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Tuesday 12 April 2016

HCS 490 Week 1 Current Article Summary

Find a short news or online article that has been recently published (within the current month) that addresses health care consumer: Trends and Marketing or that aligns with the week's topic, challenges facing consumers.

Write a 350- to 700-word summary that describes the issue and its impact on the health industry and society as a whole.

Consider the following:
  • What is the article about?
  • Does the article provide a national or global perspective about the issue?
  • Does the information presented in the article affect you or people you know? Explain.
  • Does the article make any claims about possible solutions or responses to the issue?
Format your summary consistent with APA guidelines.


HCS 490 Week 1 Product Review


Identify two health care product advertisements from radio, television, newspaper, magazines, or social media. Possible products could include blood pressure cuffs, blood glucose meters, and food diary apps.

Write a review (350- to 700- words) of the two health care product advertisements in which you do the following:
  • Describe the products.
  • Describe the advertisement for the products.
  • Does it target a specific age group? Indicate what information allowed you to make this conclusion.
  • Based on the intended age group, is this advertisement effective? Explain.
  • Does it target a specific ethnic group? Indicate what information allowed you to make this conclusion.
  • Based on the intended ethnic group, is this advertisement effective? Explain.
  • Does this advertisement appeal to you as a consumer? Explain why or why not.

HCS 490 Week 2 Case Study Comparisons


Faculty will provide each team with a profile of a fictional person.

Research health care costs and coverage options for your assigned individual.

Write a 1,050- to 1,400-word summary of your findings. Prepare to share your findings with the class. 


HCS 490 Week 2 Current Article Summary


Find a short news or online article that has been recently published (within the current month) that addresses healthcare reform in the United States.

Write a 350- to 700-word summary that describes the issue and its impact on the health industry and society as a whole.

Consider the following:
  • What is the article about?
  • Does the article provide a national or global perspective about the issue?
  • Does the information presented in the article affect you or people you know? Explain.
  • Does the article make any claims about possible solutions or responses to the issue?
Format your summary consistent with APA guidelines.


HCS 490 Week 2 Product Remarketing Activity

Review product advertisements discussed during Week 1.

Suggest a new way to market the products to a different age group (350- to 700- words). Include the following:
  • Indicate the original age group identified during the first week. Choose another age group to market this product to.
  • What media style would be most effective to reach the new audience?
  • What strategies would it take to market this product to the new age group?
  • Describe what the advertisement would look like.
  • Describe some key terms that would be used to market the product.
  • What do you think the consumers' response would be?
  • Would a different marketing plan for this product change your opinion about the product?
Long-Term Care Today
Demographics and epidemiological transitions result in dramatic changes in the health needs of individuals throughout the globe. In recent times, there has been increase in the prevalence of long-term disability in the population—causing increasing need for long-term care services. In addition, the present developing world is experiencing an increase in the demand for long-term care services at a cost much lower than industrialized countries.
Prepare a report in a 3- to 4-page Microsoft Word document comparing the US long-term care system with the long-term care system of a developing country. Research the South University Online Library and the Internet to find relevant content. 
Include the following information in your report:
  • What are the chronic illness trends of each country?
  • What is the incidence and prevalence of elderly consumers of long-term care in the United States as compared to your chosen developing country?
  • How does each country expect these numbers to change in the next ten years?
  • What are the main characteristics of the elderly population in both the countries? Is there any difference in the long-term health care needs of consumers in both the countries? Provide a rationale for your answer.
  • Who are the institutional and noninstitutional caregivers in both the countries? Support your answer with relevant examples. Explain the factors that affect care giving in each country.
  • Is there any difference in the status of quality of care of the elderly consumers in the United States as compared to the developing country?
  • Is there any difference in the health care cost provided in the United States as compared to the developing country? Define any social support that may exist to cover health care in both countries.
Support your responses with examples.
Cite any sources in APA format.


Post a short (500 words) discussion on fatigue mitigation related to the clinical environment. Find at least one journal article that relates to your topic and use it in your discussion as well as site it in APA format.
This assignment is worth 5 points. 
APA format: 1 point
Reference: 1 point
Relevant topic: 2 points
Response to classmate: 1 point


Identify Nursing Leadership Priorities

Identify Nursing Leadership Priorities

 
The goal of your course project is to showcase your understanding of systems, organizations, and leadership and demonstrate your ability to apply this knowledge to real-world situations and practices in ways that create both personal and organizational value.
The most useful way to approach this project is to set it into the context of your current workplace situation. You will be evaluating issues that are immediate to your experience, and you will be able to propose leadership strategies, resources, or tools to address those particular issues. Structured in this way, the project may also be used as a performance evaluation tool for your workplace.
If your current work situation is not applicable, you may simply choose to evaluate issues and propose leadership strategies, resources, or tools that are of interest to you. Rather than a performance evaluation, you might choose to use this project as a personal development plan.
For this assignment, you will begin to identify the content of your course project. You:
  • Start by brainstorming as many nursing leadership priorities as you can come up with. In addition, list any related leadership resources that you would like to explore as a part of this project.
  • Narrow down your ideas to 2–3 nursing leadership priorities and related leadership resources that you would like to explore as a part of your Organizational Systems and Professional Leadership project. (this I will explain to you later, but its for a different assignment)


Percentage of Course Grade: 10%.
Note: Your instructor may also use the Writing Feedback Toolto provide feedback on your writing. In the tool, click on the linked resources for helpful writing information.
Identify Nursing Leadership Priorities Scoring Guide Grading Rubric
CriteriaNon-performanceBasicProficientDistinguished
Identify nursing leadership priorities within a specific health care organization.

50%
Does not identify nursing leadership priorities within a specific health care organization.Partially identifies nursing leadership priorities within a specific health care organization.Identifies nursing leadership priorities within a specific health care organization.Analyzes nursing leadership priorities within a specific health care organization and provides specific examples and supporting evidence.
Identify nursing leadership resources and tools that will help implement nursing leadership priorities.

45%
Does not identify nursing leadership resources and tools that will help implement nursing leadership priorities.Partially identifies nursing leadership resources and tools that will help implement nursing leadership priorities.Identifies nursing leadership resources and tools that will help implement nursing leadership priorities.Analyzes nursing leadership resources and tools that will help implement nursing leadership priorities and provides specific examples and supporting evidence.
Communicates effectively by integrating research into written documents that follow APA format, and consistently using the grammar, punctuation, and mechanics expected of a nursing professional and leader.

5%



Does not communicate effectively by integrating research into written documents that follow APA format, or consistently using the grammar, punctuation, and mechanics expected of a nursing professional.Communicates effectively by integrating research into written documents that follow APA format, or consistently using grammar, punctuation, and mechanics expected of a nursing professional, but not both.Communicates effectively by integrating research into written documents that follow APA format, and consistently using the grammar, punctuation, and mechanics expected of a nursing professional.Communicates effectively by integrating research into written documents that follow APA format, and consistently using the grammar, punctuation, and mechanics expected of a nursing professional and leader.

Health Program Assignment

Health Program Assignment. Cover the following key content:
  • State target objective from HP 2020.
  • Description of Target Community.
    • Description of your "community" at the city or county or municipality level; in other words, “who are the people whom you will be providing your program for?”  Include information about your target community. This includes target population size and target population demographics (you can typically find this demographic data from census databases or other national or local databases). Also include local incidence and prevalence rates of health outcomes that are directly related to your chosen Healthy People 2020 health behavior (you can get this info from your needs assessment assignment).
***With regards to the “community”, I strongly recommend you target a relatively narrow segment or community. For example, it would be better to choose to target the issue of underage drinking and subsequent car crashes in a target community within your county, city, town or local school district versus addressing the issue for the entire state.
  • Provide detailed and specific information about your “Health Promotion Program”.
    • Your health program should meet your HP 2020 objective, health behavior and associated health indicator. Make sure to include your plan on funding your program, the duration of your program (stop and start date), what your program will accomplish (example, reduce teenage pregnancy by 5 % in one year).
  • Guidelines:
  • Assignment should be a minimum of 5 pages, excluding the title page and reference page.
  • Utilize a minimum of 5 references, only 1 can be the text book.
  • Provide details in your content in the sections listed above.
  • Follow proper APA guidelines.
  • Submit your assignment through the Turnitin link located in the “Assignment Dropbox”.
  • Assignments that have a Plagiarism Rate from Turnitin of higher than 30% will automatically receive a 0. I strongly recommend that you submit prior to due date so you can correct if your rate is higher than this.
  • No Assignments will be accepted late, No exceptions!

What is the Christian concept of the imago dei? How might it be relevant to our unique approach in health care...

What is the Christian concept of the imago dei? How might it be relevant to our unique approach in health care and why is it important?


Nursing Home and Subacute Care


During the nineteenth and the twentieth century, the term "nursing home" was synonymous with long-term care. Although today the exclusive use of the term "long-term care" is no longer accurate for nursing homes, it continues to remain and will not change easily. However, newer terms such as "nursing facilities" will help clarify the role of specific long-term care organizations and will differentiate them from others in the health care industry.
Subacute care is a relatively new but rapidly growing medical service in the continuum of care. Today, it is considered the fastest growing segment of the health care delivery system.
Research the online references such as EBSCOhost, SocINDEX, Cumulative Index to Nursing and Allied Health Literature (CINAHL), or PubMed for information on nursing facilities and subacute units and respond to the following questions:
  • Do you agree with the change in the terminology of nursing homes to nursing facilities? Why or why not? How do the terms relate with each other?
  • What impact does the historical perspective of the nursing home have on the stigma related to the quality of care?
  • How were nursing facilities developed? What have been the consequences of the change in terminology? Do you think the change in terminology will impact the quality of care in the future? If yes, how? If no, why?
  • What changes do you see nursing homes making in the future in order to keep up with the ever changing needs of the demographics of seniors?
  • What are subacute units? How did subacute care emerge? What are the strengths and limitations of the emergence of subacute care in long-term care as related to issues in levels of patients' acuity (various levels of nursing care based on the needs of patients)? Support your answer with relevant examples.
  • What is the impact of subacute care on the cost and quality of care? Do you think subacute care needs to be an integral component of hospitals, or should it be an integral part of the long-term care system? Provide a rationale for your answer.
Based on your learning about nursing home care and subacute care, compare their funding, staffing, regulation, and marketing.
Your instructor will assign you a research article relating to the current challenges in the long-term care continuum and their impact on the current long-term care industry. Read the assigned research paper and research the South University Online Library and the Internet to learn more about the topic. After you have completed your review, create a 1- to 2-page synopsis in a Microsoft Word document addressing the main challenges discussed in the paper. Be sure to incorporate the following:
  • Introduction and background of the research paper
  • Stakeholders interested in the study
  • Challenges in the long-term care continuum
  • Impact of the challenges on the long-term care system (specifically on staffing, funding, and regulation)
  • Recommendations to address the challenges
Support your responses with examples.
Cite any sources in APA format.

Choose one topic
The list of topics for Week 2-Assignment 2:





  You may choose an article that discusses LTC (long term Care) issues or that relates to one of the following topics below:
1- How public policy has been used to improve the lives of our older adults or LTC residents
2- What is the impact of the continuum of care?
3- Measuring Client experiences in LTC facilities
4- The advantages and disadvantages of Financing LTC
5- Ergonomics for LTC professionals



Why does teen pregnancy and sexually transmitted diseases remain high in the U.S. 2.. What can healthcare providers do that decrease the rate of teen pregnancy and STD’s in the US?


Why does teen pregnancy and sexually transmitted diseases remain high in the U.S.
What can  healthcare providers do that decrease the rate of teen pregnancy and STD’s in the US?
* These questions should be researched and incorporated in the body of the paper and answered.
This is my introduction already done.
Adolescent Sex
Teen pregnancy and sexually transmitted diseases continue to be an important healthcare issue in the 20thcentury.  Although teen pregnancy rates have dropped there are still concerns and healthcare problems that are associated with teen pregnancy.   Often times they are afraid to discuss sex with their parents and deny will deny being sexually active at all.  There are problems that manifest with adolescent pregnancy for the mother and often times the infants as well.  The high school drop out rate among pregnant high school students is approximated at about 70 percent and is cited as the number reason teens drop out prior to graduation.  There is also an estimated $7 billion revenue cost associated with teen pregnancy in the United States alone. [KD2] The risk of young people engaging in early sexual intercourse is largely due to the lack of sexual education, peer pressure and social influences. 
Chlamydial infection, gonorrhea, HIV/AIDS, primary and secondary syphilis, and hepatitis B virus infection are amid the highest reported STDs with chlamydia noted as the most dominate which is likely due to the fact that there is more vigorous testing.  Some of the other noted STDs are genital herpes, trichomoniasis, Chancroid, and HPV.  Often times and without any signs or symptoms present more than one pathogen is involved with sexually transmitted diseases. Typically the only environments in which there remain viable pathogens is the bodily fluids from the genitourinary tract requiring there to be intimate contact for them to be acquired.
Although it affects men and women chlamydia is predominately seen in young women and is the most common nationally known sexually transmitted disease in the U.S.  Bodily fluids from the genitourinary tract are typically the environments in which there remain viable pathogens, so intimate contact is generally required to obtain STDs.  Chlamydia infections are asymptomatic in most women and can be transmitted during childbirth with thepotential of a newborn developing pneumonia as a complication.  If it is not treated chlamydia can spread to the uterus and fallopian tube creating further health problems and permanent damage to the reproductive system.
Teaching abstinence is the most affective way to prevent pregnancy and STDs but sexuality and curiosity of sex begins at a young age and exploration into sexuality is a natural part of personal development.  I feel it is our[KD3] role and responsibility as healthcare providers to provide adolescents and teens with the information and risk factors involved with having sex.  They need to be educated on contraceptives, pregnancy and STD prevention.
There is an urgent need for programs that adequately addresses the impacts of peer groups, social norms and the influences they have on an adolescents decision about having sex (Kalmuss, Davidson, Cohall, Laraque, & Cassell, 2011).  Evidence from the literature indicates that engaging in a comprehensive sex education which teaches both abstinence and contraception could lead to delayed initiation of and frequency of sex, a decrease in the number of partners and an increase in the use of contraception which may also lead to a reduction of adolescent and teen pregnancy (Basch, 2011).Providing such knowledge about pregnancy, sex, contraceptive use and STD will also provide a foundation and direction in making responsible choices.

2.  Building on what you wrote in Part 1 last week, locate, read, and write about the research and findings in two articles about your topic. These articles should have been published in the past two years in refereed nursing journals. Your paper should analyze, compare, and contrast the authors' hypotheses, methods, and findings. In addition, you need to make revisions to Part 1 based on the feedback from your instructor, your readings, and/or discussions in class.

  • Part 3: Synthesis of literature and proposal
  • Part 4: Editing as needed and submission of the completed paper
For Part 3 of the research review paper, you will do a synthesis of the literature and create a research proposal.
Before you begin, review the overall assignment instructions from Weeks 1 and 2. Revise Parts 1 and 2 of your paper, as needed, on the basis of instructor feedback, new knowledge acquired in class, or discussion questions and/or additional readings.
Part 3 will probably be the most challenging part of the assignment, so allow yourself plenty of time to think about what you've read and develop an argument for further research. Using the knowledge gained from work on Parts 1 and 2, identify one research question that has not been investigated previously or that you would address in a different way than you've read about so far. This is sometimes known as gap analysis, in that you are looking for a gap in the existing body of knowledge where new research would contribute to an understanding of the issue in a way that could improve clinical practice for the nurse practitioner and improve patient outcomes.
Your research question must be clearly related to Parts 1 and 2. Be sure to state this clearly as a research question. Explain why you think this is a gap in existing research (relate directly to published research), its clinical relevance (why you think your specific research question is an important area to explore), and your ideas about research design (how you would conduct research to investigate it). Include a discussion of whether your question would lend itself to a quantitative, qualitative, or mixed design; why; and how you might be able to acquire participants for the study.


APA style with research less than 2 years old.


 Revison of 1st part with the questions inside the introduction and the litature research due by Tuesday at 9pm





                                                           





Incorporated and resubmitted revisions to Part 1 with Part 2.
 
Selected articles appropriate to the topic identified in Part 1 and as per the criteria defined in the assignment.
 
Ensured the paper summarizes selected authors' hypotheses, methods, and findings.
1
Ensured the paper follows APA format and is written creatively in the student's own words.
 Research part:
Clearly discussed the clinical significance.
 
Accurately summarized prior research.
 
Clearly defined the gap in research leading to your proposed research question.
 
Clearly stated your research question.
 
Ensured that your suggestions for methods are rational, doable, and appropriate for the proposed question.
 
Ensured that the paper is well organized and well written and demonstrates significant development in your ability to think and write from initial submission. Properly followed APA format.

Literature review of Adolecent sex. Why the teen pregnancy and STD rates are high and how can we improve them.


Adolescent Sex
Teen pregnancy and sexually transmitted diseases continue to be an important healthcare issue in the 20thcentury.  Although teen pregnancy rates have dropped there are still concerns and healthcare problems that are associated with teen pregnancy. Often times they are afraid to discuss sex with their parents and deny will deny being sexually active at all.  There are problems that manifest with adolescent pregnancy for the mother and often times the infants as well.  The high school drop out rate among pregnant high school students is approximated at about 70 percent and is cited as the number reason teens drop out prior to graduation.  There is also an estimated $7 billion revenue cost associated with teen pregnancy in the United States alone. The risk of young people engaging in early sexual intercourse is largely due to the lack of sexual education, peer pressure and social influences.  Why does teen pregnancy and sexually transmitted diseases remain high in the U.S.
The best essay title generator
Chlamydial infection, gonorrhea, HIV/AIDS, primary and secondary syphilis, and hepatitis B virus infection are amid the highest reported STDs with chlamydia noted as the most dominate which is likely due to the fact that there is more vigorous testing.  Some of the other noted STDs are genital herpes, trichomoniasis, Chancroid, and HPV.  Often times and without any signs or symptoms present more than one pathogen is involved with sexually transmitted diseases. Typically the only environments in which there remain viable pathogens is the bodily fluids from the genitourinary tract requiring there to be intimate contact for them to be acquired.
Although it affects men and women chlamydia is predominately seen in young women and is the most common nationally known sexually transmitted disease in the U.S.  Bodily fluids from the genitourinary tract are typically the environments in which there remain viable pathogens, so intimate contact is generally required to obtain STDs.  Chlamydia infections are asymptomatic in most women and can be transmitted during childbirth with thepotential of a newborn developing pneumonia as a complication.  If it is not treated chlamydia can spread to the uterus and fallopian tube creating further health problems and permanent damage to the reproductive system.
Teaching abstinence is the most affective way to prevent pregnancy and STDs but sexuality and curiosity of sex begins at a young age and exploration into sexuality is a natural part of personal development.  It is our role and responsibility as healthcare providers to provide adolescents and teens with the information and risk factors involved with having sex.  They need to be educated on contraceptives, pregnancy and STD prevention.
There is an urgent need for programs that adequately addresses the impacts of peer groups, social norms and the influences they have on an adolescent’s decision about having sex (Kalmuss, Davidson, Cohall, Laraque, & Cassell, 2011).  The literature indicates that engaging in a comprehensive sex education which teaches both abstinence and contraception could lead to delayed initiation of and frequency of sex, a decrease in the number of partners and an increase in the use of contraception which may also lead to a reduction of adolescent and teen pregnancy (Basch, 2011).Providing such knowledge about pregnancy, sex, contraceptive use and STD will also provide a foundation and direction in making responsible choices. What can healthcare providers do that decrease the rate of teen pregnancy and STD’s in the US.
Refernce
 Basch, C. E. (2011). Teen Pregnancy and the Achievement Gap Among Urban Minority Youth. Journal Of School Health81(10), 614-618. doi:10.1111/j.1746-1561.2011.00635.x
Kalmuss, D., Davidson, A., Cohall, A., Laraque, D., & Cassell, C. (2011). Prespectives on sexual and reproductive health. Retrieved from http://www.guttmacher.org/pubs/journals/3508703.html
This is part one completed.
 Building on the above Part 1 paper  locate, read, and write about the research and findings in two articles about the above topic. These articles should have been published in the past two years in refereed nursing journals. The paper should analyze, compare, and contrast the authors' hypotheses, methods, and findings. The literature review shoud be in a 3- to 4-page Microsoft Word document. Plagerism free.  ****analyze, compare, and contrast the authors' hypotheses, methods, and findings,summarizes selected authors' hypotheses, methods, and findings and incorporate it with part 1 already written above.


Note:
Read the following requirements thoroughly, and write 1-2 pages paper on the instructions given below. Your paper must include headings before started each new section. You must include 3 scholarly references cited in APA. Your answer must be 100% original.

Requirements:

1.      Select one population and consider how social support or social networks can impact health disparities within this population.
2.      Give a description of the population you selected. Explain how social support might contribute to positive health outcomes in this population.

3.      Then, explain how social exclusion in this population might contribute to health disparities and why. Be specific and provide examples.


Addressing Barriers to Effective Communication


From moment to moment, a nurse leader’s day involves communication—with patients, families, colleagues, supervisors, and so on.

Think of a particular day you spent working in a health care environment, and consider three or four distinct points in time. For each point of time, consider the following: With whom did you interact? Which forms of communication did you use? What issues were communicated about—did they seem to be light-hearted or sensitive? Straightforward or complicated? How would you describe the pace of the interactions and your work?

As you consider these questions, it becomes clear that communication can be quite complex, with many layers of meaning that shape the experience for everyone involved. How could this awareness help you to understand instances of ineffective communication when they arise?

To prepare:

  • Review the information in Chapter 19 of the course text, as well as the assigned articles.
  • Reflect on an incident involving ineffective communication within your organization or another health care setting. Consider this incident through the lens of the communication process outlined in Figure 19.1 of the course text (p. 439).
  • What barriers contributed to this incident? What other challenges may have influenced this situation?
  • Using the information presented in the other Learning Resources, consider what could have been done to prevent or address the ineffective communication. Why do you think the use of these strategies would have resulted in better outcome(s)?

Post  (1) a summary of an incident involving ineffective communication. (2) Describe communication barriers and other challenges that contributed to the incident. (3) Propose one or more strategies that could have been employed to promote a better outcome. (4) Be sure to refer to elements of the communication process.



Required Resources

Note: To access this week's required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

  • Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

    • Review Chapter 19, “Organizational, Interpersonal, and Group Communication”
  • Gifu, D., Dima, I. C., & Teodorescu, M. (2014). New communication approaches vs. traditional communication. International Letters of Social and Humanistic Sciences, (20), 46-55.

    Retrieved from Walden Library Databases.



    The study highlights some communication instances of actual approach of human society evolution in contrast with traditional communication.
  • Johansson, C., Miller, V. D., Hamrin, S. (2014) Conceptualizing communicative leadership: A framework for analyzing and developing leaders’ communication competence, Corporate Communications: An International Journal, 19 (2), 147 – 165.

    Retrieved from Walden Library Databases.



    Excerpt from Abstract: Four central communicative behaviors of leaders (i.e. structuring, facilitating, relating, and representing), eight principles of communicative leadership, and a tentative definition are presented. A communicative leader is defined as someone who engages employees in dialogue, actively shares and seeks feedback, practices participative decision making, and is perceived as open and involved.
  • Manojlovich, M., Harrod, M., Holtz, B., Hofer, T., Kuhn, L., & Krein, S. L. (2015). The Use of Multiple Qualitative Methods to Characterize Communication Events Between Physicians and Nurses. Health communication, 30(1), 61-69.

    Retrieved from Walden Library Databases.



    The purpose of this study was to develop a methodology for identifying and characterizing communication events between physicians and nurses to better understand communication patterns on general medical–surgical units. 
  • Seyranian, V. (2014). Social Identity Framing communication strategies for mobilizing social change. The Leadership Quarterly25(3), 468-486.

    Retrieved from Walden Library Databases.



    Except from Abstract: Social identity framing delineates a set of communication tactics that leaders may use to harness follower support for a vision of social change.  Results showed that participants exposed to inclusive language were more likely to indicate that renewable energy was in-group normative; intend to engage in collective action to bring renewable energy to campus; experience positive emotions and confidence about change; and to view the leader more positively. The combination of inclusive language and positive social identity increased ratings of leader charisma.
  • Van Keer, R. V., Deschepper, R. D., Huyghens, L. H., Distelmans, W. D., & Bilsen, J. B. (2014). Dealing with cultural diversity during the process of communication and decision-making in the ICU: a literature review. Critical Care18(Suppl 1), P24. doi:10.1186/cc13214

    Retrieved from Walden Library Databases.



    Excerpt from Abstract: The aim of this study is to review the experiences of the involved actors, namely the care providers, the patients and their family members, with cultural diversity during the process of communication and decision-making in the ICU.