...allows nurses to establish a baseline for the patient, determine oxygen supply and demand, make sound clinical decisions, and promote personalized care (House-Kokan, 2012). Components of a comprehensive assessment include the patient’s story, a physical assessment, and corroborative diagnostic data (House-Kokan, 2012). A comprehensive assessment for both patients in the case study will be presented. Patient’s Story The first patient was not a patient on our assignment for the day. He was a patient we found lying on the floor after we heard a loud thud and crash from across the hall, and we initially knew very little about the patient. We learn from another nurse that the patient is post-op day 2 following an amputation of his right great toe secondary to gangrene and should not have been out of bed. Immediately following the fall the patient was alert and oriented...
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...and require care of the nursing professionals, who received extensive specialized training. Although not all patients survive and regain functional recovery, the life testimony of those, who do, marks a long-lasting imprint in the memory of care providers. So did the story of Mrs. X. who I met last winter. Like many of her counterparts, Mrs. X. developed respiratory distress, failed mechanical ventilation, and was emergently transferred to the PPMC for ECMO management. Due to the body habitus and difficult airway, Mrs. X. underwent a bedside tracheotomy procedure shortly after her admission....
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...Shanti Care Plan Strategies: Shanti Shanti’s story describes the death and dying process of a 63 year old Indian woman with breast cancer and metastasis. She had lived in the United States for 32 years and both her and her family still strictly followed their Hindu beliefs and traditions. Shanti knew she was ill but not her diagnosis or prognosis. She was in constant pain and suffered from anorexia, weight loss, and digestive problems. Her religious and cultural beliefs were that all that happened in this life was the result of her past life and that her next life would be determined by her actions in this life. To Shanti the pain she was suffering was given to her by the gods and relief from her pain would produce bad karma and result in negative consequences in her next life (Gefland, Raspa, & Briller, 2005, pp 177-178). Because of her beliefs Shanti and her family had chosen not to know her diagnosis or prognosis which created multiple dilemmas in planning hospice care for the patient. After consulting their legal team and ethics committee hospice was able to honor the patient’s wishes and provide services. For the purpose of this paper the author with describe a care plan developed for the care of Shanti that respects the patient’s cultural and religious beliefs but still provides quality care. The care plan includes communication between staff, the patient, and family, treatments that align with the patient’s cultural and spiritual beliefs, family involvement...
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...treatment successful? • If treatment was successful, how long ago did this occur? Dr. Miller explains that people change with time even if they feel the same. For example, untreated endometriosis can prevent an embryo from implanting in the uterus. Additionally, age can impact fertility. A healthy woman who had no trouble conceiving at 34, may experience secondary infertility at 36 because her eggs are two years older. During the infertility consultation, Dr. Miller spends considerable time exploring the patient’s menstrual history. She will ask the following questions: • Does the patient have disabling menstrual pain? If so, has it gotten better, worse, or remained the same over time? • What is the pattern, if any of this pain? • Has the patient’s menstrual flow changed over time, becoming heavier or lighter? • What is the cycle length, and has it changed from what is used to be? These inquiries are only examples of the many questions whose answers build the patient’s unique medical and reproductive...
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...I have nothing to live for.” Helen spoke softly. A bright and articulate woman at 86, this was the first time in 20 years that I had heard these words from her. She suffered from chronic osteoarthritic pain in her joints, and fatigue and dizziness related to difficult-to-control congestive heart failure. Her nonsteroidal anti-inflammatory drugs had been withdrawn because of heart failure and her cardiac medications resulted in symptomatic hypotension. Her medication regimen involved a delicate trade-off between effective treatment and adverse effects. “I can no longer travel. I can hardly walk. My kids are grown and have moved away. They don't need me any more. I sometimes wonder why we are trying so hard to keep me around. My life has no purpose, no meaning.” Helen looked away tearfully. Silence. My resident Lisa appeared uncomfortable. “Yes you do! You have purpose,” Lisa chirped. “Tell Dr. Lee what's happening this afternoon! Who's coming this afternoon?” Helen smiled. “My newest grandchild from Denmark. My son will be visiting this afternoon.” She paused. “I do look forward to holding him. But … they don't need me. All my life I've cared for others. I can't do that anymore.” Lisa's words reminded me of some of my own, perhaps 20 years ago. I can well remember the discomfort of wanting to fix problems for which there were no fixable solutions, of wanting to provide comfort to the suffering patient but not knowing the “right” words to use. Those awkward periods of silence...
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... 2007 volume 22, issue 13, pages 42-48, written by Hilary Lloyd and Stephen Craig. In this article, Lloyd and Craig provide an overview of taking a patient’s history related to nursing. There are certain questions that should be asked and this article outlines what to ask and how to ask it. This article also provides a great overview of cardinal symptoms for each system in the body and several methods for taking a comprehensive history. Summary Taking a successful history includes preparing the environment and effective communication skills. This is “arguably the most important part of patient assessment” (Lloyd & Craig, 2007, p. 42). In the process, patients are able to present vital information about their problem in their own words. To explore a decline in a patient’s health requires a very careful evaluation of patient needs. Allowing adequate time is essential to complete the history and avoid receiving incomplete information. The environment should be assessed first for the safety of both the patient and nurse, have no distractions, be quiet, have the right equipment and be conducted in a private setting in order to maintain patient confidentiality. Cultural consideration is important to taking the history. The assessment must be conducted with respect for the patient, an approach that requires that the patient’s beliefs and values be considered, the nurse avoid being judgmental, and remain professional. It is also very important to assess health beliefs and practices...
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...how your ideas can be useful and compatible with today’s cancer treatment. We liked how you kept everything positive for the patient. One of your best examples of having a positive voice was the story of Harold. He was refusing treatment and didn’t want to live because he was afraid of becoming old and senile like his father. You convinced him that if he could take control of his own life and death, then he didn’t have to become this way. With this encouragement, he was able to accept treatment and live the way he wanted to (p. 23). This is great for cancer patients to hear, as many of them are depressed and just want to give up. It’s great the way you find something important in their lives, capitalize on it, and have the patient use that as their motivation to get better. This can be practical for the people who will be reading this article. We strongly agree with the way you explained how a doctor should be honest with a patient, without being brutally honest with them. This forms a great doctor-patient relationship, which (as you know) is vital for patient success. This will help the patient believe that what the doctor is doing for him is actually what’s best for him. You explain that when a doctor accepts their patient’s views (though not always agreeing with them), the patient’s belief toward the treatment they are...
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...contact us at: SUPPORT@WISEAMERICAN.US HLT 324V WEEK 4 COMPLETE LATEST HLT 324V Week 4 Discussion 1 Describe the spectrum of death and dying rituals and practices. Why are death and dying rituals so significant? HLT 324V Week 4 Discussion 2 What death and dying practices are contrary to your personal beliefs or chosen religious values? How will you support a patient’s death and dying rituals and practices, and still honor your own? HLT 324V Week 4 Case Study: Through the Eyes of the Patient and the Health Care Professional Topic: Spiritual and Cultural Emphases on Death and Dying Allied health professionals are confronted with different death and dying practices. An effective allied health professional recognizes the importance of understanding different cultural practices, and learns how to evaluate the death, dying, and spiritual beliefs and practices across the cultures. Read the two specified case histories and choose one for this assignment. Chapter 4, “Stories of Abby: An Ojibwa Journey” and Chapter 14, “Stories of Shanti: Culture and Karma,” by Gelfland, Raspa, and Sherylyn, from End-of-Life Stories: Crossing Disciplinary Boundaries (2005), available in the GCU Library: http://library.gcu.edu:2048/login?url=http://site.ebrary.com/lib/grandcanyon/Doc?id=10265487 Identify your role as a health care professional in supporting Abby or Shanti’s dying rituals, and in creating strategies for displaying respect while still providing quality care. Integrate your strategies...
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...his father Jonathon calls on the assistance of their family doctor. He is not without doubt and has the doctor make a special visit to the farm and makes the doctor promise not make any medical records of any kind, not even labels for the blood that she draws from Clark. While this is all taking place, a darker character named Lex Luther is trying to find out everything that he can about the meteor’s, especially the Kent’s unexplained connection. Analysis: The ethical issue in question is not something complex or supernatural as the story and character of Superman, but it does give a fresh look at the medical professional/ patient relationship that must respected and followed. The doctor in the episode was burdened with responsibility to keep her patient’s medical records and identity confidential—no matter what. However, things are not always that simple. One could argue that as medical professionals that we must honor whatever our patient’s share with us in complete confidentiality. In this...
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...2013 Introduction “A guide to taking a patient’s history” is an article which was written by Hiliary Lloyd and Stephen Craig, published in volume 22, issue 13, of Nursing Standard in December 2007. Lloyd and Craig describe the process of taking a health history and explain how environment and other factors affect the accuracy of the health history obtained. This article provides different methods to taking a comprehensive history and the order in which to do so. Summary of the Article Taking a patient’s health history is an integral of patient assessment and it is important that nurses hone their assessment skills while expanding their role as a nurse. Before a health assessment is taking the nurse must first have informed consent from the patient. While taking a health history it is important to choose the right environment, free from distractions if possible and safe for the patient and nurse. The nurse should convey respect for the patient as a person and maintain a level of privacy and dignity. Good communication skills are essential; the nurse must introduce herself to the patient, develop a rapport with the client by being professional, friendly and show interest by actively listening to the patient, the patient should not feel rushed or hurried. Nurses should refrain from using medical jargon when possible and utilize verbal and non-verbal communication skills. It is important to consider culture when taking a patient’s health history. Perform a cultural assessment...
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...and its public.” (Watson, 1999) Concepts: • Carative factors (evolving toward "Clinical Caritas Processes") • Transpersonal Caring Relationship • Caring Moment/Caring Occasion Jean Watson’s 10 carative factors that can be used as a guideline to help nursing interventions. These carative factors provide a framework that aids the nurse to pay attention to the caring processes. 1. Embrace altruistic values and practice loving kindness with self and others. 2. Instill faith and hope and honor others. 3. Be sensitive to self and others by nurturing individual beliefs and practices. 4. Develop helping – trusting- caring relationships. 5. Promote and accept positive and negative feelings as you authentically listen to another’s story. 6. Use creative scientific problem-solving methods for caring decision making. 7. Share teaching and learning that addresses the individual needs and comprehension styles. 8. Create a healing environment for the physical and spiritual self which respects human dignity. 9. Assist with basic physical, emotional,...
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...Joyce Chen Aaron Lay ENC 1101 12 August 2013 Killing Them Softly Death is an ineluctable phenomenon, but it can be quick, possibly painless, or one can bear insufferable pain. It is stated in the Hippocratic Oath, “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a pessary to cause an abortion” (United States). A physician should uphold his or her duty to save a person’s life, even though that person may be in immense amount of pain and rather die. This is where the debate over legalizing euthanasia comes in. Euthanasia and physician-assisted suicide are very similar, however, dissimilar at the same time. In all technicality, physician-assisted suicide is the active form of euthanasia, and it gained popularity after the largely controversial case of Dr. Jack Kevorkian. Comprehending the basic knowledge of euthanasia and its history will help one to understand why euthanasia is not such an unacceptable practice, but also why legalizing euthanasia can benefit many people. Euthanasia is derived from “the Greek word for ‘good death’” (Terri). This “may imply that the Greeks and Romans who coined the term agreed on the basic issues [of euthanasia although,] history shows on us that this is not the case” (McDougall 3). Until Christianity came about, if the person is suffering from immense pain and/or the quality of life is futile, a physician’s duty to kill was equated to the duty to heal. Unfortunately, euthanasia...
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...their own kind individualized care. This allows the patient to feels safe, secure, and comfortable with their particular surroundings. It is important to give this sense of security to the patient because it will allow him to respond to their treatment or medication more effectively. Additionally, it can allow them to feel good about their selves. Another advantage is the development between the doctor and patient. One way of doing this is by using active listening skills. “This means hearing every word, noting the emotion behind the word, hearing the tone of voice, observing facial expressions, dress, posture and demeanor, being aware of one’s own emotions and reactions, and being able to follow the patient’s story plus the unspoken story, the subtheme, that underlies the story” (Branch, 2014, p.3.) This helps to add to their safe, secure, and comfortable feelings. Individuals like to be heard, remembered, understood, and have relations with their particular physician. A difference in one’s culture could alter effective communication and understanding them would allow them for more appreciation for the doctor. Thus, the patient is more likely to follow the doctor’s instructions. However, there are barriers and challenges that may occur during the implementation of the individual-focused care in nursing homes. One of these barriers may include one’s religion. It is vital for the patient to have their religion or lack thereof, respected. One may be treated differently according...
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...care providers face ethical dilemma on a daily basis. The ethical dilemma presented in this paper is whether to respect a patient’s autonomy not to receive blood and blood products due to her religious belief and compromise standard of care. In the article, An Ethical Dilemma Involving a Dying Patient, the writer addresses ethical issues related to a 20 years old female who is 32 weeks pregnant, involved in an accident and sustained a life threatening injury which required an emergency blood transfusion and surgery in order to save her life and that of her unborn child. Due to her religious faith as a Jehovah witness she and her husband reject blood products and blood transfusion as option. The ethical dilemma “A conflict can be experienced when there is evidence to indicate that a certain acts is morally right and evidence to indicate that the act is morally wrong, but no evidence is conclusive” (Burkhardt, 2008, p. 118.). The ethical dilemma faced by the health care providers in this case is the patient’s decision to refuse blood transfusion in other to stay true to her religious belief, the end result of her decision was death, if she had hearken to the medical plan of care and received blood transfusion, she would have lived but be faced with the guilt of betraying her religious faith. The main ethical dilemma was that by honoring the patient’s autonomy and religious belief, the health care provider was faced with compromising their moral duty / standard of care. ...
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...his patients and family went into it. As Gawande discusses the stories and emotions he shared with these people, he explores the idea of narrative medicine that Rita Charon discusses. Rita Charon is a physician that practices narrative medicine in her practice. In her Ted Talk, “Honoring the stories of illness,” Charon presents the idea that we, as doctors and caregiver, should act as if the patient is more than their illness. Instead of treating just their physical illness, helping them understand and process it, as well as helping their mental health, are just as important....
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