We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. Purpose: Poor adherence to prescribed medicines is associated with increased rates of poor outcomes, including hospitalization, serious adverse events, and death, and is also associated with increased healthcare costs. Approach: We posited that application of a data model and a process matrix when designing data collection for medication adherence would improve identification of variables and data accessibility, and could support future research on medication-taking behaviors. Conclusions: Combining a taxonomic approach with a process matrix methodology may afford significant benefits when designing data collection for clinical and population-based research in the arena of medication adherence.
Identifying variables for medication adherence is critical to achieving improvements in quality, outcomes, and costs in SEDI. At project initiation, we faced the challenge of developing data collection to record behaviors and interventions associated with medications. In the following sections, we discuss our rationale for this decision and our experience designing data collection for the intervention.
We analyzed data requirements for each of the pre-specified indicators of medication adherence and management of adherence. A multidisciplinary working team met regularly for 5 months to develop the data collection design for a stand-alone electronic data capture system to be used in conjunction with existing EHR systems. We encountered many decision points during these meetings that proved important to variable selection and affected project development. To apply consistent decision-making criteria, a list of data selection and developmental decision points was compiled and used as a process matrix.
In the following scenario, we present a hypothetical case study to provide context for the decisions made regarding data capture in the SEDI project. John Doe is a 62-year-old male with uncontrolled type 2 diabetes, hypertension, and hyperlipidemia. On further questioning, the patient reported frequently forgetting to take his metformin at night. The provider recommended prescribing extended-release metformin for once-daily dosing to increase adherence (Table 3). As illustrated in this use case, adherence to oral medication can be assessed using pill bottle fill dates, pill counts and devices such as MEMs caps.
In this clinical case, although prescribed medications were obtained and initiated, the implementation and management of the medications was insufficient without considerable support from family caregivers, providers, and community-based resources. Our data collection design related to medication adherence relied heavily on the combined expertise of the team rather than existing sources. Importantly, this taxonomy distinguishes between the work associated with taking the prescribed medication (Adherence to Medication) and the work that supports management of the medication (Management of Adherence). The taxonomic construct Adherence to Medication comprises four domains: initiation, implementation, discontinuation, and persistence.
Verbal CommunicationIt is an established fact that most communication is verbal.However, it should be underscored that verbal communication skills can be lacking. Poor Communication SkillsThe video above describes when thecommunication skills of a nurse has been lacking. Course assessment is valuable to the teaching process because it allows you to identify what is “working” in the classroom, make informed revisions in future courses and record success for funding agencies and other actors.
Effective teaching can be measured through different types of direct and indirect assessment. The following matrix [Table A: Learning Outcome Assessment Matrix] will guide you in the process of aligning over-arching goals, desired learning outcomes, teaching methods and assessment strategies for your course.
When developing measurable learning outcomes, consider including a combination of lower- and higher-order thinking skills. Table D provides a sample of pre- and post-test assessment content aligned with the overarching goals, desired learning outcomes and teaching methods in a learning outcome assessment matrix. Other types of indirect assessment include informal feedback strategies (incorporating specific questions into a lesson) focus groups, self-reflection assignments and individual student interviews. The Maslow’s hierarchy of needs is a theory proposed by Abraham Harold Maslow in his 1943 paper A Theory of Human Motivation. According to Maslow, each person had a different set of needs at different point of time in his life.
Physiological needs: This level of needs deals with the basic necessities of human survival like food, clothing and shelter.
Safety: Once the first level needs are met, a person feels the need to have a life of security where safety in all aspects of life is ensured. Social needs: This deals with the innate need to feel as if one belongs in a chosen social group and in various other relationships that are a part of human life.
Esteem: Deals with the need to feel good about oneself and getting recognition from others. The levels are presented in the form of a triangle or a pyramid with the largest and most fundamental levels of needs at the bottom tier, and the need for self-actualization at the top.
The limitations with this theory lie in the fact that different cultures may cause people to have different hierarchies of needs.
If you don't want to record clock in and clock out times, check out our other free Excel Timesheet and Time Card templates.
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This version has been updated for Excel 2007+ and is now part of our new free Time Card Calculator.
How to Use a Timesheet Template in Your Business - Share your experience and give feedback. If you have PDF conversion software, you could convert or print to a PDF and then email it. If your company uses an online time sheet system, you could update the Excel file throughout the week and then use it as a reference to complete the online form. Overtime regulations vary from state to state and may contain many exceptions, so it may be necessary to enter overtime manually instead of using the formulas.
Here are some questions that you can consider as you contemplate a role in nursing management. Today, many organizations have a clinical ladder that describes the various roles available for nurses and the requirements needed for each level.  Depending on your current academic status, this may be a good time to think about going back to school. In addition to the clinical side of healthcare, understanding the business side of healthcare is important as you progress in your nursing career. Communication is one of the most important skills you must have in order to move up the clinical and leadership ladder.
Moving into a leadership position takes you to the next level and opens you up to public scrutiny.

Sharing your goals with someone you trust is important as it helps you see yourself through another lens.  As a result, many people seek a mentor or a professional coach to share their career goals.
Today, many organizations are putting programs in place to groom leaders who can assist the organization to move forward during these disruptive times. In next week’s column (Tuesday, March 11th), I will look at qualifications and opportunities open to those who want to be an interim nurse manager or director.  Have a good week!
Career in nursing would be beneficial for a girl as the chances of development opportunity will be doubled.
This law enforcement sample cover letter was used for a client who was changing careers, and who wanted to secure a management position.
This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. However, current approaches to evaluation of medication adherence using real-world electronic health records (EHRs) or claims data may miss critical opportunities for data capture and fall short in modeling and representing the full complexity of the healthcare environment. We then constructed a use case in which data related to medication adherence would be leveraged to support improved healthcare quality, clinical outcomes, and efficiency of healthcare delivery in a population-based intervention for persons with diabetes. Significant intellectual and financial investment in research to improve adherence has not yielded measureable improvements in medication adherence at the population level, and adherence-related clinical outcomes have not appreciably changed.
We assumed that the existing electronic health record (EHR) systems used by our clinical teams would be adequate to collect information associated with medications and interventions within the project. These included documentation of variables associated with the steps in medication reconciliation, shared goal setting, and planning for management of medications between consultation intervals.
The team comprised clinical providers (physicians, nurses, nutritionists, licensed clinical social workers, and community health educators), data analysts, and programmers. We applied judgments within the process matrix to make decisions about data quality, access, and the feasibility of data collection processes for medication adherence (Table 1A). Process matrix: data collection considerations for medication adherence variable selection. This case highlights common patient concerns, provider quandaries regarding medication management, and caregiver and health system opportunities to support patients in the daily work of taking medication-taking.
His medication regimen includes metformin 1000 mg twice daily, insulin glargine (Lantus) 20 units via subcutaneous injection at night, lisinopril 20 mg daily, and atorvastatin (Lipitor) 40 mg daily (Table 2). He stated he is less likely to forget his insulin because he kept the box of insulin on the kitchen table to remind him to take it. The community health worker was asked to help the patient submit a Medicaid application and to help him use public transportation to obtain medications. However, assessing adherence to an injectable drug such as insulin poses unique challenges. Data capture for the variables reflecting management of adherence was also found to be insufficient. We found that although some measures were well-defined, such as the MMAS, we lacked definitive sources and exact data element specifications to define all variables within our project, especially to support appropriate measures relating to medication adherence and leading to robust analyses of the intervention.
Yet for researchers attempting to measure and evaluate these behaviors in relation to clinical outcomes, this broad definition entails a conundrum of choices and decisions regarding variable selection, with each option potentially varying widely across studies. The former refers to initiating the medication, persisting in taking the medicine over time, and discontinuing the medicine at the appropriate time. Their distinct representative data elements provide multiple options for measuring, assessing, and evaluating each distinct domain. THE NURSING PROCESSFrom the time a patient is admitted to the hospital, the nursing process begins. COMMUNICATION SKILLS VERBAL AND NON-VERBALLike it or not, every nurse engages in communication. If you’d like to share your own brain sheet with the Scrubs magazine community, or would like to have a Word version of any of these brain sheets, please contact us! Since measuring teaching is clearly not an exact science, the more varied the data sources, the more useful the measurement is likely to be. Table B is an example of a completed, yet simplified matrix [Table B] for a statistics course organized according to these principles.
Student A, while not achieving the same level as Student B, actually showed greater improvement as a result of teaching strategies and course instruction.
These types of exercises offer instructors the opportunity to gauge comprehension of material and achievement of specific learning goals. There is a need to be accepted or otherwise people are prone to negative effects like depression & loneliness. According to Maslow physiological, security, social, and esteem needs are deficiency needs or D-needs that arise because of deprivation. People necessarily may not satisfy one level after another and may have other needs not mentioned in the list and may be ready to sacrifice some needs. A time sheet template isn't really meant to be the cure to all of your time management problems, but if you are looking for a very simple low-cost timesheet system, or want to create your own blank printable timesheet, Vertex42's templates are an ideal place to start. The free timesheet calculators on this page all involve entering the time in and time out to calculate total hours worked.
If all you need is something you can use to print a blank timesheet, this one is the easiest to customize.
Hopefully, you'll go ahead and download it, figure out how it works, and customize it to suit the needs of your company.
If so, find out what the requirements are and what type of commitment you have to give in return for assistance. Management and nurse executives are under tremendous pressure to ensure their organizations are meeting the clinical, regulatory, and financial requirements pertinent to healthcare. As a manager and nurse leader, you need to be able to clearly communicate your views to your supervisors and also how to convey business goals to the team so that you have their support and buy-in as it takes a team to work in healthcare today. From them, nurses can obtain objective advice that will help them understand their strengths and weaknesses and ways to enhance and improve each. Most probably people with medical backgrounds are always getting good and suitable opportunities to develop their career; as medical industries is now one of the growing industries in the world.
A powerful one-bullet illustration of the candidate's investigational skills really grabs attention and ensures an interview. We sought to explore a framework for understanding and improving data capture for medication adherence in a population-based intervention in four U.S.
Because EHRs in use at participating sites were deemed incapable of supplying the needed data, we applied a taxonomic approach to identify and define variables of interest. However, while developing our data requirements, we realized that existing EHR data collection did not capture the granularity necessary for analysis.
Measures for each of these data requirements were selected from observable, objective data sources, as well as from patient-reported, subjective measures such as the Morisky Medication Adherence Survey (MMAS) (Morisky et al., 2008). Consensus was sought for parsimonious variable selection that would achieve the goal of high-quality, accessible, and robust measures for medication adherence.

Often, the most robust measures were not collected at the SEDI sites as part of usual care and therefore were not reflected in the EHR.
We then kept a similar list of decision points and judgments for variable selection and data documentation issues that would ultimately affect the analysis plan (Table 1B). The case also highlights important opportunities for data capture, many of which go unrecognized and unfulfilled—resulting in missed chances to garner fact-based feedback for all participants in the process of care.
John Doe lives alone in an apartment, is currently uninsured, and does not have personal transportation.
While demonstrating insulin administration, the patient injected insulin into his abdomen but removed the pen early. The patient was educated regarding insulin storage, insulin administration, and reviewing insulin expiration dates.
In the example above, delivering a dose of insulin requires knowledge of injection technique, and withdrawing the needle prior to finishing injection can result in delivery of less than a full dose of medication. We relied on the adherence taxonomy (Vrijens et al., 2012) for a critical conceptual basis.
As a result of this variability, the ability to standardize data elements in an EHR, case report form, or data warehouse is lost and opportunities to scale interventions or generalize study findings across settings and populations are sacrificed.
The latter encompasses prescribing accurately, facilitating accessibility, and ensuring the understanding of instructions for administration. The definition of a discrete data element is constant, but the availability of data elements that represent a variable of interest in a given study context may vary.
The second nurse took the trouble to explain the need for aggressive deep breathing exercises, to prevent postoperative pneumonia.Please watch the video above for more examples of verbaland non-verbal communication.
Guidelines for developing and assessing student learning outcomes for undergraduate majors. It requires you to manually allocate the Regular and Overtime hours, but for some people, that flexibility is preferrable. So, if you have ideas or questions about how to use the timesheets, feel free to contact me. If you are an employer with many employees and this template doesn't meet your needs, you may want to consider looking into some kind of web-based time management system, or electronic punch card system.
As a result, many nurses are looking at business programs to ensure they have the competencies to meet the requirements needed to perform their role. We then applied a process matrix methodology, in which we identified key research goals and chose optimal data domains and their respective data elements, to instantiate the resulting data model. We therefore designed an independent data collection system that complemented EHR data collection for each of the four participating counties. Each data requirement was selected and designated for a measurement frequency that correlated with meaningful intervention time points.
After the design was reviewed by clinical teams in all four counties, it was finalized in February 2013. This led to feasibility challenges, including the cost and time commitment required to complete some patient-reported outcome (PRO) surveys. The criteria were applied to variable or measure for medication adherence across each of the patient care interactions.
During inspection of pill bottles, both the lisinopril and atorvastatin bottles were found to have been refilled within the past month and the appropriate number of pills were left in the bottle. Additionally, injecting into areas of lipohypertrophy (areas of fibrosis or lipid tissue deposits) can lead to less absorption of the insulin. This taxonomy comprises two overarching constructs: Adherence to Medications and Management of Adherence.
The taxonomy for medication adherence creates fresh possibilities for both research and practice (Vrijens et al., 2012).
The need to establish these two distinct areas that both contribute to a shared goal is at the heart of achieving the goals of improved quality, clinical outcomes, and costs. Some people may have dominant needs at a particular level and thus never move through the entire hierarchy. You will come under scrutiny as you move up the leadership ladder as you are held at a higher standard.
If you belong to a professional organization, ask if they need help on a committee or in other areas of leadership.
Measurement and data capture from the many entities that contribute to management of adherence over time, including patients, caregivers, providers, communities, and health systems, are inaccessible or absent (Sanfelix-Gimeno et al., 2013). Measures such as the MMAS, Patient Activation Measure (PAM-13), health literacy assessment (REALM-SF), and self-care skills assessment for managing medications will be collected at baseline and at follow-up at intervals of 6 months. In addition, many interventions and strategies used to support medication adherence take place in outpatient settings governed by multiple regulatory agencies, leading to inconsistent definition of terms and selection of measures. Most decision points were resolved using the clinical, regulatory, data analytics, and research expertise offered by group members.
However, the bottle of metformin had too many pills left in the bottle and the box of insulin pens sitting on the kitchen table had expired.
Alternating sites of injection from areas of slower absorption, such as the thigh, to areas of quicker absorption, such as the upper arm or abdomen, can lead to variations in insulin bioavailability.
Developed in a series of international consensus panels hosted by the European Society for Patient Adherence, Compliance and Persistence (ESPACOMP), the taxonomy was defined and validated using an established Delphi technique carried out by the Ascertaining Barriers to Compliance (ABC) Project from 2009 to 2012.
For this reason, we propose that applying this taxonomy to identify EHR variables would advance research in this field and improve data collection. Keep up to date by reading articles and join social networks that provide opportunities for you to share your expertise and grow professionally as a nurse. The purpose of this article is to describe medication adherence data capture in a population-based intervention, the Southeastern Diabetes Initiative (SEDI), which aims to improve healthcare quality, outcomes, and costs for patients with diabetes mellitus.
In each of the four counties participating in SEDI, these variables were not available in the EHR.
Because of the unique multidisciplinary composition of our group, we were able to engage in constructive discussions that resulted in redirection of data element selection and lessons learned. The patient stated that his daughter was able to help him with the cost of the medications for this month, but also anticipated that he would be unable to pay for the next month's supply because his daughter is only present for a short visit.
Some insulin regimens require multiple shots per day that must be taken at certain times with regard to meals.
Based on our experience in this use case, we posit that developing a data model and using a process matrix to redesign data collection for medication adherence will improve variable identification, data access, and future research on medication-taking behaviors. We determined that any effort to incorporate these forms of data capture into existing EHR systems would be costly and not feasible within the project timelines. Insulin expiration dates and storage are additional variables that are difficult to assess outside of the patient's home.

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