Risk Management Plan in Healthcare

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  • Cyrill Hannah A. de Leon

  1. Introduction

Risk Management is known as the process and system of distinguishing risks, assessing risks and planning approaches to regulate risks. In this growing business industry, risk management plan and business core analyses are essential and integral parts of a business plan. Each company or organisation must be aware of the possible potential risks that may arise within the organisation for it to be prepared if ever an unavoidable problem occurs and discover ways to reduce the effects if ever such problem takes place.

There are different types of risks from one business to another. Risk Management plan follows a systematic process. It must describe the strategies of dealing the risks that is particular to the business. Risk Management is essential in scheming, observing and reducing unfortunate events that will impact the business.

Each organisation has its own risk management. Healthcare Risk Management provides its own standards in delivering quality healthcare, ensuring patient safety and avoiding unfortunate consequences thus, carrying effective, efficient, and high quality patient care to clients.


  1. The Purpose of Risk Management within an Enterprise.

Risk Management is very essential in determining the possible problems that may arise in each organisation and for it to be equipped with risk precautions in order to manage and tolerate adverse effects. Quality management has always been important when we speak of the service division. This is specifically true with healthcare. In a healthcare setting, there are numerous risks that are prevalent like risk among the staff, risk among the patients or even risk among the entire organisation. Thus, it is very important for each organisation to have risk managers who will assess, monitor and respond to each risk to minimize exposure of risks that may be a threat to the organisation. As a healthcare provider, our main concern is the safety of our patients. In order for us to deliver the best quality healthcare to our clients, healthcare professionals specifically health care managers must work reactively and proactively to minimize any damage that may occur in the future or prevent any malpractice. (The University of Scranton, 2014)


  1. The Benefits of Risk Management within an Enterprise

Development and implementing of Risk Management is relative in each organisation. It is a continuous process that transpires not only in the beginning but all throughout the entire process itself. The benefits of Risk Management includes:

(Grow Indiana Media Ventures (LLC), 2014)

  1. Awareness of Risks

With the help of risk management process, the organization may be able to assess and identify the potential risks that may occur within the enterprise. In this way, managers may be able to weigh the severity of the risk and provide measures to solve the problem. It is the responsibility of those in higher positions or the enterprise managers to allocate time to it’s staff to let them be aware of the hazardous risks and the corresponding approach.

  1. Reduction of Financial Risk

Every company’s aim is to gain profit. It is the prerogative of each company to develop risk management plan to evaluate the risk that may affect the market, operational services and other related circumstances. Risk management will also help to better manage the costs and the visibility of risks to the economic condition.

It will also aid in the management of financial stability of the company thus avoiding any chance financial instability or worst, bankruptcy.

  1. Improved Attention and Communication of Risk

This provides a standardised context of risks for all the members within an organization. It is very important that each organization should communicate among every department regarding the status of the company and communicate up from the senior management down to its labor workers regarding risk information within the operations of the company and discuss insights on how to properly manage risks to develop an effective approach to minimize risks.

  1. Avoid Future Problems

Risk management will enable the company to foresee the possible glitches that may occur in the company. With the aid of risk management, every company will be prepared on how to face these problems and minimizing or reducing financial costs. With this awareness, proper management will be implemented and it’s objective in controlling risks will be observed. Risk management enables to reduce or eliminate financial risk through a cost effective approach and proper intervention with the execution of a contingency plan that will aid in reducing risks that the company shall face.


  1. Risk Management Components in relation to the overall role of the Risk Management.

  1. Reviewing of Activities and Internal Environment

In this evolving world, the healthcare industry faces a number of issues regarding the reform of healthcare. Risk management in the field of healthcare is very important in achieving its goals and objectives and constructing plans in delivering quality healthcare to its clients. Risks in the internal environment of a healthcare institution is observed where standards should be observed in order to ensure the safety of the clients and to avoid jeopardizing their welfare. Risk Management in healthcare organizations focuses on patient safety and ensuring that clients receive the effective and efficient quality healthcare.

The following are the risks in the internal environment of a healthcare industry:

  • Machines/Equipments

There are certain healthcare facilities that lack equipment or machines due to lack of resources or funds or due to unavailability because of certain damage or defect. The use of defective diagnostic machines may produce unreliable reults. This may jeopardize the treatment process of clients like for example, a patient with pneumonia may need to have an chest xray examination. If the xray machine would be unavailable or is damaged, the treatment process of the client may be delayed due to the inaccessibility of the diagnostics that will support the diagnosis of the disease.

  • Staffing of Personnel

In as much as each healthcare provider would like to give the best quality healthcare to it’s clients, it’s is unavoidable that the workplace will be understaffed or overstaffing. But among the two, understaffing would likely affect the services that will be rendered to the clients. Whenever there is a lack of manpower, services are usually hampered and clients may most likely not receive suffer. The hiring of unskilled staff may also jeopardize the safety of clients. It’s the responsibility of the human resource department to properly screen newly hired personnel and provide them with basic training whenever someone will be hired in the company in order to ensure that they provide the best quality care that each client deserve. There are also incidents wherein services may be hampered due to absences of staff from work.


  1. Setting objectives

Setting objectives for Risk Management:

  1. The first step regarding risk management is Risk assessment. Risk assessment should be recorded, systematic and reviewed regularly. In this step, management committee will identify the potential risks that the company will be facing then manage the major risks that will arise.
  2. Identifying the risk whether it will just be a minor or major threat to the organisation. Determine what might happen when this potential risk will be observed in the organisation
  3. Analyse the level of the risk whether it will just be a minor or better yet a major issue and reviewing the controls into the system and the possible likelihood or the consequences that may occur when the risk will be observed.
  4. Evaluate the severity of the risk and then rank the risks. Communication within the organisation is very important because this will give awareness to the people and will enable them to discuss further what are the possible ways of minimizing the risk within the organisation
  5. Treat the risks by identifying the options, selecting the best responses, developing risk treatment plans and implementing them within the organisation. In this way, it will give them the assessment whether goals have been met.

  1. Event identification

There are internal or external events that may affect the risk management plan or strategies. In the healthcare setting, an example of an internal event that may affect the organisation is technical risk. If I will relate it to the healthcare, almost all hospitals use the patient information system in supporting the patient care process through computer based patient records, patient care systems and patient classification systems. This system provides the necessary details in order to properly manage clients according to their specific needs. If for instance there will come a time that the software may fail, this will surely affect the entire organisation. It may affect the function of the organisation in keeping track of the record of the patient. Thus, it is very important that each organisation should not only be reliable to software programs. They must also keep hard copies of each patient record to serve as standby file of their records. In this way, patient care may not be jeopardized.

In the external events, there are uncontrollable situations or events that occur outside the organisation causing a great impact like natural calamities such as floods, earthquakes, fire. These events may affect the organisation in such manner that there will be a great possibility that the staff may not be able to work and the company will suffer because it will lack manpower thus, production may be put risk and profit will be minimized.


  1. Risk assessment with particular reference to the impact and likelihood of risk

Each organisation follows its own policies and regulations. Orientation of the staff is very important to decrease the likelihood of risk. For example in a healthcare setting, the administration should orient its staff for them to be aware of the policies within the organisation or better yet provide them with seminars, programs and trainings from time to time that will help them increase their knowledge, let them be aware of the up to date changes in the management and let them be equipped with the desired skills in case potential threat may arise in the company.


  1. Risk response plans

Many organisations implement risk response plans that will help them avoid or control potential threats and apply the necessary risk management controls to a specific organisation. There are different ways on how to respond to specific risks. Few of the following are:

  1. Recognition

In case of occurrence of any risk, each organisation must be able to accept and recognize the problem. With this, the team will be able to develop proper management plans in order to regulate risks.

  1. Control

There are always risks in every organization. We know for a fact that it is unavoidable but with mitigation, this will reduce the probability and impact of risk in the organisation by taking some measures by the time the company faces the risk. For instance, companies may organize seminars that will help the team develop project management plans.

  1. Prevention

In this, risk is eliminated by developing strategies even before the company will face the risk. This will also help in preventing major damage to the organisation.

Risk Management strategies identifies external threats along with strategies that will aid in addressing each problem.


  1. Control activities

Risk Control is the method by which the organisation evaluates the potential losses and takes the necessary action to reduce or eliminate the threat. It involves the implementation of standards and policies and managing procedural changes. Controlling risk management is the solution in maximizing profits in the business. Developing control activities will help in decreasing the risk of business failure and for the accomplishment of goals and objectives. Control activities that will decrease the likelihood of risk includes supervision of the team by the senior management in taking precautions in case a threat may be predisposed in the company. Reporting will also help in keeping the team updated on the latest strategies that will be useful in controlling the risk in the organisation.


  1. Information and communication

Information and Communication should be observed within the organisation to help the team keep posted on what are the precautions that should be observed in case the company faces a threat. The top management plays a very influential role in the dissemination of information in the enterprise. It is the obligation of the top management to relay the necessary information down to the different departments of the organisation. Communication serves as a foundation in planning, organizing, motivating each team. It can be through verbal or written form such as memorandums, emails or forms. Communication and relaying of information is necessary in moulding the reputation of the organization. Correct dissemination of information within the organization will prompt customers to be loyal with the company and promote or boost the organization’s image and to its customers.


  1. Monitoring

Monitoring is the process of implementing risk plans, tracking identified risks, monitoring residual risks, identifying new risks, and evaluating risk process effectiveness throughout the project. Regular monitoring enables the management to keep track of the risks and to foresee circumstances making the implementations effective and analysing the results of the plans. This includes the continual measurement and monitoring of risk environment and the performance of risk management strategies.


  1. Conclusion

Risk management is important in an organisation because without it, a firm cannot possibly define its objectives for the future. If a company defines objectives without taking the risks into consideration, chances are that they will lose direction once any of these risks hit the organisation. Risk management is very essential in each organisation because it will help in preventing loss or even damage to the institution.

The risk management plan should propose applicable and effective security controls for managing the risks.


  1. REFERENCES

Grow Indiana Media Ventures (LLC). (2014). Benefits of Enterprise Risk Management. Retrieved from


http://www.insideindianabusiness.com/contributors.asp?id=2148

The University of Scranton. (2014). The purpose of Risk Management in Healthcare. Retrieved from


http://elearning.scranton.edu/resource/health-human-services/purpose-of-risk-management-in-healthcare

Emergency Care Research Institute (ECRI). (2009). Healthcare Risk Control. Retrieved from


https://www.ecri.org/documents/secure/risk_quality_patient_safety.pdf

Exploring leadership in health and social care practice

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Today’s vibes in healthcare organisation requires individuals who are creative, flexible, and able to empower others to be creative and flexible. Many leadership issues are the same regardless of industry, but healthcare industry presents many unique issues (Robinson, 2005 cited in Mechanic, 2005, p53). The relationships, life and-death nature of the work, emotional demands, and service delivery challenges with much shortage, managed care, higher client acuity, fewer resources, highly diverse demographics, and outside influences in this industry, make it very different from those in other fields. Because of these unique issues, healthcare practitioners need to be more effective leaders than ever as they manage clients in various settings. Regarding to that, this essay will critically analyses my leadership role and style in health and social care practice and how this may be developed to enhance client care. This essay will discuss the concept of leadership in health and social care in my practice, impact of organisational culture on my personal effectiveness, the key leadership qualities required to meet current challenges in my practice and how it will enhance my personal effectiveness, my team and client care.

Development of health and social care organisations in service sector industries require an uptight need for mounting efficiency in the concept of leadership. In my opinion upon my working experience in rehabilitative services, leadership can been defined as the process of envisioning a new and better world, communicating that vision to others, motivating others and enticing them to join in efforts to realize the vision, thinking in a different way, challenging the status quo, taking risks, and facilitating change (Grossman and Valiga, 2005, p45). Leadership has evolved from theories of the past, which pronounced that only great and noble men could be leaders, to more current theories that look at leadership as a learned process or a changing role depending on the situation (Ilies et al., 2004, p207-19). Organisation strategies are drawn from both leadership and management theories and it involves both the leader and the follower (Burns et al., 2004, p840). As integration of multitasking operational processes and clinical assessment results an improvement in client care outcomes (Graham, 1995, p120-121), valid development in the client care practice initiates by leadership construction, institutes a legitimate for initiating a patient care improvement. In this subject, health and social care leader, lead and manage care for clients and communities in a variety of settings. They also lead and manage care across the health-care continuum, including primary health promotion and prevention, secondary skilled, long term, rehabilitative and tertiary: emergent, urgent, and acute care. Meanwhile, effective followers are entity who support and work with health care leaders. They are individuals who are engaged, suggest new ideas, share criticisms with the leader, and invest time and energy in the work of the group, upholding constructive interaction within the group, and stand-in as potential “leaders-in-waiting” in health and social care legacy (Pittman et al., 1998, p118). Morgan et al. (2005, p110-118) suggest that management is regarded with taking resources collectively, mounting strategies, planning, organizing, controlling and coordinating activities with the aim realize agreed missions. The approach of health and social care towards leadership and management, reflects the dynamic state of social and health care practice. Management has evolved from competing health and social care managerial activities in a hierarchical, bureaucratic organisation to complexity theory involving both health and social sciences. Therefore, health and social civilizing and ecological context has to be deposit within the concept of leadership that been adopted in the organisation. I consider that all therapists must be looked to as leaders in and for the profession. In leading Neuro Spinal Rehabilitation team in my organisation, I have my role and responsibility in setting the team’s goals and built up the teamwork spirit among members. I also lead the team by being a decision maker, team’s delegator and mentor for the junior staffs.

Rehabilitative services are a major component of a health-care organisation, and it is important to understand the organisation culture in which to provide effective personal leadership quality in rehabilitative care. Organisational culture can be defined as the assumptions and beliefs that organisational members have in common. It is the “shared values and beliefs within the organisation” (Huber, 2000, p437). The culture of the organisation contains the norms that characterize the environment (Sleutel, 2000, p53-8). The culture consists of things that are not written down but are known by all members, which affects the outcomes of quality for the organisation. The culture is learned through the relationship between behaviors and the consequences (Jones and Redman, 2000, p604-10). Working in the medical centre of choice which serving the globally community, surely have a strong value set, mission, vision, and philosophy in order to meet ever-changing events and the needs of our clients. Staffs were repeatedly been remind that the organisation have a vision and mission in delivering quality tertiary services and best care to the client. Appraisal was vital and we were supervised. Our performance determines our promotions, increment, and year on year bonus. Straightforwardly, these principles generated a competitive culture between staffs to strive and earn as much as we can without jeopardising the care of the clients. The working mood was conducive and work satisfaction far above the ground. Interpersonal bond was pleasant in manner, open and constructed on mutual respect. Kouzes and Posner (1990, p29) affirms that good leadership arrives from within one’s values, sense of integrity and trustworthiness. Teamwork, respect, comradeship, empathy, honesty, loyalty and integrity were the values projected as our department culture. Russell (2001, p76) believed that good values yield a great form of leadership. With the intention of establishing transformational leadership practices, as leaders I have to scan my own self-awareness and a plan for self-development. This positive self-regard satisfies my self-esteem, needs and will result in “self-confidence, worth, strength, capability, adequacy, and being useful and necessary” (Barker, 1990, p159). By establishing this form of leadership, I will have a better relationship with my team (Morrison et al., 1997, p27-34). Transformational leadership was positively related to empowerment. Thus, as ‘the most senior among junior’ staff in my department, indirectly I will set an example for the juniors to follow. I understand that initially I should strengthen my personal values before give good quality organisational values to my followers. With these all elements that been mentioned, its help me as a leader to understand my work environment. Me my self as a leader and also other therapists need to be knowledgeable and comfortable within the culture and the climate of the organisation. Our organisation is improving in work environment through shared governance and magnet status for the therapists. This provides autonomy and demonstrates the importance of my personal leadership effectiveness in a professional practice environment that been offered by my organisation.

Leaders keep the organisation continually moving forward by looking for ways to improve while managing the goals of the organisation. As to describe the important of key leadership qualities required in order meet current challenges within my practice, I need to outlook myself as a leader, build-up my leadership capacity, and hold the obstacles that been faced (Grossman and Valiga, 2005, p122). Communication and teamwork issues have been often cited as shortcomings in the health-care system. Many of the problems that occur within teams are the direct result of people failing to work in a team (Kaissi et al., 2003, p211-18) and communicate effectively (Maxfield et al., 2005). In my team, there are individuals that tend to work outside the team’s globe. That individuals always put into account the differences occurs among the team members, refused to take clients that been referred and did not take part in any team brainstorming and team meeting. That individuals display a lack of trust, a lack of tolerance for healthy conflict and lack of passionate commitment toward the organisation. There are also problems of miscommunication. This always happens especially on issue of client’s treatment appointment that leads to incompetence in rehabilitation service delivery.

As a leader in the rehabilitation team, I should develop varied formal and informal key leadership qualities, which involve team building, communication, negotiation, delegation, and mentorship in order to lead and manage the challenges successfully. As a leader, I must be able to work as a team builder. I should develop a mission and goals of the organisation unify the team and should reflect the goals of the team. There also a need for me to set ground rules. I agreed that members need to know expectations for structure and behavior. Ground rules that were considered most important included, clear expectations for time, place and attendance of meetings, communication, collaboration, and mutual respect among members. For example, through the use of attractors, I can help the team focus and move forward in the use of the knowledge and expertise of the team members. Both formal and informal communication is important for effective communicator leader. According to Barnum and Kerfoot (1995, p300), personal face-to-face communication is optimal, so I must make every effort to stagger my hours to allow this communication on a regular basis. Leaders who make time for informal communication will have a more accurate understanding of the issues, will develop more open, trusting relationships within the organisation as well as a greater understanding of factors affecting morale and avoiding issue of miscommunication. Another key leadership quality that will facilitate me to meet my challenges is being a good delegator. I should be able to delegate every job and task in delivering services within the team (Blanchard et al., 2007, p175). This helps to organize time and complete the task within different clients or variations of equipment used. As a ‘coach’ for the junior staffs in my organisation, I also should have a mentorship quality. Bennis suggest, “drawing out the leadership qualities (of others) is the way of the true leader” (Bennis, 2004). I must mentor juniors and acknowledge their ideas. My protégé definitely will have the same brain and idea as me, as a result, it will establish an effective teamwork and avoid team conflict.

As realizing that there are lots of lacking in my leadership values of practice, assessment exercises definitely help in fixing the missing qualities. Leadership assessment exercises represent a wide range of strategic, organisational, and interpersonal challenges which been measured using coworker ratings (Sloan, 1994, p1061). There are three basic purposes for leadership assessment, which is prediction, performance review, and development. The assessment that been used was multisource (also called 360-degree) feedback surveys which collect anonymous performance ratings from supervisors, subordinates, peers, and sometimes customers for comparison to self-ratings (Smither, 2003, p24).

The development of the key qualities that been mention above is likely will enhance personal effectiveness, team working and client care. I unanimously agreed that my experienced in leading interdisciplinary teams left me with the beliefs that good teams create safer and better patient care, improve resource utilization, improve team collaboration, and contribute to more personal effectiveness satisfaction. I always emphasized that a condition for success was the identification of clear goals and the need for leaders to facilitate the “buy-in” of goals by all team members. As a team builder, by asking each team member to commit to the success of the team was noted as a successful strategy within one team. The importance of leaders having public support of the team from highly regarded influential hospital leaders was also crucial in adopting national quality improvement for patient care issues. Leaders with effective communication always believed the need for good communication was imperative. I noted that willingness to communicate created opportunity to solve problems effectively within the team. I also noted that when team members became more familiar with each other’s roles, communication improved as did respect and collaboration. There is a need to communicate across generations. New team approach seemed to threaten autonomy and “old way of doing things” for some practitioners. My team agreed to enlist key peers of older generation, who were accepting of changes to communicate rationale for changes. This development will directly improve the service delivery to the client, as there is no more miscommunication between therapist and client such as in client appointment issue.

The good delegator leader will recognize the wisdom of members of the health-care team, support the interconnectedness of team members in the health-care delivery system, and embrace a more fluid, innovative system. The leader will foster an environment that supports the notion of associates, which is being partners in the delivery of health care, being accountable for evaluating the outcomes of the interventions, having the equity in the team to make “point of service delivery” decisions, and feeling a sense of ownership in the organisation (Wilson and Porter-O’Grady, 1999, p32-8). Improved relationship and respect for others led to sharing of professional literature and ideas. Assessment tools and protocols were developed reflecting interdisciplinary interests. Team members reported more collaborative care and more satisfaction with their work environment.

Mentorship is the process to accomplish all of these (Byrne and Keefe, 2002, p391). Mutual respect, goal setting, accountability to each other, and open dialogue are hallmarks of an effective mentoring relationship of a leader. The leader with a mentorship quality has the responsibility to create opportunities for professional growth and involvement, whereas the protégé is responsible for responding to these opportunities. The mentor has the responsibility to provide opportunities for the protégé to gain recognition for the work accomplished; the protégé is accountable for being responsible and reliable with the work accepted. The mentor empowers, encourages, and challenges the protégé.

As a conclusion, health and social care organisations need leadership at all altitudes, from top to bottom. Leaders play very important roles in managing health care organisations, as the cliché goes, “where the rubber hits the road.” Leaders translate strategy into action. Leaders responsible to make sure work gets done, services are delivered, and clients are satisfied. Leaders can almost make or break a company by how they lead the workforce and by how effectively their practical decisions respond to any challenges in the organisation. Leadership greatly affects the attitudes and the productivity of workers. As the one who lead platoons into battle, leaders must make critical adjustments to local conditions and terrain, keeping people together, be an effective communicator and a mentor for the junior. With the intention of developing leadership proficiencies, it is essential for me to study professional leaders, work together with all, and get constructive feedback on my performance. Having an outline and experience with a senior leaders, permits me as a ‘junior among senior leaders’ to comprehend the framework of my organisation, communicate and collaborate effectively, extend negotiation ability, reflect more extensively and be empowered (Grossman, 2005, p266-78) in order to develop my personal effectiveness, team working and service delivery.

“Reduction in Force at Sierra Veterans Affairs Medical Center,” on pages 501–509 ofHuman Resources Management in Healthcare.Case 2: “Management Challenges of a Customer Service Center,” on pages 511–522 of Human Resources Management in Healthcare

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“Reduction in Force at Sierra Veterans Affairs Medical Center,” on pages 501–509 ofHuman Resources Management in Healthcare.Case 2: “Management Challenges of a Customer Service Center,” on pages 511–522 of Human Resources Management in Healthcare

Case: African Gold, Inc.—Ethics and AIDS in the Workplace in Human Resource

On your own, respond to the questions posed at the end of each case. (You will synthesize your responses in your Discussion posting.) Then, reflect on what you have learned throughout this course, and how this particular case furthers your thinking about human resources management in health care. What are the implications of this case and the insights you have gained for your work as a health care manager?

Identify the case you have selected in the first line of your posting.

Synthesize your responses to the questions posed at the end of the case.

Explain how this case furthers your thinking about human resources management, including the ethical considerations involved in business decisions. Describe the most significant implications of this case and what you have learned for your work as a health care manager.

Complex Adult Health Needs Assessment

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Background Information

Patient J. H.  is an 84-year-old African American female. Past medical history includes upper gastrointestinal bleeding, hyperlipidemia, Cerebral Vascular Accident in the cerebellum since 06/15/2017, hypertension and arthritis. Surgical history includes a hysterectomy and laser cataract surgery. Patient’s diagnoses are meningitis and hypertension.

Patient was presented to the emergency department with complaints of altered mental status for 24 hours, a blood pressure of 204/140 and a fever of 101.1 Fahrenheit. Patient’s daughter brought her to the ED and stated that patient was found to be incoherent when daughter came back home from grocery shopping. Upon assessment, neurological status was evaluated. Patient was alert and oriented only to self. Patient could not state where she was, what time it was and the reason for being hospitalized. Pupils were round and reactive to light and brisk bilaterally. Face is symmetrical. Reflexes were two plus. Patient’s speech was inherent and was not able to follow to follow commands. Vital signs were heart rate of 64, blood pressure of 177/91, respiratory rate of 18, temperature of 97.9 and oxygen saturation of 97%. Head is normocephalic with no lesions and no masses. Eyes are symmetrical with conjunctiva pink and sclera white. Ears are symmetrical with no drainage and no pain when palpating tragus. Nose is symmetrical with no drainage and no deviated septum. Trachea is midline. Mouth is symmetrical with dry mucous membrane and tongue midline. Upon auscultation, lung sounds were clear bilaterally with no adventitious sounds. No accessory muscle. Respiratory effort normal. S1 and S2 were heard with no extra sounds and with regular rhythm. No elevation of jugular vein was observed. Bowel sounds were active on all four quadrants. Abdomen was nondistended and nontender.  Pedal pulses and tibial pulses plus two. No edema on lower extremities. Extremities were warm and dry upon palpation. Skin was dry and no intact with no lesions or rashes.


Labs and Diagnostic Tests

LABS RESULT REASON
WBC 15,000 Patient presented to ED with fever of 101.1 and admitting diagnosis of meningitis
Hgb 13.7 Within normal range. Patient had a history for upper GI bleed.
Htc 42.6 Within normal levels.
Platelet 315,000,000 Within normal levels. Patient received antiplatelet and anticoagulant therapy for deep vein thrombosis prophylaxis and stroke prevention.
Neutrophils 13.7 Patient’s neutrophil count is high due to meningitis infection.
INR 1.2 Within normal. Patient is on anticoagulant and antiplatelet aggregator therapy to prevent deep vein thrombosis and stroke.
BUN 21 Slightly elevated probably d/t acute kidney injury
Creatinine 1.1 Within normal levels. Patient in on several antibiotics and has a history of acute kidney injury.
Sodium 135 Within normal levels. Patient received a complete metabolic panel.
Chloride 98 Within normal levels.
CO2 35 Within normal levels
Alk Phos. 148 Slightly elevated. Can be correlated due to infection.
Proteinuria 500



Diagnostic Tests


Test
Reason (s) Needed

EKG
 		To monitor for nay cardiac changes

CT
 		To rule out Cerebral Vascular Accident. Results showed diffuse atrophy and moderate chronic changes. Patchy low-density area noted in left posterior parietal lobe.



Medications


Trade Name, generic name & classification
Pharmacological & Therapeutic use
Adverse Effects
Time, dose & route
Why is patient receiving this medication
Nursing Implications

Acyclovir (ZOVIRAX)


Antiviral & purine analogus

Medication interferes with DNA synthesis.  It stops viral replication. Seizures, dizziness, N/V, headache, renal failure, Steven-Johnson Syndrome
Dose:

455 mg in 250 mL sodium Chloride 0.9%


Time:

0500, 1700


Route

: IV

Patient was admitted with diagnosis of meningitis. Started pt on this medication since at this time it wasn’t known if it was bacterial or viral. Monitor BUN, Creatinine before and after medication administration. This medication can lead to kidney failure.

Ampicillin


Anti-infective propreties and aminopenicillin

Binds to bacterial cell wall leading to cell death. It is used as a bactericidal for infections caused by Streptococci, Pneumococci Seizures, C. Diff, diarrhea, rash, anaphylaxis, serum sickness and superinfection
Dose

: 2 g in sodium chloride 0.9% in 100 mL


Time:

4 times per day


Route

: IVPB

During the period of care, patient had meningitis. Patient was receiving IV antibiotics Assess for s/s of infection. Assess patient for s/s of anaphylactic shock. Assess bowel function. Monitor liver enzymes

Ceftriaxone


Anti-infectives


3



rd



generation cephalosporin

Binds to cell wall membrane & cause cell death. Seizures, C. Diff. D/N/V, cholelithiasis, pancreatitis, agranulocytosis, hematuria, phlebitis at IV site.
Dose:

2g in 50 mL sodium chloride 0.9%


Time:

q 12hr


Rout

e: IVPB

Patient is receiving this antibiotic to treat meningitis. Assess of s/s of infection. Assess bowel function as it can lead to C. Diff. Assess for rash during therapy. Monitor Liver enzymes, BUN and creatinine

Clopidogrel (PLAVIX)


Antiplatelet agent


Platelet aggregator

Inhibits platelet aggregator. Reduces the risk for developing a stroke or Myocardial Infarction Epistaxis, GI bleeding, neutropenia, abdominal pain, edema, hypertension, gastritis
Dose:

75 mg


Times

: daily


Route:

PO

Patient is receiving this medication to prevent development of stroke. Patient has a developing stroke Assess pt for signs of stroke. Monitor for s/s of bleeding. Monitor platelets

Enoxaparin (LOVENOX)


Anticoagulant


Antithrombotic

Prevents formation of thrombus Bleeding, anemia, dizziness, constipation, urinary retention, rash, ecchymoses
Dose:

30 mg/0.3 mL


Time:

Daily


Route:

SC

This is a prophylactic treatment to prevent deep vein thrombosis Assess for s/s of bleeding or hemorrhage

Observe site of injection for hematoma or inflammation

Monitor of hypersensitivity.

Monitor CBC and platelets


Famotidine (PEPCID)


Antiulcer agent


Histamine H2 antagonist

Prevention of gastric ulcers by inhibiting secretion of gastric acid Confusion, drowsiness, hallucinations, arrhythmias, agranulocytosis, drug-induced-hepatitis
Dose:

20 mg diluted in 5 mL 0.9% NS.


Time

: daily


Route

: IV

Patient on gastrointestinal bleed prophylaxis. Assess abdomen for any epigastric pain. Assess for frank or occult blood. Assess elderly for confusion

Hydralazine (APRESOLINE)


Antihypertensive


Vasodilator

Causes peripheral arteriolar vasodilator. Lowers blood pressure Dizziness, tachycardia, angina, arrhythmias, orthostatic hypotension, drug-induced lupus syndrome Dose: 5 mg

Time: PRN systolic greater than 160.

Route: IV

Patient has a history of hypertension. Patient has been hypertensive throughout hospitalization. Monitor and assess blood pressure and heart rate during therapy.


Nursing Diagnoses


Nursing diagnosis
Nursing outcomes
Nursing intervention
Collaborative interventions

Decreased cardiac output related to heart not being able to meet metabolic demands as evidenced by patient’s blood pressure being >177/>140.
Stabilize blood pressure to normal base <177/<140


Administer hydralazine per MD orders. Monitor blood pressure q 30 min.


Raise HOB and stay with patient to provide support



Disturbed thought process related to cerebral infection as evidenced by patient grabbed my hand upon assessment and pretended it was a phone
Patient will demonstrate regain of consciousness by end of clinical day


Patient




Risk for injury related to altered level of consciousness as evidenced by patient is restless and tried to get out of bed several times
Patient will remain free of injury throughout clinical hours.


Patient will recall her name and current date.


Patient will not be restless by end of clinical day


Prevent injury by raising 2/4 bedrails and staying with patient.


Orient patient to person, time and situation.


Decrease stimuli by turning off lights and maintaining quiet environment




Nursing Interventions

Different interventions were provided for the patient to provide an overall quality of care.  Patient’s level of consciousness was impaired which prevented patient from moving and repositioning. To prevent skin breakdown and the development of pressure ulcers, patient was repositioned every two hours. According to a scholarly article, repositioning every two hours helps relieve pressure and friction off certain skin areas which can potentially lead to the development of skin breakdown (Peterson, M. J., Gravenstein, N., Schwab, W. K., van Oostrom, J. H., & Caruso, L. J. 2013). The patient was not able to independently move due to weakness and altered mental status from meningitis diagnosis.


Describe 3-5 independent nursing care you provided in the care of the critically‐ill individual. Examples include, but are not limited to: activity level, position, ongoing monitoring, and nutrition (prescribed diet, tube feedings/TPN, formula, rate, patient education, & wound care etc.). Each intervention should include a rationale,

evidence to support the intervention

with citation, and why it is important to the client. Each intervention should be a paragraph. One way to set this up is MEAL. M=main idea (ie positioning), E=evidence (citation of scholarly article supporting this intervention. For example. According to Perry and Potter (2016), repositioning should be done every two hours to avoid impaired skin integrity.), A= analysis and               L=link to patient (This client was immobile due to a fracture of the right femur and will need assistance with repositioning to avoid skin breakdown.



Interdisciplinary Management


Collaborative Care Management

To be able to provide overall care of the patient, interdisciplinary care must be provided.

Patient was diagnosed with meningitis. A sample of cerebral spinal fluid was needed to confirm the patient’s diagnosis and to select the correct antibiotic treatment to eliminate infection. Unfortunately, patient’s power of attorney declined spinal fluid tap. Collaboration with physician and neurologist was needed to intervene and to provide teaching on the benefits of such procedure.

The neurologist is a type of physician that specialized in diseases of the brain and spinal cold. The role of the neurologist is to provide and explain the benefits of a lumbar puncture to the patient’s durable power of attorney. The patient’s power of attorney was concerned about the lumbar puncture and the risks associated with it. The neurologist’s role was to provide patient and family education on the benefits and complications of this procedure. Patient’s power of attorney ended up declining procedure.

Since patient has a history of an evolving stroke and has lost strength and mobility of the right arm, occupational therapy was another interdisciplinary collaboration requested for the patient. Occupational therapy (OT) role is to help patient retain or regain the abilities lost prior to stroke. OT helps to gain or maintain the ability to perform activities of daily living (ADLs) such as regaining the ability to move arm completely or partially, learning how to cook, bathe, or brush teeth (The Role of Occupational Therapy in Stroke Rehabilitation (n.d). OT provided the patient of passive range of motion exercises. The overall goal of OT is to help with stroke recovery.


Therapeutic Modalities

Describe the various therapeutic modalities used in the management of care for the critically‐ill individual. Discuss the extent of the nurse’s responsibilities and skills required to manage the therapeutic modality in comparison to the responsibilities of the members of the interdisciplinary team. Therapeutic modalities include but are not limited to oxygen therapy (mode, FiO2,), dialysis/CRRT (settings), ventilator therapy (mode of ventilation, settings, FiO2). The rationale must be included for each modality. Each therapeutic modality should be a paragraph and have an

in-text citation and reference.


Nursing Role Reflection

Provide a brief summary of how your role interacted with the members of the interdisciplinary team. Each section should be a paragraph and include:

•                      Analysis of communication style preferences among interdisciplinary team members and with the critically‐ill individual and family members. What is the impact of your own communication style on others?

•                      System barriers and facilitators. Did the organizational framework for interdisciplinary management of care facilitate or hindered the quality of care/outcomes for the critically‐ill individual? What evidence-based recommendations can you make to the organizational system for enhancing interdisciplinary collaboration? Provide at

evidence


‐


based


literature


sources


to


support


your


recommendations

. Examples include SBAR, bedside rounding, etc.

Professional Development. Based on your experience(s), write ideas for your own professional self‐development plan to enhance your potential for becoming an effective member in an interdisciplinary team. For example: seminars, webinars, classes, CEU’s, etc.


Conclusion

Papers should end with a conclusion or summary. The assignment directions will specify which is required. It should be concise and contain little or no detail. No matter how much space remains on the page, the references always start on a separate page (insert a page break after the conclusion so that the references will start on a new page).

  • The Role of Occupational Therapy in Stroke Rehabilitation (n.d). Retrieved from https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/stroke.aspx
  • Peterson, M. J., Gravenstein, N., Schwab, W. K., van Oostrom, J. H., & Caruso, L. J. (2013). Patient repositioning and pressure ulcer risk-Monitoring interface pressures of at-risk patients.

    Journal of Rehabilitation Research & Development

    ,

    50

    (4), 477–488. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1682/JRRD.2012.03.0040

Critique Of A Research Article Nursing Essay

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Critique research articles mean careful and critical appraisal of strength and limitations of a piece of research, rather than hunting for and exposing mistake (Polt and Beck 2008).

A critical review is an evaluation of an academic article or essay. It makes judgment, positive or negative, about the text using various criteria. It is an overall critical appraisal, which mainly focus on the reliability, validity, strengths and weakness, rather than the faults or weakness of the research (New South Wales University, learning Centre).

It is the summarization and evaluation of the ideas and information in an article. It expresses the writer’s point of view in the light of what you already know on the subject and what is acquired from related texts.


Purpose of the essay

The aim of this assignment is to develop a solid understanding of the experiences of residents in nursing home care by critiquing a published qualitative health research.

In this article critical thinking frame work is based on critical review guideline for qualitative studies by Beck, C 2009, ‘Critiquing Qualitative Research, Aorn Journal, vol 90,issue 4, pp. 543-545.

Reason behind to use this frame is that this frame provides specific guideline and cover all most all questions of critique such as how to do critique on title, phenomenon, structure, research design analysis data, findings and other prospective of the article.


TITLE:

The title is catchy and peaks the interest of the reader. Title of the study is well described and self-explanatory. Resident’s while living in a nursing home are clearly identified as the key phenomenon being investigated. The article title included o age of participants, their experiences of interpersonal relationship factors in nursing home care (Kitto, 2010, p-201).

Title indicates that it is a qualitative study and title match with context of article. The objective of study is clearly stated in title.


ABSTRACT:

The abstract is clearly and concisely summarised the main features of the report like background, objectives, participants, method, design, setting, results and conclusion. Background stated that the number of those who needing care in nursing home will also increase dramatically over the period of next 20 years (Huber et al., 2009).

Quality of care across developed countries mainly focus on patient safety, excellence in care and patient satisfaction (Nakrem et al., 2009)


INTRODUCTION


STATEMENT OF PROBLEM:

The problem statement is unequivocally and easily located in the first paragraph of the article. The researcher focus on how nursing home quality can be understand from resident point of view. The problem certainly has significance for nursing because the life expectancy and number of resident will increase in next 20 years. The problem statement convinced clearly and having a ability to persuade because the study is a great under standing of interpersonal factors which are very important for improving the quality of patient nurse relationship in nursing homes. This Statement of problem does build a cogent and persuasive argument for the new study as the consideration of interpersonal relationship factors and quality of nursing care could be difference from nurses and resident’s perspective. It has great significance in nursing as people who were the owners of the house is now the resident’s of the nursing home. So they feel their integrity is at risk in nurse patient interaction and care. They feel more dependent and sometime helpless. So it is very important to study those aspects and find out the drawbacks and rectified them so the residents feel safer, secure and live their life happily in nursing home. The match between the research problem and the qualitative paradigm and tradition used in the study is good. The researcher used the phenomenological methods in order to explain the life experience of people in nursing home in regards to quality of care and their expectations.


RESEARCH QUESTIONS:

Nursing question mean generating and assessing evidence for nursing (Hilarie, 2011, p-105).

In this article author did not clearly state the researcher question, the author did ask research question, and author further divided the each research question in to sub categories for more understanding of problems. Qualitative method of data collection fit the research question by using phenomenological theory, in residents with lived experience (Polit, Beck & Hungler 2001,p-214).


LITERATURE REVIEW:

The reporter adequately summarized research that had been conducted on the phenomenon of interpersonal aspects of nursing care. The author clearly stated the gaps in the knowledge, in previous study it was identified that to provide good quality of care and to understand interpersonal aspect of care is essential and residents are primary source to find out the interpersonal factor and outcomes of care, on other hand recent study provide better understanding of interpersonal factor by taking depth interviews of the residence in order to improve the residents relationship with their nurses and also in the improvement of the quality of nursing.


CONCEPTUAL UNDERPINNINGS:

The researcher provided a conceptual definition of the key concept of interpersonal aspects of quality care. This helps the reader to understand what interpersonal aspects of nursing referred to, and it include not only medical care but also physical and psychological care, to protect their integrity and to recognize their individual psychosocial needs. The researcher did not stated philosophical basis of this study in introduction. The author did not make any conceptual framework for this study, he just compare and contrast the content on one research theory to compare the content of the study.


METHODS:


PROTECTING THE PARTICIPANT’S RIGHTS:

Approval was obtained from regional committee for medical and health research. The Ethical issues related to the research include informed consent, the identity of the researcher, the purpose and nature of the study, the right to refuse and to participate and other such as responsibilities of researcher and possible study benefits, privacy, autonomy, confidentiality, etc. these all aspects were taken into consideration by regional committee of medical and health research ethics. For data collection, confidentiality and right to refuse and withdrawal and written consent in addition to oral consent was taken from residents (Minichiello et al, 2004).


RESEARCH DESIGN AND RESEARCH TRADITION

This is a qualitative study and the author has used a descriptive and exploratory research design. A phenomenological method is used in which the idea is taken from of the individuals who have actually experienced the situation ( Poor in text referencing

The researchers used the phenomenological study to describe the life experiences of people in nursing home in regards to quality of care and their expectations. An adequate time was spent with participants, each interview was lasted for one hour, and author find that the long-term residents are individuals with individual background but they also have a shared meaning of experience living in nursing home.


SAMPLE AND SETTING

Participate individuals are selected to participate in qualitative research is based on there first hand experience with a culture social or phenomenon interest (poor in text referencing, see the student learning centre for help with this, Strabert, Dona, Rinaldi, Carpenta, 2011,p-28)

There are no hard and fast rules about numbers, Participants were selected on based of condition and on the eligible criteria completed by the team. This is the plus point for the research (Rawlinson &Annette 1999, p.859)

Initially 24 participants between the ages of 45 to 100 years were chosen from four municipal public nursing homes in Norway. But only 15 participants chosen 9 women, 75-92 years old and 6 men 80- 96 years old. For qualitative study it could be 10 -100 but minimum 30 should be when looking for evidence or trying to achieve maximum variation (Tuckett, 2004,p-2)

The inclusion criteria was set on the basis that they were mentally sound residents in the nursing home for minimum of a month and longer and had physical and mental capacity to participate.


DATA COLLECTION:

Yes, the method of gathering data is appropriate. The data was collected by in-depth interviews with the residents. To assist the residents an interview guide with open-ended questions, conducted all interviews and probes were used. Three experts reviewed it. A narrative approach was used to encourage the resident to freely speak about their experience. The interviewer repeated and summarised during the interviews to check whether it was correct.


PROCEDURE:

The procedure used to collect and record data were adequately described and were appropriate for phenomenological study. Because resident tell there views to the researcher in interviews and bias were minimised but the author did not discussed about staff training for data collection.


ENCHANCEMENT AND RIGOR:

The rigor in qualitative research is demonstrated through researches attention to confirmation of information discovered. The goal of rigor in qualitative research is to accurately represent study participant experiences (Helen, Streubert, Dona, Rinaldi 2011,p-48)

Yes, different methods was used to enhance the trustworthiness of the data and analysis, to enhance rigour in data analysis the authors of the article were all involved in discussions about development of analytical concepts. Researcher documented researcher procedures and decision process sufficiently to confirm that the finding is suitable and confirmable, the author himself and two other interviewers coded interview separately and compared with the coding done by main author and discussed for abstraction in categories and subgroups in meeting.


DATA ANALYSIS:

Yes data is sufficiently described, data was analysed by recording and transcribed the data by verbally, the data analytical approach was consisted of coding with categorization, and Interviewer took notes and summarized them. An electronic tool was used for mind mapping as well. To enhancing the rigour of the study all authors were involved in discussion about the development of analytical concepts (Ryan, Nichollas & Will 2009).


FINDINGS:

Finding from the qualitative studies may be a show constructive format of phenomena (Polit, Beck & Hungler 2001.p.313).

The findings of this research highlight and acknowledge the importance of nurses in general and specialized care, prevention of complications and prioritizing the individual needs. In this article Findings also expressed the quality of care according to resident’s point of view to optimize and fulfil their medical, physical and psychosocial needs whilst protecting their integrity. Findings were all expressed in the article under separate subheadings for easy review and understanding.


INTERPRETATION OF THE FINDING:

Finding is interpreted within an appropriate frame. Author focused on finding related to interpersonal factor of direct nursing care. Yes the finding interpreted and discussed within the context of previous studies. The author compares the study with the previous study. Both studies focus on the interpersonal aspect of care so that nurses can provide better quality of care to residents the author also mention about limitation of this study nurse as representative of the health care took interview from the residents might be reluctant to criticize the nursing home quality and author did not put much efforts to understand cultural of the interviewees. Author did not address the issue of transferability of the finding due to small sample consisting of mentally lucid residents from four nursing homes.


IMPLICATION AND RECOMMENDATION:


PRESENTATION:

The report was well written, flowed logically, and was written in enough detail for critical analysis the description of finding was rich and powerful.


RESEARCHER CREDIBILITY:

The researcher qualification enhanced confidence in the finding. Researcher was member of Norway college of nursing facility.


SUMMARY ASSESMENT:

The study result appears trustworthy. This study provide some evidence that can be used in nursing practice in help in improving (Beck, 2009).

This study provide some evidence that can be used in nursing practice in help in improving interpersonal relationship and quality of care in nursing homes. Appear to be trustworthy but author could take more sample/ participants in this study to make finding more general.


CONCLUSION

Study provides a snap shot of how residential care is experienced by older person. There is a need for more innovative carring of programmes, which combine nursing homes, such as intimacy, privacy, autonomy (Galvin, Cathy, and Roiste 2005,p-92).

Overall, this was a good qualitative article. The research used a qualitative research design to explore the experience of residents those who live in the nursing home and providing the evidence for the practice for the healthcare to fulfill the individual needs through interpersonal relationship. However, study sample taken was small and the interview was taken by one of the nurse of the nursing may be this effect the views of the resident. Does this affect the study really as many qualitative studies are like this?


REFERENCES

Beck, C 2009, ‘Critiquing Qualitative Research,’ Aorn Journal, vol. 90, no.4, pp. 543-545.

Galvin, Cathy, Roiste and Aine 2005, Living in care: older person experience of nursing homes, Irish Journal of applied social studies, vol. 6, issue.1.

Minichiello, V Sullivan, G Greenwood, K and Axford, R 2004, Handbook of research methods for nursing and health science, 2nd Pearson Education Australia, Australia.

Nakrem, S, Vinsnes, A. G, Seim, A, 2011. ‘Residents experiences of interpersonal factors in nursing home care: A qualitative study’, International Journal of Nursing Studies vol .48 no.11, pp. 1357-1366.

New South Wales University Learning Centre n.d., Writing a Critical Review, viewed 21 Oct 2011.

Polit, D.F & Beck, C.T, 2008, Nursing research: generating and assessing evidence for nursing practice, 8thedn, pp.105-138, Lippincott Williams and Wilkins, Philadelphia, USA.

Polit, DF, Beck, CT & Hungler, BP 2001, Essential of nursing research methods, appraisal, and utilization, 5th edn, Lippincott Williams and Wilkins, Philadelphia, USA.

Ryan-Nicholls, KD & Will, CI 2009, ‘Rigour in qualitative research: mechanisms for control’, Nurse Researcher, vol. 16, no. 3, viewed 9 September 2012.

Taylor, B & Roberts, K 2007, Research in nursing and health care: evidence for practice, 3rd edn, Thomson, South Melbourne.

Thomas, Sp & Pollio, HR 2002, Listening to patients: a phenomenological approach to nursing research and practice, Springer, New York.

Vivilaki, V & Johnson, M 2008, ‘Research philosophy and Socrates: rediscovering the birth of phenomenology’, Nurse Researcher, vol. 16, no. 1, viewed 9 September 2012).

Critiquing Qualitative Research

Basic Questions for Critiquing Title & Introduction in Qualitative Reports


Title

Was the title a good one, suggesting the key phenomenon and the group or community under study?


Introduction


Statement of the problem

Is the problem stated unambiguously and is it easy to identify?

Does the problem statement build a cogent and persuasive argument for the new study?

Does the problem have significance for nursing?

Is there a good match between the research problem on the one hand and the paradigm, tradition, and methods on the other?


Research questions

Are research questions explicitly stated?  If not, is their absence justified?

Are the questions consistent with the study’s philosophical basis, underlying tradition, conceptual framework, or ideological orientation?


Literature review

Does the report adequately summarize the existing body of knowledge related to the problem or phenomenon of interest?

Does the literature review provide a solid basis for the new study?


Conceptual underpinnings

Are key concepts adequately defined conceptually?

Is the philosophical basis, underlying tradition,

conceptual framework, or ideological orientation

made explicit and is it appropriate for the problem?


Basic Questions for Critiquing Results in Qualitative Reports


Results


Data analysis

Were the data management (e.g., coding) and data analysis methods sufficiently described?

Was the data analysis strategy compatible with the research tradition and with the nature and type of data gathered?

Did the analysis yield an appropriate “product” (e.g., a theory, taxonomy, thematic pattern, etc.)?

Did the analytic procedures suggest the possibility of biases?


Findings

Were the findings effectively summarized, with good use of excerpts and supporting arguments?

Do the temes adequately capture the meaning of the data?

Does it appear that the research satisfactorily conceptualized the themes or patterns in the data?

Did the analysis yield an insightful, provocative, and meaningful picture of the phenomenon under

investigation?


Theoretical integration

Are the themes or patterns logically connected to each other to form a convincing and integrated whole?

Were the figures, maps, or models used effectively to summarize conceptualizations?

If a conceptual framework or ideological orientation guided the study, are the themes or patterns linked to it in a cogent manner?


Basic Questions for Critiquing Discussion in Qualitative Reports


Discussion


Interpretation of the findings

Are the findings interpreted within an appropriate frame of reference?

Are major findings interpreted and discussed within the context of prior studies?

Are the interpretations consistent with the study’s limitations?

Does the report address the issue of the transferability of the findings?


Implications and recommendations

Do the researchers discuss the implications of the study for clinical practice or further inquiry, and are those implications reasonable and complete?


Basic Questions for Critiquing Methods in Qualitative Reports


Methods


Protection of participants’ rights

Were appropriate procedures used to safeguard the rights of study participants?

Was the study subject to external review?

Was the study designed to minimize risks and maximize benefits to participants?


Research design and research tradition

Is the identified research tradition (if any) congruent with the methods used to collect and analyze data?

Was an adequate amount of time spent in the field or with study participants?

Did the design unfold in the field, giving researchers opportunities to capitalize on early understandings?

Was there evidence of reflexivity in the design?

Was there an adequate number of contacts with study participants?


Sample and setting

Was the group or population of interest adequately described?

Were the setting and sample described in sufficient detail?

Was the approach used to gain access to the site or to recruit participants appropriate?

Was the best possible method of sampling used to enhance information richness and address the needs of the study?

Was the sample size adequate?

Was saturation achieved?


Data collection

Were the methods of gathering data appropriate?

Were data gathered through two or more methods to achieve triangulation?

Did the researcher ask the right questions or make the right observations, and were they recorded in an appropriate fashion?

Was a sufficient amount of data gathered?

Was the data of sufficient depth and richness?


Procedures

Were data collection and recording procedures adequately described and do they appear appropriate?

Was data collected in a manner that minimized bias or behavioral distortions?

Were the staff who collected data appropriately trained?


Enhancement of rigor

Were methods used to enhance the trustworthiness of the data (and analysis), and was the description of those methods adequate?

Were the methods used to enhance credibility appropriate and sufficient?

Did the researcher document research procedures and decision processes sufficiently that findings are auditable and confirmable?


Basic Questions for Critiquing Global Issues in Qualitative Reports


Global Issues


Presentation

Was the report well written, well organized, and sufficiently detailed for critical analysis?

Were the descriptions of the methods, findings, and interpretations sufficiently rich and vivid?


Researcher(s) credibility

Do the researchers’ clinical, substantive, or methodological qualifications and experience enhance confidence in the findings and their interpretation?


Summary assessment

Do the study findings appear to be trustworthy and do you have confidence in the truth value of the results?

Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline?

Policies the facility has implemented that address managing emergency triage in high-risk areas of health care service delivery.

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Policies the facility has implemented that address managing emergency triage in high-risk areas of health care service delivery.

Select a health care organization in your community to conduct an interview with an appropriate risk management employee. The organization can be your current employer, or a different health care facility in your community. Acute care, urgent care, large multi-provider private medical clinics, assisted living facilities, and community/public health clinical facilities are all ideal options to complete the requirements of this assignment. Make sure to select an individual who can provide sufficient information regarding how that organization manages risk within its facility to answer the questions below.
In your interview, address the following:
1. Identification of the challenges the organization faces in controlling infectious diseases.
2. Risk management strategies used in the organization’s infection control program, along with specific examples.
3. How the facility’s educational risk management program addresses key professional issues, such as prevention of negligence, malpractice litigation, and vicarious liability.
4. Policies the facility has implemented that address managing emergency triage in high-risk areas of health care service delivery.
5. Strategies the facility utilizes to monitor and maintain its risk management program.
Post-interview, compose a 750-1,000 word summary analysis of the interview to include the questions above as well as the following elements:
1. A brief assessment of the organization’s risk management program, including what works well and what could work better (the pros and cons).
2. Action steps you would take to improve the program. Select one area and provide your rationale and possible steps required to implement your suggestion.

Study On Substance Abuse Among Nurses

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Alcohol and drug addiction are foremost, habitual, advanced, and often a catastrophic problem. United States society does not acknowledge addiction as a disease, but as a moral failure or lack of will power. (Trossman 27) Several nurses are reserved when faced with a colleague who may have a substance-abuse addiction because of dedication, concerns of being a hypocrite, or concerns of threatening a colleague’s license to practice. Substance abuse addiction must be accepted as an illness so that nurses can help one another recognize and seek treatment for the problem.

The prevalence of substance abuse in the nursing population has not been fully documented, but it is thought to be equal to the general population. An estimated 10 percent of the nursing population has an alcohol and/or drug abuse problem, and of that 6 percent of nurses have problems that are serious enough to interfere with their ability to practice. (Ponech) The American Nurses Association shows that 6 percent to 8 percent of nurses abuses alcohol or drugs to an extent adequate enough to impair their professional judgment. (Daprix) Nurses tend to use prescription-type medication more than marijuana and cocaine. (Trinkoff) Statistics show that nurses are more likely to practice sobriety when compared to other occupations. (9)

A significant underlying reason for nurses to participate in substance abuse is associated to family histories that include emotional impairment, alcoholism, drug use, and/or emotional abuse that result in low self-esteem, overachievement, and overwork. (Monahan) Nurses are often highly caring individuals who often take on the role of caregivers, which could be healthy or unhealthy; this characteristic attracts them to the nursing field. Many nurses find this occupation allows them to continue with the role of a caregiver, the same role they play as the children of alcoholic parents. (Monahan) Nurses have a higher occurrence rate of alcoholism then their family history. (Fisk) One statistic shows that family alcoholism contributed to alcohol abuse in approximately 80 percent of nurses who had an alcoholic family member. (Stammer)

Stress in the workplace presents another reason for why some nurses abuse substances. Increased workloads, decreased staffing, double shifts, mandatory overtime, rotating shifts, and floating to unfamiliar units all contribute to feelings of alienation, fatigue, and, ultimately, stress. (Bennett, Mustard) Many nurses are workaholics and are addicted to their careers so they choose to deal with these issues. (Trossman)

Nurses are also at risk for substance abuse due to the high availability of medications in their workplace, and with their knowledge of pharmacological agents, this provides a climate that makes it seem safe to correct internal feelings or illnesses. (Serghis) Nurses have always been taught that medications solve problems such as pain, infections, and anxiety. Not only are medications highly accessible, but nurses wrongly believe that they are able to control and monitor their personal self treatment without becoming addicted. (Creighton, Ellis) Nurses become familiar with controlled substances and easy access to them increases the changes that they will use them for personal use. Due to the fact that nurses administer these medications and watch how they affect their patents, they tend to falsely believe that they can control and monitor their own personal use. (Trinkoff) Some nurses “believe that they are immune to the negative consequences of drug use because they are so familiar with drugs.” (Trinkoff 581)

The effectiveness of a nurse’s job performance can be aggravated by sleep deprivation, a poor social life, financial problems and being overworked. Several nurses blame psychological or physical pain, emotional problems that are too complex to handle, added with a demanding, high -pressure, and stressful work environment reasons that led them to chemical substance abuse. (Stammer) Even though these nurses who abuse substances have a hard time admitting that they have problems, they are well-liked and respected, highly skilled, and ambitious.(Stammer) Statistics shows that nurses who abuse alcohol “tend to be achievement oriented people who strive to be ‘super nurses’ at work and ‘superwomen’ elsewhere.” (Stammer 79)

Studies have proven that nurses don’t abuse substances more than the rest of the society, (Trinkoff) there are nursing subgroups that are more prone. Exposure to death and dying, lack of education on alcohol and medication hazards, and burnout in general increase the risk of substance abuse. (Trinkoff) Every nursing specialty has different personnel factors, demands and availability of controlled substances.

Critical care nurses, in the emergency rooms, intensive care units, and operating rooms, show more prescription-type substance abuse along with easier access. (Trinkoff) The frequency of patients dying, work pace, work demands, access to controlled substances results in an increase in substance abuse for these subgroups. (Trinkoff) Critical care unit nurses show to be emotionally and technically demanding. Nurses can have feelings of failure, if patients die unexpectedly. These work demands can test a nurse’s training which can have its downfalls, leaving the nurse with high levels of stress.

Oncology nurses have increased substance abuse rates, specifically with alcohol, and binge drinking. (Trinkoff) It is thought that these nurses are trying to distance themselves from the emotional pain they are experiencing while working with patients who have cancer, so they use alcohol to cope. (Monahan)

Psychiatric nurses experience increase levels of substance use, this practice is heavily oriented around pharmacologic agents. (Trinkoff) These nurses tend to self-medicate more because they are exposed to a culture that accepts using psychotropic medications to cope with life. Psychiatric nurses tend to be more willing to report their substance abuse than other specialties because they tend to believe this is an acceptable form of treatment. (Trinkoff)

The lowest nurses to report use of addictive substances are pediatric and women’s health nurses. (Trinkoff) This is most likely due to the lack of availability of these substances, or these types of nurses are emotionally expressive. Most people that express their feelings may have less need for substance use. (Trinkoff)

Some nurses may be successful at disguising or hiding a drinking or drug problem, other peers that are familiar with substance abuse are more likely to detect it. (Bennett) Many of the symptoms are general, but when the nurse’s behavior is scrutinized over a period of time, the outcome becomes conclusive. Symptoms such as poor job performance, such as excessive time off, isolation, fatigue, mood swings, and impaired cognition. (Bennett)

Nurses who abuse drugs may support their addiction with prescription medications. They may forge prescriptions, or divert medications directly from patients or the unit’s supply. (Ponech) Nurses may use saline to substitute for a patient’s dose, and save the medication for their personal use. Another way to distract medications would be to sign them out for patients who are discharged, or needed medication for patients that have not requested it. (Ponech)

Recognizing that substance abuse is a medical illness that requires treatment is start in helping addicted nurses get the help and support needed to become productive members of society and nurses again. Nurses that are suspected of abusing substances need to be reported. Even though it is an emotional issue that follows reporting a colleague, it would be less hampered if the patient being treated by a nurse that was impaired was a loved one. This is a higher level of nursing that every nurse should practice.

Mental Health Standards for Involuntary Community Treatment Orders

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Mental Health Standards for Involuntary Community Treatment Orders


Introduction

In Australia there are currently over 600,000 people living with severe mental illnesses such as psychotic disorders and debilitating forms of anxiety and depression (Light, Kerridge, Robertson, Boyce, Carney, Rosen, Cleary, Hunt, O’Connor, & Christopher, 2015). Many of these individuals are incapable of or resistant to, taking prescribed medications, or participating in treatment (

Rolfe

, 2001).

Following deinstitutionalisation of psychiatric services, people who live with persistent and severe mental illness deemed of harm to themselves or others, are often required to receive treatment of mental health services in a community setting through a Community Treatment Order (CTO) in order to avoid involuntary hospitalisation (Light et al., 2015).

Although it can only be enacted when legislative criteria are met and there are no less restrictive options available, being treated without consent raises significant issues around individual choice and liberty (Campbell, 2010). Investigations into these processes has found considerable distress and harm caused from forced treatment with evidence suggesting CTOs in fact hinder recovery from ill mental health and in some even cases exacerbate it (Vrklevski, Eljiz, & Greenfield, 2017).

Despite contentious debates, around the value and efficacy of CTOs and their significant prevalence and alarming rate of increase, information about government policy principles and objectives in relation to CTOs is scarce with very little information made publically available. As such, it is believed by many to be a major area of concern (Light, Kerridge, Ryan, & Robertson, 2012).

This submission will consider the social problem of severe mental health and the impact of involuntary community treatment orders on people experiencing mental health issues, along with the consequences of these orders on society. Current legislation and policies will be presented and evaluated in regards to this restrictive practice, including the ideological frameworks upon which they are based. Potential changes to Mental Health policies and standards will be outlined for consideration and assessment in the next review scheduled for 2020 for their inclusion in the Mental Health Acts across all Australian jurisdictions.

Background

Considered the leading cause of disability and ill health world-wide (World Health Organisation, 2001), mental illness is considered one of Australia’s National health and social policy priority areas (Parliament of Australia, 2000).AIHW estimates 1 in 5, equating to approximately 3.2 million Australians, experience a mental disorder each year with severe mental illness impacting approximately 690,000. It is reported that less than half of those living with ill mental health seek treatment incurring significant individual suffering and social and economic costs (Department of Health, 2016). Along with risk of individual, negative economic and social problem outcomes including for example poverty, housing instability, homelessness and unemployment, those living with mental illness are also subjected to significant stigma and discrimination (Light et al. 2015). The social and economic costs have been shown to extend into society, costing the economy an estimated $60 billion per year in expenditure, personal cost and lost productivity (National Mental Health Commission, 2016).

In response to the impact of this on the country, political agendas and policy strategies that aim to prevent mental illness have been implemented with the intention of addressing these social and economic costs and achieving better mental health outcomes for Australians (Parham, 2007).

The differences in the mental health acts between the jurisdictions are significant, not only in the content but in the way in which the laws are processed, resulting in a substantial lack of coordination or consistency in the approach to Mental Health across the country (Barnett, 2012).

A National Mental Health Policy was adopted in 1992 by Commonwealth, state and territory Governments to encourage a consistent approach to the care, treatment and control of people living with mental illness. In 1996 National Standards for Mental Health Services were introduced to guide implementation and quality of mental health policy, service and practice (Mental Health Standing Committee, 2010). Australian Governments have since developed and regularly reform their respective Mental Health Acts and the legislations and policies in line with these to support the appropriate provision of services for those living with mental health issues these include involuntary treatment (Australian Law Reform Commission, 2014).

Involuntary and oppressive practices are believed to have begun in the early 1800s with the introduction of ‘insane’ asylums in Tasmania and NSW (Rosen, 2006). These practices were influenced by an underlying fear, still largely prevalent and influential in society and government policy today, that people with mental illness were dangerous, posed a risk to society and needed to be controlled Due however to political pressures to respond to facility scandals of abuse and neglect in asylums, the development of anti-psychotic medications, and the changing social attitudes on people’s rights,  Australia entered a trend towards deinstitutionalisation from asylums to hospitals in the 1960s (Rosen, 2006). Following inquiries into social justice and human rights issues with mentally ill people living and dying hungry and un-medicated in the streets, a National Mental Health Policy was established. Subsequent strategies that followed aimed to shift and mainstream, mental health services away from psychiatric hospitals and into the community (Light et al. 2012). Critics however suggest that this is not representative of social progression as sold by governments, but rather a ‘long leash approach to the surveillance and control of non-compliant patients outside of hospital’ and are reflective of custodial frameworks of the past where the aberrant in society who posed a risk the wider community, where punished through detention and the deprivation of liberty (Rogers & Pilgram, 2014, p.166).

Significantly differing rates of and reasons for use between the jurisdictions, has exposed that there is a significant lack of government knowledge with regards to the needs and treatment of those living with mental health issues (Mental Health Standing Committee, 2010). Understandings and treatment of mental illnesses by health care providers, especially in the field of psychiatry, are often based on treatment ideologies that incorporate the often strict beliefs around the aetiology of mental illness and the effectiveness of varied interventions and treatments, including those against a person’s wishes (Scheid, 1994). Psychiatric ideologies lie at the core of involuntary treatment policy initiates and legislation within each state or territories’ Mental Health Acts, which allow psychiatrists and health care professionals to implement legislative powers to use CTOs (Power, 2008).

However as reported in the 1993 National Inquiry into Human Rights of the Mentally Ill, psychiatry lacks clarity about the cause of illness and its treatment due to being under conflicting and often contradictory influences of ideologies including social or environmental versus biological or genetic explanations (Australian Human Rights Commission, 1993). Despite this, governments have however allowed policy and legislation in the area of mental health to be led by experts in psychiatry. This has ultimately resulted in a prevailing but relatively well- hidden ideology of control through forced treatments that eliminates individual autonomy in personal decision making to those deemed to not be ‘sane’ enough to deserve that basic human right (Rosen, 2006).

Although there are arguments for forcing non-compliant patients to accept necessary medication or treatment considered to be in their best interest, the counter arguments are significant. These include: insufficient evidence of efficacy; patient relapses under CTOs; less adherence to treatment than when not on CTOs; no reduction on hospital admissions (as aimed and expected); increased demand on health services including time consuming bureaucratic CTO administrative systems that reduce patient-centred care; human rights and ethical violations from coercion; social control and the deprivation of patient’s freedom and liberty; and the stigmatising of people with acute mental health issues  (Heun, Dave & Rowlands, 2016). Phenomenological studies into CTOs that probe and offer insight into the personal experience and perception found patients also experienced; excessive fear of inadvertently violating conditions; a belief that their speech and freedom was limited; disempowerment due to the coercive nature of treatment and an unwillingness to seek help for their mental illness; or ill health due to fear of the imposition of further control in their lives (Rogers & Pilgram, 2014). With important aspects of personal recovery such as their sense of hope and self-efficacy also negatively impacted, research show CTOs significantly interfere with a person’s mental rehabilitation.  It is suggested that CTOs in fact exacerbate mental illness and further it’s social and economic impact on society (Power, 2008).

Policy Analysis

Community treatment orders were first introduced into the mental health system in Victoria in 1986

under the mental health act 1986

before being adopted by the rest of states and territories. Justification for their implementation lay in the rationale of ‘parens patriae’ and ‘police powers’ which empower the state the obligation to act in the best interest of those with compromised capacities to do so for themselves, and to restrict their freedom in order to protect and ensure social order (Rolfe, 2001).

Enforced under mental health legislation in Australia, enabling enforcement of those diagnosed with mental illness to comply, even against their wishes with treatment of their condition, CTOS can be implemented when less restrictive practices are deemed to not protect either the individual health and safety or other members of the public (Light et al., 2012).

The authorisation of compulsory treatment has been justified by policy makers as being a continuation of deinstitutionalisation through the provision of less restrictive services compared to that of inpatient psychiatric services (Brophy, 2018).

As well as aiming to provide an alternative to restrictive detention and contributing to freeing up resources within the health system, the logic is that CTOs will support people to achieve stability in their mental health through consistent treatment and therefore prevent repeated relapse know to leads to frequent readmission (Mental Health Review Tribunal, 2018). Forced treatment that is deemed necessary by health professionals is also championed as reducing the suffering or even death of those experiencing severe mental health conditions, and as a result can improve patient’s quality of life (Department of Health, 2016).

However, implementation of CTOs are recognised as challenging human rights frameworks and have instigated recommendations from the United Nations Committee on the Convention on the Rights of Persons with Disabilities to repeal legislation (Brophy, 2018). Calls for reforms to policy by human rights advocacy groups such as Justice Action are also not uncommon with CTO’s considered to be inefficient, ineffective and a challenge to privacy, autonomy, self-determination, human rights and social justice (Campbell, 2010). Although significant changes and been made to involuntary treatment of inpatients, CTOs have largely remained untouched, and the power to make CTOs has been retained by the Mental Health Acts enacted in all jurisdictions. Policy information around CTOs, principles and objectives are also hidden from information publically available. The seeming invisibility found within policies highlights issues with not only transparency but the accountability of mental health systems. It is also believed to contribute to entrenching further the discrimination and marginalisation of those living with mental illness

and as such counter social justice and rights? (

Vrklevski, Eljiz, & Greenfield, 2017).

In Australia there are over a million involuntary services recorded each year with 45% of these out in the community. With rates increasing in all jurisdictions, figures suggest that the system is failing in the

early and/or

effective intervention of mental distress (NSW Mental Health Commission, 2015). Advocacy, social Justice, human rights organisations will continue to advocate on this area of policy and support recommended policy changes in standards for CTO made by this submission.


Recommended policy changes

With mounting evidence of the failure of Community Treatment Orders in meeting objectives alongside the violation of rights and the negative impact they have on the mental health and recovery of patients subjected to them, the importance of policy revision is paramount.

Recommended policy changes for consideration:

1)     Clarity regulation and compliance within the standards

In light of the lack of transparency in CTO policies and their implementation, the most basic recommendation is to clarify the terminology, expectations and use of CTOs as well as the inclusion and awareness of social justice principles so that the policy and legislation truly works to protect individual rights, advance empowerment, and provide all necessary resources for full access and participation to be achieved. Consistent and socially just CTO assessment, implementation and use can be developed across jurisdictions through appropriate obligation to adherence, monitoring and management of CTO standards and principles.

2)     Inclusion of greater critical holistic consideration of the person

This strategy involves the critical holistic consideration of the person and their circumstances by specifically and appropriately trained professionals. This will support improved delineation of patients, separating those that will benefit from coercion from those that will relapse or be treatment resistant when coercion is enforced and would benefit more from alternative support services. Greater transparency of this process and appropriate standards should be shared across all jurisdictions to support greater consistency and bring down excessively high and or/unnecessary CTO use (Brophy, 2018).

3)     Inclusion of less restrictive models

Further considerations need to be assessed with regards to the opportunities for, and potential benefits of, less restrictive models such as assertive community treatment and case management for those assessed to not benefit from CTO coercion. The involves the development of more collaborative approaches within a team of specifically trained CTO support services and health professionals, that work alongside patients in the ongoing, tailored management of their ill mental health (Heun, Dave & Rowlands, 2016).

4)     Improvement of Mental Health Services

The use of involuntary treatment orders would be substantially reduced through the increase and improvement of mental health services that provide effective early access to to community based mental health services for individuals and families. These will be focused on recovery and not just management of symptoms as well as essential long term planning support services for care in the community (NSW Mental Health Commission,, 2015).

The development and use of streamlined, holistic care that promotes service delivery that is tailored, recovery-orientated and achieves  consumer empowerment (Brophy, 2015) will embody social justice principles and objectives and ultimately support personal recovery from mental illness and therefore reduce demand on the health system.

Summary and Conclusion

This submission has presented the relevant history and influences surrounding the development and implementation of Community Treatment Orders in Australian mental health policies. These include These influences can explain the inclusion of restrictive involuntary practices similar to institutional treatments of the past, but not justify them when infringement on a human rights and social justice principles are considered (Light et al. 2012), Due to the removal of personal agency and self-determination, alongside the added stigma and discrimination, CTOs believed to in fact be a hindrance to recovery and well-being. Overall CTOs have been found to be ineffective in achieving the championed social or economic benefits aimed for in their implementation. As such recommendations presented within this submission would support the development of a system that is considerate of both rights and needs and as a result, drastically improve the treatment and outcomes from those with severe mental health issues.


Recommendations

1)     Clarity within the standards

2)     Inclusion of greater critical holistic consideration of the person

3)     Inclusion of less restrictive models

4)     Improvement of Mental Health Services


References

MN 561 Contraceptive counseling Discussion

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MN 561 Contraceptive counseling Discussion

MN 561 Contraceptive counseling Discussion

 

 

Contraceptive counseling provides education, dispels
misinformation, facilitates selection of a method that will be successful for
the individual, and encourages patient involvement in healthcare decisions and
life goals. Discussing contraception brings the nurse practitioner and patient
together to create a tailored plan that meets the individual’s reproductive
needs over a lifetime.

Discuss any clinical encounters that you may have had
relating to contraception. How did you counsel patients on their choices and
possible risks? Describe how you would explain the differences to your patients
in the long acting reversal contraceptive devices.

DQ2 Topic 2: Sexuality

Sexuality affects individuals and society across a broad
spectrum of activities through health, but also through factors at multiple
levels, such as gender relations, reproduction, and economics. Physiologic,
behavioral, and affective measurement of sexuality and sexual behavior is
complicated by cultural values and norms but is essential to individual health
(including happiness) as well as public health. Cultural or structural norms
that stigmatize aspects of sexuality, such as sexual orientation, have adverse
effects on individuals across their lifespan, with homophobia being a prominent
example of such.

Discuss how one’s age, race, lifestyle, and demographics
have an impact on your choice to complete a sexual history when working in the
primary care setting with women across a lifespan.

This study of over 700 women in western Pennsylvania found that women who received contraceptive counseling from a primary care provider were significantly more likely than those who did not to subsequently report use of hormonal contraception the last time they had intercourse. These findings provide further support that contraceptive counseling by clinicians improves women’s contraceptive use  and provide evidence that PCPs can play an important role in promoting contraception use. Efforts to expand provision of contraceptive counseling in primary care settings may help reduce unintended pregnancies .

Strengths of this study include its large sample size, the use of EMR data to determine prior evidence of contraception, and the inclusion of clinics that serve both privately and publicly insured women in both academic and community-based primary care settings. While the survey response rate was relatively low, women who completed surveys were similar to those who did not.

When interpreting these results, there are important limitations to consider. As this was a secondary analysis of data collected to evaluate clinical decision support, we were unable to determine whether participants’ last intercourse occurred before or after the index clinic visit. However, prior studies indicate that the majority of women aged 18–50 have sex at least monthly ,. Since surveys were completed up to 30 days after women visited their primary care clinic, for most women the last episode of intercourse likely followed receipt of counseling. Our results are subject to recall bias because women were asked to provide details of counseling that occurred a week or more prior to the survey. There is the possibility that women who chose to use a contraceptive method were more likely to recall receiving counseling. There is also the chance women’s need for contraceptive counseling may have been misclassified.

ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:MN 561 Contraceptive counseling Discussion

Some women we considered “in need of counseling” may have already been using adequate contraception prior to their survey visit. Others may have been inconsistently using the contraception documented in their EMR, as 15% of women we considered in less need of contraceptive counseling reported use of no contraception at last intercourse. By comparing the survey and EMR data when classifying women, we aimed to reduce misclassification bias. Although we controlled for several important variables that influence contraceptive use, other key covariates, such as a history of reproductive coercion, which has been negatively associated with contraceptive use , was not assessed in this survey. Finally, there was no way to account for whether the counseling was initiated by the patient or by the physician; patients seeking contraceptive counseling who initiated such discussions with their physician would be expected to be more likely to use contraception following their visit.

Future studies are needed to assess how frequency of contraceptive counseling, length of time devoted to counseling, and number of contraceptive methods discussed affect women’s subsequent contraceptive use. In addition, studies are needed that focus on the relationship between contraceptive counseling and contraceptive use among populations at high risk for unintended pregnancy. For example, studies that focus on minority and less-educated populations are needed as these women are at high risk of unintended pregnancy  but were less likely to complete this survey. Consideration should also be given to compensating clinicians for time spent providing contraceptive counseling, as many PCPs’ ability to provide contraceptive counseling is limited by time . In a previous study, 46% of private providers and at least 21% of public providers reported that providing insurance reimbursement for time spent counseling would be a very important way to increase their provision of contraceptive counseling .

In conclusion, we found that receipt of contraceptive counseling from a primary care provider was highly associated with reported use of hormonal contraception at last intercourse. Policy-makers, including the USPSTF, should be encouraged to support provision of contraceptive counseling in primary care settings.

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Overview In this assignment- you are working as the software architecture for a large hotel chain. Your company wants to create a web application that allows users to do the following: · Book r

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Overview

In this assignment, you are working as the software architecture for a large hotel chain. Your company wants to create a web application that allows users to do the following:

·        Book room

·        Cancel reservation

·        Review facility available at a specific hotel

·        Room selection options


Instructions

For this assignment, you will need to develop a project report that:

·        Defines key points for software architecture related to this application.

·        Describes the type of software architecture you want to use.

·        Designs the entire architecture diagram.

·        Assesses modularity – cohesion and coupling.

·        Describes the importance of a modular approach for your project.


General Requirements

·        Refers to current literature to support the development of ideas in a well-organized three to four-page project report.

·        Cites a minimum of two credible sources and provides a reference page in APA format.

·        Uses professional language with correct spelling, grammar, and punctuation.