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Recovering Motor Function fter Stroke
Stroke and Motor Learning
Strategies for Recovering Motor Function after Stroke
Strategies for Recovering Motor Function after Stroke
On an annual basis, close to a million U.S. citizens are hospitalized for stroke and their length of stay averages 5.3 days (NHLBI, 2013). Close to 60% of these are first time stroke patients. In terms of morbidity, stroke is responsible or 1.7 million mericans currently suffering from chronic physical and/or cognitive impairment. With nearly 80% of all stroke survivors suffering from limb impairment (reviewed by Thieme et al., 2012), there is a great need for remedial strategies that minimize the level of disability these patients suffer from. This report will review recent research in the area of upper limb rehabilitation strategies to better understand progress being made in this area of research.
ssessing Upper Limb Motor Impairment
s Higgins and colleagues (2011) discuss, there is a…
All instruments, except the modified Ashworth Scale and Star Cancellation Test, revealed all treatment groups experienced significant improvement after 20 therapy sessions over the course of 5-week intervention (p < 0.002) (Thieme et al., 2012). In contrast to this finding, the Ashworth Scale and Star Cancellation Test revealed between group differences. The Ashworth scale, which is used to assess changes in passive finger and wrist movement resistance, revealed that individual mirror therapy patients experienced significant improvement in finger flexors (p < 0.001), but not for wrist flexors (p = 0.08) and that intergroup difference were significant for finger flexors only (p < 0.05). The Star Cancellation Test, which is designed to measure visuospatial neglect, revealed individual therapy patients improved significantly more compared to the control group (p < 0.01). Importantly, the five-week intervention reduced the level of visuospatial neglect experienced by individual and group patients, but the mock therapy group had increased visuospatial neglect. These findings suggest that individual mirror therapy can significantly reduce the magnitude of visuospatial neglect for the affected arm of a stroke patient.
A similar approach for improving a patient's mind-body connection is constraint-induced movement therapy (reviewed by Brunner, Skouen, and Strand, 2012). This is done by restricting the good arm during tasks requiring the use of an arm, thereby forcing the patient to rely more heavily on the impaired arm. In contrast, bilateral arm training is believed to be superior to constraint-induced therapy by some researchers based on the theory that both sides of the brain are required for proper retraining of the impaired arm.
To try and resolve this controversy, Brunner and colleagues (2012) conducted a randomized controlled study to directly compare the efficacy of both strategies. They found no statistically-significant difference between the two strategies for a number of tasks after 4 hours of training for 4 weeks. The outcomes were measured using the Action Research Arm Test, Nine-Hole Peg Test, and the Motor Activity Log and both treatment groups improved significantly by the post-treatment and 3-month follow-up assessments (p < 0.010-0.001). These findings suggest that either the constraint-induced movement or bilateral arm training therapy approaches are equally effective in improving the use of the impaired arm
Coping Styles in Middle Aged Stroke Survivors
Extant literature has been dedicated to coping styles in middle aged stroke survivors. Rochette et al. (2006) conducted a study to evaluate the adaptation process, participation as well as depression over a period of six moths in souses and fists-stroke individuals. In their study they described the changes in the process of adaptation (both coping and appraisal) within six months after the very fist stroke with the aim of identify the domains of the process of adaptation that is related to the participation as well as the depressive symptoms for the affected persons and their spouses. The study design employed by Rochette et al. (2006) was a descriptive longitudinal approach that was conducted over the initial six months after the first-stroke. Data was collected from two groups at three different times; in the initial two weeks after stroke (T1) and then after three…
Mary Young is a 71-year-old Aboriginal Australian female. She has present with a number of different health issues, including osteoporosis, hypercholesterolaemia, atherosclerosis, atrial fibrillation and Type 2 diabetes. She has been feeling fatigued for the past several months, and her current admission was on account of increasing dizziness, blurred vision and persistent headache. She was found to have suffered an ischaemic stroke, of moderate to severe status. This paper will outline the primary admission diagnosis, the nursing problems, nursing management strategies and discharge planning for Mary.
Primary Admission Diagnosis
Mary was admitted to the ED with left-sided hemiparesis, aphasia, and hypertension. She had an irregular pulse rate. An ECG revealed atrial fibrillation. A thrombotic ischaemic stroke was suspected and confirmed on CT. She has now been stabilized, and has been admitted to the medical ward for clinical management and rehabilitation.
Thrombotic ischaemic strokes are caused by a number of…
Collo, S., Feigin, S. & Dudley, M. (2007). Post-stroke fatigue -- where is the evidence to guide practice? New Zealand Medical Journal .Vol. 120 (1264) 1-9.
Gordon, C., Hill, C. & Ashburn, A. (2008). The use of conversational analysis: Nurse-patient interaction in communication disability after stroke. Journal of Advanced Nursing. Vol. 65 (3) 544-553.
Hinkle, J. & Guanci, M. (2007). Acute ischemic stroke review. Journal of Neuroscience Nursing. Vol. 39 (5) 285-293.
ISC. (2016). Ischaemic stroke. Internet Stroke Center Retrieved April 19, 2016 from http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/
Interventions for: PYELONEPHITIS
While most UTIs affect the urethra and bladder, pyelonephritis comes about when there is progression of a urinary tract infection to the upper urinary system. Pyelonephritis, by definition, "is a bacterial infection of the renal pelvis, tubules, and intestinal tissue of one or both kidneys" (Smeltzer, Bare, Hinkle, Cheever, 2010). The infection could be unpleasant and painful and is worse than cystitis. It is important to note, from the onset, that pyelonephritis does not cause serious or long-term harm if promptly treated. However, delays in treatment could bring about permanent kidney damage. In essence, there are two kind of pyelonephritis -- chronic and acute. While acute pyelonephritis has got to do with the unanticipated development of inflammation in the kidney, chronic pyelonephritis is a persistent or perennial infection that refuses to clear. The latter is rare and could result in kidney scarring and failure. Interventions for both…
Bope, E.T. & Kellerman, R.D. (2011). Conn's Current Therapy 2012.Philadelphia, PA: Elsevier Health Sciences.
National Institutes of Health (2016). Stroke. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000726.htm
Smeltzer, S, C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner and Suddarth's Textbook of Medical-Surgical Nursing, Vol 1. New York, NY: Lippincott Williams & Wilkins.
The treatment approach is constraint-induced movement therapy as an early option for patients’ post-stroke. The kind of scoring to help determine a patient’s functional level is the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) (Auwal Abdullahi, 2014). To identify level of physical ability, this scoring system allows for assessment of balance, joint functioning, and motor functioning around 4 months after stroke. Patients will have initial pre-intervention motor function score taken (FMA) and then given the treatment modality.
It is important to continually assess motor function starting at the beginning of intervention, then in the middle and finally towards the end of intervention for a total of two weeks (Yue, Liu, Huai, Gao, & Zhang, 2017). Some barriers/obstacles are related to the type of therapy involved. Modified Constraint-Induced Movement Therapy (mCIMT) is a method used to improve a patient’s mobility and functionality in the often more affected upper extremity post…
In the world of post strokes or major brain injury there are many difficulties to overcome. One such difficulty is aphasia. The most common way to treat aphasia is through speech therapy, by using various techniques with picture images to repeat words. This gives the patients the ability to remember the words that they learned. However there is a newer treatment, Melodic Intonation Therapy (MIT). This treatment has better results than the traditional therapy. The article, "From Singing to Speaking: Why Singing may Lead to Recovery of Expressive Language Function in Patients with Brocas's Aphasia" by Schlaug, Marchina, Norton (Schlaug, 2008), tries to prove that MIT works better on Patients with Broca's Aphasia.
Aphasia is a condition which is an inability to communicate or understand through language, which is either through speech, reading, writing, or listening. Aphasia is caused by brain injury usually to the left hemisphere of the…
Kathy Smith and Jillian Michaels:
Different Strokes for Different Folks
Not all exercise videos are created equal and we can say the same thing about the instructors that create them. One might think that one aerobics exercise video is like all others but this is not the case. Many aerobic instructors have their own style and two popular instructors that demonstrate this point are Kathy Smith and Jillian Michaels. Kathy Smith, for example, has been making fitness videos for decades and her style is comfortable and relaxed. Jillian Michaels, on the other hand, approaches working out as something that should feel like a challenge and if it does not feel challenging, it probably is not being performed correctly. Two videos that illustrate these different but effective styles are Smith's Build Muscle, Shrink Fat and Michaels' 30-Day Shred.
Style is the most noticeable difference between the two instructors. Kathy Smith falls…
Ambandos, Andrea. 30-Day Shred. (2007). Michaels, Jillian. Lions Gate Productions.
SWIING INSTRUCTION: THE BREASTSTROKE
The traditional breaststroke underwent radical transformation, leading to a bitter controversy, at the 1956 Summer Olympics in elbourne, Australia.
Swimmers had gradually come to understand that they could decrease their lap times by surfacing less often to breathe, because breaking the surface dramatically increases the coefficient of friction between their bodies against the water, thereby adding unnecessary resistance.(Wipkedia)
Several breaststroke competitors were disqualified that year for swimming much of their laps entirely submerged. In order to get around the rule prohibiting extensive underwater swimming, competitors quickly learned to remain submerged as long as possible after the start, before breaking the surface for the first time. As competitors perfected the technique originally pioneered by asaru Furukawa, swimmers began losing consciousness completely, while attempting to swim as far as possible before breaking the water surface for the first time after the official start of the race.…
Mills, G. Breaststroke: Breathing Every Other Stroke. (2003) © GoSwim.com; Accessed March 20, 2004 at http://www.goswim.tv/articles/dotw/breastbreath.html
Salo, G. Teaching Breaststroke (2002);
Accessed March 21, 2004 at http://www.breaststroke.info/salobreast.htm
Stroke is widely regarded one of the leading causes of deaths in the U.S. Indeed, recent statistical figures paint a grim picture with regard to the number of people who suffer a stroke in the U.S. each year. In basic terms, strokes are triggered by an interruption of blood flow into the brain. In this text, I concern myself with the physiological processes associated with stroke. In so doing, I will amongst other things define the disease and the body systems it affects, its causes, manifestation, and complications. Further, I will also discuss the hereditary or familial factors commonly associated with stroke.
Stroke: An Overview
In basic terms, stroke is said to be "an abrupt onset of neurological functions caused by a sudden reduction of cerebral blood flow, which is due in turn to either an ischemic occlusion or a hemorrhagic episode" (Gulini, Gianelli, Quaglia, and Marrucci, 2000, p. 239).…
Eisenberg, M.G., Glueckauf, R.L. & Zaretsky, H.H. (Eds.). (1999). Medical Aspects of Disability: A Handbook for the Rehabilitation Professional (2nd ed.). New York, NY: Springer Publishing Company.
Gulini, M., Gianelli, M., Quaglia, W. & Marrucci, G. (Eds.). (2000). Receptor Chemistry Towards the Third Millennium. Amsterdam: Elsevier Science.
Huether, S.E. & Mccance, K. (2012). Understanding Pathophysiology (5th ed.). Philadelphia, PA: Elsevier Science.
Mohr, J.P., Grotta, J.C., Wolf, P.A., Maskowitz, M.A., Mayberg, M.R. And Kummer, R.V. (2011). Stroke: Pathophysiology, Diagnosis, and Management (5th ed.). Philadelphia, PA: Elsevier Health Sciences.
Stroke Hearing Impaired
Plan: Physical, Occupational, Speech, and Psychological Therapies
Implementation: Daily regimen, with one of the four core areas (physical therapy, occupational therapy, speech therapy, and psychological therapy) emphasized or addressed on each day.
Evaluation: After each session, therapist will write a thorough evaluation of the patient including a progress report. After the end of each six-week period, a thorough progress report will be shared among the various members of the health care team in a collaborative setting.
The follow-up will consist of maintenance therapies in each of the four core areas.
Documentation of Actions and Activities: According to the National Stroke Association (2013), the activities and actions should begin immediately after the stroke. The Physical Therapy sessions will include yoga and other systematic movement interventions to improve coordination, balance, strength, and range of motion. Each week, the therapist will implement a unique type of movement therapy,…
Hetu, R., Jones, L. & Getty, L. (1993). The Impact of Acquired Hearing Impairment on Intimate Relationships: Implications for Rehabilitation. International Journal of Audiology 32(6).
National Stroke Association (2013). Rehabilitation therapy after stroke. Retrieved online: http://www.stroke.org/site/PageServer?pagename=REHABT
"Stroke Health Center," (2011). WebMD. Retrieved online: http://www.webmd.com/stroke/tc/stroke-rehabilitation-overview
Wharton, T. (2013). Utah firm: Loop helps hearing impaired at movies and more. The Salt Lake Tribune. 24 Oct, 2013. Retrieved online: http://www.sltrib.com/sltrib/money/57001349-79/loop-hearing-system-technology.html.csp
Patients with aphasia struggle with language disorders including both oral and written communication problems. Also, clinical depression is found to be common among many stroke victims. [NINDS]
Given the high stakes involving both mortality and morbidity, stroke prevention is considered a very vital health care policy. Prevention strategies are usually targeted on controlling the important 'first tier risk factors' which were mentioned earlier. First and foremost among these is to control hypertension. ased on evidence-based practices, the American Heart association recommends that antihypertensive treatment including the use of diuretics and class 1 ACEI drugs be standardized for all patients to prevent recurrent strokes as well as to serve as a proactive intervention against other cardiovascular complications. Since diabetes is considered a high risk factor for stroke, clinical practice also recommends that glucose levels for all diabetic patients with ischemic stroke be maintained near-normoglycemic levels. The AHA guidelines also…
1) Washington University, (2010) 'Stroke Information for Patients and Families: U.S. Statistics: ', retrieved Aug 2nd 2010, from, http://www.strokecenter.org/patients/stats.htm
2) Larry B. Goldstein, (2009), 'A Primer on Stroke Prevention and Treatment', Pub by American Heart Association.
3) NINDS, 'Post Stroke Rehabilitation Factsheet', retrieved Aug 2nd 2010, from, http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm
4) Ralph L. Sacco, MD, MS, @ Robert Adams MD et.al (2006), 'Guidelines for Prevention of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack', Stroke. 37:577, available online at, http://stroke.ahajournals.org/cgi/content/full/37/2/577
The most common cause is blockage of an artery, usually by a piece of atherosclerotic plaque in one of the brain's main arteries that ahs broken off and gotten stuck "downstream." TIA are also caused by blood clots that originate in the heart, travel to the brain, and become lodged in a small artery there. By definition, the symptoms of a TIA last less than 24 hours, in contrast to the symptoms of a stroke, which last longer -- and are often permanent. (Komaroff, 2006, p. 88)
An individual may have one or more experiences with a TIA, though they may have none, prior to the actual stroke vent, often leading up to it, within a year or more of the stroke event. If these symptoms are noted, and even if they go away an individual should still seek care to begin treatment for medical stroke prevention. Individuals should also…
Better Control of Hypertension Has Reduced Stroke Deaths. (1987, July/August). FDA Consumer, 21, 2.
Centers for Disease Control and Prevention Division of Heart Disease and Stroke (2008). Stroke Fact Sheet. Retrieved, December 5, 2008. http://www.cdc.gov/DHDSP/library/fs_stroke.htm
Ha, M., Lee, D., & and Jr.,. R. (2007). Association between Serum Concentrations of Persistent Organic Pollutants and Self-Reported Cardiovascular Disease Prevalence: Results from the National Health and Nutrition Examination Survey, 1999-2002. Environmental Health Perspectives, 115(8), 1204.
Health; Blood Pressure Drugs Can Prevent Strokes, Heart Attacks - Studies. (2008, April 2). Manila Bulletin, p. NA.
Strokes and African-Americans
African-Americans are reported to be nearly twice as likely to experience a stroke as their white counterparts however, African-Americans are much less likely to know the risk-factors and symptoms of stroke or to seek early treatment. The purpose of this study is to examine the issue of African-Americans and stroke. The significance of this study is the additional knowledge that will be added to the already existing base of knowledge in this area of study. The methodology employed in this study is of a qualitative and interpretive nature and has been conducted through a review of literature in this area of study.
Strokes and African-Americans
African-Americans are reported to be nearly twice as likely to experience a stroke as their white counterparts however, African-Americans are much less likely to know the risk-factors and symptoms of stroke or to seek early treatment.
Purpose of the Study
National Stroke Association (2010) What is Stroke? Retrieved from: http://www.stroke.org/site/PageServer?pagename=STROKE
The Office of Minority Health (2010) U.S. Department of Health & Human Services. Retrieved from: http://minorityhealth.hhs.gov/templates/content.aspx?ID=3022
National Stroke Association (2010) African-Americans and Stroke. Retrieved from: http://www.stroke.org/site/PageServer?pagename=AAMER
Neipris, Louis (1998) African-Americans and Stroke Risk. My Optum Health. Retrieved from: http://www.wtvm.com/global/story.asp?s=12834243
Signs and Symptoms of Stroke
Patients with stroke symptoms are advised to seek out for emergency cure without any dilly-dallying. Definite signs of a stroke rely on the kind of stroke. However all kinds of stroke share several attributes. Warlow (1996, p.2) stated that cerebral embolism stroke generally comes on rather abruptly and is extreme right from the beginning. On the other hand schemic strokes signs consist of reduced vision in one eye or both eyes and stern headache. Other symptoms include feebleness, numbness or facial paralysis or arm and leg paralysis which are normally restricted on one side of the body.
Furthermore, other symptoms of schemic strokes include faintness, stability or coordination failure particularly when pooled with other signs. Hemorrhagic strokes are a bit different and the signs include loss of realization, distorted mental condition and seizure. Other signs include vomiting or stern nausea and extreme hypertension. Lastly, the…
American Heart Association and American Stroke Association (n.d.). Stoke diagnosis
Retrieved May 14, 2010, from http://www.americanheart.org
Caplan, L. R, Dyken, M.L., & Easton, J.D. (1996). American Heart Association Family
Guide to Stroke Treatment, Recovery, and Prevention. New York: Times Books.
Stroke is identified as one of the leading causes of death and to decrease mortality rate a review of the causes is required. The importance of measuring and reviewing health care quality is no longer questioned. However quantifying quality is a difficult task one that involves a subjective element and judgment. Different methods are employed in measuring quality such as level of care provided, administration accuracy, staff sufficiency, hygiene level and therapies provided. The need to combine the facts and figures with judgments and evaluation is a complex process and needs to be done with utmost care. The quality measures need to be evaluated on a regular basis to ensure their relevance and validity in the given circumstances.
Measures used to monitor and review quality:
As the hospital administration began to realize the link between stroke patients death and the quality of service rendered the need to analyze data…
AHO, (2006). Joint Commission on Accreditation of Healthcare Organizations: 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Joint Commission Resources, 2005
American Heart Association, (1999) Heart and Stroke Statistical Update. Dallas, Tex. Available at: http://www.americanheart.org /statistics/index.html.
Donabedian, A. (1988). The quality of care: how can it be assessed? JAMA.. 1988;260:1743-1748.[Abstract/Free Full Text]
Ryan, T. Antman, E., Brooks N. (1999) update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation.. 1999;100:1016 -- 1030.
The general exception to that rule is that women are likely to see gynecologists/obstetricians. The fact that certain strains of HPV may be linked to stroke makes this connection an even more critical one, since ob/gyns are the doctors most likely to provide HPV screening and treatment. Moreover, women are likely to visit pediatricians for child healthcare. Therefore, the health initiative that should be instituted is that ob/gyns should be involved in stroke symptom screening and education with every patient at every visit. Furthermore, pediatricians should engage in screening and education for parents, because maternal health is a critical component of child health.
The desired sponsor for this advocacy program would be the U.S. Department of Health and Human Services Offices on Women's Health. It could partner with national organizations such as the National Stroke Association, the American Heart Association, the Women's Heart Association, and even Planned Parenthood, since Planned…
National Stroke Association. (2012). Women and stroke. Retrieved from:
U.S. Department of Health and Human Services Office on Women's Health. (2009, January 28).
Stroke fact sheet. Retrieved January 30, 2012 from Women's Health website:
It was also found that higher levels of education were associated with a greater sense of well being across the dimensions.
Using the prior quantitative information as a guideline, Clarke proceeds to the qualitative section of her research with the attempt to shed more light on aspects of the stroke experienced wither not researched in the prior study or that were left with ambiguous explanation. While admitting that it would have been ideal to use the participants from the original CSHA, it was not possible. So she found a group of eight stroke survivors who were culled from a group of 250,000 individual patients from the Sunnybrook, and Women's College Health Sciences Centre in Toronto, Canada. Of these eight, five had more sever impairments due to hemiparesis or hemiplegia, the remaining three were higher functioning, this gave the study a broader base to compare. The subjects were also recruited with…
Clarke, Philippa. (2003) "Towards a greater understanding of the experience of stroke: Integrating quantitative and qualitative methods" Journal of Aging Studies 17 pp. 171 -- 187
These include aging, family history, diabetes, and artery disease. (Women and Stroke)
There are numerous factors that contribute to stroke prevention that are useful in a nursing situation. The include checking blood pressure as dietary observance and history. There are also a number of warning signs that should be monitored. These include:
Sudden weakness or numbness of the face, arm or leg -- especially on one side of the body; Sudden confusion or trouble speaking; Sudden dizziness, loss of balance and coordination or trouble walking; Sudden difficulty seeing with one or both eyes; Sudden severe headache without a known cause." (ibid)
While there is no direct and exact correlation between stroke and migraine there are sufficient studies that have been undertaken to show that there is evidence to assume a link between these two ailments, especially among women. Studies have also found that among the many variables, women…
Cutlip, W.D., (1995). "Migraines and other headaches: an approach to diagnosis and classification. American Family Physician, May 1, 1995.
Headache and Migraine Glossary. Retrieved November 16, 2004 from Avout.Com. Web site: http://headaches.about.com/library/glossary/bl-isch-stroke.htm
Hecht, B. And Hecht F. (2004)
Migraine with Aura & Stroke. Retrieved November 18, 2004 from Medicine Net. Web site: http://www.medicinenet.com/script/main/art.asp?articlekey=32332
"If the victim refuses water, is vomiting, or there are changes in the level of consciousness, they should not be given anything to eat or drink (http://www.redcross.org/services/disaster/keepsafe/heat.html#treat)."
Heat stroke is a life-threatening condition which should be treated as quickly as possible. hen Korey Stringer began to exhibit signs and symptoms of heat stroke, such as complaining of being sick during practice and difficult breathing, help should have immediately been called for. He should have been moved to a cool place and measures should have been taken to cool down his body.
By understanding and implementing first aid measures recommended by the American Red Cross, victims have a greater chance of survival with fewer potential side effects.
American Red Cross - Heat ave. (accessed 18 April 2005).
American Red Cross - Heat Wave. (accessed 18 April 2005).
ORIGINALDOCUMENT http://www.redcross.org/services/disaster/keepsafe/heat.html#treat ).
Reading the Spirit Catches You and You Fall Down was a pivotal moment in my life, completely shifting my perspective about health care and the duties of doctors and nurses. As a minority student I am familiar with different types of discrimination. I also know the importance of compassion and understanding to all human interactions. However, working with diverse patient populations is about more than ending stereotyping or discrimination. Nursing in a diverse community requires the willingness to change approaches to health care, even entailing policy changes. As Fadiman points out in the Spirit Catches You and You Fall Down, diversity requires a whole new approach to human communication.
Having volunteered at several health care centers and assisted living facilities I have worked with a population that is diverse in terms of gender, age, and ethnicity. Patients often have trouble letting go and trusting their nurses and doctors for…
nursing development class. The theme of Stroke and brain injury will be continued to be used in order to highlight how an instructive class may be developed, instituted and assessed. This essay will discuss the learning objectives and present their delivery in a form that outlines basic teaching and learning principles that reflect the essence of healing and the professional medical community.
Class Need Assessment
Evaluating the learning for this class will come in different stages. The first half of the class is based on the cognitive and basic knowledge skills that nurses need to have to identify the important factors dealing with stroke. This knowledge can be assessed with a simple testing procedure that quizzes the student on their knowledge using multiple choice questions and answers. The second half of the instruction is more hands on and requires the students to perform their job in a simulated activity of…
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., ... & Warren, J. (2007). Quality and safety education for nurses. Nursing outlook, 55(3), 122-131.
Hanger, H.C., Walker, G., Paterson, L.A., McBride, S., & Sainsbury, R. (1998). What do patients and their carers want to know about stroke? A two-year follow-up study. Clinical rehabilitation, 12(1), 45-52.
Mant, J., Carter, J., Wade, D.T., & Winner, S. (1998). The impact of an information pack on patients with stroke and their carers: a randomized controlled trial. Clinical Rehabilitation, 12(6), 465-476.
Rodgers, H., Bond, S., & Curless, R. (2001). Inadequacies in the provision of information to stroke patients and their families. Age and ageing, 30(2), 129-133.
Marketing in Health Care
Problems Faced by the Stroke Center
Some of the problems faced by the Stroke Center are caused by lack of information and knowledge acquired by stroke patients and their families in the course of heart attacks, and the financial capability of the Stroke Center to build up more teams that can specialize in the administration of heart attack patients.
The foremost problem of the Stroke Center is the limited knowledge of heart attack victims and their families in managing a heart attack event, especially knowledge on TPA and the immediate medical attention required by victims to be administered with TPA. Such lack of knowledge results to the victim missing the chances of overcoming the battle against the consequences of a stroke such as disability. It also results to a very low percentage rate of heart attack victims who get TPA treatment.
Another problem the Stroke Center…
Borfitz, Deborah. Stroke Centers: Hospitals Seek Payoff with Quicker Care, Shorter Stays Resources Secondary to Education, Coordination, and a Can-Do Attitude.
Marketing for Stroke Centers.
Social Marketing and Franchising for Essential Health Care.
Naco.Nic.In. 13 June 2003. http://www.naco.nic.in/nacp/public.pdf
Biomechanics is the study of mechanical and physics principles in relation to motion in sports. Every sport has its biomechanical theories and each one is specialized to that particular skill with equations derived from Newtonian physics and knowledge of the human body and its capabilities. When combined and properly practiced, biomechanics can improve an athletes overall performance, making the athlete superior to their competitors.
The freestyle arm-pull in swimming is a precise study in the art of biomechanics introduced for an efficient result. It is an established fact that water is 773 times as dense as air and 55 times as viscous (Miller, 1975). What this means is that planning an efficient stroke in water is going to require greater strategy than planning an efficient stroke in air. The primary factors that go into creating the ideal stroke in swimming are vectors, motion, force, work, and…
Boone, Tommy; Birnbaum, Larry (2005). Exercise Physiology: Professional Issues, Organizational Concerns, and Ethical Trends. Edward Mellen Pr.
Burkett, Brendan (2012). Basic principles for understanding sport mechanics. Human Kinetics. Accessed 14 March 2012 from http://www.humankinetics.com/excerpts/excerpts/basic-mechanical-principles
Miller, Doris (1975). Biomechanics of Swimming. Exercise and Sport Sciences. Vol. 3.1, 219-248.
Richardson, AR (1986). The Biomechanics of Swimming: The Shoulder and Knee. Clin Sports Med. Vol 5.1, 103-13.
absence within the neurological community of executive function performance testing for various real-world activities (that include multi-tasking) on subjects who have suffered brain damage (Baum & al, 2008). By testing real-world functioning via the EFPT, the researchers, as occupational therapists, hoped to provide more accurate information on the ability of subjects to function independently in their day-to-day existence and to perform functions within society (Baum & al, 2008). This study served as a test of the validity and reliability of the EFPT model on patients with mild to moderate stroke, as a follow-up to previous studies of EFTP validity and reliability on subjects with multiple sclerosis and schizophrenia (Baum & al, 2008). Hypothesis: Stroke will have a negative effect on executive functioning in real-world tasks.
esearch study design and characteristics
This was an empirical, quantitative, conclusion-oriented, lab/simulation research study using the EFTP. The EFTP measures executive cognitive functions (initiation, organization,…
Baum, C., & al, e. (2008). Reliability, Validity, and Clinical Utility of the Executive Function Performance Test. American Journal of Occupational Therapy, 62 (4), 446-454.
Efficacy and Safety of Dabigatran vs. Warfarin for Stroke
After more than five decades as the preferred anticoagulant worldwide, warfarin is being challenged by a new rival that doesn't require careful dosage monitoring. Pradaxa (dabigatran) was unanimously approved by the FDA on October 19, 2010 for treating atrial fibrillation (AF) patients, who are at an increased risk for suffering stroke and systemic embolisms (.S. Food and Drug Administration). Dabigatran acts by binding directly to thrombin. Warfarin (Coumadin) is an anticoagulant that functions by inhibiting the synthesis of vitamin K-dependent clotting factors (Lemos et al., 770-771). Variations in the levels of vitamin K in the diet can influence how effective a given dose of warfarin is for a patient, so appropriate therapeutic dosages are determined on an individual basis periodically through a standardized clotting test (international normalized ratio [INR]). Even though warfarin can reduce the risk of stroke in AF patients…
U.S. Food and Drug Administration. "FDA News Release: FDA approves Pradaxa to prevent stroke in people with atrial fibrillation." U.S. Food and Drug Administration, 19 Oct. 2010. Web. 22 Jan. 2011.
Schulman, Sam, Kearon, Clive, Kakkar, Ajay K., Mismetti, Patrick, Schellong, Sebastian, Eriksson, Hentry, Baanstra, David, Schnee, Janet, and Goldhaber, Samuel Z. "Dabigatran vs. warfarin in the treatment of acute venous thromboembolism." New England Journal of Medicine 361 (2009): 2342-2352. Web.
Wallentin, Lars, Yusuf, Salim, Ezekowitz, Michael D., Alings, Marco, Flather, Marcus, Franzosi, Maria Grazia, Pais, Prem, Dans, Antonio, Eikelboom, John, Oldgren, Jonas, Pogue, Janice, Reilly, Paul A., Yang, Sean, Connolly, and Stuart J., on behalf of the RE-LY investigators. "Efficacy and safety of dabigatran compared with warfarin at different levels of international normalized ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial." Lancet 376 (2010): 975-983. Web.
Executive Function Performance Test (EFPT) for healthcare practitioners who deal with mild and moderate-severity stroke patients. Executive function is important to overall health because it allows us to regulate our actions, plan our behavior, and set goals. Stroke patients frequently suffer from executive-function related losses; this study proposes a measure that will help quantify the extent of executive function loss.
The design of this study was a basic experimental 3x1 design. The authors compared three groups on their performance of the EFPT. The three groups were: mild stroke, moderate stroke, and age-matched control (no stroke). All participants performed the EFPT and stroke group participants were tested 6 months after the stroke event to allow for an even amount of healing time.
The EFPT is noticeably different from other performance-based measures because unlike the Kitchen Task Assessment (its closest relative), it records cues from experimenters that support patient performance. Support cues…
Healthcare Master Case Study
Baum, C.M., et al. (2008). eliability, Validity, and Clinical Utility of the Executive Function Performance Test: A Measure of Executive Function in a Sample of People With Stroke The American Journal of Occupational Therapy 62 (4); pg 446.
Study rationale. The research study is designed to assess the validity and reliability of a test for executive function in post-stroke occupational therapy patients. Clinical tests of executive function may not be good predictors of a patient's ability to function in day-to-day life. The Executive Function Performance Test (EFPT) employs ordinary daily living skills in which the post-stroke patients are likely to have engaged in the past, and are reasonable target behaviors for adaptation to independent or supported living arrangements. The test is particularly valuable in that it offers a convenient test for executive function using real-world tasks.
esearch design. An experimental design is employed in this study.…
Baum, C.M., Connor, L.T., Morrison, T., Hahn, M., Dromerick, A.W., Edwards, D.F. (2008). Reliability, validity, and clinical utility of the executive function performance test: A measure of executive function in a sample of people with stroke, The American Journal of Occupational Therapy 62 (4), 446. Retrieved http://www.practicechangefellows.org / documents/Baum_et_al.pdf
Chaytor, N., & Schmitter-Edgecombe, M. (2003). The ecological validity of neuropsychological tests: A review of the literature on everyday cognitive skills. Neuropsychology Review, 13, 181 -- 197. Retrieved http://www.dissertations.wsu.edu/Dissertations/
Swallowing Difficulty and Speech Difficulty on Quality of Life in Patients with PEG Tubes vs. Those on NGT Feeding Systems
Stroke can effect neurological functioning and can have an effect on the patient's ability to talk and swallow. This condition can lead to severe malnutrition A decision is often made to feed the patient using a tube feeding method. Many studies have been performed to measure the clinical outcomes of these procedures, but few have focused on the effects of the patient's quality of life after receiving these interventions. This study will measure the effects of having a PEG tube inserted on the patient's quality of life as it relates to their ability to communicate and swallow. Two research questions will be answered: "Does a PEG procedure have an effect on the patient's ability to communicate their wishes and improve there satisfaction with the quality of their life in regards…
Finucane Thomas E. MD., Colleen Christmas, MD., and Kathy Travis. (1999) Tube feeding in patients with advanced dementia. A review of the evidence. Journal of the American Medical Association (JAMA)October 13 (282) [HIDDEN]
James A, Kapur K, Hawthorne AB.(1998) Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing (27):671-676.
Taylor, Paula, MD. (2001) Annals of Long-Term CareDecision Making in Long-Term Care: Feeding Tubes. Annals of Long-Term Care: Clinical Care and Aging. 9 (11) p. 21-26
In order to avoid that for this study, reliability of the EFPT was measured through trained raters who rated participants. How they were rated by the EFPT and by the other raters were then compared.
7.Define validity. How was validity of the instruments assessed in this study?
In order to determine whether the instrument was valid, there was construct validity and criterion validity that had to be tested. Construct validity is requiring a test to be able to distinguish between people who have and who do not have a known trait. This was assessed by determining whether the EFPT was able to distinguish people based on their level of stroke. Criterion validity was determined by comparing the EFPT scores with a lot of scores that were established for these same patients on neuropsychological tests.
8.Summarize Table 1.
Table one offered demographic information as well as information regarding how well the…
Baum et. al. (2008). Reliability, Validity, and Clinical Utility of the Executive Function Performance Test: A Measure of Executive Function in a Sample of People With Stroke
The American Journal of Occupational Therapy 62 (4), 446. Retrieved August 29, 2008 from Proquest.
Transactional Analysis in Education
Educational Transactional Analysis is the area for this case study example where the client is a school that is experiencing a rise in unruly delinquent behaviors. The purpose of the case study is to assist the school with finding ways to deal with the students that is conducive to changing their behaviors creating a learning environment. The study will also show how an TA in education can benefit educators in a teaching and learning setting . There are a number of reference books that show that this theory is beneficial to educators. For example Improve Behavior and aising Self-Esteem was one text that brought out advantages of TA in the classroom (Barrow, Newton, and Bradshaw, 2001). The experience will allow students and teachers to experience improved communication by providing tools and resources to bridge gaps (Barrow, Newton, and Bradshaw, 2001, 5). This is accomplished by using…
Berne, E. (1964). Games People Play. Grove Press.
Barrow, G., Bradshaw, E., Newton, T., (2001). Improve Behavior and Raising
Self-Esteem in the Classroom: London, Fulton.
Harding, A. (2004) 'Have I Got the Right hat On? Using TA to Deliver High
The study will also be important to those in the future, because scientists have not yet found ways to cure these chronic illnesses or correct some of these problems that are seen today, and therefore it stands to reason that there will be more people in the future who will have to face the same problems as those with chronic illnesses and traumatic injuries today.
Scope of the Study
The scope of the study is relatively large, simply because there has been a great deal written about chronic illness and injuries from the perspective of the physician and from the perspective of the patient. Both sides are important, although the focus here will remain largely on the patient perspective. Because there are so many people today that suffer from a chronic illness or traumatic injury, much study has been done about these individuals. Despite these studies, however, not a lot…
Anderson, B.L. (2002). Biobehavioral Outcomes Following Psychological Interventions for Cancer Patients. Journal of Counsulting and Clinical Psychology, 70(3), 590-610.
Brannon, L., & Fiest, J. (2004). Health Psychology: Vol.. An Introduction to Behavior and Health (Fifth ed.) Belmont CA: Thompson/Wadsworth.
DiMatteo, M. (2004). Social Support and Patient Adherence to Medical treatment: A Meta- analysis. Health Psychology, 23(2), 207-218.
Eitel, P., Hatchett, L., Friend, R., Griffin, K.W., & Wadhwa, N.K. (1995). Burden of Self-Care in Seriously Ill Patients Impact on Adjustment. Health Psychology, 14(5), 457-463.
Anger and Its Effects
Anger is a very intense feeling, and can be characterized by a number of behaviors. These include grinding teeth, an increased heart rate, rising blood pressure, clenched fists, and other signs of aggravation or frustration (Hendricks, et al., 2013). Each person reacts to anger in a different way, and some of the manifestations of anger may not be outwardly apparent. ises in blood pressure and heart rate, for example, are not easily noticed by others, but they can still be very damaging to the person who is struggling with the anger itself (Hendricks, et al., 2013). People also get angry for a number of different reasons, and they may react in an angry manner when they feel hurt, threatened, frustrated, or disappointed (Hendricks, et al., 2013). This is a relatively natural reaction for the majority of people, but that does not mean it is healthy or…
Hendricks, L., Bore, S., Aslinia, D., & Morriss, G. (2013). The effects of anger on the brain and body. National Forum Journal of Counseling and Addiction, 2(1): 2-11.
Now I will discuss the middle ground of the painting. The middle ground consists of a triangular shape and of the roadway leading back to the focal point. Together with the Roman Aqueduct, which resembles bridge, a triangular shape is forged. It leads the eye back to the mountain.
The background of the painting consists of the focal point - the luscious, golden hued mountain.
Paul Cezanne's Mont Sainte Victoire is an exceptional piece of work that has its roots in realistic landscape painting. At the same time, with Cezanne's masterful line work and heightened color effects, the painting comes across as something truly not of this world.
Martin, David F., and Lee a. Jacobus. The Humanities Through the Arts. 7th ed. New York:
Lisa Moore, 2008.…
Martin, David F., and Lee a. Jacobus. The Humanities Through the Arts. 7th ed. New York:
Lisa Moore, 2008. 26-27
Patient, Mr. D., is a 74-year-old male Caucasian, married and retired. Mr. D. complains of dizziness and weakness. Type-2 diabetes was diagnosed in 1994, hypertension in 2002, and arthritis in 2007. Mr. D. is currently taking 20mg Lipitor/daily; 81 mg Aspirin/daily; 333mg Calcium/daily; 5mg zinc/daily, and 500mg Vitamin C/3X day. He denies any drug or herbal use, and uses 650 mg of Tylenol for pain as needed. He has no known food allergies, does not use tobacco or illicit drugs, but has a family history of diabetes and heart disease with both mother and father. His general health acuity is strong (bowels, urinary, etc.), but has occasional slurred speech, weakness in right lower limb, syncope, vertigo, and vision fluctuations. Mr. D. reports that his wife complains he asks the same question repeatedly within a short time period.
Areas for Focused Assessment- The combination of syncope, vertigo, vision, and memory issues…
Hypoglycemia. (2012). Web MD. Retrieved from: http://symptoms.webmd.com/#./conditionView
Ezzo, J., et.al. (2001). Is Massage useful in the Management of Diabetes? Diabetes Spectrum -- The American Diabetes Association. 14 (4): Retrieved from: http://spectrum.diabetesjournals.org/content/14/4/218.full
Madden, S., Loeb, S. (2009). An integrative literature review of lifestyle interventions for the prevention of diabetes mellitus. Journal of Clinical Nursing, 17(2), 2243-56.
Polin, B. (2011). Why Water Aerobics is Good Exercise. Diabetic Lifestyle. Retrieved from: http://www.diabeticlifestyle.com/exercise/why-water-aerobics-good-exercise
Financial Plan Explanation
Grady's budgeting is done on an incremental basis. What this means is that the budget for next year will be based on the budget for last year, with adjustments for inflation, for changes in the payer mix, for strategic changes relating to the service offering mix, and for new facilities in the system, as well as new capital expenses.
Grady uses a cost-benefit analysis, which takes the form of net present value, as part of its decision-making criteria for capital expenditures. Grady is in the midst of a capacity expansion. Karkaria (2013) notes that Grady has a $74 million expansion plan for downtown Atlanta which will enhance its system capacity with respect emergency care, in anticipation of a spike in demand relating to the ACA, and to meet existing demand in the market that is yet unfulfilled.
Grady has sought financing for this project, including…
Foreman, J. & Argenti, P. (2005). How corporate communications influences strategy implementation, reputation and the corporate brand: An exploratory qualitative study. Corporate Reputation Review. Vol. 8 (3) 246-264.
Grady 2013 Annual Report. Retrieved December 3, 2014 from https://gradyhealthfoundation.org/wp-content/uploads/2014/07/Grady-Health-System_2013-Annual-Report.pdf
Grady. (2014). The Marcus Foundation awards Grady Health System $30 million for Emergency Department and Stroke Center expansion. PR Newswire. Retrieved December 3, 2014 from http://www.prnewswire.com/news-releases/the-marcus-foundation-awards-grady-health-system-30-million-for-emergency-department-and-stroke-center-expansion-277449311.html
Karkaria, U. (2013). Grady's $74m expansion includes upgrading ER. Atlanta Business Chronicle. Retrieved December 3, 2014 from http://www.bizjournals.com/atlanta/print-edition/2013/08/02/gradys-74m-expansion-includes.html?page=all
Obesity in Los Angeles County
The United States, while being one of the most technologically developed countries in the world, is not a healthy nation. Typically, when we think of disease pandemics we think of things like Swine Flu, Ebola, Lyme disease, etc. However, in the 21st century, we have a new pandemic that affects our children, adults, and eventually the whole population. Because of a more sedentary lifestyle, a proclivity for fast food, a high-fat diet, and hundreds of sugary drinks, obesity is now statistically so rampant that it is having a serious effect on American's health. Almost every researcher, whether medical or academic, as well as the public health sector, agree that there are statistical links between what we ingest and the consequences to our overall health profile. Certainly, all we need to is walk down any grocery store aisle, open up most magazines and newspapers, or watch…
About Health People. (2012, December 17). Retrieved from HealthyPeople.gov: http://healthypeople.gov/2020/about/default.aspx
Executive Order on Physical Fitness. (2010, June 22). Retrieved from The President's Council on Physical Fitness: http://www.fitness.gov/about/order/index.html
Overweight and Obesity, (2008) Centers for Disease Control and Prevention, Retrieved
from: http://www.cdc.gov/nccdphp/dnpa / obesity / economic_consequences.htm
Obesity is a serious social problem in America. The effects of obesity in childhood are well documented in both the social science literature and medical journals. During the last 30 years, the percentage of obese children between the ages of 6 and 11 has risen 200% while the percentage of obese children between 12 and 19 has tripled (CDC, Preventing Childhood Obesity, 2010). Obesity in the nited States has increased among all cohorts and ethnicities, spans across generations, and is not limited to income or educational levels. However, the incidence of obesity among African-American women is of particular concern given the prevalence and severity of the issue in America.
Public health issue
More than two-thirds of Americans are now obese or overweight (Ogden et al., 2010).
Rates of adult obesity now exceed 20% in 49 states and D.C and 25% in 40 states. By way of comparison, in 1991, rates…
U.S. Centers for Disease Control and Prevention (2011). Morbidity and Mortality Weekly Report. Vital Signs: Prevalence, Treatment, and Control of Hypertension -- United States, 1999 -- 2002 and 2005 -- 2008
Ward, S., Gray, A., Paranjape, A. (2008). African-Americans' perceptions of physician attempts to address obesity in the primary care setting. The Journal of General Internal Medicine, 24(5), 579-584.
Coenen, K.R., Hasty, A.H. (2007). Obesity potentiates development of fatty liver and insulin resistance, but not atherosclerosis, in high-fat diet-fed agouti LDLR-deficient mice. Retrieved from: http://ajpendo.physiology.org/content/293/2/E492.short
Risk Factors for Mr. Jablonski
CHD: Mr. J is a classic case for a potential Coronary Heart Disease (CHD) patient. His history shows several risk factors, which can be divided into uncontrollable and controllable risk factors. The uncontrollable factors are his age (48 years old) -- older people are more susceptible to CHD, his sex (male) -- men are more likely to get CHD, and his family history. The controllable risk factors are his obesity, his smoking habit, lack of physical activity, high blood pressure, and his high LDL cholesterol.
Hypertension: The risk factors for Mr. J are his age, gender, obesity, excessive salt intake, and his inactive lifestyle.
The risk factors described as 'controllable' can be mitigated by dietary control and medication. If his condition remains untreated Mr. J is a potential candidate for a severe heart disease and possible stroke.
In order to lower his high…
Practical esearch Finding Implementation and Experimentation Stage -- Phase I
The experimenter did not set out to determine specifically which of the various contributing factors (or combinations of factors) identified by the empirical research of medial tibial stress syndrome was most responsible for the experimenter's symptoms. However, since the initial attempts to resolve the symptoms incorporated changes to all of the external variables except a change in running surface, the experimenter immediately sought a softer running surface and temporarily abandoned running on any hard surface that magnified instead of minimized the physiological trauma associated with running on harder surfaces.
Because the empirical research also implicated poor running stride mechanics and excessive vertical elevation, the experimenter devoted considerable attention to making the following specific changes to the running stride: (1) shorter strides to minimize travel of the body while neither foot is in contact with the running surface; (2) conscious attempts…
AOS. (2007). Shin Splints. American Academy of Orthopaedic Surgeons. Retrieved October 20, 2009, from: http://orthoinfo.aaos.org/topic.cfm?topic=A00407 .
Braver, R. "How to Test and Treat Exertional Compartment Syndrome: Why the ECS
Diagnosis Is Often Missed" Podiatry Today; Vol. 15 (May 1, 2002). Retrieved
October 20, 2009, from: http://www.podiatrytoday.com/article/382
For example, because different etiologies require corresponding therapeutic designs and mechanisms (Spector, 2000; Steefel, 2002), specific support group makeup must consider the need to develop different strategies and methodologies for the following types of patients at a minimum if support groups are to provide equal benefit to all patients:
Elderly Patients and Lifelong Laborers - This group typically presents with psychological issues in the realm of a direct link between their sense of purpose and self-worth and their ability to continue to function productively in their community. Their need for acute medical and ancillary services, particularly in the Longview/East Texas community are often precipitated by chronic physical deterioration from a lifetime of relatively hard labor. Therefore, support group rehabilitation services must address the issues of self-esteem as a function of vocational productivity and lifestyle changes necessitated by medical conditions.
Prime-of-Life Victims of Traumatic Injury - This group typically presents with…
Clark, C., Robinson, T. (2000). "Multiculturalism as a Concept in Nursing" Journal of the Black Nurses Association, 11(2), 39-43.
Spector, R. (2000). Cultural Diversity in Health and Illness (5th ed.). New Jersey: Prentice Hall.
Stanhope, M., Lancaster, J. (2004). Community and Public Health Nursing (6th ed.)
St. Louis: Mosby.
I was also inspired by the communication skills and dedication pharmacists showed in making my aunt's course of treatment comprehensible, so my aunt understood why she was taking certain medications, the possible side effects that she should be aware of, and also of possible drug interactions. The pharmacists involved my aunt's nurses and family in their interactions with my aunt, and I began to envision myself in a similar role, combining chemistry with communication, compassion, and caring.
The future of pharmacy, in a world where medication's side effects and interactions are often dangerous, and treatment schedules because of drug interactions can be quite complex, requires pharmacists who are caregivers and teachers, not mere dispensers of prescriptions. A pharmacist is part of a patient's plan of care, right along with the patient's doctors and nurses. The sick, confused, and elderly, depend upon their pharmacist to ensure that their prescriptions are correct,…
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.
reason I selected the University of Alabama at Birmingham School of Nursing for graduate studies in nursing is because I ultimately seek to become a leader in the field of nursing, and there are several facets of this institution that legitimize its "vision to sustain nursing leadership worldwide." In particular, I was attracted to the synthesis of different disciplines and areas of erudition that the UAB School of Nursing emphasizes as part of its graduate education in this field, which include various aspects of management, economics, information technology, marketing and consultation to equip graduates with the necessary skills to perform as leaders within this profession.
It is increasingly necessary for nurses in advanced positions to utilize evidence-based practices as part of their means to fulfilling their responsibilities. The UAB School of Nursing, with its research center providing funded opportunities to counter some of the most pressing health care issues in…
Egenes, K.J. (2012). The nursing shortage in the U.S.: a historical perspective. Chart. 110(4), 18-22.
Harper, D.C. (No date). About our school. www.uab.edu. Retrieved from http://www.uab.edu/nursing/home/about
Marelli, T.M. (2013). The good, the bad and the ugly in the changing healthcare landscape: the role of nurse practitioners in meeting increasing demand for primary care (the good), CMS and contractor oversight of home health agencies (the bad), and the sad demise of the Medicaid hospice benefit in Louisiana (the ugly). Home Health Care Nurse. 31(3), 121-123.
UAB Nursing. (2013). Nurse practitioner family primary care. www.uab.edu. Retrieved from http://www.uab.edu/nursing/home/images/stories/info_sa/MSN_Flyer_NP_Family.pdf
People die each year of cardiac related health problems. Some die of heart attacks and others of congestive heart failure and so forth. This research proposal highlights five peer reviewed journal articles that show how to improve, step-by-step, the infrastructure of a hospital cardiac program. Quantitative data from the studies along with in-hospital data will reveal the need for quality improvement as well as how successful certain methods are when implemented among specific populations. Information was gathered through the search engine Google Scholar and PubMed. All articles are less than four years old and reveal ways to not just improve the safety and care of patient's but also how to improve surgical outcomes and enhance IT infrastructure, all of which are essential to running a great hospital cardiac program.
Several patients in (Hospital Name) have come in complaining of cardiac related health problems. Some have had issues with cardiothoracic…
Elliott, M.J. (2012). The role of information in ensuring quality and patient safety. Progress in Pediatric Cardiology, 33(1), 5-10. Retrieved from http://www.sciencedirect.com/science/article/pii/S1058981311000853
Grace, S.L., Poirier, P., Norris, C.M., Oakes, G.H., Somanader, D.S., & Suskin, N. (2014). Pan-Canadian Development of Cardiac Rehabilitation and Secondary Prevention Quality Indicators Endorsed by the Canadian Association of Cardiac Rehabilitation. Canadian Journal of Cardiology, 30(8), 945-948. Retrieved from http://www.sciencedirect.com/science/article/pii/S0828282X14002335
Guillamondegui, O.D., Gunter, O.L., Hines, L., Martin, B.J., Gibson, W., Clarke, C., Cecil, W.T. (2012). Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes. Journal of the American College of Surgeons, 214(4), 709-714. Retrieved from http://www.sciencedirect.com/science/article/pii/S1072751511013287
IEEE Conference on Software Engineering Education and Training, & IEEE Computer Society. (2011). Educating software engineers of the future: Software quality research through problem-based learning. In CSEE&T 2011: Proceedings (pp. 91-100). Los Alamitos, California: IEEE.
The employees should be firmly committed to the firm, they are the face of a firm (also its eyes and ears). The staff focus should be involved in the process management, also their measurement and knowledge as well as initial contact with customers, all contribute to the performance of the organization.
Firms need to provide results on a consistent basis, be innovative and should respond quickly to any changes in environment for giving exceptional results and satisfying customers. Further in continuous improvement, aspects such as redesign of processes or services, upgraded technology systems, proper paperwork should be focused upon. Continuous improvement requires all firms' members to look for opportunities to improve. Overall, the continuous improvement process involves customers, leadership, employees and quality. It is the customers who determine if the firm is providing quality. They are the judges of it. The leadership is useful for setting direction of the firm.…
Brown, S.A. (1998). Breakthrough Customer Service. Toronto: John Wiley & Sons.
Buttle, F. (2004). Customer Relationship Management. Amsterdam: Elsevier Butterworth-Heinemann.
Els, W. (2003). Winning at Service. Hoboken: John Wiley & Sons.
Horrell, E. (2006). The Kindness Revolution. New York: AMACOM.
My career path solidified in front of me, I have maintained this focus since the end of my studies. I believe that the more I am exposed to this career, the better I will become. To that end, I still watch the speech pathologists at the daycare. Their work was the inspiration for me to seriously pursue this career path and it continues to inspire me. I study their techniques, their frustrations and their successes, knowing that one day I will be right there with them.
I am also currently working with the developmentally disabled for an organization called Ohel/Bais Ezra, and have done so for the past four years. To me, this is the most rewarding type of challenge imaginable. I derive an enormous sense of joy and satisfaction from helping others overcome difficulties.
Now, my goal is to continue my studies in Speech Language Pathology. This is the…
A way to better distribute the information that is being taught in the classrooms is also through the community so that the changes are also effecting the parents to the students, as a change on their part as well would be helpful in the battle against obesity. It would be useful to initially target pamphlets, an informational booth or table at grocery stores, where the foundation of the problem lies. It would be effective if information is given before families go grocery shopping so they are more conscious of the items that they are purchasing. Furthermore, information should also be initially presented on TVs, in newspapers and magazines and other mediums that would likely be used in the more low-key and sedentary setting in order to galvanize individuals to get outside. Once outside, in order to sustain the physical activity, it would be nice to have water and juice at…
Ahuja, Gitika, & Salahi, Lara. (11, February 2010). School nutrition program takes up obesity fight. Retrieved from http://abcnews.go.com/GMA/OnCall/school-nutrition-program-takes-obesity-fight/story?id=9802468
CausesofChildhoodObesity.org, Initials. (2010). Causes of childhood obesity. Retrieved from http://causesofchildhoodobesity.org/
Facts about obesity in the United States. (n.d.). Retrieved from http://www.cdc.gov/pdf/facts_about_obesity_in_the_united_states.pdf
Mayo Clinic Staff, Initials. (2011, May 06). Risk factors. Retrieved from http://www.mayoclinic.com/health/obesity/DS00314/DSECTION=risk-factors
ECMO requires constant monitoring and assessment in order to maintain proper oxygen saturation levels, blood pressure, and circulatory activity (Schuerer et al. 2008; Mielck & Quintel 2005).
Institutional experience and multidisciplinary focus are both of extreme importance in determining patient outcome following ECMO, as technological innovations and the high-risk of the procedure make an ongoing knowledge base and expertise level a major determiner of outcome (Schuerer et al. 2008). As serious complications including infection, instability of oxygenation, thrombosis, and volume requirements can all occur, patients should be treated in a manner comparable to an acute stroke response -- increased risk for disrupted blood flow is a definite result of an ECMO procedure (Yang 2011). ECMO can only last a few days, and decreased fluid requirements and increased pulmonary function are both indicators that the weaning process should begin (Yang 2011). Mortality rates for ECMO vary significantly depending on the specific…
Mielck, F. & Quintel, M. (2005). Extracorporeal membrane oxygenation. Current Opinion n Critical Care 11(1): 87-93.
Schuerer, D., Kolovos, N., Boyd, K. & Coopersmith, C. (2008). Extracorporeal Membrane Oxygenation Current Clinical Practice, Coding, and Reimbursement. Chest 134(1): 179-84.
Yang, E. (2011). Extracorporeal membrane oxygenation. In Fundamentals of Pediatric Surgery, P. Mattei, editor. New York: Springer.
Miami was where it all happened. I dated then. I guess you could say I had a life. Back then, if I were to be living under any rock, it had to be a very beautiful one, such as limestone, the kind of limestone that grew in small crevices on the road leading up to my grandfather's home on the island. I felt then that Prince Charming would come, eventually and when he did he wasn't going anywhere. After all, I am amazing; he must just not have received the memo quite yet. All of this was in the past and the time was now. I had been through enough doubt and feeling that I was some creature living under a rock. I was going to meet him and this situation would be resolved. Tonight was my coming out from under the rock.
Lucas. His name is Lucas Walker. We…
The Topic Company: DN.
1) Does the organization treat management and leadership as one in the same? YES or NO
2) Does the organization rely heavily on employee training and development? YES or NO
3) Does the program use employee feedback at the lowest levels in its overall decision making process? YES or NO
4) Do you believe all stakeholders are aware of the organizations goals and objectives and are willing to work towards the achievement of those goals? YES or NO
5) in your opinion is the organization structured in a way that inhibits innovation? YES or NO
6) Are there any other aspects that you believe should be improved within the organization? If so, how?
1) Bulmer, M. And Warwick, D. (1993). Social research in developing countries: surveys and censuses in the Third World. London: outledge.
2) Ebbutt, D. (1998). Evaluation of projects…
1) Bulmer, M. And Warwick, D. (1993). Social research in developing countries: surveys and censuses in the Third World. London: Routledge.
2) Ebbutt, D. (1998). Evaluation of projects in the developing world: some cultural and methodological issues. International Journal of Educational Development, 18, pp. 415-424.
3) Potter, C. (2006). Program Evaluation. In M. Terre Blanche, K. Durrheim & D. Painter (Eds.), Research in practice: Applied methods for the social sciences (2nd ed.) (pp. 410-428). Cape Town: UCT Press.
4) Potter, C. (2006). "Psychology and the art of program evaluation." South African journal of psychology 36 (1):
Alcohol abuse is a condition that is characterized by a pattern of excessive drinking in spite of negative effects resulting from the use of alcohol on an individual's occupational, legal, educational, medical, and/or social life. Alcoholism results from this destructive pattern of alcohol abuse after a period of time and includes a number of other symptoms including: increased tolerance to alcohol over time; alcohol withdrawal; a pattern of using more alcohol and/or use for a longer time than planned; destructive patterns health, social, and occupational functioning as a result of alcohol use; and failed attempts at reducing its use (APA, 2000). Alcoholism is also known as alcohol dependence or alcohol addiction as the terms are used interchangeably in the medical and treatment literature. These terms describe a destructive pattern of chronic alcohol use that results in the development of tolerance to alcohol, needing more alcohol to achieve the same effects…
American Psychiatric Association (APA, 2000). Diagnostic and statistical manual of mental disorders (4th Ed.). Arlington, VA: Author.
Boorse, C. (1997). A rebuttal on health. In J.F Humber and R.F. Almeder (Eds.), What is disease? Totowa: Humana Press.
CDC (Centers for Disease Control, 2001) Chronic disease prevention: about chronic disease [Online]. Available: Internet: http://www.cdc.gov/nccdphp/about.htm .
Dick, D.M. And Bierut, L.J. (2006). The genetics of alcohol dependency. Current Psychiatric Reports, 8, 151-157.
The high levels of blood glucose lead to the production of insulin therefore patients have excessive production of insulin. There is insulin resistance and hence body cells do not respond in an appropriate way in the presence of insulin (Mealey, 2010).
The main difference between diabetes insipidus, and diabetes mellitus, is that in diabetes mellitus insulin resistance is referred to being "post-receptor." This implies that the problem lies with the cells which respond to insulin as opposed to there being a problem in the production of insulin. The onset of diabetes mellitus is slow and the disorder might go undiagnosed for a very long period of time. Diabetes insipidus has an abrupt onset and it might be diagnosed at any age.
Factors affecting diagnosis and treatment prescription of diabetes
There are various factors that might affect the diagnosis and treatment of these two types of diabetes.one of these factors is…
Mealey, B.L. (2010).Diabetes Pathophysiology. Retrieved July 29, 2013 from http://www.health.am/db/diabetes-pathophysiology/
MediLexicon International Ltd.(2013). All about Diabetes. Retrieved July 29, 2013 from http://www.medicalnewstoday.com/info/diabetes/
Healthcare Quality Management
PDCA Modeling in Healthcare
Psychiatric emergencies in medical settings may be particularly challenging since the staff does not encounter them frequently and may not have experience dealing with behavioral crisis intervention. The purpose of this exercise is to help staff improve understanding and coping with nonmedical emergencies that occur in medical settings using the PDCA cycle.
X is a 41-year-old male admitted to a medical unit with a diagnosis of possible stroke. The patient is ambulatory, 5'10," and 350 lbs. Mr. X presented to the emergency department the day before after apparently losing consciousness at home. The initial CAT scan of his head was negative. It is suspected that Mr. X may be an IV drug user since his urine toxicology screening came back positive for opiates. The medical staff thinks that Mr. X had a seizure prior to admission, but he has shown no abnormal signs…
Bennet, L., & Slavin, L. (2009, April 3). What Every Health Care Manager Needs to Know. Retrieved from Continous Quality Improvement: http://www.cwru.edu/med/epidbio/mphp439/CQI.htm
i Six Sigma. (N.d.). Focus - PDCA. Retrieved from I Six Sigma: http://www.isixsigma.com/dictionary/focus-pdca/
Pestka, E., Hatterberg, D., Larson, L., Zwygart, L., Cox, A., & Cox, D. (2012). Enhancing Safety in Behavioral Emergency Situations. Medsurg Nursing, 335-341.
nonverbal behavior has James made?
From the case study provided, there are various mistakes of James' own nonverbal behavior. Nonverbal behaviors such as emotions, attitudes and personality traits come clear from his conversation with Bob Croze. For instance, when Bob tells James that he was late and therefore he had already placed an order with one of James' competitors, James conveys his attitudes and expresses his emotions by increasing his voice in speed and pitch as well as, rising up ready to leave. This shows that James was not happy with Bob since he had placed an order with his competitor.
Cite at least 3 examples, explaining James' nonverbal behaviors and the messages they sent.
Expressing emotion (For example, James not happy with Bob, and so increases his voice in speed and pitch)
Conveying attitudes (For example, crossing arms and legs while talking to Bob)
Demonstrating personality traits (For example,…
Cherry, K. (2014). Types of Nonverbal Communication. Major Nonverbal Beahviors. Retrieved July 20, 2014, from http://psychology.about.com/od/nonverbalcommunication/a/nonverbaltypes.htmFind a website by URL or keyword...
Hallett, T. (2014). Body Language: Understanding Non-Verbal Communication. Body Language. Retrieved July 20, 2014, from http://www.mindtools.com/pages/article/Body_Language.htm
Swimming is the only activity that I enjoy doing so much. This is because it involves the whole of my body yet at the same time it relaxes my nerves (Gifford 17). It is a sport that has come a long way from its inception. There are no chronological recordings of discovery of when the sport. Therefore, it is one among the few sports that has been in existence for the longest time possible. Swimming in sports and recreational activities, is the forward motion of the body in water by a combination of legs and arms motions and the natural floating of the body on water. It is a tremendously enjoyable recreational activity.
The archaeological evidences and other sources show that swimming had been in practice since 2500 BC. The practice of swimming started in Egypt and later spread through Assyria, Greece and the Roman empires…
Montgomery, Jim, and Mo Chambers. Mastering Swimming. Champaign, IL: Human Kinetics,
Wiltse, Jeff. Contested Waters: A Social History of Swimming Pools in America. Chapel Hill:
University of North Carolina Press, 2007. Internet resource.
As expected, NIHSS scores indicated mild stroke severity, while the FIM scores suggested moderate motor deficits. A comparison of the demographic variables for the patients that met the inclusion criteria with those that did not, revealed no significant differences except in terms of stroke severity, laterality, and comprehension impairment.
The results of the cognitive evaluations (MMSE vs. MoCA, r = .79, p < .001; MMSE vs. cFIM, r = .56, p < .000; MoCA vs. cFIM, r = .67, p < .000) revealed good agreement between the three instruments (Toglia et al., 2011) and mirrored the results of Stewart et al. (2012). A comparison of the mean scores for MMSE and MoCA, however, revealed a significant difference (24.4 vs. 17.8, respectively, p < .001) in terms of sensitivity to subtle changes in cognition. This finding supports the conclusion that the MoCA may be more sensitive to MCI than the MMSE.…
AHRQ. (2013). Assessing cognitive functioning. in: Evidence-based geriatric nursing protocols for best practice. Retrieved 3 Apr. 2014 from http://www.guideline.gov/content.aspx?id=43917 .
Alzheimer's Association. (2012). Mild cognitive impairment. Retrieved 3 Apr. 2014 from http://www.alz.org/dementia/downloads/topicsheet_mci.pdf .
Alzheimer's Association. (2013). 2013 Alzheimer's Disease Facts and Figures. Alzheimer's & Dementia, 9(2), 1-69. Retrieved 3 Apr. 2014 from http://www.alz.org/downloads/facts_figures_2013.pdf .
Aslam, S., Georgiev, H., Mehta, K., & Kumar, a. (2012). Matching research design to clinical research questions. Indian Journal of Sexually Transmitted Diseases, 33(1), 49-53.
Gender variation in clinical decision-making was measured, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD (Maserejian et al., 2009).
This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. The results: Physicians (n=128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age, but only among middle-aged women were they significantly less certain of the CHD diagnosis. Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts. An interaction effect showed that females with high…
Chou, Anne F., Sarah Hudson Scholle, Carol S. Weisman, Arlene S. Bierman, Rosaly
Correa-de-Araujo, & Lori Mosca (2007). "Gender Disparities in the Quality of Cardiovascular Disease Care in Private Managed Care Plans." In Women's Health
Issues 17: 120 -- 130.
DeVon, H., Ryan, C.J., Ochs, a.L., & Shapiro, M. (2008). "Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men." In Am J. Crit Care 17:14-24.
elationship of high cholesterol levels to the development of cardiovascular disease
Diabetes, heart disease, and high cholesterol are all strongly correlated. Even when diabetes is being well-managed, the patient's risks factors increase for comorbidity with these disorders. "High blood pressure has long been recognized as a major risk factor for cardiovascular disease. Studies report a positive association between hypertension and insulin resistance. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles" (Cardiovascular disease and diabetes, 2014, AHA). Also, in the case of Ms. X, because of her uncontrolled diabetes, her risk for high cholesterol is higher than average even in the absence of obesity and inactivity. "This triad of poor lipid counts often occurs in patients with premature coronary heart disease. It is also characteristic of a lipid disorder associated with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia…
Burden, M. (2003). Diabetes: Treatment and complications. Nursing Times, 99(2) 30/
Cardiovascular disease and diabetes. (2012). American Heart Association. Retrieved from:
Use tools and equipment that are properly designed to reduce the risk of wrist injury, (Zieve & Eltz 2010)
Workstations, tools and tool handles, and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work, (National Institute of Neurological Disorders and Stroke 2010).
Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing, (Zieve & Eltz 2010)
Training and awareness; the encouragement of frequent breaks; yoga classes offered for free at the workplace; job rotation.
Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers, (National Institute of Neurological Disorders and Stroke 2010)
Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous…
"Tension Neck Syndrome" (n.d.). Retrieved online: http://www.rsi.org.uk/text_only/conditions/tension_neck_syndrome.asp
Zieve, D. & Eltz, D.R. (2010). Carpal tunnel syndrome. National Center for Biotechnology Information. Retrieved online: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469
Combustion Engine Works
The development of engines and other machineries revolutionized industrialization particularly in the area of transportation whereby the transport of raw materials, finished products and people made possible increased efficiency in the overall production and manufacturing processes. Transportation has been a major beneficiary predominantly with the invention of smaller combustion engines that powered various vehicles. Gottlieb Daimler is attributed with the invention of the first combustion engine during the late 1800s. He "constructed what is generally recognized as the prototype of the modern gas engine: small and fast, with a vertical cylinder, it used gasoline injected through a carburetor (Morris Motor Company 2011)." From this prototype, several combustion engines have been developed and Daimler even improved his engine prototype by introducing "in 1889 a four-stroke engine with mushroom-shaped valves and two cylinders arranged in a V, having a much higher power-to-weight ratio; all modern gasoline engines are descended…
Armstrong Auto Center, Inc. Internal Combustion Engines. How does it Work? 2010. 01 May 2011. .
Ignition UK. Ignition Principle: How the Internal Combustion Engine Works. 2009. 01 May 2011. .
Morris Motor Company. Internal Combustion Engine Basics. 2011. 01 May 2011. .
Wesley, Tad. How the Combustion Engine Works. Helium: Engine Repair. 10 Apr. 2007. 01 May 2011. .