...Care Management Model Based on My Philosophy Care Management A shift from encounter based care to continuums of care is one of the biggest changes occurring in health care today. This change is driven by governmental legislation, payer incentives, and the recognized need by providers and healthcare systems. The lack of coordinated care results in medical errors, unnecessary procedures, and other forms of waste. This also creates higher costs for the patient, lower quality, and produces an unsatisfactory patient experience. A study performed by the Midwest Business Group on Health in collaboration with the Juran Institute revealed that 30% of all health care expenses result from poor quality care. In 2009, total health expenditures in the U.S. were $2.5 trillion. This means that $750 billion was the result of poor quality (Ralston & Park, 2011). Care Management Model Based on My Philosophy Case management and clinical pathways are strategies used to manage patient care. Although they use different approaches, both are related. The primary function of a case management program is to enhance the coordination of needed resources for patients and their families. Case managers facilitate access to services, both clinical and non-clinical, by connecting the individuals to resources that support him/her in playing an active role in the self-direction of his/her health care needs. Clinical pathways, on the other hand, are tools and systems. The tool reflects only part of the case...
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...avert a government shutdown[->0] after midnight action in the House to delay President Obama[->1]'s healthcare law[->2], with both parties trading accusations Sunday about who would be to blame for an impasse. Neither the House nor Senate[->3] planned to meet Sunday, with fewer than 36 hours left to approve a new stopgap spending measure. Instead, members of Congress[->4] fanned out to the TV networks' Sunday news shows to react to mostly party-line votes the House took overnight to again send the spending bill back to the Senate with provisions to undermine the Affordable Care Act. Republicans[->5] have insisted that such provisions be part of any deal to keep federal agencies open once the new budget year begins Tuesday. Sen. Ted Cruz[->6] (R-Texas), who has assumed a lead role among conservatives in pursuing the “defund or delay” strategy, repeatedly argued Sunday that Senate Majority Leader Harry Reid[->7] (D-Nev.) now stands in the way of a resolution. Cruz accused Reid of using "brute political force" to resist any changes in the healthcare law, which Cruz described as the "biggest job-killer in this country." "So far Majority Leader Harry Reid has essentially told the House of Representatives[->8] and the American people, 'Go jump in a lake,' " Cruz said on NBC's "Meet The Press." "If we have a shutdown, it will only be because when the Senate comes back, Harry Reid says, 'I refuse even to talk.' " Reid on Saturday called the Republicans' latest offer — a one-year...
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...The Liverpool Care Pathway: Does it improve the quality of dying? The Liverpool Care Pathway (LCP) is an integrated care pathway developed in the late 1990’s (Ellershaw et al, 1997) as a means of transferring best practice in care of the dying, from the hospice environment to other sectors starting in the acute setting. Currently the LCP is a recognised tool used by clinicians in the United Kingdom as well as over twenty countries, to give appropriate care to patients who have reached the last hours or days of their lives. Described to provide comfort to the dying and also address the needs of the carers (Chapman 2009). During this assignment the author will highlight and explain how a data search was conducted, and will analyse the data retrieved, explaining and evaluating the data to build a discussion based on the chosen topic of end of life care, with a focus on the Liverpool Care Pathway. The author will conclude by producing recommendations for practice. Although described above that the Liverpool Care Pathway is an appropriate tool for providing adequate care for patients, it can also be seen as a controversial pathway, being described as a ‘tick box’ approach rather than a humanistic approach (Chapman 2010). It has been referred to by the UK’s Daily Telegraph as ‘sentenced to death on the National Health Service’ (Devlin 2009). The author has a keen interest in palliative care, after researching is interested in enhancing knowledge surrounding the LCP as there are many...
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...Assisted Suicide: Governmental or Personal Decision? Assisted suicide is a widely argued ethical issue. A lot of the debate on this subject stems from either different viewpoints of when this act is appropriate, or what the resulting consequences would be if such an act were ever permissible. The point mostly debated between opposing sides is life-worth. What constitutes a life worth living and who is to ultimately decide this? The main problem with this question is that suffering cannot be measured unless one is to endure that same suffering themselves. The view that life is a special gift bestowed by God is held highly by many religions and it is of most importance to them when the debate on assisted suicides arises. A gift from God should not be tampered with let alone destructed. Although the number of ethical issues involved is endless this paper will be focusing on three points. The first point engages in the ethics of assisted suicide and will involve the psychologically vulnerable and the elderly. The second ethical issue to be mentioned will be the presence and/or lack of a definition for a terminal illness. The last point is concerned with the human will to power and how this creates a problem should assisted suicide be permissible. These ethical issues, although strong convictions on their own, can lead to slippery slope arguments and must be looked at very carefully. In addition depending on the standpoint that one would take, these arguments have both strengths and...
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...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 for assessing competence and continuing professional development of staff can help make this process much easier (Jasper 2001). Reflection is a very personal matter, through our reflections we learn not only about our own...
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...of communication amongst the health care professionals and how a good nursing documentation is an integral part of nursing. It will also demonstrate how reflection enabled me to make sense of and learn from this experience, as well as identify any further learning developments needed to improve my practice and achieve the level of competency needed for when I qualify as an assistant practitioner. While discussing the knowledge underpinning practice, evidence based literature will be reviewed to support my discussion and for the purpose of reflection the essay will be written in the first person. Spouse, J, et al (2008). Jonhs, C (2009) defined reflection as learning through our every day experiences, towards realising one’s vision of desirable practice as a lived reality. He also added that it is a critical and a flexible process of self inquiry and transformation of being and becoming the practitioner you desire to be. However, Ghaye, T et al. (2000) stated that for the health care professionals to develop a more reflective posture, they must fully embrace both the principles and the practices of reflection. It is about becoming more aware of how we learn and how this affects what we think, feel and do. There are different models for reflection; some are more complex and detailed than others. To help me with my reflection, I have chosen Gibbs (1988) reflective cycle as a guide: The names of the patient, staff members and health care setting will be changed to protect...
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...document Essence of Care (2010) published by the Department of Health addresses twelve fundamentals, which are important guide lines in providing holistic care for the patient admitted in this ward.. Food and drink is one such area, which is the focus of my service improvement initiative. The change I propose was to introduce different colour lids for the water jugs to indicate fresh water is being provided twice a day in the ward where I was under going my recent placement. This ward caters “step down” patients who are initially admitted to cardiac care unite, thus involvement of multidisciplinary team and interprofessional working is essential. The paper ‘Making a Difference’ Department of Health (1999) suggests that ‘effective care is the product of interprofessional working. Professionals working in collaboration provide care which is designed to meet the needs of the patient’ I shall use a model of reflection in order to describe the proposed change I have suggested. Reid (1993) suggests ‘that reflective practice is potentially is both, a way of learning and a mode of survival and development once formal education ceases’. I have chosen Gibbs model (1988) of reflection as it incorporates the following: description, feelings, evaluation, analysis, conclusion and an action plan thus Gibbs’ reflective cycle encourages me to think systematically about the phases of an experience and therefore I shall use all the headings to structure my reflection. Discussion under...
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...Personal reflections are characterized as learning through experience in gaining new insights and changed perception of self and practices. Reflection can be a difficult experience without the support and guidance of an expert (Johns, 2004). This personal reflection presents an exciting opportunity for me to consider how successful my placement in the intermediate care has been in terms of my own personal learning. By reflecting on the positive aspects of the placement, I will be able to make sense of my personal learning and apply what I have learnt into future careers. At the beginning of my placement I knew very little about intermediate care or services it provided regarding alternatives to hospital care for elderly patients. In preparation for my placement, I visited a local health center and spoke to a therapist who agreed to send me information about intermediate care service. I familiarized myself with the services that are offered by intermediate care, for instance in house provisions and therapist group run services. This helped to alleviate some of my anxiety about the placement that I experienced during my first week, reflecting on my experiences has helped. During my placement I was allocated a mentor who was a knowledgeable and professional nurse. I learnt so much from my mentor, especially what it takes to be a crucial member of a rapid response team of the intermediate care service. Shadowing the mentor gave me the opportunity to observe all the rapid...
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...Nursing Expertise Self-Report Scale and Reflection HCS/350 November 21, 2012 Nursing Expertise Self-Report Scale and Reflection This paper is to provide my reflection of the results of The Nursing Expertise Self-Report Scale. I will explain how my results can improve my communication skills in the health care field. “The nurse-expertise self report scale has 20 items scored using a Likert Scale from Strongly Agree to Strongly Disagree” (Hansten & Jackson, 2009, p. 178). Based on the scoring of the 20 questions, I scored 56 out of 100, reflective of a novice nurse. I am not surprised with the results. I do not currently work as a Registered Nurse (RN). I graduated from nursing school in May 2012. In my current position as a pharmacy assistant, I spend my day communicating with patients, pharmacists, and co-workers. I can take the results to better improve my communication skills, when interacting with patients, physicians, and other members of the team and apply it to practice. I have little experience when it comes to communicating with team members in the hospital. As a student, in the beginning, I was very intimidated to speak to physicians and other members of the health care team. As time went on, I became comfortable communicating with other nurses, patients, and their families. The Self-Report Scale is a reminder of how novice of a nurse I am. I have a lot to learn once I get a nursing job. In the interim, I can take the knowledge I acquire from...
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...Critical Reflection on current clinical knowledge and development Within this assignment I will critically reflect on my clinical knowledge to date and consider my future development needs with a focus on my final management placement and future career as a registered nurse. I have chosen two areas which I feel are relevant to my future development needs namely Quality Assurance and Multidisciplinary/Agency team working and using the Gibbs model (fig. 1)as a framework will reflect upon my own learning experiences and achievements to date and write an annotated reflection highlighting my development needs from which I will formulate a Personal Development Plan. This undertaking demonstrates my commitment to the need for continuing professional development in order to enhance my knowledge, skills values and attitude needed for effective nursing practice (proficiency 4.1) and will address deficits in my knowledge and skills and identify any shortcomings within my own or others practice and help me cope with practice related issues experienced within my previous placements. I have chosen Gibbs reflective model as a basis for reflection as I feel it is easily understood and encourages a clear description of the situation, analysis of feelings, evaluation of the experience, conclusion and reflection upon the experience to consider a solution if the situation arose again (Brooker & Nicol 2003). It has been advocated that reflective practices are a method of bridging the gap between...
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...Therapeutic Relationship Patients [pic] Translate This Page [pic] Powered by [pic]Translate [pic][pic] Download PDF Free Essay Quote This piece of reflection will focus on my experiences whilst on practice placement; I will be using the (Gibbs 1988, cited in Jasper 2003, p.77) model of reflection. Gibbs cycle is set out in order of categories made up of different headings. (See appendix 1). By using this cycle it allows me to reflect in structured and effective way. The subject of this final piece of reflection will cover the development and utilisation of interpersonal skills in order to establish and maintain therapeutic relationships. Neal (2003, p100) states a therapeutic relationship can be described as being between nurse and patient and is based on patients needs for care assistance and guidance. It is a relationship that is established solely to meet the patient’s needs and therefore, is therapeutic in nature. Chambers et al (2005, p303) suggest interpersonal and therapeutic relationships are at the centre of nursing work, the relationship that exists between nurse and patient can often provide the energy and be the catalyst, the motivation and the source of strength to continue with treatment or face difficult sometimes life threatening situations. I felt the need to develop therapeutic relationships with the patient’s so that they could feel they could put their trust in me, also that I was there to listen and talk to them not just care for them. There is also...
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...describe through reflection, and analyze a clinical encounter I was involved with during my placement which gave me an opportunity to engage in a therapeutic manner. Critical reflection has become an important part of learning and development (King 2006). Gibbs (1988) noted that in recent years reflective practice has been embraced by professionals such as nurses, social workers and teachers. He said the process of reflection provides a systematic way of describing how a learner’s performance grows in complexity when mastering academic tasks. This work will employ a reflective model to analyze the therapeutic engagement with one of the patient that I was involved with. The central theme of this assignment is to explain the condition of a client who was admitted to the ward via accident and emergency department. For the purpose of this essay the patient will be referred to as Mrs. X. The pseudo name is given in accordance with the confidentiality and privacy code NMC (2004). Mrs. X has a condition of schizophrenia (a condition of mental health) because she had not complied with her prescribed medication. I selected this patient for my reflective essay because of the insight that my interaction with her gave me. In my encounter with Mrs. X, I had to administer medication on her by intramuscular depot (Injection). I decided to reflect upon this patient and the nursing procedure carried out on her because it was my first time to administer an injection on a patient. To assist me...
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... 1 | 2. | Contents page | 2 | 3. | Introduction | 3 | 4. | Case Study | 3 | 5. | Conclusion | 6 | 6. | References | 7 | Introduction For this summative report, I will reflect upon an aspect of my professional practice on the care with particular patient I nursed recently. Reflection is important. According to Greenwood (2001), it is the process of creating and clarifying the meaning of experience in terms of self in relation to self and also to the world. For the purpose of the reflection, this essay shall be written in the first person. In accordance with the NMC (2002) code of professional conduct, confidentiality shall be maintained and all names have been replaced to protect identity. Case Study Janet is a 67 year-old lady admitted a week ago for chest infection. We also discovered that Janet had developed a mild form of Type II diabetes mellitus from the levels of sugar in her urine and her blood sugar levels were mildly elevated. Soon after she responded to the treatment, we discovered that Janet is suffering from a mild stroke leaving her with expressive dysphasia. For her plan, we...
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...Fairleigh Dickinson University School of Pharmacy Assignment #1: Prescription Label Assessment Student: Site: ___________________________ ______________________ Date: __________________________ Preceptor Signature: ______________ Print Name: ___________________________ 1. Items on the prescription label that are required by New Jersey State Law: 2. Items on the prescription label that are not required by New Jersey State Law: 3. Overall opinion as to the overall appearance and acceptability of the label in your pharmacy: 4. Reference(s) used for this assignment: . PRECEPTOR COMMENTS (OPTIONAL): Fairleigh Dickinson University School of Pharmacy Assignment #2: Over-the-Counter Medication Assignment Student: ______________________ Site: _________________________ Date: _____________________ Print Name: ________________ Preceptor Signature ___________________ Please use the respective forms on the following pages to complete this assignment: 1. Category 1: Cough/Cold and Allergies (REQUIRED) Reference(s) used for this assignment: 2. Category 2: Women’s Health (REQUIRED) Reference(s) used for this assignment: 3. Category 3: Please indicate the category you chose for this assignment.(Select ONE of the following: Pain/Fever; Constipation/ Diarrhea; Heartburn/Dyspepsia; Smoking Cessation) Reference(s) used for this assignment: PRECEPTOR COMMENTS (OPTIONAL): Fairleigh Dickinson University School of Pharmacy Assignment...
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...professional. • Write a 350-word reflection on your results from the Nursing Expertise Self-Report Scale and explain how you plan to use this information to improve your communication skills in health care settings. The Nursing Expertise Self-Report Scale and Reflection was an interesting assessment on my nursing skills. The questions that were asked in the scale were difficult to answer based on the grading scale. Overall it was a good reflection of how I approached my patients and utilized my skills. After completing the nursing scale, I realize that there are some things that I need to do different. For example, question number six mentioned, “Emotional attachment to get in the way of good care.” (Hansten, 2009, pp. 175-176) I feel that is a question that is difficult to answer because a nurse needs to have an emotional attachment to connect. The reason we became nurses is because we care for others and we want to care for their health. We came into this field with an emotional attachment. I will continue to treat my patients how I would like to be treated and show them the respect they deserve being under my care. Every nurse is different in how they treat and care for our patients. We all have procedures and guidelines to follow by as a health care professional, but we use our own instincts in other areas of care. Another question that came to mind was question number three. It states, “Quality nursing care results from strictly adhering to...
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