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Hospice nursing can be difficult. Many times nurses transitioning into hospice care face struggles they would not encounter in other specialties. However there is a level of recognition involved in hospice care as it necessitates better care of patients and a stronger connection to the job and self. Many nurses working in hospices have detailed their work experiences in reflective essays and even journal articles. "Chapter members are nominated by peers in recognition of their contribution to oncology nursing and to ONS, both locally and nationally. The timing of the award prompted me to reflect on my nursing values and the steps that led me to where I am today" (Thompson, 2013, p. 673). This essay will include the experience of one community health nurse by the name of osalind and her struggles and triumphs in hospice nursing.
esearch has gone into hospice care and community SPCs. An article by…
Levin, P.F., Swider, S.M., Breakwell, S., Cowell, J.M., & Reising, V. (2013). Embracing a Competency-Based Specialty Curriculum for Community-Based Nursing Roles. Public Health Nursing, 30(6), 557.
Luckett, T., Davidson, P.M., Lam, L., Phillips, J., Currow, D.C., & Agar, M. (2013). Do Community Specialist Palliative Care Services That Provide Home Nursing Increase Rates of Home Death for People With Life-Limiting Illnesses? A Systematic Review and Meta-Analysis of Comparative Studies. Journal of Pain and Symptom Management, 45(2), 279.
Meier, D.E. (2011). Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care. Milbank Quarterly, 89(3), 343.
Rosser, M., & King, L. (2003). Transition experiences of qualified nurses moving into hospice nursing. Journal of Advanced Nursing, 43(2), 206. doi:10.1046/j.1365-2648.2003.02695.x
Kubler-oss became an advocate of the hospice concept, and testified before Congress in 1972, where she advocated patient care at home for those with terminal illnesses. This helped lend support to the growing call for hospice care in America. After her testimony, hospice legislation was introduced in Congress in 1974, but it did not pass. It did however, bring the idea to light, and the movement began to spread across the country.
The first American hospice was Hospice of Connecticut, which opened in 1973. It began as strictly a home-care program that provided visiting nurses to help care for terminally ill patients in their own homes. Many early home-care hospice units, like the Hospice of Connecticut, turned into full-fledged freestanding facilities that could take care of dozens of patients in their facilities at once, but they still offered home-care alternatives for patients, as well. As the hospice concept has developed,…
Editors. "History of Hospice Care." National Hospice and Palliative Care Organization. 2008. 14 March 2008. http://www.nhpco.org/i4a/pages/index.cfm?pageid=3285
Munley, Anne. The Hospice Alternative: A New Context for Death and Dying. New York: Basic Books, 1983.
What Is Hospice Care?." The Hastings Center Report 33.2 (2003): 6+.
Government Regulations and Hospice
Government Regulations Affecting Health Care in Hospice
Regulations Affecting Health Care in Hospice
Impact of rules on Hospice services
This paper focuses on how government regulations impact hospice. The paper starts off with an introduction to the hospice system that was revived by a nurse, Cecily Saunders, who then went on to become a physician, establishing one of the first modern hospices. The concept of total pain is explained in some detail. The body of the paper then includes the studies that have been conducted on patients and caregivers in hospice systems as well as on people who died after they were diagnosed with terminal illness resulting in death in six months following the prognosis. The overall conclusion that can be drawn here is that while in Japan there is a marked need for improving the Day hospice system, the American hospice industry…
American Medical Directors Association. (n.d.). White Paper on Palliative Care And Hospice In Long-Term Care. Retrieved March 10, 2012, from American Medical Directors Association: http://www.amda.com/governance/whitepapers/palliative_care.cfm
Carlson, M.D., Morrison, R.S., Holford, T.R., & Bradley, E.H. (2007). Hospice Care: What Services Do Patients and Their Families Receive? Health Services Research, 42(4), 1672-1690.
Centers for Medicare & Medicaid Services. (2008). Medicare and Medicaid Programs: Hospice Conditions of Participation; Final Rule. Federal Register, 73(109), 32088-32220.
Christakis, N.A., & Escarce, J. j. (1996). Survival of Medicare patients after enrollment In hospice programs . The New England Journal of Medicine, 172-179.
health care system has focused on the prevention and cure of disease and illness. When people got sick, every bit of energy and finances went into trying to figure out how to stop it. This was true even when the patient had a disorder or a disease that was deemed incurable. For many years when someone got a disease in which there was no cure, it did not change the method of treatment. The medical community, the family and the patient continued to try every possible avenue to stop the progress. Often times the patient would submit to painful and disorienting treatments, because they didn't want to disappoint their family members or their doctors. At the same time the medical community was expanding the length of life so that many people were living longer than ever before. These two things began to clash. At what point do people stop trying…
Public health system suffers from chronic underfunding http://home.aigonline.com/content/0,1109,16263-694-ceo,00.html
NEWS FROM AROUND AFRICA http://www.hospicecare.com/Newsletters/july2003/page8.html
Healthcare & Medical Market in Morocco http://www.tradepartners.gov.uk/healthcare/morocco/profile/overview.shtml
What is Hospice? http://www.hospicefoundation.org/what_is/
Community Dementia Care and the Chronic Care Model
nd-Stage Dementia valuation Proposal
Health Promotion Plan for Community nd-Stage Dementia Care: The Chronic Care Model
Health Promotion Plan for Community nd-Stage Dementia Care: The Chronic Care Model.
In 2013 an estimated 5.0 million Americans over the age of 65 suffered from Alzheimer's disease (Alzheimer's Association, 2013). Although the U.S. Centers for Disease Control and Prevention (CDC) considers dementia/Alzheimer's to be the fifth leading cause of death among adults 65-years of age or older, careful examination of Medicare claims data revealed that dementia is probably right behind cardiovascular disease as the second leading cause of death for this age group (Tinetti et al., 2012). Most of these patients would prefer to die at home, not only because of comfort concerns, but due to the higher quality of care that tends to be provided by informal and paid caregivers in this setting (reviewed…
Eloniemi-Sulkava and colleagues (2009) evaluated patients at baseline using the Barthel Index and Neuropsychiatric Inventory (NPI) (see Appendix). The Barthel Index (Stone, Ali, Auberleek, Thompsell, & Young, 1994; University of Iowa Healthcare, n.d.) and NPI (Cummings et al., 1994) were administered again at 6 and 12 months into the study and will be used in the current study to track ADL and BPSDs using the same intervals. PQOL will represent a composite score obtained using the Color Analog Scale for pain (Santos & Castanho, 2013) and the Quality at the End of Life Scale (QUAL-E) (National Palliative Care Research Center, 2005) (see Appendix). In cases of severe cognitive impairment, completion of the QUAL-E may depend on family caregivers. FCQOL will be evaluated using the Zarit Burden Scale (Regional Geriatric Program Central, 2014) (see Appendix). The success of the intervention, as perceived by family caregivers and providers, will be assessed using the questionnaires developed by Morita and colleagues (2013). The goal of these questionnaires will be to evaluate how effective the community palliative intervention was in improving the knowledge and skills of palliative care, increasing access to specialized services, coordinating care services, and increasing deaths at home. This evaluation will be performed following the death of the patient or the end of the study period, whichever comes first. The validity and reliability of the questionnaires developed by Morita et al. (2013) have not been evaluated, but should prove informative and provide context for the other findings.
A review of interventions designed to improve the quality of community palliative care has revealed mixed findings, but the trend is in the desired direction of reducing the number of patients dying in hospital wards, ICUs, and hospice facilities. CCM has garnered the interest of researchers interested in improving palliative care outcomes for patients, family caregivers, and providers alike, and have begun to study the efficacy and quality of interventions, including CCM. This proposal provides justification for implementing CCM for end-stage dementia patients residing at home and details an evaluation strategy that can be implemented to determine the efficacy, effectiveness, and quality of the care provided. In contrast to many other studies, however, this proposal places equal value on the experiences of patients, family caregivers, and providers alike, in addition to the more common outcome measures of BPSDs and institutional admissions. The methods of data gathering will involve the review of patient records and several instruments designed
Day treatment programs can provide services at less cost because the patient goes home at night after being treated during the day, which often is used for rehabilitating chronically ill patients (Sharfstein, Stoline, & Koran, 1995, p. 249). The mere fact of having more choice benefits some patients by giving them more say in their care.
Patient-focused care involves a method for containing in-patient costs for hospitals and for improving quality by "restructuring services so that more of them take place on nursing units rather than in specialized units in other hospital locations, and by cross-training staff on the nursing units so that they can do several 'jobs' for the same small group of patients rather then one 'job' for a large number of patients" (Kovner, 1995, p. 186). Kovner notes a number of barriers to this type of care. One reason has been that hospitals have not had to…
Doctors Say Managed Care Strains Patient Relationships (1997, June 9). Westchester County Business Journal 36(23), p. 24.
Kovner, a.R. (1995). Hospitals. In Jonas's Health Care Delivery in the United States, a.R. Kovner (ed.), pp. 162-193. New York: springer Publishing.
Moore, G.T. (1991,
April 24). Let's provide primary care to all uninsured Americans ? now! JAMA, pp. 2108-2109.
The Foundation called specific attention to the prospect of institutional and policy-level strategies to increase the participation of under-represented minorities in the health professions. In response, the Institute Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce came out with a report, entitled "In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce." The Committee consisted mostly of academicians, two of whom represented the nursing profession.
In its report, the Committee recognized the importance of increasing racial diversity among health professionals in order to improve access to care, greater patient choice and satisfaction and better educational experiences for practitioners, among other benefits. It also recognized the lack of strategies in reducing institutional and policy-level barriers among health profession educational institutions or HPEIs. In response to the lack, the Committee recommended that health professions education make a clear stand and mission on the…
AHRQ (2007). The national healthcare disparities report, 2006. Agency for Healthcare
Quality and Research, Medscape. Retrieved on June 18, 2009 from http://www.medscape.com/viewarticle/552271
Alabama Nurse (2004). ANA Review: Institute of Medicine report on workforce diversity,
The death of elderly individuals takes place in different circumstances and settings such as painless death at home or painful death in a healthcare facility. Social workers have an important role in planning end-of-life care as part of providing essential social support to elderly individuals. The role of social workers in this process is attributable to the significance of their professional practice in a multidisciplinary palliative care team in hospice and hospital settings (Watts, 2013). Since the death of elderly individuals occurs in a variety of conditions and settings, social workers need to plan for end-of-life care. The planning and delivery of end-of-life care helps in helping the elderly cope with serious illness, face mortality or manage the process of dying in an effective manner.
One of the major functions of social workers in their role in planning for end-of-life care is providing psychosocial and practical support to individuals who…
PATIENT & HEALTH POFESSIONAL PESPECTIVES
Patient & Professional Perspectives
Quality of care is a massive concern when it comes to healthcare in general. The issue is so multi-dimension and complicated. Even further, there are a lot of ideological bents and perspectives that further shape and form the issue as it exists today. A significant part of the paradigm mentioned above would be the perspectives of both patients and healthcare professionals as it relates to the aforementioned quality of care. Obviously, there are going to be some differences and similarities when talking to any large swath of patients or healthcare providers. The differences could be huge divides in some cases due to what is being expected being too different than what is able to be delivered given the resources or even the perspective or opinion of the healthcare professionals or providers. While there is no simple or neat answer to how…
Bagchi, A., af Ursin, R., & Leonard, A. (2012). Assessing Cultural Perspectives on Healthcare Quality. Journal of Immigrant & Minority Health, 14(1), 175-182.
Butala, N. (2010). Perspectives on efficiency and quality in an ever changing system:
Healthcare 2010. The Yale Journal Of Biology And Medicine, 83(2), 93-95.
-Mother can attend cancer support groups and receive advice and education through other channels regarding proper methods of providing care and improving quality of life for her husband
-Son can explore employment options as well as discuss various needs and responsibilities with his parents in order to determine his most effective utilization within the changed family dynamic
-Father can provide the levels of self-care that come easily, but should educate himself regarding his condition and ease care by allowing others to help when necessary
-Provide educational materials/answer questions for both mother and father
-Assist son with psychological transition of increased responsibility/familial dependence
-Instruction of proper care techniques for mother and father regarding father's condition
Levels of comfort and competence in new family roles should be easily assessed in regular visits through brief questioning. Monitoring father's health through standard vital sign and other appropriate tests will…
Palliative care is a specialty that is relatively new but that has evolved steadily over the past few decades. Its goal is providing advanced cancer patients with end of life care. Its rise was because of the public's growing dissatisfaction and concern with how dying patients were being taken care of in the 1960s and the 1970s (Cole, Carlin & Carlson, 2015). At the time, oncologists were mostly concerned with curative interventions and so did not give the necessary attention to end of life care. According to the studies that were done at the time, medical care that was given to the terminally ill was suboptimal or in some cases did not even exist. The father of palliative care, Dave Cicely Saunders, reported having the same experience. She was the founder of St. Christopher's Hospice, based in the United Kingdom. The facility was the first modern hospice (Cole, Carlin &…
alMahrezi, A., & AlMandhari, Z. (2016). Palliative Care: Time for Action. Oman Med J., 161 -- 163.
Bhatnagar, S., & Gupta, M. (2015). Future of Palliative Medicine. Indian J. Palliat Care, 95 -- 104.
Bruera E, Hui D. Integrating supportive and palliative care in the trajectory of cancer: Establishing goals and models of care. (2010). J Clin Oncol. 28:4013 -- 7
Cole TR, Carlin NS, Carson RA. (2015). Medical humanities: An introduction. Cambridge University Press. 1 stEdition. New York.
Finite Health Care esources
Cutting health care costs is becoming a serious issue for the government and for medical corporations and patients throughout the U.S. today. There are several ways in which these costs can be cut, and one of those ways is to limit the life-extending care that is currently being provided to the elderly (Bond & Bond, 1994). This is not the same as limiting care that would improve their lives, but is only designed to limit the care that prolongs a life that already has little to no quality. However, it is not just the elderly who cost the country a great deal of money when it comes to medical care. Premature infants are also very expensive to keep alive, and an argument could be made that these infants should be allowed to expire, since they were not viable when they were born. It is a conundrum…
Bond J. & Bond S. (1994). Sociology and Health Care. NY: Churchill Livingstone.
Saunders, C.M. & Kastenbaum, R. (1997). Hospice Care on the International Scene. NY: Springer Pub. Co
While most hospitals seem to be well-run and most situations and scenarios are planned for in advance when it comes to what nurses should be doing, should not be doing and why, this is not always the case. Just one example of this would be situations where palliative care is probably or definitely called for in a given situation but there is not a defined or clear protocol as to when the palliative path should be started and what criteria should be used. Indeed, patients that are facing such a situation are typically terminal or they at least cannot be treated for what is ailing them. An easy example to point to would be a cancer patient whose disease is beyond what medicine can do for them. When there is an absence of leadership when it comes to palliative care protocols, it falls to nurses to collaborate, work…
Engel, J., & Prentice, D. (2013). The ethics of inter-professional collaboration. Nursing Ethics,
20(4), 426-435. http://dx.doi.org/10.1177/0969733012468466
Ewashen, C., McInnis-Perry, G., & Murphy, N. (2013). Inter-professional collaboration-in-practice: The contested place of ethics. Nursing Ethics, 20(3), 325-335.
Ruth E. Mathias and a.E. Benjamin (2003) report that social workers are becoming increasingly concerned about elder abuse in long-term care settings (p. 174). A study conducted by these social scientists/authors, reveals that Medicaid related agency care demonstrates no harmful or increase in the abuse suffered by elderly people receiving care through private agencies, but that there is little social worker oversight, and because of that, reports and information supporting that fact can be misleading at this point in time (p. 174). Mathias and Benjamin reported, too, that direct care provided by family members was proven to be less abusive to the elderly than services rendered by state and private providers (p. 174).
The most concentrated areas of consumer complaints reported was the difficulty in scheduling services, language barriers, and high care-giver/assistant turnover (p. 174). These are areas of concern, because the elderly are often suffering levels of dementia that…
Healthcare Organization Case Study
Health Care Organization Case Study
Health Care Organization Case Study
Banner Healthcare represents a set of diverse healthcare related facilities that provide healthcare services to societies in USA and beyond. Banner seeks to establish a healthier life for communities through developing a healthy environment. Banner Healthcare is arguably the largest healthcare provider in the country. The organization spans seven states, including Arizona, California, Colorado, Nevada, Alaska, Nebraska and Wyoming. The organization operates 20 hospitals, including healthcare facilities. The organization offers such services as hospice care, home care and physician services. Banner Healthcare also provided $130 million as their contribution to charity. The organization is a healthcare leader in all the communities it offers its services. The agency has shown tremendous growth in the past years. They admit over 190 000 patients every year and have a workforce in excess of 29-000. The emergency departments…
Banner Health, (2008). Here Now: Making a Difference. Retrieved from http://www.bannerhealth.com/_communityupdate/Banner_Health_Community_Update.pdf on 18 May 2016
Harrington, C. & Estes, C. (2008). Health Policy: Crisis & Reform in the U.S. Health Care Delivery System, 5th Ed. Jones & Bartlett Publishers
Wolf, J., Hanson, H. & Moir, M. (Eds.) (2011). Organization Development in Health Care: High Impact Practices for a Complex and Changing Environment. IAP
The interest in palliative care, or counseling for bereavement comes to different people in different ways, and one doctor came into it through home care as long ago as 1975. The doctor had just finished working as a house staff in the University of California in San Francisco. Then he got a job at Massachusetts General Hospital as a physician. The doctor was placed at Chelsea Memorial health Center. This was a neighborhood health center in a poor multi-ethnic community, yet not a great distance away from MGH. The doctor had come to replace a person who had come from Britain for a working experience of a year in United States and had gone to the houses of a few elderly patients. In the beginning itself, it was suggested to the doctor by the senior that he visit two patients who were being cared by relatives at home. This…
A Compendium of Hospital-Based Palliative Care Practices. Retrieved from http://www.haponline.org/downloads/PPCN_Compendium_2004.pdf Accessed on 31 May, 2005
Austenfeld, Jennifer L. Stanton
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1467-6494.2004.00299.x;jsessionid=iVt_UOAe61_b?journalCode=jopy Accessed on 31 May, 2005
Bloomington School District. 20 November, 2002. Retrieved from http://www.shfsc.org/reports/BL2002.pdf Accessed on 31 May, 2005
Care Case Study
Slide 1 Footnotes
There have been enormous changes due to introduction of various cultural elements in the continuum of care. Before, when people were admitted to assisted living facilities or hospital settings, there were very little cultural elements outside of the majority culture which had sponsored the facility. For example, if a facility was associated with some sort of church or temple, there were elements of that religion present, but there was little alternatives for members of other cultures or religions.
Yet, today, there are now a much wider array of cultural elements available in assisted living homes and hospital facilities. Assisted living programs are regulated on the level of the state.
As such, different states have different types of programs and policies that impact the degree to which cultural characteristics are included or excluded within various assisted living facilities. Some programs encourage cultural elements of patients…
ALFA - Assisted Living Federation of America. (2009). Assisted Living Regulations and Licensing. Retrieved from http://www.alfa.org/State_Regulations_and_Licensing_Informat.asp
Medicare Payment Advisory Commission. (2011). Report to the Congress: Medicare Payment Policy. Retrieved from http://www.medpac.gov/documents/Mar11_EntireReport.pdf
National Caregivers Library. (2012). Independent Living Facilities. Retrieved from http://www.caregiverslibrary.org
Next Step in Care. (2012). Reducing the Stress of Hospitalization for Patients with Dementia and their Family Caregivers: A Guide. Family Caregiver Alliance. Retrieved from http://caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2449#researchpractice
As well as expanding patient's abilities to obtain primary care, virtually, telemedicine can enable patients in isolated locations to see specialists. When rural patients are connected to a hospital network such as the Grinnell egional Medical Center, they are able to access high-quality physicians through some of the more advanced healthcare technology available, although this is not always possible in a local healthcare system with fewer physicians and less access to high-level technology. Technology can still enable patients in a variety of settings to keep track of vital signs such as heart rate, blood pressure, and blood sugar, and to alert their physician immediately if their readings are abnormal.
While some surgeons have even performed procedures through virtual consults, certain aspects of medicine remain challenging to provide rural patients, such as physical rehabilitative services, which may require the patient to travel to receive the full benefit of the services. Patients…
Campbell, James D. (2001, May). Introducing telemedicine technology to rural physicians and settings. Journal of Family Practice. Retrieved January 27, 2011 at http://findarticles.com/p/articles/mi_m0689/is_5_50/ai_75244766/
Spath, Patrice. (2011). Community Continuum of Care planning.
Brown-Spath & Associates. Retrieved January 27, 2011 at http://www.brownspath.com/original_articles/cccplan.htm
Caring for the Old
The End of Life Care
End of life care refers to the total care of a person that has an advanced illness that is incurable and does not equate with death. This end of life care can last for a number of weeks, months or even years depending on the state an individual is.it is usually the care which helps those that have advanced, progressive and illnesses that can not be cured to live life as well as possible until they meet their death. End of life care makes it possible for the patient and their family to get supportive and palliative care needs identified and met throughout the last phase when they are living and into the bereavement period. Supportive care is care which helps a patient and the family to cope with the condition and the treatment of that condition right from the pre-diagnosis…
Boswell, Kahana & Worth-anderson, 2006). Spirituality and Healthy Lifestyle Behaviors: Stress Counter-balancing Effects on the Well-being of Older Adults. Retrieved April 30, 2014 from http://www.case.edu/artsci/soci/documents/Spiritualityandhealthylifestylebehaviors.pdf
U.S. Department of State, (2012).Legal & Financial Issues In Caregiving for Older Adults. Retrieved April 30, 2014 from http://www.state.gov/m/dghr/flo/142266.htm
American Society of Clinical Oncology (ASCO), (2014). Caregiving Considerations. Retrieved April 30, 2014 from http://www.cancer.net/navigating-cancer-care/older-adults/caregiving-considerations
The Joanna Briggs Institute, (2011). Age-friendly nursing interventions in the management of older people in emergency departments. Retrieved April 30, 2014 from http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=7127
However...generally a vast difference exists between what healthcare providers understand and what laypersons are able to comprehend. This immeasurability of knowledge was evident in the participants' narratives and was exacerbated by the conveying of "false hope" or "false optimism" to patients and patients' family members.
Seconding Robichaux's argument is ackstrand's (2006) findings that hospital-based EOL programs are not the "ideal" form of healthcare that elderly patients should receive, according to a survey of nurses. For the nurses, "no patient should face death alone," which ultimately happens when patients are confined in a hospital facility receiving palliative care. Comparing ICU EOL care against the hospice and nursing home care programs, 'dying with dignity' is remote in this kind of program, since "[t]he ICU is no place to die. It would be nice to have a comfortable, quiet, spacious room for those who are dying. Let everyone in and let the rest…
Anderson, R. (2003). "Nursing home quality, chain affiliation, profit status, and performance." Journal of Real Estate Research, Vol. 25, Issue 1.
Backstrand, R. (2006). "Providing a "good death": critical care nurses' suggestions for improving end-of-life care." American Journal of Critical Care, Vol. 15, Issue 1.
Elliot, D. (2006). "Determining the financial impact of hospice." Healthcare Financial Management, Vol. 60, Issue 7.
Imhof, S. (2005). "What do we owe the dying? Strategies to strengthen end-of-life care." Journal of Healthcare Management, Vol. 50, Issue 3.
Provide sustained technical assistance (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Evaluation of the process in rural and small communities includes: (1) scope of the project; (2) goals; (3) critical success factors; and (4) technical assistance." (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Community grants have been focused on the provision of 'personal digital assistant (PDA) systems in assisting with the decision support role. The initiative is stated to include: (1) development of toolkits; (2) leveraging known tools; (3) developing capacity; and (4) disseminating best practices. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Ormond, Wallin, and Goldenson report in the work entitled: "Supporting the Rural Health Care Safety Net" (2000) state: "The policy - and market-driven changes in the health care sector taking place across country are not confined to metropolitan areas. Rural communities are experiencing changes impelled by many of the same forces…
Healthcare and Healthcare Insurance Country Report: India (2004) Tata Consultancy Services and Microsoft. WebHealthCentre.com. 2004 August. Online available at http://download.microsoft.com/documents/customerevidence/7144_WebHealth_CS.doc
Expert Panel Meeting: Health Information Technology (2003) Agency for Healthcare Research and Quality (AHRQ) 23-24 July 2003. Online available at http://www.ahrq.gov/data/hitmeet.htm
Silberman, P. And Slifkin, R. (nd) Innovative Primary Case Management Programs Operating in Rural Communities: Case Studies of Three States. Working Paper No. 76 North Carolina Rural Health Research and Policy Analysis Program.
Ormond, Barbara a.; Wallin, Susan Wall; and Goldenson, Susan M. (2000) Supporting the Rural Health Care Net. 15 May 2000 Urban Institute
Hispanic Community and Healthcare
This paper is an examination of how the Hispanic community experiences healthcare. The data from a number of articles related to the subject form the basis for the conclusions reached in the analysis.
One study looked at whether Hispanic-specific training should be included for healthcare worker training. It was found that there is a serious lack of training that is currently implemented regardless the community examined. Healthcare workers were unaware of social conventions that were normal among their Hispanic clients which limited the effectiveness of the healthcare treatment given. Because women were unable to discuss personal problems with male healthcare workers and males had similar issues with females, it was difficult for the various agencies to be truly effective. The recommendation, of course, was to include a training curriculum that included cultural training.
Another issue that Hispanic individuals faced is that they were underrepresented in…
health care for the disabled. The writer explores the health care stages that are available for the disabled in every stage of life. The writer uses published works from various sources to illustrate and underscore the need for solid health care access for all disabled individuals in the nation. There were six sources used to complete this paper.
"Different stages of available health care for people with disabilities"
The issue of health care has been a hot topic of debate in this country for many years. Health care costs are skyrocketing, available services are dwindling and the public is screaming with outrage and demand for improvements to the entire health care system. While those who can speak for themselves are having no trouble voicing their upset about the current state of the nation's health care system, there is a population that cannot always speak up. The disabled in this country…
HEALTH CARE DECISIONS FOR THOSE WHO CANNOT CARE FOR:DIANE COLEMAN THEMSELVES. Congressional Testimony; 4/19/2005
Congressional Testimony. 04-19-2005
LONG-TERM HEALTH CARE:MARK R. MEINERS
Congressional Testimony; 4/19/2005
egistered nurses are both qualified, educated, and certified to provide a high quality of various care services that an individual may need in a home setting or elsewhere. Hence, providing these practitioners with the power to certify and provide home care is a solution to an overwhelming problem that has plagued the health care environment in recent years. Nursing practitioners, as a result of the nature of their work, are closely connected to the needs of individual patients. This means that they, more than many other health care providers and institutions, are able to assess the needs of individuals, their households, and the level of care they require. This places them in a position to accurately determine the need and/or of such individuals to obtain long-term home care and when such home care becomes unviable. As such, registered nurses who serve individuals in the home setting are able to maintain…
AARP Public Policy Institute. (2013). FAQs. Retrieved from: http://assets.aarp.org/rgcenter/ppi/ltc/ltss_faq.pdf
Brassard, A. (2011). Removing Barriers to Advanced Practice Registered Nurse Care: Home Health and Hospice Services. AARP Public Policy Institute. Retrieved from: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/removing-barriers-advanced-practice-registered-nurse-home-health-hospice-insight-july-2012-AARP-ppi-health.pdf
Doty, P. (2000, June). Cost-Effectiveness of Home and Community-Based Long-Term Care Services. U.S. Department of health and Human Services. Retrieved from: http://aspe.hhs.gov/daltcp/reports/2000/costeff.htm
Lynch, M., Estes, C., and Hernandez, M. (2007, June). Long-Term Care Policy Option Proposal: Consumer Controlled Chronic, Home, and Community Care for he Elderly and Disabled. Georgetown University Long-Term Care Financing Project: Working Paper No. 4. Retrieved from: http://ltc.georgetown.edu/forum/4lynch061107.pdf
Contracts with doctors often contain a clause which doesn't allow the doctors to discuss
Health care 7 with their patients financial incentives to deny treatment or about treatments not covered by the plan (Glazer, 1996). This has caused many consumers, especially those with chronic illnesses, to form organizations with the American Medical Association and physician specialty groups to promote legislation forbidding "gag rules" (Glazer, 1996). One group, Citizen Action, has 3 million members and "has been lobbying in state legislatures for laws that would require plans to disclose how they pay their doctors; give patients the right to choose specialists outside the plan; and provide appeals for patients who get turned down for expensive treatments" (Glazer, 1996).
The doctor-patient relationship is also affected if a patient must switch to a new doctor under managed care. Having a longterm relationship with a primary doctor is important because he or she is…
Bennett Clark, Jane (1996, July). What you should ask your HMO.
Kiplinger's Personal Finance Magazine. pp. 92-93.
Glazer, Sarah (1996, April 12). Managed Care. CQ Researcher, 6,
Koop, C. Everett (1996, Fall). Manage with care. Time. pp. 69.
Leadership & Management, Health Care
Leadership & Management in Health Care
President Clinton's Secretary of Health and Human Services, Donna Shalala, used to tell a story about her mother, who was 86 at the time but still a full-time attorney representing several clients who lived in nursing homes. She would tell Shalala, "Donna, I don't care whether they are good nursing homes or bad nursing homes, you have to watch them like a hawk" (Cited in White House, 1998, quoted by Hovey 2000, 43). Clinton's presidency was very aware of health care issues, even if it was unable to solve them. Shalala's remarks were delivered at a press conference regarding nursing home regulation; arguably, under the current administration, issues of health care for the aged have gotten more problematical rather than less.
Despite relatively little action regarding health care for the aged by the federal government, there is little…
Fox-Grage, W., & Shaw, T. (2000, April). The crisis ahead in long-term care. State Legislatures, 26, 30. Retrieved June 30, 2004, from Questia database, http://www.questia.com .
Froeschle, M.L., & Donahue, P.M. (1998). Academic health care: Leadership in time of change. Journal of Leadership Studies, 5(4), 60. Retrieved June 30, 2004, from Questia database,
Health Care Reimbursement and Billing
Both Mrs. Zwick and Mr. Davis face significant issues in the presented scenarios. Mrs. Zwick has multiple considerations under Medicare Parts A, B and D, in addition to her hospital-acquired urinary tract infection. Meanwhile, Mr. Davis must address the severe time constraints and costs of COBRA in light of his job termination. These two scenarios underscore current difficulties and complexities of current health care in the United States.
Discussion of Mrs. Zwick's coverage under Medicare Parts A, B and C
Medicare Part A (often called "hospital insurance") (U.S. Department of Health and Human Services, 2011, p. 15) assists in covering inpatient hospitalization and skilled nursing facilities, hospice and home health care (U.S. Department of Health and Human Services, 2011, p. 14). There is usually no monthly premium if you and/or your spouse paid Medicare taxes while employed (U.S. Department of Health and Human Services, 2011,…
Ethical implications of Mrs. Zwick's incurring costs related to her hospital-acquired condition are applicable despite the rehabilitation facility's exemption from POA/HAC Medicare laws. Having no first-hand knowledge of the cause of the urinary tract infection, no clear indication that I work at the rehabilitation facility and neither the privilege nor the duty of diagnosis, it would be unethical for me to tell Mrs. Zwick about my suspicions. Rather, a nurse is required to maintain his/her professional boundaries (American Nurses Association, 2001, p. 6). Simultaneously, a nurse is supposed to assure "responsible disclosure of errors" to patients and act to stop bad practices and promote best practices (American Nurses Association, 2001, p. 6). Consequently, a nurse in my position faces a dilemma: lack of personal knowledge and authority vs. my concern for the patient's well-being and constant improvement of the profession. In the face of this dilemma, I would: contact the rehabilitation facility's newly-hired nurse and advise/remind him/her of the duty to report to the appropriate supervisor and responsible disclosure to Mrs. Zwick; contact Mrs. Zwick's personal physician and explain the entire situation; direct Mrs. Zwick to discuss her health issues with her personal physician, who can review, diagnose and discuss the ramifications of her medical records, including but not limited to the urinary tract infection (American Nurses Association, 2001, p. 7). The desired outcomes would be: the rehabilitation center's absorption of Mrs. Zwick's costs related to her hospital-acquired infection through pressure exerted by its own nursing staff and Mrs. Zwick's personal physician; Mrs. Zwick's awareness of the true cause of her infection by health care providers who are directly responsible and capable.
Explain how the COBRA will allow Mr. Davis to continue his insurance coverage while he is out of work.
Due to Mr. Davis' termination from an employer of more than 20 employees, he can obtain coverage for himself, his spouse and his dependent children for up to 18 months (U.S. Department of Labor, 2012). In addition, due to his chronic cycle cell anemia, he may be entitled to an additional 11 months' extension for disability (U.S. Department of Labor, 2012). His employer is required to give a qualifying event notice to COBRA; then, COBRA sends a notice of the right to elect to continue coverage and an explanation of the steps that must be taken to continue coverage; Mr. Davis, his spouse and either or both of them in behalf of dependent children may elect for continuation of coverage
Mission, Vision, And Values of Healthcare Organizations
This paper discusses four healthcare organizations in the best way about their missions, visions and value. The featured four healthcare organizations include Nightingale Home Care Inc., Scripps Home Healthcare, Sharp Home Health Care, and Vitas Hospice. This discussion seeks to compare and deliberate on these three specific areas of management about the organization. Some of the important aspects with which the company seeks to deliberate on the matters at hand include the issues of leadership and how the same seeks to deliberate in making work potentially possible. In this case, the stakeholders of interest are the patients who are the recipients of the services offered by these hospitals.
Differences in the Selected Organizations
Nightingale Home care's mission is to assisted San Diegans achieve quality healthcare through environmental alteration and modern technology. This mission is coined out of the desire to set an example…
If the area wage index is greater than 1, the labor share equals 69.7%. The law requires the labor share to equal 62% if the area wage index is less than 1.0.
2) the wage adjusted labor share is added to the non-labor share of the standardized amount.
3) the wage adjusted standardized amount is multiplied by a relative weight for the DG. The relative weight is specific to each of 746 DG's (for fiscal year [FY] 2009) and represents the relative average cost of a beneficiary in one DG compared to another.
4) if applicable, additional amounts will be added to the IPPS payment for hospitals engaged in teaching medical residents, hospitals that treat a disproportionate share of low income patients, and for high cost outlier cases" (Acute Inpatient Prospective Payment System, 2009).
Physician services include office visits, surgical procedures, and other diagnostic services. These services are usually performed…
Acute Inpatient Prospective Payment System. (2009). Retrieved April 2, 2009, from Centers
for Medicare and Medicade Service Web site:
Physician Services Payment System. (2008). Retrieve April 3, 2009, from MedPac Web site:
the Allied health care staffing agency is a staffing agency that focuses on the niche of the nursing jobs within the healthcare industry in Chicago
The Allied healthcare staffing agency works to recruit registered nurses belonging to all medical Specialties, Practical Nurses that are licensed also called LPNs, Nursing Assistants that are certified also called CNAs and Specialists from the allied health sciences. These professionals would be hired both from the area of the metro city as well as the suburbs and placed within the hospitals, the neighborhood medical centers, Adult care facilities, clinics, and rehabilitation centers.
The mission of the Allied Healthcare Staffing Agency is to provide the best opportunities of employment both to its collaborators which are the local healthcare organizations as well as serving the entire nursing community to provide amply amount of job opportunities to choose from in a time when the turnover of…
Bureau, U.C. (2000). Census 2000 Demographic Profile Highlights:. chicago illinois, fact sheet .
commerce, U. d. (2010). bear facts, state illinois. bureau of economic analysis .
directory, a. h. (2010). free stats & national stats. Retrieved september 7, 2011, from american hospital directory: www.ahd.com
Lindberg, R.C. (1991). To Serve and Collect: Chicago Politics and Police Corruption from the Lager Beer Riot to the Summerdale Scandal. chicago: praeger publications.
Predict the economic impact (e.g., costs, benefits, efficiency, cost containment) on healthcare delivery at the local, state, national, or international level if the legislative bill were enacted.
This paper examines the economic impact upon the nation if the bill, the Palliative Care and Hospice Education and Training Act, were passed. Fundamentally, the economic impact of the bill would ultimately be a positive one. The bill proposes the necessity for better training and support for the clinicians who will ultimately work in palliative care. The bill represents a long-term investment: more expenditure to better train and educate these professional healthcare personnel, but with the understanding that definitive savings will be substantial. First of all, there's almost always a substantial amount of fiscal savings when the quality of care is improved; this has been demonstrated in a range of studies and is something which is experienced at the local and national level.…
Ascan.org. (n.d.). Evidence-based research: cost savings of palliative care to hospitals and the medicaid program. Retrieved from http://acscan.org/ovc_images/file/action/states/or/QoL/Cost_savings_of_Palliative_Care .
Healthcare Administration Mission Viejo Executive Summary
Over the last several years, the healthcare delivery environment has been continually evolving. This is because consumers are demanding efficient ways for receiving a variety of services. That is focused on reducing costs and enhancing quality. The result is that the entire system is continually changing to keep up with them. In the case of Golden Age Hospital (GAH), they are reaching a crossroads with rising number of seniors locally and nationally. This is in response to the rising demographic and many local facilities feeling overwhelmed. The new location can be utilized as an integrated business model that will achieve these larger objectives. In the long-term, this will make them more competitive and able to respond to changes in the way industry is operating. Those who are able to do this will see their employee turnover rates decrease and they can enhance the care…
Community Profile. (2014). City of Aliso Viejo. Retrieved from: http://www.cityofalisoviejo.com/wp-content/uploads/ApdxC_Community_Profile.pdf
Mission Viejo, California. (2015). U.S. Census. Retrieved from: http://quickfacts.census.gov/qfd/states/06/0648256.html
Rising Demand for Long-Term Care. (2014). CBO. Retrieved from: http://www.cbo.gov/publication/44363
Cuellara, A. (2006). Strategic integration of hospitals and physicians. Journal of Health Economics, 25 (1), 1-28.
Planned change in the eldercare advocacy organization
In the coming years, many countries will experience a dramatic shift in healthcare infrastructure due to an expanding elderly population size. However, the changes may vary across countries depending on many factors such as the kind of social welfare available in each country, the political environment which determine policies, the level of healthcare available and individual expectations in each country. Due to this wide variance, the innovations within this space will also vary greatly. What this means to the healthcare manager is that managing innovations becomes very hard (Shlutz, Andre & Sjovold, 2015 p 42). This also impacts on performance management which is fast gaining popularity in the public sector as a means to improve on accountability. Unfortunately, it has been cumbered by a series of challenges in its implementation; this is in spite of the frameworks developed over the last couple of…
Ethical Analysis -- Strategy for Palliative Care
The sector for healthcare has, in the last 50 years, improved in its efforts towards cost minimization and service delivery enhancement. Some elements of improvement (such as automation) ensued from technological advances. However, other elements (such as strategy application) owe their establishment in the health sector to endeavors on the part of intelligent, like-minded people who understand life's worth, and that of minimal suffering when it comes to illness. Palliative care represents one such effort. It denotes a system targeted at delivering respite from painful, disturbing symptoms through the affirmation of life and considering death to be a process. Palliative care, as defined by the World Health Organization, is an approach, which enhances quality of life (QOL) of patients, suffering from life-threatening ailments, and their family via prevention and symptom relief. This, they achieve through early diagnosis, and proper assessment and pain treatment,…
Chambers, M. (2015) The Strategic Importance of Palliative Care Within the Irish Heath Service, The Irish Hospice Foundation, http://hospicefoundation.ie/wp-content/uploads/2013/01/The-strategic-importance-of-palliative-care-within-the-Irish-health-service-Perspectives-on-future-service-delivery.pdf (Retrieved;13,12,2015)
Fromme, E., Smith, M. (2015) Ethical Issues in Palliative Care, UptoDate, http://www.uptodate.com/contents/ethical-issues-in-palliative-care (Retrieved;13/11/2015)
Gabel, S. (2010) Ethics and values in Clinical practice: Whom do they help?, Mayo Foundation and Licence Information, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084645 / (Retrieved, 13/11/2015)
Policy Directive, (2010) Palliative Care Strategic Framework 2010-2013, Ministry of Health, NSW, http://www0.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_003.pdf (Retyrieved:13/11/2015)
Madeleine Leineger's Cultural Care Theory
Theories are made of interrelated ideas that systematically give a systematic view about a certain phenomenon (an event or fact that is observable) that can, then, be predicted, and explained. Theories entail definitions, concepts, propositionspropositions, and models. Theories are created on the basis of assumptions. There are two ways in which theories are derived; inductive and deductive reasoning. The theory of nursing is meant to describe, explainexplain, and predict the nursing phenomenon.
It should give the bases of the nursing practice a strong foundation, thereby assisting in further creation of knowledge and show the future direction that for nursing should take. Theory is of great significance as it guides us in our decisions of what we already know as well as what we ought to know. Theory describes the nursing practice, hence giving us the foundation of nursing. The merits of a definite theory body…
Current Nursing. (2012, January 28). Application of Theory in Nursing Process. Retrieved from Current Nursing: http://currentnursing.com/nursing_theory/application_nursing_theories.html
McFarland, M., & Eipperle, M. (2008). Culture Care Theory: a proposed practice theory guide for nurse practitioners in primary care settings. Contemp Nurse, 28(1-2), 48-63.
Raudonis, B., & Acton, G. (1997). Theory-based nursing practice. J Adv Nurs, 26(1), 138-45.
Wayne, G. (2014, August 26). Madeleine Leininger's Transcultural Nursing Theory. Retrieved from Nurse Labs: http://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/
End-of-Life Care: Scholarly Nursing Practice Choice
I am an advanced practice registered nurse (APN) board-certified to practice in adult care (ANP-BC). Currently, I am employed as a nurse practitioner (NP) in palliative care within a hospice setting. Accordingly, my scholarly nursing practice is focused on the care of individual patients in need of palliative care, many of whom are in need of end-of-life care.
The phenomenon of interest that I have chosen is end-of-life care. Compared to palliative care, end-of-life care is not provided for patients receiving curative treatments or undergoing a disease process that is life-altering (Petersen, Breakwell, & Callahan, 2014). End-of-life care encompasses the principles of palliative medicine, including a focus on the patient's and family's quality of life, optimal functioning, individual growth, and care planning; however, end-of-life care will also emphasize a patient's dignity during the dying process, comfort through effective pain management, and care of family…
Faust, C. (2002). Orlando's deliberative nursing process theory: A practice application in an extended care facility. Journal of Gerontological Nursing, 28(7), 14-8.
Petersen, C.L., Breakwell, S., & Callahan, M. (2014). Palliative and end-of-life care: Precepts and ethics for the orthopaedic population. Orthopaedic Nursing, 33(3), 127-34.
Enhancing Service Delivery in U.S. Healthcare System
Any rehabilitative and chronic system aims at a cost-effective healthcare. The move towards the consideration of alternative methods to provide health care for patients emanates from the federal spending of over $2.5 trillion in 2010. The figure represents 17.6% of the nation's gross domestic product. An aging American population has demanded the need for an innovative and creative patient health care delivery system from the U.S. health care system. The new system promises to provide quality health care in a cost-effective manner that includes end-of-life care.
End-of-Life Care Environment Health Care System
Currently, the U.S. health care system primarily focuses on the provision of aggressive acute care for patients admitted to an inpatient facility. An enormous chunk of the budget spent, close to 80%, in the final months of the patients, covered costly aggressive treatments, resuscitation efforts, and ventilator support. Despite the expensive…
McGrath, L. S., Foote, D. G, Frith, K. H., & Hall, W. M. Cost Effectiveness of a Palliative Care Program in a Rural Community Hospital. Nursing Economics. 2013 Jul-Aug; 31(4):176-83.
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.
Hawaiian elde cae pofessionals impove patient eldecae sevices to Japanese nationals, taking into consideation Japanese cultual noms and expectations
Caegiving fo eldely paents in Japan
Japan has witnessed a significant gowth in its elde population. In the yea 1950, 4.9% of the Japanese population was aged 65 yeas and above. This figue inceased to 14.8% (1995). By 2025, it is estimated to gow to 25.8% (Yamamoto & Wallhagen, 1997). Japan's 'vey old' population goup (aged 85 and above) is swiftly inceasing in numbe. It has been pojected that by 2025, the nation's 'vey old' population will account fo 4.3% of its total population -- a five-fold ise in thee decades. Futhemoe, it was pojected that as many as 2.62 million Japanese would be suffeing fom senile dementia by the yea 2015; the 1990 estimate fo senile dementia was about one million individuals (11WSA 1996).
Change in the pecentage of Japan's…
references, and Arrangement of End-of-life Care and Decision-Making among Japanese-American Older Adults, ProQuest LLC.
National Asian Pacific Center on Aging. (1998). Growing APA elderly population adds urgency to improving health services. Asian Pacific Affairs, 6 (Dr. 2-3.
SALDOV, M., KAKAI, H., McLAUGHLIN, L. & THOMAS, A. (1998). Cultural barriers in oncology: Issues in obtaining medical informed consent from Japanese-American elders in Hawaii, Journal of Cross-Cultural Gerontology 13: 265-279.
Sato, S. (2015). THE IMPACT OF GENDER AND CULTURAL FACTORS ON THE PATTERNS OF ELDER CARE SERVICE UTILIZATION AMONG FAMILY CAREGIVERS OF JAPANESE ANCESTRY IN THE STATE OF HAWAII, ProQuest LLC
SOROCCO, K.H. (1998). BECOMING A HEALTH ACTIVE OLDER ADULT: THE EFFECTS OF A WORKSHOP FOR JAPANESE-American OLDER ADULTS. ProQuest Information and Learning
Cae Planning Analysis
In eality, sound healthcae-elated advanced planning is a continuous convesation, involving pioities, values, QOL (quality of life) and what one's life means. Tool kits, in this context, compise vaious self-help esouces, woksheets, and ecommendations. They aid individuals in pefoming the moe complex tasks of identifying, confiming, and shaing impotant facts with an individual faced with a seious ailment (Ameican Ba Association, 2005). Iespective of whethe the individual is teminally ill o suffeing fom an acute ailment o chonic, long-tem ailment, advanced cae planning (ACP) is capable of facilitating the alleviation of unnecessay suffeing, impoving QOL and offeing a bette gasp of decision-elated challenges faced by the ailing individual, his/he family, and othe caegives. Advanced cae plans may be implemented at any junctue in the patient's life and must be updated when changes occu in patient cicumstances. A peson who contacts a pogessive disease that leaves him/he disabled…
references? A Study of the U.S. Medicare Population. Medical care, 45(5), 386.
Centers for Disease Control. (2013). Advance care planning: ensuring your wishes are known and honored if you are unable to speak for yourself. Retrieved 16 February 2016 from http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf
Wehri, K. (2011). Living well at the end of life: a national conversation. Caring: National Association for Home Care magazine, 30(9), 38.
In 2001, the trial court judge stated that clear and convincing confirmation demonstrated that Ms. Schiavo would have selected not to be given life-prolonging action beneath the conditions that were present. This decision was also confirmed by the Florida appeals court and the family was deprived of a hearing by the Florida Supreme Court. When Terri Schiavo's feeding tube was taken out for the second time, in 2003, the Florida legislature fashioned Terri's Law to supersede the court decision, and the tube was for a second time put back. This law was consequently stated an illegal breach of the separation of powers (Quill, 2005).
Terri Schiavo's case fascinated the nation for quite a bit of time during March of 2005 as the dying woman laid in Florida hospice. Mrs. Schiavo had been in a vegetative condition for many years, and her husband Michael Schiavo effectively asked the Florida state courts…
Calabresi, Steven G. (2006). The Terri Schiavo Case: In Defense of the Special Law Enacted by Congress and President Bush. Retreived October 6, 2010, from Web site:
Cruzan v. Director, Missouri Department of Health. (2010). Retrieved October 6, 2010, from Answers Web site: http://www.answers.com/topic/cruzan-v-director-missouri -department-of-health
Cruzan v. Director, Missouri Department of Health et.al.497 U.S. 261 (1990). Retrieved October
Blog -- APN Quality Improvement Project
Blog: Provider-Associated Barriers to Hospice eferrals
The process of writing the quality improvement project for improving hospice referrals for patients suffering from end-stage dementia care was very instructive. eading the relevant literature revealed which research questions in dementia care are considered important by scientists and care professionals and which questions have yet to be asked. Aside from helping to outline appropriate goals for the quality improvement project, this task revealed that end-stage dementia care is a relatively understudied area of medicine. Writing the literature review also uncovered a list of best practice recommendations for palliative care, in relation to dementia, which was previously unknown to me. Overall, writing the quality improvement project helped me collect best practice recommendations authored by dementia care experts and understand the state of research in palliative care for patients suffering from end-stage dementia. This in turn increased my proficiency…
Mitchell, S.L., Miller, S.C., Teno, J.M., Davis, R.B., & Shaffer, M.L. (2010). The Advanced Dementia Prognostic Tool: A risk score to estimate survival in nursing home residents with advanced dementia. Journal of Pain and Symptom Management, 40(5), 639-51. Doi: 10.1016/j.jpainsymman.2010.02.014.
Snyder, S., Hazelett, S., Allen, K., & Radwany, S. (2013). Physician knowledge, attitude, and experience with advance care planning, palliative care, and hospice: Results of a primary care survey. American Journal of Hospice & Palliative Care, 30(5), 419-24. Doi: 10.1177/1049909112452467.
During that time, I cannot recall mourning, but I cannot recall feeling much of anything else, either.
My grief returned more intensely than before at the graveside service.
Afterwards, I was exhausted by the emotional flood that I had experienced, but it is equally possible that the relief was more a function of all the energy that it had required not to release during the time between my father's death and his funeral. As powerful as the feelings of outright grief were some of the more unexpected feelings I began to experience in the next few weeks: feelings of anger at my father, anger at myself, shame, totally inexplicable feelings of hurt, and fear, and also relief.
A realized for the fist time, only weeks after my father's death, that I was angry at my father: angry that he'd refused the dialysis which could have prolonged his life; angry at…
Leadership is paramount in the more globalized economic structure. Companies are now expanding into emerging markets at a very rapid pace. Competition from markets including China, India, and Brazil, now create a more competitive dynamic in regards to labor. Companies need leaders who can flourish irrespective of their geographic locations. Leaders now must also be cognizant of cultural values as they attempt to inspire and motivate their personnel. An awareness of individual leadership strength and weaknesses is therefore needed to navigate a constantly changing and dynamic environment. A self inventory of corresponding strengths and weaknesses will allow the future leader to be better prepared for many of the more complex aspects of leadership (Spillane, 2004).
While reading the leadership styles inventory, a litany of concepts emerged. For one, my style is not that of an authoritarian but rather that of a cooperative, collectivistic leader. I prefer to work alongside my…
1) House, Robert J. (1971). "A path-goal theory of leader effectiveness." Administrative Science Quarterly (Johnson Graduate School of Management, Cornell University) 16 (3): 321 -- 339
2) Paul C. Dinsmore et al. (2005) The right projects done right! John Wiley and Sons, 2005. ISBN 0-7879-7113-8. p.35-42
3) Spillane, James P.; et al., Richard; Diamond, John (2004). "Towards a theory of leadership practice." Journal of Curriculum Studies 36 (1): 3 -- 34
4) Lewis R. Ireland (2006) Project Management. McGraw-Hill Professional, 2006. ISBN 0-07-147160-X p.110- 116
ANA Nursing Code of Ethics
ANA Code of Ethics Applied to Current Practice Philosophy
The objective of this study is to discuss provisions one through nine of the ANA Code of Ethics and apply it to the current practice philosophy. A well this work will discuss provisions seven through nine of the ANA Code of Ethics and apply it to the current practice philosophy and answer how the two relate. The differences between professional responsibility and accountability in the nursing practice will be discussed and examples provided. Finally, this study seeks to answer after what has been learned in addition to readings and self-assessment activities what can be implemented in the practice that would strengthen this experience for one's peers and in terms of self-development on the Novice to Professional continuum.
The American Nurse Administration Code of Ethics Provision One states that the nurse practices, in all professional relationships "with…
Bamford, M, Wong CA and Laschinger H (2012) The Influence of Authentic Leadership and Areas of Worklife on Work Engagement of Registered Nurses. J Nurs Manag 2012 26 Apr. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/?term=nurse+ethics
Butts, JB (nd) Ethics in Professional Nursing Practice. Chapter 3. Jones and Bartlett Publishers. Retrieved from: http://www.jblearning.com/samples/0763748986/48986_ch03_pass3.pdf
Code of Ethics for Nurses with Interpretive Statements (2010) Nursing World. Retrieved from: http://nursingworld.org/FunctionalMenuCategories/AboutANA/Leadership-Governance/Nursing-Code-of-Ethics.pdf
Dahnke, MD (2009) The Role of the American Nurses Association Code in Ethical Decision Making. Holist Nurs Pract 2009. Mar-Apr;23(2):112-9. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19258853
Transitioning From Closed to Open Systems: How Effective Nurse Leaders Approach Problem Solving and Decision Making in Organizations
The objective of this study is to examine transitioning from closed to open systems and how effective nurse leaders approach problem solving and decision making in organizations. This study will utilize systems theory in identifying an issue or process that could be improved and apply knowledge and strategies related to systems theory.
The problem addressed in this study is the excessive trust vested in unlicensed personnel resulting in some to make decisions reserved to licensed health professionals.
Responsibilities of the Nurse Manager
It is reported that the licensed nurse manager or supervising nurse has the responsibility to "delegate professional responsibilities only to persons who are qualified by education, experience or licensure to carry out the responsibility." (New York Office of the Professions, Division of Professional Licensing Services, 2009, p.27) It is additionally…
2013 NACNS Annual Conference: Clinical Nurse Specialists Leading Innovation for Healthcare Change. April 2013. Vol. 27. No. 2. Retrieved from: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=1505534
Explanation of RN Scope of Practice and Nurse Practitioner Practice (1996) Board of Registered Nursing, Sacramento, CA. Retrieved from: http://www.rn.ca.gov/pdfs/regulations/npr-b-19.pdf
Health Care Liability and Inju8red Patients and Families Compensation. (2013) State of Wisconsin. Chapter 655. Retrieved from: https://docs.legis.wisconsin.gov/statutes/statutes/655.pdf
Nursing Guide to Practice (2009) New York Office of the Professions, Division of Professional Licensing Services. Retrieved from: http://www.op.nysed.gov/prof/nurse/nurse-guide-april09.pdf
Effective communications between doctors and nurses has always been a high priority in the medical field, especially in an arena such as a hospital, health clinic or hospice. Communicating effectively between the nurses and the doctors is especially important in a hospice setting due to the fact that the patient is usually suffering the most; both with the physical and the emotional pain and suffering that is being experienced as the patient nears death.
One recent study determined that "doctors and nurses have different but complementary roles in what, when and how treatment choices are negotiated with patients" (Mccullough, Mckinlay, Barthow, Moss, Wise, 2010, p. 482) and the treatment choices when facing death are decisions that should not be taken lightly, either by the involved nurses or the doctors. The decisions taking place in the hospice setting will often determine how much pain and suffering the patient will endure…
Basch, E.; (2010) The missing voice of patients in drug-safety reporting, New England Journal of Medicine, Vol. 362, Issue 10, pp. 865-869
Bezzina, A.J.; (2009) Prevalence of advance care directives in aged care facilities of the Northern Illawarra, Emergency Medicine Australia, Vol. 21, Issue 5, pp. 379 -- 385
Byrnes, J.; Braden, J.; James, G.; Broadus, T.; Owen, R.; (2011) Implementing an electronic medical record (EMR) in an integrated delivery system Sharp Healthcare (SHC) San Diego, California, accessed on September 25, 2011 at http://proceedings.amia.org/1alo2n/
David, S.E.; Ahmed, Z.; Salek, M.S.; Finlay, A.Y.; (2005) Does enough quality of life related discussion occur during dermatology outpatient consultations? The Journal of Dermatology, Vol. 153, pp. 997 -- 1000
McMillan, S.C., & Small, B.J. (2007). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients. Oncology Nursing Forum, 34(2), 313-21.
Are there any HIPAA concerns that are evident in this study?
Both caregivers and patients were required to sign informed consent documentation in order to participate in the study. Were any concerns related to HIPAA indicated in the protocol or procedures for conducting the study, those concerns would need to be delineated in the consent documents and explained to the participants. Since caregivers were an integral component to the hospice care and quality of life measures for patients, patient privacy could be maintained just as with any other medical or healthcare services.
What methods were put in place to ensure that the subjects were giving true informed consent?
The inclusion criteria and protocol for participating in the study required that patients and caregivers both be…
McMillan, S.C., & Small, B.J. (2007). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients. Oncology Nursing Forum, 34(2), 313-21.
Rosedale, M., & Fu, M.R. (2010). Confronting the unexpected: Temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Oncology Nursing Forum, 37(1), 28-33.
Using the COPE Intervention for Family Caregivers to Improve Symptoms of Hospice Homecare Patients: A Clinical Trial
This study was designed to test an intervention for hospice caregivers in order to help them better manage symptoms experienced by patients with cancer. The authors maintain that research indicates caregivers are unable to accurately assess and report the intensity of symptoms and overall quality of life (QOL) of patients with cancer and patients in hospice care.
Three symptoms, pain, dyspnea, and constipation, are commonly are seen in patients with advanced cancer. However, the author's site research that asserts that these symptoms are assessed inadequately and managed poorly in many patients. Pain and dyspnea have been found to create symptom distress, significantly affecting patient QOL.
The authors claim that caregivers must develop the skills needed to function effectively as part of the healthcare team. Building the knowledge base and teaching…
McMillan, S.C. & Small, B.J. (2007, March). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: A clinical trial. Oncology nursing forum, Vol. 34, Issue 2, 313-321. Retrieved January 20, 2012, from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&hid=14&sid=b3e07ee7-388a-4d19-97ef-163b481297fd%40sessionmgr15
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…
Burkhardt, M. & . (2008). Ethics issues in Contemporary Nursing. Clifton Park: Delmar.
Chorney, J., McGrath, P., & Finley, G. (2010). Pain as the neglected adverse event. CMAJ: Canadian Medical Association Journal, 182(7), 732. Retrieved from EBSCOhost.
Guido, G.W. (2010). Legal & Ethical Issues in Nursing (5 ed.). Vancouver, Washington: Julie Levin Alexander.
King, J.S., Eckman, M.H., & Moulton, B.W. (2011). The Potential of Shared Decision Making to Reduce Health Disparities. Journal of Law, Medicine & Ethics, 3930-33. doi:10.1111/j.1748-720X.2011.00561.x
Of course, as Medicare beneficiaries increase because of the number of baby boomers, the Medicare program may adjust. However, current hospice figures demonstrate that only about twenty percent of all elderly individuals that die are enrolled in hospice programs.
Implementation and Monitoring
The needs of this new program will require thorough training and once implemented, precise monitoring. "When you approach a problem in the way your work group functions, you're implementing an organizational change. By taking a critical look at your process, and using some theories from organizational design, you can fix the problem -- and change your organization to make quality more likely." (Derby, 1999) The training will be a key because of the potential requirements associated with the Hospice program that may require completely new skill sets for the majority of our staff. The fact is that many of our nurses may not have acquired the necessary skills…
Derby, Esther. (2002). Modeling Organizational Change. Retrieved on February 12, 2005, at http://www.estherderby.com/writings/modeling.htm
Hospice Benefits and Utilization in the Large Employer Market. Ed. Beth Jackson, Teresa Gibson, Joline Staeheli. March 2000. U.S. Department of Health and Human Services. Retrieved on February 12, 2005, from http://aspe.os.dhhs.gov/daltcp/Reports/empmkt.htm.
Rubenfeld, M. Gaie, & Scheffer, B.K. (1995). Critical Thinking In Nursing. Philadelphia: JB Lippencott.
Social Security Administration. (1993) "Social security programs in the United States." Social Security Bulletin 12/22/1993.
Patients also say they want to awake and conscious when their pain is managed. The issue is that there are not many U.S. physicians and nurses who are certified to extend palliative care. There are only 33 physicians and only 41 nurses for every 10,000 patients (Peres).
The hospice movement has been changing the face of care for people at the end-of-life stage (Radulovic 2004). Hospices have been providing options and choices to these patients for the last three decades. The hospice movement began in the UK but spread to America in response to the need for more compassionate care for the dying and terminally ill. A hospice is not a place but a concept of palliative and support services for the terminally ill to be cared for primarily at home. A home can be the patient's residence or that of a loved one, a long-term care facility. It provides…
Bone, Roger C. Analysis of Indications for Intensive Care Unit Admissions. Chest:. American College of Chest Physicians, December 1993
Earl, C et al. "Rise in Aggressive Treatment." Trends in the Aggressiveness of Cancer Care Near the End of Life. Journal of Clinical Oncology:. Springhouse Corporation, 2007
Peres, Judith. U.S. End-of-Life Gets Passing Grade. Health Care Benchmarks and Quality Improvement: American Health Consultants, Inc., 2003
Radulovic, Jan.W. Trends in Hospice and Palliative Care in the United States and Kansas. Kansas Nurse: Kansas State Nurses Association, 2004
Most palliative care vocational nurses are generalists. However, there are specialties in palliative care, such as oncology and geriatrics. Hospice and palliative care nurses can become Certified Hospice and Palliative Nurses (CHPN).
Palliative nurses practice in a variety of settings. The most common setting is the patient's home. Palliative nurses also work in the hospice units of medical facilities, such as hospitals, nursing homes, and other long-term care settings. Patients typically die within a month of enrolling in a hospice program. In contrast, palliative care nurses are more likely to practice in long-term care facilities and have more extended involvement in their patients' end of life.
In order to be an effective palliative care nurse, the vocational nurse needs an understanding of a specific group of practice areas. Those areas include: pain management, end-stage disease process, loss and grief, and bereavement care. However, in addition to medical knowledge, palliative care…
Other limitations which further hindered the analytical strength of the study, was the fact it was conducted only in one hospital.
The suggestions provided by the researchers in the conclusion of the study are both enlightening and appropriate to further study and methodology of care giving within hospice. The designers of this research propose the idea that hospice care should include attention towards a patient's physical symptoms, but also their psychological symptoms which are bound to be prevalent within the atmosphere of a hospice. Attention geared towards the patient's psychological wellness will greatly improve the quality of life which the patient must endure while awaiting the inevitable inside the hospice walls. These conclusions and suggestions, although somewhat of a transgression from the primary focus of the study, are important for the truth they hold within them.
McMillan, Susan C., Dunbar, Sandra, B., Zhang, Weihua. (2007). The prevalence of symptoms…
McMillan, Susan C., Dunbar, Sandra, B., Zhang, Weihua. (2007). The prevalence of symptoms in hospice patients with end-stage heart disease. Journal of Hospice and Palliative Nursing. 9(3).
Sociology/Social Work Questions
Explain why children in the early-school-aged period may be especially vulnerable to fluctuations in self-esteem and feelings of "worthlessness."
Young children, in the early school aged years are in a developmental stage that is focused on feelings of identity and self-esteem (Nutbrown & Clough, 2009, p 191). It is during the early years of school that children begin to form concepts of identity through a sense of belonging as well as through the demonstration that they are needed by others in their community, and especially those they hold in high regard, peers and teachers. They seek to demonstrate for themselves that they play an important role in their own lives and communities to help them establish a sense of self. In other words they seek almost above all else to establish that they are valuable and have purpose in their community and especially in school as this…
Barker, E.D., Tremblay, R.E., Nagin, D.S., Vitaro, F., & Lacourse, E. (2006). Development of male proactive and reactive physical aggression during adolescence. Journal Of Child Psychology And Psychiatry, 47(8), 783-790. doi:10.1111/j.1469-7610.2005.01585.x
Craig, W.M., Vitaro, F., Gagnon, C., & Tremblay, R.E. (2002). The road to gang membership: Characteristics of male gang and nongang members from ages 10 to 14. Social Development, 11(1), 53-68. doi:10.1111/1467-9507.00186
Emanuel, E.J., & Emanuel, L.L. (1998). The promise of a good death. Lancet, 351(9114), SII21.
Hamachek, D. (1990). Evaluating self-concept and ego status in Erikson's last three psychosocial stages. Journal Of Counseling & Development, 68(6), 677-683.
As the compliance officer at ABC Hospital, one of my major tasks is to research the Office of the Inspector General (OIG) website to locate the 2012 plan with a view of identifying compliance issues under review by the OIG. Generally, the Office of the Inspector General Work Plan establishes several projects to be dealt with during the financial year by the Office of Audit Services and other agencies or departments. The Work Plan has considerable impacts on each of its major entities including the public health agencies. While the information in the Work Plan is offered on projects associated with issues that intersect departmental programs, some of these projects are statutorily mandated.
ole of OIG egarding Hospital Compliance
The Office of the Inspector General was established in 1976 by the U.S. Department of Health and Human Services to play a crucial role in the country's efforts toward…
Gossett, D. (2008, March 26). OIG Issues Guidelines for Hospital Compliance Programs.
Retrieved February 15, 2015, from http://corporate.findlaw.com/law-library/oig-issues-guidelines-for-hospital-compliance-programs.html
"Summary of the OIG 2012 Work Plan." (2011, October 6). Health Law News. Retrieved February 15, 2015, from http://www.hallrender.com/library/articles/924/100611HLN.html
Sanford, J., Townsend-Rocchicciolli, J.,Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice, 25(1), 55-70.
Describe the population for this study.
participants were recruited from cardiology offices, inpatient hospital units, or adult day care facilities. The participant had to be related to the patient with heart failure (HF), provide one activity of daily living, and/or assist the care recipient with two activities of daily living and do this voluntarily.
How was the sample selected? What are the strengths and weaknesses of this sampling strategy?
This was a convenience sample. The participants were recruited from cardiology offices, inpatient hospital units, or adult day care facilities and had to meet certain conditions. The strengths are that the researchers know and get precisely what they are looking for (in terms of qualifications of participants). The weaknesses are that…
It is related that "This patterns of delayed referral does more than deprive individuals of palliative care-it jeopardizes hospice programs themselves. To be financially viable, hospice programs, which receive per diem reimbursements, must be able to balance out the high initial costs of services to new patients with the lower costs of maintaining stabilized patients." (Open Society Institute - Project on Death in America, 2007) Finally, it is related that "high quality end-of-life care depends upon an integrated network of in-hospital, out-patient, home and nursing home services." (Open Society Institute - Project on Death in America, 2007) Issues requiring research which present barriers to the provision of comprehensive quality palliative care include the issues as follows: (1) How does the six-month eligibility requirement affect patient access to end-of-life care?; (2) What is the impact of delayed referrals on hospice services?; (3) Are there cost incentives within HMOs to rush patients…
Thomas, Keri Dr. (2003) Caring for the Dying at Home: Companions on the Journey. Chapter Five Excerpts. Online available at http://www.goldstandardsframework.nhs.uk/content/guides_and_presentations/Evidence_base.doc
Cramer, LD et al. (2003) Nurse's Attitudes and Practice Related to Hospice Care. J Nurs Scholarsh. 2003;35:249-255
Wright, K. (2002) Caring for the Terminally Ill: The District Nurse's Perspective. Br J. Nurs. 2002;11:1180-1185
Palliative Care (2007) Nursing Matters - Fact Sheet. Online available at http://www.icn.ch/matters_palliative.htm
Program Budget and Cost Analysis
Line-Item Budget for an in-Service Dementia Care Training Program
Florida now requires all direct-care staff working with dementia patients to receive specialized training. The curricula offered must be vetted by the Training Academy of the University of South Florida's Policy Exchange Center on Aging, otherwise assisted living facilities, nursing homes, adult day care, and hospices will be unable to accept patients with dementia into their facilities. In order to meet these statutory requirements and improve patient care, an in-service training program in dementia care will be instituted for a hospice facility located in Florida.
The Hospice House in Cape Coral, Florida maintains 36 beds for patients with terminal illnesses. On average, a little over 60% of the residents suffer from dementia at any one time, which is consistent with national trends (Williams, Hyer, Kelly, Leger-Krall, and Tappen, 2005, p. 98). The number of patients tends…