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Nursing Theory And One Counseling Theory Essay
Nursing Theory And One Counseling Theory Essay Nursing Theory And One Counseling Theory Essay Week 1: Assignment below Practicum Journal Entry: You will select one nursing theory and one counseling theory to best guide your practice in psychotherapy. You will explain why you selected these theories and support your approach with evidence-based literature. You also will develop at least three goals and at least three objectives for the practicum experience in this course. Nursing Theory And One Counseling Theory Essay As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal. Permalink: https://nursingpaperessays.com/ nursing-theory-a ing-theory-essay / ? Learning Objectives Students will: Analyze nursing and counseling theories to guide practice in psychotherapy* Develop goals and objectives for personal practicum experiences* Create timelines for practicum activities* * The Assignment related to this Learning Objective is introduced this week and submitted in Week 4. Nursing Theory And One Counseling Theory Essay In preparation for this courses practicum experience, address the following in your Practicum Journal: Review the media Clinical Interview: Intake, Assessment,& Therapeutic Alliance in your Learning Resources. Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to the Wheeler textbook in this weeks Learning Resources. Explain why you selected these theories. Support your approach with evidence-based literature. Develop at least three goals and at least three objectives for the practicum experience in this course. Create a timeline of practicum activities based on your practicum requirements. Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to this weeks Learning Resources. Nursing And Counseling Theory Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Nursing Theory And One Counseling Theory Essay Note: For guidance on nursing and counseling theories, refer to this weeks Learning Resources. Explain why you selected these theories. Support your approach with evidence-based literature. For the assignment write on Nursing Theory (Hildegard Peplaus Interpersonal Theory) and the Counselling Theory (Humanistic Approach) Members of a cohesive group feel warmth and comfort in the group and a sense of belongingness; they value the group and feel in turn that they are valued, accepted, and supported by other members. Irvin D. Yalom, The Theory and Practice of Group Psychotherapy Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author. Note: The approximate length of this media piece is 2 minutes. Accessible player Group and family therapy offers a unique sense of community and support that may not be achieved through other therapeutic approaches. As you help clients effect change within themselves, they are able to in turn help others within the group change. Although many clients thrive in this environment, it is important to recognize that group and family therapy is not appropriate for everyone. Like any other therapeutic approach, group and family therapy has limitations that must be considered. Nursing Theory And One Counseling Theory Essay This week, as you begin exploring group and family therapy, you examine legal and ethical considerations of this therapeutic approach. You also prepare for your practicum experience by examining counseling theories and developing goals to guide your practice. Learning Resources Note: To access this weeks required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer. · Chapter 11, Group Therapy (pp. 407428) Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson. · Chapter 1, The Foundations of Family Therapy (pp. 16) · Chapter 2, The Evolution of Family Therapy (pp. 728) Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 2023. Retrieved from http://innovationscns.com/ Note: You will access this article from the Walden Library databases. Nursing Theory And One Counseling Theory Essay Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400408. Retrieved from http://www.hsj.gr/medicine/group-therapy-in-psychotic-inpatients.php?aid=2644 Note: You will access this article from the Walden Library databases. Lego, S. (1998). The application of Peplaus theory to group psychotherapy. Journal of Psychiatric & Mental Health Nursing, 5(3), 193196. doi:10.1046/j.1365-2850.1998.00129.x Note: You will access this article from the Walden Library databases. McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf Assignment: Practicum Week 1 Journal Entry As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal. Learning Objectives Students will: · Analyze nursing and counseling theories to guide practice in psychotherapy* · Summarize goals and objectives for personal practicum experiences* The Assignment related to this Learning Objective In preparation for this courses practicum experience, address the following in your Practicum Journal: Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to this weeks Learning Resources. Explain why you selected these theories. Support your approach with evidence-based literature. For the assignment use please write on Nursing Theory (Hildegard Peplaus Interpersonal Theory) and the Counselling Theory (Humanistic Approach) Nursing Theory And One Counseling Theory Essay The post Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to this weeks Learning Resources. appeared first on best homeworkhelp. In the past 100 years, the basic concept of psychology and counseling has been realized. During this period these concepts have evolved from several coarse psychological concepts to more inclusive interventions and methods. Along with the continuous development of professionals, it became possible for the original theorist to adapt to the development of human nature and personality. These adaptations continue to contribute to this field as well as the integration of new concepts and ideas. Nursing Theory And One Counseling Theory Essay (A) referral by counseling experts, (b) counseling and personality theory, (c) coaching skills, (d) group procedures and coaching theory, and (e) ethical and legal issues. In addition, students at MHC and MCFC courses must complete counseling diagnosis and treatment courses. MHC and MCFC program students must complete 63 credits, but SC students must complete 60 credits (if there is no certificate of education) or 51 credits (if there is a valid educational certificate) . Courses are offered by various counselors educators who decide course content and style according to their teaching methods. Counseling theory and counseling therapy are cornerstones of occupation. Perhaps each consultant has at least one tutorial theory course and the names of major theorists such as Sigmund Freud, Albert Ellis, Carl Rogers are legendary and well known. In this article I will explain the composition of counseling theory, why counseling theory and treatment are very important, and how these theories evolve. It is estimated that more than 350 counseling theories and treatments are being promoted. Most of them have not received much attention and verification, but the core group of about 10 major theories, and minor methods of minor theories have been revised or are less than 50. And they dominate consulting experts. Most of these theories have the following important elements. Nursing Theory And One Counseling Theory Essay As health professionals, every day we are invited to face patients presenting different problems and which need various solutions or therapies such as medical treatment, information giving, teaching, counseling, etc. I am a trained nurse in dialysis and renal pathologies management and I work in dialysis unit of our hospital. My main role is to receive patients with renal pathology and lead them to the Nephrologist, to plan and to execute prescribed treatment for those who are diagnosed with renal failure. That treatment concerns in general renal replacement therapies like hemodialysis or peritoneal dialysis. For the following work, I have chosen one of our patients because of the following reasons: He is a patient suffering of end stage renal disease and undergoing dialysis treatment since 2 years, he passed the first year under peritoneal dialysis but after developed chronic peritonitis and for this he has been transferred for hemodialysis. Nursing Theory And One Counseling Theory Essay He is waiting for renal transplantation but now lacks fund needed for the process Because of peritonitis he has received painkiller drugs for a longtime to relieve pain but he finished by developing addiction to painkillers. Still now he continues to claim for painkillers while there is no valuable reason. He presents signs of anxiety and depression IDENTIFYING THE PROBLEM Identifying clients problem is the key of the success of counseling process. Problem exploration is an important step, because it permits counselor-client initial contacts and to map out the clients problem. For this, all the process has to be well prepared. The preparation concerns the client and the environment in which counseling will be given. Concerning my client preparation, to get his consent, I have before all explained him what is counseling and what its benefits are for people undergoing it. Concerning the environment, all counseling sessions have taken place in our service, in one of our offices that I have chosen because its calm, well illuminated and aerated and where distracting conditions have been eliminated. We used chairs permitting to have various positions but every time it was possible, I arranged them in manner to permit face to face interaction. This arrangement permits us to avoid distractions and to have a full opened interaction. Counseling sessions were arranged to have place before each hemodialysis session, and I tried to avoid they went over 30 minutes. This has the purpose to permit my client to begin quietly his hemodialysis session. Nursing Theory And One Counseling Theory Essay My client MV is a young adult presenting various problems. After a careful analysis, I found that my client has various problems which need to be resolved by himself or through assistance from other people. Here, I found that neededassistance could be categorized as following: Problem necessitating other help than counseling Treatment of End stage renal disease: the management of that condition is accomplished primarily by medication, diet therapy and renal replacement therapy. The initiators of the treatment are Physicians (Fink et al., 2001). Nursing Theory And One Counseling Theory Essay Problems which may find solution with counseling Addiction to painkiller drugs: treatment by painkiller began while my client was treated by peritoneal dialysis. He developed chronic peritonitis with intolerable abdominal pain. For the pain he received painkiller each time he claimed it. After stopping peritoneal dialysis and starting hemodialysis, my client continues to ask painkiller although we dont see a real reason for it. We concluded that he has developed dependency to painkillers. Understanding a variety of models and theories of addiction and other problems related to substance use, describing helping strategies for reducing the negative effects of substance use, abuse, and dependency are among competencies of a counselor in addiction (U.S CSAT, 2005). Nursing Theory And One Counseling Theory Essay Problem which may find solution in combination of medical assistance and counseling: Anxiety and depression which according to my assessment are due to: Waiting a long time the renal transplantation without hope to find financial assistance for the process. Thinking to be useless for the family Anxiety and fear of the future: before he felt sick, he was going to begin university studies and has been obliged to stop them Brusque stop of painkiller treatment Cucor D. et al, (2007)recognized that depression is one of common mental health problem for people with End-stage renal disease. According to them, depression is one of factors influencing morbidity and mortality rates among those people. Various medications are used to fight anxiety and depression but to be more effective, medication need to be combined with other therapies like behavioral therapies. When associated, both medical and behavioral therapy, patient benefits from better decrease in symptoms and a lesser risk of setback (http://helpguide.org/mental/anxiety_types_symptoms_treatment.htm). Nursing Theory And One Counseling Theory Essay The client has developed dependency on painkillers drugs and has been obliged to stop them without any psychological assistance to help him to do gentle withdraw from drug taking. According to my assessment and a long time passed with the client, its for that problem that my client needs to be helped firstly and its about it I have chosen to work with him as also he has wished. It may be a hard task, but this will help the client and will help me to get more experienced because we are lacking experienced counselors. Nursing Theory And One Counseling Theory Essay TRANSCRIPT OF PART OF MY COUNSELLING INTERACTION WITH MY CLIENT During counseling sessions, the counselor uses various techniques to interact with his client. Communication and interaction management skills are used during counseling interaction and their use depends on how the session is going. Here below is a short transcript of one session I had with my client. Myself: you come just to present me problems which are stressing your life, could you tell me now about the intensity of each problem? Here I have used questioning skills to help my client to express himself and explore issues concerning his problems. Nursing Theory And One Counseling Theory Essay Client: As I told you in the last session, I have been suffering from chronic renal failure there are now more than 3 years. As you see it, I am young and I was about to begin my university studies when I felt ill. At the beginning, I was confident even though my doctor had told me that I will need long term treatment. Now when I think about my future, I feel hopeless. My studies stopped, I lost a lot of money with medical treatment, and I dont have money for renal transplantation, and for my unluckiness although he knows that I am suffering the doctor has stopped my injections of painkiller. Myself: I understand you feel overburden by all those problems; according to you which problem is mostly troubling your life? What are your main concerns? Nursing Theory And One Counseling Theory Essay Client: actually its my continuous unrelieved pain. Myself: Can you briefly speak about that pain? Here, focusing skills to bring my client to give a clear definition of the problem for which he needs our help. Client: as you know it, I have started treatment with peritoneal dialysis. After 5 months of treatment I developed peritoneal infection which was causing me serious pain. Other patients who had the same problem in the past advised me to ask to my doctor to prescribe me Pethidine which relieves pain and permits to sleep. Nursing Theory And One Counseling Theory Essay Here, active listening skills helped me to show to my client that I am attentive to what he is telling me. Myself: how did you appreciate the treatment with Pethidine? Here also I used questioning skills to get full information which can help me to analyze the relationship between my clients problems and his medical history. Client: at the start it was wonderful to not feel pain and I was again able to close my eyes and sleep. Nursing Theory And One Counseling Theory Essay Myself: and after? Client: after, it became impossible for me to sleep without my injection and one injection a day was not sufficient for me. For this, all the day I was harassing my nurse to provide me Pethidine. Myself: You told me that when you begin treatment with Pethidine everything was ok, no pain and you were able to sleep. So, how did you take it when the Nephrologist decided to stop Pethidine injection for you? Here I used summarizing skills to help my client to stay fixed on our subject; pain. I asked him that question as a challenge to see if he will continue to tell me that he still needs Pethidine injection. Nursing Theory And One Counseling Theory Essay Client: it has been a bad moment for me and up to now I dont understand him because I am still feeling pain. Myself: how do you feel when you are at your home? His family members have told me that he is quite at home and claims to feel pain only when he arrives in medical facilities. I wanted to get deep information about his pain. Client: Not very bad. I feel exaggerated pain when I come for treatment. THEORETICAL UNDERPINNINGS In this work, I have been using the client-centered approach. That approach of counseling has been conceptualized by Carl Rogers (1946). The fundamental belief turns around the idea that each individual innately strives towards self actualization, in the other words to be the best that he can. Nursing Theory And One Counseling Theory Essay Find out how NursingAnswers.net can help you! Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations. Essentially the person or child centered approach extends the central conditions of empathy, no conditional positive regard and congruence to the client, facilitating, in a reflective and non directive way the clients exploration and harmonizing of his emotional and personal issues that have been arisen from his lifes experiences. Nursing Theory And One Counseling Theory Essay The target is, to help the client to give up the personal image which he has built around his individual experiencing (Mearns D. & Thorne B, 2000 p5). This approach considers a client as an active agent, able to take responsibility for his own condition. Palmer reinforces this when he notes clients are encouraged to explore their most intimately held opinions and values, in order to discover for themselves, what it is that really matters to them, what it is worth living for or what would be worth dying for (Palmer, 1996:p31). The respect of client is essential in this approach. According to Corey (1977) the strength of this approach come from its capacity to focus on preferences and pathways headed for personal growth. Emphasis is on freedom, responsibility and the persons ability to redesign his life through attentive choice. Nursing Theory And One Counseling Theory Essay The counselor-client relationship is also essential to good practice of client-centered approach. To participate effectively in counseling, Freshwater (2003) claims that nurses necessitate to recognize the client as an equal, though as clients often view nurses as experts it can make this relationship difficult to obtain. Through this work I have been using the theories of motivational interviewing counseling, in which the main objective of the counselor is to identify and work with the clients motivation to change. Motivational interviewing builds on Carl Rogers optimistic theories about peoples capabilities for exercising free choice and changing through a process of self-actualization (Alcohol answers, 21.8.2009). Nursing Theory And One Counseling Theory Essay The therapeutic relationship counselor-client is a reciprocal partnership. The counselors role in motivational interviewing is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating discrepancy to enhance motivation for positive change (Miler and Rollnick, 1991). As healthcare providers, we are often asked to act as change agent for our patients, students, and colleagues. When we play that role we try to help people make necessary behavior changes by instructing them in the whys and hows of making them. We may have been trained to believe that if we simply teach our patients what they need to do to change and do it effectively enough; they will change (Ellen R. Glovsky, and Gary R., 2007). Nursing Theory And One Counseling Theory Essay In our daily work, tendency is to think that our clients need only medical assistance, but when we try to analyze the situation, we may find that we are wrongful. All clients needs are not answered by medicines or other medical and nursing interventions. Most of the time, we ignore the socio-psychological aspect of the problem. This is remarkable with chronic renal diseases like end stage renal failure, diabetic nephropathy, cancer, etc. Sensky (1993), in his work, showed how renal failure impacts on persons life. The impact doesnt only concern the physical condition but the whole person. With renal failure, various alterations come in the life; the patient has to learn new skills and strategies which can help him to cope with his condition. The patient has to attempt to adapt to his chronic illness and the necessity to deal with dependence on dialysis machine or other elses kidney to continue to live. Nursing Theory And One Counseling Theory Essay In their works, (Levenson, 1991; Kimmel, 1993, and Finkelstein, 2002) recognize that anxiety and depression are the most common psychological problems in dialyzed patients. The same idea can be found in the work of Chilcot and his colleagues. They found 20% to 30% of End stage renal disease patients with signs of depression at various levels (Chilcot, & Al., 2008). The other problem found in patients undergoing long term dialysis is a possible addiction on pharmaceutical drugs like painkillers (Manjula, Bennett, Chertow, 2003). Addiction is defined as a state characterized by impaired controlover the use of chemical substance and/or behavior. This lead the addict to seeking and abuse of drugs, a need to continue to take drugs to which some one has become habituated following a repetitive utilization because it produces some special effects like euphoria and other types of mental status alteration. Clinical manifestations occurbeside physical, psychosocial and spiritual dimensions (College of Physicians and Surgeons of Saskatchewan, 2008). Nursing Theory And One Counseling Theory Essay Addicted substances are like alcohol, stimulant substances like cocaine, heroine, marijuana, and medicines like tranquilizers and painkillers.Others may habitually mix prescribed drugs with alcohol to numb the mind from staying on disappointments or personal conflicts. Many people persist in taking medications to feel better physical or psychologically even when no ailments are present; and some insist that they cant function without them. Statistics indicate that, the number of visits in emergency room for prescription and illegal drugs overdoses are the same and that individual abusing medical drug like codeine can be just as addicted as the one who abuses of illegal drug like cocaine. While prescribe medicines is absolutely legal, ethical and moral laws prohibits the use of medicines for purposes other than the original aim. Addicted people need therapists specialized in chemical dependence counseling and who can help them to recover from the addiction by reviewing past medical history and patterns of substances abuse. Most of the time counselors discover that long term abuse has produced undesirable psychological and physical effects. The case presented above concern a patient addicted to Pethidine, a painkiller of opioids pharmacological family. Addiction to opiates like morphine can occur after chronic pain suffer is given dosages to control acute discomfort, and continues its use long after pain has collapsed (ChristiaNet, 2009). Nursing Theory And One Counseling Theory Essay Many people with long-lasting pain receive treatment by opioids. But, there are evidence throwbacks and side effects that may follow this treatment. Developing tolerance to drugs is one major risk, sometimes at short time. The second major risk is the development of addiction. Addicted people to painkillers becomeso fixated on getting more of them that the obsession prevail over the medical target of relieving pain (Media Planet, 2009). COUNSELING IN ADDICTION The focus of individual drug counseling is on the symptoms of substances addiction. It also relates areas of weakened function and the structure and content of the clients ongoing rehabilitation program. The first target of counseling in addiction is to support the addict to achieve and maintain abstinence from addictive substances or behavior. The second target is to aidthe addict to recover from damages which have caused by addiction in his life (Delinda E. & Georges W., 1999). Nursing Theory And One Counseling Theory Essay The addicts counselor works firstly by helping the client to be aware of the reality of a problem and the connected unfounded thinking. In the next steps, client is stimulated to achieve and uphold abstinence from addicted substance or behavior. This can help to develop needed psychosocial abilitiesand spiritual growth to remain in recovery process (Delinda E. & Georges W.). ADDICT INDIVIDUALIZE COUNSELING PROCESS Counseling as a helping process consists of 3 main phases. Each phase has its distinct aims although the same skills may be used in those 3 phases. Those three main phases are: Nursing Theory And One Counseling Theory Essay Exploration, assessment and planning phase In this phase, the main objectives are to apprehend the client as a whole person, to plan counselors interventions, and to arrange an agreement between counselor and client. Rehabilitation counseling and goal achievement phase Counselors objectives in this phase are the initiation and implementation of his treatment plan in collaboration with his client. Nursing Theory And One Counseling Theory Essay Termination and evaluation phase In the closing phase, objectives are to conclude treatment process and deliberate its outcome with the client, and to arrange agreement on upcoming actions. Rehabilitation and relapse prevention In addiction counseling, the objectives of the all process are to rehabilitate the client from the addicted substance or behavior and to prevent the relapse. Rehabilitation Rehabilitation may be defined as the process consisting in recovering the capacities that have been reduced due to injuries or illness. The recovery is sustained only when there is no relapse or return back to addicted substance or behavior. Here, the goal of counseling is to lead the client to a full reintegration into his community as dynamic and valued person. Each time its possible, detoxification comes first, and after can be started the laying of the basis of rehabilitation process. Abstinence from addicted substance or behavior is not enough in itself. The addict has to see the profits of staying abstinent; otherwise he can relapse at short or long term (United Nations International Drug Control Program, 2003). Nursing Theory And One Counseling Theory Essay Individual addiction counseling doesnt only focus on stopping or reducing addicted substance or behavior. It will also address the other related domains of impaired functioning and those are such as social relations, illicit activities, employment status, etc. When additional helps are needed, the counselor is advised to refer the client (U.S National institute of Health, 2009). Relapse Above, I have mentioned that counseling process has to help client to maintain abstinence after the recovery period, otherwise the client can relapse and return back in addiction. What is a relapse? There is a relapse when, a client in recovering period or in post recovery, returns to the addicted substance/behavior or becomes addicted to a new substance. Nursing Theory And One Counseling Theory Essay Prevention of relapse in counseling process Preventing relapse is a very important element of recovery. When the client becomes able to establish some constancy in abstinence, he could begin to develop skills to put off future relapse to addicted substance/behavior. To prevent relapse, the addict has to be taught how to identify in advance, when he is headed near a relapse and to modify course of events. Through counseling process, by education, the addict can identify indicators of coming up relapse. Those indicators are like negatives changes in clients behavior, feelings and attitudes. Once the client became conscious of the environment of relapse process, his next mission is to build up the skills to intervene and change any occurring negative behavior or feelings (Delinda E. & Georges E.) SELF-EVALUATION I am not a professional or trained counselor. I am only a student in nursing studies who is trying to apply learnt counseling skills. I have chosen to work with my client about his addiction. I know its a very complicated subject for a beginner in counseling, more experience is needed.Difficult to handle that subject has stimulated and encouraged me to do further reading and researches concerning addiction; what is it, its causes, its management by a combination of counseling and other ways of help like pharmacotherapy. During my counseling process, in my clients needs assessment; I was more influenced by medical side of my clients problems. The social situation of the patient has not been full analyzed and I think that this can a bit weaken the problem exploring process. The second difficult is to know borderline between intervention domains of a professional counselor and a health professional who applies counseling skills to help a client. We may think that its easy but in practice its very complicated. You ask yourself: Does the clients problem need a professional counselor or a skilled health professional can help? Nursing Theory And One Counseling Theory Essay This can lead us to be fluctuating in our practice. I suggest here to insist on this point during elaboration of Professional practice and counseling skills module. My strength now reside in fact that I can now lead counseling process without apprehension, methodically and without asking about the beginning or next stages. To help my client, I di
Cardiac Disease and Pregnancy Sample Essay
Cardiac Disease and Pregnancy Sample Essay Cardiac Disease and Pregnancy Sample Essay Pregnancy imposes unique physiological strains on the cardiovascular system which are magnified in presence of heart diseases. Maintaining maternal cardiovascular stability with adequate placental perfusion can be challenging. Many mothers are asymptomatic and the physiological changes of pregnancy may precipitate decompensation. Cardiac Disease and Pregnancy Sample Essay The risk and the preferred anesthetic techniques differ amongst the various cardiac conditions. Goal of anesthetic management is to maintain hemodynamic parameters within a narrow therapeutic range. The risk in mother and fetus doubles increasing the peripartum morbidity and mortality. Thus multidisciplinary planning should be at the helm of pre, peri and post partum management.1 Permalink: https://nursingpaperessays.com/ cardiac-disease- ncy-sample-essay / ? INTRODUCTION Cardiac disease in pregnancy accounts for 0.1-4% in the developed nations of which 70-80% are patients with congenital heart disease who survive to adulthood because of better surgical techniques and newer and better drugs. As women present at a much advanced age in recent times ischemic heart disease also may complicate pregnancies .1 There is usually deterioration by 1 grade (NYHA class) during pregnancy in patients with pre existing cardiac disease.1 (Table 1)Cardiac Disease and Pregnancy Sample Essay While assessing a pregnant patient certain warning signs may point to a cardiac pathology in an otherwise unsuspected case. ⢠A rising pulse rate may be a harbinger of cardiac decompensation. The radial pulse is difficult to detect when the heart rate is fast or irregular. Hence auscultating the heart with a stethoscope is more prudent and accurate.Cardiac Disease and Pregnancy Sample Essay ⢠The blood pressure (BP) should be recorded with the woman sitting comfortably with a manual sphygmomanometer with an appropriate sized cuff. The arm should be at an angle and supported to ensure that the cuff is at the level of the left atrium. ⢠Crackles may sometimes develop in late pregnancy due to the splinting effect of the enlarged uterus resulting in poor lung expansion. These crackles disappear on asking the woman to take several deep breaths and then cough several times. Crackles posteriorly in the lung bases may be pathognomic of incipient cardiac failure.1 The risk and the preferred anesthetic techniques differ amongst the various cardiac conditions which are enumerated below. (Table 2) The FDA classifies drug risk during pregnancy based on available data (Table 3).Cardiac Disease and Pregnancy Sample Essay The various cardiac conditions complicating pregnancy and their management are discussed below.Cardiac Disease and Pregnancy Sample Essay 17.1 CONGENITAL HEART DISEASE Grown up with Congenital Heart Disease (GUCH) is now becoming the most common cardiac disease in pregnant patients as due to improved medical and surgical management as many congenital heart disease (CHD) patients reach childbearing age.2 Maternal and fetal mortality varies depending upon the lesion associated. If complete repair and normal cardiovascular function is achieved by successful surgery during childhood then patients often require no special management except antibiotic prophylaxis as per the current recommendations. Some patients present during pregnancy with uncorrected lesion or partially corrected lesion, which may decompensate during the course of pregnancy and labor and their management is a challenge.2 -4 Major categories of CHD are ⢠Left to right shunts which includes atrial septal defect (ASD), patent ductus arteriosus (PDA), ventricular septal defect (VSD). ⢠Right to left shunts includes tetralogy of fallots (TOF), Eisenmengerâs syndrome. ⢠Congenital valvular and vascular lesions- aortic stenosis, pulmonary stenosis and coarctation of aorta In these entire lesion the anesthetic goal should include antibiotic prophylaxis, avoid factors which can cause reversal of shunts such as hypoxia and hypercarbia. Left-to-Right Shunts Either small ASD, VSD or PDA with modest left to right shunt without pulmonary hypertension is often well tolerated during pregnancy. However mortality is high with coexisting pulmonary hypertension. Physiological changes during pregnancy may increase left-to-right shunt and worsen the degree of pulmonary hypertension. There may be increased risk of preeclampsia and small for gestational age babies in case of unrepaired lesions. 2-4 There is increased incidence of Supraventricular arrhythmias (Atrial fibrillation and flutter) due to ⢠Chamber enlargement ⢠Pulmonary hypertension (PH) Paradoxical embolus is common during pregnancy as ⢠Respiratory efforts may increase due to physiological changes in pregnancy ⢠Straining during parturition Management of ASD in a woman of childbearing age Anesthesia Management: The major goal in peripartum management is maintenance of systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) ratio as alteration in them may lead to ventricular failure, shunt reversal and hypoxia. 5 Continuous monitoring (standard monitoring plus trans-esophageal echocardiography [TEE] if available) and supplemental oxygen therapy is essential.6 Accidental intravenous infusion of air bubbles should be avoided.Cardiac Disease and Pregnancy Sample Essay Early lumbar epidural analgesia for labor and vaginal delivery is desirable to avoid pain and resulting increase in SVR. 5 For caesarean section slow graded segmental epidural anesthesia is preferred. During epidural space localization loss of resistance to saline is preferable than air as identification of the epidural space with air might result in systemic air embolization especially in pregnancy due to high epidural venous pressure and engorged veins. General anesthesia is also well tolerated and combined opioid and inhalation technique is preferred. 5-7 Oxytocin is used to induce uterine contractions and reduce bleeding following delivery of the baby. This should be given as slow intravenous infusion and not as a bolus.Cardiac Disease and Pregnancy Sample Essay Presence of isolated ventricular septal defects (VSD) possesses a low risk during pregnancy. However when complicated by pulmonary hypertension and or Eisenmengerisation there is a high risk of cardiac complications. If the VSD has been repaired prior to the development of pulmonary hypertension risk is minimal. General precautions during transcatheter closure of ASD during pregnancy ⢠Should be performed during second trimester ⢠Long venous sheath to reduce radiation dose to pelvic area ⢠Intracardiac echocardiography for balloon sizing and deployment of device reduces radiation dose Key points ⢠Avoid accidental injection of air ⢠Treat arrhythmia promptly ⢠Infective endocarditis prophylaxis Right-to-Left Shunts Eisenmengers Syndrome Uncorrected left to right shunt (ASD, VSD or PDA) may result in right ventricular hypertrophy, elevated pulmonary artery pressure and eventually right ventricular dysfunction. The conglomeration of these signs and symptoms are known as Eisenmengers Syndrome. After irreversible pulmonary hypertension occurs, correction of primary lesion does not help. Patients with Eisenmengers syndrome who become pregnant should be consulted to terminate pregnancy as there are chances of sudden profound hypoxemia and death. Maternal mortality is as high as 30-50 % in these patients.2, 7 Management includes early hospitalization, continuous oxygen administration, pulmonary vasodilators and prophylactic anticoagulation. Patient may however not respond to above treatment and pregnancy may be fatal. [21] Anesthetic management Supplemental oxygen must be provided to combat the hypoxia and prevent further increase in PA pressures. Continuous monitoring including central venous and intra arterial catheter facilitates rapid detection of sudden changes in hemodynamics and cardiac filling pressures. However a pulmonary artery catheter is relatively contraindicated as it is difficult to position and carries the risk of pulmonary artery rupture. Trans-esophageal echocardiography (TEE) is preferred.Cardiac Disease and Pregnancy Sample Essay For labor analgesia, as anticoagulation may contraindicate regional techniques, intravenous remifentanil infusion or patient controlled analgesia (PCA) may be the modalities of choice.8, 9 If not contraindicated epidural or intrathecal opioid or cautious segmental epidural analgesia provided the SVR is maintained, can be considered. 8 For emergency caesarean section general anesthesia is the anesthesia of choice .However few authors mention use of slow onset epidural anesthesia for elective caesarean .9 It is essential to maintain preload, SVR and oxygen saturation. To maintain adequate venous return avoid aorto-caval compression and judicious intravenous crystalloids and small doses of phenylephrine are considered.Cardiac Disease and Pregnancy Sample Essay Regardless of the anesthetic technique, many life-threatening complications may occur in the postpartum period mainly hypoxemia, cardiac dysrhythmias, and thromboembolic events . Hence continued use of invasive monitoring, oxygen, inhaled nitric oxide and extreme vigilance is recommended in the peripartum period. 7, 9Cardiac Disease and Pregnancy Sample Essay Key Point ⢠Maintain in SVR : PVR ratio ⢠Prevent hypoxia, hypercapnia, acidosis Tetralogy of Fallot (TOF) It is the most common right-to-left shunt lesion in women of childbearing age. Four components of TOF include VSD, overriding of aorta, infundibular or right ventricular outflow tract obstruction, and right ventricular hypertrophy. Presence of cyanosis, history of syncope, polycythemia (hematocrit > 60), decreased arterial oxygen saturation (<80%), right ventricular hypertension, and congestive heart failure indicates poor prognosis .2,10 Goals of management should include ⢠Avoid decrease in SVR ⢠Maintain adequate intravascular volume and venous return ⢠Avoid myocardial depressants ⢠Infective endocarditis prophylaxis For labor analgesia and vaginal delivery in these patients systemic or intrathecal opioids, or pudendal block may be considered. Segmental epidural analgesia is not recommended because of chances of decrease in SVR. For forceps-assisted deliveries low dose ketamine may be considered. Anesthesia of choice for caesarean section is general anesthesia with invasive monitoring and TEE. Patients with corrected TOF, even if asymptomatic, 2 D echocardiography is must along with 12 lead electrocardiogram (ECG) as they may have residual lesions and atrial and ventricular arrhythmias due to surgical injury to the cardiac conduction system. 11 Management of TOF in a woman of childbearing age is as follows: Key points ⢠Regional anesthesia may lead to worsening of right to left shunt and should be avoided ⢠In corrected TOFs, RV and RVOT should be assessed 17.2 PRIMARY PULMONARY HYPERTENSION It is a rare disease entity affecting young women of child bearing age with very high mortality reaching nearly 30%. 12 There is reduction in vascular nitric oxide and prostacyclin synthesis. At the same time there is increase in endothelin and thromaboxane production .Cardiac Disease and Pregnancy Sample Essay The pulmonary artery pressure (PAP) is raised above 25 mmHg at rest without any obvious cause. Pregnancy should be avoided as far as possible. However use of oral contraceptives in unadvisable as they are known to accelerate the progression of the disease. 13 Management Any factors which increase the pulmonary vascular resistance (PVR) should be avoided such as hypoxia, hypercarbia and acidosis. Avoidance of myocardial depression and aortocaval compression and maintenance of SVR , intravascular volume and venous return should be the goal. Anticoagulation is a must in any patient with primary pulmonary hypertension. As Warfarin is known to be teratogenic ,subcutaneous Enoxaparin (1 mg/kg twice daily) is recommended.13 Oxygen to counter the hypoxia and diuretics for right heart failure should be administered. IV epoprostenol should be administered by continuous infusion as it has a very short half life of less than 6 minutes and can cause rebound increase in pressures if abruptly discontinued. Endothelin receptor antagonists are contraindicated .Calcium channel blockers are not favoured because of their negative inotropic effects.12 Timing of delivery: The delivery should ideally be carried out between 32 to 34 weeks . 14 Vaginal delivery using low dose epidural analgesia would be the safest mode. If elective caesarean section is planned single shot spinal anesthesia should be avoided as the RV may not be able to respond to deceased venous return. In fact it is prudent to avoid regional anesthesia in any form. Vasopressors are to avoided as they increase the pulmonary artery pressure. Stress associated with laryngoscopy and intubation may also increase the PVR.6 Careful titration of oxytocin is required as it may decrease the SVR. Carboprost should be avoided because of its pulmonary side effects and methergin should be avoided as it causes vasoconstriction. Fluid management in these patients is challenging as neither hypovolemia nor hypervolemia are tolerated.Cardiac Disease and Pregnancy Sample Essay Fluid should be administered monitoring the central venous pressure or echocardiography. Right ventricular diastolic dysfunction is best treated with diuretics or haemofiltration.12 Inotropic agents may be required for systolic failure of the RV. Dobutamine at doses less than 10µk/kg/min decreases the pulmonary vascular resistance but at higher doses may have a detrimental effect on vasculature. Dopamine is avoided for its propensity of causing tachyarrhythmias. Phosphodiesterase inhibitors like milrinone have been known to reduce the pulmonary vascular resistance. Nebulised milrinone has the advantage of direct effect on pulmonary vasculature with less incidence of systemic hypotension.12 Vasopressors like norepinephrine may be used to maintain the systemic vascular resistance above the pulmonary vascular resistance.Cardiac Disease and Pregnancy Sample Essay However their effect is offset by the rise in pulmonary vascular pressure which may result in RV failure. Also the effect of α adrenergic agents on the α receptors of the uterus may result in reduced uterine blood flow.12 Patients should be monitored in high dependency units for 72 hours post partum as the fluid shifts associated with delivery may decompensate the right ventricle. Key points: ⢠Factors which increase pulmonary artery pressures must be avoided ⢠Pulmonary vasodilators and oxygen form the mainstay of therapy ⢠Anticoagulation is must ⢠Regional anesthesia should be avoided as decrease in systemic vascular resistance may result in RV ischemia ⢠Inotropic agents which do not increase the PVR should be used 17.3 HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM) It is a genetically transmitted cardiac disease characterised by left ventricular hypertrophy. Cardiac Disease and Pregnancy Sample Essay There is reduced left ventricular size and compliance. Chest pain , dyspnoea and palpitations which may be confused with normal symptoms of pregnancy are the hallmark of HOCM Any reduction in the preload or the afterload can result in increased outflow gradient and decreased left ventricular filling. Thus regional anesthesia is relatively contraindicated in these patients. Invasive monitoring is indicated and any hypotension should be promptly treated with fluids and phenylephrine. Since it is a pure α agonist it does not have a positive inotropic effect and at the same time it slows the heart which may be advantageous for the perfusion of the hypertrophied ventricle. The morbidity directly correlates with the preconception NYHA status of the patient. 15 Tachyarrhythmias including atrial fibrillation should be aggressively treated.2 Beta blockers should be continued throughout the pregnancy. In patients with history of syncope an automatic implantable cardiac defibrillator (AICD) should be implanted preconception. Key points ⢠Chest pain , dyspnoea and palpitations are the hallmark of HOCM ⢠Phenylephrine and beta blockers are the drugs of choice ⢠Adequate intravascular volume, maintain SVR and avoiding increase in myocardial contractility and pulse rate are the goals in anesthesia management 17.4 ISCHEMIC HEART DISEASE It is uncommon in pregnancy with an incidence of 1 in 10000 pregnancies. Myocardial infarction can commonly occur in third trimester or in the puerperium of the first or second pregnancies. The mortality may be very high up to 45% if myocardial infarct occurs within 2 weeks postpartum. The presenting symptoms are usually ischemic chest pain , with ECG abnormalities and elevated cardiac troponin I levels ( > 0.15 ng/ml ). Creatinine kinase levels may increase during normal labour and is not a sensitive indicator . In 78% of the women there is no predisposing cause. However increasing maternal age , smoking amongst young women and prevalence of type 2 diabetes mellitus may be some of the contributory causes.Cardiac Disease and Pregnancy Sample Essay Differential diagnosis are pre-eclampsia, acute pulmonary embolism , sickle crisis haemorrhage and aortic dissection Management consists of early coronary angiography as spontaneous coronary dissection is the most common cause. 84% of the lesions involve left anterior descending artery. Coronary stenting or coronary artery bypass grafting may be the treatment options. Thrombolysis using tissue plasminogen activator (TPA) 100mg over 90minuts may be used. However its use in early post partum period is contraindicated due to the risk of haemorrhage.Cardiac Disease and Pregnancy Sample Essay Intramuscular or intravenous ergometrine may be associated with myocardial infarction due to coronary artery spasm. It would be best to avoid ergometrine in patients at risk of ischemic heart disease and to use it intramuscularly or small incremental intravenous doses if required in high risk patients. Ergometrine acts rapidly with 2 minutes of intravenous administration. Glyceryl trinitrate 10 -400 mg/min injected immediately intravenously or sublingually 300mg may be used to prevent infarct if coronary artery spasm is suspected. If this is not effective immediate coronary angiography and intracoronary injection of GTN or aspiration of thrombus may be undertaken.Cardiac Disease and Pregnancy Sample Essay Another rare cause of myocardial infarction is the use of nifedipine for the treatment of preterm labour where the cause may be either hypotension or reflex tachycardia associated with it.15 Differential diagnosis are pre-eclampsia, acute pulmonary embolism, sickle crisis haemorrhage and aortic dissection. Diagnosis can be confirmed by ischemic chest pain, with ECG abnormalities and elevated cardiac Troponin I levels ( > 0.15 ng/ml ). Key points ⢠Ergometrine to be avoided if there is risk of myocardial ischemia ⢠Early thrombolysis ⢠Coronary stenting or coronary artery bypass grafting may be the treatment options 17.5 VALVULAR DISORDERS Valvular heart diseases are most frequently encountered in pregnant women in developing nations.Cardiac Disease and Pregnancy Sample Essay Many of these women are asymptomatic and the physiological changes of pregnancy may precipitate failure. Rheumatic mitral stenosis is the most commonly encountered valvular lesion during pregnancy. Complications during pregnancy include failure, atrial dysrhythmias, systemic or pulmonary embolism, and infective endocarditis. Regurgitant lesions are well tolerated during pregnancy due to physiological changes of pregnancy, however stenotic lesions are poorly tolerated due to the risk of failure and pulmonary edema.16 Goal of anesthetic management is to maintain hemodynamic parameters within a narrow therapeutic range. Patients with symptomatic disease warrant invasive monitoring. The incidence of complications is greater in 1. Patients with prior history of arrhytmias, heart failure, transient ischemic attacks or stroke 2. If the baseline NYHA class is III or more or presence of cyanosis. 3. Ejection fraction less than 40% 4. Pulmonary artery pressure 50% of systemic pressure 5. Patients with aortic or mitral regurgitation who have NYHA class III or IV symptoms Mitral stenosis (MS) The normal area of the mitral valve is 4-6 cm2. The symptoms of MS begin to appear when the valve area is reduced to less than 2 cm2. As a result of MS the filling of the left ventricle from the left atrium is hindered. This results in decreased stroke volume and cardiac output. A state of fixed cardiac output ensues and it is difficult for the heart to meet the increased cardiac output demanded by the pregnant state. 17 The increased heart rate in pregnancy limits the time for diastolic filling with the resulting increased left atrial pressure and the propensity for pulmonary edema.Cardiac Disease and Pregnancy Sample Essay Thus there is a downhill course and the patients NYHA status usually worsens by one grade. The situation becomes further grim with the onset of atrial fibrillation and there is 80% incidence in systemic emboli in these patients. There is a sudden increase in preload due to autotransfusion immediately after delivery and there is high incidence of pulmonary edema and death which can occur in the immediate peripartum and postpartum period and require close monitoring.Cardiac Disease and Pregnancy Sample Essay Medical management Bed rest, oxygen therapy and diuretics form the basis of therapy. Beta blockers can be used to reduce the heart rate. They reduce the incidence of maternal cardiac failure without adverse effects on the fetus. Recent evidence does not show any beneficial role of digoxin in treatment of cardiac failure. If there is atrial fibrillation then aggressive treatment with digoxin, beta blockers and anticoagulation is required. Anticoagulation has proven to be beneficial even in the absence of atrial fibrillation. The standard guidelines for anticoagulation during pregnancy are: ⢠Up to 12 weeks antepartum SC/IV heparin (aPTT 1.5-2.5 times the normal) ⢠Between 12-36 weeks warfarin ( INR 2.5-3.0) ⢠After 36 weeks SC/IV heparin Unfractionated heparin has been replaced by low molecular weight heparin. When anticoagulation is necessary, especially in women with mechanical valves, warfarin or low-molecular-weight heparin should be replaced by unfractionated heparin 36 h before induction of labour. Unfractionated heparin should be discontinued 4â6 h before delivery and restarted 4â6 h after delivery. Antibiotic prophylaxis for bacterial endocarditis is reserved for those patients who have previous history of endocarditis or in presence of infection.Cardiac Disease and Pregnancy Sample Essay Surgical Management Mitral commissurotomy is preferred if mitral stenosis is diagnosed prior to pregnancy Percutaneous valvuloplasty is the treatment of choice during the second trimester in pregnant women. After valvulopasty the valve area increases to 1.5cm2 with a 100% success rate. Foetal loss is high in open commissurotomy though maternal outcome is same for both the procedures. In severe cases where there is a calcified valve or thrombus, valve replacement may be indicated. In open valve replacement there are high chances of losing the fetus 16-33%. Maternal mortality may be also as high as 1.5 -5%.18, 19 Anesthesia management For vaginal delivery, labour analgesia is a must as it attenuates pain and associated sympathetic response which might precipitate failure. Segmental lumbar epidural analgesia is gold standard.Cardiac Disease and Pregnancy Sample Essay For caesarean section plain epidural or combined spinal epidural (CSE) techniques are preferred as it produces controlled hemodynamics. Spinal anesthesia is contraindicated as sympathetic blockade produced by single shot can lead to cardiovascular collapse in severe MS. 14 However general anesthesia is the method of choice in cases of decompensated heart failure, obstetric emergency or when patient is on anticoagulation. Avoiding tachycardia, hypotension and judicious fluid management along with ICU care in postoperative period is the key to management.Cardiac Disease and Pregnancy Sample Essay Mitral Insufficiency/ regurgitation (MR) Mitral valve regurgitation is the second commonest valvular lesion in pregnancy. Though most patients with MR tolerate pregnancy well some present with atrial fibrillation, bacterial endocarditis, systemic embolization, and pulmonary edema during late pregnancy. However if associated with coexisting MS morbidity and mortality increases significantly.18 Congenital mitral valve prolapse (MVP) is well-tolerated during pregnancy and therapeutic interventions are thus rarely necessary.18,20 In MR, regurgitation through an incompetent mitral valve results in chronic volume overload of the left atrium and dilatation with resultant pulmonary venous congestion. Physiologic decrease in SVR improves forward flow. However increases in SVR due to sympathetic stimulation during labor pain, uterine contractions, or surgical stimulation, may lead to acute left ventricular failure.Cardiac Disease and Pregnancy Sample Essay Anesthetic management Adequate analgesia for labor will decrease peripheral vasoconstriction and thus attenuate the increase in left ventricular afterload and forward flow. Segmental lumbar epidural analgesia is the preferred technique. Controlled sympathetic blockade which decrease SVR and is beneficial. However to augment preload adequate intravenous fluid infusion to maintain left ventricular filling volume is must. For caesarean section plain epidural or combined spinal epidural (CSE) technique can be considered. Graded epidural supplementation produces minimal sympathetic blockade and hemodynamic changes with the advantage of better pain relief in the post operative period.Cardiac Disease and Pregnancy Sample Essay Keypoints MS MR Prevent Tachycardia Avoid fluid overload Avoid Decrease in SVR and increase in PVR Maintain sinus rhythm Prevent Bradycardia Avoid increase in SVR Avoid myocardial depression Maintain sinus rhythm Aortic stenosis and regurgitation (AS, AR) Rheumatic mitral stenosis is the most commonly encountered valvular lesion during pregnancy, but aortic valvular involvement has greater functional significance. Mild to moderate aortic stenosis during pregnancy can rapidly deteriorate the hemodynamics and precipitate congestive heart failure, carrying a high risk of maternal and foetal mortality.Cardiac Disease and Pregnancy Sample Essay Bicuspid aortic valve is the most common congenital cardiac malformation occurring in 1 2% of the population.18 It can present either as a regurgitant or stenotic pathology. Calcification of the bicuspid aortic valve occurs at an early age due to degeneration caused by mechanical strains on the valve. 21 However it is a rare entity in child bearing age. Regurgitant valvular lesions are well tolerated during pregnancy, whereas stenotic lesions have a greater potential for decompensation and left ventricular failure. 22, 23 There is a higher incidence of preterm birth (44%), intrauterine growth retardation (22%), and lower birth weight in these patients. 19, 20 Anesthesia goals in aortic stenosis include maintenance of intravascular volume and preload, avoiding aorto-caval compression, cardiac arrhythmias and myocardial ischaemia. Regional and general anesthesia have been used successfully. General anesthesia in patients with stenotic valvular heart diseases should be induced with high dose opioid technique, which is detrimental for the fetus. Volatile agents also have a depressant effect on the fetus. However general anesthesia is the method of choice in emergency or when anticoagulation has been instituted or in case of decompensated heart failure.Cardiac Disease and Pregnancy Sample Essay Profound sympathetic blockade produced by single shot spinal anesthesia can lead to cardiovascular collapse and is contraindicated in severe aortic stenosis. 14 In the immediate postpartum period cardiac output and stroke volume increases by 80% due to autotransfusion and relief of venacaval compression. 24 To counteract this, induced controlled diuresis with furosemide should be considered. Major cause of post partum haemorrhage is uterine atony, the primary treatment of which is a titrated infusion of uterotonic drugs. Rapid infusion of IV oxytocin (>5U over 5mins) can cause hypotension, tachycardia and fluid retention leading to heart failure. 25 Hence oxytocin should be used slowly (an infusion pump is preferred over drip) with vigilance.Cardiac Disease and Pregnancy Sample Essay The argument of general versus regional anesthesia for complex valvular diseases in pregnancy is still inconclusive and is based on anecdotal case reports and theoretical risks. Repeated reassessments of the cardiovascular system should dictate the management. Anesthetic plan for delivery should include use of invasive monitoring throughout labor and delivery, with provision of high-dependency postpartum care. Multidisciplinary and comprehensive antenatal care of these patients is essential and should involve the anesthesiologist, obstetrician and cardiologist.Cardiac Disease and Pregnancy Sample Essay Keypoint Single shot spinal anesthesia is contraindicated in severe aortic stenosis Keypoints AS AR Avoid decrease in SVR Avoid Bradycardia Maintain preload and ventricular filling Avoid marked increase in SVR Avoid Bradycardia Avoid myocardial depression 17.6 PERIPARTUM CARDIOMYOPATHY (PPCM) This entity may present in late pregnancy or in early puerperium. However it has also been known to occur up to as late as five months post partum. There should be a high index of suspicion in pregnant or a puerperal woman who complain of increasing shortness of breath especially on lying flat or at night. There may be confusion with preeclampsia as 25% of the females may be hypertensive. 26 The incidence ranges from 1:1500 to 1:4000 live births and the mortality may reach as high as 18- 56% 1 The exact etiology is not known. However viral, autoimmune and idiopathic have all been implicated. Predisposing factors include advanced maternal age, multiple gestations, associated preeclampsia, prolonged tocolysis, multiparity, diabetes, obesity and Afro- Caribbean descent. 1, 27, 28An urgent electrocardiogram (ECG) , Echocardiogram (Echo) and X ray chest is volunteered in all these patients.26 PPCM is an entity which is diagnosed mainly by exclusion.Cardiac Disease and Pregnancy Sample Essay Terbutaline when used for prolonged tocolysis has been implicated as one of the causative factors. However it is still unknown whether β agonist therapy is a causative agent or it simply unmasks a clinically silent heart disease.15 Conditions which may mimic PPCM and a high degree of suspicion are required in diagnosis include myocardial infarction , severe pre eclampsia, sepsis, pulmonary thromboembolism and amniotic fluid embolism. 15 The criteria for PPCM were first put forth by Demakis in the year 1971 27 ⢠Absence of any heart disease before the last month of pregnancy ⢠No known etiology ⢠Heart failure in the last month of pregnancy or the one which may develop within the first five months in the post partum period. To this the echocardiographic evidence has also been added which include 27 ⢠Ejection fraction < 45% ⢠Left ventricular end diastolic dimensions > 2.7 cm/m 2 ⢠Fractional shortening < 30% Electrocardiography ⢠Normal sinus rhythm , sinus tachycardia or dysrhythmias may be present ⢠Other changes which may include left ventricular hypertrophy, inverted T waves, non specific ST changes and Q waves may be present.Cardiac Disease and Pregnancy Sample Essay Xray chest usually shows cardiomegaly. Thus diagnosis lays mainly on echocardiographic findings and there should be a low threshold for taking the patient for echocardiography.Cardiac Disease and Pregnancy Sample Essay In cases where diagnosis is unclear an endomyocardial biopsy if performed will show myocarditis in 76% of the patients.15 Treatment includes supportive management. Symptoms may improve significantly with the delivery of the fetus. Salt restriction and diuretics to decrease the pulmonary congestion and volume overload are recommended. Vasodilators
NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper
NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Nursing Informatics and Patient Safety In 2011, Mason General Hospital was named by Hospitals & Health Networks magazine as one of the Most Wired hospitals in the United States. What makes this particularly significant is that Mason General is a small, 25-bed, rural hospital in the state of Washington. It credits its success to nurse Eileen Ransomer, director of clinical informatics. Under her leadership, the hospital adopted such innovations as visual smart boards where real-time patient information is always available.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper According to the magazine, those hospitals designated as Most Wired show better outcomes in patient satisfaction, risk-adjusted mortality rates, and other key quality measures through the use of information technology (IT) (Mason General Hospital and Family of Clinics, 2012). Developments in information technology have enabled patients and health care providers to collaborate for quality improvement at an unprecedented level, and nurses have consistently been at the forefront of these efforts. This week you focus on the IOM report To Err Is Human and consider how health information technology has helped to address the issues of patient safety and quality health care. Permalink: https://nursingpaperessays.com/ nurs-6051-transf logy-essay-paper / Clinical transformation: Blending people, process, and technology Together with all of the healthcare reform efforts being considered, the massive adoption of electronic health records (EHRs) nationwide is expanding the focus on reducing costs and improving quality. Many healthcare organizations are embracing the concept of clinical transformation to achieve these goals, but they still require the tools and capabilities to make data available in real time and reduce the burden on scarce resources. These are among the key findings from the HIMSS 2011 Clinical Transformation Survey.1 This is the HIMSS organizations first industry survey to measure clinical transformation. To ensure respondents had a level foundation for their responses, the following definition was developed: NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Clinical Transformation: This involves assessing and continually improving the way patient care is delivered at all levels in a care delivery organization. It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results and embraces a common goal of patient safety, clinical outcomes and quality care through process redesign and IT implementation. By effectively blending people, processes and technology, clinical transformation occurs across facilities, departments and clinical fields of expertise. Approximately 175 respondents assessed the degree of clinical transformation within their organizations in terms of measurement, governance and leadership, organizational behavior and data access. Among the key findings: NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper * Clinical priorities: Nearly half of respondents indicated that their organization was presently focused on ensuring that a fully operational EHR is in place. * Key drivers for addressing quality metrics: While meaningful use/ARRA is the influence driving which quality metrics to address, the choices made by healthcare organizations are also driven by other federal efforts, The Joint Commission, and other quality initiatives. * Improved outcomes: Organizations arent only using the analysis of clinical and financial data to improve quality and efficiency of care, but to control costs and improve revenue, as well.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper * Barriers: Respondents identified the fact that data arent captured in discrete fields or defined consistently as key barriers to the capture and use of clinical data for quality metrics. * Clinical transformation teams: While nurses and physicians are well represented on clinical transformation teams, one-third of respondents noted that these teams were lead by a member of the executive office. * Organizational changes: As organizations are evaluating how to use IT to effectively implement clinical and quality improvement efforts, more than 80% are evaluating clinical workflow and process. * Addressing change management: Three-quarters of respondents rely on education and training to address change management issues. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper According to the survey findings, there are numerous improvements that organizations can make to enhance their ability to use clinical and financial data to improve patient outcomes. For instance, data isnt always available in a way that facilitates easy access and reporting. Only 35% of respondents presently import data into a data warehouse, and nearly half of respondents noted that they rely on interfaces to assist with integration. Since not all data is available in an electronic fashion with discrete data elements, reviewing charts by hand is still a key means for measuring clinical quality. Having the correct resources in place to improve reporting capability is also an issue. Nearly two-thirds of respondents noted that their organization needs additional resources in order to report appropriately on quality measures.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Although theres organizational support for clinical transformation, there are gaps and barriers to being able to accomplish goals and objectives in this area. Specifically, nearly three-quarters of respondents noted that they needed additional IT resources to report on quality measures. This was closely followed by additional staff (61%) and more money (58%). Only 4% of respondents indicated that they dont need additional resources. In addition, two-thirds of respondents directly noted that while they had staff qualified to report on quality measures, the staff simply didnt have the time needed to create reports. Other respondents (43%) noted that their organizations priorities were focused elsewhere. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper The role of clinical informatics, including nurse informatics, continues to be a much valued and necessary position in todays healthcare organization because these experts are essential to the success of quality initiatives, participating in the executive clinical team that analyzes clinical data. Survey results indicate that these human resources are necessary to ensure that clinical transformation efforts benefit from appropriate access to clinical data that is derived from the EHR. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper The recently published IOM report on The Future of Nursing asserts the U.S. healthcare system has the opportunity to transform itself, and envisions nurses as active leaders in this transformation.2 Nurses have already taken a leadership role in embracing technology as a necessary tool to innovate the delivery of healthcare. The report recommends that nurses take on leadership roles to improve safety and efficiency, bring evidence for decision making to the point of care, and empower patients to be involved partners. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Also recognizing the vital leadership role of nurses in providing quality patient care, the HIMSS Board of Directors approved a position statement this summer describing how to transform nursing practice through technology and informatics.3 Leaders from the HIMSS Nursing Informatics Community, representing over 2,900 members who not only serve the nursing profession, but also, the broader healthcare industry and HIMSS membership at large, developed the following position statement. Position Statement: Nurses are key leaders in developing the infrastructure for effective and efficient health information technology that transforms the delivery of care. Nurse informatics play a crucial role in advocating both for patients and fellow nurses who are often the key stakeholders and recipients of these evolving solutions. Nursing informatics professionals are the liaisons to successful interactions with technology in healthcare. As clinicians who focus on transforming information into knowledge, nurse informatics cultivate a new time and place of care through their facilitation efforts to integrate technology with patient care. Technology will continue to be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to transforming nursing practice through technology. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper In addition to the need for knowledgeable and available leaders, nearly all survey respondents (87%) indicated that their organization leverages technology to standardize and automate practices, such as the format of a discharge summary, to enable additional focus on new quality initiatives. Survey respondents were also asked if they were leveraging data from diverse information sources to measure quality. Approximately half of respondents (53%) noted that theyve created interfaces to support integration. A third (35%) noted that their organization imports all data into a repository-warehouse. Only 12% reported that the tools they use are fully integrated into their EHR. 55% reported that these tools are partially integrated, and 13% reported that these tools arent automated with organizational EHRs. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper One organizational leader in this area, Catholic Health East (CHE), has launched a massive, multi-year initiative to move forward with the development and implementation of a system-wide evidence-based care/clinical transformation initiative.4 This new delivery model, the ACT (Advancing Clinical Transformation) initiative, was developed in 2008 and introduced throughout CHE in early 2009. The initiative is focused on ensuring excellence in quality and patient safety outcomes-every person, every place, every time. Evidence-based care has been established throughout CHE using core measures, technology assessments, standardized documentation, order sets and computerized provider order entry. CHE will also leverage existing information systems and introduce new system capabilities and industry standard clinical terminology to provide patients with their personal health information and exchange key clinical information with authorized entities and public health agencies.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper New Nursing Technologies and Trends Nursing technology has transformed the way nurses work and continues to evolve, along with the roles that nurses play in todays health care arena. According to various studies and surveys, technology in the nursing world has increased patient satisfaction and overall outcomes, reduced clinical errors and decreased the amount of paperwork that nurses were once required to perform. The outlook for new technology in nursing remains robust, as new devices, computers and robots aim to transform the future of health care. The following technologies are just a few that have made headlines recently as they ease and streamline each nurses workload to help them focus on what matters mosttheir patients.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Point-of-Care Technology Accessing patient records, X-rays, medication information and even obtaining a second opinion from another health care professional, can all be done directly from the bedside thanks to new advances in point-of-care technology. Utilizing a wireless network and computer, nurses in many hospitals can now access and receive a wide array of information right from the patients room. Computer and software companies are working to further advance point-of-care technology to include wireless and mobile applications that will enable nurses to have the information they need directly at their fingertips.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Electronic Health Records Electronic Health Records (EHR) have been a hot topic lately as policymakers work towards establishing a Nationwide Healthcare Information Network (NHIN) that would standardize EHRs. Although paperless health records have been utilized for years, a new Harvard research study showed that fewer than 1 in 5 nurses are using EHRs, although computerized documentation was linked to nursing excellence and better patient outcomes. As more hospitals began to implement EHRs, experts predict that there will likely be fewer medical errors, an increase in quality care and satisfaction, and an overall increase in accuracy.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Electronic Lift Systems, Smart Beds and Computerized Staff Schedules Many of the health care technologies we see today have been put in place to make a nurses everyday routine safer and more efficient. Electronic lift systems operated by remote control and other wireless technologies have greatly reduced injury and stress for both patients and nurses. Smart beds and computerized staff scheduling systems have also improved general nursing efficiency. Smart beds, such as those developed by Hill-Rom, work in conjunction with other point-of-care technology to obtain and analyze patient information such as weight, temperature and head and neck elevation. New staff scheduling systems improve efficiency by enabling nurses to set up coverage and even schedule their shifts remotely.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Patient and Staff Identification Systems Patient and staff identifiers in the hospital setting have become increasingly important in light of patient mix-ups and unauthorized people entering a facility or accessing patient records. Bar codes, wristbands and radio frequency identification (RFID), all work to track and identify patients in an effort to reduce errors while also keeping the hospital population safe. New palm vein technology, eye scans and microchips have also been introduced as a way to identify both patients and healthcare professionals, and to cut down on unauthorized access to patient files. As new technologies continue to emerge, nurses roles will continue to evolve, with each advance, bringing a safer and healthier future for both nurses and the patients in their care.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Technology in Nursing The technology involved in nursing today would likely surprise even the most devoted gadget freak. Nurses must increasingly master a host of complex technologies, from smart medical devices to tablet PCs. Theres no way to get around it, says Carol Bickford, PhD, RN, BC, a senior policy fellow in the department of nursing practice and policy at the American Nurses Association. You need to know the tools, and new ones are coming in right and left. Nursing Tech Types The technology nurses encounter on the job falls into two broad categories clinical and other information systems, and smart medical devices, often with integrated computer chips and screens. Specific technologies include:NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Clinical Information Systems: These systems bring together an organizations patient records, lab results, pharmaceutical data, medical research resources and other information, providing nurses and other caregivers with integrated, PC-based tools to help them input and retrieve information. Electronic Health Records: Patient records in this format provide instant access to a patients medical history, improve communication between caregivers and offer flags and alerts to prevent conflicts over prescriptions and tests. Drug Retrieval-and-Delivery Systems: These utilize several technologies, including bar codes and automated dispensing machines, to ensure patients receive the correct medications and dosages. Tablet Computers, Wall-Mounted PCs and Mobile Carts: These computer-based tools allow nurses to enter and retrieve information housed in a facilitys information system without leaving the bedside. The systems can operate wireless and connect to databases containing care guidelines and other clinical resources.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Medical Devices: Devices such as infusion delivery systems and ventilators often have brains built into them, says Joyce Ramsey-Coleman, vice president of nursing and patient-care services at Childrens Healthcare of Atlanta. These electronic brains assist nurses by flagging problems and helping to avoid errors. Personal Digital Assistants: PDAs with add-on software can help nurses research conditions and check medication doses. Furthermore, wireless tech integrates information from disparate sources and delivers data faster, so nurses dont need to be tied to a specific workstation to get the necessary information. Boon and Burden While nurses acknowledge the advantages of using technology, they also say training is sometimes inadequate, IT systems occasionally force them to rethink how they do their jobs, and technological snafus can impede their work.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper But without a doubt, the introduction of new technologies may bring considerable changes to nurses day-to-day work. Consider the experience of Texass Baylor Medical Center at Achievable after touch-screen computers were installed in the emergency department. The system has helped improve efficiency and patient care in a number of ways, says Mike Beaning, RN, the emergency departments day supervisor. With the system in place: Nurses dont have to find a doctor to get a patients chart. Charts are easier to read, minimizing potential errors. Lab results are available in real time. Various departments communicate better. Because of the time that is saved by using this system, it gives the nurses more time for more personalized care, Behning says. But new technologies dont always result in more time for patients. Bar-code scanning, Bickford notes, can serve as part of a check-and-balance system for catching errors, but the bar-code systems arent always convenient and can take up nurses time. The same goes for automated medication systems, which may be designed more for the convenience of the pharmacy than for use during nurses daily duties, she says. Many times the technologies are imposed on nurses, Bickford explains. There has not been thoughtful consideration about the work processes or the business processes.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Bickford expresses concern about losing the sounds and touch of nursing when dealing with screens and nursing equipment. While technology can improve patient care, she acknowledges that sometimes its burdensome. TECHNOLOGIES THAT CHANGED NURSING FOREVER Anyone who has been in the nursing field for an extended period of time will tell you that a lot has changed. In fact, the twentieth century brought literally a technological invasion to nursing. According to Kaplan Nursing, from small advances, like digital thermometers, to sophisticated strides, like laser surgery, health care as a whole has been on quite a roller coaster and nurses have been along for the ride.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Medical advancements and information technologies of the twentieth century have not only changed the face of the nursing they have become part of the intricate fabric of the field. But what are the technologies responsible for this monumental transformation? One nursing professional and author of a site called The Nurse Lady- offers these 19 technologies that changed nursing forever. 1. Electronic IV monitors There was a time when IVs had to be administered with a nurses constant attention to ensure a steady flow. Manual IVs were highly sensitive to a patients movement and the flow of the IV could be sped up or slowed to a crawl by a subtle movement. To prevent this, nurses had to directly administer an IV from beginning to start. With the advent of IV pump infusion and electronic monitoring, nurses are freed up to initiate an IV and allow a machine to monitor and regulate the process. If there is an error, the system tries to correct it, and otherwise contacts the nurse via remote monitoring.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 2. The Sphygmomanometer The sphygmomanometer is simply a fancy term for electronic blood pressure cuffs that also measure heart beat rate automatically. Gone are the days when a nurse had to measure blood pressure manually. According to one nurse, this is the technological change that makes the biggest daily difference. 3. Information management As computer technologies become the primary means of managing patient information, nurses have had to adapt their record-keeping practices and increase their computer skills. Nursing informatics is a specialty that has emerged, combining IT skills and nursing science.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 4. The portable defibrillator Manual CPR can only do so much and for the longest time this was the only method available to many nurses for reviving someones heart. Now, even school nurses stand a fighting chance to save the life of a person whose heart has failed. The few minutes after heart failure are critical, and the portable defibrillator allows for immediate resuscitation action. Sturdy, portable IT devices Tablet computers and mobile wireless computer stations are now a standard part of the day-to-day methods of delivering care to patients. Charts are updated continuously, in real time, providing nurses with immediate access to essential patient information. 6. Readily accessible base of information Wireless Internet connections quickly make reference materials available. This can prove very helpful for diagnosis, especially when using a resource like Web MD.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 7. The sonogram/ultrasound Ultrasound devices provide nurses working with pregnant patients the ability to see inside the womb. Ultrasound has been nothing short of revolutionary in the field of Womens Health and pregnancy, allowing nurses and doctors to noninvasive identify the health of the baby throughout pregnancy. Now, with the advent of 4-D ultrasound, unprecedented detail is available for diagnosing fetal well-being. In addition to pregnancy monitoring, sonogram technology also offers many other new diagnostic advances such as the ability to easily identify cancer tumors in the bladder, and to tell whether the liver is enlarged. 8. Local wireless telephone networks These systems significantly reduce communication delays. Not only is this type of communication technology being utilized between nursing staff, but also between patients and staff, changing the dynamics of the relationship between patients and their nurses. 9. Hands-free communication devices Hands-free devices such as Voceras Call Badge provide the ultimate in communication while a nurse is engaged in active patient care or associated tasks.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 10. Communications options It is not uncommon for patients and nurses (and doctors) to communicate via e-mail or even web cam; a practice that is becoming common for parents of children in neo-natal intensive care units. 11. Patient remote monitoring In addition to high-tech and ultra-sensitive vital signs monitoring equipment, web cams and other technologies make the close monitoring of multiple patients much easier, changing how environments are staffed and operated. 12. RFID technologies RFID-enabled devices make monitoring hospital assets easier, ranging from drugs and equipment to records and patients. They also enhance safety and security with less effort and lower long-term cost. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 13. Compact, portable medical devices Combined with portable IT and communication equipment, these small, high-tech types of devices allow well-equipped nurses to take their skills on the road. They can travel to patients homes and treat conditions that once had to be treated on an in-patient basis. Neo-natal nursing advancements New, more affordable portable devices for the care of tinier and more health-compromised babies. 15. Drug management technologies High-tech systems of medication retrieval and delivery, such as bar coding and verification, have greatly reduced the potential for dangerous error. Infusion equipment advances have made the delivery of slow-administer drugs much easier, with computerized machines able to control dosages and rates. 16. Configurable nursing environments Configurable work spaces increases efficiency and safety, reduces stress, and prevents accidents and injuries. 17. Learning technologies The availability of individual and off-site learning opportunities and degree programs, via specialized software and online classes, allows for more rapid career advancement.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 18. Video conferencing The ability to interact with nursing professionals throughout the world, through such means as video conferencing, offers advantages and opportunities like never before, both in terms of the further development of the nursing profession and the continued improvement in patient care outcomes. 19. The blogosphere Medical technologies have brought changes to the process of life and death and the role of the nurse. The Internet allows nurses to share their experiences and feelings. As technology transforms the profession, nurses adapt and change as well. The big question is: What will the rest of the twenty-first century bring? What Technology Do Registered Nurses Use? Modern nursing care has been called a mixture of high tech and high touch, a way to describe the traditional nurturing and compassion of a nurse in combination with the advanced health care technology of the 21st century. Technology, such as computers and monitoring equipment, is used in nearly every aspect of nursing. Many of the applications nurses use are wireless.Todays nurses must not only know how to care for patients, but how to use technology safely and appropriately in their day-to-day work.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Computers Computer technology is one of the most common applications used in nursing. Nurses use computers to schedule staff, for timekeeping, to order medications or supplies, and for research and email. In some organizations, nurses use computers for all patient care documentation, using systems called electronic health records or electronic medical records EHRs and EMRs. A nurse who uses an EMR may document medication dosages, administration, dressing changes and other treatments in the computer, rather than on paper. Monitors Monitoring systems are technological devices that allow a nurse to obtain patient information. These devices include fetal monitors, which can show the heart rate of a baby still in the uterus; heart monitors that display the electrical rhythm and pattern of a patients heart; and vital sign machines that automatically take the patients blood pressure, pulse and respiration. Other monitoring systems measure pressure inside the heart or brain or the amount of oxygen in a patients blood. Systems built into the hospital bed report a patients weight or movement during sleep.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Intravenous Devices Hospital patients often have intravenous lines that are threaded through technological devices that control the flow and sound an alarm if the line becomes kinked or plugged. Other alarms warn the nurse if the IV bag or bottle is getting empty. Some machines can even switch back and forth from a a primary IV solution to a separate IV antibiotic solution without human intervention. A patient in an intensive care unit may be attached to several IV monitors at once. Medication Administration Safety in medication administration dictates the use of bar-coding and scanners in many hospitals. In the past, human vigilance was the only protection against medication errors. Now medications come prepackaged with a bar code that the nurse scans prior to administration. Patient armbands are also bar-coded, and the patients band is scanned as well. The system will sound an alert if the patient is allergic to a medication or if the nurse selects the wrong medication or patient.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Important Technological Advancements for Nurses Looking back over the past few years, many people would have never been able to understand how significantly technology would affect the way we work, live, and play. The healthcare industry has been one area that technology has helped. Patient care has been drastically improved by these advances, as have the nurses and doctors who use new measures. The job of a nurse today looks nothing like it did 10, 20 or even 30 years ago. RNs and Nurse Practitioners have changed the way they administer patient care. They are able to increase their workflow all while limiting their human errors. In return, it makes their job safer, and it is also less challenging on their bodies. Over the years, there have been seven major enhancements that have changed the nursing field Today, these advancements are being used at top hospitals and health care facilities across the world. These practices have made nursing a better profession to be a part of.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 1. Enhanced Communication When nurses received pagers back in the 1980-1990s, they were able to increase patient care. Fast forward nearly 20 years and each nurse carries a cell phone with the ability to order a pizza and medicine all at the same time. Most hospitals have advanced communication systems. Use smart phones and apps, nurses can receive text messages and receive alarms from their patients through their phones. Forget those old-fashioned pagers. The entire nursing staff is more in touch with their patients and with each other. Its efficiency at its finest and the nursing staff of today wouldnt know how to do it any other way. 2. Electronic Records Piles of endless paperwork consumed the nursing staff for decades. Physical paper charts and faxing medical records is pretty much a thing of the past. Hospitals and medical care centers have switched to electronic records. This allows everyone in the hospital to access the patients information with the touch of a button. A nurse can quickly see what medications the patient is taking and which ones they are allergic too. They can look up test results and see all sorts of other data. Doctors can put notes that the nurse needs to see about the patients needs. Even things like religious preference can be recorded. Its one way that nurses are connecting with their patients without hours of paperwork.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 3. GPS tracking Hospital efficiency has been increased through GPS tracking. Tagging and tracking medical equipment is much easier than it was before. Radio frequency identifications tags help nurses find the nearest blood pressure machine or another piece of equipment. It sounds like a simple matter, but being able to centrally monitor equipment has increased bed management and patient care incredibly. 4. Enhanced Diagnostic Devices Most of the technological advancements are to help doctors, nurses, and the patients. Take for instance diagnostic exams. These can now be performed n
Workforce Injuries In Healthcare Essay Paper
Workforce Injuries In Healthcare Essay Paper Workforce Injuries In Healthcare Essay Paper The Occupational Safety and Health Administration or OSHA is a part of the US Department of Labor, and was started in 1970 as part of the Occupational Safety and Health Act. Its mission is to prevent work-related injuries, illnesses, and deaths by issuing and enforcing rules (called standards) for workplace safety and health. Since its inception it has helped to cut the incidents of workplace fatalities by sixty percent, and occupational injury and illness rates by forty percent. This presentation will present what OSHA has accomplished in the past, present and what it hopes to accomplish in the future.Workforce Injuries In Healthcare Essay Paper Forty-five percent of all workplace violence incidents in the USA that result in lost workdays occur in the health care sector. Among attendants, orderlies, and nursing aides in 2011, the incidence rate of injuries requiring days off work was 486 cases per 10,000 employees, over four times higher than the national average for all workers Even though health care workplaces are more dangerous than anywhere else, OSHA (the Occupational Safety and Health Administration) carries out relatively few inspections of health care facilities. The authors added that even when it does find safety problems, there is often not much OSHA can do because of an absence of much needed safety standards.Workforce Injuries In Healthcare Essay Paper Co-author, Keith Wrightson, a worker safety and health advocate for Public Citizen, said OSHA is required by law to ensure safe conditions for every employee in the United States. The record is clear that the government has broken its promise to health care workers. Permalink: https://nursingpaperessays.com/ workforce-injuri care-essay-paper / ? More musculoskeletal injuries are suffered by orderlies, attendants, nurses and nursing aides than workers in any other industry . Back injuries in the health care industry are estimated to cost over $7 billion every year. Some industries with very low injury rates are exempt from these recordkeeping requirements. Rights of Employee Workers Compensation An Important Right When a worker is injured, becomes ill or is killed as a result of work, that person is eligible for Workers Compensation benefits. The system of Workers Compensation was established in the early part of the 20th century. It was a compromise. Workers were guaranteed some compensation and coverage of medical costs if they were injured on the job, regardless of whom was at fault. In return, workers gave up their right to sue their employer for a work-related injury. Workers Compensation became the exclusive remedy the only method for workers or their families to be compensated for the workers lost ability to work .Regardless of the size of the enterprise, or how they chose to measure it, the safety of each and every employee is crucial to your organizations success.Workforce Injuries In Healthcare Essay Paper Ensuring the health and safety of employees is of primary importance to the Organization. Organization is committed to maintaining safe facilities, sponsoring appropriate training programs, and providing necessary safety equipment. In addition, Administration and staff shall cooperatively develop appropriate procedures and regulations for ensuring employees health and safety, with special emphasis on the handling of potentially hazardous equipment or substances and for investigating and reporting any accidents and mishaps. All newly employed staff shall be required to comply with the physical examination. Every employee must provide annually, at a minimum, an updated health history of current health problems. accidents and mishaps are unforeseen circumstances that can affect individuals and groups at any time and in any place. Most accidents are preventable, but the carelessness or negligence of the involved individuals leads to major injuries and grievances. Accidents can also occur in the workplace and seriously affect the ability and health of the involved workers.Workforce Injuries In Healthcare Essay Paper The objectives of this essay to discuss the safety and wellbeing of all workers are necessary for the organization not only for consistent productivity but also due to regulatory requirements. Workers and human resources are the necessary components of all organizations due to their role in the effective accomplishment of objectives. Corporations cannot achieve long-term success and sustainable growth in the absence of motivated, safe, healthy, and effective workers. The health and safety of all workers are necessary to ensure the enhancement of productivity and efficiency at all levels and areas. Lack of safety measures can create havoc for the organization and negatively affect the working criterion of an organization. The management has to devise and implement effective safety procedures to reduce hazards and prevent accidents in the workplace. The can motivate the employees through this perspective as employees admire working in organizations that prefer safe working conditions. Employees believe that safer working conditions enhance their ability work because they do not feel scared in troublesome situations. The management should coordinate with all the related stakeholders when they devise policies about safety at workplace, as this would enhance a positive change in an organization. Different legislations also depict that organizations should focus on these perspectives and they should attain self-sufficiency in providing workplace safety.Workforce Injuries In Healthcare Essay Paper Corporations in the current era focus on the development of employees and they believed in the ideology of benefiting employees through different approaches. Safety at the work force is an important aspect that many organizations of todays world disregard. Many people face mishaps and accidents in various situations especially due to negligence, recklessness, and carelessness. Many accidents and serious injuries are avoidable and preventable by taking effective safety measures and reducing hazards. For example, drivers and passengers can avoid serious injuries and death by wearing seatbelts while traveling in cars. However, many people fail to realize the importance of seatbelts and face a variety of consequences in the event of an accident. Mishaps and accidents are unforeseen occurrences that can lead to several adverse consequences in the absence of effective safety measures and precautions. Accidents, disasters, and mishaps can also occur in the workplace and affect several employees in the absence of precautions and safety procedures. Certain mediocre organizations do not regard this aspect as important and they do not focus on safety at the workplace. The owners and management of the organization need to implement rules, regulations, procedures, and systems relevant to safety and health. The management also needs to ensure that all workers have ample knowledge and information regarding safety procedures, prevention of accidents, and safe working practices.Workforce Injuries In Healthcare Essay Paper Human resources Human resources are one of the most important assets of the organization with respect to success and growth. The success and growth of the organization depend on the effectiveness and efficiency of the human resources. However, the inefficiencies in human resources caused by any circumstances, occurrences, and events can hinder the accomplishments of the organization. Organizations take all necessary measures to ensure the productivity of all workers and employees to maximize profits and achieve organizational objectives (Blair, 2013). The wellbeing, safety, and health of all employees are among the highest priorities of all organizations. Organizations cannot take risk for their respective employees because an occurrence of a negative event would tarnish the credibility of an organization. Safe and healthy workers are more productive as compared to injured or sick employees. Employees that cannot work in safe conditions feel suffocated because of the risks associated with their respective work. Risks and hazards associated with a specific job or organization adversely affect the morale and motivation level of employees. The unsafe or hazardous working conditions have several long-term psychological and physiological consequences for the workers and the organizations. When a negative event occurs in an organization, it sets up the mindset of an employee. Employees would feel that this event would occur again and this would create hurdles in their effective working process. Organizations need to create a safe and healthy working environment for all workers to ensure high levels of motivation and enhancement in efficiency (Stricoff & Groover, 2012).Workforce Injuries In Healthcare Essay Paper Safety at Workplace Workplace safety refers to the prevention of illness, injury, and hazards in the workplace for all employees. Workplace safety involves the creation of a safe and healthy environment for all workers to evade hazards, injuries, and illnesses. Organizations can ensure the efficiency of all workers and circumvent a considerable amount of costs by ensuring workplace safety and health. Organizations develop different strategies through which they set up different work place safety policies and benefit the workers through this. Workplace injuries and illnesses lead to compensation benefits, health insurance costs, hiring temporary replacements, lost work hours, and lawsuits. Lack of concentration would cost severe damage to an organization and they should sort such issues in order to attain proactive benefits. Business can save a considerable amount of costs by creating and maintaining a safe and healthy environment for all workers. Safeguarding the interests and wellbeing of the employees allows organizations to circumvent costs relevant to injuries and illnesses (Legg, Laird, Olsen, & Hasle, 2014). On the other hand, workplace safety instills a sense of commitment and dedication among the employees due to the safety assurance of the organization. The morale and motivation of the workers increase due to the implementation of rules that safeguard the health and interest of the employees. Employees feel that they are safe to work in this place, and through this perspective, they would perform well.Workforce Injuries In Healthcare Essay Paper Purpose of Workplace safety The primary objective of safety in the workplace is to create a safe, healthy, and risk-free environment for all workers. Workplace safety involves the evaluation, analysis, prevention, and elimination of hazardous and dangerous elements from the workplace. Workplace safety programs evaluate and remove the risks and hazards relevant to the safety, well-being, and health of workers and other relevant individuals. Organizations develop health and safety standards due to several reasons including laws, regulatory requirements, organizational policies, and historical occurrences. Certain industries and their associations bind organizations to work for the benefit of their employees and they force organizations to focus on different safety related perspectives. Workplace injuries and illnesses caused by working conditions or environment can lead to lawsuits, high costs, and deterioration of the corporate image. There are instances when employees at times die because of sever working conditions. Employees might got injured because of certain safety and the lack of safety would be the only probable reason of this. Enhanced safety measures and appropriate quality of these measures can reduce this perspective to a considerable level.Workforce Injuries In Healthcare Essay Paper Safety at the workplace enables organizations to comply with regulatory requirements and prevent high costs resulting from injuries and illnesses. Several corporations can consider the fact that these safety measures would save their health and medicinal costs that would arise when an employees would hurt him. They should take proactive measures earlier through which people can benefit from these perspectives. The management can maintain high levels of productivity and efficiency by creating a safe and healthy working environment. Conversely, the employees work with dedication due to their perceptions regarding the commitment of the organization with respect to the wellbeing of the workers.Workforce Injuries In Healthcare Essay Paper Importance of safety at workplace Legislative and legal requirements are the most prominent cause of health and safety policies in most organizations. The Occupational and Safety Health Act is the primary law for the assurance of health and safety of all workers throughout the United States. The Occupational and Safety Health Act (OSHA) necessitates the dissemination of standards, rules, and regulations relevant to the safety and health of workers. The government establishes and enforces the standards for the safety and health of all workers and their families through the Act. All public and private organizations have to comply with the rules, regulations, and standards prescribed in OSHA (Jung & Makowsky, 2014). They would face legal complications if they do not comply with such policies and measures taken by the decision makers. However, many organizations develop and implement health and safety procedures to safeguard their interests relevant to organizational objectives rather than legal requirements. The financial and moral aspects of workers health and safety have a greater influence as compared to regulatory compliance. Corporations can save considerable costs by avoiding high insurance expenses, lawsuits, and employee replacement costs in the event of injuries and illnesses (Barling & Frone, 2003).Workforce Injuries In Healthcare Essay Paper Manpower and Management The primary objective of all managers is to enhance and promote productivity and efficiency in all areas and functions. However, the managers cannot uphold efficiency and effectiveness in the absence of a safe workplace. The managers need to create a safe working environment and increase the awareness and knowledge of all employees with respect to safe working practices. The employees and workers also need to understand the importance of workplace safety and reduce personal injury through attentiveness and removal of hazards. These safety hazards are negative for the effectiveness of organizations and create a long-term negative impact. The attitude of the employees, management, and employers plays a vital role in preventing accidents and creating a safe working environment. The negligence on the part of the employers and employees can cause a variety of hazards and accidents (Rahim, Ng, Biggs, & Boots, 2014). However, the diligence and commitment of all stakeholders regarding safe work practices leads to the prevention of major accidents and injuries. The employees and management can create a safe workplace through a shared responsibility model for workplace safety and cooperation. Organizations should own this perspective and they should realize the fact that it is their managerial responsibility to focus on this perspective so that employees can remain safe.OH&S legislation is the result of the vested interests of doctors and lawyers rather than genuine concern for employee health or management excellence. Do you agree with this statement? Discuss. As an Occupational Health and Safety Special we evaluate, and analyze work environments and design programs and procedures to control, eliminate, and prevent disease or injury caused by chemical, physical, and biological agents or ergonomic factors. We conduct inspections as well as enforce adherence to law and regulations governing the health and safety of the individuals. May be employed in the public or private sector. While on the job occupational health and safety specialist can.Workforce Injuries In Healthcare Essay Paper o Order suspension of activities that pose threats to workers health or safety. o Investigate accidents to identify causes or to determine how such accidents might be prevented in the future. o Recommend measures to help protect workers from potentially hazardous work methods, process, or materials. Educational requirements including any relevant certification or credentials o To be an occupational safety and health specialist a bachelors degree or masters degree is usually needed. There are also 55 certification listed according to (careeronestop). Certified industrial hygienist certified governmental safety officers, certified safety manager, certified safety and health manager to name a few. Employees in these careers need several years of work related experience and training. Both on the job and classroom training may be needed. Personality traits and skills sets required for you profession. Explain how the traits you learned about yourself from the personality profile in the Unit 3 Learning activity line up with your field and areas you may need to work on.Workforce Injuries In Healthcare Essay Paper There are various problems related to the implementation of policies and procedures related to the health and safety measures of at organizational setting. The major dilemma could be related to communicate all the plans and procedures within the organization at various hierarchical levels. However most of the people remain familiar with these aspects but still there could be proper requirement of following these health and safety policies. Sometime the situation arises that some people within the staff behaves in very careless manner and it just creates troubles with respect to ensuring the safety. Further the lack of training towards operating the machineries and equipments could also be a dilemma in relation to implementing the systems and policies for health and safety and security. It is one of the most troubling issues for the health and social care setting. The training is one of the major sections of ensuring the patients security. Other dilemmas could be related to sensitivity related to spreading of bacteria and virus or harmful germs. Thus these are certain dilemmas that could be faced by health and social care sector. With respect to addressing these issues there is requirement of aligning with the legal aspects within the organization. The internal legal aspects should be compatible as per the external legal aspects. It can provide highly security and safe environment. All the departments and staff people were required to behave in attentive manner and the element of carelessness could be avoided. Thus the role of legal aspects is very immense in ensuring the avoidance of dilemmas. Further the role of training is also huge in order to ensure the effectiveness of security measures. The dilemma related to the lack of training could be eradicated very easily (Verderber, 2010). The training could be imparted in various areas or fields. It is to ensure that training should have proper modules and sessions must be categorised in such a way that it caters all the areas. The seminars and conferences can definitely help in eliminating the dilemmas in appropriate manner. The training could be beneficial in providing the practical knowledge to the employees and most importantly the equipment handling process could be explained. Thus in this way these dilemmas could be addressed or removed in effective manner.Workforce Injuries In Healthcare Essay Paper 2.4 Effects of non-compliance experience in relation to health and safety legislation in the workplace. There are various factors associated to the non compliance of health and safety regulations in the workplace. If the legislations are not clear than lots of problems and issues could be faced. The major negative consequences could be that the roles and responsibilities of care workers could be explained in proper way. It is one of the major problems related to non compliance. The care workers wont be able to understand various aspects which are helpful on the ground of their rights as well. The delay in tasks completion could be faced and most importantly the delay in decision making could be experienced. The integration among the staff people could lower down and it can create lots of negative aspects. The chaos could be created and definitely confusion can make the scenario worst. The teamwork could be hampered and differences among the staff people could be realized. It is to acknowledge that it might be noticed that peace and harmony among the staff people has been minimized and the level of grudges is also very high. It lowers down the productivity as well and the working efficiency could be diminished. Irresponsible attitude could be developed among them. it is one of the major issues related to the non compliance experience. Thus the legislation must be implemented and followed in an appropriate manner. Ahead problems could be faced in achieving the organizational goals and objectives (Ludhra, 2014). The reputation of the firm could also be spoiled at very large scale if the legislation practices are not so appropriate. People can never put their faith and it just minimizes the footfalls ratio of patients.Workforce Injuries In Healthcare Essay Paper This essay has been submitted to us by a student in order to help you with your studies. This is not an example of the work written by our professional essay writers. On the basis of above study it can be concluded that the marketing has power to establish the business and it integrates with other department as well. In order to improve the position of company within the market the marketing mix elements must be used in effective and proper manner. the major learning of the study is that marketing mix elements could be designed in proper manner if the marketing audit has been done in an appropriate way. It includes both internal and external environment assessment. For the travel and tourism company they need to focus on variety of segments even they are focusing on particular tourism activity. However it is very risky for any business but uniqueness could be supported through marketing strategies. Overall it could be stated that all the marketing strategies are inter linked to each another and must be designed in well organized as well as well systematic manner. Further the study has contributed well in developing the intellect towards the difference between Business 2 business marketing and business to consumer marketing along with international and domestic marketing. It is very crucial as well as significant learning of the study.Risk and challenges are important to children, avoiding these would result in a very timid child/ adult who would lack in everyday skills and abilities and wouldnt be aware of risks and dangers. Children need to explore and take risks to learn and develop the UN Convention on the rights of children stresses on their right of making choices and taking decisions. But they do not always have the skills and judgments to make safe choices. This is where the adults working with children have to strike a balance between the childs right of freedom to make choices and our duty of care to ensure children in our care dont get harmed or injured . For example: A special needs child having physical disability might be restricted in play because of concern that the child could hurt himself whereas the child really wishes to take part in play however in a well controlled environment the child could be encouraged to explore and try out new skills under adult supervision. In my nursery we allow children free flowing take over, respecting their choices and decisions ,allowing them to pick any activity and toy they want to play with yet keeping an eye on them that they take turns, share and do not do anything that could harm themselves and other children. It applies to our out door activities as well we ensure they are appropriately dressed for the weather, they are freely allowed to play with sand, climbing the frame, ride on the bike and cars etc yet on these events the staff is evenly split for childrens safety and care Workforce Injuries In Healthcare Essay Paper Health and Safety job roles and responsibilities Employer responsibilities include informing the health and safety representative or joint health and safety committee of any work-related accidents involving injury, death or occupational illness, and providing the health and safety representative or joint health and safety committee with the results of any reports relating to health and safety in the workplace. Director It is the role of the director to run the business, to interact with the business community and in essence, to seek to make a profit, which is then either reinvested into the business. The law imposes a number of different duties on directors. These are contained in a mixture of common law duties that have evolved over many years of case law e.g. not to prefer the directors own interests over those of the company and shareholders as well as now a number of statutory duties that have been codified in the Companies Act 2006. Directors of all types of organisations in both the private and public sectors, have responsibilities for ensuring that health and safety risks arising from their organisations activities are properly managed.Workforce Injuries In Healthcare Essay Paper Effective directors input of health and safety risks will help: * maximise the well-being and productivity of all people working for an organisation * stop people getting injured, ill or killed through work activities * Improve the organisations reputation in the eyes of customers, competitors, suppliers, other stakeholders and the wider community. Management As an employer you must comply with certain legal responsibilities. Strong and active health and safety leadership is important for three main reasons: * protecting the health and safety of employees or members of the public who may be affected by your business activities * identifying health and safety as a key business risk * complying with health and safety legislation duties Workforce Injuries In Healthcare Essay Paper The results of risk assessment are very much positive in informing the people towards the care of people and patients. The risk assessment help in making the familiarity with possible risks available into the health and social care settings and most importantly its reflections could be experienced upon decision making process as well. If the risk assessment is not so proper then the policies related to health and safety could never be implemented or designed in proper way. The systems and procedures could also become lead towards the familiar as the business entity is actually not familiar to their real problem and issues. The risk assessment process has main advantage related to the fact that it enables an organization to identify the problems and issues which they are facing currently. The weak aspects and errors in the health and safety measures could also come into notification. The risk assessment process also provides the facility to compare the actual standards with the current standard and through comparative analysis the improvements could be introduced. The planning process could be improved as it enables an organization to get hold on their review and monitoring process as well. The major contribution is that the areas of concern and possible risks could be assessed in painstaking manner and huge level of security measures could comes into existence. The guidelines could also be identified in an appropriate and effective manner by the company. With the help of those guidelines the equipments and machineries could be installed accurately. The international standards could be followed as risk assessment process indicates towards following all the internationally set benchmarks. The changes into the existing policies could also be facilitated if the existing policies are not compatible to set guidelines. The decision could be effective and result oriented and most importantly could benefit all the people associated to the health and social care organization. The safety of people could be ensured through risk assessment but it should be done in honest and effective way, it is the only requirement of getting the right results from risk assessment process (Boden, Hall, Levenstein & Punnett, 1984). Thus in this the planning could be improved at very large scale through these risk assessment practices and every kind of health care unit could undertake this process and avail the positive consequences.Workforce Injuries In Healthcare Essay Paper Numerous initiatives launched by international, governmental and non-governmental organizations are making the concept of human security recognizable and are entrenching it firmly into public policies. These policies shape society and lives in order to achieve the highest possible level of safety, security and personal dignity. Human security is increasingly being adopted as a doctrine to guide foreign policies and international development assistance, as well as a policy tool for planning in the fields of security, development and humanitarian work.Workforce Injuries In Healthcare Essay Paper To define human security policies, we could use two terms policy and politics . The term policy would refer to decision making activities in the public sphere which are important to the community. Using the term politics, would limit the interpretation to advocating the interests of a community. It is important to note the key differences between traditional security policy and human security policy. Human security approaches and policies focus on the physical and material safety and dignity of people globally , and not on the military and strategic interests of individual states , which is the case with traditional security policies. Defending human life is more important than defending states and personal integrity is just as important as territorial integrity.Workforce Injuries In Healthcare Essay Paper Wars between states are still a major global problem, and together with civil wars (intra-state conflicts), pose major threats to human security around the globe. Use of threat and force has not been reduced in international policies as the war in Syria shows. Additionally, human security is also increasingly threatened by disasters, state collapse and widespread human right abuses. As human life and its protection is always the highest priority for people, human security policies place an emphasis on addressing a wide range of threats, on prevention, and lived experiences and a bottom-up approach rather than a focus on territory and elite agendas as in classic security. From the perspective of human security peace always comes before war , incentive for cooperation before armed conflict, and transparency and factual reporting on military operations should replace secrecy and propaganda when providing information.Workforce Injuries In Healthcare Essay Paper Human security policies involve a much wider spectrum of actors who need to contribute to security . While military and police forces are the principal guarantee of security in the traditional approach, for human security policies, civil society is an important actor as well. Civil society, among other things, plays a part in arms control and may help bring about disarmament, as seen in disarmament programs goods for weapons in Central America, Eastern Europe and Africa, under the auspices of local non-governmental groups. Civil society plays a key role in promoting compliance with national laws, and in verification of international treaties (this is the case, for example, with conventions on the prohibition of the use of landmines), in generating information and a bottom up perspective and in improving the legitimacy and sustainability of policy responses.Workforce Injuries In Healthcare Essay Paper The importance of human security policies is also reflected in seeking to bring together security and development . The development of a community plays an important role in supporting disarmament, removing incentives for violence and criminalised economy, and when striving for security of a community, development is considered at the same time, as a way of ensuring peace. Conflict can be seen as development in reverse. Threats to human security are interconnected and often produce a domino effect. For example, violent conflicts often arise out of mar
NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper
NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the units size, its complexity and the differentiation of the service provided.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper A cardiology department, a hydrodynamic unit or an neurophysiologys unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Permalink: https://nursingpaperessays.com/ nurs-6241-strate ions-essay-paper / Strategic Planning in the Healthcare Industry Over the last 10 years we have seen a tremendous change in the healthcare industry. Whether it is a shift in philosophy to focus on more value-based care or navigating the impact of implementing the Affordable Care Act here in the United States, significant shifts and changes have occurred and are occurring every day. Given the relative unpredictability of how the healthcare market will change, is there really any use for those in the industry to go through a strategic planning initiative? The answer is of course yes, but the real question is how?NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper To be successful in the future, no matter how turbulent the path forward may be, organizations need to create a vision based on the best future assumptions they can identify. With any strategic planning effort is it really important to have at its foundation key assumptions about how the world will be different. Organizations then can describe what they need to look like given those future assumptions, and then design a strategy to help them bridge the gap between where they are today and achieving that future success. But if all our assumptions of the future are up in the air, then how can we really build a strategy effectively?NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper I would argue that in industries that are experiencing a lot of change it is even more important to be strategic! Yes, there are many unknowns given the relative volatility of the US political landscape as it pertains to healthcare. But there are some key assumptions that can be made that are relative certainties regardless of any potential future political or regulatory shifts? If we can identify those most probable assumptions in the healthcare industry or in our particular marketplace, then it would be worth our time to identify them and begin building our response strategies accordingly. I would like to present the follow set of ideas as examples of assumptions that most participants in the healthcare sector need to consider over the next five years and could be the basis for strategic discussion. These are not meant to be all inclusive, but merely to demonstrate that there are fundamental assumptions that can be identified even in a marketplace where significant uncertainty exists.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper The need to provide ever increasing quality patient care will continue. The focus over the next five years will continue to be on delivering highly impactful, cost-effective healthcare. Whether it is driven by key stakeholder requirements or customer expectations, we know that successful players in the healthcare industry will be those that can generate healthy outcomes for their patients. Fundamentalist having strategies built around improved effectiveness and efficiency in delivering quality patient care will be a fundamental requirement in the future. No real surprises but any strategic discussion in the healthcare sector must begin with patient care! The point is that the ability to differentiate regarding healthcare outcomes will be the bases for any future success in the industry.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Changing in customer volume and demographics will continue. The fact is that the US population is going to continue to grow over the next five years. In May of 2017, the US passed the 325 million mark and is expected to be over 332 million by 2020 (US Census data). That means essentially there will be more people needing care in the future with some healthcare markets seeing fairly dramatic increases in patient populations. We have seen a significant impact in demographic shifts in the US over the last five years and this trend will continue over the next five years as the increases in Hispanic and Asian demographic groups continues at a high rate. How will these assumptions impact capacity requirements or service delivery requirements within the healthcare sector? Labor supply changes. The US has seen labor supply grow by 2.6 percent per year over the last decade, but that trend will not continue. Rand researchers (Karoly & Panis, 2004) have postulated that the growth of labor supply will only be around .04 percent over the next decade and will be even smaller the following decade.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Also, while the trend has been a more aging workforce over the last 20 years this will also change with the workforce being more evenly balanced across age groups in the future. How will this impact the availability of skill workers and experience levels in the healthcare industry? What does this mean for how we need to recruit and retain of workforce? Continued increase on wellness and prevention. Significant increase in innovation with regard to nutrition for example will be driven by increase consumer demand for wellness. Patients are sharing that they want advice on weight management and diet therapies (PwC Health Research Institute, 2016) for example leading to increased focus on these services within the industry. Smoking cessation and fitness programs are other programs that are already tied to health outcomes and will continue to be important in the future. How will this trend impact the future services healthcare practitioners will provide? Or the information they make available to their patients?NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Emerging technologies in the healthcare marketplace. PWC reports that the US health industry lags behind other industries, such as retail and telecommunications, in deploying emerging technologies, including artificial intelligence, drones and virtual reality but that this trend is about to change. (PwC Health Research Institute, 2016). Accenture reports that the global healthcare industry in the year 2020 will be a highly connected environment powered by large data networks, cloud computing, and mobile devices. There will be widespread increases in the number of connected healthcare networks providing seamless integration between care providers, patients, pharmaceutical companies, health insurers, and other invested parties anywhere in the world. Care within this model will become more patient-eccentric, less expensive to provide, and more innovative. (Meissner, 2013). These assumptions would call for a need to invest in breakthrough technologies that impact how patient care is provided and operational business processes are managed moving forward. This will also impact the types of skills needed in the future within the industry.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Rising operating costs driven by government regulations and expanded capacity requirements will impact the financial viability of healthcare systems (Jonash & Ronanki, 2015). Healthcare CEOs and COOs must find innovative was to drive revenue and decrease costs. How will rising costs impact the future viability of healthcare providers? How must they change how they do business? In what areas must they innovate to reduce costs? I share these discussion points as merely a sampling of assumptions that could be discussed by healthcare industry players in formulating their 3-5-year strategies. With proper research conducted, there are dozens of additional assumptions that we could discuss to really understand the future of the healthcare industry. I provide these few ideas as evidence that even in an industry that is experiencing rapid, constant change, there is a need to really understand how the world will be different in the future. To do so, we must first understand what assumptions can be made and set out to use a strategic planning framework to understand how our healthcare organization must transform in the future in the face of those assumptions. Once we are able to articulate that future successful state, we can then work to understand what must be accomplished to get from where we are today to achieving the needed transformation that must take place in the next few years our strategy becomes the path and the plan to future success. NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Strategic planning is a process by which we determine the answers to two questions and then craft a plan to achieve desires results. The two questions are: How much? By when? These questions are generally framed as goals and objectives, while the action plan that supports these two questions is called strategies and tactics. Oftentimes, the strategic plan is divided into strategic themes also called areas of focus, pillars of excellence or some similar terms which is how Harvard Medical School approached its planning process. Emory University followed a similar model, identifying five strategic themes on which to develop its 10-year plan.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Regardless of the methodology used, it is vital that the organization establish concrete definitions for the strategic planning process itself. At a minimum, goals, objectives, strategies and tactics should all have specific definitions that are agreed upon by every person on the strategic planning team, similar to those established at the California State University at Fresno. Goals provide the organization long-term focus, while objectives provide the quantitative measurements for achieving the goals. Strategies and tactics are those things we implement on a week-to-week and day-to-day basis that we believe have the best chance of achieving the objectives. The University of Illinois adopted four long-term goals aimed at making the university one of the premier institutions of higher learning in the country.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper In order to create a relevant and timely strategic plan, the organization must first collect and disseminate information that provides a conceptual framework to help understand current conditions. Michigan State University does this by focusing on: Internal operational constraints; The external environment and the realities it imposes; The organizations intentions and priorities; and The organizations sense of direction. The key to any strategic plan is to first answer the two important questions of how much, by when, and identify baselines and targets for each of its strategic plan objectives. Without measurable and quantifiable strategic plan objectives, the planning process remains largely unfocused, with real results weak or non-existent.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Set a long-term vision through goals, identify strong objectives to measure progress toward the goals and then create actionable strategies and tactics that will move the objectives toward the desired results. That is the fundamental definition of strategic planning. Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the units size, its complexity, and the differentiation of the service provided. A cardiology department, a hydrodynamic unit, or an neurophysiologys unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium, and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper The 5 Stages of Strategic Health Care Planning Strategic planning is a proven resource for enabling health care organizations to navigate an environment that evolves continually. It allows organizational leaders to clearly identify and communicate organizational objectives. [1] Health care administrators often fill the strategic plan leader role for care provider organizations. The following article details the basics of the most common strategic planning technique known to organizational leaders -SWOT analysis which stands for: Strengths Weaknesses Opportunities Threats When executed correctly, strategic planning results in an ongoing process of discovery and improvement. Analyzing the External Environment Strategic plan leaders begin a SWOT analysis external evaluation by segmenting patients into groups relevant to organizational objectives. [3] Next, they identify and record characteristics that differentiate competing health care organizations while noting how their own organization compare to these groups. Providers are the next important influence that plan leaders analyze when evaluating external influences. The final external factor is the objectives of the organization owner such as an individual, enterprise, or government agency. For example, a retail organization might start with geographical competitors, a global enterprise with changing political environments, and a government agency may begin with a review of current public needs.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Analyzing the Internal Environment During this phase, plan leaders evaluate resources that stakeholders can change such as budgets and contractual agreements. They must also assess the organizations legal environment during this phase. Other entities, such as unions and organizational decision makers, also represent important groups that plan leaders must evaluate. Finally, strategic plan leaders must assess processes related to clinical services and how these factors contribute to quality of service and patient outcomes. The SWOT Matrix During this stage of planning, the plan leader and the designated strategic planning group have developed several opportunities for improvement and move SWOT analysis. The evaluation team now examines the internal strengths and weaknesses as well as external opportunities and threats, categorizing the internal and external influences into one of four SWOT matrices labeled strengths, weaknesses, opportunities or threats. With external factors such as economic, technological, or legislative influences organizations must exploit opportunities and protect themselves from threats. For internal influences, decision makers develop strategic plans to mitigate weaknesses and nurture and grow strengths in order to maximize organizational performance. Plan leaders also delineate the importance of each influence by ranking results as high, medium, or low importance, rankings that the organization later uses to decide which strategies to pursue.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Strategic Alternatives During the fourth phase, the strategic planning team formally records alternative actions into a document without regard for whether the idea is viable. The strategic planning steering committee then classifies the alternative actions into defined action groups. Now group participants refine and vet the suggestions while narrowing down the scope of activities to realistic undertakings. During this stage, the steering committee identifies and discards the suggestions that do not meet organizational objectives or fall outside the scope of possibility. When this phase ends, the steering committee will have identified a maximum of 20 action items as potentially viable options for strategic action. Strategic Areas and Objectives Ideally, the team should have settled on 5 to 6 strategic areas to focus on over the next several years by now, making sure not to exceed ten improvement areas in total. Spreading organizational resources too thin will result in poor outcomes for all strategic activities.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper An activity must remain open to intervention for the entire duration of the plan, and the team should identify no more than 5 objectives for each area. Finally, the team must name the strategic area using generic terminology that does not influence activities one way or the other. For example, the team might name an area Performance rather than Performance Improvement, because Performance can include Performance Improvement as well as other objectives. A Successful SWOT Case Study In 2011, the Rush University Medical Center wanted to improve its ability to manage incoming patients. [3] At the time, the facility managed beds by manually tracking inventory with clipboards, which greatly limited the amount of patients that could check in each day. The organization opted to expand on an internal strength (the TeleTracking patient flow software that the facility already utilized for transfers) by expanding the technology to manage bed occupancy. After initiating this strategic action, the medical center experienced a transfer volume increase from 1,200 to 4,000 patients per year and a $53-million-dollar increase in revenue.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper There are some planning initiatives overreach so far that activities start to spiral out of control. [2] When this occurs, health care administrators keep strategic planning initiatives on track. It is critical that administrators recognize the difference between being agile and flopping when faced with this challenge. Flopping involves making random changes and hoping for positive outcomes, where agility is making an alternative decision based on experience and forward thinking. It is inevitable that strategic plans will meet with some troubles, but this is when the best and brightest health care administrators display their merit by leading organizations out of troubled waters. Best Practices for Creating a Hospital Strategic Plan in Uncertain Times I came across this article the other day on Becker Hospital Review and thought it would be a great one to share for those in the medical field who are in the strategic planning process. James R. Trimarchi, director of strategic planning at Southwestern Vermont Medical Center in Bennington, explains what he believes are the 5 best practices for creating a hospital strategic plan in uncertain times.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper Healthcare reform legislation has increased demands concerning quality, cost and efficiency of hospitals and health systems. One way to manage these expectations is to create a strategic plan that clearly outlines goals for the future and how to reach them. Strategic planning is more important now than its ever been, says James R. Trimarchi, director of strategic planning at Southwestern Vermont Medical Center in Bennington. Although strategic planning can help hospitals manage changes from new rules and regulations, it presents its own challenges. Strategic planning works best when the marketplace is either in a stable trajectory or a known trajectory. The current healthcare environment is neither, Mr. Trimarchi says. However, practices like frequent evaluation can help combat the uncertain future. Mr. Trimarchi offers five tips for creating a strategic plan in todays world. 1. Follow the strategic plan anatomy. The strategic plan establishes several strategies that help focus resources to better achieve mid-range goals that support the organizations mission and vision. A strategic plan has a cascading anatomy. The mission and vision serve as the touch stone and rarely change. Goals are three- to five-year targets that if achieved would move the organization towards its mission and vision. Strategies are specific actionable approaches. Measures monitor progress towards the goals and are the tool used to determine if particular strategies are working. If a measure indicates a strategy is not effectively moving the organization towards its goals, then the strategy should be discontinued and a different strategy should be launched. Adhering to this cascading anatomy (mission, vision, goals and strategies tracked by measures) helps hospitals avoid drifting away from the core mission and vision in uncertain times yet allows organizations to remain flexible enough to respond to changes in regulations and the marketplace by reallocating resources, Mr. Trimarchi says.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper 2. Push strategies close to the mission and vision. The larger the separation between strategies and the core mission and vision the more regulatory or marketplace changes can disrupt the relevance of the strategic plan. Choosing strategies closely linked to the mission and vision introduces a level of certainty to an otherwise vague future. 3. Focus on a few goals. Following the less is more philosophy is key to forming a successful strategic plan, according to Mr. Trimarchi. If the plan includes too many goals, not only can you not keep them straight, but you dilute resources, he says. Instead of a list of 20 goals, Mr. Trimarchi suggests concentrating on the top five to six concerns. Hospitals can then reallocate resources to support and achieve the most important goals. 4. Be realistic. Identifying the doable is essential to strategic plans. Keeping goals and strategies realistic will help hospitals make real improvements in the organization, whereas spending time on impractical goals will stifle hospitals progress. A common mistake people make when forming a strategic plan is including strategies or goals that are too grandiose without enough capital or resources to accomplish them Mr. Trimarchi says. Identifying feasible strategies may be particularly challenging in the current environment. Ascertaining the doable is somewhat dependent upon your ability to predict the future, Mr. Trimarchi says. He suggests leaders honestly ask themselves whether they can actually implement a strategy to help ascertain whether a strategy is realistic.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper 5. Develop really good measures. One of the most important elements of an effective strategic plan is developing measures to monitor progress made towards the goals. Depending on what the measures show, hospitals may have to alter strategies to better reach their goals. It is so important today to have really good measures to monitor where youre going because the environment is changing so fast and you may need to change strategies, Mr. Trimarchi says.Mr. Trimarchi describes a measure Southwestern Vermont Medical Center used to assess progress in its goal of reducing CT scan utilization. SVMC wanted to lower CT use per patient because of the harmful effects of radiation. Simultaneously, however, the hospital was trying to open a new market. If the hospital measured the overall volume of CT scans, the numbers would show an increase because of additional patients from the new market. Instead, SVMC tracked the number of CT scans for patients from a particular zip code in the original market. This technique more accurately measured progress towards the goal of reducing CT scan utilization because it reflected CT use per person within a defined geography. As the overall use of CT scans increased due to an expanding market, the CT scans per zip code decreased, suggesting lower usage per person. This example demonstrates the complexity of thinking required to develop useful strategic measures. The rate at which hospitals should measure progress depends in part on how fast hospitals anticipate meeting their goals, according to Mr. Trimarchi. A short-term goal will require more frequent tracking and evaluation of measures, such as monthly, whereas long-term goals can be reviewed quarterly. Regardless of the frequency of review the question that should be answered is Are we making progress or do we need to change the strategies? Mr. Trimarchi says. Adhering to these five basic practices can help hospitals develop a strategic plan that is focused, effective and flexible. By leveraging measures to continually evaluate progress towards the goals the strategic plan becomes a living document that can guide an institution through uncertain times.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper strategies for hospital financial planning in an era of value, consumerism and growing drug costs As hospitals more fully embrace value-based care and as patients begin to shoulder more of their own healthcare costs, traditional financial planning strategies may no longer hold. In a panel discussion at Beckers 5th Annual CEO + CFO Round table in Chicago, four financial leaders and experts from the healthcare industry discussed these trends and how they have adjusted their approaches to financial planning. Panelists included Janice James, co-founder and managing partner of Prism Healthcare Partners, Lisa Carlson, interim CFO of Chilliness, Ohio-based Adena Health System, Dennis Hesch, executive vice president and CFO of Urban-Ill.-based Carlie Health System, and Stan Frazier, vice president of solution engineering at Relay Health. Here are five takeaways from the discussion. 1. Focus on quality and cost improvements will follow. At this point, every hospital needs to be invested in some way in driving quality improvements. There is a cost to quality that no one can afford not to take on, Mr. Frazier said. A focus on care standardization and providing value for patients can help drive down costs, too. Its very important we focus on clinical quality as we move forward, and this will inevitability going to lead to discussions about cost control, Ms. James said.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper 2. Dont isolate financial planning. Most of my time in healthcare you could do the accountant-in-a-dark-closet approach to financial planning and make some reasonable assumptions; know what investments are required for the status quo, Ms. Carlson said. Now these assumptions need to be re based for the new healthcare environment, she said. Every healthcare organization is at a different point on the journey to value-based care, and sometimes departments within an organization have made varying levels of progress. Financial planning can no longer be in those three- to five-year plan ranges, Mr. Hesch said. It requires continual moderating.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper 3. Adjust revenue cycle management for the new payer patients. Increasing out-of-pocket costs and the rise of high-deductible health plans means patients are writing their own checks. You used to deal with 15 or 20 payers. Now you are dealing with hundreds of thousands of patients. Its much more complicated and much more labor intensive. Mr. Hesch said. Revenue cycle processes need to be sophisticated to collect from patients with any success. Mr. Frazier suggested investing in eligibility and estimation products that help pinpoint a patients propensity to pay so providers can tailor revenue cycle strategies and efforts effectively. 4. Invest in experts to get the most out of your data. Data analytics is the biggest place everybody is looking to capture and drive improvement, Mr. Hesch said. But, he added, You need actionable data at the right time to affect change. Many organizations are doing a great job collecting data, but not-so-great a job of interpreting it. This means more providers are investing in data scientists and experts who can really dive in and make data useful for their organizations. 5. Bring pharmacy in house to help control drug cost increases. Pharmaceutical cost is one of those areas that is really escalating across the country, Mr. Hesch said. When you are taking on risk, its hard to control [drug costs]. You can see huge swings year to year. To help offset this swing, he said his organization brought pharmacy in-house to grow overall profitability on the drugs they prescribe and to better understand costs at a manufacturing level for prescriptions.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper How Hospitals Should Approach Financial Planning in Changing Times The basic tenets of financial planning by hospital and care system leaders remain the same, but the status quo is no longer the baseline. Evolving reimbursement models, physician alignment, exposure to health insurance exchanges, emerging retail initiatives all of these developments, and more on the horizon, necessitate a continuous strategic financial planning process that is integrated, disciplined and supported by analytics. The American Hospital Associations Hospitals in Pursuit of Excellence team collaborated with Kaufman, Hall & Associates to provide step-by-step advice on the financial planning process and how it can help hospitals and care systems to plan for value-based care and payment. Navigating the Gap Between Volume and Value: Assessing the Financial Impact of Proposed Health Care Initiatives and Reform-related Changes was written by Jason H. Suss man, managing director, Kaufman Hall, and Brian R. Kelly, executive vice president and chief financial officer, Excels Health. According to Suss man, Whats important now is building financial projections that reflect reality that are not aspirational but operational. It is important to follow a time-honored, fundamental financial planning principle: Cash flow must be sufficient to meet the strategic capital needs of the organization, within an acceptable risk tolerance. To provide high-value care, an organization must (1) establish parameters of financial performance, (2) balance sources and uses of capital, (3) estimate a future financial trajectory, and (4) assess how changes to key assumptions will affect its financial position. Sound projections are integral to developing a realistic financial outlook, including setting goals and performance targets to keep the organization within its corridor of control that is, balancing its strategic requirements and capital capabilities, while protecting its long-term financial integrity. This balance drives financial support for the organizations strategic direction.NURS 6241 Strategic Planning in Healthcare Organizations Essay Paper ORDER HERE Baseline projections typically reveal sizable performance gaps relative to an organizations strategic capital requirements, according to Suss man and Kelly. Working from a realistic baseline plan, leaders must incrementally test the impact of major strategies or changes on the organizations ability to bridge the gap between projected results and targeted performance goals. Strategic cost-management, focused on achieving efficiency, historically has been a mainstay of operational efforts. Suss man advises that hospital and care system leaders move beyond strategic cost-management toward strategic cost-transformation. Trustees and senior executives should ask: Are we doing the right things? Providing the right services? Are we using the right venues and the right providers? Can we sustain these over the long haul? To continue meeting community health care n
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