...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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...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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...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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... 2006, ‘the term person-centred care is used…to indicate a strong interest in the patient’s own experience of health, illness, injury or need. It infers that the nurse works with the person’s definition of the situation, as well as that presented through a medical or other diagnosis’. (pg. 49 – 56) The notion of person-centeredness has become well recognized within healthcare and especially within Nursing (Binnie & Tichen 1999, McCormack 2001,2003). Person Centeredness is also ingrained in many policy initiatives within the UK (eg. The National Service Framework for Older People, Department of Health 2001). Evidence has suggested that implementing person centeredness within nursing can provide patients with more holistic style of care and may even increase the patient satisfaction with the level of care. (Binnie & Tichen 1999) There are a variety of frameworks which have been established to aid nurses in implementing Person Centred Care, and although these frameworks differ they all share important components. Person centred care focuses on delivering a standard of care which include incorporating a patients beliefs and values, maintaining a sympathetic presence, sharing and involving client in decision making all whilst providing for the patients physical needs or requirements. (McCormack & McCance, 2006) There are many different concepts which contribute to person centred care; in this essay I am going...
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...INTRODUCTION In recent years, patient-centeredness and cultural competence have been promoted as integral to improving health care quality. Although patient- centeredness and cultural competence have grown out of separate traditions each with its own focus they have many similarities. Health care that is patient-centered is likely also to be culturally competent, and culturally competent care is likely to be patient-centered. Proponents of patient-centeredness may therefore view cultural competence as within its purview; likewise, proponents of cultural competence may view patient-centeredness as an essential element. THE EVOLUTION OF PATIENT-CENTEREDNESS Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. The IOM (Institute of Medicine) defines patient-centered care as: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions." The term “patient-centered medicine” was originally coined by Balint in 1969 to express the belief that each patient “has to be understood as a unique human being (Balint)".The concept has evolved and expanded, and today, no one would deny that health care should be patient-centered.2 However, despite universal endorsement of patient-centeredness, there is considerable ambiguity in its definition and use across settings...
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...Introduction Within this Professional Devolvement Plan (PDP) I will be discussing my strengths, weaknesses, concerns and expectations prior to me going on placement as a student nurse. The use of the SWEC model will enable me to identify what skills or concerns I can improve or build on before I start on my first placement. I will be picking 3 specific areas out of my SWEC table to focus on in this PDP. It is an important skill to be able to identify my strengths and weakness as a student nurse so that I can improve my own skills to give the best patient centred care possible. Code 22.3 of the Nursing and Midwifery Council (NMC) code of conduct (2015) refers to the need for midwives and nurses to keep their skills and knowledge up to date,...
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...Forging relationships We all can probably recount our personal experiences of receiving some form of nursing care. This might have been as a patient in hospital, in a community or doctor’s clinic or in some other kind of health service provision. The personal relationships we formed with the nurses responsible for our care will have been important to us. For all patients, and their families, the relationships forged with nurses and other carers are central to the quality of their healthcare experience. The quality of these relationships is singled out in patient satisfaction surveys as being of particular importance. To engage successfully with their patients, nurses need to listen carefully, and to get to know their patients as people. Getting to know the person behind the patient is the raison d'être of person-centred nursing care. So what is person-centred nursing? A person-centred approach to nursing focuses on the individual’s personal needs, wants, desires and goals so that they become central to the care and nursing process. This can mean putting the person’s needs, as they define them, above those identified as priorities by healthcare professionals. In the words of Bob Price, a nurse academic writing for the Nursing Standard in 2006, ‘the term person-centred care is used…to indicate a strong interest in the patient’s own experience of health, illness, injury or need. It infers that the nurse works with the person’s definition of the situation, as well as that...
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...Systematic Approach to Care through Effective Person-Centred Care Planning. The NHS places a strong emphasis on delivering person-centred care to patients. Patient-centred planning was adopted as national government policy in 2001 via the “Valuing People” paper and more recently as part of the “Valuing People Now” document (DOH,2009). Person-centred planning is now promoted as a key method in delivering the personalisation objectives of the Governments “Putting People First” programme for social care (DOH, 2007). The Coalition continues this commitment towards personalisation of care with its “Capable Communities and Active Citizens” document (DOH, 2010). One key area to ensure that care is delivered in a systematic person-centred way is through effective care planning that involves the patient in the process as a key stake holder. Several systematic models to nursing care are available that will facilitate practitioners in ensuring that all needs of the individual are identified and met. This essay will define what is meant by the term “person centred care”, will explore the systematic nursing models of care delivery and will highlight good practice in constructing person-centred care plans. This will be done using examples of an original care plan (constructed by the author for a real patient whose name has been changed) - and will draw upon information and evidence from a range of contemporary sources. It is appropriate in the context of this essay to firstly define...
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...of messages to the receiver; these messages are sent and received both knowingly and unknowingly (Sully and Dallas, 2005). Nurses evidently deal more with patients than any other health care worker (McCabe and Timmins 2006), therefore it is very important that effective communication skills are developed, as they will be supporting the patients, the relatives and then communicating back to other health care workers. This essay will be looking at the importance of developing effective non verbal communication skills, the effect different levels of communication has on patients, and adapting communication skills where barriers exist. Communication is both verbal and non verbal, Verbal communication is often seen as the most important form of communication (McCabe and Timmins, 2006). However when people are communicating, words make up only seven percent of the message. The other ninety three percent is made up by how the message is said, the tone of the message and body language (Argyle, 1989 cited by McCabe and Timmins, 2006). So from looking at the information Argyle presents, it is clear to see that non verbal communication has much more of an impact than verbal communication. Although what is said will still have to have meaning and be appropriate. Non verbal skills need to be developed to a high standard to ensure patients are always receiving the message the sender wants them to receive. Non verbal communication specifically used by nurses includes listening, touch and body...
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...Evidence Based Practice Task 1 Western Governors University Evidence Based Practice and Applied Nursing Research The nursing topic of interest is bedside handover, which is the concept of conducting shift handover at the patient’s bed instead of doing it at the front desk. Part A The article being analysed is: Tobiano, G., Chaboyer, W. & Murray, A. (2012). Family Members’ Perceptions of the Nursing Bedside Handover. Journal of Clinical Nursing, 22, 192-200. The analysis of the primary research report is done in the form of a graph (figure 1). Each of the four analysis areas is rated within a scale of 1-10; 1 denotes extremely weak while 10 denotes very strong. Table 1 then gives justifications for the rating by explaining why each area of analysis was rated that way in the analysis chart. [pic] Figure 1 Table 1 |A1 Article: Tobiano, G., Chaboyer, W. & Murray, A. (2012). Family Members’ Perceptions of the Nursing Bedside Handover. Journal | |of Clinical Nursing, 22, 192-200. | |A2 Background or introduction |The researchers provided an in depth introduction of the research topic outlining | | |important issues, previous research on the topic and their findings. The introduction | | ...
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...Describe the factors that help or hinder person-centred care and interprofessional working in relation to a chosen incident. (Word Count 2,993) In this essay a consultation observed during a Primary Care placement will be described, with the aim of defining person centred care in relation to it. To protect confidentiality and in accordance with the Nursing and Midwifery Council’s code of conduct (NMC, 2008), the names of persons or places are not referred to. The roles and responsibilities of the professions involved, the importance and difficulties of interprofessional collaboration and the effects of this on person centred care will also be explored. A conclusion will be drawn as to whether the event provided a person centred approach. The observed consultation (Appendix 1) took place in an elderly care clinic held in a hospital outpatient department. Outpatients Clinics are provided by the local NHS Primary Care trust on a regular basis as part of ongoing care for clients. A consultant, a nurse, the client and her carer were present. The client had an appointment to review her ongoing treatment of Parkinson’s disease. A publication to support the National Framework for older people (Department of Health, 2001) regarding the implementation of medicines endorses the monitoring of treatment to ensure the medication remains appropriate and to raise awareness of any adverse effects. The lady was in her eighties, frail and hard of hearing. A carer accompanied her from...
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...Supporting individuals with Dementia Legislations which govern work with of individuals with Dementia Enduring Power of Attorney Act An enduring power of attorney is a legal agreement that enables a person to appoint a trusted person – or people – to make financial and/ or property decisions on their behalf. It is an agreement made by choice that can be executed by anyone over the age of 18, who has full legal capacity. ‘Full legal capacity’ means that the person must be able to understand the nature and effect of the document they are completing and the nature and extent of their estate. An enduring power of attorney cannot be made by another person on behalf of a donor whose capacity might be in doubt due to mental illness, acquired brain injury, cognitive impairment or Dementia. It can be operational while the person still has capacity but may be physically unable to attend to financial matters. The benefit of the ‘enduring power of attorney’ is that unlike an ordinary power of attorney; it will continue to operate even if the donor loses full legal capacity. However, it does not permit an attorney to make personal and lifestyle decisions, including decisions about treatment. The authority of the attorney is limited to decisions about the donor’s property and financial affairs. To cancel (revoke) the ‘enduring’ power of attorney the donor must have full legal capacity. The revocation must be made in writing. If the donor has lost capacity, an application must be made...
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...Critically evaluate how the use of advanced communication skills may facilitate reflective practice and enhance the delivery of care in district nursing practice. Barbara Brush Student number: B00628470 Word count: 2084 Due Date: 3rd February 2015. Introduction. Due to the increasing demands on the Health Service the “Transforming your care “ report (Department of Health Social Service and Public Safety, (DHSSPS) 2011a) made recommendations to increase care in the community, making home the centre of care aiming to reduce the strain on limited resources and give value for money. Within the community care district nurses are vital, there role is autonomous, unique and varied. Furthermore there expert theory, skills, and knowledge of self and practice adds to their advanced interpersonal communication skills to assess clients with increasing complex needs (Blazor et al 2008). Communication is the cornerstone of the nurse patient therapeutic relationship and is the essence of good care (Stein-Parbury, 2009). Within the community care setting, therapeutic relationships are a high priority of the health service to enhance the well-being of the growing ageing population and patients with complex palliative care needs (Bain and Baguley 2012). The Department of Health (2006) acknowledges that communication is paramount for human interaction, otherwise people cannot relate to others effectively, make their needs known and identify what is happening to them. A fundamental aspect...
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...was it effective? In order to investigate the different views and opinions that patients have in regards to patient- centered care, interpersonal interviews, a research methodology, was utilized. Interpersonal interviews were conducted in this phenomenological study in order to inquire about the “lived experience” or phenomena of patient’s experience of patient- centered care. This methodology ensured reliability and validity. Reliability was achieved through the interpersonal interview technique by using the same interview framework and the same researcher to conduct all of the interviews. This allowed the data that was being extracted to have consistency. All interviews were applied in a ‘coherent and consistent manner’ through the use of open and in depth discussions about the phenomena of patient centered care. This ensured validity and provided a further insight into the participant’s views of patient centered care. The interviews were accurately recorded and interpreted by two researchers separately to identify different meanings of the data. The methodology used was definitely effective, as it allowed data saturation to occur, which meant that no new themes were forthcoming and the data was repeating itself. This signified that all data that was required on the study of patient centered care was collected. How is the study unbiased? The study or phenomena of patient centered care appears to be unbiased. The concept of phenomenology encourages the researcher to put...
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