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Hospice Care and Catholic Ethics
Is Hospice care consistent with Catholic bioethics? Chapple, in her discussion of the topic "Hospice care" in Catholic health care ethics, argues that ultimately the answer is yes, but she acknowledges that there are levels of difficulty in answering the question (Chapple 2009). The ethics of Hospice care present us with a complicated question, insofar as Catholic teachings on end-of-life care have at times provoked public controversy -- the most noteworthy example within recent memory was the Congressional and Presidential intervention in Terri Schiavo case, which brought Catholic teachings about medical intervention at the end of life into national debate and discussion. The Schiavo case was about a straightforward case of euthanasia, and to a certain degree Catholic teachings about hospice care resemble (in their logic about the nature and purpose of human life and death) the Catholic teachings about larger end-of-life issues. The ultimate…
Catechism of the Catholic Church. Accessed 18 March 2013 at: http://www.vatican.va/archive/ENG0015/_INDEX.htm
Chapple, HS. "Hospice care." In Furton, EJ Cataldo PJ and Moraczewski AS. Catholic health care ethics: a manual for practitioners. 2nd Edition. Philadelphia: National Catholic Bioethics Center, 2009.
Gawande, A. "Letting Go: What Should Medicine Do When It Can't Save Your Life?" The New Yorker. August 2, 2010. Accessed 18 March 2013 at: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande#ixzz2Nxoxy3kI
Pope John Paul II. "To Participants in the 19th International Conference of the Pontifical council for Health Pastoral Care." L'Osservatore Romano, English language edition. 24 November 2004. 6. Accessed 18 March 2013 at: https://docs.google.com/viewer?a=v&q=cache:UxsPB9YKUdUJ:www.lifechoicehospice.com/sites/lifechoicehospice.com/files/LCH-028_Catholic_Hosp.pdf+catholic+view+of+hospice+care&hl=en&gl=us&pid=bl&srcid=ADGEESi1P6zIukv2v0SOqYtsbX5GcBTApzyN6GkARX42h1JfgnPoHCG7E1Ohdq9hnEW5P_b6G40sJflNESmCqwEAw8iPqQzM_HoJZPPj5KPH6MRoeXyav_G3Y8kSGm7oR0vCIYewjnKZ&sig=AHIEtbRWuO9dVLtlu9B0sUtukIj_f45dBg
In fact it is federally mandated that hospices must give the patient every option available to them in order to efficiently manage pain, "the federal guidelines regulating hospice require the hospice to make every reasonable effort to assure that the patient's pain is controlled," (Hospice Patient's Alliance, 2008).
Hospice services are sophisticated and rely on a number of professionals to help comfort and ease the pain of patients who have chosen to enter into a hospice care program. There is an entire structural hierarchy of care professionals which is designed to help the patient and family members along every step of the process. First and foremost comes the immediate medical staff which will be making medical decisions in regards to pain management and other forms of medical treatments. These staff members include doctors and trained nurses. Physicians are responsible for administering effective pain management methodologies, and are therefore very important…
American Cancer Society. "What is Hospice Care? www.cancer.org.2008. 24 May. 2008. http://www.cancer.org/docroot/ETO/content/ETO_2_5X_What_Is_Hospice_Care.asp?sitearea=ETO
Harrison, Irene. "Hospice Care." Cancer Supportive Care Programs.
A www.cancersupportivecare.com.2007. 24 May. 2008. http://www.cancersupportivecare.com/hospice.html
Help Guide. "Hospice Care: Full Service Support at Home or in a Facility." www.helpguide.org.2008. 24 May. 2008. http://www.helpguide.org/elder/hospice_care.htm
Who provides the care is dependent upon the patient and the type of care their illness requires. Also, some families are more active in taking care of end of life patients than other families.
Indeed, hospice care providers have a significant number of responsibilities as it relates to taking care of the patient. The type of illness that the patient has can increase or decrease the number of responsibilities of the hospice care providers. In any case, hospice care providers provide services tat ensure the comfort of the patient and they also attempt to make the emotional and psychological issues associated with dyeing, more palatable for the patient.
In addition to the issues that arise for the patient, caring for a loved one that is terminally ill is also extremely difficult for family members. As was mentioned previously in the discussion the purpose of a hospice is to serve both…
Csikai, E.L. (2004). Social Workers' Participation in the Resolution of Ethical Dilemmas in Hospice Care. Health and Social Work, 29(1), 67+.
Egbert, N., & Parrott, R. (2003). Empathy and Social Support for the Terminally Ill: Implications for Recruiting and Retaining Hospice and Hospital Volunteers. Communication Studies, 54(1), 18+.
Forman Walter B..
Published 2003. Hospice and Palliative Care: Concepts and Practice. Jones and Bartlett Publishers
However, they are often emotionally isolated and are unable to determine whether or not they are loved by their family members or whether they will be missed after passing on. This often happens because the family members are not directly involved in providing hospice care to their patients. Hospice care can be a great way of strengthening the connection between the terminally ill patient and their loved ones and family members. It is thus essential for hospice care professionals to support interactions between patients and their family members for the latter to make extra efforts to make them feel that they are loved.
Conventional medical care institutions often fail to provide adequate care to terminally ill patients because professionals at these institutions do not understand the crucial part that family members play in the last moments of the terminally ill patient. This is part of the case that is put…
Armstrong-Dailey, Ann. Hospice Care for Children. Oxford: Oxford University Press, 2001. Print.
Coleman, a.M. "End-of-Life Issues in Caring for Patients with Dementia: The Case for Palliative Care in Management of Terminal Dementia." Am J. Hosp Palliat Care 29.1 (2012): 9-12. Print.
LaPorte, Marianne, and Deborah Witt Sherman. Palliative Care Nursing: Quality Care to the End of Life. Berlin Heidelberg: Springer Publishing Company, 2010. Print.
Sachs, G.A., J.W. Shega, and D. Cox-Hayley. "Barriers to Excellent End-of-Life Care for Patients with Dementia." J. Gen Intern Med 19.10 (2004): 1057-63. Print.
Hospice and Attitudes Towards Death
Attitudes towards dying, death, and bereavement are very dependent upon culture. Some cultures embrace death as a natural part of the life cycle and do not attach fear to death. Other cultures are very fearful of the topic of death and treat it like a taboo. "In many preliterate societies, the dead are imbued with special powers and considered potentially harmful to the living. Many customs and funereal rituals surrounding death represent efforts to ensure the well-being of the community" (Quadagno, 2008). However, individual attitudes towards death and dying can vary within a community. Modern society certainly reflects a wide range of feelings towards death and dying. Some people still avoid the topic of death as a taboo, while others are much more comfortable with the idea.
One of the most interesting movements in modern medicine has been the hospice movement. After years of medicine…
Devi, P.S. (2011). A timely referral to palliative care team improves quality of life. Indian J.
Palliat Care, 17(Suppl): S14-6.
Quadagno, J. (2008). Aging and the life course: An introduction to social gerontology. New York: McGraw Hill.
Tan, Y.S., & Cheong, P.Y. (2011). Experiences in caring for the dying: a doctor's narratives.
Children believed that death is more like sleep and the dead may or may not return. Children between five and nine years of age belonged to the second group. Maria observed that children belonging to the second group perceived death as an irreversible phenomenon but still thought of it as an avoidable one. Death for these children represented a certain shadowy or skeletal figure who could possibly be evaded with some luck and intelligence. According to the author only the last group of children representing the ages of ten and above fully understood death as an inevitable eventuality for everyone. Thus Maria Nagy classified children's perception of death as a measure of their age. [Lewis R. Aiken]
However, studies, which were conducted much later in the United States, showed different results. These studies showed that the interpretation of death by children is not limited by their age alone and their…
1) AAP, (Aug 2000), "Palliative Care for Children', Retrieved March 31st 2008, from, http://aappolicy.aappublications.org/cgi/content/full/pediatrics;106/2/351
2) Lewis R. Aiken, (2000), "Dying, Death and Bereavement', Published by Lawrence Erlbaum Associates, Thanatology, 3) Joseph F. O'Neill, (July 2000), "HIV and Palliative Care," retrieved March 31st from, http://hab.hrsa.gov/tools/palliative/chap1.html
4) AVERT, "United States: AIDS Cases and Deaths by Year," retrieved 31st march 2008, from, http://www.avert.org/usastaty.htm
5) Carol K. Sigelman, (2006), 'Life Span Human Development', Published by Thomson Wadsworth
Hospice and Hospital Oncology Unit Nurses a Comparative Survey of Knowledge and Attitudes About Cancer Pain," authors Connie J. Hollen et al. (2000) set out to examine any strengths, weaknesses and misconceptions that affect the ability of registered nurses to care for their patients.
To conduct their research, Hollen et al. (2000) went to 11 community hospices and 7 inpatient oncology units in hospitals around an urban county area in a southcentral state. The researchers then took a sample of 30 nurses working in hospices and 34 nurses from the hospital inpatient oncology units. These "convenience samples" were administered with surveys to determine their inclusion in the study, as well as their knowledge and attitudes about the management of pain in cancer patients.
The researchers used the North Carolina Cancer Pain Intiative (NCCPI) survey. This survey measures the primary components of a subject's knowledge, attitudes, perceived difficulties and demographic information…
Hollen, Connie J, Hollen, Charles W, and Stolte, J. 2000. "Hospice and Hospital Oncology Unit Nurses: A Comparative Survey of Knowledge and Attitudes About Cancer Pain." Oncology Nursing Forum. 27(10). November/December.
This will also take the focus away from individual grief by sharing and understanding the concerns of others.
IV. Group structure
Recruitment will occur by means of advertisement in a variety of media. The notice boards of medical facilities and pharmacies will be used as a primary advertisement site. Pamphlets will also be available at waiting rooms and at counters of medical venues and hospitals. The local newspaper will furthermore be used for advertising the group, as well as the Internet. The latter will be used on a smaller scale, focusing on local site with relevant content and advertising facilities.
The screening process will entail the criteria mentioned above. Advertisements will suggest the criteria, while each woman will be interviewed for a further screening process. In addition to the already determined criteria, all women need to be fairly mentally stable apart from the grieving process. uicidal, homicidal or…
Carson, Tracy (2005). Emotions Associated with Grief. Rochester Funeral Homes. http://www.rochesterfuneralhomes.com/Resource_Guides/grief_counseling.html
Egbert, Nichole (2003, Spring). Empathy and social support for the terminally ill: Implications for recruiting and retaining hospice and hospital volunteers. Central States Speech Association, Communication Studies.
Ford-Martin, Paula Anne. (1999). Group Therapy. Gale Encyclopedia of Medicine. Database: FindArticles.com
Gross, Donalyn. (2004, Sept.). Missing: death education for nursing facilities; Staff need to be trained in comforting dying residents, their families, and themselves. Nursing Homes, Medquest Communications. Database: FindArticles.com
Rather than giving over control to medical experts to cure disease, the dying person is empowered by the interdisciplinary team of hospice practitioners to guide and direct the time that remains." Noted as a serious challenge that is faced by hospice practitioners is that associated with "the legal option of choosing death." (Miller, 2007) Miller additionally reports: "A lethal dose of medication can be obtained (within guidelines) by a terminally ill person in Oregon in order to hasten death. Hospice providers across all disciplines have found that this choice has posed a serious challenge to the underpinnings of their work." (2007) Miller reports a study in which the data "...are based on interviews with interdisciplinary hospice providers from eastern and western regions of the U.S. A total of 12 hospices were visited and 60 hospice professionals engaged in a semi-structured interview. The responses to six open-ended questions were taped and…
Doka, Kenneth J. (2005) Facing Illness and Loss: Caring for Someone Who is Dying. Hospice Foundation of America, Caregivers Corner. Online available at http://www.hospicefoundation.org/hospiceInfo/dearabby/caring.asp
Hospice Foundation of America
1621 Connecticut Ave. NW, Suite 300
Washington, DC 20009 www.hospicefoundation.org
Hospice Staff, Volunteers, and Hospice Patients
There are very few critics of the Hospice organization, and rightfully so. Who could criticize such a helpful, vital organization? Indeed, if Hospice wasn't available to provide their pivotal services, then who would be there? A key reason for the value of the Hospice group is that there is a general acceptance among thoughtful people that Americans do not handle death very well. And when death hits someone in his or her family suddenly, or even when there is a long-term illness in the family, leading inevitably to death, most families are not prepared. Hospice delivers humanitarian care and nurturing to not only the terminally ill, but also to their loved ones, before and after the passing.
Meanwhile, the specific services offered through the interdisciplinary team of medical professions and trained volunteers that make up Hospice include the following: medical and personal care visits;…
Ascribe Business & Economics News Service (2004, February). Hospice Effective in Delivering Quality Care to Dying Americans According to Current Research;
Hospice Serving Record Number of Terminally Ill Patients, Families. National Hospice and Palliative Care Organization.
Fleming, Skye O'Neil; & Malespina, Joan. "Care for the dying in America: two perspectives." JAAPA-Journal of the American Academy of Physicians Assistants, 16, 11-16.
Hannay, Jayme (2000). National Survey of Hospice Volunteers and Staff. Retrieved April 20, 2004, from The Robert Wood Johnson Foundation Web site:
Freedom and Moral esponsibility in Hospice and Palliative Services
The different ethical theories
Decision making within the medical field and provision of palliative services is influenced by three ethical theories. The theories are respect for autonomy, beneficence, and non-maleficence. espect for autonomy asserts that a patient should be allowed the option of decision making. This principle will value the patient's intrinsic worth as an individual allowing them to make a decision that is in their best interest (Holland, 2013). In order for healthcare professionals not to interfere with patient autonomy, they should respect the decisions made and actions taken by the patient. The respect for autonomy will require a doctor to give the patient full information regarding their illness without using jargon. Autonomy is vital for decision making especially for patients with incurable progressive illness, where treatment decisions are unclear and are dependent on the patient's personal values and preferences.…
Andersson, G.B., Chapman, J.R., Dekutoski, M.B., Dettori, J., Fehlings, M.G., Fourney, D.R., . . . Weinstein, J.N. (2010). Do no harm: the balance of "beneficence" and "non-maleficence." Spine, 35(9S), S2-S8.
Holland, S. (2013). Arguing About Bioethics. Abingdon, Oxon OX14 4SB: Taylor & Francis.
Murray, J.S. (2010). Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk. Online Journal of Issues in Nursing, 15(3).
Ross, J.R., Capozzi, J.D., & Matava, M.J. (2012). Discussing treatment options with a minor: The conflicts related to autonomy, beneficence, and paternalism. The Journal of Bone & Joint Surgery, 94(1), e3 1-4.
Hospice care is a kind of philosophy and care that centers on the palliation of a patient who is seriusly or terminally ill. Hospice care includes tending to the patient's pain and symptoms as well as their emotional and spiritual needs. The proposed research examines how referral and admission to hospice care can lead to a reduction in hospital re-admissions. This author proposes to look at current hospital referrals to hospices in 2013 (control) and hospital 30 day re-admission rates of current local level II trauma center for patients with chronic disease. The Proposal is to add "Hospice and Palliative medicine consult" to current standing orders. This literature review will focus on eight articles/reports that recommend palliative care among other things to achieve a high quality of care.
In an article by Smith et al. (2012), the writers address the integration of palliative care services into standard oncology practice during…
Abel, J., Pring, A., Rich, A., Malik, T., & Verne, J. (2013). The impact of advance care planning of place of death, a hospice retrospective cohort study. BMJ Support Palliat Care, 3(2), 168-173. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632964/
Brown, R.S., Peikes, D., Peterson, G., Schore, J., & Razafindrakoto, C.M. (2012). Six Features of Medicare Coordinated Care Demonstration Programs that Cut Hospital Admissions of High-Risk Patients. Health Affairs, 31(6), 1156-1166.
Coleman, E.A., Parry, C., Chalmers, S., & Min, S. (2006). The Care Transitions Intervention: Results of a Randomized Controlled Trial. Archives of Internal Medicine, 2006(166), 1822-1828. doi:10.1001/archinte.166.17.1822
Goodman, D.C., Fisher, E.S., & Chang, C.H. (2011). After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries. Retrieved from The Dartmouth Institute website: http://www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf
Improving Hospice Urinary Infection Rates:
An Analysis of Foley Catheter Use in a Hospice Setting
Change is a necessary part of any organization. One critical area that demands change in hospice nursing is overzealous use of Foley catheters. Often these instruments are used when not medically necessary despite their leading to urinary tract infections and antibiotic resistance. In order to change the culture of nursing regarding Foley Catheters, an analysis of the key steps of organizational transformation are presented with a focus on ewin's Force Field Model. Through an understanding of the mechanisms of change, nursing administrators can improve patient outcomes and improve antibiotic efficacy in any healthcare setting.
The comedian Billy Crystal once quipped that, "Change. It's such hard work!" Nowhere is this remark more valid than in managing change in the healthcare setting. For effective change, expert planning is required, therefore this paper is going to…
Lewin, K. 1951. Field theory in social science; selected theoretical papers. Harper & Row: New York.
Marquis, B. And Huston, C. 2006. Leadership Roles and Management Function in Nursing. Lippincott: New York.
Urden, L., & Watson, S.L. 2001. Outcomes of hospital restructuring and reengineering: How is success or failure being measured? Journal of Nursing Administration, 31(4), 203-209.
Hospice affirms life and neither hastens nor postpones death" ("Preamble and Philosophy," NHPCO, 2010). The NHPCO formal mission statement is: "To lead and mobilize social change for improved care at the end of life" ("Mission & Vision," NHPCO, 2010).
Financial and economic statements
Hospices individually operate under a wide variety of financial models, including for-profit and not-for-profit systems. Most use "a managed-care model, with insurance companies providing per visit and per diem reimbursement" (Baxendale & Dornbusch 2000, p.1). "Hospices receive funds from government programs or private insurance, from donations made by the public or other corporations, and from grants donated by charitable foundations...Hospices are not reimbursed on a fee for service basis: rather, hospices are paid, on a basis of how many days the patient is enrolled in the program and received services…In return for payment, Medicare, Medicaid and private insurance companies expect the hospices to provide all services which…
"About NHCPO." National Hospice and Palliative Care Organization (NHPCO).
September 8, 2010. http://www.nhpco.org /i4a/pages/index.cfm?pageid=3253&openpage=3253
Baxendale, Sidney J & Victoria Dornbusch. "Activity-based costing for a hospice." Strategic
Finance. March 2000. September 8, 2010. http://findarticles.com/p/articles/mi_hb6421/is_9_81/ai_n28767403/?tag=content;col1
Bridge/Prehospice Program: Do Hospice Bridge Programs Increase Quality of Life for Terminal Patients by Encouraging Earlier Access to Palliative esources?
The work of Levy, Bemski, and Kutner (2008) entitled "Are Hospices Establishing Pre-Hospice/Palliative Care Programs?" reports that outpatient palliative care programs (OPCPs), sometimes known as prehospice or 'bridge programs' allow for patients to receive comfort care in their home, nursing home, or assisted living facility even if they are not eligible for or are not ready to choose to enroll in hospice care." (p.1)It is reported that the OPCPs in terms of their "prevalence and sustainability…remains uncertain because these programs are, in general, not supported by health care insurance in the United States." (Levy, Bemski, and Kutner, 2008) eported by Levy, Bemski, and Kutner (2008) is a survey that was comprised by an 18-question Web-based survey "created based on input from a team of palliative care/hospice clinical and researcher physicians…
Levy, C., Bemski, J., and Kutner, JS (2008) Are Hospices Establishing Pre-Hospice/Palliative Care Programs? Journal of Palliative Medicine. Vol. 11 Issue 3, March 25, 2008. Retrieved from: http://www.liebertonline.com/doi/abs/10.1089/jpm.2007.0274
Carlson, M. (2010). Impact of hospice disenrollment on health care user and Medicare expenditures for patients with cancer. Journal of Clinical Oncology, 28(28),
Casarett, D. (2007). I'm not ready for hospice": strategies for timely and effective hospice discussions. Annals of Internal Medicine, 146(6),
Casarett, D. (2001). Patients with cancer referred to hospice vs. A bridge program: patient characteristics, needs for care, and survival. Journal of Clinical Oncology, 19(7),
Organizational Analysis -- Hope Hospice
Advanced Organizational Analysis - Hospice
As a nonprofit, Hope Hospice has undergone a tremendous evolution from a small agency to a major presence in south Florida. What is perhaps most remarkable is the ability of Samira Beckworth to withstand the pressure of the bottom line. Hope Hospice is a nonprofit organization, but it has grown into a going enterprise that is -- by all appearances -- surprisingly corporate. The influence of strong leadership can be felt in the single-minded way that Hope Hospice has tracked the mission. This paper briefly examines the organizational attributes of Hope Hospice and explores the motivation behind the mission. Collins' analytical framework was used to explore and discuss Hope Hospice with (Collin, ).
The purpose of the paper is to examine the influence of leadership on the resiliency of Hope Hospice as an agency and on the fidelity to its…
Bauer, K. (2004). Strategic alignment pyramid. [In Quality Assessment: Process or Outcome? The use of performance indicators for quality assessment in Dutch health care. Quality Digest, 2005, October 28.] Retrieved http://www.qualitydigest.com/inside / fda-compliance-article/quality-assessment-process-or-outcome
Buckingham, M. And Coffman, C. (1999). First, break all the rules: What the world's greatest managers do differently. New York, NY: Simon & Schuster.
Collins, J.C. (2001). Good to great. New York, NY: HarperCollins Publishers.
Deming, W.E. (2000). The new economics for industry, government, education, (2nd ed.), MIT Press.
Lone Star Hospice 2012
he FY2011 General Fund budget proposal for the Lone Star Hospice -- our commitment to the community to a new level during a mainly difficult financial period by improving the quality of the hospice and budget experience, holding increases in cost of aid to a minimum and investing meaningfully in financial aid. his budget suggestion attains the lowest aid rate increase for all of the patients through forceful cost reduction and reorganization. his notable budget has been thoughtfully industrialized during a period of extreme financial stress and indecision and has tested us to transfer resources to our highest priorities so that the patient experience can be advanced at an cost that is affordable.
he General Fund budget recommendation for the Lone Star Hospice results from many months of planning and incorporates a multi-year view of cost and revenue projections. he Hospice is likely to face dramatic…
Thompson, K.F., Bhargava, J., Bachelder, R., Bova-Collis, R., & Moss, A.H. (2008). Hospice and ESRD: Knowledge deficits and underutilization of program benefits. Nephrology Nursing Journal, 35(5), 461-6, 502; quiz 467-8.
von Gunten, C.,F., & Ryndes, T. (2005). The academic hospice. Annals of Internal Medicine, 143(9), 655-8.
Zerzan, J., Stearns, S., & Hanson, L. (2000). Access to palliative care and hospice in nursing homes. JAMA, 284(19), 2489-94.
The United Kingdom has ecently expeienced an incease in the numbe of childen and young people with long-tem health conditions. Actually, ecent suveys have indicated a 30% incease in the numbe of these childen and young people who need palliative cae in the past decade (Hughes-Hallett & Gelb, 2012). Childen and young people in the United Kingdom who need palliative cae suffe fom a seies of sevee disabilities and complex medical needs. The health secto in the UK has attempted to addess this need though vaious initiatives including medical advances and hospice sevices that enable the population to live into adulthood. Unlike in othe developed counties, childen and young people equiing palliative cae need to tansit fom childen's to adults hospice sevices in the UK. The tansition to these adult hospice sevices is a pospect fo childen and young people with life-limiting health conditions who need palliative cae.…
Hospice UK Company 2014, Making a Difference, Hospice UK Impact Report, viewed 30 December 2015,
Hughes-Hallett, T & Gelb, B 2012, Don't Let Me Down: Ensuring a Good Transition for Young People with Palliative Care Needs, Marie Curie Cancer Care, viewed 30 December 2015,
Johnson et al. 2013, The Future of Hospice Care: Implications for the Children's Hospice and Palliative Care Sector, Together for Short Lives, viewed 30 December 2015,
Kirk, S & Fraser, C 2014, 'Hospice Support and the Transition to Adult Services and Adulthood
hospice nurses cope with patients at end of life and death?
Nursing is an emotional job since nurses' experience emotions and feelings towards their patients. On top of having the clinical skills of nursing, end-of-life care requires skills to deal with the patients as well as their relatives. Therefore, the nurses must be mature emotionally. Some of the nurses create an emotional distance by avoiding discussions regarding their patients' concerns and emotional problems (Peters et al., 2013). In the past thirty studies, several studies have looked into the issue of death anxiety. This can be regarded as a feeling of fear, dread, anxiety when one thinks of death, or anything associated with it. This is a common phobia among many people. In their work, nurses face situations of death of patients, under their care. How they serve people who are in the last stages of life could depend on their…
Carter, P.A., Dyer, K.A. & Mikan, S.Q. (2013). Sleep disturbance, chronic stress, and depression in hospice nurses: testing the feasibility of an intervention. Oncol Nurs Forum. 40(5): E368-73. doi: 10.1188/13.ONF.E368-E373.
Edo-Gual, M., Tomas-Sabado, J., Bardallo-Porras, D. and Monforte-Royo, C. (2014), The impact of death and dying on nursing students: an explanatory model. Journal of Clinical Nursing, 23: 3501-3512. doi: 10.1111/jocn.12602
El Emam, K. (2013). Guide to the deidentification of personal health information. Boca Raton, FL: CRC Press (Auerbach Publications).
LaToya, J.M. & Harris, Dr. P.H. (2013). Caring and Coping: Exploring How Nurses Manage Workplace Stress. Journal of Hospice and Palliative Nursing.; 15(8):446-454.
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 Promotion Plan
Health Promotion in Hospice
The use of Dorothea Orem's Self-Care Theory as the framework for the health promotion plan, for improving depressive symptoms among hospice patients (Nursing Theories, 2012), is appropriate and consistent with a patient-centered care model. This model provides enough room for a gradient of patient self-care efficacy, from fully autonomous to unconscious, which is appropriate for the hospice setting. The author of Health Promotion in Hospice emphasized the need to increase the care efficacy of both hospice patients and their caregivers and mentioned how the role of a hospice nurse must remain fluid to constantly changing care needs of hospice patients. Under Orem's model there is thus a gradient of self-care need and autonomy that is negatively correlated and where deficits emerge the nurse must step in to meet these care needs.
I would also emphasize the concept of 'nursing client' discussed in Orem's…
Hirdes, J.P., Freeman, S., Smith, T.F., & Stolee, P. (2012). Predictors of caregiver distress among palliative home care clients in Ontario: Evidence based on the interRAI Palliative Care. Palliative & Supportive Care, 10(3), 155-63.
Murray, R.B., Zentner, J.P., & Yakimo, R. (2008). Health Promotion Strategies Through the Life Span. Upper Saddle River, NJ: Pearson Prentice Hall.
Ng, C.G., Boks, M.P., Roes, K.C., Zainal, N.Z., Sulaiman, A.H., Tan, S.B. et al. (2014). Rapid response to methyphenidate as an add-on therapy to mirtazapine in the treatment of major depressive disorder in terminally ill cancer patients: A four-week, randomized, double-blinded, placebo-controlled study. European Neuropsychopharmacology, published online ahead of print 20 Jan. 2014, doi: 10.1016/j.euroneuro.2014.01.016.
Nursing Theories. (2012). Dorothea Orem's Self-Care Theory. Accessed 2 Mar. 2014 from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html .
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…
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.
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
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/
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…
CMS (Centers for Medicare & Medicaid Services). (n.d.). Hospice Center. CMS.gov. Retrieved 13 Mar. 2012 from www.cms.gov/Hospice/Downloads.2011_Aggregate_Cap.pdf.
Goyder, Judith, Orrell, Martin, Wenborn, Jennifer, and Spector, Aimee. (2012). Staff training using STAR: A pilot study in UK care homes. International Psychogeriatrics, published online ahead of print, p. 1-10. Retrieved 13 Mar. 2012 from http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8473487 .
Hobday, John, V., Savik, Kay, Smith, Stan, and Gaugier, Joseph E. (2010). Feasibility of internet training for care staff of residents with dementia: The CARES® Program. Journal of Gerontology Nursing, 36, 13-21.
Hyer, Kathryn, Molinari, Victor, Kaplan, Mary, and Jones, Sharmalee. (2010). Credentialing dementia training: The Florida experience. International Psychogeriatrics, 22, 864-873.
The Terri chiavo case was an unusual incident where a person who should have been removed from life support long ago was sustained due to federal and public intervention. The case instigates moral and ethical questions of decision to end life as well as the limits of autonomy in surrogate decision making. Torke et al. (2008) argue that guardian judgment is often used as decision-making when a patient lacks the cognitive abilities to decide treatment for herself. urrogate decision-making, however, has its own flaws and should be replaced by something more rational. Using the Terri chiavo case as base, the following essay argues that the decision whether or not to prolong a patient's life (or indeed any decision revolving on an incumbent or cognitively disabled patient) should focus on the patient's dignity and individuality rather than on his or her autonomy.
The Terri chiavo Case: background
The Terri chiavo…
Ditto, PH (2006) What would Terri want? On the psychological challenges of surrogate decision making. Death Studies, 30: 135 -- 148,
Lazzaerini, Z et al. (2006) Legal and policy lessons from the Schiavo case: Is our right to choose the medical care we want seriously at risk? Palliative & Supportive Care, 4, 145-153
Mathes, P (2005) Terri Schiavo and End-of-Life Decisions: Can Law Help Us Out? MEDSURG Nursing, 14 Issue 3, p200
Torke, AM et al. (2008) Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making J. Gen Intern Med. 23(9):1514-7.
Equally destructive is the attitude that communicating with the Deaf person may involve more time and effort than one wishes to expend" (Zieziula, 1998, p. 193).
Moreover, and perhaps one of the most important challenges related to this issue, a large percentage of deaf individuals do not trust the hearing society. "Historically, the dominant hearing culture has relegated deaf people to social categories such as "handicapped" and "outsider." The history of oppression and exclusion of the deaf community -- although with important variations depending on the countries -- and the ignorance and rejection of the natural and preferred means of communication of many of them is a well-known and many times denounced phenomenon," (Munoz-Baell & uiz, 1999, p. 1).
Finally, there is a real deficiency of information in Deaf culture regarding hospice and its related services. Finding appropriate facilities can be a time-consuming and frustrating process.
The program: breaking down…
Berke, J. (2009). Deaf Awareness Week. Retrieved April 10, 2010, from the About.com Website: http://deafness.about.com/cs/events/a/deafawareness.htm
Deaf Community Health Workers Provide Education and Support to Deaf Patients, Facilitating
Access to Linguistically and Culturally Appropriate Care, Improving Patient Health
Knowledge and Adherence to Recommended Care. (2005.) Retrieved April 10, 2010, from the AHRQ Health Care Website: http://www.innovations.ahrq.gov/popup.aspx?id=2757&type=1&name=print
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
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.
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.
As a new graduate of six months working night shift on a small cancer unit, I am faced with a dilemma. Mr. V has been in and out of the unit several times over the last few months. He has liver cancer and has gone through several episodes of chemotherapy. His wife has been staying with him since his admission. There are two RN's on this unit.
Mr.V recently joined the hospice program. His current admission is for pain control with orders to start a morphine drip to be regulated for pain control.
The only set parameters indicated by hospital policy are to decrease the drip when respirations are less than twelve breaths per minute. Mr. V has requested that the drip be increased several times during my shift. Even though he does not appear to be in any discomfort, I increase the drip. On my final round of…
Strevy, S.S. Myths & facts about pain. RN, 42-45. 1998, February.
C. Junkerman and D. Schiedermayer, Practical Ethics for Students, Interns, and Residents, 2nd Ed, Frederick, MD: University Publishing Group, 1998.
American Nurses Association. Code for Nurses With Interpretive Statements. Kansas City, MO: the Association. 1985.
Strevy, S.S. (1998, February). Myths & facts about pain. RN, 42-45.
These included guidelines fom the Austalian National Beast Cance Cente and the Austalian National Cance Contol Initiative; an updated systematic eview of the eseach evidence, and a consensus by the Clinician -- Patient Communica-tions Woking Panel of the Pogam in Evidence- Based Cae of Cance Cae Ontaio.
The eliability of these studies also lends cedence to the outcome measues in that the study gains intenal validity due to the fact that the pocess measues matched the objective of the study.
The fact, howeve, that only 33 paticipants esponded endes the sample small and detacts fom its eliability making it difficult to eplicate to othe instances. This endes the outcome measues uneliable.
On the othe hand, simila online and offline eseach, both quantitative and qualitative, time and again, indicates the impotance of communication in tems of hospice patient cae. Cance patients, it is shown, too pofit fom impoved docto-patient communication (e.g.…
Significant news should be given carefully, one-to-one, in a quite place
Communication should be honest and optimistic, showing concern for patient and willingness to be there for him or her
Use memory heuristics, such as visual aids, or recording the consultation to help patient remember details.
Allow patients to express feedback and articulate their feelings
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…
In terms of communication within the hospice setting, this might occur by means of communicating with patients and their families to determine whether they experience their care setting in an optimal manner. If this is not the case, strategies are implemented to address the commonly experienced difficulties.
In conclusion, communication is a vitally important part of any care setting. Patients and their families must feel that they are the recipients of patient-centered care, and that they receive sufficient information to help them through difficult times. It is suggested that the PDSA model will be an effective way to accomplish this, along with process mapping. A logical sequence of steps must first address the underlying reasons behind the lack of effective communication among staff and patients. This can relate to the stress factors and harsh work schedules that practitioners often face. To work in such an emotionally eroding environment makes…
IHI.org. (2011). Improvement Methods. Retrieved from: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/
Leavitt, M.O. (2009). Report to Congress on the Evaluation of the Quality Improvement Organization (QIO) Program for Medicare Beneficiaries for Fiscal Year 2006. Retrieved from: http://www.cms.gov/QualityImprovementOrgs/downloads/2006RtCQIO.pdf
Melinkovich, P. (2011). Adoption of Rapid Cycle Improvement Process From Toyota Increases Efficiency and Productivity at Community Health Clinics. AHRQ. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=1807
Victorian Quality Council. (2007, June.) Process Mapping. Retrieved from: http://www.health.vic.gov.au/qualitycouncil/downloads/process_mapping.pdf
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
Losing a loved one is a major event that every individual experiences because death is a normal part of life. The process through which an individual approaches death or grieves after losing a loved one is usually affected by his/her social environment. The social environment affects this process through familial, societal, and cultural factors. One of the most common issues in today's social work practice helping clients deal with the loss of a loved one. Consequently, understanding the grieving process and models is an important competency for social workers because of the likelihood of handling clients who need to learn and know how to grieve with the loss of a loved one. An understanding of the grieving process helps the social worker to understand how to address the needs of a grieving individual and his/her family. However, social workers need to develop self-care strategies since handling such individuals can…
Caregiving to Elderly People
In this document, interactive caregiving training is briefly discussed.
Caregiving to Elder People
ecent developments at the medical industry and more health conscious diet increase the life expectancy. According to the Census, 36.3 million Americans were 65 and over in 2004 and the numbers are expected to increase as 71.5 million in 2030. Aging brings serious memory problems, emotional and physical declines along with the natural changes of inner and outer organs. Taking a good care of an elderly person with memory loss, dementia and Alzheimer's disease is a very demanding job requiring serious physical and mental efforts. Therefore, intellectual and mental training of the caregivers is very important. The physical work caregivers undertake is very hard including bathing elderly people, feeding them, running errands and trying to understand what they really need. The result of this long-term care is exhaustion, anxiety and depression. egardless of…
Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias" American Psychiatric Association. October 2007. http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007 . Retrieved 2007-12-28.
They are noo logner able to live; it is the etchial obligation of the hostpital staff to ensure that they die in peace. t is cruaical, tehore, we work towards and test methods for alleviating pain.
mplementation of 48-hour Pain Management System in Hospice Care
The American Pain Society (APS) issued a set of guidelines in the 1990s intended to standardize and improve pain management, thereby providing a framework for assessing care quality. n January 2001, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began to assess pain management as part of its accreditation process, through the use of evidence-based standards ( Gordon et al., 2002). n 2002, a set of six consensus pain management standards were revealed by a meta-analysis of 20 research studies from 1992-2001 (Gordon et al., 2002). These were (1) the use of a numeric or descriptive scale to represent pain intensity, (2) frequent pain…
Implementation of 48-hour Pain Management System in Hospice Care
The American Pain Society (APS) issued a set of guidelines in the 1990s intended to standardize and improve pain management, thereby providing a framework for assessing care quality. In January 2001, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began to assess pain management as part of its accreditation process, through the use of evidence-based standards ( Gordon et al., 2002). In 2002, a set of six consensus pain management standards were revealed by a meta-analysis of 20 research studies from 1992-2001 (Gordon et al., 2002). These were (1) the use of a numeric or descriptive scale to represent pain intensity, (2) frequent pain checks, (3) avoidance of intramuscular analgesics, (4) regular analgesic administration and preferably multimodal in nature, (5) keeping the patient informed about the pain management approach, and (6) treating with the goal of improving function and quality of life.
Such efforts to identify benchmarks or key performance measures (KPM) were intended to address many significant shortcomings related to effective pain management. A series of reports in the 1990s revealed these shortcomings and they included inadequate pain management, lack of coordinated care, and shortsightedness in terms of the long-term costs (Twaddle et al., 2007). In the past, palliative care would also be deferred until it became obvious the patient was dying. In essence,
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.
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
Ocial Work Practice With Individuals: Engagement Strategies
First I need to get past Mr. Fahza's son in order to get to his father. I need the former's agreement because I need a smooth start. His son agreement would encourage a discussion under the right auspices.
According to The Patient Self-Determination Act (PSDA) of 1990, Mr. Fahza has the right to be informed about his own clinical condition in order to take a decision about continuing with chemotherapy or going to the hospice and die peacefully. This is the strict approach of the western hemisphere.
The religion of Islam believes in death and resurrection of the body and soul, like Christianity. Islam also teaches about how to prepare for death, when aware that death is imminent. Statistics show that a vast majority of the American male population would want to know about the eventuality of dying because of a fatal illness…
Kagawa-Singer, M., & Backhall, L. (2001). "Negotiating cross-cultural issues at end of life." Journal of American Medical Association, 286(3001), 2993-. Available at: http://ethnomed.org/clinical/end-of-life/Table2.pdf retrieved: Oct 7th, 2014
Koenig B.A., Gates-Williams J. (1995) "Understanding cultural difference in caring for dying patients." West J. Med. Sep 1995; 163(3): 244 -- 249. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303047/?page=4
Coolen Phyllis R., DNP, MN, RN. (2012)Cultural Relevance in End-of-Life Care. EthnoMed. Available at: https://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care
Rizvi, Sayyid Muhammad. What You Should Do Just Before Death. Islam.org. Available at: http://www.al-islam.org/articles/what-you-should-do-just-before-death-sayyid-muhammad-rizvi
friend of mine overcome the desire to kill himself. He was suicidal and made several attempts on his life. Gradually he found the help he needed and today is still alive and healthy and no long suicidal.
I think my culture would find this story inspiring because today despair is everywhere and we see people succumb to it all to often, so when someone overcomes despair, which can be life threatening, is a great blessing to see. I think this would be true for every culture because despair is a universal phenomenon.
Freud felt that there was a death instinct and a life instinct, with the sex drive characterizing the life instinct and self-destructive behavior characterizing the death instinct (Life and Death Instincts, 2016). Thus Thanatos can be defined as the unconscious desire to die -- death being the end goal of life, according to Freud. He felt that this…
Doka, K. (2005). Death Awareness Movement. Retrieved from http://feleciamoon50.typepad.com/blog/2011/07/the-death-awareness-movement-description-history-and-analysis.html
Eig, J. (2005). Luckiest Man: The Life and Death of Lou Gehrig. NY: Simon & Schuster.
Escobar, P. (2015). Empire of Chaos. MI: Nimble Books.
Gatto, John. "AgainstSchool." WesJones.com. (n.d.). Web.
-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…
This is going to get done by means of using email, text messaging and the Internet to interact with my workers in a professional manner. egardless, I am shaping my staff to change and become better people. I will have to maintain an open mind to their various ideas, and see whether or not they are able to get implemented within the Hospice.
As I strive to become a better leader through using humility, freewill and delegation. I know that I can positively impact others through my hard work. They may want to one day become a Nurse Practioner themselves in any setting of their choosing. The decisions I make could become the deciding factor on whether or not they go further in the medical field. I want to set aside my pride, and become a better servant and transformational leader. This will mean that I strive to put others…
Collins, J. (2001). Good to great. New York, NY: HarperBusiness.(Chapters 2).
Collins, J. (2005). Good to great and the social sectors, A monograph to accompany Good to Great. Boulder, CO: Jim Collins.
Goleman, D. Emotional intelligence: Why it can matter more than IQ. New York: Bantam
Linda Wertheimer and Robert Siegel extensively interviewed Helen Payne, an 81-year-old woman dying of leukemia, and family members, regarding the process of coping with terminal illness in a loved one. hey included observations from Payne's oncologist and hospice nurse as well. heir interview shows a wide range of logical and emotional responses exhibited by family members as Payne's illness progressed, and demonstrated just how complex our reaction to such illness can be.
Wertheimer and Siegel are presumably competent radio reporters. heir article was organized around open-ended questions they put to Helen Payne, one of her granddaughters, and medical experts. he result is a compelling narrative reflecting how families handle the complex emotions that occur when a loved one faces death. Family members demonstrated both logical and emotional responses to Payne's situation, although Payne herself accepted the doctor's diagnosis with poise and dignity. Since this article was not research, including…
That anecdote in particular was moving to me because my grandmother did something similar when she was dying. I spent hours sitting by her bedside. One time she drifted off to sleep. When she awoke, she told me that she was ready to die. She had dreamed of heaven, and in the dream, when she got there, was told of her beloved cousin who had died many years before. She was told this cousin was anxiously waiting to see her again. This belief that death would rejoin her with loved ones gave her great comfort.
In doing more formal research on this topic, it would be interesting to see if it is typical for those in say, the eightieth or ninetieth decades of life to accept the prospect of impending death more easily than their family members can.
Wertheimer, Linda, and Siegel, Robert. "All Things Considered." National Public Radio, 1997.
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.
Mitigating isks from Dementia
Providing adequate care for an individual suffering from dementia presents many difficulties for nurses. Patients with dementia often have debilitating conditions such as Alzheimer's or similar neurologic diseases which are progressive, thereby making it challenging for them to remember, think lucidly, communicate effectively or complete activities of daily living. Furthermore, dementia can cause rapid variations in mood or even modify personality and behavior. With the tremendous number of elderly in society more and more nurses are required to care for patients with progressive dementias. It is imperative that a diagnosis be reached early in the course of the cognitive impairment and that the patient is closely monitored for coexisting morbidities. Nurses have a central role in assessment and management of individuals with progressive dementia. This essay provides some evidence-based practical strategies for managing the behavioral problems and communication difficulties often encountered in this population.…
Aud, M.A., Oliver, D., Bostick, J. And Schwarz, B. 2011. Effectiveness of Social Model Care Units for Dementia. International Nursing Research Congress 2005.
Care, N.D. 2010. Teaching and Learning. Pulse. Winter Edition.
Fletcher, S. And Zimmerman, S. 2010. Trainee and trainer reactions to a scripted dementia care training program in residential care/assisted living settings and nursing homes. Alzheimer's Care. 11(1): 61-70.
Goodman, C. 2011. The organizational culture of nursing staff providing long-term dementia care is related to quality of care. Evidence-Based Nursing. 47:1274-1282.
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
Psychology -- Letter of Application
Thank you in advance for your consideration of my application to be accepted into the Psy D. program at Marshall University. I am competent, committed, and caring undergraduate student at Marshall with a powerful work ethic which propels me to the goal of achieving my doctorate. I am a psychology major with a 3.34 GPA and I will graduate in May, 2013.
I am focusing like a laser on my goal so I may (upon completion of my doctorate) provide sorely-needed professional services to rural est Virginia, where I grew up and have lived my entire life.
Indeed, my parents have lived in southern est Virginia for 36 years; my mother was raised in McDowell County, est Virginia, where, according to the U.S. Census, 35% of the population is presently living below the poverty line -- and 43.4% of those under the age of 18…
Zhang, Zhiwei, Infante, Alycia, Meit, Michael, and English, Ned. (2008). An Analysis of Mental Health and Substance Abuse Disparities & Access to Treatment Services in the Appalachian Region. National Opinion Research Center / University of Chicago. Retrieved December 27, 2012, from http://www.norc.org .
isks for Falls
'isks for falls' have been an area of concern for medical professionals especially nurses. Statistics have shown that an increasing number of falls in hospitals and hospice settings not only raises question marks on the services provided to the patients along with negative consequences for the healthcare professionals and patients but also increases the overall costs of providing healthcare services. There are various researches which have shown that following clinical practice guidelines (CPGs) has found to reduce the number of falls substantially however the effectiveness of these CPGs is mainly dependent on the experiences of the healthcare professionals and patients after falls along with the impact of social factors such as community obligation, organizational resources, and individual resources.
esearch by Stenberg and Wann-Hansson (2011) has shown that the in order to comply with the provided CPGs, personal experience after the event of falls plays a…
Rycroft-Malone J. (2004). The PARiHS framework -- A framework for guiding the implementation of evidencebased practise. Journal of Nursing Care Quality, 19(4), 297 -- 304.
Rycroft-Malone J., Harvey G., Seers K., Kitson A., Mc- Cormack B. & Titchen A. (2004). An exploration of the factors that influence the implementation of evidence into practise. Journal of Clinical Nursing, 13, 913 -- 924.
Rycroft-Malone J., Kitson A., Harvey G., McCormack B., Seers K., Titchen A. & Estabrooks C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality Safe Health Care, 11, 174 -- 180.
Semin-Goossens A., Van Der Helmi J.M.J. & Bossuyt P.M.M. (2003). A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention. Journal of Nursing Care Quality, 18(3), 317 -- 325.
Nursing and Ethics
The emotional debate over abortion had been mischaracterized in the media, and hence disrupted any positive attempt to make progress in resolving the ethical and medical problems which have been created by the practice. A majority of Americans recognize and desire that abortion should be available when the life of the mother is at risk, or in the cases of rape or incest. However, liberal proponets like to expand this definition under the ubiquitous definition of the 'mothers health' which has been used to justify abortion on demand, for any reason. This latter expanded definition is significantly opposed by a majority of the ameircan population. In the midst of this struggle, comes the person needing medical care, who has neither been properly informed as to the dangers of the paractive, nor adequately counseled as to the options which exist regarding the future of her unborn child. The…
O'rourke, Kevin. PROXY CONSENT: DECIDING FOR OTHERS October 1980 accessed 23 April 2004. Available from: http://www.op.org/domcentral/study/kor/80100202.htm .
Bernard Lo, (July 2, 1987) "Behind Closed Doors: Promises and Pitfalls of Ethics Committees." NEJM 317;46.
Toward a More Natural Science, (1985) New York: Free Press,; p.211.
Curzer, Howard J. (6/22/1993) Fry's concept of care in nursing ethics. (response to Sara T. Fry, Hypatia, vol. 4, no.2, p.88, 1989) Hypatia.
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.
Policy, Politics and Global Trends in Health Sector
Why the Public Policy Issue Was Chosen?
According to the report released by National Priorities and Goals -- aligning efforts meant to transform America's Health care (NQF, 2009; Partnership, 2008). NPP (National Priorities Partnership) came up with 6 priorities. If the priorities are addressed, it could improve the quality of health care delivered to the U.S. citizens. NPP consists of 48 major U.S. health care organizations, which work with NQF (National Quality Forum). It identifies and advances priorities geared at improving health care in the future (NQF, 2009). NPP has identified palliative care as one of the six priorities that can help improve patient-based utilization outcome. This article provides the background to help identify steps to assist match the medical treatment of the patient and family objectives. It concerns itself with access to quality hospice services and palliative care (Meier, 2011). This…
AHRQ. (2002). Healthcare Cost and Utilization Project (HCUP): Hospitalization in the United States. Retrieved from Agency for Healthcare Research and Quality: http://www.ahrq.gov/data/hcup/factbk6/factbk6c.htm
American Hospital Association. (2009). AHA Hospital Statistics. Chicago: American Hospital Association.
ANA. (2008). Organizational Affiliate Criteria. Silver Spring: American Nurses Association.
ANA. (2015, December 10). Palliative and Hospice Nursing Panel. Retrieved from American Nurses Association: http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Professional-Issues-Panels/Palliative-and-Hospice-Nursing-Panel
LTC choices for UPSA members
LTC (Long Term Care) is an attempt at assisting people of any age with their daily activities and/or medical needs for an extended duration of time (WebMD, 2019). This type of care may be offered in various care facilities, inside a community, and at home. This is an educational brochure focusing on LTC choices for UMUC Premier Student Association (UPSA). When seeking for long term care it is necessary to bear in mind that quality is likely to vary based on the caregiver and/or place where the LTC is provided. It is fundamental to critically think and assess the alternatives available prior to making a decision. Arriving at an LTC decision may be quite difficult even when sufficient planning has been done.
One of the quick ways to assess the quality of care is to verify that the LTC service is established and/or accredited…
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
Physically, massage or TT eases muscle tension and improves circulation. In turn, it improves digestion and breathing, enhances mental clarity, and encourages better sleep. TT is particularly useful to terminally ill patients in reducing or mitigating pain to the extent of making prescription painkillers unnecessary. Emotionally, TT or massage is a gentle and compassionate experience for the dying. It reduces the sense of isolation by providing him or her with physical connectedness. It can also re-establish dwindling or lost self-esteem and self-acceptance on account of disease. As a result, it contributes to increased quality of life and a much-needed release of emotions. Medicare as yet does not cover massage therapy for hospice settings but an increasing number of group have been lobbying for its inclusion.
Useful Alternatives to Pain and Discomfort Management
These alternatives have shown to be effective in easing spiritual, emotional and psychological pain that contribute to the…
Aghabati, N et al. (2010). The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evidence-based Complementary Alternative
Medicine: PubMed. Retrieved on June 16, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887328
Catlin, A. (2009). Hospice massage: easing the pain of a life-limiting illness (Part 1).
vol 9 # 3, Massage Today: MPA Media Publications. Retrieved on June 19, 2011
The objective is to impede rumination. 3. In the third stage -- relapse prevention or rehabilitation -- Mr. Thomas will be encouraged to participate in activities (such as hobbies that he enjoys, listening to music, socializing, his work and so forth) and to move towards increased interest in his work, and other components of his life outside of his depressing domestic situation. The whole model would focus around prevention and intervention where prevention aims at reducing the individual's psychobiological vulnerability (via for instance reducing the stress facing Mr. Thomas by enlisting the aid, for instance, of his children and coworkers) whilst intervention seeks to strengthen that same vulnerability (via for instance cognitive-behavioral techniques or other depression-reducing interventions).
oemtiems, conflicts in commucantion occur inthis type sof stiaution when ethical condudresm are invoeld such as a perosn wishing to die whislt eveyroen else wants her to live on, or the gnawing unceratiny…
Berne, D. Games People Play. Grove Press, Inc., 1954
Couric, K. (2011) The best advice I ever got: Lessons from extraordinary lives. NY: Random House
Goulston, M. (2010). Just listen USA: AMACOM
Jaffe, C. & Ehrlich, C.H. (1997). All kinds of love: Experiencing hospice. New York,
¶ … Rural Healthcare Facilities
Context of the Problem
Twenty-five percent of the total population in the United States are living in rural areas and compared with urban Americans and healthcare facilities in rural areas generally serve low-income, the elderly, and individuals who are less informed and armed with less knowledge concerning health care prevention measures. Moreover, rural individuals accessing healthcare in rural facilities face barriers to healthcare such as fewer doctors, hospitals and health resources in generation and face difficulty in accessing health services.
Hospital closures and other market changes have adversely affected rural areas, leaving State and Federal policymakers, and others concerned about access to health care in rural America. Considerable changes in the health care delivery system over the past decade have intensified the need for new approaches to health care in rural areas. Managed care organizations, for example, may not be developed easily in rural areas,…