for one provider only.

    The charge is for one procedure (adding a column for the CPT code would be helpful).

    The “adjustment” is the difference between what the office charges and what the insurance contract allows.

    The “credit” is what the insurance allows and the amount that should be pending from insurance.

    The “Net Change” is the amount paid by the patient.

    The Day Sheet is filled out each day and represents all patient visits for that day.

    The day sheet can be used to provide a monthly report “at a glance” by carrying the totals from the previous day to top the list on the next day.

    Sample Insurance Claims Registry

    The Insurance Claims Registry is important for tracking all pending insurance payments. When an insurance claim is submitted it is logged in the registry. When the payment is received that too is logged in the registry.

    The registry can be used to track payments that have not yet been received and indicates a claim that requires further investigation.

    A claim that is more than 30 days old

    A claim that is more than 60 days old, etc.

    n67

    ## image2.jpg

    ## image3.jpg

    ## image4.png

    ## image5.jpg

    ## image6.jpg

    ## image7.jpg

    ## image8.jpg

    ## image9.jpg

    ## image10.jpg

    ## image11.jpg

    ## image12.jpg

    ## image13.png

    ## image14.png

    ## image15.jpg

    ## image1.png

    **## WK3DISCUSSION1HP-214.docx**

    WK3 DISCUSSION1 HP-214

    The Day Sheet (Daysheet)

    Before the widespread use of computers, and in some small practices today, office finances were monitored with a system called the “pegboard”. The pegboard, or write-it-once, bookkeeping system uses a board with pegs running down the left side. The pegs hold a daysheet, or daily journal, in place on the board. All transactions for the day are recorded on this daysheet. Each patient has a ledger card (record of the patient's financial activities). When a patient transaction occurs, the bookkeeper places the ledger card over the daysheet and the charge slip (preprinted patient bill) over the ledger card on the next available entry line and makes the appropriate entry on the ledger card. At the end of the day, all the transactions have been added to the daysheet, allowing for easy tracking of charges, payments, and adjustments.

    Your text describes the importance of the daysheet but does not elaborate on the value that the financial information can provide to the office staff.  An example can be found when the daysheet includes a column for the CPT code for the service provided.  The office manager, or billing specialist, can observe what codes are used most often by each provider. If one provider charges more often for a higher-level code (E&M office visit) than their peers (other providers) this may be a flag that indicates the need to verify chart documentation to ensure that it supports the higher services or may indicate the benefit of providing a “coding in-service” to providers. In other words, the daysheet can be instrumental for process evaluation purposes.

    Refer to the daysheet example on
    **slide # 35** of this week’s PowerPoint.

    1. Compare the different patient information on the sheet and explain the information following the name Timothy Taylor.

    2. Review if the daysheet did include the CPT codes and there was an indication that one provider was either upcoding or downcoding (not intentionally of course)

    3. New information to keep in mind is that this practice has 4 providers and 3 exam rooms. Mentally, add a column for the CPT codes and a column for the provider’s initials. (You will not be turning in a revised daysheet, only discussing possibilities.) Be sure to explain your reasoning…. Any answer can be correct if it is well supported.

    Model the process for tracking finances in a medical office.

    Include the following aspects in the discussion:

    · What do we know about Timothy Taylor?

    · Discuss how you would suggest to providers the benefit of a meeting to review E&M coding.

    · Discuss one suggestion for how to present a coding in-service to the providers.

    · Name one other way that we can use the daysheet as an evaluation tool.

    ·
    Make an educated guess for one way that we could use the daysheet as a process evaluation tool

    **## WK3DISCUSSION1INFOHP-214PPT.pptx**

    REIMBURSEMENT METHODOLOGIES

    Revenue Cycle Management

    Also known as

    Accounts Receivable Management

    Week 3

    Development resource obtained from www.cengage.com

    Revenue Management Cycle

    Strong performing businesses will often use a CQI model (Continuous Quality Improvement). For a medical office this would mean tracking every step that a patient takes from the moment they have contact with the office and walk in the door to the moment they leave including all follow-up contacts and billing.

    The revenue cycle, or accounts receivable, management not only improves the financial outcome but can help to provide quality services to patients.

    The completion of each step, using caution to ensure accuracy, is very important.

    Important Forms

    First, let’s look at the forms that you will be using both in the office setting and in this course

    Sample Portion of Patient Registration Form

    Provides unique information for patient identification and billing.

    Forms you will use

    Insurance verification form – Note, you can think of this form as a sandwich where the meat is in the middle.

    The plan type (HMO vs PPO, etc.) is important if the office is helping to setup diagnostic testing or an appointment with a specialist. Knowing the plan type may indicate the need for a preauthorization.

    The patient’s deductible, and if that deductible has been met, directly impacts the patient’s charge for today’s visit.

    Whether the patient has a flat rate copayment or has coinsurance that is a percentage of the total bill also directly impacts the charge to the patient for today’s service.

    Forms you will use

    The Encounter Form (superbill)

    Generated for each appointment

    Provider marks procedures performed and diagnosis for each service

    Used by biller to fill out the CMS 1500 form which will be submitted to the insurance company for payment in the outpatient setting.

    Forms you will use

    CMS 1500 claim form used for billing insurance

    The UB-04 is a similar form used to bill insurance in the hospital setting.

    Revenue Cycle – Step 1

    Physician’s order in the hospital setting or

    Patient calls to schedule appointment in the office setting

    \*\* Because there are more coding and billing positions in the outpatient setting, and because these positions typically require the employee to take on several roles, we will focus from the perspective of the outpatient setting.

    Revenue Cycle – Step 2

    Patient Registration

    Established Patient – 3 steps

    Verify patient registration
    information.

    Collect copayment from patient.

    Generate encounter form for
    current visit.

    New patient – 8 steps (continued)

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Preregister new patient and ensure PAR status (participating provider)

    On day of appointment patient completes registration form, which is inspected for completeness and accuracy. (form on slide 3)

    Photocopy front and back of patient’s
    insurance identification card(s). (example on slide 10)

    File copy in patient’s financial record.

    Typical Information on Insurance Card

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Confirm patient’s insurance information by contacting payer via
    telephone, Internet, or fax. (form on slide 5)

    Collect copayment from the patient.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Verify information with patient.

    Make appropriate changes.

    Perform coordination of benefits (COB)
    when patient has more than one policy.

    \*\* The COB is VERY important and there are consistent rules for you to know and follow:

    COB
    Rules for knowing which insurance to bill first:

    For Adults Primary is the insurance where the patient is the policyholder versus secondary insurance the patient is listed as a dependent. (example: married heterosexual couple when patient is the wife then bill her insurance. The husband’s insurance will be secondary.)

    For Children

    Children of divorced parents – custodial parent’s plan is primary

    If parents are remarried – custodial parent is primary, custodial step-parent is secondary and the non-custodial parent is tertiary.

    Children living with both parents

    Each parent has different insurance then follow the birthdate rule = parent whose DOB month and day (not year) comes first in the calendar year is primary. (if parents both born on same month and year then oldest policy is primary)

    Gender rule for parents – some self-funded insurance plans use the father as primary

    So, you may need to verify with the insurance plan which rule they follow.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Create new patient medical record.

    Generate patient encounter form. (slide 5)

    Collect copayment

    Revenue Cycle – Step 3

    Charge Capture – may be done via a “chargemaster”, “encounter form” or computer program.

    Chargemaster

    Also called charge description master (CDM)

    List of procedures with charges for each procedure.

    Revenue Cycle – Step 4

    Diagnosis and procedure coding by completing the “Encounter Form” which is then given to the coder/biller.

    Revenue Cycle – Step 5

    Patient Discharge Processing

    Discharge instructions (hospital)

    Schedule follow-up visit

    Begin preauthorization process if needed for appointment with specialist or diagnostic testing.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 7) for outpatient visit or UB-04 for hospital visit

    \*\* When this step is performed accurately and completely the Revenue Cycle is shortened saving frustration, time, labor and costs. No errors when filling out the claim (producing a “clean claim”) means that claims will not need to be “resubmitted” or “appealed” for non-medical reasons.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 6) for outpatient visit or UB-04 for hospital visit

    Signature of patient and provider required

    SIGNATURE ON FILE can be substituted for patient’s signature (if patient’s signature is on file in the office).

    Completed claim is proofread for accuracy.

    Supporting documentation is attached to claim (if needed).

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Often providers will use a “clearinghouse” where errors can be caught, claim information is encrypted to ensure PHI is intact and submitted to the insurance provider.

    **A clearinghouse can be compared to the post office where letters are checked for completed addresses and a stamp.

    Claim
    Processing

    The typical route for a claim from the office to the insurance company.

    Important for HIPAA/HITECH compliance

    Revenue Cycle – Step 7

    Resubmitting Claims – needed due to initial errors or missing information, which leads to a claim rejection.

    A rejected claim will be accompanied by a “RA” from the insurance company that will explain the missing information.

    RA = Remittance Advice

    Correct and resubmit

    Claim
    Processing

    Insurance Adjudication Process

    {

    Why Claims are Denied

    Procedure/service not medically necessary

    Incorrect codes or incorrectly linked codes were reported.

    Preexisting condition not covered or failure to
    obtain preauthorization

    Noncovered benefit or termination of coverage

    Out-of-network provider used

    Lower level of care could have been provided

    Bundled service or global period service is not eligible for separate payment.

    Claim contained incomplete information or another insurance plan is primary.

    A Clean Claim

    The revenue cycle for a “Clean Claim” (without errors or omissions) will look like this:

    Revenue Cycle – Step 8

    Third-Party Payer Reimbursement Posting

    First party = patient

    Second party = provider of care

    Third party = insurance, workman’s comp, auto policy following accident, etc.

    \*\* Post the insurance payment to patient’s account

    RA and EOB

    The Insurance company will send the provider a RA (remittance advice) explaining the payment or denial and will send the patient an EOB (explanation of benefits).

    The RA may look very similar to the EOB except the EOB will always say, “This is not a bill.”

    Example EOB on next slide

    Example EOB

    Revenue Cycle – Step 9

    Appeals process for denied claims

    Rejected claim = missing information

    Denied claim = coding error, lack of medical necessity, data error, patient not covered

    Revenue Cycle – Step 10

    Patient Billing only needed if:

    Did not collect copay at time of visit

    Patient has “coinsurance” that is a percentage of the bill not a flat copay

    Patient has no insurance and did not pay at time of appointment

    Revenue Cycle – Step 11

    Patient payment is posted to their account.

    Steps 12 & 13

    Collections and collections reimbursement posting Have a standardized “collections

    procedure”. Example on pg 108 of text.

    Sample Patient Ledger

    The patient ledger will contain all charges, payments and write-offs (adjustment for charge that is not “allowed” by the contract agreement between the provider and the insurance company)

    This software tracks each “visit” as a transaction number. Some software will group by date of service.

    In both visits logged above, it took over one month to receive payment from the insurance company.

    Sample Day Sheet

    What does this day sheet tell us:

    There is only 1 NPI so we know that this is for one provider only.

    The charge is for one procedure (adding a column for the CPT code would be helpful).

    The “adjustment” is the difference between what the office charges and what the insurance contract allows.

    The “credit” is what the insurance allows and the amount that should be pending from insurance.

    The “Net Change” is the amount paid by the patient.

    The Day Sheet is filled out each day and represents all patient visits for that day.

    The day sheet can be used to provide a monthly report “at a glance” by carrying the totals from the previous day to top the list on the next day.

    Sample Insurance Claims Registry

    The Insurance Claims Registry is important for tracking all pending insurance payments. When an insurance claim is submitted it is logged in the registry. When the payment is received that too is logged in the registry.

    The registry can be used to track payments that have not yet been received and indicates a claim that requires further investigation.

    A claim that is more than 30 days old

    A claim that is more than 60 days old, etc.

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    **## WK3DISCUSSION1HP-214.docx**

    WK3 DISCUSSION1 HP-214

    The Day Sheet (Daysheet)

    Before the widespread use of computers, and in some small practices today, office finances were monitored with a system called the “pegboard”. The pegboard, or write-it-once, bookkeeping system uses a board with pegs running down the left side. The pegs hold a daysheet, or daily journal, in place on the board. All transactions for the day are recorded on this daysheet. Each patient has a ledger card (record of the patient's financial activities). When a patient transaction occurs, the bookkeeper places the ledger card over the daysheet and the charge slip (preprinted patient bill) over the ledger card on the next available entry line and makes the appropriate entry on the ledger card. At the end of the day, all the transactions have been added to the daysheet, allowing for easy tracking of charges, payments, and adjustments.

    Your text describes the importance of the daysheet but does not elaborate on the value that the financial information can provide to the office staff.  An example can be found when the daysheet includes a column for the CPT code for the service provided.  The office manager, or billing specialist, can observe what codes are used most often by each provider. If one provider charges more often for a higher-level code (E&M office visit) than their peers (other providers) this may be a flag that indicates the need to verify chart documentation to ensure that it supports the higher services or may indicate the benefit of providing a “coding in-service” to providers. In other words, the daysheet can be instrumental for process evaluation purposes.

    Refer to the daysheet example on
    **slide # 35** of this week’s PowerPoint.

    1. Compare the different patient information on the sheet and explain the information following the name Timothy Taylor.

    2. Review if the daysheet did include the CPT codes and there was an indication that one provider was either upcoding or downcoding (not intentionally of course)

    3. New information to keep in mind is that this practice has 4 providers and 3 exam rooms. Mentally, add a column for the CPT codes and a column for the provider’s initials. (You will not be turning in a revised daysheet, only discussing possibilities.) Be sure to explain your reasoning…. Any answer can be correct if it is well supported.

    Model the process for tracking finances in a medical office.

    Include the following aspects in the discussion:

    · What do we know about Timothy Taylor?

    · Discuss how you would suggest to providers the benefit of a meeting to review E&M coding.

    · Discuss one suggestion for how to present a coding in-service to the providers.

    · Name one other way that we can use the daysheet as an evaluation tool.

    ·
    Make an educated guess for one way that we could use the daysheet as a process evaluation tool

    **## WK3DISCUSSION1INFOHP-214PPT.pptx**

    REIMBURSEMENT METHODOLOGIES

    Revenue Cycle Management

    Also known as

    Accounts Receivable Management

    Week 3

    Development resource obtained from www.cengage.com

    Revenue Management Cycle

    Strong performing businesses will often use a CQI model (Continuous Quality Improvement). For a medical office this would mean tracking every step that a patient takes from the moment they have contact with the office and walk in the door to the moment they leave including all follow-up contacts and billing.

    The revenue cycle, or accounts receivable, management not only improves the financial outcome but can help to provide quality services to patients.

    The completion of each step, using caution to ensure accuracy, is very important.

    Important Forms

    First, let’s look at the forms that you will be using both in the office setting and in this course

    Sample Portion of Patient Registration Form

    Provides unique information for patient identification and billing.

    Forms you will use

    Insurance verification form – Note, you can think of this form as a sandwich where the meat is in the middle.

    The plan type (HMO vs PPO, etc.) is important if the office is helping to setup diagnostic testing or an appointment with a specialist. Knowing the plan type may indicate the need for a preauthorization.

    The patient’s deductible, and if that deductible has been met, directly impacts the patient’s charge for today’s visit.

    Whether the patient has a flat rate copayment or has coinsurance that is a percentage of the total bill also directly impacts the charge to the patient for today’s service.

    Forms you will use

    The Encounter Form (superbill)

    Generated for each appointment

    Provider marks procedures performed and diagnosis for each service

    Used by biller to fill out the CMS 1500 form which will be submitted to the insurance company for payment in the outpatient setting.

    Forms you will use

    CMS 1500 claim form used for billing insurance

    The UB-04 is a similar form used to bill insurance in the hospital setting.

    Revenue Cycle – Step 1

    Physician’s order in the hospital setting or

    Patient calls to schedule appointment in the office setting

    \*\* Because there are more coding and billing positions in the outpatient setting, and because these positions typically require the employee to take on several roles, we will focus from the perspective of the outpatient setting.

    Revenue Cycle – Step 2

    Patient Registration

    Established Patient – 3 steps

    Verify patient registration
    information.

    Collect copayment from patient.

    Generate encounter form for
    current visit.

    New patient – 8 steps (continued)

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Preregister new patient and ensure PAR status (participating provider)

    On day of appointment patient completes registration form, which is inspected for completeness and accuracy. (form on slide 3)

    Photocopy front and back of patient’s
    insurance identification card(s). (example on slide 10)

    File copy in patient’s financial record.

    Typical Information on Insurance Card

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Confirm patient’s insurance information by contacting payer via
    telephone, Internet, or fax. (form on slide 5)

    Collect copayment from the patient.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Verify information with patient.

    Make appropriate changes.

    Perform coordination of benefits (COB)
    when patient has more than one policy.

    \*\* The COB is VERY important and there are consistent rules for you to know and follow:

    COB
    Rules for knowing which insurance to bill first:

    For Adults Primary is the insurance where the patient is the policyholder versus secondary insurance the patient is listed as a dependent. (example: married heterosexual couple when patient is the wife then bill her insurance. The husband’s insurance will be secondary.)

    For Children

    Children of divorced parents – custodial parent’s plan is primary

    If parents are remarried – custodial parent is primary, custodial step-parent is secondary and the non-custodial parent is tertiary.

    Children living with both parents

    Each parent has different insurance then follow the birthdate rule = parent whose DOB month and day (not year) comes first in the calendar year is primary. (if parents both born on same month and year then oldest policy is primary)

    Gender rule for parents – some self-funded insurance plans use the father as primary

    So, you may need to verify with the insurance plan which rule they follow.

    Revenue Cycle – Step 2

    Patient Registration

    New patient – 8 steps

    Create new patient medical record.

    Generate patient encounter form. (slide 5)

    Collect copayment

    Revenue Cycle – Step 3

    Charge Capture – may be done via a “chargemaster”, “encounter form” or computer program.

    Chargemaster

    Also called charge description master (CDM)

    List of procedures with charges for each procedure.

    Revenue Cycle – Step 4

    Diagnosis and procedure coding by completing the “Encounter Form” which is then given to the coder/biller.

    Revenue Cycle – Step 5

    Patient Discharge Processing

    Discharge instructions (hospital)

    Schedule follow-up visit

    Begin preauthorization process if needed for appointment with specialist or diagnostic testing.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 7) for outpatient visit or UB-04 for hospital visit

    \*\* When this step is performed accurately and completely the Revenue Cycle is shortened saving frustration, time, labor and costs. No errors when filling out the claim (producing a “clean claim”) means that claims will not need to be “resubmitted” or “appealed” for non-medical reasons.

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Complete CMS 1500 form (slide 6) for outpatient visit or UB-04 for hospital visit

    Signature of patient and provider required

    SIGNATURE ON FILE can be substituted for patient’s signature (if patient’s signature is on file in the office).

    Completed claim is proofread for accuracy.

    Supporting documentation is attached to claim (if needed).

    Revenue Cycle – Step 6

    Billing and Claims Processing

    Often providers will use a “clearinghouse” where errors can be caught, claim information is encrypted to ensure PHI is intact and submitted to the insurance provider.

    **A clearinghouse can be compared to the post office where letters are checked for completed addresses and a stamp.

    Claim
    Processing

    The typical route for a claim from the office to the insurance company.

    Important for HIPAA/HITECH compliance

    Revenue Cycle – Step 7

    Resubmitting Claims – needed due to initial errors or missing information, which leads to a claim rejection.

    A rejected claim will be accompanied by a “RA” from the insurance company that will explain the missing information.

    RA = Remittance Advice

    Correct and resubmit

    Claim
    Processing

    Insurance Adjudication Process

    {

    Why Claims are Denied

    Procedure/service not medically necessary

    Incorrect codes or incorrectly linked codes were reported.

    Preexisting condition not covered or failure to
    obtain preauthorization

    Noncovered benefit or termination of coverage

    Out-of-network provider used

    Lower level of care could have been provided

    Bundled service or global period service is not eligible for separate payment.

    Claim contained incomplete information or another insurance plan is primary.

    A Clean Claim

    The revenue cycle for a “Clean Claim” (without errors or omissions) will look like this:

    Revenue Cycle – Step 8

    Third-Party Payer Reimbursement Posting

    First party = patient

    Second party = provider of care

    Third party = insurance, workman’s comp, auto policy following accident, etc.

    \*\* Post the insurance payment to patient’s account

    RA and EOB

    The Insurance company will send the provider a RA (remittance advice) explaining the payment or denial and will send the patient an EOB (explanation of benefits).

    The RA may look very similar to the EOB except the EOB will always say, “This is not a bill.”

    Example EOB on next slide

    Example EOB

    Revenue Cycle – Step 9

    Appeals process for denied claims

    Rejected claim = missing information

    Denied claim = coding error, lack of medical necessity, data error, patient not covered

    Revenue Cycle – Step 10

    Patient Billing only needed if:

    Did not collect copay at time of visit

    Patient has “coinsurance” that is a percentage of the bill not a flat copay

    Patient has no insurance and did not pay at time of appointment

    Revenue Cycle – Step 11

    Patient payment is posted to their account.

    Steps 12 & 13

    Collections and collections reimbursement posting Have a standardized “collections

    procedure”. Example on pg 108 of text.

    Sample Patient Ledger

    The patient ledger will contain all charges, payments and write-offs (adjustment for charge that is not “allowed” by the contract agreement between the provider and the insurance company)

    This software tracks each “visit” as a transaction number. Some software will group by date of service.

    In both visits logged above, it took over one month to receive payment from the insurance company.

    Sample Day Sheet

    What does this day sheet tell us:

    There is only 1 NPI so we know that this is for one provider only.

    The charge is for one procedure (adding a column for the CPT code would be helpful).

    The “adjustment” is the difference between what the office charges and what the insurance contract allows.

    The “credit” is what the insurance allows and the amount that should be pending from insurance.

    The “Net Change” is the amount paid by the patient.

    The Day Sheet is filled out each day and represents all patient visits for that day.

    The day sheet can be used to provide a monthly report “at a glance” by carrying the totals from the previous day to top the list on the next day.

    Sample Insurance Claims Registry

    The Insurance Claims Registry is important for tracking all pending insurance payments. When an insurance claim is submitted it is logged in the registry. When the payment is received that too is logged in the registry.

    The registry can be used to track payments that have not yet been received and indicates a claim that requires further investigation.

    A claim that is more than 30 days old

    A claim that is more than 60 days old, etc.

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