Compare and contrast culture- ethnicity- and acculturation.

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Topic 3 DQ 1

Discuss a patient of another culture. How can the health care professional communicate in presenting patient education? Consider language, family, cultural differences, and method of communication.

Topic 3 DQ 2
Compare and contrast culture, ethnicity, and acculturation.








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Reflect on the content and identify ways in which the principles of PHC and Health Promotion (HP) are demonstrated.

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Reflect on the content and identify ways in which the principles of PHC and Health Promotion (HP) are demonstrated.

Nursing Assignmnet

More than 9 references (within 6-7 years) in additional to prescribed textbook. If you find more than 6-7 years old references which are fully relevant to questions answer you can put that references in your references as well but firstly try to search current references
References Style: APAv6
Prescribed textbook: McMurray, A., & Clendon, J. (2014). Community health and wellness: Primary health care in practice (5th ed.). Chatswood, Australia: Elsevier.

PHC= Primary Health Care

Aim of assessment

The aim of this assessment is to provide you with the opportunity to gain a deeper understanding of the application of PHC concepts and health promotion practice with particular reference to the health of Indigenous Australians.

Details of the assessment
A DVD, (or TV program, YouTube video) concerning Australian Indigenous health issues will be used as a trigger for students to respond to 5 questions relating to the PHC principles and health promotion elements identified in the DVD.
In order to complete the assessment you will:
– Access and view the program (https://www.youtube.com/watch?v=ZYlS7v1Pt6U) a few times so that you can become familiar with the content.
– Reflect on the content and identify ways in which the principles of PHC and Health Promotion (HP) are demonstrated.
– Review on-line learning materials. Reflect on what you have been taught about the health of Aboriginal Australians and factors influencing their health.
– Read and watch the additional learning materials and do some searches yourself for background material about PHC, HP and Aboriginal health, as well as other programs aimed at improving the social determinants of health for Aborigines.

• This short answer paper has a word limit of 750 words (maximum) including in text references.
• Additional to the written component, a health promotion poster will also be submitted
• The poster does not contribute to the word limit
• Answers to questions 1-4 will have a maximum word limit that will total 750 words including in text references. Word limit for each question will be identified with the questions.

Determine the most-effective budgeting approach for a hospital, indicating how this approach can lead to effective financial management of the facility.

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Determine the most-effective budgeting approach for a hospital, indicating how this approach can lead to effective financial management of the facility.

Suggest one (1) key insight that may be gained by the administrator in regard to the performance of the organization. Provide support for your rationale. Use the Internet or Strayer databases to research the current and projected inflation rates and the related impact expected on health care costs. Next, assess the level of importance of one (1) key driver of the inflation of health care costs. Indicate how this inflation can be managed strategically in the future to minimize the financial impact. Provide support for your rationale.

Use the Internet or Strayer databases to research information related to the budgeting processes within the various types of health care organizations. Next, determine the most-effective budgeting approach for a hospital, indicating how this approach can lead to effective financial management of the facility. Provide support for your rationale. Assume that you are an administrator for a hospital, and you need to acquire a new technology system so that you may comply with regulatory requirements. Create an argument to be presented to the leadership team in which you justify the need for your facility to invest in this new technology. Then indicate the value to the organization and provide support for your argument.

In the scenario, the contract negotiations between North Creek Healthcare and the community hospital concluded with an agreement on non-financial (legal) terms. Suggest the most critical element of the contract and the impact to the short-term and long-term operational strategy of a community hospital. Indicate the potential implications to the hospital’s financial targets. Imagine you work for a hospital where the operating margins have been consistently below national norms for the past three (3) years. Discuss one (1) key driver of the below average performance. Suggest one (1) strategy to improve the future management of the driver that you’ve discussed.

Massage Therapy Reducing Pain- Depression and Anxiety in Hand Osteoarthritis Patients

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Abstract

This paper explores five published articles that report on results from studies conducted to explain how massage therapy reduces pain, depression and anxiety in patients with hand osteoarthritis (OA). The articles were able to describe the treatments used to reduce symptoms of pain, depression and anxiety in patients with hand (OA). Moyer et al. (2002) suggest that massage therapy may deliver beneficial outcomes in many ways, each being differently important depending on the desired effect (Moyer et al., 2002). Other articles center focus was more on the reduction of pain and explained how treatment can be helpful to relieve pain. This paper examines Moyer et al. (2002) findings in relation to four other research articles suggesting that certain treatments may help reduce pain, depression, and anxiety in patients with hand (OA) (Moyer et al., 2002). This paper included specific types of treatments associated with massage therapy to decrease pain levels indicating that patients may notice a decrease in depression and anxiety after massage therapy.

A significant number of patients with hand osteoarthritis use massage therapy to alleviate symptoms of pain as well as anxiety and depression (Moyer, Rounds, & Hannum, 2004). There is research that supports the evidence that massage therapy is effective. One study has shown that grip strength, a technique in massage therapy, increases muscles strength and decreases pain in hand osteoarthritis (OA) (Field, Diego, Hernandez-Reif, & Shea, 2007). This same study found a decrease in self-reported anxiety and depression following massage therapy (Field, Diego, Hernandez-Reif, & Shea, 2007). In a different study, massage therapy did not show an impact on immediate assessment on pain, but it did have a huge impact on the delayed assessment of pain. Participants who received treatment and were evaluated a few days or weeks after treatment experienced lower levels of pain (Moyer, Rounds, & Hannum, 2004).

Zwolińska et al. (2018) stated that patients with osteoarthritis (OA) may have problems in their daily activities and a decrease in well-being, which can lead to a change in mood leading to depression (Zwolińska et al., 2018). A form of therapy used for recovering from physical or mental illness is Occupational Therapy. Occupational therapy promotes rehabilitation to get back to doing daily life activities

(Kjeken, et al., 2016).

Another study mentions that occupational therapy interventions include joint protection and exercises that improve daily living, but their main goal is to keep up and enhance capacity of the affected areas of the hand (Stamm, et al., 2002). Stamm, et al. (2002) mentions that joint protection is intended to “strengthen muscular support, improve shock absorption around a joint, and reduce mechanical stress on the joint with different techniques or devices” in people with OA. These techniques help control pain, fatigue, inflammation and increase health and well-being (Stamm, et al., 2002). Patients with hand (OA) will see their pain reduce in random episodes if they continue to show up to their appointments and get the proper treatment needed for hand osteoarthritis.


Methods

This paper explores the question of how the use of massage therapy such as massage therapy can reduce pain, anxiety, and depression in adults with hand osteoarthritis (OA). There is evidence that massage therapy is expected to reduce symptoms of pain, anxiety, and depression. Increasing grip strength can be associated with massage therapy increasing muscle strength, which may decrease pain levels. On the other hand, once grip strength increases, pain can decrease. Patients who self-report a decrease in anxiety and depression prior to massage therapy notice a decrease in pain levels. (Field, Diego, Hernandez-Reif, & Shea, 2007).


Sample

The population in this study are adults both female and male ranging from 30-66 years old. Patients will be recruited at a hand therapy clinic. Patients must be experiencing symptoms of pain, anxiety, and depression, and must have hand osteoarthritis to participate in the study. Individuals who have these characteristics will be observed individually and asked questions about how they are feeling. These observations will allow us to see how the patient is dealing with their symptoms caused by hand (OA). In addition, they will be asked if they are interested in filling out a Pain Questionnaire based on their attitudes/opinions on the effect of massage therapy reducing the symptoms they are experiencing as well as the Beck Depression Inventory and State-Trait Anxiety Inventory. These surveys will take place during their treatment. Providing these surveys to patients will determine if the patient is really experiencing symptoms of depression and anxiety. Patients will be given the option to participate, and they will have the right to opt out at any time.


Measures

The BDI is a 21 question self-report multiple choice survey that measures depression. The scale runs from 0-3 and ranges from 0-63. The STAI inventory diagnoses anxiety and it distinguishes it from depressive symptoms. It consists of 20-item subscales that measure the state and trait anxiety. In state anxiety items, patients are asked to describe how they feel at a certain moment, and trait anxiety asks them how they usually feel. Each item in the STAI inventory is measured on a 1-4 Likert Scale and the total score of the state anxiety trait subscale ranges from 20-80.


Intervention.

The patients participating in this study will mainly receive massage therapy on their hand. Some of the techniques that will be used are heat pads, transcutaneous electrical nerve stimulation (Tens), hand dynamometer, and 3 other exercises. The heat pad will be placed on their hand for 15 minutes and the Tens for 10 minutes. The hand dynamometer will be used to measure grip strength and will be done three times. The patients will have to sit with their shoulder’s in neutral position, elbow flexed at a 90-degree angle, thumb upward and outside the fist. The patient will not be allowed to rest the arm on the table. The patient will be asked to press firmly, and it will be done three times. The 3 exercises will consist of making a fist, touching the tip of each finger with the tip of the thumb, spreading the fingers as much as they can with their hand flat on a table. Each exercise will be done for 5 minutes.


The Effect of Massage Therapy for Reducing Pain.

The symptoms of pain will be examined in patients participating in the study. Massage therapy is a better outcome in patients with strong pain perception.


The Effect of Massage Therapy for Reducing Anxiety and Depression

. Patients having pain can develop anxiety and depression and more likely to make the symptoms more visible. One way a patient can reduce anxiety is to relax. Physiological relaxation is found to be of importance to reduce anxiety. Another way to see if the patient has reduced their anxiety would be to monitor their respiratory and heart rate after the massage. This will allow us to see whether the patient was able to relax or not. When physical contact comes into play, anxiety can be reduced. When the therapist gives the massage, he/she comes into physical contact with the patient. The patient must be okay with physical contact for the effectiveness of the treatment.


Procedures

A baseline measure of depression, anxiety, and pain would be used for the 80 participants in the study. Then you could compare these scores after you have applied the intervention (hand therapy) to see if there is a change in depression, anxiety, and pain. Quantitative data will be collected from patients who have (OA) and are experiencing symptoms of pain, anxiety, and depression. The patients will receive information that explains the purpose of the study. Participation will be voluntary, and participants are guaranteed confidentiality. The Pain Questionnaire is a self-report that will estimate the patient’s pain. Depression and anxiety will be measured using the BDI and the State-Trait Anxiety inventory. The data will be continuous since we are measuring the effect of massage therapy reducing symptoms of pain, anxiety, and depression in adults with hand osteoarthritis. The average would be calculated based on the reduction of each symptom with the help of massage therapy.


Limitations

The limitations found are the types of massages given and the setting of the clinic which can be impacting factors of the symptoms being experienced. If therapist were to indicate the type of massage whether it is gentle touch or deep tissue, it gives the patient an idea of what to expect of it. Another limitation would be the administration and the timeframe of the massage in which these would have to be relatively  consistent across patients. In addition, the position of the hand the patient was put in is another limitation. Depending on the position of the hand, it could have caused discomfort and decreased the timeframe of the massage. The massage therapist would need to come up with an approach to be flexible to complete the massage properly.Another limitation found was whether the effects of massage therapy lasted after the final day of treatment. Moyer et al. (2004) stated that therapists giving massage therapy should make assessments not only after treatment has ended, but also weeks or months later, to determine whether there were any decrease levels of anxiety, depression and other symptoms (Moyer, Rounds, & Hannum, 2004). Other limitations found in the same study was how much and what sorts of communication there was between the massage therapist and patient, whether it was verbal or nonverbal; the expectations for whether treatment will be beneficial; and if the therapist showed compassion or empathy toward the patient (Moyer, Rounds, & Hannum, 2004). Therapist having a good relationship with their patients can be beneficial for how the treatment goes. Kjeken, et al. (2016) found that occupational therapy should be applied earlier in hand (OA) to diminish functional limitations and the requirement for expensive medical procedure in secondary care (Kjeken, et al., 2016).


Study significance

Massage therapy is effective in patients if they are developing a relationship with the therapist, if they have positive experiences prior to treatments, if the therapists are warm and respectful to their patients (Moyer, Rounds, & Hannum, 2004). The effects of massage therapy are not only dependent on the interventions themselves but also on the setting of the clinic, the position in which the patient is in, the type of massage, and the time of day. This observation may support the hypothesis on how massage therapy can reduce symptoms of pain, anxiety, and depression. Some of the benefits of treating depression and anxiety in addition to pain can help the patient feel better about themselves. They can get back to their daily activities. Further studies will have to be made to guarantee the effectiveness of massage therapy reducing the symptoms in patients with hand osteoarthritis.


References

  • Field, T., Diego, M., Hernandez-Reif, M., & Shea, J. (2007). Hand arthritis pain is reduced by massage therapy.

    Journal of Bodywork and Movement Therapies,11

    (1), 21-24. doi:10.1016/j.jbmt.2006.09.002
  • Kjeken, I., Eide, R. E., Klokkeide, Å, Matre, K. H., Olsen, M., Mowinckel, P., . . . Nossum, R. (2016). Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial.

    BMC Musculoskeletal Disorders,17

    (1). doi:10.1186/s12891-016-1321-3
  • Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A Meta-Analysis of Massage Therapy Research.

    Psychological Bulletin,130

    (1), 3-18. doi:10.1037/0033-2909.130.1.3
  • Stamm, T. A., Machold, K. P., Smolen, J. S., Fischer, S., Redlich, K., Graninger, W., . . . Erlacher, L. (2002). Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial.

    Arthritis & Rheumatism,47

    (1), 44-49. doi:10.1002/art1.10246
  • Zwolińska, J., Weres, A., & Wyszyńska, J. (2018). One-Year Follow-Up of Spa Treatment in Older Patients with Osteoarthritis: A Prospective, Single Group Study.

    BioMed Research International,2018

    , 1-7. doi:10.1155/2018/7492106

 

Evaluate the effects of the global nursing shortage on health policy. How has the shortage affected the United Nation’s Millennium Development Goals?

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Evaluate the effects of the global nursing shortage on health policy. How has the shortage affected the United Nation’s Millennium Development Goals?

 

Evaluate the effects of the global nursing shortage on health policy. How has the shortage affected the United Nation’s Millennium Development Goals? Analyze how nursing ideas, values, and beliefs impact policy agenda. Identify when policy can dictate treatment options.

Risk Factors of Cardiovascular Drugs

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Characteristics and risk factors of Cardiovascular Drugs induced Adverse Drug Reactions: Hospital based Active Surveillance Study.


Abstract:


Background:

Adverse Drug Reactions (ADRs) is one of the major drug-related problems in hospitalized patients. Several studies report the incidence various from 10 – 50% of all hospital admissions due to ADRs and no recent data available on the safety of cardiovascular drug from India.


Aim

: This study aims 1). To estimate incidence and characteristics of ADRs due to cardiovascular drugs in patients admitted in cardiology unit of a tertiary care teaching hospital. 2) To identify the risk factors for ADRs in hospitalized patients treated with cardiovascular drugs.


Methods

: A prospective active surveillance study was carried out in the cardiology department of a south Indian tertiary care teaching hospital for eight months. Population averaged Poisson regression [Generalized Estimating Equation (GEE)] models was used to estimate the adjusted relative risk associated with ADR.


Results

: The overall incidence of cardiovascular drug induced ADRs was 31.8%. A total of 757 patients treated cardiovascular medications. Of which 241 patients (31.8%) including 122 (16.1%) females and 119 (15.7%) males reported at least one ADR. Aspirin produced the highest number of ADRs (150; 38.7%) followed by Heparin (45; 11.6%), Atorvastatin (24; 6.2%) and Ramipril (24; 6.2%). The causality assessment reveals that 85.3% of ADRs were probable in nature. GEE was used to estimate the adjusted relative risk of each covariate associated with ADRs. The predictors of ADRs identified were: female gender, age > 60 years, multiple drug therapy (p= 0.0231) and concurrent diseases like diabetes, drugs like Heparin (RR-2.90, 95% CI 2.22-3.8) and Enalapril (RR-1.95, 95% CI 1.34-2.83).


Conclusion

: The incidence of cardiovascular ADRs was 31.8%. The most common drugs causing ADRs were the anti- platelet and anticoagulant class of drugs. Female gender, age > 60 years, multiple drug therapy, concurrent illness and certain drugs like heparin were identified as potential predictors for adverse reactions.


Keywords

: adverse drug reactions, hospitalized patients, cardiovascular drugs, pharmacovigilance, Risk factors


Key Messages:

  • This study reports the risk factors for adverse reactions to cardiovascular drugs from an Indian clinical setting.
  • The incidence of cardiovascular drugs induced ADRs was 31.8%, which is higher than many reported studies.
  • Anti-platelet and anticoagulant drugs were commonly associated with ADRs in the study population.


Introduction

:

Adverse Drug Reactions (ADRs) is one of the major drug-related problems in hospitalized patients. ADRs are one of the major drug-related problems, resulting in increased morbidity and mortality and healthcare costs.

[1-3]
The WHO defines an ADR as “a response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function”.

[4]

The prevalence of cardiovascular diseases (CVDs) has increased in recent years and it has been estimated that CVDs are the most common cause of death.

[5]
Reports on drug related problems including adverse drug reactions associated with cardiovascular pharmacotherapy are available.

[6-10]
Studies report that cardiovascular drugs may account for 10 to 50% of all hospital admissions due to ADRs.

[11-13]
There are reports of serious adverse drug events with cardiovascular drugs.

[14]
Continuous monitoring of ADRs are important in patients treated with cardiovascular drugs since, these patients who need multiple drug therapies to treat their comorbid conditions and other related risks

[15]

Various methods are used to detect ADRs in hospitalized patients.

[16]
Analyzing the adverse reaction data in relation to the presence of risk factors provide the link between the ADRs and the associated factors. Such analysis might help to identify patients who are at increased risk for the adverse reaction and therefore employing suitable monitoring and the preventive procedure is possible.

[17]
Reports are available on the risk factors for adverse reactions.

[18-20]

Studies have shown that the cardiovascular drugs are most common cause of ADRs.

[6,21]
A university hospital-based studies report 49 % ADRs are due to commonly used cardiovascular drugs (nitrates, digoxin, propranolol, heparin, warfarin, anti-hypertensive and anti-arrhythmic drugs)

[22]
A number of studies are available on the adverse effects of cardiovascular drugs. In the Indian context data on adverse effects of the cardiovascular drugs is not available. Therefore, the current study was planned to evaluate ADRs due to cardiovascular drugs in hospitalized patients. This study aims 1). To estimate incidence and characteristics of ADRs due to cardiovascular drugs in patients admitted in cardiology unit of a tertiary care teaching hospital. 2) To identify the risk factors for ADRs in hospitalized patients treated with cardiovascular drugs.


Subjects and Methods:

A prospective active surveillance study was carried out in the department of cardiology of a tertiary care teaching hospital for eight months (Feb to Sep 2009). The study protocol was reviewed and approved by the institutional ethical committee. All patients admitted to the cardiovascular units were monitored and evaluated for cardiovascular drugs induced adverse reactions. Patients who were previously treated or newly prescribed with cardiovascular drugs were monitored and followed for detecting and recording of ADRs. Adverse drug reactions were identified by conducting a daily patient charts review, patient interview, and consultations with treating physicians. In the suspected cases, past medical/medication history of patients were collected. In addition to patient’s medication history, information on co-morbidities was also collected. We used the WHO criteria for defining ADRs.

[4]
For every identified patient with ADR, two patients without ADRs were enrolled as matched controls.

The information pertaining to the suspected ADRs was collected and documented in a specially designed ADR computerized documentation database for further assessment.

[23]
An ADR alert card was distributed to those patients who experienced severe adverse reactions to prevent further re-exposure of the suspected drug. All ADRs were reviewed and assessed by the research team. The documented ADRs were evaluated and characterized respect to patient demographics, nature of the reactions, drugs and organ system involved and outcome of the reactions. Using standard approach, the Causality, severity, preventability and the presences of predisposing factors of the reactions were assessed and reported.

Patient’s age and sex were considered for the analysis. ADRs were classified as either ‘Type A’ or ‘Type B’ according to the system introduced by Rawlins and Thompson.

[24]
The suspected drugs were classified according to Anatomical Therapeutic Chemical (ATC) classification based on WHO-ATC Index 2009.

[25]
Using WHO Adverse Reaction Terminology documented ADRs were further classified into various organ system classes.

[26]
Management strategies employed for the ADRs were categorized as drug withdrawal, dose reduction, additional treatment for ADR and no change in a regimen without any additional treatment. Patient outcomes were reported as fatal, fully recovered, recovering and unknown.

The causality of suspected ADRs was assessed using Naranjo’s ADR probability scale and classified into certain, probable, possible and unlikely to be drug induced depending upon the level of association.

[27]
The preventability of ADRs was analyzed and categorized into definitely preventable, probably preventable and not preventable using the modified criteria of Schumock and Thornton by Lau et al.

[28]
Using the criterion developed by Hartwig et al., for severity assessment, we assessed the suspected ADRs and classified into mild, moderate and severe reactions.

[29]
The onset of ADRs was assessed and classified into sub-acute, latent and acute groups.

[4]


Predisposing/risk factors

Many patient-related factors predispose the occurrence of ADRs. The patient related factors like age, gender, multiple and inter-current disease states, and polypharmacy are considered as significant risk factor for developing ADR.

[30]
Patient’s age was categorized into 6 groups (less than 20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, more than 60 years). Polypharmacy was categorized as minor (2-3 drugs), moderate (4-5 drugs) or major (5 drugs) based on the classification by Veehof et al.

[31]
Gender of the patient was also considered as a one of the predispose factor for the development of ADRs. Multiple disease state ( > 2 coded diseases) of the patient at the time of reaction also include in the analysis. The overall incidence of ADRs was calculated using the total number of in-patient episodes which resulted in ADRs in relation to the total number of in-patients followed during the study period.

The length of hospital stay for each patient was collected from Hospital Patient Administrative System (HPAS) and used to compare the Length of Stay (LOS) between patients with and without ADRs. Additional hospital stay due to ADRs was assessed using the nature and clinical features of ADRs, discussion with treating medical staffs and assessment of patient’s medical records.


Statistical analysis

Descriptive statistics was used summarize the patient demographic and clinical characteristics like gender, diagnosis, a number of drug dispensed, the frequency of ADR, drugs involved, organ system involved and severity of ADRs. Mean with 95% confidence interval was used to summarize age and LOS. Chi-square test was used to find the association between age group, gender, the LOS with and without ADRs. Relative risk was used to measure the strength of association. The data were hierarchically arranged, to count the multiple ADR episodes which can occur with multiple admissions. Population averaged Poisson regression (GEE) was used to estimate the adjusted relative risk of each covariate associated with ADR.

[32,33]
Further compound symmetry was used to account for the within-subject correlation. All analysis was performed using SPSS for window 15 (SPSS Inc., South Asia, Bangalore). The significance level was set at P< 0.05.


Results:

A total of 757 patients (431 men and 326 women) using cardiovascular medications were intensively monitored. The mean age of the study population was 57.21 ± 14.22 years (18 -92 years). The average length of hospital stay was 10.6 ± 5.8 days. Overall, the incidence of ADRs was 31.84%. Two hundred and fourteen patients including 122 females and 119 males reported at least one ADR. Maximum of six ADRs were reported from one patient. Compared to males, females developed more of ADRs was observed more in females when (p 0.0001). The length of stay was increased due to ADR for a minimum of 3 days and a maximum of 28 days.

The frequency of different age groups in patients with and without ADRs is presented in table-1. The main diagnosis of the study population is listed in table-1. Age group of less than 20 years is excluded because of lower sample size. Age group of more than 60 years had more ADRs compared to other age groups. Cardiovascular risk factors of a patient with and without ADR are shown in table-2.

The most frequent system-organ class affected by ADRs was Platelet, bleeding & clotting disorders (188, 48.89%), followed by metabolic and nutritional disorders (53, 13.66%) and gastrointestinal system disorders (50, 12.89%) (Table-3). The most common strategy for management of ADRs was drug withdrawal (94.3%) and dose alteration (5.4%) (Table-4). The mean length of hospital stay was 13.3 and 6.5 days for patients with and without ADR respectively. The length of stay was found to be longer in patients with ADR.

Aspirin produced the highest number of reactions (150; 38.7%) followed by heparin (45; 11.6%), Atorvastatin (24; 6.2%) and Ramipril (24; 6.2%) (Table -3) with Platelet, bleeding & clotting disorders (188, 48.89%). The most frequently reported reaction was bleeding (186; 47.9%) followed by gastric ulcer (52, 13.4%) (Table-3). The causality assessment of ADRs revealed that 85.31% of ADRs were classified as probable, followed by 7.99% as definite and 6.7% as possible. 64.4 % patients recovered from the ADRs and 35.6 % were recovering at the time of discharge (Table-4).

The GEE analysis shows that the female, alcoholics, smokers and patients those taking more than 7 drugs had a higher risk for developing an ADR. (Table-2). Statistical analyses also revealed that patient taking Heparin (RR 2.90, 95% CI 2.22-3.80, Enalapril (RR 1.95, 95% CI 1.34-2.83), warfarin (RR 1.69, 95% CI 1.33-2.54) had a significantly increased probability of developing of ADRs (Table-5).


Discussion

:

ADRs can significantly increase patients’ mortality or morbidity and consequently higher healthcare expenditure.

[34]
The study findings reveal that developing an ADRs in hospitalized patients substantially contribute to patients’ morbidity, further increasing the disease burden and cost of managing ADRs. The incidence of ADRs (31.8%) found in this study was twice higher than a previously reported systematic review of international studies (15.1%).

[2]
The present study showed that females experienced a higher incidence of ADRs (9.87%) when compared to males (7.23%) which are similar to the findings of previously published studies.

[1,35-37]
Several reasons have been put forth for this observed difference. Men and women have a different pharmacodynamic response to various drugs; which may consider as one of the factors for women to develop more number of ADRs. But in a study reported by Jose., on comparable Indian population male patients were found to have more ADRs than female population.

[38]

The incidence of ADRs was higher in the elderly patients (31.19%; age > 60 Years) compare to other age groups. (χ2= 23.03, df-5, p 0.0001); this finding is similar to the results of Mohebbi et al.

[19]
Studies have shown that the incidence of ADRs may increase with increasing age. Again, due to multiple comorbid conditions and receive multiple drug therapy the elderly patients tend to have a higher risk for developing an ADR. In addition, older individuals undergo changes in drug responsiveness and disposition.

[39]
It appears that elderly patients need more attention to prevent the occurrence of ADRs.

In this study, the incidence of Aspirin-induced ADRs was 38.7% (n=150); which was the highest rate compared to other cardiovascular drugs in this study. However, High rates of ADRs with streptokinase have been reported previously.

[40]
Studies reported a rate of amiodarone-induced ADRs as 16%, whereas in the current study it was too low at 0.5%.[41] This might be due to the lower use of amiodarone in the current study subjects. In a study conducted by Wiffen et al., investigating ADRs induced by all groups of drugs, warfarin was among the top three drugs causing ADRs.

[42]
In our study, the rate of ADRs attributed to warfarin was just 3.6%, whereas heparin-induced bleeding was the second highest ADR in this study population (45, 11.6%).

In this study, we found central nervous and gastrointestinal systems are the most frequently affected organ system classes by ADRs. These findings were similar to the findings of a study conducted in Iran.

[13]
The incidence of preventable ADRs in this study (6.9%) is comparably lower than those detected in other studies.

[34]
This might be probably due to intensive monitoring of CCU patients in our study. The rate of serious ADRs (22.2%) detected in this study tend to be higher than other studies.

[14]

Population averaged Poisson regression (GEE) model showed that factors like gender and age of more than 60 years, multiple drug therapy and the presence of co-morbidity were risk factors for experiencing ADRs. The average duration of drug usage was found to be longer in patients without ADR. It appears that most of the ADRs have been noted shortly after initiating cardiovascular drugs and the incidence of ADRs in this study population was not related to the duration of usage. Similar to findings of many other studies, increasing the number of drugs led to increased frequency of ADRs.


Conclusion

The finding of this study indicates that cardiovascular drugs cause serious and frequent adverse reactions. The incidence of cardiovascular ADRs was 31.84%. The most common drugs causing ADRs were the anti-platelet and anticoagulant class of drugs. Female gender, age more than 60 years and use of more than 7 drugs was found to be the risk factors for developing ADRs. The identified incidence was higher than many reported studies. The current study identified the common ADRs and their predictors. Patients with identified predictors for adverse drug reactions can be intensively monitored and necessary preventive measures can be initiated if signs of reactions are observed.

Identify pertinent information from a first-time patient, including demographic and insurance information.

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Identify pertinent information from a first-time patient, including demographic and insurance information.

1000 – 1500 words; APA Format
Research and describe what you would need to do when a first-time patient comes to a medical office or facility. Be sure to address the following:
• Identify pertinent information from a first-time patient, including demographic and insurance information.
• Discuss the consequences of not obtaining the correct information.
o How this will affect the patient’s care?
o How does this affect the submission of an insurance claim?
List all forms that must be reviewed with a new patient per HIPAA’s guidelines.
• Describe each form and what information is needed to complete it.
• Identify the purpose of each form.

Building Organizational Capacity in Healthcare.

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Building Organizational Capacity in Healthcare.

The Sydney Community Hospital (SCH), a 110 bed community hospital situated in the outer northern suburbs of the Sydney, has provided general acute medical, surgical, obstetric and emergency services to the local community. Over the last 15 years the population of the area has increased significantly to include a much larger proportion of young families and a significant number of retirement villages with nursing homes attached. The hospital is no longer able to provide the range of services and care required to meet the needs of the community and the resources allocated.
To deal with these changes the Government has allocated resources to redevelop the hospital facilities and restructure the organisation to provide a focus on the health needs of the growing population and to provide a number of specialty services including cancer, paediatric, cardiovascular, renal services, trauma services, aged care and community services. The bed numbers will increase to 200, with an increase in the capacity for community clinics in the specialties.

-The Vision statement of the hospital is to “Provide positive health experiences for the community”.
-The stated mission of the new, larger hospital is “to provide highest quality, specialist health care in partnership with patients, carers, the community at large and other health care providers”.
-The overall strategic goals of the new organisation are “to develop high performing, multidisciplinary teams within the specialist services in order to provide high quality, patient-centred care that is effective, efficient and able to respond to the changing health needs of the population”.

The existing hospital has a traditional, functional organisational structure but the management team is currently reviewing Matrix organisational structures which might be better suited to the changing internal and external environments of the organisation and which have the potential to improve communication and collaboration across teams as well as accountability for resource utilisation, quality of care and patient outcomes.

Within the essay, ensure that the following key points below are part of the discussion.
1. The advantages and limitations of the traditional functional organisational structure for the current health care environment and changing health needs of the population.
2. Identification of a matrix organisational structure; describe the features of such a structure and identify how this structure might better facilitate the achievement of the new mission and strategic goals of the organisation.
3. Identify the key lines of authority and responsibility for achieving the overall organisational goals within the matrix structure (you may wish to compare this with the key lines of authority and responsibility in the previous functional structure) and discuss how this might enable this new hospital to achieve their stated objectives.
4. Critically analyse the advantages and limitations of the matrix structure in relation to the changing health care environment and what the organisation wishes to achieve for patients, carers and the community.
5. only references from the supported files, you may not to reference any scholar articles.
6. introduction and conclusion only need general idea and does not need references.

Nursing Reflection Essay – Skills Assessment

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According to the New Collins International Dictionary of the English language, a reflection is to reflect or to be in the state of reflection. (Collins & Brash, 1983) In this essay, I aim to give a brief description of the skills assessment that I underwent, the thoughts and feelings it provoked, the evaluation and analysis of it ,conclusion and lastly my action plan.

REFLECTION OF THE SKILLS ASSESSMENT

2.1 Description

As part of the Fundamentals of Nursing (FON) skills assessment, I had to attend a test on week seven. Wound dressing and vital signs were the two subjects of this assessment. I had to draw lots to choose which room and subject I got and then proceed to sit outside the room to read the case scenario within the allocated five minutes. Once the case scenario of taking vital signs was clear to me, I was allowed to enter the evaluation room to perform the necessary procedure on the patient within twenty minutes. During the course of the procedure, all the vital signs such as pulse rate, respiration rate, blood pressure and temperature were recorded on a clinical chart. The entire procedure was then assessed and graded by an assessor, who was observing my nursing skills.

2.2 Thoughts and Feelings

I felt really nervous and anxious before the skills assessment as I was seated outside the assessment room. When the time came for me to read and digest the background information, I felt overwhelmed as at that point in time, remembering the information on the sheet provided was just exhausting. As I was about to enter the room and the previous student came out crying, I felt even more nervous as that gave me an intuition that the assessment might be a challenging one . Despite that, I mustered all my confidence and proceeded with the nursing procedure when my turn came. I carried out the procedure in a calm and smooth manner. After my task was complete, I felt satisfied with my performance and happy with myself for having prepared well for the assessment before-hand as it turned out to be a good experience.

2.3 Evaluation

On the whole, the skills assessment was a memorable experience for me as I felt that I had carried out the nursing procedure efficiently, keeping in mind all the protocols that had to be followed. Also, the six domains namely critical thinking, communication, technical skills, management of care, safe practice and professional and ethical practice were carried out to my ability in many instances. Then again, I could have done better in certain areas.

For instance under the critical thinking component, I could have planned my working area carefully. Instead, I was immediately involved in attending to the patient and completing the procedure within the time limit which should not have been the case. As a result I had to move around quite a bit which could have been minimized with careful area planning.

On the part of communication, I tried my level best to re-assure the patient and addressed his anxiety to a large extent. This skill I believe I portrayed well.

In terms of technical skills, I was unsure about my readings for the systolic and diastolic blood pressures and I had to repeat the procedure twice in order to double check my first reading. Even then, I experienced some level of uncertainty with the readings. Thus, I have to improve my skills in this domain to become a better healthcare professional.

To add on, I managed the patient’s care relatively well as I made it a point to ensure that he was feeling comfortable throughout the procedure. Keeping in mind the importance of understanding the emotions of the patient (Matsumoto & Hwang, 2011), I took note of the changes in his facial expressions to make sure he was receiving good care and was not in any kind of stress.

To ensure safe practice I had carried out good hand hygiene however ,I almost had forgotten to clean the ear plugs of the stethoscope, thereby downplaying on safe clinical practice on protecting myself. Furthermore, I had also plotted the readings on the wrong column which was an unacceptable mistake.

Lastly, on the part of professionalism and ethical practice, I believe I had done a commendable job. I kept the patient informed on the risks he was taking by undergoing the cataract surgery. Also, I kept the staff nurse informed of his concerns and his rash that he had developed. Apart from these, all the procedures during the assessment were within the terms of ethical practice.

2.4 Analysis

For in-depth examination, I have analyzed my skills in each of the above mentioned six domains.

Critical thinking is defined as the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action (Paul, 1990). In nursing, critical thinking for clinical decision-making is the potential to think in a organized and sensible manner with the readiness to question and think carefully about the reasoning process used to ensure safe nursing practice and good care. (Heaslip, 1993) In the nursing profession, it is important to plan carefully to save valuable time while attending to the patient. During my practical assessment, I could have placed the hand sanitizer on the same table as I had placed the other medical requisites on. This would have prevented me from constantly shifting to the table close by to perform my hand rubs, saving time. As mentioned by Mr. Tan during lab sessions, area planning is very important. Nurses also need to apply their intellectual skills for sound reasoning. (Heaslip, 1993) Having noticed rashes on one of the patient’s arm, I chose to take blood pressure from the arm with no rashes as placing the non-sterile cuff on the affected hand could have worsened the rash.

As for communication skills, I believe I played a good role as a nurse by clearly explaining the risks involved in the cataract surgery to the patient. As pointed out by Crow et. al, it is paramount for a patient to be aware of his/her medical condition and develop a better understanding of the procedures involved. (Crow, et al., 1999) To add on, I informed him of his various readings to ensure his awareness of his medical status.

In terms of technical skills, I could not distinctively identify the Korotkoff sounds hence had to repeat the blood pressure measurement. When I re-took the blood pressure however, I found it hard to release the pressure as I had turned the valve a little too much making it too tight to be released. It is mandatory for nurses to be fluent in the procedures. (Rennie, 2009) Hence, I should keep in mind not to turn the valve too much to allow easy release of the valve in future.

During the procedure, I constantly made an effort to ensure that the patient was feeling comfortable by questioning him frequently instead of just carrying out the nursing procedure silently. Reference to Bensing, reveals that it is important for nurses to communicate at an emotional level so that the patient feels cared for and also helps disclose his concerns which he might otherwise not reveal. (Bensing, 1991). Also, I addressed the presence of the rash on his left arm and questioned him on how it originated instead of only taking note of his vital signs. These actions I hope would have sent across the message to the patient that I cared for him well.

In terms of ensuring safe practice, I kept the staff nurse informed about the rash the patient had developed on his arm and what medication he had previously consumed which might have led to the allergy. However, I had not plotted the readings taken on the correct column onto the clinical chart. I was unaware of this mistake until I read the remarks on the assessment sheet. Therefore, I have to strictly avoid such a mistake in the future as it may lead to further misinterpretations.

My professionalism and ethical practice was portrayed rather well as I maintained a steady and confident poise which I trust would have also allowed the patient to place his trust in me to carry out the nursing procedure safely and effectively. Butts has given a detailed description of the ethics that needs to be followed in the nursing profession (Butts). Not only that, I ensured that the patient was aware of the side effects and risks involved in the surgery so as to maintain ethical practice.

2.5 Conclusion

All in all, this reflection has helped me better identify my mistakes in this skills assessment and how I can further improve myself in the near future. Not only that, it has also aided me in the pursuit of realizing the importance of the six different domains that we were assessed on. This assessment was also a good platform for us to reflect upon ourselves and further improve our nursing competencies bringing our skills to a whole new level. At the end of the day, such assessments are the ones that mould us into trustworthy and reliable healthcare professionals.

2.6 Action Plan

In similar situations in the future, first and foremost, I would quickly run through area planning in my mind so as to maintain minimal movement to save time when I am carrying out my nursing procedure. Then, when I am taking the patient’s blood pressure, I will remind myself not to turn the valve too hard so that it will be easier to release the pressure from the cuff when I am recording the blood pressure readings. Most importantly, I would ensure that I record my findings accurately onto the clinical chart. I hope all these precautions will help me carry out my duty as a nurse efficiently in years to come.

Communication Skills in Assessment of Service User

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An Evaluation of the communication skills demonstrated in the assessment of a service user

This assignment will analyse the communication skills of a physical skill that has been observed by a member of staff whilst in practice. Furthermore relevant literature will be explored to interpret if the communication skills that were used were the most effective including that of both verbal and non-verbal communication skills. All names have been changed for patient confidentiality in accordance with the NMC guidelines (NMC, 2008). The name will be changed to Mr. Smith.

Any form of interaction is done through communication as a skill. To human interaction it is pivotal. Communication is a process which enables people to relate with those around them and to make concerns and needs know very well indeed. Communication can be verbal and non- verbal.Peate (2005) states that non- verbal communication reinforces a verbally communicated message. Non-judgemental interactions are focused on therapeutic communication, helps settle emotional conflicts and supports heart to heart talks allowing a patient to feel safe and free to share their true feelings, fears, values, hopes and ideas.

This assignment is going to be discussed about a physical observed assessment which was observed during practice at placement. Mr. Smith was a gentleman who admitted to the ward with a viral infection. This infection caused his stomach and his intestines to become inflamed. At the same time Mr. Smith suffers learning disability were he could brutally impairs both verbal communication and cognition. Due to Mr. .Smith’s condition he lives in a care home .he had lived at this care home for ten years. Mr. Smith had been eating pureed diet food and his drinks used to be thickened however he begun to vomit.

The patient’s bloods were done and showed that his renal function was becoming severely damaged followed by dehydration. Therefore Mr. Smith immediately required a cannula to administer IV fluids intravenously. My mentor went to cannulate Mr. Smith. My mentor was instructed of Mr. Smith’s fragile and was also informed that his level of thoughtful was impaired and he would not be capable of verbal consent due to his condition.

My mentor went to Mr. Smith’s bed side as he was in a bay not in side room. She drew the curtains first for the dignity of the patient. She explained to him as to what she was going to do, she took his left arm which was closer to her and began to look for a clear vein, she could see so that she will be able to administer the cannula. The patient became distressed and started to shout and shows that he was in pain. After the cannula was in position my mentor left the bay and informed the person who was in charge that Mr. Smith can now have IV access and IV fluids could now be started.

My mentor who cannulated Mr. Smith failed to introduce herself which is important when conducting nursing skills. First impressions last, by identifying yourself as well as your role provides patients with the feeling that you are genuine and that they are being respected (Henderson, 2004). Kate Granger, a medical registrar who is terminally ill found that many staff failed to introduce themselves during her stay in hospital. This revelation brought in the “hello my name is…” campaign in order to prompt staff to introduce themselves to all patients (NHS England, 2014). However (Parahoo 2006) stated that “The process of agreeing to take part in a study based on access to all relevant and easily digestible information about what participation means, in particular, in terms of harms and benefits”.

Although Mr. Smith suffered with severe learning difficulties he still should have been addressed the same as any other patient on the ward. Nurses should always maintain a therapeutic nurse-client relationship by establishing and maintaining nursing knowledge and skills as well as applying caring attitudes and behaviors (Forchuk etal, 2000). Therapeutic nursing services based on trust, respect, empathy and professional intimacy contribute highly to the patients’ health and wellbeing (Hupcey etal, 2001).

Mr Smith was given a verbal informative account of the cannulation process and the reason for doing this by the mentor. Verbal language is one of the principal ways in which we communicate and is a successful method in both gathering and informing patients of their condition (Berry, 2007). It is usually a two way process where a message is sent, understood and feedback is given (Apker, 2001). It also successful for a patient to describe their level of pain (Stevenson, 2004).

Ensuring a patient has understood what has been said is vital (Grover, 2005). This process normally involves both open and closed questions and often have the ability to ascertain a vast amount of factual information. The nurse who cannulated Mr. Smith did verbally tell Mr. Smith what she was going to do however this method alone failed to ensure that Mr. Smith had understood what was happening to him. She was aware of his condition but failed to ensure that he understood the process.

There are grouped together into two categories which is Open questions and closed questions. Open questions are used when you want to help someone to ‘open up’ about themselves, or to give you some insights into how they feeling or to explore a situation in more depth. Open questions do not allow a straightforward ‘yes’ or ‘no’ response, but it will invite the patients to talk about the topic like what Mr. Smith did to my mentor. Not everyone will feel able to open up’ easily and share their deep thoughts and feelings. Some people needs to go step by step and to be led by interviewer until they gain confidence to go deeper. This is why closed questions also have an important role to play. Closed questions invite a straightforward ‘yes’ or ‘no’ answer, they are necessary in gathering factual information in as straightforward a way as possible.

Poor listening skills and conducting skills without the patient fully understanding can affect the therapeutic relationship and often form a barrier to communication (Andrews & Smith, 2001). Environmental barriers such as a busy ward or a stressed nurse can often reduce the level of empathy and influence effective communication (Endacott & Cooper, 2009). However nurses should always remain compassionate towards patients regardless of stress levels and workload (Von Dietze & Orb, 2000). My mentor’s technique did not comply with the NMC guidelines in regards to consent as she failed to inform the patient of the process therefore Mr. Smith would not have known what he was consenting too.

Consent in respect of people with learning disabilities is compound and can carry a step of risk for both patients and healthcare professionals. In this situation Mr. Smith was unable to provide consent and the cannula that he acquired was in his best interest. However, nevertheless of the patients understanding the offer of consent should still be attempted (Green, 1999). Timby, (2005) stresses that a patient’s right to autonomy should be upheld and respected regardless of gender, race, religion, culture and disability.

Communication is vital in all aspects of nursing. However well practiced communication techniques are ineffectual if the central notion of the interpersonal connection goes unacknowledged (Arnold & Boggs, 2007). Charlton etal (2008) argue that there are two different communication styles, biomedical and biopsychosocial. The biomedical style concentrates on specific information concerning the patient’s condition that is information focused. The biopsychosocial style is a patient centered approach which is conducted by determining patients’ needs to provide the most effective communication method.

My mentor ideally should have formed an action plan to determine the most effective way of communicating with Mr. Smith in order to carry out the cannulation process. As every patient is different their needs must be assessed prior to carrying out any invasive procedures. A patient centered approach is said to have a more positive

impact on patient outcomes. However there is little research that discusses interpersonal skills in contrast to a vast amount of rich research that discusses basic communication skills despite evidence suggesting that patient centered care is the most effective method (Jones, 2007).

Patients with learning difficulties who have difficulties with both verbalising and thoughtful often have barriers in relation to communication. This leads to a breakdown in communication and in turn can lead to their health needs not being met (Turnbull & Chapman, 2010). Kacperek, (1997) defines nonverbal communication as the term used to use to describe all forms of communication not controlled by speech. Argyle, (1988) suggests that the nonverbal component of communication is five times more influential than the verbal aspect. When Mr. Smith was cannulated my mentor lacked the use of nonverbal communication. Studies have often indicated that language has no real occurrence when communicating with patients (Foley, 2010). Nonverbal action such as body language, touch, posture, facial expressions and eye contact show many emotions without having to verbalise (Foley, 2010).

Furthermore Crawford et al (2006) states that sometimes patients just need you to be there, quiet and listening and this can also be achieved using the acronym SOLER. Consequently, a good listener will always pay attention to non-verbal cues too and this encourages the patients to open up giving more information and expressing their concerns. (Albert’s et al 2012) suggest that from this it can be deducted that respect is given to a patient’s contribution best when they are listened too.

The Soler acronym is also an aid to identify and remember the behaviors that should be implemented in order to achieve effective communication (Burnard, 1992). This tool comprises of position of seat, open posture, leaning towards the patient, eye contact and relaxation. If these techniques of non-verbal communication were used Mr. Smith may have felt less anxious and more reassured (Mason, 2010). Dougherty & Lister, (2008) is in agreement with this theory as he argues that remaining eye contact, lowering stance to the patient’s level and gently touching the patients hand whilst verbally communicating has a great effect at reducing symptoms of anxiety. Although touch is seen to be an effective form of nonverbal communication which can help put a patient at ease if they are feeling anxious or upset.

It is important to note that this technique is not appropriate for all patients as not all patients will feel comfortable with closeness can interpret this as invasion of personal space (Heidt, 1981).

Cooperating with people with learning disabilities appears to contemporary difficulties for health care providers (Thornton, 1999). According to Angermeyer, (2005) a significant stigma exists in regards to learning disability patients as it tends to carry the label of “different” (Angermeyer, 2005). Schafer etal, (2011) says that this negative stigma is due to a range of factors such as ignorance and misinformation stemming from lack of knowledge. However, the NMC, (2015) competency standard instill that all nurses are to deliver high quality compassionate care encompassing ethical and cultural issues as well as disability.

Jormfeldt, (2010) has shown that a high level of nursing education in both theoretical and practical settings can positively influence attitudes of nurse’s perceptions towards learning disability. In addition, reflection is seen as a vital component of coping in these environments as it offers a process where student nurses can challenge, compare and critique their value systems and embrace the process of change to a positive attitude towards patients with disabilities.

Dodd & Brunker, (1999) argue that by forming collaborative partnerships with both carer’s and professionals who are involved in the patients care can enable you to assess the patient’s communication skills and their preferred method of communication. Furthermore, in accordance with the NMC (2015) guidelines it is essential that all nurses must treat all patients with respect and dignity and not discriminate in any way regardless of their age, gender, race and or disability.

To improve the situation the nurse who cannulated Mr. Smith could have liaised with the nursing home where Mr. Smith resided. This could have given the nurse vital information regarding Mr. Smith’s likes and dislikes and could have provided her with the most effective way to carry out the procedure. Carers or family members could have been asked to accompany the nurse which could have put Mr. Smith at ease. Passports are becoming increasing popular which accompany patients who suffer with learning disabilities into the hospital environment. These documents are customised to each individual and summarise the patient and can often aid in providing the best patient centered care.

Health care professionals are legally able to access essential information which carers possess in relation to communication with an individual with special needs or challenging behavior (Michael, 2008). Nurses should always put patients individual needs first and understand what is best for the patient ethically rather than that of a professional opinion alone (Mencap, 2007).

In conclusion, this assignment has explored the communication skills that were observed during the cannulation process. It is evident that communication is important in nursing care and that assessments of patients are paramount in providing patient centered care. However, communication is certainly a principle commanding for the real caring. Performance and communication of caring and capability at this time have a main effect on the ability of patients and relations to adjust the update, reflect choices, and adjust to anything deceptions forward.

Lack of awareness in regards to the best way of communicating with patients can pose a high risk to patients as many people working within the healthcare sector may not have a clear understanding of learning disabilities unless they are specialised. Further training may be needed to ensure that all health care workers are able to provide compassionate care to patients with learning disabilities. Individuals with learning disabilities have the right to be treated the same way as others, regardless of the severity of their disability as all patients should be entitled to a professional and effective service during their experience within the healthcare environment.



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