Case Study of Anxiety and Pain Management in Palliative Care

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Anxiety experiences different in everyone in different times, it’s a normal response to actual danger, promoting the body through stimulating of sympathetic and parasympathetic nervous system will be helpful action. (Springhouse, 2007). Anxiety affects our whole being. It affects how we feel, how e behave and has very real physical symptoms. It feels a bit like fear but whereas we know what we are frightened of, we often don’t know what we are anxious about. Mild anxiety is vague and unsetting-severe anxiety can be extremely debilitating (Medical News Today, 2010). Acute pain it is not good sign about tissue damage, (Gulanick et al., 2010).

1- How can you manage Evert’s pain?

As a nurse, the following can be done to manage Evert’s pain:

Anticipate need for pain relief: early analgesic intervention helps to decrease pain.

We have to respond to pain complain as soon as possible: early respond to patient’s complaining of pain its help to decrease anxiety and on other side its help to make a trust relationship.

Trying to eliminate the addition of stressor or comfort as we can: help patient to tolerate the pain either these elements from environment, intrapersonal, or intrapschic factors.

Make an good atmosphere of comfort, relaxation, and sleep: we have to help patient to be in good atmosphere to take a rest and sleep comfortably because some patient’s experiences of pain may will put them in fatigue condition, so we have to put him in darkroom and disconnected his phone (Gulanick et al., 2010).

2- What can you do to alleviate Evert’s anxiety?

The following interventions can be done to alleviate Evert’s anxiety:

Anticipate need for pain relief: early analgesic intervention helps to decrease pain.

We have to respond to pain complain as soon as possible: early respond to patient’s complaining of pain its help to decrease anxiety and on other side its help to make a trust relationship.

Some of cognitive behavioral strategies as follows:

Images: if patient use his mental images its help to distract stress and pain with using all his five senses.

Distraction techniques: heighten one’s concentration upon nonpainful stimuli to decrease one’s awareness and experiences of pain and reduce stress such as nerve stimulation and breathing modifications.

Use the relaxation exercises: it’s important for patient to decrease attention and pain.

Use breathing exercises.

Using Music Therapy in treatment: the music therapy works well on patients. Its apart of treatment team (Mount& Munro, 1978).

3- Why was Evert’s wife so worried the Evert did not eat? Should you treat with IV nourishment?

Evert’s wife was worried because Evert might suffer from dehydration and malnutrition, and this will cause electrolyte imbalances and his condition will be aggravated by this, his health will deteriorate more rapidly. As a nurse the treatment plans for Evert to restoring fluid and correcting any electrolyte imbalances. Early treatment intervention its help to prevent any potentially life threatening such as hypovolemic shock (Gulanick et al., 2010).

4- Make a nursing care plan for Evert. Explain and motivate you suggested nursing intervention in according with the four key areas listed in the introduction?

A. Assessment: defining characterized: Evert verbalizes pain, especially in connection with moving, narrowed focus such as withdrawal from social and physical contact, relief or distraction behavior( seeking out staff to do activities), restless, anxiety manifested, expression of helplessness, and inability to procure fluid and food.

B. Nursing Diagnosis: actual diagnosis: acute pain related to severe anxiety.

Nursing outcome: Evert will be enable adequate relief of pain when moving or ability to deal with the pain are not fully satisfied. Evert is able to recognize signs of anxiety.

Risk diagnosis: while the patient is unable to buy fluid and food it will affect fluid volume.

Nursing outcome: sufficient fluids volume and electrolyte balance as evidence by urine output grater than 30ml/hr, consistency of weight, and normal skin turgor (Gulanick et al., 2010).

C. Nursing Intervention:

1. Assess pain characteristics: Quality as example sharp, burning, and shooting. If we want to measure the level of severity from 1 to 10, with 10 level it is more sever to patient. Location according to anatomical description, onset if it’s gradual or sudden. Duration for how long is it intermittent or continuous (Gulanick et al., 2010).

2. Administer parenteral fluids as ordered: the nurse must give patient IV fluids as needed and as ordered, challenge with intermediate infusion of fluids for Evert who is unable to procure fluid and food (Gulanick et al., 2010).

3. Assess patients and help them to recognize the sign and symptoms of anxiety: it is important for patients to be able to know and recognize the sign and symptoms of anxiety, which will help Evert to be able to solve his sign and symptoms when anxiety level is low (Gulanick et al., 2010).

4. Relieving factors. Monitor the patient signs and symptoms with pain: Like Heart Rate, Temperature, Blood Pressure, skin color, restlessness, and patient inability to focus. Some patient’s ignoring sign and symptoms of pain when occur. The patient’s must inform the nurse about these sign and symptoms because it well helps the nurses in evaluation (Gulanick et al., 2010).

5. Assessing the main causes of pain: it is important for doctors and nurses to look to the causes of pain because the different causes having different treatments (Gulanick et al., 2010).

6. Assess the patient knowledge regarding pain relief strategies: a lot of patient’s may not realize how effective non drug method on them either with or without pain killing medication. So, we have to explain to them this point carefully (Gulanick et al., 2010).

7. Evaluate patient’s regarding response to pain medications or therapeutics: it is important to give patient’s chance to tell nurse about his expression regarding pain medication, and also let him to talk about effect of medication on him (Gulanick et al., 2010).

8. Assess patients from cultural, intrapersonal, intrapsychic, and environmental degree factors which are share to relief pain: these factors will affect patient’s expression on experiences, for example some cultural you have complete freedom to express how you fell (Gulanick et al., 2010).

9. Evaluate what is the meaning of pain to individuals: it is important to all patients’ to know the meaning of pain because if he doesn’t know it will affect him to response (Gulanick et al., 2010).

10. Assess patient’s regarding expectation of pain relief: it is important for nurses to know patients expectations regarding pain relief either the pain decreased or pain disappeared. Because these patient expectation will help the nurse to know either the pain relief or need to participate in another treatment (Gulanick et al., 2010).

11. Assess patients if they would like to explore some other techniques to control pain: it is important to patient to know that there is many ways of pain relief (Gulanick et al., 2010).

D. Evaluation: Evert manifests adequate relief of pain, recognizes sings of anxiety, and demonstrates positive coping mechanism. Evert’s urine output greater than 30ml/hr, weight is consistent and with normal skin turgor (Gulanick et al., 2010).

FOUR MAJOR AREAS:

Symptoms Control: A palliative approach, involving attention to symptoms control and social, psychological, and spiritual wellbeing of the patient and their family is relevant at all stages of the disease, and it has been argued that attention to these aspects combined with understanding of the patient’s feelings and concerns all contribute to improving quality of life of the person with acute pain (Montazeri et al., 1998). The principles of symptom control, which are used as standard by clinicians include: assessment of the symptom, understanding the meaning ascribed to it by the patient, explanation of the likely cause, investigation should only be undertaken if they will change the course of action to be followed, institution of treatment based on known or likely etiology, available options for treatment, and wishes of the patient, monitoring of the response to treatment and modification as necessary ( Steinhauser et al., 2000).

Communication: make a good relationship between nurse and patient which well make patient comfortable in communication. Trying to orient the patient to the environment and help him to take experiences from people as needed, and also when the patient is aware and oriented very well it will help him to be comfort and may will decrease anxiety. Help the patient to express anxious felling if the patient has ability to describe them. (Gulanick, 2010).

Teamwork: during assessment pain in patient, contributions from the multidisciplinary team is very important to evaluate the following: a detailed history of each pain, full examination, and psychosocial assessment, a history of analgesics already used and the response to them, investigations to confirm the diagnosis, and this will depend on treatment options and stage of disease (Ripamonte et al., 1997). Perception of pain will be influenced by the meaning of pain for the patient. Open discussion among team members, family and patient, allowing fears to be discussed, providing explanation of the symptoms and reassurance of continued support is important (Twycross, R. G, 1993).

Family: the nurse must teach patient and his/her family about intervention regarding inadequate intake, and explain to him the importance of intake such as drinking fluids and eating food. Explanation of the importance of the rationale and intended effect of treatment program to alleviate pain, diminish anxieties (Gulanick et al., 2010).

Mental Health;Nursing Theory.

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Mental Health;Nursing Theory.

Mental Health;Nursing Theory Term 4 – Short Essays

The body of the paper will be 5-6 pages in length, not including title page and references page.

A minimum of 3 peer-reviewed or evidence-based sources (1 peer reviewed or researched journal article, 1 Foundational textbook in nursing, and 1 reputable internet

website) must be used for this paper.
Use of APA formatting from the “Publication Manual of APA 6th Edition” is required. You must use Level 1 headings in order to organize your academic paper.

Choose Only Two from the following three cases in order to complete your two short essay assignments:
Case A:
A client with paranoid schizophrenia has made a great deal of improvement. His hallucinations have abated; he is taking his medications, is compliant, and is

nonviolent. As the nurse is planning his discharge and discussing it with him, along with other members of the health care team, the client states, “I am not ready to

be discharged yet. I think I need to stay a bit longer.”
Case B:
Matt Wexler is being admitted to the psychiatric unit for violent behaviour. He is a 28-year-old member of the Canadian Armed Forces who has just returned from three

tours in Afghanistan. His girlfriend stated that he tried to strangle her when he confused her with an undercover Afghani secret agent. Marlene is the nursing student

assigned to Mr. Wexler. She reviews his intake forms and health care provider’s orders. His diagnoses are post-traumatic stress disorder, paranoia, and psychosis.
Case C:
Mrs. Celia Scherer is a 33-year-old woman admitted to the medical-surgical unit for management of a bowel infection secondary to a colostomy. She has had a colostomy

and colostomy pouch for three years, but she is not compliant in correctly cleaning the area and changing the dressing and pouch as required. She is placed on

antibiotics to fight the infection, intravenous fluids to maintain hydration, and nonsteroidal anti-inflammatory medications for pain. Lucy is the nursing student

assigned to Mrs. Scherer. Lucy’s priority in caring for Mrs. Scherer is to educate the patient about the importance of maintaining hygiene and to promote comfort.

Nursing Theory Term 4 – Short Essay
MARKING RUBRIC FOR EACH Short ESSAY:
Your Short Essay Must INCLUDE Marks
Discuss how you would approach the case study as a Registered Practical Nurse (2 Paragraphs) 2
Discuss how the nursing process (ADPIE) would influence your caring of the patient in the case study (4 to 5 Paragraphs) 4
Conclusion: Brief summary of main points (2 Paragraphs) 2
Conclusion: What influence will the knowledge gained from this assignment have on your future care of patients in similar situations as the one detailed in this case

study? (2 Paragraphs) 2
APA Format:
Title page; page numbers; font (Courier or Times New Roman 12); whole paper is double spaced; one inch margins; proper citation format within the body of the paper;

References List Page; minimum of 3 peer-reviewed or evidence-based sources; headings; and proper sentences, spelling, and grammar. 4
Total / 14

A STAFF NURSE HAS TO ADMINISTER MEDICATIONS FOR BLOOD PRESSURE TO SEVERAL PATIENTS IN THE CORONARY CARE UNIT. THE MEDICATIONS INCLUDE CAPTOPRIL, DILTIAZEM AND NITROPRUSSIDE.

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A STAFF NURSE HAS TO ADMINISTER MEDICATIONS FOR BLOOD PRESSURE TO SEVERAL PATIENTS IN THE CORONARY CARE UNIT. THE MEDICATIONS INCLUDE CAPTOPRIL, DILTIAZEM AND NITROPRUSSIDE.

CASE STUDY#43 A staff nurse has to administer medications for blood pressure to several patients in the coronary care unit. The medications include captopril, diltiazem and nitroprusside.

The medications have to be administered to three older adults. ( learning objective 34,and 5).

(A). What are the indications for captopril?

(B). What are the therapeutic actions for diltiazem?

(C). What are the most adverse reactions for nitroprusside?

(D). What are the lifespan considerations in the older adult for the use of drugs that affect blood pressure?

(E). What are the nursing implementation considerations for a patient receiving nitroprusside for blood pressure?

Placement at a mental health rehabilitation centre

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The purpose of this write up is to explore and analyse how learning theories informed knowledge development and competence in promoting health and psycho education in clinical settings. I will examine the principles underpinning the facilitation of learning and assessment. I will demonstrate my knowledge and understanding of the theoretical concepts in an episode in which I facilitated learning to clients while on placement at a Mental Health Rehabilitation Centre. Finally, I will use the reflective model by (Gibbs, 1988) to reflect on the strategies used within the episode and discuss the implications in relation to my future role as a nurse.

The NMC (2008) stipulates that as nurses we must maintain our professional knowledge and competence regularly. You must keep knowledge and skills up to date throughout your working life and that you must take part in an appropriate learning and practice activities that will maintain and develop your competence and performance. In view of the aforementioned this essay is aimed at enhancing my knowledge and competence in facilitating learning through understanding of the underpinning concepts.

I observed most residents having fast foods such as burgers, kebab, and chocolate as well as fuzzy drinks which are rich in saturated fatty and sugar for lunch regularly and they were also smoking a lot. I was really concerned because of my duty of care as a nurse (NMC, 2004) and due to findings from several researches for example (Bottomley and Mckeown, 2008 and Hallpike, 2008) which shows the risk of malnutrition was commonly associated with people with psychosis which predisposes them to host of physical health problems. I had a chat with my mentor of my intention to use the weekly communal meeting to carry out a teaching session to raise awareness and sensitise the residents on the effects of fatty foods and fuzzy drinks on their body chemistry and the need to improve and develop a healthier eating habits and life styles, considering the fact that most of them were on various antipsychotic medication which predisposes them to becoming obese. Timms (2008) said that a huge majority of people with mental health problems are most likely to have weight issue due to side effects of their antipsychotic medication. My mentor agreed to table it before the resident in the next meeting to gain their consent in compliance with NMC (2008).

The residents consented to it and were quite interested because some them were really concerned about their weight and really wanted to do something about it. We agreed on a date for the teaching. The onus was now on me to facilitate the learning process that will empower the residents to take responsibility for their health and make a positive change. A vast majority of physical health problems are caused by people life styles and their failure to see the risk associated with their daily habits. Kiger (1995) defined health as state of balance between different facets of life suggesting that it is a dynamic concept which he termed “movable”. What this means is that our life styles can alter the balance resulting in an adverse effect on our health.

As facilitators it is essential that we have a clear understanding of the different learning styles in order to tailor our teaching to meeting the varied approach of our learners. This is because learners are intrinsically different and preferred different ways of learning. Teaching is an act of imparting knowledge, a purposeful intervention aimed at promoting learning and causing learning to happen. Kemm and Close (1995) defined teaching is an act of assisting others to learn and putting it to use in their life. While Kiger (2004) defined teaching as a process of enabling people to learn through the dissemination of information and advice; it creates room for people to express their feeling, clarify their thought and acquired new skills. Learning is the acquisition of knowledge through education and experience. It is essentially important because it enable people to make informed choice about their own health. Roger (1996) defined learning as a kind of change often in knowledge but also in behaviour. Reece and Walker (2002) stated that learning brings about change and that teaching and learning proceeds pari passu and cannot be considered in isolation.

I spent time engaging with the residents so as to build a therapeutic relationship based on trust whilst observing their behaviours as I gather information to facilitate the learning process. This was to enable me identify their preferred style of learning so as to increase ease of transmission of knowledge. There are a host of approaches available in health promotion. Ewles and Simlet (2003) identified five approaches which include medical, client-centred, behaviour, education and societal change. In his word all these approaches must be taken into cognition when undertaking health promotion to clients.

Kolb (1984) developed the experimental learning theory (learning by doing) by this he suggested that learning is not fixed but formed from previous experiences.

Kolb learning theory

which is cyclical affirmed that people have different learning style and he identified four distinct learning styles as shown in figure 1 below includes concrete experience (having an experience ), reflective observation( taking time to reflective on their experience from different perspective), abstract conceptualization ( drawing their conclusions) and active experimentation ( putting theory into practice). For effective learning to happen Kolb said all this four must be taking into context when planning a teaching session. Honey and Mumford’s learning cycle is slightly different from Kolb system.

http://www.nwlink.com/~donclark/hrd/styles/honey_mumford.html

Figure 1 Honey and Mumford’s variation on the Kolb system

Honey and Mumford (2000) said that there four different types of learners which must be taken into consideration when planning a teaching session as shown in figure 1 above. These include the activists, like learning situation that presents them with new challenges, problem solving, and role play and uses the first opportunity to experiment; reflector like brainstorming and learning activity that gives room for observation, thinking and reflecting on they have learned; theorist like to research into fact before taking it onboard, they prefer a step by step approach and pragmatist like practical based learning and been given the opportunity to try out techniques and getting feedback in return. In view of fact that people have varied approach to learning considering the fact that it’s a group teaching. I intend to present my teaching to my mentor first to get feedback on whether I have considered all the four learners identified by both Kolb and Honey and Mumford.

As nurses the education of our clients about their health is a vital aspect of our nursing process. It is important that we use an approach that encompasses congruence, empathy and respect in assisting our client (Roger, 1996) instead of coercing them to change their life style. Therefore it is imperative that we aware that teaching the client requires consent and that the client has the right and autonomy to refuse any intervention even when it can result to death provided they have the mental capacity to make informed decision (Mental Capacity Act, 2005 and NMC, 2008). DH (1996) states that the client must be provided with vital information about their health, so that they can make informed choice about the treatment options, life styles changes and behaviour. The subject was brought before the residents for them to make informed decision with regards to the teaching and they consented to because they wanted to do something about their weight. Kemm and Close (1995) wrote that there is high tendency for client to learn if teaching is directed to meeting their needs, interest and within their ability.

Effective communication plays a vital role in facilitating learning. As nurses the way we communicate and the kind of rapport we build with our client plays an essential role in empowering or disempowering them (Brown, 1997). Good communication skills act as therapeutic tool in delivery a holistic and person-centred care (Burnard, 1992). Our role as facilitator should be to explore and support our client to build that intrinsic motivation to make a change in their life, strengthen their commitment to change and then develop a plan to fulfill that change (Miller and Rollnick 2002). The responsibility for change lies purely on the client however as facilitator we should use an approach that confront the client with the idea of need for change without been persuasive and argumentative rather we should create an environment that show a sense of genuinity, respect and empathic understanding through collaboration and working in partnership with the client.

Based on my assessment of the residents needs and considering the fact that they were adult learners capable of self-directing their learning, I decided to use andragogical instead of the pedagogical teaching style so as to enhance collaboration and for it to have a positive impact in residents’ lives. Pedagogy is the art and science of teaching children, it is a teacher- centred education and the teacher decided what, how and when it will be learned while andragogy is the art and science of assisting adults to learn and it is learner-centred education. Andragogical approach help learning to take place because of the client’s own effort or willingness and it helps learners to learn what they want to learn (Knowles, 1990).

Over the years educational psychologist and educationalist have developed models and learning theories (Hincliff, 2004). These include the behaviourist, cognitive or humanistic. Three domain of learning exist; Cognitive, psychomotor and affective (Bloom, 1972). The way we learn is however dependent on some other factors even though these three domains are the dominant. Individual’s personal values, beliefs and altitude are motivating factors for self-directed learners. I decided to use the humanistic approach in facilitating the awareness and sensitization of the need for them to improve their diet and life style In order to meet the residents learning needs. The humanist theory as explained by (Maslow, 1943) is concerned with individual fulfillment and self-actualisation. The influence of the environment on the residents and their relationship with others is explained by the socio-cognitive theory. Bandura (1977) stated that learning take place as a result of social interaction through observation and mimicking others whom the learner look up to for example family , peers and health professionals. To facilitate learning; a conducive learning environment, learning material suited to the learner’s need and their literacy level must be considered (Quinn, 1995).In view of this, I gathered all the necessary resource taking into account the residents individual learning styles and planned the teaching in such a way that it is tailored to meeting their varied learning styles.

Based on my engagement with the residents I identified that majority of them belong to the theorist, pragmatist and reflector learning styles from (Honey and Mumford, 1982). Prior to the start of the teaching session I made sure the environment was conducive for leaning, spacious, quite and with the right temperature. I introduced myself to the residents and my mentor and other member of staff present. I explained the rationale for the teaching session. I gave them handout I prepared for the session which contain literature and pictures, which were simple to understand and which they could keep with them and refer to later at their convenience and I also use video from YouTube http://www.youtube.com/watch?v=pp0nc4kY-tc to explain the potential side effects of fatty food and fuzzy drink on their heath and I highlighted the main topic, which is the makeup of the food they eat and its functions in the body and the calories recommended daily. I brought in several fatty foods like ground oil, butters in different make to explain to them the difference between the good product and the bad product. I explain to them that the one that contain high saturated fat and low unsaturated is not good because the body find it difficult to break down the saturated fatty into small unit which is used by body instead they are gradually deposited thereby raising their cholesterol level. The deposition of fat gradually blocks the artery wall which could lead to anterosclerosis, stroke and heart diseases while product rich in unsaturated fats and low saturated fats are better. I encouraged them to always check for this information on the food product whilst shopping. I asked them if they know what cholesterol means and if anyone has check out their cholesterol level. I then brought out some more products for them to point out which one was better to check if the understood the lectures and they did perfectly well in identifying the good and the bad product and I offered them praise for a job well done. I then showed them they kind of food that is good for the body from you Tube http://www.youtube.com/watch?v=mAFTcfaA-pc&feature=channel and what constitute a balance diet. The teaching session was an interactive one and as facilitator I suggested and encouraged them to adopt a healthier lifestyle by eating more fruit and vegetable instead of chocolate, drink more water instead of fuzzy drink and to cook their meal which was more nutritious and economical and to exercise by going to gym or taking a light work every day. I suggested that we could contribute one pound to cook for the weekly communal meeting and then see how it goes from there and the feedback was positive. I gave room for question and answer session. I thanked them for their collaboration and for making the teaching successful. Their willingness to learn was quite beneficial. I provided information on what make a balance diet and some activities aim at dealing with weight issues in the communal lounge.

As nurses it’s imperative that we take time to reflect daily on our professional and clinical practice. Gibb et al (2005) stated that constant reflection allows learning to occur at every given opportunity and it improves practice. I felt competent though initially nervous teaching the residents on the need for healthy eating and life style change. Ewles and Simnett (2003) stated that health promotion is the process of empowering people to take proactive action over and improve their health. I was able to facilitated residents’ learning by building a rapport and through process I observed their learning styles and knowledge base which made it possible for me to tailor the teaching to their varied approach of learning. I believe the teaching session had a positive impact in enlightening the residents on the need for them to improve their diet and lifestyles change from the feedback I got at the end of the teaching. I use the humanistic approach clearly stating the rationale for the session because I wanted them to have the knowledge so that they can take responsibility for their own health. The session was collaborative and interactive with the residents fully involved in the discussion and asking appropriate when seeking clarification.

During the evaluation Amos felt that the learning outcome had been achieved and also said that the handouts and leaflets given during the teaching session were very useful and helpful. My mentor suggested that I could have done more and it would have been good, if I had used an overhead projector. But his feedback was encouraging. I had to rush towards the end of the session due to time factors. But I realised that as a student nurse, my professional development is still in progress and as my course develops I will become confident in dealing with this type of situation. My experience of teaching on this occasion will improve my professional practice.

During the session I adopted a personal counselling approach based on the Beattie (1991) model, (cited in Ewles and Simnett 2003), which is a combination of the educational and client centred approach. According to Rogers (1983) people experience the world differently and know their own experiences better than anyone else. Amos’ ability to take responsibility for his actions helped to be more independent.

In conclusion, I have been able to facilitate a teaching session by building a therapeutic relationship with Amos and through achieving effective communication. I found out from this experience that empowering clients does not mean that nurses should enforce decisions on clients but rather that; they should encourage and motivate them to achieve a desired result. I feel the experience was an interesting one. Looking back on the teaching skills demonstrated and the assessment of the client’s need, I think the aim of the teaching was achieved. The feedback received from the learner and my mentor has given me an insight on how to improve in my teaching in future. I hope to use video clips and overhead projector in future teaching and to continue using the lecture learnt in taught module to enhance my skills and knowledge in my future role as registered mental health nurse.

identify consumers? needs and concerns and then develop marketing strategies to address them.evaluate elements of marketing research related to a particular scenario.

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identify consumers? needs and concerns and then develop marketing strategies to address them.evaluate elements of marketing research related to a particular scenario.

 

 

Marketing research is a valuable resource that guides organizations? decision making. As noted in the Learning Resources, research is used to help organizations identify consumers? needs and concerns and then develop marketing strategies to address them.For tApplication Assignment, you will evaluate elements of marketing research related to a particular scenario. Also in tApplication, you will consider the difference between customer satisfaction and customer loyalty and examine approaches to promote customer retention.Prepare for tApplication as follows:For Section One: Marketing ResearchReview the instructions for Chapter 6 Problem 6 on page 228 of Essentials of Health Care Marketing. In addition to considering how you will answer tproblem, think about the marketing-research process. What elements of the marketing-research process described in Chapter 5 of the text would you recommend the organization apply in tscenario?For Section Two: Customer LoyaltyConsider the following statement: Although it is obvious that dissatisfied customers will certainly switch, it has been found that even satisfied customers will switch providers or suppliers. Satisfaction in and of itself is not sufficient (Berkowitz, 2011, p. 236). With tin mind, think about the following questions: Why are customer satisfaction surveys important for health care organizations? What is the difference between customer satisfaction and customer loyalty? How would you assess customer loyalty? Why would tdistinction be important for a health care organization as it considers its financial investments in marketing strategies? What implications does thave in terms of attracting new customers versus retaining customers? What is the purpose of organizational branding? Pg 228 Chapter 6 Question 6A new group of primary care physicians has decided to locate in a suburb of Washington, D. C. After conducting some primary market research on the area, the group?s research firm has characterized the community as comprising boomers Gen-Xers, and a significant number of N-white collar workers, all employed by high tech and consulting firms located in the outer belt that surrounds Washington, D.C. What are the implications of tmarket profile with regards to:Several of the group?s older partners have announced their intentions to retire At a recent meeting the group has decided it wants to bring in 5 new partners over the next 12 to 20 months. The group hopes it can attract younger primary care physicians who are no more than 3 to 5 years out of training. In tway the group believes the group can continue to stay viable and grow, suggest a recruiting plan to attract tcohort of physicians. Customer Loyalty Pyramid

: Define what long term care is and why it has continued to increase in terms of importance amongst the healthcare landscape.

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: Define what long term care is and why it has continued to increase in terms of importance amongst the healthcare landscape.

What is the mechanism of action of fluoxetine?
Why is fluoxetine the drug of choice?
What are the side effects of fluoxetine?
What are the risks of abruptly discontinuing fluoxetine?
define what long term care is and why it has continued to increase in terms of importance amongst the healthcare landscape.

Innovation- six sigma & sustainability paper – costco

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Assignment #4

Students will prepare a graduate level analysis to show a deep understanding about how to beat the competition using operations and supply chain. This is the most important paper in the class and should demonstrate all that have learned during this course. You may need to make this paper longer than three to five pages to make your case. Remember this paper is not a book report of what you have read, or a book report on a company, but a direct application of what you have read and learned in this class to show how a company can beat the competition by using operations and supply chain tools.

This paper is designed for you to demonstrate through application and analysis the key points you have learned in this class and how you will apply these key points.

#1 Choose a company: you can use a small or a medium sized company, it is not recommended that you use the same company that you have used for papers in this class. However, if you use the same company for this paper that you have analyzed for other papers in this class, you may not use the same data or analyses for this paper that you have used in other papers for this assignment. You are in danger of failing this paper (and this class) if you duplicate your analyses from other papers. Remember it is a violation of academic integrity to use material from one class or one assignment for another.

#2 Analyze: the competition for a company you have chosen. Through research get to know the industry or field that your company occupies. Find out who is doing well in that field? Who is not? Why? What are the core competencies for your chosen organization? What do they do better than anyone else in their industry? As part of this paper you must identify the competition (using a chart?) and then show the strengths and weaknesses of each of the competition to look for a window of opportunity for the company you have chosen (all of this needs to be cited with graduate level sources).

#3 Create: three to five specific examples of how your chosen company can beat their competition using information that you have directly learned in this class about operations and supply chain. Use the concepts AND THE analytical models provided to gain this advantage. These recommendations need to be backed up with analysis, citations from the text book and independent research. The recommendations need to be innovative and interesting and very well thought out and written.

#4 Write: like a graduate student, APA, sources referenced, perfect grammar. Clear strong declarative sentences. Use very few pronouns. Include a strong reference section from the text book and additional resources from your research. Be sure to use APA headings (see below).

#5. Question: Describe the powerful questions that you will ask and answer in this quantitative and qualitative analysis to gain competitive analysis through operations.

#6. Class Concepts: You should include at a minimum three to five of the following concepts in your paper (See Rubric below to see how these class concepts (a – g) are to be woven through your paper):

a) Introduction to operations and the global supply chain

b) Foundations of operations

c) Process innovation and mapping

d) Managing systems in the supply chain

e) Integrating relationships with suppliers and customers

f) Planning supply chain innovation including technology

g) Managing for change and innovation to create value

Business papers always use headings, and graduate students need to use APA headings:

https://owl.english.purdue.edu/owl/resource/560/16/

Essential Oils for Muscle Discomfort and Inflammation Relief

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Whether from overwork or under use, many of us have had to deal with muscle aches and discomforts at one point or another. While there are several remedies available to relieve muscle discomfort, both natural and pharmaceutical, essential oils have their own role in soothing the sore muscles and offering relief. The most popular essential oils that are generally used to soothe muscle discomfort include wintergreen, cinnamon, marjoram, cypress and basil. With that said, here are some of the best essential oils you can use for muscle pain relief:


  • Basil

Basil can be applied directly as a massage oil to reduce swelling in the muscles. It works as a decongestant, antiseptic, muscle relaxant, anti-inflammatory, anti-bacterial, antiviral and antispasmodic. Individuals with epilepsy, kids, and pregnant females must avoid making use of basil. It may likewise be a skin irritant. Basil can either be ingested in diluted forms or used in a diffuser.


  • Marjoram

Marjoram essential oil can be beneficial for bronchitis, headache, asthma, whooping cough or any irregularity in muscles. With the right knowledge of its use, Marjoram fits for both oral consumption and topical application with no known side effects involved.


  • Tea Tree

There are not many side effects involved with the use of tea tree oil; however, a little caution must be followed when using this oil on children under the age of 6. In addition, I have found people using tea tree oil to have a higher vulnerability to contact sensitization.


  • Neroli

Neroli is calming, relaxing, promotes self-confidence, sensuality, peace of mind, and positivity. When used properly, there are no known side effects to using the oil. Neroli can be applied topically as a fragrance, or used in diffused form.


  • Spearmint

Spearmint essential oil can work wonders for those suffering from muscle pain and inflammation. There are no known adverse effects to using this oil; however, skin irritation is one of the negative outcomes when this oil id used for long. This oil can be taken orally, used externally or in a diffuser.


  • Helichrysum

Helichrysum is useful for reducing the inflammation of the muscles, acne and headaches. In addition, this oil promotes the healing of injuries or burns, detoxifies the body and boosts the immune system, reverses the signs of aging, and fights the fungal infections. There are no known adverse effects to making use of this essential oil, but ingesting it orally can be toxic. Helichrysum can be used both topically and in a diffuser.


  • Peppermint

Peppermint essential oil is highly relaxing for those suffering from muscle pain and inflammation. While there are no known negative effects to making use of peppermint oil, I have seen some people reporting problems like mild skin irritation. It can be taken internally, topically, or used in a diffuser.


  • Wintergreen

Wintergreen essential oil can be beneficial for small muscle aches and pains, issues of the kidney, nerve pain, arthritis, throbbing joints and menstrual pain. This oil is hazardous when ingested orally, and can trigger ringing in the ears, forgetfulness, belly pain, headache, vomiting and nausea, if not used appropriately. It can be applied topically to the skin or used in a diffuser.


  • Clary Sage

Clary Sage essential oil can be helpful for inflammation of the muscles when applied to the skin. There are no recognized negative effects to making use of clary sage, when taken in right amounts. It can be taken orally (it acts as a flavor for food) or used topically.


  • Chamomile

Chamomile essential oil helps in sleep and has soothing and relaxing properties that help to lower stress and anxiety. Possible adverse effects can include contact dermatitis, anaphylaxis and other extreme hypersensitivity reactions. You can diffuse it or rub 2 drops of this oil on the temples or back of the neck, either prior to going to bed or when dealing with a difficult situation.


  • Cinnamon

Cinnamon essential oil has the ability to stabilize blood sugar, reduce inflammation, and battle the infection. There are no known side results to using cinnamon; however, it may be a skin irritant and may irritate the nasal passages if not watered down.


  • Cypress

Cypress essential oil reduces pain in the muscles including muscle fatigue and spasms. In addition, this essential oil helps in relieving aching muscles after a strenuous exercise session. When used topically, it easily penetrates the skin and mixes with the blood within minutes, triggering immediate relaxation and pain relief.


Common muscle illnesses and the essential oils you can use for them


  • General Muscle Discomfort

The best essential oils to use for general muscle discomfort are Marjoram and Pepper mint followed by wintergreen, white fir, vetiver, Spanish sage, silver fir, rosemary, Lemongrass, lavender, Ginger, Cypress, Birch, Basil and Balsam fir.


  • Muscle aches

If you are throbbing due to muscle pain or have fibromyalgia or connective tissue discomfort, the following essential oils are most helpful: Peppermint, Oregano, Marjoram, Clove and Birch. Other than these essential oils, I have found Wintergreen, White Fir, Thyme, Rosemary, Chamomile, Lavender and Helichrysum to be quite useful.


  • Cardiac Muscle pain

Yes, your heart is a muscle. Marjoram and Lavender work best for such muscle issues, followed by Rosemary, peppermint and Cinnamon. You can use these oils topically or in a diffuser for aromatic use.


  • Cartilage Injury

Birch, Marjoram, and Wintergreen are best for this kind of injury. Lemongrass and Peppermint are likewise useful.


  • Lack of energy in muscles

To energize the muscles prior to a workout, use Rosemary. It warms the muscles and helps them to stretch for optimal efficiency.


  • Muscle Cramps

Often prompted by pressure or lack of blood circulation, leg and foot cramps can often be prevented by remaining hydrated. Lemongrass, Marjoram, and Peppermint are the best oils for relief, followed by Vetiver, Rosemary, Chamomile, Lavender, Grapefruit, Cypress, Clary Sage and Basil.


  • Muscle Fatigue

List of essential oils that I can confidently recommend for muscle fatigue includes White Fir, Peppermint, Marjoram and Cypress. Other than that, Thyme, Rosemary, Grapefruit and Eucaluptus have also shown quite good results with my patients.


  • Muscle Spasms

While spasms are not usually agonizing, they can be eased with the use of Basil, Chamomile and Marjoram. Peppermint, Lavender, Cypress and Clary Sage can likewise help.


  • Muscle Sprains

Stress in the ligament can be treated with White Fir, marjoram and Lemongrass. Other essential oils that might be helpful are Vetiver, Thyme, Rosemary, Lavender, Helichrysum, Ginger, Eucalyptus and Clove.


  • Tendinitis

Marjoram and Lavender are the best essential oils you can use for swelling of the tendon.


  • Muscle stress

Whether caused due to physical stress, or emotional anxiety, Marjoram is your best choice for muscle stress. Helichrysum, Lavender, Peppermint, and Roman Chamomile are also useful.


Prepare your own essential oil Blends

For a muscle pull, blend 3 drops of Roman Chamomile and 2drops of sugary food grade Marjoram together. Apply this blend via cold compress.

For muscular pain, combine 3 drops of Roman Chamomile with 3 drops of Lavender. Apply this blend using cold compress.

For swelling in the muscles, use a cold compress of 3 drops of Peppermint and 3 drops of Yarrow.

To release a muscle spasm, mix 2 drops of Ginger, 3 drops of Cypress and 3 drops of Sweet Marjoram with 3 teaspoons of carrier oil of your choice. Apply this blend topically twice in a day.

To soothe tender muscles, blend 3 drops of Lemongrass, 5 drops of Ginger, and 5 drops of Lavender with 5 teaspoons carrier oil of your choice. Apply this blend topically three times in a day.

To relax tight muscles, blend 4 drops of Lavender, 4 drops of Rosemary, and 2 drops of Ginger with 4 teaspoons of carrier oil. Use this blend topically three times in a day.

In order to ease rheumatic pain, blend 3 drops of Lavender, 3 drops of Ginger, and 3 drops of Silver Fir in 5 teaspoons of carrier oil. Apply this blend over the impacted areas three times in a day.

In order to enhance flow of blood to the cramping muscles of the leg combine 3 drops of Ginger, 5 drops of Black Pepper, and 5 drops of Cinnamon in 5 teaspoons of carrier oil. Use this blend over areas where muscle cramps exist.

For centuries, essential oils have been recognized for having therapeutic properties. Ancient cultures exercised the art of making essential oils for reliving muscle pain by first soaking the leaves, branches, bark and flowers of plants in oil for duration of time and then using linens to cleanse, separate and filter the oils in a concentrated form.

Always remember that muscles need potassium, sodium, magnesium, calcium, glucose and sufficient amounts of water to work. So, I would recommend that you do not overlook something that is the basic requirement for your muscles to function optimally.

Instructions First- review the module resources- including the text readings and SHRM resources. Next- carefully examine the behavioral competencies within the Business domain. The three clusters with 1

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Instructions

First, review the module resources, including the text readings and SHRM resources. Next, carefully examine the behavioral competencies within the Business domain. The three clusters within the business domain are business acumen, consultation, and critical evaluation. Once you are familiar with the business domain clusters, conduct a self-reflection and analysis by responding to the following three questions as your journal:

Strengths: What are your areas of strength within the business domain, and how did you determine a cluster as a strength? Provide supportive examples.

Weaknesses: What are your areas of weakness within the business domain and how did you determine a cluster as a weakness? Provide supportive examples.

Strategies: What are your strategies for the development of behavioral competencies within the business domain? Provide supportive examples and information from your research.

Refer to the module resources and other course materials to support your responses. Your instructor will provide feedback pertaining to your self-reflection and offer recommendations for skill development.

For additional details, refer to the Module Two Journal Guidelines and Rubric document.

Also, 100% free of plagiarism and completed on time!!!!!

Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created.

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Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created.

In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:
1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
You are required to cite five to 10 sources to complete this assignment