Reflective Account of Communication Skills

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Communication as defined by the Department of Health is a process that involves a meaningful conversation between two people or more. To express a range of feelings and share information through both verbal and non-verbal means (The Open University 2019a)

In healthcare communication is essential in ensuring the delivery of safe and effective care to patients. Good communication with patients ensures patient centred-care, helps them feel at ease, in control and valued. Patients often feel anxious when in hospital, worried about their health and what treatments they may need to have that can make communication challenging (RCN, 2011)

This assignment will explore a reflective account of communication between myself and family members when a patient’s condition deteriorated (see appendices). I have chosen to reflect on this account as I found the communication a challenging experience. There are several models that can be used in the reflection of practice for example Gibb’s Reflective Cycle (1988), Johns Model of structured reflection (1994) and Borton’s Reflective Framework (1970). The communication reflection is structured using Borton’s Model (1970). Borton’s model of reflection incorporates three simple questions to ask of the experience or activity to be reflected on What? So what? Now what? (OU,2019b). It will also encompass different styles of communication skills used and theories on communication.

Confidentiality of the patient will be maintained throughout by not naming the individuals involved. The communication episode began when the patient in my care Mrs. A, condition deteriorated and cardiopulmonary resuscitation (CPR) was started. I noticed the patient’s daughter and other family members were stood at the door of the ward whilst treatment was continuing. Observing their body language, they appeared distressed and anxious. I wasn’t sure if it was appropriate for them to be in the ward witnessing the CPR and no one was currently able to go talk to them about what was happening. I decided to go over to the family and suggested they could go and wait in the day room and guided them to where this was. As stated by Baghcheghi et al (2011) cited in the Open University as a nurse it is expected that you will communicate accurately, clearly and effectively including verbal and non-verbal interpreting others body language not just with your colleagues and patients but also their relatives (OU, 2019c)

I felt quite intimidated as there was quite a lot of family members present, Asian’s have strong family values and this cultural value needs to be respected and considered in the future care of the patient (Carteret. M, 2010) I ensured my approach was calm, clear and friendly and used hand gestures to guide the family to where I wanted them to go. Communication is a transactional process and a person is influenced by the input given or lack of it and mirror a similar approach given. If I had approached the family in a hash manner, stating they could not stand there and had to leave with no further input that may have unnecessarily escalated the situation. This could have impacted the care being provided to the patient. Using a range of verbal and non-verbal communication enables you to build empathy and offer the appropriate support (OU,2019d)

I chose the day room as it offered the family some privacy to discuss the situation as explored in Activity 3.7, I adopted the principles of Soler to communicate effectively with the family. I ensured I used eye contact with the family members and portrayed a relaxed appearance. It was difficult at times to show attentiveness to all family members due to the number of relatives present.

I sat with them, rather than standing over them and used my intuition to provide touch to the daughter who was visibly upset to show empathy and that I was interested in listening to them (OU, 2019e). Illness of a loved one causes anxiety and stress, relatives have an expectation that healthcare professionals will treat them with respect and consider their feelings and wishes. However ethical principles need to be considered when talking to relatives, to ensure the welfare of the patient is at the centre of everything you do. This includes respecting the patient’s autonomy by only sharing information with family members that is agreed with the patient. Acting in non-maleficence when discussing the patient, only sharing relevant information that benefits the patient. In this case no restrictions where in place to share information with family (Al-Jawad, M et al, 2017)

I ensured the information I communicated to the relatives was clear and appropriate with no medical jargon to answer their questions, worriers and concerns. That it provided direction on what would happen next building rapport with the family. As cited in The Open University, Hood and Leddy (2006) acknowledged that clear, appropriate communication is essential for effective healthcare delivery and in the development of interpersonal and therapeutic relationships (OU, 2019f)

An understanding of Bylund et al (2012) theories of communication, I felt this communication episode with relatives fitted to uncertainty management theory (UMT). Uncertainty causes a wide range of emotions and people can still feel insecure about a situation regardless of the information they have been provided with (OU, 2019g)  I found the communication experience with the relatives challenging as I had not been in that position before, I had nothing to compare the experience against and had not had the opportunity to observe conversations with relatives whilst on placement. As Hargie (2011) discussed communication as a professional is very different to communication with your friends and family when you can focus on your own needs. When communicating to patients, relatives and other colleagues you need to remain professional and focused on the needs of the person in your care (OU, 2019h)

The identified barriers to the communication episode though reflecting on the experience was my feelings. I felt out of my depth due to it being my first experience dealing with upset relatives. I was worried that I would upset the relatives further by saying or doing the wrong thing, and I would not be able to answer the questions asked. In previous pressured communication experiences, I have found I get quite nervous and speak fast, this can affect the way the message is received.

After the event I was able to discuss further with my mentor what I thought went well, what didn’t go well and what could be improved. It was identified that completing some further training would be beneficial to increase existing knowledge in communicating with different people.  Also, suggestion of obtaining feedback from patients and relative where suitable on my communication to further improve my skills and build my confidence.

In conclusion effective communication is essential in healthcare delivery. It ensures delivery of high-quality compassionate care. It also provides a positive experience to patients and their relatives. The positive experiences help improve therapeutic relationships meaning patients feel less anxious. The effective communication also gives access to relevant information being shared allowing patients to make informed decisions about their care. (Bramhall, E 2014). Reflecting and acting on feedback is a professional standard to practice effectively and promotes professionalism as set out by the Nursing and Midwifery Council in The Code (NMC, 2015) It creates an opportunity to identify strengths and weaknesses in order to continually improve practice. Reflection can also help apply learnt theoretical knowledge and best evidence to practice.


References


Appendices

Reflective account of an episode of communication using Borton’s Model of 1970 reflective framework (The Open University, 2019)


Reflection on practice placement – Firth 7


What?

Today I was working in C Bay – An 8 bedded unit of level 2 beds for acute cardiology patients. Patients are admitted to the ward with various life-threatening heart conditions that need close cardiac monitoring and treatment. The ratio of staff for patients is one staff nurse – two patients. I was assisting with my mentor looking after two patients. Mrs A (changed to protect anonymity) is a 62-year-old Asian lady with limited English, admitted after a suspected myocardial infarction (heart attack). The patient’s daughter was present at bedside and providing comfort to Mrs A and translation when needed. The patients monitor started to alarm and the patient went into cardiac arrest the patient’s daughter left the ward and CPR was started on the patient. As a student I observed the process and passed relevant equipment when needed. Whilst observing I noticed the patient’s daughter was stood at the door of the ward looking very distressed with several other family members. I wasn’t sure if it was appropriate for them to be in the ward, also no one currently was available to go talk to them about what was going on. So, I went over to the family and suggested they could go and wait in the day room and guided them to where this was. What I hoped to achieve was less distress to the family members but also allow staff to provide the care needed to the patient without distraction. I have learnt from this situation that this is an area I feel less confident in.


So what?

Once in the day room the family members obviously upset and distressed wanted to know what was happening, if patient was still alive, if they could go see her. I have not been in this position as a student nurse to talk to relatives in this situation or observed a situation to have knowledge on what to say. I explained to the relatives that she had gone into cardiac arrest and the doctors and nurses was with her now trying to get her heart beating again, the daughter who witnessed the arrest was crying, I held her hand and stated she was in good hands, and as soon as they could someone would come and speak to them to update them. I offered them a drink and stated If they needed anything to let me know. I went back to check on the family several times and once able to updated staff that the patient’s family was in the day room and would someone be able to go speak to them. I felt very out of depth in this situation and was worried about upsetting the family members by not saying the right thing. I have identified I need to increase my current knowledge in speaking to patients and/or relatives in distressing situations.


Now what?

I talked thought the communication episode with my mentor to gain relevant feedback. She suggested I could participate in some further training in communication through eLearning courses provided by the trust – ‘The importance of good communication’ to increase my confidence in communicating in difficult situations. She also encouraged me to shadow staff when talking to patients and relatives and to continue to reflect on practice to look at what went well, an what I could do differently next time.


References

Differentiate between quality in a free market healthcare system and in single payer government system with three (3) examples for each.

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Differentiate between quality in a free market healthcare system and in single payer government system with three (3) examples for each.

Due Week 6 and worth 200 points
Assume that you are a Quality Officer who is responsible for one of the state’s largest healthcare organizations. You have been told that the quality of patient care has decreased, and you have been assigned a project that is geared toward increasing quality of care for the patients. Your Chief Executive Officer has requested a six page summary of your recommended initiatives.
Note: You may create and /or make all necessary assumptions needed for the completion of this assignment.
Write a 6 page paper in which you:
1. Analyze three (3) quality initiatives for your organization.
2. Determine the supporting factors that would aid in the reduction of healthcare cost in your organization without reducing quality of care for the patients.
3. Differentiate between quality in a free market healthcare system and in single payer government system with three (3) examples for each.
4. Specify three (3) common law quality initiatives that are still found in 21st century healthcare organizations.
5. Defend your position on the importance of healthcare quality for your organization. Provide support with at least three (3) examples that illustrate your position.

Describe the role of statistics in business decision-making.

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Describe the role of statistics in business decision-making.

Write a 525- to 700-word response that addresses the following prompts:

Define statistics with citation and reference.
Contrast quantitative data and qualitative data with citation and reference.
Describe the levels of data measurement.
Describe the role of statistics in business decision-making.
Provide at least two business research questions, or problem situations, in which statistics was used or could be used.

Copy and paste the five prompts above into a Microsoft® Word document and write a response below each prompt. Add an APA title page to your document. Use APA quotation, citation, and reference format for all sources used.

Removing Ethnocentrism and Discrimination from Australias Healthcare Systems

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Week Two Task

Australia is a multicultural country made up of a multitude of Minority Population Groups (MPGs); therefore, it is integral that the Australian healthcare system is culturally responsive and free from ethnocentrism and discrimination. Ethnocentrism is the inherent prejudicial belief that one’s own culture, values and beliefs are superior to others (New World Encyclopedia, 2017). Ethnocentrism is commonly expressed through prejudice, bigotry, racism and discrimination. Moreover, discrimination is the unjust or prejudicial treatment of different groups of people; such as MPGs (Merriam-Webster, 2019). Therefore, it is vital that the Australian health care system practice culturally competent care to prevent the Negative Health Effects (NHEs) associated with ethnocentrism and Perceived Discrimination (PD).

Moreover, PD and ethnocentrism toward MPGs are strongly associated with anxiety, stress, depression, suicide and racially motivated violence; which have detrimental effects on psychological, physiological and physical health. Furthermore, PD leads to growing feelings of anger, fear, hostility and mistrust; which in turn, lead to anxiety and feelings of exclusion and isolation from society (Rebelo, Fernandez & Achotegui, 2018; Schmitt, Branscombe, Postmes & Garcia, 2014). Moreover, these feelings lead to a reluctance to seek medical advice, adhere to treatment and access services which subsequently worsens the health of MPGs and increases preventable hospitalisation (Bastos, Harnois & Paradies, 2018; Rebelo et al., 2018; Ben, Cormack, Harris & Paradies, 2017).

Furthermore, constant PD can lead to NHEs associated with chronic anxiety which increase the risk of high blood pressure and heart disease, excretory and digestive issues, lowered immunity, stress and depression (Schmitt et al., 2014; Paradies et al., 2015). Furthermore, anxiety leads to a reluctance to use health services due to the anticipation of discrimination which further worsens MPG health (Bastos et al., 2018; Ben et al., 2017; Rebelo et al., 2018; Ben et al., 2017). Moreover, PD leads to increased risk of NHEs associated with stress such as high blood pressure, heart disease, obesity, diabetes, anxiety, substance abuse and depression (Schmitt et al., 2014; Paradies et al., 2015).

Furthermore, stress decreases motivation to participate in healthy behaviours such as sleep and exercise; and increases the development of unhealthy behaviours such as over-eating and alcohol and illicit substance abuse (Schmitt et al., 2014; Paradies et al., 2015). Furthermore, PD leads to increased risk of NHEs associated with depression such as heart disease, lowered immunity, low self-esteem, poor life satisfaction and suicide (Paradies et al., 2015). Moreover, PD lowers self-esteem as it devalues and disempowers MPGs; which in turn, decreases life satisfaction and increases risk of suicide (Schmitt et al., 2014). Furthermore, poor life satisfaction is significantly associated with substance abuse, self-harm and suicide. Furthermore, in extreme cases ethnocentrism and PD can have negative physical effects on health through racially motivated violence (Paradies et al., 2015). Furthermore, experienced racially motivated violence can lead to post-traumatic stress (PTS) and post-traumatic stress disorder (PTSD) (Schmitt et al., 2014; Paradies et al., 2015). Moreover; research suggests, that PD and witnessing discrimination in the health care system can exacerbate PTS and PTSD, prevent adherence to treatment, and prevent future access to services (Paradies et al., 2015). Therefore, it is vital that culturally responsive care is instilled in the health care system to prevent the anxiety, stress, depression and suicidal effects associated with ethnocentrism and discrimination.


Week Three Task

Indigenous Australians (IA) are one of the most disadvantaged groups in Australia and experience more health disparities than non-Indigenous Australians. In order to eliminate these health disparities and attain health equity, it is important to determine and address the social determinants of health that affect the IA community. The social determinants of health are the socioeconomic conditions that influence the health of people and communities (World Health Organisation, 2008). Two major social determinants of health that affect IA are health literacy and unemployment. Health literacy is the degree to which individuals have the capacity to find, process, understand and utilise health information and services (Huhta, Hirvonen & Huotari, 2018). Furthermore, IA with Low Health Literacy (LHL) are more likely to be uncertain of when to access the health care system; and access primary health care services when their health has deteriorated significantly. Subsequently, this delayed access to primary and preventative services increases the incidence and prevalence of common illnesses and chronic conditions amongst the IA community. Furthermore, IA with LHL are more likely to have trouble understanding health information regarding their condition; which in turn, increases the risk of uniformed medical decisions, which can be detrimental to health. Consequently, IA who have poor knowledge of their condition are more likely to have poor health-management strategies; low levels of adherence to treatment; and unsafe medication administration. Which result in, an increase in hospitalisation and re-admission, longer stays in hospital, and avoidable mortalities.

Secondly, unemployment is a social determinant that affects the IA community and is strongly associated with economic hardship, low levels of income and an inability to afford basic living necessities such as; food, adequate housing, medical expenses and access to health services. According to Australian Institute of Health and Welfare (2017), the rate of unemployment in the IA community is higher than non-Indigenous Australians. Subsequently; IA are at a higher risk of economic hardship, which is significantly related to anxiety, psychological distress, stress-relate chronic conditions, low levels of self-esteem and self-worth; loss of purpose and identity within the community, social exclusion and isolation, depression and suicide (Goodman, 2015). Moreover, these negative health effects subsequently impede IA ability to attain employment due to poor health conditions. Additionally, unemployment is associated with low income and an inability to afford basic living necessities which result in poor nutrition, inadequate housing, and reduced access to necessary medication and healthcare. Poor nutrition and inadequate housing can contribute to stress and developing illnesses and chronic conditions that further reduces IA capacity to work (Ride. 2018; AIHW, 2017). Furthermore; the Australian Institute of Health and Welfare (2014) reported, affordability as a barrier to accessing healthcare for IA. Moreover, the costs associated with healthcare can discourage IA to seek medical care and specialist care; and purchase necessary medication. This in turn, increases the risk of illness and chronic conditions, hospitalisation, and mortality. Therefore, in order to attain health equity, it is integral to address social determinants of health affecting Indigenous Australian communities in Australia.


Week Six Task

Australia is a culturally diverse country; therefore, it is integral that the health care system incorporate diversity in the workplace that reflects the Australian community and will understand and meet the needs of the people. Diversity and inclusion in the workplace involve acknowledging and respecting individual differences; and encouraging an inclusive environment where Health Care Professionals (HCPs) and patients are valued and can participate and contribute (Department of Human Services, 2016; Berman, Kozier & Erb, 2014). There are a multitude of benefits that arise through the implementation of a diverse workplace: The two most integral benefits are improved relationships between HCPs; and improved relationships between HCPs and their patients. Firstly, the benefits associated with promoting a culturally diverse workplace that improves the relationships between HCPs are increased innovation; improved multidisciplinary communication, collaboration and practice; increased job satisfaction and lower employee turnover. Diversity in the workplace increases innovation and creates an environment that encourages learning and the exchanging of different perspectives and ideas (Davis, Frolova & Callahan, 2016; O’Callaghan, Loukas, Brady & Perry, 2019). Furthermore, constant communication and discussion within the multidisciplinary team strengthens relationships, enables HCPs to have a better understanding of each other and different cultures, and ensures culturally responsive and competent care (O’Callaghan et al., 2019). Moreover, diversity within the workplace increases efficiency through collaboration and the utilisation of HCPs different skills and abilities and applying them in practice (Biedermann & Burnes, 2015; Davis et al., 2016). Furthermore, creating an environment that encourages learning, communication and collaboration for its members produces a fulfilling workplace that will retain employees, decrease employee turnover, and maintain knowledge and skills within the workplace (Davis et al., 2016).

Secondly, the benefits associated with promoting a culturally diverse workplace that improves the relationships between HCPs and patients are increased communication, increased patient involvement in their health care, and improved patient satisfaction and cultural safety. A diverse workplace creates an inclusive environment where a patient who might have experienced prejudice or discrimination in the community can feel comfortable to communicate freely with an HCP of the same background or culture. Furthermore, a workplace that is culturally diverse and inclusive will apply culturally safe practice when caring for patients of different backgrounds or cultures which will make the patient feel more comfortable. Moreover, through open communication HCPs can receive a better understanding of the patient and provide care that supports the patient’s values, beliefs and attitudes; improves patient health outcomes; and reduces disparities in health care (Berman, et al., 2014; Delaney, 2018). Furthermore, communication and collaboration with HCPs increases the patient’s involvement in their care, improves patient satisfaction, strengthens HCP and patient relationships, and ensures culturally responsive, efficient and safe care (Delaney, 2018). Moreover, increased patient satisfaction encourages patients to access health care resources, services and facilities in the future without fear of prejudice or discrimination. Furthermore, an increase in accessing health care promotes better patient health outcomes. Therefore, it is integral to promote a culturally diverse workplace as the benefits of improved relationships between HCPs; and their patients, ensures culturally competent and safe practice and care.


References

  • Australian Bureau of Statistics. (2017).

    Census of population and housing: Reflecting Australia, 2017

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    http://www.abs.gov.au
  • Australian Health Minister’s Advisory Council. (2015).

    Aboriginal and Torres Strait Islander health performance framework 2014 report.

    Retrieved from

    https://www.pmc.gov.au
  • Australian Institute of Health and Welfare. (2017).

    Australia’s welfare 2017: In brief

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    https://www.aihw.gov.au
  • Bastos, J.L., Harnois, C.E., & Paradies, Y.C. (2018). Health care barriers, racism, and intersectionality in Australia.

    Social Science and Medicine, 199

    , 209-218.

    https://doi.org/j.socscimed.2017.05.010
  • Ben, J., Cormack, D., Harris, R., & Paradies, Y. (2017). Racism and health service utilisation: A systematic review and meta-analysis.

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  • Berman, A., Kozier, B., & Erb, G. (2014). Values, ethics and advocacy. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, . . . D. Stanley (Eds.),

    Kozier & Erb’s Fundamentals of nursing

    (3rd Australian ed., Vol. 1., pp. 90-94). Frenchs Forest, NSW: Pearson Education Australia
  • Biedermann, N., & Burnes, D. (2015). Diversity and inclusive practice in the workplace. In Davis, J., Birks, M., & Chapman, Y. B.,

    Inclusive practice for health professionals

    (1st ed., pp. 84-106). South Melbourne, Victoria: Oxford University Press
  • Davis, P.J., Frolova, Y., & Callahan, W. (2016). Workplace diversity management in Australia.

    Equality, Diversity, and Inclusion: An International Journal, 35

    (2), 81-89.

    https://doi.org/10.1108/EDI-03-2015-0020
  • Delaney, L.J. (2018). Patient-centred care as an approach to improving healthcare in Australia.

    Collegian, 25

    (1), 119-123. https://doi.org/10.1016/j.colegn.2017.02.005
  • Department of Human Services. (2016).

    Workplace diversity an inclusion strategy 2016-2019.

    Retrieved from

    https://www.humanservices.gov.au
  • Goodman, N. (2015).

    The impact of employment in the health status and health care costs of working-age people with disabilities.

    Retrieved from

    www.leadcenter.org/system/files/resource/downloadable_version/impact_of_employment_health_status_health_care_costs_0.pdf
  • Merriam-Webster. (2019).

    Discrimination.

    Retrieved from

    https://www.merriam-webster.com
  • New World Encyclopedia. (2017).

    Ethnocentrism

    . Retrieved from

    https://www.newworldencyclopedia.org
  • O’Callaghan, C., Loukas, P., Brady, M., & Perry, A. (2019). Exploring the experiences of internationally and locally qualified nurses working in a culturally diverse environment.

    Australian Journal of Advanced Nursing, 36

    (2), 23-34. Retrieve from

    http://www.ajan.com.au
  • Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., . . . Gee, G. (2015). Racism as a determinant of health: A systematic review and meta-analysis.

    Public Library of Science One, 10

    (9), 1-48.

    https://doi.org/10.1371/journal.pone.0138511
  • Rebelo, M.J.D.S., Fernandez, M., & Achotegui, J. (2018). Mistrust, anger and hostility in refugees, asylum seekers, and immigrants: A systematic review.

    Canadian Psychology, 59

    (3), 239-251.

    http://dx.doi.org/10.1037/cap0000131
  • Ride, K. (2018).

    Major review of Aboriginal and Torres Strait Islander nutrition.

    Retrieved from

    https://www.ruralhealth.org.au
  • Schmitt, M.T., Branscombe, N.R., Postmes, T., & Garcia, A. (2014). The consequences of perceived discrimination for psychological well-being: A meta-analytic review.

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    (4), 921-948. doi:10.1037/a0035754

statistics of the implications with the incorrect use of inhalers related to nursing.

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Statistics of the implications with the incorrect use of inhalers related to nursing.

One paragraph, evidenced-based information, on the statistics of the implications with the incorrect use of inhalers related to nursing

Another paragraph cited from literature, that demonstrates how frequently the incorrect use of inhalers occurs.

APA format, must contain in-text citations for each paragraph, references must be within last 5 years.

Healthcare Policy in the US

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A healthcare policy is a set of rules and regulations that are put into effect to assist in the operation and the shape of health delivery. A healthcare policy covers a range of issue including public health, chronic illness and disability, long-term care, the financing of health care, preventive health care and mental health. There are two models of a healthcare which consist of the single payer and the social insurance system. In the single payer model, taxes are paid to the government which then pays healthcare providers such as nurses, doctors, and dentists to provide health services to individuals. In a social insurance system, citizens must purchase health insurance from non-profit insurance companies who will then use this health insurance to pay for services provided by healthcare providers. Healthcare is financed through private insurance companies which individuals can access through their employers and for the many Americans that are uninsured, there are three programs in which they can go through called Medicare, Medicaid, and The State Children’s Health Insurance Program. Medicare mainly deals with Americans who are over the age of 65 or disabled. Medicaid deals with people who are of low income or maybe classified as being poor. The State Children’s Health Insurance Program deals with people who are uninsured or low income children. There are so many aspects that can make up healthcare policy and there will be many more that will have an impact on healthcare in the future.

Principles of US Health Policy

There are many principal features of the United States health policy, but to name a few critical ones are: government as subsidiary to the private sector; fragmented, incremental, and piecemeal reform; pluralistic politics; the decentralized role of the states; and the impact of presidential leadership. These key characteristics of health policy work together or separately to pressure the progress and growth of health policy to benefit the country.

The United Sates is one of the few countries in the world that does have a national health care system where their government pays the majority and is the leader in the health care organization. That is not the case in the US. The private sector is the leader and the government takes a back seat in the majority of the development of health policies. It is funny that Americans prefer to have as less involvement from the government as possible in relation to health care financing, delivery, and policy. Being a capital nation we are under the notion that the private sector can best organize and operate the production and consumption of goods and services in our country rather than the government.

The US health care system is fragmented so much that it is almost impossible to track. Employers provide a voluntary insurance program to their employees that are paid for through payments from employees and employers together. Then you have the elderly you are covered through Social Security tax, government subsidized voluntary insurance for physician, supplementary, and prescription drug coverage. The indigent obtain health care through Medicaid which is funded through federal, state, and local revenues. American Indians, Congress, members of the armed forces, Veterans, and the executive branch have health insurance that is financed through the federal government directly. Any type of reform in America is incremental and piecemeal especially health care. For example Medicaid has had many much needed changes since its beginning in 1965. First, Congress changed the policy to have more children become eligible and in 1984 pregnant women and children in two parent families were granted health care if income restrictions were met. Policy changes are met with an array of complex political roadblocks that make much needed reform difficult to accomplish. Often it takes a revolutionary presidential election to overcome such barriers.

As in any other policy debates in the US politics interest groups’ pluralism have an effect on the health policy. Powerful interest groups involved in health care politics adamantly resist any major change (Alford 1975). Each group deeply believes that their interests are the best and will fight very hard to protect their interest. For instance, American Association of Retired Persons (AARP) is a nonprofit, nonpartisan membership organization for American citizens over the age of 50. They are one of the most powerful lobbying groups in the United States with over 40 million members. Because they are such a well organized interest group they are very effective in influencing the decisions on policies that affect the seniors in this country.

A decentralized role of the states has its pros and cons. The states provide financial support for the indigent and disabled through comprehensive health care programs. They also take on the additional responsibility of implementing the governments Medicaid and SCHIP programs for the elderly and children. On the flip side critics have suggested there is too much state control in regards to health policy changes. With each state having control over their own health policy decisions makes it extremely difficult to create a unified national health care policy.

New presidents have always been the stepping stone for policy changes in America. Every president from Johnson to Bush has made an attempt to reform health care in some shape or form. The most recent major historical change has come with the election of President Obama. He has done what no other President has done, Health Care Reform. He is putting the control of peoples’ health care needs in their own hands. President Obama’s presidential leadership impact will reform health care by making it more affordable, making insurance companies accountable for their actions, and provide coverage to all Americans.

Development of legislative health policy

“Health policy is a set course of action undertaken by governments or health care organizations to obtain a desired health outcome” (Cherry & Trotter Betts, 2005). The health care system, including the public and private segment, with the political forces influence how systems are shaped by the health care policy-making processes. Public health policies start from local, state, or federal legislation, regulations which manage the terms of health care services. There are also institutional or business policies related to health care in addition to public policies. In the private sector the policies are developed by hospitals, accrediting organizations, or managed care organizations. Nurses, the largest number of health care providers are the most familiar with institutional policies including those developed and implemented by the Joint Commission on Accreditation of Healthcare Organizations.

“The decision making in the public or the private sector, the scope of the issue, and the nature of the policy all have an impact on the characteristics of a policy” (Thurber,1996). A basic understanding of the policy process is the first step in having a strategy on how to encourage potential power and control important changes in the health care system. It is a process that uses multiple points of access in order to provide a vision that influences the decision makers involved at each stage. There are three stages of policy making: the formulation stage, the implementation and the evaluation stage. In the formulation stage, input of information, ideas, organizations, research from key people and interest groups are put together. The implementation stage involves disseminating the collected information and starting to put the policy into action. During this stage, “the proposed policy is transformed into a plan of action” (International Council of Nurses, 2005). Public policy endorsed by local, state, or federal governmental identities is usually put into practice through the normal process that interprets the policy into a written set of rules issued by the government agency that is responsible for overseeing the policy.

All concerned groups contribute in the development of health care policy by providing necessary information needed to decide on the implementation. Nurses are a very important part in the preparation and implementation of the policy. As the largest one group of health care providers, nurses can successfully sponsor health care policy project; they also have a distinctive point of view on health care policies and expertise to share with the responsible agents. Nurses are a strong voice and active advocated group that leads to positive change and build consensus on important issues.

“The policy process also includes an evaluation and modification phase when existing policies are revisited and may be amended or rewritten to adjust to changing circumstances” (Longest, 2006). Most major public policies are subject to modifications in this process. Smaller changes in already existing policies are usually easier to be implemented than major changes as less clarification and efforts are required to be implemented. A good example would be when the Medicare Program has undergone since its enactment in 1965. Another change is when the U.S. Congress in 1998 added nurse practitioners and clinical nurse specialists as providers that can bill for Part B services they provide to Medicare beneficiaries. Congress has changed Medicare program many times after that and put a number of preventive services to the Medicare program. The most recent change was done to Medicare Part D and added a prescription drug program available for Medicare beneficiaries.

“Health care issue moves through the phases of the policy process, from a proposal to an actual program that can be enacted, implemented, and evaluated, the policy process is impacted by the preferences and influences of elected officials, other individuals, organizations, and special interest groups” (Longest, 2006). “Political interactions take place when people get involved in the process of making decisions, making compromises, and taking actions that determine who gets what in the health care system. Special interest groups and individuals with a stake in the fate of a health care policy use all kinds of influencing, communication, negotiation, conflict management, critical thinking, and problem solving skills in the political arena to obtain their desired outcome” (Cherry & Trotter Betts, 2005; Kalisch & Kalisch, 1982).

Health care system is continuously changing, nurses in many institutions are taking the advocacy role, working together to reflect nursing’s perception in health care policies and to be implemented. However, the legislative process needs to be well understood and policy advocates should be aware that they may run the risk of working with the wrong people or at the wrong time and therefore the policy may not be established. Well prepared professionals can always find ways to promote for a better health care system. For the more experienced professional there are many resources available to nurse policy advocates who want to learn more about how to make a difference in key health care issues using legislative and policy processes and working within the political arena.

The Future of Health Policy

The future of health policy is unknown and difficult to predict. The US has struggled with conquering the health care system as one comprehensive unit. Instead, there have been individual attempts at specific problems, resulting in fragmented solutions. The anti-socialist views of the US citizens have thus far prevented a nationalized health care system, but this has not and will not stop many influential leaders from trying. Regardless of health care being a universal or disjointed system, the future of health policy aims at containing costs, increasing access, and improving quality.

On March 2010, President Obama signed a health care reform bill. A preliminary estimate claims that the bill will reduce the deficit by $130 billion in the first ten years and by $1.2 trillion in the next ten years (Jackson & Nolen, 2010). State-based insurance exchanges will be implemented as a way to purchase insurance for those who do not have access through their employer. The Medicare prescription coverage “donut hole” will be closed by 2020 and seniors will receive a 50% discount on brand name medications. Medicaid will be expanded, will include childless adults, and illegal immigrants will not be eligible. Insurance companies will no longer be able to deny coverage based on preexisting conditions and children will be able to stay on their parents’ insurance plans until age 26. Beginning in 2014, there will be an individual mandate that everyone must have health insurance or have to pay a fine, with exceptions for low-income people. Employers with greater than 50 employees will be required to offer health insurance. There is no telling what the ultimate success will be of this bill, as it is a continued hot debate between political parties, but it puts some definition on the future of health policy.

The role of state governments in health care has become more substantial. They hold the majority of the responsibility for regulating all aspects of the health care system. In addition, states contribute to financing Medicaid services, finance health coverage for state/public employees and retirees, and subsidize the costs of health care services for the uninsured. States also have the role of protecting the public’s health through controlling the spread of communicable diseases, protecting the environment, preventing injuries, promoting healthy behaviors, responding to disasters, providing health services to those without access, monitoring the population’s health status, and developing health care policies to benefit the community. The future of health policy shows that states will continue to perform these roles.

Conclusion

In closing, we feel that an issue such as healthcare must be thought through and have a decision made based on the need of the American peoples as well as the needs of the American economy. By this we mean that a decision should be developed based on a way to keep this great country from going bankrupt or prevent the American people from going broke when a plan goes into effect. In today’s world, the U.S health Care System of today is turning into a disaster because many people are getting to the point to where they are not able to afford healthcare services due to the fact that they are not able to afford it or have lost their jobs are may have partial health care benefits. We feel that all Americans must try to stand up for what they believe and fight for a healthcare policy that will enable everyone to be able to have healthcare coverage so that our government will see that there is a need for a change in the future.

Resources

1. Shi, L. & Singh, D.A. (2008.) Delivering Health Care in America: A Systems Approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers

2. Jackson, J. & Nolen, J. (March 23, 2010). “Health Care Reform Bill Summary: A Look At What’s in the Bill.” cbsnews.com. Retrieved, April 20, 2010, from: http://www.cbsnews.com/8301-503544_162-20000846-503544.html.

3. Alford, R. R. 1975. Health Care Politics: Ideology and interest group barriers to reform. Chicago: University of Chicago Press.

4. S M Williams-Crowe and T V Aultman, State health agencies and the legislative policy process. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403499/?page=1

5. Pamela White, Tobie H. Olsan, Carolanne Bianchi, Theresa Glessner, Pamela Mapstone, Legislative: Searching for Health Policy Information on the Internet: An Essential Advocacy Skill. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN

Emergency Care And First Aid

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Emergencies always strike suddenly, without warning. One moment everything is fine; the next, someone is involved in a serious accident. Victims include all ages, from tiny children to elderly folk. Cuts, bruises, lacerations, fractures, bites, stings, fainting spells etc are common amid all the bustling activity of life. Emergencies are likely to occur at any time, and one of your loved ones may be involved. What you do or fail to do promptly may make a great deal of difference between a quick recovery and a prolonged illness, perhaps even death.

First aid is the initial help given to an injured or a sick person before professional care can be provided. Timely assistance is most critical to the victims and is, often, life saving. Any layperson can be trained to provide first aid, which can be carried out using minimal equipments. Basic training in first aid skills should be taught in schools, colleges and in work places. In general, first aid skills should be learnt by all.

Basic life support (BLS)

Basic life support is one of the most important first aid skills, the steps which have to be familiar to all and is described below.

On seeing a sick or injured person, check if the person is responsive by tapping him on the shoulder and shouting at him. If the person also has absent or abnormal breathing (i.e., only gasping), the rescuer should assume the victim is in cardiac arrest. If the victim is in cardiac arrest, immediately call for help towards taking the person to the nearest hospital.

Check for pulse in the neck (one should not search for more than 10 seconds for the same). If no definite pulse is felt, start CPR (Cardio Pulmonary Resuscitation). It can be done as described below.

Chest compressions at the rate of 100/minute is to be given at the lower half of the sternum (breastbone) with a compression depth of 5 cm. After giving 30 compressions, the victim should be given 2 rescue breaths via mouth to mouth breathing. Start chest compressions again at the same rate mentioned above and repeat cycles of 30 chest compressions and 2 rescue breaths. This should be continued till CPR is taken over by an expert medical team at the site of the accident or at a hospital.

If pulsations are felt in the neck, but the victim is not breathing, provide mouth to mouth rescue breaths at the rate of 1 breath every 5-6 seconds or 10-12 breaths every minute.

Anaphylaxis

Anaphylaxis is a life threatening allergic reaction. Manifestations include dizziness, fainting, weak pulse, swelling of face and lips, itching, red rashes in the skin, wheezing, breathing difficulty etc. Common causes include bee or wasp stings, medications, certain foods like seafood, peanuts etc.

Have the victim lie still. Clothing should be loosened. If there is vomiting, turn the person to his or her side so as to prevent choking. If the victim is unresponsive, perform BLS. Arrange to take him or her to a hospital as soon as possible.

Animal bites

Bites, both from domestic and stray dogs are common in India. Other animals include cats, rats, monkeys etc. Wounds can range from small skin breaks to large cut wounds. The victim should be calmed. The wound should be washed with soap and running water. Antibiotic ointment if available should be applied. The wound should be dressed with sterile bandage or a clean cloth. Bleeding wounds should be tightly dressed, so as to prevent further bleeding. After first aid, medical treatment should be sought quickly.

Burns

Severity of burns is based on the depth and the extent of involvement. Burns are classified into first degree, second degree and third degree based on the depth of skin involvement.

First degree burns involve only the outer layer of the skin. The skin appears red and swollen. The victim will be in pain. Second degree burns involve the second layer of the skin (called dermis) in addition to the first layer. In addition to pain, redness and swelling, there will be blisters also. Third degree burns involve all layers of skin and may also involve underlying structures like fat, muscle and even bone. The affected areas will appear charred black or even dry and white. The victim may have difficulty breathing due to burns involving the airways.

Assessing the extent of burns is important in determining the severity of the burns. Burns involving small areas less than around 8 cm and first or second degree in depth can be treated as minor burns. Burns with depth and extent more than as described above should be treated as major burns.

Minor burns can be treated by keeping the involved area under cool running water for 10-15 minutes. Clean cloth dipped in cold water can also be placed over the area involved if the above is difficult. Cover the area with a clean bandage if available. Simple analgesics like paracetamol or ibuprofen can be given to the victim if pain is present.

For major burns, do not remove the burned clothing. Cover the involved areas with moist cloth, towels, or sterile bandages. Raise the burned parts of the body above the heart level if possible. If unresponsive, provide basic life support. Arrange to take the victim to a hospital as soon as possible.

Chest pain

Chest pain is a common problem. It can be caused by minor problems such as acidity, costochondritis, stress etc as well as serious problems such as a heart attack, pulmonary embolism, aortic dissection etc. Finding the true cause of the chest pain is not easy.

If a person has unexplained chest pain lasting more than a few minutes, it is better to seek assistance from a medical professional. Find out if the person has any underlying heart problems and has been advised medicines for chest pain. Advise him or her, to take the same. Make arrangements to take the person to a hospital quickly.

Choking

Choking occurs when a foreign object gets stuck in the throat. The common cause is food especially meat pieces. This results in blocking the flow of air. If could be fatal if first aid is not administered immediately.

The most common sign of choking is hands clutched to the throat. Other manifestations include inability to talk, breathing difficulty, noisy breathing, loss of consciousness, skin turning blue etc.

Five and five approach needs to be followed to provide first aid. It consists of alternating five back blows and 5 abdominal thrusts. Five blows have to be delivered between the person’s shoulder blades with the heel of the rescuer’s hand. Subsequently five abdominal thrusts (also known as Heimlich manoeuvre) have to be provided. The rescuer must stand behind the victim and wrap his or her arms around the waist of the victim. Subsequently the victim has to be tipped forwards. The rescuer must then make a fist with one hand and position it slightly above the victim’s navel. He or she should then grasp the first with the other hand and press hard into the abdomen and provide a quick upward thrust as if he or she is trying to lift up the person. A total of five abdominal thrusts have to be provided. If the blockage hasn’t been dislodged, five and five cycles of back blows and abdominal thrusts must be repeated.

Cuts

Assess the wound to see how big it is. Minor cuts and scrapes do not require a visit to a Doctor. Still, it has to be attended to with proper care to avoid infections and other complications.

Bleeding from minor wounds usually stops on its own. If it does not, apply gentle pressure with a clean cloth or bandage. Pressure can be held continuously for up to 20-30 minutes. If possible, elevate the wound. If there is spurting of blood or continuous flow even after applying pressure as mentioned above, medical assistance has to be sought.

The wound has to be cleaned by rinsing with clear water. Use soap around the wound. If dirt is present in the wound even after rinsing the same, gently remove the dirt with forceps which has been cleaned with alcohol. Apply an antibiotic ointment after cleansing. Cover the wound with a sterile bandage. Change the dressing at least once daily or earlier if the wound gets wet or dirty. If the wound is not healing or there is redness, increasing pain, wetness, warmth or swelling, there is high likelihood of infection. In such situations, medical assistance has to be sought.

Wounds more than 5 mm deep or is gaping require stitches. Hence the same has to be shown to a Doctor. If the person with the wound has not had tetanus immunization within the past 10 years, the same has to be taken.

Dislocation

Dislocation is the condition, where the ends of bones get dislodged from their normal positions in joints. It usually occurs due to falls, motor vehicle accidents etc. The most common site of dislocation in adults is the shoulder joint. In children, it is the elbow joint.

If a joint dislocation occurs, prompt medical attention is needed. While medical attention is being sought, the affected joint has to be splinted in its normal position, so as to prevent movement. Splinting can be done with a folded newspaper, folded blanket, folded magazine, folded cardboard box etc. Movement can result in damage to the joint and adjacent tissues. Ice can be put on the injured joint, which can reduce swelling and pain.

Electrical shock

Electrical shock can result in numbness and tingling, burns, muscle pain and contractures, heart rhythm problems, cardiac arrest, seizures etc.

Carefully inspect the victim without touching him or her as the person might still be in contact with the electrical source. Turn off the source of electricity. If the victim is unresponsive, provide basic life support. Shift the person a nearby hospital for further evaluation.

Foreign body in the ear

Foreign objects in the ear causes pain. Do not attempt to remove the object with cotton swab or matchstick. This can cause the object to move farther into the ear and damage the fragile structures inside the ear. If the object is clearly visible, it can be removed using a forceps. The head can be tilted to the affected side to see if the object will fall off.

If the foreign body is an insect, tilt the person’s head, so that the ear with the insect will be facing upwards. Warm, but not hot oil, like coconut oil, baby oil etc can be poured into the ear. This is done to float the insect. If there is bleeding or discharge from the ear, do not attempt this. If this does not help, seek medical aid.

Foreign body in the eye

Keep the affected person seated in a well lit area. After washing of hands, gently examine the eye to find the object. The lower eye lid can be pulled down and the person asked to look up. Subsequently the upper eye lid has to be pulled up and the person asked to look down. If the object is found floating in the tear film on the surface of the eye, it can be attempted to be flushed out using lukewarm water. One should be careful, not to rub the eye or attempt to remove an object embedded in the eyeball. Seek help from a doctor if, the object cannot be removed, there is abnormal vision or pain, there is redness or if there is a sensation of an object in the eye persisting even after the foreign body is removed.

Foreign body in the nose

Ask the person to blow the nose gently to free the object from the nose. If only one nostril is affected, the opposite nostril can be closed by applying gentle pressure and then blowing gently through the affected nostril. If the object is visible, gently remove it with a forceps. Seek medical help, if these measures are unsuccessful.

Fracture

A fracture is a broken bone. There will be pain, deformity and inability to move the affected area. Any bleeding has to be stopped by applying pressure with a sterile bandage or a clean cloth. Immobilize the fractured area with a splint (folded newspaper, cardboard, magazine, folded blanket etc). Application of ice packs will help in reducing the swelling and in relieving pain. Look for shock and provide first aid for the same. If unresponsive, provide basic life support. Arrange to take the victim to a hospital.

Gastroenteritis

Gastroenteritis is the condition in which there is inflammation of the stomach and intestines. Causes include infection with viruses, bacteria, parasites; certain medications; reaction to certain foods.

Manifestations of gastroenteritis include vomiting, diarrhoea, cramping abdominal pain, fever etc.

Plenty of fluids are to be taken to make up for dehydration and ongoing losses. Oral rehydration solution diluted as per instructions in the packet, rice kanji water with salt, coconut water etc is advised. It is advised to take these fluids frequently so as to pass light coloured urine. Only simple diet preferably fruits, rice kanji, bread, vegetable dishes with minimal spices and masala etc should be consumed. Adequate rest is advised.

If recurrent vomiting, persisting diarrhoea more than 2 days, decreased or absent urine output, high grade fever, severe abdominal pain etc occurs, medical help has to be quickly sought.

Headache

Headaches are a common problem. Most of them are due to minor causes. However, there are also serious causes of headache. Watch out for alarm symptoms or characteristics of headache, which will pinpoint to a more serious cause warranting further evaluation. They include vomiting, drowsiness, weakness or paresthesias in the limbs, reddened eye, etc. Sudden onset severe headache, steadily worsening headache, worst headache to have occurred till date, different type of headache than the usual, headache with fever, headache after a head injury are also descriptions or situations which warrant further evaluation. In such cases medical attention has to be sought.

In the absence of the above mentioned alarm features, the person can be given analgesics like paracetamol or ibuprofen. He or she can be advised to take rest.

Head injury

Most injuries to the head are minor and do not require hospitalization. However symptoms and signs such as severe head or facial bleeding; bleeding or leaking of fluid from the ears or nose, drowsiness or coma; black or blue discolouration around the eyes or behind the ears; slurred speech, weakness in limbs, imbalance while walking; seizures etc are suggestive of serious head injury and would warrant urgent medical intervention.

If there is severe head trauma, keep the person still. Stop bleeding by applying firm pressure on the wound with a sterile gauze or clean cloth. If unresponsive, provide basic life support. Arrange to take the person to a hospital quickly.

Heat cramps, heat exhaustion and heatstroke

Heat cramps are painful and involuntary muscle spasms that occur after heavy exercise or working in hot and humid environments. Lack of adequate fluid intake is often a precipitating factor. The cramps usually involve muscles in the calves, arms, abdomen, and back.

Heat exhaustion is a heat related condition worse than heat cramps. There is in addition to the cramps, nausea, feeling faint, fatigue, rapid heartbeat, headache, low grade fever, heavy sweating, dark coloured urine etc.

Heatstroke is the worst heat related condition. In addition to cramps and other symptoms mentioned above, there is cessation of sweating, worsening drowsiness to coma, higher body temperature and low or elevated blood pressure.

In case of heat cramps, the person is advised to drink clear water with a pinch of salt added, fruit juice, or electrolyte containing sports drinks.

Gentle stretching and massage of the affected muscles can be done. Avoid strenuous activities for a day. If the cramps persist, seek medical attention.

In case of heat exhaustion or heatstroke, quickly get the person out of the sun into a cool room. Lay him or her down. Loosen or remove the person’s clothing. Cool him or her by spraying with cool water and fanning. Cool water or other beverages as mentioned above can be given for drinking. Take the person to a hospital promptly.

Insect bites and stings

Insect bites and stings cause itching, pain and sometimes anaphylaxis. Move the person to a safe area to avoid further stings. The stinger if stuck in the skin has to be removed with a sterile blade to prevent further envenomation. Wash the area with soap and water and apply a cold pack (ice with cloth wrapped around) to reduce the swelling and pain. Simple analgesics like paracetamol or ibuprofen can be used. Anti allergens like ceterizine can also be used.

If severe reaction occurs with manifestations like breathing difficulty, swelling of face or lips, fainting, arrange to take the person to a hospital immediately. Provide basic life support if the person is unresponsive.

Nosebleeds

Nosebleeds are a common problem. Make the person sit upright and leaning forward, which will reduce the pressure in the veins of the nose decreasing further bleeding. The nose should be pinched between the thumb and the index finger to keep the nostrils shut. Ask the person to breathe through his or her mouth. Ask the person not to pick or blow the nose and also not to bend down for several hours after the bleeding episode. If the bleeding lasts more than 20 minutes,recurs or occurs after a head injury, seek medical help.

Poisonings

Signs of poisoning include vomiting, breathing difficulty, drowsiness, unresponsiveness; empty medication bottles or scattered pills lying beside the victim; chemical smell in the breath; burns or redness around the mouth etc.

If the victim has been exposed to poisonous fumes, shift him to fresh air quickly. If there is any poison in the mouth, remove it. If the poison has spilled on the person’s clothing remove the same. Flush the skin or eyes with cool water. If the person is unresponsive, provide basic life support. Arrange to shift him or her to a hospital quickly. If any medication containers/strips or poison bottle is lying beside the patient, take it to the hospital.

Snake bites

Immobilize the bitten arm or leg of the victim and position in such a way that the bitten area is below the level of the heart. Ask the victim to remain calm and quiet. This will help in reducing the amount of poison spreading to other parts of the body. Cleanse the wound with water. Avoid flushing water with force on to the wound. Apply a splint to reduce movement of the limb. The splint should be loose enough so as to not restrict blood flow. Tourniquet should not be used. Also avoid cutting the wound or attempting to remove the venom. Shift the victim to nearest hospital for further management.

Severe bleeding

Make the person to lie down and avoid movement. Wear a pair of gloves and remove any dirt if present from the wound. Put a sterile bandage or clean cloth over the wound and apply pressure directly on the wound till the bleeding stops.

If the bleeding does not stop with direct pressure, pressure has to be applied to the artery providing blood to the bleeding area. Points where such pressure has to be applied on the arm, are the inside of the arm just above the elbow and just below the armpit. Pressure points of the leg are just behind the knee and in the groin. The main arteries in these areas have to be squeezed against the bone. The fingers have to be kept flat and with the other hand continuous pressure has to be exerted on the wound itself.

Once the bleeding has stopped immobilize the victim. Arrange to take him or herquickly to a hospital.

Sprain

Ligaments are tough elastic like bands, which connect bones in joints and keep them in place. Sprain is an injury to ligaments, which can cause joint instabilities. Knee and ankle sprains are most common. There will pain, redness, swelling and instability in joint movement if the sprain is a major one.

Treatment can be remembered with the mnemonic R.I.C.E., which stands for Rest the injured limb, Ice the area, Compress the area with a bandage and Elevate the area above the level of the heart. Seek medical attention after providing the above.

Sunburn

Manifestations of sunburn include pain, redness, swelling and occasional blistering. If large areas of the skin are involved, there can also be headache, fever and fatigue. Advise the person to take a cool bath. Moisturizing cream has to be applied to the affected areas several times a day. Blisters have to be left intact to speed healing and avoid infections. If they burst on their own, antibacterial ointment has to be applied on the open areas. Pain relieving medications like paracetamol or ibuprofen can be used. If the sunburn begins to blister or if fever occurs, it is advisable to see a doctor.

Shock

Shock can occur due to trauma, heatstroke, blood loss, allergic reactions, poisoning, severe infections, severe burns etc. When a person is in shock, there is inadequate blood supply to his or her organs. If untreated, this can lead to death. Manifestations of shock include drowsiness, rapid breathing, cool clammy skin, weak pulse etc.

Keep the person in his or her back with feet about a foot higher than the head level. Keep the person still. Keep him or her comfortable and warm, by covering with a blanket. Do not give anything by mouth. If vomiting occurs, turn him or her to the sides. If there is bleeding, apply pressure to stop the same. Shift him or her to a hospital quickly.

Planning Nutrition Therapy for a Complex Pediatric Patient

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Planning Nutrition Therapy for a Complex Pediatric Patient

Order Description
Unit outcomes addressed in this Assignment:
• List the major factors that influence the recovery of a sick child.
• Explain three methods of improving nutrient intake in a pediatric patient with a chronic disease.
Course outcomes addressed in this Assignment:
NS335-5: Design a realistic and therapeutic meal plan for a patient with a severe food allergy or disease that prohibits certain types of foods or nutrients.
GEL-8.3: Formulate a logical solution to a problem.
Kaplan University School of Health Sciences
NS335
Unit 8 Assignment
Unit 8 Assignment
Unit outcomes addressed in this Assignment:
• List the major factors that influence the recovery of a sick child.
• Explain three methods of improving nutrient intake in a pediatric patient with a chronic disease.
Course outcomes addressed in this Assignment:
NS335-5: Design a realistic and therapeutic meal plan for a patient with a severe food allergy or disease that prohibits certain types of foods or nutrients.
GEL-8.3: Formulate a logical solution to a problem.
Instructions:
Imagine that you are a nutrition assistant working at a pediatric rehabilitation center. This rehabilitation center provides care for pediatric patients who are recovering from recent hospitalizations. This facility is considered to be the bridge between hospitalization and home care.
The supervising dietitian has informed you that a new patient was admitted overnight from the nearby hospital and is recovering from a skin graft surgery due to a severe pressure ulcer (bed sore). Imagine that you are asked to review the patient’s chart notes and provide a nutrition assessment summary along with some ideas about what type of therapeutic diet or nutrition therapy she requires.
Patient information from the hospital medical chart:
Name: Cindy
Age: 6-year-old female
Height: 43 inches
Weight: 38 pounds
Admitting Diagnosis (Dx): Cerebral Palsy, bedridden, stage 3 pressure ulcer on sacrum, food allergy to eggs
Surgery: Skin graft performed to increase healing and reduce further infection risk.
Diet order: Thickened liquids and pureed foods with precautions due to dysphagia (swallowing deficiencies) associated with CP. No eggs: Severe Egg Allergy.
Kaplan University School of Health Sciences
NS335
Unit 8 Assignment
Speech/Cognitive: Patient receives speech and swallowing therapy due to CP. Her speech and cognitive abilities were reported to be around that of a 2-year-old.
Cindy normally resides at home with her family. She qualifies for state-funded home medical assistance due to the CP diagnosis. She is bedridden and relies on the home health nursing assistants for care. Her parents have three other children and involve her in as many family activities as possible, but the actual care is provided by the in-home medical team. Cindy has had a gastrostomy feeding tube (G-tube) since she was just a few months old. In recent years, it has only been used nocturnally if her oral intake of the pureed/soft diet foods fell below the 50% mark for two or more meals. She received a specialized enteral formula that did not have eggs as any source of the protein.
For many years, Cindy was cared for by the same team of nurses and nursing assistants, and she did not have any major medical or nutrition-related problems. However, about 6 months ago, the state funded program changed home care contract companies and a new company began to provide care. Cindy’s parents felt that the care was sub-standard and reported it numerous times, but without any improvements. It was not until Cindy’s quarterly check-up that these problems were identified. Her weight had dropped by 15% in just 3 months, her albumin was low, and her lean muscle mass and strength had decreased. Most alarmingly, she had developed a pressure ulcer on the sacrum. The MD immediately admitted Cindy into the hospital.
Upon further investigation, the new home health company had been administering nocturnal tube feedings with a formula that contained egg as one of the partial sources of protein. They thought that it was a comparable substitute for the previous brand. Additionally, they had misread the original nutrition order to only give night enteral feedings (via the G-tube) if her oral intake was insufficient. Until the issues were discovered, Cindy went several months receiving a full night of tube feedings that provided a feeling of fullness to her. She also was suffering from chronic diarrhea and associated malabsorption. Subsequently, she would not feel well enough to eat the next day and the cycle repeated itself daily. She also started having many more nasal and respiratory symptoms, which the new care providers explained away as being typical seasonal allergies. She was prescribed an antihistamine. Her parents were unaware of the nocturnal tube feedings because the nursing staff would run them about 8–10 hours while the patient was asleep.
Questions to address:
Kaplan University School of Health Sciences
NS335
Unit 8 Assignment
1. Why was Cindy at risk for a pressure ulcer? What were some of the contributing factors, and why?
2. What are the symptoms of an egg allergy? Why do you think her allergy was not ever life threatening when she was receiving the nightly tube feedings at home?
3. Take into consideration her multiple medical conditions of cerebral palsy, egg allergy, and recent pressure ulcer, and calculate her estimated calorie needs and protein needs.
4. Recommend an appropriate tube feeding formula brand name or type that has no albumin from egg protein (for the days that she does not have adequate oral intake of her meals).
5. Appendix: Design a full-day meal plan for Cindy that includes pureed/soft foods. This diet needs to fully address her CP-related chewing/swallowing challenges. Be sure to consider her protein needs for wound healing promotion and future prevention, but without foods containing eggs or egg by-products. Oral protein drink supplements can be considered. Include the total calories, carbohydrates, fats, protein, and any micronutrients that are important in this case.
Requirements: Please include the answers to questions 1–4 in an essay of at least 2 pages in length. Incorporate at least three references in APA style within the essay. Part 5/Appendix should be formatted as a well-organized 1-day sample meal plan with a detailed description of the food items and accurate serving size. The meal plan is in addition to the 2 pages for questions 1–4.
Submitting your work:
Submit your Assignment to the appropriate Dropbox. For instructions on submitting your work, view the Dropbox Guide located under Academic Tools at the top of your unit page.
Please be sure to download the file “Writing Center Resources” from Doc Sharing to assist you with meeting APA expectations for written Assignments.
To view your graded work, come back to the Dropbox or go to the Gradebook after your instructor has evaluated it. Make sure that you save a copy of your submitted work.
Kaplan University School of Health Sciences
NS335
Unit 8 Assignment
Unit 8 Assignment Grading Rubric = 150 points
Assignment Requirements
Points possible
Points earned by student
Student answers each of the following:
Why was Cindy at risk for a pressure ulcer? What were some of the contributing factors, and why?
0–25
What are the symptoms of an egg allergy? Why do you think her allergy was not ever life threatening when she was receiving the nightly tube feedings at home?
0–25
Take into consideration her multiple medical conditions of cerebral palsy, egg allergy, and recent pressure ulcer, and calculate her estimated calorie needs and protein needs.
0–25
Recommend an appropriate tube feeding formula brand name or type that has no albumin from egg protein (for the days that she does not have adequate oral intake of her meals).
0–25
Appendix: Design a full-day meal plan for Cindy that includes pureed/soft foods. This diet needs to fully address her CP-related chewing/swallowing challenges. Be sure to consider her protein needs for wound healing promotion and future prevention, but without foods containing eggs or egg by-products. Oral protein drink supplements can be considered. Include the total calories, carbohydrates, fats, protein, and any vitamins or minerals that are important in this case.
0–40
Required amount of APA style references are used within the paper to effectively support ideas.
0–10
Total (Sum of points earned)
0–150
Kaplan University School of Health Sciences
NS335
Unit 8 Assignment
The Proposal is written in the most current version of APA format with no grammatical, spelling, copyright, plagiarism, or proofreading errors.
Points deducted for spelling, grammar, and/or APA errors.
Adjusted total points earned
Instructor Feedback*:
*Instructor may also leave feedback comments within Assignment submission.

Discharge transfer-the disposition of an inpatient to another health care institution at the time of discharge. Census Assignment

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Discharge transfer-the disposition of an inpatient to another health care institution at the time of discharge.

Census Assignment

In this assignment you will learn to calculate a monthly census report for a health care organization.Use the Census Data Assignment Instructions to complete the monthly census report in the Excel file provided to you. Here is a key for the abbreviations in the spreadsheet file:

A/C means adults and children
Nb means newborns

Trf In means transfers in
Trf Out means transfers out
b means births

Census Data Assignment:

READINGS

Read and understand the inpatient census data pg 426-430 of the Statistic chapter (LaTour chapter 15).

Understand the following:

-Hospital Inpatients-a hospital patient who is provided with room, board, and continuous general nursing service in an area of the hospital where patients generally stay at least overnight.

-Hospital Newborn-a hospital patient who was born in the hospital at the beginning of the current inpatient hospitalization (normal or with some kind of pathologic condition).

Geographic Organization of the Facility:

Inpatient beds-accommodations with supporting services for inpatients excluding those for newborn nursery.

Newborn bassinets-accommodations with supporting services for newborn (possibly bassinets, cribs, incubators, isolettes in a regular nursery or NB-ICU).

Medical care units-an assemblage of inpatient beds (or newborn accommodations) and related facilities and assigned personnel in which medical services are provided to a defined and limited class of patients according to their particular medical care needs.

Special care unit-a medical care unit in which there is appropriate equipment and a concentration of physicians, nurses, and others who have special skills and experience to provide optimal medical care for critically ill patients, or continuous care of patients in special diagnostic categories (ICU, CCU, NB-ICU).

Labor and delivery-a special unit in which there is appropriate equipment and a concentration of physicians, nurses, and others who have special skills and experience to provide services related to the labor and delivery of maternity patients.

Operating room-an area of a hospital equipped and staffed to provide facilities and personnel services for the performance of surgical procedures but not considered a unit or counted for inpatient census.

Surgical Pain Relief: Multimodal Analgesia And Paracetamol

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INTRODUCTION

As a nurse on a surgical ward dealing with a diversity of operating procedures it is important to understand the effects of surgical pain, as pain intensity and control is an integral part of the nursing duties. Layzell (2008) argues that pain management for postoperative patients should be a priority for all healthcare professionals. Furthermore having a say in how medications are administered but not prescribing drugs also means that it is essential to have an understanding of pharmacology. This ensures that informed discussions can talk place with the medical officer when it is felt that pain relief for a patient requires review. Additionally this enables the right balance of pain relief to be administered to minimise distress for the patient throughout their surgical journey. According to Lucas (2008) the benefits and adverse effects of the different types of analgesia also need to be considered when treating postoperative pain.

Pain is a complex phenomenon that is difficult to define. The most general definition used was published by the International Association For The Study Of Pain (IASP) in 1979 and refers to pain as an ‘unpleasant, sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage’ (IASP 2010). Pain is also subjective and the intensity can only be experienced by the sufferer (Mann and Carr 2006). Neurophysiology there are three types of pain receptors communicating pain signals through nociceptors or pain fibres (Mann and Carr 2006). These receptors can be found in ‘the skin, surfaces of the joints, periosteum (the specialised lining around the bone), arterial walls and certain structures in the skull’, although the brain itself does not have any of these receptors (Mann and Carr 2006, p3).

Each receptor reacts to a different stimulus. The mechanical receptor to touch, thermal to heat or cold and chemical to products present in the body that are released after trauma causing inflammation and increased sensitivity at the wound site (Mann and Carr 2006). The chemical receptors also react to chemicals introduced into the body (Mann and Carr 2006). The nociceptors are the sensory instruments that transmit pain signals through sensory nerve fibres to the dorsal horn of the spinal cord and into the brain (Mann and Carr 2006). There are three types of nerve fibres: A-delta responds to mechanical or thermal sensations, C fibres also known as polymodal because they respond to mechanical, thermal and chemical influences and A‑beta fibres which occur in the skin, reacts to touch but does not transmit pain sensations (Mann and Carr 2006).

Psychologically pain can induce fear, anxiety, anger, frustration and also a sense of helplessness may be experience from being unable to physically control the intensity of the pain being felt (Rothrock et. al. 2007).

Physiologically pain can reduce the functions of the immune system whilst increasing the potential for wound and chest infections as well as impairing the wound healing processes (Middleton 2003, Pudner and Ramsden 2010). Pain also induces vomiting, increases the workload of the cardiovascular and gastrointestinal systems, decreases lung capacity and can also reduce physical mobility (Middleton 2003, Rothrock et. al. 2007).

Traditionally following surgery, a single opioid drug such as morphine is used, depending on the type of surgery performed, for moderate to severe or acute pain (Shorten et. al. 2006).

It is argued that patients who receive this mono‑therapy would prefer to be treated with non­â€‘opioid remedies (Shorten et. al. 2006). According to Mann and Carr (2006) using the mono‑therapy method only targets one pain pathway and although morphine is considered the gold standard it tends to have many adverse effects. These include a 0.2% risk of respiratory depression, sedation, urinary retention, nausea and vomiting which affects around 30% of patients, itching or pruritus, hypotension or low blood pressure plus confusion and hallucinations in the elderly (Mann and Carr 2006, Rothrock et. al. 2007, Manley and Bellman 1999). Some of these side effects are controlled with anti‑emetics for sickness and anti‑histamines for pruritus (Rothrock et. al. 2007).

Combinational drug therapy began in the 1950’s (Michielsen 2007). Since then there has been increasing developments in establishing opiate sparing analgesic regimes with fewer side effects for surgical pain (Shorten et. al. 2006). Painkillers such as paracetamol (acetaminophen) can be combined with drugs from the codeine group, tramadol and non-steroidal anti‑inflammatory drugs (NSAIDs) as part of a multimodal regime (Manley and Bellman 1999). This allows for lower doses of individual drugs to be given, reducing the severity of adverse events and targeting more than one pain pathway as each drug has a different mechanism of action (Shorten et. al. 2006).

Paracetamol is a universal drug that is generally well tolerated but its mechanisms are not fully understood (Mann and Carr 2006). There are only mild to rare reported occurrences of side effects such as skin rashes and other allergic reactions (Manley and Bellman 1999).

Paracetamol, a member of the non-opioid group is one of ‘oldest known synthetic analgesic and antipyretic drugs’ (Manley and Bellman 1999, p470). Being also an antipyretic paracetamol has the ability to reduce fever temperature (Pudner and Ramsden 2010). It can be administered orally, rectally or intravenously in the form of a prodrug known as perfalgan or propacetamol (Manley and Bellman 1999, Royal Pharmaceutical Society of Great Britain 2007). Prodrugs are treatments that need to be broken down in the body before they become active (MedicineNet 2010). It is suggested that paracetamol should be used as part of a multimodal regime for surgical patients experiencing mild to moderate pain (Pudner and Ramsden 2010). Multimodal treatments involve combining drugs to form a compound in order to increase pain relief and reduce opioid adverse effect (Shorten et. al 2006, Manley and Bellman 1999, Pudner and Ramsden 2010). These combinational drugs are regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA) and European Medicines Evaluation Agency (EMEA) and only a limited number has been approved (Shorten et. al 2006, Department of Health 2010). ‘Pharmaceutical companies have also introduced several fixed‑dose‑combinations’ such as co‑codamol a combination of codeine phosphate, a weak opioid and paracetamol as well as co‑dydramol a compound of dihydrocodeine and paracetamol (Shorten et. al 2006, p185). The main side effect of these codeine products is constipation, which can be remedied with a mild laxative (Manley and Bellman 1999).

Tramadol, another weak opioid can also be combined with paracetamol (Manley and Bellman 1999). The side effects of tramadol include minimal respiratory depression, nausea, vomiting, dizziness, headache and sweating (Manley and Bellman 1999).

Using this drug appears to defeat the object of reducing opiate contraindications but the combination is generally well tolerated and effective for moderate to severe pain (Shorten et. al. 2006). Rothrock et. al (2007) argues that combining NSAIDs with opioid drugs effectively reduces opioid usage by 20-40%. However increased postoperative bleeding and the chances of developing gastrointestinal ulcers cause NSAIDs to be used sparingly for surgical patients ((Rothrock et. al. 2007).

The Human Rights Act 1998 states that ethically it is the duty of all healthcare staff to ensure that patients are protected from any form of ‘torture, inhuman and degrading treatment and punishment’ (Office of Public Sector Information 1998, Article 3). Nurses are also responsible for their actions and as such must be able to justify decisions made or omissions which affect the well‑being of a patient (Nursing and Midwifery Council 2008). From a surgical nursing perspective this means it is imperative to ensure patients receive good pain management following their operation. However according to a recent study by Dolin, Cashman and Bland (2002) one in five patients still report severe postoperative pain. Manley and Bellman (1999) suggest patients commonly believe that pain is acceptable following surgery. While Pudner and Ramsden (2010) argue that postoperative pain should be controlled and patients should not expect or see pain as inevitable.

This literature review aims to firstly evaluate current research and evidence in relation to the use of paracetamol as one part of a multimodal analgesia regime for surgical pain relief. Secondly to use the results to make recommendations for standardising multimodal pain control for postoperative patients and re-educate staff on the importance of effective pain management.

METHODOLOGY

Search Criteria

For this literature review an advanced search was carried out over the internet. The health and medical sciences specific databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Online (MEDLINE), Cochrane Library and Internurse.com were explored (Thomas 2000). CINAHL includes full text and is the most relevant source of information for nursing while MEDLINE ‘focuses on life sciences and is produced by the National Library of Medicine’ (LoBiondo-Wood 2010, p68). The Cochrane Library holds a collection of systematic reviews and Internurse.com has journal articles written by nurses (LoBiondo-Wood 2010, p68). The Cochrane Library was used to determine if any critical reviews had previously been carried out on the subject of paracetamol being used as part of a multimodal regime for postoperative patients. Only 4 papers were found. Internurse.com was exploited for articles containing current knowledge on the use of multimodal therapy for surgical patients. These editorials were utilised within the introduction.

The keywords or inclusion criteria for the literature search included paracetamol in the title while the words surgical and post operative were left optional to increase the depth of the search. Truncation or wildcards were employed to make the search more sensitive and specific to the topic being researched as follows: surgical – surg* and post operative – post op* (Gerrish, and Lacey 2006). The search mode was set to Boolean which ‘defines the relationships between words or groups of words in a literature search (LoBiondo-Wood 2010). This process involved using the word ‘AND’ before the truncated words ‘surg*’ and ‘post op*.

The date time frame was also limited from 2000 to 2010 to ensure that the studies were up to date and relevant to present day policies and procedures for pain control (LoBiondo-Wood 2010). Restrictions were also placed to only include papers that were based on humans, research papers and in the English language. Humans were selected as experiments on animals due to their biological makeup was not considered to be relevant to controlling postoperative pain in human beings. As this is a literature review it was appropriate to only select research papers for analysis. Language was also deemed to be significant as finances and the time schedule to complete the review did not allow for interpretation of the papers from other Dialects. Expanders were included to find papers that had related words and for the search to be carried out within the full text of the articles.

Review

8 papers resulted from the above search criteria. These were then screened using inclusion criteria, the titles and abstracts to determine their relevance to relieving surgical pain with multimodal analgesia therapy. The inclusion criteria was trials that included patients who had received paracetamol (acetaminophen) postoperatively, trials that included multimodal therapy, papers that were published within the last 10 years, subjects who were adults as my surgical setting only treats patients over the age of 18 and within a hospital environment. Exclusion criteria were trials that involved animals or children as discussed earlier. The types of interventions could include any routes for drug administration as paracetamol can be administered via intravenous, oral or rectal modes.

One paper was excluded from the review at this point as it was a mono‑therapy trial for paracetamol. The remaining 7 papers met with the inclusion criteria and were scored for methodological quality using a critical appraisal skills programme (CASP) containing 10 questions {{488 Public Health Resource Unit (PHRU) 2007}}. The questions were answered ‘yes’, ‘no’ or ‘can’t tell’ for each paper. Using a tool provides a way of systematically appraising what is published and filtering through papers to determine their relevance and accuracy {{427 Crookes, P. and Davies, S. 2004}}.