Patient Visit Home Wellness Exam

Patient Visit
The first patient is MMH, a 67 year old retired Caucasian married female. The patient visit was conducted in the home, which was a uncluttered trailer
located in Greenwood, IN. Her husband was present during the exam. The purpose of the well visit was to determine medication compliance, evaluate
functional and mental status and perform a complete physical evaluation. The past medical history (PMH) was positive for insulin dependent diabetes,
cataracts, hyperlipidemia, hypertension and Dupuytrens contracture of her right ring finger. She was being followed by her family physician, a
dialectologist and an orthopedic surgeon. All immunizations were current and she had a colonoscopy in 2016. She had not had a dilated eye exam for
two years, however.... Show more content on Helpwriting.net ...
But, in conducting such a comprehensive history and physical, there is significant sharing that occurs. The patient often shares recent difficulties in
their lives, like deaths of parents, spouses or children. Tthat allows for the spiritual experience of listening to another person's sorrow and giving
positive feedback and communicating empathy. It is helpful to share grief and pain in order to lessen it.
Think back over your recent clinical experiences and determine if and how spiritual care was provided to your patients. If so, in what way was
spiritual care provided. If spiritual care was not provided, do you see any missed opportunities for this with patients over the last 3 workshops? In
my first week of clinical experience, during a well visit, a patient's wife shared that she was raising her granddaughter. She expressed her
frustration that she and her husband were both retired and should be relaxing but instead they were raising a three year old girl. The mother had
been killed in a drive by shooting. As well as her frustration, she shared that she was shattered emotionally by her daughter's death. Again, active
listening and empathy was what I felt God wanted for this lady. She was obviously heartbroken and I shared with her what a blessing it was that she
was willing to take on such a task after raising her own children. I relied on my own experiences of loss and grief to realize that at times,
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Patient Placement
This study will utilize a stratified, randomized, placebo–controlled, pretest–posttest design with an intention to treat analysis. Patient enrollment will
take place over a course of 6 months. Prior to randomization to subject groups, all participants will complete the Numeric Rating Scale for Pain
(NRS–11). To ensure similar baselinepain scores between the treatment and control groups, subjects will be stratified into three groups based on their
baseline pain scores: no –to –mild pain (0–3), moderate pain (4–6), and severe pain (7–10). Subjects from each pain level group will then be randomly
assigned to either the standard of care group (SC) with placebo or the treatment group (SCK) consisting of standard of care with Kinesio taping ... Show
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Shaffner9 describes the proper method of measuring mouth opening with the TheraBite ROM Scale as follows: "When measuring mouth opening, the
notch at the lower left portion of the scale is stabilized on the superior aspect of the lower incisors. Once stabilized, the instrument is rotated up toward
the inferior aspect of upper incisors until contact is made."9 Lateral deviation and protrusion can be measured similarly but with lateral deviation being
determined by the distance between the incisors of the mandible and maxilla, and protrusion being determined by the distance between the incisors.9
Average normal values for mouth opening, protrusion, and lateral deviation are approximately 35–50 mm, 5 mm, and 8–10 mm

Patient Centered Care And Patient Care
Patient Centered Care Providing patient centered care each and every time I am in the hospital is something that I hold to a very high esteem for
myself and everyone I work with. My preceptor and I both think it is very important to treat patients like they are our own family member or
friend, so there are many examples I could give for how I exhibited patient centered care while I completed my senior practicum on 5200/5300.
Perhaps the most memorable from my time on this floor was when I had a patient who had been in the hospital for more than 30 days. This patient
was getting restless, had been in restraints, was unable to really communicate due to a tracheostomy, and had also been NPO for multiple days
while waiting for surgery to insert a PEG tube and fix an elbow fracture. Although this patient was in isolation and many team members were worn
down with him constantly trying to get out of bed, I was a fresh face and spent hours upon hours by his side trying to understand why he was
acting the way he was. The patient was starving and was in pain due to his injuries and illness. His surgery had been postponed multiple times
because of more emergent cases and unstable labs. He wanted nothing more than food in his belly and his own bed. Laying in a hospital bed for
weeks on end can really wear a person down, and I can only imagine how he was feeling since it was so difficult to understand what it was he wanted. I
easily could have left him alone in his room like others

Patient Centered Care And Patient Care
Pain and Sleep and how they correlate to Patient Centered Care. In the physical realm of patient–centered care pain, comfort, sleep, and rest are
important aspects of the fourth dimension of patient–centered care. Patient–centered care is the complete focus of the medical team on providing
respectful care to meet patient needs, preferences and values guide decisions on each individual patient care. To understand the subjective view of the
patient, these four aspects are at the forefront of their needs within the hospital setting to provide the best patient outcome. Nurses provide good
patient–centered care by actively partnering with patients to determine care priorities and plans to tailor their level of involvement, according to their
preferences, and being flexible by changing the care plan as the situation changes including providing smooth transitions between care goals. By
doing this, nurses can assist patients with all pain by providing comfort and assuring the patient that there will be no deficiency of their quality of
sleep. Pain and comfort as a rule are considered opposing in the needs of human beings. Pain is defined as an unpleasant sensory or emotional
experience associated with potential tissue damage. Pain can be divided into categories of long–term pain or short–term pain and by the type of pain,
level of pain, location of pain, and ease of solving the pain. Frequently, there is no way to completely manage pain, specifically in end–of–life care.
Pain is at

Patient Care For A Patient
Pediatric patients in hospital settings are unquestionably in a defenseless position and are highly reliant on nurses to provide for their individual needs.
In the poem above, not only was the pediatric patient's needs met, but also the nurse showed caring qualities that made the patient feel comforted. As a
pediatric nurse, caring is a quality that is imperative to include along with nursing interventions to provide holistic care for a patient. Caring holds
significant value to us professionally. We believe caring is an essential characteristic in nursing. Without this characteristic, one will not be able to care
for a patient effectively. Patients we work with deal with many different issues, may it be extensivehealth or social issues. ... Show more content on
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By researching more about the caring theory, it may change some nurses' perception about implementing caring more within their nursing practice.
Researching more about caring and how to implement it can be essential when dealing with a difficult patient or family member. A concept analysis is
used to evaluate the development of nursing concept by identifying gaps in nursing knowledge, determining the need to refine or clarify a concept
when it appears to have multiple meanings, evaluating the adequacy of competing concepts in their relation to other phenomena, examining the
congruence between the definition of the concept and the way it has been operationalized, and determining the fit between the definition of the concept
and its clinical application. Caring has been investigated, researched and studied in various methods, this concept analysis paper will clarify vague or
ambiguous concepts and identify and classify the caring theory. Applying the caring theory to pediatric nursing can help improve patient outcomes in
several areas. One goal using the caring theory is to apply the caring theory along with medical oriented nursing in the hospital to help increase
compliance among transplant pediatric patients on immunosuppressant therapy. Second goal is to incorporate the caring theory when taking care of
suicidal pediatric patients to help decrease the number of readmissions for suicidal attempts. The

Patient Education For Patients And The Education
Introduction
Patient Education is dedicated to patients and the education we should be providing as health care professional on a day–to–day basis. Patient
Education is one of more important jobs we do in our career as nurses. Children with chronic health problems or diseases such as on a pediatric
hematology/oncology unit, require skilled, home–based care by parents, supported by professionals. However, once patients are discharged, it is evident
that there is a continuous need for online resources to help supplement their learning and the professional support they may have received during
discharge. At this time, existing resources consist on patient/parent education at the bedside, with supplemental handouts to back up the teaching. ...
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Dedicated to serving the specialized medical needs of children, from newborns to adolescents, diagnosed with cancers such as leukemia, brain tumors,
and blood related diseases such as hemophilia, this 33–bed unit often has a full census with patients waiting to get in. They provide support for family
members as well as care for the unique needs of the oncology patient during all phases of their illness, diagnosis, treatment, education, and when
needed, end of life care. Being that it is a pediatric unit, most of the education is done by the nurses directly to the parents or care givers of the children
being treated. But often times, the care givers are given educational information while under extreme stress, still trying to process all the new
information and quite often, they have not come to terms with their child's new diagnosis. Other times, the nurse may be in a hurry, or may have other
challenges that factor into the lack of understanding. Some of those contributing factors could include; inadequate knowledge or training of the
clinicians, inconsistencies in quality of care, changes in current practice guidelines, limited health literacy skills, conflicts with prior training
implementation challenges, such as language barriers, and lastly, inadequate resources for the care givers. It was this last contributing factor that it was
determined a change needed to take

Patient Advocacy
Advocacy has been long–established as a necessary obligation for each healthcare institution and professional to implement in daily practice in order
to be successful. In recent years, the topic has gained much attention, with many claiming it as a professional imperative for each facility. As one
author notes, "If we are to adopt a practice grounded in inclusiveness that promotes universal access and equity as a mode of thinking, a therapeutic
tool, and an ethical responsibility, then advocacy must be a professional imperative" (Kirsh, 2015, p. 216), alluding the profound role of advocacy in
both clinical care and healthcare administration. However, the term is ambiguous to all applications it serves for: law, politics, social work, healthcare...
According to Schwartz (2002), "advocates can help clients translate their expressed desires into an effective plan of action that can help steer the
healthcare team towards a plan preferred by the client" (p. 38). Also, for patients having difficulties understanding healthcare documentation and
information, healthcare advocates can "clarify matters for the client" (Schwartz, 2002, p. 38). In addition, advocacy safeguards patients "from
incompetent, unethical, illegal, or impaired practice of any healthcare provider", while also ensuring their rights to self–determination are secured. A
study conducted on military nurses' experiences with advocacy found the act ensured that the patient was safeguarded from all physical and
psychological harm induced by the complexity of the healthcare system, had a voice (even if it was limited due to circumstance), and that the
individual's human dignity and ethical rights were preserved (Foley, Minick & Knee, 2000, p. 8–9). Lastly, an analysis of Swedish nurses' views of
advocacy recognizes case advocacy as an intervention through which the patient is "empowered and builds a caring relationship with the professional
to establish trust" and ensure that they are ready – both psychologically and physically – to receive the care they are about to receive (Lindahl &
Sandman, 1998, p. 181–182). Advocacy provides support and assistance to the patient and can help diminish their fears or worries when receiving
their services. Thus, case, or patient, advocacy is imperative for every institution to provide safe, excellent and satisfying services for each and every
patient, client or

Patient Identifiers
When analyzing the degree of alignment between the nurse's current practice and best practice, it is undeniable that there are many differences. For
one, the nurse does did not ask Mark to state his name and date of birth before scanning his wristband. The issue with skipping this crucial step in the
MAP is that it could lead to a patient receiving the incorrect medication for a variety of reasons, which could thereby lead to the development of
adverse side effects and possibly even death (Jo, Marquard, Clarke, & Henneman, 2013). To prevent this negative outcome from occurring, best practice
states that Mark's nurse should have used two acceptable patient identifiers when administering his medications. These identifiers include, but are not ...
In spite of the medications he has been prescribed requiring him to monitor his blood pressure, Mark's nurse has never provided him with a teaching as
to the importance of measuring and tracking his blood pressure while taking these medications (American Heart Association, 2016). Without this
teaching, or any medication–based teaching for that matter, patients like Mark are left in the dark in regards to their knowledge and understanding of
their own medications (Macdonald et al., 2014). In order to avoid being left in the dark, best practice suggests that Mark's nurse should have provided
a health teaching that addressed various aspects, including the reason he has been prescribed each of his medications, why they may look different
from those that he takes at home, as well as the physical assessments that he should conduct while taking the medications, if any (Macdonald et al.,
2014). In the future, Mark's nurse should make patient teaching a high priority and spend a few minutes talking to him about each of his medications.
She must also address any concerns he may have regarding any of his medications and their side effects (Macdonald et al., 2014). By doing this, she
will ensure that Mark understands what medication he is taking and why, thus fostering patient–centred care and allowing Mark to feel that he is an
active participant in caring for his health (CNO, 2015; Macdonald et al.,

The Ethics Of The Patient
'One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient''– Francis F
Peabody. As I continued my journey in internal medicine and hematology, I realized that ethical practice and empathy are the essence of medicine
every single day.
My interest in Internal Medicine developed during my 12 month long internship at Dhaka Medical College & Hospital, the largest teaching hospital
serving patients with all types of medical complaints from all over Bangladesh. Each admission day, I was enthralled by the diversity of problems
and the complexity of clinical presentations of the diseases. Because Internal Medicine deals with diseases involving all organ systems of human
body, it requires a vast yet, in depth clinical knowledge and diagnostic acumen. I found it intensely satisfying for an intelligent and inquisitive mind to
formulate a list of differentials for any presenting complaint and deduce one final diagnosis using clinical and laboratory clues. Even more rewarding
was developing relationships with the patients as I cared for them from admission to discharge. I remember how Mr. K's face lit up when I said, 'Ah!
You and your grandson have the same birthday, right?''
My favorite Internal Medicine rotation, however, was in the hematology department. To me it was a blend of basic science and clinical medicine
including critical care, infectious disease and palliative care. I noticed the

Influencing Patients
It is noted with regard to doctors that the basic means of influencing the acceptance of CAM and informing patients is their personal passion for
medicine and their passion to find the appropriate solutions for the treatment of their patients. The next means of informing them was their family and
their wider environment, ie people who trust them. According to Adams et al (2012), this conclusion of the practical part is confirmed, in particular
they stated in their study that the basic criteria for influencing doctors are mainly personal study and participation in informative seminars, while an
important means of information is the broader cycle (Akilen et al., 2014; Andrikopoulos et al., 2015), the relevant environment as an important factor....
Demographics do not seem to affect consumer behaviour. According to Harris et al. (2012) the initial decision is not based on the severity of the
condition, the malfunctioning or the assessment of the possible consequences of the treatment, but it is based more on: 1) personal experiences, 2)
repetitive recommendations to test a particular treatment, and 3) continuous or repeated support that may be presented for this treatment: "I heard for
this (alternative) treatment, then I happen to read books about it ... I was constantly encountering things that reminded me of this treatment, all of
which worked as signs that I should investigate

Patient Confidentiality
What is confidentiality? Confidentiality is the right of an individual to have personal, identifiable medical information kept private. It is ones private
information that comes to the knowledge of a person, in circumstances where an individual has been given notice, or is held to have agreed, that the
information is not to be disclosed. A non–disclosure agreement is a standard written agreement that is used when two or more companies work
together. Anyone that have access to private information is often required to sign a confidentiality agreement and it is often a clear indication that the
information is sensitive and non–sharable. Non–disclosure agreements are used in almost all professions, as people rely more and more on confidential
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This is when a patient's private information is disclosed to a third party. Breaches in patient confidentiality can have long–term adverse effects, even
when no lawsuit is filed. Patients are at risk of having their private information shared or the practice's reputation can be permanently damaged.
The HIPAA Privacy Rule can also come into play. HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The main goal
of this law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the
healthcare industry control administrative costs. In doing so providers are rules that they are required to follow. They must develop and
implement a privacy policy. Train all employees to ensure their understanding of and full participation with the privacy policies and procedures,
and to also designate a person to see that the practice's privacy policies are in affect and followed and ensure that patient records are secure and
accessible only to those who need them. A HIPAA violation can result in both civil and criminal penalties and monetary civil penalties of $100 per
violation can be incurred up to $25,000/person/year. Anyone who knows and obtain or discloses private information in violation of HIPAA can be
fined up to $50,000 and be imprisoned up to one year. If the offense is committed with intent to sell or be used for personal

Patient Privacy
patient privacy was often compromised. Upon discussion with the practice manager, we learned this was not the first time this had happened with
nursing staff in this facility. The turnover rate was extremely high due to the frequent lack of a professional nursing team. We completed an incident
report regarding the substandard care not only for the specific patients we had, but to protect future patients the nurses may care for, as this was not an
isolated incident. This nursing staff did not effectively implement the role of advocate or protector for the patients at this facility. Nurses have a duty to
protect the rights of their patients including the rights of confidentially and privacy. Privacy is being secluded from the presence of others.

Patient Portals
A review of literature was conducted to evaluate the current state of patient portals and the benefits a community patient portal has on patient outcomes
and organizational processes. Patient engagement solutions are relatively new to healthcare, which this limits both the number and the duration of
studies that are available. However, with an emphasis on meaningful use, portals are becoming both readily available and more important. The variety
of portals and providers has increased to the point that a patient is often managing many platforms that are disjoined. Studies show that if patient portals
are complicated and difficult to use this can result in a decreased enrollment and compliance, which negates the point of creating them in them... Show
One of these vendors is a company named InterSystems. InterSystems recently launched their next–generation platform, Personal Community, for
advanced care coordination. Their vision is to transform healthcare by sharing health information and connecting communities on a single platform
(Intersystem, 2015). While similarities exist between the Personal Community system and a patient portal, what makes the Personal Community
system unique is that the application can be placed across several different healthcare systems. Another vendor in the community platform market is a
company called HealthyCircles. HealthyCircles created a product called Engage that can also be placed across multiple healthcare systems and can help
organizations drive patient engagement by organizing communications and information more effectively than a traditional patient portal and provides
the ability to measure health outcomes. They do this by using tools and equipment that transmit information to the portal, sometimes from the patient's
house, to monitor conditions and spot trends. This connected solution can offer recommended solutions to the patient's case manager and help
coordinate the patient's new care plan to the entire care team (HealthyCircles,

Nurse Patient Ratio And Patient Outcomes
Nurse Patient Ratio and Patient Outcomes
Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher
incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which
in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked,
overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued
that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are
employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.
According to Martin (2015), California is the only state that stipulates that in law and regulations have a required minimum nurse to patient ratios to be
maintained at all times by unit. Nurses across the United States are talking to their Senators to help them lobby bills that would help establish a
minimum nurse to patient staffing ratios for all hospitals in the country, among other improvements of nursing rights. Nurses from around the country
also visited Congressional Representatives on Capitol Hill and urged them to support

Patient Centred Care : Patient Care
This essay will discuss patient centred care and some of the main principles associated to it. It will also discuss why patient centred care is so important
in nursing and acknowledges that there will always be opportunities and times when these principles can continually be improved upon and developed
through further training and education.
Gerteis et al (1993) suggests there are 7 dimensions of patient centred care. These involve respect, preferences and expressed need, coordination and
integration of care, information, communication and education, physical comfort, emotional support, involvement of family and friends, and
continuity. These dimensions do not appear to have changed over the past 20 years, however McCance et al (2009) suggest that the attributes of the
nurse should be another dimension included in patient centred care.
The Institute on Medicine (2012) defines patient–centred care as respectful and responsive to individual patients' preferences, needs, and values and
ensures that the patient or family are in control of all clinical decisions and maintaining core values. This again highlights the focus on the patient, their
values, and involvement of the family.
The International Alliance of Patients Organizations (2012) state that in patient centred care patients should be equal partners in planning and
developing their care and that the care must be focused to promote independence and automony and based on a collaborative philosophy.
Collins (2014) suggests

The Competence Of A Patient
When a patient is autonomous an individual has the right to make decisions on his own without the consent of outsiders such as nurses, doctors, or
other caregivers. Outsiders may attempt to influence the decisions of an autonomous person; it is essential that patients are allowed to make well
informed decisions without approval from others. Although autonomy means having freedom of choice, there are limits to those choices. For example,
if a patient is requesting anything illegal or unsafe, caregivers do not have to honor his request. Decisions relating to a patient should not be made
without the patient's consent and interests in mind. The only way that a caregiver may deviate from this requirement is if the patient is deemed as
incompetent or if there is an emergency situation. However, even if a patient is incompetent this does not mean he is incompetent entirely. Just because
a patient is incompetent in one area of decision making, this is not necessarily true for all areas. The competence of a patient may be assessed in terms
of high and low risks. When a patient is autonomous and competent his informed consent is required. The patient is allowed to have a choice of
healthcare providers and the treatments or procedures that will be administered to him. In fact, a patient may make decisions for the future such as
creating a living will. Institutions must disclose all information regarding treatments and procedures so that the patient will not be consenting to
anything

Patient Obligations
Position Paper A tiny measure of patients deny care from the earliest starting point, having been conveyed to the healing center without wanting to by
law implementation faculty or prehospital care suppliers (West Publishing Company , 2008). Despite the conditions under which the patient arrives, a
choice to leave the crisis office against therapeutic counsel places work force in an unbalanced bind, constraining attendants and doctors to pick one of
two choices which incorporate permitting the patient to leave, or they can control him and compel him to acknowledge treatment. Like most choices
made in the crisis situation region, this one must be made in a flash. Picking impulsively can have significant lawful ramifications. A doctor or
attendant who permits a patient to leave rashly welcomes a case of medicinal misbehavior. Then again, crisis office faculty who power undesirable
treatment on a hesitant patient open themselves to cases of strike, battery, and even wrongful detainment. Another option mirrors a business which can
be held at risk for the on–obligation activities of its representatives, the healing center might be named as a litigant too. Doctors and medical attendants
can't constrain treatment on a patient just on the grounds that they trust the patient will profit by such care. This remains constant notwithstanding...
Refusals of consideration, similar to agrees to treatment, must be educated. Crisis office staff have a commitment to depict for a leaving patient the
nature and seriousness of the patient's condition; the nature, liabilities, and advantages of the proposed treatment; and the results of denying that
treatment. At the point when a patient shows a craving to leave without treatment, work force will be enticed to depict the potential results in the
broadest conceivable terms. This might be the simplest methodology, yet it isn't as a matter of course the

Patient Overcrowding
There are consistent reports across all studies that show overcrowding and patient flow is a big challenge at the emergency department (ED) that affects
the quality of patient care. Bahena and Andreoni (2013) included increasing the number of patients, untimely and inefficient primary care, frequent
flyer, special circumstances such as influenza season, and the change in the health care delivery system as reasons contributing to overcrowding.
DeFlitch, Geeting, and Paz (2015) mentioned that overcrowding can be associated with less timely care, decreases patient satisfaction, ineffective care,
and poor outcome. Quattrini, and Swan (2011) revealed the consequences of overcrowding as risk of poor patient outcome, lengthy waiting times and
boarding... Show more content on Helpwriting.net ...
Welch (2012) stated that using a physician in triage reduces waiting time, overall length of stay (LOS), and left without being seen (LWBS), and it
increases patients' and health care workers' satisfaction. According to his study, the ED volume at Arrowhead Regional Medical Center in
Colton, California, doubled from 50,000 visits to 110,000 visits in 5 years. The experience of using provider in triage showed them that they are able
to discharge about 50% of their patient from triage. This intervention opened beds for many patients who were in more critical condition by
decreasing waiting time. Luaks et al (2016) researched on the similar method of having a provider in triage which they called it the medical team
evaluation (MTE) in a hospital in Switzerland which served 48000 cases of ED admission in 2014. The results of this change in triage system were
decrease in the median waiting times improved from 41.2 to 10.2 minutes, the median ED LOS dropped by 73%, and the total number of diagnostic
orders increased by

Patient Safety
Patient Safety As we all know, patient safety in a healthcare setting is extremely important and is to be taken very seriously. This is a very
challenging topic with any healthcare establishment, because people do make errors and it's only human. It is everybody's job within the facility,
hospital, or any healthcare setting to work on making sure that the safety of every patient that enters and leaves their building is safe. We want
patients to feel safe and confident when they have to go to the hospital for a procedure, or even to a skilled nursing facility to have rehabilitation or to
eventually stay long term. Not only is it the prospective patients that we have to take care of and maintain their safety while they are in "our hands",...
This is very scary for many people. Nobody wants to go to the hospital go "get better" and then end up with another type of infection. Once again
you see this topic a lot in the news, such as the "super bug" and the "MRSA". Yes, these are all infections and most of them do occur in a
healthcare setting. They can be very expensive as well to cure because the antibiotics are so expensive. Really the only way to take control of the
spreading of infection is to really have good education from a physician or a nurse. But, once again it is something that you an acquire within the
healthcare setting, so you have to make sure that the employees that are working there have the proper training of infection control and they know
the proper steps in maintaining the spread of infection. If you are a patient and someone walks into your room to give you medication, take your
blood pressure, of assist you in anyway, make sure that they have washed their hands and that they have gloves on. In a healthcare setting it is their
job to treat everyone as though they have "something" and they should be taking proper precautions no matter what. A lot of the reason that infections
occur in a hospital or nursing facility is because staff members are extremely busy and they are going from room to room to answer bells and take
care of their patients, and they don't always think to stop and wash their hands. Just try to remind them to wash their hands in order to keep yourself

Patient Advocacy
Community–focus and patient advocacy are two values that hold importance in my life. For community–focus, I know that giving back to the
community has been an essential part of my routine since middle school. Recently, I have been volunteering at the homeless shelter and Red Cross, in
order to assist those who are struggling get back on their feet. Furthermore, being involved in the community can alleviate health care problems, and
future costs associated with health care, for each individual. Improving the characteristics of our community can provide a template for other
communities to improve as well. Patient advocacy is also an integral value because our patients always come first, and we should instill care that
promotes their well–being,

Asthma Patient
11.0 DISCUSSION ON MEDICAL MANAGEMENT OF THE PATIENT
We all know the ABCs of resuscitation, but for asthma patient A doesn't for patient. Asthma is a respiratory problem not an airway difficulty. Unless
the patient arrives in arrest, there is no reason to intubate immediately.
The fast action is to start oxygen and bronchodilators. Give both albuterol and ipratropium bromide. Also, stick to nebulizers for patients.
a)Oxygen: Asthmatic patients generally do not require a lot of supplemental oxygen. Dr ordered nasal prongs because it is going to be replaced with a
nebulizer.Definitely , nebulizer with oxygen.
b) Albuterol : Patient given 5mg doses frequently or run a continuous nebulizer at 10–20mg/hr.As long as patient get as much beta–2 ... Show more
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Epinephrine can be safely given to asthmatic patients of any age (Cydulka 1998).
Nebulised epinephrine
п‚·0.5ml of 2.25% racemic epinephrine
п‚·5ml of 1:1000 L–epinephrin
Systemic epinephrine
п‚·IM 0.5mg
п‚·IV infusion – start at 5mcg/min and titrate to effect
п‚·Quick epinephrine drip: 1 mg of epinephrine in a 1L bag of saline. This results in a concentration of 1mcg/mL. Therefore a 60ml/hr infusion will
give 1 mcg/min
Ketamine (+/– Delayed Sequence Intubation)
Patient feeling appearing probably secondary to hypoxia ketamine is agent of choice, theoretically as part of a delayed sequence intubation. Ketamine
is used to treat the psychological state, allow for proper pre–oxygenation of the patient and get the rest of the medications on board. Non–invasive
positive pressure ventilation can be used as part of this pre–oxygenation. The plan is to use ketamine to pre–oxygenate and buy time to provide for a
safe, manage intubation. All intubation equipment is prepared for patient. If the patient condition is not better with maximal medical management,in
this situation to start intubation.
Goals in the ED for preoxygenation should include:

пѓ Achieve an 02 saturation of

Difficult Patient
At some point in all of our practicing careers, we will encounter a challenging patient. It is critical for practitioners to devise ways to work with
difficult patient. The patient may be "difficult" for different reasons. It is rare that he or she is difficult for no reason. Finding the root of the cause may
assist in caring for this patient in future visits. This root cause may be related to culture, communication, or autonomy of care. I believe that the
majority of "difficult" patients behave the way they do because of some unfulfilled need. They may feel frustrated, afraid, ignored, uncared for,
misunderstood, lonely and the list goes on. These patients may need an apology, empowerment, education, empathy, reassurance or simply a listening

Improving Patient Satisfaction Patients
Patient satisfaction has been considered as when patients feel that their needs and expectations are being met by the services provided. Some of the
important factors which are strongly effective, are included: availability of out–of–hours care, doctor's style, care delivery and continuity of care. All of
these happen when there is a good communication between doctors and their patients. Clear understanding of the patients' concerns as well as an
accurate clinical diagnosis. Doctor and patient's relationship always has described as cornerstone of general practice. If there is trust between the
patients and them, patients are more likely to connect to the recommended treatment. Continuity of care provided by the same doctor most of the time

Patient Escorts
Case #37
Zachary Hancher
MGT 3374 – 003
January 30th 2014
Case #37
The chief supervisor of patient escorts argued that the problem with the present hiring system is that the application does not have any useful
information on the applicant. He said that there are no longer questions that give insights into the employee's personality. His suggestion was to ask
applicants about hobbies, outside activities and their personal likes and dislikes on the application. He also suggested that each applicant be required
to have 3 letters of recommendation, centered on the applicant's ability to be friendly at all times, from people who know the applicant well. On the
surface, this option seems doable and helpful. A ... Show more content on Helpwriting.net ...
Akousa Sakyiwaa, 38, (left) and Sharmila Gunda, 36, (right) are charged with several counts of ill–treatment or neglect under the Mental Capacity Act
2005
Ms Sakyiwaa, of Leytonstone, is charged with seven counts of ill–treatment or neglect and one count of assault by beating.
Ms Jackson, of Hounslow, is charged with five counts of ill–treatment or neglect. Ms Gunda, of Ilford, is charged with two counts of ill–treatment or
neglect and one charge of assault by beating.
They deny all the charges.
Annette Jackson, 33, also faces several charges of neglect
Sakyiwaa and Gunda accused of beating elderly Winifred Dempsey and June Evans.
Mrs Evans, who is wheelchair bound, is the only patient still alive or well enough to come to court to give evidence against them. The other patients
are too ill or suffer from dementia.
Jurors heard the healthcare assistants were arrested after q student nurse Lucy Brown whistleblew on them following a placement on the ward last
Spring.
John McNally, prosecuting, said: 'The conduct complained of simply had no place on any ward. It cannot be justified.'
Snaresbrook Crown Court heard 92–year–old Lily Oliver was admitted to the ward on March 27, 2012, suffering from septic arthritis in her left knee.
Mr McNally told jurors: 'She was bed bound and extremely frail and it is the expert's professional opinion that she suffered from dementia and wasn't

able

Patient Autonomy, Patient Safety And Risk
Patient autonomy, patient safety and risk are the main key issues which have arose from the scenario of Ward 6 regarding patient, Mrs Green. These
issues have been chosen to be addressed as it is important that the patients in your care have the choice and are always safe and not at risk, to do this
The Institute of Medicine (2010) says nurses and other health professionals should work together to ensure a safe delivery of quality care (cited in
Kim et al. 2015 p.2491).
Patient autonomy, safety and risk are all important yet the decisions made from the student nurse on Ward 6 will be responsible and accountable,
however as the student nurse will be mentored they will not have the accountability which a registered nurse does as "to be accountable; practitioners
must: have the ability to perform the activity or intervention, accept responsibility for doing the activity and have the authority to perform the activity
through delegation and the policies and protocols of the organisation" (Royal College of Nursing 2016). The student nurses will be responsible for
communication with their senior and make sure they seek advice beforehand. Responsibility is mentioned within accountability yet is different as
Dohmann (2009) claims that nurses individually have the responsibility to make sure that actions they carry out or delegate to must be done
appropriately and they are then accountable for the results from the actions that were taken.
240
The Royal College of Nursing (2016)

Curteous To Patients
Jenny is an patient advocate" "Always verifies medication orders" "Always performs double checks and is conscious" "Never afraid to speak up,
does what is right for the patients needs, attentive to her patients" "Repeats verbal orders, always verifies med dosages, asks improtant questions"
"Alerts MD, CN and team leader of critical patients, always supporting new hires as well as nursing students by answering questions" "Anticipates
patients and family needs" "helpful to peers" "always leadning a hand" "constiently checking on patients Qhr/VS, Throuogh documation" "Curteous to
patient and family" "always addresing patients needs" "Actively checks on patients" "Always addressing patients concerns" "Answering any questions
thoroughly" "Gives accurate/detailed report" "Asks patients if they needs anything before leaving patients rooms" "Patience" "Great bedside manner"
"Jenny uses theraputic communication" ' Actively listens and addressess patients concerns" "Jenny is always paying attn to detail, she always thinking
and acting in ways of safety (for patients and staff)."... Show more content on Helpwriting.net ...
She definitely encourages fellow co–workers, speaks kindly, has a professional way of constructive criticism" "Jenny has been heard saying "No, I
don't think that's a good idea" you can always count on Jenny to "Do what's Right" "You will never find Jenny on her cell phone or surfing the
internet. She is always alert and paying attn to what's going on in the department surrounding her so she can jump in and help" "Jenny can be overheard
constantly stating "3 way..." with the lab & pharmacy,

Patients Experience And Patients Satisfaction
Patients Experience and Patients Satisfaction While the explicit study of the effect of patient experience and satisfaction has been limited, many
scholars have explored the relationship between aspects of patients' experience during their stay at hospitals or health centers and their satisfaction
ratings. Most of this literature focused on patient centered care and its various manifestations from physicians' communications to nursing attention
time spent per patient. Tables 2 and 3 presents the summary of this research. Overall, improved experience represented by high levels of patients'
centered care has resulted in improved patients' satisfaction. Professionalism, respect, empathy and support are parts and parcel of the process... Show
This study shifted focus from patient defined criteria to the doctor domain criteria of patients' experience. The study utilized 103 videotaped doctors'
consultations and presented them to a panel of twelve judges. The judges were trained physicians with 5 years of experience or higher in general
practice. All judges rated the consultations based on a number of scales measuring different aspects of doctor–patient–communication Empathy,
encouragement and engagement defined a good quality of care from the doctors' perspective. Judges generally rated the consultations as having good
quality of care. Further analyses compared the highly rated consultations with the low rated ones resulting in significant differences. Tests and
discriminant analysis results indicated that the higher ratings of doctor–patient–communications aspects were associated with higher levels of patient
satisfaction. This research concluded that when doctor's express empathy, encouragement and engagement, the experience of the patient becomes much
better. The authors concluded that). The study evidence provided by the study seems to possess credibility, support, reasonableness and accuracy. The
study used facts, statistics and arguments backed by previous studies. The study is useful for my research since it shows a robust connection between
patients' experience from the physicians' point of view and patients'

Patient Empowerment
Among several skills, good communication is important to have as a nurse. I will be covering what factors should be considered when a nurse and
patient hold different values and if there should be limits on patient empowerment. I will also be giving an example of patient empowerment that may
pose an ethical dilemma, along with discussing how I would respond to a patient whom I thought was making an unwise decision. The purpose of this
discussion is to discuss the outcomes of patient empowerment. As nurses, we are not always going to agree with the patient's decision. We as humans
do not always agree with our loved ones. The factors to consider are that every patient has their own beliefs. Nurses must be in check with their own
self, referred... Show more content on Helpwriting.net ...
We provide them with fluids and medications to help them with the withdrawal symptoms and help them stay comfortable. Sometimes, it is hard to
take care of these patients. We can encourage them to continue to stay clean after the detox. However, half of them go right back to the drugs and
they come back to us to detox. Once we see frequent flyers, it is hard to respect their decision to continue to come and detox when it feels like they
are wasting our time and theirs. I have already disagreed with a patient's decision, with something as small as a patient refusing to allow me to
perform neuro checks on them or refusing to take their potassium. I feel the only thing I can do is to make sure the patient is full educated. They have
the right to refuse and make their own decisions. I also do not feel as if patient empowerment should be limited. The patient knows their body the best
and it is their right to decide what happens or not. We encourage empowerment by being mutually respectful (Burkhardt & Nathaniel, 2014, p.521). In
conclusion, empowerment is essential to nursing and patient care. Patients have the right to empowerment and it should not be limited. They know
themselves best and ultimately should make the final decision. We can only make sure they are fully educated. It is imperative for nurses to have
self–awareness to

Patient Advocacy : A Patient Advocate
The business operation I am going to discuss is patient advocacy. Patient advocacy is an effort to protect and/or defend patients; taken on by
individuals, organizations, or groups. Therefore, advocacy is standing for or with a patient that have particular challenges or health concerns. Patient
advocacy may include educating the patient and family, affecting public policies, and joining associations. Professional patient advocates heave often
worked as social workers, case managers, nurses, or other professions that now focus on helping patient in their decisions making. Patient advocates
works in partnership with patient educators, dietitians, psychologists, pharmacist, and community health workers. The person I interviewed is Raegan.
Raegan is a patient advocate in a nursing home. Raegan received her Bachelor's Degree in psychology at Western Michigan University. She received a
Graduate Certificate in patient advocacy from the University of Toledo. Raegan has been a patient advocate for 5 years. She became a patient advocate
because she likes helping patients with their direct care needs, and enjoys helping patients navigate through the complex health care system. As a
patient advocate, she helps patients in numerous ways. Raegan ensures that patients see the correct doctors, coordinates care between doctors, ensures
the patient has access to all available treatment options, and that the treatment plans are being followed. She also educates the family on how to

Patient Lookup Patient Training Plan
My training plan is for patient lookup function which to me would be hands on training. For maybe few patients that can't look up information on a
computer a training program would be beneficial for them. There needs to be a complete understanding of the information system in order to look up
information. To me patient looks up function can mean the patient can look up information or what it probably means is that information system
programmer can look up all the information system programmers can look up. All the information needed for that patient and what sort of treatment
they have had and any other information for their quality care. However, looks up information, whether a programmer or anyone else they need to have
a complete understanding

Patients Knew
In an article published by Consumer Reports in 2011, 660 physicians were questioned regarding "What Doctors Wish Their Patients Knew."
(Chesanow, 2014). The topic that gained first place in the list was concerning patient noncompliance to medication and treatment. (Chesanow, 2014). It
is reported that about 50% of the medications are not taken as prescribed by clinicians (Brown & Bussell, 2011). As a matter of fact, the number of
noncompliant patients have significantly risen to levels considered as an epidemic (Chesanow, 2014). Low medication adherence has significant
consequences on the health of patients. Approximately 125 000 deaths per year in the U.S. are directly related to poor adherence to medication
(Bosworth et al., 2011). A retrospective

Improving A Patient 's Patient Essay
In today's world, hospitals are seeing an influx of patients now more than ever. These rising numbers are primarily due to the fact that patients have
more access to healthcare and are therefore living longer, but also sicker. This increase in patient population is a huge concern for hospitals as the
threat of limited space is often a reality. According to statistics released by the Healthcare Financial Management Association, with rapid growth of the
healthcare industry, healthcare production from 2010 to 2020 will increase from $1.8 trillion to $3.1 trillion, growing by over 70%; the increase of
patients will significantly impact the availability of beds and spaces in the hospital (Hegwer).
Focusing on ways to safely decrease length of stay in order to make room for new patients and keep hospital costs down is a primary concern of
healthcare institutions. An overcapacity of patients could cause a cancelation of operating room cases and delayed incoming hospital transfers, leading
to possible losses in patient revenue. The purpose of this research is to analyze and discuss how to effectively decrease a patient's length of stay in a
hospital in order to save the most amount of money with the rising healthcare costs. Some of these approaches include reimbursement payment
methodologies, technological advancements, proper triage and diagnosis, discharge practices, multidisciplinary teamwork and patient education.
Prior to discussing these strategies, it is important to note

Patient Refusal
Patient's decision–making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the
available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively,
emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians.
Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying
reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.
Patient or family factors
Patient refusal could result from misinterpreting what is said during difficult situations of decision making or due to denial of the truly bad situation,
poor registration of bad news or even confusion by multiple sources of information. In addition, ... Show more content on Helpwriting.net ...
A physician cannot force a patient to undergo a procedure or treatment against his or her will. Physicians must make informed refusal an integral part of
their informed consent process. Physician should understand what patients' needs and balance between the psychological need and social and physical
health. Sometimes, the stress environment of the doctor made him frustrated and they don't spend enough time with their patient to get the optimum
information and don't show interest about patients' psychosocial problems. When a patient feel that their doctors have a lack of knowledge of other
treatment options may also contribute to why patients refuse our treatment plan. Good physician–patient relationship allows a trusting relationship to
develop. Most patients will agree to doctors' treatment strategies if they have a good communication and patients are kept fully informed by their

Patient Dilemma
D–The patient arrived late to his session, but informed this writer that he was in an car accident today. The patient did in fact dose today. This writer
informed the patient that this writer have to report to the Director and Nursing have to assess him today. The patient is willing to comply, but asked if
he can assess tomorrow because he has to get to school today and take a test. This writer addressed with the patient about being in car accident and is
health is priority. This writer also strongly advised the seek medical attention as the patient complained about having a stiff neck and soreness, which
the patient can potentially have a whiplash as he was rear ended on the highway. Please note, this writer shared the patient dilemma through... Show
This writer strongly advised the patient that if he does not produce a negative UDS result next month, he's at risk for a tx violation and will have to
engage in a self help group. The patient agreed to the terms and is confident that he will provide a negative UDS result. This writer also added, " It
does not mean you give a negative UDS result for July, not August....it has to be consistent." Employment: The patient reported, business is going well
and showed this writer the house he is currently renovated on his own. This writer was immediately impressed with the patient work and commends the
patient. Mental Health Services: The patient wants to explore mental health services as it had worked in the past. This writer provided the patient with
infomration of two walk in clinics–Hartford Behavioral Health and Wheeler Clinic. A–Based on this writer's assessment, the patient was seen limping
as he walked to this writer office. Denies immediate medical attention. Appears alert and oriented. No evidence of SI/HI. P–Next appointment is
scheduled for tomorrow at 7am– patient will need to provide his hospitalization

Patient Engagement
Although patient hold the main role of patient engagement, for health care providers, they also play a very important role as facilitator and
collaborator. However, in practices, they were not adequately prepared to assist patients to engage in clinical treatment because of external barriers,
including heavy workload, time constraints and hospital special setting et al. Consistent with previous researches, communication offer a critical lens for
assessing the extent to which patient are engaged in their care. In our study, TB inpatients committed that keep cooperation with health providers in
hospital settings may help to making them feel cared and promote patient engagement. Conversely, poor communication undermined trust in
relationship with

The For A Patient With Cancer
Clinical exemplars are a great tool for healthcare professionals to express their clinical experience that changed their lives through a memorable event
in their healthcare practice. According to Association of Perioperative Registered Nurses (AORN) Journal, writing an exemplar can help the nurse to
show on their clinical experience, and it can enhance their critical–thinking skills. The goal of the exemplar is to provide readers with clear and
organized information on what did the healthcare professional did well and what the personal accomplished to improve patient outcome (Tinkham, M.
R, 2014).
Caring for a Patient with Cancer
All patients in the hospital have a story behind them that brought them to the hospital. Being a nurse for nine months, some patients have left a
footprint in my mind and heart. One such patient was Mrs. R. She was diagnosed with a tumor in her abdomen which then metastasized to her lungs.
It was a weekend morning, in which I was getting reports on my patients. The previous shift nurse gave the report on Mrs. R and told me that she was
forty–six–year–old Hispanic woman with metastasized cancer to the lungs. Patient recently came to know about the diagnosis and never had any
symptoms or pain, but the patient was in the last stage. When I went into the patient room to introduce myself, I found that the patient had been crying
for whole night.
During the time when I was interacting with Mrs. R, while providing quality care, we discussed the her

Patient Observation
During my ICE rotation at Clements University Hospital, I saw a variety of patients. The first patient I worked with was a 68–year–old male diagnosed
with diverticulitis. The patient had surgery to reduce the inflammation and pouches formed, but the problem persisted. The patient received two more
abdominal surgeries following the first one, which helped significantly. Although the physical therapist did not mention any precautions, the patient
was very slow to sit up and move. The patient had a hard time speaking, but understood the physical therapist when he spoke to him. The patient was
very slow with his movements and required maximum assistance. The patient was in the intensive care unit. The patient was attached to an EKG
monitor, required

Patient Care And Patient Safety
Surviving the Shift
The topic of nurse to patient ratios has remained a consistent focus of controversy in the medical community. Nurses, physicians, patients, CEO's and
countless other individuals, have questioned the growing concern with patient safety and patient outcomes. Laying at the root of this concern, is the
ever growing unease for patient safety based on the number of patients a nurse cares for during one shift. Hinno (2011) states "Knowledge of the
relationship between nurse staffing and adverse patient outcomes is crucial to optimize the management of professional nursing resources and patient
care." (p. 1584) What are the outcomes for patients who are being cared for by an over loaded nurse? There appears to be a plethora of ... Show more
content on Helpwriting.net ...
Nurse to Patient Ratios Each nurse is expected to care for a certain amount of patients during their shift. During this time, the nurse is expected to care
for these patients in a prompt and able manner. Passing medications, completing assessments, assisting in and out of bed, providing wound care and
offering education to each patient, no matter the amount of patients, the nurse is obligated to provide care.
Averages
The amount of patients that each nurse cares for differs from state to state and facility to facility. Presently there are few set standards for choosing
how many patients each nurse is assigned. The most common way of deciding patient load depends upon patient acuity. This golden standard does not
include patient needs, the patient's family's needs, necessary education or procedures required. This can cause a nurse to become overwhelmed.
Perhaps not because her patient is of high acuity, but because the patient is in high need of her services and takes up a large portion of her time. This
can lead to a great number of problems for the nurse as well as the support staff which must be utilized momentously. High demanding patients increase
a nurse's workload prominently.
In certain situations nurse to patient ratios can be as low as 1:1, if the patient is in the critical care unit this often occurs. This category of patient
ordinarily includes multiple medications being delivered via pump, intubation or respiratory support and complex procedures.

Patient Satisfaction
Patient Satisfaction
Introduction [The medical field is very important to us all, and when you become the patient in a hospital your mindset changes all together. This paper
will be about patient satisfaction while in the hospital. There are major concerns when patients or their family are admitted into the hospital. Hospitals
are very concerned with patient satisfaction and the scores that come with it. Patient satisfaction is very important in hospital settings. The patients are
the heartbeat to the large body of doctors, nurses, aids, and dietary. Being able to effectively make the patients stay or visit more satisfactory is
important in a hospital. The hospital process is strict on patient satisfaction ... Show more content on Helpwriting.net ...
Patient satisfaction scores weigh on non–physician staff like dietary just like doctors, nurses, and aids that provide(I took out the s) care.] Time to Go
[Patient satisfaction and being discharged from the hospital go hand in hand. This is the opportunity for the patient to see the hospital staff at their best.
Getting them out in a timely manner, making sure appointments have been made, and that they leave with all their belongings. From a patient point of
view finding and keeping good staff is most important. Something as simple as sitting when you speak with them about discharge orders gives them the
impression that the nurse is not rushing and that they are a priority (Chung–Larivee 2012). As the patients speak with the doctors and they are informed
they are ready to go home is like music to the patient's ears. As they once were sick being able to hear those words relieves a patient. The patients
really start to realize how kind that the workers at the hospital had taken care of them. The excitement of going home being able to sleep in your own
bed relieves the pressure of the previous nights' spent in the hospital. The patient needs to have all documentation at their fingertips and ready to roll.
The importance of patient satisfaction while being discharged is you should always wait on the patient and the patient should never wait on you.]
Conclusion [Patient satisfaction

Patient Visit Home Wellness Exam

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