Environmental and Genetic Factors That Influence Health
1A)
Environmental and Genetic Factors That Influence Health
In Le Roy, New York, in 2011, a mysterious medical condition emerged: Several teenage girls suddenly began to exhibit symptoms similar to those of Tourette’s Syndrome, including involuntary twitches, movements, and sounds. Soon after, the number of individuals experiencing comparable symptoms increased. As media attention toward the situation grew, questions and concerns intensified about the origin of this condition. Did an environmental exposure trigger this? Was it the result of an infectious disease? If so, why were some people in the region affected and not others? In other words, could genetic factors play a role in this?
This week, you have been exploring a number of environmental and genetic factors that influence population health. Understanding how environmental and genetic factors influence populations will support your work as an advanced practice nurse. Therefore, for this Discussion, you will investigate the relationship between an environmental agent or genetic factor and a population health problem. You will also give attention to health disparities that may arise within a population because of environment or genetics.
To prepare:
• Review the Learning Resources, and select one environmental agent or one genetic factor and an associated population health problem. For example, you might consider lead paint and its effect on children, air pollution and its effect on individuals with asthma, genetic associations of various cancers, etc.
• Conduct additional research using the Walden Library and credible websites, reviewing the literature on your selected health problem and the relevant environmental agent or genetic factor.
• Explore health data resources and determine morbidity, mortality, incidence, prevalence, exposures, and costs to society as they relate to your chosen environmental agent or genetic factor.
• How might your chosen environmental or genetic factor result in health disparities in populations?
By Day 3, post a cohesive scholarly response that addresses the following:
• Identify the environmental agent or genetic factor that you selected and the population health problem with which it is associated.
• Evaluate the significance of the health risk resulting from your selected environmental agent or genetic factor, discussing such aspects as morbidity, mortality, incidence, prevalence, exposures, and costs to society. Support your response with references and data.
• How might the environmental or genetic factor you identified result in health disparities in populations?
Readings
• Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
o Chapter 13, “Epidemiologic Aspects of Work and the Environment”
o Chapter 14, “Molecular and Genetic Epidemiology”
Chapter 13 examines the impact of the environment on human health in populations as determined through the use of epidemiologic methods. In Chapter 14, the authors address molecular and genetic epidemiology, rapidly growing areas of this field.
Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295–300. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525/pdf/procrsmed00196-0010.pdf
In this landmark contribution, Sir Austin Bradford Hill delineated a series of criteria for evaluating whether an observed association between an exposure and an outcome should be considered causal.
Hines, A. B. (2011). Asthma: A health disparity among African American children: The impact and implications for pediatric nurses. Journal of Pediatric Nursing, 26(1), 25–33.
Retrieved from the Walden Library databases.
In this article, the author examines asthma, the most common chronic illness among children, and notes that this health issue is particularly relevant for pediatric nurses. The author addresses the significant health disparity for African-American children and their families.
Quansah, R., & Jaakkola, J. J. (2010). Occupational exposures and adverse pregnancy outcomes among nurses: A systematic review and meta-analysis. Journal of Women’s Health, 19(10), 1851–1862.
Retrieved from the Walden Library databases.
Synthesizing epidemiological evidence, the authors of this article examine the association between occupational exposures and adverse pregnancy outcomes for those working in the nursing profession.
Vieira, V. M., Hart, J. E., Webster, T. F., Weinberg, J., Puett, R., Laden, F., Costenbader, K. H., & Karlson, E. W. (2010). Association between residences in U.S. northern latitudes and rheumatoid arthritis: A spatial analysis of the Nurses’ Health Study. Environmental Health Perspectives, 118(7), 957–961.
Retrieved from the Walden Library databases.
The authors of this article utilize spatial analysis to visualize geographic variation in rheumatoid arthritis risk—a method, they note, that is particularly useful for generating hypotheses for further investigation and supporting existing hypotheses.
Media
• Laureate Education, Inc. (Executive Producer). (2012). Epidemiology and population health: Epidemiologic applications: Environmental and genetic factors. Baltimore, MD: Author.
Note: The approximate length of this media piece is 7 minutes.
In this week’s program, the presenters discuss the influence of environmental and genetic factors on population health.
1B
Stakeholder Involvement
For a program to be effective, it is essential for members of the target population to be involved in developing the mission, goals, and objectives.
Who would you reach out to for developing your program? Are there other community organizations or business partners that you would like to connect with during this process? How would you facilitate the involvement of various stakeholders? What challenges do you think you might encounter?
In this Discussion, you and your colleagues address the myriad issues related to stakeholder involvement during the creation of a program’s mission, goals, and objectives.
To prepare:
• Review the information presented in this week’s Learning Resources and conduct additional research of your own to learn about programs that have successfully involved various stakeholders in the target population.
By Day 3, post a cohesive scholarly response that addresses the following:
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• Why is it important for representatives from the target population to be involved in developing the goals and objectives for the program?
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• How could you involve the representatives from the target population in designing the program?
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• What strategies could be used to navigate disagreements or lack of interest?
Learning Resources
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
Readings
• Course Text: Designing and Managing Programs: An Effectiveness-Based Approach
•
o Chapter 6, “Selecting the Appropriate Intervention Strategy”
o Chapter 7, “Setting Goals and Objectives”
Chapter 6 introduces the notion of developing the program hypothesis as a critical feature of program design and a precursor to setting goals and objectives, which is addressed in Chapter 7. Both of these topics serve as a critical link between the earlier phases of problem analysis and needs assessment and the forthcoming design of services and program evaluation.
• Course Text: Assessment and Planning in Health Programs
•
o Chapter 7, “Identifying and Writing Mission Statements, Goals, and Objectives”
The authors provide guidance for developing a mission statement, program goals, and objectives in this chapter.
• Article: Compas, C., Hopkins, K. A., & Townsley, E. (2008). Best practices in implementing and sustaining quality of care. A review of the quality improvement literature. Research in Gerontological Nursing, 1(3), 209–216.
This article discusses the importance of a specific, measurable goal statement and the involvement of the client in this process as necessary components for a successful intervention, identified through a review of the literature.
• Article: Manthey, A., Bliss, D. Z., Savik, K., Lowry, A., & Whitebird, R. (2010). Goals of fecal incontinence management identified by community-living incontinent adults. Western Journal of Nursing Research, 32(5), 644–6 61.
This article uses semistructured interviews with the target population to establish goals for future efforts. It serves as an example of how to incorporate client-identified goals in creating interventions.
• Article: American Red Cross. (2011). Corporate: Ombudsman office. Retrieved from
http://www.redcross.org/about-us/governance/corporate-ombudsman
The American Red Cross is a large humanitarian organization that responds to emergencies and offers relief in times of disaster. Within this organization, it is the role of the ombudsman to address public concerns with the Red Cross. The Ombudsman office has created a strategic plan that clearly defines and delineates between its vision, mission, goals, and objectives.
Optional Resources
• Article: National Institute of Mental Health. (2007). The National Institute of Mental Health strategic plan. Retrieved from http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml
The National Institute of Mental Health conducts research to help work toward the treatment and prevention of mental illnesses. Its strategic plan offers an example of the importance and intricacies of vision, mission, goals, and objectives.
2A) Discussion 1: Psychosocial Factors in Health
Although the United States spends more money per capita on health care delivery, statistics indicate it is not a particularly healthy country. Over 50% of all preventable deaths in the United States are a result of unhealthy lifestyle behaviors (AACN, 2006). As epidemiologists explore essential questions such as how stressful life events and behavioral choices may influence an individual’s health, society wrestles with the distinction of what is actually within the control of an individual, and therefore relates to a personal responsibility for promoting well being, versus how larger-scale efforts can modulate psychosocial risk factors that result in population health problems.
In this Discussion, you will consider the connection between psychosocial risk factors and health outcomes. As you review the research literature, consider how you have come across this issue in your professional practice. As a nurse leader, what opportunities do you have to apply the information presented this week to promote improvements in population health status?
To prepare:
• Review the Learning Resources, focusing on the influence of psychosocial factors on health and disease.
• Locate at least two examples from the research literature of how these factors influence health. If necessary, conduct additional research using the Walden Library and credible websites.
• Examine strategies currently being employed to address these factors, including health promotion and disease prevention efforts.
• Ask yourself: How are these strategies designed to improve population health status?
By Day 3, post a cohesive scholarly response that addresses the following:
• Provide a brief summary of each example, including the influence of psychosocial factors on health and disease as discussed in the research literature. Cite your sources.
• What strategies are currently being used to address these factors? Support your response with examples from the literature.
• Knowing that there are psychosocial factors that influence acute and chronic diseases, what is the role of the nurse in probing for that information or in larger initiatives?
Second 2A)Discussion 2: Appraising the Literature
For the DNP-prepared nurse, it is important to hone skills related to reviewing and evaluating research literature to implement evidence-based practices. As you examine epidemiological research, in particular, it is essential to ask, “What are the strengths and weakness of the research method(s)? Are the data analysis and interpretation sound? Is there any evidence of bias?” This Discussion provides you and your colleagues valuable practice in critically analyzing research literature.
To prepare:
• With this week’s Learning Resources in mind, reflect on the importance of analyzing epidemiological research studies.
• Critically appraise the Oppenheimer (2010) and Elliott, Smith, Penny, Smith and Chambers (1999) articles presented in the Learning Resources using Appendix A in Epidemiology for Public Health Practice as a guide.
• Determine the strengths and weaknesses of the research methods and data analysis of each study.
• Ask yourself, “Is any bias evident in either study? What did the researchers do to control for potential bias?”
• Finally, consider the importance of data interpretation in epidemiologic literature and the issues that may arise if potential confounding factors are not considered.
By Day 5, post a cohesive scholarly response that addresses the following:
• Appraise the Oppenheimer (2010) and Elliott et al. (1999) articles, summarizing the strengths and weaknesses of each study.
• Analyze potential sources of bias in each study, and suggest strategies for minimizing bias.
• Suggest possible confounding variables that may have influenced the results of each study.
Readings
• Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
o Chapter 10, “Data Interpretation Issues”
o Chapter 15, “Social, Behavioral, and Psychosocial Epidemiology”
o Appendix A – Guide to the Critical Appraisal of an Epidemiologic/Public Health Research Article
In Chapter 10, the authors describe issues related to data interpretation and address the main types of research errors that need to be considered when conducting epidemiologic research, as well as when analyzing published results. It also presents techniques for reducing bias. Chapter 15 features psychosocial, behavioral, and social epidemiology. Appendix A includes criteria to consider when reading an empirical journal article.
Elliott, A. M., Smith, B. H., Penny, K., Smith, W. C., & Chambers, W. A. (1999). The epidemiology of chronic pain in the community. The Lancet, 354(9186), 1248–1252.
Retrieved from the Walden Library databases.
This article describes an early epidemiologic study on chronic pain. Carefully review this article noting the structure of the research design, assessment and data collection, and analysis strategies. You will refer to this article for Discussion 2.
Oppenheimer, G. M. (2010). Framingham Heart Study: The first 20 years. Progress in Cardiovascular Diseases, 53(1), 55–61.
Retrieved from the Walden Library databases.
The Framingham Heart Study is a landmark epidemiologic study that began in the 1940s. The author of this article reviews the history of the Framingham Heart Study and its contribution to population health. As you read this article, consider any sources of bias or potential conflict of interest. You will refer to this article for Discussion 2.
Phillips, C. V., & Goodman, K. J. (2004). The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives & Innovations, 1(3). Retrieved from http://www.biomedcentral.com/1742-5573/1/3
In 1965, Austin Bradford Hill worked on a paper that has become a standard in public health and epidemiologic study about how to make decisions based on epidemiologic evidence. Hill put forth strategies for inferring causation and stressed the need for considering costs and benefits when planning health-promoting interventions. Review this article, which examines how Hill’s strategies are often misused or misinterpreted.
Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, Supplement, (60), 1–114. Retrieved fromhttp://www.cdc.gov/mmwr/pdf/other/su6001.pdf. [Read pages 11–32]
This report consolidates national data on disparities in mortality, morbidity, behavioral risk factors, health care access, preventive health services, and social determinants of critical health problems in the United States by using selected indicators. The required section of reading introduces the social determinants of health and environmental hazards.
World Health Organization. (2011). Social determinants of health. Retrieved fromhttp://www.who.int/social_determinants/en/
According to the World Health Organization, “The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.” This article presents an introduction to social determinants of health.
World Health Organization. (2011). Social determinants of health: Key concepts. Retrieved fromhttp://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html
This article outlines key concepts related to the social determinants of health.
Healthy People 2020. (2011). Social determinants of health. Retrieved fromhttp://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
This website presents an overview of the social determinants of health and addresses how the information relates to Healthy People 2020.
UCL Institute of Health Equity. (2012). ‘Fair society healthy lives’ (The Marmot Review). Retrieved fromhttp://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review
In a report called “Fair Society, Healthy Lives” (also known as “The Marmot Review”) published in 2010, Professor Sir Michael Marmot and colleagues proposed evidence-based strategies for reducing health inequalities in England. This website features that report and supports ongoing work related to that challenge.
Optional Resources
• Genaidy, A. M., Lemasters, G. K., Lockey, J., Succop, P., Deddens, J., Sobeih, & Dunning, K. (2007). An epidemiological appraisal instrumental – a tool for evaluation of epidemiological studies.Ergonomics, 50(6), 920–960.
• Centers for Disease Control and Prevention. (2011). Social determinants of health. Retrieved fromhttp://www.cdc.gov/socialdeterminants/
2B Strengths and Barriers to Program Implementation
As you design your program, it is important to anticipate potential issues related to program implementation. Careful forethought can help you to minimize unnecessary stumbling blocks during implementation.
There are strengths and barriers associated with every program. What do you see as the key factors to be aware of for your program? Brainstorm key terms such as community, culture, environment, organization, client, bias, and ethics. Give consideration to the factors you come up with (along with those in the Learning Resources) as you proceed with this Discussion.
To prepare:
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• Review the information presented in the Learning Resources. What are some of the factors (e.g., community, organization, environmental, ethical) that you consider strengths or facilitators for your program?
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• Which ones do you think may pose a challenge for your program?
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• How do these barriers need to be addressed in your program design? How might the strengths be leveraged to help overcome the barriers?
By Day 3, post a cohesive scholarly response that addresses the following:
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• Analyze two or more community, client, organization, and/or environmental forces that may facilitate your program and two or more that may pose a challenge for your program.
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• Propose a strategy for addressing one of the barriers as a part of your program design.
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• Ask questions of your colleagues regarding how you might address the other challenge
Learning Resources
Required Resources
You may view this course video by clicking the link below or on the course DVD, which contains the same content. As a reminder, additional Learning Resources for the week are listed below the link. Be sure to scroll to the bottom of the web page to view the complete list of Required and Optional Resources.
If you experience technical difficulties viewing the course video through the link, please contact your Student Support Team at 1-800-WALDENU or support@waldenu.edu.
To view this week’s media resources, please click on the link below. Once you’ve opened the link, click on “Designing Effective Programs” then click the light purple box.
http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/8400/interactive_video_player/index.html
Media
• Course Video: Design and Evaluation of Programs and Projects
•
o “Designing Effective Programs” (featuring Dr. Donna Shambley-Ebron, Dr. Debora Dole, and Dr. Rebecca Lee)
Dr. Donna Shambley-Ebron, Dr. Debora Dole, and Dr. Rebecca Lee share experiences related to designing effective programs.
Readings
• Course Text: Assessment and Planning in Health Programs
•
o Chapter 4, “Program Planning: The Big Picture”
o Chapter 5, “Social Marketing, Program Planning, and Implementation”
o Chapter 8, “Identifying Strategies and Activities”
o Chapter 9, “Program Implementation”
Chapter 4 outlines the program planning steps and emphasizes the importance of including your target population and additional stakeholders in the design process. Chapter 5 reemphasizes this focus on the target audience as the authors discuss the use of marketing principles in relation to program development and implementation. Chapter 8 discusses the importance of utilizing strategies that are aligned with the theoretical foundations of a program, and presents recommendations for developing suitable activities. In Chapter 9, the authors note that even implementation requires planning; they provide guidance for implementation planning and advise how this can also support evaluation.
• Course Text: Designing and Managing Programs: An Effectiveness-Based Approach
•
o Review Chapter 6, “Selecting the Appropriate Intervention Strategy”
o Chapter 8, “Designing Effective Programs”
Review Chapter 6, which discusses the connection between the program hypothesis and service decisions. Chapter 8 addresses how to design elements of a program systematically in order to promote consistency and attend to the necessary details.
• Article: KIDASA Software. (n.d.). Gantt charts. Retrieved December 12, 2011, from http://www.ganttchart.com/Examples.html
This site provides examples of different forms of Gantt charts.
• Article: Microsoft Corporation. (2011). Create a Gantt chart in Excel. Retrieved from http://office.microsoft.com/en-us/excel-help/create-a-gantt-chart-in-excel-HA001034605.aspx
This site shows how to create a Gantt chart using MS Excel.
• Article: Mind Tools Ltd. (2011). Gantt charts: Planning and scheduling more complex projects. Retrieved from http://www.mindtools.com/pages/article/newPPM_03.htm
See this site for information on how to prepare and design a Gantt c
2 C)
Application 2: Program Design Elements
Program Design
With the continuation of Application 2, it is important to notice and appreciate the congruity provided through systematic program planning and evaluation. A well-developed program design facilitates the alignment necessary for an effective intervention, enabling the program to address the problem through appropriate services that—ideally!—result in positive outcomes.
This week you further delineate your program design, crafting elements visually and creating a time line using a Gantt chart.
To prepare for this week’s section of Application 2:
• Refer to the information presented in this week’s Learning Resources as you consider all of the elements of your program.
• Begin to visualize or draft a graphical representation of your program based on the theory or model you have chosen (Week 3) as demonstrated in Chapter 8 of Designing and Managing Programs. If your theory or model of choice does not have such a visual representation associated with it then you will need to create one.
• Also, in this design, state your mission, goal(s), and objectives for your program. State all activities that will assist in meeting each objective and outline this in a Gantt chart with time lines for implementing the activities.
The full Application 2 is due by Day 7 of this week. Instructions have been provided in previous weeks to help you prepare.
To complete:
Write a 3 page paper and create accompanying documents that address the following:
Stakeholder Involvement in Developing Mission Statement, Goals, and Objectives (developed in Week 5)
• Explain why it is important for representatives of your target population to be involved in developing the goals and objectives for the program.
• Identify which stakeholders you would involve in the planning process, and discuss two or more strategies for facilitating their involvement.
Program Design (developed this week, with elements developed in Week 5)
• Create a visual representation of your program design (e.g., a table or graph) that includes the program’s mission statement, goal(s), objectives, and activities to meet the objectives.
• Develop a Gantt chart with time lines for implementing all activities that will assist in meeting each of your program objectives.
3A) Measures of Effect
One important application of epidemiology is to identify factors that could increase the likelihood of a certain health problem occurring within a specific population. Epidemiologists use measures of effectto examine the association or linkage in the relationship between risk factors and emergence of disease or ill health. For instance, they may use measures of effect to better understand the relationships between poverty and lead poisoning in children, smoking and heart disease, or low birth weight and future motor skills.
What is the significance of measures of effect for nursing practice? In this Discussion, you will consider this pivotal question.
To prepare:
• With the Learning Resources in mind, consider how measures of effect strengthen and support nursing practice.
• What would be the risk of not using measures of effect in nursing practice?
• Conduct additional research in the Walden Library and other credible resources, and locate two examples in the scholarly literature that support your insights.
By Day 3, post a cohesive scholarly response that addresses the following:
• Analyze how measures of effect strengthen and support nursing practice. Provide at least two specific examples from the literature to substantiate your insights.
• Assess dangers of not using measures of effect in nursing practice.
Readings
• Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
o Review Chapter 3, “Measures of Morbidity and Mortality Used in Epidemiology”
o Chapter 9, “Measures of Effect”
Chapter 9 extends the discussion that began with Chapter 6 (which looked at ecologic, cross-sectional, and case-control study designs) by introducing additional measures that are useful in evaluating the potential implications of an exposure-disease association.
• Tripepi, G. Jager, K. J., Dekker, F. W. & Zoccali, C. (2010). Measures of effect in epidemiological research. Nephron Clinical Practice, 115(2), c91–c93.
Retrieved from the Walden Library databases.
As noted by the authors of this article (2010), “Measuring the strength of observed associations between a given risk factor (e.g., blood pressure) and a given outcome (e.g., stroke) is an important goal in epidemiological and clinical research” (p. c91). This article provides an accessible overview of the terminology and various methods used to measure associations in research.
Optional Resources
• Krethong, P., Jirapaet, V., Jitpanya, C., & Sloan, R. (2008). A causal model of health-related quality of life in Thai patients with heart-failure. Journal of Nursing Scholarship, 40(3), 254–260.
• Ibrahim, M., Alexander, L., Shy, C., & Deming, S. (2001). Common measures and statistics in epidemiological literature. ERIC Notebook, 17, 1–6. Retrieved fromhttp://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_17.pdf
• Goldin, R. (2008). Odds ratios.Retrieved from http://stats.org/stories/2008/odds_ratios_april4_2008.html
• Schmidt, C. O. & Kohlmann, T. (2008). When to use the odd ratio or the relative risk? International Journal of Public Health, 53(3), 165–167.
• Vineis, P. & Kriebel, D. (2006). Causal models in epidemiology: Past inheritance and genetic future.Environmental Health: A Global Access Science Source, 5, p. 21.
3B) Business Planning
Program planning, strategic planning, business planning. This Discussion asks you to consider the relationships and intersections between these essential forms of planning.
All programs should have a strategic plan, as well as a sound business plan to guide their endeavors. Although completing a robust business plan (or a strategic plan) is beyond the scope of this course, it is beneficial to understand how and why such a plan could be useful for your program. Give some thought to this as you engage in this Discussion with your colleagues.
To prepare:
•
• Review the information in the Learning Resources, focusing on Chapter 4 of Assessment and Planning in Health Programs (for the logic model), as well as additional resources on business planning such as the U.S. Small Business Administration website.
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• Conduct additional research on your own regarding the relationship between strategic planning and business planning, and consider how these relate to program planning.
By Day 3, post a cohesive scholarly response that addresses the following:
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• What is the prospective impact of a business plan on the strategic planning of a program? Support your response with references to the logic model and program theory models.
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• How does business planning relate to program planning? Support your response with an example from the literature.
Learning Resources
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
Readings
• Course Text: Assessment and Planning in Health Programs
•
o Review Chapter 4, “Program Planning: The Big Picture”
o Review Chapter 5, “Social Marketing, Program Planning, and Implementation”
As you review Chapter 4, focus on the budgeting information presented on pp. 113–115.
• Course Text: Designing and Managing Programs: An Effectiveness-Based Approach
•
o Chapter 10, “Budgeting for Control, Management, and Planning”
o Chapter 11, “Line-Item, Functional, and Program Budgeting Systems”
Chapter 10 introduces budgeting as an important part of the planning process, noting that it also serves essential management and control functions for programs. Chapter 11 addresses three systems of budgeting—line item, functional, and program—each of which has a distinct focus.
• Article: U.S. Small Business Administration. (n.d.). Writing a business plan. Retrieved December 12, 2011, from http://www.sba.gov/category/navigation-structure/starting-managing-business/starting-business/writing-business-plan
The “Writing a Business Plan” section of this website introduces elements of a good business plan, which is an essential document for any program. Investigate the information presented. In addition, see the “Preparing Your Finances” section for information on break-even analysis and other budgeting-related matters.
Optional Resources
• Article: Dirubbo, N. E. (2006). Break-even analysis: Can I afford to do this? Nurse Practitioner, 31(7), 11.
This article briefly explains break-even analysis and its use in initiating new programs.
• Article: McBryde-Foster, M. J. (2005). Break-even analysis in a nurse-managed center. Nursing Economic$, 23(1), 31–34.
This article explains how break-even analysis can be used in a nursing environment and how to apply it for program proposals
