A Multidimensional Approach to Combating Chronic Pain and Opioid Crisis

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Multidimensional Approach to Combating Chronic Pain and Opioid Crisis

Opioids are a class of drugs that involve masking pain as they work by blocking the signal that let the brain know that a painful stimulus was encountered. Opioid overuse and abuse in the United States is a public health crisis. Our country is facing an epidemic of mass proportions that from 1999-2014 cost over 165,000 individuals their lives.

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Furthermore, opioid-related fatalities rose by 345% from 2001 to 2016.

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In the year 2012, there were 259 million prescriptions filled for opiate based drugs, more than the entire population of adults in the country.

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While very effective at masking pain, opioid based drugs can have very serious side effects including developing a tolerance, being highly addictive, and having a high rate of abuse, which can lead to a condition called opioid use disorder.

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The opioid crisis began due to a multitude of factors including haphazard and aggressive opioid marketing, poor insight into the addictive quality of the opioid-based medications, lack of education in prescribing providers, lack of initial oversight by the government, but most importantly, the success of opioids as an incredibly effective pain blocking drug.

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This major public health issue is profoundly complicated as patients need their pain to be treated fairly and compassionately, but at the same time minimizing the risk of abuse. Due to the complex nature of this issue, a multidimensional approach including, physical therapy, psychotherapy, patient education, non-opioid pain medications or reduction of opioids, and lifestyle changes as a means to reduce both pain and abuse of opioids.

Opioids work to block the sense of pain by inhibiting the release of neurotransmitters that allow the painful message to reach the brain.

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The mechanism involves opioid molecules binding to opioid-receptors in the presynaptic terminal inhibiting the release of neurotransmitters.

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While this isn’t the only effect that opioids have on the body, it is the main action in blocking pain.

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Opioids have a high risk for abuse because they can change mood, elicit physical dependance, are relatively fast at building up a tolerance, and upon being introduced to the system elicit a “reward” effect.

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These factors can contribute to using the drug compulsively and abusing it. Different opioids have different relative strengths, and are all compared to morphine through the use of morphine milligram equivalents (MME).

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This is significant as patients who took 36 MME or less had a .7% chance of abusing opioids, while patients that took greater than 120 MME had a 6.1% chance of abusing opioids, and patients taking greater than 200 MME have a 3.1% chance of dying from an opioid overdose.

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The dramatic rise of opioids actually began as a proposed solution to another health crisis going on. In the mid 1990’s there was a lack of support and treatment for patients dealing with a lot of pain, especially patients with cancer pain and patients in end of life care.

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This led to companies to begin creating opioid based medication as a solution to this problem. Purdue Pharmaceuticals, the company that created Oxycontin, is perhaps the largest and most significant company involved in the opioid crisis. In 1995 Purdue created Oxycontin, which is an opioid based pain blocker that is twice as strong as morphine, but what made it unique at the time was that it was the first slow release opioid providing relief for twelve hours, meaning that patients only had to take it twice a day.

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This also meant that there was much more of the drug in one pill when compared to other opioid medications at the time. Oxycontin was intended to be safer than other opioids due to its slow release nature, however individuals intending to abuse the medication could crush it up so it all absorbed immediately providing a “high.”

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Purdue’s real contribution to the epidemic, however, was due to the nature of their aggressive marketing strategies. They promoted Oxycontin not only to oncologists and pain specialists, but to primary care physicians as well.

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They also promoted the drug as pain relief for any kind of moderate pain, rather than the original intention, which led to primary care practices prescribing more than half of the prescriptions for Oxycontin in 2003, which at that point had become the most prescribed narcotic medication on the market.

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Finally, Purdue used false and misleading advertisements in marketing this drug both to the public and to physicians by downplaying the addictive nature and harmful effects causing them to be cited by the FDA twice.

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All of this led to an incredibly dangerous situation as primary care physicians were not sufficiently trained in pain management compared to pain specialists and tended to over-prescribe, and to prescribe as an initial treatment for many types of pain before exploring non-narcotic treatments.

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Many Americans struggle to deal with pain due to many different ailments. In a study conducted in 2016, it is estimated that 55.7% of US adults reported some kind of pain in the past month.

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The feeling of pain begins when primary nociceptive sensory neurons are influenced either by a strong potentially dangerous external source or by chemicals released as a result of the inflammation cascade.

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Through action potentials and the release of neurotransmitters, these neurons transmit this nociceptive information to the brain, to which the brain responds with feelings of pain.

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The most common type of pain is acute pain. this pain is short lived and is a natural defense mechanism against noxious stimuli, and allows people to heal injuries properly.

Chronic pain lasts much longer than acute pain and is experienced by 14.6% of adults. It is defined as lasting longer than three months past normal tissue healing, and can be caused by a plethora of different medical conditions, diseases, or have unknown causes.

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According to the Center for Disease Control (CDC) “there are clinical, psychological, and social consequences” of chronic pain that can cause “low work productivity, reduced quality of life, and stigma.”

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A lot of patients with chronic pain are prescribed opioid medications. This is very dangerous because the opioids do nothing to treat the cause of the pain, just to temporarily block it. Due to the long lasting nature of chronic pain these patients tend to be taking opioids for long durations, opening up the door to tolerance, physical dependence, and abuse.

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In a study done in 2015, it was found that 61.5% of patients that had an opioid-related death were also diagnosed with chronic pain

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Pain is such a big issue in this country which makes the opioid crisis all the more challenging. In its current recommendations, the CDC emphasizes only that short-term (>12 weeks) use of opioids is effective in treating pain unrelated to cancer or end of life.

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It recommends attempting treatments that are safer and treat the root of the issue.

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They concluded that for chronic pain, there was only very limited evidence that long-term opioid therapy may be effective, and there was no evidence that long-term opioid use was more effective than non-opioid therapy.

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As mentioned above, a multidimensional approach to treating chronic pain can provide a safer, more effective, and longer lasting treatment as compared to opioid use.

Many people know that physical therapy is known to help relieve pain and improve function, however many do not realize how accessible it is, or that they do not need a doctor’s prescription to obtain treatment. Furthermore,  many people do not know that physical therapy is recommended as a first line of defence when it comes to pain, especially chronic pain. A study was done in 2018 that compared outcomes of patients with back pain who either saw a physical therapist as a first line of defense, or saw a physical therapist later in treatment or not at all.

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There were very substantial results that indicated that patients who saw a physical therapist first were 89.4% less likely to obtain an opioid prescription.

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Additionally, they were 27.9% less likely to need expensive advanced imaging, and 14.7% less likely to go to the emergency department because of this issue.

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Finally, the patients on average had much lower out of pocket costs for treatment.

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Physical therapy can help patients manage their pain through many different means. First and foremost, A physical therapist can develop and supervise an exercise plan that will help improve balance, strength, conditioning, and other pain causing weakness.

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A study done concluded that patients who exercised at least once a week were 20% less likely to have chronic widespread musculoskeletal complaints.

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Physical therapists can also help treat pain through manual therapy using manipulations to decrease inflammation, increase flexibility, and improve mobility.

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Finally, physical therapists can educate the patient on proper movement and pain education so that the patient can go about their daily activities with as minimal pain possible.

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Physical therapists are an integral part of a multidisciplinary team aimed at reducing pain in patients.

Psychotherapy is also very important in helping patients deal with pain. Patients that undergo cognitive behavior therapy (CBT) have positive results when it comes to disability and catastrophic thinking.

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In a study done by the military in 2013, a group of soldiers were given psychosocial education on low back pain and another group was not.

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The education was meant to alleviate concern and threat of low back pain.

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The results of the study showed that the group that received the psychosocial education had marginally lower health care costs over a two year period compared to the group that did not receive the education.

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Patients with chronic pain are already at a high likelihood to develop depression and anxiety due to the nature of chronic pain.

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This should be a contraindication to opioid based medicine as a side effect of opioids is depression. In patients that died due to opioid overdose, 61.6% also filled a prescription for a benzodiazepine, and 59% for an antidepressant within the 12 months leading up to death.

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It is noted that a lot of these patients used many different doctors and pharmacies.

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This is very risky as those drugs and interact negatively and amplify each others effects.

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There are pharmacological means to treating pain besides opioids if other methods aren’t working. The CDC recommends acetaminophen, NSAIDS, and COX-2 inhibitors in treating patients for pain before using opioids.

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They also stated that certain anticonvulsants and antidepressants can play a role in reducing pain.

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There was a study done on 240 patients experiencing chronic pain and half of the group was prescribed opioid analgesics, and the other half used non-narcotic pain medicine and after 12 months there was no significant difference in pain related function.

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The researchers also saw that medication related side effects was much greater in the opioid group.

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This study shows that for long term pain, a patient is much better off avoiding opiates.

There are also research out there that shows positive outcomes in reducing or discontinuing opioid use in patients that are doing long term opioid therapy (LTOT).

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A review was done on 67 different studies centered around LTOT and many of the studies reported positive outcomes with dose reduction.

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Many of the studies looked at saw patients have improvements in pain severity, function, and quality of life.

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This review shows that even if patients are already on LTOT they can have positive outcomes by reducing the dose or discontinuing LTOT in favor of other therapies.

In conclusion, pain is a very complex issue, but there are many different approaches when treating patients with pain before opioids are considered. Physical therapy provides patients not only with pain relief, but can help treat the source of the pain rather than mask the symptoms. It can also help patients learn how to move more effectively so that they can do their daily activities and work with less pain. Psychotherapy can help patients have a better perspective on their pain and be in the best head space to avoid abusing medication. Using non-opioid drugs instead of opioids can have similar outcomes without the negative side effects, and for long term users, a dosage reduction or transition to other therapies can have positive outcomes. Opioids are not evil drugs. They can help a great deal of patients dealing with pain related to cancer, as well as patients in the later stages of terminal illnesses who need palliative care. Opioids also have some proven use in treating severe short-term pain. However, the high risk of abuse, significant side effects, and dangers of opioids should leave them as an absolute last resort in noncancer pain management. The opioid crisis has gone on long enough. It is time for patients and physicians to choose a better, multidimensional way to manage pain.

  1. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.

    MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports

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  2. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States.

    JAMA network open

    . 2018;1:e180217.
  3. United States. General Accounting Office. Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem. United States. General Accounting Office; 2003. Available from: http://digital.library.unt.edu/ark:/67531/metadc293500/.
  4. Chahl LA. Opioids – mechanisms of action.

    Australian Perscriber

    . 1996;19.
  5. Nahin RL. Estimates of Pain Prevalence and Severity in Adults: United States, 2012.

    Journal of Pain

    . 2015;16:769-780.
  6. Olfson M, Wall M, Wang S, Crystal S, Blanco C. Service Use Preceding Opioid-Related Fatality.

    American Journal of Psychiatry

    . 2018;175:538-544.
  7. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs.

    Health Services Research

    . 2018;53:4629-4646.
  8. Hayhurst C. Moving Away From Opioid Reliance.

    American Physical Therapy Association.

    PTinMOTION; 2018:32-44. Available from:
  9. Holth HS, Werpen HKB, Zwart J, Hagen K. Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study.

    BMC musculoskeletal disorders

    . 2008;9:159.
  10. Childs, John D., PT, PhD, MBA, Wu SS, PhD, Teyhen, Deydre S., PT, PhD, Robinson ME, PhD, George, Steven Z., PT, PhD. Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain–related health care costs.

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    . 2014;14:571-583.
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    JAMA

    . 2018;319:872-882.
  12. Frank JW, Lovejoy TI, Becker WC, et al. Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review.

    Annals of internal medicine

    . 2017;167:181-191.

Briefly review the biblical narrative in Mark 5: 1-20. How would you help a psychotic individual who presents to your treatment center and insists that the etiology of his disorder is spiritual in nature and not biochemical?

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Briefly review the biblical narrative in Mark 5: 1-20. How would you help a psychotic individual who presents to your treatment center and insists that the etiology of his disorder is spiritual in nature and not biochemical?

Review the vignette of Brett located in the topic five materials, and then provide a DSM diagnosis. Based on your cultural background/worldview, what is your perspective on the nature of psychotic disorders?

Briefly review the biblical narrative in Mark 5: 1-20. How would you help a psychotic individual who presents to your treatment center and insists that the etiology of his disorder is spiritual in nature and not biochemical?

Review Mercer’s article and identify two or three recommendations/practices you find relevant in this source as pertaining to a clinician that considers treating Brett.

How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? Moreover, how are culture and climate manifested within the organization?

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How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? Moreover, how are culture and climate manifested within the organization?

 

Organizational Foundations (Use all 3 references/reading below)
As you strive to grow in your leadership skills and abilities, you will find that the context in which you work influences your motivation and areas of focus. In a similar vein, your commitment to developing professionally can contribute toward organizational effectiveness.
To that end, it is critical to recognize the importance of organizational culture and climate. In particular, through this week’s Learning Resources, you may consider several questions: How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? Moreover, how are culture and climate manifested within the organization?
For this Discussion, you explore the culture and climate of your current organization or one with which you are familiar. You also consider decisions and day-to-day practices and the way they relate to the organization’s mission, vision, and values.
that seem to indicate whether behaviors within the organization are congruent with its mission, vision, and values.
Begin to examine and reflect on the culture and climate of the organization. How do culture and climate differ?
Why is it important for you, as a master’s-prepared nurse leader, to be cognizant of these matters?
Question: Post a 1 page discussion paper on a description of your selected organization’s mission, vision, and values. Describe relevant data, or artifacts, words, and actions of leaders and others in the organization that support, or perhaps appear to contradict the organization’s mission, vision, and values statement. In addition, discuss the organization’s culture and its climate, differentiating between the two. Explain why examining these matters is significant to your role as a nurse leader.
REFERENCES/READING:
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Chapter 1, “Decision Making, Problem Solving, Critical Thinking: Requisites for Successful Leadership and Management, and Clinical Reasoning”

Chapter 7, “Strategic and Operational Planning”

Chapter 12, “Organizational Structure”
“Organizational Culture” (pp. 260–286)

This section of the chapter addresses organizational culture
Collins, J. C., & Porras, J. I. (1996). Building your company’s vision. Harvard Business Review, 74(5), 65–77.

Retrieved from the Walden Library databases.

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Nelson, W. A., & Gardent, P. B. (2011). Organizational values statements. Healthcare Executive, 26(2), 56–59.

Retrieved from the Walden Library databases.

Was the sample approach adequate for the research design that was selected and explain why.

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Was the sample approach adequate for the research design that was selected and explain why.

1) What is the purpose of this research?
2) What is the research question (or questions)? This may be implicit or explicit.
3) Give a complete description of the research design of this study.

4) What is the population (sample) for this study.
5) Was the sample approach adequate for the research design that was selected and explain why.
6) Describe the data collection procedure.
7) How were the data analyzed after collection?
8) Discuss the limitations found in the study.
9) Discuss the authors’ conclusions. Do you feel these conclusions are based on the data that they collected?
10) How does this advance knowledge in the field?

How did the author establish the significance of the study? In other words, why should the reader care about tstudy? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

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How did the author establish the significance of the study? In other words, why should the reader care about tstudy? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

 

pare a critical analysis of a qualitative study focusing on the problem statement, study purpose, research question, literature review, and theoretical framework. Tcan be one of the selected articles from your previous literature review or a new peer-reviewed article. The completed analysis should be 800-1000 words and should connect to your identified practice problem of interest. Refer to Research Critique Part 1. Questions under each heading should be addressed as a narrative, in the structure of a formal paper. Prepare tassignment according to the Aguidelines found in the AStyle Guide, located in the Student Success Center. An abstract is not required. Tassignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit tassignment to Turnitin. NRS433V.v10R.ResearchCritiquePart1Guidelines_student.docx( Research Critique, Part 1 To write a critical appraisal that demonstrates comprehension of the research study conducted, respond to each of the questions listed under the headings below. Do not answer the questions with a yes or no; rather, provide a rationale or include examples or content from the study to address the questions. CRITICAL APPRAISAL GUIDELINES: QUALITATIVE STUDY Problem Statement Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? Tgap in knowledge is the research problem. How did the author establish the significance of the study? In other words, why should the reader care about tstudy? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Purpose and Research Questions Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. Were the purpose and research questions related to the problem? Were qualitative methods appropriate to answer the research questions? Literature Review Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. Did the author evaluate or indicate the weaknesses of the available studies? Did the literature review include adequate information to build a logical argument? Conceptual / Theoretical Framework Did the author identify a specific perspective from which the study was developed? If so, what was it? When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings?)

Case Study On A Breakdown Of Communication

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Peter Roy Gillam died as a result of sepsis and pulmonary thrombo-emboli complicating a ruptured cerebral artery aneurysm with subarachnoid haemorrhage. The coroner’s report outlines the background and history surrounding this gentleman’s presentation to his local General Practitioner and subsequent presentation to Modbury Hospital. Contributing to this mans death the Coroner found the following:

lack of communication and failure to properly convey true the situation of the patient between the Emergency Department Career Medical Officer, the Medical Registrar, and General Practitioner;

the lack of understanding by nursing personnel regarding after hours access and cost for procedures that present to the Emergency Department;

And a Medical Officer with little experience as a clinician performing the role of Career Medical Officer.

The coroner highlighted in this case that poor communication both verbal and documented contributed to the death of Mr Gilliam. The ability to communicate well is an essential skill for medical and nursing staff (Moore, 2005). It is important that principles of effective communication are utilised. Firstly information giving is not communication. The initial contact that the Gilliam’s had where they met a nurse and were informed that the facility was not open, payment would be required and they should return in the morning was not true communication. Communication requires that participants share a mutual interaction, with the receiver providing feedback to the sender. Stein-Parbury (2003, p. 3) states that nurses must be effective interpersonal communicators which is defined as “…interactions with patients which are helpful to the patients”. This first contact was not effective communication.

The patient’s re-presentation the next day also highlights the breakdown in communication between the patients General Practitioner, the Career Medical Officer and Medical Registrar. It is important that collaboration occurs between health professionals to ensure a seamless flow of work based on knowledge of the patient and their care (Stein-Parbury & Liaschenko 2007). In this case the communication between the Career Medical Officer and the patient’s General Practitioner was either ignored or overlooked as unimportant. It is vital that if the patient’s history did not match that of the General Practitioner that communication should have occurred to clarify these issues. Secondly the communication between the Medical Registrar and Career Medical Officer was also shown to be lacking. If communication tool such as SBAR (Situation-Background-Assessment-Recommendation) was used it may well have eliminated this problem by improving communication between clinicians. The SBAR technique provides a framework for communication between members of the health care team about a patient’s condition (Haig, Sutton, & Whittington, 2006). It is a straightforward, easy-to-remember mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what and how things will be communicated between health team members. This is essential for developing teamwork and fostering a culture of patient safety (Sherwood, Thomas, Bennett & Lewis, 2002; Calalang-Javier, HV 2010).

In addition the Coroner’s report highlights that notes within the patient’s medical records were misleading. This draws attention to the importance of documentation and good record keeping. The most significant documentation practice is to actually write something. It needs to be factual, consistent and accurate. It should be written as soon as possible after an event has occurred, providing current information on the care and condition of the patient. It should identify problems that have arisen and the action taken to rectify them, providing clear evidence of the care planned, the decisions made, the care delivered and the information shared (Nursing and Midwifery Council, 2004). In this case the Career Medical Officer could not be questioned as to the intent of his documentation and it was inconsistent with the recall of the Medical Registrar. Therefore it is vital that every entry should stand independently and provide enough information so a new care giver reviewing the medical record would know exactly what the patient was being seen for, their course of treatment and the doctor’s plan of action (Murphy 2001).

Good record keeping, whether at an individual, team or organisational level, has many important functions, including helping to improve accountability, supporting the delivery of services, supporting effective clinical judgements and decisions and helping to identify risks, and enabling early detection of complications (Dimond 2005). Like the implementation of health and safety regulations, it is not easy to ensure that there is always a reasonable standard of record keeping: there are peaks and troughs depending on the priority given to record keeping and the competing pressures for the time of registered practitioners. However, it must always be remembered that records and record keeping are an intrinsic part of the professional activities of a registered practitioner, not an optional extra.

The coroner report investigating Mr Gillam’s death does not specifically question the ethical decision-making of either the nursing or medical staff; however I believe that some questions should have been asked. Medical and nursing staffs are both bound by professional ethics. Ethics are defined as the science of using moral criteria to guide human conduct and morals are accepted values and standards of human behaviour (Honderich 1995; Thain 2006 p 524). Personal ethics reflects general expectations of any person in any society, acting in any capacity. These include concern for the well-being of others, respect, trustworthiness, honesty, justice and preventing harm. Professional ethics include impartiality, objectivity, confidentiality and duty of care. These need to be taken into account as providing rules of conduct or standards of behaviour of individuals acting in a professional capacity (Hanbury 2004).

Both the Australian Medical Association (2004) and the Australian Nursing and Midwifery Council (2008) in their Code of Ethics have the first consideration as the well-being of the patient. I believe that in this case the Career Medical Officer and the nurse who had initial contact with the patient need to look at their ethical decision-making. In neither case did they have the well-being of their patient in the forefront of their care. The nurse needs to look at the choice to undertake a ‘corridor consult’ and whether that was the most appropriate a decision. Surely the patient deserved to be properly triaged and assessed, before a pronouncement was made to give information that necessitated returning in the morning. I believe that if the nurse had stopped and followed a systematic ethical decision-making model then his course of action would have been different. Hanbury (2004) provides a straightforward guide for cutting to the heart of an ethical issue:

Is it legal?

Is it balanced and fair?

How will it make me feel about myself?

How would it look on the front page of the newspaper?

This is a very simplistic method to view a situation and a more multifarious ethical decision-making model would be appropriate when identifying problems within health care. Forester-Millar and Davies (1996) write that an ethical decision-making model involves identifying the problem, applying the Code of Ethics, determine the nature and dimensions of the dilemma, generating potential courses of action, considering the potential consequences of all options, choosing a course of action, evaluating the selected course of action and finally implementing the course of action. If a model like this had been implemented at Mr Gillam’s initial presentation to Modbury Hospital I believe the outcome may have been different. Using the maxim of ‘safeguarding individuals’ (Fry & Johnstone 2002, p 39), I believe that he would have been directed into the Emergency Department and been appropriately triaged and assessed. This may not have prevented his death, but it could have seen a different outcome, as his current medical information (headache) would have been relevant and could possibly have been viewed differently.

Secondly the Career Medical Officer ethics need to be called into question. The Coroner’s report highlighted, that with limited substantiation to the contrary, the doctor’s lack of recent clinical experience, even though a practiced Forensic Pathologist, one had to query the competence of the doctor to perform the role of Career Medical Officer. It is necessary to question whether this doctor was considering the well-being of his future patients when applying and accepting the position at Modbury Hospital.

The inquest did not question the nurses’ involvement in the care of this patient when he returned to the Emergency Department. At this presentation where were the nurses who were looking after Mr Gilliam? Should they have been advocating for this patient? Questioning whether it was appropriate to discharge patient without CT scan. It is important that nurses take proper concern to protect individuals (Fry & Johnstone 2002, p 38), meaning that nurses need to act to prevent patient harm. Nurses have legal accountability which is structured by Registration, Acts and Legislation. However in Australia, a nurses moral accountability is guided by Value Statement 5 in the Code of Ethics for Nurses (ANMC 2008), where it indicates that one is answerable to for oneself and others for ones own actions. The nurses caring for Mr Gillam should have been advocating for him, questioning the Career Medical Officers assessment, querying whether this gentleman should have been discharged without comprehensive follow-up. They should have then documented these discussions and if not satisfied the nurse would be expected to report or take “appropriate action to safeguard the individuals when their care is being endangered by a co-worker or any other person” (International Council of Nurses 2000, p.3). It is important that nurses take on the role of advocating for patient’s rights and care.

The death of Mr Gillam may have been prevented if communication systems had been in place. The failure to order and undertake a head CT scan following a request by the patient’s local general practitioner and the history of headaches could well have contributed to this patient’s death. Without more in-depth documentation indicating that after proper clinical examination the history was inconsistent with subarachnoid haemorrhage then a diagnostic CT scan should have been attended. Nurses advocating strongly for this patient and querying the decision of not undertaking a scan may have resulted in a different outcome. Having systems in place to ensure that Career Medical Officers are appropriately experienced and credentialed may also have prevented this death.

The level of Career Medical Officers clinical experience increased the likelihood that he did not have the medical skills required in dealing with patients in an ordinary clinical setting. The coroner’s recommendation to the Department of Health to investigate and to the clinical competence of the clinician will prove difficult if he is unable to be contacted. The gap of three years prior to his appointment as Career Medical Officer in the hospital already highlights the difficulty that will be found in finding further information from international sources. A system to ensure that the whereabouts of doctors are when they leave the public hospital system will be complicated to develop and then enforce. Medicine in Australia, is made up of many overseas practitioners, who have a wide variety of expertise, developing a system that will keep track of any medical practitioner that has worked within the public health system will be very complex unless the medical officers involved see this as part of the ethical and moral obligation to do so.

Summer 2021 – infotech in a global economy (its-832-m21) – full term | infotech in global economy

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Submission Date : May 21st 2021

Residency Assignment

Research Paper

As we have discussed in class, Blockchain is a rapidly emerging technology that will disrupt global business.

Write a paper that explores in detail how blockchain will revolutionize a particular area of business. Do NOT choose cryptocurrency or supply chain for your business vertical.

Requirements:

Length

Minimum 10 pages / Maximum 20 pages

The title page and references pages do not count towards the       page length requirements.

Double spaced

Times New Roman Font

APA style (https://owl.english.purdue.edu/owl/resource/560/01/)

At least 5 works cited

At least 2 of your references have to be scholarly      peer-reviewed articles

Research paper will be checked for plagiarism so be sure to      correctly cite your sources!

Research Presentation

Goal is to summarize your research paper

PowerPoint Presentation is required and must be submitted      inside of iLearn

Must present for at least 10 minutes but no more than 15      minutes

All group members need to      participate in the presentation

Discuss your thoughts, as well as to what extent models of belief and behavior help to explain actual behavior. Draw from all of your readings to illustrate your points.

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Discuss your thoughts, as well as to what extent models of belief and behavior help to explain actual behavior. Draw from all of your readings to illustrate your points.

 

In your reading, (pages 13-28), you were asked to consider why it is important to explain and predict health related behaviors. Discuss your thoughts, as well as to what extent models of belief and behavior help to explain actual behavior. Draw from all of your readings to illustrate your points. Your Discussion should be 3-4 paragraphs in length, detailing your thoughts and position using 2 readings references for support. Also be sure to pose 1-2 well thought out questions from which your colleagues can formulate a response or generate further discussion. Be sure to cite any references using APA format. You can get assistance with APA formatting at: https://owl.english.purdue.edu/owl/resource/560/01/ ***Please remember to respond to 3 peers and rate their initial post ????

Dignity in Care for Adults with Learning Disabilities

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The primary aim of the proposed research is to analyse the meaning, perceptions and quality of dignity in healthcare with respect to adults who have learning disabilities in the United Kingdom and study the range of healthcare services available for adults with learning disabilities.

Specific Objectives

  • To assess challenges of access, inclusion, choice, attitudes and legislation faced by adults with learning disabilities in healthcare.
  • To determine whether dignity in care for adults with learning disabilities exists in reality as proposed and promoted by the UK Department of health or not.
  • To understand and compare the types of health care services offered and available to adults with learning disabilities.
  • To analyse the quality of healthcare provided to adults with learning disabilities in the United Kingdom and inequalities faced by them.

Methodological Details

The primary method that will be utilised in this research is based on systematic literature review whereby observations are made on the basis of data accessible in the respect of people with learning disabilities. Literature search will include key words such as ‘about learning disabilities’ ‘dignity’ and ‘type of services offered and available for them in the United Kingdom. This method is implemented in this research because it would definitely be helpful because of various reasons identified in the proposal. The relevant literature will be gathered from various sources including journal articles, research reports and books.

Ethical Issues

Confidentiality and privacy of individuals participating in a research is quite important especially if the research topic is quite sensitive as the case is with dignity in care for adults with learning disabilities. The researcher needs to understand and realise the seriousness of ethical issues and considerations in such a research. Although there is a danger of participants being named or personal information being compromised, the approval from the ethical issues committee is not necessary, as the proposed study will only present a systematic literature review of the data already accessible by public.

Relevance to Practice

The entire research would be quite useful in enhancing the level of dignity in adults who are suffering from learning disabilities in United Kingdom. However, one of the major points that should be focused by different agencies and social workers would be how fast and effectively they can implement all these processes. Moreover, significant research has been carried out in this regard from different perspective and from different researchers but the reviewed literature shows several gaps in the standards laid down by different government health authorities and the current practices related to dignity in health care of adults with learning disabilities.

Introduction:

Dignity is a broad and complicated notion that can be used in legal, religious, bioethics, scientific and political contexts with different meanings. The term dignity signifies that a person has a birthright of being respected and treated morally and ethically by others. Dignity implies that people should be treated in such a manner that they feel their value and worth as individuals within the societal context (Soulen and Woodhead 2006). Dignity can be elevated and alleviated by several factors in a healthcare facility. These factors include the facility culture, surroundings and environment, attitudes and behaviour of caregivers and the practice of care being carried out in the facility. People feel more comfortable, confident and in control for making various decisions on their own in the presence of dignity but if there is a lack of dignity they may feel discomforted, devalued, embarrassed and humiliated (Weisstub and Pintos 2007). “Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals” (RCN, 2008).

As dignity creates a sense of comfort and control, it is quite important that caregivers in medical institutions realise the importance of dignity while giving care to adults with learning disabilities. The proposed research will analyse the literature associated with dignity in care for adults with learning disabilities in the United Kingdom.

The study Aim:

The primary aim of the proposed research is to analyse the meaning, perceptions and quality of dignity in healthcare with respect to adults who have learning disabilities in the United Kingdom and study the range of healthcare services available for adults with learning disabilities.

The Study Objectives:

  • To assess challenges of access, inclusion, choice, attitudes and legislation faced by adults with learning disabilities in healthcare.
  • To determine whether dignity in care for adults with learning disabilities exists in reality as proposed and promoted by the UK Department of health or not.
  • To understand and compare the types of health care services offered and available to adults with learning disabilities.
  • To analyse the quality of healthcare provided to adults with learning disabilities in the United Kingdom and inequalities faced by them.

The following section of the research proposal will discuss the literature as methods and methodology used to achieve the research aim. As it is systematic literature review in general and as it used to this study in research particular.

Methodology:

Research methodology is an important aspect through which researches are conducted. A research methodology will actually depict that what is the appropriate approach of conducting a research and which research strategy will be applied in this research. In the similar manner it would also depict that which data will be collected for the research and how it will be collected.

This entire research would focus on learning disabilities with adults and the issue of dignity will also be addressed in this research. The main objective of this research is to understand the issues of meaning, perceptions and quality related to learning disabilities and how dignity of these individuals is affected. The primary method that will be utilised in this research is based on systematic literature review which is useful for several reasons such gives a genuine, clear idea about the issue being studied.

This method is implemented in this research because it would definitely be helpful because of several reasons. First and the foremost reason is that it would give a clear about the issue that is being studied. Wolf (2008) presented an idea about that systematic literature review that philosophy of science, development of health related materials etc can be analysed through systematic literature review. In the similar manner it gives a genuine and a clear idea about the issue that is being studied. Through this approach findings can be properly analysed and systematic literature review helps the researchers in the decision making process. Wolf (2008) believed that through this approach the information that is collected for this research can easily be summarised. The benefits of this approach would be that past researches can easily be utilised and this would definitely reduce the cost of researching. Another important factor for choosing this approach is the benefit of time that is attached with systematic literature review.

According to Britton and Jonsson (2004) systematic literature review is actually a cost effective approach for conducting a research. Both the researchers agreed with Wolf (2008) that generalisation and collection of data in this approach is quite simple and easy as compared to other approaches. Therefore, it can be said that because of these benefits this approach of systematic literature review is selected for this research.

Ethical Considerations:

Ethics is the term used for differentiation of right over wrong, good over evil and signification of justice or equality in the general behaviour or actions of individuals in a society (Hinman 2007). Confidentiality and privacy of individuals participating in a research is quite important especially if the research topic is quite sensitive as the case is with dignity in care for adults with learning disabilities. The researcher needs to understand and realise the seriousness of ethical issues and considerations in such a research. Although there is a danger of participants being named or personal information being compromised, the approval from the ethical issues committee is not necessary, as the proposed study will only present a systematic literature review of the data already accessible by public. The information collected in the proposed research will only be used for research purposes and real identities will be replaced by codes or false names when required. The following section provides an analysis of literature relevant to the research topic that will be used in the proposed research. In this research proposal, there is no need to seek the prior approval of the research ethical issues committee because the study will be beleaguered to summarise the related literature only. All the subjects included as a part of the literature review and studied / observed are free from any such biases. This research does not use any kind of personal information of patients or people suffering from learning disabilities and hence there is no incidence of violation of rights on moral or ethical grounds.

Study of the Literature:

According to The UK Department of Health (2001) learning disability is a combination or collection of several disabilities and disorders. These disabilities may include disability to understand new information or skills, impaired function in society and an onset of any disability that started before adulthood and had a lasting effect. Learning disability or intellectual disability also referred to as learning difficulty in the United Kingdom is quite difficult to explain as it covers a broad collection of disorders or disabilities that people may face.

These disabilities include but are not limited to challenges in processing information, understanding written or spoken language and other challenges that may affect quality of life (Corley and Taymans 2002). This notion by Corley and Taymans (2002) is backed by Turnbull and Chapman (2010) who suggest that people with learning disabilities face several problems in understanding and processing complex information and face challenges in developing new skills. These descriptions of learning disabilities indicate that adults with such disabilities may have difficulties in processing information in several social circumstances including healthcare. This implies that adults with learning disabilities will have a higher degree of healthcare needs as opposed to people with no learning disabilities at all.

McGrath (2010) argued in an extensive literature review that people with intellectual disabilities have greater healthcare requirements as compared to the general population. While explaining the nature and intensity of these healthcare needs he argues that the health care needs of people with intellectual disabilities are more complex in comparison with the general population and can result in premature death, which could otherwise be prevented through effective care. This argument by McGrath (2010) is also backed by several other researches conducted in the context of healthcare needs of people with learning disabilities (Michael 2008; Leyshon et al. 2004; Cooper, Melville and Morrison 2004; Paxton and Taylor, 1998; Nocon, Sayce and Nadirshaw 2008). Gaskell and Nightingale (2010) also agree with McGrath (2010) regarding the greater healthcare needs of people with learning disabilities. They suggest that healthcare needs of adults with learning disabilities tend to be higher in comparison to the general population due to a variety of reasons including visual and hearing impairment, challenges in mobility, heart conditions, diabetes and osteoporosis.

The greater needs for healthcare of adults with learning disabilities are also perceived by caregivers as Vecchio, Cybinski and Stevens (2009) in their study analysed the effect of disability on needs of caregivers. They implemented descriptive statistics and regression analysis to conclude that caregivers of adults with disabilities indicated that they required assistance while providing care to such adults. It was also concluded in the study that the needs of adults with learning disabilities were even greater than the needs of adults with physical disabilities with respect to healthcare (Vecchio, Cybinski and Stevens 2009).

Adults with learning disabilities face several challenges with respect to societal factors including unethical treatment, abuse, undue pressure in interpersonal communication and biasness from the general population due to their specific disability (Slater 2005). Slater (2005) argued that the most prominent challenges with respect to societal factors in healthcare were neglect, poor treatment and abuse by caregivers. He argues that adults with learning disabilities have every right to dignity in life as the general population and should not be subject to abuse due to a specific disability. The Department of Health (2001) provides a clear strategy regarding treatment and care of elderly people especially when they face challenges due to learning disabilities. The recommendations presented by Slater (2005) are in line with the department of health framework with respect to poor treatment and abuse. The framework clearly outlines that dignity should be a top priority in healthcare where people should be treated in an ethical, moral and respectful manner. The importance of dignity and equality in healthcare services is iterated by another report of The Department of Health (2002) by implying the importance of fair access to care services irrespective of age and any disabilities a person may have.

Philp (2007) recommended that dignity in care should not be an afterthought and caregivers should understand and realise the importance of dignity in healthcare of adults with learning disabilities. He suggests that caregivers are very busy and they need to incorporate dignity into the overall framework for providing care. In his study, Philp (2007) emphasised the need for treating adults with respect and integrity while giving them a sense of freedom and control over their actions and behaviour. He concluded that there are various forms of abuse and caregivers need to provide care with thorough understanding and realisation of dignity in care of adults with learning disabilities (Philp 2007).

Holland (2000) on the other hand, analysed how ageing affects people with learning disabilities with respect to social, psychological and biological issues. He argued that adults with severe learning disabilities faced more challenges in later parts of life with respect to services as compared to adults without any disabilities. He concluded in his study that gaps were present in the healthcare and social services provided to learning disabilities and the standards established by the department of health (Holland 2000). This implies that albeit healthcare providers may focus on providing the most effective quality of services but improvements can still be made to make the quality of services more effective especially with respect to dignity in care.

Batesa and Davis (2004) in their study of social inclusion and services for people with learning disabilities presented several societal challenges faced by adults with learning disabilities. These challenges include hindrance in local community participation, perceptions of general population, problems in safety and trust, limited access to social networks and limited access to services being offered. The study indicates that these challenges are faced by adults with learning disabilities mainly due to the perceptions of community and general population with respect to these people. The research concludes that social capital concept provides an effective model for services that focus on promoting social inclusion of adults with learning disabilities (Batesa and Davis 2004). The concept of social capital, which is based on social networks, and standards of trust and reciprocity Batesa and Davis (2004) can also be implemented in healthcare for adults with learning disabilities for better outcomes.

Health care services are of utmost importance to individuals who are suffering with different learning disabilities. McGrath (2010) believed that people with learning disabilities needs health checks to monitor the discrepancies they have. Annual health checks is a type of health care service that is offered and available to adults with learning disabilities. Usually, people who are facing these difficulties are less likely to receive continuous screening and they have less frequent routine checks. That is the reason why annual health checks should be offered by different health care institutions so that they can benefit from it in both the short and the long run. However, a concern is that whether these health checks are needed or not because if they are not viable enough so there is no need to have an exercise that would engage them in such activity. Albroze (2005) discussed that these annual health checks are very important because they assist the patients in every aspects and people who are suffering from these difficulties can gauge that what is their current situation. People who have learning disabilities usually live in communities and they have the right to access different mainstream health care services.

Deshler, Schumaker and Bulgren (2001) discussed that individual importance should be given to people who are suffering with learning disabilities and this can be considered as a health care service. Nurses should be effectively trained in this regard and they should help the individuals who are facing learning difficulties. These researchers also believed that equal health care services should be provided to patients who are suffering from learning disabilities. In the similar manner disability awareness should be given to them in different regards like trainings and workshops should be organised so that they can easily benefit from these activities. Certain special health care services should be allotted to those individuals that have complex and special needs (Bergmark, Parker, & Thorslund, 2000). In the similar manner, certain action plans should be developed for this cause so that all these health care services would be implemented in a proactive manner. Besides certain annual checks individuals suffering from learning disabilities should be offered regular checkups. This will provide an equal opportunity to learn about their health and they can lead a happy and a prosperous life. Certain picture-based books should be provided to them so that they can learn how they can face different complex situations (Deshler, Schumaker and Bulgren 2001).

Emerson, Davies and Spencer (2005) analysed that learning disability in adults is a condition that is quite long lasting. A survey showed that about 62% of all the people who are suffering from this disability live with their parents or with their relatives. Similarly, 30% of the people especially adults live in certain form of residential care or they live with people who are also suffering from learning disabilities. However, only 7% of the people live with their partners or they live alone.

There are different inequalities faced by adults when they are receiving health care facilities. Michael (2008) believed that at times people receive unequal health care treatment and this can be considered as an important issue for people who are providing learning disabilities and for those who are accessing it. People that are facing learning difficulties are not always offered the same level of services and treatment as the general population. People and health care service providers assume certain things when they are dealing with individuals facing learning disabilities (Kuntz, Minnes, Garcin, Martin, Lewis, & Holden, 2005). In the similar manner the routine health care services received by these adults over the year in the United Kingdom is patchy too. Finally, people who are suffering from learning disabilities as not served and perceived as a priority (Michael 2008).

Cooper, Melville and Morrison (2004) believed that people who are facing learning difficulties face unequal atmosphere. They are not treated as equal citizens in many conditions and this creates a sense of inequality in them. People with learning disabilities are discriminated in the society and there are different health care professionals who do not understand much about learning disabilities. In the similar manner many professionals in the society are not familiar with the laws associated with capacity to consent. There are certain professionals who are aware with this scenario but most of them do not consult the family of these individuals who are suffering with learning disabilities (Corley and Taymans 2002). Individuals that are suffering with learning disabilities may not understand the significance and importance of health care screening or it is highly probable that they may not recognise the symbols of ill health. This factor might create issues for the carers in both the short and the long run. Therefore, people with learning disabilities should be dealt with extreme care and the level of dignity should be maintained so that they can lead a healthy and a prosperous life.

Summary:

The primary aim of the proposed research is to analyse the issues related to dignity in healthcare with respect to adults who have learning disabilities in the United Kingdom and study the range of available healthcare services. This primary aim will be accomplished by achieving several underlying objectives. All the researches that were analysed in the literature review depict that adults with learning disabilities face several challenges especially with respect to dignity and they should be dealt with extreme care. There are certain discrepancies and difficulties in this regard and there should be a proper equal approach adopted to care for adults with learning disabilities. It was also stressed in this research paper that dignity of these individuals is the main issues and once the dignity of these individuals are present they can live with self respect in the society.

Relevance to Practice:

The entire research would be quite useful in enhancing the level of dignity in adults who are suffering from learning disabilities in United Kingdom. However, one of the major points that should be focused by different agencies and social workers would be how fast and effectively they can implement all these processes. A significant amount of research has been conducted in this regard but the reviewed literature shows several gaps in standards laid down by government health authorities and current practices. The proposed research will be helpful in filling these gaps. The proposed research would be beneficial for adults who are facing with learning disabilities and it would be beneficial for caregivers who are planning to implement these processes.

Evolving Practice of Nursing and Patient Care Delivery Models Custom Essay

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Evolving Practice of Nursing and Patient Care Delivery Models Custom Essay

Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.
In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
A minimum of three scholarly references are required for this assignment.

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