You have $700 million in expenses and only $500 million to work with. How do allocate your resources? Who gets treated and who has to wait?

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You have $700 million in expenses and only $500 million to work with. How do allocate your resources? Who gets treated and who has to wait?

 

Question description
Work through the simulation titled Resource Allocation from the end of Chapter 8 of your course text. Review the various options in the simulation, then select “Your Own Option” to type out your own solution to the scenario. You will need to copy and paste your response from “Your Own Option” into the discussion board forum as it will not be transferred otherwise. Here is a brief synopsis of the simulation regarding the hospital’s budget and dilemma:

Hospital costs in millions for one year:

One 35-year-old cancer patient who needs significant time with the doctor, medical supplies, tests, and around the clock care. Cost: 100
Emergency Room operations for daily care and treatment of about 100 people (~365,000/year). Cost: 100
2 Senior Patients who need hip replacement surgery. Cost: 50
10 patients (ranging in age from 18 to 45) receiving assistance in your inpatient drug/alcohol rehab unit. Cost:100
An MRI unit that is on the fritz and could die any day. Replacement Cost: 170
One of your two X-ray machines is inoperable and must be replaced. Cost 100
Ambulance drive-in area was damaged and needs to be repaired. Cost: 25
Training needs for nursing staff for certification requirements. Cost: 55

TOTAL: $700 million

For this discussion, address the following:
You have $700 million in expenses and only $500 million to work with. How do allocate your resources?
Who gets treated and who has to wait?
What about your facilities?
Determine what you plan to do and explain your reasoning as well as the ethical considerations behind your decision.

Your initial response must be at least 250 words and must use at least two scholarly sources.
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Service Learning Experience Custom Essay

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Service Learning Experience Custom Essay

Service Learning Experience

My service learning experience was located at Memorial Hospital on the Cardiac floor. This experience brought a brightened confidence accompanied by a welcomed knowledge of the field of nursing and the people I will be facing on a daily basis as a nurse. I grasped the importance of helping those in need and a respect grew for the medical staffs that were there to help. The times that I’ve spent there, was taking care of the older adult population; assisting them to the bathroom, straighten up their room, giving them ice when needed and especially answering their call lights. This was a time where nurses had the opportunity to chart on their patients and their workload became a bit less. In addition, I noticed many things with the older adults; they appreciated someone just spending time with them and I enjoyed making them smile, and the stories they had to offer behind those smiles

Prevention Suicide People Mental Health Health And Social Care Essay

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Suicide is defined as the process involving one ending his/her own life. There are various types of suicide which can make it rather difficult to help define the term. Traditional suicide is referred to those individuals who plan or act upon self-destructive thoughts and feelings whilst under immense stress. Assisted suicide is another term where a physician may help a terminally ill person to die, avoiding an imminent, inevitable and potentially painful decline.

The World Health Organisation (WHO) defines mental health as a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community (Organization, http://www.who.int/mediacentre/factsheets/fs220/en/, 2010).

The rate of suicide in the UK is continuing to fall where figures reached their lowest in 2007 for both men and women. Suicide rates in 2008 were slightly higher than those seen in 2007 where 5,706 suicides were recorded however in 2009 there was a slight decrease were 5,675 suicides were recorded in the UK (Statistics O. f., Suicide rates in the United Kingdom, 2011).

Although suicide rates are seen as rather low when compared to the early years such as the period between 1990- 2000, there is still a major concern in the number of suicides committed each year.

The prevalence of suicide in the UK is still rather high and remains a major concern due to the number of people going to hospital after having attempted suicide.

The rate of men committing suicide is estimated to be about three quarters of the men in the UK, where men aged 25-34 are at highest risk of suicide, followed by men aged 35-44. Suicide is considered as the second most frequent cause of death within men aged between 15-44, after accidental death (NHS Choices , 2009).

Suicide and young people is also common within people aged 15-24, where accidental death is generally the cause of death followed by suicide. Figures state about 7-14% of young people will self-harm at one point in their life (NHS Choices , 2009).

Suicide is major problem when it comes to the elderly because figures in 2006 showed that 217 people aged 80 or over took their own lives which equated to 5.2% of overall deaths from suicides (NHS Choices , 2009).

Comparing the suicide rates in 2008 between men and women, there were 17.7 suicides per 100,000 population in men and 5.4 per 100,000 in women, thus showing men were three times more likely to commit suicide than women (Statistics O. f., Suicide rates in the United Kingdom, 2010).

Statistics are currently as they stand where women are less likely to commit suicide than men, as women are more likely to report symptoms of common mental health problems instead of men therefore they receive appropriate treatment be it drugs and/or therapy (Statistics N. , 2003).

Possible risk factors for suicide:

A previous attempt at suicide

Possible exposure to suicidal behaviour of others (friends, family or media figures)

Family history of suicide

Family history of substance abuse

Substance abuse

Incarceration

Violence within the household (physical or sexual)

Family history of mental disorder

Depression or other mental disorders

When dealing with suicide many individuals who have lost a loved one sometimes wonder if they could have possibly prevented it or some individuals may even blame themselves for the main cause of suicide in others. Therefore this self blaming may lead to behavioural changes which could represent itself as a decrease in the person’s ability to express emotions. Those who experience grieving go through a series of emotions which could render them rather emotionally unstable, those who do experience these emotions sometimes become fixated upon the fact that they may be involved in the death in some manner thus feeling suicide may be the only option to make up for what they believe is all their fault.

Observing suicide rates and the possible risk factors behind suicide, research has shown that majority of people who do commit suicide or attempt to commit suicide actually do have a mental illness where the common cause is depression. Following depression, 10-15% of people affected by bipolar disorder will commit suicide followed by 4% of people with schizophrenia committing suicide soon after their illness begins (NHS Choices , 2009).

The most common types of mental health problems currently in the UK are: (Organization, mhGAP Intervention Guide, 2010)

Anxiety

Mood disorders

Eating disorders

Psychotic disorders

Impulse control and addiction disorders

Mental illness has shown to play a crucial role and is possibly the main precipitating factor in preventing suicides. Research studies (stated earlier) have shown to form a relationship between suicide rates and mental disorders which leads to suggest that if the appropriate help and support is provided to those with mental illnesses then possible there could be a decline or prevention in the number of suicides seen each year.

Depression is the leading cause of suicide in people with mental health problems thus people in this mind of frame are usually of low mood and may occasionally have thoughts of suicide.

Therefore if we treat the mental disorder then it can stand to reason that thoughts of suicide may also disappear.

Preventing suicide isn’t simple and people who do experience episodes of depression or reoccurring thoughts of suicide should be dealt with efficiently and as soon as possible to prevent harm to them but also to others. It is important to emphasise that people are reminded that help is always available wherever and whenever they need it and many health care professional such as GPs or Pharmacists are there at their disposal.

Although GP’s and Pharmacists are qualified health care professionals they still may not be fully competent in providing advice in situations involving people with mental health disorders. Practitioners that are unsure whether an individual actually is mentally ill and may also be suicidal can still play a part by providing help and support and referring them to more qualified personal for diagnosis.

Suicide prevention can be carried out through many procedures such as using drugs (antidepressants) or talking therapies (counselling or cognitive behavioural therapy).

Those who are described as having a mental disorder, have the hidden burden of stigma and discrimination often faced by those with mental disorders. The term mental illness can be rather misleading as although these problems can arise from biological or medical contributions they can also result from a series of complex interactions of biological, psychological or social factors. Also many illnesses experienced by individuals may differ slightly from normal categories used to describe mental illnesses therefore sometimes a true diagnosis cannot be determined or may be misleading.

Furthermore, when diagnosing people as having a mental health problem there is no universal agreed cut off point between normal behaviour and that which is associated with mental illness. Therefore if it is hard to diagnose people with a mental illness then it does also make it rather difficult to prevent suicides from occurring aswell (foundation, 2010).

Mental illness can lead to improper thoughts such as suicide as many individuals may feel it’s not worth living if they have to go through feelings which make their quality of life rather unsatisfactory. Measures which can be taken to help fight such thoughts and help cope with feelings of sadness, loneliness or just general low self of esteem can involve:

Focusing on certain things which help shift your mind from negative thoughts such as socialising with people who you generally have fun with, spoiling yourself with new cloths/food, or doing deep breathing exercises.

Stimulating the mind and body through performing light exercises, going for a walk outside of the house to get some fresh air and to get a change of atmosphere, planning the day to ensure productivity and try to maintain your usual sleeping pattern.

Avoid depressants such as alcohol or illegal drugs which may feel beneficial at first but long term effects can cause depression and sometimes anxiety, furthermore you may make decisions that you normally would regard as dangerous/pointless.

Socialising to stay connected to the world can help prevent feelings of entrapment, also talking to people about any feelings you may be experiencing can help and spending time with friends to fight against loneliness.

Focusing on positive things in your life rather than regretting what could or should have been.

Go to support/self-help groups and share similar experiences with people in the same situation as yourself and see how they manage their day.

Comparing the likelihood of who is more likely to develop mental health problems, it was reported that women receive more treatment for mental health problems than men, however studies determined this was mainly due to women being more likely to report their symptoms rather than suffer in silence which many men tend do.

Depression is also thought to play a vital role in the development of suicide, where 1 in 4 women will require treatment for depression, whereas only 1 in 10 men will require treatment. Diagnosing depression in men and women is somewhat a difficult process and can sometimes be under diagnosed because they may present to their GP with different symptoms or possibly due to social or biological factors, thus possibly showing men more likely to become diagnosed with depression.

A common mental health problem that also occurs more in women than men is anxiety, obsessive compulsive disorder and increased chances of developing phobias. On the other hand, men are more likely to develop an alcohol or drug addiction compared to women.

It is also thought that mental health problems may be greater in minority ethnic groups than in the white population; however they are less likely to be diagnosed by the GP.

Although it is not clear to what extent mental health care and primary care providers can prevent suicide in those individuals who die due to their mental health problem(s) it is believed they can play a significant role in the prevention. Also for those who do make contact with mental health care providers, majority of these people are adults thus suggesting the youth segment may need to be targeted more to ensure everything was done to prevent their death.

When we look at prevention techniques to minimise or even deplete the frequency of suicides committed by those individuals who are not thinking clearly or those with mental health problems, we firstly think what can be done to reduce the chances of this person committing suicide, and then hopefully aiming to remove all thoughts about suicide and what he or she hopes to achieve by carrying out this act.

Mental health professionals as stated early can play a crucial role in preventing suicide through the means of providing support and help whenever the person may require it, be it day or night. The term health professional is rather a vague term which can be used to describe a broad range of qualified group of individuals each trained in their specific field to offer their unique services to ensure the can do their role in the prevention of suicide.

Many people with mental health problems who think suicide is the only way they will be free from what they may be going through, can be treated not only through the means of supplying various drugs to manage their condition but also by using techniques which provide support to those who may need it the most.

There are many mental health professionals which can provide their services to help those which are not in the correct state of mind by making sure to identify the most suitable plan of action which will be of benefit to the patient, which could entail recommending patients to other mental health professionals (such as a GP recommending a patient to see psychotherapist) to ensure their needs are fully met and overall to ensure the most beneficial therapy or treatment has been considered.

Mental health professionals: (care, 2010)

General Practitioners

Psychiatrists

Clinical psychologists

Nurses in psychiatric hospitals

Community psychiatric nurses

Keyworkers

Occupational therapists (OTs)

Social workers

Support workers

Community support workers

Psychotherapists

Counsellors

Befrienders

Carrying out a history of past suicide attempts is one of the most accurate predictors of possible future risk attempts. It has been estimated that about 10-15% of people who make contact with a healthcare service due to a first suicide attempt eventually die by suicide, the risk being greatest during the first year after an attempt.

The White Paper The Health of the Nation (1992) outlined the health strategy for England, and recognised mental health as one of the five main areas in which targets were set for ensuring improvements in people’s health. The aims/targets focused on decreasing the total rate of suicide by at about 15% by 2000 and declining suicides of people with severe mental disorders by at least 33%.

Those people, who have previously attempted to commit suicide, are mainly at risk as they are more likely to repeat their actions until they are successful. Furthermore a good indicator could be those who have a history of suicide attempts within the family. Suicidal thoughts do play any important part in depression and those individuals who have symptoms of depression are therefore more likely to be at risk, in particular if they express a sense of despair about the future or see no point in life.

Research studies have shown good indication that both people with mental illnesses and some people with medical disorders, for example heart disease and cancer, are associated with an increased risk of suicide. Functional mental disorders such as depression and bipolar disorders are associated with the highest risk overall; substance misuse and organic disorders are associated with a lesser degree of risk. On average, people with reoccurring depression have a 15-20% increased risk of suicide; people living with schizophrenia have a 10-15% increased risk. These figures may be rough estimates but, as many who die by suicide may have been experiencing undiagnosed depressive illness.

The most common mental illnesses which cause suicide are depression and schizophrenia where in depression the mental health foundation estimates that about 70% of suicides are due to those in a depressive state (Foundation, 1997).

Depression is known to result in suicidal thoughts and indeed suicidal ideation is an important element in the diagnosis of depression. There is link made where the risk of committing suicide does increase with deeper the depression. However suicidal rates do increase when a individual comes out of a depressive state and energy levels and motivation become greater.

Schizophrenia was the also one of the most leading causes of death a study which was shown by the World Health Organization (WHO). Depression is generally the main factor leading to suicide in schizophrenia; however it is the hopelessness about ones future that actually leads to suicide.

Therefore certain strategies to help prevent suicides in people with mental health problems can involve: (Health D. o., 2002)

Using a Care Programme Approach for those who have severe mental illnesses and a history of self-harm

Have local arrangements for information sharing between criminal justice agencies

Carry out follow-up sessions within a week of discharge for people with severe mental illnesses or a known history of self-harm

Use of atypical antipsychotic medication to be made available for all patients with severe mental illness who are non-compliant with ‘typical’ drugs due to side effects

Promotion of access to services for people in crisis and their families

Adequate staff training in the management of risk, every three years

Prompt access to services for people in crisis and their families

Strategies for dual diagnosis entailing management of substance misuse services

Specialised care plans specifying actions to take if a patient is non-compliant or fails to attend

Assertive outreach teams to prevent loss of contact with vulnerable and high-risk patients

The prevention of suicide in patients with mental health problems is not an easy task, as we have seen there is no single route to achieving these targets for reducing deaths by suicide, since the factors associated with suicide are many and varied.

Explain potential implications of ambiguity in terminology, such as “likely” or “probably,” in investigative settings.

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Explain potential implications of ambiguity in terminology, such as “likely” or “probably,” in investigative settings.

 

Forensic Psychology and Criminal Investigation
PART 1 –
Likelihood of Inferences Made Based on Phrasing
When words are spoken, written biases, heuristics, and tendencies are introduced. In this Discussion, you analyse perceptions of probability or certainty based on the phrasing utilised in conveying messages. For this Discussion, select one of the following pairs of statements and rate the likelihood that each of the events will occur in the form of a percentage (0 will not occur; 100 will definitely occur):
Statements
Pair 1
• It is likely that a hurricane will strike the Caribbean this summer.
• It is likely that a hurricane will strike mainland Europe this winter.
Pair 2
• It is possible that the offender will kill another victim.
• It is possible that the offender will return to the crime scene.
Label your essay with the name of the pair of statements you selected.
Questions:
1. State the pair of statements you selected with the corresponding percentage you assigned to each.
2. Explain your rationale for the percentages you provided.
3. Finally, explain potential implications of ambiguity in terminology, such as “likely” or “probably,” in investigative settings.

Make sure you support your response with references to the literature and Learning Resources.

PART 2 – 750 WORDS
Strength of BIAs’ Inferences
Inferences made by BIAs are only as good as the empirical backing or support on which they are based. In this Hand-in Assignment, you evaluate the strength of inferences made by BIAs and revise the inferences to improve their strength. In order to prepare for this assignment, review this week’s Learning Resources.
Inferences
Inference 1
The rapist is likely to have a previous conviction for sexual offences. This is supported by the fact that the offender was known to have worn a condom, and research shows that the odds of having a previous conviction for sexual offences are almost four times greater for offenders who made efforts to avoid leaving semen than for those who make no such efforts. However, should the witness report on re-interview that the offender only applied the condom after engaging in oral sex, such an inference would be nullified.
Inference 2
Initial searches for the child’s remains should focus on an area 100 yards from the abduction site. Specific research (Boudreaux et al, 1999) that focussed on the abduction of pre-school children (the victim in this case is 3 years of age) revealed that victims’ remains were disposed of within 100 yards of the abduction site in 50% of cases.
Assignment questions:
1. Explain which inference concerning the unknown offender is stronger and why.
2. Based on the Toulminian philosophy of argument, explain how each inference might be improved to provide a stronger argument.
3. Justify your response with references to the Toulminian philosophy of argument and Learning Resources.
Support your Hand-in Assignment with specific references to all resources used in its preparation.
Required Resources
• Weekly Notes should be read before the remaining Learning Resources.
• Core Text: Villejoubert, G., Almond, L., & Alison, L. (2011). Interpreting claims in offender profiles: The roles of probability phrases, base-rates and perceived dangerousness. In L. Alison & L. Rainbow (Eds.), Professionalizing offender profiling: Forensic and investigative psychology in practice (pp. 206–227). London, England: Routledge.
• Core Text: Almond, L., Alison, L., & Porter, L. (2011). An evaluation and comparison of claims made in behavioural investigative advice reports compiled by the National Policing Improvement Agency in the United Kingdom. In L. Alison & L. Rainbow (Eds.), Professionalizing offender profiling: Forensic and investigative psychology in practice (pp. 250–263). London, England: Routledge.
• Article: Alison, L., Smith, M. D., Eastman, O., & Rainbow, L. (2003). Toulmin’s philosophy of argument and its relevance to offender profiling. Psychology, Crime and Law, 9(2), 173–183
• Article: Bonnefon, J., & Villejoubert, G. (2006). Tactful, or doubtful? Expectations of politeness explain the severity bias in the interpretation of probability phrases. Psychological Science, 17(9), 747–751.
• Article: Teigen, K., & Brun, W. (1995). Yes, but it is uncertain: Direction and communicative intention of verbal probabilistic terms. Acta Psychologica, 88(3), 233–258.
• Article: Weber, E., & Hilton, D. (1990). Contextual effects in the interpretation of probability words: Perceived base rate and severity of events. Journal of Experimental Psychology: Human Perception and Performance, 16(4), 781–789.

Nursing Theorist Presentation about Margaret Newman

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Nursing Theorist Presentation about Margaret Newman

Include the following about Margaret Newman (theorist)

• Information about the theorist’s life, nursing role, and time period
• An introduction to the theory, what level it falls under, and what influenced its development
• The constructs of this theory in relation to the nursing metaparadigm
• The influence the theorist has or had on practice
• How the theory continues to influence the role of the nurse

Misuse Of Opiates Health And Social Care Essay

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The misuse and abuse of illicit and prescription opiates is a growing problem in the United States. Even though Americans make up less than 5 percent of the world’s population, we consume close to 100% of the world’s supply of hydrocodone and nearly 80% of the world’s supply of legal and illegal opiates .

Because of the vast availability of drugs and its impact on many facets of healthcare and the economy, it is imperative that health care providers and policy makers understand what drugs are being abused, who uses these drugs, where the drugs come from, and the health and economic burden on the United States. It is becoming exceedingly important for those directly involved with substance abusers to understand the physiological consequences, psychosocial consequences and withdrawal consequences of drugs. Opiates and opiate derivatives in particular, whether illicit (such as heroin) or prescription (such as Oxycontin) are being heavily abused across the country. These drugs can have serious health implications during use and during abrupt cessation (detoxification or withdrawal).

This paper will present a review of the literature on the epidemic of heroin and prescription opiate abuse. Through a critical review, concepts such as the prevalence of the problem, the physiologic consequences of abuse, the current trends in management of the problem and implications for nursing and healthcare will be explored.

Background

Before proceeding, it is important to briefly discuss the basic pharmacology of opiate drugs. Opiates, otherwise known as narcotics, include the drugs heroin, morphine, codeine, oxycontin, hydrocodone, methadone and other chemically-related derivatives. All opiates are considered dispensable only by prescription in the United States with the exception of heroin, which is illegal in all circumstances. Opiates wield their effects by activating pleasure centers in the brain. The neurobiochemical model of addiction suggests that over time, the brain’s chemistry changes so that it yearns for the substance when it is not there and can produce physiologic effects of withdrawal when stopped. Heroin for example, which is chemically-related to morphine (the chemical name for heroin is diamorphine) readily crosses the blood-brain barrier to cause a rapid spilling of dopamine into the dopaminergic receptors of the brain’s neurons. For this reason, the drug is easily addictive and absence of the drug causes a sensation of craving and can cause feelings of illness, such as nausea and diarrhea, when stopped abruptly. .

Prevalence of the Problem

Several researchers in the nursing, allied health and economics disciplines have explored and discussed the prevalence of prescription opiate abuse and hypotheses of the origin of the problem. However, there is a large gap in the literature related to the prevalence of illicit drug abuse (heroin) among different populations. The prevalence data for heroin abuse in the US is largely reported by national survey trends, such as the National Institute of Drug Abuse (part of the National Institutes of Health) Survey on Drug Use and Health (NSDUH). Even so, the massive survey document pays little attention to the problem of heroin abuse and reports only two percent of the 67,500 survey respondents using heroin in the month preceding the survey (National Survey on Drug Use and Health, 2009).

The etiology of prescription drug misuse and abuse is discussed more heavily in the literature than is heroin abuse. According to the NSDUH, in 2009 4.8% of the survey respondents aged 12 and older reported using prescription opiates for non-medical reasons. Of those, over 55% reported obtaining the drug for free from a friend or relative, and 4.8% reported purchasing the drug from a dealer on the streets (National Survey on Drug Use and Health, 2009).

Researchers at Columbia University surveyed adolescents aged 12 to 17 in 2005 and found that 9.3% reported the misuse of prescription opiates over the past month. In exploring the adolescents’ motives for abuse, the researchers found that the most commonly reported motives were ease of attainment and affordability . Among young adult college students, prevalence of non-medical prescription opiate abuse has been reported between seven and nine percent in the past month to twelve to fourteen percent lifetime prevalence .

One of the most at-risk groups for misuse of and addiction to prescription opiates is the chronic pain population. When used appropriately, opiate pain medications are a gold standard of care for serious pain-related conditions (such as post-operative pain, neuropathic pain and so on). In an effort to better manage pain, the number of prescriptions for opiate medications increased 154% in the ten-year period from 1992 to 2002, even though the population of the United States increased by only 13% .

Although prescription opiates have been used to treat pain and improve the quality of life among acute and chronic pain patients, the advent of the drugs’ misuse has led to a wide body of literature on prescriptive practices and monitoring of opiate drugs. There delicate balance between managing pain adequately and the risk for misuse, addiction and diversion has been discussed in the literature recently, largely among the adolescent/young adult and chronic pain populations.

Although there is a general lack in the literature of the number of people prescribed opiates for chronic pain . There is a large body of literature which suggests that the increased number of prescription opiates for chronic pain patients has contributed significantly to the drug abuse problem. In studies to investigate the use of prescription opiates for chronic pain, it has been found that pain treatment plans are sparse, good documentation on the patient’s health history and history of substance abuse is rare, and opiates are sometimes improperly utilized or not indicated at all .

Health Consequences of Opiate Abuse

Both prescription and illicit opiates have the potential to exert a myriad of acute and chronic negative health effects for the user. Neurological decline, vision changes, cardiac abnormalities, vascular complications, pulmonary disorders and mortality have been studied and reported.

In a study of over 500 opiate addicts, electrocardiographic changes were documented in 61% of the sample. These ECG changes included ST-segment elevation, which may indicate ischemic heart damage (or lack of oxygen-rich blood to the myocardium) and QTc prolongation (seen mostly with methadone addicts). Prolonged QTc intervals may lead to inappropriate triggering of the ventricles and may lead to potentially lethal ventricular tachycardia .

The use of heroin and other drugs by injection with non-sterile or reused needles may produce powerful toxins in the bloodstream leading to endocarditis, left ventricular hemorrhage and death. Researchers in Ireland reviewed the autopsy findings from eight cases of heroin users and found rapid fatal illness caused by the endotoxin Clostridium novyi which caused fatal subendocardial hemorrhage, spleen enlargement and pulmonary edema in all of the subjects studied .

Heroin can cause significant acute peripheral and central nervous system complications such as neuropathy and hearing loss. In a study six of intravenous and intranasal heroin users admitted to the hospital for acute illness, five had documented rhabdomyolysis between three and 36 hours after administration of the drug. In each of the five cases, there was no documented trauma. Typically rhabdomyolysis occurs after a traumatic, compression-type injury where enzymes spill into the musculature and cause rapid neurological decline, loss of muscle tone and coma. In each of the subjects studied, no trauma or compression injury occurred . In a group of patients with a reported history of “speedballing” (or mixing heroin and cocaine), 2 of the 16 studied experienced sudden, bilateral sensorineural hearing loss four hours after “speedballing” which resolved within three days. One additional participant experienced sudden hearing loss after “speedballing” but unilaterally. The mechanism by which the hearing loss occurred was described as a possible cochlear toxicity or autoimmune reaction related directly to the drugs .

Injection of drugs of any type can cause vascular complications, skin and soft tissue infections and infectious diseases such as hepatitis and HIV . In the most severe cases, opiate abuse may lead to death, generally from overdose. Heroin has been related to 1.65 deaths per 100,000 people in the Florida population alone over the last decade and in Alabama between 1986 and 2003, a review of medical examiner’s reports revealed those who’s cause of sudden death was undermined were 5.3 times more likely to have a history of drug abuse . Researchers in the United Kingdom have further investigated heroin deaths and concluded that overdose related to heroin rarely occurs after the use of heroin alone- in 50% of the cases they reviewed, alcohol was also involved .

Although studies have been published on the health effects of abuse itself, a review of nursing, medical and allied health literature shows a significant lack of studies on the health consequences of withdrawal (abrupt cessation) of opiate drugs. Several studies have been found relating to the use of pharmacotherapy to treat opiate addiction (such as methadone and similar programs) but no studies have explored the physiologic effects of withdrawal without medication assistance. Searching online databases for relevant articles on opiate withdrawal does not yield any studies other than those using medication-assisted withdrawal therapies (such as methadone and buprenorphine). This is important to populations such as inmates in a correctional facility where pharmacotherapy is not generally used during detoxification and requires further attention .

In sum, the potential health-related consequences of opiate abuse can negatively affect a myriad of body systems. The risk of potentially fatal infectious disease, neurological and cardiovascular complications and death by overdose creates a public health problem that demands attention. Health care providers in all arenas must be able to rapidly and appropriately identify those at risk.

Implications for Advanced Nursing Practice

Nurse practitioners are allowed prescriptive authority in almost any state across the country. Depending on the practice setting, they may prescribe opiates to treat pain. Opiates are the gold standard for treating moderate to severe pain in both acute and chronic pain syndromes . There has been some discourse in the literature on the dilemma to treat or not to treat pain with opiates. On the one hand, effective pain management is not only ethical but also opiates are effective for many patients for pain management – and on the other hand there is a fear of misuse, dependence and addiction issues . The ability for advanced practice nurses to identify drug-seeking behavior, issues with addiction and possible diversion of opiates is crucial to the problem of opiate abuse. As it has been documented in the literature, diversion of prescription opiates generally occurs with the patient selling, trading or giving away the medication to another. According to Annie Gerhardt, emergency room nurse practitioner, “drug seekers become victims of their own disease”, becoming involved in a tangled web of addiction, drug-seeking, drug diversion and criminal behavior that escalates over time with increased drug use . Gerhardt (2004) suggests monitoring patients treated with opiates for refilling meds before their follow up appointments, patient reports of “losing” medications, attempting to see different providers for pain medications (which can usually be identified by pharmacies), and “scamming” providers for more medications by complimenting the provider or the office staff or displaying increased levels of pain in order to procure more medication. When prescribing opiates to treat pain in patients already known to have addiction issues, using sustained-released formulations may reduce dependency while adequately treating pain. Sustained-release formulations usually have a reduced street value and are less likely to be sold and diverted, and the withdrawal from sustained-release opiates is typically not as severe .

In terms of advanced practice nursing, prescribers have the unique ability to screen for potential addiction issues, monitor those who are prescribed addictive medications and potentially control diversion of those medications to others for whom they are not prescribed. Ultimately, the knowledge of drugs of abuse and health-related consequences is important for nurses at all levels to possess.

Implications for Research

To further add to the body of literature on the subject of opiate drug abuse, addiction and withdrawal, several areas still need to be explored.

First, patterns of drug use in individual populations and communities should be investigated. The types of drugs most commonly used, the routes of administration of these drugs and their negative health-related consequences should be studied in a variety of communities, both urban and rural, to gain a better understanding of the patterns of use across the country. More research is needed beyond simple prevalence studies on the number of people who use to expand on the actual patterns of abuse. Similarly, the psychosocial consequence of drug use across different populations needs further investigation in order to articulate the negative impact on individuals and communities.

Because the abrupt cessation of opiate drugs without medication assistance occurs frequently in specific settings, more research needs to be done on the physiological effects of non-assisted detoxification. The patterns of symptoms of withdrawal and negative health effects among populations such as the incarcerated and the hospitalized need to be explored. The potential for the development of evidence-based protocols for the management of abuse and withdrawal in these settings can occur once the patterns of symptoms and health consequences are documented.

Conclusion

In sum, the problem of drug abuse (which extends far beyond even opiate drugs) has been reported in multiple sources, and prevalence studies seem rampant in the literature. However, much more work needs to be done on the consequences of drug abuse from a healthcare perspective across a variety of populations in different settings to begin to understand the impact of drugs on communities.

Communication Skills To Deal With Aggressive Patients Nursing Essay

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This essay will illustrate a personal experience, which demonstrates how practitioners use good communication skills to deal with anger and aggression in patients who are in pain and also recognize and respect choice and religious needs of clients. I was student radiography of about 11 weeks on my first clinical placement. I was working on x ray department which I dealt with and angry and religious patients. . I aim to explore my feelings about the events that transpired, and describe what I would do differently if anything similar situation happens in the future using Graham (1998) framework for reflection. The first centre of discussion shall be in reference to a patient who I will identify as Mr X , to maintain confidentiality Nursing and Midwifery Council 2008) who came for x ray examination for his leg which was in plaster. As a student I attended Mr X with his consent and under the supervision of the mentor. Mr X stormed out of the room in anger after learning that I did not do the procedure right and another x ray was required. That would mean going over the process again yet the patient couldn’t bear the pain. The second centre of discussion shall be referred to a nineteen year old Muslim female who was referred from the outpatient department to the x ray department for a head scan due to persistent severe headache. I was doing receptionist duties and I booked her in. She was wearing a religious dress code that covered from head to toe apart from the eyes. As it was against her religion, she refused to take off the cloth covering her head for the scan to be conducted. Before her examination she came back to the reception office to ask if she could get a private room for a prayer.  I gave her directions to a prayer room.

Having been into placement for only first time I did not have knowledge to dealt or experience to dealt with angry and aggressive patients who are in pain. I remember that I lost my confidence and I was very upset about myself for failing to handle the situation in a professional manner. As a student radiographers, I should recognise anger and aggression and find out the root cause of it. I am now aware that the best way of dealing with someone’s anger is to assess and recognise how they are feeling in order to help and diffuse the situation, Walker et al (2004). In light of the above case, I should have apologised for the mistake and use effective communication skills in explanation the the procedure needed for a repeat of the X ray was necessary. The best way to react to client’s anger is by listening and acknowledging it. Acknowledgment of anger is very important because the client will definitely calms down. There are proven ways to diffuse tense situations and control anger before it rises to the level of conflict. Empathetic listening is necessary in this case, listen to the patient and truly understand his or her feelings and their needs. It is a way of disagreeing, without being disagreeable. Listen empathetically to the patient’s distress and apologise without getting defensive. Honest expression means explaining to the patient that you acknowledge his or her frustration in being told to go over the x ray examination process again, but the patient should understand that you a future radiographer and students make mistakes. Students should bear in mind that, any hurtful things said by the client are as a result of his extreme suffering and they need time to work through their anger.

Recent study suggests that, older people may use anger as a strategy for maintaining some sense of power over their own lives because as long as they remain angry or resistant, people will notice them. Walker et al (2004), as people get older, they are exposed to a wider variety of situations and are therefore less likely to find new situation stressful, though some older people may be resistant to change. The patient was in severe pain, so i would think he used anger and aggression as a pain coping strategy. Cowan (2000), anger is therapeutic in relieving stress. Hyland and Donaldson (year please) say, health care professional can reduce patient anger by providing the information the patients wants about his condition. So communication plays a very important part in diffusing tense situations.

This experience taught me that, anger and aggression could be used as cover for deeper problems. Anger could be a cover up for fear, being used as a shield to keep other people at a distance so they are unable to see one’s insecurities and weaknesses, Booth (2003). In real life, older adults are known to express anger outwardly less often and report more inner control of anger using calming strategies as compared to their younger counterparts unless and otherwise. So, looking at the whole incident, the patient was upset to the core by the idea of going over the process again yet the pain was unbearable. I felt that the mr X was trying to express the stress he was going through due to pain. As a student radiography I should try to use my communication skills effectively to take control of the situation by calming Mr X down and be able to understand what he feels by listening to him and asking him questions. Communication is a two way flow of information that nourished client and professional relationship that establishes the base of information upon which health planning decision are made and programme developed Spradley and Allender (1996). . Health care professionals need to develop their communication skills of assessing patient. They should be able to form an impression of patient’s personality and assess the way patient reacts to particular types of situation, Alder et al (2004).

To be more effective, as a student radiographers should attempt to understand the extent and expression of the anger, the specific problems resulting from the anger, the function the anger serves and the underlying source of the anger.

As a muslim, I am already aware that religious Muslim females from conservative communities will not accept to be examined by a male health care professionals. When miss X arrived for a head scan, I should I have explained to her that there are not a female radiographer in duty to scan her. Unfortunately I did not know she will refuse to be seen by a male radiographer as she was in severe pain. However, I was called to talk to her. I managed to explain to miss X that uncovering her head for medical treatment for a few minutes was not a violation of Muslim religious rules and it was really important for the scan to be done, but she was not convinced. Miss X was a strict practicing young Muslim lady; I never thought she would put religion first before her own health. I told Miss X that I will be her during the examination but she strongly declined. Few minutes after this incident a female radiographer came to collect her payslip and I asked her if she could scan miss X as she refused her colleague to examine her due to her religion belief. Religion is a very sensitive issue in health care. It plays a very important role in the lives of many religious clients. Putting religious needs first before health needs is unbelievable. This is how important religion is to other people.

Many religions carry dress codes or guidelines on appearance and presentation. Overall, dress codes can be a powerful statement of self identity and be a marker of social identity that others will recognise, Giddens (2001). Muslim women are required to cover their bodies as a sign of modesty. Interpretation of the Haddiths differ, so you may see other Muslim women wearing just a head covering whereas others may only show their eyes and they are not allowed to take off their head covering in public or in the presence of men. Henley and Schott (1999) state that some religions provide detailed rules, which may cover aspects of daily life such as prayer, and wearing of religious symbols. Therefore, members of the public and staff should acknowledge diversity and respect the differences within and between groups of people. Health care professionals should understand that each individual is unique and recognise our individual differences, Townsend, cited in Mackay et al (1998). These could be along the dimensions of race, culture, age and religious beliefs. It would be fair to say that, many of the problems faced in the work place around the issue of religion stem from a lack of knowledge and information about other faiths do and believe. However, in health service, patient’s religion is often noted and disregarded; an important opportunity to find out more about the individual religious and spiritual needs is lost, Henley and Schott (1999).

In today’s multi cultural Britain, it is important for health care professionals to be aware of and appreciate the difference between Muslims and other religious groups and must demonstrate a non judgmental attitude towards clients. More training is required for members of staff to deliver a service of the highest standard that would not discriminate service users.

In an attempt to appreciate diversity, most hospitals have reserved a room for prayers. Most religious patients would do a prayer before being seen for their appointments as they believe that a prayer could aid in recovery, not due to divine influence but due to psychological and physical benefits. Many studies have suggested that a prayer can reduce physical stress, regardless of the God or Gods a person prays to. Of course, other patients pray to seek guidance as the day progresses, and some say it promotes a more positive outlook and strengthen the will to live. In light of this, health care professionals need to demonstrate a willingness to learn about the patient’s religious beliefs and needs. They should have a deep understanding and a wider knowledge about a range of problems which arise from religious issues.

In the provision of holistic care, both male and female radiographers should be always available on duty to meet the religious needs of Muslim clients and other religious groups. Failure to meet the religious needs of patients would be seen as discrimination on the grounds of religion. So, members of staff require appropriate training and a range of skills to successfully work with ethnic minority clients to promote social inclusion.

I believed that a  good communication and open dialogue is the key to diffusing anger and

providing culturally sensitive care. I am now prepared for patients who get angry and aggressive. I had always thought before that it would not happen to me and that the person who was verbally attack was to blame in some way. . In the future where patients have an aggressive history, I will be more on my guard. I do feel that I am more aware of the potential of anger and aggression and I have learned to approach situations in a different way from this experience. I have also prompted to read more about anger and aggression in the NHS and learn strategies to dealt with I will take the time to reassure and talk to the patient and ensure that I get their cooperative. Next time when I will be at reception duty, I will try to ask patients if they prefer to be seen by male or female radiographers. A female radiographer should be at least on call rota on duty. If possible, healthcare should be given by people of the same sex as the patient. For female patients, there is an overriding objective of modesty and privacy.

Identify and describe the problem, purpose, and hypothesis or research of each study.

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Identify and describe the problem, purpose, and hypothesis or research of each study.

Identifying Research Components

The focus of this week’s assignment is identifying research components. You will be responsible for reviewing two articles (listed

below) and completing the following tasks for each one:

* Summarize each article utilizing the Week 2 research template.

* Identify and describe the problem, purpose, and hypothesis or research of each study.

* Analyze and state if and how the study is significant to nursing.

Cite all sources in APA format.

Assignment 2 Grading Criteria Maximum Points Summarized the two assigned research articles. 32 Identified and described the problem of each article. 16 Identified the purpose statement of each article. 12 Identified the hypothesis or research question for each article. 20 Discussed the articles’ significance to nursing. 20 Written component. 20 Total:

 

Flu Shot Dosage A hospital in a developing nation is forced to manually put the flu shot vaccine into syringes. The recommended dosage for the flu…

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Flu Shot Dosage

A hospital in a developing nation is forced to manually put the flu shot vaccine into syringes.

The recommended dosage for the flu shot is 0.5mL. The local health authorities define all

syringes that have less than 0.45ml or more than 0.55mL as defective.

In a sample of 100 syringes, the hospital’s quality control officer finds the average dosage to be

0.5mL. The standard deviation of the dosage is 0.02 mL and the distribution of the dosages

resembles a normal distribution reasonably closely.

FD1. What is the capability score of the manual filling process?

FD2. What percentage of the manually filled syringes will be outside the specification limits

provided by the local health authorities? (Please answer in decimal form.)

FD3. To what level would the hospital have to reduce the standard deviation of the operation if

his goal were to obtain a capability score of Cp=4/3 (i.e., get 63 defects per million)?

A Critical Phase Of Nursing Communication Nursing Essay

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Patients handoffs is a traditional clinical practice in nursing that permits the transfer of patients information and care responsibility from the off going nurse to upcoming nurse; and this handover has an essential role in the continuity, safety, and quality of the patient care. Literature highlighted that failure in communication between shifts is one of the contributing factor in several accidents (Johnson & Arora, 2009). Moreover handover is critical point in patient care; insufficient care transition can result in preventable patient harm, suboptimal care, medical error, longer hospital stay and a lower patient and provider satisfaction (Johnson & Arora, 2009). Handover is a crucial part of providing quality nursing care and maintaining continuity in care, but any error and omissions during hands off can lead to the dangerous and life threatening consequences.

Similarly, the opportunity of working at intensive care unit in one of the tertiary care hospital allows me to observe and reflect on the importance of handoffs and impact on patient care and nurses satisfaction. During clinical I observed so many interruptions during the process of handoffs. From a distance nurses were talking to each other like usual chatting, chaos and noisy environment, and physician’s orders just dilute the essence and importance of effective communication during hand-off. Besides this, when I was taking over the other nurse was also chatting with nurse around the bedside which is not related to patient’s information and care and this was very much distracting to concentrate and grasp the information which further leads disorganized care and can lead to any life threatening situation where patient is intubated with full inotropic support. This is not the one time problem, but it occurs daily during the time of shift hand over. Although, there is no formal format for shift handover, but traditional method is also not followed properly during handoffs.

This scenario raised many questions in my mind that what is going on during handoffs? How can one person entertain many people at a time? Does nurses are really aware the importance of shift hand over? Do they really realize that miscommunication and omission of important information can lead to any kind of dangerous situation or dissatisfaction of nurse and patient care? What is the role of nurse leader in providing safety during patient care? Moreover, how they have been mentored and trained during their internship? Do we have the role of training schools and what special aspect during the training of nursing students can bring a change in their future practices? Thus, Study highlighted that failure in communication and misunderstandings between shifts have led to loss of life, property damage, serious injury, lost production and adverse environmental impact (Blouin, 2011).

On analysing the scenario, the thought came into my mind is that the scenario is occurring due to lack of importance of effective communication during handoffs. This also reflects the quality of training and mentorship provided to the trainees during their internship. Moreover, the lack of appropriate role modelling by the senior staff in the unit is also not evident, therefore the practices continue in a vicious cycle. Since the skills of shift handover never taught in the schools, nurses learn this process in the actual ward setting and the culture of discussing patient information is not very evident in the scenario which actually enhances the learning of the new comers. Performing handoffs and transferring information in one breath really question the quality of care provided by the upcoming shift. Most of the time lack of sufficient time and busy duties used to be common excuses for the quick and inappropriate shift handover, but I do not agree with this justification of nurse as shifts handover should not be compromise at any cost.

Nursing shift handover is the most commonly occurring handover process in inpatient units which allows the transfer of pertinent patient’s information between nurses at the end of the shift to maintain continuity and safety of patient care. The primary purpose of shift handover is to transfer the accurate information about patient’s care, current condition, and any anticipated changes, which leads to maintain continuity of care and patient’s safety. Nursing handover has received considerable attention in the literature and it estimates that 80% of serious medical errors involve miscommunication between care givers during the transition of care (Blouin, 2011). However, high quality handover practices may assist in providing safe and efficient care to the patient; and this can result in better patient’s health outcomes (Patterson & Wear 2010). Hands-off process is the crucial point of patient care when patient is being handed over to other health care professionals with its complete information. According to the Joint Commission the issues of communication, continuity of care, or care planning are the root cause of errors in more than 80% of the reported sentinel events (Streitenberger et al., 2006). In addition, Greenberg et al. (2007) examined the errors occurred in a surgical department, and indicated that 43% of surgical errors occurred because of inappropriate handover communication, which result in injury to the surgical patients. Moreover, Suresh et al. (2004), in their study of medical errors and their contributing factors at neonatal intensive care unit concluded that out of 584 voluntary reported medical errors, 5.6% errors occurred due to incomplete information transfer during nursing handover. These evidences from the literature highlighted that communication breakdown during handoffs is one of the causes of medical errors and this signifies the importance of handoffs effective communication in the relation to the patient’s safety.

In order to avoid the errors and enhance patient’s safety many literature proposed the format to perform appropriate process of handoffs which emphasize on accurate transferring of patient related information through standardized protocol such as SBAR tool and TJC National Patient Safety Goal 2E. Besides this, realizing nurses on the importance of hand-off communication can improve the practices of handoffs among nurse. Moreover, appropriate mentorship from the senior staff and the training novice nurses can bring a change in the process of hand-off. In addition, the clinical round of the unit head nurse and CNIs can also help bedside nurses to learn from the role modelling to enhance best practices. Handoffs process should not focused only on transferring of information, but it also fulfil the purpose of teaching and support to the novice nurses in maintaining continuity and safety of patient care (Scovell, 2010). Besides this, the dicussion and question answer during shift handover process allow off going nurse to recall her performance and responsibilities which they needs to fulfil during the shift.

Blouin, A. S. (2011). Improving Hand-Off Communications new solutions for nurses. Journal of Nursing Care Quality, 26(2), 97-100.

Greenberg, C. C., Regenbogen, S. E., Studdet, D. M., Lipsitz, S. R., Rogers, S. O., Zinner, M. J., & Gawande, A. A. (2007). Patterns of communication breakdowns resulting in injury to surgical patient. Journal of American College of Surgeons, 204 533-540.

Johnson, J. K., Arora, V. M. (2009). Clinical hanover: creating local solution for a global problem. Quality and Safety Health care, 18, 244-245

patterson, E S., & Wears, R L. (2010. Patient’s handoffs: standerized and reliable measurement tool remai elusive. The Joint Comission Journal on Quality and Patient Safety, 36 (2), 52-61.

Scovell, S. (2009). Role of the nurse-to-nurse handover in patient care. Journal of Nursing Standard, 24(20), 35-39.

streitenbergr, K., Breen-Reid, K., & Harris, C. (2006) Handoffs in care-Can we make them safer? Pediatric Clinics of North America, 53, 1185-1195.

Suresh, G., Horbar, J. D., Plsek, P., Gray, J., Edwardset, W. H., Shiono, P. H., & Goldmann, D. (2004). Voluntary anonymous reporting of medical errors for the neonatal intesive care. Pediatrics, 113 (6), 1609-1618.