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Palliative Care represents an approach that aims at improving the quality of life of patients and their families experiencing the problem in association with life-threatening illness. This is through prevention and relief of the suffering process by means of early identification of the illness and impeccable assessment and eventual treatment of pain and other related problems. Palliative care offers crucial development to patients by affirming life and regarding death as a normal process. The medical process also performs the vital role in relieving the patients from the pain and other distressing symptoms. Palliative care practices neither hasten nor postpone death. This is through offering significant support system to patients in the process of pain until death. Palliative care also enables the health personnel to address the issues of the patients and their families in relation to the suffering. In the contemporary world, several arguments are in place to understand the…
New York: McGraw-Hill, 2011
Dyck, Arthur. Life's Worth: The Case against Assisted Suicide. Eerdmans, 2002.
Lynn, Joanne, Janice Lynch Schuster, and Joan Harrold. Handbook for Mortals: Guidance for People Facing Serious Illness, 2nd ed. Oxford Univ Press, 2011
Palliative Care Queensland is basically an independent not for profit body that represents the palliative care providers, consumers and their families. This organization is concerned with people who have an interest in palliative care in Queensland (The State of Queensland, 2013). This organization works in favor of the people who want to provide ideal quality care at the end of life for all the residents of Queensland. Since this company is a part of the Palliative Care Australia network, it hopes to meet the national aims at the State level.
Palliative care is a very important aspect of the society because a person is meant to go through it at one time or another. In order to get a global perspective on it, it should be noted that over fifty million Americans assist a family member with an illness or a disability on a regular basis. (McMillan et.al, 2006) Palliative…
Australian Institute of Health & Welfare (2007).
Cancer Council Queensland (2009). Palliative Care.
Government Response to Recommendations. Health and Community Services Committee, Palliative and community care in Queensland: towards person-centred care (Report No. 22). .
McMillan, S.C., Small, B.J., Weitzner, M., Schonwetter, R.,Tittle, M., Moody, L., & Haley, W.E. (2006). Impact of coping skills intervention with family caregivers of hospice patients with cancer. Cancer, 106(1), 214-222.
FOR END-OF-LIFE CASES
Palliative Care Nursing Theories
Theories and a Theoretical Framework for Nursing
A nursing theory helps structure decisions and practice for the nurse professional (Scribd, 2014). The three major types are the grand theory, the middle-range theory and the nursing practice theory. The use of any of these theories enables the nurse to provide more effective patient care more efficiently. Grand theories deal with the overall nature and goals of nursing, as discussed by Marilyn Parker in "Nursing Theories and Nursing Practice." The scope is broad and synthesizes nursing experience, observations and scholarship. Middle-range theories deal with specific and applicable concepts and research to nursing practice. They make available many practical strategies to the nurse in delivering quality patient care. And nursing practice theories tackle issues and questions relating to specific populations or settings. They provide models t help nurses address day-to-day practice experiences (Scribd).
Kolcaba, K. (2011). Comfort theory. Nursing Theories: Current Nursing. Retrieved on January 31, 2014 from http://www.currentnursing.com/nursing_theory/comfort_theory_Kathy_Kolcaba.html
Lyles, E.W., et al. (2011). A shift to early palliative care. Vol. 15 # 3, Journal of Clinical
Oncology: Oncology Nursing Society. Retrieved on January 31, 2014 from
No body of evidence has developed to support these concerns, influential though they have been.
It is helpful to recognize that they are not new issues, but have frequently been identified and applied to many groups and individuals. Such concerns have often been associated with traditions of 'protecting' (vulnerable) service users, issues of 'gate keeping' by service providers and paternalistic health and welfare cultures (Brownell, 2006). This is in sharp contrast to more recent thinking that patients and service users should have the chance to be 'co-producers' of their own welfare.
Stress, Anger in Communications
Although most assessments of bereaved children have not included symptoms of traumatic stress, recent reports of these symptoms as a component of some children's responses to loss have made them a necessary part of grief assessment and intervention. The study of trauma and grief emerged from different practice experiences and theoretical frameworks. Only in the…
Aday, RH. 2005. Aging Prisoners' Concerns Toward Dying in Prison. OMEGA: The Journal of Death and Dying 52:199-216.
Beach, S.R, et al. 2005. Risk Factors for Potentially Harmful Informal Caregiver Behaviors. Journal of 'the American Geriatrics Society 53: 255-61.
Butler, S. 2005. Depression and Caregiver Burden Among Rural Elder Caregivers. Journal of Gerontological Social Work 46: 47-63.
Baarsen, B., and Broese van Groenou, M.I. 2001. Parmer Loss in Later Life: Gender Differences in Coping Shortly After Bereavement. Journal of Loss and Trauma 6: 243-62.
Palliative care is comfort care for an individual who is no longer in need or desires life saving care. Most palliative care is offered near the end of life. Palliative care often takes a more holistic approach where therapeutic touch, pain management and a higher degree of interpersonal communications occur between the nurse and patient and the nurse and family occur. Members of the health care team often approach the situation by working together to ensure that both patient and family are offered palliative intervention both on a schedule (with pain management care) and sometimes on demand responding to newly emerging needs for both medical and social intervention and information surrounding the comfort needs of the patient. Doctors are often called upon to respond to new orders associated with patient symptoms on a 24-hour period some examples would be ordering increases in pain medication depending on level…
This study will include a sample of 100 registered nurses working at two large medical centers including nurses working in intensive care and long-term care facilities. The study will also include a sample of 100 patients in the same settings. All participants will range in age from 40-80, and will include a random selection of male and female patients and caregivers.
Design, Setting, Instruments
Patients will be provided a questionnaire to fill out that assesses their attitudes, beliefs and feelings about the care provided to them in the past, and the care they expect from their healthcare providers. Nurses will be provided a 10 question questionnaire that will include a discussion of their roles, their attitudes and beliefs about palliative care and their involvement in palliative care decision-making processes. Nurses will also be asked to describe the level of interaction they have with patients and the education they…
Carmel, S., Werner, P. & Ziedenberg, H. (2004). Nurses' and social workers' attitudes and beliefs about and involvement in life-sustaining treatment decisions. Health and Social Work, 29(1): 27.
Coulton, C.J. (1990). Research in patient and family decision-making regarding life sustaining and long-term care. Social Work in Health Care, 15(1): 63-78.
Csikai, E.L. (1999). The role and experience in determining social workers' attitudes toward euthanasia and assisted suicide. Social Work in Health Care, 30(1): 75-95.
DeMarrais, K. & Lapan, S.D. (2004). Foundations for research: Methods of inquiry in education and the social sciences. Mahwah: Lawrence Erlbaum Associates.
Will's desire to withdrawal all life support and refuse his treatment
is supported by legal precedent, even though it is likely that his refusal
of treatment will result in his death. Conversely, Will does not have the
legal right to demand treatment or intervention which would hasten his
death. Therefore, were Will placed on life support, and it was known that
his desire was not to have such support given to him, then this could be
withdrawn. There is a catch-22 situation in the Supreme Court has found
that while laws which prohibit physician assisted suicide are not
considered unconstitutional, laws permitting physician assisted suicide are
not unconstitutional. The withdrawal of intervention on Will's part is
based on the assumption that Will's request for the removal of intervention
is a rational one, in light of his illness, his pain and his desire to
avoid becoming a burden to his family…
Palliative Care for Terminal and Non-Terminal Patients
Although palliative care is sometimes viewed as a synonym for care for patients with terminal illnesses, a wide variety of different types of patients can benefit from palliative care. "Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness" (Meier, McCormick, & Arnold 2015). Palliative care can operate in conjunction with curative methods for non-terminal patients, such as patients experiencing chronic pain, or can be used with patients suffering from terminal illness to make end-of-life care for themselves and their families less painful physically and psychologically. WHO defines palliative care as: "An approach that improves the quality of life ... through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems,…
The debate in hospice care (2008). Journal of Oncology Practice, 4 (3): 153-157.
Retrieved from: http://jop.ascopubs.org/content/4/3/153.full
Meier, D., McCormick, E., & Arnold, R. (2015). Benefits, services, and models of subspecialty palliative care. UptoDate. Retrieved from: http://www.uptodate.com/contents/benefits-services-and-models-of-subspecialty-palliative-care
It might appear simple to claim one has possession of these competencies yet, a breakdown in communication and the ability to discern the patients mental and physical condition will render health care incapable of fulfilling any of the competencies stated by the American Association of Colleges of Nursing. The palliative care nurse who is well educated and trained will know that prior to the progressive stages of the disease, the patient and family members, as well as the nurse must commit to a plan used for communication. It cannot be stressed how critically important it is that communication methods be anticipated by all parties. If the nurse is competent then palliative care specialists may be unnecessary and this is optimal in that extra involvement from unknown care staff during the end-of-life period is often stressful to both the patient and their family members. The nurse who possesses the stated competencies…
Ferrell, Betty R. And Coyle, Nessa (2002) an Overview of Palliative Nursing Care. American Journal of Nursing May 2002 Vol. 102 No. 5
Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of Life Nursing Care (1998) American Association of Colleges of Nursing Feb. 1998. Online available at http://www.aacn.nche.edu/Education/deathfin.htm
Kristjanson, Linda J.; Toye, Christine; and Dawson, Sky (2003) New Dimensions in Palliative Care: A Palliative Approach to Neurodegenerative Diseases and Final Illness in Older People. Palliative Care - the Medical Journal of Australia. 2003; 179 (6 Suppl): S41-43.
Hisory of Palliatve Care
Palliative Care Methods
Palliative care entails assisting patients get through pain caused by different diseases. The patient may be ailing from any diseases, be it curable or untreatable. Even patient who are sick and almost passing away will need this care. Palliative care has characteristics that differentiate it to hospice care. The key role for palliative care is to help in improving the existence of someone and help people manage the pain they experience when they are sick (Ferrell & Coyle, 2010). The care system has been helpful and has assisted lots of people suffering from severe illness learn various way that they can manage the pain they feel. Ones someone learns the various methods to sustain the pain they feel or how to get reed of it, they can have time to do other things apart from spending the better part of their…
Yes, it is appropriate. Sometimes people need care but are embarrassed to seek it out or their situation does not enable them to get to traditional clinics. For the case of women living in shelters or in extreme poverty, it can be difficult to obtain medical care because they may lack the funds to pay for it, they may lack awareness of the fact that they need care, or they may be hampered by social or environmental issues that keep them from reaching out for help. Sometimes people need to see first that there are others outside of their own small world who are willing to enter in and offer assistance. This has been shown to be the case with educators who make home visits and the same is true for physicians (Ventura et al., 2014).
Genital warts are spread through skin-to-skin contact and cannot be spread…
Genital Warts. (2017). Planned Parenthood. Retrieved from
National Research Council. (1993). Understanding Child Abuse and Neglect.
Washington, DC: The National Academies Press.
Ventura, A. et al. (2014). Home-based palliative care: A systematic literature review of
the self-reported unmet needs of patients and carers. Palliative Medicine, 28(5): 391-402.
Palliative care has gone under a lot of changes as the years have progressed. Just like how general care has been advanced for the sick in areas such as pharmacology and medical engineering, palliative care has also been given much importance. Palliative care has been recognized as a specialty in many countries. There has been evidence that a care outlook that takes note of psychosocial, psychological and spiritual support is very effective and holds great importance in the eyes of those who are sick and their families. (Beaver et al., 2000) In simpler terms, palliative care means to relieve the sufferings of the sick and not really to make the treatment effective. (Macpherson, 2002)
Watching the movie Wit, I was truly saddened and affected by the degree of importance that is given to research these days. esearch for a horrible disease like cancer should be carried out but not on…
Beaver, K. et al. (2000) Primary care services received during terminal illness. International Journal of Palliative Nursing; 6, 220 -- 227.
Macpherson, G. (2002) Black's Medical Dictionary. London: A&C Black.
Nursingtimes.net (2009) Palliative care 1: principles of palliative care nursing and end-of-life care. [online] Available at: http://www.nursingtimes.net/nursing-practice/clinical-zones/end-of-life-and-palliative-care/palliative-care-1-principles-of-palliative-care-nursing-and-end-of-life-care/2007480.article [Accessed: 11 Jan 2013].
Wit (2001) [DVD] USA: Mike Nichols.
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.
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
It brought continuity to the process of dying, and a way to deal with critical issues in a way everyone could understand. it's holistic because it takes the process of dying, coordinates the patient's care, and brings resolution to things often left unstated. It allows the patient to have a degree of control. And it evaporates some of the high-tech coldness that can come between caregivers and patients."
The most significant area of spirituality and palliative care still unaddressed by researchers seem to be those identified by Cohen and Koenig: "the religious and spiritual needs of people of different religions, the positive and negative effects of religion and spirituality in palliative and end-of-life care, and the contributions that religious and spiritual institutions as well as health care professionals can make to such endeavors" (Cohen and Koenig
Currently, there is a widely held belief that spirituality is a valuable part…
Bogin, Rabbi S. (2000) Spiritual issues of palliative care. Nursing Homes, December. Retrieved 13 March 2005 from www.findarticles.com.
Burnside, G. (1998) New paths in end-of-life care. Health Progress, May/Jun. Retrieved 13 March 2005 from www.findarticles.com.
Cohen, a.B. And H.G. Koenig. (2002) Spirituality in palliative care. Geriatric Times 3(6). Retrieved 13 March 2005 from www.findarticles.com.
Cole, B.V. (2001) Nursing care at the end of life. Perspectives in Psychiatric Care 37(3). Retrieved 13 March 2005 from www.questia.com.
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)
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.
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
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.
photo novellas to test the creative aptitude of nurses working in oncology and palliative care. esearchers asked how they defined spirituality and were told to select between four to six photographs out of a photo novella they captured from their work in the field to represent these feelings. The participants in the study included five female oncology and palliative nurses, all working within Atlantic Canada. esearchers claim that "these specialty areas of nursing were selected because of the life-threatening nature of patients' illnesses, end of life issues, and the associated need for spiritual care" (Burke & Evans, 2011). Essentially, nurses within palliative and oncology contexts do often help patients with spiritual care as patients prepare to deal with a variety of end of life issues. Ultimately, the primary purpose was then to test the spiritual aptitude of these nurses in a qualitative context, while also including an exploration of how…
Burke, D., & Evans, J. (2011). Embracing the creative: The role of photo novella in qualitative nursing research. International Journal of Qualitative Methods, 10(2), 164-177.
eligion and Spirituality
According to Ferrell & Coyle (2010), religion and spirituality both fall under the rubric of "experiencing transcendence," (p. 14). The difference between religion and spirituality is in the ways transcendence is codified. eligions offer specific languages and modes of discourse, whereas spirituality remains more nebulous because of the lack of the need to share or express ideas with others. eligion has a social function, and can even be conceived of as a means of social control. As a sociological phenomenon, religion serves a totally different purpose and function in a person's life. Spirituality is more of a psychological than a sociological phenomenon, but unlike religion, has no bearing on community. As Judy Labonte states in her blog post, spirituality is much "broader" than religion, and it is important that nurses working in palliative care be sensitive to the personal beliefs of people, even when those beliefs do…
Ferrell, B.R. & Coyle, N. (2010). Oxford Textbook of Palliative Nursing. New York: Oxford University Press.
Wolpe, D. (2013). Viewpoint: The limitations of being spiritual but not religions. Time. March 21, 2013. Retrieved online: http://ideas.time.com/2013/03/21/viewpoint-the-problem-with-being-spiritual-but-not-religious/
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
The Management of Constipation in Palliative Patients
hich strategy is considered the best when nurses must intervene with a patient suffering from constipation? The PubMed publication put out by the National Institutes of Health and the U.S. National Library of Medicine explains that there is some uncertainty within the healthcare field about the choice between managing constipation with drugs (pharmacologically) or with other various clinical programs in palliative care settings (Clemens, et al., 2013).
A section in the Oxford Textbook of Palliative Nursing dedicated to bowel management -- written by researcher Denice Caraccia Economou -- explains that there is no absolute rule as to what intervention is best (220).
Pharmacological Management: The use of opioids is not always recommended for constipated patients, because they increase electrolyte and water absorption in both intestines which can lead to dehydration and dry, hard stools, according to Economou (221). Also morphine is not…
Clemens, K.E., Faust, M., Jaspers, B., and Mikus, G. (2013). Pharmacological treatment of constipation in palliative care. PubMed. Retrieved September 8, 2015, from http://www.ncbi.nim.nih.gov.
ConvaTec. Retrieved September 9, 2015, from http://www.convatec.com .
Economou, D. C. (2015). Bowel Management: Constipation, diarrhea, obstruction, and ascites. In the Oxford Textbook of Palliative Nursing, Ferrell, Coyle, and Paice, Eds.
Oxford Textbook of Palliative Nursing. Cary, NC: Oxford University Press.
A.J., an 82-year-old female, was admitted three weeks ago with acute on chronic congestive heart failure (CHF) after presenting to the emergency department (ED) with c/o progressive worsening SOB, leg edema, and fatigue. She has a history of severe CHF, atrial fibrillation, myocardial infarction (MI), renal insufficiency, and hypothyroidism. Since admission, A.J. has needed intubation and ventilation for acute decompensated heart failure due to a massive MI. She is alert when not sedated but has been too unstable for a cardiac catheterization and has needed vasoactive medications to support her blood pressure. Her renal function has declined and plans are being made for hemodialysis. Today when speaking with A.J.'s husband, he conveys to you her nurse that "she would not have wanted all of this." "
Discuss the pros and cons of continued therapy and what role nursing can play in helping the patient and family.
This case deals with…
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.
The study was reported as qualitative and to have been conducted by the 'Australian National Health and Medical Research Council' research study. It is stated as follows of the study: "The nursing insights indicate that an understanding of end-of-life care in hematology needs to be set in a trilogy of overlapping models (labeled functional, evolving, and refractory) that address the complexity of issues associated with professional and hospital culture." (McGrath, 2007)
Findings include the development of a working model focused on enabling the "integration of palliative care into adult hematology. The model is accredited the development of a new language for understanding and fostering the integration of palliative care and hematology." (McGrath, 2007)
One reason that palliative care is so important for hematology patients are necessary provisions of informed consent and other end-of-life issues. That is because many of these issues have to do with factors related to survival and…
Finlay, Ilora (2001) UK Strategies for Palliative Care. JR Soc Med 2001;94. Online available at: http://jrsm.rsmjournals.com/cgi/reprint/94/9/437.pdf
Audrey, Suzanne et al. (2008) What Oncologists Tell Patients About Survival Benefits of Palliative Chemotherapy and Implications for Informed Consent: Qualitative Study. BMJ 2008, 337:a752. Online available at: http://www.bmj.com/cgi/content/full/337/jul31_3/a752
McGrath, Pam D. (2007) Description of an Australian Model for End-of-Life Care in patients with Hematological Malignancies. Oncology Nursing Forum. Vol.43 No.1 2007. Online available at: http://ons.metapress.com/content/w1l1mx43646772k3/
Maganto, Vincente Valentin, Gonzalez, Maite Murillo and Moreno, Maria Valentin (2004) Continuous Care in the Cancer Patient: Palliative Care in the 21st Century. Clinical and Translational Oncology. Vol. 6 No. 7 October 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…
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
The hospital should always defer to the patient and family that has an advanced directive in place, and if the patient cannot speak for themselves but has an advanced directive, then a proxy must make the decision. The only case where the hospital should be allowed to make the decision on futile care is in the absence of a proxy, in the absence of an advanced directive, and only if it is in the best interest of the patient.
In this psychological-based model, the healthcare professional and hospital is put in the position of negotiating with the family and/or patient. Burns and Truog (2007) state that in these situations the healthcare professional should always follow the wishes of the patient's family in futile care efforts (Burns & Truog, 2007). However, that view places a burden on the healthcare professional to compromise medical principles when that professional deems the care to…
Burns, J., & Truog, R. (2007). Futility: A Concept in Evolution. Chest, 1987-1993.
Forde, R. (1998). Who is to define the futility of treatment -- the patient or the physician? Tidsskr nor Laegeforen (Norwegian), 2652-2654.
Jonson, a., Seigler, M., & Winslade, W. (2002). Clinical Ethics 5th ed. New York, NY: McGraw-Hill.
Lachman, V. (2009). Ethical Challenges in Health Care: Developing Your Moral Compass. New York, NY: Springer Publishing.
U.S. & Norway Healthcare Systems
healthcare system has many advantages and disadvantages which are most revealing when compared to the other health care systems of the world. An analysis between the U.S. healthcare system and a government run healthcare system of Norway provides a deeper understanding of the similarities and differences in the two systems.
Almost every other developed nation in the world has some form of universal coverage which reduces this disparity in care. However, many of these systems are purportedly ridden with their own issues such as high cost and long waiting times. By comparing the U.S. system with the universal system like that of Norway, I can investigate the effectiveness of each in terms of the quality of care provided and the equality of distribution of that care.
A Comparison and Analysis of Healthcare Systems in the United States and Norway
A. United States
The healthcare system…
Goldman, Dana P. And Elizabeth A. McGlynn. (2005). U.S. Healthcare Facts About Cost, Access and Quality [Online]. Retrieved from http://www.rand.org/pubs/corporate_pubs/2005/RAND_CP484.1.pdf
Johnsen, Jan Roth. (2006). Health Systems in Transition: Norway. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0005/95144/E88821.pdf
Tanner, Michael D. (March, 18, 2008). Policy Analysis: The Grass is Not Always Greener: A Look at National Health Care Systems Around the World (policy number 613). Retrieved from http://lib.trinity.edu/research/citing/APAelectronicsources.pdf
The University of Maine. (2001). The U.S. Health Care System: Best in the World, or Just the Most Expensive? [Online]. Retrieved from http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
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.
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…
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 .
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.
Health Care -- Regulatory Scheme and Licensure Requirements -- Operating a Health Care Organization
California's licensing process for health care organizations is governed by the State's Health and Safety Code, with responsibility for licensing, licensing, inspecting, regulating and/or certifying shouldered by State and Federal agencies. In a straightforward yet rigorous process aided by online application packets and checklists, these agencies are intent on ensuring compliance with State and Federal laws and regulations.
The process for becoming licensed to operate as a health care organization in California is governed by §1200 -- 1209 of the California Health and Safety Code (California State Legislature, 2003). These code sections broadly deem the term "clinic" or "primary care clinic" to mean an "organized outpatient health facility," whether a community clinic, free clinic, specialty clinic or clinic corporation required to be licensed (California State Legislature, 2003). The requirements and processes outlined in these code sections…
Long Term Care Administration
What are some of the ethical issues in this case?
Mrs. Beaudoin appears to be in a real ethical dilemma given the fact that she does not have formal power of attorney and her husband also lives in the same facility with her with moderate dementia and is very frail. The ethical issue involved in this case is that Mrs. Beaudoin’s health is failing steadily. She is known to have cancer throughout her body, a failing heart, moderate dementia and diabetes type II. Due to the cardiac arrest she suffered after a short stay in the intensive care unit she subsequently suffered a severe brain injury occasioned by lack of sufficient oxygen. Since she cannot make healthcare decisions on her own and her husband is in a state that is just as bad, the ethical issue here is; who will make healthcare decisions and end of…
The author of this report has been asked to describe and detail a community partner that shall be the basis for further research and description. Several important facets and traits of the organization will be mentioned. Those items will include the name of the organization, a brief history of the organization, the mission statement of the organization, the vision statement of the organization, the populations that the organization serves, the public policy areas that the group focuses on, the geographic area that is served by the group and the role that volunteers play when it comes to the organization. While HK Cares is not the largest or best communication organization in Hong Kong, they are certainly a part of what helps the community and makes it feel and live better.
As noted in the introduction, the name of the organization is HK Cares. HK is short for…
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.
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
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.
The progressive care unit (PCU) is a practice setting in which the researcher’s health care team is often failing to meet quality care objectives according to patient reporting on the hospital consumer assessment of healthcare providers and systems (HCAHPS). Opportunities for growth in quality care based on the HCAHPS of the PCU include topic areas related to patient inclusion as well as communication skills of the members of the healthcare team. Patient perception of quality is that the healthcare team in the PCU is unable to explain the care process in a way that the patient and family members feel comfortable with or that allows them to understand the care that is being provided to them. The researcher has first-hand experience with this challenge in the PCU and has heard first-hand from patients there that the care seems disjointed, that continuity is lacking, and how problematic it is for…
care in the situation of Mr. and Mrs. P would be holistic in nature, grounded in a philosophy of caring. There are serious existential issues at stake, as Mr. P has wondered why God has not "taken him" already, while Mrs. P may be suffering from depression given her inability to leave the house or handle the life affairs like paying the bills. Therefore, a recommended treatment plan would focus more attention on the mental and spiritual health of the couple without taking attention away from Mr. P's physical needs. It would also look after the physical health of Mrs. P as well as her psychological needs. As holistic nursing takes a "whole person" approach, it is the ideal philosophical framework for working with this small family unit.
As the AHNA (2016) puts it, holistic nursing aims "to integrate self-care, self-responsibility, spirituality, and reflection." From the holistic nursing framework, the…
AHNA (2016). What is holistic nursing? Retrieved online: http://www.ahna.org/About-Us/What-is-Holistic-Nursing
Cameron, R. (2016). Look again at psychedelic drugs. Nursing Standard. Retrieved online: http://journals.rcni.com/doi/abs/10.7748/ns.30.44.29.s28
Shumate, T. (2013). The Benefits of Psychedelic Drug Application for Clinical Treatment of Mental Illness. Journal of Undergraduate Nursing Writing 6(1). Retrieved online: http://archie.kumc.edu/bitstream/handle/2271/1175/STTJUNW-2013-Shumate.pdf?sequence=1
environmental analysis helps any organization to recognize factors that impact its performance. The factors impacting an organization's performance may be internal to the organization and they can also be external. Environmental analysis is therefore critical to an overall strategic plan. Several methods of performing environmental analysis can help organizations like the Carolina Health Care System, including the PESTLE and SWOT analyses ("What is Environmental Analysis?" n.d.). These types of analyses help to identify strengths, weaknesses, opportunities and threats (SWOT), as well as political, economic, social, technological, legal, and environmental (PESTLE) factors impacting the organization. Without performing systematic environmental analyses, business and public sector administrators would be working blindly and likely lead their organizations to fail in key preventable ways. On the other hand, a skillful and deft environmental analysis helps managers to develop strategic plans for the future, buffer against possible challenges, mitigate crises, and ensure long-term success.
Arthur, L. (n.d.). The implications of environmental analysis on strategic plan. Houston Chronicle. Retrieved online: http://smallbusiness.chron.com/implications-environmental-analysis-strategic-plan-35303.html
Carolinas Health Care System (2016). About Carolinas Healthcare System. Retrieved online: http://www.carolinashealthcare.org/about-us
Henry Schein Medical Systems (2016). Advantages of electronic medical records. Retrieved online: https://www.micromd.com/emr/advantages.html
"What is Environmental Analysis?" (n.d.). Pestle. Retrieved online: http://pestleanalysis.com/what-is-environmental-analysis/
A Model Healthcare Delivery System
The healthcare delivery system also referred to in short as the HCDS is the most effective system that works for most healthcare organizations in all countries with fair, effective and efficient distribution of resources. It is a fast growing service that demands attention from various quarters and domains. At the optimal level, the service program presents relief and hope to the individual, and the general population. The system offers a balanced quality care service through efficiency and fairness. HCDS varies across the world but its focus is constantly on enhancing healthcare access, quality of service and coverage. The success of the program is dependent on the availability of certain basic resources (Kumar & Bano, 2017, p. 1).
HCDS is how the society has responded to the health determinants. The idea of a healthcare system contemplates involving the people that are likely to be served…
Moral Meanings of Caring for the Dying
When it comes to taking care of the dying, there is so much to consider. Nurses who care for dying patients are often forced to start seeing the world differently, mostly because they become very close to the people they care for. The article Moral Meanings of Caring for the Dying, by Bouchal, addresses some of that from the personal standpoint and insights of nurses who work in end-of-life care situations. Some of them work with the elderly, but many of the patients are middle-aged and younger people, including children. It can be very hard to care for a dying person, especially if that person is still young, and nurses who do so shed many tears, often crying with the patient and/or the family (Cook, et al., 2012). This is a release for the nurses and the stress they must deal with when…
Cook, K.A., Mott, S., Lawrence, P., Jablonski, J., Grady, M.R., Norton, D., Liner, K.P., Cioffi, J., Hickey, P., Reidy, S., & Connor, J.A. (2012). Coping while caring for the dying child: Nurses' experiences in an acute care setting. Journal of Pediatric Nursing, 27(4): e11-e21.
Peterson, J., Johnson, M., Halvorsen, B., Apmann, L., Chang, P-C., Kershek, S., Scherr, C., Ogi, M., & Pincon, D. (2010). What is it so stressful about caring for a dying patient? A qualitative study of nurses' experiences. International Journal of Palliative Nursing, 16(4): 181-187.
An interdisciplinary team is formed from a group of health care providers belonging to different fields of health sciences; they work together as a team to bring the best possible outcome for patient. The efficiency of this team is achieved by following three basic steps that include communication, coordination and sharing of responsibilities. In order to provide quality care in primary health care system, the hospitals need to get closely integrated with the whole health service system (Ilyas, 2006).
Who makes up the membership of the interdisciplinary team in this agency?
Members of the interdisciplinary team vary according to the age and the degree of disability of an individual. Main aim of such team is to provide support to the patient in the best possible manner. The interdisciplinary team members of Hospitals at Ontario, includes Physicians, Nurses, Midwife, Dietitian, Pharmacist, Psychologist, Podiatrist, Physiotherapist, Chiropractor and Occupational Therapist. In…
Grech, H. (2012, October 28).Communication Skills in Health Professionals. Map-n.net. Retrieved on January 10, 2013 from http://map-n.net/pastevents/violence%20and%20aggression/Prof.%20Helen%20Grech%20-%20Communication%20Skills%20in%20Health%20Care%20Professionals.pdf
Ilyas, M .(2006).Public health and Community Medicine. Karachi:Time Publisher.
Ontario (2005, July 5). Guide to Interdisciplinary Team Role and Responsibilities.Health.gov.on.ca. Retrieved on January 10, 2013, from http://www.health.gov.on.ca/en/pro/programs/fht/docs/fht_inter_team.pdf
Salgado, C.D., Farr, B.M., Hall, K.K. And Hayden, F.G. (2002, March).Influenza in Acute Hospital setting. Lancet Infectious Diseases, Volume 2(3),145-55
GEONTOLOGICAL & GIATIC NUSING
Nursing Paper-Gerontological & Griatric Nursing
End of Life Issues and the Elderly
(2) "Identify and discuss the role of the nurse in providing family centred care to an elderly client who is palliative and living at home with his/her spouse or another family member."
Palliative care is an approach to provide a coordinated medical, nursing, and allied health service to address the patient's physical, social emotional and spiritual needs for people with progressive incurable illness. Palliative care seeks to deliver allied health service within the environment of person's choice to improve quality of life for both an ill person and the family or friends. In the United States, Europe and other part of the world, number of people reaching the advanced age and having the need of specialities for the management of pain control continues to increase. (oyal College of Nursing, 2004).
Meanwhile, a nurse plays…
Bliwise, D.L. Bliwise, N.G. Partinen, M. et al.(1988). Sleep Apnea and Mortality in an Aged Cohort. Am J. Public Health.78:544-547.
Bruce, S.D. & Hendrix, C.C. (2006). Palliative Sedation in End-of-Life Care: The Role of The Nurse in Palliative Sedation. Journal of Hospice and Palliative Nursing.8(6):320-327.
Canadian Nurses Association (2008). Providing Nursing Care at the End of Life. Ottawa Canada.
Davies, E. & Higginson, I.J. (2004). Better Palliative Care for Older People. World Health Organization.
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 field of nursing is shaped by a range of ethical principles; while all of these concepts are important, one could argue that perhaps the most crucial ethical principle is that of beneficence. "Beneficence is the obligation to do good and avoid harm. Nurses help others to gain what is beneficial to them, which promotes well-being and reduces the risk of harm" (Young et al., 2009, p. 75). Having a clear understanding of beneficence is important as nurses are often presented with a range of complex ethical situations and dilemmas and they need strong principles to help guide their actions and nursing practice. As Young and colleagues explain, avoiding the harm that comes to a patient involves balancing this against the perceived amount of benefit. Other theorists see this concept in a slightly different perspective: "Beneficence is the principle of promoting the legitimate and important aims and interests of…
Addington-Hall, J.M., Bruera, E., Higginson, I.J., & Payne, S. (2007). Research methods in palliative care. Oxford: Oxford Publishing.
Cedar, S.H. (2006). Stem cell and related therapies. Nursing Ethics, 13(292),
Hitchcock, J.E., Schubert, P.E., & Thomas, S.A. (2003).Community health nursing: Caring in action. Clifton Park: Delmar.
Randall, F.M. (1999). Ethical issues in palliative care. Acta Anaesthesiol Scand, 43(9), 954-6.
For elderly patients who have no one to appoint as their proxy, completing a living will that outlines their wishes is preferable to not providing any information at all about care preferences. This is equally so for patients who want to provide their proxy with some guidance about their treatment preferences and end-of-life care wishes, including artificial nutrition, ventilator support, and pain management. A living will (LW) provides specific instructions to health care providers about particular kinds of health care treatment that an individual would or would not want to prolong life. Living wills are often used to declare a wish to refuse, limit, or withhold life-sustaining treatment when an individual is unable to communicate. All but three states (New York, Massachusetts, and Michigan) have detailed statutes recognizing living wills. The usefulness of LWs is limited, however, to those clinical circumstances that were thought of before the person became incapable…
Burnell, G.M. (1993). Final Choices: To Live or to Die in an Age of Medical Technology. New York: Insight Books.
Fisher, C.B. (2002). A Goodness-of-Fit Ethic for Informed Consent. Fordham Urban Law Journal, 30(1), 159.
Galambos, C.M. (1998). Preserving End-of-Life Autonomy: The Patient Self-Determination Act and the Uniform Health Care Decisions Act. Health and Social Work, 23(4), 275.
Hardwig, J. (2000). Spiritual Issues at the End of Life: A Call for Discussion. The Hastings Center Report, 30(2), 28.
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
Nursing Case Study and Theoretical Knowledge of Healthcare System
Significant evidence shows that the responsibilities of the primary and acute care nurses vary significantly. The variation creates differences in the scope of work for the nurses, as they are engaged in different job perspectives. Primary and acute care nurses provide an array of services that aim at promoting health, preventing the occurrence of diseases, treating the sick, and providing the e clients with services, meeting their needs alongside creating public awareness to issues that affect their health and well-being. The difference of the services provided by the two becomes evident by the fact that the acute care nurses provide their services to patients who are critically sick, creating continuum variation in the services provided. In addition, nurses involved in the provision of nursing care services in the acute setups require specialized knowledge, skills, and expertise that allows them to provide…
Brown, L., Burton, R., Hixon, B., Kakade, M., Bhagalia, P., Vick, C., et al. (2011). Factors Influencing Emergency Department Preference for Access to Healthcare. Western Journal of Emergency Medicine, 13(5), 410-415.
Brown, S., & Stenner, P. (2009). Psychology without foundations history, philosophy and psychosocial theory. London: Sage Publications.
Crowe, M., & Carlyle, D. (2003). Deconstructing risk assessment and management in mental health nursing. Journal of Advanced Nursing, 43(1), 19-27.
DiClemente, R.J., Crosby, R.A., & Kegler, M.C. (2002). Emerging theories in health promotion practice and research strategies for improving public health. San Francisco: Jossey-Bass.
Public health ethics relates to the ethics as it relates to an entire population, in contrast to medical ethics, which relates more to the rights of individuals. osenau and oemer (2013) note that there are often ethical conflicts that emerge when individual rights conflict with the greater good. They highlight the overarching public health principles, that provision of care is regardless of external factors, that there should be equity in the distribution of resources, and that there should be respect for human rights. The case of the burn patient is primarily regarding the human rights dimension.
The human rights dimension results in an ethical dilemma here for a couple of reasons. The first is that the individual in this instance has rights -- or the family members have rights -- and there is question as to whether those rights were respected. The outcome might have been the same…
Curtis, J. & Vincent, J. (2010). Ethics and end-of-life care for adults in the intensive care unit. Lancet. Vol. 375 (2010) 1347-53.
Rosenau, P. & Roemer, R. (2013). Chapter 15: Ethical issues in public health and health services. Introduction to Health Services In possession of the author.
Sprung, C., Cohen, S., Sjokvist, P., Baras, M., Bulow, H., Hovilehto, S., Ledoux, D., Lippert, A., Maia, P., Phelan, D., Schobersberger, W., Wennberg, E. & Woodcock, T. (2003). End-of-life practices in European intensive care units. Journal of the American Medical Association. Vol. 290 (6) 790-797.
A third approach in this area is the establishment of new co-pay programs which force patients to bear the costs of more procedures and treatments. This theory tends to shift part of the blame for over treatment back on the patient. Doctors claim that they order additional treatments because their patients insist on them. Forcing patients to share a greater portion of the costs of these additional treatments should arguably result in their being less demanding about receiving them.
Bureaucracy and overhead created in the delivery of health care and the administration of insurance benefits has also contributed to the substantial increase in health costs (Woodhandler 2003). The health insurance industry has campaigned to reduce health care costs but, in the process, has created a bureaucratic system that has effectively contributed to the problem. Additionally, compliance with governmental regulations has contributed to the bureaucratic difficulties as well. Practicing physicians and…
Avraham, Ronen. The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums. Research, Cambridge, MA: National Bureau of Economic Research, 2009.
Bodenheimer, T. "High and rising health care costs ." Annals of Internal Medicine, 2005: 932-937.
Davis, K. Mirror, mirror on the wall: an international update on the comparative performance of American health care. Research Study, New York: The Commonwealth Fund, 2007.
Epstein, Arnold M. "Health Care in America - Still too Separate, Not Yet Equal." New England Journal of Medicine, 2004: 603-605.
Psychosocial Model of Health
Use questions 2, 3, 5, 11, and 12
Many times a health professional will look at a health issue and see only the problem at hand. The difficulty with this approach is that most health problems affect the entire person whether or not the issue is localized or not. The psychosocial model of health looks at more than an individual's physical state to determine how they will respond to treatments in the short- and long-term. A patient's psychological well-being and their support system are as important as a willingness to see a treatment through to the end. The following paper looks at two patients and whether they were well-served from a psychosocial perspective, and, if not, what improvements could be made to serve the patient better.
In the documentaries, two of the patient interviews stood out as especially relevant to this discussion. One of these…
Back, A.L., Arnold, R.M., Baile, W.F., Fryer-Edwards, K.A., Alexander, S.C., Barley, G.E., Gooley, T.A., & Tulsky, J.A. (2007). Efficacy of communication skills training for giving bad news and discussing transitions too palliative care. Arch International Medicine, 167, 453-459.
Douglass, J.L., Sowell, R.L., & Phillips, K.D. (2003). Using Peplau's Theory to examine the psychosocial factors associated with HIV-infected women's difficulty in taking their medications. Journal of Theory Construction & Testing, 7(1).
Ellingson, L.L. (2002). Introduction to the field of healthcare communication. Communication Research Trends, 21(3).
Holland, D.J., Bradley, D.W., & Khoury, J.M. (2005). Sending men the message about preventive care: An evaluation of communication strategies. International Journal of Men's Health, 4(2).
The authors describe findings from a survey designed to gather baseline data about changes organizations experience after implementing the Clinical Practice Model framework, and report how the Clinical Practice Model Resource Center staff used the survey findings to build the capacity of individuals accountable for implementing this integrated, interdisciplinary professional practice framework into the organization's operations." (2002) The following model has been created for monitoring the progress of the nursing staff at the MD Anderson Cancer Center MEDVACM specifically checking progress in Years 1,3, and 5.
MD ANDERSON CANCER CENTER MEDVAMC
Job Performance Review Guide
PERFORMANCE GOALS AND OJECTIVES
ecome familiar with your department's business goals.
Work with your manager to define and document your goals. Include what you are expected to produce by your first review, activities needed to accomplish results, and success criteria.
Magnet Designation (2006) Inside UVA Online Vol. 36, Issue 14 August 26, 2006. Available at http://www.virginia.edu/insideuva/nursing_excellence.html .
Bailey, F. Amos (2000) Balm of Gilead Center, Cooper Green Hospital Pioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at http://www.milbank.org/pppc/0011pppc.html #foreword.
Forrow, Lachlan (2000) Palliative Care Program, Beth Israel Deaconess Medical Center/CareGroupPioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at
Among the most important aspects to the health promotion plan will be the benefits associated with a care manager, who can ensure that all six core elements of CCM are implemented fully. If this is accomplished, there should be a significant reduction in health disparities for patient and caregiver outcomes across generations.
AHQ. (2012). National Healthcare Disparities eport, 2011. No. 12-0006. ockville, MD: Agency for Healthcare esearch and Quality. etrieved 16 Apr. 2014 from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf.
Braveman, P.A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L.N., Manderscheid, . et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl. 1), S149-55.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217-28.
Castro, A. & uiz, E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Journal of the American Academy of Nurse…
AHRQ. (2012). National Healthcare Disparities Report, 2011. No. 12-0006. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved 16 Apr. 2014 from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf .
Braveman, P.A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L.N., Manderscheid, R. et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl. 1), S149-55.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217-28.
Castro, A. & Ruiz, E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Journal of the American Academy of Nurse Practitioners, 21(5), 278-86.
Protocols are an important part of any organizational paradigm as they provide a set of guidelines dealing with specific topics. This prevents potential legal issues, and allows for staff to be appropriately trained on specific issues. For our case study, we will use Louisiana State University Health Sciences Center (Shreveport). The purpose of this policy is to "define the services provided by the Pastoral Services Department for patients and employees of LSU-Health Science Center (LSU Health Sciences Center, 2013). The purpose of this paper is to provide information to help revise the current pastoral care protocol at the LSU Health Science Center.
Pastoral care is a model of emotional and spiritual support that in the modern hospital is non-denominational and focused on the paradigm of servant leadership. During periods of high emotional stress, tragedy or situations involving the very sick, pastoral care can provide comfort for both patients…
Balboni, T. (2010). Provision of Spiritual Care to Patients With Advanced Cancer: Associations with Medical Care and Quality of Life Near Death. Journal of Clinical Oncology, 28(3), 345-52.
Bay, P., et al. (2008). The Effect of pastoral Care Services on Anxiety, Depression, Hope, Religious Coping and Religious Problem Solving Styles. Journal of Religious Health, 47(1), 57-69.
Bush, J. (2006). Gentle Shepherding: Pastoral Ethics and Leadership. Danvers, MA: