Pueblo Software Requirement Impact on Product Quality

Pueblo Software Requirement Impact on Product Quality ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Pueblo Software Requirement Impact on Product Quality Select two journal articles pertaining to the assigned topic. Must be Scholarly / Peer Reviewed and no older than 5 years. Please feel free to choose your own articles as long as they meet these requirements. If you are unable, I will attach the articles I had chosen for your convenience. I will also attach the assigned (RI) standard from The Joint Commision. Pueblo Software Requirement Impact on Product Quality Once you have chosen two articles related to your assigned Standard, identify, and summarize the two articles chosen. In addition, your response should reflect the TJC Standard, how it is utilized, and why it is important in health care. Include any best practice mentioned, and discuss at least one new concept that you learned from the articles. 300 word minimum Required use of attached outline/template. Response to 2 classmates: Your guided response posts should be a minimum of five well-developed sentences. How does your assigned standard relate to your classmate’s assigned standard? Give at least two examples of how they tie together. article_1_informed_consent.charade_or_choice.pdf article_2_culturally_tailoring_a_patient_empowerment_and_diabetes_education.pdf tjc_standards_rights_and_responsibilities_of_the_individual.pdf tjc_standards_and_processes_template.docx classmate_posts.docx Informed Consent: Charade or Choice? George J. Annas T he physicians of ancient Greece valued conversation with their patients. Conversation, however, did not apply to slaves, whose minds and opinions did not matter. More than 2000 years later, slavery has been abolished and the law has joined ethics in setting standards for the doctor-patient relationship. The most important doctrine, in both medical ethics and health law, is the doctrine of informed consent (better termed “informed choice”), including its corollary, the right to refuse treatment.1 Today this doctrine is under attack. The attack is direct from business models that see genuine doctor-patient conversations as inefficient (and a waste of time), and indirect from new information technologies, especially the use of computer screens during doctor-patient encounters. Even the law has helped undermine informed choice by replacing doctor-patient conversations with legal forms. Almost all patients want to trust their physicians. Courts see the desire to trust physicians as a necessity, describing the doctor-patient relationship as a “fiduciary” relationship in which the patient must trust the physician to honestly present treatment options and their benefits and risks. Patients want their physicians to speak to them; but as important, they want their physicians to listen to them. Professor Jay Katz, probably the world’s foremost authority on informed consent, argued that the physician-patient dialogue envisioned by the doctrine is much more difficult to accomplish than judges ever seemed to realize.2 This is for at least two basic reasons. The first is that the doctrine, most clearly enunciated in the Nuremberg Code in the judgment of the Nazi physicians in 1947, was seen by physicians as a requirement being imposed on the profession from the outside, by lawyers and judges. Moreover, its birth at Nuremberg led many to think that it applied only to Nazi-like deadly research, not to what US physicians did. Only decades later, in the 1970s, did US courts impose the duty of informed consent on therapy as well as research. Pueblo Software Requirement Impact on Product Quality The second reason that honest conversations about treatment options are more difficult than judges might think is that they require that both doctor and patient share uncertainty. But this is very unnerving, since both the physician and patient are highly motivated to believe that medicine can provide a cure or at least make an illness or injury better. The situation is even more stressful in the research setting where an intervention is being tested for posGeorge J. Annas, J.D., M.P.H., is the Director of the Center for Health Law, Ethics & Human Rights at Boston University School of Public Health, School of Law, and School of Medicine. He is also the Founding Editor of the Journal of Law, Medicine & Ethics. 10 journal of law, medicine & ethics The Journal of Law, Medicine & Ethics, 45 (2017): 10-11. © 2017 The Author(s) DOI: 10.1177/1073110517703096 Annas sible general application, rather than for the patient’s benefit. In this context the “therapeutic illusion” (in which both the researcher and subject want to believe that they are in a beneficial doctor-patient relationship) is inherent in physician-investigator research. as IRB review, may apply to research as well). Waivers of informed choice should not be permitted — it is your life and future and you have an obligation to yourself and your family to participate in decisions that could radically alter your life. Informed consent has historically been described as critical in theory, but incapable of realization in practice, a superficial charade rather than an autonomous choice. This observation should help inspire us to reform our practice to make sure that informed choice actually upholds patient dignity, promotes rational decision-making, and protects self-determination. The reality is that the researcher is following a protocol to obtain generalizable knowledge. Katz believed the therapeutic illusion could only be dispelled, if at all, by the researcher explicitly insisting to the subject that the proposed intervention was not for the subject’s benefit. (2) Katz, the psychoanalyst, knew that the subject would resist hearing this message, and that the researcher would also resist delivering it. Institutional Review Boards were adopted to help encourage information sharing, but they have become counterproductive. Pueblo Software Requirement Impact on Product Quality The attempt at dialogue has been replaced by a complex research “consent form” (approved by the IRB) which contains the information the institution’s lawyer and IRB believe is necessary to avoid liability, or at least to fulfill a risk management function. And even in research, informed consent is often explicitly ignored by the adoption of incoherent concepts such as “broad consent” and the oxymoron, “standard of care research.”3 Informed consent has historically been described as critical in theory, but incapable of realization in practice, a superficial charade rather than an autonomous choice. This observation should help inspire us to reform our practice to make sure that informed choice actually upholds patient dignity, promotes rational decision-making, and protects self-determination. These goals are critical to a human rights-based medical practice, and the informed choice doctrine is central to the ethical practice of medicine and the dignity of all patients. Here are a few suggestions that could help us make it more meaningful in practice. First, informed consent should be referred to by its more functional designation: informed choice. This puts the emphasis on the process rather than the outcome, and states more precisely what is at stake. It should also help insure that physicians and researchers grasp that the doctrine applies equally to therapy and research (although additional requirements, such reconceptualizing informed consent • spring 2017 The Journal of Law, Medicine & Ethics, 45 (2017): 10-11. © 2017 The Author(s) Second, we need to do a better job of educating patients and research subjects about their rights, and why they matter. People should be able to do more than complain about their physicians not listening or talking to them: the doctrine of informed choice gives patients the right to demand a dialogue, rather than beg for it as a luxury. And the right to refuse treatment altogether can also be used to insist on conversation before making a treatment decision, and also to insist on being left alone. Pueblo Software Requirement Impact on Product Quality Third, in the research setting, we should eliminate written consent forms and reform IRBs. At least twothirds of IRB members should be non-researchers; and, at this point, the only way to encourage informed choice as a process rather than a form is to replace forms with a discussion (which should be audiotaped or videotaped for review by the subject and documentation for the researcher and institution). The public eagerly supports the trendy “personalized medicine” movement because it seems to hold out the prospect of more personal attention, and at least some conversation, from their physicians. The public’s hope that medicine will reverse its current trend and become less impersonal will be dashed unless strong steps are taken to promote conversation and informed choice. Without public resistance to the attack on informed choice medicine is in danger of relapsing to the very efficient and inhuman silence of the Greek slave doctor. References 1. G. J. Annas, “Doctors, Patients, and Lawyers: Two centuries of Health Law,” New England Journal of Medicine 367, no. 5 (2012): 445-450. 2. J. Katz, The Silent World of Doctor and Patient (New Haven: Yale University Press, 1986). 3. G. J. Annas and C. L. Annas, “Legally Blind: The Therapeutic Illusion in the SUPPORT Study of Extremely Premature Infants,” Journal of Contemporary Health Law & Policy 30, no. 1 (2013): 1-36. 11 725280 research-article2017 TDEXXX10.1177/0145721717725280Diabetes Education for the African-American ChurchWhitney et al Diabetes Education for the African-American Church 441 Culturally Tailoring a Patient Empowerment and Diabetes Education Curriculum for the African American Church Purpose Eric Whitney, MSEd Elijah Kindred, MDiv Conclusions Themes extracted from focus groups and input from a faith-based community partner provided a methodical and patient-informed foundation for culturally tailoring and piloting a diabetes self-management curriculum for the African American church setting. This study illustrates how spirituality can be incorporated into interventions to enhance health promotion and behavioral change among African Americans with diabetes. Participants in our study described how religious beliefs play an active role in many aspects of diabetes care, including selfmanagement behaviors, coping strategies, and patient/ provider communication. In addition, this intervention can serve as a model for the development of patientcentered health interventions. Whitney et al Abdullah Pratt, MD Yolanda O’Neal, MPA Rev. Chauncey P. Harrison, MDiv Monica E. Peek, MD, MPH, MSc From The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois (Mr Whitney, Dr Pratt); The University of Chicago, Divinity School, Chicago, Illinois (Mr Kindred); Pueblo Software Requirement Impact on Product Quality The University of Chicago, Section of General Internal Medicine, Chicago, Illinois (Mrs O’Neal, Dr Peek); New Beginnings Church of Chicago, Chicago, Illinois (Mr Harrison); Trinity United Church of Christ, Chicago, Illinois (Mr Harrison); and Department of Emergency Medicine, The University of Chicago Medical Center, Chicago, Illinois (Dr Pratt). Correspondence to Monica E. Peek, MD, MPH, MSc, The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA ([email protected]). Funding: This research was supported by the Chicago Center for Diabetes Translation Research (NIDDK P30DK092949) and the Merck Foundation. E. T. was also supported by the Ruth L. Kirschstein National Research Service Award (T32 HS000078-17). M. E. P. was also supported by a Greenwall Foundation Faculty Scholar Award. DOI: 10.1177/0145721717725280 © 2017 The Author(s) tool chest The African American church has long been recognized as a valuable partner for health interventions in the community. While an extensive literature exists documenting the potential efficacy of diabetes education programs in church settings, there has yet to be an effort to leverage spiritual beliefs and practices to promote diabetes selfmanagement and shared decision making within a faithbased framework that is culturally tailored to the African American church. The purpose of this article is to describe the translation of a clinic-based diabetes education program into faith-based education curriculum tailored for use in the African American church. The Diabetes EDUCATOR 442 I n the US, racial and ethnic minorities experience disproportionately high rates of diabetes-related morbidity and mortality.1 These national trends extend to the city of Chicago. For example, the South Side of Chicago, which is comprised primarily of low-income African American neighborhoods, has documented disparities in diabetes prevalence (ie, estimates of 19% in some South Side communities compared to 7% Chicago prevalence estimates2),Pueblo Software Requirement Impact on Product Quality diabetesrelated health care delivery (eg, eye examinations, influenza vaccinations3), and diabetes-related complications (eg, 1.5 to 5 times the rate of diabetes-related lower extremity amputations among blacks vs whites4,5). Launched in 2009, the South Side Diabetes Project (SSDP) is a multisite, multitargeted intervention designed to improve diabetes care and outcomes on Chicago’s South Side.6-8 A collaboration between the University of Chicago, community health centers, and community organizations, the SSDP consists of 4 key components: culturally tailored patient education/empowerment, health provider training, quality improvement/health systems change, and community partnerships. The SSDP has been successful in terms of patient experience, patient skills and health behaviors, health care delivery change, and diabetes-related health outcomes.6-16 The cornerstone of the SSDP’s patient empowerment work, the Diabetes Empowerment Program (DEP), has combined culturally tailored diabetes education with the innovative use of skills building in shared decision making.9 Shared decision making emphasizes equity between patients and physicians in discussions and decisions about clinical care, and has been associated with better control of diabetes and hypertension as well as higher ratings of self-reported health.17,18 Preliminary studies of the DEP showed improvements in diabetes self-efficacy, self-management activities, shared decision-making behaviors, and diabetes control.9 Despite effectiveness within clinic-based settings, the DEP’s impact has been limited by its lack of reach within community settings, such as the church. The African American church represents a valuable community resource with nearly 5 million African American church members in the US.19 Within Chicago, an estimated 150 000 persons are members within 385 church congregations.19 Previous studies have demonstrated the effectiveness of health interventions in the African American church setting, including programs for weight loss, nutrition, physical activity, and diabetes prevention and control.20-25 Pueblo Software Requirement Impact on Product Quality While the effectiveness of diabetes education in the African American church has been explored, there has not yet been an effort to combine diabetes education and shared decision-making skills training within an explicit religious framework.26 That is, there have been faithplaced diabetes interventions but few faith-based interventions, particularly that leverage spirituality to enhance patient/provider communication as well as diabetes selfcare behaviors. This project aimed to develop and pilot test an intervention to address this gap in evidence-based practice. Methods This project consists of 2 phases: (1) informative qualitative work and (2) program adaptation and pilot testing. The Institutional Review Board at the University of Chicago approved this study. Phase 1: Informative Qualitative Work To better understand the opinions and cultural preferences of religious African Americans, patients who had completed the clinic-based 10-week DEP curriculum were recruited for participation in 2 focus groups. All patients recruited had made explicit references to religiosity and church attendance during previous classes. Recruited participants (n = 13) were African Americans with diabetes, ages 21 and older. Study participants were given a $20 gift card to a local grocery store as an incentive. A moderator experienced in leading discussions about religion and health led focus groups. Each focus group consisted of 5 to 7 people and lasted approximately 60 minutes. A topic guide was created to lead the discussion using the constructs of the theory of planned behavior (TPB) and the ecological model (EM).27,28 The guide explored normative beliefs about spirituality and diabetes self-care as well as the role of faith-based institutions in promoting health behavior change. Focus groups were audiotaped, transcribed verbatim, and imported into Atlas.ti 4.2 software for coding. Three coders independently reviewed and coded each transcript; emergent themes were identified and iteratively discussed. Phase 2: Program Adaptation and Pilot Testing The themes identified in the focus groups were used to guide adaptation of the existing DEP curriculum. All Volume 43, Number 5, October 2017 Diabetes Education for the African-American Church 443 adaptations were made in collaboration with a local church (New Beginnings Church of Chicago [NBCC]) that serves as a neighborhood resource (eg, social services, violence prevention, charter school) for the lowincome African American community in which it is located. New Beginnings Church of Chicago has collaborated with the SSDP on prior diabetes education and community outreach activities.6,29 Specifically, Pueblo Software Requirement Impact on Product Quality NBCC has served as a site for the SSDP’s culturally tailored physical fitness program since 2013 and has also partnered with the SSDP to sponsor diabetes awareness activities (eg, creation of a public service announcement about diabetes screening).6,29 Conversely, the SSDP has supported NBCC’s antiviolence and health promotion programs since 2013. These aligned missions and ongoing collaborations were essential for fostering trust among church leaders and members when designing and implementing this program. The intervention team included physicians, religious scholars, church leaders (ie, pastors, health ministry leaders), clinician researchers, public health experts, diabetes educators, and persons with diabetes. Church members were recruited for the study through health ministry outreach, presentations by SSDP staff during church service, and church-based social media (eg, Twitter and Facebook). Eighteen adults with diabetes were recruited for the pilot intervention. Classes met weekly for eight 90-minute sessions in the fall and winter of 2015. •• Theme 4: Role of church community and social support. Participants noted that physical and social environment of the church fostered relationships between church members and provided social support for health promotion. •• Theme 5: Patient/provider communication. Study participants frequently referenced the importance of communication with their clinicians to successful diabetes management. Results Taking into account the focus group’ emphasis on the integration of physical and spiritual health (Theme 1), SSDP staff met several times with the NBCC health ministry leaders and an assistant pastor to design and review the curriculum adaptations prior to the launch of the pilot study. The NBCC staff helped select scripture for discussion and approved all materials. The health ministry also took an active role in teaching the program, with members of the health ministry leading 3 of the 8 classes. The head of the health ministry has a master’s degree in public health and taught 2 classes. Another member of the health ministry, a nursing student, taught 1 class. In both cases, the health ministry was provided the curriculum and teaching instructions with SSDP staff providing clarification as necessary. Pueblo Software Requirement Impact on Product Quality The SSDP staff led the remaining 5 classes. Two physicians affiliated with the SSDP taught 4 of these classes, with 1 class taught by an SSDP staff member with a master’s in public administration. The SSDP instructors were chosen on the basis of their previous experience teaching the Phase 1: Informative Qualitative Work Thirteen patients who had previously completed the DEP participated in the focus groups (Table 1). All participants were African Americans with diabetes living on the South Side of Chicago. Five recurring themes arose from the transcripts, which were used to guide adaptations to the DEP curriculum (Table 2): •• Theme 1: Faith as a motivator for health behavior change. Spiritual faith was discussed by patients in the context of diabetes as an impetus for self-management (eg, diet modification, increasing physical activity). •• Theme 2: Integration of physical and spiritual health. Participants described how their religious practices and beliefs were integrally associated with their physical health. •• Theme 3: Coping/stress. Church members described faith as a means of weathering the emotional and physical challenges of living with diabetes. Whitney et al Phase 2: Program Adaptation and Pilot Testing Eighteen members of the NBCC congregation participated in the pilot study (Table 1). Recruitment was carried out with assistance from the NBCC health ministry and included distribution of informational materials at church events and SSDP staff promoting the program (with sup … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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