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The scenario described herein is in grounded in geriatric medicine, and utilizes the NANDA, NIC, and NOC elements to link the various components in standardized language to the data, information, knowledge, and wisdom associated with this exercise. The key parts of the paper are as follows: 1) Introduction; 2) nursing diagnosis (NANDA), including actual diagnosis, risk diagnosis, and wellness diagnosis; 3) nursing outcomes classification (NOC); 4) nursing interventions classification (NIC); 5) conclusions.
The patient is an elderly woman with early stage dementia, who reports her age as 87 years. The patient's family brought her to the clinic because she has been complaining of malaise and refuses to receive help with dressing, both of which are unusual for the patient. Vitals were taken and all are within normal range, except that the patient had a temperature just above 37.9C. Examination revealed that the patient was experiencing suprapubic…
Beveridge, L.A., Davey, P.G., Philliops, G. & McMurdo, M.E.T. (2011, June). Optimal management of urinary tract infections in older people. Clinical Interventions of Aging, 6, 173 -- 180. . doi: 10.2147/CIA.S13423. PMCID: PMC3131987
Mellen, C.K., Ford, M., & Rindone, J.P. (2010, July). Effect of high-dose cranberry juice on the pharmacodynamics of warfarin in patients. British Journal of Clinical Pharmacology, 70(1), 139-142. doi: 10.1111/j.1365-2125.2010.03674.x.
Nicolle, L.E. (2000). Asymptomatic bacteriuria in institutionalized elderly people: evidence and practice. Canadian Medical Association Journal (CMAJ),163(3), 285 -- 286.
The client is a 78-year-old female. She has been divorced for 30 years. She is retired. Her social class is upper middle class. Her medical history is free from significant trauma. She had six hospitalizations, all for childbirth, and one surgery; a cesarean section combined with a tubal ligation. She has two chronic health conditions: high blood pressure and chronic obstructive pulmonary disease (COPD). She is a former smoker. She lives with an adult son and her other children live nearby. She was a domestic violence victim for the 20 years of her marriage and has some lingering physical problems (an improperly healed broken rib) and emotional problems from that period of abuse. Her parents, a younger brother, and two of her children predeceased her.
The patient is not currently suffering from any acute medical issues. She does have two significant chronic medical issues: high blood…
Friedman, G.D., Asgari, M.M., Warton, E.M., Chan, J., & Habel, L.A. (2012).
Antihypertensive drugs and lip cancer in non-Hispanic whites. Arch Intern Med, 172(16): 1246-51. doi:10.1001/archinternmed.2012.2754.
Goren, A., Annunziata, K., Schnoll, R.A., & Suaya, J.A. (2014). Smoking cessation and attempted cessation among adults in the United States. PlosOne, 9(3): e93014. doi: 10.371/journal.pone.0093014
Hoonhorts, S.J., Ten Hacken, N.H., Lo Tam Loi, A.T., Koenderman, L., Lammers, J.W.,
Geriatric Patient Assessment
Blood Pressure: 110/70
Pulse Oximetry: 97% on room air
General Appearance: Fairly good, decently nourished. Non-toxic, Ambulatory female
Mental Status: Patient is alert and fully oriented times 3 . . . .Glasgow coma scale is
Heart: Mild tachycardia
Lungs: Clear, no noticed issues
Extremities: Pulses are symmetric and seem to be intact
Known Issues/Comorbidities: Type II (Adult Onset) Diabetes, family history of heart disease and arthritis
2A) MMSE will be attached
Pulled from: http://www.dementiatoday.com/wp-content/uploads/2012/06/MiniMentalStateExamination.pdf
2B) KATZ Index will be attached
Pulled from http://micmrc.org/system/files/11.2-ADL.pdf
Vitals fairly in line what is expected a normal for patient of this age, family/patient history of type II diabetes but fairly well controlled, mild arthritis but decently controlled, no sign of heart disease despite family history
4) Patient is putting on a little weight, lives a mostly sedentary lifestyle (but not abnormally so for age bracket), diet a…
Mayo. (2017). Low blood pressure (hypotension) Treatments and drugs - Mayo Clinic. Mayo Clinic. Retrieved 4 April 2017, from http://www.mayoclinic.org/ diseases-conditions/low-blood-pressure/basics/treatment/con-20032298' target='_blank' REL='NOFOLLOW'>
hat is the best way to assure that older people are well cared for in an acute healthcare setting? hat are the roles that nurses should play when it comes to providing the best possible care to older, frail people? These questions will be addressed in this paper using scholarly research from the available literature.
Advanced nursing skills for frail older people
Sarah Goldberg is a senior clinical academic nurse at the University of Nottingham's University Hospitals, and she writes in the journal Nursing Older People that an "innovative solution" in terms of providing the necessary skilled care to older people is to train experienced nurses to become "advanced nurse practitioners (ANPs) (Goldberg, 2014). An advanced nurse practitioner will be able to conduct comprehensive geriatric assessments, which will be important given that many very old and frail patients have "cognitive impairment, depression and anxiety," which can lead to…
Goldman, S. (2014). Developing Advanced Nursing Skills for Frail Older People. Nursing Older People, 26(4). 20-24.
Krail, E., Close, J., Parker, J., Sudak, M., Lampart, S., and Colonnelli, K. (2012). Innovation
Pilot Study: Acute Care for Elderly (ACE) Unit -- Promoting Patient-Centric Care. Herd Journal, 5(3), 90-98.
The Argument -- She Could be Given a Transplant
I could not find a prohibition against liver transplants for those 70 or over, but there is a good deal of information in the literature supporting transplants for older people. In the PubMed section of the National Institutes of Health a study of 1,446 "consecutive liver transplant recipients was conducted" and 241 elderly patients (over 60) in that group were compared with younger counterparts. The conclusion: "Low-risk elderly patients fare as well as younger patients after liver transplantation" (Levy, et. al, 2001).
Meanwhile, Dr. Gerald S. Lipshutz, assistant professor of surgery at the David Geffen School of Medicine at the University of California reports the results of the findings at the orld Transplant Congress in 2006. In a study of 62 patients (Group I) between the ages of 70-79 that had received liver transplants -- compared with a group of 864…
Flaman, Paul. "Organ and Tissue Transplants: Some Ethical Issues." St. Joseph's College, the University of Alberta. Retrieved June 23, 2011, from http://www.ualberta.ca/-pflaman/organtr.htm . (2001): 1-14.
Kahn, Katherine. "Age Alone Does Not Affect Outcome of Liver Transplant in Elderly."
Medscape Medical News. Retrieved June 24, 2011, from http://www.medscape.com . (2006): 1-2.
Levy, Marlon, Somasunder, Ponnandai S., Jennings, Linda W., Jung, Ghap J., Molmenti,
With the help of a thorough clinical evaluation, the risk factors, risks associated with falling and working out adequate intervention methods to curb the rate of elderly falls can be achieved. As per the 2011 AGS / BGS guidelines, (Panel on Fall, 2011) certain particulars need to be incorporated in a particular clinical evaluation: 1: Patient history, physical examination, mental and physical functionality; 2: Number of falls occurring, number of medications taken; issues regarding mobility, balance and gait; blurred eyesight; various mental disabilities; weak muscular strength; uneven heartbeat and rhythm; postural hypotension; problems in feet and risks related to environment (Shubert, 2014).
Strategies to Prevent Elderly Falls and Health elated Consequences
Assistive Devices and Other Protective Equipment: Appropriate footwear is required for particular conditions, for instance, wintery weather necessitates anti-slip shoes whilst warmer weather requires cleated footwear, facilitating decreased falls (Panel on Fall, 2011).
Clinical Disease Management (Acute…
Clemson, L., Mackenzie, L., Ballinger, C. & Close, J.C.T. (2008). Cumming RG. Environmental interventions to prevent falls in community-dwelling older people: A meta-analysis of randomized trials. J Aging Health. 20(8):954-971.
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., and Cumming, R.G. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. (2), Art.No.: CD007146
Panel on Fall prevention in Older Persons, American Geriatrics Society and British Geriatrics Society, (2011). Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc.;59(1):148-157.
Scott V, Gallagher E, Higginson A, Metcalfe S, & Rajabali F. (2011). Evaluation of an evidence-based education program for health professionals: The Canadian Falls Prevention Curriculum (CFPC). Journal of Safety Research. 42(6):501-507.
Patient Access to Experimental Drugs
Experimental drugs are being used in treating cancer and other life-threatening diseases in the hopes that effective cures and treatments can be identified. There are however, ethical questions relating to the use of experimental drugs and this work seeks to answer the question that asks whether patients should have access to experimental drugs and to answer why or why they should not have this access.
Experimental drugs have carved inroads to treating cancer patients and most recently; this has been reported in the form of a drug that serves to "neutralize two mechanisms cancers need to survive." (Coghlan, 2012) The new drug is Cabozantinib. This drug is reported by one individual interviewed in this study to have been used by a family member who died while taking the drug for non-small cell carcinoma in the form of lung cancer. When asked the question…
Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from: http://books.google.com/books?id=_14H7MOw1o4C&source=gbs_navlinks_s
Coghlan, A.K (2012) New Cancer Drug Sabotages Tumor's Escape Route. 24 Feb 2012. New Scientist. Retrieved from: http://www.newscientist.com/article/dn21516-new-cancer-drug-sabotages-tumours-escape-route.html
Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from:
DIAGNOSIS AND TREATMENT PLAN
Diagnosis and Disease Processes
Using an appropriate patient assessment form (Sample Forms, 2013), D.M. has been found to have uncontrolled Type 2 diabetes, hypercholesterolemia, uncontrolled hypertension, chronic anemia, and probable hypothyroidism (Sample Forms).
Diabetes Type 2
is most probably on a poorly controlled diet of high cholesterol and high simple sugars. Diabetes mellitus type 2 is a metabolic disease wherein the body is not able to properly use ingested food because of insulin resistance. If more simple or refined sugars are consumed, the less the body is able to process them as nutrients. These tend to stay and float in the blood stream, un-used, and in this condition, they cause trouble in the different parts of the body. These include the end organs, such as the brain, the eyes, the kidneys, the heart, and even the feet. A poorly controlled diet and the lack…
Glasgow, R.E., et al. (2005). Development and validation of the patient assessment of chronic illness care. Vol. 43 # 5, Medical Care: PuMed. Retrieved on October 15,
2014 from http://www.ncbi.nlm.nih.gov/pubmed/15838407
Sample Forms (2013). Patient assessment form. Sample Forms.org. Retrieved on October 15, 2014 from http://www.sampleforms.org/patient-assessmentform.html
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge…
Mitigating isks from Dementia
Providing adequate care for an individual suffering from dementia presents many difficulties for nurses. Patients with dementia often have debilitating conditions such as Alzheimer's or similar neurologic diseases which are progressive, thereby making it challenging for them to remember, think lucidly, communicate effectively or complete activities of daily living. Furthermore, dementia can cause rapid variations in mood or even modify personality and behavior. With the tremendous number of elderly in society more and more nurses are required to care for patients with progressive dementias. It is imperative that a diagnosis be reached early in the course of the cognitive impairment and that the patient is closely monitored for coexisting morbidities. Nurses have a central role in assessment and management of individuals with progressive dementia. This essay provides some evidence-based practical strategies for managing the behavioral problems and communication difficulties often encountered in this population.…
Aud, M.A., Oliver, D., Bostick, J. And Schwarz, B. 2011. Effectiveness of Social Model Care Units for Dementia. International Nursing Research Congress 2005.
Care, N.D. 2010. Teaching and Learning. Pulse. Winter Edition.
Fletcher, S. And Zimmerman, S. 2010. Trainee and trainer reactions to a scripted dementia care training program in residential care/assisted living settings and nursing homes. Alzheimer's Care. 11(1): 61-70.
Goodman, C. 2011. The organizational culture of nursing staff providing long-term dementia care is related to quality of care. Evidence-Based Nursing. 47:1274-1282.
The main focus of this essay is going to concern the nurse-patient relationship idea, and why it is important. This was chosen because the researcher desired to achieve a better accepting of how a helpful nurse-patient relationship can be advanced and even from different theorists who have discovered this idea. In this essay, the researcher sets out to demonstrate what they have learnt regarding the nurse-patient relation concept and how this connection can utilized in the clinical practice setting. T The nurse patient connection, according to a study done by Press Gamey Associates Inc., creates the quality of the care experience and generates an influential influence on patient gratification. Nurses will a lot of their time with patients. Patients see nurses' relations with people among the care team and make their own conclusions about the hospital founded on what they are observing. Furthermore, nurses' approaches toward their vocation,…
Berdes, C. & . (2001). Race relations and caregiving relationships: A qualitative examination of perspectives from residents and nurses aides in three nursing homes. Research on Aging, 23(1), 109-126.
Biering, P. (2002). Caring for the involuntarily hospitalized adolescent: The issue of power in the nurse-patient relationship. Journal of Child and Adolescent Psychiatric Nursing, 16(2), 65-74.
Heijkenskjold, K.B. (2010). The patients dignity from the nurses perspective. Nursing Ethics, 6(3), 313-24.
LaSala, C.A.-B. (2007). The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes. The Journal of Continuing Education in Nursing, 38(6), 262-70.
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…
Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.
Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.
Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.
Digiovine, B; Chenoweth, C; Watts, C; Higgins, M (1999)The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. RespirCrit Care Med, 160:976-981.
" (Stone, 2006) Treatment is stated by Stone (2006) to be "diagnosis dependent and may be medical or surgical." Practical modifications include simple steps such as crushing of pills or opening of capsules to ease and facilitate swallowing.
The work of Leibovitz, et al. (2007) entitled: 'Dehydration Among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia" states that long-term care (LTC) residents in the nursing home "especially the orally fed with dysphagia are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly." (Leibovitz, et al., 2007) it is related however that "combinations of these indices are more reliable." (Leibovitz, et al., 2007) the study reported by Leibovitz et al. is one that assessed hydration status among elderly LTC residents with oropharyngeal dysphagia and in which a total of 28 orally…
Spieker, Michael R. (2000) Evaluating Dysphagia. American Family Physician 14 Jun 2000. Online available at http://www.aafp.org/afp/20000615/3639.html
Marik, Paul E. And Kaplan, Danielle (2003) Aspiration Pneumonia and Dysphagia in the Elderly. Chest. July 2003. Vol. 1224, No. 1. Online available at http://www.chestjournal.org/content/124/1/328.full
Bautmans, I., et al. (2008) Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization. J. Rehabil Med. 2008 Oct;40(9):755-60. PubMed Online available at http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18843429
Stone, Rebecca S. (2006) Dysphagia in the Elderly. Inpatient Times. October 2006. Online available at http://www.bmc.org/geriatrics/RStone_DysphagiaintheElderly.pdf
In addition, those who are emotionally troubled and who are overweight -- often a contributing factor to emotional difficulties -- do not receive extra counseling time." Seale, Seale & Zhang (2008, p.425) This is a serious concern and one that must be addressed immediately by physicians who are providing care for obese patients.
A lot of revamping has to be done to meet this increased need of obese elderly and this has to be done fast. The numbers are increasing by the day and unless some initiatives are taken right away, it can blow up into a full-fledged catastrophe in the future. The first and foremost step that is required is to change the present healthcare system to make it more effective and efficient. Changes have to be made in the delivery of service as well as payments to make it more accessible to the elderly.
Another important step…
Arterburn, David E. (2004). The Coming Epidemic of Obesity in Elderly Americans. Journal of the American Geriatrics Society. 52(11). 1907-1912
Odilia I; Bermudez; Tucker, Katherine L. (2001). Total and Central Obesity among Elderly Hispanics and the Association with Type 2 Diabetes. Obesity Research (9), 443 -- 451; doi: 10.1038/oby.2001.58
Thompson, Dennis. (2009, December 31). As U.S. Ages, Health Care May Need to Change. HealthDay Consumer News Service.
Dutton, Drake, D; Engelke. K; McAuliffe, M; Rose, M., (2005). Challenges that nurses face in caring for morbidly obese patients in the acute care setting. Surgery for Obesity and Related
For instance, a decline in peripheral vision may impact the ability to pass approaching vehicles safely, and the decreased range of motion in an older person's neck may impair the ability to look behind when backing up. Also, reaction time decreases by almost 40% on average from age 35 to 65 (Jackson, 1999).
It also appears that the aging process may affect cognitive skills. Short-term memory loss, for instance, can decrease driving skills by interfering with an individual's ability to process information effectively when merging onto a highway into traffic or changing lanes. Such issues are magnified when driving under stressful situations. The higher incidence of cognitive impairment, particularly dementia, among older men and women leads to an increased risk of accident involvement (Jackson, 1999).
According to AAP, as a group, persons age 65 and older are relatively safe drivers. Although they represent 14% of all licensed drivers, they are…
Bedard, M., Stones, M., Guyatt, G. & Hirdes, J. (2001). Related fatalities among older drivers and passengers: past and future trends. The Gerontologist. 41 (6), 751-57.
Beers, M.H. & Berkow, R. (eds.) (2000) the Merck Manual of Geriatrics. 3rd ed. Whitehouse Station, NJ: Merck & Co.
Central Intelligence Agency (1998). World Fact Book Washington, D.C.: Government
Pressure Ulcers in the Elderly
Dr. Judi Kuric
DNP Project Question
Will Every Two Hourly Turning and Positioning Decrease Pressure Ulcers in the Elderly Bed Bound Population in Nursing Home.
Will Every Two Hourly Turning and Positioning Decrease the Pressure Ulcers in the Elderly Bed Bound Population in Nursing Homes.
Pressure ulcers are a common cause of immobility among the elderly, which results in immense pain, suffering, and substantial costs with charges because of increased length of stay in the nursing homes. Prior studies suggest that patients who receive care in accordance to evidence-based guidelines are not at risk of developing pressure ulcers. However, the empirical evidence on the effectiveness of the measures is inadequate. Nevertheless, frequent manual repositioning of patients is a firmly established standard of care for the elderly; although there has been no much evidence on the same, experts suggest that…
One important aspect of nursing home living is that most of the time the people living there are helpless to accomplish many tasks that are part of everyday living. The employees are trained (for the most part) and as one study found it is "important to assess whether nursing staff levels and skills are meeting nursing home resident care needs" (Zhang, Unruh, Wan, 2013, p. 290). For example, incontinence is a significant risk factor for skin breakdown. The moisture changes the chemical balance of the skin, and often without adequate ventilation and care, a route for bacterial infection. In either case, pressure on the wound area, increased bacteria and moisture, all contribute to the lesions becoming rather serious (Gefen, 2008).
Many of the employees are taught to turn the elderly in their beds to relieve pressure, presumably thereby lowering the incidence of pressure ulcers. According to Fossum et al., "pressure ulcers can be prevented if residents at risk are identified early and relevant preventive measures are implemented" (Fossum, et al.,, 2011, p. 2429).
Current research shows that, at least in nursing homes, employees have a cognitive nature concerning pressure ulcers (amongst other things) and the positive results from taking preventive measures. Much of the current literature espouses the fact that nurses are trained to do so, but there is not really a lot of specific information on
affordable Care Act (also known as the ACA or Obamacare) on the elderly
Obamacare: Its impact upon the elderly
The impact of the Affordable Care Act (ACA) (often called 'Obamacare') upon America is often discussed by politicians as if it had a uniform impact upon all citizens. However, the ACA's effects have been relatively disparate, depending upon the nature of the population. This paper will specifically focus upon the impact of the ACA on the elderly of a variety of socio-economic categories.
One of the criticisms of the American healthcare system before the passage of the ACA was the spiraling cost of entitlement programs such as Medicare, the federally-provided health insurance program for seniors. "One good result of all this [ACA] is that the burden of Medicare for taxpayers in future years has been drastically lowered. In fact, the day Barack Obama signed the ACA into law he cut the…
ACA. http://www.hhs.gov/healthcare/rights / Accessed November 6, 2014.
FAQ: What retirees and seniors need to know about the ACA? NPR. October 11, 2013.
http://www.npr.org/2013/10/11/231101137/faq-what-retirees-and-seniors-need-to-know-about-the-affordable-care-act Accessed November 6, 2014.
Goodman, John. What seniors have to fear from Obamacare? Forbes. October 28, 2014.
Healthcare for Mentally Impaired Patients
Probing what information is available about the current status of placement or accommodation and level of personal healthcare available to mentally impaired and emotionally disturbed individuals, it is clear that the analysis is as diverse as there are different mental illnesses. While statistics on managed care treatment for people with severe and disabling mental illnesses are sparse, it is evident that the financial responsibility to care for and house these patients is enormous.
According to Dr. David Satcher, the Surgeon General (1999), approximately 20% of the U.S. adult population has a mental illness. He says, "These illnesses include anxiety disorders, mood disorders, anorexia nervosa, and severe cognitive impairment. More serious mental illnesses include ipolar disorder and schizophrenia. Mental illness accounts for 15% of overall burden of disease -- more than malignant cancer and respiratory diseases -- and as far back as 1996 the direct cost…
Boulard, G. (2000, April). Forgotten Patients the Mentally Ill. State Legislatures, 26, 12. Retrieved February 13, 2004, from Questia database, http://www.questia.com .
Callahan, D. (1993, October) Minds and hearts: priorities in mental health services.
The Hastings Center Report.
Fox, M. & Kim, K. (2004, January) Evaluating a Medicaid Home and Community-based Physical Disability Waiver. Family and Community Health. Vol 27: 37.
Fact sheet on end-of-life care. American Psychological Association. http://www.apa.org/pi/eol/factsheet1.pdf
Fact sheet on end-of-life care, published by the American Psychological Association discusses the adult's mental health needs near the end of life and the obstacles they confront to having a comfortable death.
Foley, K.M., (1995). Pain, Physician assisted dying and euthanasia. Pain 4, 163-178.
Foley discusses how access to and delivery of pain treatment are seriously deficient in the present health care systems in the United States. The author advocates expanding services and resources to care for the dying patient.
Isaacs, S.L. And Knickman, J.R (1997). To improve health and health care. San Francisco, CA: Jossey ass.
Isaacs and Knickman examine programs of the Robert Wood Johnson Foundation, a health care philanthropy. They reports its history, evaluates its effect, and discusses lessons learned as well as provide a frank discussion of why some problems can't be easily solved.
Langer, G. (2003,…
Bernstein, S. (1997, September 30). An act of mercy or murder?
Bernstein includes opinions (both pro and con) on whether services be available to any patient who is terminally ill and facing certain death within six months.
Coleman, C.H. And Miller, T.E. Stemming the tide: Assisted suicide and the Constitution. http://law.shu.edu/faculty/fulltime_faculty/colemaca/pdf_docs/coleman_miller_watermark.pdf
The emphasis is on normal, everyday activities provided for residents. According to the authors, however, little research has been conducted to investigate the actual effect of such activities and settings upon residents. The assumption is that such settings have a better effect that traditional institutions, but there is little empirical research to support this.
Hence, Verbeek et al. (2010) conducted a study to compare small-scale living with regular care in nursing homes in the Netherlands. Interestingly, they found no significant difference between the quality of life experienced by residents in traditional institutional settings and those in small-scale living facilities. Furthermore, there was also no significant difference in the job satisfaction levels of nursing staff between both types of institution was found. Another important aspect, namely neuropsychiatric symptoms and agitation were also significantly similar for both institution types. According to the authors, a difference was found in the satisfaction level of…
Gaugler, J.E. (2005, Mar.). Family Involvement in Residential Long-Term Care: A Synthesis and Critical Review. Aging and Mental health, Iss. 9, vol. 2. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247412/
Lyness, J.M., Yu, Q., Tang, W., Tu, X., and Conwell, Y. (2009, Dec.). Risks for Depression Onset in Primary Care Elderly Patients: Potential Targets for Preventive Interventions. American Journal of Psychiatry. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2982671/
Simonazzi, a. (2009, Jun). Home care and cash transfers. Effects on the elderly care-female employment trade-off. Retrieved from: http://www.aiel.it/bacheca/SASSARI/papers/simonazzi.pdf
Verbeek, H., Zwakhalen, S.M.G., Van Rossum, E., Ambergen, T, Kempen, G.I.J.M., and Hamers, J.P.H. (2010, Nov.). Dementia Care Redesigned: Effects of Small-Scale Living Facilities on Residents, their Family Caregivers, and Staff. American Medical directors Association. Retrieved from: http://www.unimaas.nl/hcns/websiteVW/publications/Publication%20scans/Verbeek.%20Dementia%20care%20redesigned.pdf
Multisystem Failure in a Geriatric Patient
Multisystem Failure in a Geriatric
eflect on your analysis of the geriatric patient in multisystem failure by doing the following:
Explain key immediate assessments you should make that would help assess the patient's homeostasis, oxygenation, and level of pain.
There are various diagnoses undertaken in assessing the patient's homeostasis, oxygenation, and level of pain. The immediate objective that nurses prioritize on is checking the patient's vital symptoms. Vital symptoms form the baseline of the assessment by providing significant information that illustrates whether the most essential organs function as required.
The assessment may involve checking the health status of the patient in the laboratory (Kane, 2004). In the laboratory, there is an assessment of the patient's capillary tube, urine test and blood pressure. When there is simultaneous malfunctioning of the body organs, nurses refer to this condition as multiple organ dysfunction (MODs).
Multiple organ dysfunction…
Esteban, A., Anzueto, A., Frutos-Vivar, F., Alia, I., Ely, E.W., Brochard, L., et al. (2004).
Outcome of older patients receiving mechanical ventilation. Intensive Care
Medicine, 30(4), 639 -- 646. Evidence Level IV: Nonexperimental Study.
Happ, M.B., Baumann, B.M., Sawicki, J., Tate, J.A., George, E.L., & Barnato, A.E. (2010).
Cognitive Disorder in Elderly
Cognitive Disorders in Elderly
Cognitive Assessment & Lab
Kris Thomas, PhD
The research of this study is related to cognitive, dementia, Alzheimer disease, and depression issues with the elderly populations of the United States and in the world in general. Societies with a large number of elderly people such as the U.S.A. are increasingly focusing their efforts on improving the life standards of these people based on the types of services given to them. The well-being of those on palliative and hospice care is as important as the well-being of the family members of these patients. Although many health issues present themselves during the elder years of any patient, there is a lot of attention paid to cognitive and mood issues in this age group. The disorders and maladies that are relevant to this population include, among others, depression, dementia, mild cognitive impairment (MCI)…
American Psycholgical Association (APA) (2010). Ethical Principles of Psychologists and Code of Conduct. American Psychologists Association.
Abby C. (2010). Physical Activity for an Aging Population. Public Health Reviews, Vol. 32. Retrieved from: http://www.publichealthreviews.eu/upload/pdf_files/8/PHR_32_2_King.pdf
Aklin, W. M., & Turner, S. M. (2006). Toward understanding ethnic and cultural factors in the interviewing process. Psychotherapy: Theory, Research, Practice, Training, 43(1), 50-64.
Management Performance Within Elderly Care Homes in Gibraltar
The elderly nursing community in Gibraltar is dispersed and characterized by different institution specific challenges and particularities. The current project assesses the general level of leadership competencies within three pre-selected institutions, the management performance assessments of employees, the basic leadership skills required and formulates a series of recommendations as to how these competencies could be obtained. The approach is predominantly a quantitative one, combining various research methods, such as the questionnaire, the case study and structured interviews.
With the aging of the population, more pressure is placed on the health care system throughout the world, and Gibraltar is no exception. As 15.41 per cent of its population is aged over 65 years (Website of the Central Intelligence Agency, 2015), a question arises regarding the country's ability to provide adequate care for its aging population. In this sense then, the current project sets…
Arras, John, D. (1995). Bringing the Hospital Home. Baltimore: Johns Hopkins University.
Barker, A.M., Sullivan, D.T., Emery, M.J., (2006) Leadership competencies for clinical managers: the Renaissance of transformational leadership, Jones & Bartlett Learning
Benner, P. (1982). Novice to Expert. Am J Nurs, 82(3):402-7
Booyens, S.W., (1998) Dimensions of nursing management, Juta and Company Ltd.
The Aging Population and Dementia
Dementia is generally defined as a problem that impacts the elderly population and includes “impairments in cognitive and intellectual ability, memory, language, reasoning, and judgment that interfere with everyday functioning” (Agency for Healthcare Research and Quality, 2014). The two leading types of dementia in the world are Alzheimer’s and vascular dementia (Livingston et al., 2017). Dementia is a problem for the elderly population because it is so prevalent and still somewhat poorly understood. As Jayadev et al. (2010) point out, the cause of the disease is still relatively unknown, which makes treating it difficult for care providers. An average of 25 million elderly people suffer from some form of dementia in developed nations—and that number is double in developing nations (Livingston et al., 2017). The best that care providers can hope for in this situation is to treat it by using preventive care interventions,…
ICU and Delirium
Evidence-Based Project Proposal
Patients that are sixty-five years or older account for an average of more than fifty percent of the visitors to the Intensive Care Unit (ICU) and there are a host of known risk factors that are associated with individuals who are among this demographic and many elderly patients are discharged directly to long-term living facilities due to the fact that they are unable to continue to function independently and maintain daily activities (Tang, Tang, Hu, & Chen, 2016). It is further estimated that approximately one quarter of all of the elderly patients that are admitted to the emergency department display some form of metal impairment related to delirium, dementia, or both, and many hospital departments have made mental assessments for these demographics part of their routine operations (Soryal & al., 2014). Therefore, not only does the prevalence of mental impairments serve as a serious…
Barr, J., & al., e. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 263-306.
Malone, M., & al., e. (2014). Acute Care for Elders: A Model for Interdisciplinary Care. Aging Medicine, 233-244.
Soryal, S., & al., e. (2014). Best Practice Models of Emergency Department. Aging Medicine, 220-231.
Tang, H., Tang, H., Hu, F., & Chen, C. (2016). Changes of geriatric syndromes in older adults survived from Intensive Care Units. Geriatric Nursing, 1-6.
educe Patient Falls in a Hospital Environment
Method of Obtaining Necessary Approval(s)
Description of Current Problem
Explanation of Proposed Solution
esources equired for Implementation
isk and quality management is a fundamental and important aspect to many health care organizations and patient lives are often at stake. This is especially true in nursing facilities or hospitals that house elderly patients because of the level of direct patient interactions that occur on a daily basis and the specific needs of this population. There are many potential risks that can emerge from this population. Three common risks were identified from a literature review based on evidence-based practices. One common risk deals medication error and making sure patients receive the right dosage of the correct medication at the right time. Another risk that is becoming increasingly common is the risk of the spread of infection and in severe cases infections that are…
Colon-Emeric, C., Schenck, A., Gorospe, J., McArdle, J., Dobson, L., Deporter, C., & McConnell, E. (2006). Translating Evidence-Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative. Journal of the American Geriatrics Society, 1414-1418.
Renteln-Kruse, W., Krause, T., & Georgr, D. (2007). Incidence of In-Hospital Falls in Geriatric Patients Before andAfter the Introduction of an Interdisciplinary Team -- BasedFall-Prevention Intervention. The American Geriatric Society, 2068-2076.
An opportunity has been identified in a growing niche that has been largely untapped to date. The opportunity further can be described as being at a crossroads that exists where many factors come together in an intersection in which many social changes are present. The business model that is being proposed in this report consists of developing prepped meal service for seniors, where prepared, nutritionally-balanced meals are delivered to seniors who have trouble cooking for themselves, at a cost-effective price. The need for a sustainable food service model that focuses on meals that are easy to prepare, nutritionally-balanced, consistent with dietary requirements, and affordable is especially relevant to a vulnerable population like the elderly who, in many cases, has difficulty in maintaining a proper diet. The demand for such a service has quietly build a niche industry that is still developing.
There are many social factors that have been identified…
It is also wise to have it reviewed by a doctor or attorney, the Family Doctor eb site suggests; that way you can be assured that what you wish to have done with you and to you if you become incapacitated is "understood exactly as you intended" (Family Doctor).
The advance directives are sensitive and private, and they are very important for seniors. But the advance directives can be controversial, so it is wise for older people to know the law and understand the facts. To wit, there have been rumors and falsehoods spread on the orld ide eb and elsewhere about the advance directives that are spelled out in the recent overhaul of the healthcare system. Former governor of Alaska Sarah Palin made news in the summer of 2009 by asserting that the advance directives in the healthcare overhaul created a "death panel" of bureaucrats who will "decide, based…
Binstock, Robert H., and George, Linda K. (2010). Handbook of Aging and the Social
Sciences. Maryland Heights, MO: Academic Press.
Black, Jane A. (2008). Notes: The Not-So-Golden Years: Power of Attorney, Elder Abuse, and Why Our Laws are Failing a Vulnerable Population. St. John's Law Review, 82(1), 289-314
Collier, Elizabeth. (2005). Latent age discrimination in mental health care. Mental Health
Substance / Alcohol Abuse among the Elderly
Substance/alcohol abuse among the elderly 60 years and older
Alcohol and substance abuse among the elderly is a significant social problem, not only because people in this age group tend to have very permissive attitudes towards social drug and alcohol usage but also because the stressors that accompany aging may result in increases in drug or alcohol usage to problematic levels. While people may begin experiencing age-related problems in their 40s and 50s, it is not generally until their 60s that most people begin to experience significant physical or emotional challenges related to age. These challenges are often accompanied by major life changes, such as retirement, the death of a spouse or friends, relocation, and diminished physical and intellectual capabilities. These changes may mean a lack of access to the coping mechanisms that have traditionally served the individual, leading to a rise in…
Center for Substance Abuse Treatment. (2012). Substance abuse among older adults: Treatment improvement protocol (TIP) series, No. 26. HHS Publication No. (SMA) 12-3918. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Finkelstein, E., Prabhu, M., & Chen, H. (2007). Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions. The American Journal of Geriatric Psychiatry, 15(7), 611-619.
Folkman, S., Bernstein, L, & Lazarus, R.S. (1987). Stress processes and the misuse of drugs in older adults. Psychology and Aging, 2(4), 366-374.
Garland, E.L., Schwarz, N.R., Kelly, A., Whitt, A., & Howard, M.O. (2012). Mindfulness-oriented recovery enhancement for alcohol dependence: Therapeutic mechanisms and intervention acceptability work. Journal of Social Work Practice in the Addictions, 12, 242-263. doi:10.1080/1533256X.2012.702638
Social Work Internship Experience With Alzheimer Patients
My service learning experience was a positive one. I had the opportunity to work at an Alzheimer's care facility, with patients exhibiting various stages of Alzheimer's disease. I learned through my interactions with older adults at the clinic that much like anyone else, Alzheimer's patients need stimulation, warmth, compassion and an environment that encourages interaction and relationship building.
My views of older adults have changed significantly since working with patients at the care center. Whereas in the past I might have assumed that all older adults were mentally less cognizant of their emotions and feelings and 'numb' to the world around them, I learned instead that many have a great compassion for caring, and many desire simply to enjoy much of the same things than anyone else would at their age. My experiences are described in greater detail below.
Summary of Experiences
Gebo, L. "Biological Systems and their Impacts on Later Adulthood." Chapter 14. New
York, Thompson Brooks Cole: 2004.
This paper will focus on the geriatrics service line. Elderly patients are coming in at higher rates and the geriatric population is trending upward (Advisory Board, 2018). One problem the department is having is the identification of elder abuse among geriatric patients. Elder abuse has been defined as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (Jackson, 2016, p. 265). According to the World Health Organization (2002), elder abuse can take any one of or combination of forms: (a) physical abuse, (b) psychological abuse, (c) sexual abuse, (d) neglect, (e) abandonment, and (f) financial exploitation or theft. Recognizing and addressing elder abuse is important for the geriatrics service line because it will help to better serve the elderly patient and the geriatric community overall and it will…
Brain training with non-action video games and its effects on brain health among the elderly showing early signs of dementia
Past researches have revealed the potential contribution of video game-playing to the improvement of certain cognitive functions among healthy aged individuals (Lampit, Hallock & Valenzuela, 2014; Jak, Seelye & Jurick, 2013). Drawn by the above results reached by scholars in the field, game-making firms have developed and released several kinds of games aimed at brain training (for instance, Brain Age, Brain Challenge and Big Brain Academy). Ever since their earliest releases into the gaming market, games of this sort have enjoyed immense popularity worldwide (Toril, Reales & Ballesteros, 2014; Nouchi et al., 2013). Among the anticipated advantages of such games is improved cognitive functions (for instance, recall, processing pace, executive function, and concentration), indicated often using the term 'transfer effect'.
This research project specifically aims at examining the…
patient was admitted due to a broken hip which required a total hip replacement (TH). This injury has required two weeks of in-hospital rehabilitation to this point, and Mr. Trosak will probably need more physical rehabilitation to completely recover from the injury. Since there are secondary concerns (such as some loss of cognitive function (text, 462)) after a fall, it will be necessary to monitor M. Trosak. The falling incident could also reoccur due to the fact that the patient resides on the second floor of his apartment building. It will be necessary to ensure that Mr. Trosak understands the risk of a recurrence, and that he has sufficient assistance.
Prior to being hospitalized for the fall, Mr. Trosak was not taking any prescription medication, and he has not had a physical examination for more than ten years. While admitted, the patient was found to have chronic hypertension, which is…
Smith, M., & Segal, J. (2011). Depression in older adults and the elderly. Retrieved from http://www.helpguide.org/mental/depression_elderly.htm
Vanwanseele, B. (2009). To rehab or not to rehab following a total hip replacement. Retrieved from http://sydney.edu.au/research/opportunities/opportunities/561
Caring for the Old
The End of Life Care
End of life care refers to the total care of a person that has an advanced illness that is incurable and does not equate with death. This end of life care can last for a number of weeks, months or even years depending on the state an individual is.it is usually the care which helps those that have advanced, progressive and illnesses that can not be cured to live life as well as possible until they meet their death. End of life care makes it possible for the patient and their family to get supportive and palliative care needs identified and met throughout the last phase when they are living and into the bereavement period. Supportive care is care which helps a patient and the family to cope with the condition and the treatment of that condition right from the pre-diagnosis…
Boswell, Kahana & Worth-anderson, 2006). Spirituality and Healthy Lifestyle Behaviors: Stress Counter-balancing Effects on the Well-being of Older Adults. Retrieved April 30, 2014 from http://www.case.edu/artsci/soci/documents/Spiritualityandhealthylifestylebehaviors.pdf
U.S. Department of State, (2012).Legal & Financial Issues In Caregiving for Older Adults. Retrieved April 30, 2014 from http://www.state.gov/m/dghr/flo/142266.htm
American Society of Clinical Oncology (ASCO), (2014). Caregiving Considerations. Retrieved April 30, 2014 from http://www.cancer.net/navigating-cancer-care/older-adults/caregiving-considerations
The Joanna Briggs Institute, (2011). Age-friendly nursing interventions in the management of older people in emergency departments. Retrieved April 30, 2014 from http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=7127
In addition, epinephrine injection should not be used when women are in the second stages of labor. Furthermore, because the effects of this drug on pregnant women remain unclear, pregnant women should only use epinephrine injection when the risks to the mother outweigh the potential risks to the fetus (product insert).
hat not to do when taking this medication:
Although there are no specific recommendations provided by the manufacturer, patients who use this drug should be aware of the possible side effects and avoid strenuous activities that will cause additional increases in blood pressure or heart rates. Take it easy after using this drug!
In addition, patients should avoid using the same injection site repeatedly since it can adversely affect skin integrity (product insert).
You may experience the following side effects following an injection:
Headaches, fear, and hearts palpitations (these side effects are more common in patients who suffer from…
Albertine, Kurt H. Anatomica. Willoughby,
NSW: Global Book Publishing Ptd
Barlow, David H. Anxiety and Its Disorders:
older patients over the age of 80 due to complications in health such as dementia and depressive symptoms, do not go for additional follow-ups. Yes, the authors explain repeated in person visits help better identify risk factors. There is no obvious research question however they do highlight the use of a study to confirm the hypothesis of whether or not repeated in person follow-ups help with problems experienced as patient's age. "We hypothesized that the type of visit would be related to key demographic, lifestyle, health and function characteristics and that the oldest aged participants would have the poorest retention for in-person visits, particularly clinic visits" (Strotmeyer et al., 2010, p. 697). This is a directional hypothesis because the retention rates are directly associated with increase in age. It is a simple hypothesis because it directly states a cause and effect. The hypothesis was tested and it revealed in-home visits…
Strotmeyer, E.S., Arnold, A.M., Boudreau, R.M., Ives, D.G., Cushman, M., Robbins, J.A., Newman, A.B. (2010). Long-Term Retention of Older Adults in the Cardiovascular Health Study: Implications for Studies of the Oldest Old. Journal of The American Geriatrics Society, 58(4), 696-701. doi:10.1111/j.1532-5415.2010.02770.x
Patient Protection and Affordable Care Act/Impact of ACA from the Organizational and the Patients view
Impact of the Affordable Care act (ACA) on the population that it affected
Impact of the economics of providing care to patients from the organization's point-of-view
How will patients be affected in relationship to cost of treatment, quality of treatment, and access to treatment?
Ethical implications of this act for both the organization and the patients
Impact of the Affordable Care act (ACA) on the population that it affected
The Affordable Care Act (ACA), as initially passed, mandated Medicaid expansion, for covering a majority of low-income, as-yet-uninsured American citizens and immigrants (with legal residency in the U.S. for a minimum duration of 5 years). The United States Supreme Court, however, in the historic National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012), maintained that the obligatory Medicaid expansion proved to be unconstitutionally…
ACA. (2015). The Patient Protection and Affordable Care Act. Retrieved on 13th September, 2015 from http://www.dpc.senate.gov/healthreformbill/healthbill52.pdf
Howard, P. (2015). The Impact of the Affordable Care Act On the Economy, Employers, and the Workforce. edworkforce.house.gov. Retrieved on 13 th September, 2015 from http://edworkforce.house.gov/uploadedfiles/02.09.11_howard.pdf
Kengmana, R.T. (2015). An Ethical Perspective on the Affordable Care Act. MA: Psych Central. Retrieved on 13th September, 2015 from http://googleweblight.com/?lite_url=http://psychcentral.com/about/feedback&lc=en-IN&s=1&m=101&ts=1442202299&sig=APONPFlqjqQURNK5jFIewCvXRMJzyhz8zA
NCIOM. (2015a). Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina. Chapter 7: Quality. Retrieved on 13th September, 2015 from https://www.google.co.in/url?sa=t&source=web&rct=j&url=http://www.nciom.org/wp-content/uploads/2013/01/Final-Ch7-Quality-FINAL.pdf&ved=0CCYQFjABahUKEwjv_JDfr_XHAhVIB44KHfLKAPg&usg=AFQjCNEdTlwW2QuvqN5Rn6qM31poi4lBUA
Restraining the Elderly
The Project Management path for this research proposal will follow the path of quantitative research in a 'quasi-experimental' environment. Adhering as closely as possible to quantitative experiments designed to establish the causal factors or interdependent links between grouped variables, the researcher will follow a natural course of progression in administering dependent and independent variables, designing the sampling set, determining the optimal time(s) and location(s) for conducting the research, developing the measures and instruments necessary for evaluation of non-empirical evidentiary conclusion (i.e., the thought processes and reasoning of medical staff), measuring the response to education and procedural methodology, documentation to include evaluation materials, response forms, and restraint logs, preparing the education program, delivering the lectures, and evaluating the results in change or lack of change in care providers attitudes toward patient restraint.
Any project that measures the process of learning, comprehension, acceptance or denial,…
Osteomyelitis in the Diabetic Patient
Management OF OSTEOMYELITIS IN THE DIABETIC PATIENT
Osteomyelitis is an infection of the bone or bone marrow which is typically categorized as acute, subacute or chronic.1 It is characteristically defined according to the basis of the causative organism (pyogenic bacteria or mycobacteria) and the route, duration and physical location of the infection site.2 Infection modes usually take one of three forms: direct bone contamination from an open fracture, puncture wound, bone surgery, total joint replacement, or traumatic injury; extension of a soft tissue infection such as a vascular ulcer; or hematogenous (blood borne) spread from other infected areas of the body such as the tonsils, teeth or the upper respiratory system.2(p807) Bacteria such as Staphylococcus aureus, Pseudomonas, Klebsiella, Salmonella, and Escherichia coli are the most common causative agents of the disease, although viruses, parasites and fungi may also lead to the development of osteomyelitis.3
1. Stedman's Medical Dictionary. 27th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000.
2. Butalia S, Palda V, Sargeant R, Detsky A, Mourad O. Does This Patient With Diabetes Have Osteomyelitis of the Lower Extremity?. JAMA: Journal of The American Medical Association [serial online]. February 20, 2008; 299(7):806-813. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
3. Lavery L, Peters E, Armstrong D, Wendel C, Murdoch D, Lipsky B. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Research & Clinical Practice [serial online]. March 2009; 83(3):347-352. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
4. Turns M. The diabetic foot: an overview of assessment and complications. British Journal of Nursing [serial online]. August 12, 2011;:S19-S25. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
Therapeutic Massage on Elderly, Grieving Widows
The prosperity of a country is in accordance with its treatment of the aged," states an ancient Jewish Proverb ("Massage for the Mature Adult," 2001). This is an honorable and true statement. Too often many of our elderly people's needs are not noticed or attended to by family, friends, or medical practitioners. This is especially true for older women whose husbands have died.
Widowhood can have a tremendous impact on the health of older women (Ferraro, 1989; owling, 1987; Gass & Chang, 1989). The death of a spouse or partner has been described as the most disruptive and difficult role transition that an individual confronts throughout the life course (Lopata, 1987). In the United States, over 49% or 8.4 million women over the age of 65 are widows (radsher, 2000). Houdin (1993) states that "although the literature abounds with subjective pieces concerning bereavement, little…
Bibliography for Chapters One and Two
Barry, Kasl, and Prigerson
Turvey, 1999 (Parkes, 1998).
In a study of the prevalence of elder abuse in the United States, financial difficulties on the part of the abuser did appear to be an important risk factor (Krug, 2002, pp. 130-131).
elationship factors - in the early theoretical models, the level of stress of caregivers was seen as a risk factor that linked elder abuse with care of an elderly relative. While the accepted image of abuse depicts a dependent victim and an overstressed caregiver, there is growing evidence that neither of these factors properly accounts for cases of abuse. Although researchers do not deny the component of stress, they tend now to look at it in a wider context in which the quality of the overall relationship is a causal factor. Today, the belief is that stress may be a contributing factor in cases of abuse but does not by itself account for the entire phenomenon.
Brandl, Bonnie. (2000). Power and Control: Understanding Domestic Abuse in Later Life.
Generations. 24(2), p. 39-45.
Elder Abuse and Neglect. (2009). Retrieved February 11, 2010, from Helpguide.org Web site:
Q4. Participants at treatment facilities might be disproportionately affluent and white, given that historically, individuals of color suffering from addictions have more often been relegated to prisons, rather than received support and assistance. Public as well as private treatment facilities may need to be compared, to ensure a more representative sampling.
Benshoff, John J., Laura K. Harrawood, & Darwin Shane Koch. (2003, April-June). Substance
abuse and the elderly: unique issues and concerns. Journal of Rehabilitation. 69.
In this study, the authors used a literature review format to examine a variety of previous studies of substance abuse amongst the elderly. In general, while individuals tend to age out of illicit drug use, alcohol abuse remains a risk throughout an individual's lifespan, given the lack of social and cultural taboos. Broad-ranging studies have found that alcohol abuse amongst the elderly is a silent epidemic, and both late and early-onset…
The modern nurse must then be willing to move beyond a simple catch-all of medical jargon and bureaucracy and become someone who is both supportive and critical of the system. This may seem dichotomous, but in reality is not. The system is designed with beneficence in mind -- to help the patient at all costs. It is thus up to the nurse advocate to ensure that that actually happens (Sheldon, 2009).
Undertake assessments which are sensitive to the needs of the patient- Assessment is one of the key factors in management of clinical medicine. The nurse is often at the forefront of that process simply due to the logistical nature of the situation -- taking vitals, preparing the patient for blood work, etc. However, it is in two particular areas that the nurse can be most effective when assessing the actual needs of the patient; culturally and when questions are…
Edwards, N., et.al. (2003). Aging, Heart Disease, and Its Management. Humana Press.
Lundy, K. And Janes, S. (2003). Essentials of Community-Based Nursing. Sudbury, MA:
Jones and Bartlett.
Miller, C. (2009). Nursing for Wellness in Older Adults. Philadelphia, PA:
If I found myself in a conversation with a citizen from a country where healthcare is socialized, I would be more than likely to speak with candor by expressing my disapproval for the nature of America's healthcare industry. As the same time, I would connect this to the more general nature of America's economy, political culture and socioeconomic hierarchy. The healthcare industry's monetarily-based exclusivity is consistent with most other aspects of public life in America such as the distribution public services, access to education and infrastructural maintenance. The way that Americans experience all of these things is highly subject to socioeconomic status. That said, I would explain quite simply that this constitutes one of the single greatest flaws in American public governance.
Indeed, the problem of a lack of insurance for many is related to the problem of the cost of healthcare. So confirms the article by Consumer Reports…
Consumer Reports (CR). (2008). High Health Care Costs. Consumer Reports Health.org.
Gawande, A. (2009). The Cost Conundrum. The New Yorker.
Hussey, P.S.; Vries, H.D.; Romley, J.; Wang, M.C.; Chen, S.S.; Shekelle, P.G. & McGlynn, E.A. (2009). A Systematic Review of Health Care Efficiency Measures. Health Services Research, 44(3), 784-805.
Waldman, J.D.; Kelly, F.; Arora, S. & Smith, H.L. (2010). The Shocking Cost of Turnover in Health Care. Health Care Management Review, 35(3), 206-211.
Mildred's Case Study
Mildred's Story was made to form part of a 'ecognizing isk and Improving Patient Safety' course. The progression takes a novel method to educating healthcare professionals in regards to the significance of non-clinical services, behavior and attitudes in guaranteeing the safety of the patient. It attracts upon the experiences of patients that are within healthcare settings, and information achieved from other high-risk businesses, to come up with a strategy allowing healthcare workers to disapprovingly appraise and interfere in the development of patient danger. There are so numerous prospects of improvement in Mildred's case study, but the writers designated Effective communication & patient assessment to resolve the issue of (patient falls).With that said, instead the researcher has used the SPO model along with using formwork (FOCUS- PDSA) also using tools (Fishbone, 6 huts, flow chart and 5 whys) in order to improve effective communication and patient assessment to…
Alireza, N., 2014. Evidence of Using FOCUS PDCA. [Online]
Available at: http://npmcweb-en.tbzmed.ac.ir/Uploads/37/cms/user/File/54/MEP/Effectiveness.pdf
[Accessed 10 December 2015].
Anon., 2015. What is the quality improvement process?. [Online]
Elderly in Monrovia, CA
The population of people aged 65 years or greater is steadily escalating, as baby boomers come of age. It is estimated that this age bracket accounts for 10% of the total world population, and is statistically increasing. As this sector of the population steadily increases, there are of course, accompanying health care issues: osteoarthritis, cardiac and kidney issues, Alzheimer's or dementia, and an ever-growing problem with depression. For this essay, we will concentrate on several health issues that plague seniors nationally, but will specifically focus on the aging population over 65 in Monrovia, California.
Monrovia is a smallish city located at the foothills of the San Gabriel Mountains in the San Gabriel Valley, Los Angeles County. Monrovia was settled in the late 1800s as a central hub for the growing orange grove industry, but has now become more of a bedroom community that supports the urban…
Breathe California of Los Angeles County. (2009). Cited in:
California Department of Public Health. (June 2009). "Healthy California -- 2010
Midcourse Review." Executive Summary. Cited in:
Living Aangements Among the Eldely
This is an eight page pape concening the divesity in living aangements among the eldely. Thee ae six efeences used.
People today ae living longe, which means thee is a lage eldely population in ou society. Thee ae many concens facing the eldely, one of which is housing. The eldely have seveal options available to them and it's inteesting to see how divese they can be.
Befoe we look at the housing options fo the eldely, we should fist exploe the statistics concening the population of this gowing goup. Thee wee ove 35.0 million pesons ove 65 in the United States in 2000. This accounts fo 12.4% of the population o one in evey eight Ameicans. Since 1990, the numbe of eldely has inceased 12.0% in compaison to the 13.3% incease of those unde 65. The statling fact is those aged 45-64 inceased…
references. (accessed 10-20-2002).
Greenwald, John. (1999, 30 August). Family: Elder Care: Making the Right Choice
Nursing homes used to be the only stop for seniors who need help. Now there are options.
Time. pp. 52+.
(Housing and Living Arrangements of the Elderly. (accessed 10-19-2002).
Improving Provider-Patient Communication Among LEP Patients
Elderly Hispanic patients experience numerous challenges when seeking for healthcare services since they are only eloquent in their native language and are classified as Limited English Proficient (LEP) patients. Language barriers contribute to poor provider-patient communication and necessitate the integration of third parties in the care delivery process. This paper whether the use of professional interpreters improves patient-provider communication and results in better health outcomes. Through a study that was carried out a sample of 40 elderly Hispanic diabetic patients at a Wellness Center in Los Angeles, using a professional interpreter improves provider-patient communication. The use of professional interpreters and language concordance is associated with improved provider-patient interactions, enhanced interpersonal care, and better medication adherence within three months.
Keywords: elderly Hispanics, patients, medication adherence, bilingual interpreters, treatment, patient-provider communication, healthcare providers.
Provider-patient communication is an important factor in enhancing patient outcomes in…
Fall Among the Elderly Age Group
Falls among the Elderly Age Group
Expected falls and unexpected falls
isk Elements for Falls
Outline of Several Different Strategies
Counseling and Health Education Strategies
Exercise and physical activity 8
Interventions of Unidentified Effectiveness
Developed Based on your Understanding of the Public Health Problem
Schedule an appointment with your Medic
Wear sensible shoes
According to JM (2009), "As people get older, falls turn out to be a typical and often hurting issue that occurs among those that are in the elderly category, producing a huge quantity of illness, death and use of health care services as well as premature nursing home admittances ( p. 42)." However, falls are a difficult, multi-faceted problem that comprises of social, medical, and financial elements. Medically, the mixture of a high occurs of falls and an increased…
A., B. (2012). Research methods in health: investigating health and health services. United Kingdom: Open University Press.
Campbell AJ, R. M. (2013). Rethinkingindividual and community fall preventionstrategies: a meta- regression comparingsingle and multifactorial interventions. Age and Ageing, 21(6), 656-662.
JM., H. (2009). Cognitive and Emotional benefits of exercise may mediate fall reduction. British Medical Journal, 128, 325(.
Lord SR, T. A. (2013). The effect of an individualized fall prevention program on fallrisk and falls in older people: A Randomized Controlled Trial. Journal of the American Geriatrics Society, 14(8), 1296-1304.
foundational issues at hand for our culture is the provision of health care for all. Challenging the standard by limiting health care for the elderly is a substantial ethical question. (Etzioni, 1988, pgs. 168-174) Yet, regardless of the bargaining power of organizations who advocate for the elderly the limitations are being made, in more covert and less effective ways. Regardless of public opinion the system we have now adopted is inefficient and not only do the elderly suffer, but all others who are not offered services in economically feasible ways suffer.
The system will continue to be based upon capitalistic standards as long as benefits exist in a manner that provides profits for cutting corners on standard preventative care and offering substantially overblown services to those who can afford to pay for it or who have no voice to say no. (Lamm, 1989, pgs. 158-162) Providing care in such a…
Kutter, Robert. (1988), 'National Insurance Should Fund Long-Term Care."
Lamm, Richard. (1989) "The Elderly Cannot Be Guaranteed Full Access to Health Care."
Sager, Alan. (1988) "The Elderly Should Be Guaranteed Full Access to Health Care."
health issue of falls among the elderly in Canada.
Community Health Problem
The major reason behind the Canadian seniors' hospitalization is fall-related injury. Approximately 20% to 30% seniors fall in a year. For instance, Canadian Community Health Survey statistics shows mostly over 80-years older seniors, 20% living in the community are fall (Seniors' Falls in Canada: Second eport - Public Health Agency of Canada, n.d).
Extent of the Problem
256,011 older Canadians suffered from fall-related injuries in 2009/2010. Comparing with injured people, other than fall-related, percentage was higher in females over 74-year age (63.6% as compared to 54.3%). Statistically, difference based on marital status was also notable. 55.9% fall-related injured people were married as compared to other injured that were 63.6%. Furthermore, 31% of the fall-related injured people were widows as compared to 23.6% other injured people. In this education group, 30% people had fall related injury as compared to…
CARROLL, N., SLATTUM, P., & COX, F. (n.d.). Academy of Managed Care Pharmacy. The Cost of Falls Among the Community - Dwelling Elderly. Retrieved December 13, 2015, from http://www.amcp.org/data/jmcp/research_307_316.pdf
(n.d.).Public Health Agency of Canada (PHAC) -- Agence de la santepublique du Canada (ASPC).Seniors' Falls in Canada: Second Report - Public Health Agency of Canada. Retrieved December 13, 2015, from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php#s1-1
clinical cases and examine malpractice perspectives.
Concerns over mounting healthcare expenses have resulted in increased inquiry into medical practices. With the rise of malpractice risk and medical liability to unprecedented levels, the field of medical law has influenced defensive medical practice as healthcare providers endeavor towards liability risk mitigation (Nahed, et.al, 2012).
Elements Needed to Prove Malpractice
Medical malpractice is associated with four fundamental elements, all of which have to be present for forming the base for any claim. For any case of medical malpractice to succeed, an attorney is required to prove all four aspects, which are: duty, causation, damages, and breach (What are the Elements of a Medical Malpractice Claim? n.d.). The first element -- Duty -- implies that health care professionals owe their patients the duty to take reasonable and appropriate action; i.e., the practitioner is accountable for delivering some form of treatment or care…
Florida Healthcare Law (n.d.). - A Florida Medical Malpractice Blog - Shoulder Dystocia Erbs Palsy. What are the Elements of a Medical Malpractice Claim? -- Florida Healthcare Law - A Florida Medical Malpractice Blog - Shoulder Dystocia Erbs Palsy. Retrieved March 8, 2016, from http://floridahealthcarelaw.com/what-are-the-elements-of-a-medical-malpractice-claim/
Kurreck, & Twersky. (2012). Home -- AHRQ Patient Safety Network. Residual Anesthesia: Tepid Burn -- AHRQ Patient Safety Network. Retrieved March 8, 2016, from http://psnet.ahrq.gov/webmm/case/276
Nahed, B., Babu, M., & Smith, T. (2012, June 22). Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons. Retrieved March 7, 2016, from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0039237
Saltzman, J. (2008, January 29). Medical Malpractice Attorneys Lubin & Meyer -- Boston, MA, NH, RI. Family Sues in Operating Room Fall - Wrongful Death Lawsuit. Retrieved March 8, 2016, from http://www.lubinandmeyer.com/news/or_fall.html
I also need to know the length of time that I have scheduled to speak since professional research conventions usually allocate 10 minutes to 90 minutes for a presentation. If only a short time, I may be advised to present highlights and to give handouts of my presentation. Visual images also facilitate the learning. I will need to build in time for question and discussions.
With each audience, I should consider their specific interests and structure the speech accordingly. With non-health laypeople, for instance, I can structure it to the challenges of dealing with relations with dementia and the kind of characteristics they should look for in caregivers as well s ways that can give them less stress and give their patients more comfort in dealing with them. I should also present it in a creative way in order to make it more interesting.
When approaching journals (and there are…
Byrne, M. Disseminating and presenting qualitative research findings - Research Corner
Environmental Interventions for Patients With Dementia
Dementia is a neurocognitive disorder that has been treated in various ways throughout all history. The modern era has proposed pharmacological interventions in the past but these have proved dangerous and degrading to the quality of life that dementia patients and their loved ones prefer. For this reason, environmental interventions have emerged as an alternative method for treating elderly dementia patients. This intervention method consists of altering the environment in which the patient lives by accommodating for the needs of the patient with clearly identifiable pathways, open spaces for communication, naturalistic settings, adequate stimuli and private rooms for quiet. This paper discusses the fundamental principles of environmental interventions for patients with dementia and includes a justification for this approach as a suitable alternative to prevailing psychoactive drug interventions. It also includes a discussion of the historical context of the disorder, its current description according…
Agency for Healthcare Research and Quality. (2015). Non-pharmacologic Interventions
for Agitation and Aggression in Dementia. U.S. Department of Health and Human Services. Retrieved from http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1999&pageaction=displayproduct
Bupa. (2015). A dementia friendly society. Bupa. Retrieved from https://www.bupa.com/corporate/our-purpose/healthy-ageing-and-dementia/reports-and-publications/a-dementia-friendly-society
Fleming, R., Purandare, N. (2010). Long-term care for people with dementia:
person creative? In what ways do you think creativity can be supported and enhanced by the environment?
What makes a person creative is the combination of imagination and will and exercising of that interaction. A creative person is one who can do things in a unique way -- one who is imaginative and likes to take part in the creative process by developing ideas and utilizing latent skills within the individual that all concepts and expressions to be manifested in any number of ways. Creativity stems from a desire to produce works, whether art or writing or sewing or knitting or architecture -- anything that one can put the mind to accomplishing -- in a manner that is pleasing. It does not even have to be something that is aesthetically pleasing to all. For some creative people, what they make is only admired by a few or maybe even by…
Abel, V. (2013). Insight into Psychology of Aging. Retrieved from https://www.youtube.com/watch?v=q-31glZYYr8
Carstensen, L. (2012). Emotion and Aging: Exploding the Misery Myth. Retrieved from https://www.youtube.com/watch?v=BXhrrbQCElw
Cavanaugh, J. C. & Blanchard-Fields, F. (2015). Adult development and aging. (7th
Edition). Stanford, CT: Thompson Learning.
Substance Abuse in the Elderly
The increase in substance abuse among people over 60 years of age is understandable from several perspectives. The boomer generation grew up in a society that was experimenting with controlled substances, and in -- or on the margins of -- a culture that viewed the use of drugs as normative. Indeed, much of the rhetoric about drugs and alcohol was that these substances could enhance life experiences, provide deeper insights into one's life -- transcendence, if you will -- and ease the suffering brought about by life transitions and quotidian pressures. This generation found self-medicating for personal angst and genuine disorders such as depression or post-traumatic syndrome was acceptable.
While many life challenges are universal and do not occur in higher percentages according to particular demographics, other challenges are linked to demographics. People in their 60s and beyond do experience an uptick of physical and…
Garland, E.L., Froeliger, B., & Howard, M.O. (2014, November 11). Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT. Journal of Behavioral Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/?term=25385024
New Marketing Plan
Overview of Company
Dawn is a startup company that plans on making the most of the prospect that is the entrance into retirement age of the Baby Boomer generation. The company perceives this as a business opportunity to offer services to this population. In particular, the company will serve as a housing community that offers the product package or services to active seniors who have attained 55 years of age and above. This will encompass assisted living that could be partial or full-time, depending on the needs of the client. Dawn intends to not only offer these services, but also other amenities that will make life comfortable for the adult patients. The company plans on setting up its premises in Boston. The following is a marketing plan that is purposed on creating a profitable business model for the company.
Market esearch Strategies
The company will make use…
Ferrell, O. C., Hartline, M. (2014). Marketing Strategy. Ohio: South Western Cengage Learning.
Pride, W., Ferrell, O. C. (2010). Marketing. Ohio: South Western Cengage Learning.
Hanssens, D. M., Pauwels, K. H., Srinivasan, S., Vanhuele, M., & Yildirim, G. (2014). Consumer attitude metrics for guiding marketing mix decisions. Marketing Science, 33(4), 534-550.
Henry, A. (2011). Understanding Strategic Management. New York: Oxford University Press.
Huntington's disease (HD) was the first autonomic dominant disorder for which genetic prediction became possible" (Harper, et al., 2000, Journal of Medical Genetics, p. 567). HD is a disease that occurs due to an inherited disorder leading to the death of brain cells. A diagnosis of HD is accomplished through genetic testing which can be implemented at any age regardless of whether the symptoms manifest or not. Although, the specific symptoms vary between people, nevertheless, symptoms can start with people between 35 and 45 years of age and can also start in some individuals at even anearlier age. The disease may affect successive generations if health interventions are not implemented (Mandel, 2016).
Additionally, "the cause of HD is due to a dominant mutation of autosomal form of the gene called Huntington. This shows that a child born by an affected person has a 50% chance of developing or inheriting the…
Causes and risk factors. (2016). Health Communities. Retrieved from http://www. healthcommunities.com/huntingtons-disease/cause.shtml.
Denbo, S. M. (2013, January 1). Balancing the rights of children, parents and the state: The legal, ethical and psychological implications of genetic testing in children. Southern Journal of Business and Ethics, 5, 188-190.
Domaradzki, J. (2015, January 1). Lay constructions of genetic risk. A case-study of the Polish Society of Huntington's Disease. Polish Sociological Review, 189, 107-111.
Draper, B. (2004). Dealing with dementia: A Guide to Alzheimer's Disease and other dementias. Crows Nest, NSW: Allen & Unwin.
6. Identify the collaborative team members pertinent to the care of the geriatric patient in the scenario, including the emergency room nurse's response to changes in the level of consciousness and increasing respiratory distress.
The collaborative team here would consist of a primary care physician / geriatrician, pain management specialist, laboratory specialists, and x-ray team. Additional consultants may be neurologist, neurosurgeon, gastroenterologist, psychologist, and drug and alcohol detoxification specialist.
In the case of increasing respiratory distress, the nurse is advised to continue or modify the interventions: to continue to teach patient how to breath and cough correctly; to summon a productive cough; to attempt to clear lungs to auscultation; and to achieve symmetric chest excursion of at least 4 cm; also that her respirations and pulse beats should be regular, and that she should inhale a normal volume of air. This is done by encouraging Fowler or semi-Fowler's position; monitoring…
Eliopoulos, C. (2001). Gerontological nursing Philadelphia: Lippincott,
Kandel, J. (2009). The encyclopedia of elder care New York, NY: Facts on File,
Marvin J.A. (1995). Pain assessment vs. measurement. J Burn Care Rehabil 16, 348-357
Melzack R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1, 277-299
self-therapy in the context of what needs to be done to elevate the healing process in life. The therapy that is often used to treat is that which people rely on to practice self-treatment. In this paper, Art Bohart's talk on self-healing is will be used to manifest what is best-used means of conducting self-therapy. In this paper, the general supportive treatment of stress and other psychological ailments will be covered. The aim is to reach out to the diverse sections of the therapy and how it may be of use to the people. The paper also discusses the relevance of this program in the treatment of emotional challenges that people face. Finally, the paper will discuss whether the lessons learned from Art Bohart's talk can be integrated into real life. The focus extends to include the texistential-humanistic therapeutic interventions and the benefits associated with their use on patients.
Bohart, A. C., & Tallman, K. (1999). What Do We Mean By The Client As Active Self-Healer? In, How Clients Make Therapy Work: The Process of Active Self-Healing (Pp. 3-23). Washington, DC, U.S.: American Psychological Association. doi:10.1037/10323-001
Bohart, A. C., & Tallman, K. (1999). Research Results That May Surprise You -- How Do We Know the Client is an Active Self-Healer? In, How Clients Make Therapy Work: The Process of Active Self-Healing (pp. 25-55). Washington, DC, U.S.: American Psychological Association. doi:10.1037/10323-002
Bohart, A. C., & Tallman, K. (1999). Self-Healing Without a Therapist. In, How Clients Make Therapy Work: The Process of Active Self-Healing (Pp. 57-84). Washington, DC, U.S.: American Psychological Association. doi:10.1037/10323-003
Bohart, A. C., & Tallman, K. (1999). Self-Healing With a Therapist. In, How Clients Make Therapy Work: The Process Of Active Self-Healing (Pp. 87-104). Washington, DC, U.S.: American Psychological Association. doi:10.1037/10323-004