Interest Groups And Their Influence On Public Policy

Interest groups are organized to create an influence in governmental policies. Interest groups abide by three structures: interest groups share common interests and goals, they are an organized structure, and they desire to influence public policy. Interest groups come in many different sizes and backgrounds but all are important to representatives and reelections. Interest groups typically release documents with representative â€Å"report cards† to indicate how well or not a representative is voting in Congress to that specific interest group’s standards. According to Congress and Its Members, members of Congress may face a primary challenge in the next election if their voting strays to far from their promises and pledges to certain issues. Report cards are based off of the members’ roll call voting and is based on a scale from zero to one hundred. The scores also affect whether or not a member of Congress will receive support and financial aid during campaign s. There can be plentiful of issues to worry about when casting a vote as a member of Congress. The scores can positively and negatively affect a member especially if a member is trying to win reelection (Davidson, 1981). These scores are not used to indicate whether an interest group favors a representative and is also not an indicator of whether or not a representative is â€Å"working† for an interest group. Through the use of interest group ratings, political scientists can determine how Representative Loretta Sanchez,Show MoreRelatedThe Influence of Interest Groups on Public Policy2075 Words   |  8 PagesThe Influence of Interest Groups Introduction An interest group is an association of individuals or organizations who share ideas and/or attitudes and attempt to influence public policy without trying to be elected. These groups may also be known as advocacy groups, pressure groups, or lobbying groups. Berman and Murphy (2011) note that American democracy is influenced by a number of well organized groups designed to persuade government policy toward a particular outcome. Although many distrustRead MoreAmerican Civil Liberties Union Of Michigan ( Aclu )1378 Words   |  6 PagesInterest Groups with a Mission to Help Flint Residents Gain Access to Clean Water Introduction Interest groups are collections of people with common interests, beliefs, concerns, or goals who advocate for public policies that coincide with their agendas. These groups are most influential when they are formal, have a standardized agenda for policy change, and are non-governmental actors. One of the most recent and crucial issues to many environmentally minded interest groups is the Flint water crisisRead More The Interest Group Essay1015 Words   |  5 Pages An interest group is a group that seeks a collective good, the achievement of which will not selectively and materially benefit the membership or activists of the organization. These organizations try to achieve at least some of their goals with government assistance. The difference between interest groups and political parties is that political parties seek to constitute the government, whereas interest groups try only to influence it. Some of the things that interests groups seek from governmentRead MoreModels of Public Policy1550 Words   |  7 PagesMODELS FOR POLICY ANALYSIS Uses of Models. The models we shall use in studying policy are conceptual models. Simplify and clarify our thinking about politics and public policy Identify important aspects of policy problems Suggest explanations for public policy and predict its consequences Selected Policy Models. INSTITUTIONALISM: POLICY AS INSTITUTIONAL OUTPUT Government institutions have long been a central focus of political science. Public policy is authoritatively determined, implemented, andRead MoreEconomic Inequality Of The United States910 Words   |  4 Pagesmeans that the top 1% of wealthy group is gaining more, but the middle and lower classes are hardly maintaining the same earnings or even making fewer profits than before, arguably the latter happens more often today. This controversial issue - the economic inequality that has been increasing significantly since the 1970s, seemingly attributed to the expansion of interest groups, which in turn negatively impacts the democracy in the United States. The interest groups in the United States started toRead MoreCorporate Internal Policy Interference : A Paramount Determinant Of The Mncs Direct Influence Over Government Policy1547 Words   |  7 PagesSection III – Corporate Internal Policy Interference A paramount determinant of the MNCs direct influence over government policy is the subsystem of government policy development that includes the intense cooperation and competition between external and internal interest groups. This policy subsystem includes powerful structural industry groups that utilize economic power to create alliances in government and directly influence policy development (Eisner, p. 137, 2007). This subsystem is stable inRead MoreSpecial Interests Groups and Political Participation Paper1102 Words   |  5 PagesSpecial Interest Groups and Political Participation There are many Special Interest Groups involved in the influence of public policy. The view about the influence these Special Interest Groups create is that their attempts are biased to their special interest and the interests of their clients. Unfortunately, the influence of the most well funded interest groups overshadows even the most well intentioned under funded interest groups. This paper will focus on one special interest group thatRead MorePolitical Parties And Interest Groups1088 Words   |  5 Pagesparties and interest groups are able to get citizens to participate in politics and political party participants or interest group members. This is a comparison and contrast paper. The following will be a comparison between political parties and interest groups. Three points will be mentioned. The first point will be the purpose, the second will be the role they play and finally three strategies parties and interest groups use to get people to participate. A political party is a group of dedicatedRead MoreWhy Voting Is Important For Public Policy853 Words   |  4 Pages Voting is very essential and one of the easiest methods to influence public policy. You just need to be registered, and go to a polling station. It is simple because the government encourages people to vote, to hear a broad range of opinions. It is a form of direct democracy because when you vote, it directly affects the side or issue you support. Your vote is one more supporting opinion for a candidate or issue that is counted. Some people may think that their vote won’t make a big differenceRead MoreThe Presidential Campaign And Obama s Administration970 Words   |  4 Pageswas interest groups and lobbyists. Obama had to deal with interest groups all throughout his presidency, whether it was dealing with Congress or his interaction with committees. Over time interest groups have taken on a larger and more important role in government. The intera ction between interest groups and Obama played an influential role in shaping his presidency. Special interest groups are a group of people, usually formally organized that share a common concern and wish to influence public

Importance Of Interpersonal Communication - 1539 Words

Interpersonal communication is a face-to-face interaction, something we all do in our daily lives. Even though everyone communicates, we all do it differently and at different degrees of experiences. Not everyone will be perfectionists at communicating and socializing, but there is always room for improvement to slowly build your way up and become more efficient and competent. If you are anything like me, I consider myself an advanced communicator under certain circumstances. I tend to communicate and am more talkative in a smaller environment. For example, I am more comfortable conversing with one other individual or in a small group than I am with a big crowd or in big classes. I will talk more and be more interested in the conversation†¦show more content†¦Three goals that fall under effectiveness include self-presentation, instrumental, and relationship. Self-presentation refers to how one presents self in a certain way for a certain situation. The goal is to present one self in a way you want others to make of you. Another goal is instrumental which relates to practical aims or desires. For example, if an individual’s aim is trying to borrow money from someone else, that would be considered an instrumental goal. The last goal mentioned is relationship which deals with a specific relationship an individual makes with another person. There are three main points involving a healthy relationship. The first point features how one initiates or establishes the relationship, which is essentially the easiest first step to do. The next point requires a slight effort from both parties to maintain a relationship with one another. The third and final point is deciding whether to stay or terminate the relationship. This last goal achievement is crucial because you want to keep all healthy relationships and dispose of any unhealthy ones. Appropriateness, the last component, refers to people’s reaction matching up to the different situation, culture, and relationship expectations (Comm 1500 workbook, 2017). A type of appropriateness includes self-monitoring which is simply a self observation. There are two degrees of this type: high self-monitoring and lowShow MoreRelatedThe Importance of Interpersonal Communication1186 Words   |  5 Pages------------------------------------------------- The Impact of Interpersonal Communication for Startup Business in TANRI ABENG UNIVERSITY ------------------------------------------------- English for Academic Purpose Naimy Zam Zam / Corporate Communication / 13.013 Abstract This research proposal contains the analysis about interpersonal communication in startup business The Impact of Interpersonal Communication in Startup Businesses Introduction These days, there are so many startupRead MoreImportance Of Interpersonal Communication996 Words   |  4 PagesTaking this Interpersonal Communication course has opened my eyes to the importance of effective communication as it relates to relationships. The information that I’ve learned has inspired me to take a deeper look into how I communicate with my husband. It has also provided an understanding regarding the differences in how he and I communicate. The communication style that I use is expressive, the style he uses is instrumental. He also interprets communication different than myself. I ve also noticedRead MoreThe Importance Of Interpersonal Communication1316 Words   |  6 PagesCommunication is vital to the survival of humanity. Without communication, people tend towards insanity, desperately craving human interaction. Yet many, including myself, are uninterested in learning the ways of communication: how it works, how to communicate well, and how to listen well. Interpersonal communication is â€Å"†¦a transactional process involving participants who occupy different environments and create meaning and relationships through the exchange of messages,† (Adler 12). CommunicationRead MoreThe Importance Of Interpersonal Communication1038 Words   |  5 PagesInterpersonal communication can be seen everywhere is vas locations, and is needed for relationships and the idea of yourself. In life, communication becomes very vital in continuing and maintaining these relationships, and having the ability at a competent level is a necessity.   When it comes to communication you’re either good at it or not as good, but there is always room for improvement. Interpersonal communication skills are learned behaviors that can be improved through knowledge, practiceRead MoreThe Importance Of Interpersonal Communication1091 Words   |  5 PagesHave you ever taken into consideration how your intrapersonal communication has an impact on yo ur interpersonal communication? Our interpersonal communication is communication that strives us to create and maintain relationships with others in our life. My interpersonal communication is solely based on my self-concept, self-image, how I perceive myself, my bad and good qualities, and my non-verbal communication. My expectations about myself or my self-concept influences how I communicate with othersRead MoreThe Importance Of Interpersonal Communication1032 Words   |  5 PagesCommunication is the behaviours, whether they be verbal or non-verbal, that one individual perceives from another (Judith Dwyer, 2016). The efficient communication between a sender and receiver plays a crucial role between organisations and personal use as it allows us as communicators, to comprehend the fundamentals and processes which flow from the sender, to the receiver to ensure a dynamic and clear communication is achieved. Effective communication plays a crucial role in the delivering of messagesRead MoreThe Importance of Studying Interpersonal Communication913 Words   |  4 PagesInterpersonal communication is an important day-to-day life skill that many people may go their entire life without formally learning about. Interpersonal communication is the communication between two or more people who are sendin g and receiving verbal or nonverbal language back and forth. The opportunity to study it at a college level is very important in that it can give you a more refined insight into how it works without needing to breeze over or amend certain segments for the audience. WithoutRead More The Importance of Interpersonal Communications in a Friendship1493 Words   |  6 Pagesfaults within our relationship, I knew it was time to act. Focusing on the Struggle Spectrum by the National Communication Association, I noticed that we were repeatedly climbing the struggle ladder and falling off the edge only to repeat it again. My younger, less educated version of myself would never have seen the problems but now, after years of college and my Interpersonal Communications class, I could see what needed to be done. I began by making a check-list of issues that I needed to work onRead MoreThe Importance Of Effective Interpersonal Communication Skills1264 Words   |  6 PagesInterpersonal commu nication is a fundamental skill that nurses use every day to interact and communicate. These skills include clinical empathy towards patients, diverse cultural understanding, non-verbal communication and skills used to communicate with deaf patients. This paper will discuss why it is important for nurses to use effective interpersonal communication skills and tips to overcome elderspeak to help minimize patient complains within the healthcare practice. To create a healthy nurseRead MoreImportance of Interpersonal communications in Information Technology Career907 Words   |  4 PagesInterpersonal communications can be a very important part of a person’s professional success. Information Technology is an industry that relies on certain areas of communication. Wendy, the person I interviewed, emphasized the importance that people in her industry must be up to date (educated) on the constant changes. Communication, gaining communication and interpersonal skills is again such an easier said than done skill for any profession. Communication is such an essential skill it could

My Ambition Essay Example For Students

My Ambition Essay From the bayonets of milatary personals to the razor sharp scalpel neurosurgeons, there is a vast army of occupations available for capable men and women of todays industrialized world. Ranging from lawyer to englineer. These people are the workforce of our nation. After much consideration and deep thoughts plus recommendation from friends and relative, I decided to be a practionner of medicine or better known as a doctor. The reason i chose this ambition generally because this is a noble job and it is financially rewarding. Naturally, I am a very kind-hearted person myself who finds satisfaction and pleasure in helping others who are weak and in need. Directly, this shows that a doctors job is compaitable to my characteristics. I also admire the valiant duty of a doctor saving lives of his patient with undivided care and passion. Besides, a doctor is known to be one of the most financially rewarding, knowledgeable and respected job in the world. In order to archieve this glorious ambition, I must study extremely hard. It would be very important to ace every important subject in my secondary education. From what I have heard, I must be very good im my Engligh language, chemistry, biology, physics, additional mathematics and modern mathematics in order to get one step closer to my ultimate goal of becoming a doctor. I should start burning the midnight oil to study whether I am in secondary school or a tertiery institude, or more specifically medicine school. Even though being a doctor is my dream, I know all too well that I must put in a massive proportion of hardwork so that my dreams would not be equivalent to building castles in the air. I pray that God will bless me with wisdom and knowledge and determination to endure the challengesI will meet. I also admit that I will need the moral and financial support of my family to archieve this dream. Through being a medical praticionner is only a choice out of the hundred thousands of the occupations, I would be ultimately estatic and sastifiedif I were to archieve it. I shall put in plenty of effort to nullified challenges that impede me from reaching my goal. With perseverence and hardwork, I know that I can finally acquire certificate that states P.hD Medicine and Surgery.

Nursing Informatics Essay Example

Nursing Informatics Essay NURSING INFORMATICS and the Foundation of Knowledge Introduction Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (McGonigle, 2009). Most hospitals now utilize computer systems to track patient health information. The purpose of this paper is to show how a computerized system can help the health care worker provide the best care for the patient by utilizing available programs that when implemented will aide staff in detecting weight gain in a patient with a diagnosis of heart failure. Concept Map The patient comes to the unit where admission history information is gathered, vital signs obtained and a head to toe assessment is completed. The patient has a diagnosis of hypertension and diabetes which is currently be treated with medication and is now having signs and symptoms of congestive heart failure (CHF). Nurses may generate and record the data from their own observations or with the assistance of various devices. In this way, data (often qualitative data that cannot be traditionally measured) can be organized and processed (McGonigle 2009). More information is needed so the nurse logs onto the hospital computer system and checks the patient’s previous admission history, including previous vital signs, lab results, and any testing that has been completed in the past few months for comparison. She also reviews physician notes, dietary, and social services for education given related to diagnosis of hypertension and diabetes. The nurse sorts through useful information that pertains to the patient’s current condition and complaints. The nurse notes the patient has gained some weight, her blood pressure is higher than previous readings and her mother ecently died from complications of CHF. The computer system allows the nurse to see results along a linear time line during any specific time chosen. This gives the nurse a clear picture of trending. The data is interpreted, organized and structured into useful information (McGonigle, 2009). The knowledge the nurse has acquired during her educational years combined with life experience allows her to put the signs and symptoms together to formulate the next step of action. She knows that the patient meets common criteria for CHF; the patient has a diagnosis of diabetes and hypertension, is overweight, an older female, is aving fluid retention in the lower extremities, shortness of breath and noted crackles in the lungs. The nurse anticipates the doctor will order various labs to check current levels of lipids, enzymes, BNP, liver, kidney and thyroid function that will be used to compare against past results, stored in the computer system for easy access. The doctor may also order chest x-ray, echocardiogram, check ejection fraction, and EKG/ECG to verify suspected diagnosis. All results are entered into the computerized system by each area of discipline and transferred into the a review results â€Å"tab† for easy access. We will write a custom essay sample on Nursing Informatics specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Nursing Informatics specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Nursing Informatics specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The information gained from testing will be synthesized so that relationships are identified and formalized (McGonigle, 2009). All disciplines have access to patient testing results via the computerized charting system, to assist them in formulating a plan of care for the patient while in the hospital and upon discharge to home. Wisdom is sometimes thought of as the highest form of common sense resulting from accumulated knowledge or erudition (deep, thorough learning) or enlightenment (education that results in understanding and the dissemination of knowledge) (McGonigle, 2009). A plan of action is formulated at this point based in knowledge. Daily weights are ordered and recorded, IV or oral diuretics, cardiotonics, vasodilators, and/or angiotensin inhibitors are ordered from pharmacy and sent to the unit via a house wide tube system. Medications are administered to the patient and routine labs obtained to monitor patient reaction to interventions. Other disciplines dietary, physical therapy, respiratory, and social services will meet with the patient to discuss patient care plan. Education will be provided to the patient and family members in relation to decreasing isk factors and barriers for compliance. Patient will have access to a computer educational program called, EMMI Manager. It is a website that addresses a variety of diagnosis in common language. INNOVATIONS Background In today’s world of technology, it is imperative that health care facilities stay current with the ever changing electronic health record (EHR) systems. EHR a computer- based data warehouse or repository of information regarding the health status of a client, replacing the former paper based medical record; it is systematic documentation of a lient’s health status and health care in a secured digital format, meaning that it can be processed, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high quality health care across the client’s healthcare continuum (McGonigle, 2009). The one that is utilized in the IU Health care system is called Cerner. Cerner has consistently been ranked among the nation’s leading information technology providers and the company’s healthcare products have won numerous awards (Answers, 2012). It has layer after layer of programs and connective ites that are not, nor probably ever will be, fully utilized. It is possible to add task and warnings to the system to meet the needs of the hospital and staff. The EHR system helps move simple data into the information realm and converts it into usable knowledge based on the input which allows the system to send a pop-up notice directing the staff member to utilize their wisdom to notify the doctor because the patient’s condition has changed. Projected costs The Cerner system is currently in use but, any changes that are made to the system needs to be approved. In this instance a pop-up tab is requested by nursing that ill automatically alert the nurse of weight gain within specified parameters for the patient with heart failure (HF). An example of how it will work is, the patient is weighed daily and the program will keep a running total of any weight gained or lost and show the total based on a three and five day course that will signal a pop-up if the patient’s weight is 3 or more pounds in 3 days or more than 5 pounds in 5 days. The nurse will see the pop-up tab and notify the doctor, so an intervention, usually a diuretic can be administered. The floor nurses will bring their idea to the Unit Based Council (UBC) it is pproved and moves on to the Professional Nursing Council (PNC) for approval. It is then taken to the Clinical Information System (CIS) team. If they feel it is a worth while project they in turn take it to the IU Health board of directors for approval. P. Smith head of the CIS team claimed the basic cost for the added feature is approximately $9,600, broken down as follows; it will require 4 computer technicians working for approximately 48 man hours each at $50. 00 an hour, before it is available to use (personal communication, March 12, 2012). S. Holloway head of the Education epartment at the hospital added that the nurses will need to be in-serviced relating to its features and use. With approximately 2800 nurses using the system at IU Health Ball Memorial Hospital, it will require 15 minutes of individual training via a learning module system (LMS) to understand how to apply and utilize the tab for the designated patients. The average pay for nurses is $22. 00 an hour which works out to a cost of $15,400 provided all of them stayed after their shift to complete the 15 minute LMS. The technical support and maintenance would be included in the current system contract personal communication, March 13, 2012). Projected Benefits This technology impacts the quality of care at the bedside by increasing response to a possible critical health value. A timely intervention to the patient may mean a difference in length of stay in the acute care setting. The projected benefits are an increase in positive outcomes to the patient wit h HF with fewer set backs. Stakeholders The biggest stakeholders are the nurses. By having a system in place to calculate weight gain on a continuing day by day bases, it reduces the time spent changing the ates and scrolling back and figuring the changes with paper and pencil from the values in the computer. The pop-up warning will assist the nurse by decreasing the chance of error related to miscalculations or oversights and notifying the doctor of changes sooner. Gaining the nurses buy-in is relatively easy, by pointing out the benefits they will gain by not having to take the time to figure the weight for three and five days every day. The nurses would be asked to participate in the build to offer suggestions as to where the tab will pop-up, on the task list or right on the screen where the weights are recorded. Evaluation The Heart Failure Team at the hospital has a subgroup that is monitoring patients with HF diagnosis who readmit for HF in less than 30 days. They discovered during a random chart check that 4 out of 36 patients in post acute care, had a weight gain greater than the set parameters and the doctor was not notified in a timely manner, to order a diuretic. The four patients were sent to cardiac care for treatment related to complications that could have been avoided with a timely administration of a diuretic. An increase in positive outcomes for HF patients would significantly increase our patient rust and satisfaction scores. The Heart Failure Team subgroup will continue to monitor timely notifications to doctors, of HF patients who have weight gain outside the parameters and report back to the Team on monthly bases to evaluate its effectiveness. The lead CIS nurse P. Smith also added that she is taking our idea a step further by checking into the possibility of the Cerner system being able to â€Å"shoot† a notice to the attending doctor via the Cerner system, letting him know that his patient has had a weight gain outside the set parameters. So if the nurse forgets or gets busy he will still be otified and can act on the changes (personal communication March 13, 2012). Competencies How Nursing Informatics competencies impact the use of technology for transforming data to wisdom. The concept map moves data to wisdom on a patient who presented with signs and symptoms of congestive heart failure (CHF). Heart failure is a serious medical condition where the heart does not pump blood around the body as well as it should. This means your blood can’t deliver enough oxygen and nourishment to your body to allow it to work normally. It also means that you can’t eliminate waste products roperly leading to a build up of fluid in your lungs and other parts of your body, such as your legs and abdomen (Heart Failure Matters, 2012). A build up of fluid increases weight and may indicate worsening of condition Data to Information Data is raw information gathered objectively without interpretation. (McGonigle, 2009). The data collected from the concept map is entered into the patient’s electronic health record (EHR) by the nurse. Being able to input data into the EHR correctly is imperative for patient safety and positive patient outcome. The nurse inputs vital signs, ssessments, medical history, and medication orders. The results of ordered patient testing example; chest x-ray, echocardiogram, lab results ordered is interred by the appropriate departments. All the data migrates to corresponding tabs in the patients EHR. Past medical history can also be found here, so if the patient leaves out information from previous visits, it is still available to the care giver. This is the essential information that must be available in a common data base to support patient care (QSEN, 2009). The nurse must be educated on the use of the EHR so she will be able to place meaning to all he information contained there and be able to pull that information upon request. Information to Knowledge Information is data that are interpreted, organized or structured. The data derived from direct care of an individual may then be complied across persons and aggregated for decision-making by nurses, nurse administrators, or other health processionals (McGonigle, 2009). Navigate the electronic health record (QSEN, 2009). By assessing the patient EHR the care giver can compare past values with present values. In a patient with CHF it is imperative that the patient be weighed accurately every day. The nurse eeds to know how to calibrate and zero out a free standing or bed scale for an accurate daily weight. This is just as important as knowing the patient should be weighed at the same time of day, wearing the same type of clothing or that the bed should contain the same amount of bedding for a more accurate weight. A weight gain of 2-3 lbs. per day or more than 5 lbs. in 5 days should be reported to the physician immediately as it could indicate a decrease in t he heart function. An alert feature that will notify the nurse of a weight gain, over the recommended period of time would assist the nurse in physician otification in a timely manner, leading to a more positive patient outcome. Knowledge to Wisdom Knowledge is information that has judgment applied to it or meaning extracted from it. Wisdom is knowledge applied in a practical way or translated into actions; uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters (McGonigle, 2009). Value technologies that support clinical decision-making, error prevention and care coordination (QSEN, 2009). The EHR is a form of technology that is invaluable to the health care field. All of the patient nformation is a click away for the care giver. The timeline side by side comparison for information necessary to make an informed decision related to patient care increases response time. Front line users are the first line of defense as to what types of programs could be added on to current systems to prevent errors, and should be included in meetings for system updates. Care coordination can be better utilized using the EHR when access to the system is so easy and all discipline notes migrate to the patient record. Conclusion The benefits of having a pop-up warning system, to alert the nurse when a atient has had a weight gain outside the set parameters, will increase efficiency related to doctor notification. When the doctor is notified sooner an intervention can be implemented sooner to improve patient outcome. Quicker intervention may lead to faster recovery, shorter hospital stay, improved quality of care, patient satisfaction, and reducing cost to patient and/or the insurance provider. With a growing focus on patient satisfaction, medical intervention that will support better patient outcomes and better care will improve patient satisfaction scores as they relate to direct nursing care and satisfaction with the doctors. All patients expect and deserve the best care every day. References Answers. com. Cerner Corporation, 2012. Retrieved March 11, 2012 from; http://www. answers. com/topic/cerner-corporation. Heart Failure Matters, 2012. Retrieved March 21, 2012 from; http://www. heartfailurematters. org. McGonigle, D. Mastrian, K. , (2009). Nursing Informatics and the Foundation of Knowledge (pp. 85,450, 459, 480). Sudbury, MA. Jones and Bartlett Quality and Safety Education for Nurses (QSEN), (2009). Quality and safety competencies. Retrieved March 1, 2012 from: http://www. QSEN. org/competencies.