Limited Access to Healthcare Paper
Socratic Problem-Solving Approach The Socratic Method is a teaching style in which teachers ask students questions designed to stimulate more complete thinking and deeper insight. It also relates to the steps of performing scientific research. When the Socratic approach is applied, students are prompted to look more closely at your ideas, question your assumptions and accepted premises, and view your choices through a rigorous lens. Apply the Socratic approach Applying the Socratic approach to problem solving helps you identify gaps and improve your thinking when writing papers or completing projects. The questions may be used to spark new insights when responding to discussion topics and posts. • • • • • • Identify the elements of the problem, issue, or question Analyze, define, and frame the problem, issue, or question Consider solutions, responses, or answers Choose a solution, response, or answer Implement your choice Evaluate the results Socratic problem-solving references Paul, R., & Elder., L. (2006) The miniature guide to critical thinking concepts & tools (4th ed.). Dillon Beach, CA: The Foundation for Critical Thinking. Wertheim, E. G. (n.d.). A model for case analysis and problem solving. College of Business Administration, Northeastern University. Retrieved August 7, 2007, from http://web.cba.neu.edu/ewertheim/introd/cases.htm (Material no longer available at this link.) *Source: Dictionary.com RELATED RESOURCES Apply critical thinking Learn more about applying the Socratic approach when creating discussion posts. Socratic problem-solving approach Identify gaps and improve your thinking when writing a course paper or completing a project. Practice Activity Use the Socratic approach when responding to a discussion question. Top Write a 4-6-page analysis of a current problem or issue in health care, including a proposed solution and possible ethical implications. Introduction In your health care career you will be confronted with many problems that demand a solution. By using research skills you can learn what others are doing and saying about similar problems. Then you can analyze the problem and the people and systems it affects. You can examine potential solutions and their ramifications. This assessment allows you to practice this approach with a real world problem. Demonstration of Proficiency By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: • o • o o • o • o o Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care. Use scholarly information to describe and explain a health care problem or issue and identify possible causes for it. Competency 2: Apply scholarly information through critical thinking to solve problems in the field of health care. Analyze a health care problem or issue by describing the context, explaining why it is important, and identifying populations affected by it. Discuss potential solutions for a health care problem or issue and describe what would be required to implement a solution. Competency 3: Apply ethical principles and academic standards to the study of health care. Analyze the ethical implications if a potential solution to a health care problem or issue was implemented. Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others, and that is consistent with expectations for health care professionals. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Write following APA style for in-text citations, quotes, and references. Instructions Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed. 1. Describe the health care problem or issue you selected for use in Assessment 2 (from the Assessment Topic Areas | Transcript media piece) and provide details about it. 2. To explore your chosen topic, you should use the first four steps of the Socratic ProblemSolving Approach to aid your critical thinking. This approach was introduced in the second assessment. 3. Identify possible causes for the problem or issue. 4. Use scholarly information to explain the health care problem or issue. 5. Identify at least three scholarly or academic peer-reviewed journal articles about the topic. o You may use articles you found while working on Assessment 2 or you may search the Capella Library for other articles. o You may find the applicable Undergraduate Library Research Guide helpful in your search. 6. Assess the credibility of the information sources. 7. Assess the relevance of the information sources. 8. Analyze the problem or issue. 0. Describe the setting or context for the problems or issues. 1. Describe why the problem or issue is important to you. 2. Identify groups of people affected by the problem or issue. 9. Discuss potential solutions for the problem or issue. 0. Compare your opinion with other opinions you find in sources from the Capella Library. 1. Provide the pros and cons for one of the solutions you are proposing. 10. Analyze the ethical implications if the potential solution (the one for which you provide pros and cons) were to be implemented. 0. Discuss the pros and cons of implementing the proposed solution from an ethical principle point of view. 1. Provide examples from the literature to support the points you are making. 11. Describe what would be necessary to implement the proposed solution. • Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like: Assessment 3 Example [PDF]. Additional Requirements 1. Length: At least 4–6 typed, double-spaced pages, not including the title page and reference page. 2. Font and font size: Times New Roman, 12 point. 3. APA Template: Use the APA Style Paper Template [DOCX] as the paper format and the APA Style Paper Tutorial [DOC] for guidance. 4. Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. 5. Using outside sources: Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style. 6. References: Integrate information from outside sources to include at least three scholarly or academic peer-reviewed journal articles and three in-text citations within the paper. 7. APA format: Follow current APA guidelines for in-text citations of outside sources in the body of your paper and also on the reference page. Organize your paper using the following structure and headings: • • • • • • • • • Title page. A separate page. Introduction. A brief one-paragraph statement about the purpose of the paper. Elements of the problem/issue. Identify the elements of the problem or issue or question. Analysis. Analyze, define, and frame the problem or issue. Considering options. Consider solutions, responses, or answers. Solution. Choose a solution, response, or answer. Ethical implications. Ethical implications of implementing the solution. Implementation. Implementation of the potential solution. Conclusion. One paragraph. Note: Read the Analyze a Current Health Care Problem or Issue Scoring Guide to fully understand how your paper will be graded. If you would like assistance in organizing your assessment, or if you simply have a question about your assessment, do not hesitate to ask faculty or the teaching assistants in the NHS Learner Success Lab for guidance and suggestions. Note: Your instructor may also use the Writing Feedback Tool to provide feedback on your writing. In the tool, click the linked resources for helpful writing information. Topic 1: Limited Access to Healthcare Short Description: Consumers face barriers to healthcare access for assorted reasons. For example: due to geographic location, provider availability, transportation issues and mobility. Potential Intervention Approaches: • • • – Healthcare information online – Telemedicine – In–home healthcare services Keywords for Articles: online health information seeking, health care access, health information systems, consumer health information, chronic disease, health information search, health seeking behavior, rural nursing References: Bhandari, N. (2014). Seeking health information online: does limited healthcare access matter? Journal of the American Medical Informatics Association: JAMIA (1067-5027), 21 (6), p. 1113. https://wwwncbi-nlm-nih-gov.library.capella.edu/pmc/articles/PMC4215038/ Lee, K., Hoti, K., Hughes, J. D., & Emmerton, L. (2014). Dr Google and the Consumer: A Qualitative Study Exploring the Navigational Needs and Online Health Information-Seeking Behaviors of Consumers with Chronic Health Conditions. Journal of Medical Internet Research, 16(12), e262. http://doi.org.library.capella.edu/10.2196/jmir.3706 Ware, P., Bartlett, S. J., Paré, G., Symeonidis, I., Tannenbaum, C., Bartlett, G., … Ahmed, S. (2017). Using eHealth Technologies: Interests, Preferences, and Concerns of Older Adults. Interactive Journal of Medical Research, 6(1), e3. http://doi.org.library.capella.edu/10.2196/ijmr.4447 Pratt, D. (2015). Telehealth and telemedicine. Albany Law Journal of Science & Technology. (10594280), 25 (3), p. 495. http://www.lexisnexis.com.library.capella.edu/hottopics/lnacademic/?shr=t&csi=148364&sr=TITLE( %22Telehealth+telemedicine+in+2015%22)+and+date+is+2015 Topic 2: Healthcare Disparities Short Description: In 2010, the Federal Department of Human and Health Service (DHHS) launched the Healthy People 2020 goals to include a goal to eliminate health inequality/disparity. Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion” (Office of Disease Prevention and Health Promotion, 2017, p.1). Potential Intervention Approaches: • • • • – Federal goals – Community health improvement plans – Patient advocacy efforts – “Triple Aim” for populations Keywords for Articles: health disparities, community health assessment, community health improvement plan, strategic planning, local health departments, health inequities References: Office of Disease Prevention and Health Promotion. (2017). Disparities. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/disparities Shah G.H., & Sheahan J.P. (2016). Local health departments’ activities to address health disparities and inequities: Are we moving in the right direction? International Journal of Environmental Research and Public Health. 2016; 13(1):44. http://www.mdpi.com/1660-4601/13/1/44 Institute for Healthcare Improvement. (2017). Triple Aim for Populations. http://www.ihi.org/Topics/TripleAim/Pages/Overview.aspx CONTINUE TO Topic 3: Medication Errors Short Description: A medication error is a preventable adverse effect of a patient taking the wrong medication or dosage, whether or not it is evident or harmful to the patient. Medication errors can be a source of serious patient harm, including death. Potential Intervention Approaches: • • • – Medical staff education – Packaging improvements – Patient medication safety training Keywords for Articles: medication administration, medication errors, medication safety References: Cohen, M. (2016). Medication errors (miscellaneous). Nursing. 46(2):72, February 2016. DOI: 10.1097/01.NURSE.0000476239.09094.06 Institute for Healthcare Improvement. (2017). Improve Core Processes for Administering Medications. http://www.ihi.org/resources/Pages/Changes/ImproveCoreProcessesforAdministeringMedications.as px Agency for Healthcare Research and Quality. (2012). Table 6: Categories of Medication Error Classification. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safetyresources/resources/match/matchtab6.html Schmidt, K., Taylor, A., & Pearson, A. (2017). Reduction of medication errors: A unique approach. Journal of Nursing Care Quality. 32(2), April/June 2017, 150–156. Topic 4: Healthcare System Errors Short Description: The health care system in the United States has been the subject of much debate as experts try to determine the best way to deliver high-quality care. In Crossing the Quality Chasm, the Institute of Medicine (2001) called for the redesign of health care delivery systems and their external environments to promote care that is safe, effective, patient-centered, timely, efficient, and equitable. Potential Intervention Approaches: • • • – Systemwide transformation – Process redesign – Electronic health records Keywords for Articles: multi-stakeholder collaboration, healthcare system redesign References: Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US).Agency for Healthcare Research and Quality. (2017). Hospitals and Health Systems. http://www.ahrq.gov/professionals/systems/index.html Analyze a Current Health Care Problem or Issue Scoring Guide CRITERIA NONPERFORMANCE Use scholarly information to describe and explain a health care problem or issue and identify possible causes for it. BASIC PROFICIENT DISTINGUISHED Does not use scholarly information to describe and explain a health care problem or issue and identify possible causes for it. Describes a health care problem or issue but does not explain it or identifies possible causes for a problem or issues but the identification is incomplete or inaccurate. Uses scholarly information to describe and explain a health care problem or issue and identify possible causes for it. Uses scholarly information to describe and explain a health care problem or issue and identify possible causes for it. Indicates which causes are the most likely. Analyze a health care problem or issue by describing the context, explaining why it is important, and identifying populations affected by it. Does not analyze a health care problem or issue by describing the context, explaining why it is important, and identifying populations affected by it. Identifies a health care problem or issue but does not analyze it. Analyzes a health care problem or issue by describing the context, explaining why it is important, and identifying populations affected by it. Analyzes a health care problem or issue by describing the context, explaining why it is important, and identifying populations affected by it. Provides examples that support the analysis. Discuss potential solutions for a health care problem or issue and describe what would be required to implement a solution. Does not discuss potential solutions for a health care problem or issue and describe what would be required to Incompletely or inaccurately discusses potential solutions for a health care problem or issue and what would be required to Discusses potential solutions for a health care problem or issue and describes what would be required to implement a solution. Discusses potential solutions for a health care problem or issue and describes what would be required to implement a solution and describes CRITERIA NONPERFORMANCE BASIC PROFICIENT DISTINGUISHED implement a solution. implement a solution. potential consequences of ignoring the problem or issue. Analyze the ethical implications if a potential solution to a health care problem or issue was implemented. Does not analyze the ethical implications if a potential solution to a health care problem or issue was implemented. Identifies ethical implications if a potential solution to a health care problem or issue was implemented but does not analyze the implications. Analyzes the ethical implications if a potential solution to a health care problem or issue was implemented. Analyzes the ethical implications if a potential solution to a health care problem or issue was implemented and uses examples from the literature to support the analysis. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Does not write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Writes clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics with some errors and lapses. Writes clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Writes clearly and logically, using evidence to support a central idea, with correct use of spelling, grammar, punctuation, and mechanics; the paper contains supporting examples for the main points. Write following APA style for intext citations, quotes, and references. Does not write following APA style for in-text citations, quotes, and references. Writes following APA style for in-text citations, quotes, and references Writes following APA style for in-text citations, quotes, and references. Writes following APA style for in-text citations, quotes, and references without errors, CRITERIA NONPERFORMANCE BASIC with some errors and lapses. PROFICIENT DISTINGUISHED and uses current reference sources. Running head: ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE Analyze a Current Health Care Problem or Issue Learner’s Name Capella University Developing a Health Care Perspective Analyze a Current Health Care Problem or Issue March, 2018 Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. 1 ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 2 Analyze a Current Health Care Problem or Issue Patient safety, as discussed in the previous assessment, is an important element of quality health care. This assessment will expand upon patient safety issues that occur when patients are exposed to inadvertent harm or injury while receiving medical care. Health care organizations should maintain and develop a safety culture to prevent patient safety issues. Patient safety culture is defined as a system that promotes safety by shared organizational values of what is important and beliefs about how things work. It also encompasses how these values and beliefs interact with the work unit, organizational structures, and systems to produce behavioral norms (Ulrich & Kear, 2014). As such, care should be taken to improve the infrastructure of health care organizations. Improving patient safety should be discussed and addressed by every individual associated with public health care. Elements of the Problem/Issue Research shows that while getting treated at health care organizations, patients might be at risk of experiencing the harm or injuries associated with medical care. The most likely causes of patient safety issues are preventable adverse events, which are adverse events attributable to error. These errors can be classified as diagnostic errors, contextual errors, and communication errors (Ulrich & Kear, 2014). Diagnostic errors take place when health care professionals provide a wrong or delayed diagnosis or no diagnosis at all (James, 2013). An example of a wrong diagnosis is a health care professional diagnosing a patient with gastric troubles when the patient is actually experiencing a heart attack. An example of a delayed diagnosis is a patient not being notified of an abnormal chest X-ray, thereby delaying diagnosis of a serious medical condition. An example of a missed diagnosis is a patient not being diagnosed with heart failure despite warning symptoms. Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 3 Contextual errors occur when health care professionals fail to consider their patients’ personal or psychological limitations while planning appropriate care for them. An example is a health care professional’s failure to recognize that basic follow-up discharge instructions may not be understood by patients with cognitive disabilities (James, 2013). It is important for health care professionals to be aware of their patients’ mental and physical abilities before they formulate a plan of care. Communication errors occur when there is miscommunication or lack of communication between health care professionals and patients (James, 2013). They can cause severe harm to Comment [A1]: You provided a clear explanation regarding the problem investigated. The possible causes were explored. patients. An example of this is a nurse failing to tell a surgeon that a patient experienced abdominal pain and had a drop in red blood cell count after an operation, resulting in the death of the patient due to severe internal bleeding. Limited health care knowledge; language barriers; and auditory, visual, and speech disabilities could also lead to communication errors and cause safety issues. Analysis As a medical transcriptionist, it is important for me to be aware of potential transcription errors and privacy standards, which affect patient safety. Errors like these pose dangerous risks; therefore, it is necessary to have an overall quality evaluation of the transcribed documents. Also, I must ensure that serious difficulties in transcription resulting from poor-quality voice files are reported immediately to the manager, who will then convey this to the health care professionals involved in the process. This will help ensure that patient safety is not compromised. Context for Patient Safety Issues Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. Comment [A2]: Which error classification describes these errors? Add this information to add continuity. ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 4 With the advancement of medical technology, health care processes have become extremely complex. Health care professionals are required to stay up-to-date with a lot of new knowledge and innovations obtained from research. This often overburdens them as there is a need to apply the learning from research in their practice. Also, at the individual level, there is a dearth of wellbalanced continuing education programs, which has resulted in a lack of attention to patient safety among health care professionals. At the system level, organizations fail to deliver optimum health care as a result of being understaffed, an inability to provide appropriate technology, and ineffective execution of patient care transfer (James, 2013). Overcrowding and understaffing delays initiation of treatment and puts critically ill patients at significant risk. All of these factors contribute to a rise in patient safety issues. Comment [A3]: You effectively indicated which causes were the most likely to create safety issues. Populations Affected by Patient Safety Issues Patients with a psychiatric history are also a vulnerable group of people who face patient safety issues because their psychiatric records are often combined with their current symptoms. Patients with a documented history of psychiatric illness may avoid seeking health care services as they feel that their care will be based on their past record of illnesses and not their present needs. Therefore, psychotherapists should implement measures such that their psychiatric data is concealed from their medical records before it is shared with the third party, which helps protect patients’ confidentiality (Shenoy & Appel, 2017). Considering Options Patient safety in hospitals can be achieved by creating a culture of safety that involves effective communication, correct managerial leadership styles, and the use of Electronic Health Records (EHRs). Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. Comment [A4]: This section was very informative about special populations, but it would be of value to also include the general populations discussed earlier in this paper (such as public health patients and hospital patients). ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 5 Effective communication while passing patient-specific information from one health care professional to another is essential in ensuring continuous and safe patient care. Training the team could likely improve consistent successful communication and help prevent errors. Standardizing critical content that needs to be communicated by the initial health care professional ensures safe transfer of care (Farmer, 2016). It is essential for leadership teams to adopt organizational strategies that would improve patient safety and transform their organizations into reliable systems for enhanced patient satisfaction. They should set strategic safety goals, which could include adhering to standards of health, assessing quality, using patient satisfaction reviews, and analyzing adverse event reports to determine improvement in safety issues (Parand, Dopson, Renz, & Vincent, 2014). An EHR is another potential solution to prevent patient safety issues. It is a digital record of a patient’s medical information that includes history, physical examination, investigations, and treatment (Ozair, Jamshed, Sharma, & Aggarwal, 2015). It helps manage multiple processes in the complex health care system and prevents errors. EHRs utilize less storage space compared to paper documentation and allow an infinite number of records to be stored. In addition to being cost-effective and preventing a loss of records, EHRs help conduct research activities and provide quick data transfer (Ozair et al., 2015). Solution In health care, because transmission of information takes place among different people and electronic devices, there is a high likelihood of errors occurring. For example, transcription errors (which occur due to poor audio quality or the lack of a quality evaluation process) can be prevented by using recording equipment with good sound quality and by maintaining proofreading and quality checks. However, integrating transcription processes with the EHR Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 6 system helps prevent errors, helps access the required information faster, and allows health care professionals to take accurate decisions about patients’ care. Implementation An EHR is an important mechanism for improving patient safety. Its advancement has made it a viable option to prevent medical errors. However, the use of EHRs has certain ethical implications such as security violation, data inaccuracies, lack of privacy and confidentiality, and challenges during system implementation. Security violation takes place when patients’ confidential health information is accessible to others without their permission. To avoid security violation, data should not only be password protected but also encrypted to restrict access to unauthorized individuals. Firewalls and antivirus software should be used to protect data (Ozair et al., 2015). Though EHRs improve patient safety by reducing medical errors, data inaccuracies are increasing. Loss of data during data transfer leads to inaccuracies that affect decision-making related to patient care. A problem of concern related to data inaccuracy is medical identity theft, which leads to incorrect information being filed into a person’s medical record, which in turn leads to insurance fraud and wrong billing (Ozair et al., 2015). In health care, information that is shared during physician–patient interactions should be kept confidential and should be made inaccessible to unauthorized individuals. Enabling rolebased access controls based on user credentials will restrict access to the EHR system to authorized users. The user should also be made aware that he or she is responsible for any information that he or she misuses (Ozair et al., 2015). As EHR is a complex software, there is a high likelihood that software failure may result in inaccurate recordings of patients’ data. Therefore, EHR system implementation may have Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 7 ethical implications due to the violation of data integrity (Ozair et al., 2015). EHRs can safeguard patient confidentiality by using various methods that prevent security breaches. In addition to this, creating reminders that ask for a confirmation before accessing confidential information can help protect data. A nesting system could be developed, which would allow, for example, a health care professional from a specific specialty clinic to access patient records by signing into the specialty domain (Shenoy & Appel, 2017). These methods will enable the safe and efficient use of EHRs and ensure patient safety. Conclusion Patient safety involves preventing the risk of harm or injuries to patients by establishing a safety culture and providing high-quality medical care. Health care organizations must understand patient safety issues and find solutions for these issues by designing systems that prevent errors from occurring. Potential solutions include effective communication, changes in leadership style, and the use of EHRs. The ethical implications of these solutions should be considered before implementing them in a health care setting. It is also important that health care professionals undergo continuous education and effective training, provide appropriate medical care, prevent errors, and follow safety practices to improve clinical outcomes. Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. Comment [A5]: The concluding paragraph summarizes the analysis and solutions offered in this paper. ANALYZE A CURRENT HEALTH CARE PROBLEM OR ISSUE 8 References Farmer, B. M. (2016). Patient safety in the emergency department. Emergency Medicine, 48(9), 396–404. Retrieved from https://mdedge.com/emedjournal/article/113659/trauma/patient-safety-emergency-department James, J. T. (2013, September). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122–128. Retrieved from https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_ba sed_Estimate_of_Patient_Harms.2.aspx Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in Clinical Research, 6(2), 73–76. http://dx.doi.org/10.4103/2229-3485.153997 Parand, A., Dopson, S., Renz, A., & Vincent, C. (2014). The role of hospital managers in quality and patient safety: A systematic review. BMJ Open, 4(9). http://dx.doi.org/ 10.1136/bmjopen-2014-005055 Shenoy, A., & Appel, J. M. (2017, April). Safeguarding confidentiality in electronic health records. Cambridge Quarterly of Healthcare Ethics, 26(2), 337–341. Retrieved from https://search-proquest-com.library.capella.edu/docview/1882434628?pqorigsite=summon&https://library.capella.edu/login?url=accountid=27965 Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: Foundations of excellent health care delivery. Nephrology Nursing Journal, 41(5), 447–456, 505. Retrieved from https://search-proquestcom.library.capella.edu/docview/1617932572/fulltextPDF/1486CC30B3624B3CPQ/1?ac countid=27965 Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. Comment [A6]: You provided a wellresearched paper. Your paper is enhanced by the use of recently published academic peer review journal articles.