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There are two important things to remember when it comes to the health issues of older adults. First, older and senior adults account for the lion's share of healthcare problems and costs as compared to the younger groups. This makes sense as the body is aging and/or shutting down not to mention that the bad habits (if any) of a person in their younger years truly start to take hold and render their effects once a person reaches their 50's, if not before. Second, there are common sense and evidence-based ways to handle these issues and help improve healthcare outcomes. Rather than try to "reinvent the wheel" and/or go with unproven methods in general, it is generally better to go with what is known to be effective based on past research and initiatives. While the older groups of Americans will always have more health problems than the younger…
According to the Centers for Disease Control, muscle-related problems and a lack of exercise account for about 24% of the falls in subacute facilities. Other causes, which can also be easily addressed within subacute facilities, "include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs" (Falls in nursing homes, 2010, CDC). These types of environmental hazards are estimated to cause 16% to 27% of falls for patients. Even seemingly unavoidable problems such as medications that interfere with coordination can be mitigated by flagging the individual as taking such a drug, and notifying staff that additional care of the patient is required.
In the instances of patients with dementia, or those who cannot care for themselves enough to learn to improve their balance skills to mitigate the risk of falls, measures other than educational endeavors should be undertaken. "Grab bars, adding raised toilet seats, lowering bed heights,…
Barclay, Linda. (2003). Vitamin D may reduce falls in elderly nursing home patients. Cochrane Database of Systematic Reviews. Retrieved through Medscape on December 29, 2010 at http://www.medscape.com/viewarticle/716100
Falls in nursing homes. (2010). Centers for Disease Control (CDC). Retrieved December 28,
2010 at http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html
Haines, Terry P., Kim L. Bennell, Richard H. Osborne, & Keith D. Hill. (2004). Effectiveness of targeted falls prevention programme in subacute hospital setting: randomized controlled trial. British Medical Journal, 328(7441): 676. Retrieved December 28, 2010 at
Patient Safety Against Injurious Falls
A White-Paper Testimony on Current Risks
With more than a thousand preventable deaths a day, the need to pay greater attention to improving current patient safety conditions and standards is unquestionable (Gandhi, 2014). This was the gist of a testimony to the U.S. Senate Committee on Health, Labor, Education and Pensions Subcommittee on Primary Health and Aging. The white paper discussed the current safety risks faced by ambulatory patients in the hospital setting. This has been the direction of the patient safety movement since 15 years with emphasis on ambulatory safety problems. Recent studies identified the major safety issues confronting hospital settings. These include medication safety, missed or delayed diagnoses, transitions of care, patients' non-adherence to medication (Gandhi) and poor clinician communication with patients (Schnall et al., 2012). The last issue was the finding of a recent survey of 162 registered nurses attending an…
Ballinger, C. And Brooks, C. (2013). An overview of best practice for falls prevention from an occupational therapy perspective. The Health Foundation. Retrieved on April 14, 2015 from http://patientsafety.health.org.uk/sites/default/files/resources/an_overview_of_best_practice_for_falls_prevention_from_an_occupational_therapy_perspective_0.pdf
Child, S. et al. (2012). Factors influencing the implementation of fall prevention programmes: a systematic review and synthesis of qualitative studies. Systematic Review: Implementation
Science. Retrieved on April 11, 2015 from http://www.implementationscience.com/content/7/1/91
Ensign, M.R. (2008). Ethical issues and the elderly: guidance for eldercare providers. Ensign Law. Retrieved on April 14, 2015 from http://www.ensignlaw.com/Ethical%2020Issues%20and%20Elderly.html
Hourly Nurse ounds, Can They Make a Difference?
[Author Name(s), First M. Last, Omit Titles and Degrees]
Pressure ulcers or as some refer to as bed/pressure sores or decubitus ulcers are categorized as localized areas of damaged tissue that is caused by shearing forces and excess pressure usually from maintaining the same position over a long period of time. Pressure ulcers typically happen in people who have nerve damage and/or limited mobility. When the person feels pressure, from sitting or lying on any certain body part, this often results in nutrient and oxygen deprivation to the wound or affected area. Strategies to circumvent this involve repositioning. epositioning consists of moving the person into a different position to give the body the ability to redistribute or remove pressure from the affected area. "Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood…
Callahan, L., McDonald, S., Voit, D., McDonnell, A., Delgado-Flores, J., & Stanghellini, E. (2011). Medication review and hourly nursing rounds: An evidence-based approach reduces falls on oncology inpatient units.Nursinglibrary.org. Retrieved 12 December 2015, from http://www.nursinglibrary.org/vhl/handle/10755/164025
Marsden, G., Jones, K., Neilson, J., Avital, L., Collier, M., & Stansby, G. (2015). A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers. J Adv Nurs, 72(12), 2879. http://dx.doi.org/10.1111/jan.12753
Moore, Z., & Cowman, S. (2012). Repositioning for treating pressure ulcers.Cochrane Database Of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd006898.pub3
THE ISSUE OF ACCIDENTAL FALLS
At some point, anyone who had learned how to walk has had the experience of falling down -- it is a universal experience for infants as they gain ambulatory ability. In hospitals, however, the accidental fall is the most reported type of patient safety incident, with elderly patient populations displaying a particular vulnerability (Oliver 2007, p.173). Approximately one-third of adults over the age of sixty-five will experience an accidental fall this year (CDC 2012, n.p.) Fischer (2005) offers some clarification as to how these incidents should be defined -- the simplest basic definition is "a sudden, uncontrolled, unintentional, downward displacement of the body to the ground or other object" (p822). This definition takes into account the unpredictable nature of the incident, and the fact that it frequently involves a certain loss of control on the part of the patient; it also reminds us that…
CDC (2012). Adult falls. Web. Accessed at: http:/ / www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htm
Currie, LM. (2006). Fall and injury prevention. Annual Review of Nursing Research. 24(1):39-74.
Fischer ID; Krauss MJ; Dunagan WC et al. (2005). Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital. Infection Control and Hospital Epidemiology. 26(10):822-7.
Grubel, F. (1959) Falls: A principal patient incident. Hosp Manage. 88:37-8.
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.
Falls in the Nursing Home
There has been an increase in falls in the nursing home. A number of things can cause residents to fall (Patient falls: How to prevent them). Illnesses, such as dementia among others, can cause residents to be confused. Confusion with residents requires continual monitoring in keeping the resident safe. Muscle weakness and instability cause falls when residents are confused, or when the resident insists on doing things themselves and maintaining their own independence in spite of the weakness or instability issues. Medications can also cause confusion. Sedatives and anti-anxiety medications are a particular concern in causing confusion. Medications can also cause drowsiness that can cause falls if patients are not put to bed when the medications are given.
Environmental factors also play a role in falls. Wet floors, poor lighting, incorrect bed height, improperly fitted shoes, unmaintained wheel chairs, or items…
Falls in Nursing Homes. (n.d.). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/HomeandRecreationSafety/Falls/nursing.html
Patient falls: How to prevent them. (n.d.). Retrieved from patient Safety Partnership: http://www.patientsafetypartnership.org/Patient_Falls.html
Fall Reduction Project: An Evaluation of the Implementation Process
Chapter 3: Implementation
Blank hospital had a significant increase in falls in the inpatient acute care setting. For this reason, the need for an immutable and comprehensive fall strategy was identified at the hospital following an evaluation of the various costs (both financial and ethical) associated with falls deemed preventable. Towards this end, a fall prevention project was undertaken. I was responsive for overseeing the fall prevention project implementation.
1. Description of Steps
· Pre-implementation phase
· Implementation phase
· Sustainment phase
1.1. Pre-implementation Phase
The pre-implementation phase took a total of 2 months. In essence, pre-implementation phase was meant to prepare the entire facility for the actual phase of implementation. Towards this end, various steps were undertaken. These will be highlighted below.
1.1.1. Identification of Improvement Opportunities
This was founded on the collected fall data. There was an…
Today, research shows that many people are today suffering from mental disorders as a result of alcohol and drugs addiction. This has caused parents, the elementary schools, communities as well as, mental health professionals to express their concern in regards to drug addiction in order to develop a prevention plan that will help teens/high school student before they become addicts. Drug addiction in families contributes to an extensive list of serious mental illness; as a result developing an invention plan is a good idea because it will minimize the chances of occurrence. The primary goals of the prevention plan include;
To reduce the use, the types of substances used as well as limiting the number of users
To ensure that the use of drugs and alcohols in teens/students are delayed. Delaying the use of drugs and alcohol reduces harm during a child's development as well as reducing the…
Alexander, B. (2010). The Meaning of Addiction 3.A Theories of Addiction. Overcome Addiction Life Process Program. Retrieved November 19, 2013, from http://lifeprocessprogram.com/the-meaning-of-addiction-3-theories-of-addiction / www.mentorfoundation.org
Givaudan, M., & Pick, S. (2001). 1 A Preventive Program for Substance Abuse in Mexico: Best Practices . 1 www.mentorfoundation.org 1 A Preventive Program for Substance Abuse in Mexico: Best Practices . Retrieved November 21, 2013, from http://www.mentorfoundation.org/pdfs/prevention_perspectives/3.pdf
Keegan, K., & Moss, H. (2008). Chasing the high: a firsthand account of one young person's experience with substance abuse. New York: Oxford University Press.
"Twenty-three million Americans experience workplace bullying within their work lifetimes" (cited in Seagriff, 2010, p. 575). With the economic challenges Americans are facing recently, tensions in the workplace are also on the rise, as employees increasingly worry that their jobs are in jeopardy. This fear over possibly losing their job means many employees will not risk reporting bullying to their employers.
Interdependence conflicts, as mentioned, are another common type of workplace conflict. This type of conflict centers on an employee's dependence of another person's assistance, input or output to perform their job (Kankanhalli, Tan, & Kwok-kee, 2007). In other words, task interdependence varies depending on the extent which an employee needs materials, information or support from their workplace peers, in order to do their job. "Task interdependence alters the course and consequences of conflict. Some have asserted that because high task interdependence implies the need for intensive interactions among members,…
Bacal, R. (1998). Conflict prevention in the workplace: using cooperative communication. Winnipeg: Bacal & Associates.
Bhattacharya, S. (19 Sept 2010). "Resolving conflict at work." Busienss Today, 19(9). p. 127-129.
Booher, D. (May 1999). "Resolving conflict." Executive Excellence, 16(5). p. 5.
Budd, J. & Colvin, a. (Jul 2008). "Improved metrics for workplace dispute resolution procedures: Efficiency, equity and voice." Industrial Relations, 47(3). p. 460-479.
Incontinence is another condition not frequently intimated to their doctor. Less than a third of them actually report falls despite the availability of initiatives and measures, which can address falls. These include home-based exercises, home environment assessment, cataract surgery, medication review and Vitamin D and calcium supplements (CFA).
Falls Prevention Intervention
Studies reveal the importance of physical activity in preventing or reducing the risk of falls among older persons in the community and at home (Rose 2007). There is, however, limited evidence at present that physical activity benefits very weak ones in care facilities. Physical activity promises benefit to healthy older adults against the risk of falls. Those at moderate risk, on the other hand, will gain more from structured exercise programs aimed at risk factors, which can be manipulated or changed. They can be adjusted to progress according to the individual's capabilities and earlier physical activity experience. And those…
Cripps, R. 2001, 'Deaths from falls in the elderly top 1,000-year,' Australian Institute of Health and Welfare [Online] Available at http://www.aihw.gov.au/media-release=detail/?id=6442464404
CFA 2011, 'Fall rates need to fall further,' Continence Foundation of Australia [Online]
Available at http://www.continence.org.au/news.php/38/fall-rates-need-to-fall-further
Ory, M.G. et al. 2009, 'Implementing and disseminating on evidence-based program to prevent falls in older adults, Texas, 2007-2009,' Preventing Chronic Disease [Online]
As the percentage of older Americans continues to increase, the need for timely and accurate assessment screens and the formulation of effective clinical interventions will become even more pronounced. Fortunately, the research also showed that there are a number of assessment tools that are available to facilitate the process, including sophisticated multifactor instruments with proven validity and reliability. One of the more important issues to emerge from the research concerned the need for individualized interventions that draw on strengths and interests in order to minimize the risk factors that are involved.
Faber, M., Bosscher, .J. & Van Wieringen, P.C. (2006). Clinimetric properties of the performance-oriented mobility assessment. Physical Therapy, 86(7), 944-954.
Functional assessment. (2012). NursingLink. etrieved from http://nursinglink.monster.com / training/articles/331-functional-assessment-the-key-to-geriatric-care-in-the-21st-
Gates, S. & Smith, L., Fisher, J.D. & Lamb, S.E. (2008, October 1). Systematic review of accuracy of screening instruments for predicting fall risk among independently living older…
Faber, M., Bosscher, R.J. & Van Wieringen, P.C. (2006). Clinimetric properties of the performance-oriented mobility assessment. Physical Therapy, 86(7), 944-954.
Functional assessment. (2012). NursingLink. Retrieved from http://nursinglink.monster.com / training/articles/331-functional-assessment-the-key-to-geriatric-care-in-the-21st-
Gates, S. & Smith, L., Fisher, J.D. & Lamb, S.E. (2008, October 1). Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults. Journal of Rehabilitation Research & Development, 45(8), 1105-1113.
isks for Falls
'isks for falls' have been an area of concern for medical professionals especially nurses. Statistics have shown that an increasing number of falls in hospitals and hospice settings not only raises question marks on the services provided to the patients along with negative consequences for the healthcare professionals and patients but also increases the overall costs of providing healthcare services. There are various researches which have shown that following clinical practice guidelines (CPGs) has found to reduce the number of falls substantially however the effectiveness of these CPGs is mainly dependent on the experiences of the healthcare professionals and patients after falls along with the impact of social factors such as community obligation, organizational resources, and individual resources.
esearch by Stenberg and Wann-Hansson (2011) has shown that the in order to comply with the provided CPGs, personal experience after the event of falls plays a…
Rycroft-Malone J. (2004). The PARiHS framework -- A framework for guiding the implementation of evidencebased practise. Journal of Nursing Care Quality, 19(4), 297 -- 304.
Rycroft-Malone J., Harvey G., Seers K., Kitson A., Mc- Cormack B. & Titchen A. (2004). An exploration of the factors that influence the implementation of evidence into practise. Journal of Clinical Nursing, 13, 913 -- 924.
Rycroft-Malone J., Kitson A., Harvey G., McCormack B., Seers K., Titchen A. & Estabrooks C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality Safe Health Care, 11, 174 -- 180.
Semin-Goossens A., Van Der Helmi J.M.J. & Bossuyt P.M.M. (2003). A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention. Journal of Nursing Care Quality, 18(3), 317 -- 325.
Nursing and Issue of Falls
Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls can occur in a home, community, long-term rehabilitation, or acute care Setting (Laurence Z.. et.al, 1994). The risk of falls can be related mostly to mobility status, exposure to hazardous environments and risk-taking behaviors such as climbing ladders for seniors living in the community setting. Factors for a fall in hospitalized adults are greatly influenced by acute illness that often has a marked, albeit temporary, impact on physical and cognitive function compounded by care provided in unfamiliar surroundings in the long-term care setting, the risk factors for falls are influenced by impaired cognition, wandering or impulsive behavior, use of psychotropic medications, incontinence and urgency, lack of Exercise, unsafe environments, and low staffing levels. Patient falls are serious problems
In acute care hospitals and are used as…
Anuradha Thirumalai, (1998). Nursing Compliance with Standard Fall Prevention
Protocol Among Acute Care Hospital Nurses. Retrieved September 26, 2012 from http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1191&context=thesesdissertations&sei-redir=1&referer=http%3A%2F%2Fwww.google.co.ke%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dnursing%2520compliance%2520with%2520standard%2520fall%2520preventionprotocol%2520among%2520acute%2520care%2520hospital%2520nurses%26source%3Dweb%26cd%3D1%26ved%3D0CCAQFjAA%26url%3Dhttp%253A%252F%252Fdigitalscholarship.unlv.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1191%2526context%253Dthesesdissertations%26ei%3Dg-NiUPW8CuLB0QW_r4DgAw%26usg%3DAFQjCNE6__5zNu8vjRxc-jIFBXbBfKVIng#search=%22nursing%20compliance%20standard%20fall%20preventionprotocol%20among%20acute%20care%20hospital%20nurses%22
Dykes, P.C., Carroll, D.L., Hurley, A.C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? Journal of Nursing Administration, 39(6), 299-304. doi:10.1097/NNA.0b013e3181a7788a
Laurence Z. Rubenstein, Karen R. Josephson & Alan S. Robbins, (1994). Falls in the Nursing
Falls in the Elderly
It is no secret that elderly people fall more than people in younger age groups. Each year, approximately one-third of elderly people will experience a fall of some kind (Yoshida, n.d.; Centers, 2013). There are several reasons that this can be the case. The theory here is that balance simply becomes more tenuous as a person ages, and that not all falls in the elderly can be prevented. However, there are racial differences seen in falls, as well. White men experience the largest number of fatal falls, followed by white women, then black men, and black women (Yoshida, n.d.). People who have limited access to health care and other helpful options are also more likely to fall. They may have diseases or conditions that make falling more likely, putting them at risk (Yoshida, n.d.). Additionally, people who live alone and who do not have a lot…
Blake, A.J., Morgan, K., Bendall, M.J., Dallosso, H., Ebrahim, S.B., Arie, T.H., Fentem, P.H., & Bassey, E.J. (1988). Falls by elderly people at home: Prevalence and associated factors. Age Ageing, 17(6): 365-72.
Centers for Disease Control and Prevention (2013). Falls among older adults: An overview. CDC. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
Yoshida, S. (n.d.) A global report on falls prevention. Epidemiology of falls. World Health Organization. Retrieved from http://www.who.int/ageing/projects/1.Epidemiology%20of %20falls%20in%20older%20age.pdf
Bed and Chair Alarm in to Help educe Falls in Short-Term Care Facility
In long-term care facilities (e.g., assisted living centres and nursing homes), a fall is one of the single most devastating category of unpleasant events. In consequence, there is need for long-term care facilities to pay attention to issues of resident falls. To a significant extent, adequate fall prevention depends on the ability of caregivers to hold on to a well-structured process that comprises of timely fall risk and post fall evaluations and targeted multidisciplinary involvements, which are based on recognized risk factors and reasons why falls occur. To lend support to nurses in their attempts to control these falls, certain technologies that relate to minimizing the number of hazards linked to falls have been found to be vital strategies against the luxury of resident protection. Some of the most popular technologies used for fall management include:
Aberg AC, Lundin-Olsson L, Rosendahl E. (2009). Implementation of Evidence-Based Prevention of Falls in Rehabilitation Units: A Staff's Interactive Approach. J Rehabil Med 41(13): 1034-40.
American Nurse Today. (2012). Special Supplement to American Nurse Today - Best Practices for Falls Reduction: A Practical Guide - American Nurse Today. Retrieved January 22, 2016, from http://www.americannursetoday.com/special-supplement-to-american-nurse-today-best-practices-for-falls-reduction-a-practical-guide-2/
KanolanK. (n.d.). Nursing 110 final. Retrieved January 22, 2016, from https://quizlet.com/20498057/nursing-110-final-flash-cards/
McHugh, M. D., & Lake, E. T. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research in nursing & health, 33(4), 276-287.
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.
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.
Small usiness' Need for a CPA
One of the critical investments a small business can make to mitigate loss and risk is hiring a CPA and putting that CPA on the 'management team.' As Wells notes in his groundbreaking research, "Denise, a bookkeeper for a small trucking firm in irmingham, Alabama, wishes she had never heard of Ralph Summerford, CPA. ecause of his thoroughness, Denise is facing several years in prison for embezzling $550,000 from her employer. At least she will look good standing before the sentencing judge: Denise spent a great deal of her illegal loot on head-to-toe cosmetic surgery. She blew the rest on a shiny new Lexus, luxury vacations, clothing and jewelry. And, of course, Denise had to have a big house to store all of her finery." (Wells, 2003)
Surprisingly, it was not at all the fancy standard of living that made her employer suspicious. "The…
Wells, Joseph. 2003. Protect small business: small companies without adequate internal controls need CPAs to help them minimize fraud risk. Journal of Accountancy.
Small Business Administration. 2005. www.sba.gov.
Federal Reserve Bank. 2004. www.federalreserve.gov.
AICPA. 2005. At www.aicpa.org/antifraud/training/homepage/htm.
Medical Conditions -- There are a number of factors that can increase the likelyhood of type-2 diabetes: hypertension, eleveted cholesterol, and a condition called Symdrome X, or metabolic syndrome (combination of obesity, high cholesterol, sedentary lifestyle, stress, and poor diet). Cushing's syndrome, cortisol excess and testosterone deficiency are also associated with the disease. Often, it is a number of co-dependent conditions that seem to give rise to diabetes (Jack & Boseman, 2004).
Genetics -- There is ample evidence that there is a strong inheritable genetic condition in type-2 diabetes. In addition, there is a genetic mutation to the Islet Amyloid Polypeptide gene that results in early onset diabetes (Lee & Hasim, 2001). There is a stronger inheritance pattern for type-2 diabetes with a significant association between family members. Typically, this is excacerbated by cultural and lifestyle factors that, while not inherited, are culturally shared. Gene expression promoted by a diet…
ise and Fall of Nortel
Nortel initially engaged in telecommunications and expanded its business to a net gear for them to uphold competitiveness. The affiliation was performing exceptionally in 2000 when it garnered 37% of the stock exchange in Toronto. Nortel progressed through aggressive procurement with analysts purporting that it was sustainable. Norton hailed as an exemplary and successful affiliation in Canada. Accounting irregularities and poor management resulted in Nortel's stock prices declining rapidly in 2001 (Markarian, Magnan & Fogarty, 2009). Nortel's frail unethical management practices pursued improper directives in fraudulently embezzling company funds, over-paying benefits to executives, merging with other unsuccessful affiliations and being overly aggressive in its endeavors. This explication covers its rise and fall among other concerns addressing recovery from such mistakes.
Norton's ise and Fall
The formation of any affiliation focuses on its goals and objectives. Stakeholders ought to begin implementing measures that enhance an organization's…
Markarian, G., Magnan, M.L., & Fogarty, T. (2009). Inside Agency: The Rise and Fall of Nortel. Journal of Business Ethics, 84(2), 165-187.
Nurses, who have first hand knowledge and understanding of how to live healthy and how to take proper care of themselves, are far better equipped to teach others about these concepts. Certain populations can benefit greatly from prevention, especially those who are prone to specific types of diseases or conditions.
One of the most common behaviors that leads to many chronic and often very damaging health conditions is smoking. Smoking can cause a multitude of diseases and conditions from emphysema to heart disease to lung cancer (Chapman, 2007). The list goes on and on. But smoking is 100% preventable and nurses need to understand not only how to treat these smoking-related diseases but how to more importantly discourage and prevent people from smoking in the first place. Many nurses agree that this behavior leads to many of the worst case scenarios for people with pre-existing chronic conditions. It is therefore…
Chapman, Simon. (2007). Public Health Advocacy and Tobacco Control: Making Smoking
History. Blackwell Publishing, New York, NY. Pp. 55-56.
Chung, Daniel C. (2008). "Stool DNA Testing and Colon Cancer Prevention: Another Step
Forward." Annals of Internal Medicine, Vol. 149, No. 7. pp. 509-510.
Long-Term Care Facility Safety: Prevention and Reduction of Injuries Due to Falls
One out of every three adults ages 65 and older experiences a fall annually however, only about 50% of health care providers discuss falls with these individuals. Falls are the leading cause of injury death in adults 65 years of age and older. More than 19,700 adults died in 2008 form accidental fall injuries and in 2009 out of the 2.2 million nonfatal fall injuries in older adults in excess of 581,000 individuals had to be hospitalized. The direct medical costs were over $19 billion in 2000. (Centers for Disease Control and Prevention, 2012) According to the National Council of Certified Dementia Practitioners, "One of the most challenging, life-threatening issues related to care of the person with cognitive loss is the occurrence of wandering, wherein the person strays into unsafe territories and may be harmed." (2012) It is…
Comprehensive Prevention Program (2012) Premier Inc. Retrieved from: https://www.premierinc.com/quality-safety/tools-services/safety/topics/falls/prevention_program.jsp
Falls Among Older Adults: An Overview (2012) Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
Koski, K., Luukinen, H., Laippala, P., & Liisa-Kivela, S. (1996). Physiological factors and medications as predictors of injurious falls by elderly people: A prospective population-based study. Age and Ageing, 25: 29-38.
McCarthy, R. Adedekun, C and Fairchild, R. (nd ) Preventing Falls in the Elderly Long-Term Care Facilities. RN Journal. Retrieved from: http://www.rnjournal.com/journal_of_nursing/preventing_falls_in_the_elderly_long_term_care_facilities.htm
The prescriptions include wisdom, honesty, and courage, as well as human dignity, integrity, respect, health, and independence.
Part 3: Formulate possible evidence-based practices and an action plan that could work towards achieving improvement outcomes.
Provide insight into the diagnostic processes (e.g., root cause analysis) used to determine the primary causes of the problem. Consider both qualitative (cause-effect diagram, barrier analysis), and quantitative (theory testing or drill down analysis) methods.
Analyze the cost-effectiveness of your initiative and how your initiative mitigates risk and improves health care outcomes.
Countless interventions have been used for fall prevention amongst the elderly population. These include risk-assessment and management programs, I.e. Designed to screen those who are most at risk and to design interventions that will reduce their risk of falling; exercise programs slanted dot enhancing flexibility, endurance, and strength; education programs (including one-to -one counseling on methods to prevent falls); environmental modification in homes or…
ANA Nursing-Sensitive Indicators. http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/the-National-Database/Nursing-Sensitive-Indicators_1
Butts, JB Ethics in professional Nursing Practice
Broe, K et al. (2007) a Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing
Incidence of in-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team -- Based Fall-Prevention Intervention
olfgang von Renteln-Kruse, MD, and Tom Krause, Dipl Geogr
Falls are the leading cause of hospital related injuries in the United States. There are a plethora of different factors that can be considered as possible causes of fall related incidents which cover a fairly broad range of concepts that apply to patients of all ages and over a range of different scenarios. As a result the fall incident rate has been the subject of many academic research projects as well as health care facilities due to the fact that world and professionals alike as inpatient falls are serious patient safety and quality issues. Fall prevention is an important aspect to patient safety and effective communication among staff, patients, and their families is required to mitigate potential risks. There have been…
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.
Preventing Falls: A Program to Address Elderly Falls Using the Strategy of Education
The goal of this program is to prevent elderly persons from experiencing falls, which can have severe impacts on their health. Falls are one of the most dangerous experiences an elderly person can suffer (Owen, 1985) and so it is important not only for them to be aware of the dangers around them but also for others who care for them or who know them to be aware of how we could help to prevent falls (American Institute of Architects Foundation, 1986). The main goal of this program, therefore, is to spread knowledge and education about elderly fall risks and to adopt preventative measures that can be adopted both by the elderly and by their caretakers, children, neighbors, friends, loved ones -- in short, anyone who comes into contact with them and cares to help them avoid…
Al-Faisal, W. (2006). Falls Prevention for Older Persons. Eastern Mediterranean
Regional Review. Retrieved from http://www.who.int/ageing/projects/EMRO.pdf
American Institute of Architects Foundation. (1986). Design for Aging: An Architect's
Guide. Washington, D.C.: American Institute of Architects Press.
quality where data is gathered through interviews, surveys and observations, while quantitative study establishes its results on the basis of surveys, questionnaires and statistical data. A quantitative study "Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey" by Prem et al. can be compared with the qualitative study in question to understand the difference. The aim of this study is to assess the knowledge of nursing professionals about palliative care through a palliative care knowledge test (PCKT) (Prem et al., 2012).
A cross-sectional survey has been done amongst 363 nurses working in a multi-speciality hospital by using a questionnaire PCKT, unlike qualitative study done by Dykes et al. that utilized a sample of 23 Ns and 19 NAs which can be easily interviewed, questioned and observed. A general finding of the quantitative study was in agreement with the previously established facts of poorer knowledge of palliative care but…
Dykes, P. C., Carroll, D. L., Hurley, A. C., Benoit, A. & Middleton, B. (2009). Why Do Patients in Acute Care Hospitals Fall? Can Falls be prevented." J. Nurs Adm., 39(6), 299 -- 304.doi: 10.1097/NNA.0b013e3181a7788a. Retrieved 19 September 2016 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107706/#R19
Lobiondo-Wood, G. & Haber, J. (2014). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. (ed. 8). Missouri: Mosby, an imprint of Elsevier Inc. Retrieved 19 September 2016 fromhttps://books.google.co.in/books?id=wXWSAAAAQBAJ&printsec=frontcover#v=snippet&q=grounded%20theory&f=false
Prem, V., Karvannan, H., Kumar, S. P., Karthikbabu, S., Syed, N., Sisodia, V. & Jaykumar, S. (2012). Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey. Indian Journal of Palliative Care, 18(2), 122-127.doi: 10.4103/0973-1075.100832
Wyse, S. E. (2011). What is the Difference Between Qualitative Research and Quantitative Research? Snap Surveys.com. Retrieved 21 September 2016 fromhttp://www.snapsurveys.com/blog/what-is-the-difference-between-qualitative-research-and-quantitative-research/
Alzheimer’s Intervention Evaluation
This paper provides a basic evaluation plan for evaluating a health program for elderly patients with Alzheimer’s. The health program focuses on designing and implementing an open space concept for the patient, having a social worker regularly meet with the patient and loved one or caretakers to ensure support, having family therapy sessions available for loved ones acting as caretakers if they should want it and providing a falls prevention initiative through training in an exercise routine to strengthen the balance and agility of the elderly person—all of which are considered vital aspects to improving the health status of an elderly person with Alzheimer’s (Canning et al., 2015; Hoof, Kort, Van Warde & Blom, 2010; Rubin, 2011). The overall question an intervention evaluation asks is: Was the intervention implemented as planned? (Harris, 2010). The purpose of this paper is to provide an evaluation plan for the…
Myra's case is just one instance of many that a mental health nurse encounters on a regular schedule.
Nursing is best practiced when it follows the intentions of its founder Florence Nightingale who urged that nursing should be a practice that should literally provide for and care for the patient. Nursing, in other words, should be purely patient-centered. This caring extends to all aspects not just to the illness so that one treats the patient in a holistic way, considering all components of the patient such as the family, his or her social needs, hobbies, desires, spiritual inclinations and so forth. When done in this way, nursing extends itself from an automatic, robotic procedure to something that can motivate the nurse and uplift the patient (Watson, 1998). 'Nursing', in other words, extends to caring for the patient as a whole.
An effective nurse will strive to accomplish her best in…
Sansoni, J et al. (2004) Anxiety and depression in community-dwelling, Italian Alzheimer's disease caregivers, retrieved from International Journal of Nursing Practice: 10: 93-100.
Hayslip, B et al. (2008) Predictors of Alzheimer's disease caregiver depression and burden: what noncaregiving adults can learn from active caregivers. Educational Gerontology, 34: 945-969,
Broe, K et al. (2007) A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing
Home Residents: A Randomized, Multiple-Dose Study JAGS 55:234 -- 239
This study is a theoretical framework exploring whiteboard use preferences and recommendations for patient-centered care and communication through whiteboard use.
This study is a theoretical framework exploring whiteboard use, script-based communication, and hourly rounding to evaluate effectiveness of care associated with pain management and patient satisfaction.
The study utilizes a conceptual framework.
This article uses a conceptual framework that provides a literature review
A 3-week pilot involving multidisciplinary whiteboard use
The setting is Stanford University Medical Center
Sample characteristics (# of patients) Patients available for the pilot were 104 patients: 56 from inpatient units with use of whiteboards and 48 from inpatient units with no use of white boards.
internal medical residents were also surveyed.
Design: The study involved a semi-structured interview.
Setting: The interview took place in a pediatric urban academic hospital inpatient surgical service
Sample characteristics (# of patients) The…
Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logsdon, M. C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 16(3), 321-327. doi:10.1016/j.pmn.2014.08.008
Brosey, L. A., & March, K. S. (2015). Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes. Journal of Nursing Care Quality, 30(2), 153-159. doi:10.1097/ncq.086
Cholli, P., Meyer, E. C., David, M., Moonan, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. K. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 6(7), 426-430. doi:10.1542/hpeds.2015-0182
Emerson, B. L., Chmura, K. B., & Walker, D. (2014). Hourly Rounding in the Pediatric Emergency Department: Patient and Family Safety and Satisfaction Rounds. The Journal of Emergency Medicine, 47(1), 99-104. doi:10.1016/j.jemermed.2013.11.098
Democracy and Public Administration
This report is a theoretical essay on the inevitable conflicts that consistently occur between public agencies that are managed by unelected civil servants and the political environment in which these individuals and organizations operate in. Public agencies in the healthcare environment are prime examples of successful interdepartmental cooperation in most cases, but, there are also examples where they can demonstrate both internal and external in-fighting. "The health sector workforce, which usually comprises a significant element within the total public sector workforce, may be either directly employed by the public sector health system, or work in public-funded agencies or organizations (e.g., social insurance funded). In many countries healthcare will also be delivered by organizations in the private sector and by voluntary organizations." (World Bank Group) As concerns like the nation's aging population, a rapidly depleting Medicare Trust or the many potential pandemics such as SAs, Swine…
Antos, Joseph. (2008). "Medicare's Bad News: Is Anyone Listening?" American Institute for Public Policy Research. April, No. 3.
American Public Health Association (2009). Retrieved on November 2, 2009, from American Public Health Association Web Site: http://www.apha.org aphanet. (2001). Senators' Introduce Bill to Prepare For Possibility of Biological Warfare. Retrieved on November 2, 2009, from http://www.aphanet.org
CDC. (2009). H1N1. Retrieved on November 3, 2009, from Center For Disease Control web site at http://www.cdc.gov/h1n1flu/sick.htm .
Center for Disease Control. (2009). State and Local Infrastructure. Retrieved on November 3, 2009, from Center for Disease Control Web Site: http://www.cdc.gov/programs
Nursing Leadership and Management
Organizational Analysis -- The Organization
The hospital is well recognized and has been named a top 100 Heart hospital and top 100 hospitals nationally. The organization also has a nationally ranked children's hospital that has newborn and pediatric intensive care services. Sanford Medical Center is a level II trauma center that is supported by AirMed transport services that cover a three-state area. The services offered within the facility include:
• 3D Mammography
• Allergy & Immunology
• Behavioral Health
• Breast Health
• Dermatology & Cosmetic Services
• Diabetes & Endocrinology
• Ear, Nose & Throat
• Emergency Medicine
• Family Medicine
• Palliative care
• Laboratory and Pathology
Sanford Medical Center is a not-for-profit rural health facility. The facility does partner with the community to bring health and healing to the…
Leslie L.C., (2010). Hourly rounding benefits patients and staff. http://Www.americannursetoday.com/From-our-readershourly-rounding-benefits-patients-and-staff/
This article states that even as hourly rounds have been proven to have its good effects, the proper implementation of the same is a hindrance in the way of reaping the benefits of the program.
With statistical data the article states that nursing satisfaction is achieved by the process as the nurses get additional time for bedside care.
However there are implementation problems as research has shown that the evidence-based practice change is challenging and complex and there is no universal method of implementation.
Tucker, Bieber, Attlesey-Pries, Olson and Dierkhising, (2011)suggests that the implementation should incorporate several essential components to the successful implementation and the translation of the process into practice which include understanding the complex nature of the intervention, the assessment of the adopters and an effective communication plan (Tucker, Bieber, Attlesey-Pries, Olson & Dierkhising, 2011).
esearchers also stress…
Brosey, L., & March, K. (2015). Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes. Journal Of Nursing Care Quality, 30(2), 153-159. doi:10.1097/ncq.
Carroll, D., Dykes, P., & Hurley, A. (2010). Patients' perspectives of falling while in an acute care hospital and suggestions for prevention. Applied Nursing Research, 23(4), 238-241. doi:10.1016/j.apnr.2008.10.003
Deitrick, L., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly Rounding. Journal Of Nursing Care Quality, 27(1), 13-19. doi:10.1097/ncq.0b013e318227d7dd
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls. Nursing, 45(2), 25-30. doi:10.1097/01.nurse.0000459798.79840.95
Building Linkages Between Nursing Care and Improved Patient Outcomes: The ole of Health Information Technology
Health IT (HIT) is capable of transforming care quality and establishing connections between patient outcomes and nursing care. This article will examine the application of health IT and nursing-sensitive measures/indicators (NSIs) for improving care quality and establishing connections between better patient outcomes and nursing care. NSIs refer to measures reflecting nursing care process, structure, and outcomes. NSIs of outcome denote caregiver or patient measurement approaches sensitive to nurse care. While a number of advocates deliberate over the perceived advantages of health IT, an honest consideration of practical experiences with real HIT systems, together with the drawbacks and obstacles associated with poorly-constructed systems, is not addressed. Ultimately, the aim must be improvements to quality, added convenience, and growth of efficiency, rather than mere creation of wired health facilities. Nursing informatics as a practice specialty is having…
Balas, M. C., Rice, M., Chaperon, C., Smith, H., Disbot, M., & Fuchs, B. (2012). Management of delirium in critically ill older adults. Critical Care Nurse, 32(4), 15-26. doi: 10.4037/ccn2012480
Council of Economic Advisors (2009). The economic case for health care reform. Washington, D.C.
Chapter 3 (n.d) HEALTHCARE ENVIRONMENT: INNOVATION, TECHNOLOGY, AND LEGAL ISSUES IN NURSING. Retrieved 19 April 2016 from http://www.nursecredentialing.org/documents/certification/reviewmanuals/nurseexecchapter.aspx
Dykes, P., & Collins, S. (2013). Building linkages between nursing care and improved patient outcomes: The role of health information technology. OJIN: The Online Journal of Issues in Nursing, 18(3).
This really helped me to remember why it was I became a nurse, and demonstrates the true needs of patients that I was helping to care for and not simply trying to cure. These moments also made the more mundane and laborious elements of the job seem more worthwhile, and I was definitely feeling less stress and more satisfaction upon the completion of my shift than I had the previous day, when such patient connections has not seemed possible.
Though falls from hospital beds are more common than might be expected, a fall that occurred in the medical-surgical unit was deemed worthy of calling a meeting of available nursing staff to review fall prevention procedures and stress the importance of maintaining regular and frequent rounds as well as sitting with fall-prone patients whenever possible, even in short and frequently rotating shifts, to ensure that movement can be facilitated…
Furukawa, M., Raghu, T. & Shao, B. (2010). Electronic Medical Records, Nurse Staffing, and Nurse-Sensitive Patient Outcomes: Evidence From the National Database of Nursing Quality Indicators. Medical Care Research and Review 67(11):77-89.
Heaven, C. & Maguire, P. (2008). Communications Issues. In Psychological Issues in Palliative Care, Lloyd-Williams, M, ed. New York: Oxford University Press.
Shever, L., Titler, M., Mackin, M. & Kueny, a. (2010). Fall Prevention Practices in Adult Medical-Surgical Nursing Units Described by Nurse Managers. Western Journal of Nursing Research 32(9): 17-24.
Simonazzi, a. (2009). Care regimes and national employment models. Cambridge Journal of Economics 33(2): 211-32.
overarching aim of the proposed study is to analyze the role of health administration leadership. In support of this aim, the study has several objectives, including promoting sound professional practices, ethics, social accountability, and community orientation, integrating analytical and critical thinking skills into professional activities, demonstrating cooperative team work, analyzing professional development in the health field through planned, reflective, self-directed learning and demonstrating effective leadership and interpersonal, written, and group communication skills.
he Future of Health Care Services as hey Relate to Geriatric Services in an Acute Care Hospital
he study's introduction will be used to describe the importance of geriatric services in general and these services in an acute care hospital in particular. he introduction will explain that the study identifies the problem of interest, its background and context, and the impact of geriatric services on hospital environments. Recommendations and leadership considerations are followed by a…
This study of geriatric inpatient admissions showed that the most prevalent physical illness experienced by elderly upon admission was visual impairment; this physical condition was followed by cardiovascular disease, rheumatic illnesses, pulmonary illnesses, hearing impairment, genitourinary diseases and neurological disorders, in that order. Although not an age-related disease, advanced age was associated with an increased prevalence of dementia.
Yeo, G. (2009). How will the U.S. healthcare system meet the challenge of the ethnogeriatric imperative? Journal of the American Geriatric Society, 57(7), 1278-1285.
As the elderly segment of the population continues to grow faster than the population at large, there is a concomitant need for cross-cultural and minority-sensitive geriatric care. Differences in the manner in which the aging process is regarded can influence the effectiveness of geriatric interventions, and geriatric service providers must expand their knowledge base concerning these differences in order to provide optimal care.
Often home-based caregivers, either a spouse or adult child, rely on institutional care only as a choice of last resort, and this is often reported only after their own health and well being begins to be perceived as degraded by caring for the individual in the home, relevant to supplemented home care services as well. (Ducharme et al. 2007, p. 3-31) Researchers in fact contend that individuals will employ a vast variety of coping mechanisms to attempt to remain independent, and though these mechanisms should be supported in the community, when they are productive and effective rather than destructive but that alternatives should be better, in a number of fundamental ways. (Robichaud & Lamarre, 2002) What this trend of last resort means, according to Clemmitt, is that those with dementia and other functionally debilitating and progressive chronic diseases, i.e. he most vulnerable of populations are those who end up in…
Though this work has briefly touched on the issue of collaborative care, regarding caregivers and family, these structures also need to be expanded to a picture that more broadly develops the idea of holistic care. In general this issue has been dealt with in the literature in the case of specialization, such as follow up care and collaboration between institutions and caregivers from hospital and surgical settings. Yet, the continuity of care issue needs to be addressed in a more formal way. The discussion of the desire of previous care providers, such as hospital staff and physicians having follow up information as well as to influence future care needs to be addressed in the future long-term care setting. The days of LTC being an oasis of its own should end as more and more previous care givers seek to have at least a minimal understanding of the future well being of patients they have treated and families as well as patients tend to seek the same connectivity. Some caregivers are in fact so concerned about this disconnect that they present the idea of creating better outcomes if intermediate care offerings were provided in hospital, rather than in separate LTC facilities. (Raj, Munir, Ball, & Carr, 2007) This call for research on this subject likely has as much to do with the overall disconnect that exists between previous care providers and LTC rehabilitative service provisions as it has to do with the medical community, as well as the public having serious and enduring questions about the quality of care offered in such facilities, i.e. real and fear poor patient outcomes. (Kane, 2001) (Torres et al., 2006)
Reinardy & Kane contend that decisions made about future care are often associated with many factors and autonomy is one of the most important to most. Many often stress the choice of an unregulated assisted living facility, even if they could benefit from more skilled care because they perceive that their privacy as well as their autonomy will be better protected in such as situation. The system of future long-term care must address this issue with regard to autonomy and privacy likely by building on more private room structures and better individualization options for individuals. The days of the stark white institutional flooring and a single hospital bed, arm chair setting may very well be over and for good reasons. Long-term care centers of the future need to integrate the ideation, physical, social and emotional aspects of each cohort, i.e. those who are primarily concerned with rehabilitative care and those who are primarily concerned with privacy and autonomy, to create an environment that would meet the needs of both cohorts, possibly improving physical/medical offerings in assisted living and improving issues of privacy and autonomy in nursing homes. (2003)
Finally, and last but certainly not least LTC facilities of the
Nurse Practitioners Providing the Full Spectrum of Health Care Services
As the National Organizatoin of Nurse Practitioner Faculty (NONPF, 2013) competencies indicate, full spectrum of health care services should include health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative care and end of life care. This is a standard that is vital to primary care nursing because patients expect and have a need to obtain each of these services, as they are all part of quality care.
As the study by Flanagan-Kaminsky (2013) points out, end of life care is something that more and more patients in the Veterans Affairs Hospice program and looking to receive (p. 69). This is just one example of the type of quality care that patients and their families expect from nurse practitioners and health care providers. Counseling is another aspect of this type of care and is included in the study…
Flanagan-Kaminsky, D. (2013). Intentional Anticipatory Mourning, Caregiver and Bereavement Support Program for Terminally Ill Veterans, Their Families & Caregivers in the VA Contract Home Hospice Program. Omega, 67(1-2): 69-77.
Manheim, C., Haverhals, L., Jones, J., Levy, C. (2016). Allowing family to be family:
end-of-life care in Veterans Affairs Medical Foster Homes. Journal of Social Work in End-of-Life & Paliative Care, 12(1-2).
Matthews, A. (2014). Care of military service members, veterans, and their families.
Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental…
Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logdson, C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 321 - 327.
Brosey, L., & March, K. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 153.
Cholli, P., Meyer, E., David, M., Moonam, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 426 - 430.
Emerson, B., Chumra, K., & Walker, D. (2013). Hourly rounding in the pediatric emergency department: patient and family safety and satisfaction rounds. J Emerg Med, 99 - 104.
Designing a Safety System
Safety management system is a management policy to prevent or minimize injury within a workplace. Top organizations across the United States are increasingly investing in safety management because of the general believe that safety is central precondition to market competitiveness and "an integral part of high quality business operations." (Tervonen, Haapasalo, & Niemela, 2009 P. 17). Safety is defined as a state where all the business related risks are managed at acceptable level. Typically, safety management is a management policy used to protect workers from undetermined accidents. Safety management is very similar to corporate safety where corporate safety is a holistic management strategy to protect an organization as a whole against accidents, misuse, harm and crime.
Objective of this project is to design safety management system for Hobart Brothers Co. To design safety management system for the company, the paper provides essential components that could prevent…
Azadeh M.A.(2000). Creating highly and reliable manufacturing systems: an integrated approach. Intern J. Reliabil Saf Eng. 7(3): 205-22.
Honkasalo A. (2000). Occupational health and safety and environmental management systems. Environ Sci Policy. 3(1): 39-45.
Miettinen J. (2002). Corporate Safety Manual Jyvaskyla: Gummerus Printing Ltd. .
New South Wales Government (2012).Unit 2: Managing Workplace Hazards, and Consultation in the Workplace. NSW Education and Communities.
Hourly Nursing ounding
Nursing rounding is the schedule or process that ensures a member of staff, either the nurse or the nursing assistant visits the patient's room to offer the needed service to the patient. It is common that during the day, each hour this exercise is repeated and during the night, then after every two hours the patients are visited. Studies have shown that hourly rounding significantly decreases call light use and reduces unit noise levels. The practice also increases the satisfaction levels of both the patients and the staff members. The hourly rounding is also seen to increase staff productivity as they feel that they have control over the patient care. The hourly visits are also seen to significantly reduce the pressure sores that patients who are not able to turn on their own would suffer and also decreases falls that would otherwise be rampant if the rounds…
The report highlights the essentials that were observed during the training of nursing staff on a monthly basis. It also highlights the perspective of patients on the issue of hourly visit and how that is important to them. It also records the view that the nurses have about the proactive patient rounding and how that positively influences their work within the nursing facility.
Decision Making for Providers
hat were the consequences of a failure to report?
It appears that Mike, as the case study indicates, has made being late to report to his medical records position a habit. In fact, it has been addressed directly by his supervisor and the case seems to indicate that his job is "on thin ice" due to his frequent tardiness. During his last visit with his supervisor, Mike promised to be on time on his next shift and he actually did leave 20 minutes earlier than he normally does. This addition to Mike's case makes it appear that he does have the ambition to try to fulfill the requirements that his position in the organization requires, but whatever reason he has been unable to do so, at least consistently.
There are other parts to the story that might help to explain Mike's plight. For example, the case…
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.
Conlan, C. (N.d.). 10 excuses for being late for work. Retrieved from Monster: https://www.monster.com/career-advice/article/excuses-for-being-late-to-work
Simmons, J. (2010, October 13). Reducing In-Hospital Patient Falls. Retrieved from Health Leaders Media: http://www.healthleadersmedia.com/page-1/MAG-257370/Making-Falls-Go-Down##
eports from medical center services and committees concerning patient incidents are used to develop appropriate interventions.
Trended data of patient incidents can point to shift and date where most incidents occur.
A 50% reduction in the number medication errors of all types over the next 12 months.
Goals and Objectives to Facilitate Outcome
The overarching goal of this program would be to reduce the number of medication errors in general and among those wards/shifts with the highest numbers of medication errors over the past 12 months. The objectives in support of this goal include:
1. Developing awareness campaign materials such as locally prepared newsletter articles, posters and brochures concerning the goal to reduce medication errors.
2. Conduct a medication error theme seminar that provides basic guidelines for avoiding medication errors (the "5 Ps").
Translation of Goals and Objectives into Policies and Procedures
The above-described goals and objectives would…
Jorm, C.M. & Dunbar, N. (2009, August). Should patient safety be more patient centered?
Australian Health Review, 33(3), 390-395.
Tillman, P. (2013, January 7). U.S. Department of Veterans Affairs. Retrieved from http://www.
Older Americans Act (OAA) was first passed in 1965, alongside Medicare and Medicaid. Whereas Medicare and Medicaid offered extended insurance benefits through the federal government, the OAA established "the foundation for a system of services and supports that enables millions of older adults in this country to continue to live independently as they age," ("The Older Americans Act: Aging Well Since 1965," (The Older Americans Act: Aging Well Since 1965," n.d.). Along with its federal provisions, the OAA freed up grant money for the states to develop " community planning and social services, research and development projects, and training personnel in the field of aging," (The Older Americans Act: Aging Well Since 1965," n.d.). Basically, the OAA created an actual infrastructure to support America's aging population.
The OAA is currently comprised of seven titles:
• Title I: Declaration of Objectives
• Title II: Administration on Aging (Aoa)
• Title III:…
The general impression of Mrs. Smith so far are that she is nearing an end-of-life phase: she is becoming weaker, tired, does not feel like going out much, and experiences a general sadness -- though she says she does not feel "sad exactly." Her general mood is pensive, somewhat concerned about her frailty -- definitely concerned about having another fall like she had last year and becoming dependent upon caretakers. Her fears are founded on the experience of friends and just an overall awareness of the fact that she is aging -- now 80 -- and will not be able to live independently forever. This is no doubt causing some slight depression -- which is not uncommon or unusual in seniors at this age (Shulman, 2007). Likewise her gait pattern -- slow, "reduced walking speed, arm swing and vertical head movements" are indicative of "sadness and depression" (Michalak…
Al-Faisal, W. (2006). Falls Prevention for Older Persons. Eastern Mediterranean
Regional Review. Retrieved from http://www.who.int/ageing/projects/EMRO.pdf
Grundberg, A., et al. (2016). Home care assistants' perspectives on detecting mental
health problems and promoting mental health among community-dwelling seniors with multimorbidity. J Multidiscip Healthc, 9: 83-95.
Prevention of Back Injuries
Twenty percent of the injuries experienced in the work place in America are back injuries. In some areas, such as EMS, these injuries are responsible for the fact that at any point in time, ten percent of their workers are not working. Statistics from the Center for Disease Control actually reveal that the EMS had over 20% of all 27,000 work related sicknesses, being specifically lower back injuries (CDC, 2015). The nation pays dearly for back related injuries from the bills that are incurred as well as the income lost when workers are away from work. This amounts to about $50 billion of which $20 billion emanates from the injuries occurring in the medical field. Ironically, this surpasses the cost of similar injuries occurring in less surprising places, such as manufacturing, mining and construction industries. For a physician who is injured, the costs are estimated at…
Advice, B. L. (2015, November 17). Training in Lifting Techniques May Not Improve Prevention of Back Pain. Retrieved from Medscape: www.medscape.org/viewarticle/569657
AFSCME. (2002, March). Preventing Back Injuries in Health Care. Retrieved from American Federation of State, County & Municipal Employees: http://www.afscme.org/news/publications/workplace-health-and-safety/fact-sheets/preventing-back-injuries-in-health-care
CDC. (2015, November 17). Emergency Medical Services Workers Injury and Illness Data. Retrieved from Centers for Disease Control and Prevention: www.cdc.gov/niosh/topics/ems/data2011.html.
Collopy, K. T., Kivlehan, S. M., & Snyder, S. R. (2014, May 1). Preventing Back Injuries in EMS. Retrieved from EMS World: http://www.emsworld.com/article/11373351/back-injuries-and-protection
Environments serving elderly people, such as nursing homes or clubs for the elderly, should also be structured in such a way that the possibility of falling would be prevented. It has been found for instance that the unfamiliar hospital environment or introduction to the unfamiliar setting of a nursing home can encourage falls.
Three individual changes
1. isk-assessment and management programs designed to screen those who are most at risk and to design interventions that will reduce their risk of falling
2. Exercise programs slanted to enhance flexibility, endurance, and strength; education programs (including one-to -one counseling on methods to prevent falls)
3. Nutritional or hormonal supplementation (Fabre et al., 2010).
Health risk assessment plan. Why it should be included in health promotion and wellness.
I would use a diagnostic screening tool that would identify people who may have a certain condition therefore be more prone to falling. Although none…
Fabre, J. et al.(2010) Falls Risk Factors and a Compendium of Falls Risk Screening Instruments Journal of Geriatric Physical Therapy, 33, 184 -- 197
Gillespie, L. (2004). Preventing falls in elderly people. BMJ, 328, 653-4.
Oliver, D. & Healey, F (2009) Falls risk prediction tools for hospital inpatients: do they work? Nursing Times. Net.
Nursing Intervention in Disaster
The possibility of occurrence of disasters is a reality. With this in mind there should be efforts made to prevent any upcoming or potentially disastrous events. These efforts are what are known as disaster prevention. Disaster prevention therefore refers to efforts put in place to ensure that adverse effects of events that are potentially disastrous are prevented even when the disaster cannot be controlled. Disaster prevention is done at various levels of the society and is undertaken so as to prevent all types of disasters. Nurses are involved to a large extent when it comes to the prevention and mitigation of disasters. Nurses are involved in institutions that can influence change and due to the unique skills that they posses they can make interventions in disasters. To perform efficiently, a nurse must be always prepared to make changes in plan actions at any time and at…
Harden, E.G., (2004). The role of nursing in disasters. Retrieved march 22, 2013 from http://helid.digicollection.org/en/d/Jdi018e/2.html
Rittenmeyer, L., (2007). Disaster preparedness: Are you ready? Retrieved march 22,2013 from http://www.nursingcenter.com/prodev/ce_article.asp?tid=726331
Wolters Kluwer Health, (2007). LWW Journals - Beginning with A. Retrieved March 22, 2013, from http://journals.lww.com/smajournalonline/fulltext/2007/09000/spiritual_issues_in_the_aftermath_of_disaster.32.aspx
Moreover, it is unclear whether Jim has attempted to reestablish any meaningful contact with his children; rather, his entire focus has been on becoming a better person. While there is certainly nothing wrong with that goal in and of itself (it is, after all, a universal human quality), he appears to have pursued this goal to the total exclusion of making any substantive reparations to his family. Finally, it is interesting that Jim somehow feels compelled to tell others -- including potential employers -- about his criminal past and his current status in treatment, as if this ongoing commitment to all-out honesty somehow absolves him from a deceptive and duplicitous history, or at least helps to explain it (which it does if one is interested). According to Jim, "Entering into society again was very difficult. I had lost my business, my friends and was now divorced. After leaving jail, I…
Black's law dictionary. (1991). St. Paul, MN: West Publishing Co.
Bryant, J.K. (2009, June). School counselors and child abuse reporting. Professional School
Counseling, 12(5), 130-132.
Bryant, J. & Milsom, a. (2005, October). Child abuse reporting by school counselors.
, 1999). In many areas of the country this may be very accurate.
Another problem that comes into the picture where obesity in children is concerned is that many parents must work very long hours today to pay bills and have money for what their family needs (Mokdad, et al., 1999). ecause of this, many children are latchkey kids and are not watched as closely by their parents as they used to be (Mokdad, et al., 1999). Children used to come home from school and go and play with others, but many now live in neighborhoods where this is unsafe or where there are no children their age so they remain inside watching TV or playing video games and snacking on whatever is available (Mokdad, et al., 1999).
If there is healthy food in the house this is often not a problem, but many households are full of potato chips,…
Anderson, J.G. (1987). Structural equation models in the social and behavioral sciences: Model building. Child Development, 58, 49-64.
Arlin, M. (1976). Causal priority of social desirability over self-concept: A cross-lagged correlation analysis. Journal of Personality and Social Psychology, 33, 267-272.
Averill, P. (1987). The role of parents in the sport socialization of children. Unpublished senior thesis, University of Houston.
Bandura, a. (1969). A social-learning theory of identificatory processes. In D.A. Goslin (Ed.), Handbook of socialization theory and research (pp. 213-262). Chicago: Rand McNally.
Nursing Case Study
Managing a possible Case of Gastroenteritis: A Nursing Case Study
The effective delivery of optimal nursing care requires a comprehensive treatment plan that addresses both the patient's symptoms and the security of the immediate environment. This report presents a case study of appropriate evidence-based nursing practices in treating an elderly female patient presenting with abdominal discomfort in a residential care setting.
The client presents with new onset faecal incontinence, diarrhoea and increasing abdominal discomfort and cramps. These symptoms suggest a possible gastrointestinal disturbance (Crisp & Taylor, 2009) and present a number of possible diagnoses. While the client's nursing care plan indicates that she is normally continent, her confidential disclosure to the nurse suggests that her symptoms may be more prolonged. Another relevant client characteristic is her advanced age of 85 years.
The client's proximity to the dirty utility room in the aged care facility and the report…
1. Crisp J, Taylor C. (2010). Potter & Perry's fundaments of nursing (3rd ed.). Chatswood, N.S.W.: Elsevier, Australia.
2. Kirk MD, Hall GV, Veitch MGK, Becker N. (2010). Assessing the ?incidence of gastroenteritis among elderly people living in long-term care facilities. Journal of Hospital Infection, 76, 12.
3. Australian Government: Department of Health and Ageing. (2007). Retrieved from- http://www.health.gov.au/internet/main/publishing.nsf/content/icg-guidelinesindex.htm .
4. Andrew E, Simor MVD. (2010). Diagnosis, Management, and Prevention of Clostridium difficile Infection in Long-Term Care Facilities: A Review. The-Americans Geriatric Societ, 58(8), 1557-1593.
MEDIA LA: Argue Against: Discuss 1st amendment implications Family Prevention Tobacco Act 2009. Are tobacco
The Family Prevention Tobacco Act of 2009 was one of the more controversial pieces of legislature passed in recent times, for the simple fact that it gave a great deal of authority to the Food and Drug Administration to limit the effectiveness of the tobacco industry and its various companies to sell its products. There are multiple components of this legislation, which encompass various aspects of sales, advertising, inspections and registration of new products on the part of manufacturers. Among the many points of dissension that individual and collective entities within this industry claim regarding this legislation is that it limits their First Amendment right of freedom of speech. A thorough examination of the spirit and the lettering of this act, however, reveals that of its many different components, only one (that pertaining to advertising)…
No author. "Tobacco Controls Have Public Health Impact." Centers for Disease Control and Prevention. 2011. Web. http://www.cdc.gov/Features/TobaccoControls/
Sifferland, Alexandria. "Colorful Ways Tobacco Industry May Be Skirting Labeling Rules." Time. 2013. Web. http://healthland.time.com/2013/03/15/colorful-way-tobacco-industry-may-be-skirting-labeling-rules/
U.S. Food and Drug Administration. "Overview of the Family Smoking Prevention and Tobacco Control Act: Consumer fact Sheet." U.S. Department of Health and Human Services. 2013. Web. http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/ucm246129.htm
S. were "proficient in reading and math," Pytel explains. These statistics "loudly states that students entering high school" are simply not prepared, Pytel goes on. Moreover, U.S. students do not fare well on the international educational stage. At a time when globalization has brought much closer linkage between cultures, economies, and countries, American school children are lagging behind. The justification for focusing on strategies to keep children interested in school -- and to help them succeed in school -- is to be found in the fact that U.S. students' average scores are very poor in comparison to other students internationally.
To wit, according to the 2003 data from the Program for International Student Assessment (PISA) (in cooperation with the Organization for Economic Cooperation and Development, OECD), 15-year-old American students rank 24th out of 38 countries in science. U.S. students rank 12th of 38 countries in reading, and 26th of 38…
American School Counselor Association. (2010). Why Middle School Counselors. Retrieved January 20, 2011, from http://www.schoolcounselor.org/content.asp?contentid=231 .
Barlow, Sally H., Fuhriman, Addie J., and Burlingame, Gary M. (2004). The History of Group
Counseling and Psychotherapy. In J.L. DeLucia-Waack (Ed), Handbook of Group
Counseling and Psychotherapy (pp. 4-18). Thousand Oaks, CA: Sage Publications.
If police officers are not sufficiently deterred by the prospect of evidence being suppressed at a hearing where a person's liberty is in jeopardy, it is a fortiori that they will not be deterred by the possibility of suppression at a civil forfeiture hearing where only the person's property is in jeopardy.
Law enforcement officials have much to gain in the outcome of the issues raised in Scott, and will likely bring challenges to the exclusionary rule in civil forfeiture. While the court's trend is moving away from applying the exclusionary rule in civil contexts, law enforcement agencies are increasingly relying on civil tools to attack crime. At the forefront of this movement is the use of civil forfeiture to seize the fruits and instrumentalities of the narcotics trade. Civil forfeiture statutes allow law enforcement officers to seize privately held assets that have been used in a crime, a practice…
Crandley, Mark J (2001) a Plymouth, a parolee, and the police: the case for the exclusionary rule in civil forfeiture after Pennsylvania Board of Probation and Parole v. Scott.
Albany Law Review
Bilionis, Louis D. (1998) Process, the Constitution, and substantive criminal law.
Michigan Law Review
Alonso, J., Banegas, J.R., Graciani, A., Guallar-Castillon, P., Gutierrez-Fisac, J.L., Lopez-Garcia, E., & Rodriguez-Artalejo, F. (2007). Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly. European Journal of Cardiovascular Prevention & Rehabilitation, 14(3): 456-462.
This study examined health-related quality of life among elderly people living with obesity, hypertension, and diabetes. The results found that obesity in elderly women and diabetes in elderly men are the two factors that were most closely and dramatically related to a reduced health-related quality of life. Obese elderly women with hypertension and diabetes should the greatest decline in health-related quality of life. The researchers conclude by stating that these high-risk groups are in need of special attention and further research.
This article pertains to my research because it discusses the impact obesity has on the elderly population. As well, it discusses the implications of this epidemic for health care professionals.…
Messier, SP. (1994). Osteoarthritis of the knee and associated factors of age and obesity: effects on gait. Medicine & Science in Sports & Exercise, 26(12):1446-1452.
This article is a literature review which examines old age and obesity in relation to osteoarthritis (OA) and how it affects walking mechanics. It was found that there is a strong association between knee OA and obesity among the elderly. It is unclear whether or not the reduced physical function of elderly people living with obesity and OA would improve by treating the obesity; thus, the researchers suggest further study in the area.
This article pertains to my research because it discusses the increased mobility and joint issues faced by obese elderly people.
S. inhabitants would be vaccinated and thus the spread of influenza mitigated.
In regards to flu transmission, the virus can be transferred in numerous ways. First according to the CDC, influenza a is found in many different animal products. These products include, ducks, chickens, pigs, and whales. According to the CDC, "Wild birds are the primary natural reservoir for all subtypes of influenza a viruses and are thought to be the source of influenza a viruses in all other animals. Most influenza viruses cause asymptomatic or mild infection in birds; however, the range of symptoms in birds varies greatly depending on the strain of virus." These symptoms can provide wide spread fatalities among wild animals.
Influenza B, circulate widely through human interaction. Symptoms include runny nose, sore throat, coughing, congestion, and nausea. More importantly, in regards to transmission, if an animal such as a pig is infected with a human…
Communicable Disease: Influenza
Description of the Disease
Influenza or "the flu" is a common illness in the winter months, all throughout the United States and many other countries. Both birds and all mammals can contract influenza (Brankston, et al., 2007). In recent years there have been scares regarding "bird flu" and "swine flu," both of which are simply different strains of influenza. The cause of the flu is an NA virus in the family Orthomyxoviridae (Eccles, 2005). Once people contract the flu, they present with common symptoms such as chills, fever, a runny nose, muscle pains, a sore throat, and a headache. The headache is quite often severe, and flu sufferers may also have weakness, fatigue, severe bouts of coughing, and a general feeling of overall discomfort. People with the flu can also become nauseated and vomit, although that is more typical in children and not nearly as common in…
Ballinger, M.N. & Standiford, T.J. (2010). Postinfluenza bacterial pneumonia: Host defenses gone awry. Journal of Interferon Cytokine Research, 30(9): 643 -- 52.
Brankston, G., Gitterman, L., Hirji, Z., Lemieux, C., & Gardam, M. (2007). Transmission of influenza A in human beings. Lancet Infectious Diseases, 7(4): 257 -- 65.
Eccles, R. (2005). Understanding the symptoms of the common cold and influenza. Lancet Infectious Diseases, 5(11): 718 -- 25.
Harper, S.A., Fukuda, K., Uyeki, T.M., Cox, N.J., & Bridges, C.B. (2005). Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendation Report, 54(RR -- 8): 1 -- 40.
The pathways scheme aims to offer opportunities for every grade of practitioner. This is part of a national process that anticipates quality improvement as a continuously evolving process.
Achieving fair and equal access to professional development for nurses and healthcare providers in the private sector has been difficult in the past. Education has sometimes been viewed as expensive and time-consuming, with staff release for learning difficult to achieve especially acute staff shortages are a definable obstacle already to effective treatment provision. However, it is vital to the principle of performance improvement and the pursuit of standardizing quality outcomes that healthcare provision be based on the active pursuit of staff excellence. This is to be seen as a far more desirable approach to personnel orientation than the imposition of sanctions for poor performance. Central to this is the need for improvement of the local facility's knowledge economy. To this extent, knowledge…
Burgess, M.M. (2003). What difference does public consultation make to ethics? Electronic Working Papers Series. W. Maurice Young Centre for Applied Ethics, University of British Columbia.
Cho, I. & Park, H. (2003). Development and evaluation of a terminology-based electronic nursing record system. Journal of Biomedical Informatics, 36(4), 304-312.
Cooymans, M.P.M. And Hintzen, E.F.M. (2000) Winst en Waarden. Deventer and Den Bosch: Samson.
DoH. (2004) Quality Standards. The Department of Health.
This could be on account of the normal human reaction to being placed in frustrating conditions, or drawbacks like very poor security, and lethargy of the authorities. Investing in controlling mechanisms like weapons, guards, and other means of surveillance and control, while suppressing the violent tendencies of most inmates do little to help remove the causes of aggression. A more comprehensive approach is required that takes a study of the whole gamut of psychological emotional, physical needs and suffering into one group and then provide better training to the personnel in handling these emotions and the prisoners. They must be adepts in identifying the threat potential is necessary. (Carter; Glaser, 1977)
Another important fact that was clearly visible in the negotiation process and the later handling of the issue was the tardy help received from the outside, or the reluctance to get outside help. The negotiators must have gone in…
Carter, Robert Melvin; Glaser, Daniel. (1977) "Correctional Institutions" Lippincott.
Corcoran, Michael H; Cawood, James S. (2003) "Violence Assessment and Intervention: The Practitioner's Handbook" CRC Press. Boca Raton, FL.
Garrett, Michael. (2004, Jun) "In Need of Correction: Arizona's prison system is overloaded and its staff is overwhelmed" Retrieved 4 April, 2008 at http://www.tucsonweekly.com/gbase/Currents/Content?oid=oid%3A57551
At the time, the industry sought to examine both oil pollution in general and ocean dumping as well as land-based sources of ocean pollution. According to ang, "More significant was the rapid technological development in the design of large-sized oil tankers which required constant rule changes. By 1973 it was evident that the 1954 convention provisions were inadequate or outdated, and by then the likelihood of the 1954 convention coming into force was rather doubtful" (334).
The new protocol ultimately entered into force in January 1978. The 1973 version of MARPOL was comprised of 20 articles concerning general obligations under the convention (e.g., prohibition of violation of requirements, rules for ship inspection, enforcement, reporting on incidents involving harmful substances, and most importantly, five technical annexes or regulations on 1) oil pollution; 2) control of noxious liquid substances in bulk; 3) harmful substances carried by sea in package forms or in…
Advice on Impact of Reduction in Sulfur Content of Marine Fuels Marketed in the EU." (2002, January 1). European Commission Study C.1/01/2002.
Brewer, Stuart. (2005, March 15). "Marpol Annex VI sets sulphur test." DNV Germany. [Online]. Available: http://www.dnv.de/Publikationen/classification_news/class_news_1_2005/MarpolAnnexVIsetssulphurtest.asp.
Chasek, Pamela S. Earth Negotiations: Analyzing Thirty Years of Environmental Diplomacy. New York: United Nations University Press, 2001.
Consultation Paper regarding the European Commission's proposal for a Directive amending Directive 1999/32/EC as regards the sulphur content of marine fuels. (2003, July). European Parliament.