...Analysis: Providing Good Care to Dying Patients: Paper 2 Jaime Holtgrewe Chamberlain College of Nursing NR 449 Evidence Based Practice February 2013 Clinical Question In my group, the focus of research is based on the following clinical question: What are the best practices for end of life care? Within the group, research is driven to focus on enhancing care for end of life patient, including collaboration with physicians and surrogate decision makers or a power of attorney (POA), as well as pain management policies. However, all aspects of care for end of life patients are taken into consideration when determining which facet is most important. The group’s research consists of quantitative and qualitative articles focusing on transitioning to hospice programs, new measures of care, acceptance of death and experience of caregivers for the dying patient. According to the Journal of Health Politics, Policy & Law (2008), three of every four Americans do not fear death as much as they fear being in pain at the time of death. End-of-life care can be a challenge requiring the full range of a family physician's skills. Significant pain is common but is often undertreated despite available medications and technology. Physicians must overcome their own fears about using narcotics and allay similar fears in patients, families and communities. Drugs such as corticosteroids, antidepressants and anticonvulsants can also help to alleviate pain. A considerable amount of research...
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...What is so stressful about caring for dying patients? Trisha Day Grand Canyon University Intro to Nursing Research NRS-433V June Helbig February 27, 2011 What is so stressful about caring for dying patients? Here is an article that can be used as research within our field in which we practice every day. Death is inevitable part of life and a cycle that will never stop. This article deals with how being a nurse can be stressful and tests the limits with death. How much death can one take before it starts to affect their everyday life, or the care of their patients? Nurses are at risk for a great level of stress and burn out. One may ask is it from the round the clock twenty four hour one on one care that they give. Nurses are expected to attend to the humanity needs of medicines than any other health provider (Peterson et al., 2010). A nurse dealing with death on a daily basis could affect them in a negative manner. Inefficient stress management will come to of burn out. The nurse is the primary caregiver which initiates the relationship with the patient. Considering what the duration is of their stay I will be the bond of this relationship. If one has not ever had to care for an end of life patient this could be mentally disturbing. Common clinical stressors are A) watching the patient suffer, B) death of a patient, C) listening to the patient talk about his/her death (Peterson et al., 2010). Nurses are the symbol of wellness, healing and aren’t...
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...Aladdin Come friends, come close. This is the tale of a wonderful man named Al Addin. Al, short for Albert, mind you. This tale is sure to appease any appetite for adventure and, in the process, ignite questions and quench desire for a delightful tale of epic proportions. Now, without further ado, the tale of Al Addin. We start in New York City, America where, if you can make it there, you could make it just anywhere. Thousands of people flood into New York for opportunities in life. The year is 2019. Now, you may be wondering, where’s Al in all this? Well, he’s struck out of luck. Born into poverty, he lived his life working odd end jobs until they could no longer hire him; not because of anything in particular that he had done wrong, simply out of quickly developed annoyance towards his unpredictable character. He fell into the cracks of New York's elite and thus resorted to... ‘other means’ to get by in daily New York City Life. "Stop, thief!" the baker yelled in vexation, rushing out of his store, chasing Al with a rolling pin. As he does so, multiple policemen appear from either side of the street and join him in tailing the thief. The group chase after the poorly dressed lad, who stood 5 foot 10 inches, accompanied by a wildly yapping Pomeranian. He looked constantly alert, calculating, his eyes a deep shade of brown. His skin, usually clear of blemishes, was dirty and looked like it had been weeks since he had had a proper shower, the same amount of grime...
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...The Liverpool Care Pathway: Does it improve the quality of dying? The Liverpool Care Pathway (LCP) is an integrated care pathway developed in the late 1990’s (Ellershaw et al, 1997) as a means of transferring best practice in care of the dying, from the hospice environment to other sectors starting in the acute setting. Currently the LCP is a recognised tool used by clinicians in the United Kingdom as well as over twenty countries, to give appropriate care to patients who have reached the last hours or days of their lives. Described to provide comfort to the dying and also address the needs of the carers (Chapman 2009). During this assignment the author will highlight and explain how a data search was conducted, and will analyse the data retrieved, explaining and evaluating the data to build a discussion based on the chosen topic of end of life care, with a focus on the Liverpool Care Pathway. The author will conclude by producing recommendations for practice. Although described above that the Liverpool Care Pathway is an appropriate tool for providing adequate care for patients, it can also be seen as a controversial pathway, being described as a ‘tick box’ approach rather than a humanistic approach (Chapman 2010). It has been referred to by the UK’s Daily Telegraph as ‘sentenced to death on the National Health Service’ (Devlin 2009). The author has a keen interest in palliative care, after researching is interested in enhancing knowledge surrounding the LCP as there are many...
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...Assisted Suicide: Governmental or Personal Decision? Assisted suicide is a widely argued ethical issue. A lot of the debate on this subject stems from either different viewpoints of when this act is appropriate, or what the resulting consequences would be if such an act were ever permissible. The point mostly debated between opposing sides is life-worth. What constitutes a life worth living and who is to ultimately decide this? The main problem with this question is that suffering cannot be measured unless one is to endure that same suffering themselves. The view that life is a special gift bestowed by God is held highly by many religions and it is of most importance to them when the debate on assisted suicides arises. A gift from God should not be tampered with let alone destructed. Although the number of ethical issues involved is endless this paper will be focusing on three points. The first point engages in the ethics of assisted suicide and will involve the psychologically vulnerable and the elderly. The second ethical issue to be mentioned will be the presence and/or lack of a definition for a terminal illness. The last point is concerned with the human will to power and how this creates a problem should assisted suicide be permissible. These ethical issues, although strong convictions on their own, can lead to slippery slope arguments and must be looked at very carefully. In addition depending on the standpoint that one would take, these arguments have both strengths and...
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...This also creates higher costs for the patient, lower quality, and produces an unsatisfactory patient experience. A study performed by the Midwest Business Group on Health in collaboration with the Juran Institute revealed that 30% of all health care expenses result from poor quality care. In 2009, total health expenditures in the U.S. were $2.5 trillion. This means that $750 billion was the result of poor quality (Ralston & Park, 2011). Care Management Model Based on My Philosophy Case management and clinical pathways are strategies used to manage patient care. Although they use different approaches, both are related. The primary function of a case management program is to enhance the coordination of needed resources for patients and their families. Case managers facilitate access to services, both clinical and non-clinical, by connecting the individuals to resources that support him/her in playing an active role in the self-direction of his/her health care needs. Clinical pathways, on the other hand, are tools and systems. The tool reflects only part of the case management process. Ideally, the plan outlined on the pathway includes patient care interventions and outcomes (Spath, 1994). These pathways can be used as tools in order to achieve my philosophy of quality management that parallel that of Dr. Joseph Juran. As tools, pathways are used to organize and sequence specific elements of patient care to promote movement of the patient toward...
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...There are many recurring themes from the novel “As I Lay Dying” by William Faulkner, most of which that have to deal with family, loyalty, and love. The author helps brings together this large cast of fifteen different narrative characters by having each character's different ideas and passions within their lives to teach the audience that despite the disagreements and misunderstandings, the idea that the sense of family should stimulate a sense of loyalty and compassion in us all. Through the narration of Addie Bundren, who is by all means one of the most important characters since the entire story revolves around her death, we are able to see how her attitude towards her family and how it doesn’t bring out any good memories. When Addie...
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...A Lesson Before Dying Movie Review Mekhi Phifer stars as Jefferson, a black youth living in 1940s Louisiana. Jefferson is present during the shooting of a white grocery store owner, which also leaves two black men dead, and although he was not responsible for the shooting Jefferson makes the mistake of deciding to help himself to the contents of the cash register. He is caught in the act, and wrongly accused of the murders. During his trial, his white attorney uses a defence typical of the period whereby he equates the boy with a lowly hog, in an attempt to show that he would not have had the intellect to know what he was doing in other words, that Jefferson is not even worthy of conviction. This depressing defence fails, and Jefferson is convicted and sentenced to die. Although accepting that he is facing the death penalty, his outraged mother Miss Emma (Irma P Hall) and his aunt Tante Lou (Cicely Tyson) want him to go to his death like a man, and not still thinking of himself as a hog. To this end they recruit local schoolteacher Grant Wiggins (Don Cheadle) to visit Jefferson in his cell. He is the only educated black man that they know, and they hope that he will be able to convince Jefferson that he is indeed a man. Wiggins is reluctant, uncertain what good it will do, but eventually agrees. When he meets Jefferson, he will find that it changes his views on everything not only must Jefferson learn that he is a man and find a way to die with dignity, but Wiggins will learn...
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...Jefferson, a black man condemned to die by the electric chair in the novel, A Lesson Before Dying, by Ernest J. Gaines, is perhaps the strongest character in African-American literature. Jefferson is a courageous young black man that a jury of all white men convicts of a murder he has not committed ; yet he still does not let this defeat destroy his personal character. Ernest Gaines portrays Jefferson this way to illustrate the fundamental belief that mankind’s defeats do not necessarily lead to his destruction. The author uses such actions as Jefferson still enjoying outside comforts, showing compassion towards others, and trying to better himself before dying. These behaviors clearly show that although society may cast Jefferson out as a black murderer, he can still triumph somewhat knowing that he retains the qualities of a good human being. The first trait Jefferson demonstrates after his incarceration is the fact that he still enjoys the outside comforts of small things such as a radio and diary. The fact that Jefferson still wants these things shows his imprisonment does not defeat him. In one of his last diary entries, Jefferson says , “shef guiry ax me what I want for my super an I tol him I want nanan to cook me som okra an rice an som pok chop an a conbred an som claba” (232). Jefferson still enjoys his aunt’s cooking, an outside pleasure from prison. The fact that he can still take pleasure from these small outside things clearly demonstrates that Jefferson...
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...Professor Askassi ENGL 102 Section 021 12 April 2010 A Lesson Before Dying using Identification and Consubstantiality by Kenneth Burke in Chapter One and Two. In the story, A Lesson before Dying by Ernest J. Gaines starts off tremendously well. Ernest Gaines started by introducing what was happing as soon as Chapter One opened. He went on to explain what was going on to give the readers a clear understanding off the story and what action are taking place. The main character, Jefferson a young black man was in a situation at the wrong place at the wrong time. Now he has to face consequences that no one should ever have to accept. In Chapter One and Two, I’m going to explain the chapter’s using Identification and Consubstantiality by Kenneth Burke. Identification and Consubstantiality by Kenneth Burke suggests that whenever someone attempts to persuade someone else, identification occurs, because for persuasion to occur, one party must identify with another. I believe this is a great explanation explaining Chapter One. For example, Jefferson a young black man went to the store with his no good friends Brother and Bear. The store owner Old Grope knew Jefferson because of this godmother. They all was intoxicated with alcohol, so Bear wanted to purchase a bottle of Apple White but didn’t have enough money to get it. Then fire opened up in the store and Bear, Brother, and Old Grope was down but Grope wasn’t died. But, Grope told another story when the police came and poor Jefferson...
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...A Lesson Before Dying by Ernest J. Gaines explores racism and reveals the deep prejudice against African Americans in the city of Bayonne. The first example of racism in Bayonne occurs when Miss Emma, Tante Lou, and Grant go to Henri Pichot’s home to speak to him about Grant going to see Jefferson. In the book, they walk through the back door to the kitchen, and Grant acknowledges that he never wanted to walk through that back door again after he left for college. It symbolized the deep prejudice between whites and blacks because all of the white guests were welcomed through the front door and could move throughout the house. When Pichot comes to speak to Miss Emma, he is with his guest, Louis Rougon. Both of the men continue to drink while Miss Emma begins her speech. Soon, they rudely raised their glasses for Inez to fill them while Miss Emma is talking. This lack of attention for Miss Emma shows their lack of respect for blacks. Grant recalls, “I looked at the two white men, who raised their glasses. Henri Pichot finished his drink and stuck out his hand. Inez knew what it meant, and she came forward to get the empty glass. (pg 20, ch 3)” Soon after, Pichot begins to get impatient with Miss Emma when she asks him when he would talk to the sheriff. Again, his disrespect for blacks is shown. He did not even acknowledge Grant, Tante Lou, or Miss Emma as guests, because he soon after asked to turn his attention back to his guest, Rougon. Another...
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...A Lesson Before Dying by Ernest J. Gaines reveals many fundamental and universal ideas. The book gives a reader a lot of mental pabulum. It makes people think about life and its value, about people’s relations and behaviors, and about the past and the present. The book teaches people to recognize injustice in the society and to take responsibilities to improve it; it teaches to accept the past as it is and to face problems; it teaches that a lie can be constructive, and that it can decrease people’s sufferings. Grant Wiggins, the protagonist of the novel, often criticizes and bitterly resents racist society. He tends to run away and escape the society he feels will never change. Like Professor Antoine, he believes no one can change society without being destroyed in the process. Jefferson’s trial reinforces Grant’s pessimistic attitude. Grant sees the wickedness of a system designed to uphold the superiority of one race over another. He sees a man struck down to the level of a hog by a few words from an attorney. During the course of the novel, however, Grant comes to realize that cynicism like his is akin to lying down and dying, and that even small victories can accumulate and produce change. Rather than looking at Jefferson as a hopeless stranger, Grant accepts Jefferson’s plight as his own and begins to fight for Jefferson’s salvation. He accepts his duty to the society he inhabits, thereby taking the first step toward improving that society. Alongside with the theme of...
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...In the novel, A Lesson Before Dying by Ernest J Gaines, there are several central symbols to the novel. Throughout the end of the novel, the central symbol is kneeling/ crawling, it is used to show a deeper meaning and the theme. The central symbol of kneeling/ crawling ties back to one lowering themselves to help another stand. Kneeling/ crawling represents the self-sacrifice of the person, as they have to lower themselves and degrade themselves for another by kneeling/ crawling. Also, kneeling/ crawling can also represent strength in a way, by being able to lower your pride and putting yourself down to put another person first. Many of the characters in the novel kneel/ crawl for the benefit of another to stand. Kneeling/ crawling is the...
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...In A Lesson Before Dying by Ernest J. Gaines, Gaines brings a new perspective of friendship through the transformation of a teacher and a young man sentenced to death during the late 1940’s in Bayonne, Louisiana. Jefferson, a young African American man, faces the death sentence after being convicted of shooting the owner of a liquor store and labeled as a “hog” by his own lawyer. Seeking to prove that Jefferson is a “man” instead of a hog, Jefferson’s godmother, Miss Emma, seeks help to make Jefferson a man again. With the help of her friend, Tante Lou, Miss Emma receives support from the local reverend, Reverend Ambrose, and a teacher, Grant Wiggins to guide Jefferson from a wild animal to a man. When Jefferson and Grant first meet, Jefferson treats himself and the people who love him without respect and acts as though life his life is already over. However, Grant soon realizes how to empower Jefferson to believe that he is important to his community. On the dreadful day of his execution, Grant decides to stay at school, questioning his entire effect on Jefferson and contemplating why he was not physically “there” for Jefferson in the end. However, Grant was truly “there” for Jefferson in the end because he changed into a friend who not only reminded Jefferson of his self-worth, but ultimately transformed Jefferson into a “man” again. Initially, Grant disapproves of helping Jefferson because he acts...
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...culture. She followed, observed, and interviewed nurses, physicians, therapists, patients, family members, social workers, and others while trying to understand the factors that led to the prevailing practices. She was particularly interested in how hospitals organized dying as a result of acculturated behavior that was regarded as normal and unproblematic by practitioners who did not understand the origins of the behavior. She discovered how hospitals shape medical practices, how shared medical rhetoric frames decision making about dying patients, and how cultural factors determine the way death occurs in the hospital and even which patients are considered to be dying by physicians and nurses. Kaufman was particularly intrigued by patterns of social behavior. She observed that today death usually is orchestrated by professionals in hospitals and no longer is waited for, a transition that has markedly shortened the “waiting time” for dying. She found that hospital procedures and bureaucracy produced the imperative to “move things along,” mandating that health care professionals expedite decision making and produce the conditions for death. She identified “pathways” for moving things along, such as heroic intervention, and discussed how and why patients may stop moving along a pathway. Her ethnographic study features the detailed case histories of 27 patients culled from more than 100 dying patients she observed. In their clinical and social detail, multidisciplinary approach, and...
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