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Total Hip Replacement
Necessary Pre-Op arrangements.
New minimally invasive method.
Postoperative Care sedation
In the hospital
Total Hip Replacement
Total Hip Replacement procedures are becoming increasingly common around the world. hereas once the replacement of a deteriorated hip joint was either impossible, or extremely difficult (both to perform, and recover from, successfully), today's new minimally invasive technology makes the procedure significantly less risky, painful, and beneficial.
As people age, many people are faced with the debilitating effects of late-stage degenerative hip disease. Unfortunately, the symptoms accompanying the disease are not only painful, but in the later stages (especially after a fracture), can make mobility close to impossible for the patient. In such a case, Total hip replacement or THR is indicated. Not only does it offer hope for significant relief from the pain of degenerative hip disease,…… [Read More]
Case Study #3
Care of the Patient after a Total Hip Replacement Surgery
1. What would be three nursing diagnoses for M.Y. based on the data given?
· Impairment in physical movement
· Inadequate knowledge concerning the clinical procedure
· Severe pain
2. What would be three achievable goals that would coincide with the nursing diagnoses for M.Y.’s plan of care for today?
· Demonstrate as well as aid with utilizing mobility supports such as walkers, trapezes, etc., and transfer techniques, in addition to engagement in an exercise regime
· Offer diversion activities and comfort measures such as back rubs and repeated repositioning. Further, offer therapeutic touch when needed and promote stress management approaches which include progressive relaxation, meditation, guided imagery, and visualization.
· Articulate patient understanding of clinical diagnosis and process.
3. List two or three potential complications may occur for M.Y. which would be related to the procedure…… [Read More]
A collaborative communication strategy is pursued in relational, supportive, symmetrical channel conditions; and,
2. An autonomous communication strategy is pursued in transactional, unsupportive, asymmetrical channel conditions (Varney 2002, p. 139).
Therefore, marketers at Smith & Nephew can fine-tune their marketing communications with business partners and customers depending on the existing relationship in order to maximize the return on their investment of resources in the marketing campaign (Varney 2002). These respective communication strategies are set forth in Table 2 below.
Collaborative and Autonomous Marketing Communication Strategies
Collaborative communication strategy
Autonomous communication strategy
Interaction is frequent and prolonged with bi-directional flows of data through informal media, and direct efforts to change behaviour through requests, recommendations, promises, and appeals to legal obligations
Interaction is infrequent and mostly unidirectional and formal, concentrating on indirect efforts to change the beliefs and attitudes about the desirability of intended behaviour with no specific request for…… [Read More]
A Caucasian Man with Hip Pain
Decision Point One
The patient presents physical, social, and psychological complications. He is experiencing pain in his hip but is considered to be an unsuitable candidate for a hip replacement because of his age. The initial diagnosis was torn cartilage but the patient has also been diagnosed with complex regional pain syndrome (CPS). He previously worked as a machinist but has since been unemployed and has a conflicted relationship with his girlfriend who has accused him of being a junky. The patient does exhibit some symptoms of depression.
The patient has previously complained about the negative side effects of some of the drugs he has been given to address his pain symptoms, including constipation and sleepiness. Given this, the use of the tricyclic antidepressants like amitriptyline would seem counterproductive given that these drugs often produce similar side effects ("Amitriptyline," 2016). However, Savella…… [Read More]
Synovial joints like the knee and hip are qualified by their possessing a liquid that serves as a lubricant; that liquid is called synovia or synovial fluid. The fluid is surrounded by the synovium, which is the soft connective tissue that holds the synovial fluid. Whereas the synovium is actually permeable to water, the synovial fluid is far more viscous. Furthermore, a synovial membrane generates the synovial fluid. The name synovia comes from the words syn (like) and ovium (egg), due to its thick, stringy consistency resembling that of egg white (Laptiou, 2014). With age, the synovial fluid may become thinner, leading to insufficient lubrication and symptoms such as reduced range of motion, painful movements, stiffness, and swelling. Other classes of tissue that comprise the synovial joint system include the bone and cartilage, as well as the surrounding tensile tissues and ligaments. (Lapitou, 2014). epair of synovial joints depends on…… [Read More]
Globalization and American Health Care
What explains the directionality of flows in health care? Patients, health workers, managerial practices?
Globalization has brought in the information revolution and this has again brought changes in the medical profession and the way health care is being administered. It has also brought in unforeseen problems and expansion of the health care issues and running debates on health care is still strong. The flows of healthcare primarily have to deal with the patient -- how the patient is induced to seek treatment and the process of the treatment and the final discharge and post treatment care. This also involves lot of information exchange, and abiding by insurance contracts, payment options and quality care for the patients. (Phillips, 2005)
The second set is the personnel who include doctors, paramedics and all staff. The flow of work of these sections follows the patient and there are changes…… [Read More]
Jody Smith: Application of the Moral Model…
Applying Ethical Decision Making Model
"Jody Smith Case Study: Application of Thiroux's Moral Model"
The decision making model that will be applied in this work is the Moral Model (Thiroux 1977) and the case it will be applied to is the Jody Smith case. The reason this model was chosen is because the model lends itself best to a situation, such as Smith's where an impasse has been reached between the patients values and desires and that of family and the health care team. In this case the ethical dilemma is one clearly of informed consent as Smith has been excluded from conversations associated with her prognosis and care and this is contrary to her values and her identity. Without inclusion of this communication standard Smith has very little to go on regarding her prognosis and may be seeing her situation as insurmountable…… [Read More]
Nursing - Discharge planning
Discharge Planning in Nursing
Mr. Trosack's Case
The three main health issues include movement hindrance where by Mr. Trosack will move with the help of a walker. Mr. Trosack diabetic condition is main health issue. Mr. Trosack is depressed and lonely and requires a special care and assistance. Mr. Trosack lives in a crowded apartment located at a second floor in a 3-storey building. The building does not have an elevator and thus Mr. Trosack has to use the stairs to reach to his apartment. The house has furniture and personal valuables and thus making it hard for him to use his walker once inside the room. e takes the garbage by himself since he lives alone because his wife died two years ago. e fears climbing up the stairs because of pain that emanate from the strain. is family works for 60 hours a week…… [Read More]
Assessment of the Situation
As a case manager for patient in this case scenario there are at least four easily identifiable healthcare issues associated with the discharge of patient; 1. Patient safety related to second floor placement of apartment and navigation of two flights of stairs with walker while using pain medication and recovery time needed for hip replacement 2. Patient safety with regard to size and condition of apartment with limited room to navigate with walker, cluttered space and rug placement all of which are barriers to proper use of walker and ambulation an essential aspect of recovery, 3. The potential for patient non-compliance with new medication regimen for diabetes and dietary plan for weight and glucose control 4. Patient well being with regard to isolation and the inability to follow normal routines such as helping in bakery (two flights down) eating in bakery and interacting with…… [Read More]
Flows in Health Care
Since the government had started the practice of handing over major departments to private sector like health care and education, these areas are now more focused on employing techniques that can draw major profit flow. On examining the three crucial aspects of profit earning such as the number of patients, quality of staff and management, we come to a conclusion that all three areas go side by side and need to be checked upon regularly (Michael, 2006 ).
The numbers of patients are important, to a hospital; patients are the customers who are taking advantage of the health care services provided by that respective hospital. Another item that is associated to the number of patients is the type of patients coming in which is directly associated with the services that a hospital is providing at that particular time. In order to earn more profit in this…… [Read More]
Do not sit on the bottom of the tub, this causes too much bending of the hip. Use liquid soap to avoid dropping the bar of soap. A long-handles bath sponge will help in bathing below the knees."
The necessary precautions for the post-operative housekeeping process, according to the Center for Patient and Community Education (2009), "sit for rest breaks as needed. Slide objects along the countertop rather than carrying then. Use a utility cart with wheels to transfer items to and from the table. Attach a bag or basket to your walker or wear a fanny pack to carry small items. Use a long-handled reacher to reach objects on the floor. emove all throw rugs and long electrical cords to avoid tripping in your home. Watch out for slippery/wet areas on the floor." (Center for Patient and Community Education, 2009) Certainly watch out for slippery floors if pets are…… [Read More]
Elder Care Case Study
Elder Care - Case Study
The objectives of this study are to discuss how social isolation can affect an older adult's recovery from surgery or illness and to identify safety issues when older adults return home from the hospital after a major illness or surgery. This work will additionally assess the safety of an older adults living environment in a given scenario and determine appropriate discharge placement for an older adult based on a given physical or psychological status. This work will explain how specified psychological factors can play a role in the recovery process. Finally this work will assess the adequacy of the family or caregiver's knowledge of skills necessary to deliver care to an older adult in a given situation and collaborate with a given patient's family to develop a plan of care for an older adult upon discharge from the hospital.
Assessment of…… [Read More]
esearch eport: Gance-Cleveland (2004)
1) This study sought to explore the characteristics, clinical elements, methods, and benefits of school-based support groups for children of alcoholics (COA). Identification of this information may aid in the intervention process of adolescents who are coping with the addiction of a loved one and could improve long-term outcomes for the adolescent.
2) the author found that the support groups educated on the dangers of drug and alcohol use, improved coping strategies, enhanced resiliency factors, improved relationships, and increased school achievement. Of equal importance where the observed positive changes in behavior and an increased awareness of the effect of addiction on their lives (Gance-Cleveland, 2004). The findings of the current study were consistent with previous literature including the ability of the group process to empower youth and create a sense of awareness that can be correlated to improved decision making and long-term outcomes.
3) This study…… [Read More]
Greenhalgh and Taylor (1997) describe quantitative research as that which examines one clearly formed question using multiple research methods. In this study the authors utilize the sickness impact profile (SIP), the hip outcome tool, and pain and mobility to test functional status pre- and post-operatively.
3. In this study, the independent variables are pain and mobility. The dependent variable is functional status. The patient's perception of his/her illness depends on his/her level of pain and ability to ambulate. The research hypothesis is that functional status improves post-operatively.
4. The authors talk about the history of hip replacement surgery outcome reporting. The authors state that although hip surgery has been used since 1970 it was not until 1988 that a study by Gartland proposed the need for health based outcome research as opposed to only surgical outcomes. The study indicates that as of 2000 there still was a lack in health…… [Read More]
Research Report: Ridge and Goodson
The Ridge and Goodson study, "The Relationship Between Multidisciplinary Discharge Outcomes and Functional Status After Total Hip Replacement" (2000), takes place in an academic medical center. Inclusion criteria required the patient to be planning to undergo total hip replacement during the study period. Of those eligible, 25 declined to participate. Further exclusion criteria included a lack of English language proficiency and being under 40 years of age, which left a total of 24 eligible participants. Of these, 21 returned usable surveys and were included in the final sample.
This is a descriptive sample, representing a non-probability sampling design technique. The authors chose their sample based on prospective patients at one hospital, who were available and willing to participate during the study time frame. As such, these subjects may differ from a strictly random sample of the general surgical population.
Ridge and Goodson followed 21 subjects…… [Read More]
placement practice I discovered a great deal about pressure ulcers that occur following perioperative care. I am normally community based and I treat patients that have been discharged from hospital that have developed pressure ulcers following an operation. During my complementary placement on a short stay ward I was involved in the care of patients through their perioperative period. I was amazed how quickly one patient developed a pressure ulcer. The experience and subsequent investigation produced several facts concerning the reasons why such ulcers develop, how to prevent them from occurring, treatment and the emotional, financial and physical hardships that having these ulcers produce in patients.
To evaluate my experience, I have chosen to use Driscoll's model of reflection. Driscoll's model was chosen because of the simple but reflective manner in which it concentrates on questions that are pertinent to the care of patients. The model is divided into three…… [Read More]
" Orthopedic Nursing. 19 (1); 71-82.
1. 1. What data was collected in this study? How was the data analyzed? Data from 24 patients who were admitted for primary hip replacement was collected. Participants were assessed for functional status using standard modification; mobility assessed, as well as general medical issues. Data was analyzed using the 1975 Sickness Impact Profile, a standard explanatory measurement within the field.
7. 2. Summarize the results of the study in your own words -- remember that results are the findings based on analysis of the data. The study found that functional status improved between pre and post-operative states in patients who underwent total hip replacement surgery. This also included basic mobility and movement. No real relationship was established regarding the patient's pain, however.
8. 3. What findings from this study were based on descriptive statistics? List them below.
Patients asked to rate (describe) themselves on…… [Read More]
Penington, P., Caminniti, S., Schein, J.R., Hewitt, D.J., & Nelson, W.W. (2009). Patients' Assessment of the Convenience of Fentanyl HCl Iontophoretic Transdermal System (ITS) Versus Morphine Intravenous Patient- Controlled Analgesia (IV PCA) in the Management of Postoperative Pain After Major Surgery, Pain Management Nursing, 10, 124-133
to evaluate patients' assessment of fentanyl ITS and morphine intravenous patient-controlled analgesia (IV PCA)
Two previous studies used Ease of Care questionnaire in order to assess the superiority of ITS over morphine intravenous patient-controlled analgesia. However extensive analysis of the EOC data was not collected. This study intends to do just that, assessing the convenience of each patient modality using the EOC questionnaire form both previous studies.
Review of the literature
There is inadequate management of postoperative pain, which can impact a host of conditions including chronic pain. Patient controlled anesthesia is preferred to clinician-controlled anesthesia. The common analgesic used until now…… [Read More]
Arthritic conditions found within the joints of the body: their causes, treatment, current research, and what effect they have on athletic participation.
Types of Arthritis
Causes of Arthritis
Arthritis and Athletic Activities
Arthritis is said to be the number one cause of disability in the United States, with more individuals disabled with arthritis than by both heart disease and strokes (Lewis 2000).
Arthritis is also a disease that is plagued with misunderstanding. The Center for Disease Control warns that it is these misunderstandings that result in the disease doing so much harm (Lewis 2000).
Some of the common misunderstandings involve recognizing that there are different types of arthritis and that arthritis is not only a disease of the aged. Arthritis is also often not taken seriously enough in its early stages, preventing individuals from seeking medical help that could…… [Read More]
Apart from that, Chennai has become the eye specialist city and Kerala has become the ayurvedic center for healing. These facilities are being made use of by the non-Indian nations (Connell, 2011).
Huge market at hand
The population is surging, the patterns of diseases are altering, salary levels are rising, clinical needs aren't attended, health issues aren't being attended, demand for quality care is needed at moderate prices and medical tourism is all set to rise. So is the need for modern equipment. In any case, demand for modern equipment is needed in India on a basis of 12%-15% yearly. Many foreign companies commence their initial 500 surgeries in India after getting approval from FDA. Medical services are still shallow by the way. China has 106 doctors while India has 60 doctors per 1000. Australia has 247 doctors per 1000 people. The rural areas suffer a lot from this lack…… [Read More]
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…… [Read More]
Chronic Illness: Coronary Heart Disease
Outline of Coronary Heart Disease
The Coronary Heart Disease (CHD) has been on the increase of late across the globe and this disease, alongside stroke have been the top causes of death in many countries like Australia (Baker Heart and Diabetes Institute, 2017). There have been cases of people succumbing to complications occasioned by the CHD hence the need for any medic or clinician to fully furnish themselves with the CHD and the causes and effects as well as how it can be managed.
CHD is a disuse characterized by the development of a waxy substance called plaque building up in the inner walls of the coronary arteries. These are the arteries responsible for supplying oxygen-rich blood to the heart muscles. The buildup of plaque on the inner walls of the arteries results into atherosclerosis and this takes many years to pile up to harmful…… [Read More]
The NIH (2014) defines robotic surgery as "a method to perform surgery using very small tools attached to a robotic arm", wherein the surgeon operates the robot. Robotic surgery was developed to enable the performance of surgical procedures through smaller cuts than open surgery. The robot is capable of smaller, more precise movements that would be possible with a human arm. It is also much easier for the surgeon to work with the surgical tools than would be possible with, say, an endoscope. The NIH notes that robotic surgery is used for an increasing range of procedures, including coronary artery bypass, cancer excision, gall bladder removal, hip replacement, hysterectomy, kidney transplants and pyloroplasty (NIH, 2014).
The minimal invasiveness of robotic surgery means that there is lower risk to the patient during the course of the surgery, and that the post-surgery healing time is lower, and less risky as…… [Read More]
Interviews on Nursing
I interviewed three people. Lucile is 80 years old. The only hospitalization she has had, except for the birth of her child, was for a hip replacement two years ago. I also interviewed Lucile's daughter, Roberta. Roberta is 50 and has diabetes. Finally, I interviewed Roberta's nephew, Robert. Robert is a 20-year-old college student.
Is nursing a profession?
Lucile: I think it's a profession. Nurses have to have a lot of training, don't they? When I was in the hospital I think the nurses made decisions about my medical care. Doesn't that make them a professional?
Roberta: To me, to be a professional means that you make important decisions independent of people who are over you. I'm an engineer, and the decisions I make don't have to be approved by someone else. So to me, a doctor is a professional but a nurse is not. I'm not…… [Read More]
3%) are very satisfied with their health care services, compared to only 41.5% of Canadians; a lower proportion of Americans are dissatisfied (6.8%) than Canadians (8.5%).
Atlas (2009) acknowledge that Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K. Maligned as a waste by economists and policymakers naive to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MI) as the most important medical innovations for improving patient care during the previous decade (Fuchs & Sox, 2001). This is justifiable in the presented table showing the most important recent medical innovations, below. Hence, Atlas (2009) claim that the United States has nearly 27 MI machines per million compared to about 6 per million in Canada and Britain.
According to" The U.S. Health Care System as an Engine of Innovation," 2004 Economic…… [Read More]
Moreover, EBSCO, U.S. National Library of Medicine National Institutes of Health, PubMed, and Sage Publication databases also contain thousands of research articles on the TEDs, DVT, Pulmonary Embolism, Anti-Embolism Stockings and the safe use of TEDs within the clinical units.
To identify the articles and research papers relevant to the study, the paper uses the keywords to search for data from the database and the keywords include:
Deep Vein Thrombosis (DVT )
TEDs (thromboembolic disease stockings)
PE (Pulmonary Embolism).
TEDs Anti-Embolism Stockings
Prevention of DVT,
The goal of using the keywords is to search the articles and research papers relevant to the study. When the author submits the keywords to the database, numerous articles come out from the database and the study only selects the articles that relevant to complete this study. Using the relevant search strategies, the author has been able to source for the quality research papers to…… [Read More]
Future of Healthcare as it Relates to the Geriatric Population
Description and Problem Statement
The geriatric population in the United States is growing and compared to the population of health care providers the geriatric population growth is advancing much more rapidly. This presents a problem in making provision of health care to the future geriatric population. While there is a growth in the demand for geriatric health care services, there is not a matching growth in the population of health care providers and in fact, a shortage presently exists.
The population of geriatric patients is experiencing rapid growth while the population of health care providers specifically trained in geriatric medicine is seriously lagging behind. In fact, of the approximately 650,000 medical doctors who are practicing, only a small percentage receives the training and education required to provide geriatric care. Exacerbating the problem is the fact that only three medical schools…… [Read More]
Business Case Quality for Athens Medical Center
A cost reduction, and high quality healthcare delivery are paramount to the values of a healthcare organization. Typically, a cost reduction is driven by operational quality, and clinical improvement leading to removal of harm, variation and waste. The objective of this paper is to present a business case to achieve quality improvement for Athens Medical Center to deliver optimal quality improve patients outcomes. Moreover, the business case develops the implementation plan to enhance the quality of healthcare delivery for our Medical Center. The implementation plan will focus on health education for diabetes patients. After 6 months of the plan implementation, the paper previews that 50% of diabetes patients who receive the health education will record a lower HA1C by 1 point. At least, 25% of the patients will be able to lower their HA1C by 2 points. (Homer et al., 2004, Swensen et…… [Read More]
A driver came to the house and picked Robert up five days a week at 7:30 and brought him home at around 4:00 P.M. The couple received a grant from United ay to fund the service they received from the Respite Center, which cost around $200 per week. The Respite Center had well-thought-out activities designed for seniors with dementia and Alzheimer's, and those activities "helped slow down his Alzheimer's" (Claunch). Those activities include arts and crafts, chair aerobics, games, socializing, breakfast, lunch and a snack, Claunch explains. On many days a special visitor or group comes to entertain the seniors; among those groups are the Gulf Coast omen's Club, the Garden Club, PAS Ministry, gospel groups, line dancers, pianists and sing-along singers.
hen an Alzheimer's patient is stimulated (by being entertained, walking, or engaging in a game of some kind that challenges the mind but does in minimally) the nerve…… [Read More]
Clinical Experiences Journal
For ten minutes, I just held her hand while her eyes slowly opened and closed. The first patient I worked with was a woman in her seventies. She had had a whole host of physical problems. Her back went out; she had a hip replacement. Now it seemed she might have dementia or Alzheimer's Disease. The medication the head nurse gave her was strong and made the woman fall in and out of consciousness. I kept asking the head nurse what I could do, and all she would say was, "Just stay with her for now. I don't want her to get too confused." In addition to performing some of the basic duties like helping the woman get to the washroom, reach for the television remote control, eat, and take her medicine, the only thing really left for me to do was to hold her hand. I…… [Read More]
counting or documenting observations," according to authors Maxfield and Babbie. The descriptive study in this paper relates to a controversy in a small town near my home, in which a barbed wire fence has been erected to keep people out of a forest of pine trees. The problem emerged when The Nature Conservancy purchased an 800-acre easement on 1,400 acres of woodlands. People in the community had used trails in the property (it has always been private property) to get downtown, or to the high school. Suddenly a 6-strand barbed wire fence blocked the trails citizens had used for 80 years or more.
hat is the purpose of this research? The research is to document and explain how neighbors and other people in the community responded to the erection of a 6-strand barbed wire fence (with barbed wire wrapped around the top of the gates that were installed).
The descriptive…… [Read More]
9/10/66 (46 years old)
Extremely painful headache that won't go away.
Deep pounding headache more pronounced behind eyes;
- Headache has lasted more than 72 hours
- OTC Pain medications ineffective (Tylenol)
No accompanying nausea or vomiting
Physical Exam: Elevated blood pressure
Diagnostic Testing: Frequency of symptoms log; More than 72 hours of pain; Two or more of unilateral, pulsating, moderate or severe pain; not reporting nausea or sensitivity to light; lack of response to pain medication
TMJ (Tempormandibular Joint Disorder)
History: Emanating pain but no jaw spasm or difficulty chewing or biting
Physical Exam: No clicking or popping of TMJ when opening or closing mouth
-No inflammation of muscle around jaw
Diagnostic Testing: No jaw pain or face pain, no earache so…… [Read More]
Against the Expanded Use of Full-ody Scanner in Airports
The use of full body scanners in airports is a method that is too invasive because it actually produces pictures of the individual's body and as well the method is time consuming and expensive and as well there are viable alternatives available.
Cost, Risk, Passenger Inconvenience, and Privacy Concerns
Jim Arkedis a reporter for 'The Hill' relates that body scanner in 2011 cost approximately $700 million. In addition Arkedis is reports that a viable alternative is that of 'smart-screening' or construction of a security net that screens passengers for those which are potentially dangerous which would assist in "balancing risk, passenger inconvenience and privacy concerns." (2010) According to Arkedis, smart screening would further save money. Arkedis reports, "it is time to let the selectee list think for itself.
. Alternatives Exist to Combat Terrorist Acts
With technological innovation, the…… [Read More]
Donated body organs like hearts and kidneys contribute to the saving of hundreds of lives each year. The fact is that bequeathed tissues like skin, bone and heart valves could remarkably enhance the value of life for the persons receiving them. A patient who is dead following a cardiac arrest i.e. whose heartbeat has stopped permanently cannot be an organ donor but can be a tissue donor. Though in case of tissue donation the urgency of restoring a life by donation of liver or heart is absent, yet it is no way less critical to bring back vision by the help of a donated cornea, avert the severing of a leg using a bone donated by somebody or brighten the odds of survival of a patient having sustained burn injuries by skin donation.
Transplanted tissues offer advantages like it helps in alleviating trauma, assisting individuals to see again,…… [Read More]
One mid-range nursing philosophy is that of Barbara esnick, with her "Middle ange Theory of Self-Efficacy." This theory states that 'self-efficacy expectations and outcome expectations are not only influenced by behavior, but also by verbal encouragement, physiological sensations and exposure to role models or self-modeling" (Nurses.info, 2014).
esnick is an Associate Professor at the University of Maryland School of Nursing. She is also a geriatric nurse practitioner at oland Park Place. Her research is focused on motivation, particularly with older adults. She has written papers on motivation for older adults to recover from disabling events, for example, noting that where motivation is high recovery is more likely to be successful, and life prolonged. She found support for her theory in this study (esnick, 1998), for example, lending credence to her prior work on finding ways to enhance the likelihood of recovery in all populations, but particularly in older and…… [Read More]
From a very young age, I came to understand what it means to be poor and underprivileged. I recognize so much more regarding the manner in which paucity touches numerous Canadians as well as the tussles they endure. As I am from a tiny out port municipality that earns their livelihood from fishing, I have seen numerous people with tiniest pay occupations, getting communal help, or Employment Insurance (EI) benefits. It was clear to me that my blood relations are engaged within the Fishing industry as well as claiming EI benefits throughout the winter season, I was aware just how difficult it often was to not have sufficient money on hand. Although we have always remained above the scarcity line and me along with my brothers and sisters have got used to receiving all that we ever needed, to some degree, we are aware about what happens when a…… [Read More]
Value-based reimbursement models are becoming more common in healthcare. Value-based models structure reimbursements according to metrics like efficiency, cost, quality, and patient feedback (Pennic, 2014). Some of the most commonly used value-based reimbursement and payment models include Medicare Quality Incentive Programs, Pay for Performance, Accountable Care Organizations, Bundled Payments, Patient-Centered Medical Home, and Payment for Coordination (Pennic, 2014). More traditional reimbursement models include standard fee-for-service systems, which are woefully inefficient for patients with chronic conditions due to the large number and type of treatments needed (Sanghavi, George, Samuels, et al, 2014). While there is no one preferred approach to reimbursements, value-based models are clearly superior to fee-for-service models.
One of the most promising value-based reimbursement models is the Patient-Centered Medical Home model. This model tends to be more culturally-appropriate than others, taking into account individual and family needs, community diversity, and other contextual variables that might impact patient health outcomes…… [Read More]
The U.S. Healthcare Systems
The U.S. healthcare system is fragmented by the fact that incentives do not align with the actual goal of healthcare (Enthoven, 2009). For instance, healthcare facilities are incentivized to “treat” patients rather than to help them lead healthier lives. As Goldhill (2009) points out, healthcare treatments are subsidized by taxpayer dollars—and there are powerful lobbies in the healthcare field that promote the use of pharmaceuticals or new health technology (like hip replacements, which could end up leaking cobalt into one’s body). Moreover, care providers are encouraged to perform tests on patients even though there is no real need for them and they may in fact lead to overdiagnosis and to a deterioration of the patient’s quality of life, as the patient becomes obsessed with every minor health problem (Lichtenfeld, 2011).
Fragmentation impacts patient care in a negative way because it leads to the patient being…… [Read More]
Hormone Replacement Therapy
Menopause and Its Consequences
Menopause is that inevitable and irreversible time when a woman's reproductive cycle and menstruation periods gradually end, as her ovaries cease to respond to male gonadotropins and her capacity to become pregnant stops (Mayeux, Jr. 1997). This spontaneously occurs between 45 and 55 in American women, with 51 as the median age.
A woman's ovaries at the menopause are nearly empty of primary follicles - which, in child-bearing age, are abundant, mature and can be fertilized by the male sperm cell, resulting in conception and pregnancy. At menopause, the ovaries' production of the hormone called estrogen becomes very minimal, and this altered condition of a lack of estrogen produces many unpleasant symptoms in approximately 70% of all postmenopausal women (Mayeux, Jr.). These symptoms include hot flushes and extreme warmth, profuse sweating, tremor, irritability, and depression. Physically, the female reproductive organs shrink and lose…… [Read More]
Pharmaceutical industries have to operate in an environment that is highly competitive and subject to a wide variety of internal and external constraints. In recent times, there has been an increasing trend to reduce the cost of operation while competing with other companies that manufacture products that treat similar afflictions and ailments. The complexities in drug research and development and regulations have created an industry that is subject to intense pressure to perform. The amount of capital investment investments required to get a drug from conception, through clinical trials and into the market is enormous. The already high-strung pharmaceutical industry is increasingly investing greater amounts of resources in search of the next "blockbuster" drug that can help them gain market position and profits. Laws, regulations and patents are important to the industry while spending billions of dollars in ensuring the copyright of their products.
It is the intention of this…… [Read More]
jazz as a musical tradition not only has a bright future ahead of it, but has also had an illustrious past. The reasons for this are its flexibility. This flexibility, as well as its ability to effortlessly mould itself not only to current events, but also to current musical paradigms, ensures that jazz has a past, a present and a future that can be rivaled by few other genres in music.
The flexibility of jazz translates to and from the world around it. We live in a very dynamic world, with overnight change accepted as the order of the day. Jazz then caters to this by being a flexible musical tradition.
Jazz has also become a sort of language; the "English" of the musical world. It crosses all musical boundaries and is likely to appeal to most audiences. The audience for jazz then is the "global village." Jazz can potentially…… [Read More]
Management 4 course book written Chuck William scenario assignment provided professor. Decision Making Case Assignment #2 - What Would You Do? Management Decision Making Case #2 Interface, Inc.
Interface, Inc. -- Implementing Sustainability
Which level of social responsibility best describes the company's current operations?
At present, the company is operating on a totally unsustainable model -- it generates waste in the production of the carpets it sells and the carpet materials are non-recyclable and simply fill up landfills. The company's business is "turning petrochemicals into textiles" which means using petroleum "which took millions of years to make, [and] is irreplaceable" and turning it into carpet which will not decompose and yet which is usually discarded within ten years (Fishman 1998). The factories which produce the carpets also generate pollutants.
Q2. What environmental vision do you communicate to your task force? In other words, what social responsiveness strategy will you adopt…… [Read More]
The Effect of the Flappers on Today's Women
The 1920's in the U.S. And UK can be described as a period of great change, both socially and economically. During this period the image of the women completely changed and a "new women" emerged who appears to have impacted social changes occurring in future generations of both men and women. This new symbol of the women was the Flapper. The Flapper was a new type of young woman that was rebellious, fun, bold and outspoken (Zeitz, 2006). This research paper explains the rise and fall of the Flapper in the 1920's, explores its historical and current impact on women in terms of culture, work, gender and social behavior and reflects on its long-term impact of the position of today's women.
Evolution of the Flapper
Flappers, most often characterized as the "New Woman," originally emerged in the 1920s in the…… [Read More]
Chapter 10: Direct to Consumer Advertising
Television advertising has caused a rift in traditional doctor-patient relationship.
Patients arriving for doctor visits with a firm, fixed idea of outcome -- prescribe me the drug because I saw it on television! Encourage consumers to think buying drug like buying soap.
End of expectation that individual doctor knows best and best medical care emerges from open discussion of patient symptoms, concerns, and exam and consideration of the options, some of which may involve lifestyle changes not drugs
1. Even in car, hear about medical miracles that can change your life. Unending assault on consumer ears through various media.
There are financial ties between many of the supposedly most trusted medical experts and the medical industry
Medical 'news' or advertising masquerading as news
Studies on real news shows, funded by drug companies are presented as objective
Inadequate medical coverage and…… [Read More]
he researcher was able to pull up information on Venous hromboembolism hospitalizations by utilizing ICD-10 (Maynard & Stein, 2010)
he clinical diagnosis of Venous hromboembolism is defective; people that are suffering with signs and symptoms of Venous hromboembolism, just 20% have thrombosis confirmed by diagnostic testing.13Clinical prediction rules have been developed to improve the probability of an accurate diagnosis. he most widely used model classifies patients into a high, moderate, or low probability of deep vein thrombosis (Maynard & Stein, 2010). When joined with research laboratory and radiological imaging tests, this method is superior to the old-style method of executing a diagnostic test in all patients with suspected Venous hromboembolism (Martinez- 2008).
Prognosis, broken down by risk groups
A lot of the Deep Vein hrombosis is occult and most of the time resolves instinctively without there being a problem. he main longstanding illness from Deep Vein hrombosis is PS,…… [Read More]
Discuss the Challenges of eference Pricing-describe it, is it currently feasible, what are the pitfalls if it was part of your job assignment to build and manage such a program to control cost. What are the advantages and pitfalls if you are an individual using this "reference pricing" as an element of your personal health insurance program?
eference pricing has enormous potential to curb rising healthcare costs. In this situation, the insurance company or other stakeholder sets a target price that reflects what is considered a fair market value. Then if the consumer selects a healthcare service that is less than that amount, they are obligated to pay nothing. However, if the consumer selects a service that is greater than the reference price, then they are obligated to pay the difference. This system gives the consumer an incentive to participate in controlling costs whereas they might not otherwise…… [Read More]
More times than not, a patient will argue that he did not understand what the physician stated to him; even amidst documented proof the medical professional and the patient did engage in an informed conversation. "The fact that a meeting took place does not necessarily mean that there was a meeting of the minds" (Informed consent…, 2010, ¶ 5). This issue leads some health care providers to assert that informed consent forms possess little value, particularly when a legal battle ensues and the professional cannot prove the patient did, in fact, understand the informed consent process.
Currently, lawyers routinely challenge informed consent forms in courtrooms throughout the United States (U.S.). "The model consent forms incorporate substantial details of anesthesia techniques, risks and other elements of 'informed consent', so that a strong presumption is established on its face" (Informed consent…, 2010, ¶ 7). During the informed consent process, to help inoculate…… [Read More]
Similarly, this type of non-invasive acoustic and vibrational monitoring has been used by doctors to get a better assessment of in vivo hip conditions so that they can better comprehend things like total hip arthroplasty (Glaser et al., 2010).
"Acoustic emissions are elastic waves generated by a rapid release of energy at a localized source. They are produced by events such as particle impact, gas evolution, boiling, phase transitions, precipitation. Some processes produce emissions that can be heard. A lot more emit either outside the audible frequency or at too low an intensity to be heard (McLenna, 1995, p.338). Using non-intrusive acoustic monitoring is definitely a way to monitor an entire structure continuously and effectively (Wu & Abe, 2003). Acoustic signal-based monitoring can assess individual entities and mechanisms or total structures, pinpointing abnormalities, failures or red flags which need attention (Wu & Abe, 2003). It provides experts with…… [Read More]
Description of Industry
Gap, Inc. is one of the most leading American forte apparel retailers who foundation is centered in San Francisco, California. It trades things like the casual apparels, decorations, and other products that are personal for men, women and children. The merchandises of Gap, Inc. comprise of khakis, T-shirts, boxers, denim, casual wear, and others. The trade is done in the New York Stock Exchange which goes up under the symbol GPS. The brands that signified reasonable stylishness and just about everyone-from well-known celebrities to usual American families had a pair of Gap clothing somewhere in their closet. Many people had to have the latest pair of khakis or a cardigan from Gap. Gap, Inc. maintains an unusually large number of various brands, specifically Gap, Forth & Towne, Piperlime, Old Navy, banana republic, and others. All of these various businesses are purchased by a business in different…… [Read More]
Woods up with an exercise group close to her house, or a support group
who could help her with adjusting to her new diagnosis and give her
support. The social worker and the nursing staff would also be able to
educate Mrs. Woods' family on the condition and what needs to be done to
maximize her bone health.
5. Should Mrs. Woods have a history of renal calculi; care will be
taken for the administration of calcium supplements. Any supplement she
would take would need co-administration of Vitamin D for proper absorption.
Hormone replacement therapy is no longer considered to be a stable of
treatment due to concerns about heart disease. Additionally, there was no
significant evidence of fracture reduction of the HES study, so the risk
of thrombosis and breast cancer probably outweighs the need for HT.
Selective estrogen receptor modifiers are other alternatives which preserve
bone density but…… [Read More]
The energy it stores (?180 Wh kg?1) at an average voltage of 3.8 V is only a factor of 5 higher than that stored by the much older lead -- acid batteries. This may seem poor in the light of Moore's law in electronics (according to which memory capacity doubles every 18 months), but it still took a revolution in materials science to achieve it. Billions of lithium-ion cells are produced for portable electronics, but this is not sustainable as cobalt must be obtained from natural resources (it makes up 20 parts per million of Earth's crust). (Armand & Tarascon, 2008, p. 653).
Fu investigated the lithium-ion conductivities of glasses and glass-ceramics in the LI2O-AlO3-TiO2P2O5 system. Fu's samples revealed high conductivity, albeit when Abrahams and Hadzifejzovic similarly investigated the LI2O-AlO3-TiO2P2O5 glass and glass-ceramic systems, their findings revealed "a maximum room temperature conductivity of 3.98 x 10-6 S/cm in their crystallized…… [Read More]
The former might be, 'What specific...' [while] Less structure might be exemplified by: "Please respond to the following in your own words: I....'" (Dereshiwsky, 1999) in addition:
adding some open-ended items such as these to a more traditionally scaled quantifiable survey, such as one with Likert-scaled attitudinal items, and/or "check/off" questions on demographic background variables, is a good way to make the survey "multimethod" in nature. This is because you'd be using that "single" data collection vehicle (survey instrument) to collect your data (responses) in more than one form: quantitative and qualitative! You could ask the same general questions in both forms and then compare the two alternative forms of responses to see if they 'converged,' or agreed, regarding the phenomenon that you are trying to measure via the survey (e.g., attitudes towards school climate). If they do, you can have greater assurance that "there's something real being captured/measured" regarding…… [Read More]
Stocker, deaf since birth, admittedly attempted to compensate for her disability, her imperfection, through the relentless pursuit of achieving perfection physically and athletically, and even when she excelled, Stocker confesses, for a long time she remained emotionally tortured by disability for which no amount of body shaping or athletic skill in sports could change that disability (2001, p. 154). Stocker's struggle with her self-image, her identity and hers sexuality were in large part shaped by her disability.
While it is not an attempt here to disparage Stocker, or to belittle the significance of her disability; Stocker is a woman who suffered her hearing impairment from birth. Stocker suffered emotionally as a result of her disability, struggled with it for most of her life in the ways in which it impacted her self-esteem, self-image, and sexuality. So, might not a woman who acquired a disability at that point her life when…… [Read More]
Leadership style is a part of cultural distinctiveness. Among the western nations, American leadership style has been developed in the United States and the German leadership style embraced in Germany. France has it independent style. Likewise, in Asia a variety is present, and, Japan has promoted its independent distinctive style. Corporate leadership continues to be a quintessence of every nation's old cultural legacy. (Globalization and Japanese-Style Leadership) Since the bygone forty years, thoughts on management styles have been influenced primarily by the American management model and later by the Japanese. The fundamental supposition has always been the presence of a management model specific to a nation as an effect of the national cultural heritage. (In Europe, does national culture induce a particular management style
The United States follows the democratic system of governance and it is increasingly intricate to ascertain regarding the degree of authority centered at the…… [Read More]
Lifespan development is a field of study that involves growth patterns stability and change in one's behavior in the whole stretch of life. The definition does not fully capture the intricate process of the study. The study employs scientific approaches to establish these trends. We need a close examination of the elements of the definition above. In examining stability, growth and change, lifespan development checks the assumptions about the course and nature of the development of a human being. This is a scientific way of establishing the facts in the study. Scientists evolve development theories and apply systematic scientific methods to establish the exactness of these assumptions. The focus of the studies is the development of human beings (FLDNMC, 2010).Lifespan Development scientists select a topical area of focus and consider the age range of study. The span normally spreads out in broad age range segments. These segments include…… [Read More]
..the stimulus plan calls for laying 3,000 miles of new transmission lines -- considered crucial for moving wind and solar power to different corners of the country" (LaMonica 2008). This sets a shining example for the nation for the need to make current and future structures environmentally sustainable.
Even if prices of fossil fuels decline, there are also other pressures that increase public awareness about the need for green housing -- finite timber resources, increasing overpopulation, and also the expansion of the densely populated developing world in China and India will make green building a continued priority on an international level.
The sad rise of asthma due to mold and other allergies contained in sick buildings may make a green building that can reduce mold, mildew and other build-up a necessity rather than a debatable luxury for many home owners in the future.
The current administration is working to bring…… [Read More]
A Solution Refinement for Individual Smoking Cessation
Cigarette-smoking, tobacco addiction and nicotine dependency are widespread and permeating public health concerns. Indeed, the combination of the high rate of addiction to tobacco products and the clear empirical relationship between these products and a number of critical negative and even fatal health outcomes qualifies this is a substantial problem requiring a direct solution. According to the National Cancer Institute (NCI), "smoking is a leading cause of cancer and death from cancer. It causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia. Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive pulmonary disease (COPD) (chronic bronchitis and emphysema), asthma, hip fractures, and cataracts." (NCI, p.1)
This constitutes a very compelling motive for pursuing resolution of the problem…… [Read More]
Since gang-related crimes fall within the jurisdiction of state, this research will give an insight on the need to find solutions that increasingly include all levels of government. Congress needs to pass legislation that will change immigration enforcement laws and make more aliens deportable. In addition, the federal government should take a more active participation in helping local and state jurisdictions develop anti-gang responses. The local, state and federal governments must take a stand, and combine forces to combat the immigration problem that continue to plague this country into the next generation.
Importance of the Study
The die has been cast, there is no turning the clock back now and the Mara Salvatrucha and 18th Street Gang have established themselves in the United States and far beyond. The origins of the current situation with MS-13 and the 18th Street Gang date back to the late 1980s and early 1990s…… [Read More]
Market Model Changes
The medtech, or medical technology, industry is a large and intensely competitive industry that produces highly innovative medical devices for hospitals and other healthcare facilities in the effort to save lives and improve health for patients (Research, 2012). It is spread across different segments including, cardiology, oncology, neuro, orthopedic, and aesthetic devices. It relies largely on aging baby boomers, high unmet medical needs, and increased incidence of lifestyle diseases, including cardiovascular disease, diabetes, hypertension, and obesity.
The industry is being challenged by pricing concerns, hospital admissions and procedural volume, uncertainty concerning healthcare reform, Medicare reimbursement issues as agencies are looking for cost reduction measures, and regulatory overhang. There is a rise in patients deferring treatment in elective procedures. "One factor aligning economic and clinical forces: in the U.S., the number of medical practices owned by hospitals grew from 25% in 2005 to 50% in 2008" (practice, 2011).…… [Read More]
NICE Compliance Standards eview
NICE has developed a set of guidelines and standards to help minimize the risk of VTE and ensure healthcare protocols are in place to educate patients about the risks of VTE. The purpose of this literature review is to examine a tool to access a Hospital Trust compliance with the National Institute of Clinical Excellence (NICE) published standards on Venous thromboembolism (VTE) prevention. The tool will have the capability to monitor, report, and disseminate relevant information.
National Institute for Clinical Excellence
The National Institute for Health and Clinical Excellence, or NICE, is an institution whose goals including providing clinical quality guidelines and standards to help manage a nationwide database. The purpose of this database includes help improve total healthcare at multiple levels, including at the cardiovascular, vascular, mental, neurological at other levels of health (NICE, 2011). The goals of NICE include prevention of disease,…… [Read More]