...Discharge planning is a process that aims to improve the coordination of services after discharge from hospital by considering the patient’s needs in the community. It seeks to bridge the gap between hospital and the place to which the patient is discharged, reduce length of stay in hospital, and minimise unplanned readmission to hospital.1 Discharge planning is an established part of hospital care, but the process varies and is not entirely evidenced based. A Cochrane review analysed 11 randomised controlled trials looking at discharge planning in over 5000 patients and failed to show a reduction in mortality among elderly medical patients, lower readmission rates, or a shorter length of hospital stay.1 However, two trials in the review did report greater satisfaction of patients and carers when discharge planning was used.2 3 The Cochrane review concluded that discharge planning remains important as a small improvement, not detected by the studies performed so far, could still yield highly significant gains in health care with huge resource implications and better use of acute hospital beds.1 Unfortunately, none of the included trials assessed communication with primary care staff about patient transfer of care. This is an important aspect of discharge planning and another potentially important advantage for patients. On a patient’s initial contact with health services, discharge planning should be started.4 This is often difficult to achieve when acutely unwell patients...
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...Kyle Thompson – 05970640 Management of discharge Management skills in adult nursing UZTR6D4-40-2 05970640 The NMC Code (2008) charges nurses to protect confidential information, and to only use it for the purposes given – for their treatment. Therefore all patients and events mentioned in this essay are inspired by real patients and events, but names, locations, dates and other details have been altered or obscured to make identification impossible. Following the introduction of the knowledge and skills framework (DH 2004a) and emphasis on quality of health care and patient centred, interprofessional, health and social care (DH 2000; Leathard 2003; Thompson et al. 2002) health care professionals and students will need to be able to demonstrate the quality of our care and team working abilities. There is a connection between practice and thinking about practice – action and reflection are interdependent; they need one another. Reflection may be triggered by an awareness of a gap between theory and practice, a difference between what ‘should be’ and ‘what is’ (Sullivan & Decker 2005). Our actions and the quality of our care are improved by reflection-on-action, by making sense of what we have experienced, and thinking about how we might act differently in the future (Lillyman & Ghaye 2000). Reflection has a rôle in maintaining one's personal portfolio and maintaining competency and continuing professional development. Support and supervision from managers, who already have a responsibility...
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...across all health and social settings. 1.1 Literature Review “A good…handover process is a crucial part of providing quality…care…The conservation of patient data during the handover process is vital to ensure good continuity of care and safe practice. Any errors or omissions made during the handover process may have dangerous consequences…” (Pothier, et al., 2005) Delays in transferring or discharging patients can result in a range of problems for both patients and organisations (Bryan, et al., 2005). For patients these problems include: increased dependency; depression; loss of choice, control and confidence; and being placed at risk of exposure to hospital acquired infection. For organisations delays in the transfer or discharge of patients may result in bed blocking, leading to the possibility of greater waiting times for patients needing hospital care and treatment. In addition,...
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...Implement and monitor nursing care for clients with acute health problems. Contribute to complex nursing care of clients. Administer and monitor medications. Administer and monitor IV meds. Assessment 2 Post-op Case Study Assessment 2 Question 1. Identify a minimum of 5 nursing actions, in order of priority you would perform related to above information. Mrs Abu has had a considerable change in her vital signs (blood pressure lowered, her pulse is rapid, her respirations increased and temperature has dropped) form the baseline taken before surgery. These findings alone would be reported to the Registered Nurse and monitored. But because of the changes in vital sings, coupled with Mrs Abu reporting light-headedness and nausea, plus her significant blood loss form the surgical wound, you would be assessing for hypovolemic shock which can be life threatening. As the nurse you would be seeking assistance immediately, assessing her airway, breathing and circulation. Applying oxygen, applying pressure at the surgical site and continuing to monitor (airway, breathing, circulation) and vital signs until help arrives. Mrs Abu should be given nil by mouth as she may return to surgery (Gulanick, Myers, Klopp, Galanes, Gandishar & Puzas 2003, p.329). Question 2. Complete the interventions and rationale in Mrs Abu's care plan related to the following diagnosis |Nursing Diagnosis |Interventions |Rationale ...
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...record. (Complete for all that are listed in Abdelhak under the “health data users and uses” section. - Patient: uses their medical data to understand their health care and to become more active partners in maintain or improving their health. - Health care practitioners: uses it as a primary means of communications among themselves. - Health Care providers and Administrators: uses the data to evaluate care, monitor the use of resources, and receive payment for services rendered. Administrators analyze financial and patient case mix information for business planning and marketing activities - Third party payers: the data become the basis for determining the appropriate payment to be made. - Utilization and case managers: uses it to coordinate care so that the patient is cared for in the most clinically cost-effective manner. - Quality of care committees: use the information as a basis for analysis, study, and evaluation of the quality of care given to the patient. - Accrediting, licensing, and certifying agencies: use the record to provide public assurance that quality health care is being provided. - Governmental agencies and public health: to determine the appropriate use of the governmental financial resources for health care facilities and educational and correctional institutions - Health information exchanges: provides patient centered care that improves quality, safety, efficiency, timeliness and accessibility -...
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...this foundation the strategy expands to specialists, hospitals, and ancillary providers of services to build a delivery system for Amerigroup . members that are aligned to produce better outcomes, higher quality, and lower costs. AmeriGroup Florida Amerigroup Florida, a health plan, works collaboratively with seven psychiatric hospitals to improve patients' transitions to outpatient care, with the goal of reducing readmissions. The plan's behavioral health manager meets quarterly with hospital leaders to review data on admissions and length of stay, discuss select cases of readmitted patients to determine how patient care could have been managed differently, and identify strategies to improve quality and reduce the risk of readmissions going forward. Strategies focus primarily on steps that can be taken in the inpatient setting to facilitate the provision of appropriate treatment and support services after discharge. The program significantly reduced overall readmission rates at participating hospitals. Patients involved in specific quality improvement initiatives that came out of the program also experienced significantly fewer readmissions, along with associated declines in inpatient days and costs. What They Did Many hospitalized psychiatric...
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...to help people become independent as rapidly as possible. She saw how nursing could focus on the patient and on developing a good nurse-patient relationship. She believed that the patient-focused nursing was the most beneficial kind of nursing. Henderson emphasized the use of nursing care plan. To develop effective care plan, collection of necessary information is important. She developed the 14 Basic Needs in her Theory (Fitzpatrick & Whall, 2005) as basis of individualized nursing care plan. The emphasis on the patient individual needs comes from Henderson’s link between the patient and nurse. Henderson’s theory fits in the interactive model because it focuses on the relationship between the nurse and the patients. In this case study, the authors will use Henderson’s 14 Basic Needs to develop Mr. C’s care plan. Each of his problems has a link to one of her...
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...Mary Kanu NUR 180 February 24, 2009 Case Study on Client with Breast Lesions 1. (a) Was it painful and tender? (b) When was your last Mammogram? (c) Have you being doing your BSE regularly? (b) Are you taking any hormonal replacements or antidepressants? (c) Did you notice any changes in the breast symmetry, skin temperature and color changes? 2. Yes, it is very important that you go see your Doctor for an evaluation. Secondly, it has taken two years since your last mammography. This should be the best time to have it done again either for screening or diagnostic. 3. (a) Explore the client feelings for a frozen section and possible mastectomy by encouraging her to express her feelings about her illness and determine her level of knowledge. (b) Evaluate the client and family coping ability (c) Provide a clear explanation of the procedure and her post operative care such as the placement of tube to collect the drainage from the incision and that her arm on the affected side will be elevated. In addition to the above, she would have to begin arm exercises shortly after sugery. Nurse to demonstrate the exercise and have client repeat the exercise. (d) If the client seems able to absorb the above information, provide other information such as the types of beast prostheses available. (e) Take measurement on both sides of the breast to obtain baseline data (f) Explain to the client that if she is going to have a radical mastectomy, the skin on...
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...well as longer inpatient length of stays. The objective of this study is to measure the incidence and determine the predictors of re-admissions to the Adult Intensive Care Unit. Methods: Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified. Conclusions: For a patient, coming back to the ICU is always a cause of concern for physicians, patients as well as their families. After reviewing a significant number of studies, we can see how certain factors have linear and non-linear relationships...
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...Change and Culture Case Study II Maria Ricks-Bailey HCS/514 August 22, 2011 Albert Hart Change and Culture Case Study II Madison Regional Medical Center (MRMC) and Richmond Community Hospital (RCH) merged and became Richmond Community Health System (RCHS). The new administration has initiated a significant reduction in force and tasked management to redesign patient care delivery; this includes the introduction of universal workers. A committee developed to assist in this process recommends transforming RCHS into a learning organization to encourage workers to adapt and excel despite the changes. After presenting past studies where this model failed when implemented in other organizations, administration charged management with making redesign and universal workers a success at RCHS. This task brings about many challenges: how does management begin the process of redesign? What work processes and performance expectations must be considered once the design is completed? What structures will management put into place to turn RCHS into a true learning organization? Additionally, what plans will be necessary to control the intra-organizational and inter-organizational communications that must occur to implement the job redesign changes? Finally, how can management ensure individual job satisfaction for the universal worker position? Implementation of Job Redesign The RCHS senior management team decided to redesign the job of nurses...
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...traces of the disease had disappeared (from 1 to 12 months, average 3.6 months). In 1929, his successor, E. Bruusgaard, reported on a follow-up study of 473 of these patients and provided information on the outcome of untreated syphilis, which has formed the basis for prognostic statements on syphilis for more than twenty-five years. Now, in the department of Bruusgaard's successor, Danbolt, the entire material has been restudied successfully by Gjestland. This restudy represents a striking example of the application of the modern epidemiologic approach. In addition to the scientific contribution of this investigation, an outstanding illustration of international scientific cooperation has been demonstrated. The remarkable degree of success in obtaining significant information on approximately 80 per cent of the study group, 1,404 Norwegian residents of Oslo of 1891–1910, was undoubtedly due to the careful planning which preceded the tracing efforts. This planning included: (a) a consideration of the nature, extent, and significance of the problem of untreated syphilis; (b) an appraisal of existing information on the subject; (c) the setting up of hypotheses to be tested and questions to be answered; and (d) a detailed outline for a practical experiment design. The pretracing experiment design comprised: the selection of the study group; the listing of possible sources of information; a...
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...ASSIGNMENT Q.1 a) What is the impact of globalization and liberalization on industries in our country? Answer 1(a) During the mid 1980s, the Congress Government headed by Rajiv Gandhi made a move to change the policies regarding business, licenses, and permits, as also its attitude towards multinational companies (MNCs) operating in India. However, it was only during the succeeding government of Narasimha Rao government that a strategy was actually formulated in this direction and marketed both in India and abroad. The strategy aimed to bring the Indian economy into the mainstream of the global economy, and at the same time allow a whiff of competition and growth to Indian business. This it was hoped would bring a new dimension to the concepts of quality, productivity, and growth. In evitably, the winds of liberalization that swept through the nation opened a variable Pandora box, with far-reaching implications for hu7man resources management. It bought in a new era of technology, quality consciousness and competition which compelled Indian business to wake up from its somnambulism and reassess its assumptions for dealing with the complete-or-perish’ situation. India has proven world that despite its chaotic political scenario, imbalance wealth distribution, redundant bureaucracy, past baggage of Nehruvian socialism, and its sundry other problem, it can implement sustainable economic restructuring in the world’s most populous democracy. India has the...
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...Environmental Management and Sustainable Development in Vietnam Kenichi Nakagami As a result of the Asian currency crisis, wishful thinking about a future leading role of the East Asian economies in the world economy has lost momentum.The currency crisis has had a great impact on Vietnam,which adopts the ‘Doi Moi’ policy, and negative changes in regard to the outlook towards economic growth and foreign investment are becoming noticeable. However,since Vietnam joined ASEAN in 1995, improvement of hard and soft infrastructures, which contributes to Vietnam’s economic development,is well underway,and industrialization and urbanization are rapidly progressing. This has caused the gravitation of population towards cities, and the impoverished conditions of rural communities. The citizens are now facing the difficulty created by widening earning differentials between city and rural communities. The serious environmental pollution such as air pollution(CO2,SOx,NOx), waste disposal,and water pollution occurred in urban area. There is a need to work out a countermeasure to this situation, need for the sound economic development of Vietnam. It is necessary to perceive environmental and social effects precisely and to learn from the experience of environmental destruction in the Japanese economy which is described as “noneconomic mindedness of economy inconsiderate of environment” in order to achieve sustainable development. The objective of this paper is to grasp the relationship between...
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...October 5, 2012 Risk Loss, Prevention & Emergency Planning Case Study #3 October 5, 2012 Risk Loss, Prevention & Emergency Planning Case Study #3 Risk Loss, Prevention and Emergency Planning Case Study 3 Disaster preparedness is achieved partially through readiness measures that expedite emergency response, rehabilitation and recovery and result in rapid, timely and targeted assistance. It is also achieved through community-based approaches and activities that build the capacities of people and communities to cope with and minimize the effects of a disaster on their lives. Disaster preparedness is a continuous and integrated process resulting from a wide range of activities and resources rather than from a distinct sectorial activity by itself. It requires the contributions of many different areas—ranging from training and logistics, to health care to institutional development. Viewed from this broad perspective, disaster preparedness encompasses the following objectives: • Increasing the efficiency, effectiveness and impact of disaster emergency response mechanisms at the community, national and Federation level. This includes: * the development and regular testing of warning systems (linked to forecasting systems) and plans for evacuation or other measures to be taken during a disaster alert period to minimize potential loss of life and physical damage * the education and training of officials and the population at...
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...DECLARATION I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University. Signed __________________ Date _________________ Abstract Windsor Airmotive Asia Pvt Ltd is the leading repair and overhaul shop for CFM56-3/-5/-7 series turbine engine components. During development of a new repair scheme, to replace the inner inducer and outer inducer of the Forward Inner Nozzle Supports (FINS), a major challenge was encountered at the Electric Discharge Machine (EDM). A trial done on a scraped part revealed that 112 vanes have to be aligned before it can be machined by EDM to the inducer. By introducing a semi-automated machining fixture, the alignment of the vanes will be made easier, on top of increasing the utilization of the EDM by 20%. The aim of this project is to develop a machining fixture for the EDM so that the alignment of 112 vanes will be made easier.By developing this fixture, the company can expect to reduce the scrap rate of FINS. These FINS are often scraped because of the inducer wall rub marks that exceed the limits given in the engine manuals.This will also be beneficial to the customers by helping them to reduce their overhaul cost for the engine rebuild. This will...
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