What change would you like to make in your current workplace?

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What change would you like to make in your current workplace?

 

What change would you like to make in your current workplace? Identify at least one advocacy strategy that you can use to create that change.include reference and in text citation.

As you look under number A and number B of the question below. what had the most meaning for you and most impacted your daily practice? What trend or issue are you seeing in nursing that you wish had been discussed in this class?

A, importance/role of advocate for improving health care delivery.
B, Choose one legislator on the state or federal level who is also a nurse, and discuss the importance of their role as advocate for improving health care delivery.include reference and in text citation.

Health Promotion Intervention Plan On Cardiovascular Disease

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Planning is defined as a step by step movement from the beginning till the end of a programme (Naidoo and Wills, 2009).It was also clearly stated by Tones and Green (2005) as an outline of different parts of a programme and how they are interwoven together.

Planning a health promotion programme requires logical approaches that run through different stages before an effective outcome can be established (Naidoo and wills,2009).This involves the use of different kind of planning model. In this circumstance the Ewles and Simnett (2003) planning schema will be made use of to plan this intervention. This is a schedule that encompasses seven key planning actions. They include identifying health need assessment, setting goals and objective, choosing good strategies for the set objectives, sourcing for fund and man power, mapping out evaluation plan ,so as to enhance good performance ,setting an action plan, and lastly implementing the plan (Bartholomew et al.,2006).A top-down approach in executing programme plan will be used in this arena (Laverack,2005).This Top-down programmes approach are usually apprehensive with lifestyle and behavioural fulfillment to specific stipulated norms (Boutilier,1993).This is the reason why the approach will best suite this plan.

Background knowledge

Cardiovascular disease is an ailment of the heart and the circulatory system. It consists of the coronary heart disease – heart attack and angina as well as stroke. The organ that is affected by this disease is part of the toughest muscle in the body, so as to keep blood pumping constant. There are specific arteries for different organs in the body, but the one that supply the heart is called the coronary artery. When this blood vessel is affected it lead to the ailment called the coronary heart disease. This ailment occur when the blood vessel supplying the heart become narrowed by accumulation of fatty substances called atheroma within their walls. A condition called atherosclerosis. This could cause reduction of blood current to the heart due to the tightening of the vessel, which could lead to having an heart attack or myocardial infarction. This

. The nature of the health needs assessment

Cardiovascular diseases are a worldwide leading cause of death, which causes approximately 17.1 million deaths per year (WHO, 2010).

These diseases of the heart are the major cause of death in the United Kingdom which includes the Northern Ireland (Chief Medical Officer, 1999; DHSSPS, 2004, p. 97). In spite of the reduction in the drift in death rate of diseases of the heart and the circulatory system, coronary heart disease still remains the common cause of death in the United Kingdom (British Heart Foundation, 2007). The mortality rate incurred by this ailment every year is roughly 208,000 deaths (British Heart Foundation ,2007).This reflected roughly one in 3 people death per year, which is around 36% of the populace (British Heart Foundation, 2007).The major form of Cardiovascular Disease are coronary heart disease (CHD) ,which account for around 48% of mortality rate and around 28% death rate from stroke.

This ailment which could lead to angina, heart attack and heart stoppage is one of the main causes of death in Northern Ireland. It was reported that this ailment causes 1 in 3 deaths in men and 1 in 4 deaths in women and is accountable for approximately 20% of the entire loss in productive years in this part of UK (Chief Medical Officer, 1999). Unal et al. (2004) claimed that a reduction in coronary heart disease (CHD) in the U.K between the 1980s and 1990s was around 58% which account for more than half of the populace. .This reduction was brought by drastic change in the primary threat, which is smoking and the remaining 42% was achieved from the secondary prevention and treatment provided (Unal et al., 2004). McWhirter (2002) claimed that the electoral wards with the top mortality rates in Northern Ireland are also those with the uppermost levels of deficiency. National Heart Forum (2002) pointed out that various citizens have a heritable nature towards coronary heart disease, but for huge mass of people the danger of coronary heart disease is basically determined during one’s lifespan by the food being consumed, physical immobility and smoking. National Heart Forum (2002)stated that heart attacks and ill health from coronary heart infection may seem inaccessible to children’s lives, but the major risk factor for developing coronary heart disease like (rise in blood cholesterol, high blood pressure, high blood glucose level and smoking) all build up throughout the lifespan, most occurring during childhood and teenage years. Various researches have confirmed that the early signs of coronary heart infection are already obvious in some children and teenagers (DHSSPS, 2004). The growing levels of obesity amongst children and young people mean that they are likely to be at advanced threat of developing coronary heart disease in later life (National Heart Forum, 2002).

Cardiovascular disease need to be addressed all over the field from primary prevention in not at risk population that is by considering diet, physical fitness, overweight prevention and smoking in children and young people , which could predispose them to other life threatening diseases that are non-communicable. Therefore cardiovascular disease especially coronary heart disease is a health problem that require drastic intervention.

Aims

The overall aim of this plan is to educate and increase the level of awareness among university undergraduate students about the risk of having coronary heart disease by using the behavioural and life style approach (Laverack, 2005).

Objective Labonte (1998) claimed that nearly all conventional health promotion goals are based on disease prevention, decreasing death rate, morbidity, and behavioural changes. Therefore, the objective of this proposed intervention will focus on school based prevention approach (Laverack , 2005) by creating awareness which will result in healthy way of life from the grassroots by catching them young. The objective is tailored towards a SMART ideology, that is must be Specific, Measurable, Achievable, and Realistic as well as time conscious. The educational objective are as follows

To encourage students to dissipate knowledge among their peers of the consequences of getting a coronary heart disease.

To increase student awareness of the kind of food that could predispose them to getting the disease.

To enlighten students about the kind of lifestyle they need to inculcate to avoid the danger of having the disease.

To establish whether student have a prior knowledge about the disease and it consequences.

To inform participant about the healthy food that they need to adopt to reduce the risk of being affected by the ailment.

Prac wk1 Assign

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Practicum Experience Plan


Overview:

Your Practicum experience includes working in a clinical setting that will help you gain the knowledge and skills needed as an advanced practice nurse. In your practicum experience, you will develop a practicum plan that sets forth objectives to frame and guide your practicum experience.

As part of your Practicum Experience Plan, you will not only plan for your learning in your practicum experience but also work through various patient visits with focused notes as well as one (1) journal entry.


Complete each section below.



Part 1: Quarter/Term/Year and Contact Information



Section A


Quarter/Term/Year:


Student


Contact Information

Name:

Street Address:

City, State, Zip:

Home Phone:

Work Phone:

Cell Phone:

Fax:

E-mail:


Preceptor


Contact Information

Name:

Organization:

Street Address:

City, State, Zip:

Work Phone:

Cell Phone:

Fax:

Professional/Work E-mail:



Part 2: Individualized Practicum Learning Objectives

Refer to the instructions in Week 2 to create individualized practicum learning objectives that meet the requirements for this course. These objectives should be aligned specifically to your Practicum experience. Your objectives should address your self-assessment of the skills found in the “PMHNP Clinical Skills Self-Assessment Form” you completed in Week 1.

As you develop your individualized practicum learning objective, be sure to write them using the SMART format. Use the resources found in Week 2 to guide your development. Once you review your resources, continue and complete the following.

Note

: Please make sure each of your objectives are connected to your self-assessment. Also, consider that you will need to demonstrate how you are advancing your knowledge in the clinical specialty.


Objective 1:

<write your objective here> (


Note


: this objective should relate to a specific skill you would like to improve from your self-assessment)


Planned Activities:


Mode of Assessment:

(Note: Verification will be documented in Meditrek)


PRAC Course Outcome(s) Addressed:

· (for example) Develop professional plans in advanced nursing practice for the practicum experience

· (for example) Assess advanced practice nursing skills for strengths and opportunities


Objective 2:

<write your objective here> (


Note


: this objective should relate to a specific skill you would like to improve from your self-assessment)


Planned Activities:


Mode of Assessment:

(Note: Verification will be documented in Meditrek)


PRAC Course Outcome(s) Addressed:

·


Objective 3:

<write your objective here> (


Note


: this objective should relate to a specific skill you would like to improve from your self-assessment)


Planned Activities:


Mode of Assessment:

(Note: Verification will be documented in Meditrek)


PRAC Course Outcome(s) Addressed:

·



Part 3: Projected Timeline/Schedule

Estimate how many hours you expect to work on your Practicum each week. *

Note

: All of your hours and activities must be supervised by your Preceptor and completed onsite. Your Preceptor will approve all hours, but your activities will be approved by both your Preceptor and Instructor. Any changes to this plan must be approved.

This timeline is intended as a planning tool; your actual schedule may differ from the projections you are making now.


I intend to complete the 144 or 160 Practicum hours (as applicable) according to the following timeline/schedule. I also understand that I must see at least 80 patients during my practicum experience. I understand that I may not complete my practicum hours sooner than 8 weeks. I understand I may not be in the practicum setting longer than 8 hours per day unless pre-approved by my faculty.


Number of Clinical


Hours Projected for Week


Number of Weekly Hours for Professional Development


Number of Weekly Hours for Practicum Coursework


Week 1


Week 2


Week 3


Week 4


Week 5


Week 6


Week 7


Week 8


Week 9


Week 10


Week 11


Total Hours

(must   meet the following requirements)

144 or 160 Hours



Part 4 – Signatures


Student Signature (electronic):


Date:


Practicum Faculty Signature (electronic)**:


Date:

** Faculty signature signifies approval of Practicum Experience Plan (PEP)

Submit your Practicum Experience Plan

on or before Day 7

of

Week 2

for faculty review and approval.

Before embarking on any professional or academic activity, it is important to understand the background, knowledge, and experience you bring to it. You might ask yourself, “What do I

already

know? What do I

need

to know? And what do I

want

to know?” This critical self-reflection is especially important for developing clinical skills, such as those for advanced practice nursing.

The PRAC 6635 Clinical Skills List and PRAC 6635 Clinical Skills Self-Assessment Form, provided in the Learning Resources, can be used to celebrate your progress throughout your practicum and identify skills gaps. The list covers all necessary skills you should demonstrate during your practicum experience.

For this Assignment, you assess where you are now in your clinical skill development and make plans for this practicum. Specifically, you will identify strengths and opportunities for improvement regarding the required practicum skills. In this practicum experience, when developing your goals and objectives, be sure to keep assessment and diagnostic reasoning in mind.


To prepare:

  • Review the clinical skills in the PRAC 6635 Clinical Skills List document. It is recommended that you print out this document to serve as a guide throughout your practicum.
  • Review the “Developing SMART Goals” resource on how to develop goals and objectives that follow the SMART framework.
  • Download the PRAC 6635 Clinical Skills Self-Assessment Form to complete this Assignment.

Assignment

Use the PRAC 6635 Clinical Skills Self-Assessment Form to complete the following:

  • Rate yourself according to your confidence level performing the procedures identified on the Clinical Skills Self-Assessment Form.
  • Based on your ratings, summarize your strengths and opportunities for improvement.
  • Based on your self-assessment and theory of nursing practice, develop three to four (3–4) measurable goals and objectives for this practicum experience. Include them on the designated area of the form.

Review the learning theories presented in this week’s Learning Resources. How can each theory, or combination of theories, guide the curriculum development process?

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Review the learning theories presented in this week’s Learning Resources. How can each theory, or combination of theories, guide the curriculum development process?

Theorists have always been interested in how people learn. They have created and refined learning theories and provided authentic examples of human motivation and learning preferences. Much research has also been conducted on how educators teach others. Literature suggests that even when educators did not believe that they were using a theory, they were in fact using one or more to drive their instruction. Though nurse educators may naturally incorporate theories into their instruction, great care should be taken to consciously incorporate theories into the design and presentation of the curriculum. Doing so will not only benefit diverse learners but also aid in the curriculum development process.
In this Discussion, you explore how learning theories offer distinct strategies, approaches, and considerations.

Questions to be addressed:
1. Review the learning theories presented in this week’s Learning Resources. How can each theory, or combination of theories, guide the curriculum development process? A brief description of how learning theories guide curriculum development.
2. Identify your Course Project setting (Arizona State University) and provide a brief description of your team’s proposed curriculum or program (Doctor of Nursing Science (DNSc) programs).
3. Reflect on the curriculum or program that your team is developing for your Course Project. In addition, reflect on the learning needs and diverse learning styles of your students/staff/patients.
4. Select one learning theory that you could apply to your team’s curriculum or program. Consider how this learning theory could guide your team’s curriculum development process.
5. Explain how your selected theory applies to your team’s curriculum/program by sharing at least two authentic examples.
6. Access the “VARK: A Guide to Learning Styles” website, also found in this week’s Learning Resources (http://www.vark-learn.com/english/page.asp?p=questionnaire).Complete the learning styles assessment and review your scores and learning preferences. These results will assist you in your response post.

Communication Skills in Nursing | Reflection

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This essay will present a reflective account of communication skills in practice whist undertaking assessment and history taking of two Intensive Care patients with a similar condition. It will endeavour to explore all aspects of non verbal and verbal communication styles and reflect upon these areas using Gibbs reflective cycle (1988).

Scenario A –

Mrs James, 34, a passenger in a road traffic collision who was not wearing a seatbelt was thrown through the windscreen resulting in multiple facial wounds with extensive facial swelling which required her to be intubated and sedated. She currently has cervical spine immobilisation and is awaiting a secondary trauma CT. Mr James was also involved in the accident.

Scenario B –

Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and orientated but currently breathless and requiring high oxygen concentrations.

Patients who are admitted to Intensive Care are typically admitted due to serious ill health or trauma that may also have a potential to develop life threatening complications (Udwadia, 2005). These patients are usually unconscious, have limited movement and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invasive procedures for the purpose of monitoring and regulation of physiological functions. Having the ability to effectively communicate with patients, colleagues and their close relatives is a fundamental clinical skill in Intensive Care and central to a skilful nursing practice. Communication in Intensive Care is therefore of high importance (Elliot, 1999) to provide information and support to the critically ill patient in order to reduce their anxieties, stresses and preserve self identity, self esteem and reduce social isolation (João: 2009, Alasad: 2004, Newmarch:2006). Effective communication is the key to the collection of patient information, delivering quality of care and ensuring patient safety.

Gaining a patients history is one of the most important skills in medicine and is a foundation for both the diagnosis and patient – clinician relationship, and is increasingly being undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is crucial (Carr, 2005). Often the patient is transferred from a ward or department within the hospital where a comprehensive history has been taken with documentation of a full examination; investigations, working diagnosis and the appropriate treatment taken. However, the patient’s history may not have been collected on this admission if it was not appropriate to do so. Where available patients medical notes can provide essential information.

In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective communication is restricted and obtaining a comprehensive history would be inappropriate and almost certainly unsafe (Carr, 2005). The Nursing Midwifery Council promotes the importance of keeping clear and accurate records within the Code: Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). Therefore if taking a patients history is unsafe to do so, this required to be documented.

Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy person is taken for granted (Booker, 2004). In Scenario A, Mrs James’s arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has often been accompanied with other injuries such as traumatic brain injury and complications such as airway obstruction. This may have been caused by further swelling, bleeding or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. Within scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for over half of the thoracic injuries from non-penetrating trauma (Middleton, 2003). When ribs are fractured due to the nature and site of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is pain. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effectively. These combined increase the risk of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003). A key component of Intensive Care is to provide patients and relatives with effective communication at all times to ensure that a holistic nursing approach is achieved.

Intensive care nurses care for patients predominantly with respiratory failure and over the years have taken on an extended role. They are expected to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a physical assessment and collect the patients’ history in a systemic, professional and sensitive approach. Effective communication skills are one of the many essential skills involved in this role.

As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history taking process (Appendix A) and the physical assessment process. Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Council’s Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/Examination (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to blood cells and the oxygen cannot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid assessment, continuity of care and the reduction of errors.

Communication reflects our social world and helps us to construct it (Weinmann & Giles et al 1988). Communication of information, messages, opinions and thoughts are transferred by different forms. Basic communication is achieved by speaking, sign language, body language touch and eye contact, as technology has developed communication has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication: Verbal and non verbal.

Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, understood and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Baron:2005, Zastrow:2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and orientated and had some ability to communicate; he was breathless due to painful fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions can allow breathless patients to communicate without exerting themselves. Closed questions such as “is it painful when you breathe in?” or “is your breathing feeling worse?” can be answered with non verbal communication such as a shake or nod of the head. Taking a patients history in this way can be time consuming and it is essential that the clinician do not make assumptions on behalf of the patient (Ashworth, 1980). Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal communication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al:2000, Alasad:2004). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and crossed legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Although Mr. James could verbally communicate, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles.

A patient’s stay in Intensive Care can vary from days to months. Although this is a temporary situation and many patients will make a good recovery, the psychological impact may be longer lasting (MacAuley, 2010). When caring for the patient who may be unconscious or sedated and does not appear to be awake, hearing may be one of the last senses to fade when they become unconscious (Leigh, 2000). Sedation is used in Intensive Care units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony between the patient and ventilator. Poor sedation can lead to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. Over sedation can lead to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care delirium. Derlerium can be distressing for both the relatives andthe patient, who may have some recolection after the deleium epsiode (Mclafferty, 2007). Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation (Page, 2008). Within this stage of sedation or delirium it is impossible to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological status would unavoidably have an effect on Mrs James’s capacity to communicate in a usual way. It is therefore important to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch – when a patient is being moved, washed or having a dressing changed and secondly a caring touch – holding Mrs James hand to explain where she was and why she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of talking to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been (Baron, 2005). If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of communication process as the Intensive Care environment in itself can cause communication barriers. Intensive Care can be noisy environment (Newmarch, 2006). Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength (Newmarch, 2006). Weakness of patients can affect the movement of hands and arms making gestures and handwriting frustration and difficult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The University of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient – clinical and patient – relative communication in future care.

This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overall research (Alasad: 2004, Leigh: 2001, MacAuley, 2010: Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further education within Intensive Care may be required to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contributions that others offer, to improve patients care and the overall patient experience.

Appendix 1, The History Taking Process:

“The questions are the key to a good interview. You need to use a mix of “open ended questions” and “close

ended questions.” Open ended questions leave the door open for the patient to tell you more. Questions like

“when it this problem start?,” “have you had any recent health problems?,” and “can you show me where it

hurts?” are open ended. The patient feels free to provide additional information. While questions like “does

it hurt here?,” “did you have this pain yesterday?,” and “have you had the flu in the past month?” are close

ended. Close ended questions seek very specific, often yes or no responses from the patient and don’t

encourage the patient to provide any additional information. Good interviews are a mixture of both kinds of

questions.” (Secrest, 2009)

Basic Elements:

1. Greeting

a. Introduction

b. Identification of patient and self

c. Assessment of the patient’s overall appearance and demeanor

2. Personal history

a. Age

b. Occupation

c. Sex

d. Height / Weight

e. Marital / Family status

i. Children

3. Chief complaint (CC) or Presenting complaint

a. Why is the patient seeking care?

b. What other problems concern the patient?

4. History of present illness

a. Location and radiation of complaint

b. Severity of complaint

c. Timing of onset

d. Situation (setting) of onset

e. Duration of complaint

f. Previous similar complaints

g. Exacerbating and relieving factors

h. Associated symptoms

i. Patient’s explanation of complaint

5. Past medical history

a. Systematic questioning regarding previous adult illnesses

i. Neurological/Psychiatric

ii. Eye, ear, nose, throat

iii. Skin/Hair/Nails

iv. Musculoskeletal

v. Cardiovascular/Respiratory

vi. Genital-urinary

vii. GI tract

b. Childhood illnesses

c. Surgeries, injuries or hospital admissions

d. OB/GYM

i. Birth control

ii. Pregnancies / Births

iii. Menstrual periods

iv. Pelvic exams / Pap smears

e. Psychiatric

f. Immunizations

g. Screening tests

h. Allergies

6. Family history

a. Disease history

b. Parental health

c. Children’s health

7. Drug history

a. Current medications

i. Prescription

ii. Over-the-counter

b. Drug allergies

8. Lifestyle (social history)

a. Alcohol

b. Smoking

c. Recreational drug use

d. Sexual life style/orientation

e. Reproductive status

f. Occupational issues

(Secrest,2009)

Evidence-Based Practice in Nursing & Healthcare

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Evidence-Based Practice in Nursing & Healthcare.

Order Description
PLEASE SEE ORDER#81614184 that I have submitted to this writer ID 262229, this is a continuation of THAT same topic that you have CHOSEN and will continue to be throughout this course. I am requesting writer ID 262229 to work on this project throughout this course.

Module 2 OBJECTIVES:
At the end of this module, the student will
1). Continue to refine his or her clinical practice problem and research and research question.
2. Have begun tracking reviewed literature using an evidence table.
3. Assemble evidence resources into reference management software(such as Refworks or end notes).

READING ASSIGNMENT;
Module 2 in Black Board(I will upload)
Evidence-Based Practice in Nursing & Healthcare, second edition. Authors Bernadette Mazurek Melnyk and Ellen Fineout-Overholt. Read chapter 2,3

Health science literature review made easy. The matrix method 3rd edition. Author Garrard, J. (2010). Read Chapters 1-3.

Assignment:
Start working on your Problem Background Paper. Address each of the following points(use them as headings in your post be sure you address everything).

1. Your beginning problem background and question for investigation,
2. a beginning evidence table with articles supporting the problem(this can be attachment to your discussion posting)
3. a short discussion of conceptual models used in the studies,
4. your PICOT question(see rubic for the Problem Background Paper, which is due at the end of Module 3).
5. Discuss how your question evolved as you read using a concrete example of of your shift in thinking.

An advance directive is a legal document that defines a patient’s wishes for medical care.

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An advance directive is a legal document that defines a patient’s wishes for medical care.

Reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document.

Directions*** week 9 and 10 are separate assignments and each need their own reference list. At least 2 references requires for each week. APA format. No certain page requirement as long as it covers the topics

Week 9 Journal

An advance directive is a legal document that defines a patient’s wishes for medical care. This document is a way for patients to share their wishes with family members and health care providers when their illness or mental capacity prevents them from making decisions. As an advanced practice nurse who has care discussions with patients and their families, you need to not only be familiar with the process of completing an advance directive, but also understand how this document might impact your role in patient care and treatment.

Journal Entry Part 1

For the first part of your journal entry, reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document. (**I will message you the state i live in) Then, explain how your experience of completing your Five Wishes advance directive will help you guide discussions with patients and their families. Finally, explain how you might apply the Five Wishes advance directives to your nursing practice. Include how this advance directive might benefit patients in decision making for specialized areas of care.

Impact Of Family Presence During Cpr Nursing Essay

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Family presence during cardio pulmonary resuscitation is always a debatable issue among health care professionals. However, the family plays a very critical role in providing supportive care and has the most stakes in the patient’s survival, progress and outcome. This paper reviews the literature and highlights the benefits and consequences of the family presence during CPR.

Benefits of family presence during CPR includes, providing value to patient’s preference and dignity, supporting each other in the grieving process and reducing risks of medico legal divergence. On the other hand, consequences of family presence include neglect of patient’s right to autonomy, breach of confidentiality, emotional trauma to the family and possible law suits. Therefore we, as health care professionals, play a pivotal role in easing the patient’s distress by providing psychological support during CPR through family contribution.

Key words: Cardio pulmonary resuscitation, grieving, medico legal divergence, autonomy

Many years ago, mortality was a family unit matter, with family members providing emotional support to the dying person. Medical breakthroughs and technological advances like Cardio-Pulmonary Resuscitation (CPR) have made it possible to prolong a dying person’s life. Cardiopulmonary resuscitation (CPR) is an emergency procedure that is often employed after cardiac or respiratory arrest (1).

To avail this advance technology, families started transporting their loved ones more frequently to the hospitals with the desire of their survival. However, in the past, hospitals had adopted the practice of not allowing family members to witness the procedure of CPR, (3,12) despite the fact, that families play a very critical role in patients’ access to medical care in such emergencies. They are the one’s who serves the most in the patient’s survival, progress and outcome (10). The practice of family presence during CPR first emerged in the 1980s from the Foote Hospital in the United States, and since then the concept has gained momentum (2). The presence of patient’s immediate family member during CPR is an ethical, moral, and legal dilemma among healthcare professionals (2,10). This paper will highlight the benefits and the consequences of the family’s presence during CPR.

Benefits of family presence during CPR include, providing value to patient’s preference and dignity, supporting family in the grieving process and reducing risks of medico legal divergence (2) . Most of the patients prefer presence of family members when they are in distress. As Meyers, Eichhorn, Guzzetta and Klein (2000) have emphasized that if patients were provided opportunity to decide the presences of their family members, when they are struggling to survive, they will accept it (3). So loved ones, who were always the source of happiness and strength, need to be present when the patient require them the most; the patient may feel secure and less frightened with their family’s presence. It is estimated that only 10% to 15% of patients who receive CPR in the hospital survive and get discharged (2). Therefore, because of the high mortality rate and patients’ desire to be close to their family at the moment of death, it is the ethical and moral responsibility of the health care provider, to work as an advocate for patients’ dignity by allowing family during CPR. As Snoby (2005) found that “60% to 80% of the public believe that family members should be permitted to be with their loved one during resuscitation”(4).

Family presence during CPR facilitates family in the grieving process (10,12 ) and helps to meet their emotional and psychological needs. While working in an emergency department of a private tertiary care hospital, one of the authors (of this article) primary author of this manuscript came across a patient’s family who were provided the opportunity to be with the patient during CPR. The family members later expressed that it allowed them the possibility for closure and gave them a chance to say goodbye to their loved one . Family members who were at the bedside during CPR process expressed that their presence had helped them to face the reality of the situation and also facilitated in their grieving process. (5,12). Hanson and Strawser (1992), referring to his study, stated that “76% believed their adjustment to the death of their love one and 64% believed their presence was beneficial to the dying person”(1). Thus, family presence during CPR facilitates grieving with subsequent death and therefore,the health team should support family presence during CPR.

In addition, family presence during CPR may alleviate the uncertainty which may lead to possible lawsuits. Beside this argument, family presence during CPR enhances communication which facilitates the understanding between the medical staff and the family. A study conducted at the Parkland Health and Hospital system reveals that 95% of the family members who were present during resuscitation, verbalized that it helped them to understand the patient’s grave condition and efforts that were made by health care team members to save the life of their loved ones(3). Hence, family presence eliminates uncertainties about the procedure and efforts made for patient survival.

On the contrary, consequences of family presence may present certain issues such neglect of patient’s right of autonomy, breach of confidentiality (10), emotional trauma to the family and possible law suits. (21, 9,10)). Several healthcare professionals views that by allowing the family to be present during resuscitation, violation of the patients’ rights to autonomy and disregard to his/her confidentiality. Allowing immediate family without patient’s consent contravenes his or her autonomy, privacy and confidentiality. Often exposing patient in front of family members may also cause discomfort for the survivors of CPR. As Nibert declares that some patients choose to face death alone and do not allow their relatives to invade their privacy(6).

It is also argued in literature that relatives should not be present at resuscitation as it creates more psychological difficulties throughout their bereavement (11). It might be challenging for the family members to deal with the memories of blood loss, needles, body fluids, intubation process, chest compressions and defibrillation procedures performed on their loved one. Many people are sensitive to see their dear ones in distress; therefore it has been observed that the family becomes emotionally traumatized during CPR. As Morse and Pooler allege that family members who remain with the patient have crumpled during relatively minor procedures, and were required to seek medical assistance and care for themselves (7). In one CPR procedure performed at a hospital, one of the authors of this manuscript experienced the distress of a family member. The brother of the patient had chosen to be present and was allowed to do so. During the procedure the brother broke out in tears and left the room. Later he reported that he could not bear to see his brother suffering.

It has also been asserted that the presence of family member during CPR may lead to lawsuits. Hospital management may have fears that family members can notice errors and take them to the court. As Rattrie pointed out that, ” The nurses and health professional are at risk of legal claim for the compensation of negligence (8). This argument leads to the major concern for the health care professionals for continuation of their profession and their career growth. Fear may be due to lack of confidence or lack of skills of the health team members in the CPR procedure (2).

Health teams may not prefer presence of family members as they could interrupt the procedure (11) by asking either to prolong or to discontinue prematurely. Similarly, medical staff may feel that family presence and their emotional reactions can cause constraints during the CPR procedure. Furthermore, considering the poor understanding of the CPR procedure by untrained family members who may consider it an offence, the resuscitation team may end up with an argument by the family during the procedure (10).

In one CPR procedure in a private tertiary care hospital, it was experienced by one of the author (of this article), that a parent requested doctors to stop CPR on their 12 year old chronically ill child. In contrast, it is also observed by another author (of this article) that the family insisted to prolong CPR even though the patient was clinically dead.

In conclusion, we, as health care professionals, are at prime position to ease patient’s distress by providing psychological support during CPR through family contribution. However their presence during the procedure remains debatable. The health care team has an ethical and moral accountability to provide liberty for family presence during CPR, rather than considering health care professionals comfort, preference (6) and fears. Further studies on the experiences of the survivors of the CPR and their family can give further insight to the phenomenon. Development of comprehensive guideline, based on such experiences and expert opinions, can facilitates the decision making and support the needs of patients’ family members and health professionals in this critical time (10) This may produce a more integrated and consistent approach to this sensitive aspect of clinical practice.(10)

One of the hardest parts of nursing is having to deal with the death of a patient.Explain

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One of the hardest parts of nursing is having to deal with the death of a patient.Explain

According to Sharon, one of the hardest parts of nursing is having to deal with the death of a patient. “Someone goes into cardiac arrest and you do not know if they are going to live or die. If you ever get to the point where this does not bother you, it is time to change professions”

Factors leading to Frequent Readmission Rate in Impatient Psychiatric Wards in the UK

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Title:

Factors leading to Frequent Readmission Rate in Impatient Psychiatric Wards in the UK –  A Narrative Review of Literature


Review Question:

What factors lead to Frequent Readmission Rate in Impatient Psychiatric wards in the UK.


Introduction and Aim of




the Review

The emphasis of shifting care and support of mental health patients from psychiatric institutions into community based settings has been the focus of  the UK government in recent times. The problem of frequent psychiatric readmission rate or the ‘revolving door’ phenomenon poses significant challenges to the implementation of the psychiatric deinstitutionalization policy,  (Langdon  et a., 2001).

The aim of this narrative literature review is to gather, synthesize and analyse existing literature to find out the factors that lead to frequent  psychiatric readmission rate in the UK. This would help to guide service redesign and development work, as well as stimulate further research and highlight gaps in the literature dedicated to this area. The literature is going to be criticised using the Critical Appraisal Skills Programme (CASP), (CASP, 2018). In line with the Nursing and Midwifery Council code of conduct, Confidentiality about the research participants will be maintained throughout this literature review, (Nursing & Midwifery Council (NMC), 2015).



Ethical Statement

In reviewing the literature, the author has ensured the literature review is unique and no existing literature is copied. The literature used in this review, has been  treated accurately and fairly. The authors of the literature used were not contacted because their literature is already in the public domain. Furthermore, the narrative literature review does not intend to raise any ethical issues or cause harm to any person.


Problem, Context and Background

The UK government has placed much emphasis on psychiatric deinstitutionalization, that is moving care and support to the community. However, the problem of frequent psychiatric readmission poses a significant challenge, as it exposes the fragility of the network of mental health services in the UK, (Langdon  et a., 2001). The implication of frequent psychiatric readmission is that, although patients are not permanently hospitalized, they have developed chronic mental health illnesses which are severe and persistent, these illnesses usually interferes with their interpersonal relationships and social skills which expose them to frequent psychiatric readmissions. The phenomenon of frequent rehospitalisation typifies a new form of  psychiatric institutionalisation. Furthermore, the phenomenon of frequent psychiatric readmissions highlights the limitations of the mental health services network. Even though, currently the mental health services in the UK are undergoing changes, they still bear features of the old models, practices and problems which are yet to be overcome. There has been specific interventions and community based care approaches aimed at reducing the rate of readmissions, (Vigod et al. 2013), thus gaining an understanding of the factors associated with frequent readmission  would help to guide service redesign and development work as well as stimulate further research.



Methodology



Search Strategy and Key Words

The literature search was conducted using Boolean search of the Discover Database. The Discover database was chosen because it has an extensive list of peer reviewed journal articles in subjects of nursing, health, medicine and psychiatry.

Considering the coverage and relevance of the literature review, a Boolean search was conducted using different combinations of Descriptors (DeCS) based on the review question, such as: readmission and mental disorders, readmission and mental health, readmission and psychiatric hospital, recall and mental health,  recall and psychiatric hospital, recall and mental disorder, rehospitalisation and mental health. rehospitalisation and psychiatric hospital, rehospitalization and mental disorder.


Inclusion and Exclusion Criteria

The search was further narrow down using an inclusion and exclusion parameters as describe below. The inclusion criteria were:

(1)articles that addressed the factors associated with psychiatric readmission, as well as studies that evaluated effectiveness of psychiatric patients transitions from in-patient to community care and readmission (2) articles written in English, (3) articles published between January 2009 and January 2019; and (4) articles that presented primary research results or studies; (5) articles mainly on studies from UK and Ireland.

The following exclusion criteria were also established:

(1) articles in the format of a dissertation, thesis, book, book chapter, editorial, comment or critique, proceedings and scientific reports; (2) review or reflective articles on readmission in general terms, that is, not exclusive to psychiatry; (3) articles about psychiatric readmission, which dealt exclusively with children and adolescents; (5) articles that considered only long-term hospitalized patients.

Finally, the author read through the abstracts of the articles that met the inclusion criteria , reviewed and appraised them and 7 of the most suitable articles from the search were selected and gained approval to be used in the literature review.


Data Extraction

Information in the selected articles was analysed, summarised and extracted to a Datasheet to aid the literature review process. The datasheet with the summarised information has the following Headings;

Article (Full reference), Geography, Number of participants, Study Method, Summary of the findings, Conclusions, (See Appendix 2)




Keywords:

Readmission, Readmitted, Recall, Rehospitalisation, Mental Health Hospital, Psychiatric  Hospital,


Literature




Review



Description of studies


The articles selected for the review includes a mixture of both qualitative and quantitative research studies. From the seven articles selected, 4 articles used quantitative method to carry out their research studies (Tulloch et al. 2015; Puntis et al. 2016; Stefan et al. 2009; Attfield et al. 2017) and 2 articles used qualitative design in their research studies, (Daly et al. 2017;  Chiringa et al. 2014). One article used both qualitative and quantitative design in their approach, (O‘Donoghue et al. 2011).


Broadly speaking, research methods are split into quantitative and qualitative research.  Ellis (2013), explained that quantitative research mainly aims to explain phenomena by collecting numerical data that are analysed using mathematically and statistical based methods. Quantitative research studies focus on proof, and cause and effect and the findings are presented in numbers, tables and graphs. Four of the selected articles (Tulloch et al. 2015; Puntis et al. 2016; Stefan et al. 2009; Attfield et al. 2017) employed the quantitative approach.  On the other hand, Ellis (2013) stated that qualitative research focuses on trying to answer questions about why and how people behave in a certain way. It provides in-depth information about human behaviour and phenomenon, two of the selected articles took this approach, (Daly et al. 2017;  Chiringa et al. 2014). In comparison to quantitative research, qualitative research looks to study what people think, believe, feel and understand. Unlike quantitative research, it is not concerned about proving concepts. The greater percentage of the studies took the quantitative methodology, they intended to find out the causes or factors that leads to frequent psychiatric readmissions. Equally, the other studies which took the qualitative approach was able to not only ascertain the causes of psychiatric readmission but also ascertain the views and feelings of patients who have been previously readmitted.


Reporting the Findings

Three main themes were identified from reviewing the literature articles. The three themes that were identified were, Clinical factors and readmission, Demographic and Socio-Economic factors  and readmission, Continuity of care and readmission

.

The select literature are going to be reviewed using these themes.



Clinical factors and readmission

The  study established that, a patient mental illness diagnosis is a predicting factor the chances of readmission, The literature studies confirmed that after discharge the chances of readmission goes down quickly, depending on the type of diagnosis. For instance, Tulloch et al. (2015), reported that patients diagnosed with personality disorder are more likely to be readmitted compared to patient with schizophrenia at the time of discharge.

Specifically, the studies pointed out that only a diagnosis of personality disorder had a negative correlation with frequent readmission shortly after discharge, in that patient diagnosed with personality disorder have an increased psychiatric readmission rate compared to patients diagnosed with other mental health disorders shortly after discharge. In line with other research, largely the studies found out that, there is a modest-sized effect of diagnosis on readmission except the diagnosis of personality disorder. However, It was noted form the studies that, although the diagnosis of personality disorder might be a predicting factor for frequent readmission, it is likely that other underlying clinical influences operate before and after discharge which are not measured for this high risk patient group. For instance, most patients diagnosed with personality disorder are known to  express a lower satisfaction level with hospital care with their first admission and have more chances of being readmitted within 1 year after discharge. Also, non-compliance with prescribed medication leads to increased likelihood of readmission irrespective of the type of diagnosis,  (Rittmannsberger et al, 2004)


Demographic and Socio-Economic factors,




and readmission

The importance of social systems (i.e. family, friends, neighbours) as a contributory factor for readmission was strongly highlighted by three studies (Daly et al. 2017; Priebe et al. 2009; O‘Donoghue et al. 2011), and this seems to reflect wider research in this area. The Silva et al. (2009) study for example, stress the need for stronger community psycho-social support services in helping prevent multiple psychiatric readmissions. Additionally, the findings are in line with other studies that have shown that there is a negative correlation between socioeconomic deprivation and readmissions. For instance,  Cotton et al. (2007) found the strongest and most consistent reason for psychiatric readmissions to be social and economic factors. For instance, patients who find it difficult to manage their own home, finances, and are on benefit, most times indicating poor socio-economic status have higher psychiatric readmission rate, (Daly et al. (2017, Priebe et al. 2009).

A demographic factor found in the study that was significantly associated with frequent psychiatric readmissions was people who are from black ethnic background. The study, by Priebe et al (2009), reported that patients of Black African or Black African–Caribbean origin have a higher rate of readmission within a year after discharge than patients of White origin. This may be the case, because of the of socio-economic factors (i.e. being on welfare benefits, lack of family support) which might predispose patient from black African/Caribbean ethnicity to difficulties after discharge, and the subsequent risk of higher readmission rates. This stress the importance of designing social support and inclusion programmes aim at helping patients with mental disorders to not rely on benefits but helped to gain employable skills to mitigate some of the socio-economic factors that predispose them to frequent psychiatric readmissions, (Priebe et al., 2009).



Continuity of care and readmission

Lack of support after discharge into the community has been identified as a significant factor. Three studies (Daly et al. 2017; Puntis et al. 2016; Chiringa et al. 2014), established that, when patients receive efficient and effective support (i.e. medication management, someone to talk to about problems and support to access local community services) from the  Community Mental Health Team (CMHT), frequent readmission is reduced. In Chiringa et al. (2014) article, most of the participants who live in supported accommodation or hostels, stated that, the aftercare support they receive is very poor and ineffective and this leads to frequent readmissions. Also, the studies reported that lack of engagement from the CMHT and other services in informing patient about their care and support available leads to frequent readmission as they are not able to relate with the services and the CMHT when help is needed.

The practice of making available to patient relevant copies of clinical letters and documents can greatly  reduce the likelihood of early readmission. Most patients want information about, their treatment, lack of communication and miscommunication were cited by most studies (Daly et al. 2017; Puntis et al. 2016; Chiringa et al. 2014) as  a contributing factor for frequent recall or readmission.

However, the common perceived assumption that more frequent face-to-face contact would lead to less readmission was in contrast to the findings of the study (Puntis et al. 2016. When readmission and continuity of care was first debated in psychiatry, the consensus was that more frequent and consistent patient face to face contact would result in less readmissions, but the findings from the literature (Puntis et al. (2016) contradicts this commonly held view. This shows that, the evidence for associations between frequent readmission and continuity of care in psychiatry remains limited and requires more research. It was also established in the review that frequent changes in care coordinator leads to frequent readmission rate (Puntis et al. 2016).

Overall, the studies included in the literature review featured a total of 10.296 participants and the sample size range from 7891 to 6 participants (Tulloch et al. 2015; Chiringa et al. 2014). The sample size is very important in research studies as it has an influence on the reliability of the study. For instance,  Tulloch et al. (2015), has a sample size of 7891, thus it could be assumed to be the most reliable study among the selected literature articles. On the other hand, Chiringa et al. (2014), has a total of 6 participants, being the smallest sample size, thus its reliability might be questioned as it might excessively represent a small sub-group from the target population which  could increase the probability of sampling error. However, because it is a qualitative study, it has the advantage of gathering in-depth information on a particular subject and reporting of the findings can be detailed and extensive compare to a small sample size in a quantitative studies. Thus, from the literature articles selected, those with quantitative and qualitative methodology can equally be said to have a high reliability.

Furthermore, the selection methodology of some of the articles (Attfield et al. 2017; Puntis et al. 2016)  are randomised control trials which has an advantage of eliminating selection bias and can be effective in making causal inferences, for instance finding the causes of frequent psychiatric readmission rate. However, in randomised trials informed consent is often impossible to get, and this might raise ethical questions. Also, randomised trials which test for effectiveness might be too large and more expensive to run compare to convenience sampling. On the other hand, a couple of the studies (Chiringa et al. 2014; O‘Donoghue et al. 2011) use convenience or non-probability  sampling which are mainly made of participants who are easy to reach. An advantage of convenience sampling is, it can be conducted easily with much rules governing the sampling or selection process, the cost and time required to carry out a convenience sample is minimal in comparison to random sampling techniques. This allows you to achieve the sample size you want faster and in relatively easy way.  For instance, (Chiringa et al. 2014; O‘Donoghue et al. 2011) research studies would be easy and less costly to conduct, compared to ((Attfield et al. 2017; Puntis et al. 2016) research studies which employed randomised trails,  but both provide useful information in finding out factors that lead to psychiatric readmission. The use of convenience sample may help in collecting useful  information in  a way that might not be possible using random sampling techniques, which may require a formal access to lists of populations. However, convenience sample often suffers from bias. Since the sampling frame is known, and the sample is not chosen at random, it might not be a representative of the entire population being studied. This undermines the ability to make generalisations from the sample to the population that is being studied.

All the studies were conducted in the UK (Tulloch et al. 2015; Puntis et al. 2016; Stefan et al.2009; Attfield et al. 2017; Daly et al. 2017;  Chiringa et al. 2014), with the exception of one study (O‘Donoghue et al. 2011) that was conducted in Ireland. The advantage of this is that, the results can be applied to the UK in helping to find out factors that contribute to frequent  psychiatric readmission in UK. However, the generalisation is decrease in its application to other countries outside UK and also useful information from countries outside UK  which might contribute to knowledge and development are missed. All the same, the study (O‘Donoghue et al. 2011) from Ireland serve to help to make comparison with the UK to gain useful information and facts  to guide service redesign and development work, as well as stimulate further research.


Discussions

It is evident from the literature review  that among the many factors that leads to frequent psychiatric readmission,  clinical, demographic and socio-economic factors as well as efficient and effective continuity of care are the main contributory factors. Both demographic and clinical factors have been demonstrated to be the high risk characteristics in readmission rates in the UK. For instance,  in the UK, mental health patients of African or Caribbean origin are at higher risk of involuntary readmission (Priebe et al., 2009)  and this is mainly due to their socio-economic predispositions. The Silva et al. (2009) study for example, underscore the importance of  providing community psycho-social support services for people with mental health disorders  to reduce frequent psychiatric readmissions. The review established that, although diagnosis is a predictable factor of frequent readmission, notably, only personality disorder was significantly associated with increased readmission, all other mental health diagnosis has modest-sized effect on the rate of readmission (Martinez-Ortega et al., 2012). Furthermore, the literature review illustrates that psychiatric readmission is not only a reflection of the quality of inpatient care but also the continuity of care in the community (Vigod et al., 2013). Effective and efficient support and care in the community reduces frequent readmission. However, it was apparent from the literature review that more frequent face-to-face patient contact does not necessary lead to less readmission and this is at odds with popular held consensus that frequent face to face patient contact reduces psychiatric readmissions. This implies that evidence for associations between continuity of care and readmission remains limited. Furthermore, the literature review suggested that effective continuity of care should include better communication between the CMHT and patients, better support and improvements in the standards of care and a collaborative approach to risk assessment, these would go a long way in reducing the frequency of psychiatric readmission.


Conclusion

The literature review intended to find out the factors that lead to frequent psychiatric readmission or the ‘revolving door’ phenomenon to guide service redesign and development and to stimulate further research.  From the articles reviewed in this narrative literature review, it is evident that the aim of this narrative review has been met with better understanding  of the factors that leads to frequent psychiatric readmission. The correlation between demographic and socio-economic  factors and frequent psychiatric readmission were clearly identified to help inform knowledge and help in future service design and development. Also, the gap in knowledge on continuity of care in relationship to frequent psychiatric was highlighted to pave way for further research as well as recommendation were made for effective aftercare support from the CMHT to help reduce frequent psychiatric readmission.